Healthcare Reform Would Be A Done Deal If We Stick To The Facts
If false and misleading ads from the private for profit health insurance companies and their cohorts were debated objectively by responsible journalists, the healthcare reform debate would be over. If Congress follows the will of the people and the facts that are readily available on the internet from reputable objective organizations, the healthcare debate would be over.
Follow my healthcare tweets at http://twitter.com/EgbertoWillies
Fact:
It is mathematically impossible for a for profit private insurer to
be less expensive than a public not for profit insurance giving the
same benefits. It is for this reason why insurers are fighting the
public option. They must convince you that basic arithmetic does not
apply here. Of course it does.
Fact:
Medicare's administrative cost is between a low of 2 percent and a
high of 6 percent. Private for profit insurance ranges from 16 percent
to over 30% in administrative costs. In other words for every thousand
dollars you pay in premiums 300 of those dollars go into the pockets of
shareholders, overpaid executives, advertising and other costs. Those
are dollars that could have been used to lower healthcare costs.
Fact:
US Healthcare as % of GDP: 15.3%
Canada Healthcare as % of GDP: 10%
Fact:
US Per Capita Cost of Healthcare: $6714.00
Canada Per Capita Cost of Healthcare: $3,678.00
Fact:
Government Spending on Healthcare Per Capita is 23% higher in the US than Canada.
Fact:
Canadian health outcomes are better than ours.
Basic Statistics U.S. Canada
Life Expectancy (Male)74.8 77.4
Life Expectancy (Female) 80.1 82.4
Infant Mortality/1000 live births 6.8 5.3
Obesity Rate (Male) 31.1 17.0
Obesity Rate (Female) 32.2 19.0
HC spending as % of GDP (2005) 16.0% 10.4%
Fact:
Accusations by for profit health insurers and their cohorts stating
that government will take over healthcare delivery are false. It is a
fact that for profit insurance today tells you which doctor you can
see. It is a fact that for profit insurance tells you what medical
procedure you can have. It is a fact that for profit insurance tells
you which hospital you can use. It is a fact that for profit insurance
tells your doctor which drugs you may be prescribed. It is a fact that
for profit insurance selectively rescind your coverage if they can find
away to qualify your medical condition as pre-existing. It is a fact
that for profit insurance will not insure those with pre-existing
conditions.
If we stick to the facts healthcare reform will be realized
Links:
Most People Support Public Option
CBS/New York Times Poll
Quinnipiac Poll
Cost of Administering Healthcare in US Versus Canada Versus All Countries
The New England Journal Of Medicine
OECD Health Data 2009
World Health Organization Core Health Indicators
For full disclosure, PT, let me say that I agree with you completely. The problem, though, is that I'm not the person you have to convince. Rather, an important challenge is convince members of Congress who are subject to many pressures. Let's agree that these include lobbying by insurance and pharmaceutical interests, but that's not all. There are also the average voters.
Imagine you're one of them. You already have health insurance - sure millions don't, but you're among the majority who do. If one of these new plans involving the government passes, someone has to pay for it, and that means your taxes will go up. Of course, you've been told that you'll save money because of reduced paperwork and an end to exorbitant profits by insurers and drug companies, but will that really make up for those extra taxes you have to pay? After all, you'll be paying to help all those other guys who can't afford insurance today. Now you're a good-hearted guy, and you'd like to help all those people, but times are tough, and you have trouble just making ends meet. Maybe in a couple of years when things are better, you'd be willing to sacrifice some tax money for the other guy, but right now it's too much to ask.
So, let's not rock the boat, right?
(I could supply some rebuttal to the above, but not in the simplistic language that would necessarily convince my imaginary friend)
July 9, 2009 11:09 PM | Reply | Permalink
Maybe I missed something here Fredo, but I didn't hear PT even mention 'universal healthcare' as part of his argument. Here's an argument for those hypothetical voters you're reaching out to Fred. The McKinsey & Co. report puts the savings for US healthcare costs at $470B/year by switching to a single payer system. The Congressional Budget Office places the cost of insuring our 37 million uninsured at $1.6T over the next 10 years, or $160B per year. Switch to a single payer system and insuring the uninsured will be paid for, with a net decrease in US healthcare costs to boot. I know, I know. Single payer is off the table so to speak. The public option is the best alternative to attaining similar reductions in healthcare costs, other than a single payer system. Without it, we're never going to see significant reductions in our costs, and we appear not to be willing to fund Universal Healthcare anyway, so why are you even using that canard in the argument for a public option? I didn't see politicaltruths mention it. Is this some slight of hand on your part? I couldn't have framed an argument against the public option any better than you if I was on the payroll of the insurance companies.
July 9, 2009 11:53 PM | Reply | Permalink
Slight of hand. Distract from the argument in hand and divert to a contentious straw man and the viewers at home become baffled, and go back to watching the latest 'reality' TV show.
July 9, 2009 11:56 PM | Reply | Permalink
I think he is just playing devil's advocate and not out to derail anything. Preaching to the choir is all well and good, but can be counter to the stated goals when persuasion is needed.
In order to formulate a winning strategy, one has to understand the objections to the proffered solution. I agree that these will be some of the likely objections and developing responses to those objections that go beyond the dismissive will be important to our eventual success. I could design a system that would address the concerns of both sides of the issue, but it would require a whole lot more strategic thinking than either side seems capable of.
I seem to remember being accused of the same crime of building straw men in order to derail a conversation when in fact the goal was to deepen it.
July 10, 2009 8:36 AM | Reply | Permalink
You are absolutely correct. But politically the politicians simply want to keep PI in business. That said if the American public really new the facts we would have single payer yesterday.
July 10, 2009 11:04 AM | Reply | Permalink
What are you - some stuck-up type that thinks your better than me because you went to college? I work hard on the assembly line all day, and I just get enough on payday to pay the bills. What am I supposed to do - pay taxes so that some other guy whos too lazy to work and get insurance gets taken care of? Don't give me that crap about "net healtcare costs" I don't even know what that means and I think your trying to con me so that you can collect my tax money for your pet liberal project.
If you can explain in SIMPLE LANGUAGE why I should have to pay higher taxes so the goverment which can't run anything can take MY MONEY and run, I'll be for your stupid plan. If you can't, forget about it. I'm nobody's fool.
July 10, 2009 11:27 AM | Reply | Permalink
That was to Miguelito.
July 10, 2009 11:35 AM | Reply | Permalink
If we're going to start having mock debates between your idealization of some meat head and a public option advocate, I quietly abandon the field, and leave that for the advertising copywriters of the world.
July 10, 2009 12:28 PM | Reply | Permalink
Sorry to hear you give up so easily. I thought healthcare reform was important to you.
July 10, 2009 12:57 PM | Reply | Permalink
thanks, it confused the hell out of me. lol
July 10, 2009 4:29 PM | Reply | Permalink
Simple answer: rising costs will inevitably force you to pay much more than you would if you paying for the Cadillac-driving welfare queen. You are treading water and refusing a life-saver because a drowning man may get to it first.
July 10, 2009 2:15 PM | Reply | Permalink
McKinsey & Co must be one of those ultra liberal, socialist, communist, fascist automatically lying think tanks, right??
July 10, 2009 1:48 PM | Reply | Permalink
Smart ass! ;)
July 10, 2009 2:00 PM | Reply | Permalink
Don't worry, I know who McKinsey is. About ten years ago I worked on a project with a bunch of their young MBA's. Very sharp people.
Great find on that report by the way Miguel!
I thought their was some candy coating, but even McKinsey Global can't deny the numbers.
July 11, 2009 1:04 PM | Reply | Permalink
Excellent post!
The problem is that even if we do stick to the facts, there are so many political whores in Washington that can be bought every decent proposal is imperiled by their willingness to scuttle it for a price. But still we must keep pushing the facts and the truth as hard as we can. The only approach that makes any sense for the people of the United States is a single payer plan of some sort. All the rest is just bullshit designed to keep the current bonanza for the insurance and othe parasites going for a while longer.
July 10, 2009 2:02 AM | Reply | Permalink
Thats what we have to do blog all over, get on TV, call into radio stations, etc.
July 10, 2009 11:05 AM | Reply | Permalink
I'm for a public option and way more regulation of the 'for profits', if only for the 'for profits' to stop wasting money on their damn TV advertising. There's a drug to solve everything folks! You see it on TV and then ask your doctor to give it to you! We don't care about wellness, just selling drugs!
There's an Alzheimers one out now that makes me cringe. Let's play on people's tragedy to sell our drugs.
The whole thing's messed up. Doctors should be advising us what drugs might be the best for treatment of certain things. Not something that Sally Fields spouts. This is our money that went to buy those drugs and they waste it on advertising? Sheesh.
And this is just one itsy bitsy reason why we need to do something with our healthcare system. The big thing is that so many people aren't covered or aren't covered enough.
July 10, 2009 2:02 AM | Reply | Permalink
I agree. The idea of people seeing ads on TV then going to their doctors and saying gimme is just bizarre. People must do it because the ads keep coming. And please don't even tell me why the doctors agree to subscribe the meds on demand because I know it will make me scream!
July 10, 2009 3:12 PM | Reply | Permalink
Patients are supposed to remember to ask their doctor to give them a certain Alzheimer's drug?
Sorry couldn't resist.
July 10, 2009 3:33 PM | Reply | Permalink
ouch.
July 10, 2009 4:59 PM | Reply | Permalink
Everything that is happeneing right now is because there are no penalties whatsoever for anyone who lies or misleads.
GWB set the standard for this and congress agreed to it.
No matter what harm ensues or how many people might die, it is OK to lie.
The truth is totally meaningless.
Plain old lies are destroying our country. Citizens very much need to express outrage at the totality of the ethical and moral collapse.
As a society, we are absolutely sunk because of this complete and utter betrayal.
Bush and the repugs took us here and now it is all but impossible to go back. It cannot happen without acknowledging what has occurred. Which means a mess.
Bush and Cheney and the congressional leadership incarcerated for at least criminal negligence would be the minumum logical outcome. Whem dems took over congress after the 2006 elections the major crimes were history. Pelosi had the one chance to fix this but didn't have the personal integrity to do what the law required and thus drove home the final nail in the coffin of democracy.
All of this denotes the progressive ethical decay that has us in a bind. Our national leadership has failed horribly. Obama is the same. He has chosen to disregard the law as well, and thus is also criminally negligent. The Bush WH, the CIA, DOJ, congress etc are all criminally liable and that is why nothing will happen. The entire government would be trashed. At every turn the repetitive failure to follow the law has made the problem increasingly worse. Regulatory failures by the treasury and SEC follow the same pattern.
We are stuck with the fact that we cannot recover from the moral and ethical decline all this has produced. Jean Paul Sartre and his existentialist play, No Exit, precisely describe our dilemma. Acknowledgement of, "The truth will set you free", which was our only chance, may not be a choice anymore. I think we've effectively burned every bridge to freedom behind us.
July 10, 2009 6:07 AM | Reply | Permalink
Except for the misdirection on the Medicare numbers, I agree with the underlying premise of the blog. We need to remember that keeping costs low when you cover the sickest forty million people in America requires only 80% payment of below-market rates with the delta being passed on to the for-profit sector through higher charges and decreased care across the board. Medicare and Medicaid are part of the problem, not part of the solution.
What is wrong with our sick care system could be fixed very simply and would by-pass the objections many might raise.
First, regulate the for-profit health care industry to within an inch of its life. It will no longer be acceptable to profit off of denying care or claims. Add a mandated medical IT system that everyone uses. Perhaps one developed by the government and leased to private industry. Do it under HIPPA to make implementation easier by going around Congress. The savings derived through a new regulatory environment that is ruthlessly applied will be almost immediate. If they can drive a profit in this environment, they should be allowed to do so. If not, we have a new non-profit code that allows them to stay in business without crippling the health care system.
Second, fix Medicare and Medicaid to be more cohesive, cover 100% of market rates and offer it as the "public option" that any American can buy into at a set rate determined by your specific local. This will turn the Medicare roles into one that is more representative of the country as a whole and drastically reduce its costs. The system as it stands right now will collapse under the weight (literally and figuratively) of aging Boomers and the newly disabled by way of diet.
Third, outlaw pharmaceutical advertising. OK, it may be a first amendment issue or whatever, but we have plenty of exceptions to the Constitution and this should be one of them. They spend ten times the amount they spend on R&D through direct-to-consumer advertising of prescription drugs, many of which were approved under one set of trials and are now being proscribed for secondary affects that have never been tested. The FDA needs to be more Eliot Ness and less Lock Ness.
Fourth, health care providers must implement the same IT system designated to the insurers. They must not over-charge for procedures (or pills or pillows) in order to get some percentage of that paid. Perhaps we set reasonable market rates for basic care via the public plan and that flows into the system as the baseline. Specialists who aren't covered under Medicare (elective surgeries and the like) will be allowed to charge whatever the market can bear.
At the end of the day, the idea that "single payer" will be a panacea that saves us all is not factually correct. No other country in the world with our complexity of competing interests has settled on a strictly single-payer system. In fact, most are a combination of solutions both private and public. Liberals must realize that we have an existing system that must be molded to our needs because starting over isn't an option. Conservatives must understand that status quo isn't an option. Both camps need to use the strengths of various approaches to counter the weaknesses in others.
My only question is when will the adults take over the conversation?
July 10, 2009 8:58 AM | Reply | Permalink
Single payer is mathematically unbeatable. The only reason we have private insurance is to tranfer wealth to a few shareholders etc. I am a capitalist but for issues like healthcare payments there is no need to give away 30% of our premiums for paying for healthcare when they provide no intrinsic value. The only reason to have profits in any part of healthcare is to ensure innovation. That said it takes no innovation to pay a bill.
July 10, 2009 11:10 AM | Reply | Permalink
You are making two different arguments, neither one of which is entirely true or substantiated by the data you provided. The only country that uses a purely single-payer system is Canada and only because they have a tenth our population.
By way of contrast, Medicare/Medicaid is insuring about the same amount of people on Canadian health insurance and can only afford to cover 80% of the cost at drastically reduced rates. That is a system that is neither sustainable in its current form nor scalable to cover the entire country without massive restructuring.
I understand the need to find simple solutions to complex problems but this debate won't be solved by soundbites.
July 10, 2009 12:11 PM | Reply | Permalink
Unfortunately, that's how most things are decided these days... in the halls of Congress, the newspapers....and here.
July 10, 2009 6:54 PM | Reply | Permalink
Look at this guy's continued responses to me - Single Payer is a magic bullet. Conversation over. Well, not exactly. Put 320 million hypochondriacs on the same system without fixing a whole host of other things and single payer wouldn't last a decade.
July 11, 2009 8:51 AM | Reply | Permalink
The size of Canada's population has nothing to do with the outcome. The numbers scale quite well. Right wingers have said that and it drives me crazy. It is like these guys believe we never took simple arithmetic let alone algebra. Healthcare cost like everything else scales.
July 10, 2009 11:08 PM | Reply | Permalink
Your inability to have a discussion using actual facts (rather than supposition) is frustrating and is probably why "liberals" are losing the health care debate.
You still have yet to offer real numbers or statistics or another country that has our population, our sicknesses and our complexities. The relative health and size of a population is certainly important when designing a health insurance system that will be actually affordable and sustainable. Your assurances aside, the numbers are nearly as clearly as you make them out to be.
This is not a left-right issue. It is a right-wrong issue. Hoping or pretending that the problems with single payer being implemented in America don't exists is wishful thinking at its worst.
July 11, 2009 8:49 AM | Reply | Permalink
You seem stuck on the rate that medicare is paying for services. What you are missing is that medicare is getting creamed on the volume of services being performed that are either not supported by empirical evidence or that make no positive difference to a person's health.
You have to change the fee-for-service incentive structure, then we can figure out what rational rates should be.
July 10, 2009 1:02 PM | Reply | Permalink
I am not stuck on any one data point, just the idea that Medicare, as it exists today, would be the right vehicle to insure the entire country. I am actually an advocate of a more holistic view of the problem, of which unnecessary procedures certainly plays a major role.
July 10, 2009 1:16 PM | Reply | Permalink
OK you are missing the point. It's the incentives embedded in the payment system that are the problem, not the prices or rates of reimbursement. In the now famous example, rates for services are similar in McAllen and El Paso, but we are spending three times as much in McAllen because they are over-utilizing resources.
I agree that we could use the current public option (medicare parts B and D are voluntary after all) to drive down costs throughout the whole health care system. And I agree that requires medicare to operate very differently.
Unnecessary care is a far larger part of the problem than administrative costs or private industry profits. I mean how many people give a shit how much Toyota pays for administration or how much they profit. They make great cars for a very good value. By contrast our health care industry is making Chevy Malibu's circa 1985.
Much of what we are doing in the delivery of care is useless, wasteful and not back by evidence that it is good for you. That's costing us about 30 cents on the dollar or more. It could be solved almost entirely at the bedside (with help from a smart IT operation)if people were really serious about it.
July 10, 2009 1:33 PM | Reply | Permalink
The reason unnecessary costs make it into the system in the first place is because no one is secure in the knowledge that everyone is playing by the same set of rules. There is little evidence of the burden this particular data point takes into account, but it hardly matters. Every one has their axe to grind in this debate.
Codify a sane and sustainable set of medical regulations for all involved and the rest of the system will fall into place. We need to determine the desired outcomes and compare it to the available resources. We need to balance a complex set of competing interests to come up with the right solution.
I don't think focusing on any one problem will fix things, but if I had to choose one it wouldn't be hypochondriacs clogging up hospitals who are willing to cater to their disease. I would change the food system that causes them to feel like something is wrong in the first place. We are sick because of the way we eat and that is what makes our health care system unsustainable.
You are pointing to a symptom of the actual problem as being the place to start designing the solution.
July 10, 2009 1:43 PM | Reply | Permalink
You are mostly speaking gibberish.
This has nothing to do with hypochondriacs. Doctors make most of the decisions about health care in this country not patients.
You can pretend to think that unwarranted or oversupply of care is not THE major problem but it is. The Dartmouth Atlas has documented this very carefully and if you go to any of the major integrated health care institutions who are doing things the right way you will see it is possible to deliver higher quality care at significantly lower costs. It has nothing to do with regulation imposed from the outside but with rigorous application of quality control and evidence-based practices.
Of course we would be better off if we eat right and exercised more, but that does not explain why a hospital in Miami performs cesarean sections at a rate three times a hospital in Salt Lake. Or why in the last 2 years of your life you'd spend way more days in the hospital and see way more specialists if you lived in Boston instead of New Haven.
July 10, 2009 2:51 PM | Reply | Permalink
None of this has anything to do with single payer health care. It also has nothing to do with designing a sustainable system.
Throwing out disconnected "statistics" with no context is not the same thing as being right. Why not provide some corroborating evidence that unnecessary procedures are the problem? You can't because this is a problem that has no one cause despite your single source of information. It is multifaceted and will require a multifaceted approach.
How do you suppose to make these changes you discuss as being THE ONLY problem that is worth solving? It takes regulation from without, because no one will just change the way they are doing business because its the right thing to do. Fixing health care delivery will certainly need to be a part of health care reform, but it is not the only thing that needs to be changed.
If that was the case we wouldn't be having this discussion.
July 11, 2009 8:57 AM | Reply | Permalink
PS: Your ad hominem attacks are what is gibberish here. Perhaps you can have a conversation without being a dick? You point to a single "group" who have studied your problem du jour and have decided that is the Achilles Heel for the whole system. That is not only a poor process but it is immature and lacking in intellectual merit.
July 11, 2009 8:59 AM | Reply | Permalink
They have to thoroughly understand all aspects of this multi-faceted issue to develop a workable solution. My bet is they'll come up with something that's marginally better than what we have now in hopes it can be revised later on -- a very risky prospect.
July 10, 2009 3:59 PM | Reply | Permalink
I agree that we are lacking the political will to create the health care environment we need to sustain life in this country.
I also agree it is because we have mostly inbred morons in Congress who are incapable of doing even the most basic tasks of their job, let alone something this big. I suspect many politicians will lose their jobs over the coming years if this problem doesn't get fixed.
I am pretty sure it will cost Obama a second term unless things progress at light speed on a number of other fronts.
July 11, 2009 9:02 AM | Reply | Permalink
In the letter from the Blue Dogs that was posted this morning on the TPM main page, a couple of sentences read:
"Medicare reimbursement is on average 20 to 30 percent lower than private plans .... Using Medicare's below market rates would seriously weaken the financial stability of our local doctors and hospitals."
You also make reference to making Medicare and Medicaid cover 100% of market rates. I understand that Medicare uses a so-called market rate and then reimburses at a percentage (
If a public plan (single payer, public option, whatever) is to reduce costs, it must pay at below the "market rate", because what we call the market rate right now is, we all acknowledge, inflated. That's what we're trying to address.
So what is this market rate, and how do we determine it? Isn't reducing the rates paid to healthcare providers a necessary part of reform? Couldn't conservative critics of any public system claim that because it is competitive with private insurers to the extent that it undercuts them, it is because it is paying "below market rates"? So this, like the bipartisanship canard, is an objection by the Blue Dogs that simply can't be addressed without gutting the proposed legislation?
What am I missing?
July 10, 2009 1:30 PM | Reply | Permalink
I think we just need to realize that Medicare is only possible because of their payment policy. They would need to be on a level playing field with private insurers if we wanted to design a system that was fair and widely supported. I think by regulating and simplifying heath insurance, we lower the overall cost of delivering health care which will lower the market rate to a sustainable level.
Further, a health care information system that finally leverages our modern information technology will deliver huge returns on efficiency and productivity, not to mention it affect on medical mistakes. Finally, by stabilizing the market, we increase the ability of businesses to think strategically instead of tactically.
We need all the involved parties to start speaking in terms of Synergy and Gestalt instead of This-Or-That partisan hackery.
July 10, 2009 1:37 PM | Reply | Permalink
Let's simplify this for you Jason. Stop trying to figure out what Medicare does relative to private insurers. But you do need to answer this question: why is Medicare more expensive than Medicare? By which I mean why is spending for similar patients with similar prognoses so different in different regions of the country, in different cities/town within the same region, within different hospitals in the same city/town?
July 10, 2009 3:25 PM | Reply | Permalink
Why is the sky blue? Why do white guys become serial killers more often than other races? How many angles can fit on the head of a pin?
The questions you raise are just about as compelling. Concentrating on a single data point to the exclusion of all other data points is moronic. There are thousands of different explanations for the problems you cite, most of which have nothing to do with the doctors or the hospital.
Pull your head out of your ass. (See, isn't it nice to have a conversation with someone who does nothing but toss insults.)
July 11, 2009 9:07 AM | Reply | Permalink
The main thing you are missing is that it is less about rates than about utilization. We use to much care right now and one major reason is that the payment system is based on fee-for service.
Consider two options: (a) I pay you a flat fee to treat a person's back; (b) I pay you separately for each exam, test, drug, and procedure you perform in trying to treat a person's back. Under which system do you think it is more likely that a doctor orders more exams, drugs, tests and procedures?
July 10, 2009 3:31 PM | Reply | Permalink
Except, of course, that isn't the way it works. The doctor doesn't make more money for more tests. You are creating a straw man argument made from paper mache.
July 11, 2009 9:08 AM | Reply | Permalink
Someone here recently suggested taxing pharmaceutical advertising. The idea has merits.
July 10, 2009 4:36 PM | Reply | Permalink
PT you can't argue that on the one hand it's mathematically impossible for a for profit private insurer to be less expensive than a public not for profit insurance giving the same benefitsand then on the other argue Accusations by for profit health insurers and their cohorts stating that government will take over healthcare delivery are false.
You're saying they can't compete thus they will be put of business and so by attrition the government plan will be the only one left. Viola single payer and defacto government control of the whole system. And don't kid yourself we need to drastically rein in costs and not just on the insurance end. To do that there has to be oversight and control of providers by those signing the checks.
Single payer would be fine by me but total government takeover of healthcare is the strongest Republican boogeyman talking point against reform and it just might kill this bill or turn it into useless junk.
Dozens of countries have competing public and private plans that work well together. In the Netherlands the incentives are such that private plans compete tooth and nail for diabetic patients.
We're not going to get pure single payer this year. There's just too much opposition. But we can get a very good public/private hybrid plan like they have Holland, France, or Germany.
And if for-profit insurance companies insist on blowing cash on huge executive salaries, big shareholder profits, marketing and congressional lobbying, and figuring out ways to deny care they will go out of business.
If they find profitable niches where they can provide needed services at affordable cost and they invest the premiums they collect wisely (good luck with that) they can thrive along side the public plan. If not they'll have to find productive work where they make an actual contribution to American society instead of leeching off it.
July 10, 2009 9:59 AM | Reply | Permalink
We are in agreement. My statement is consistent in that Obama gave up on forcing single payer. I think there are staunch Conservative Republicans that will continue pay more for plans just not to be covered by a government plan. Conservatives are fanatic in voting against their own economic interest for their ideology.
July 10, 2009 11:15 AM | Reply | Permalink
PT if I had my way I'd tell everybody we're going to have two new plans as part of one bill. Give the Republican caucus free rein to write one with their insurance company and pharma cronies complete with their high deductables and "free market" principles like recission. It'd be a mess. The only thing Republicans are worse at than telling the truth is writing policy. We'll write the other, a public plan as close to single payer as possible.
Put 'em on an even playing field and after a few years only wealthy far rightwing ideologues would be dumb enough to stick with the wingnut plan.
July 10, 2009 12:07 PM | Reply | Permalink
I can save you the time.
Republican plan: cut capital gains taxes. It cures the common cold.
July 10, 2009 3:37 PM | Reply | Permalink
Capital gains cuts are a primary cause of ebola virus, ya heard it here first!
July 10, 2009 4:45 PM | Reply | Permalink
No they cure ebola. Where have you been for the past 28 years?
July 10, 2009 6:51 PM | Reply | Permalink
I wrote two comments above - the first as myself and the second as my alter ego (intended for Miguelito although it appeared after several other comments).
I haven't yet seen an adequate response, which is why the opponents of a public option are doing very well currently in the struggle to frame the issue. They know how to speak to individual Americans, while some on the public option side speak in generalities, to no-one in particular. Returning to my alter ego frame of mind, please someone, don't tell me why the American people should support a public option. I'm not the American people - I'm me. Why should I support it?
July 10, 2009 11:34 AM | Reply | Permalink
Three comments now, because I added one above to make clear I had been responding to Miguelito in my second comment, not to PT.
July 10, 2009 11:37 AM | Reply | Permalink
Ok. Here's a non alter egoed reason:
My grandfather had terminal colon cancer 4 or so years ago. He had to continue to work at a grocery store, while he had cancer, to pay for his drugs and those of my grandmother (who'd had a stroke). So not only was he sick, but he couldn't even afford his own treatments outright. A system that makes people with cancer work to help fight for their life (oh yes, he was on Medicare, Medicaid), is a system that doesn't work, is inhumane, and just plain-old fucked-up stupid.
July 10, 2009 12:48 PM | Reply | Permalink
To Matyra from Alterego -
Hey lady, sorry to hear about grandpa, but dont blame me. I can't even pay my bills, and your asking me to pay taxes to help these other people? Yeah, when I can help my own family I'll do that, but don't insult me saying I'm inhumane.
YOU HAVEN'T GIVEN ME ONE SINGLE REASON WHY I WOULD BE BETTER OFF PAYING MORE TAXES WHEN I CAN'T EVEN FEED MY FAMILY WITH THE TAXES THE GOVERMENT ALREADY SOAKS ME FOR. SO CUT OUT THE "INHUMANE" INSULTS. I BET IF YOU HAD MY PROBLEMS YOU'D BE INHUMANE TOO, EXCEPT I'M NOT INHUMANE JUST HUMAN.
July 10, 2009 1:05 PM | Reply | Permalink
um, maybe to pay for your trips to the psychoanalyst?
July 10, 2009 1:08 PM | Reply | Permalink
Dude! It's not about what you pay in taxes. It's about what you pay for health insurance.
July 10, 2009 7:36 PM | Reply | Permalink
If you are the average American you are probably paying at least 30% more for health care than you should be. Since the average premium for single coverage is about $4000, that's $1000 a year you are throwing away. If you have family coverage, whose premiums are three times as high, you are throwing out $3000 a year. And those figures are increasing about 10 percent every year. And you should expect to pay at least another 10-20 percent on top of that out of your pocket. Every year. Growing 10 percent a year.
You may think it is your employer who is paying most of those costs, but the truth is you are. That's the reason your wages are not going up. Over the past decade your premiums went up 120% and your wages only went up 30%. That's right, your employer is paying all the gains form your hard work to the insurance company just to get you the same insurance coverage you have always had, or maybe less than you have always had. And the whole mess is just getting worse and worse. As a result you can kiss a higher standard of living or a comfortable retirement goodbye.
Yeah, that's right. You are paying a big tax to the insurance companies and medical industry that is going up 10 percent a year. And what are you getting for it? Is your health care any better? Are you ten percent healthier every year? Is the chance you get a heart attack or cancer or diabetes or arthritis going down 10 percent every year? Does your doctor spend more time with you at each appointment? Do you feel more financially secure?
$1000 to $3000 a year going up 100 to 300 every year. And nothing for it. Compare that to what you are paying in taxes. I dare you.
Next time you are lying on the beach at a five star resort in Antigua look around at who is there with you. A bunch of government employees or a bunch of doctors and insurance company executives? Who's living high off the hog on your "taxes"?
July 10, 2009 12:58 PM | Reply | Permalink
Its really amazing.
People continue to write here and everywhere, reasons why so and so is what it is.
But its just a waste of time and is part of the problem.
You want to know why we don't have health care?
Its because the people who are supposed to represent us are totally corrupt and work for business interests.
Save all your other arguments.
OK?
And because no one with integrity can ever get elected in this country(few rare exceptions obviously) we argue back and forth as if that made a difference.
Well its a fools game and those who play it are perpetuating the status quo and at best are fools because they don't understand reality.
July 10, 2009 12:11 PM | Reply | Permalink
Maybe you should ask doctors why they are wasting so much of our money? Is Congress forcing them to be indifferent to or ignorant of the need for evidence-based practice.
Health care decison get made at the bedside, not in Congress. We could improve health care and reduce it's costs massively if we just did the right thing at the bedside, and stopped obsessing so much about what is happening in the Pharma lab, the bean counter's office or the Congressional cloakrooms.
That said Congress surely are corrupt and couldn't make good policy when it really maters even if you offered them all cushy "lobbying" jobs for them and their families when they retire. Oh wait.
July 10, 2009 1:22 PM | Reply | Permalink
Let's throw up our hands then.
July 10, 2009 2:24 PM | Reply | Permalink
1. A public option is automatically less expensive because it is subsidized by tax payments, not because it would automatically cut costs. You can't simultaneously complain that private insurers don't cover enough things (they exclude preexisting conditions, etc.) and that the public option would be less expensive. Private insurers wouldn't go to the effort of denying coverage and doing actuarial work on coverage if it didn't save them money on net.
2. Canadian health outcomes are better than ours primarily for lifestyle reasons, not because they have a different healthcare system. See: obesity figures. Americans are fatter and lazier than Canadians. Fat, lazy people have poor health outcomes.
3. The problem is that while the story told for single payer is very compelling emotionally, the "facts" don't actually support that story. That isn't to say there isn't a reasonable, supportable story for single payer (or any other broad reform). But it isn't "It's cheaper", because it isn't, and it isn't "Canada is better" because it isn't.
The unfortunate fact is that health care providers are, by and large, relatively efficient operations. They spend a lot of money on actuarial operations; but only because they would have to spend -more- money on care if they didn't. Even without adding to insurance rolls, cutting out those operations would make health care more expensive, not less. Operating margins at health insurers simply aren't that high; the stockholders aren't skimming any 30% off the top. Some years, they might get 5%.
Anyone who tells you otherwise is selling something.
July 10, 2009 12:27 PM | Reply | Permalink
July 10, 2009 12:51 PM | Reply | Permalink
He was in hospital for 31 hours and the bill was $52,398.03. The charges included $31.78 for one Lipitor tablet, $5.00 for one 500 mg vitamin C tablet, and several IVs at $958.30 each.
July 10, 2009 3:13 PM | Reply | Permalink
Some good stuff in here except for the idea that health insurance companies are lucky to take a 5% margin. No company with a 5% margin pays their CEO 1.2 billion dollars. That just isn't going to happen.
Otherwise, I agree completely. The solution we are likely to end up with will need to be a multi-pronged attack that addresses health insurance regulation, medical information technology, life-style changes (no more corn subsidies being the obvious starting point), health care delivery and disease prevention.
No other system will be sustainable for a growing population of 320 million people, many of them who are not healthy by even generous standards.
July 10, 2009 1:24 PM | Reply | Permalink
Well, the 5% margin would be after paying CEO salaries and the like. So they aren't really relevant. The presumption is that if they weren't getting their money's worth from the CEO they would hire someone else or someone cheaper.
Now, that may or may not be true, and I strongly suspect that most readers here don't believe it for a minute. But if it isn't, then the problem is corporate governance, not health care reform. It may be that the pay of top executives (and by this I don't mean the hundred finance guys making $500K; they probably -are- worth every penny to the company) is a serious drag on the industry.
But that doesn't say anything about health care, it says something about corporate governance, and in particular the protection of management from activist shareholders.
July 10, 2009 1:49 PM | Reply | Permalink
Which is why I am a fan of a multifaceted discussion rather than one that focuses on simple cures that will never work.
July 10, 2009 1:52 PM | Reply | Permalink
The root of all evil in our democratically elected government is our present system of campaign financing. Outright bribe taking isn't really a significant problem. The real problem is that our system confers influence proportionate to one's wealth, not one's status as an individual citizen. This is, of course, the reason why so many elected officials seem to go against the wishes of those who elected them.
This situation is inherently undemocratic, by which I mean, each person doesn't have an equal opportunity of accessing their elected representative. Some citizens may choose not to exercise their equal opportunity of directly petitioning their elected representative, but those who do should not have a disproportionate access commensurate with their wealth. To do otherwise is inherently undemocratic. Which is among the reasons why the vote was not given only to the wealthy. A notion that was proposed at the constitutional convention. Neither was the vote apportioned based on the amount of a man's wealth. It was one man, one vote. An equal amount of power per man (cutting out blacks and women, of course), irrespective of wealth.
Our whole system of lobbying and campaign financing strike me as antithetical to those basic founding democratic principles. It seems that our current system exists specifically to subvert the principle of one person, one vote. Proposed reforms to the current system usually run up against first amendment objections. Those objections typically argue that any reform would basic curtail freedom of speech rights for the wealthy. The question isn't whether a wealthy citizen has the right to speak, the question is whether their wealth should enable them to be heard more loudly.
Hasn't the answer to that question already been provided by the founding fathers? Isn't it set down in the principle of one person, one vote - the core principle conferring legitimacy to our government? Doesn't one person, one (equal) vote logically extend to also mean one person, one person (equal) opportunity of access to the representatives elected on that principle?
July 10, 2009 12:54 PM | Reply | Permalink
What the Blue Dogs (smells like dog s...) and republicans are trying to do is protect one of the last areas where CEOs and investors can get filthy rich off the consumer by selling snake oil.
C
July 10, 2009 1:13 PM | Reply | Permalink
I'm nothing if not persistent. I'll try again. I just filled out a survey questionnaire on healthcare reform sent to me by my Congressman (Republican). There were 17 questions on the multitude of principles and policies involved. There were 21 questions on what type of extra tax I wanted to pay if the government became involved in healthcare reform.
Anyone who believes the debate won't revolve around costs and taxes with "socialized medicine" just thrown in for comic relief, isn't paying attention. Senators know that if the electorate in their state perceives them to be tax raisers for no good reason, their stay in office may be limited.
What any of us interested in promoting a public option must do, beyond any discussion of "net national health care expenses" is tell the average voter why he or she would end up better off paying more taxes. Pretend you're answering a question from one of these voters in a forum. The voter is reluctant to pay more taxes, and already has health insurance. Quote here what you would say to him or her.
July 10, 2009 1:22 PM | Reply | Permalink
The question of taxes and how it's been framed is part of the spin put on the issue of single payer/public option. What is the difference between paying an insurance premium of $5k and paying taxes of $5k if they both provide comparable services. How about if the public option has elements that will help keep those annual costs from increasing at 10% each year? If your employer is freed from paying escalating health insurance costs on your behalf, does that not free up more cash on his/her part to pay you more in compensation?
July 10, 2009 2:39 PM | Reply | Permalink
I'm certain you'll take the lack of responses fitting in to your little box as proof there are no simple answers, and therefore the whole process is doomed. Doomed, I tell you.
July 10, 2009 2:59 PM | Reply | Permalink
Unless we marginally increase taxes or some other revenue base today to support healthcare reform with a public option
1) Jobs will continue to further migrate overseas since the current burden on employers make them uncompetitive and you will eventually lose your job.
2) You will be ultimately left without insurance since companies cannot sustain a continued 7%+ increase in insurance yearly.
3) Pandemics will be prevalent as more and more are left without insurance and not seeking medical treatment early enough thus emulating many third world countries.
4) More to come but your point is well take.
July 10, 2009 11:23 PM | Reply | Permalink
If your employer is freed from paying escalating health insurance costs on your behalf, does that not free up more cash on his/her part to pay you more in compensation?
I (or rather my alter ego) am not convinced. My taxes would also be going to pay for other people's insurance, and so clearly (says my alter ego) the extra $5k I pay won't all go toward reducing my own costs by that much.
Actually, Miguelito, I do think that your latest point is starting to focus on what individual voters will worry about. However, we have to frame the issue in even more compelling terms, as I see it. The one part that's been missing - probably because many people here take it for granted without realizing that the public doesn't - is that when we pay taxes for a public component to insurance, we may be paying for someone else's health care for sure, but it's not a new cost - we're already paying for those other people. When you get a hospital bill and ask, "How can they possibly charge me so much for those services?", the hospital would tell you, "You're paying for your services and also the services we provided last week to John Doe, who couldn't afford to pay for them. For us to survive, someone had to pay, and you're the lucky one.
July 10, 2009 2:59 PM | Reply | Permalink
NPR recently reported results of a study by the health care reform advocacy group, Families USA, that a family of four pays $1,000 more per year in insurance premiums to cover the uninsured. The premium for a single person is roughly $350 a year more.
This morning I received a reply to an email encouraging my republican senator to vote in favor of a public option. He offered the following:
Note, he says could in both cases. However, your alter ego would read or hear this and accept it as inevitable. I don't think your alter ego will be persuadable until the new system is in place and the cost-savings and benefits are readily apparent.
It appears the naysayers to a public option are much louder than the proponents. This may be in some part due to the fact that many of its supporters don't have specifics with which to argue its case.
Until the House gets it down on paper, there doesn't seem like much to work with.
July 10, 2009 3:43 PM | Reply | Permalink
Personally, I wouldn't mind paying a bit more to fund universal healthcare. You seem to be continually conflating universal healthcare with a public option. I've seen no suggestion that a public option should be anything other than self funding.
July 11, 2009 1:50 AM | Reply | Permalink
Exactly Fredo.
You're payin now anyways!
You're payin way too much!
You're payin Rich CEO's and their companies to shuffle paper and figure out ways not to pay your claim if you get sick (http://www.latimes.com/business/la-fi-rescind17-2009jun17,0,5870586.story).
You're payin Rich CEO's to pay politicians to keep the gravy train rolling (http://www.washingtonpost.com/wp-dyn/content/article/2009/07/05/AR2009070502770.html)
So, do you like how things are now? Paying more and more for less and less?
Or...do you want to change the game?...pay less for a system that's organized to deliver quality healthcare to you and your family and NOT organized to make some guy in Connecticut rich?
July 10, 2009 3:25 PM | Reply | Permalink
There's a way to do this that has proved effective in other contexts - offer the example of a typical American family, say a family of four with a $60,000 annual income. I don't happen to have the exact figures for that example, but the figures I use for illustration are in the right direction. You say, "If we implement a public option plan, you'll pay $150 per year more in taxes, but your health care costs (insurance plus out of pocket expenses) will go down by $400 per year. You'll have an extra $250 to spend on whatever you've been wanting but couldn't pay for. That would be nice wouldn't it? And you also would never have to worry about losing your health benefits. That wouldn't be bad either.
July 10, 2009 3:35 PM | Reply | Permalink
And Fred heaven forbid that you, your wife or one of your kids gets a chronic disease or a very serious condition. If that happens you're either "job locked" if you can keep your job or unemployable because you and yours are now uninsurable.
I know a woman who is in prime physical shape. In her early 40s, she rides her bike about 80 miles a week, eats well, really takes care of herself. Through no fault of her own she acquired something called "common variable immunodeficiency disease". Her body just doesn't make antibodies for a variety of illnesses all of a sudden. She lost her job last year and can't find a new one. Her husband makes about $21,000 a year repairing wheelchairs. She's on his insurance and the meds that keep her alive cost $40,000 a year. Last year they had to pay the big honkin deductable on his policy at the beginning of the year. Then the company was sold and he had to pay to get in the new company's plan. Then the company switched plans and they had to pay again. Their out of pocket costs last year were $13,000. Their savings are about gone, she can't find work and he's praying nothing happens to his job.
We recorded her statement for a Campaign for Better Healthcare youtube yesterday but she had someone else read it. She doesn't want to appear on camera telling her story because it's hard enough finding a job without a prospective employer seeing that.
She told that story to our local Republican congresswoman Judy Biggert and Biggert asked what her monthly payment was. She said about a $150 bucks. The dunce Biggert responded by saying her's is about $350/mth. I doubt Biggert paid thousands upfront like they did so they could afford the monthly payment.
Nobody is talking about paying more anyway. We spend way too much on healthcare in this country, 17.5% of GDP while the rest of the world pays half that.
In Taiwan they spend 6.23% of their GDP on their single payer system and it covers everybody for everything from acupuncture to the latest cancer surgery. Their politicians are worried because it actually costs about 8% but they're afraid if they boost premiums they'll get booted out of office.
We're all getting screwed by this system. It makes our businesses and the American worker uncompetitive. It's costs GM $1500 per car that'd be better spent on engineering and materials.
July 10, 2009 4:42 PM | Reply | Permalink
And this is an interesting point. Why is something where there is *not a scrap of hard scientific evidence for its benefits* covered under a government insurance?
I certainly hope that all homeopathic 'treatments' are not eligible in whatever makes it through Congress. And here lies another debate... the ignorant claiming their right for the treatment of their choice.
July 10, 2009 6:59 PM | Reply | Permalink
We can argue about the efficacy of traditional Chinese medicine but the point is they cover more than we do about a third of the price. And you're making a good argument for a strong Cost Effectiveness Commission so people don't expect useless Alzheimers drugs or shark cartilage for arthritis to be covered.
July 10, 2009 7:58 PM | Reply | Permalink
Well for one thing I think everyone kind of misses the point here. It's not that republicans and blue dogs are mean or nasty or unfeeling. It's that they are cheap. They will vote for and support anything that they do not have to pay for.
National health would be a done deal if someone can get say...the Swiss to pay for it. They'd vote for it in a heart beat.
I know because I live in Florida and Tallahassee will back anything that can get totally funded by tourists.
C
July 10, 2009 3:56 PM | Reply | Permalink
They are also mean, nasty and unfeeling.
July 10, 2009 8:27 PM | Reply | Permalink
Can we just keep posting this blog until we have single payer?
Seriously maybe we could just keep adding from here via comments and create an ongoing string.
I am in support of single payer. I understand it is very scary for the republicans but we really need to show tough love and get it done anyway.
In the meantime I am fighting for the so called 'public option' that has no real definition and could end up being the name of something meaningless if the lobbyists get their way.
July 10, 2009 3:56 PM | Reply | Permalink
Not just republicans. This isn't a left-right issue. It is scary to everyone who currently has insurance as well. Why? Because we still have yet to see a single progressive explain the issue in a way that combats the industry and its tactics.
It is also scary because I have yet to hear a plan that accounts for all the various and sundry issues that make our health care system unsustainable in its current form - things like diet and exercise and a nation of hypochondriacs who think there is a pill to fix their inability to take responsibility for their own health.
We keep discussing this as if it were simple and "Why not expand Medicare to cover everyone?" is considered an acceptable solution on the left while "We know its bad by why make major changes?" is accepted as cogent debate on the right.
July 11, 2009 9:20 AM | Reply | Permalink
Political Truths, thanks for the excellent post and links. There's good substance there as well as in many of the comments.
July 10, 2009 4:25 PM | Reply | Permalink
Anyone hear Nancy Pelosi on NPR yesterday? When asked about the public option, she was more than a little testy. Nothing associated with these numbers. Let's be frank: her leadership and Reid's have been lacking here. And if they aren't going to lead, who is going to follow?
July 10, 2009 7:01 PM | Reply | Permalink
Testy is a bit of an understatement. To my ears she was rude. Definitely not befitting someone in her position, bad day or not.
July 10, 2009 7:09 PM | Reply | Permalink
There's been as much leadership on this by Howard Dean as anyone probably because he actually gives a damn.
July 10, 2009 8:26 PM | Reply | Permalink
Here's a little congressional leadership in action:
Clarifying a few differences between US and Canadian Healthcare for the Manhattan Institute:
http://guerillawomentn.blogspot.com/2009/07/kucinich-rips-opponent-of-canadian.html
July 10, 2009 7:14 PM | Reply | Permalink