Health Care Reform

[Voronwë the Faithful]

yov, another point that really struck me is that "the market" really can't work in healthcare. The product is "save my life" (or "my mother's life" or "my baby's life"). People don't, as a rule, say, "You want $250K to treat the cancer you just told me my 8-year-old daughter has? Well, I'm going to shop around for a better deal. There's no hurry." In my experience people don't even ask what it will cost. They just hope they end up being able to afford it. That's not a place where "free-market forces" are going to drive prices anywhere but up.

I get what you're saying but why would a non-market solution be any different?

The bottom-line answer to this is that a non-market solution would emphasize health, not profits. If there is one area where "socialism" makes sense, it is in health care. Yet the political realities result in a situation where the real answer to the problem - true socialized health care - is completely off the table because the "S-word" is verbotim. So we search for some odd, probably unworkable hybrid in order to avoid doing what we should do.

*sigh*

[Primula Baggins]

Even a step in the direction of public health care as an option is a breakthrough, though. It hasn't existed for anyone but the poor and elderly. One reason the private insurers fear any public plan is that it may indeed prove to be cheaper and better than they can match without eating into their profits, which they can't do; profits have to grow every year, or shareholders sell.

If the public plan works and is popular, it will be strengthened over time.

[axordil]

Although it should be said many European systems, and even the Canadian system, are hybrids of a sort. There are still private health insurers in those countries, but they cover "extras" like private hospital rooms.

[Primula Baggins]

I can't imagine a system in this country that doesn't provide extra frills for those willing to pay extra—even if we ended up with single-payer.

Private rooms. . . . The new hospital built here recently includes only private rooms, so even under some kind of public plan, you'd get one.

[Maria]

I worked for a doctor's office once, and I heard one of the doctors say several times that if only they didn't have to mess with all the insurance, they could easily run their clinic charging just $10 per visit. The overhead involved in all the complexities of getting paid by insurance rather than immediately by the patient caused them to charge $40 per visit. This was about 14 years ago, so the numbers would be different nowadays.

[Primula Baggins]

I'm keeping my fingers crossed.

The plan from the HELP committee is not as good as the one from House Democrats in an important way: if you're already covered by employer-provided health insurance, you can't switch to the public plan unless your employer's plan is costing you more than 12.5% of your income to pay your share of the premiums.

The unemployed, people employed by small businesses (<50 employees), and sole proprietors like me can opt in. So could anyone going into business for themselves, and people whose employers don't provide health insurance.

[Voronwë the Faithful]

Here's article by billionaire Independent (and formerly Republican) Mayor of New York Michael Bloomberg explaining why he supports a public option:

A public insurance plan will help heal a broken health care system

[axordil]

Really good article about underlying issues with health care in the US here:

http://www.nytimes.com/2009/07/08/busin ... ml?_r=1&hp

[Cenedril_Gildinaur]

Although it should be said many European systems, and even the Canadian system, are hybrids of a sort. There are still private health insurers in those countries, but they cover "extras" like private hospital rooms.

What we have is also a hybrid system, but a much more patch-work hybrid system.

[axordil]

Agreed. We have some degree of public coverage for the elderly that's usually supplemented by private coverage, public coverage for the very poor that is usually NOT supplemented, and some public coverage for veterans. There's also the coverage that public entities (active military forces, Federal employees, et al) have for their own people.

[Andreth]

I have a couple of quick comments. I understand the system is broke. I work in it. However, I don't like a plan being rammed through just to do something. The folks in Washington are taking a sledgehammer approach instead trying to work on one area at a time. I see a plan that will be expensive, inefficent, deepen the deficit and will leave alot of people unhappy.

Healthcare is a business as well as an alturistic endeavor. I want to help people but I also want to be compensated for my work. Finding a balance between the two is going to be difficult even under the best of circumstances.

The Canadian system has flaws. It's great from primary care, not so great on timely specialty care.

[sauronsfinger]

The New York Times is reporting that there is a serious plan being offered in the US House of Representatives to pay for about half of the cost of the health care program.

http://www.nytimes.com/2009/07/11/healt ... ml?_r=2&hp

While the plan should pass in the House, its future in the Senate is less clear.

[axordil]

The Canadian system makes different tradeoffs than we do. Is a shorter wait for a hip replacement worth bankrupting families who suffer a catastrophic illness or injury, even with coverage?

[Primula Baggins]

I agree that healthcare workers should be paid fairly for their work, Americans should receive prompt, excellent medical care, and insurance companies should earn an honest profit. But I don't think we can fix this without all of those ideals ending up less than ideal; there isn't enough money. Even if savings materialize because there are fewer medical catastrophes and fewer uninsured people, that won't happen until after a big investment is made up front. And the most logical ways to find the money to pay for it are political non-starters few people seem willing to fight for.

"Fixing" healthcare so it costs employers less and so employees are not locked into jobs they don't want any more, smothering entrepreneurism and eliminating job mobility, is going to be an economic stimulus just in itself, if it happens. I wish I heard that point mentioned much more often in mainstream media coverage or on Capitol Hill.

[axordil]

Prim--Thanks for bringing that up. The employee end of a free market economy depends on job mobility. If I can't offer my services elsewhere without fear of exposing my family to risk--as would be the case if ANY of us had a pre-existing condition, and insurance companies can ALWAYS come up with one if they want to--I'm not an employee, I'm an indentured servant.

In systems where jobs and health care are unrelated, this isn't an issue. It's a huge boon to entrepreneurial types, who have one less thing to worry about amidst the risks they're already taking.

[yovargas]

So the question from my ignorance self to those who understand these things is - why did Health Care and your job end up getting tied together? When you point out its problems, it doesn't seem like the most natural or intuitive setup for anyone involved.....

[Primula Baggins]

It dates back to World War II, yov. Workers were scarce, and the U.S. government froze wages, so the only way companies could compete to hire the best was to offer better fringe benefits, which included health insurance. That established the idea, and it got locked in place when the government made companies' health-insurance expenses nontaxable.

[Frelga]

"Fixing" healthcare so it costs employers less and so employees are not locked into jobs they don't want any more, smothering entrepreneurism and eliminating job mobility, is going to be an economic stimulus just in itself, if it happens. I wish I heard that point mentioned much more often in mainstream media coverage or on Capitol Hill.

And I believe this is the main reason why this is such a high priority for President Obama. Throughout his campaign, he impressed me with his ability to see issues in broad context, rather than each in isolation. As I understand it, Obama considers affordable health care and clean energy to be cornerstones to the economic and political strength of the United States. The first is to free up the constraints on the employee end of the free market, as Ax so aptly put it, and release the pent-up entrepreneurship and productivity. The second is to free us from dependence on unfriendly nations, and prevent said unfriendly nations from placing a choke-hold on our economy at their whim, not to mention the short-term boon to, again, entrepreneurial types working on these new technologies.

The third leg of his platform was education, and I am very curious to see what he will do about it.

[Cerin]

This is a fairly concise summation by former Labor Sec. Robert Reich, of what he sees as the current situation in the health care debate.

I'm practically inarticulate with anger and frustration these days, as the extent of corruption and hopelessness in our political system is being exposed in the new administration's inability to affect any real change in the face of corporate control of our government. I hope it's ok that I've copied a couple of brief comments that follow the piece, as they pretty well sum up the way I've been feeling of late.

reichblog

Obamacare Is At War With Itself Over Future Costs

Right now, Obamacare is at war with itself. Political efforts to buy off Big Pharma, private insurers, and the AMA are all pushing up long-term costs<snip>

Big Pharma, for example, is in line to get just what it wants. The Senate health panel’s bill protects biotech companies from generic competition for 12 years after their drugs go to market, which is guaranteed to keep prices sky high. Meanwhile, legislation expected from the Senate Finance committee won't allow cheaper drugs to be imported from Canada and won't give the federal government the right to negotiate Medicare drug prices directly with pharmaceutical companies. Last month Big Pharma agreed to what the White House touted as $80 billion in givebacks to help pay for expanded health insurance, but so far there's been no mechanism to force the industry to keep its promise. No wonder Big Pharma is now running "Harry and Louise" ads -- the same couple who fifteen years ago scared Americans into thinking the Clinton plan would take away their choice of doctor -- now supportive of Obamacare.

Private insurers, for their part, have become convinced they'll make more money with a universal mandate accompanied by generous subsidies for families with earnings up to 400 percent of poverty (in excess of $80,000 of income) than they might stand to lose. Although still strongly opposed to a public option, the insurance industry is lining up behind much of the legislation. The biggest surprise is the AMA, which has also now come out in favor -- but only after being assurred that Medicare reimbursements won't be cut nearly as much as doctors first feared.

<snip> My sources on the Hill tell me there aren't enough votes in the House to get either major bill through, even with a provision that would pay for it with a surcharge on the richest 1 percent of taxpayers. <snip>

Obama has less than three weeks before August recess. Chances are dimming that he can get some form of universal health care passed in both Houses before the clock runs out. The Democratic National Committee is running ads favoring passage in Blue Dog states and districts, but that won't be enough. Now is the time for the President to begin twisting arms and knocking heads. To control long-term costs, he'll also have to take away some of the goodies that have been promised to the health-industrial complex, and maybe even cross Big Labor. He also needs to come out clearly and forcefully in favor of a way to pay for the whole thing -- ideally, in my view, a surtax on the top.

It's over.

Obama has failed already.

The (entire) Congress is corrupt.

I am voting green from now on, and if the GOP resumes power in 2012 (as I anticipate will happen) I am moving out of the country to escape the resulting wave of fascism that will set in once and for all.

Obama should vow to resign by Auguest if he fails to enact health care reform by then. Only then will the corrupt Dems wake up.

I have to say we have one of the most dysfunctional governments I have ever seen. The problem now is that it seems these idiots are going to make it worse. The republicans seem to be at war with most Americans as far as I'm concerned, but the democrat's are the party if complete ineptitude.
It is simply amazing, to watch these people take this country down into the bowls of mediocrity and third world status.

They have no incentive to make any real changes. To really stand up to the corporate interest who seem to be calling the shots. It's shameful, disgusting and corrupt.

These people already have a tax national health care system paid for by us, the tax payers.

Personally I think this is doomed, and Americans, the rubes that we are will just take it on the chin and go broke.

[Voronwë the Faithful]

I hope it's ok that I've copied a couple of brief comments that follow the piece, as they pretty well sum up the way I've been feeling of late.

There certainly isn't anything "inappropriate" about you doing so, at least from my perspective. Still, if I had my druthers, I would prefer to have you sum up the way you feel yourself rather than letting others do so, simply because I know you, and I don't know them. But it sounds like you would largely use similar language anyway.

I'm not feeling quite as frustrated as that, though I can certainly relate to the opinions expressed. I largely agree with Reich's comments, particularly the last couple of sentences:

Now is the time for the President to begin twisting arms and knocking heads. To control long-term costs, he'll also have to take away some of the goodies that have been promised to the health-industrial complex, and maybe even cross Big Labor. He also needs to come out clearly and forcefully in favor of a way to pay for the whole thing -- ideally, in my view, a surtax on the top.