(apologies to Mr. Swift)
Extensive research done by the Physicians for a National Health Program (PNHP), particularly by Steffie Woolhandler and David Himmelstein, have identified at least $400 BILLION in annual “waste” from our current system of health insurance (and, of course, lack of insurance for tens of millions of Americans). Drs. Woolhandler and Himmelstein are major advocates of a single-payer system, as am I (OK, I’m not so major!) and I have used much of their research in supporting single payer and in pointing out the limitations of a “public option”. Himmelstein, in his testimony to Congress (http://www.pnhp.org/news/2009/april/testimony_of_david_u.php) and in more detail on his PNHP blog (http://www.pnhp.org/campaign/materials/Refuting%20the%20Public%20Option.pdf) notes that a public option “…foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes. They would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95% of Americans who are currently privately insured were to join a public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer.”
More than that, only a part of that 16% is actual insurance company profit, as noted in a letter to the New York Times (June 21, 2009) by Dr. Woolhandler: “Moreover, the savings on overhead from a public plan option are far smaller than you suggest. While it might cut insurers’ profits (which is why they hate it), that’s only 3 percent of the roughly $400 billion squandered on health bureaucracy annually.” (http://pnhp.org/blog/2009/06/25/paul-starr-and-steffie-woolhandler-on-the-public-option/).
Let’s think about that. We waste $400 billion a year in administrative overhead so that the insurance companies can make 3% of that, or about $10-15 billion. That is a lot of money, but it is also a high waste:profit ratio. We could just pay the insurance companies their $15 billion a year, maybe for a limited time (5-10 years, perhaps decreasing 10% per year, so they could get into some other business, perhaps cleaning up the environment or rebuilding infrastructure or teaching underserved inner-city children), and tell them to disappear, leave the debate, get out; then we do single-payer and save the other $385 billion.
Sounds like a good deal to me. And not so bad for the insurance companies, since they won’t have to work or bribe Congressmen! Sure, it is lacking in morality, but so was the bank bailout, and this is a lot cheaper. And it would get us a plan a lot better than any of those being tossed around by the administration and congressional committees.
Maybe we should go for it!
.
Showing posts with label Medicine: Health Reform Poll. Show all posts
Showing posts with label Medicine: Health Reform Poll. Show all posts
Sunday, August 23, 2009
Sunday, August 2, 2009
Not "Special Interests": The Wealthy and Powerful
.
One thing a blog might do is to provide connections between seemingly disconnected news stories. I have tried to do that, as well as focus primarily on medicine and health issues, but also with an emphasis on the social justice implications (or at least that is my attempt). I will make that effort here.
On July 31, 2009, the New York Times has a lead article titled “Big banks paid billions in bonuses amid Wall St. Crisis” by Louise Story and Eric Dash (http://www.nytimes.com/2009/07/31/business/31pay.html?_r=1&hp). I have often made clear my feelings about those big bankers and financiers (that they should have all their money taken away and either be put in prison or in surplus FEMA trailers), but apparently the bankers do not share that opinion. The information for this story came from NY Attorney General Andrew Cuomo, and reports that “At Goldman Sachs, for example, bonuses of more than $1 million went to 953 traders and bankers, and Morgan Stanley awarded seven-figure bonuses to 428 employees. Even at weaker banks like Citigroup and Bank of America, million-dollar awards were distributed to hundreds of workers…. ‘If the bank lost money, where do you get the money to pay the bonus?’ said Mr. Cuomo." Good question; apparently the answer is either directly (from our deposits or loan payments), or indirectly (from TAFP funds), from you and me. “Some compensation experts questioned whether the bonuses should have been paid at all while the banks were receiving government aid.” You can add some non-compensation experts, like me, to that group.
On the health reform front, we are treated to news reports that President Obama’s popularity has slid to 53% with only 42% approving and 47% opposing their understanding of the President and Congress’ health plans (NPR July 28, 2009, and widely reported). I have been following the health reform debate pretty closely and I am not sure I understand what the President’s health reform plan is; even the ones that are proposed variously in the House and Senate keep changing, and are hard to tell even with a scorecard, such as that offered by the Kaiser Family Foundation website, http://www.kff.org/healthreform/upload/healthreform_sbs_full.pdf.
Thus, there is a possibility that most of the Americans surveyed for this report also may not have a clear understanding. One of the reasons, of course, is the reporting in the media, which is always interested in conflict, as it sells better, and in the case, at least, of much of TV news – the source of most Americans’ information – frequently biased. One source of bias, even among less egregious offenders than Fox, is the constant parade of Republicans, a group whose contribution to the health debate has been limited to attacks and scare tactics.
The Republicans, of course, have no plan; it is a lot easier to shoot arrows at the Democratic proposal – any proposal – than themselves offer an actual plan that might be criticized. And, of course, it would be torn to shreds, since the only values that the Republicans share on health care is making sure that the wealthiest are protected in their wealth, that insurance and pharmaceutical companies make out like bandits, and that there be no government sponsored health plan, which effectively means not only would the currently uninsured be left out, but the currently underinsured and scared would be at even more risk.
The President has said the right things: Everyone must be covered. Costs must be controlled. There is no “null” option, the alternative is to continue things as they are and see massive growth in health care costs combined with more and more uninsured and underinsured people getting less and less health care that they need resulting in worsening health status for Americans. But the health plans being proposed by the Congress with the support of the White House are second rate (that is to say, they will not cover everyone and save money the way that a single player plan would). However, the big mistake is that the Congress has not supported the President’s play. Committed to repeating the mistakes of the Clinton health plan, they insist on compromises to try – absolutely without hope of success – to get bipartisan support. This is a mistake, as the Republicans have no credibility and are worthy of no respect or attention; this is, after all, the party of Alabama Senator Jeff Sessions, who voted against the confirmation of Sonia Sotomayor in the Judiciary Committee the same day because she has a judicial philosophy that is not consistent with the American ideal of Blind Justice. I suppose Sessions – whose own Supreme Court nomination faltered on the fact that he was tied to the Ku Klux Klan – has managed to pull the sheet over his own eyes.
Unfortunately, too many of the Democrats, as well as Republicans, are in the pockets of the lobbyists of wealthy billionaires and the huge companies, especially insurers and pharmaceutical companies but also large hospitals and hospital chains who stand to lose a great deal of money if we enact real health reform. After all, if there is “waste” in this system – and I think most informed people believe that there is – it is going into someone’s pocket. I call “waste” all those billions – hundreds of billions – of dollars spent on “health care” that is not spent on health care at all but insurance company profits and bloated administrative structures that are designed (on the insurance company side) to not pay, and (on the provider side) to try to get the insurance companies to pay. And the enormous mark-ups for certain drugs, such as cancer chemotherapy drugs. If we save all this money, certain companies won’t make it, and they are lobbying like heck to keep their piece of this huge, bloated, tasteless pie.
To call these “special interests” is, on the face of it, accurate, but deceptive because the term is without meaning. It has been developed and put forward precisely to hide the influence of wealthiest and most powerful corporations by conflating them with much smaller and weaker groups as “special interests”. Let us be clear: the influence of the Health Insurance Association of American or PhARMA is not the same as that of, say, those seeking rights for the transgendered. Or even of labor unions. These groups are powerful in our lives outside government all the time – hey, that is the problem, that the health insurance companies deny us coverage if we have pre-existing conditions, won’t insure us if we don’t work for a big company and don’t have the money to pay, makes us pay huge deductible and coinsurances, and still won’t pay the bills all too often. The one area of society that should be responsive to the needs of the people and not big corporations is our elected government, but the fact is that those companies have bought Congress too. After all, they have to run again and that requires a lot of money and it is a proven fact that wealthy individuals and corporations contribute a lot more money than poor and middle-class people. (What is it with those poor folks? Why don’t they contribute more to their congressmen?)
Which, of course, brings us back to the beginning of this piece. The problem facing health reform is the same problem facing reform of the financial and banking system. Money talks. Even after the gigantic disaster perpetrated by the banks and financial houses, the one that took down YOUR retirement, as well as, coincidentally, the entire US and world economy, they still have way more power than you do, and Congress is still feeding their interests. My last blog post addressed the “Tragedy of Meaning”, and how we like to explain suicide by people (like Adolph Merckle) as their reacting to bad events rather than because they suffer from depression. The best argument for that is in the first paragraph of this piece – of all those financial leaders who brought this ruin on all of us who are not committing hara-kiri but are demanding, expecting, and getting huge payoffs. The position being put forward that some of them are not the same individuals who were in charge before is nonsense; they have the same values, beliefs, and arrogance.
What can regular people do? We can be clear that we need a health reform plan that 1) covers everyone, every single one of us, 2) covers our needed services based on evidence, 3) doesn’t pretend that choice of insurance companies is the same as choice of doctors or hospitals. And that makes for every one of us to have access to all of the proven preventive and treatment modalities for the diseases we have or might get. And to write that email or make that phone call to our congressman daily if we have to. Start, for example, with urging them to vote for the Weiner Amendment in the House, which will come to the floor in September, that calls on the House to replace the current, flawed, patchwork HR 3200 health bill with HR 676, the Improved and Enhanced Medicare for All Bill, which will put us all in the same program (Medicare, the most popular government program in history) and at the same time revise payment structure to encourage what is GOOD for us rather than what is PROFITABLE for providers.
If the President and the Congress would just take the lead in not only saying, but proposing a plan, that would cover everyone and pay for it using the dollars currently wasted on both insurance company profit and the huge administrative infrastructure necessary to run that system; to say and propose a plan that says “we want health and health care for the American people and do not care a whit for the insurance industry”, the American people would be behind it.
Time to send that email.
.
One thing a blog might do is to provide connections between seemingly disconnected news stories. I have tried to do that, as well as focus primarily on medicine and health issues, but also with an emphasis on the social justice implications (or at least that is my attempt). I will make that effort here.
On July 31, 2009, the New York Times has a lead article titled “Big banks paid billions in bonuses amid Wall St. Crisis” by Louise Story and Eric Dash (http://www.nytimes.com/2009/07/31/business/31pay.html?_r=1&hp). I have often made clear my feelings about those big bankers and financiers (that they should have all their money taken away and either be put in prison or in surplus FEMA trailers), but apparently the bankers do not share that opinion. The information for this story came from NY Attorney General Andrew Cuomo, and reports that “At Goldman Sachs, for example, bonuses of more than $1 million went to 953 traders and bankers, and Morgan Stanley awarded seven-figure bonuses to 428 employees. Even at weaker banks like Citigroup and Bank of America, million-dollar awards were distributed to hundreds of workers…. ‘If the bank lost money, where do you get the money to pay the bonus?’ said Mr. Cuomo." Good question; apparently the answer is either directly (from our deposits or loan payments), or indirectly (from TAFP funds), from you and me. “Some compensation experts questioned whether the bonuses should have been paid at all while the banks were receiving government aid.” You can add some non-compensation experts, like me, to that group.
On the health reform front, we are treated to news reports that President Obama’s popularity has slid to 53% with only 42% approving and 47% opposing their understanding of the President and Congress’ health plans (NPR July 28, 2009, and widely reported). I have been following the health reform debate pretty closely and I am not sure I understand what the President’s health reform plan is; even the ones that are proposed variously in the House and Senate keep changing, and are hard to tell even with a scorecard, such as that offered by the Kaiser Family Foundation website, http://www.kff.org/healthreform/upload/healthreform_sbs_full.pdf.
Thus, there is a possibility that most of the Americans surveyed for this report also may not have a clear understanding. One of the reasons, of course, is the reporting in the media, which is always interested in conflict, as it sells better, and in the case, at least, of much of TV news – the source of most Americans’ information – frequently biased. One source of bias, even among less egregious offenders than Fox, is the constant parade of Republicans, a group whose contribution to the health debate has been limited to attacks and scare tactics.
The Republicans, of course, have no plan; it is a lot easier to shoot arrows at the Democratic proposal – any proposal – than themselves offer an actual plan that might be criticized. And, of course, it would be torn to shreds, since the only values that the Republicans share on health care is making sure that the wealthiest are protected in their wealth, that insurance and pharmaceutical companies make out like bandits, and that there be no government sponsored health plan, which effectively means not only would the currently uninsured be left out, but the currently underinsured and scared would be at even more risk.
The President has said the right things: Everyone must be covered. Costs must be controlled. There is no “null” option, the alternative is to continue things as they are and see massive growth in health care costs combined with more and more uninsured and underinsured people getting less and less health care that they need resulting in worsening health status for Americans. But the health plans being proposed by the Congress with the support of the White House are second rate (that is to say, they will not cover everyone and save money the way that a single player plan would). However, the big mistake is that the Congress has not supported the President’s play. Committed to repeating the mistakes of the Clinton health plan, they insist on compromises to try – absolutely without hope of success – to get bipartisan support. This is a mistake, as the Republicans have no credibility and are worthy of no respect or attention; this is, after all, the party of Alabama Senator Jeff Sessions, who voted against the confirmation of Sonia Sotomayor in the Judiciary Committee the same day because she has a judicial philosophy that is not consistent with the American ideal of Blind Justice. I suppose Sessions – whose own Supreme Court nomination faltered on the fact that he was tied to the Ku Klux Klan – has managed to pull the sheet over his own eyes.
Unfortunately, too many of the Democrats, as well as Republicans, are in the pockets of the lobbyists of wealthy billionaires and the huge companies, especially insurers and pharmaceutical companies but also large hospitals and hospital chains who stand to lose a great deal of money if we enact real health reform. After all, if there is “waste” in this system – and I think most informed people believe that there is – it is going into someone’s pocket. I call “waste” all those billions – hundreds of billions – of dollars spent on “health care” that is not spent on health care at all but insurance company profits and bloated administrative structures that are designed (on the insurance company side) to not pay, and (on the provider side) to try to get the insurance companies to pay. And the enormous mark-ups for certain drugs, such as cancer chemotherapy drugs. If we save all this money, certain companies won’t make it, and they are lobbying like heck to keep their piece of this huge, bloated, tasteless pie.
To call these “special interests” is, on the face of it, accurate, but deceptive because the term is without meaning. It has been developed and put forward precisely to hide the influence of wealthiest and most powerful corporations by conflating them with much smaller and weaker groups as “special interests”. Let us be clear: the influence of the Health Insurance Association of American or PhARMA is not the same as that of, say, those seeking rights for the transgendered. Or even of labor unions. These groups are powerful in our lives outside government all the time – hey, that is the problem, that the health insurance companies deny us coverage if we have pre-existing conditions, won’t insure us if we don’t work for a big company and don’t have the money to pay, makes us pay huge deductible and coinsurances, and still won’t pay the bills all too often. The one area of society that should be responsive to the needs of the people and not big corporations is our elected government, but the fact is that those companies have bought Congress too. After all, they have to run again and that requires a lot of money and it is a proven fact that wealthy individuals and corporations contribute a lot more money than poor and middle-class people. (What is it with those poor folks? Why don’t they contribute more to their congressmen?)
Which, of course, brings us back to the beginning of this piece. The problem facing health reform is the same problem facing reform of the financial and banking system. Money talks. Even after the gigantic disaster perpetrated by the banks and financial houses, the one that took down YOUR retirement, as well as, coincidentally, the entire US and world economy, they still have way more power than you do, and Congress is still feeding their interests. My last blog post addressed the “Tragedy of Meaning”, and how we like to explain suicide by people (like Adolph Merckle) as their reacting to bad events rather than because they suffer from depression. The best argument for that is in the first paragraph of this piece – of all those financial leaders who brought this ruin on all of us who are not committing hara-kiri but are demanding, expecting, and getting huge payoffs. The position being put forward that some of them are not the same individuals who were in charge before is nonsense; they have the same values, beliefs, and arrogance.
What can regular people do? We can be clear that we need a health reform plan that 1) covers everyone, every single one of us, 2) covers our needed services based on evidence, 3) doesn’t pretend that choice of insurance companies is the same as choice of doctors or hospitals. And that makes for every one of us to have access to all of the proven preventive and treatment modalities for the diseases we have or might get. And to write that email or make that phone call to our congressman daily if we have to. Start, for example, with urging them to vote for the Weiner Amendment in the House, which will come to the floor in September, that calls on the House to replace the current, flawed, patchwork HR 3200 health bill with HR 676, the Improved and Enhanced Medicare for All Bill, which will put us all in the same program (Medicare, the most popular government program in history) and at the same time revise payment structure to encourage what is GOOD for us rather than what is PROFITABLE for providers.
If the President and the Congress would just take the lead in not only saying, but proposing a plan, that would cover everyone and pay for it using the dollars currently wasted on both insurance company profit and the huge administrative infrastructure necessary to run that system; to say and propose a plan that says “we want health and health care for the American people and do not care a whit for the insurance industry”, the American people would be behind it.
Time to send that email.
.
Monday, June 22, 2009
Government sponsored health coverage: The Good, the Cautionary, and the Ugly
The good news:
The recent New York Times/CBS News poll (June 21, 2009, http://www.nytimes.com/2009/06/21/health/policy/21poll.html?em) demonstrates conclusively that, as the headline reads, there is “Wide Support for Government-Run Health”.
“The poll found that most Americans would be NY Times willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector…72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers.”
Sound like overwhelming support for a single-payer plan, especially one like that called for in the “Improved and Expanded Medicare for All Act”, HR 676, with 100 co-sponsors in the House of Representatives (http://www.pnhp.org/docs/nhi_bill_final1.pdf).
“Sixty-four percent said they thought the federal government should guarantee coverage, a figure that has stayed steady all decade. Nearly 6 in 10 said they would be willing to pay higher taxes to make sure that all were insured, with 4 in 10 willing to pay as much as $500 more a year.” Despite the fact that “…only a fifth of those with insurance said the cost of their own medical care posed a hardship….One in four said that in the last 12 months they or someone in their household had cut back on medications because of the expense, and one in five said someone had skipped a recommended test.”
My goodness! Where are the self-centered Americans we keep hearing about? “…only a fourth said that keeping health costs down was a more urgent need than providing coverage for the country’s nearly 50 million uninsured.” People understand that we are all dependent upon one another. And that, while I might be insured through my place of work today, I might not be tomorrow. And, while I may be healthy today, I may not always be. Good for us!
The cautionary news is that “While the survey results depict a nation desperate for change, it also reveals a deep wariness of the possible consequences. Half to two-thirds of respondents said they worried that if the government guaranteed health coverage, they would see declines in the quality of their own care and in their ability to choose doctors and get needed treatment…. ‘It is the responsibility of the government to guarantee insurance for all,’ said Juanita Lomaz, a 65-year-old office worker from Bakersfield, Calif. ‘But my care will get worse because they’ll have to limit care in order to cover everyone.’”. To her credit, and that of most of the other respondents to the survey, this did not keep her – and them -- from supporting health care coverage for all. But it does indicate how effective the propagandists from the insurance companies and the right have been in convincing people that there is a trade-off between excellent care for themselves and coverage for everyone. The fact is that the United States spends far more than enough money to cover everyone, and to give them access to excellent health care. Countries that spend much less per capita than we do manage to do this, and have far better health outcomes. We spend a great deal of our health care dollar on unnecessary but well reimbursed tests and procedures. We ensure that elective procedures for the well-insured (a decreasing group, certainly) take precedence over the necessary care for the less-well, or un-insured. We spend huge amounts of money on interventions and almost nothing on prevention; while prevention may not always save money, as I have previous discussed (February 13) in commenting on the JAMA article by Steven Woolf[1] and addressed in the wonderful-in-many-ways article by Abraham Verghese in the Wall St. Journal June 20, 2009 http://online.wsj.com/article/SB10001424052970204005504574235751720822322.html#printMode, it can save and improve the quality of lives.
There will certainly be more to do. Many of my postings have addressed the importance of having a health system built upon Primary care (December 11, April 5, April 29, May 21), and we don’t – that is why newly covered people in Massachusetts can’t find a doctor. And we are not on track to – think about it. If we need 50+% primary care doctors, and we now have 30% or so, we are not going to get there by having between 20% and 25% of medical students enter primary care as we are now. Or even 30%. Even at 50%, we’d have to wait 30 years till we replaced the whole physician population to get to 50%. And yet, as previously noted, we talk about it but are not really doing anything – read “pay a lot more money for” – to effectuate it. And we have to work to convince Americans that “more” is not always “better” – but I think that the poll seems to show they are getting it. We could do this!
But, the ugly bad news is that it looks like we are not only going to not get single-payer, or Medicare for all, but we are likely to not even get a strong public option. While the New York Times editorializes in favor of such a plan (also June 21, 2009, http://www.nytimes.com/2009/06/21/opinion/21sun1.html), and these polls are published, and the letters and faxes supporting single payer come fast and furious, the Congressional leadership has maintained their well-established posture:
The recent New York Times/CBS News poll (June 21, 2009, http://www.nytimes.com/2009/06/21/health/policy/21poll.html?em) demonstrates conclusively that, as the headline reads, there is “Wide Support for Government-Run Health”.
“The poll found that most Americans would be NY Times willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector…72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers.”
Sound like overwhelming support for a single-payer plan, especially one like that called for in the “Improved and Expanded Medicare for All Act”, HR 676, with 100 co-sponsors in the House of Representatives (http://www.pnhp.org/docs/nhi_bill_final1.pdf).
“Sixty-four percent said they thought the federal government should guarantee coverage, a figure that has stayed steady all decade. Nearly 6 in 10 said they would be willing to pay higher taxes to make sure that all were insured, with 4 in 10 willing to pay as much as $500 more a year.” Despite the fact that “…only a fifth of those with insurance said the cost of their own medical care posed a hardship….One in four said that in the last 12 months they or someone in their household had cut back on medications because of the expense, and one in five said someone had skipped a recommended test.”
My goodness! Where are the self-centered Americans we keep hearing about? “…only a fourth said that keeping health costs down was a more urgent need than providing coverage for the country’s nearly 50 million uninsured.” People understand that we are all dependent upon one another. And that, while I might be insured through my place of work today, I might not be tomorrow. And, while I may be healthy today, I may not always be. Good for us!
The cautionary news is that “While the survey results depict a nation desperate for change, it also reveals a deep wariness of the possible consequences. Half to two-thirds of respondents said they worried that if the government guaranteed health coverage, they would see declines in the quality of their own care and in their ability to choose doctors and get needed treatment…. ‘It is the responsibility of the government to guarantee insurance for all,’ said Juanita Lomaz, a 65-year-old office worker from Bakersfield, Calif. ‘But my care will get worse because they’ll have to limit care in order to cover everyone.’”. To her credit, and that of most of the other respondents to the survey, this did not keep her – and them -- from supporting health care coverage for all. But it does indicate how effective the propagandists from the insurance companies and the right have been in convincing people that there is a trade-off between excellent care for themselves and coverage for everyone. The fact is that the United States spends far more than enough money to cover everyone, and to give them access to excellent health care. Countries that spend much less per capita than we do manage to do this, and have far better health outcomes. We spend a great deal of our health care dollar on unnecessary but well reimbursed tests and procedures. We ensure that elective procedures for the well-insured (a decreasing group, certainly) take precedence over the necessary care for the less-well, or un-insured. We spend huge amounts of money on interventions and almost nothing on prevention; while prevention may not always save money, as I have previous discussed (February 13) in commenting on the JAMA article by Steven Woolf[1] and addressed in the wonderful-in-many-ways article by Abraham Verghese in the Wall St. Journal June 20, 2009 http://online.wsj.com/article/SB10001424052970204005504574235751720822322.html#printMode, it can save and improve the quality of lives.
There will certainly be more to do. Many of my postings have addressed the importance of having a health system built upon Primary care (December 11, April 5, April 29, May 21), and we don’t – that is why newly covered people in Massachusetts can’t find a doctor. And we are not on track to – think about it. If we need 50+% primary care doctors, and we now have 30% or so, we are not going to get there by having between 20% and 25% of medical students enter primary care as we are now. Or even 30%. Even at 50%, we’d have to wait 30 years till we replaced the whole physician population to get to 50%. And yet, as previously noted, we talk about it but are not really doing anything – read “pay a lot more money for” – to effectuate it. And we have to work to convince Americans that “more” is not always “better” – but I think that the poll seems to show they are getting it. We could do this!
But, the ugly bad news is that it looks like we are not only going to not get single-payer, or Medicare for all, but we are likely to not even get a strong public option. While the New York Times editorializes in favor of such a plan (also June 21, 2009, http://www.nytimes.com/2009/06/21/opinion/21sun1.html), and these polls are published, and the letters and faxes supporting single payer come fast and furious, the Congressional leadership has maintained their well-established posture:
The report from the Tri-Committee Health Reform draft http://edlabor.house.gov/blog/2009/06/health-care-reform-house-dems.shtml is far from encouraging. It is precisely set up to disadvantage the public option, making it weak compared to the private plans. Quite the opposite of the campaign of disinformation put forward by the insurance companies and their flaks in Congress, the concern is not that the public plan will be “advantaged” but rather that the law will be written to “advantage” private insurance companies. This is because they are, at base, greedy profiteers who could not compete with a public plan on a level playing field. This is articulately addressed by Karen Tumulty in the Swampland blog, http://swampland.blogs.time.com/2009/06/19/house-health-care-plan/.
Don McCanne, the brilliant analyst and author of “Quote of the Day”, addresses the core problems with the Tri-Committee proposal”
"Is this the model of the public option that is going to ensure that reform will bring affordable health care to everyone? Well, here are a few things that this reform will NOT accomplish:
* Not a single one of the Republicans or conservative Democrats who are opposed to the public option will sign on to this version. It is a government program not only in name, but in fact. Not only would it eliminate any hope of bipartisan legislation, it is quite likely that it could not even muster the vote of a simple majority.
* By requiring the public option to have the same market reforms as the private plans, it will prevent the government from using the great power of beneficent public social policies. A regulated insurance exchange within a fragmented, multi-payer, business-oriented insurance market would provide a very shaky infrastructure for delivering to the community the benefits of a social insurance program. Even with greater regulation, our private insurers have a business mission whereas the European private insurers have a social mission.
* A public plan that is required to comply with private insurer rules could never provide a back door entry to a single payer system. As Medicare Advantage demonstrates, the private insurers will always use devious means to provide them with an unfair advantage over our public program, even though they provide lower value per dollar spent.
* An insurance exchange, with or without a public option, perpetuates a fragmented system that prevents us from obtaining greater health care value by having the powerful purchasing strength of our own public monopsony - the secret of other systems that have slowed cost inflation.
* The administrative complexity of this model of reform makes it impossible to cover everyone. Initial estimates that this would cover 95 percent of the population are likely overly optimistic. Regardless, supporting a program that would leave even 15 million people on their own to fend for health care reflects a callous disregard for the needs of these individuals, and certainly belies the notion that we are a caring nation.
* Although this proposal shifts spending between individuals, employers and the government, creating the appearance of financing reform, it does very little to slow the continuing escalation in health care costs. Until that is seriously addressed, as it could be through an improved Medicare for everyone, the rest of this ‘stuff is written in smoke,’ as Karen Tumulty writes.”
The same folks who bailed out the banks instead of the people (why pay banks so that they don’t lose money foreclosing on people’s houses rather than give people the money to pay off the banks, so they keep their houses and the banks stay whole?) and now let them write the financial reform laws; who voted down caps on credit card interest rates 2:1, now are firmly set on letting the insurance industry write the health reform laws. Sorry, America. The only chance we have is if everyone who cares, every day, calls, faxes, and emails their representatives to say “single payer”; maybe then they’ll feel so pressured they’ll “compromise” on a strong public plan.
[1] Woolf SH, A Closer Look at the Economic Argument for Disease Prevention, JAMA. 2009;301(5):536-538.
Don McCanne, the brilliant analyst and author of “Quote of the Day”, addresses the core problems with the Tri-Committee proposal”
"Is this the model of the public option that is going to ensure that reform will bring affordable health care to everyone? Well, here are a few things that this reform will NOT accomplish:
* Not a single one of the Republicans or conservative Democrats who are opposed to the public option will sign on to this version. It is a government program not only in name, but in fact. Not only would it eliminate any hope of bipartisan legislation, it is quite likely that it could not even muster the vote of a simple majority.
* By requiring the public option to have the same market reforms as the private plans, it will prevent the government from using the great power of beneficent public social policies. A regulated insurance exchange within a fragmented, multi-payer, business-oriented insurance market would provide a very shaky infrastructure for delivering to the community the benefits of a social insurance program. Even with greater regulation, our private insurers have a business mission whereas the European private insurers have a social mission.
* A public plan that is required to comply with private insurer rules could never provide a back door entry to a single payer system. As Medicare Advantage demonstrates, the private insurers will always use devious means to provide them with an unfair advantage over our public program, even though they provide lower value per dollar spent.
* An insurance exchange, with or without a public option, perpetuates a fragmented system that prevents us from obtaining greater health care value by having the powerful purchasing strength of our own public monopsony - the secret of other systems that have slowed cost inflation.
* The administrative complexity of this model of reform makes it impossible to cover everyone. Initial estimates that this would cover 95 percent of the population are likely overly optimistic. Regardless, supporting a program that would leave even 15 million people on their own to fend for health care reflects a callous disregard for the needs of these individuals, and certainly belies the notion that we are a caring nation.
* Although this proposal shifts spending between individuals, employers and the government, creating the appearance of financing reform, it does very little to slow the continuing escalation in health care costs. Until that is seriously addressed, as it could be through an improved Medicare for everyone, the rest of this ‘stuff is written in smoke,’ as Karen Tumulty writes.”
The same folks who bailed out the banks instead of the people (why pay banks so that they don’t lose money foreclosing on people’s houses rather than give people the money to pay off the banks, so they keep their houses and the banks stay whole?) and now let them write the financial reform laws; who voted down caps on credit card interest rates 2:1, now are firmly set on letting the insurance industry write the health reform laws. Sorry, America. The only chance we have is if everyone who cares, every day, calls, faxes, and emails their representatives to say “single payer”; maybe then they’ll feel so pressured they’ll “compromise” on a strong public plan.
[1] Woolf SH, A Closer Look at the Economic Argument for Disease Prevention, JAMA. 2009;301(5):536-538.
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