Wednesday night (Oct. 7, 2009), Olbermann outdid himself with an embarrassing, self-indulgent, hour-long rant supposedly in support of health care reform - brought about by his experience with his father's serious illness.
First off, he surely embarrassed his father with details of how the problem began - just a day or two after a comment that he had missed a number of shows because of his father's illness but didn't want to invade his father's privacy with details.
Second, it was quite clear that his father got excellent care, for which Olbermann is grateful and which, apparently, did point out to him how lucky he was in contrast to the experience of so many others without his financial resources.
That's fine. I would have given him 5 or 10 minutes to let us know why he is so emotional about the issue.
But the hyperbole went on and on and on and on - and he contributed zip to the conversation.
The media, focused as always on the politics of the issue, have been MIA when it comes to informing people about the details of the various bills and the various trade offs (e.g., why a mandate is necessary - to have a large pool in which to spread risk; the difficulties of establishing the "sweet point" for a fine: if the price is too low, it will be cheaper to pay the fine than buy health care; if too high, the risks of non-compliance, effect on employment, etc.).
I had hoped, when I first heard about his plans for an hour-long "special comment", that he might focus on the key issues. Silly me. Just an endless series of hyperbolic statements about health care being about death, speculations about how those less fortunate must feel in similar situations, repeated details about his experience, mention of his sister, more details about his father.
The whole hour was a waste, a self-referential, poorly written, poorly argued mess.
Anybody who truly cares about health reform must have writhed in pain at the thought of what they could have done with a full hour in which they need not interview anybody or present opposing opinions.
Why couldn't MSNBC have given the hour to Uwe Reinhardt, a brilliant speaker on health care reform who knows the facts and how to present them.
Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts
Saturday, October 10, 2009
Thursday, October 1, 2009
Real health reform? Maybe in 2020?. Or 2030?
What most people don't realize is that even if the Congress passes some kind of weak health care reform package, none of the provisions will go into effect until 2013. (And in at least one version of the bill, the rate reforms will be phased in over 5 years!) That's right - until the start of Obama's second term. Apparently our politicians haven't considered what is going to happen if Obama declares victory in November and in January everybody sees their premiums going up. And people still lose their health insurance for pre-existing conditions. And still can't afford health insurance.
So, what will health insurance companies do between now and 2013? Everything they can, of course, to generate windfall profits so in 2013 they're sitting on pots of money.
Somewhere around 2020, then, Americans will realize that they were yet again snookered, just as they were in the 1990s with the Republican promise that HMOs would solve all our problems.
Luckily, I'll be on Medicare by then.
So, what will health insurance companies do between now and 2013? Everything they can, of course, to generate windfall profits so in 2013 they're sitting on pots of money.
Somewhere around 2020, then, Americans will realize that they were yet again snookered, just as they were in the 1990s with the Republican promise that HMOs would solve all our problems.
Luckily, I'll be on Medicare by then.
Jon Stewart Does it Again - On Our Pissant Democratic Majority
Stewart's September 30, 2009 broadcast hit two home runs right off the top. First, he skewers the Democratic Party, rightly so, for its inability to govern even with control of both houses and a super majority in the Senate.
On the DemocratÃc Party's Inability to Govern
And more:
How the Democratic Party Thinks
I've said it before: the Republican Party is a more effective Party than the Democratic Party and has been for almost 40 years now. Whether they are in the minority or the majority, whether there is a Republican or Democratic President, Republicans act as if they were in the majority. They don't care if they won the White House with the help of the Supreme Court. They don't care if they are, theoretically, "out in the wilderness". They believe in their principles and use every weapon at their disposal, no matter how outrageous, to achieve their ends.
The Democrats, however, ever since Jimmy Carter, have acted like scared rabbits. They are afraid of their shadows, afraid of being called "liberal" or "partisan". Even when they win, they act like losers.
It's even to drive a liberal insane. What do we have to do to elect people who actually will do what we want them to do?
On the DemocratÃc Party's Inability to Govern
And more:
How the Democratic Party Thinks
I've said it before: the Republican Party is a more effective Party than the Democratic Party and has been for almost 40 years now. Whether they are in the minority or the majority, whether there is a Republican or Democratic President, Republicans act as if they were in the majority. They don't care if they won the White House with the help of the Supreme Court. They don't care if they are, theoretically, "out in the wilderness". They believe in their principles and use every weapon at their disposal, no matter how outrageous, to achieve their ends.
The Democrats, however, ever since Jimmy Carter, have acted like scared rabbits. They are afraid of their shadows, afraid of being called "liberal" or "partisan". Even when they win, they act like losers.
It's even to drive a liberal insane. What do we have to do to elect people who actually will do what we want them to do?
Tuesday, September 22, 2009
Health Care Reform - Blaming the Patient (Only in America)
One of the many depressing aspects of the health care "reform" process (more appropriately called the "preserve private health insurance profits" process) is the degree to which the patient is being blamed.
Republicans all but assert that Americans use too much health care because they don't pay directly for the services they get. To Republicans, there is no difference between buying health care and buying a car. Insurance company profits? Not an issue. The lack of true competition in most health insurance markets? Not a problem. Doctors ordering tests because they have a financial interest in the labs? Not a problem. No. American citizens are at fault.
But Democrats, too, blame the patient. We don't exercise enough. We don't eat right. We don't get regular checkups.
One can only conclude that Americans belong to a different species, that we are physically and psychologically distinct from Canadians, the British, the French, Scandinavians, the Japanese (who, BTW, visit doctors more often every year - an average of, if I recall the statistic properly, 17 times a year - than any other nationality), etc. all of whom live in countries where the average cost of health care as a share of GDP and per person is significantly less than it is in the good old U.S.A.
Republicans all but assert that Americans use too much health care because they don't pay directly for the services they get. To Republicans, there is no difference between buying health care and buying a car. Insurance company profits? Not an issue. The lack of true competition in most health insurance markets? Not a problem. Doctors ordering tests because they have a financial interest in the labs? Not a problem. No. American citizens are at fault.
But Democrats, too, blame the patient. We don't exercise enough. We don't eat right. We don't get regular checkups.
One can only conclude that Americans belong to a different species, that we are physically and psychologically distinct from Canadians, the British, the French, Scandinavians, the Japanese (who, BTW, visit doctors more often every year - an average of, if I recall the statistic properly, 17 times a year - than any other nationality), etc. all of whom live in countries where the average cost of health care as a share of GDP and per person is significantly less than it is in the good old U.S.A.
Tuesday, July 14, 2009
Republicans - Inconsistency is a Tool for Killing Health Reform
One of the most interesting aspects of the Senate's Health Committee hearings on health reform is how Republicans argue all sides of the case in order to kill the bill.
For example: they spend a lot of time asserting that Medicare and Medicaid are monumental failures because they cost too much and because large percentages* of doctors refuse to accept Medicare or Medicaid patients. But, of course, if one increases how much the government pays providers under those two programs, the costs will only be higher. The Republican solution? Obviously, they want to kill Medicare but, during the hearings, the idea seems to be to move Medicaid recipients into the private market (the health care exchanges).
With respect to the health care exchanges, the Republicans are endlessly creative. They argue about who should be eligible for subsidies. One proposal, to move people at the 150% of poverty level to Medicaid, fails their smell test because, first, it is unfair to those who are at 151%** of the poverty level and because Medicaid is a failed system giving second-class care. But, of course, if the alternative is to provide subsidies to those people so they can buy health insurance from an exchange, the cost of the bill goes up. Which is unacceptable.
Then we come to penalties for individuals and companies who don't buy health insurance. The size of the penalties, of course, is a real issue. But, although Republicans admit that it has to be high enough to encourage both to buy health insurance rather than simply pay the penalty, they object to even small penalties ($750 per full-time employee) because they will discourage small businesses from hiring new employees and might even force them to fire employees. Obviously, setting an appropriate penalty is a key to mandates which are key to covering everybody. But Republicans know that if they kill the penalties or make them really small, lots of people and businesses will rationally choose to pay the penalty rather than buy health insurance and that will put an added burden on the system which could lead to its failure - which, of course, is what they want.
Another argument about small businesses came up today. Sen. Murkowski of Alaska proposed that "small business" be defined for the purpose of the bill not as a company with less than 25 employees but as one with 500 employees because that is what the SBA uses as the definition for a small business. Now most of us don't normally consider a 500-person company to be small. And I think it was Enzi, as usual, who pointed out how unfair it would be to the company that wanted to add another employee (from 500 to 501**) because the penalty or requirement to buy health insurance would then kick in. Now, remember, Republicans like our employer-provided health care system; they just don't want to penalize companies who choose not to provide health insurance, no matter what their size.
Paying for the system? Republicans have proposed amendments specifically prohibiting higher taxes or penalties or any other method that might be used to pay for the program in order to, according to them of course, keep Obama's promise not to raise taxes. Without these elements, the program becomes prohibitively expensive. So they could oppose the bill on the grounds that it will increase the deficit.
Republicans are sure that "free market competition" will solve the cost and access problems, but they object to letting the Secretary of HHS negotiate rates for a public plan. Why? Because it will inevitably lead to the Secretary's imposing reimbursement rates which is the problem with the Medi programs. Republicans worry a lot about what may happen in the future because "that's what always happens". One of their solutions is to set the rates of a public plan as an average of the rates in the state. That many states in the country have health insurance markets that are either monopolies or duopolies - where there is, in essence, no market pressure to reduce rates - is irrelevant.
And, of course, they oppose any kind of reimbursement system based on "best practices". So how do they expect to stop the huge annual growth in health care costs? Well, letting the "free market" work. I wish, just once, some Democrat would point out that we've always had a "free market" and it doesn't seem to have held down costs. (They might also point out that Republicans assured everybody back in the 1990s that HMOs would increase coverage and decrease costs.)
And, as usual, the Republicans continue to try to talk the bill to death. Yesterday, Coburn introduced an amendment to replace the entire bill that they have been arguing about for weeks. I think this must be at least the second or third time the Repubicans have tried this. And, each time, they argue their side for ages. (I've lost track of the number of Republican amendments that have consumed a full hour of debate each - and the number of amendments proposed and pending has reached, I think, somewhere into the 400s.) Obviously, a Democrat-controlled committee isn't going to junk a bill they've spent weeks on so the only reason for this kind of amendment is to prolong the process - past the August recess.
Indeed, I am baffled by the continuing efforts of Democrats to accept Republican amendments of any kind since they must know that they will not get a single Republican vote to move the bill from the committee to the floor. Is it possible that Democrats still just don't understand Republicans?
* - this committee, and, for that matter, the rest of the Congress, needs a CBO for statistics. Representatives and Senators on both sides of the aisle throw statistics around willy nilly, rarely providing a source. A lot of time, I suspect the stats come out of their own heads, based on their oh-so-good personal experience. I'm not sure it will help the Republicans who tend to ignore studies that contradict "what they know" (even after the CBO scored a revised bill as costing about 600 billion rather than 1.5 trillion, Republicans continued to use the latter number).
**Democrats can be really dumb. Whenever an issue comes up about what constitutes a small business, or what penalty makes sense, or the percent of poverty or whatever, a Republican will wax eloquent about the poor business or person who just misses the cutoff point (26 employees, 151% of poverty), etc. I keep waiting for some Democrat to point out that this happens whenever one uses a cutoff point for anything. Earning one more dollar in income can move a person from one tax bracket to another. Short of never using a cutoff point for anything, this lack of fairness is inevitable.
For example: they spend a lot of time asserting that Medicare and Medicaid are monumental failures because they cost too much and because large percentages* of doctors refuse to accept Medicare or Medicaid patients. But, of course, if one increases how much the government pays providers under those two programs, the costs will only be higher. The Republican solution? Obviously, they want to kill Medicare but, during the hearings, the idea seems to be to move Medicaid recipients into the private market (the health care exchanges).
With respect to the health care exchanges, the Republicans are endlessly creative. They argue about who should be eligible for subsidies. One proposal, to move people at the 150% of poverty level to Medicaid, fails their smell test because, first, it is unfair to those who are at 151%** of the poverty level and because Medicaid is a failed system giving second-class care. But, of course, if the alternative is to provide subsidies to those people so they can buy health insurance from an exchange, the cost of the bill goes up. Which is unacceptable.
Then we come to penalties for individuals and companies who don't buy health insurance. The size of the penalties, of course, is a real issue. But, although Republicans admit that it has to be high enough to encourage both to buy health insurance rather than simply pay the penalty, they object to even small penalties ($750 per full-time employee) because they will discourage small businesses from hiring new employees and might even force them to fire employees. Obviously, setting an appropriate penalty is a key to mandates which are key to covering everybody. But Republicans know that if they kill the penalties or make them really small, lots of people and businesses will rationally choose to pay the penalty rather than buy health insurance and that will put an added burden on the system which could lead to its failure - which, of course, is what they want.
Another argument about small businesses came up today. Sen. Murkowski of Alaska proposed that "small business" be defined for the purpose of the bill not as a company with less than 25 employees but as one with 500 employees because that is what the SBA uses as the definition for a small business. Now most of us don't normally consider a 500-person company to be small. And I think it was Enzi, as usual, who pointed out how unfair it would be to the company that wanted to add another employee (from 500 to 501**) because the penalty or requirement to buy health insurance would then kick in. Now, remember, Republicans like our employer-provided health care system; they just don't want to penalize companies who choose not to provide health insurance, no matter what their size.
Paying for the system? Republicans have proposed amendments specifically prohibiting higher taxes or penalties or any other method that might be used to pay for the program in order to, according to them of course, keep Obama's promise not to raise taxes. Without these elements, the program becomes prohibitively expensive. So they could oppose the bill on the grounds that it will increase the deficit.
Republicans are sure that "free market competition" will solve the cost and access problems, but they object to letting the Secretary of HHS negotiate rates for a public plan. Why? Because it will inevitably lead to the Secretary's imposing reimbursement rates which is the problem with the Medi programs. Republicans worry a lot about what may happen in the future because "that's what always happens". One of their solutions is to set the rates of a public plan as an average of the rates in the state. That many states in the country have health insurance markets that are either monopolies or duopolies - where there is, in essence, no market pressure to reduce rates - is irrelevant.
And, of course, they oppose any kind of reimbursement system based on "best practices". So how do they expect to stop the huge annual growth in health care costs? Well, letting the "free market" work. I wish, just once, some Democrat would point out that we've always had a "free market" and it doesn't seem to have held down costs. (They might also point out that Republicans assured everybody back in the 1990s that HMOs would increase coverage and decrease costs.)
And, as usual, the Republicans continue to try to talk the bill to death. Yesterday, Coburn introduced an amendment to replace the entire bill that they have been arguing about for weeks. I think this must be at least the second or third time the Repubicans have tried this. And, each time, they argue their side for ages. (I've lost track of the number of Republican amendments that have consumed a full hour of debate each - and the number of amendments proposed and pending has reached, I think, somewhere into the 400s.) Obviously, a Democrat-controlled committee isn't going to junk a bill they've spent weeks on so the only reason for this kind of amendment is to prolong the process - past the August recess.
Indeed, I am baffled by the continuing efforts of Democrats to accept Republican amendments of any kind since they must know that they will not get a single Republican vote to move the bill from the committee to the floor. Is it possible that Democrats still just don't understand Republicans?
* - this committee, and, for that matter, the rest of the Congress, needs a CBO for statistics. Representatives and Senators on both sides of the aisle throw statistics around willy nilly, rarely providing a source. A lot of time, I suspect the stats come out of their own heads, based on their oh-so-good personal experience. I'm not sure it will help the Republicans who tend to ignore studies that contradict "what they know" (even after the CBO scored a revised bill as costing about 600 billion rather than 1.5 trillion, Republicans continued to use the latter number).
**Democrats can be really dumb. Whenever an issue comes up about what constitutes a small business, or what penalty makes sense, or the percent of poverty or whatever, a Republican will wax eloquent about the poor business or person who just misses the cutoff point (26 employees, 151% of poverty), etc. I keep waiting for some Democrat to point out that this happens whenever one uses a cutoff point for anything. Earning one more dollar in income can move a person from one tax bracket to another. Short of never using a cutoff point for anything, this lack of fairness is inevitable.
Wednesday, July 1, 2009
The Affordable Health Choices Act Should Be Called the PPIA
The Affordable Health Choices Act which the Senate's Health, Education, Labor, and Pensions Committee has been struggling with should really be called the Preserve the Private Health Insurance Industry Act or, in its shorter form, the PPIA (Preserve Private Insurance Act).
It is designed to provide access not to health "care" but to health "insurance". If you can't afford health insurance or you lose your insurance because you lose your job, or you choose the wrong insurance plan because you assumed you wouldn't suffer a major injury or a major illness - well, tough luck. You're uninsured and your access to health care has just disappeared.
In no other major industrialized country is it assumed that people have to estimate how much health insurance they can afford against the chance that they will get sick or injured in order to "guarantee" themselves access to health care.
As long as health insurance depends on sufficient income to buy it, and as long as plans have a trade-off between monthly premiums and deductibles and co-pays, millions of Americans will continue to be either uninsured or under-insured ... if for no other reason than the simple tendency for ordinary people to assume that nothing bad will happen to them.
As for the "public plan option", lambert at Corrente has come up with the perfect analogy: The Public Plan Option Explained By Lambert, at Corrente
It is designed to provide access not to health "care" but to health "insurance". If you can't afford health insurance or you lose your insurance because you lose your job, or you choose the wrong insurance plan because you assumed you wouldn't suffer a major injury or a major illness - well, tough luck. You're uninsured and your access to health care has just disappeared.
In no other major industrialized country is it assumed that people have to estimate how much health insurance they can afford against the chance that they will get sick or injured in order to "guarantee" themselves access to health care.
As long as health insurance depends on sufficient income to buy it, and as long as plans have a trade-off between monthly premiums and deductibles and co-pays, millions of Americans will continue to be either uninsured or under-insured ... if for no other reason than the simple tendency for ordinary people to assume that nothing bad will happen to them.
As for the "public plan option", lambert at Corrente has come up with the perfect analogy: The Public Plan Option Explained By Lambert, at Corrente
Wednesday, June 17, 2009
The Senate and Debates
In watching the endless opening statements of the Senate Health Committee (June 17, 2009) and the various speeches on the floor of the Senate, it is clear that the U.S. Senate is NOT a deliberative body. The Senators speak at each other. They never engage with each other.
The Republicans repeat the same phrases over and over (as do, of course, many Democrats). But they just spout, they don't argue or discuss. When a Republican talks about government bureaucrats interfering in the doctor-patient relationship, a Democrat can't ask that Republican about the interference of private insurance committees. Similarly, when Republicans deride Comparative Effectiveness, Democrats can't ask them about decisions made by clerks in insurance companies.
It may make these "debates" more civil, since we don't see the shouting matches all too common on TV, but it also makes them incredibly frustrating because there is no way for the observer to find out if there is any thought behind the boilerplate phrases.
The Republicans repeat the same phrases over and over (as do, of course, many Democrats). But they just spout, they don't argue or discuss. When a Republican talks about government bureaucrats interfering in the doctor-patient relationship, a Democrat can't ask that Republican about the interference of private insurance committees. Similarly, when Republicans deride Comparative Effectiveness, Democrats can't ask them about decisions made by clerks in insurance companies.
It may make these "debates" more civil, since we don't see the shouting matches all too common on TV, but it also makes them incredibly frustrating because there is no way for the observer to find out if there is any thought behind the boilerplate phrases.
Health Care Reform: Cheers for Bernie Sanders Who Confronts the Elephant
A huge big cheer for Bernie Sanders for being the only Senator on the Senate Health Committee, perhaps the only Senator or only person in either the House or the Senate who has had the nerve to address the invisible elephant in this debate: the fact that health insurance companies have only one obligation and that is to be profitable.
He had the courage to point out that health insurance profits over the past several years have increased over 400%, that their executives make huge salaries (one ex-CEO left with over 1 billion dollars in stock options), and that they hire armies of administrators to deny coverage.
Sanders is the only member of this committee who has also asked the fundamental question: is health care a universal right? Because one can't honestly evaluate a reform package without deciding if you believe health care is a right or a privilege or just a nice option.
Check Sanders out on C-Span - about the 40 min. mark
p.s. Sherrod Brown, Sen. of Ohio, gave a speech on the floor that was an extension of his comments in the committee. He had the courage to address the competition issues raised by opponents of a public plan. He pretty much made the obvious observation (I'm paraphrasing from memory) that if the private insurance companies can't compete with a public plan maybe it is the fault of the insurance companies.
C=Span Source
He had the courage to point out that health insurance profits over the past several years have increased over 400%, that their executives make huge salaries (one ex-CEO left with over 1 billion dollars in stock options), and that they hire armies of administrators to deny coverage.
Sanders is the only member of this committee who has also asked the fundamental question: is health care a universal right? Because one can't honestly evaluate a reform package without deciding if you believe health care is a right or a privilege or just a nice option.
Check Sanders out on C-Span - about the 40 min. mark
p.s. Sherrod Brown, Sen. of Ohio, gave a speech on the floor that was an extension of his comments in the committee. He had the courage to address the competition issues raised by opponents of a public plan. He pretty much made the obvious observation (I'm paraphrasing from memory) that if the private insurance companies can't compete with a public plan maybe it is the fault of the insurance companies.
Not surprisingly, the health insurance lobby has launched a massive campaign to prevent inclusion of a public health insurance option with which they would have to compete.
I guess competition is a good thing, unless they are the ones who have to compete. If you have a public option, insurance companies--the President says repeatedly that the whole point of [Page: S6703]an option is that the public plan will compete with a private plan, which will keep the private plans more honest. We have done that with student loans. Fifteen years ago, the only game in town for students, by and large, if they wanted to borrow money for college, was to go to a local bank, or another service, which were all private and unregulated. President Clinton, in the mid-1990s, decided maybe we should have a direct government program so students could borrow directly from the Federal Government. Do you know what happened? The banks brought their interest rates down. The banks started to provide better service. The banks behaved better. That is analogous to what we will see with the public plan.
The conservatives in this body, who are major recipients of insurance company money for their campaigns, whose philosophies are always that business can do it better, the people who have aligned their political careers with the insurance industry all oppose the public option, the public plan. Why? It is simple. It is because insurance companies will have to cut down their administrative costs, maybe even pay lower salaries to their top executives. Maybe they will have to change their marketing practices, be less wasteful, and maybe they will behave a little better. In that case, the public option was competing with private banks, and everybody got better. A public health insurance option competing with the private insurance companies will make everybody get better. That is the whole point.
With private insurance competition, when it is just the insurance companies competing with each other, funny things tend to happen. We see huge salaries and, second, a huge bureaucracy in the insurance companies and, third, we see all kinds of marketing campaigns, and we see huge overhead and administrative costs--sometimes up to 35, 40 percent.
We also see that the term ``private insurance competition'' is often simply an oxymoron. In Ohio, the two largest insurance companies account for 58 percent of the market. I am not a lawyer, so I didn't take the antitrust course. I didn't go to law school. When you have two companies that have 58 percent of the market, that is not competition. In some Ohio cities--as I assume it is in the Presiding Officer's State of Illinois--the two largest insurance companies account for 89 percent of the market. That is not exactly healthy competition. If we bring in a public option and compete with these two companies, their rates would come down and salaries for top executives would come down. There would be no more multimillion-dollar salaries, and administrative costs would be cut. They would be leaner and meaner, a better insurance company as a result.
C=Span Source
Thursday, May 28, 2009
When did "doctors" become "docs"?
During the various hearings on health care reform, my ear has been assaulted by the word "docs". When, exactly, did "doctors" become "docs"? No, I am not a doctor, but, quite frankly, "docs" seems to me to be rather insulting or, at least, condescending.
Kathleen Sebelius - unwilling to commit to anything
The other day I saw a rebroadcast (C-SPAN) of a hearing in early May, 2009 (Charles Rangel's committee) on health reform and it was yet another disappointment. The administration has no plan. Sebelius just wants to "work with Congress". Even on the issue of doctor-owned hospitals, which she has elsewhere condemned because they are not cost-effective (there's a real conflict of interest that encourages unnecessary and costly tests), she waffled.
Most of the things she talked about, like "encouraging" hospitals to implement checklists to lower infection rates, are fine - but there don't seem to be any sticks or carrots, for that matter. Who, for example, is going to make sure that insurance pays for outcomes rather than tests?
As with the credit card "reform" bill, all we are likely to see is more tinkering around the edges that will leave insurance companies with huge profits and citizens with too-expensive health care.
Most of the things she talked about, like "encouraging" hospitals to implement checklists to lower infection rates, are fine - but there don't seem to be any sticks or carrots, for that matter. Who, for example, is going to make sure that insurance pays for outcomes rather than tests?
As with the credit card "reform" bill, all we are likely to see is more tinkering around the edges that will leave insurance companies with huge profits and citizens with too-expensive health care.
Wednesday, May 13, 2009
Health Care Reform - And they said Hillary's plan was too complicated?
Well, I watched another hearing on health care reform yesterday, and it will take a bill at least a hundred pages long, and an army of administrators, to implement everything that is being suggested.
The elements of reform:
1. Build on employer health insurance because many companies support it. (Could it be because health insurance benefits are tax-advantaged and are, thus, less expensive to provide than higher salaries?)
2. Competition (except from a public plan). People admit that the current system is flawed but, when push comes to shove, they do not seem to fully grasp that we have had a free market, competitive health insurance system for 60 years and that is the system that is not working. They insist that this flawed system must be preserved.
3. Require or not that self-insured companies provide employees with choice by somehow associating them with health care exchanges. And what about the companies that offer only a couple choices?
4. Health care exchanges (or not). Weren't these the centerpiece of Hillary-care?
5. Pay for bundled services rather than for individual services. (And just who will implement or enforce this?)
6. Cap (or not) the tax-free status of employer-provided health insurance. Lots of ideas here: regional caps, income caps, phased in caps over x number of years so, eventually, the differences are based solely on different COLs. Grassley thinks this would be unconstitutional. Some witnesses pointed out that COL differences exist even with a single state. Arkansas doesn't want to pay for New York's higher COL (where, of course, everybody's salary or wages are adjusted upwards anyways). Who would design these? Who would be responsible for enforcing these? What kinds of changes would have to be made to the income tax rules? How about the administrative effects for multi-state corporations?
7. Incentives for best practices. Again, great idea - but who sets the best practices and who enforces them.
8. Use health savings accounts.
9. Health IT. Obviously, paper records don't make a lot of sense. But health IT is a lot harder to implement than many seem to think, to say nothing of simply being used (every time I go to Kaiser, I'm asked the same question about drugs I'm allergic to. I've provided that information at least a hundred times.) Data format and data definition issues can be extremely difficult to solve. In addition, as one witness pointed out, hospitals may not want record interoperability because that would make it easier for doctors to move patients from one hospital to another.
10. Put a "tax" on bad behaviors such as smoking or overeating.
11. Tax credits or tax deductions.
12. Rein in costs before expanding coverage.
13. Expand coverage before reining in costs.
14. The Massachusetts experience gets nothing but high marks, but I've read criticisms from Mass. doctors who would much prefer single payer. Not a word about those criticisms.
15. A public plan option? There is some support, but the key seems to be in making it so unattractive that private insurance companies won't lose any customers. (It seems not to have occurred to anybody in power that if a public plan option would attract citizens away from private insurance companies that maybe the problem is with the latter rather than the former. And that it is the insurance companies which should be expected to change their policies.)
16. Preserve (?) the ability of citizens to keep the doctors they like. Again, selective awareness operates here. Employees who lose or change their jobs often lose access to the doctors they have because their health insurance options change.
17. In all of these hearings, I've not heard a single word about the dozens of forms doctors must complete, the army of clerks they have to hire, the hours they must spend on the phone trying to get a procedure paid for. I've not heard a single word about the portion of a health care premium that goes to the insurance company's administrative costs (mainly for denying coverage), executive salaries, or profits.
18. American exceptionalism. Baucus insists that we need a uniquely American solution. (I think he read a New Yorker article). No witness has ever been asked to explain why European nations pay less for health care but get better results. Are Americans a unique species? Is it impossible for us to learn anything at all from the experiences of different countries? Except for some negative comments about Canada and England re those awful wait times, nobody pays any attention to any system outside the U.S.
I've no doubt forgotten some of the other requirements. But the key to all of this sturm und drang seems to be that private insurance companies must be preserved at all costs.
As I said in an earlier post, real health care reform is DOA. We are doomed to lots of tinkering around the edges that will not provide universal coverage and that won't reduce costs (except, of course, by denying coverage).
The elements of reform:
1. Build on employer health insurance because many companies support it. (Could it be because health insurance benefits are tax-advantaged and are, thus, less expensive to provide than higher salaries?)
2. Competition (except from a public plan). People admit that the current system is flawed but, when push comes to shove, they do not seem to fully grasp that we have had a free market, competitive health insurance system for 60 years and that is the system that is not working. They insist that this flawed system must be preserved.
3. Require or not that self-insured companies provide employees with choice by somehow associating them with health care exchanges. And what about the companies that offer only a couple choices?
4. Health care exchanges (or not). Weren't these the centerpiece of Hillary-care?
5. Pay for bundled services rather than for individual services. (And just who will implement or enforce this?)
6. Cap (or not) the tax-free status of employer-provided health insurance. Lots of ideas here: regional caps, income caps, phased in caps over x number of years so, eventually, the differences are based solely on different COLs. Grassley thinks this would be unconstitutional. Some witnesses pointed out that COL differences exist even with a single state. Arkansas doesn't want to pay for New York's higher COL (where, of course, everybody's salary or wages are adjusted upwards anyways). Who would design these? Who would be responsible for enforcing these? What kinds of changes would have to be made to the income tax rules? How about the administrative effects for multi-state corporations?
7. Incentives for best practices. Again, great idea - but who sets the best practices and who enforces them.
8. Use health savings accounts.
9. Health IT. Obviously, paper records don't make a lot of sense. But health IT is a lot harder to implement than many seem to think, to say nothing of simply being used (every time I go to Kaiser, I'm asked the same question about drugs I'm allergic to. I've provided that information at least a hundred times.) Data format and data definition issues can be extremely difficult to solve. In addition, as one witness pointed out, hospitals may not want record interoperability because that would make it easier for doctors to move patients from one hospital to another.
10. Put a "tax" on bad behaviors such as smoking or overeating.
11. Tax credits or tax deductions.
12. Rein in costs before expanding coverage.
13. Expand coverage before reining in costs.
14. The Massachusetts experience gets nothing but high marks, but I've read criticisms from Mass. doctors who would much prefer single payer. Not a word about those criticisms.
15. A public plan option? There is some support, but the key seems to be in making it so unattractive that private insurance companies won't lose any customers. (It seems not to have occurred to anybody in power that if a public plan option would attract citizens away from private insurance companies that maybe the problem is with the latter rather than the former. And that it is the insurance companies which should be expected to change their policies.)
16. Preserve (?) the ability of citizens to keep the doctors they like. Again, selective awareness operates here. Employees who lose or change their jobs often lose access to the doctors they have because their health insurance options change.
17. In all of these hearings, I've not heard a single word about the dozens of forms doctors must complete, the army of clerks they have to hire, the hours they must spend on the phone trying to get a procedure paid for. I've not heard a single word about the portion of a health care premium that goes to the insurance company's administrative costs (mainly for denying coverage), executive salaries, or profits.
18. American exceptionalism. Baucus insists that we need a uniquely American solution. (I think he read a New Yorker article). No witness has ever been asked to explain why European nations pay less for health care but get better results. Are Americans a unique species? Is it impossible for us to learn anything at all from the experiences of different countries? Except for some negative comments about Canada and England re those awful wait times, nobody pays any attention to any system outside the U.S.
I've no doubt forgotten some of the other requirements. But the key to all of this sturm und drang seems to be that private insurance companies must be preserved at all costs.
As I said in an earlier post, real health care reform is DOA. We are doomed to lots of tinkering around the edges that will not provide universal coverage and that won't reduce costs (except, of course, by denying coverage).
Health Care Reform - DOA?
During the past couple of months, I've seen Q&A with Sen. Baucus, Grassley, and Hoyer (on C-SPAN) - and it is clear that not only is single payer DOA but so is a Public Plan Option. Obama himself appears lukewarm in his support (with each new statement by Obama on health care, it appears that his minimum requirements become broader and less meaningful) - but then I don't think there is anything Obama is truly willing to fight for.
It looks as if we'll get the worst of all possible worlds: a mandate to buy insurance based on a poverty level that bears no resemblance to reality with cut-rate policies that probably won't be worth the premiums anyways.
What I find especially frustrating is that Democrats continue to echo Republican insistence that individuals must be responsible for their own health care (lose weight, exercise, etc.) but never say a word about how Insurance company administrative costs (8-14% not including what individual doctors must do to fill out dozens of forms for diff. companies) and profits (all those high executive salaries) contribute to high health care costs.
Oh, Grassley is also dead set against comparative effectiveness; he doesn't want doctors to be reimbursed based on "govt" guidelines. Again, I've heard no Democrat point out to him that insurance companies spend millions (billions?) of dollars finding all kinds of reasons to deny coverage.
It looks as if we'll get the worst of all possible worlds: a mandate to buy insurance based on a poverty level that bears no resemblance to reality with cut-rate policies that probably won't be worth the premiums anyways.
What I find especially frustrating is that Democrats continue to echo Republican insistence that individuals must be responsible for their own health care (lose weight, exercise, etc.) but never say a word about how Insurance company administrative costs (8-14% not including what individual doctors must do to fill out dozens of forms for diff. companies) and profits (all those high executive salaries) contribute to high health care costs.
Oh, Grassley is also dead set against comparative effectiveness; he doesn't want doctors to be reimbursed based on "govt" guidelines. Again, I've heard no Democrat point out to him that insurance companies spend millions (billions?) of dollars finding all kinds of reasons to deny coverage.
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