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The Republicans and Blue Dogs are Right: Your Healthcare Insurance Policy IS Going to Change.
A recent New York Times/CBS poll shows Americans support for healthcare reform is being eroded by fears that the proposed changes will limit their ability to choose doctors and treatment.
Things are beginning to happen in the healthcare reform that's working its way through congress like a peccary through a python. It's hard to tell just what shape the legislation will be in when it emerges for vote on the floor of the House or Senate, but we can be assured that our voices will be in strong competition with special interests trying to protect their own financial interests. There's a lot of money to be made, or lost, depending on your perspective. The forces of the status quo are arrayed against us as consumers of medical goods and services. We've all ready seen how the healthcare and insurance industry have donated over $133M in the second quarter alone of this year to our elected representatives. One physician owned hospital, made famous in Gawande's New Yorker article for its' disproportionately high costs, has contributed over $500K to the Democratic Senatorial Campaign Committee, and over $800K to the House's counterpart, the Democratic Congressional Campaign Committee, according to disclosure reports. That's one hospital contributing over $1.3M to just the Democrats in an effort to influence the shape of whatever bill emerges from congress. By the way, while these types of donations are made to no specific Senator, those managing these funds usually keep an unofficial tally of individual senators and congressmen, who raised these monies. These senators and congressmen usually get a say in how and to whom in the party that money is dispensed, much as the lord of the manor might, for colleagues in need. Politics is power after all, and nothing displays power quite like a campaign war chest brimming over with treasure.
It's almost funny that a senator who represents less than 0.33% of the people in this country is going to control the form of the bill that emerges from the Senate. He's not alone either. The "Gang of Six" senators who seem to be most opposed to a strong public option in their spirit of 'bipartisanship', collectively represent only about 2.74% of our population. The economic forces of the status quo are aligned against meaningful reform, and the senators from poor, rural states look like the most likely to deliver the most bang for the buck to those corporations wanting to keep things just the way they are.
Keep in mind that the size of America's healthcare sector is as large as Britain's entire economy. That's an enormous economy in and of itself, and its no wonder those invested in it are scrambling to protect their financial interests. Money will be lost regardless of how the legislation is shaped. The only question is whether it will be lost by those with economic interests in the status quo of the healthcare sector, or by the rest of us who are held hostage to high healthcare costs. Americans now spend about a 20% of the average wage earner's income on health insurance. The average cost of medical insurance for a family of four now exceeds the yearly income of a minimum wage worker. Our healthcare insurance costs have doubled in the past decade, and if congress is unable to pass legislation that will help slow or reverse that trend, our Medicare costs will bankrupt the nation, and our personal insurance costs will bankrupt each and every one of us who is not well above average with regard to our incomes. What all this means is that none of our current insurance policies are going to look the same ten years from now regardless of whether meaningful legislation is passed or not. Employers will not be able to afford to provide the same level of benefits in the future if costs continue to escalate as predicted, and insurance companies will be forced to restrict access in order to accommodate the financial reality of business and private party alike.
So when you hear the fear mongers decrying attempts to reform our healthcare system, as they try to scare those of us who have an insurance program that we're satisfied with into believing our policy will be inexorably altered by healthcare reform that includes a strong public option, know that they are right. Know also that your policy will change, and for the worse, if nothing is done to curb our spiraling healthcare costs. So make your choice wisely, and when weighing the arguments put forth by the Republicans and Blue Dogs, always follow the money. It's generally leaving a trail of campaign contributions to their doors. Our decision boils down to whether we want our healthcare insurance changed for the worse by the greed and inefficiencies of our current 'system' as we price ourselves out of affordable coverage over the next ten years, or will we attempt to change that system for the better by controlling costs via a meaningful healthcare reform act of congress which includes a strong public option? Call your senators and congressmen and demand they support a viable public option that's allowed to pay Medicare rates, and that's allowed to negotiate lower prices for drugs and services, (unlike the Republicans' Medicare reform Act of 2003, which effectively raised Medicare drug costs by disallowing such sensible negotiations as well as locking in subsidies for the insurance industry). On top of all this is the reality that reducing our per capita healthcare costs depends on our coverage of all our citizens in whatever plan emerges from congress. Contrary to the diatribes against universal coverage by pundits who maintain healthcare to be a privilege as opposed to a right, insuring all Americans is a necessary part of a program that will effectively reduce our healthcare costs.
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Wonderfully written post. Rec!
July 30, 2009 3:20 PM | Reply | Permalink
seconded!
July 30, 2009 4:50 PM | Reply | Permalink
Two promising things I've heard today.
One, there is talk of removing Max Baucus and Finance Committee Chairman.
Two, Nancy Pelosi said 'We may have to start over' and 'the health insurance companies are the villians here'.
July 30, 2009 3:37 PM | Reply | Permalink
I saw that about Baucus possibly losing the chairmanship. I would count that an major victory for anyone interested in meaningful healthcare reform.
July 30, 2009 4:38 PM | Reply | Permalink
After what I read yesterday about Baucus, I concluded single payer was a dead issue and the repuglicans won the debate even though they are the minority. I still believe that today. The only thing that will change my mind would be if Pelosi tossed the current legislation into the garbage (were it belongs) and started all over again, but this time locking the repuglicans out of the process.
July 31, 2009 1:46 AM | Reply | Permalink
Which is precisely how they should have done it from day one!
July 31, 2009 3:50 AM | Reply | Permalink
Sharp post miguelito, but the same arguments were used to sell the stimulus package (Hurry or else! If you don't pass it, the economy is going to get worse!). If this is not "fear mongering" than what is?
July 30, 2009 4:21 PM | Reply | Permalink
Although I didn't address any timetable regarding the passage of legislation, the way such a delay usually plays out is that the organizations with access to large chunks of cash, and the ability to mobilize that cash into advertisements promoting their agenda benefit from the delay. Those organizations are for the most part the insurance, pharmaceutical, and healthcare corporations that have the most to lose from reforming our current system. Delays in passing legislation that impacts the future of the country and the healthcare industry would be a moot point in a rational and informed world that didn't depend on soundbites to shape public opinion.
July 30, 2009 4:33 PM | Reply | Permalink
So, it would make sense to take more time, no?
Deep pockets can mobilize resistance much faster than grassroots movements can go. They go on dumping good money after bad in a hare-brained scheme to win the race, while the tortoise of public interest comes charging up from behind to win.
While I agree that normally delay would be a good tactic to kill this legislation in the womb, I believe it will have the opposite effect. The more time there is, the more time people will have to debunk the lies and make their wishes known to Congress. More time means more people paying attention, which is the sort of light that the medical industry (insurance and providers and pharma) desperately wants to keep pointed away from themselves.
This far into the fight last time and the numbers were dismal. I suspect that the longer the average American is focused on this, the better the outcomes will be.
July 30, 2009 4:58 PM | Reply | Permalink
I'd like to think you are correct, but I'm not convinced that most of the population devotes as much time to thinking about this as we tend to here. Those sound bites keep replaying in a large portion of the electorate's medulla oblongata, telling them, reassuring them that no change is sexy.
July 30, 2009 5:09 PM | Reply | Permalink
Well, right now it seems grassroots has the advertising advantage. The industry special interests seem to be focusing their spending on unabashed bribery for the moment.
July 30, 2009 5:54 PM | Reply | Permalink
That's almost a 2-to-1 spending advantage on reform. That's encouraging.
But I think the momentum is geared to reform. Now it's about shaping it. Lots of opinions out there....
July 31, 2009 1:04 PM | Reply | Permalink
Yeah. I've been thinking the legislators might be in for a rude awakening if they head home for recess without giving the people what they are demanding. Right now they are safe in Washington. Wait until they go back to where the people actually live. I'd rather the progressives prevent the blue dogs from pushing out any old crap just to meet a deadline, and give them a few weeks face-to-face with us having to explain their actions.
July 30, 2009 5:48 PM | Reply | Permalink
You guys are almost too sunny for me. :) Here's hoping you're right.
July 30, 2009 6:24 PM | Reply | Permalink
My thoughts exactly. Time simply means the public gets sick of hearing the spin and starts to pay attention to other inputs, like the people in their lives with tragic stories. The longer the embers have to burn, the more fierce the fire when it finally rages.
July 30, 2009 6:25 PM | Reply | Permalink
But Baucus sent his flunkies to Montana a few months ago and they got an earful about the public view single payer was the primary reason for remodeling the health care system. If he isn't listening to his constituents that voted for him, then what options does the public have to make their point heard? Voting him out in 2 to 4 years doesn't carry enough weight - that's way into the future and maybe people will forget about this (Ensign Approach).
July 31, 2009 1:53 AM | Reply | Permalink
Maybe Baucus just doesn't agree. Not all objections are obstruction.
I don't think single payer is the primary reason for reforming the system, but am convinced the system must be reformed. I think single payer is one solution to address the problems that exist but not the only one and certainly not one that is most sustainable in its current form and with our current trends. In fact, unless we address the public health issue of our steadily widening asses, I don't think any reforms will work in the long run. Too much sickness on the fat horizon.
The reasons democrats keep losing these types of fights is their inability to set the conditions for success.
One must have an ultimate goal when entering negotiations as well as an acceptable goal. While single payer may represent the former, no one in the single payer camp has taken the time offer the latter. Without a BATNA to give them a place to end up, they automatically palace all the eggs in the single payer basket. Anything less than that result then becomes failure when there are a number of alternatives that would actually address some of the problems that make contemplating a single payer system necessary.
All or nothing stances in America usually lead to nothing rather than all.
July 31, 2009 8:28 AM | Reply | Permalink
You might enjoy reviewing this July 29, 2009 New England Journal of Medicine article entitled "American Values - A Smoke Screen in the Debate on Health Care Reform". The single payer batna would have been something like a strong public option allowed to pay medicare rates and negotiate lower drug prices, but since our pols discounted a single payer system, (advocated by the majority of health economists, doctors, and nurses), from the start, we find ourselves struggling to achieve that. It's not easy to affix motives for the pols exclusion of single payer as a consideration, but a simple look at the campaign donations from the insurance and healthcare industries gives us a clue.
July 31, 2009 10:16 AM | Reply | Permalink
The link: http://healthcarereform.nejm.org/?p=1245
July 31, 2009 10:17 AM | Reply | Permalink
Again, I see it totally differently, but that is hardly surprising. I see the lack of a single payer system, meaning the entire paradigm changes overnight, as simple common sense. I truly don't believe it can work within the context of our current system and is an extreme solution when something more measured could work just as well.
Further, I see countries like Germany and Switzerland who have achieved outcomes as favorable as those seen in Canada's system, but did so in a way that is closer to what is currently being discussed in Congress than what that article suggests as being the only real way to reform the system.
Again, I don't disagree that if something could installed by fiat and the 75% of the country that doesn't agree that single payer is a panacea, though that the system needs to be reformed to provide much better outcomes could have their mind's magically changed that such a solution would be a Utopian dream.
We just don't live in that country and that isn't the situation we face. I hate repeating it, but it bears repeating: Not every objection is equal to obstruction. I want to fix the health care system as much as single payer advocates - I simply think there are much better options available to us than a wholesale reengineering of the health insurance system.
If single payer comes to America, it will be due to the fact that earlier measure to save the system we have from its own excesses failed to produce the results we need.
July 31, 2009 10:36 AM | Reply | Permalink
It will be 'interesting' to see what, if any, market efficiencies can be improved, using whatever our illustrious political class cooks up. As you say, if the approach fails to produce results, we will revisit the issue, a repeat process which I expect will be as long, painful, and as expensive as if we had just adopted a single payer system, as most health economists endorse, in the first place.
July 31, 2009 12:17 PM | Reply | Permalink
I agree. But America normally doesn't jump into the pool without first touching it with the big toe, then going down a step, and then getting into the shallow end, and then wading around a bit, finally getting its hair wet, and THEN it finally starts to swim.
What's this, the going down a step phase?
Problem is that you are right. Prolonging is excruciating compared with just jumping in.
July 31, 2009 1:10 PM | Reply | Permalink
I am not convinced that smart reforms won't work as I have come to understand the packages making their way making its way through various committees.
I was simply admitting the possibility that if these initial reforms don't work, then a full single payer system is likely to be the next step or at least factor much bigger in the discussions as this legislation is updated in coming years.
I expect to see us try the simplest, most inexpensive solution first with the hopes that the more drastic (and more expensive and more divisive) single payer idea is no longer necessary.
July 31, 2009 3:05 PM | Reply | Permalink
July 31, 2009 3:34 PM | Reply | Permalink
Based on the current trends in Medicare and how that system currently operates with regards to rates and payment.
If you were to try and simply kill the existing system and transfer all $320 million of us to Medicare without fixing all the other problems as well such as medical delivery costs and our killer diets, we could never afford such a system in a million years. The simple fact of the matter is that there is a reason why only Canada and Taiwan are the only two countries in the world that use a strictly single payer system.
This isn't a One-Size-Fits-All solution set we are talking about here.
July 31, 2009 3:44 PM | Reply | Permalink
Got a link? Why do I keep thinking of this NEJM article when I hear your platitudes about this not being a "one size fits all solution"?
August 1, 2009 1:23 PM | Reply | Permalink
I have kinds of links.
August 1, 2009 1:48 PM | Reply | Permalink
I think the republican talking point about Single Payer being more expensive because more people will actually have health care. They fear the competition will be all the riff-raff having appointments who currently don't visit doctors.
That smoke-screen about Medicare costs needing to be curtailed is just more BS. The utter waste in the profit-driven health insurance industry is fine with them.
August 2, 2009 11:47 AM | Reply | Permalink
Again, you are responding to the hype and not the actual numbers as reported by HHS itself. This is not a partisan set of data and continuing to try and make it fit into that context is a losing message for liberals.
August 2, 2009 12:15 PM | Reply | Permalink
Miguelitoh2o, thanks for the informative post.
One of the paragraphs in my letters to senators/rep. included this:
The roller coaster we're on is reminiscent of this time last year. My confidence has returned and I really believe if we keep at it, our interests will prevail.
I followed Rep. Blumenauer's example today and revised and reformatted my debunking of the viral email that's going around. Here's a link to his piece in HuffPo in which he cites examples of House Republicans quoting verbatim from the email -- or just making stuff up.
http://www.huffingtonpost.com/rep-earl-blumenauer/unhinged_b_246632.html
There's a link embedded in his post that takes you to a Myth vs. Fact sheet concerning a provision in the HC bill he authored that's been egregiously distorted.
I hope everyone is debunking at every opportunity. Nancy Pelosi was just on Lehrer. Her advice to Democrats in the House for the recess was to "sell, sell, sell." We have to do the same.
July 30, 2009 7:30 PM | Reply | Permalink
Right on ohno! The internet is one of the things that's different this time from the early 90s. We may just have a chance of countering the spin if we keep at it.
July 30, 2009 7:37 PM | Reply | Permalink
Regarding a few comments made above, everything I've read from Pelosi indicates she has every intention of pushing the current healthcare reform legislation in its most robust form, and no intention to scrap it. Also, there is no possibility that Baucus will be removed as Finance Committee Chairman, although undoubtedly some might wish to see that happen.
Miguelito's main points are important. During the August recess, it will be not only the moneyed interests, however, but individual citizens who will have chance to express themselves at "town hall" meetings and other forums organized by legislators to test public opinion. I've already attended one of these (unfortunately in a solidly conservative Republican district), and I discovered that they can convey powerful sentiments to the legislators. Everyone in a position to participate should consider doing so, but be prepared to come with facts rather than merely opinions. These forums are dominated by expressions of undocumented opinion, and when someone actually offers factual information, it stands out very powerfully.
July 30, 2009 4:49 PM | Reply | Permalink
"Things are beginning to happen in the healthcare reform that's working its way through congress like a peccary through a python."
That's a winner! DickDay, where are you?
Good post!
July 30, 2009 5:02 PM | Reply | Permalink
LOL, I saw my first peccary last weekend in Tucson (they are called javelinas there). On a mini-vacation, sitting on the patio eating fajitas with guac, and there was suddenly a lot of snorting over the short wall. We looked over and there were two javelinas nosing around (probably wanted the guac--yum).
The javelinas were about 2 feet tall, however, which begs my question: A python can really eat these guys? Wow.
July 31, 2009 12:59 PM | Reply | Permalink
Search youTube for "Large Snake Swallows a Pig" if you really want to see. If you're really up for losing your lunch search for "Komodo Swallows Pig". Why am I torturing myself like this? ;)
July 31, 2009 1:43 PM | Reply | Permalink
That was a disconcerting video to say the least. ew....
July 31, 2009 3:08 PM | Reply | Permalink
I used to live in Tucson, and on occasion a whole pack of javalinas would march through my apartment complex. The landscaping is gravel, of course, and we slept with our windows open most of the year (since Tucson is basically paradise -- shh, don't tell anyone). So all the snorting and stomping in the gravel would wake me up, and I'd watch the little guys milling around for a while. Typically there would be 10 or 15 of them together.
Never saw a python, however. (Saw a few rattlesnakes there, though!)
-- ARG
July 31, 2009 4:33 PM | Reply | Permalink
Excellent post, Miguelito; wish people who believe the insurance companies' tripe would read it (including Congress!)
July 30, 2009 5:22 PM | Reply | Permalink
July 30, 2009 5:42 PM | Reply | Permalink
Miguel - I think you've cut to the chase.
I was initially incensed when I received the email requesting that I contribute money to an Obama push for health care reform.
But it's true that the opposition is busy saturating the MSM with carefully-calculated spin, funded by the profit-rich insurance industry.
So I must reconsider. Can Obama use tax dollars to refute false claims? No. So how can he fund refutations in a time frame that matters? Perhaps by using the donation network that elected him.
I would feel better about this appeal if he acknowledged that, or even if Gibbs alluded to it. But how can I know what limitations beset the administration?
So my choice is to support reform as an idealist or as a cynical pragmatist. I don't like that choice.
But what is, is.
July 30, 2009 7:17 PM | Reply | Permalink
I would donate to groups such as Healthcare-now.org, or democracyforamerica.com rather than the president's group. These organizations are truly advocating for meaningful change. I'm not sure what Obama is willing to settle for at this point, but he has a political agenda as well as a reform agenda which might translate to his being willing to accept a less powerful public option, that would not do anything to affect healthcare costs, while requiring all Americans to subscribe to an insurance plan. That, I believe, would be a wet dream for the insurance companies, and a nightmare for the rest of us.
July 30, 2009 7:29 PM | Reply | Permalink
I didn't send money. When Obama says, "I will not sign a bill without a public option," I'll send something. If, in the end, he's going to settle for some plan that doesn't provide some challenge to insurances companies, I'll be saving my money for healthcare costs through the next decades. This is it. Right here and now. A public option has the chance to chip away just a bit at the profit structure. Once changed, and people understand that the insurance companies are not completely in control, I really think there's an opening for continued measures. If the insurance companies beat Obama and the Democrats now, it's game, set and match. All they have to do is defeat the public option. Then they win.
July 31, 2009 11:04 AM | Reply | Permalink
I just get bluer lately. But we shall see what the bills look like in September, I guess.
July 30, 2009 7:39 PM | Reply | Permalink
Dick, I can't describe how the 'debate' on healthcare affects me. Blue doesn't do it justice.
July 31, 2009 2:30 AM | Reply | Permalink
rant: I’m getting redder, that is angrier, but bluer too (purple, maybe?). It’s hard to even write about this stuff sometimes. I’ve been swallowed by the dreadful HC whale these past few months. People I love are suffering terribly and will continue suffering because of the system (just as I have with “good” insurance).
I wonder where, along the path to state or national office, good people lose their humanity (or rationalize it away)? When do they acquire the blinders it must take to enact or fail to enact programs that will certainly reduce suffering (including poverty and homelessness, unlivable wages, physically and mentally mutilating our children in useless wars, creating criminals out of wayward kids predisposed to drugs or with poor impulse control when we know the risk factors responsible, etc. etc., etc.) They rationalize politics as compromise, or jobs ("earning a living") as Holy Capitalism, feeding the fat beast instead of speaking truth to power?
We're losing a half million jobs every month. Next month, let's take those half million jobs from the insurance industry (Wall St. in Sept.). Real health care, that is saving lives or alleviation of unnecessary suffering, should not be on the auction block or taxed by pirates and highway robbers. Hell, they regulate what tow truck cos. can charge because people are at they’re mercy.
But pirates do not raid fleets. Predators separate out the young or wounded or slow. It’s divide and conquer as always. We are a society; a union. What does a union, of, by and for the peole even mean if we’re going to forbid people from acting as a collective in order to enrich the pirates? Why do people buy that as American democracy? /rant
July 30, 2009 10:58 PM | Reply | Permalink
Don, you're always welcome to rant on my blogs. You always bring something to the table, so be my guest. The part I keep trying to drive home, is that the only fiscally conservative thing to do with healthcare is squash it. It's a monster that destroys our hearth and home, and yet the Rs, (those guys masquerading as fiscal conservatives), continue to want to feed the monster. To what end? Till we just outright crash and burn? Don't get me started on rants. We might burn this place down before it's all said and done.
July 30, 2009 11:24 PM | Reply | Permalink
:) Gotcha. Thanks, Miguel. I was typing for a while before I realized I was ranting.
Sitting in a waiting room yesterday with nothing to watch but all-Fox, all-the-time, which I rarely see, the info, commentary and opinion seemed to be the polar opposite of what they were spouting the last eight years (now America is a police state?). Isn't that odd? You'd almost think they were just whores for the "opposition" of the day. Then, on reflection, you think, well, it's only two sides of a coin, like a drug bust where the dealer and buyer both turn out to be undercover cops.
I think everyone is just trying to maintain as they used to say. Maybe it’ll take a new generation (defined by collective experiences, not time spans) that hits rock bottom and rejects the status quo. Anyway, I appreciate people, like those from TPM in DC today through a collective effort, just urging on those in a position to effect change. I also appreciate blogs like yours, which never fail to be direct, interesting and honest (and the comments whether venting, discussing, defining, exploring or all of the above).
July 31, 2009 1:25 AM | Reply | Permalink
Miguel, thank you for the 10+ post! Very informative and well done. The comparison of the healthcare sector and the economy of Britain is a keeper. Gives folks an idea of the scale of what we are dealing with.
I am sick of the fear politics. You'd think folks would catch on, but apparently the tactic to distract and herd the masses continues to be effective. Shame on us.
Universal coverage is a must on so many levels.
July 30, 2009 11:52 PM | Reply | Permalink
The big lie works. The Republicans prove it daily. They don't need to convince everyone and they know it. They only need to bamboozle enough people to kill progress for us all and they can chalk up another victory for the usefulness of being a liar with no conscience.
July 31, 2009 3:55 AM | Reply | Permalink
Nice Miguel. I particularly appreciate the 2.74% (and I think they only needed half of that). The older I get the more I seriously doubt the greatness of the great compromise. Seems to me most of our countries serious structural problems have their origin in that Faustian bargain (but hey at least my vote nominally scores above the 3/5 count). Did we mention electoral college? Oh but wait did you see that David McCollough John Adams special. Or maybe Irving's latest biography of George Washington- My god those men were gods. All hail the wisdom of the fathers.
As to another point you allude to, I fully agree that we really need Health care to downsize. It is too large and skims way to much off the top. That means insurers have to shrink and some well have to go out of business. I wish someone would step up and point out the commons sense argument that private insurers are simply bloated welfare queens pretending to offer Cadillacs.
July 31, 2009 2:00 AM | Reply | Permalink
Hiya Sal! Thanks for that little trip down memory lane to view the corpulent origins of the 'upper' house of congress. If I go much further down that road, I might end up like these fellows. As far as needing 'half of that', if you separate the electorate, (of legal age, etc.), and then deduct the number of cowboys who had too much to drink the previous evening, (of election day), and then divide by two, it's probably more like 0.3% of our population. Read the McCullough book, couldn't stomach the TV movie. Welfare queens indeed. Perfect!
July 31, 2009 2:21 AM | Reply | Permalink
Don't know if they take porcine candidates for that program. But it does seem a pretty damn apt metaphor for the current Health care mash ups they keep running up the flag pole.
On the bright side at least the Gang of Six health care reform has a healthy entertainment component. That's good preventative care.
July 31, 2009 2:51 AM | Reply | Permalink
LOL. Thanks for the link.
July 31, 2009 3:06 AM | Reply | Permalink
Peace out.
July 31, 2009 3:18 AM | Reply | Permalink
Probably not as fictional as we might imagine.
July 31, 2009 8:24 AM | Reply | Permalink
Straightforward and common sense objections are not obstruction. The "Gang of Six" are a bipartisan bunch who raised some good points just as Baucus, as head of the FINANCE committee is trying to be fiscally responsible.
The perfect health system that we can't afford is not at all perfect and needs to be balanced with fiscally sound thinking. We need to reach a compromise that delivers the same ends as the perfect one we can't afford. That is what we charge the finance committee with achieving, though even their suggestions won't be the final bill.
Without some sort of alternative plan that fixes many of the more glaring problems with the system we have before trying to create a brand-new system to replace it, the democrats will not get a health care bill passed this year. Not because of republicans, but because moderate democrats are having doubts about the fiscal responsibility of a drastic medical insurance reform that we can ill afford.
Sorry for the horrible pun.
July 31, 2009 8:49 AM | Reply | Permalink
Again, I would refer you to this recent NEJM article. Regarding cost/savings, I can also recommend this study of waste in our current system, and projected savings of $480B to $700B per year should we switch to a single payer system.
July 31, 2009 10:25 AM | Reply | Permalink
Again, I am familiar with the arguments for single payer and disagree that it is our best available solution. I dispute many of the numbers in the cited article as being overly optimistic and dismissive of the serious structural problems of Medicare as it exists today.
July 31, 2009 10:38 AM | Reply | Permalink
Jason, we've had this back and forth but one I don't think we have addressed is our differing ideas regarding fiscal responsibility.
I see our government as the only agents available that can change the rules by which we all play the game. Government is the only entity which can actually change the overall economic incentives of the system. They should be acting in our best economic interest, not getting stuck on bean counting-particularly when the beans are hypothetical future possibilities.
Our legislature should be considering not just the limited fiscal costs that taxpayers will incur for a new plan but how much our entire system costs our country as a whole. What are the economic drags created by it that are not easily quantifiable, things like how much insurance costs businesses, limits job mobility, creates new mountains of paperwork whenever you move or shift jobs. How much does it affect our manufacturers abilities to compete with other manufactures that do not have these costs (e.g. GM's health care responsibilities to retirees is an obvious one that is easily found). Finally it should also be considering the whole picture 1/6 of our economy should not be Health care. That is too much and creates further drag.
I simply do not see how a continuation of the employer-based "fee for service" system will ever be able to reign costs in or effectively cover everyone. THE ECONOMIC INCENTIVES ARE ALL WRONG . No cost saving band aid is going to fix that, it requires a paradigm shift.
These are the economic, and philosophical questions our legislatures should be addressing. They are the only ones that can. If LBJ listened to the Gang of Six we would have never had Health Care, if Roosevelt had we would have never had SS. Imagine our world without those. Paradigm shifts are not easily quantifiable, however these other costs are real and our leaders should be considering them.
That is the true responsibility of our leaders. Making the hard choices that make us a stronger better country in the long run. Not sitting around whining about saving a few billion over the next decade. That is not fiscal responsibility it is in fact the cowardly opposite.
July 31, 2009 12:40 PM | Reply | Permalink
I'm miguelitoh2o and I fully endorse this comment!
July 31, 2009 1:06 PM | Reply | Permalink
I still disagree that we are talking about Status Quo versus Single Payer. Medicare and Social Security were supported by democrats and republicans alike as was the Civil Rights Act.
We need to not replace a system that is currently unsustainable and private with one that is unsustainable and public. So many of the structural problems with health care have nothing to do with insurance and simply dumping a bunch of money into a system where many of the difficenies are still unknown seems a huge risk with very little guaranteed return.
On the other, a series of changes that have very little direct costs but could deliver the end we are looking for (regulatory reforms, non-profit insurance collectives, medical IT and the like) without totally changing the entire health insurance system into a single payer system.
The simple fact of the matter is that regardless of the enthusiasm for single payer, it is still a solution that only speaks to 25% of the country while the rest of us are looking for an alternative. Not every heart condition deserves a transplant. Sometimes a pace-maker is enough to get the job done without making the patient more vulnerable to secondary infections and conditions that inherent to their environment.
July 31, 2009 3:11 PM | Reply | Permalink
I am not saying that singlepayer is the only option.
I am saying that we need to drastically change the perverse economic incentives of the current system. That will mean a lot more then tinkering with some rules, adding regulatory commissions and some neutered regional 'co-ops' for show.
Have you even considered how the complex individual mandate is supposed to work or the ridiculus subsidies to those making 800% of poverty level. This is just dumb and more make work for accountants.
Have you looked into how much decent insurance (non castrophic coverage) costs for individuals above 30? Please look it up and tell me how that is fair for someone to pay when an employee gets it as tax deducted income. 400 to 800 a month is not chump change. That is serious dough for most of us.
These reforms are needlessly complex and put more burden on businesses without any reason. THey further extend the tie to a job (limiting our labor market mobility) and will promote 'fee for service' whereby everbody graduates from medical school and becomes a specialist because that is where the money is.
Working class folks likely won't understand most of it and won't afford it. College age kids will just keep ignoring it. But as a jobs boondoggle for private insurers it will be great!
July 31, 2009 3:45 PM | Reply | Permalink
Again, I don't really see the current plan as being all that complex.
We use regulatory structure to fix the most glaring problems with the system, including cost of coverage and all the other evils the current system has.
We use a non-profit collective to bring all the various people who are currently uninsured for whatever reason into a group-benefits plan that also lowers the cost.
We reform Medicare/Medicaid in a way that makes it sustainable and more accountable in order to force medical providers to be more equitable in the way they price their services which will also lead to lower private insurance costs.
It is a three part solution that is way cheaper than instituting a single payer system for the whole country and could likely lead to the improvement you seek without forcing the entire country to accept the idea that single payer is the way to go.
It also has the benefit of being something that most Americans can support. Buy-in is perhaps the most important part of any solution and absent that support for single payer, I think it is a loser for progressives who actually want to change the dysfunctional system we have rather than advocate for something we will never get.
July 31, 2009 3:50 PM | Reply | Permalink
Fair enough on the reforms we can agree to largely agree but somewhat disagree.
Yes, lets impale ourselves on the mantle of moderation and then settle for something crappy which is a little better then what we had before. We do this every time, negotiate with ourselves and then compromise even more. This is why democrats are considered weak on defense. Truth is we're pussies.
I say argue for true structural solutions not boondoggle band aids. We need to get louder. Not more subservient. Fight, the other side doesn't care. That's what got us the weekend (and labor laws, and ss, and ...)
Fight.
July 31, 2009 4:26 PM | Reply | Permalink
Most of the truly sustainable progressive programs came over a series of years. They initially passed as a compromise measure and then were tweaked until they met our needs. Effective grassroots politics is a game of inches and not Hail Mary passes.
July 31, 2009 4:31 PM | Reply | Permalink
Jason, sometimes I wonder about you. We certainly both cherry pick our historic narrative to fit our particular biases.
Usually it is the squeaky wheel that gets the oil. Thats how the demos works. People get mad, and then placated (because they are mad). Democracy is not a system that depends on forward thinking auricular philosopher kings that make tweaks. But that is a whole 'nother disscussion.
Again though, Nice chatting.
July 31, 2009 4:39 PM | Reply | Permalink
I firmly believe that all of our differences are a matter of semantics.
I do enjoy the chats though. You are one of the more level-headed liberals on this site, which the left will need more of to get the other half of the country to come along for the ride.
Glad I can keep you guessing though!
July 31, 2009 4:43 PM | Reply | Permalink
1965 Medicare act was passed with the House makeup being 295 Ds, 140 Rs, the senate: 68 Ds, 32 Rs.
1964 Civil rights act: House was comprised of 248 Ds and 172 Rs. Senate: 67 Ds and 33 Rs.
I'm not saying that these laws weren't passed as a bipartisan effort, but I wonder how long it would have taken to pass any of them had the Rs controlled the legislature. I wonder how long it will take to get a majority in congress willing to pass meaningful healthcare legislation?
July 31, 2009 3:54 PM | Reply | Permalink
The reasons they passed, independent of the actual make-up of Congress, was because the American people supported the efforts on the left and right.
That is the disconnect for democrats on this particular effort. They haven't inspired grassroots moderates in both parties to be advocates for the changes they are proposing. It is all about positioning and semantics, which liberals SUCK at these days.
FDR and LBG? Brilliant politicians which the democrats simply don't have these days. Any more than the republicans have Teddy and Abe stand-ins to make their shit more effective and palatable to most Americans on both ends of the political spectrum.
It is about using the same methods, again, to reach drastically different ends and then wondering why the effort has been ineffective despite the common sense nature of the proffered solutions.
July 31, 2009 3:58 PM | Reply | Permalink
No Jason the reason the passed is because one party so dominated that they were able to overcome the structural impediments to changed embodied by our quirky bicameral system (see 2.74%).
To that extent you are right they were broadly supported, bipartisanship or middle of the road moderation had absolutely nothing to do with any of them.
July 31, 2009 4:18 PM | Reply | Permalink
I am talking about the acceptance of the programs at the grassroots. That is why they were successful legislative efforts. We The People wanted it, so both parties made sure it happened.
Obama missed the same opportunities that FDR and LBJ took advantage of in order to position this reform as something the American people could support, regardless of party. He left it up the democratic caucus, with the fairly predicable results that followed.
I am talking about methodology and not necessarily the specific legislation at hand. Today's progressives, as seen over the last 40 years or so, have been very ineffective at implementing their goals. Liberals have to go fairly far back in the historical record to find substantive successes, which leads me to believe they are indeed failing for reasons other than the specific programs they advocate.
I could sell progressive changes in how America do business to conservatives and republicans alike at the grassroots. Why? I am more concerned with outcomes than with the specific policies that lead to those goals.
July 31, 2009 4:25 PM | Reply | Permalink
Great post. Thanks.
July 31, 2009 11:05 AM | Reply | Permalink
I am reasonably hopeful we will end up with adequate healthcare reform legislation, which, while far from ideal, will greatly extend coverage to those currently uninsured or underinsured, and will help lower income families afford the premiums.
I base this on the negotiations in both House and Senate. These appear to portend a package with a public option - in name in the House bills and de fact in the Senate in the form of broad non-profit cooperatives, although I haven't completely given up hope that a final Senate version will impose important federal management oversight on whatever form of public component emerges.
A major remaining problem is the balance between costs and subsidies, with the latter likely to be less than adequate without making the former too great. What is missing from the Congressional debates, and much of the public debates, is recognition that excessive cost is not merely a problem of excessive insurance industry or drug industry income, but probably even more a problem of far too costly a healthcare system. In this regard, the Blue Dogs have a legitimate concern - if a public plan paid Medicare rates to rural providers, many rural resources, including hospitals, might become financially insolvent. This means that punishing the insurance industry isn't going to solve the problem.
In essence, we desperately need insurance reform, but we also need to reform what it is that insurance pays for - a disorganized array of duplicate and/or unnecessary facilities, services, and treatments, based on a fee for service payment paradigm that incentivizes excess.
Until health care itself is reformed, insurance reform will only go part way to bringing us where we need to be.
July 31, 2009 11:54 AM | Reply | Permalink
That was right said, Fred.
July 31, 2009 12:03 PM | Reply | Permalink
I mostly see this bill if it passes as just a start in bringing our healthcare costs under control while extending coverage to all Americans. I will wait to see what the legislature delivers before I can agree with your optimism on that. I largely agree with all your other points Fred. I believe Medicare rates would be adjusted to accommodate local variations in costs. The main point of hanging the public option on paying those rates, is to short circuit the current paradigm of insurers/end users paying essentially what is billed with minor adjustments and no honest market correction for cost. The polyglot nature of our insurance industry does not lend itself to efficiency in the billing/payment end of the system. I hope that a strong public option can help set a standard in that arena as well.
July 31, 2009 12:11 PM | Reply | Permalink
And not just health care systematic reform as you suggest, but there's also other issues like the food we eat (e.g. Jason's recent corn blog), drug abuse ( about 1% of our population are full-fledged addicts), our car-dependent-for-every-task transportation/city planning system, and a myriad of other lifestyle/health-related issues that are detrimental to healthcare reform cost and effectiveness.
My hope is that this is just the first stone tossed into the lake and that ripples from this reform can ricochet and aid other aspects of American life that need improving.
July 31, 2009 1:25 PM | Reply | Permalink
Great point and not just because you referenced my blog. :O)
July 31, 2009 4:52 PM | Reply | Permalink
heh, in retrospect I should have linked to it too.
July 31, 2009 5:24 PM | Reply | Permalink
Well done, amigo! Hang in there. Change has got to come - or our society is headed off a cliff!
July 31, 2009 12:31 PM | Reply | Permalink
Thanks Thera. I do get tired of our spinning in circles with feet of lead and wings of tin on healthcare reform. I'm sure that eventually we'll get it right, or at least better. We can't afford not to.
July 31, 2009 1:04 PM | Reply | Permalink
Excellitoh!
The circle of care we need is not equal to its current hearts.
Let's hope we don't all go down the drain with them.
July 31, 2009 4:03 PM | Reply | Permalink
Miguel, Great post and links. And what a threadmaster!! Been coming back to watch the new sprouts, and have been learning alot. Thanks!
My modest addition, on health-care linked bankruptcies:
"Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illnesses, including 60.3% who had private coverage, not Medicare or Medicaid.
Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings."
- From businessweek.
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/whats-most-likely-to-bankrupt-you.aspx
July 31, 2009 4:19 PM | Reply | Permalink
That's really the sad indictment of our medical insurance system. Even those carrying insurance aren't protected from bankruptcies when things turn sour in a big way regarding one's personal health. I've thought for some time that most medical coverage amounts to little more than catastrophic coverage in terms of what it and our healthcare system provides. Example as I wrote in a past blog was the cost of my prescription drugs in Mexico as compared to here in the US with my prescription plan. In the end the co-pays amounted to about $45 less than what I spent without a plan in Mexico. So, you add your premiums, deductibles, etc. and you end up basically self-insuring yourself for the little stuff. If something bad happens to you medically, you can easily run up against limits in coverage, at which point you have to make the choice to get sicker or go bankrupt. On that subject, we all end up absorbing those bankruptcy losses anyway, although they are spread unevenly and dispersed through the creditors of the bankruptcy to their other clients, and also more evenly through tax deductions on the part of the same creditors in the form of uncollected amounts due. Thanks for checking in Pugsley!
July 31, 2009 5:03 PM | Reply | Permalink
The problem with the many people 'happy' with their health insurance is that they probably don't know how bad it is. They have little knowledge of coverage limits, of the 50% likelyhood of recission - where payment is denied because of a typo on your application signed years ago. That the system is set up so that the MAIN reason for bankruptcy is health issues, the system clearly needs changing. Even if one is an inhuman heartless bastard only interested in GDP growth, independently of the quality of life of the people growing it. Must stop before this starts veering into rant territory...
July 31, 2009 5:21 PM | Reply | Permalink
Well, now that we're getting link-happy, here's one on that rescission statistic.
http://blogs.reuters.com/felix-salmon/2009/07/30/conditional-probabilities-and-evil-insurers/
July 31, 2009 5:25 PM | Reply | Permalink
lol :) http://www.youtube.com/watch?v=2U-rBZREQMw
July 31, 2009 5:30 PM | Reply | Permalink
WHA?! You wanna link-hollitakker, earthling?
http://www.youtube.com/watch?v=RUpkOWSZaOE
July 31, 2009 5:46 PM | Reply | Permalink
Harumph!
July 31, 2009 6:32 PM | Reply | Permalink
Matt Yglesias has an interesting blog on morality in the marketplace:
http://yglesias.thinkprogress.org/archives/2009/04/ideas_matter.php
July 31, 2009 5:28 PM | Reply | Permalink
Excellent point Obey. Yet another massive drag on the economy created by our silly broken system.
I am curious does the CBO account for those savings in their cost guestimates?
July 31, 2009 5:04 PM | Reply | Permalink
The CBO are a bit of a mess on this. They are way off. And miss these kind of feed-back loops through the economy. See this (scan down to the stuff from Westmoreland)
http://balkin.blogspot.com/2009/07/politicized-prognostication-at-cbo.html
July 31, 2009 5:10 PM | Reply | Permalink
And this by Bruce Vladek, former head of US Health Care Financing Admin (Medicare/Medicaid).
http://www.rollcall.com/news/37284-1.html
and this...
http://www.whitehouse.gov/omb/blog/09/07/25/CBOandIMAC/
July 31, 2009 5:14 PM | Reply | Permalink
Thanks for the link. That's quite an impressive history they have compiled- reminds me of W's costs of the Iraq war (you know pay for itself through Iraqi oil- now in the trillions; priorities).
Budget guys are good to the first connection and then they just get lost. That's why I keep hammering our good-natured Moderates around here why getting the economic structure right is much more important than saving a few pennies on arbitrary CBO guesses of the future...
July 31, 2009 5:23 PM | Reply | Permalink
A link to what? That question makes no sense. Platitudes? The only platitude I have heard offered is the Single Payer Will Solve All Our Problems. Got a link to the objective evidence that supports that ideology?
Condescension (especially with regards to speaking with republicans who support most of the end goals you would see happen) isn't helpful to effective communication nor is likely to lead to broadly supported reforms that might have a chance of getting through Congress, much less a plan that will be a success.
August 1, 2009 1:47 PM | Reply | Permalink
I was asking for a link to your assertion that "current trends in Medicare and how that system currently operates with regards to rates and payment", and how that relates to single payer being more expensive, than the multipayer modifications you advocate.
Here's a link indicating savings of from $480B to $700B per year with a system such as single payer: http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp
Sorry if I condescended Jason. I do think you add something to our discussion on this issue, however I would appreciate platitudes such as "single payer is more expensive" being backed up by something other than hot air.
August 1, 2009 2:48 PM | Reply | Permalink
I have never denied that single payer health care would be less expensive in theory. Medicare isn't a single payer system and couldn't be scaled to become one for 320 million Americans without drastic reform. It isn't sustainable in its current form, so I am not sure why single payer advocates think we should give it to everyone.
That is all I have maintained. I have also added the fact that single payer is unlikely to get through Congress and perhaps unnecessary in order to address what is truly wrong with the system. I believe we can get to the same GDP price point and performance of a single payer system through reform of the system we have.
One fact the the 25% who support a pure single payer system refuse to acknowledge is that the other 75% of the country remains unconvinced the US government could actually run such a plan as they have enormous difficulty running many things as it is. Just look at the defense budget and all the fraud, waste and abuse. Look at Medicare's operating procedures for similar issues.
Now give HHS control over the budget for 320 million Americans. Not going to happen.
However, I think many on the left and right would support the idea of turning all of the various government health systems and plans into the "public option" under Medicare while reforming private insurance in a way that manages costs and keeps them from profiting off of their client's deaths.
I simply advocate evolution over revolution when it comes to these sorts of discussions. As I have said before, all or nothing arguments typically lead to nothing in this country.
August 1, 2009 3:09 PM | Reply | Permalink
That's all very interesting, but who brought up Medicare as a model for single payer in this thread of conversation? You did. Beetlejuice mentioned the subject of single payer which set your hackles up on a blog that was written in support of a strong public option. We can continue to debate whatever we want, it just strikes me that you have an agenda with your outright rejection of single payer and your 'evolution vs revolution' arguments. We will have to continue to agree to disagree on single payer. When you obfuscate my argument in this blog as to changes in health care coverage being inevitable with or without a public option, with diatribes against a single payer system, I feel compelled to debate you, but I wonder about your motives for interjecting straw men into the argument.
August 1, 2009 3:53 PM | Reply | Permalink
Please provide a single quote that could be reasonably described as a "diatribe" against single payer. Further, what is the name of the single payer bill currently being discussed? Um, Medicare-for-All. Geez, I wonder what would make me think that plan uses Medicare as the basis for its creation. You have yet to respond to anything I have actually written. You simply refer me to a study that supports your arguments independent of the actual discussion at hand. Those studies were not written in response to actual criticisms.
It seems to me that it is you with the agenda. You advocate outright government takeover of health care insurance independent of a number of criticisms of that plan that have zero to do with any alternative plan. You try to quash any suggestions outside of your preferred solutions as being subversion. Further, a "public option" is not single payer. There are many ways to get to a public option that is sustainable yet you don't really comment on any of those. You focus on my argument that Medicare is a poor model for anything, least of all a single payer system for the entire country.
Frankly, this last comment sounds more than a little paranoid and is the most likely reason for the failure of single payer legislation to take traction with the American people.
August 1, 2009 4:05 PM | Reply | Permalink
See comment below.
August 1, 2009 4:59 PM | Reply | Permalink
LOL Go back and read my blog. Then read my comments in our thread. Now illustrate your point with what I've written. You would be funny, if you weren't so serious in your rabid opposition to your favorite whipping boys, single payer and its advocates.
August 1, 2009 4:58 PM | Reply | Permalink
What about that quote is so objectionable?
Do you or do you not advocate for single payer? Single payer, as Canada or Taiwan practices it and as Medicare-for-All spells it out, is a total government takeover of health insurance. Now, provide a single quote that any reasonable person could define as "rabid opposition" to single payer.
You can't because I don't "rabidly oppose" anything, despite the continued hyperbole and derision on your part.
Now, read my comments in your own blog and see where perhaps your favorite whipping boys - republicans and any democrat who disagrees with you - are keeping you from being objective when discussing this matter.
August 1, 2009 9:03 PM | Reply | Permalink
I've heard your objections for long enough a time to consider your opposition 'rabid'. Like a passive aggressive personality, the words and packaging belie a different core from which the well crafted words originate. You should team up with lalo and write a blog explaining your solutions to the healthcare quagmire we're in instead of pooping on any blog or comment that suggests single payer as a solution. Lalo can cover the philosophical issues, and you can cover the political issues.
August 2, 2009 11:10 AM | Reply | Permalink
The only way that regulation of the insurance industry can work is to mandate coverage, mandate premiums, forbid dumping of patients for any reason except fraud, forbid excluding people with pre-existing conditions, make all policies portable, and have national standards about what is covered, what co-pays would be allowed, and mandating the ability to negotiate pharmaceutical pricing.
If that would happen, I could live with a truly regulated insurance industry --> of course, I just described a "government take-over" of health insurance, didn't I? The only thing left out is that the insurance companies would get to keep what is left over as profit, instead of re-investing it in our medical infrastructure, which is what Single-Payer would do.
Jason, is THIS what you meant by fixing the problem through regulation?
August 2, 2009 11:59 AM | Reply | Permalink
That is exactly what I mean. Government regulates all kinds of things more effectively than it does health care. Government should protect us from the abuses inherent in the current system. I suspect that in such an environment the margins would be small enough (or possibly non-existent) that the insurance industry would most likely become a robust part of the non profit sector.
As to health care infrastructure, I don't see that coming single payer anymore than I see that coming from any other insurance program. That isn't the job of a healthy health insurance system. As in Germany and Switzerland, government regulation led greater innovation by health providers and researchers rather than the insurance companies, who were left to compete on service and price since all the plans were essentially the same, as mandated by law.
As I have consistently maintained throughout numerous blogs of my own and via comments on other blogs, I am not an advocate of the status quo. Rather, I am a fan that uses the minimum of force to exert the maximum amount of change. Besides the fact that single payer is a non-starter politically, I still think it is an extreme cure for what could potentially be a minor illness, no matter how extreme the symptoms we are discussing appear to be at first or second or third glance.
I am for pursuing a smarter strategy that relies on less revolutionary tactics to achieve the same desired ends. Work smarter and not harder.
August 2, 2009 12:14 PM | Reply | Permalink
But Jason, you know as well as I do that if the things I suggest were to become law, it would be the insurance companies writing the regulations just like the energy companies did.
August 2, 2009 12:45 PM | Reply | Permalink
If we allow that to take place, then it will be the medical providers and drug companies dictating what comes out of the public plan. Wasn't Obama supposed to ensure that the same shit that happened under Bush wouldn't happen under his administration?
This sort of argument reminds me of the inverse from some republican statements about how government can't run health care but it will put private companies out of business. In this case, government can't regulate health care insurance but it can run it just fine.
Neither argument is exactly the truth but both make for easy-to-digest, if inherently illogical and inconsistent, talking points.
August 2, 2009 2:16 PM | Reply | Permalink
Well, if that "reality-based" argument gets under your skin, it is nothing compared to how I feel about the "scare everyone to death-based" arguments I hear from you, Lalo, DeMint, Baucus and all the rest. From "government-takeover" to "rationing" to "kill the grannies" to "there aren't enough doctors if we let all the riff-raff get health care," it is disingenuous at best, and a cruel hoax at worst.
Obama isn't able to wave a wand and stop the special-interest method of regulating even if he thinks he can. His desire to appease republicans and blue dogs would cripple any meaningful regulation once they all bellied up to the trough; in fact that seems to have already happened.
So look at it this way, Jason. You have probably won.
August 2, 2009 2:30 PM | Reply | Permalink
I have not used a single one of those arguments, yet you continue to paint that caricature as if it were true. This is with someone who supports all of the things you are trying to achieve with reform of the system.
I can't imagine how you try to convince people who don't even share that much in common with you.
Just because you can't seem to except that there are different views of the same sets of data, you also don't seem capable of having a discussion that examines a number of solutions as a way of finding the one that might work for our existing system.
Health care in America is on life support. The problem seems to involve the heart and lungs, but we aren't sure of the exact cause that would explain all of the symptoms we are experiencing to be sure of the first course of treatment. I doubt anyone would suggest a heart-lung transplant when a pace-maker might fix the problem.
Using scary words like Baucus and Blue Dog and Rethuglican and all the rest won't sell America on single payer as the first step.
Not only is it an extreme solution given the actual problems we are experiencing, but it appears to be unsustainable as currently written and not supported by a majority of the country, no matter how much they would love to see a robust public option for those in government service or who can't get their own private insurance for whatever reason.
I am sorry to have a different view, but I will continue to deny the aspersions you cast on all objections to the plan that you prefer as somehow being designed and implemented the kill health care reform.
August 2, 2009 2:46 PM | Reply | Permalink
OK, you DID use government take-over. Sorry I made it sound like I thought you personally used the others.
I didn't use "rethuglican." I often use "repub," and sometimes "publican," but I don't use "repukes" or other such labels. So we're even!
Anyway, as I said before, I think your side will probably win.
August 2, 2009 2:58 PM | Reply | Permalink
Not my side. Our side. This is something that republicans and democrats at the grassroots must come together to support.
My only point is that if we can't get what is widely acknowledged as "perfect" despite some significant funding questions, then we need to make sure what we do get is effective and supported by a majority of the country. Spending too much time worrying about what some dead-end idiots are calling a solution that isn't even on the table seems a waste of energy and the ultimate distraction to our common goals of a health care system that is on the road to recovery instead of remaining on life support.
They want us to debate single payer while the bill that is actually being written right now flies under the radar. The special interest always split us up in an effort to distract.
I would hope we could focus our grassroots attention on what this legislation MUST do as a collective health system - private and public - that a single payer system could do on its own with the right amount of support.
I truly believe we can transform health care as we know it over the next decade and make this bill the first step along that road, but only if we stop fighting each other first. I am not the enemy in this debate. We mostly agree but for some specifics. Hell, I think even MCB or my republican sister would support many of the ideas I have put forth and then hold their republican reps accountable.
We The People need to join together in a way we never have before in order to force Washington to finally our bidding.
August 2, 2009 3:13 PM | Reply | Permalink
So, what you really want is for people to chime in here and tell you what a brilliant writer you are and to provide insincere "Bravos!" for a job less than well done? You say you enjoy the discussion and when you fail to change my mind you accuse me of partisan hackery by offering misrepresentations of my underlying points.
Further, you say I have not written blogs of my own on the subject and that is not true. Neither is it true of Lalo. If all you want is to preach to the choir without having to defend your ideas from common sense questions, might I suggest Blogger as a blogging option? Or you could turn comments off for your TPM blogs. No moderation here, so perhaps Blogger would be a better platform. That way you could pick and choose what comments were acceptable to the audience.
Or perhaps you could have an entire conversation without accusing my of hypocrisy or solipsism or subterfuge or whatever it is you typically use as a coup de grâce for all of our debates in order belittle and demean everything I have contributed through a long and wide-ranging discussion as being some sort of conspiracy to pollute your happy home here at TPM.
It is closing arguments like this that explains why liberals cannot convince conservatives of supporting their very worthwhile ideas.
August 2, 2009 12:25 PM | Reply | Permalink
Rather than call you blunderbutt or whatever you're used to being called , I'll just sign off. Your arguments aren't compelling, and your presentation does seem like partisan hackery designed to slow down or stymie change, however you disguise it as "a smarter strategy that relies on less revolutionary tactics".
August 2, 2009 12:57 PM | Reply | Permalink
Since you have yet to respond to anything I have written, it is hard to tell exactly what it is you object to or what would be convincing or what you would suggest as being a better solution to the objections as stated rather than dismissed.
Whatever your answer may be is important because more Americans support a more gradual and common sense approach that replacing the whole insurance system with Medicare-for-All, so it isn't on me to convince anyone of anything. I would suggest the onus is on the single payer community to address the structural problems that currently exist in Medicare, explain how they will be fixed by the current legislation and then detail how that would be scaled to cover 320 million Americans.
All you do is link me to a McKinsey report on health reform as if that is the last word on the subject.
August 2, 2009 2:51 PM | Reply | Permalink
Using the term "government takeover" is a negative way to label Single-Payer. Do you say we have "government takeover" of elementary-high school education? Of Fire & Rescue services? Of law-making?
It is a deliberately scary way to describe a universal, non-profit system of health care that would have to be structured through the government, similarly to the way all of the above things are done.
Yes, Jason; by using language like that, your objections seem rabid to me as well. I haven't heard you mention killing off everyone's grannies, though; I appreciate your restraint.
August 2, 2009 11:42 AM | Reply | Permalink
None of those services start out as private first. Fire houses started as volunteer services suggested by Benjamin Franklin and schools have been mostly public for most of our history. I suspect that if medicine had always been a public service, as many of our early practitioners wanted, we would not be having this discussion today, because we would have never allowed it to fall into private hands.
Simply changing what has been mostly a private system into one that is drastically different, at least from a payment perspective, represents a huge amount of change for most American people and what amounts to a "government takeover" for many moderates of both parties. I believe a more gradual and strategic approach would have greater benefits because of user acceptance.
A system for all Americans must be accepted by most of them and right now single payer as proposed by the house as Medicare-for-All is not supported by most Americans, as much as they would support a strong nonprofit public plan for those that can't get group coverage at affordable rates via their employer or union. I have explained a couple different ways that system would work.
Perhaps it is time for a blog that maps out the A to Z of King Jason's plan.
August 2, 2009 12:40 PM | Reply | Permalink
See my comment below.
August 4, 2009 6:53 PM | Reply | Permalink
"...what has been mostly a private system into one that is drastically different, at least from a payment perspective..." ?????
My dear sweet child, you go and spend a week reading Paul Starr's Pulitzer Prize winning book, "The Social Transformation of American Medicine" and then come back here and explain to everyone why the above sentence is highly misleading if not flat out wrong.
You'll receive extra points if you can do it in fewer than 50 words.
Now go forth and educate yourself.
August 4, 2009 8:26 AM | Reply | Permalink
Condescension from a liberal? What a surprise.
Quoting a single book that is more than 20 years old tells us exactly nothing about where we find ourselves today. The system we have now is one that is mostly a private system.
Now go forth and educate yourself about why this comment is a non sequiter and mostly irrelevant to the current discussion except as a history lesson of how we got from there to here.
Bonus points if you can do it without using the words convservative or liberal.
August 4, 2009 7:20 PM | Reply | Permalink
Brilliant retort junior. Evolution not revolution baby! Another 100 million years and we'll be there.
August 5, 2009 11:32 AM | Reply | Permalink
It won't take 100 million years to fix our system, senior. Social evolution and Darwin's evolution are two totally different concepts.
We have evolved into a more just society over the last two hundred years as a result of a bloody revolution as well as a civil war, which was revolutionary in character as well. There are problems with the current system that don't need a revolution to address.
I would prefer to continue our on-going evolution as a country rather than start over again after wading through rivers of American blood in a new round of partisan or class warfare.
August 5, 2009 12:04 PM | Reply | Permalink
comment below
August 5, 2009 1:02 PM | Reply | Permalink
You're quitethe master of hyperbole. Most of which seems designed to slow or stifle a grassroots movement for real change. Your comments here remind me of an infant who has pushed and played with his poop, sculpting forms that may fascinate him, but in the end remain a big, stinking, pile of poop.
August 5, 2009 12:15 PM | Reply | Permalink