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Tilting at Windmills

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January 23, 2008
By: Kevin Drum

UNIVERSAL HEALTHCARE....Ezra Klein has a very good piece in the American Prospect this month about why Bill Clinton's 1994 healthcare bill failed and why a repeat performance next year might not. I'm not usually very optimistic about the chances of getting a good healthcare bill passed in the near term, and Ezra's piece is the the first I've read in a long time that made me think there might be hope after all. Here's a taste of his argument:

First, the moment is more amenable to reform — in part because the reality has worsened...."My personal index," says Len Nichols, director of the New America Foundation's health policy program, "is the ratio of family premiums to median family income. In 1987, it was 7 percent. Today it's 17 percent. That fundamental dynamic, that health care costs are growing so much faster than economic productivity, means that even though unemployment is so low and the macro-economic indicators are good, there's still intense, acute anxiety."

....Business also seems exhausted by the ceaseless march of health care costs and ready for reform....The Divided We Fail coalition, for instance, not only includes SEIU and AARP, but the Business Roundtable and, more surprisingly, the National Federation of Independent Business, which was militantly anti-reform in 1994....[Senator Ron Wyden's healthcare bill] is cosponsored by six Republicans: Robert Bennett, Judd Gregg, Norm Coleman, Lamar Alexander, Mike Crapo, and Chuck Grassley...."I think we're building the sort of coalition that can break 60 years of paralysis," says Wyden.

There's more, too: Democrats are far more unified than they were in 1994. The healthcare plans on offer from all three presidential candidates are politically much savvier than Clinton's. Unions are on board. And new groups like MoveOn, which didn't even exist a decade ago, are around to help lead the fight as well.

The whole thing is worth a read. It might restore your faith in our ability to get something genuinely worthwhile done next year.

Kevin Drum 1:46 AM Permalink | Trackbacks | Comments (65)

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Comments

Lemme know whan you have a strategy for getting Medicare recipient/voters on board for more rationing than what they currently experience. The are the most powerful constituency, and they have things pretty damned good right now.

Posted by: Will Allen on January 23, 2008 at 2:20 AM | PERMALINK

It might restore your faith in our ability to get something genuinely worthwhile done next year.

Next year? Perhaps you forgot there's the whole Iraq issue to work through. If that doesn't take up most of the Beltway denizens' time I'll be genuinely shocked.

Posted by: F. Frederson on January 23, 2008 at 2:28 AM | PERMALINK

Medicare costs are out of control. The plan is entirely unaffordable. (One excuse offered for not balancing Social Security is that Medicare is a bigger problem. However, we're not fixing Medicare either. In fact, nobody seems to have any idea how to fix it.)

Medicare does good things for people, but it's a financial disaster. If we extend something like Medicare to all ages, we will have a bigger financial disaster.

Posted by: ex-liberal on January 23, 2008 at 3:15 AM | PERMALINK

Dear ex-liberal,
I guess Americans are stupid. The rest of the first world has health care that costs less and does better than ours. Why are Americans so incompetent at providing themselves with health care? We used to be good at this stuff.

Posted by: Lucy Beloungy on January 23, 2008 at 4:00 AM | PERMALINK

I'm still looking for an explanation for how the "universal mandate" scheme is supposed to be palatable to voters. It basically says to voters "if you [think you] can't afford health insurance, our solution is to force you to pay for it." And for a lot of middle-class voters who technically can pay for it, but who have set their priorities elsewhere (bigger houses, newer cars and trucks, bigger TV screens, etc.) or who have unavoidable major expenses (debts from having kids in college, existing medical bills) or who have had recent financial troubles (mortgage payments adjusting upwards, a period of temporary unemployment) the added cost of mandatory health insurance is a crunch that they're not going to shoulder easily or happily.

Obviously it's fine for those who are financially well off, but they're not typically the ones who are going without health insurance in the first place. And for those poor enough that they obviously can't pay for it, there would be some assistance. But that's not enough of a base to get voters to embrace the idea.

And another thing I don't understand about Democratic enthusiasm for a universal mandate is why it wouldn't be preferable to pay for it with a progressive tax. Is it just that the Repos have so thoroughly intimidated the Democrats that they don't dare utter the words "tax increase"? Is the idea of "mandatory payments" so much easier to sell?

Are there any other countries that have taken this approach? One of the comments above talks about how the rest of the world has health care that costs less and does better than ours. Do any of those other countries demonstrate a precedent for paying for it by universal mandate?

Posted by: bobb on January 23, 2008 at 4:14 AM | PERMALINK

This is not a technical problem, it is a political problem. America, the most powerful nation on the planet, can certainly afford universal heath insurance if it wanted it. Eventually, it will want it. But the forces opposed to universal health insurance are powerful and the public continues to buy their appeals to ignorance and fear.

When the political battle is won, the technical problems will be addressed and America will be a healthier place.

Posted by: Joel on January 23, 2008 at 7:08 AM | PERMALINK

bobb, that's got to be the most brain-dead analysis i've ever read on why we shouldn't reform how we pay for health-care in America.

Posted by: Auto on January 23, 2008 at 7:12 AM | PERMALINK

I don't think there is any mystery as to why Clinton's 1994 health care initiative failed - it ran into the largest private propaganda campaign in history. The health insurance industry, which really has no reason to exist in the first place as they are merely blood-sucking middlemen who produce nothing, torpedoed Hilarycare with their slickly produced "Harry and Louise" commercials that were full of lies and misrepresentations.

To address ex-liberal, if we can afford to piss away $2 billion a week in the sands of Iraq, with absolutely nothing to show in return other than the animosity of the Muslim world, the US can afford universal health care coverage. Get a clue.

Posted by: The Conservative Deflator on January 23, 2008 at 7:17 AM | PERMALINK

I don't think there is any mystery as to why Clinton's 1994 health care initiative failed - it ran into the largest private propaganda campaign in history. The health insurance industry, which really has no reason to exist in the first place as they are merely blood-sucking middlemen who produce nothing, torpedoed Hilarycare with their slickly produced "Harry and Louise" commercials that were full of lies and misrepresentations.

To address ex-liberal, if we can afford to piss away $2 billion a week in the sands of Iraq, with absolutely nothing to show in return other than the animosity of the Muslim world, the US can afford universal health care coverage. Get a clue.

Posted by: The Conservative Deflator on January 23, 2008 at 7:17 AM | PERMALINK

Oope, sorry for the double post...

Posted by: The Conservative Deflator on January 23, 2008 at 7:20 AM | PERMALINK

Let me get this straight. They've spent our Social Security pensions, built a bridge to no where and a $100,000 latrine, given us $200 hammers and couldn't handle Katrina and yet you still want them to take care of our medical system. OK, somebody has to explain the logic to me!

Do some investigating and you will find a great deal of Canadians, Brits and others still come to the US for the best medical treatment available (even though they have to pay for it. If universal medical is such a great idea why didn't it work for USSR or Cuba (by the way, all the glowing reports about the Cuban medical system were supplied by the Cuban government. That means no independent confirmation)?

Medical is personal and the government is a bureaucracy. They just don't go well together.

Posted by: JD on January 23, 2008 at 7:21 AM | PERMALINK

From quotes in consecutive posts:

the macro-economic indicators are good

the third-straight quarter of record-breaking foreclosures

No, the macroeconomic indicators are not good.

Posted by: rea on January 23, 2008 at 7:23 AM | PERMALINK

Medical is personal and the government is a bureaucracy

JD, you must not ahve had to deal with any health insurers lately, if you think they're not a bureaucraccy. The only difference is, the health insurers are not subject to political constraints.

Posted by: rea on January 23, 2008 at 7:27 AM | PERMALINK

It's time for a preview of September's straight talk express (tm):

As a nation we can't afford health care. Not you. Not the government. This ball of scar tissue on my face is an anachronism. It's not of our times. Simple economics and a basic understanding of stratospheric chemistry and radiation physics tell us that future Americans are going to simply get mowed down by melanoma. They'll get brain metastasis, start walking funny, and then make alters to Barak Obama just before dropping dead from pressure on their brain stems.

Your jobs aren't coming back and big brother isn't going to clean up that toxic brownfield in your back yard or pay a nurse to wipe your ass while you suffer through graft vs.host disease. In fact the government can't afford to pay for your chemo, let alone a bone marrow transplant. And sure as hell f$#k no on the liver transplant after a bone marrow transplant. People are just going to have to die the old-fashioned way. We could even start calling cancer the wasting disease again if it makes you happy.

Posted by: B on January 23, 2008 at 7:44 AM | PERMALINK

One more thing: greater foreign ownership of US firms and financial co.s (a process ongoing as we sit here) will probably move the business lobbies closer to accepting an "European" solution.

Posted by: Will Divide on January 23, 2008 at 8:12 AM | PERMALINK

Lucy Beloungy: Why are Americans so incompetent at providing themselves with health care?

Several reasons:

1. Our tort litigation system is like no other in the world. The cost of malpractice suits adds directly to the cost of medicine and indirectly be forcing doctors to add unneccessary procedures to try to protect themselves against suits. (John Edwards became rich by winning suits without scientific merit.)

2. Unwillingness to limit coverage. Medicare provides unlimited funding for very expensive end-of-life care, which adds little to life span. Private insurance covers very premature births that are very expensive. (Counting these as live births makes our medical statistics look worse than they are, relative to other countries.)

3. Research. We are leaders in medical and pharmaseutical research -- research that benefits the whole world. The medical system must somehow cover the cost of the research.

4. Our doctors are well-paid.

Posted by: ex-liberal on January 23, 2008 at 8:23 AM | PERMALINK

You might check out the objections to national health plan at www.medicynic.com

Posted by: Cycledoc on January 23, 2008 at 8:33 AM | PERMALINK

Auto wrote:

"bobb, that's got to be the most brain-dead analysis i've ever read on why we shouldn't reform how we pay for health-care in America."

Why?

Posted by: drosz on January 23, 2008 at 8:40 AM | PERMALINK

The political situation is likely to be better than it was in 1994. On the other hand, if we elect Hillary, she's going to start out with two strikes when trying to convince everyone that her new health care plan is better than the old Hillarycare that they already decided was a big mess and a bad idea. (It doesn't matter whether opinions about the plan are justified, that they exist is what's important.)

If she proposes a sweeping health care plan, it will instantly be labelled Hillarycare II, which alone might be enough to kill it. It's one more reason she's the wrong choice as the Democratic nominee.

Posted by: Doug T on January 23, 2008 at 8:49 AM | PERMALINK

Medical is personal and the government is a bureaucracy.

Breathtaking ignorance of how our current "system" really works when you need it.

Contrary to popular myth, bureaucracy is NOT a problem that is exclusive to or synonymous with government. If you define "bureaucracy" as a fragmented process with lots of non-value added steps or functions, then ANY large enterprise will be loaded with bureaucracy if the focus is on internal "empires" rather than external results. I've been a management consultant for years, and based on direct observation, I can say that large corporations are at least as bureaucratic as most governmental agencies, if not more so. Even more disappointing is that the average shareholder has even less power than the average voter to do anything about it. We can't fire incompetent or, more likely, superfluous executive management every four years.

I had to apply for an EIN from the IRS so that I could pay a household employee on the books recently (yeah I'm stupid). It took all of 3 minutes to complete the transaction on line. On the other hand, I've been spending 2-3 hours per week working on a coverage issue with my health care provider for the past month regarding my 3 month old son. I haven't even been able to get a yes, no or maybe answer from the various departments and individuals after over a month of phone tag. Not to mention that while I try to resolve the dispute, the bureaucracies of the respective hospitals and pediatrician's office all need to be dealt with and the denied payments covered (insurance companies pay $125 for a 20 minute pediatrician visit at the hospital with $40 co-pay, as an individual I owe $974 for that same visit).

Our health care system is a lot of things, but streamlined and efficient it ain't.

I also spent the entire week in the Yukon and Northwest territories. Every single person I asked about their health care thought it was adequate and most of them thought our system was insane.

Posted by: lobbygow on January 23, 2008 at 9:27 AM | PERMALINK

Medical is personal and the government is a bureaucracy. They just don't go well together.

What? You don't think your health insurance company is a bureaucracy? Guess you haven't been sick lately. We're trying to do health care with profit-making bureaucracies that suck money out of the system; let's try it with government.

Health care and government go well together in the rest of the world. They will here, too.

Posted by: David in NY on January 23, 2008 at 9:45 AM | PERMALINK

be forcing doctors to add unneccessary procedures to try to protect themselves against suits.

Sorry, but that is just BULLSHIT. Every procedure exposes the practicioner to more risk of making a mistake. The primary incentive to add unnecessary procedures is that it means more billing for the doctors -- who, as you correctly point out, are paid more than they are in most other countries in the developed world. If you apply free market fundamentalism to the medical profession, what you get are specialists (that costs more) in the items that are the highest demand and command the highest prices. I don't have a solution, but subsidizing the educational costs of medical generalists might be a place to start.

As for tort reform, I do there is some work to be done there -- BUT, that is not the primary component of cost.

2. Unwillingness to limit coverage.

Yes and no. If we want universal coverage, we must abandon the notion of completely free choice and access to every possible procedure. There has to be agreement on some minimal critical set of preventive and corrective procedures that would be available to everyone regardless of employment status. That's really the big issue. One of the better features of our brand of capitalism is that it is relatively easy to lay-off or fire people in the private sector (not easy, but relatively easy). This makes us more competitive. In exchange for that benefit, however, we must ensure that periods between jobs are not catatrophic -- that means through whatever means (tax breaks, direct subsidies, reduced premiums), administered by whatever agency (government or private, we need to provide for basic health insurance. A wealthy individual should be able to buy more if they want, but no individual should be without basics.

However, the "limits" should be based on what is good for society as a whole, not what is good for the insurance companies' profit margin. If the private insurers still want to play once their overall margins are reduced - great. If not, then single payer may be the way to go.

3. Research. We are leaders in medical and pharmaseutical research -- research that benefits the whole world. The medical system must somehow cover the cost of the research.

The problem is that U.S. consumers foot the bill, while no one else does. I consider it my patriotic duty to reduce the costs we Americans pay. We can do that by decreasing the total cost paid, reducing our portion relative to other global consumers or both. Better availability of affordable preventive care would reduce pharma usage and therefore pharma costs.

Also, it is the "lifestyle" drugs that are most heavily promoted because the profit potential is so high. Why spend research dollars on a drug to treat a cancer that affects less than 1% of the population when you can spend it on erectile dysfunction, which impacts the entire GOP?

4. Our doctors are well-paid. True, but like lawyers and some other professionals, the education costs are enormous. Even with six figure salaries it takes years to pay off the debts. Of course, the expectation of a posh lifestyle doesn't help (but that's the American dream no?)

You left out the biggest cost of all - Administration. I think we would be astonished at the inefficiency and redundancy in core processes like admissions, testing and claims. Too much paper, too much fragmentation, too many opportunities for rework and error. Of course, as a process designer, I'm biased, but this is a huge waste of hours and dollars.

Posted by: lobbygow on January 23, 2008 at 9:48 AM | PERMALINK

Democrats are far more unified than they were in 1994.

Democrats? Unified? Ever?

Stop, you're killing me.

Posted by: Steve M. on January 23, 2008 at 9:58 AM | PERMALINK

A liberal is a conservative who has had to deal with a health insurance company.

It is a massive bureaucracy, Soviet in style in that itt has no obligation to act according to any law or principle of justice. It has built into it the principle of avoiding payment. It will say of course at one point and who told you that? at another.
It has Soviet rules, like pre-existing conditions, where they will pay for illnesses except those you are likely to get. Is there pre-existing condition insurance available? There is not.
It's a system wherein you have no rights, and where the only recourse is the courts.

If some enterprising company were to offer insurance that a) had no pre-existing conditions, b) paid your bills, c) didn't cancel your policy because you got sick, and d) didn't double its rates every two years, they would quickly dominate the health care industry, and there would be no need for universal government health care. So where is it?

Of course, ask a Republican for help, and they will respond with a) helping you would be bad, b) it's really your fault for needing help, and c) liberals are unamerican.

That's why the deluge is coming.


Posted by: pbg on January 23, 2008 at 9:58 AM | PERMALINK

"by forcing doctors to add unneccessary procedures to try to protect themselves against suits."

We've monetarized the system. Everybody has a conflict of interest. Doctors make their money by doing procedures. Unnecessary procedures are done more for financial benefit than malpractice concerns.

Posted by: Cycledoc on January 23, 2008 at 10:00 AM | PERMALINK

So many people who are advocates for universal healthcare are unwilling to acknowledge whose ox needs to be gored in order to get there, other than the demonic insurance companies, of course. As intimated above, non-poor retirees in the U.S. really do get the best health care in the world, in terms of a cost/supply ratio. There really is no better place on earth to be a non-poor 75 year old fat diabetic with a heart condition and a severely arthritic knee. That constituency is one of the most sought-out in American politics, and universal health care to them means more rationing.

Kevin has been writing about this topic for years, but it appears that he still indulges in the fantasy that reform can be achieved without addressing this generational conflict, since he hasn't ever written about it, alhough I certainly may have missed it.

If he ever gets around to it, instead of reminding everyone again about how awful insurance companies are, or pretending that government "negotiating" prices of drugs doesn't amount to price controls, with the inevitable effects of price controls, kevin can also address head-on how he expects to overcome the doctors' lobby, and there guaranteed all-out war against seeing their compensation reduced.

Posted by: Will Allen on January 23, 2008 at 10:01 AM | PERMALINK

ex-liberal,

You spout your talking points, I'll spout mine.

How many deferments did you get to dodge the Vietnam draft and how do you feel about the men who went in your place to die? Do you feel the smallest amount of guilt? Do you think that is what drives you to be such an outspoken prick now?

Posted by: Tripp on January 23, 2008 at 10:26 AM | PERMALINK

Dear Tripp - Do you think each poster should be required to divulge his or her service record? Rank, number of years, where they served. etc.? Should Kevin Drum have such a requirement? I don't think so, and you don't, either. Why are you demanding a special requirement on me?

Perhaps it's your excuse for not responding to my arguments. IMHO name-calling is another way to avoid responding.

Posted by: ex-liberal on January 23, 2008 at 10:34 AM | PERMALINK

Robb is exactly right, and that's part of why Kevin and Ezra are wayyy too optimistic. Sure, the NFIB has no problem with a mandate system, as long as businesses don't have to dig into corporate wallets to help with co-pay on premiums.

Kevin, get back to anything close to a single-payer system, or even a German voucher-type system where corporate taxes are a major portion of paying for this, and the NFIB will jump off that ship so damned fast...

Can't believe you and Ezra sign off on the optimism line so easily. This "optimism" will get us enough incremental change the NFIB figures it will shut people up for 20 years or so.

Posted by: SocraticGadfly on January 23, 2008 at 10:42 AM | PERMALINK

My faith that the insurance companies' political donations to Democrats will be handsomely paid off with a mandatory health insurance requirement for every man, woman and child in America is not diminished.

Posted by: Brojo on January 23, 2008 at 10:47 AM | PERMALINK

It'll work if we have a president who doesn't unite Republicans against him or her. That would be Obama.

Posted by: markg8 on January 23, 2008 at 10:56 AM | PERMALINK

bobb, that's got to be the most brain-dead analysis i've ever read on why we shouldn't reform how we pay for health-care in America.

Whatever your name was, yours is the most brain-dead attempt to dodge the question that I've read in several minutes of reading Hillary supporters try to dodge the question.

I wasn't arguing that we shouldn't reform how we pay for health care. I was arguing that a progressive tax as a way to pay for universal health care would make a lot of sense.

And that was does not make a lot of sense is to tell voters that the Democratic solution to their difficulty in paying for health care is a "universal mandate" that forces them to pay, under penalty of law if they don't. Because what could make more sense than telling someone who is struggling to make ends meet that if they don't find a way to cough up the money for health insurance premiums on top of everything else, the IRS will come after them.

Would the Hillary plan even give them a break on the insurance payments if this is the last straw and they end up walking away from a house they can't pay for and filing for bankruptcy? Or if they are still employed would the insurance company, with the backing of the IRS, simply be one more creditor trying to garnish their wages to squeeze the money out of them?

Posted by: bobb on January 23, 2008 at 11:00 AM | PERMALINK

So many people who are advocates for universal healthcare are unwilling to acknowledge whose ox needs to be gored in order to get there, other than the demonic insurance companies, of course.

BINGO!!!!

Everyone, and I do mean everyone (except the poor and working class) will get the feeling that they are losing something. Long term, the net benefit to everyone is there, but since when do modern Americans rally behind anything that doesn't promise instant gratification without tough choices or individual sacrifice?

The "quick fix" attitude prevails in both parties. The only difference is in the ideological basis for the magic bullet.

Posted by: lobbygow on January 23, 2008 at 11:00 AM | PERMALINK

"The healthcare plans on offer from all three presidential candidates are politically much savvier than Clinton's."

This is code for "The insurance companies still have a role"?
Because that is the problem, and if the insurance companies continue to have a role, the system will remain irredeemably fscked up. You will continue to have an overhead of 20% going to absolutely nothing useful, simply admin, legal issues and trying to offload costs onto someone else.

So what's the end-game in this case? We get some sort of universal coverage; price don't change (because we've done nothing to attack the basic issues here --- things like
• the 20% insurance overhead
• the pathetic lack of electronic record keeping --- partially a lack of incentives, partially the way the law prevents data sharing even when it makes sense --- and the point is not to have electronic records at one place, but to have a SINGLE electronic record the represents me no matter how I move across the US
• the AMA acting, as it always has, as the doctor's union (in the worst possible sense) and limiting the number of entrants to med school, then doing what it can to persuade those that make it through to quit during residency. Throttle the supply of doctors, and you'll ensure that their costs remain high. Then do what you can to limit the number of jobs (even routine work) that can be done by non-doctors. Finally insist on self-policing, and institute a code of silence, even for incompetents.
Guaranteed jobs for doctors, and screw the public good.

Posted by: Maynard Handley on January 23, 2008 at 11:13 AM | PERMALINK

I've been a management consultant for years, and based on direct observation, I can say that large corporations are at least as bureaucratic as most governmental agencies, if not more so.

No kidding. I'm constantly amazed when people tell you with a straight face that corporations aren't bureaucratic. Even if you've never worked in a medium-to-large corporation, you've got to have had experience with banks or insurance companies.

And to deflate another bit of conservative hoo-hah, the "free market" will not automatically converge toward giving the consumer the best service and the best prices. If it is in a company's interest to not provide a service to customers, it will *not* *do* *so*. I've sat in meetings like that. Couple that with the general incompatibility, death spiral, and hot-potato problems inherent with multiple-payer insurance, and it's not going to get any better.

There will be tremendous resistance to change from the people whose gravy train will be in serious jeopardy, but at least this time most of the population has had enough experience with health insurance companies to not fall for that line of BS.

Posted by: ericblair on January 23, 2008 at 11:13 AM | PERMALINK

One aspect of this moment in American history that is not given enough credit is the tremendous yearning among the American people for change. While the true potential impact of that desire can't really be quantified, I think it is at least as important a factor favoring national health care as anything else.

For the great majority of American voters, the Bush WH has served as an example of failure every bit as compelling as was Jimmy Carter in his day. Because of Jimmy Carter, and the way in which he defined the Democratic Party in their eyes, Ronald Reagan was able to push the nation into a massive lurch to the right.

George Bush will do the same favor for any Democrat who comes into the WH in 2008 -- except, of course, in the opposite direction. It will, though, require extraordinary political instincts and savvy to achieve maximal results out of this wave. Most especially, it will be key that a Democratic President be prepared for the inevitable attacks that will come his or her way when powerful special interests engage in what will likely be an existential battle to protect their turf.

The one thing that frustrates me most is that none of the Democratic candidates have signed on to single payer. I once upon a time said that I'd support the first major candidate to come out committed to single payer. It does not make me happy that no one has. To this day, I have never seen anything like an adequate explanation as to why single payer is somehow politically impossible. While the players in health care such as the insurance companies would go into final battle mode if single payer were on the table, I don't see how they will spend any less money, or be less vicious in their attacks, if anything major is done to upset how they make money. And any serious reform of health care will damage their profitability, because they are essentially making money out of their pure redundancy and uselessness.

My personal belief is that the Democratic candidates opted out of single payer most importantly because they greatly underestimated how much the American people would back them if they came out for something they could call "Medicare for All". It saddens me that the unique window for change facing us in 2008 is likely to be compromised because no one could see the viability of boldness.

Short of single payer, though, only the mandate approach has viability as a universal health care policy. And if it can't be single payer, we need a President who will do this next best thing. That, of course, would be either Edwards or Hillary.

Posted by: frankly0 on January 23, 2008 at 11:14 AM | PERMALINK

As much as I'd like to see universal health care, how are we going to pay for it? The federal government is bordering on bankruptcy. We don't even have the money to pay for decaying infrastructure, or to properly equip our troops, or a million other things. We're at the mercy of China and Saudi Arabia to keep loaning us money and buying up our failing assets.

Posted by: Speed on January 23, 2008 at 11:17 AM | PERMALINK

As much as I'd like to see universal health care, how are we going to pay for it?

It's worthwhile to remember that we, as a society, are already paying massive amounts of money for health care. We pay vast sums to insurance companies; we pay for emergency health care for those who can't afford any other kind of care. A very good portion of the expense of universal health care could be covered simply by redirecting those funds. I've seen arguments that suggest that the overall expense might actually go down if we could eliminate or greatly reduce the involvement of health care insurers.

But I will say that one thing that's not clear to me is how much we can reduce the unnecessary expense of health care insurance companies under any of the plans now put forth by the Democrats.

Posted by: frankly0 on January 23, 2008 at 11:28 AM | PERMALINK

the feeling that they are losing something

Very true. Our political discourse and economy is dominated by the upper classes. They will not give up their privileges easily. The opportunity cost for the top 25% to wait in line with the rest of society for health care is too high for them. When they need tennis elbow surgery they want it now. They do not want to have to wait until a longshoreperson, a fruit picker, or a short order cook have their knee surgeries before their elbow sugery, even though those others need surgery to resume working. The wealthy also do not want to share waiting rooms, let alone hospital wards, with such low performing fellow citizens. The refusal to consider healthcare a public good, available to all, by the dominate economic classes is a major obstacle to healthcare reform. Their control of media and the political process prevents the majority from pursuing a public service policy that benefits the most people.

Posted by: Brojo on January 23, 2008 at 11:42 AM | PERMALINK

"I've seen arguments that suggest that the overall expense might actually go down if we could eliminate or greatly reduce the involvement of health care insurers."

That's definitely true, but think about the vast industry we're talking about. They will not go quietly into that good night. The sheer amount of Americans who depend on the insurance industry for their personal well-being cannot be ignored either. Total health care spending is what...15 or 16 percent...that's huge. And I think it's expected to rise to about 20 percent. How much of that chunk goes to insurance company profits do you think?

Posted by: drosz on January 23, 2008 at 12:01 PM | PERMALINK

Brojo, "When they need tennis elbow surgery they want it now. They do not want to have to wait until a longshoreperson, a fruit picker, or a short order cook have their knee surgeries before their elbow sugery, even though those others need surgery to resume working. The wealthy also do not want to share waiting rooms, let alone hospital wards, with such low performing fellow citizens."

When I asked my Congressman (Moore, KS-3, D) whether he supported Health Care for Everyone, he told me that he "couldn't support H.R. 676 because it would result in long waiting lines."

Which to me means that he doesn't want to clutter the waiting rooms with the people who aren't currently able to go to the doctor. He was honest about it. But, that was clearly the highest priority in his universe. Well, except for making sure the rich got their passports in time for summer vacation.

Posted by: katiebird on January 23, 2008 at 12:02 PM | PERMALINK

JD and ex-liberal regurgitate all of the false talking points the RNC and the right-wing noise machine have been spewing out for four decades now. They are like brain-washed, trained seals, taught to upchuck on command.

We already have socialized medicine in the United States, nimrods. Two versions - Medicare and the VA system. Govt. provided health care is far more efficient than United Health or Primerica or any of the large health insurance companies, because they don't pay thier executives multi-billion dollar stock option packages for making speeches and wearing Italian-taliored suits to cocktail parties.

It is you who are the fools - for supporting privatized medicine, which is the health care delivery system that is really bureaucratic, inefficient and costly.

Posted by: The Conservative Deflator on January 23, 2008 at 12:05 PM | PERMALINK

It seems to me that the Dems could most easily sell a public/private hybrid system such as they have in France. The French system seems to offer good basic care to everyone with supplemental insurance for those who want extras.

Check out the description of the French System at:
http://www.ambafrance-us.org/atoz/health.asp

Posted by: Bob on January 23, 2008 at 12:10 PM | PERMALINK

Yeah, sure, we could get something like "universal health care" because voters are finally ready for it. I'm very skeptical, however. First of all, the health care lobbyists will pull out a new Harry and Louise to muddy everything up and divide voters over which is the best solution. Even if we were to get past those distortions the actual bill(s) will be written by lobbyists with so many Machiavellian twists and turns so as to make it essentially the same system we have now.

I mean, criminy, just to get a simple re-up on a basic prescription, I have to make an appt. with my doctor ($160 ka-ching) for him to scribble out something on PAPER. Whereas, in most developed countries (even 3rd world!) there is a doctor at the pharmacy to take care of shit like this.

I wouldn't look for anything remotely resembling UHC in other countries (where, yes, the doctors are well-paid still) for the next 20 years.

Posted by: CB on January 23, 2008 at 12:16 PM | PERMALINK

The Conservative Deflator: Medicare and the VA system. Govt. provided health care is far more efficient than United Health or Primerica or any of the large health insurance companies

Yes, the VA is efficient and relatively cheap, but Medicare is very expensive. IMHO the best approach to government health care would be to have clinics that provided limited services, staffed by medical professionals who were employed by the government. Of course, there would be no restriction on private health care and private insurance.

But, this will never happen. More precisely, this approach might be tried, but it will never replace Medicare, Medicaid, SCHIPs etc., because it would mean a reduction in medical care for certain groups.

In reality, we are likely to get something that adds on to all the current piecemeal approaches, leading to even greater confusion and inefficiency.

Posted by: ex-liberal on January 23, 2008 at 12:25 PM | PERMALINK

First of all, the health care lobbyists will pull out a new Harry and Louise to muddy everything up and divide voters over which is the best solution.

For a hoot, go watch the original ad here. What do H&L and the Spooky Narrator complain about?

"I thought this was covered under our old plan!"
"They'll force us to pick from a few health care plans!"
"My health insurance went from $1200 to $3200 a year!"

Yeah, more Harry and Louise from the people that brought you the original. Throw the whole damn thing back in their faces.

Posted by: ericblair on January 23, 2008 at 12:29 PM | PERMALINK

Oh ex-lib, I'm here...Would you answer my question please?

How many deferments did you ask for and receive during the Vietnam war?

(By the way folks, he spent his entire career in the insurance industry - his comments on such topics are self-serving at best.)

Posted by: Isle of Lucy on January 23, 2008 at 1:08 PM | PERMALINK

In reality, we are likely to get something that adds on to all the current piecemeal approaches, leading to even greater confusion and inefficiency.

I fear this is inevitable.

If I may use a medical analogy, until the symptoms egregiously impact everyone's quality of life, there will be no unified, pragmatic, equitably supported solution to the UHC dilemma.

The common rabble are ideologically divided in spite of everyone having the same opinion about what the short comings are. This ideology gap is easily exploited by the many constituencies who have everything to lose and nothing to gain from making changes.

Ironically, I think the inevitable price and wage leveling that globalization will lead to will eventually force the issue. But what the hell do human beings do who want to maintain a decent quality of life while they are waiting for market forces to "correct" the U.S. health care problem?

This is not just a bleeding heart issue. Our failure to resolve this will directly impact our competitiveness globally over the next few decades.

If ever there was a time for the people to unite and demand a change, it is now. Unfortunately, we will all have to accept and prepare for changes we'll need to make personally in order to get the desired results.

The same goes for climate change, energy independence and the future burden represented by our entitlement programs (the fiscal version of global warming).

There is no magic bullet. There will be tough choices. Neither the government nor the free market are good fairies. We are the government. We are the market. We must be part of the solution at the individual level (consumers, doctors, insurers, pharma, etc.)

I do agree we tend to demonize a few of the actors in the system, but the reason they are demonized is because they have the most power to prevent change and the least apparent incentive (short term at least) to want to change. The main problem with the profit motive is that it is damned difficult to get people to focus on the long term rather than the short term. Everybody in the private sector talks about sustainability, but the entire investment structure is geared to support short term tactical wins. As the investment population ages, that problem will only get worse.

We've got huge structural issues on many fronts and yet our political discourse is reduced to latte drinkers vs. monster truck drivers.

We're the problem.

Posted by: lobbygow on January 23, 2008 at 1:30 PM | PERMALINK

The only solution cost-wise: single payer, medicare for all.

Hill/Bill Care is a sop to the insurance companies who partially own the Hill/Bill enterprise. The rest of the enterprise is owned by the rest of wall street crowd: Rubin, Morgan, etc.

Obama shows the same ownership pedigree.

Is there a Robin Hood figure who will take from the rich and give to the poor, bring us single payer health insurance and end our cult-of-death globo-cop rule?

Please step up to the plate.

Posted by: Dr WU-the last of the big time thinkers on January 23, 2008 at 1:37 PM | PERMALINK

Personally, I don't think we *need* Universal Health Care - all we really need is some way to "un-rig" the market, so that prices come back into line with reality, and actual real worker's salaries.

The rigged healthcare market is CRIPPLING American industry. The conservative noise machine has successfully pointed the finger of blame at Unions - when the real issue is out-of-control inflation in healthcare costs.

It sure feels as if the only way to FIX this problem is Universal Healthcare (ie. "death to the insurance companies) - but this does nothing to address the rampant, widespread practice of rampant billing fraud at hospitals and healthcare organizations. The billing fraud is supposedly a response to insurance companies reimbursement fraud - but even if we get rid of the insurance companies - who is to say that the hospitals and such won't still just overbill the government? All they'd need to do is take the right government auditor golfing, and they'd have it made.

A Free Market would solve this problem.

If only there was such a thing.

If only there was such a thing as a law enforcement that we could rely on, to take white collar criminals to prison for the crimes they commit. (billing fraud, collusion, market manipulation, etc.)

Posted by: osama_been_forgotten on January 23, 2008 at 1:42 PM | PERMALINK
Do some investigating and you will find .....JD at 7:21 AM |
Do some investigating and you will find that Americans are the world's main medial tourists. The entire medial industry in the US is a bureaucracy that wants you to have the cheapest possible care that gives them the greatest possible profit.
...As intimated above, non-poor retirees in the U.S. really do get the best health care in the world, in terms of a cost/supply ratio....Will Allen at 10:01 AM
You've been spinning that lie for a long time.

World Health Organization Assesses the World's Health Systems

The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan.... The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy....

Posted by: Mike on January 23, 2008 at 1:42 PM | PERMALINK

Dear Lucy, I don't believe any of us should be required to divulge our military service. Your demand that I do so, while not making a similar demand on yourself, Kevin, etc. seems to me to be a way to avoid dealing with my arguments.

I have no connection with any health insurance company, so my comments are not self-serving.

Posted by: ex-liberal on January 23, 2008 at 1:48 PM | PERMALINK

It is a legitimate question given your advocacy for the current unjust war. Had you not been such a water carrier for this one I would agree with you, but you have a long history of advocating for this war, when you, apparently hid out in school when it was your turn to serve. A chickenshit then, and a chickenhawk now.

Those of us who buried relatives then and have young relatives serving now are understandable revolted by the likes of you.

Posted by: Isle of Lucy on January 23, 2008 at 1:54 PM | PERMALINK

ex,

Dear Tripp - Do you think each poster should be required to divulge his or her service record?

I think those advocating the sacrifice of others should explain their own sacrifices.

My service record is this - I turned 18 in '74. The draft just ended, but there was talk of starting it back up, and they designed a lottery system based on one's birthdate instead of the previously corrupt and unfair 'deferments.' I told my parents I did NOT want to get drafted and they read me the riot act, telling me if I didn't go then someone else would have to go in my place.
They also threatened to disown me if I dodged the draft.

Thankfully my number was high and they didn't restart the draft.

That is where I come from. Some of my friends were ruined by Vietnam. The casualties of war are not all on the losing side, and they are not all fatal. There are worse things than death.

If you served I will thank you, even if it was through conscription. If you did not serve and are still parroting republican talking points I despise you.

For the record I was for Afghanistan but NOT Iraq. I had already seen one Vietnam and I could recognize another coming down the road.

Posted by: Tripp on January 23, 2008 at 3:10 PM | PERMALINK

Lucy, it's just pointless to get into an contest as to who buried more relatives. Unfortunately a substantial number of my friends and relatives died in 9/11 and in WW2. These deaths could probably have been avoided had the US and our allies acted aggressively more promptly.

But, I don't claim that my losses give my POV greater authority. My opinions stand or fall on their own.

Tripp, you and I are both advocating sacrifice. I believe an immediate withdrawal of American troops from Iraq would lead to the sacrifice of enormous numbers of people in the middle east. We saw this in Vietnam. Our precipitous withdrawal led to the deaths of hundreds of thousands of Vietnamese and millions of Cambodians.

You're free to disagree with me, but IMHO your service or lack thereof doesn't affect your argument one way or another.

Posted by: ex-liberal on January 23, 2008 at 3:45 PM | PERMALINK

My opinions XXXXXXXX fall on their own.

Fixed.

Posted by: Gregory on January 23, 2008 at 4:20 PM | PERMALINK

No true healthcare reform will occur until there is an overwhelming amount of votes for it in the Senate and House. I see the Repugs holding onto enough seats to block any reform that could be proposed.

Maybe another congressional election will wipe their little asses off the face of the earth. And then we can get a true one payer system that, like it or not, will be government sponsored and regulated.

But I doubt it.

Posted by: LuigiDaMan on January 23, 2008 at 4:39 PM | PERMALINK
....These deaths could probably have been avoided had the US and our allies acted aggressively more promptly....ex-laxat 3:45 PM
No, those deaths probably could have been avoided if George W. Bush paid attention to all the warning he received from the previous administration, his own people like Richard Clarke who was running around with his hair on fire, or if he actually gave a damn.

The problem is your gloating on Iraq despite the enormous cost in Iraqi lives and the total disruption and damage to their society. That is reprehensible from anyone but coming from a shirker, it's even more so.

Even your hero, Yon now admits to slanting his reporting.

...Mr. Yon aims some barbs at the military brass, but talking with him and reading his work, it becomes clear that he has also pulled punches, not wanting to undermine the war effort.
In an interview, he said that when he first went to Iraq, in December 2004, “I knew we were losing the war,” and that “it was worse than the news was portraying.”....Little of that dark view made its way into his dispatches, especially in his first year.

Posted by: Mike on January 23, 2008 at 5:05 PM | PERMALINK

I don't have much faith in our ability to get a good(where good = eliminates perverse incentives and inefficiencies and brings down costs and so on) healthcare plan enacted. What I hope for is passing something may be kinda crappy initially on the systemic issues, but is universal and user-friendly enough that people take to it. If it works at least well enough to become an expected entitlement, it'll be very hard to undo, and we can always fix the details(where the details = eliminating most of what the private insurance industry does) later. I especially like the aspects of the Edwards and Obama plans that let people buy into the existing Medicare system, which already is reasonably user-friendly and well liked, and which could slowly out-compete the private plans and put them out of business, but not in an abrupt way that is going to cause tons of upheaval and resentment and even employment issues.

Posted by: J. Dunn on January 23, 2008 at 5:27 PM | PERMALINK

ex-liberal: We saw this in Vietnam. Our precipitous withdrawal led to the deaths of hundreds of thousands of Vietnamese and millions of Cambodians.

the precipitous withdrawal of the troops consisting of soldiers who, unlike you, didn't take multiple deferments over a 10-year period? where is your fucking shame? how can you even stand to live with yourself?

Posted by: as it unfolds on January 23, 2008 at 9:56 PM | PERMALINK

The insurance industry, the doctors & hospitals, the pharmaceutical companies and everybody else in the health care industry do not want to be restrained from raising their prices until they destroy America. They are as irresponsible as the Bush administration or any other bully who isn't held back.

We need a president and Congress who can convince enough other interests to gather together to overcome any effort the health care industry makes.

Obama's plan doesn't cover everyone. Hillary copied Edwards.

John Edwards for President -- Leadership to get healthcare for everyone!

Posted by: MarkH on January 23, 2008 at 10:07 PM | PERMALINK

Why spend research dollars on a drug to treat a cancer that affects less than 1% of the population when you can spend it on erectile dysfunction, which impacts the entire GOP?

That was funny!

I've glanced at the French system, and IIRC the French managed to accommodate their insurance industry and offer their citizens complete choice of physicians.

I also recall Adam Gopnick raving about the greatness of the French system.

Posted by: Lucy on January 23, 2008 at 11:05 PM | PERMALINK

And new groups like MoveOn, which didn't even exist a decade ago, are around to help lead the fight as well.

All things considered, is it a net plus to have MoveOn on your side?

Posted by: MatthewRmarler on January 23, 2008 at 11:32 PM | PERMALINK

I also recall Adam Gopnick raving about the greatness of the French system.

When I was visiting Paris a few years ago, I came down with a horrible case of tonsilitis. I scheduled an appointment with a doctor two blocks from the hotel who was on his way to vacation in the south of France. He agreed to see me within the hour. I waited five minutes in his combination apartment/office before I was led in for the exam. He spent 15 minutes asking detailed questions about my symptoms and how they were impacting me. He looked at my ears (where I thought the pain was) and my throat. Gave me a prescription and sent me on my way. He had a very cordial and concerned demeanor but calming as well. The visit cost me the U.S. equivalent of 70 bucks because I was not in the system. The antibiotics (emycin or some variant) cost $10 - no waiting in line.

I understand medical professionals may get paid a little less in France, but his apartment was pretty damned nice and he rode off into the sunset on a gorgeous BMW motorcycle.

I wonder how much it would have cost me as a resident? I wonder how much the same visit would have cost here with my current provider. I'm betting with my copay I'd be paying at least half that.

Posted by: lobbygow on January 23, 2008 at 11:53 PM | PERMALINK

I understand medical professionals may get paid a little less in France...

I really need to take a second glance, but again IIRC they're also relieved of having to pay liability insurance. There may be some provision about student loans as well.

That's a bargain US phsyicians might be willing to make.

Funny that you should just now tell that happy story. I heard another story today about a healthcare odyssey--in the USA. This much I can tell you: it was a nightmare.

Posted by: Lucy on January 24, 2008 at 1:10 AM | PERMALINK




 

 

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