Rising to the Challenge
What a rich, provocative discussion! We at the Campaign for America’s Future are working to promote a widespread citizen debate about health care for all – modeled after the successful coalition that stopped Social Security privatization. And this forum, sponsored by Josh Marshall and provoked by Jonathan Cohn’s new book, has fostered a very important exchange. We are going to be linking people into it for some time.
Several participants have rightly insisted on focusing us on a large order question: what kinds of fundamental reforms are necessary to get a health care system that will cover everyone, improve health and make the health care system much more efficient? And the big debate is over the role of the private health insurance industry: can we regulate and “incentivise” big health insurers to get them to achieve these goals, even though their business model has produced many of the very problems the public wants solved?
A few others have plaintively insisted that all this talk about systemic change and the model of single-payer is politically unrealistic and therefore irrelevant.
Mark Schmitt and others rightly ask if we can combine our long term vision with a constructive participation in the messy realities of the political process. As I noted earlier in this conversation, the public has signaled to the politicians that health care is priority issue, and the politicians (at least on the Democratic side of the presidential race) have responded with a generalized pledge: “I will make sure that everyone is covered by the end of my (first or second) term.” Since they are all scrambling to figure out how to do that, we have an enormous opportunity before us.
I submit that one of the best things we on the “progressive” side of this debate can do this year is to engage the nation – and the politicians – in a public discussion about the private health insurance industry:
about the many ways the industry deforms and cripples our health care system – and about how they actually kill people.
I reported (via the OurFuture blog and Huffington Post) about Hillary Clinton's masterful presentation at the Las Vegas presidential debate on health care. Edwards was of course, specific and eloquent, embarrassing Obama for lacking details. But Hillary took out after the health insurance industry like Don McCanne or Maggie Mahar. Take a look at this short exerpt and tell me it doesn’t sound like she’s getting ready to cut private health insurance completely out of her health care plan:
I am in favor of universal health care coverage. [And a system] that begins to guarantee coverage to people who already have insurance, because, let's not kid ourselves, there are a lot of people who think they have insurance except when they need it. [She tells a story about a woman excluded from insurance because of a pre-existing condition.] Now, I don't want to wait until I'm president to begin. I'm going to introduce legislation while I'm in the Senate to end insurance discrimination. Guaranteed coverage. No more cherry picking. You cannot eliminate people on the basis of preexisting conditions, because that's what we need insurance for. And, you know, we've now met the human gene. We're going to find out we're all susceptible to something. So none of us are going to be insurable if we don't change this system. And I think we need to start now in order to make sense out of it and get people the coverage they deserve to have.
Now this kind of populist rhetoric is also useful if she is planning to go for a wimpy and dangerous Wyden-style plan that essentially gives all our public subsidies to the insurance companies – while pretending to regulate them. The point is that Hillary is aware of the public anger at insurance companies among the voters, and she is determined to make it work for her.
We should be doing the same thing -- but with the goal of channeling that anger to some productive conclusions:
Insurance companies distort our health care system at great cost, and therefore
• We should demand politicians tell us how they would make insurance companies change their business model – now based on insuring the well and the wealthy. or
• We should build our health-care-for-all vision around a public system – like Jacob Hacker’s Health Care for America – not the private insurance companies.
Even if you are one of those who believe the next President will have to capitulate to the insurance industry in order to get anything passed, you’ve got to see that having the companies publicly on the defensive – explaining that they don’t want to cut off peoples’ insurance or charge outrageous premiums – has got to give us an advantage even if our goal is getting a plan for America that is marginally better than Massachusetts or California.
But millions of Americans are telling the politicians that we can do better. John Edwards deserves the praise he’s been getting (including from me) for the way he’s detailed a plan that bites the bullet on paying for coverage in a progressive way and for requiring employers to “pay or play.” But on the role of the private insurance companies, Edwards essentially splits the difference. His plan is a cross between Schwarzenegger and Hacker (the Hackernator?). But Barak Obama is now on the spot. He’s got to decide whether he advances a plan (or at least principles) that are more progressive than Edwards – by limiting the role of the private insurance companies. And as we all know, the grass roots and the progressive bloggers have some influence on the policy decisions of Democratic candidates trying to excite the Democratic base.
Many of the participants in this conversation are very good at explaining and detailing the many ways in which the health insurance companies have helped to create our dysfunctional health care system. We at the Campaign for America's Future are eager to work with you to turn that explanation into a grass roots campaign for change.
And then, of course, we need a positive plan to cover everyone in America. One of the things we learned last time around is that Americans want a vision for health care that they can understand – and a solution to big problems of costs and coverage that proceed from an understandable diagnosis of why we face those problems. What we do over the next few months can help shape the proposals the 2008 Democratic presidential candidates offer to the nation on health care. And what we do over the next several years can help shape how those proposals evolve – and whether they have a chance of succeeding in our lifetimes.
This forum helped clarify the challenge we face. And, as motivation, I leave you with Matthew Holt’s description of the outcome he fears. (It’s a pretty good description of my fears about our legacy if we don’t rise to the challenge.):
My essential fear though, is that we’ll only get to some kind of compromised quasi-universal coverage system that doesn't really cover everybody, keeps a role for a private insurance industry operating under the wrong incentives, and looks like welfare for the poor. In that case this whole cycle will start again, and in about 15-20 years when we go into a more violent collapse—then we will end up with Soviet-style rather than Danish style socialized medicine. And we ought to be able to do much better than that.
Right on Roger!!!!
So what are people's ideas and experiences for how we launch this kind of intentional strategic activity to, as Roger says, "engage the nation – and the politicians – in a public discussion about the private health insurance industry."?
To be honest my head feels somewhat bloodied from the battles of this sort we've been engaged in here in Massachusetts. (for details on this -- the battles, not my bloodied head -- see link in my comment under "No wrong place to start" post below). But many of us, as are most of you, are fighters and keep coming back for another round.
Learning from our own experiences working on state and national campaigns and learning from others' efforts is key. We've just come out of a 4-year campaign to make univ. hc a constitutional right in Massachusetts as a tactic to expose and to overcome the insurance industry's blocking of needed reform. And to make reforms permanent. Too bad half the state legislators defied the constitution and our SJC and refused to give the hc amendment its second required vote so that it could move on to the statewide ballot. A case is pending before the SJC seeking a remedy to this travesty of justice. Stay tuned.
To enable the timely sharing of information and chance to dialogue there's a need to create mechanisms for ongoing connections with each other. How else can we share info. to develop saavier strategies to expose and de-fang/de-claw our enemy -- private insurance and big Pharma. It is absolutely essential to not overlook Pharma's self-interest in blocking universal hc reform.
Healthcare-Now in NYC together with PNHP and AMSA is coordinating lots of national activism on this front and seem to be growing by leaps and bounds. Here in Boston we did a hearing at Faneuil Hall back in '05 to build support for HR 676. Over the ensuing months activists succeeded in getting 7 of our 8 members of congress to endorse it. Now we're having to start over again on that--ughh.
Are there other groups that are building capacity and strategy to advance national work?
I'm on a steep learning curve (still, after 20 years of being a "univ. hc activist"!) but I do think a crucial goal is to build a specific reform movement that has grassroots strength -- in breadth, depth, diversity, and saavy -- in order to win.
Big money is a big ingrediant to make this work. Isn't it? Who's got it and will give?
Reactions, other ideas?
April 14, 2007 8:45 PM | Reply | Permalink
Roger Hickey-
Thanks but I am cross posting my post from "Readers Blog" section of TPM Cafe which attempts to reframe this rich dialogue.
While I respect the dialogue on health care reform I urge each of you (posters,commentors and readers)to read two books written about 30 years apart that would re-frame the entire debate.
They are philosopher Ivan Illich's Limits
to Medicine-Medical Nemesis:The Expropriation of Health(1976)and physician Nortin Hadler's The Last Well Person-How to Stay Well Despite the Health Care System(2004)
Both books posit that a major threat to human health is the medical establishment. Both books are well researched and are on the mark.
I wrote a blog about Hadler's recent emphasis on efficacy on my Critical Condition blog
I intend to distribute copies of both books to senior health care policy analysts and to the health care staffers of every major presidential candidate.
We really need to stop debating about who and how we are going to pay for a health care system that does not work
("first do no harm")
Respectfully,
Dr. Rick Lippin
Southampton, Pa
http://medicalcrises.blogspot.com
April 15, 2007 9:08 AM | Reply | Permalink
Businesses exist to make money. They cease to exist if they can't make money. The service or goods they provide to the general public is never the reason for their existence.
An insurance company only makes money if it can keep its payouts below the total of its premiums and expenses. That cannot be done if they have to pay for preexisting conditions for anyone who asks them for insurance, unless they raise their rates higher, making them uncompetitive, and losing them their healthy customers, still further driving up rates for those remaining.
So, we can either solve the health care crisis or we can live with profit driven insurance companies. To pretend that the government can make a few changes here and there, keep the insurance companies in the health care business, and solve the health care crisis is nothing but a scam. And, if this scam is perpetuated by the Republicans you can be sure the health care crisis will quickly be a critical crisis.
Only an SP system will solve the problem, so lets work towards that, not try to maintain campaign donations from insurance companies as our first priority.
Hoppy in Sacramento
April 15, 2007 1:25 PM | Reply | Permalink
Focusing on insurance distracts from the goal and the moral imperative. The goal, the moral purpose here, is providing that every American receives health CARE. Everyone needs health care. It's not like the traffic accident you may never have or the wind storm that may never hit your house.
Once upon a time, we decided that everyone needed a certain level of education. We teach kids to read. We even teach adults to read. We don't require that they can afford the class. You can argue that there are flaws in the delivery system and you can argue about the level of education we should provide but even conservatives don't deny that every child needs access to a teacher. Why shouldn't every child have access to a doctor?
Stop allowing conservaties and corporations to define the issue. It's not about insurance, it's about a basic right to health care.
April 15, 2007 2:05 PM | Reply | Permalink
Whenever the topic of national healthcare comes up, I think there's a tendency to classify it as social or national health issue first and foremost. What a lot of activists on this side of the debate and indeed on these very boards miss is the fact that healthcare costs are beginning to suffocate the viability of American business. American companies spend so much money not just on insurance for employees, but a raft of other supplementary programs that are managed out of their HR offices one can justifiably ask: why is a computer hardware company, say, in the business of providing (or denying as it were) health insurance to its employees? Isn't that an enormous distraction from what should be its central focus? The short term goals of the insurance industry are together impeding the continued profitability and viability of U.S. business at large. In this way, capitalism in America is in a rotting stage. The healthcare situation is in need of a big tweak to correct this internal profit cannibalizing trend.
So when we talk about strategies for advancing the cause of a total and comprehensive healthcare plan that will last not a generation or two but as long as the Social Security Administration has, we should be thinking about long term principles that allow the world of healthcare to thrive alongside the world of commerce. Independently.
I believe activists should be aware that for every American citizen clamoring for an equitable system that works, increasingly there is a CEO or CFO who agrees, albeit for entirely different reasons.
The insurance industry will not go gently into that good night of any plan that hobbles their power, profits or influence.
But for activists it would be fruitful to frame the debate as one between the insurers and the rest of U.S. business. Sort of restricting the diseased organ (insurance) to save the whole body (U.S. business). Let the two sides engage the power of their lobbyists and PR machines against each other while citizens take an active hand in the wording of the legislative solution.
April 15, 2007 2:05 PM | Reply | Permalink
Nonsense.
Unexpected extremely large expenses are a big part of the health care problem. I think it would probably be possible for middle class folks and above to pay for their own routine health care.
April 15, 2007 2:22 PM | Reply | Permalink
Arguing about who can afford what is an entirely different debate than arguing about what is a fundamental human right or value. Almost all of the western world long ago made universal health care a value that has been given the status of a societal right. I argue that this is the argument we should be making.
Letting people like you mire us in bean counting exercises over what percentile can afford which routine procedure obscures the philosophical issue.
April 15, 2007 2:41 PM | Reply | Permalink
I was just correcting a false statement that you made.
SOMEBODY has to wonder how the bills are going to be paid and what incentives there will be in the system.
April 15, 2007 2:47 PM | Reply | Permalink
How about the incentive to have a healthy nation?
April 15, 2007 3:07 PM | Reply | Permalink
Well, that's a laudable goal. I would like to understand the incentives required to get there
April 15, 2007 3:10 PM | Reply | Permalink
Hmmm. We seem to be talking at cross purposes. Isn't having a healthy population an incentive enough? Or do you mean economic incentives? Because it would seem the desire for health - we all need it - would be an incentive enough. I for one believe, and I know this is heresy after Pere Reagan's time, that a cancer researcher would probably continue to search for cures and preventions even if a big corporation couldn't earn $800 million off the drug when it was brought to market. In fact, keeping drugs affordable, could be a component of reining in healthcare costs. For starters.
April 15, 2007 3:33 PM | Reply | Permalink
A benevolent philosopher-king might consider that reason enough.
Or she might ask "how healthy?" and "at what cost?" and "to wht extremes?" and "as an alternative to what other worthy goals?".
But we are not governed by philosopher-kings. We are governed by taxpayer-funded representative democracy, with stakeholders and pressure groups, in a price-mediated economy. Let's discuss that reality, and see if there's a way it can get us to universal care.
April 15, 2007 3:44 PM | Reply | Permalink
you are exactly right, bluebell. but how to use this notion of shared values to advance policy reforms is a tough challenge. here in MA over the past decade we've launched 2 significant grassroots ballot initiative efforts. We have been striving to change statewide policies and laws and establish universal hc and progressive financing reforms -- not all the way to single payer although that bill has been re-filed every year for the past 8.
Re the ballot initiatives, first in 2000 our univ hc ballot initiative lost (final tally 48-52%) after it was outspent 100-to-1 by the state's HMO's and insurance co's that spent $5.4Mil to fund the "No on 5" campaign. Then in 2004 when we activists in MA attempted to change the state constitution inserting language to make affordable comprehensive health insurance a permanent right for all residents.
I do want to say that I think it is appropriate to fight for universal health insurance coverage. As you say, the goal is health care for all but isn't insurance coverage "the ticket" that allows a person to freely access timely care? And don't we need an insurance model for the billing and payment etc to take place? It should be a social insruance model, definately. Insurance is the common approach used by all industrialized countries, I believe. Canada has a Medicare For All program.
As so many other state reform experiences have turned out, the MA ballot campaign in 2000 was not able to withstand corporate-financed opposition using dishonest fearmongering tactics and the 2004-07 healthcare constitutional amendment fell victim to heavy-handed corporate "influence"--control is more apt--that resulted in legislators refusing to vote on the amendment's merits and give it a chance to advance to the statewide ballot for voters to make the final decision. We've filed a case with the SJC about this. www.HealthCareForMass.org has details.
I share MA details here in case our lessons learned help identify/ reveal what we're up against in pursuing univ hc reforms in every state and as a nation. I'm sure many TPMreaders, but not all, are all too familiar with the details fo this struggle (esp folks in CA, OR, WA, VT and ME to name a few!)
I think a commentor on this post suggested that we attempt to set corporate america against the health insurance industry to drive them out ofour midst and I LOVE THAT THINKING. But do the CEO's of all these various co's (health insurance and non-insurance co's) sit on each others' corporate boards, sign-off on each others' obscenely high compensation packages, watch each others' backs, etc? Is this why that suggested dynamic has not occured already?
April 15, 2007 3:46 PM | Reply | Permalink
Well, people should have the incentive to eat a balanced diet, not be overweight, exercise, not smoke, ect. in the interest of a healthy population. As near as I can tell from the news, they are not doing a very good job of it.
As far as people working in the health care field being dedicated and willing to work for relatively low pay, I would like to think so, but doctors seem to be more well of than they need to be and nursed form unions and occasionally strike for better pay and benefits. So I conclude that there is a limit to their altruism.
I also wonder about the incentive for patients to demand expensive treatments that they do not have to pay for that are really only marginally beneficial. Will the politically sensitive managers of the system have the will to deny access to those treatments.
I know the SP advocates think that the drug companies make too much money, but it does cost something to develop new drugs. Will the SP managers squeeze the drug companies too much and chock off future drugs?
April 15, 2007 5:15 PM | Reply | Permalink
No problem! Just pass a law!
1. Insurers shall not collect or employ any information concerning preexisting illnesses.
2. Insurers shall not collect or employ any of the following markers: genetic, race, ethnic, sex, age.
3. Insurers shall not deny coverage for any treatment, procedure, or prescription ordered by a Board Certified physician acting in her/his area of specialization.
A bit expensive, perhaps. But isn't that what SP will come down to?
April 15, 2007 5:39 PM | Reply | Permalink
. . . why is a computer hardware company, say, in the business of providing (or denying as it were) health insurance to its employees?
Presumably, because employees want the coverage and the company can provide it to them more economically than they can provide it to themselves.
Theoretically, employment benefits don't cost companies one extra penny; they're simply another form of compensation. Cancel those benefits and their competitors would compel those companies to raise their employees' cash wages.
Now, if you believe that companies are overpaying their workers, currently, then, yes -- they could drop those benefits and save money.
April 15, 2007 5:55 PM | Reply | Permalink
Re: It is absolutely essential to not overlook Pharma's self-interest in blocking universal hc reform.
Since aboslutely no one is proposing that we nationalize the pharmaceutical industry (as single paytor would nationalize the health insurance industry) why should that industry seek to block universal health care? If anything, it would bring them more paying customers.
April 15, 2007 7:25 PM | Reply | Permalink
Re: That cannot be done if they have to pay for preexisting conditions for anyone who asks them for insurance, unless they raise their rates higher, making them uncompetitive, and losing them their healthy customers, still further driving up rates for those remaining.
Unless of course people are not allowed to drop coverage (but can still switch plans). In that case companies will still raise their rates, but knowing that they may lose business to competitors if they overdo it they have to keep those increases minimized. And yes, the well and the wealthy will pay for the sick and poor thereby-- but isn't that how it would work under single payor too?
April 15, 2007 7:28 PM | Reply | Permalink
Re: I think it would probably be possible for middle class folks and above to pay for their own routine health care.
If all you are talking about is the occasional $60 office visit followed by a cheap generic Rx, you're right. But if you are talking about socking the middle class with $10,000 in healthcare bills (as most high deductible plans propose) you are very, very wrong. The middle class is already stretched tight. Bills of that magnitude will produce nothing but crowded dockets at bankruptcy courts.
April 15, 2007 7:31 PM | Reply | Permalink
A major portion of the cost of new drugs is the cost of promoting that drug first to doctors to get them to prescribe it, then to patients to get them to demand that their doctor prescribe it. Cut that cost to the bone and drug prices drop immediately. Also, many if not most new drugs are just competitors for existing adequate drugs, and are designed solely to make money for the pharmaceutical company designing that new drug - I don't object to that, but it has nothing to do with providing health care.
Medicare already limits what drugs and treatments they will pay for. Similar limitations would be needed with a SP program. As long as the criteria for approving or disapproving a treatment or drug is fully visible I don't have a problem with that either.
Hoppy in Sacramento
April 15, 2007 7:32 PM | Reply | Permalink
Re: Theoretically, employment benefits don't cost companies one extra penny; they're simply another form of compensation.
Except that companies cannot control them as easily as they can salaries. If an employee asks for a raise they can say No. If the health insurer demands a big increase, they have to pay up. (Yes, the option of dropping coverage altogether does exist, but is possible only in fairly low wage, unskilled industries where there is a huge potential employee base; if a business that needs highly skilled workers tries that, those workers will walk right out the door, and the best workers will the first to go, being the most employable at their competitors).
April 15, 2007 7:36 PM | Reply | Permalink
I think that the $10.000 is a risk figure. How much does the average healthy person really pay for health care? An annual checkup, if that. Perhaps a questionable visit to the doctor for flu symptoms. Eye exams, teeth cleaning, an occasional broken bone, perhaps?
April 15, 2007 7:49 PM | Reply | Permalink
In reality, though, companies faced with health care insurance coverage costs higher than they wish to pay -- that is, higher than the increase required to retain their workers -- don't exercize their "option of dropping coverage altogether." They lower the increase by reducing the plan's benefits, pay a portion of that reduced increase, and pass the rest to their employees.
April 15, 2007 8:03 PM | Reply | Permalink
Is one of the problems in promoting Universal Health Care, the fact that it is being addressed on the Federal level? It seems that the basic needs or platform for UHC are being both diluted and muddied on the national level. I see the m]national solution as being once again represented by a 50lb. tome of bureaucratic gobbledy-gook that only the Federal GPO can produce. Is pragmatism too pragmatic?
I hope this doesn't sound defeatist in nature, for I do think the Federal Government owes a responsibility, but in the form of monetary subsidies to the States and not in regulation. Is it too simplistic and naive to think the the States' regulatory boards should be able to set guidelines for the Insurance Providers. Like in Massachusetts, not as an example in perfection, States should only allow access to it's public as consumers of insurance if the Insurance providers offer a plan that will cover the entire population. Not one plan for everyone, but varying plans for differing consumer needs. For example, the state regulatory board demands a certain number of policies at a certain premium to gain access to the entire market.
The numbers and level of coverage are up to discussion. I think Mass. CommonwealthCare/Connector is an example of a place to start, including State Subsidized Plans and Insurance Bargaining Groups (Sec125's). Of course the populace will have to pay for this coverage. But it is a worthy price to pay for the collective health of our neighbors. Federal support should be expected as well. The shake up would seem to be minimal and getting down to the nitty-gritty of money is possible if at first it seems unattainable. Making the Insurance Providers assume a more responsible public role will bring a degree of honesty to the market structures of the industry, hopefully opening a road to discourse on the cost stratagems of the whole market.
As a response to this strong arm tactic in Mass., the Insurance providers have not fled from the State because it is now too expensive to do business here. It is just an agreement that the State, in it's role as protectorate to the most needy, can and will demand a product for market access. "If you want to come in, here's what we need. Figure it out." Let the solution be a market solution with a minimum level of entrance. They will make it fit into their business model, there is lots of money to be made still.
It certainly is not a simple process - it was a messy at times here in Mass (the industry's first offer was both laughable and depressing). And it WILL take sacrifices from all parties. That means money/taxes so we will have to get over it. A crazy idea, I know, for those that have making a sacrifice for those that don't. It might be the rebirth of progressive liberalism.
Keeping the development of UHC at the local level will limit the dilution of its basic purpose and health needs by limiting the scope and access to the process. It will take much of the grandstanding, stump speech politicization out of the issue as well. On the Federal level, it seems that the discussion of UHC is only from half of the Hill. What will happen when our representatives surely split to take their respective sides? It will also allow certain markets to develop with their specific needs. Someone in N. Dakota (an arbitrary choice) will not want to support the higher medical costs of the Northeast (Especially Boston) under a Federal plan if access, quality and economic benefit is not the same. Once a few State market plans and business models have been ironed out, it would only seem to take months to a year to implement nationwide and not multiple terms.
April 15, 2007 8:05 PM | Reply | Permalink
You're right. But the rest of the developed world isn't governed by philosopher-kings, either and they've had workable national healthcare for generations. So what gives? We need to get away from the idea that national healthcare is some sort of far-off, foreign luxury that we may be able to arrange. It's your right. Denied. It's my right. Denied. Once people see it as a right they're less bashful about saying things like, "Let's outlaw all prescription drug advertisements and promotions." That's definitely an area where we can lower the cost of medicine and the cost of healthcare. Countries that outlaw prescription drug advertisements don't pay as much for prescription drugs. And that's why I use the example of the researcher working a cure for a disease. I believe - maybe naively - that the desire to find a cure is based more on a desire for scientific discovery than on a desire for personal wealth. But the business-mindset has so polluted American healthcare that people don’t separate the ideas of a workable national healthcare from whether or not the supposedly-free market will allow it. That said, I don’t think national healthcare has to be at odds with business. I just think there is far, far too much profit built into American healthcare as it stands. Some profit is fine. But not excessive levels – say big pharma making 15% yoy for 10 years while seniors are going broke trying to pay for their prescriptions.
April 15, 2007 9:24 PM | Reply | Permalink
You're forgetting the moral hazard factor. When money is tight (and for most middle class people it is very tight) people will forgo treatment and examination for conditions which may later turn into something far more serious. Yours is a route to higher healthcare expenses, with worse (sometimes fatal) outcomes, not lower. It is, as the saying goes, penny-wise and pound foolish.
April 16, 2007 3:48 AM | Reply | Permalink
I agree almost entirely with this, although I think there should be some flexibility with approving new drugs for use in the system.
April 16, 2007 6:36 AM | Reply | Permalink
I wasn’t really advocating anything here, I was just musing that the health care financing problem is a problem of insuring against unlikely high expenses and that middle class people probably could finance their own routine care.
As far as moral hazard goes, would someone who isn’t motivated to spend a hundred bucks to protect his health be motivated if it were free? I am not so sure, I think a lot of people just don’t like to go to the doctor.
April 16, 2007 7:38 AM | Reply | Permalink
We have a long history of allowing each state to "solve" problems as they wish, and almost invariably that leads to progressive states actually trying to solve the problems, while conservative states take a pass. We are all Americans. What is bad for one of us is bad for all of us. The lack of adequate health care for all in Nevada, for example, is a blight on all of us. Just as Social Security does not leave it up to the states whether to pay SS benefits and how big those benefits are, a SP plan cannot be left up to the states either. National problems require national solutions.
Hoppy in Sacramento
April 16, 2007 12:10 PM | Reply | Permalink
Pharma would try to block SP reform or any reform that has a larger governmental role in hc b/c SP logically leads to bulk purchasing and price negiotiations. That's why.
Look at what big Pharma did to MCare Part D as it was being created (Pelosi, minority leader at the time sent out a memo detailing how Pharma gave RE_WRITTEN language specifically disallowing any gov't role in directly purchasing drugs).
And look how big Pharma's pulling out all stops to kill the current Dem-led efforts to have the gov't negotiate directly and purchase drugs for MCare recipients!! see www.DefendHealth.org for info on this.
More paying customers yes, but at significantly lower prices.
April 16, 2007 1:24 PM | Reply | Permalink
But should a Minneapolis resident be required to send one-half of his premium to Miami where it "costs" three times as much as it does in Minneapolis to achieve the same results? A "national solution" becomes an enabler of bad policy.
April 16, 2007 1:38 PM | Reply | Permalink
I agree that local and regional biases are a concern. This might be where certain medical procedures or perks can differ. It can define how broad each State accepts it's role in protecting the health of it's citizen. As a silly example, maybe in Massachusetts it is accepted that botox injections are imperative to our health - yet in Nevada, it is not. There the basic coverage would differ. I am sure there is a general consensus on what is necessary to ensure a healthy stable populace.
My suggestion to those whose representatives do not accept UHC as a public need is to get out and vote. Quantitative health care is finally having its day in the Sun. Leaders who systematically block it will not be there very long. Voting them out should be the local response. The Federal response should be as a strong arm tactic. Since it is a National concern that all have coverage, if one State doesn't move to this outcome, they don't get the benefit of Federal subsidies. Can you imagine how quickly those in Carson City would see the light if they were told, get your priorities straight or you loose Federal funding for McCarren Airport, or Medicaid subsidies.
I agree that the Federal Government should be a positive force, but one that establishes the minimal norm of Universal Coverage. If these basic concerns are not covered, they get no funding. Sometimes the economy of scale acts as a detriment to action, that is the stereotypical complaint about bureaucracies. I will use SS as an example too, showing that an ocean liner takes a long time to turn around. It has been an accepted reality that when I retire in about 30 years, I will receive 25% less than those now (and that is with the blind assumption of no change in our economic and financial environment). We have known since the 1950's that the pay-as-you-go system is burning itself out, just because of population trends. And what, since the 50's, have been to address this?
I am assuming your use of "SP" is Single Payer. Although I did not espouse any opinion on a Single Payer Program, I will say that it is one of those dividing details that is getting in the way of progress. Truly, I don't care what they call the plan or how it is managed as long as a basic level of care is afforded and doesn't exclude people or create a market and industry which is convoluted and doomed from the start. It is my belief that the end product will be a blend of differing wisdoms in it's implementation. I remember the frustration surrounding HillaryCare with all those, "but what about this, and what about this..." I am trying to point out that we will be running around in circles if this is the direction of debate. And in another 10 years we will be in disbelief why nothing could be done in '96 or '07.
The genius of the Bill of Rights is it's simplicity. Keep it Simple, Stupid. Our Federal leaders and it's environment might be able to produce a similar document. These documents espouse Big Ideas, Concepts, and Ideals. Politicians are good with that. Leave the rest to the professionals.
April 16, 2007 5:39 PM | Reply | Permalink
AARP which pretends to be a lobbying organization but is in reality an insurance company (look up their charter) has just announced that they are expanding further in to health care insurance.
They are betting millions that nothing substantive will happen after 2008, I think they are being realistic. With the exception of Prohibition the US has never banned a profitable line of business. Tobacco companies are still selling cigarettes 50 years after the Surgeon General's report.
I see no way that insurance companies will be taken out of the loop.
--- Policies not Politics
Daily Landscape
April 17, 2007 7:33 AM | Reply | Permalink
my question was not about single payor, it wasd about universal coverage. The two are not synonymous.
April 17, 2007 9:32 AM | Reply | Permalink
I know they're not synonomous,which is why I wrote:
"SP or any reform that has a larger governmental role in hc"
There is no way that we'll get anywhere close to quality universal coverage without a larger gov't role. That's why I predict the current and future wrath of big Pharma lauched to destroy our efforts for universal healthcare reform.
They, along with the insurance industry, will not spare a penny (which they've got quite a few of) to crush our grassroots efforts. This is exactly what's been happening anytime anywhere serious reform picks up any traction...