What if we do nothing on health care?
As I've written here before, the Democratic health care reform bill is a mess. In an interview with Bill O'Reilly this week, Jon Stewart called it "lobbyist gruel."
That's a pretty apt description, I think. Instead of coming up with fresh new ideas, Democratic leaders pandered and compromised until they had a bad bill on their hands.
But not passing this stinker of a bill might be worse than doing nothing. Here's the take-away from a Wall Street Journal piece published yesterday:
The impact of not reforming health care could be more dire than first thought. WSJ's David Wessel says there will be more people uninsured and greater costs to employers. As for reducing the deficit? Forget about it.The bottom line is that the status quo is no longer acceptable. Republicans may be right to oppose this bill, but they're wrong to suggest that we can afford to do nothing.
Conversation among Washington wonks, corporate chieftains and health-care executives isn't any longer about how "health reform" will work in practice. It's about what happens if nothing happens.
Last month, the Watertown Daily Times asked North Country Republicans for their views on health care reform.
Will Barclay repeated the GOP talking point that America "has the best healthcare system in the world."
Sadly, that's no longer true and every independent health care expert in the country will agree.
The numbers of uninsured are rising daily; we have the highest infant mortality rates in the developed world; and the system that most of us use is collapsing under its own spiraling costs.
Here in the North Country, we're likely to see nursing homes close this year, and hospitals will teeter on the brink.
It's hard to see a clear path forward out of this mess. But the Democrats, who control Congress, can take a couple of basic steps now.
1. They should buck their own special interests by incorporating good conservative ideas, including common sense tort reform and inter-state commerce.
2. They should implement profit caps on any insurance policies which Americans are forced to buy under the new law.
3. They should create a new, independent non-profit -- neither corporate nor government -- that can provide basic, low-cost health insurance.
4. They should jettison for now the public option.
Many of the other elements of the Democratic bill are non-controversial and would be widely popular with the American people.
Those pieces include first steps toward cost containment and reform of the most egregious insurance company behavior.
It's clear now that we won't get the 'big fix' this year on healthcare. But with the status quo crumbling around us, we need to make some progress.
As the Journal article makes clear, the alternatives are pretty dire.
posted by Brian Mann @ 2/04/2010 06:52:00 AM
29 Comments
29 Comments:
You suggest "They should create a new, independent non-profit -- neither corporate nor government -- that can provide basic, low-cost health insurance." But didn't Blue Cross used to be exactly that before becoming a for profit insurance system?
Jim - Yes, and one of the questions I'm still not clear on is why we allowed all our non-profit insurers to become for-profit.
-Brian, NCPR
Right on, Brian. I think one of the biggest challenges of our times is getting our government to be effective and efficient at standing up to entrenched business interests when it is in the interest of the public. Allowing business to flourish is important--but not at the expense of our society at large.
Health care is priority number one--over banking, finance, and energy--because it is such a basic need and it's so far out out of wack.
It IS the best health care system in the world if you have access to it and money is no object. In other words, it's great for a tiny percentage of the population.
In the absence of the public option, the Dems' "reform" bill does little to address the main problems with health care: lack of access and skyrocketing costs. They tout the elimination of pre-existing conditions but what kind of difference will that really make? It wouldn't prevent insurance companies from systematically denying claims for no reason in the hopes that people would be intimidated from pursuing it. It wouldn't prevent insurance companies from dropping people from coverage when they get seriously ill. In a way, it would be worse. People would be paying premiums but not getting the benefits. They'd be paying for nothing.
The system is controlled by the money changers (insurance companies), not the consumers, not the deliverers of medical services. The money changers are taking a 30% or cut more cut ever dollar in the medical system. It is in their profit interests to pay out as little as possible. Until this reality changes, the health care system will remain fundamentally broken for the actual consumers.
And unlike most other consumer markets, most people don't have a real choice of health insurance. It's what their company provides or nothing... health care on the "open market" being far too expensive for most people.
Brian M,
--They have jettisoned the public option. The Senate wouldn't have it.
--Define "common-sense tort reform." Many states have done a version of this, including things that may not be common sense, like capping malpractice awards at $250K. It's not the silver-bullet cost-reducer that it's often portrayed to be.
"...According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That's a rounding error..."
Also, there about the same number of malpractice claims today as in the late 1980s. The cost of health care has doubled since then. And there's a declining rate of lawsuits relative to numbers of injuries.
--What Jim said, above.
A good post, and you're right. Passing the Senate bill now, flawed as it is, still insures tens of millions of uninsured, and it gives successful state experiments like the Vermont outpatient model a national venue. But you initially said they should kill the bill and start over.
There is no starting over.
You could have avoided that trap by reading some of the back and forth on the lefty blogs and at Ezra Klein.
Less Politico in your diet may be healthier:)
I actually don't think tort reform would do very much at all to reduce health care costs.
But as a nod to the political realities, a concession on this point makes sense.
--Brian, NCPR
Brian M., I agree. Tort reform is not a bad idea, just not a major one. The major problem is the fact that there is a middleman taking a 30 pct or more cut and who maximizes that profit by denying service to those who need it. Any other reforms may or may not be good ideas in and of themselves but are just nibbling around the edges.
"But with the status quo crumbling around us". Health care reform seems to be the democrats version of "9-11". You remember how Giuliani was always bringing up 9-11 when he was trying to scare someone into buying some of the things we needed to do to stop the "terrorists from destroying the country". It has to be done now we can’t wait! Get Colin Powell down to the UN with the power point slides.
Take a breath. We can fix many of these problems. We just need to go about it the right way. We need for our president to understand that this current approach isn't working. Brian, you seem to be mirroring this misunderstanding when you say doing anything now is better than doing nothing. He didn't get the message from the 90s. So he wasted a few more years by trying to put together some humungous bill that would never hold water. Mistake made, and I think now admitted to. So what does he do when he jumps back on the stump yesterday? He starts touting the same poisoned package, and in the same speech he talks about how things were “snuck in there” that probably would negatively affect those currently insured? Who “snuck what in”, its gotta be his guys if something got snuck in there. Is this just his political inexperience showing through? The presidency and congress are still controlled by the democrats. (Despite their 59-41 “minority” in the senate!). I suggest they start about working on the smaller details that will eventually add up to the bigger picture. If they don’t show some form of success in bringing costs down and at the same time not affecting those currently insured than they were bound to fail either way. This bill is toast, give it up. They blew it, move on and start doing the work of the people. Brian here is the same article where you suggest tort as a good step you dismiss it as really having no effect. What up? So it’s one percent. You do 49 more things and you have solved half the problem. Do 19, don’t you think a 20% drop in the cost of HC is substantial? Despite what the WSJ says the problem can be solved. It won’t be solved soon if the folks in charge continue to go down a dead end road.
Paul,
So if we adopt your suggestion, we will have spent 45 years (since Medicare and Medicaid) to address a whopping 1 pct of the problem. Sorry if I don't think that's good enough...
The momentum for such an effort only comes about once every 15-20 years. Nibbling around the edges won't make a difference for most people.
Republicans have already made it clear, explicitly, if I remember correctly, that they are basing their 2010 campaign on preventing Obama and the Dems (of which I am NOT one) from having any accomplishments to claim, even if they were part of it. They've already illustrated this by voting against something they used to support (pay as you go budgeting). Why do you think they'd go along with even your exceedingly modest suggestion?
Posted this on another thread, but it's still true:
http://jamesfallows.theatlantic.com/archives/2010/02/why_bipartisanship_cant_work.php
Brian says, "It IS the best health care system in the world if you have access to it and money is no object."
First of all, I agree that our health care system IS the best in the world. Private enterprise made it so.
Your second claim that you MUST have money to access it is ludicrous.
Who can't (legal or illegal citizen) walk into an emergency an get treatment??
Programs are in place to cover everyone up to 25 years old and over 45 years old.
Tort reform, health savings, and taking away mandates are MAJOR items of reform.
There is one thing that will ruin our health care system for everyone - allowing the government to run it!!
You can walk into the ER and get care. But this causes problems in itself. First you do indeed get a bill usually for a large amount of money. One visit to the ER can cost thousands of dollars, especially if there are tests of any kind. I don't see how this makes healthcare affordably available to people without insurance.
We have 45 million uninsured people, and that number is increasing.
JDM said:
"Programs are in place to cover everyone up to 25 years old and over 45 years old."
"There is one thing that will ruin our health care system for everyone - allowing the government to run it!!"
What planet do you live on JDM? Pray tell, the only programs that come close to covering these populations are, what?, GOVERNMENT PROGRAMS!
They have their flaws and could be improved, but the VA and Medicare are existing models with worthy track records that offer rational starting points for discussing sound improvements.
Still, we face a seemingly impenatrable swamp of conflicting political ideologies when it comes to healthcare. Why are we fighting over the whole enchelada or nothing? Why not simply parce out the portions of the existing proposals that everyone "says" they agree on, and vote on those? Call the bluff of the obstructionsists and at least get somethng done.
Anon: from planet JDM.
My point is that these are indeed government programs.
Apparently they're not working. So, let's do some more of them.
No. Let's fix what is broken.
Working models - VA and Medicare? On what planet do these work well?
Oh, and it's not 45 million even if you count the 12-20 million illegals. But why would you count them?
Medicare is rife with fraud and inefficiency, the VA was letting our guys rot in filthy conditions and to this day refuses to treat many of our vets. Not exactly a sterling record. Of Megs 45 million uninsured how many are illegal aliens, people who could be insured but prefer to use the money elsewhere, people who are self insured, people who just don't want it but pay their own way? Of the remainder how many just don't bother to seek insurance? My oldest boy had a chance at insurance and turned it down till I pressured him into it. To a 20 year old insurance isn't the concern it is for Dad, and he wanted to use the money for other things.
Give us some options other than creating yet another giant, ineffective bureaucracy and reaching deeper into our pockets. I don't see anywhere in the Constitution or BoR where it says the gov't has the right to force a citizen to purchase something he doesn't want. At the state level things change and maybe that's where this should be handled.
The VA was bad in the 70s, improved greatly in the 90s, then got bad again in the 00s. Depended on who was running the show.
Brian,
I don't think you understood my comment. So Tort reform fixes 1%. Now we find 49 more things (or some set). That fixes half. Piecemeal is the only way that both sides can accept. Taking on the "whole" deal is simply not working.
and the government option breaks the 50% that is working!
Follow the money. All you need to know is the millions of dollars that have been given to lobbyist by groups that want to stop change. And it seems to be working.
Empire Blue Cross/Shield went profit in the 90s ..[health care economics 101..government regulations were lifted and marketplace forces took over..]
it was the same with Banking regulations and that fiasco..
Republicans will continue to defend the indefensible, it is money in their pocket. And they know full well that the rising cost of the present system far outstrips the cost of the new health care proposals....
Even the CBO has said it would have saved $123 billion over the next ten years. I guess conservatives and Republicans do not think that is a good idea..
Anon said,
"Even the CBO has said it would have saved $123 billion over the next ten years. I guess conservatives and Republicans do not think that is a good idea."
Republicans and Conservatives who stare down the CBO do so, not because saving $123B in 10 years isn't a good idea, they simply don't believe it.
The CBO has rules it must follow in its evaluation. The structure of the health care plan is purposely skewed to get a favorable CBO rating.
Think about it. Collecting revenues for 10 years, and spending for 7 years is the trick that was used to get the favorable rating. Beyond that (i.e. the "second 10 years") is a worthless guess at best.
Liberals, Progressives, and Democrats have trouble pointing to a government run success story. i.e one that saves money after running 10 years.
Anon: "Liberals, Progressives, and Democrats have trouble pointing to a government run success story. i.e one that saves money after running 10 years."
Conservatives and Republicans have trouble pointing to a private run success story with Health Care.
A little research will show you that once Empire blue Cross went private, it went from covering 11 million people to 4.4 million, the cost rose exponentially and so did their profits. Four times higher than other health care providers.
Research what is happening in California with their version of blue cross and you may change your thoughts on who would do a better job. To qoute the CEO in California " We will not put membership ahead of profits"....Glad you think the system works so well. Follow the money...Private Corp. are no better than Government run Agencies, but their leaders sure do make a lot more.. Just look around at all the poorly run businesses. And they are..
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Cool. Spam...
I like Medicare for all. Everyone who currently receives platinum plated benefits - Medicaid recipients, government employees, Wall Street executives, and, yes, school teachers - all paid for by us taxpayers, by the way - would be in a health care plan that actually requires co-payments and deductibles. And, everyone would be covered.
Pardon me, but I worked and earned my health care payment for my retirement by not using vacation time and selling that time back to the State ( at whatever rate they gave me)at the end of 23 years service. I also pay into it each month because no told me I needed 1340 hours of vacation time to cover my retirement insurance costs until I had 20 some years on (yeah, I missed that some place) and I only had 1200 something. I also make co-pays on every visit, for every prescription and don't have eye care or dental. That's 1200+ hours I worked and you would seize that? Sorry, I'm a bit troubled by that. If someone earns something the State has no right to deprive them of that post facto in my view. 14th amend. I think? (???) New hires or different contracts is another thing, but it's fundamentally unfair in every sense I can think of to punish someone currently retired when they fulfilled their contract. I believe one of the airlines did something similar and Enron did too, decidedly not kosher IIRC.
Now if you want to tell me my Social Security payment isn't going to be what those nifty flyers I get every year tell me....I'm only 50, I have no expectation it'll be there since LBJ started raiding it many years ago. Have at it.
What about the not-for-profit cooperative model? I recall that there was a senator, I think from one of the midwestern states, that mentioned the idea early in the health care debate, but I haven't heard anything since. It certainly works in banking as the credit union movement is stronger than ever and it works with some types of insurance, just check out USAA. They provide terrific products and services at lower cost.
Like credit unions, the health insurance cooperative could be set up for persons of modest means to cover the group that is uninsured now. Granted, many others would probably want to belong just like what's happened with credit unions. Buteven with credit union "advantages"... banks still hold something like 94% of all the assets while credit unions have about 6% I think... at least that's what the guy at the CU told me.
I guess the insurance companies would hate this just like the banks hate credit unions so this probably won't even be looked at.
Interesting idea CJ. I personally would be interested in hearing more about it. Anything that avoids another Gov't bureaucracy and higher taxes is worth listening to.
The con I anticipate hearing is "they can't afford it". Well, the taxpayer can't afford to foot the bill for everyone and everything, so maybe this is worth investigation.
Idea was chewed on last year, quite a bit. Has some drawbacks--never been proven on a large scale, and to be effective, it would need a lot of govt startup money. So you'd be creating another bureaucracy, with a lot of federal money. It just wouldn't be a "government" bureaucracy. It would be something like Fannie Mae maybe?
http://www.businessweek.com/bwdaily/dnflash/content/aug2009/db20090817_928400.htm
"And while they would not be government controlled, the federal government will probably need to provide startup funding, such as the low-interest, long-term loans that were provided to many rural electric co-ops that have since become independent. Otherwise, Hazen says, "you're not going to have the same ability to negotiate on health services as the national providers." One of three versions of the House bill includes $6 billion in seed money for the co-ops."
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