This is a long piece, but a very interesting analysis of the problems of health care economics that no one is really talking about. The author isn’t necessarily hostile to the reform proposals and hopes they will do something positive; he just thinks there are deeper problems. His focus is on distortions in the doctor-patient and hospital-patient relationship driven by the insertion of the insurance agency (whether private or government) as the intermediary that pays the bills, which stops the patient from acting like a price-sensitive consumer or being treated as a customer entitled to customer service.
Here’s how the editors introduce the piece:
After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.
This analysis surprised me, as someone who was inspired to mock Sen. Nelson for believing the Baucus proposal has any value at all. Krugman writes:
There’s enough wrong with the Baucus proposal as it stands to make it unworkable and unacceptable. But that said, Senator Baucus’s mark is better than many of us expected. If it serves as a basis for negotiation, and the result of those negotiations is a plan that’s stronger, not weaker, reformers are going to have to make some hard choices about the degree of disappointment they’re willing to live with.
Of course, those who insist that we must have a single-payer system — Medicare for all — won’t accept any plan that tries, instead, to cajole and coerce private health insurers into covering everyone. But while many reformers, myself included, would prefer a single-payer system if we were starting from scratch, international experience shows that it’s not the only way to go.
Max Baucus said yesterday that “We have the votes, it can pass the Senate.” and everyone is talking about only 59 Dems. Well….I have a possible clue. Senator Mel Martinez of Floriduh recently resigned and his seat was filled by Republican Governor Charlie Crist’s ex-cheif of staff, George LeMieux. He was sworn in on last Thursday. LeMieux is place holding for Gov. Crist who will be running for that Senate seat next year, and will not be running himself.
Health care: LeMieux praised President Obama’s call for insurance exchanges but said the overall cost, about $900 billion over a decade, was troubling and avoided answering a question about a government-run insurance plan, which is abhorred by Republicans.
But in our own Friday Sun-Sentinel there was an article headlined “LeMieux backs key Obama proposal after swearing in” by William E. Gibson. I have the actual paper but can’t find the article online. But what it says is he has a willingness to reach across the aisle, thought the exchange idea was like Charlie’s Cover Floriduh! Plan (find an interesting review of it here http://www.dailykos.com/story/2009/6/23/172150/659 ) , didn’t know if he would support a government supervised insurance plan to compete and was concerned about cost going over $900B.
It’s just a thought, but amazingly possible since LeMieux will not be running for anything next year and is beyond corrupt. And the Baucus bill came in at $880B. This could be the 60th vote Max says he has that’s flying under everyone’s radar.
Would anyone be surprised if it just might be Floriduh, AGAIN, that takes down this country?
I wrote you a couple of days ago, trying to state in a positive way my hope that you would provide some constructive leadership in search of meaningful health care reform. But … what are you thinking? You’re calling the proposal from Sen. Baucus “a good start,” when it is shaping up to be the bill no one from either party can support?
Why would you back a plan that appears to be nothing but a gift to the insurance industry? One that does so little to contain costs and so much to increase the burden on middle class families?
Some of my liberal friends assume you’re a shill for the insurance industry, in which case I may be wasting my time writing to you. I’d like to believe you have honest concerns about driving down the costs of the plan that ultimately emerges from this process and prevent it from inflating our nation’s deficit. If so, fine, fight to make sure that what ultimately passes is a fiscally responsible plan.
But please don’t stand as a roadblock to legislation that would use a public insurance option as a way of driving down costs. No one has presented a co-op program or other compromise that would have the same impact. And no government plan is going to be so generous that it will put all the insurance companies out of business. They will do just fine if they show they know how to deliver actual value to their customers.
Instead of starting with the Baucus plan, take one of the public option bills and be a hero by making it more responsible. If there is pork buried in those thousands of pages of legislation, expose it. If you have other ideas about how to make the numbers work, make your amendments.
But don’t come out the other end of this debate as one of the people who supported a reform that was worse than no reform at all.
Update: Reply I received on Sept. 18, presumably a form response to everyone who has complained
Dear Mr. Carr:
Thank you for contacting me about health care reform. In his recent speech to Congress, President Obama also provided us with a clearer view of his desires for health care reform.
What the President described is pretty close to the draft of a bill I’m helping prepare as a member of the Senate Finance Committee. This legislation will let folks who are happy with their insurance keep what they’ve got, including veterans and seniors on Medicare. It will also create State-based exchanges – a nationwide marketplace – where those without coverage, or those who are unhappy with what they have, can get it at an affordable price.
The bill will hold insurers’ feet to the fire, requiring them to cover everyone and preventing them from dropping someone who gets sick. Additionally, it contains several measures aimed at reducing overall medical and prescription drug costs and eliminating waste and fraud in the system.
I plan on improving the bill through amendments that will, among other things, help pay for reform of our health care system. One of my amendments would require drugmakers to provide rebates to Medicare, just like they do for Medicaid. This would save Medicare a ton of money and help reduce out-of-pocket prescription drug costs for many seniors. Further, by eliminating the tax break drugmakers get for TV and other advertising, we would see another $37 billion to pay for health care.
Regardless of where anyone stands on the specifics, I think we all can agree that the system we have can be unfair and too costly, and needs to be fixed. I appreciate hearing from you on this important issue. Please don’t hesitate to contact me in the future.
Senator Bill Nelson
So, Congress has decided that you can afford to have at leat 13% of your income taken to pay for private health insurance (never mind auto, home,etc.). You can count on the coverage for that 13% being basic (bottom) tier “junk insurance” that leaves you underinsured, and certainly not the comprehensive coverage tier at the top. Add to that, only a 65% reimbursement rate… you pay 35% of ALL costs. And that’s just to start. Wait a couple years for the “necessary increase” lobbying to begin.
Who on earth would support that kind of deal??? (besides our elected “representatives”)
If Business Week,(“The Insurance Companies Have Already Won” http://www.businessweek.com/magazine/content/09_33/b4143034820260.htm?chan=magazine+channel_top+stories , page 5 is really sick ) a pro-business publication, says it smells to high heaven, it HAS to give you pause. And we’re not even touching on the back door big pharma, AMA, etc., deals. This is corrupt beyond human comprehension.
Okay, 13% of income off the top is quite a hit but a little less than what some, not all, people that currently have insurance pay now. But what about the people that have no insurance because they already can’t afford it? That was how this all started to begin with. Then you should consider that the recommended maximum percentage of income you’re supposed to dedicate to shelter is 33%. Add those together and 46% of your income is gone before assorted taxes (property, sales, etc.), food, gas, other required insurance (home, auto,etc), car payments, clothing, auto repairs, home repairs & improvements, electricity, water, cable, internet, phone, credit cards, savings (hahaha), etc. Then count deductibles PLUS 35% of ALL costs. Paid mandatorily, under penalty of law & the IRS. And everyone in America is okay with this??? Probably not, but they’ve had no idea (as I keep saying) what they’ve been fighting for. This is not healthcare reform. This is legislated, mandated, financial mass suicide of a nation already on life-support.
TRUE single-payer, which is comprehensive, is estimated at 2.3-3% in the form of an across the board payroll tax. Which means 5% by the time congress would get done with it. No deductibles, coverage tiers, employer mandates or cost sharing. If you breathe…you’re completely covered….DUH! You can go to any doctor you want because EVERY DOCTOR IN AMERICA WOULD BE PARTICIPATING. The most expensive level of payroll tax for single payer in any other nation is 7%. Still half the price of what’s being proposed by “our” congress and it’s not even comprehensive. Do you think maybe that’s because private for-profit insurance companies are involved here? Could that be it?
Since it has been made abundantly clear that they have no problem financially destroying us, we should have no qualms with removing them. Both the for-profit insurance interests and their legislators. These “representatives” are certainly not ours.
Think for a second what that extra 8+% savings could do, being recirculated through the economy. To say nothing of the $350-400 billion in admistrative cost savings from the status quo by streamlining the payment mechanism from all sorts of different companies to single payer/Medicare-for-All. Even better…our businesses would not be weighed down with health insurance reponsibilites or penalties, which would be HUGE. They could hire more people…who would get paychecks and spend them, driving the economy forward (and those paychecks also generate more tax revenue) and be able to compete again with industry from other countries….if only we weren’t the “uniquely American” morons of the planet.
Instead, with a little help from the scumbags (I’m sorry, I meant corporations) and Saint Obama, we Democrats have convinced ourselves we can’t have it because it would be too “disruptive”. Nevermind that every other civilized nation in the world had the same “system” of private insurance before and still mananged to survive the “disruption” of switching to single payer so that their citizens and businesses could survive. But we’re fighting for a “reform” that is nothing but the privledge of paying Big Insurance en masse. WHY???? We don’t need to worry about the teabaggers, we ( dems) are the ones truly sabotaging our futures by supporting this “reform” that benefits no one but the Medical-Insurance-Pharmaceutical Complex and silencing members of our own party that wish to fight for the civil/human right to healthcare.
“Make a law, make a business”—Catherine Austin Fitts
I’m now given to wonder, if this “reform” passes and it passes without a functioning national “public option” of any sort, is this constitutional?
And will tort reform, being included in this vile, stinking pile of rotted, maggot-infested ethics masquerading as “reform” , somehow prevent a massive lawsuit based on constitutionality?
There is not a single law in existance that mandatorily requires, under penalty of law and/or IRS penalties no less, that a product be purchased from a private business without any alternative choice. Auto insurance? Not if you don’t own a car. Homeowner’s? Not if you don’t have a mortgage. Make no mistake, this will be a tax mandatorily payable to private industry. I believe that is illegal. It has to be. If it wasn’t, the private interest sector would have already pulled this.
While I am NOT in any way a supporter of “the public option” because I feel it is a useless red herring being used to herd the masses into this horrendous corporate rape of our nation’s individuals and businesses, it does seem to me that the only thing that would make this actually legal and enforceable is if there was a FUNCTIONING, national, public option (it has already been explained why the option, the way it is written, cannot actually be implemented, chicken & egg http://pnhp.org/b/log and http://www.healthcare-now.org/bait-and-switch-how-the-“public-option”-was-sold/ ,under “Put Yourself in the Public Option Director’s Shoes” and also http://www.rollingstone.com/politics/story/29988909/sick_and_wrong/1 ) available in every state and every “market”. Which, by the way, President Obama didn’t say it would be…or that it would happen at all. In fact, he said if it existed, it would only handle 5% of the population and would possibly be only available in markets where there was an overwhelming monopoly.
“The law allows what honor forbids.”—Rita Mae Brown
If any form of the “public option” (or co-ops, which will be presented to us as a form of “public insurance”!) survives, it will survive in name only as a legal tool to to make this mortally destructive “reform” legally enforceable. That very same option everyone begged for may just be what nails us to the wall.
I say ENOUGH! Quit screwing around with “hoping” and official OFA and supporting the “mainstream” Democratic Party’s proscribed posistions. They DO NOT have our best interests in mind.
If you’re going to fight for something, fight to support HR 676, the single payer/Medicare for All amendment. It’s an actual proven answer and not a “uniquely American” corrupted theory.
But first and foremost fight to kill this horrific atrocity being called “reform” before it can become law. It is insanely corrupt and mortally dangerous to the future of our citizens and businesses. If we can prevent this incarnation from becoming a reality, then we can come back and push again for a more sensible system after mid-terms. If we can’t kill it now, we’re stuck with it for at least two major election cycles. An enormous amount of damage can be wreaked between now and 2016.
“If you will not fight for the right when you can easily win without bloodshed; if you will not fight when your victory will be sure and not too costly; you may come to the moment when you will have to fight with all the odds against you and only a small chance of survival. There may even be a worse case: you may have to fight when there is no hope of victory, because it is better to perish than to live as slaves.” — Winston Churchill
“Americans can always be counted on to do the right thing…after they have exhausted all other possibilities.”—Winston Churchill
Thank you for your email on the important subject of health care reform. I hope you will prove to be one of the leaders in making real reform happen. I often see you mentioned as one of the Senators who may not support the public option, but everything I have read about the issue leads me to believe this is the most effective tool available to “keep the insurance companies honest,” as the President says.
I think it is good that President Obama has signaled that he will not be dogmatic on this issue, and that he is willing to listen to other ideas. But it seems to me we need to have a little more confidence in the strength of our free market economy. There should be room for insurance companies to compete with a basic government insurance plan by offering better service or more complete benefits, while also bringing down their pricing.
If your concern is with the deficit, by all means please fight to make the plan that passes a fiscally responsible one. Obama advocated some mechanism for triggering cost cuts if promised savings do not materialize. Hold him to that! If he wants to keep the insurance companies honest, there is no reason the Congress and the American people can’t keep him honest, too.
But please do not let the solution be a continuation of the status quo, or some bastardized compromise that makes no one happy.
You will win tremendous good will by making sure to pass a reform that makes a real difference.
Government does not just reflect the community that it serves. As is natural, government also therefore sets the tone for the economy and also reflects the social mores of that community. On Thursday, you sat and listened to many voices speak of the pain and suffering that will be imposed upon them, not by the hard economic times, but by the decisions that you are about to make.
Government does not just reflect the community that it serves. As is natural, government also therefore sets the tone for the economy and also reflects the social mores of that community. On Thursday, you sat and listened to many voices speak of the pain and suffering that will be imposed upon them, not by the hard economic times, but by the decisions that you are about to make. That must have been very difficult.
It is not the responsibility of the County Commission to protect the people from taxation. You are the taxing authority. Your first obligation is not to meet some promise or unrealistic mandate for a tax reduction; not if that policy will cause suffering, damage the fabric of essential county services and promote an economic deterioration of the county. It is your responsibility to raise the funds necessary to ensure the efficient operation of government. To do otherwise is poor governance and, by causing people to suffer, just not the ethical path.
Your current budget plan promises to cost people their jobs, terminate careers, perhaps even cost people their homes. When you privatize and put out county services for bid, you promise higher costs and a lower quality of service in order to pay for profit margin while costing our workforce the model of decent wages and economic security. Your budget will close opportunities for study, literacy, rehabilitation, reduced recidivism through tried and effective programs, services for the homeless, the elderly, the disabled and for children will suffer. Your employees will pay for the means of keeping those taxes low by individual sacrifice. Arts and culture will lose, not just at the government trough, but in their ability to survive in a community that understands the message of economic crisis and discouraged investment in ourselves.
When the decisions that you make
- will cause such widespread harm and suffering;
- will reduce our ability to maintain a safe and wholesome community;
- and will encourage a stifling of economic activity
Is the decision to raise adequate revenues to prevent these consequences really so hard? Yes, you may lose a few votes to people who only know to count the change in their pocket. How many votes will you lose by failing to do what is right? And who will invest in a county that fails to invest in itself?
There are a lot of great grassroots events being organized now on the Organizing for America (my.barackobama.com) website, and I’ve decided to automatically add them to the BlueBroward.org Calendar. This is an attempt to make the calendar as comprehensive as possible.
I did something similar during the last months of the presidential campaign, and I think the current campaign for health care reform is just as important. This means that if you post something to the OFA website, it’s not necessary to also post it to BlueBroward. The script to pull the latest updates from the OFA site will run every morning at 7 a.m., so your OFA events should pop up on BlueBroward the day after you post them to OFA.
For anyone interested in the details:
I’m taking an RSS feed from the OFA website, using their zip code lookup feature, so I pull in all events within 50 miles of a zip code that’s roughly at the center of Broward County. The lookup looks like this. I parse the data using the MagpieRSS utility and feed it into the BlueBroward database.
|Alan G. Ehrlich <firstname.lastname@example.org>|
PLANTATION DEMOCRATIC CLUB
The People’s Club – Serving the Community
and among the guest speakers will be
Tony Fransetta, President of the Alliance for Retired Americans.
Their remark will be followed by a question and answer period.
Refreshments will be served.
This Meeting will be at the Lauderdale West Main Clubhouse,
1141 Lauderdale West Drive (NW 85 Avenue), Plantation, FL 33322
(Between Sunrise and Cleary, just west of Pine Island Road.)
Also, don’t forget the Pot-Luck Lunch/Rally/Meeting on Health Care Reform
at the Jim Ward Community Center on Saturday, September 12th!
Robby Donaldson, Organizing for America Field Director for Broward and Palm Beach,
will discuss how we can all help to bring about real change.
Remember: Saturday, September 12, 2009 at 1 PM sharp!
301 NW 46th Avenue (954-585-2344)
Plantation, FL 33317
(The Center is just a few blocks to the west of State Road 7,
and a few blocks north of Broward Boulevard.)