On Sunday, a senior Senate Republican made his case against the Democrats’ plan for a “public option” for health insurance.
He explained that the public option would “be the first steps in… destroying the best health care system the world has ever known.”
There are very good arguments against the health care proposals being advanced by the Democrats.
This is not one of them. And with only weeks before the full Senate considers a comprehensive health care reform package, such talking points will only undermine the Republicans’ efforts to challenge and improve upon the Democrats’ efforts.
As FF contributor David Gratzer has ably argued in the New Atlantis, the Democrats’ modest sounding public option would in fact deal a fatal blow to the private health insurance most Americans enjoy.
Disincentivize employer-provided group insurance through an employer-mandate and the taxation of benefits.
Establish politically motivated benefit packages with coverage mandates, that along with guaranteed issue and community rating, will drive up the cost of insurance.
And create an individual mandate with generous government subsidies.
It is clear where this will wind up. With nowhere else to turn and no serious proposals for “bending the growth curve,” American taxpayers will be on the hook for another growing entitlement that will be paid for either by tax increases or government rationing of care.
Not a pretty picture.
But one way to guarantee that we wind up with a triumphant signing ceremony for comprehensive health care reform is to argue that America has the best health care system on earth.
While certainly decent compared to the alternatives, objectively speaking our health care system is a mess. The government subsidizes the care of the elderly by stiffing doctors, who then pass along those costs to the privately insured. In a post-industrial national economy, individual insurance decisions are subject to the regulations of 50 state insurance commissioners, undermining portability. The government provides massive and regressive subsidies to employer-provided coverage, while providing practically meaningless tax breaks to those who seek care in the individual marketplace.
In other words, the system is pretty lousy and needs work. Conservatives helped to make this case, first in the think tanks, then in President Bush’s proposal for health care reform, and finally during Senator McCain’s campaign.
It may be that the vast majority of Americans with private health insurance are satisfied with their coverage. But they certainly worry, particularly in this economy, about a health insurance system that largely ties your opportunity for coverage to your employment. And they understand that their share of coverage is consuming an ever larger portion of their income.
In other words, they might be satisfied with the system, but they aren’t ecstatic about it.
They might have real concerns about who will wind up holding the bag for the Democrats’ reform. But there is no special place in their heart for America’s insurers and pharmaceutical manufacturers.
And if Republicans’ opening shot is that the Democrats’ plan will undermine the greatest health care system on earth, Rahm Emanuel is somewhere smiling.
54 responses so far
1 Brutus1776 // Jun 11, 2009 at 8:05 am
Excellent point “Henry”, Conservative intellectual Mel Bradford made this comment in his book “Reactionary Imperative:”
“…merely to conserve is sometime to perpetuate what is outrageous…”
We need to stop being apologists for the current system and get cracking on developing something fresh…
2 midcon // Jun 11, 2009 at 8:33 am
Good point Henry,
As I have said repeatedly, the GOP needs to spend its time “proposing” instead of simply “opposing.”
There are serious with health care, not the least of which is the lack of it for many citizens. I am willing to entertain various solutions, but the ostrich solution is not one of them.
3 debs // Jun 11, 2009 at 8:50 am
Another odd posting. So: U.S. healthcare is not the best system in the world–or is it? “Best” is a comparative term. But Clay is in a rhetorical bind. He wants to argue that the current system is pretty lousy–so we shouldn’t say it’s the best in the world. But *he doesn’t want to argue that there is any other system in the world that’s better.*
Why? Because every comparable system, i.e those of advanced capitalist countries, provide universal coverage at a lower per capita cost than our system. So what can Clay do? Babble about how our system is still “better”, but not the “best.” But the World Health Organization says the French system is the best. And the Brits healthcare is almost comparable to our own–but they spend 60% less! So, yes, it’s not a great system–neither is ours. But it’s a *lot* cheaper. Obviously, if they spent anything like we did, they could hit our marks.
Similarly, the Canadians provide good or better outcomes–but is much cheaper too. As in the German, and the Dutch, and the Swedish, and the Japanese and on and on and on. All of which provide universal coverage more cheaply than we provide irrational, crazy quilt coverage that excludes 15-17% of the population.
Oh, and that public plan that Clay asserts, foolishly, will increase costs? According to the Lewin Group, it will *lower* them. But the Lewin Group only provides hard data–Clay says what he feels!!! Here’s the Lewin article below–actually a Commonwealth study thinks the cost savings will be even higher with a public plan. But, again, evidence might get in the way of dogma.
http://74.125.47.132/search?q=cache:-rf2jL9NXmQJ:www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%2520DesignOptions.pdf+lewin+public+plan&cd=2&hl=en&ct=clnk&gl=us&client=firefox-a
4 ottovbvs // Jun 11, 2009 at 8:53 am
Basically the Republicans don’t have a plan for a universal healthcare system. It’s really that simple. McCain’s plan advanced during the campaign which was basically a $5000 tax credit for a family (a typical family plan costs $13,500) and lots of vague assurances about subsidies for the poor and even vaguer assurances about special “boards” to deal with “pre-existing” condition appeals against insurance companies had more holes than swiss cheese. That’s why he could never explain it. Conversely, two thirds of the country wants major reform and basically trusts the Democrats in general and Obama in particular to do it correctly. I’ve run some fairly sizeable businesses (largest 3000 employees) and I can tell you when it came to budget time in September the healthcare bill was a nightmare. Thus I always predicted that the point at which healthcare would take off would be when business in the US had gone as far as it could in getting employees to absorb price increases (typically 7-10% a year) and would have to start shouldering even more of the burden. That tipping point has been reached which is why most of the big employer groups have signed on (Chamber/AMA etc). Insurance and big pharma know it’s going to happen so they’ve got a place at the table. Republicans are making a big push against the public option. That in my opinion makes it more certain it will be in the bill because it’s making the mainstream dems dig their heels in. Furthermore the admin needs it to keep the insurance companies. I think Obama will sacrifice some Republican votes to keep it.
5 barker13 // Jun 11, 2009 at 8:54 am
“On Sunday, a senior Senate Republican made his case…”
Ya got a link, Hank…???
“be the first steps in… destroying the best health care system the world has ever known.”
Hmm. Hank… about that link… would you mind? Not that I don’t trust your integrity with regard to the use of ellipsis, but I’d like to read this (unidentified) Senator’s remarks in context.
Thanks!
BILL
6 ottovbvs // Jun 11, 2009 at 8:59 am
Ooops missed a key word…Furthermore the admin needs it to keep the insurance companies honest!!
7 barker13 // Jun 11, 2009 at 9:24 am
Re: Brutus1776; wrote 50 minutes ago –
“We need to stop being apologists for the current system and get cracking on developing something fresh.”
Fine. To reiterate proposals made in past postings:
Move away from employer provided health insurance – at a bare minimum abolish the tax subsidy.
Politically nonviable? Not if explained properly. Not if argued as a matter of basic equality and fairness. Think about it… those with the best jobs, highest paying jobs, jobs with the most status (in a “corporate” sense) get subsidized health insurance benefits with the subsidies coming not just from other insured taxpayers in the same situation but also subsidized by those on the lower rungs of the socio-economic ladder who may work 60 hours a week at three separate low level jobs with none “giving” them insurance. Fair? Hardly.
I mean, com’on… maybe the system made sense in light of WW-2 wage controls (which left benefits as the main employer carrot to attract the best workers), but 64 years after the end of the Second World War… I think not.
In any case, third party insurance is a disincentive to personal responsibility. I mean… why not have employers provide housing… food… vehicles to all employees?
Next: Make “bumper to bumper” health insurance a thing of the past; make it illegal if need be. Move towards a system of required catastrophic coverage with some sort of safety net (perhaps government provided, perhaps privately provided via reinsurance or secondary overage policies) that kicks in as necessary in those rare situations where medical expenses have hit the coverage limit wall.
(Still… at some point there’s got to be some rationality with regard to “how much is enough, how much is too much” regarding heroic measures.)
Going back to personal responsibility, Americans should figure on a reasonable amount of yearly “out of pocket” medical expenses, just as we figure on a reasonable amount of “out of pocket” expenses for everything else in life. The concept of “insurance” is not about covering “normal” expected expenditures, it’s about extreme cases. What’s a “reasonable out of pocket” individual/family medical expense vs. “unreasonable?” Well, that’s the kind of detail the legislative process should be able to work out… perhaps a percentage (up to XX%) of individual yearly income… perhaps a percentage of family income… these are the details.
Next: Increase patent protection for pharmaceuticals. I’d say at a minimum increase protections to 15 years starting the count when the drug has actually been approved and is on the market – first day of legal mass commercial sale. Furthermore, take foreign patent infringement seriously… view it as a national economic security issue.
Back to broad “message” proposals, again, we need to deal with the insurance issue as two issues: 1) As an actual “insurance” issue in the actuarial sense; 2) As a social safety net issue where no matter how hard you try, the numbers just aren’t going to work for certain separate demographics (the poor and the old by and large) and therefore government subsidies no doubt are necessary to an extent. (But to what extent and to whom in what circumstances… these are the “details.”)
Anyway… I’m actually offering concrete proposals. Anyone else?
BILL
8 sinz54 // Jun 11, 2009 at 9:29 am
From Rasmussen, May 21:
Only 31% of Americans say that all Americans should be required to buy health insurance; 56% disagree.
But 59% of American adults believe all companies should be required to buy health insurance for their employees, while 30% are opposed.
Among the self-employed, 46% believe they should be required to buy insurance while 41% disagree. Most entrepreneurs (52%) oppose mandatory coverage for the self-employed. Entrepreneurs include both people who own their own business and the self-employed.
60% of small business owners believe that a government mandate to provide health care coverage for employees would have a negative impact on their business.
So the GOP does have an opportunity here: A majority of the nation really are opposed to forcing anyone to purchase insurance.
The GOP can certainly argue that a mandate represents a violation of freedom of choice, and a staggering blow to startup companies–and that it represents a flip-flop on Obama’s part (last year, his health care proposal, unlike Hillary’s, included no mandate).
But a mandate for universal coverage is the only way that the private insurers can afford to take on policyholders with expensive pre-existing conditions. Take the mandate away, and the private insurers may back out of health care reform and start doing “Harry and Louise” ads again. Then the entire consensus for health care reform could begin unraveling. Maybe.
The GOP may not be able to defeat ObamaCare; they just don’t have the votes in Congress anymore. No matter how unpopular the resulting bill, Obama has the muscle to pass it. But the GOP can sure get a nice issue to run on in 2010, right after it passes.
9 balconesfault // Jun 11, 2009 at 9:46 am
sinz: “So the GOP does have an opportunity here: A majority of the nation really are opposed to forcing anyone to purchase insurance.”
I don’t see how this jibes with:
“59% of American adults believe all companies should be required to buy health insurance for their employees”
10 balconesfault // Jun 11, 2009 at 9:48 am
barker: “Think about it… those with the best jobs, highest paying jobs, jobs with the most status (in a “corporate” sense) get subsidized health insurance benefits with the subsidies coming not just from other insured taxpayers in the same situation but also subsidized by those on the lower rungs of the socio-economic ladder who may work 60 hours a week at three separate low level jobs with none “giving” them insurance. Fair? Hardly. “
Out of curiousity, who do you think provides most of the financial backing for the Republican Party?
How about … ” those with the best jobs, highest paying jobs, jobs with the most status (in a “corporate” sense)”
11 barker13 // Jun 11, 2009 at 9:49 am
Re: Midcon; wrote 51 minutes ago –
“As I have said repeatedly, the GOP needs to spend its time “proposing” instead of simply “opposing.”"
So go to it, Midcon. I eagerly await your concrete proposals.
Re: Debs; wrote 33 minutes ago –
Appreciate the link! Still… lot’s of “ifs” and, er… “estimates.”
Hey… not being sarcastic! It’s a nice little 12 page report – no doubt similar to God only knows how many private, public, and academic reports based upon “available information” and “best analysis” that in the end turned out to be totally ass-end wrong.
Medicare…??? That’s the MODEL to base their rosy assumptions on…?!?! Jeez… God help us then. Medicare/Medicaid is a series of past, present, and future explosions – the future unfunded liability issues are a nightmare for those familiar with them.
Here… Debs… page 1… paragraph 4… first sentence…
“If Medicare payment levels are used in the public plan…”
(*SNORT*) So we’re talking government fiat price (and thus wage) controls effecting not just “rich doctors” but ultimately every single person employed in some facet of the medical/healthcare field.
Hey… don’t get me wrong, I’m not simply attacking… but I am pointing out that there are a great many variables to deal with. Where are the doctors coming from? Are we gonna keep the same medical school/training system? If so, at medicare/medicaid reimbursement rates who except trust fund babies will even consider medical school – how would they ever pay back their school debts?
Tort reform? Is this in the mix? Perhaps government will pick up malpractice costs on the front end while paying off lawsuits on the back end (because ultimately we’re talking about creating a VA (Vet Admin) like system of government hospital for all. That’s the logic of where this is heading.
Anyway… just a few points to ponder.
BILL
12 balconesfault // Jun 11, 2009 at 9:50 am
“Make “bumper to bumper” health insurance a thing of the past; make it illegal if need be. “
Interesting pitch – “government is not going to allow you to engage in this established, mutually beneficial contract”
I can see you’re not a libertarian.
13 barker13 // Jun 11, 2009 at 9:52 am
Re: Balconesfault; wrote 1 minutes ago –
So I take it you have nothing intelligent to add?
(*SHRUG*)
Typical.
Sad. (But typical.)
BILL
14 sinz54 // Jun 11, 2009 at 9:53 am
balconesfault: Because that’s close to the system we have now, that most Americans enjoy.
For decades, health care has been a perk offered by nearly all large American corporations. You get it automatically when you go to work for any big company. So requiring them to provide health insurance is a moot point–it’s already accomplished.
But if you are self-employed, you aren’t forced to purchase insurance for yourself.
15 balconesfault // Jun 11, 2009 at 9:54 am
Actually agree with Barker on a point!
“Are we gonna keep the same medical school/training system? If so, at medicare/medicaid reimbursement rates who except trust fund babies will even consider medical school – how would they ever pay back their school debts?”
No question – this needs to be addressed. The military has already shown that the country can do a great job of operating medical and nursing schools – no reason that we don’t start running a series of large public funded med schools where graduates have no loans to pay off, and a committment to work for a national health service that’s similar to the committment born by military doctors.
16 sinz54 // Jun 11, 2009 at 9:58 am
Just this morning, the American Medical Association told the Senate Finance Committee that it opposes any government-sponsored public plan:
The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”
Furthermore, the A.M.A. said that it cannot support any plan design that mandates physician participation….Many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate….We absolutely oppose government control of health care decisions or mandatory physician participation in any insurance plan.
17 ottovbvs // Jun 11, 2009 at 9:58 am
sinz54
wrote 17 minutes agoFrom Rasmussen, May 21:
“So the GOP does have an opportunity here: A majority of the nation really are opposed to forcing anyone to purchase insurance.”
……Only if you pay attention to Rasmussen telephone polls which are notorious for asking loaded questions…..In fact the whole question of “issue” polling is highly suspect given public ignorance about most of the “issues” being polled …..Gallup has a poll up measuring the public’s general attitude to an overhaul of the system and creating a universal alternative and it’s overwhelmingly favorable……There is no “opportunity.” Quite apart from the general public sentiment which even the insurance companies recognize or why otherwise wouldn’t attack commercials be on tv every night, there’s also the matter of time. These bills are being written now, the concrete poured in high summer, and will be passed in early August, go to conference in September after recess and be on Obama’s desk by early October. There’s only really two major points of dispute: the public option and taxing benefits. The first one will be I personally think, I’m not sure about the second.
18 balconesfault // Jun 11, 2009 at 10:01 am
I would not favor forcing businesses to purchase health insurance for employees. In fact, as I’ve said before, I think that it would spur a huge entreprenuerial boom that would result in great economic gains for our country if we removed the burden of expectation for health care coverage from all businesses.
While you’re right that health care is a perk … it is not only a perk. Large companies offer health care because they have a lot of highly efficient, highly interdependent parts that rely on well trained and high performing individuals to keep them humming along.
To wit – large companies have a vested interest in keeping their workforces healthy, and in keeping them from spending their work time worrying about how they’re going to provide for their families healthcare.
Now, were there a single payer system that companies could release that burden to, I’m sure they would take advantage. But for a lot of large corporations in America, making sure that employees have healthcare just makes good economic sense.
Hell – my company brings in nurses to administer the flu shot every November, and pays for an annual physical for every employee separate from our insurance plan. This is because we perceive a greater economic benefit from employee wellness than operating such programs cost.
19 ottovbvs // Jun 11, 2009 at 10:01 am
sinz54
wrote 0 minutes ago”Just this morning, the American Medical Association told the Senate Finance Committee that it opposes any government-sponsored public plan:”
…….This would be the group who hired Reagan to sell the idea that Medicare was the onset of Stalinism……They matter but they are nowhere near as important as they used to be and there are other doctors groups who support the public option.
…….
20 sinz54 // Jun 11, 2009 at 10:03 am
Balconesfault: Very few young Americans would go to a “publicly funded med school.” First of all, such a new school would have no status, alongside existing private schools like Cornell and Harvard. The best and the brightest would continue going to Cornell and harvard; the mediocre ones would go to the publicly funded med school. Just like in New York, the best students go to Columbia and the mediocre ones go to City College with its open enrollment. Nobody thinks City College of New York is comparable to Columbia; and a degree from City College just isn’t worth as much as a degree from Columbia.
The result would be that your “national health service” would be staffed by mediocre doctors, while the best doctors continue to work at the best teaching hospitals. Your “national health service” would soon get the reputation of the British NHS, and would devolve into a clinic for the poor who otherwise have no choice.
Secondly, a “national health service” could never pay doctors what they could earn in private practice. Why should any good medical student want this, unless he’s truly altruistic. In that case, you might as well just design a public service option like a domestic Peace Corps.
21 balconesfault // Jun 11, 2009 at 10:04 am
From the NY Times:
“But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicares, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.”
Flaw … or feature?
Damn – a medical system with low admin costs and no need to produce profits for investors. What a nightmare!
22 ottovbvs // Jun 11, 2009 at 10:06 am
balconesfault
wrote 0 minutes ago
“While you’re right that health care is a perk … it is not only a perk.”
…….Basically you’re right, it’s a perk but it’s an essential perk…what well qualified or talented person is going to work for a company without benefits…..it’s also an enormous drag on labor mobility.
23 balconesfault // Jun 11, 2009 at 10:06 am
Sinz: “Very few young Americans would go to a “publicly funded med school.” First of all, such a new school would have no status, alongside existing private schools like Cornell and Harvard. The best and the brightest would continue going to Cornell and harvard; the mediocre ones would go to the publicly funded med school.”
You have just disparaged every doctor who was trained at the F. Edward Hbert School of Medicine, you know.
Your assumption that the best and brightest would all choose to spend $200K on a top tier Med School, rather than receive medical training that came with a committment to work for a public health service for some time period, seems rather … ummm … elitist?
24 sinz54 // Jun 11, 2009 at 10:08 am
ottovbs: There can be no major doctor groups who support the Obama public option–because it isn’t even defined yet!
In 2008, there was an astroturf group called “Doctors for Obama,” but that was a campaign phenomenon and AFAIK it’s dead now.
There is a group called “Physicians for a National Health Program,” which supports a single-payer system.
http://www.pnhp.org/
But Obama has said repeatedly that he isn’t going that way–and the GOP has to make sure that the public option that emerges from discussions in Congress is structured so it can never go that way in the future either.
25 sinz54 // Jun 11, 2009 at 10:10 am
balconesfault: I’ll repeat: Nobody who has the SAT scores to get into Columbia will go to City College of New York instead.
26 ottovbvs // Jun 11, 2009 at 10:15 am
sinz54
wrote 3 minutes ago
Balconesfault: Very few young Americans would go to a “publicly funded med school.” First of all, such a new school would have no status, alongside existing private schools like Cornell and Harvard.
……..Do you have any idea how many med schools there are in the US and the extent to which even the private ones are publically funded…..Cornell and Harvard are only typically private med schools in the way that Yale Law School is a typical private law school. If the govt wanted to crank up the supply of well trained doctors they could do it easily.
……And the British NHS is not a clinic for the poor staffed by mediocrities…..90% of Brits use it and even though “going private” are often in the same hospitals albeit in private wards, seeing the same doctors.
27 sinz54 // Jun 11, 2009 at 10:16 am
balconesfault: I’m not disparaging the military academies or the military medical schools. West Point and Annapolis have reputations for excellence.
But their student bodies are made of fine and men and women who freely *chose* to serve their country in national defense, knowing full well that they could get more in the private sector. But they wanted to do something for their country. So did their faculties.
Now if you can find lots of young men and women who will choose to provide medical treatment to the poor for lower salaries and less benefits than they would get in private practice, that’s fine with me. I’m just telling you that altruism hasn’t been a big motivator in the past. We have over a million young men and women in the armed forces. We don’t have anywhere near that number in the Peace Corps or GreenPeace. And those who work for welfare agencies don’t enjoy a lot of status from their neighbors.
28 balconesfault // Jun 11, 2009 at 10:18 am
“I’ll repeat: Nobody who has the SAT scores to get into Columbia will go to City College of New York instead. “
Say their parents make enough to put them above the thresholds for significant financial aid … but really don’t have the finances to consider 45K/year chump change … I’ll bet there are quite a few. Although they’re more likely, I’ll grant, to take advantage of the many private universities which provide merit-based scholarship money (Ivy League Schools only base aid on need).
29 Cforchange // Jun 11, 2009 at 10:21 am
Health care or insurance reform is a wish of the majority electorate. Because of the complexity of this issue, has anyone considered that the party tactic is to not contribute ideas so if the new path doesn’t work their hands are clean. If this is the approach, it’s a mistake because I think Obama’s win was all about recognizing our problems and trying new approaches to solve them.
Like the election, Obama has/ is engaging large numbers of the population to converse and provide ideas to solve our perplexing dilemmas. This is partly how they won the election.
Until the GOP learns to engage large groups in the process we will lose. As Henry notes here, adding argument but no other positive voice to the table futhers the image of pure obstruction.
I personally have underwritten health insurance for catastrophe events – in the past 2 years it has become ridiculous in price. Plus the provider out of pocket medical costs have significantly (30%) increased.
Maybe if our ability to earn wasn’t handicapped, issues of affordibility for housing, healthcare, education etc wouldn’t be so critical. The effect of globalization is wage supression – fact. Things are out of balance – giving the electorate who are caught up in these circumstances an opportunity to participate in the remedy is very powerful. I know first hand, I’ve participated in these activities in my own community and we are getting positive results.
Hasn’t medical school been limited to trust fund babies for some time? Rural hospitals are manned by mostly foreign doctors. Medicare expending here appears to be totally untethered and that’s a big bad mistake.
30 balconesfault // Jun 11, 2009 at 10:22 am
“We have over a million young men and women in the armed forces. We don’t have anywhere near that number in the Peace Corps or GreenPeace.”
Well, I wouldn’t compare Green Peace to the US military. I would also note that in the last decade the US has stepped up the financial inducement to those young men and women considerably – for example, the Army will give up to 40K as an bonus for a first time enlistee for a 4-year committment. I’m pretty sure that trumps anything the Peace Corps is offering.
31 ottovbvs // Jun 11, 2009 at 10:22 am
sinz54
wrote 7 minutes ago
…..That may be true, my point was that there are other doctors groups and the AMA are not the force they were.
…..And I agree there isn’t the remotest chance of a single payer system in the bill.
…..As to whether the Republicans can structure the public option to prevent it EVER becoming a potential vehicle for single payer, I very much doubt it. Obama/Orzag are going to want a public option with teeth….how else are they going to squeeze cost out of the system…..while for most democrats it’s an article of faith…..once the system is up and running the admin can do an immense amount to determine how it works by by presidential orders and normal bureaucratic leverage.
32 sinz54 // Jun 11, 2009 at 10:25 am
ottovbvs: What choice do the Brits have? By law, NHS gives its care for free at the point of delivery, by drawing on government revenues instead of premiums. That prevents private practice from ever being anything but a tiny mosquito on the back of the NHS. It just can’t grow enough because it’s competing with an organization that gives away its service for free.
Anyone seeking care from private practice will be paying twice–once for NHS which they don’t use, and once for private practice. Even if you have a good reason (like you’ve got fast-spreading cancer and you can’t afford to wait the 25 weeks it would take to see an NHS doctor), you can’t get a credit for NHS taxes. Obviously that will limit private practice to the wealthy.
33 Cforchange // Jun 11, 2009 at 10:29 am
Health care or insurance reform is a wish of the majority electorate. Because of the complexity of this issue, has anyone considered that the party tactic is to not contribute ideas so if the new path doesn’t work their hands are clean. If this is the approach, it’s a mistake because I think Obama’s win was all about recognizing our problems and trying new approaches to solve them.
Like the election, Obama has/ is engaging large numbers of the population to converse and provide ideas to solve our perplexing dilemmas. This is partly how they won the election.
Until the GOP learns to engage large groups in the process we will lose. As Henry notes here, adding argument but no other positive voice to the table futhers the image of pure obstruction.
I personally have underwritten health insurance for catastrophe events – in the past 2 years it has become ridiculous in price. Plus the provider out of pocket medical costs have significantly (30%) increased.
Maybe if our ability to earn wasn’t handicapped, issues of affordibility for housing, healthcare, education etc wouldn’t be so critical. The effect of globalization is wage supression – fact. Things are out of balance – giving the electorate who are caught up in these circumstances an opportunity to participate in the remedy is very powerful. I know first hand, I’ve participated in these activities in my own community and we are getting positive results.
Hasn’t medical school been limited to trust fund babies for some time? Rural hospitals are manned by mostly foreign doctors. Medicare expending here appears to be totally untethered and that’s a big bad mistake.
34 Breggers // Jun 11, 2009 at 10:33 am
Brilliantly written article.
35 sinz54 // Jun 11, 2009 at 10:33 am
ottovbvs: All this time, advocates for single-payer have been saying that it’s paperwork and bureaucratic waste and advertising and high profit margins by the private insurers that increases costs. A public plan, designed from the ground up, shouldn’t have any of those problems and should be more efficient. And so it should be able to offer its service at a lower premium *without* having to be subsidized by tax revenues.
If the public plan cannot be competitive without massive Federal subsidy from tax revenues, that would represent an open admission on Obama’s part that private insurance can’t work–in which case NHS is the only way to go.
Which is what Obama really said, as a Senator. He shut his yap about that after he got the Dem nomination for President.
http://www.youtube.com/watch?v=fpAyan1fXCE
And it’s what advocates for single-payer have said: That health care simply can’t pay for itself, and has to be a kind of public utility like the water works.
36 balconesfault // Jun 11, 2009 at 10:44 am
“And so it should be able to offer its service at a lower premium *without* having to be subsidized by tax revenues.”
Note that private insurance policies are currently subsidized by tax incentives. Your comparison should at least be modified for that adjustment.
37 ottovbvs // Jun 11, 2009 at 10:51 am
sinz54
wrote 9 minutes ago
“ottovbvs: All this time, advocates for single-payer have been saying that it’s paperwork and bureaucratic waste and advertising and high profit margins by the private insurers that increases costs.”
…..They and Obama are right, a single payer system has all these advantages you enumerate….Overhead expenses at Medicare the only comparable model we have are about 4% versus 15-40% at private insurers depending on whose version you believe……it’s just not practical politics at the moment…..it’s the difference between the ideal and the attainable and the president is right to go for the attainable…….Private insurers are right be fearful of the public option as a mean of squeezing their profitability…it will.
38 ottovbvs // Jun 11, 2009 at 10:56 am
sinz54
wrote 26 minutes agoottovbvs: What choice do the Brits have?
…..They don’t want a choice…They wouldn’t swap the UK system for ours in a million years……Neither are any British govt’s of left or right interested in creating a blatant class based healthcare system based on one’s ability to pay…..They correctly perceive it would create resource imbalances and other social problems.
39 sinz54 // Jun 11, 2009 at 11:38 am
ottovbvs: I think on this point of streamlining, we agree.
Properly structured, the public plan can serve as a model for efficient management and patient “wellness”: State-of-the-art computer records and files, incentivizing physician teamwork; all recommended preventive screening tests paid for; patients sign waivers so that unnecessary tests and treatments near the end of life are NOT paid for, but giving them the best quality of life is.
But other authorities say that health care costs are mostly related to social pathologies. All other things being equal, poorer parts of the country have more patients with worse care and worse treatment outcomes. Dealing with substance abuse, smoking, obesity, unwed motherhood and sex education to prevent STDs should all be part of preventive medicine.
There was one study that said that if all Americans were of normal weight (neither overweight nor anorexic), America could save up to $1 trillion in health care costs over their lifetimes.
40 Cforchange // Jun 11, 2009 at 12:02 pm
Otto – I don’t agree w/ you about the UK. My mother switched countries over healthcare. Further, I visited there last year and found an aunt who was receiving a bizzare non surgical trmt for a genetically linked ailment that I had surgically corrected. This was her 3rd time in. Sure she was happy but she didn’t know any better. I’m happy to have the problem fixed and she was very interested in my experience.
My mother’s story from 80 years ago was horrific, I know time has past and things have improved but her experience and treatment made her a good American – always very impressed and thankful for her care especially a life saving event that she received here .
41 barker13 // Jun 11, 2009 at 12:17 pm
Re: Balconesfault; 9:54 AM –
“The military has already shown that the country can do a great job of operating medical and nursing schools…”
Actually… no it hasn’t. (*SHRUG*) There’s only one federal medical school (the Uniformed Services University of the Health Sciences (USUHS) F. Edward Hbert School of Medicine, in Bethesda, Maryland); most military doctors get their medical training the same exact way civilian doctors do… via private (or state university system) medical schools.
http://www.nejmjobs.org/career-resources/military-physician-careers.aspx
Still… aside from clarifying the facts regarding the current system… I’m certainly willing to consider proposals to greatly expand DIRECT federal government provided medical training with “payment” by students levied in the form of government service using the service academy model.
Bear in mind though… training will still cost what it costs. I mean… I don’t know what a year a West Point, Annapolis, or Colorado Springs “costs” in terms of budget per student, but I’m guessing it’s right up there, indeed, probably well in excess, of an Ivy League education.
I’m just saying… to an extent we’re simply talking shifting burdens. (*SHRUG*)
“…a commitment to work for a national health service that’s similar to the commitment born by military doctors.”
Again… not quite. Military doctors work within the physical military infrastructure – bases, hospitals, in the field. We’re talking either federal government takeover of existing private and state hospitals or else building new “federal” facilities which in many cases are unnecessary in terms of providing space. (Remember, sure, some hospitals are jammed… but many are underutilized.)
Now I suppose we could build upon the existing VA structure… but again… in real terms this would mean melding a military/civilian system with all the disruptions and cultural clashes (not to mention the reaction of the veterans) this would entail.
Again… not saying it couldn’t be done… not saying we shouldn’t look at such an option or something close to it… just once again reminding folks of the law of unintended consequences.
(*SHRUG*)
BILL
42 barker13 // Jun 11, 2009 at 12:29 pm
BTW… I’m not seeing many proactive, specific proposals from anyone other than… er… myself.
At least Balconesfault took up my challenge to go back and forth a bit on specifics; other than that, mainly what we have here is same old, same old.
(*SHRUG*)
BILL
43 Brutus1776 // Jun 11, 2009 at 12:31 pm
Bill, you’re our avant garde
*Fist Bump*
44 barker13 // Jun 11, 2009 at 1:29 pm
Re: Brutus1776; wrote 51 minutes ago –
(*GRIN*)
(*EXPROPRIATING OTTO’S MONEY IN ORDER TO BUY BRUTUS A DRINK*)
BILL
45 balconesfault // Jun 11, 2009 at 1:33 pm
Bill: “Again… not saying it couldn’t be done… not saying we shouldn’t look at such an option or something close to it… just once again reminding folks of the law of unintended consequences.”
I completely agree. I think this is a situation where politics is forcing people to advance partial situations, which have the potential of at least in the short run making things worse.
Let’s consider what we’re dealing with here, on some of the legit concerns.
a) supply of doctors. This has clearly been limited by the AMA over the recent past the same way DeBeers and their partners limit the supply of diamonds onto the market. I have no question that America produces plenty of smart motivated people who would go into the medical profession but can’t because the bar is set intentionally high to limit the number of doctors.
The way to break this is simply to build more medical schools on taxpayer dollars.
Another problem is that doctors come out of med school deeply in debt. They need to be paid a lot of money right off the bat to pay off that debt. And in our economy, we expect to be paid more over time – and more than a lot of money is a whole lot of money.
It is impractical for a nationalized system to pay a whole lot of money to doctors. However, if you pick up the tab for their med school, you remove the need for them to be paid a lot of money right off the bat.
I seriously doubt that you’d have a watered down applicant pool were the government to offer free med school, followed by an 8-year committment to do residency in and then work in assigned federal healthcare facilities at a salary starting at $80K/year and escalating over time to $160K/year (current dollars). And the cost control savings would pay off the med school investment.
b) facilities. One of the other arguments being made is that all these newly covered people will swamp existing facilities. Legit point. Let’s build new ones – in places that the current marketplace underserves. Staff them with a combo of experienced and new doctors. Yeah – there’s a cost, but it’s a cost that I think we all would agree needs to be born, if there really is not sufficient capacity to serve the needs of the population.
Unfortunately, the marketplace does not have an incentive to significantly reduce waiting times, until it negatively affects profits. There are things the market does a great job of, and things that it does poorly at – sometimes because doing poorly produces greater profits than doing well.
46 ottovbvs // Jun 11, 2009 at 1:43 pm
Cforchange
12:02 PM
“My mother switched countries over healthcare.”
……The British NHS didn’t come into existence until 1947 or 1948 ie. About 60 years ago so I’m not sure that situation 80 years ago is relevant.
……I’ve been treated in the British system both publically when I was as student there and semi privately when I was older and richer. Both experiences were excellent. I also have a British brother in law who had a 9 month hospitalization for Guillame Barre syndrome followed by 18 months of intensive after care. Didn’t cost him a cent, effectively cured or as cured as you get with that condition.
47 ottovbvs // Jun 11, 2009 at 1:51 pm
sinz54
11:38 AMottovbvs: “I think on this point of streamlining, we agree.”
…..Sinz how can I handle this….but single payer is out for political and practical reasons. Given the legalized bribery that is the US political system the insurance companies have enough clout to block it. And to be fair there’s the practical reason that we have a whole bureaucratic infrastructure built around the present inefficiencies. This couldn’t go cold turkey and stop because it employs hundreds of thousands. The public option squeezes it because the insurance companies are going to have to become more efficient if they are to compete with the public option. That’s why Obama/Orzag need it as part of their grand plan. To give you one example the insurance companies have fought for years having a standardized claim form. Thus doctors offices have these women behind the glass handling typically 10-20 different claims forms from different insurance companies, medicare etc.
48 Mike K // Jun 11, 2009 at 3:50 pm
“supply of doctors. This has clearly been limited by the AMA over the recent past the same way DeBeers and their partners limit the supply of diamonds onto the market. I have no question that America produces plenty of smart motivated people who would go into the medical profession but can’t because the bar is set intentionally high to limit the number of doctors.”
I haven’t read the entire thread but ran across this statement and it discredits your other point, which was good. LBJ tried to deal with the cost of care in the 1960s by flooding the market with doctors. My class in 1966 was 64, USC now graduates 180 or more every year. Many more schools opened plus DO schools have been opening. We now have hundreds of thousands of nurse practitioners and physician assistants who do what primary care docs did 30 years ago. The all-powerful AMA has been am myth since about 1955. Certainly since 1965. That is not the answer and the pool of good applicants who don’t get in is not that big.
What I would suggest is following the French model which has a national fee schedule which is optional but which the health plans (multiple) use for payment. They pay 80% roughly (I have the schedule of co-pays on my blog) and private insurance pays the balance. Good doctors charge higher fees and patients who choose those doctors pay the higher fees. There are private hospitals that charge higher rates and patients who choose those hospitals pay them.
Take a look at the satisfaction levels and compare France with the NHS and Canada. We could evolve our system toward the French model but the academics who designed the Clinton Plan (I know them all), and are advising Obama, know nothing about private practice. They will wreck the system if left alone.
49 balconesfault // Jun 11, 2009 at 4:00 pm
In 1966, the US population was under 200 million – now it’s over 300 million. Add that the population has aged significantly over that time, meaning that we have a higher demand for doctors per capita. I dispute that the pool of good applicants isn’t large – rather, I would suggest that many good potential applicants get driven into other fields simply because the chance of success for med school admission is perceived to be so low, and so they choose other paths. Add the cost of med school, and that will further drive many smart people to choose some other calling.
That said, I’m in agreement with you on the value of the French system. It looks like they’re getting something right that we should take a serious look at.
I get confused – are you a doctor or an aerospace engineer?
50 ottovbvs // Jun 11, 2009 at 4:07 pm
Mike K
wrote 9 minutes ago
I agree with you that the French model is a good one to copy but then you go on to say
“but the academics who designed the Clinton Plan (I know them all), and are advising Obama, know nothing about private practice. They will wreck the system if left alone.”
As of now the entire medical delivery system is going to remain essentially unchanged ie. principally in private hands. All that’s being addressed at present is how it is paid for. Inevitably in the longer term thy are going to improve efficiencies but “designing a plan.” No plan is being designed or if it is perhaps you could describe this plan since you seem to know so much about it.
51 ottovbvs // Jun 11, 2009 at 4:10 pm
balconesfault
wrote 7 minutes ago
“It looks like they’re getting something right that we should take a serious look at.”
……Actually the French get most things right……it’s only widespread Francophobia that makes us blind to the fact.
52 ottovbvs // Jun 11, 2009 at 4:12 pm
“get confused – are you a doctor or an aerospace engineer?”
……A doctor who judges the effectiveness of the UK NHS by the state of the restrooms at Heathrow as I recall.
53 sinz54 // Jun 12, 2009 at 7:20 am
ottovbvs: Applying for insurance is a one-off. You’re not going to save money on health care costs there.
The big payoff is in streamlining the operations of the medical *providers*. Many of their forms are still paper (not yet online). They don’t even have standardized procedures for management of those forms; it’s often ad hoc.
I went to a hospital a couple of years ago, and they actually misplaced my medical records! Panic ensued. Doctors, nurses, receptionists, were all running around the hospital floor trying to find my medical records. After looking for nearly two hours, they found them. (That was time they should have been spending treating patients, not running around.) And my medical records consisted of a bunch of papers stuffed into a folder. Nothing was online, nothing.
On other occasions, I had to hand-carry medical records, X-rays, CT scan films, from one hospital or one doctor to another. IOW, we patients act as unpaid couriers for the hospital’s information management. And we can screw up too.
What would really save money would be a secure “MedNet,” containing all the medical records, X-rays, CT scans, everything, for all hospitals and all doctors in the nation. If you get injured while skiing or driving, the doctor logs onto MedNet and gets all your medical history–instantly.
Obama is making a serious mistake if he thinks that the main driver of health care costs is private insurance companies. It’s not. America’s health care *costs*–what we spend on medical providers–really are rising, regardless of who pays the bill. And they will continue to rise until the providers shape up.
54 sinz54 // Jun 12, 2009 at 7:22 am
ottovbvs: I agree with you and Mike K that the French system has some interesting features we should be looking at–but the scramble going on in Congress right now is unlikely to stop, look, and listen.
In a global economy, in which America is competing, we should be looking at our competition: How does Japan deal with health care, how does France deal with health care, etc. Somehow, despite an aging (and therefore sicker) population, Japanese auto companies continue to beat the pants off American auto companies–and their electronics giants like Sony and Panasonic continue to do well too.
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