It is a measure of the political environment of the United States that a proposition as basic as trying to improve health care coverage for the millions of uninsured has unleashed a firestorm of controversy, with unusually strong opposition from people who stand to directly benefit from the reform. In this county, some on the Christian Right are praying that their fellow Americans be denied an opportunity to have better health care.
It is a testimony to the toxic power of media ideologues like Rush Limbaugh and Glenn Beck that they can so poison the atmosphere of political dialogue that people have spent months arguing over myths and distortions, with very little understanding of what the reform bills actually are trying to do and what the consequences of action—or inaction—will be.
What strikes me, as we see the Senate bill do exactly what many political insiders long predicted it would do—lose the public option—is how conservative health care reform is turning out to be. If the Senate bill passes and the final legislation mirrors its current proposals—which is not certain, but still likely—we will have what should be a conservative’s dream health care reform law.
It is still a private system. It has no large government plan. It reduces the deficit. It provides subsidies to health insurance plans to cover the uninsured (which is the only realistic way to solve this problem, if you refuse to consider a government option). It gives the drug manufacturers what they want. It doesn’t force physicians to deal with a new government bureaucracy.
Certainly it doesn’t please everyone. All those groups and many more have found reasons to criticize the bill. But it would be wrong to be willfully blind to how much this reform tries to meet all the various stakeholders half way.
In today’s political realities, of course, that’s not good enough. Willful blindness is all the rage. The bill is too conservative for Howard Dean, so he wants to tear it up and start over. It’s too restrictive for the health plans, so they oppose it. And of course, if it comes from the Democrats and Obama, the Fox News world must reflexively hate it.
What the Fox News world doesn’t realize is, they’ve won. If they really believe what they say: that they in fact DO want to reform health care, but they want to do it without the government taking over the health care system, then they have won.
But what they say and what they really want are obviously two different things. Their real opposition is to letting the Democrats get credit for fixing the county’s most pressing domestic problem. It is, to use a cliché, politics as usual.
I’ve heard, over and over again, the talking points: conservatives want to reform health care, but it should include tort reform. It should allow health plans to sell insurance over state borders. It shouldn’t explode the deficit. It should empower doctors and patients to make decisions, not the government.
Well, that last one—as nonsensical as it is, since the government was never going to intrude on medical decisions in the way that reform opponents suggested—should be satisfied by the death of the public option. The sell-insurance-over-state-borders idea is part of the Senate bill. The CBO has scored both the Senate and House bill as reducing, not increasing, the deficit. Tort reform is another idea that has merit; however, the state that has done the most in the area of tort reform is Texas: a state with one of the highest rates of uninsurance as well as the most out-of-control health care cost increases. So much for that silver bullet.
The point is, conservative ideas have been co-opted by the reform bills much more than conservatives are willing to admit. The exception is tort reform, and that, by the examples we’ve seen, is not going to make that much of a difference.
But overall, a conservative approach to reforming health care is exactly what we’re looking at. The fact is, conservatives have won this round. And really, if they would realize it and support health care reform, we’d all be better off. But they won’t realize it, and they will keep trying to go down a path that will damage the country and its future, to the bitter end.
Let me be clear in what I’m trying to say. I don’t care if some on the left see this as a sell-out or defeat of some principled ideal (single payer). I support addressing the problems we have with health care delivery in the country. If that means a conservative approach, so be it. It’s a step in the right direction. The Senate bill is very much a step in the right direction. But in its basic approach and philosophical framework, this is not a liberal reform bill.
It is a conservative one.
Saturday, December 19, 2009
Monday, December 14, 2009
Gold's Fool
News from the health care reform front is pretty grim today, so let's go back a week or so to Jon Stewart taking on Sold Gold Glenn.
Just a money changer in the Temple.
| The Daily Show With Jon Stewart | Mon - Thurs 11p / 10c | |||
| Beck - Not So Mellow Gold | ||||
| ||||
Just a money changer in the Temple.
Saturday, December 12, 2009
More Medicare stuff
Ezra Klein, who else, had some more comments on Medicare that I think are worth noting.
First, in a chat, he relays that according to MedPac--the agency that advises Congress on Medicare-related issues--96.8 percent of physicians say they will take new Medicare patients. So the argument that Medicare's lower reimbursements are driving doctors to stop taking Medicare patients seems, well, questionable.
Second, this very insightful post
argues that it's a mistake to simply paint insurers as the villians and physicians as the victims. Insurers seem like villians because they're doling out health--they're distributing life and death-- on a free-market basis. Of COURSE the people trying to make such a system profitable are going to seem evil. But it's the entire system that needs reform, and that includes providers.
Here's how Klein puts it:
"Most importantly, they [physicians] should be forced to work in a way that doesn't hurt society. That, after all, is the guiding principle behind the insurance reforms: Insurers will have to live with a market that society can live with. Similarly, providers will have to live within a market that society can afford. That will mean a strict budget, at least within the federal programs (and over time, as the private programs become unaffordable, they will probably come on budget as well).
First, in a chat, he relays that according to MedPac--the agency that advises Congress on Medicare-related issues--96.8 percent of physicians say they will take new Medicare patients. So the argument that Medicare's lower reimbursements are driving doctors to stop taking Medicare patients seems, well, questionable.
Second, this very insightful post
argues that it's a mistake to simply paint insurers as the villians and physicians as the victims. Insurers seem like villians because they're doling out health--they're distributing life and death-- on a free-market basis. Of COURSE the people trying to make such a system profitable are going to seem evil. But it's the entire system that needs reform, and that includes providers.
Here's how Klein puts it:
"Most importantly, they [physicians] should be forced to work in a way that doesn't hurt society. That, after all, is the guiding principle behind the insurance reforms: Insurers will have to live with a market that society can live with. Similarly, providers will have to live within a market that society can afford. That will mean a strict budget, at least within the federal programs (and over time, as the private programs become unaffordable, they will probably come on budget as well).
"Providers won't like this, of course. It means adjusting to a lot less revenue than they currently expect to have, and no one quite knows how to do that. People run businesses atop the assumption of growth, not contraction. And the complaints are understandable: They haven't been doing anything wrong, and don't feel like they should be punished.
"But this isn't punishment. This is, well, medicine. It's that or national bankruptcy. And the problem, if left untreated, will only get worse, and the eventual correction, when it comes, will only be more severe. That, however, is exactly what they're asking Snowe, and the rest of Congress, to permit. The fear with Medicare buy-in is that Medicare pays somewhat lower rates than private insurers because it tries to live within a budget, even if it fails. But like it or not, that's the future, or one variant of it. And as most providers know, putting a scary diagnosis off is generally not a good idea"
Wednesday, December 09, 2009
The Public Option is Dead. Long live the Public Option.
Very big developments in the health care reform bill being considered by the Senate. The latest is that a bunch of Senators have negotiated away the Public Option in favor of: expanding the age of Medicare eligiblity down from 65 to 55; doing some regulatory ju-jitsu to allow nonprofit health plans to compete in the insurance exchanges; and requiring health plans to spend 90 percent of every health premium dollar on actual health care.
I think that last one might be the most interesting. By some estimates, plans now use 70 percent of every premium dollar on actual health services. That would be a big change, and in theory could make health care less expensive and more efficient. Health plans in MN are required to be nonprofit and are currently spending 91 percent of ever premium dollar on health services. So it can be done. But it will be a big change for some of these for-profit plans. IF this actually happens, it could be that health plans nationwide are going to rue the day they celebrated the death of the public option.
The change in Medicare is going to be bitterly fought by hospitals and providers, who insist that they can't get by on current Medicare reimbursements. If you expand the number of people using Medicare, then the dollars coming in will be even less.
I understand their concerns, but really, doesn't everybody agree we have to bring health care costs down? So how will we do it without someone taking a hit? If the medical community had united in insisting on stronger reforms for the insurance side (ie public option or something like it) then the dollars would've come from health plan profits. Now... well, they didn't want a big govt plan for everybody, so they won't get one. But they will get a larger chunk of the population on Medicare, and less reimbursement. Tell me, do you think physicians will throw their hands up, say "I quit" and take on a different job, like, say, public school teacher, or sanitation worker?
Sorry to be snarky, but I don't think so either. There is no fixing this system without someone experiencing a little less income. The Medicare change means that someone is probably going to be (some) doctors. I would rather it had been insurance company CEOs. Maybe with the new 90 percent rule, we'll see some changes there too.
The bottom line is; everybody to right of Evan Bayh (not the most liberal of senators by a long shot) was screaming about socialized medicine and the horrors of a public option.
Maybe they should've been careful what they wished for.
I continue to think that the public option, or something like it, will eventually be tried. But what we're looking at with this bill is: regulation of plans to force them to be more inclusive and more efficient, controlling payments to providers, subsidizing citizens to help them afford premiums, and some combination of taxes/subsidies for businesses--depending largely on the size of the business. There's a lot more, obviously. But all of that falls squarely in the "significant reform" camp in my opinion. And it is very much still a private/public mix with the emphasis on private insurance.
Still, a big improvement over the current death spiral; again, in my opinion.
Update: I've been gently reminded by a certain provider that low Medicare reimbursments are a real financial problem for many primary care physicians and hospitals. And there is an actual trend away from primary care as a career because of such financial pressures. As with all of the health care reform debate, it's complicated, and my "doctors won't take up ditch digging" snark was probably an unfair dig in itself. For the record, Medicare reimbursments are an issue that many health care reformers are trying to address, and there are various parts of the current reform bill that take on this issue. I'm not sure yet how those are faring in the latest negotiations, but I'll try to provide an update at some point. In any case, reform is an ongoing process that is going to need a lot of fine-tuning. Medicare certainly is going to have be tweaked as we go down this road. But it will be easier, not harder, to do that if reform passes.
I think that last one might be the most interesting. By some estimates, plans now use 70 percent of every premium dollar on actual health services. That would be a big change, and in theory could make health care less expensive and more efficient. Health plans in MN are required to be nonprofit and are currently spending 91 percent of ever premium dollar on health services. So it can be done. But it will be a big change for some of these for-profit plans. IF this actually happens, it could be that health plans nationwide are going to rue the day they celebrated the death of the public option.
The change in Medicare is going to be bitterly fought by hospitals and providers, who insist that they can't get by on current Medicare reimbursements. If you expand the number of people using Medicare, then the dollars coming in will be even less.
I understand their concerns, but really, doesn't everybody agree we have to bring health care costs down? So how will we do it without someone taking a hit? If the medical community had united in insisting on stronger reforms for the insurance side (ie public option or something like it) then the dollars would've come from health plan profits. Now... well, they didn't want a big govt plan for everybody, so they won't get one. But they will get a larger chunk of the population on Medicare, and less reimbursement. Tell me, do you think physicians will throw their hands up, say "I quit" and take on a different job, like, say, public school teacher, or sanitation worker?
Sorry to be snarky, but I don't think so either. There is no fixing this system without someone experiencing a little less income. The Medicare change means that someone is probably going to be (some) doctors. I would rather it had been insurance company CEOs. Maybe with the new 90 percent rule, we'll see some changes there too.
The bottom line is; everybody to right of Evan Bayh (not the most liberal of senators by a long shot) was screaming about socialized medicine and the horrors of a public option.
Maybe they should've been careful what they wished for.
I continue to think that the public option, or something like it, will eventually be tried. But what we're looking at with this bill is: regulation of plans to force them to be more inclusive and more efficient, controlling payments to providers, subsidizing citizens to help them afford premiums, and some combination of taxes/subsidies for businesses--depending largely on the size of the business. There's a lot more, obviously. But all of that falls squarely in the "significant reform" camp in my opinion. And it is very much still a private/public mix with the emphasis on private insurance.
Still, a big improvement over the current death spiral; again, in my opinion.
Update: I've been gently reminded by a certain provider that low Medicare reimbursments are a real financial problem for many primary care physicians and hospitals. And there is an actual trend away from primary care as a career because of such financial pressures. As with all of the health care reform debate, it's complicated, and my "doctors won't take up ditch digging" snark was probably an unfair dig in itself. For the record, Medicare reimbursments are an issue that many health care reformers are trying to address, and there are various parts of the current reform bill that take on this issue. I'm not sure yet how those are faring in the latest negotiations, but I'll try to provide an update at some point. In any case, reform is an ongoing process that is going to need a lot of fine-tuning. Medicare certainly is going to have be tweaked as we go down this road. But it will be easier, not harder, to do that if reform passes.
Wednesday, December 02, 2009
Health Care Reform
It will cut the deficit by $127 billion and increase the number of the insured to 94 percent of Americans.
It will lower out of pocket costs for most Americans.
It will cover more poor people
It will help seniors by lowering drug costs—see below.
It will also take too long to phase in, not cover as many people as it should, and not do enough, at least at first, to control costs.
But the alternative is doing nothing for the foreseeable future.
What the opponents of health care reform never seem willing to consider is the cost of doing nothing.
“Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.
“That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.”
-Steve Pearlstein, Washington Post
http://www.washingtonpost.com/wp-dyn/content/article/2009/07/21/AR2009072102961.html?hpid=topnews
(Link printed out because Blogger won't hide it.)
“Barack Obama is a Muslim.”
Or so I was told in a Facebook discussion recently. This was in a discussion between a group of presumably Christian folks, several of whom agreed that Obama was not a Christian.
What does it say about people that they are willing to call a man a liar about something a personal as his religion? Without any evidence, in fact with all evidence to the contrary? It’s not like Obama has not been a public figure. It’s not like he hasn’t regularly talked to people about his faith.
Of course, from this same discussion, one poster dared me to find one video of Obama saying the Pledge of Allegience. “You can’t do it!” she crowed.
I found a youtube video of Obama leading the Pledge in about five seconds.
It’s very disturbing. My friends on the right are not just losing touch with reality. They’re rejecting it. And I can’t quite puzzle out why. Are their lives really so miserable they have to take up this crusade against the real world?
But the beat goes on. The birthers. The death panels. FEMA concentration camps. Global Warming Denial. There was even a poll that found Republicans think Obama was elected because ACORN rigged the election.
The Anti-Defamation League recently put out a report called “Rage Grows in America: Anti-Government Conspiracies.” It’s not a fun read, but it underscores some of the irrational anger I’ve been seeing out there.
“What characterizes this anti-government hostility is a shared belief that Obama and his administration actually pose a threat to the future of the United States. Some accuse Obama of plotting to bring socialism to the United States, while others claim he will bring about Nazism or fascism. All believe that Obama and his administration will trample on individual freedoms and civil liberties, due to some sinister agenda, and they see his economic and social policies as manifestations of this agenda. In particular anti-government activists used the issue of health care reform as a rallying point, accusing Obama and his administration of dark designs ranging from “socialized medicine” to “death panels,” even when the Obama administration had not come out with a specific health care reform plan. Some even compared the Obama administration’s intentions to Nazi eugenics programs.
“Some of these assertions are motivated by prejudice, but more common is an intense strain of anti-government distrust and anger, colored by a streak of paranoia and belief in conspiracies. These sentiments are present both in mainstream and “grass-roots” movements as well as in extreme anti-government movements such as a resurgent militia movement. Ultimately, this anti-government anger, if it continues to grow in intensity and scope, may result in an increase in anti-government extremists and the potential for a rise of violent anti-government acts.”
What does it say about people that they are willing to call a man a liar about something a personal as his religion? Without any evidence, in fact with all evidence to the contrary? It’s not like Obama has not been a public figure. It’s not like he hasn’t regularly talked to people about his faith.
Of course, from this same discussion, one poster dared me to find one video of Obama saying the Pledge of Allegience. “You can’t do it!” she crowed.
I found a youtube video of Obama leading the Pledge in about five seconds.
It’s very disturbing. My friends on the right are not just losing touch with reality. They’re rejecting it. And I can’t quite puzzle out why. Are their lives really so miserable they have to take up this crusade against the real world?
But the beat goes on. The birthers. The death panels. FEMA concentration camps. Global Warming Denial. There was even a poll that found Republicans think Obama was elected because ACORN rigged the election.
The Anti-Defamation League recently put out a report called “Rage Grows in America: Anti-Government Conspiracies.” It’s not a fun read, but it underscores some of the irrational anger I’ve been seeing out there.
“What characterizes this anti-government hostility is a shared belief that Obama and his administration actually pose a threat to the future of the United States. Some accuse Obama of plotting to bring socialism to the United States, while others claim he will bring about Nazism or fascism. All believe that Obama and his administration will trample on individual freedoms and civil liberties, due to some sinister agenda, and they see his economic and social policies as manifestations of this agenda. In particular anti-government activists used the issue of health care reform as a rallying point, accusing Obama and his administration of dark designs ranging from “socialized medicine” to “death panels,” even when the Obama administration had not come out with a specific health care reform plan. Some even compared the Obama administration’s intentions to Nazi eugenics programs.
“Some of these assertions are motivated by prejudice, but more common is an intense strain of anti-government distrust and anger, colored by a streak of paranoia and belief in conspiracies. These sentiments are present both in mainstream and “grass-roots” movements as well as in extreme anti-government movements such as a resurgent militia movement. Ultimately, this anti-government anger, if it continues to grow in intensity and scope, may result in an increase in anti-government extremists and the potential for a rise of violent anti-government acts.”
You Should Be Reading Ezra Klein Every Day
At least if you care about health care reform.
Day after day, he delivers great stuff on health care and other economic policy. He’s able to play the policy wonk, political insider, and sharp-eyed blogger, providing lots of information in small bundles that are easy to digest. Some great recent quotes:
“If you had tuned in six months ago for 10 minutes, you would have had all the information necessary to predict exactly where we'd be today. Democrats commanded exactly 60 votes, which meant that they had enough potential supporters to overcome a filibuster, but that each individual senator had sufficient leverage to extract enormous concessions in the final days. … Pretty much everything else has been a distraction, at least so far as the bill's ultimate fortune is concerned. The chaos of August didn't change a single vote. The Gang of Six didn't net firm bipartisan support. The president's speech didn't end the controversies. The deficit reduction embedded in the bill didn't assure a large majority.”
Or: “One of the costs of not passing health-care reform, it seems, is that policies in the individual market will cost about 23 percent more than they will under reform. A vote against change is, in effect, a vote for that.”
Or: “We've had wars of necessity, wars of choice, and the escalations of those wars stretching across both good and bad economies, and both Democratic and Republican presidents. And none of them have been paid for. The political system is learning to think of war as an off-budget expense, which is bad both from the perspective of the deficit, but also from the perspective of forcing us to confront the costs and tradeoffs of war.”
Or this interesting insight into media and politics.
Day after day, he delivers great stuff on health care and other economic policy. He’s able to play the policy wonk, political insider, and sharp-eyed blogger, providing lots of information in small bundles that are easy to digest. Some great recent quotes:
“If you had tuned in six months ago for 10 minutes, you would have had all the information necessary to predict exactly where we'd be today. Democrats commanded exactly 60 votes, which meant that they had enough potential supporters to overcome a filibuster, but that each individual senator had sufficient leverage to extract enormous concessions in the final days. … Pretty much everything else has been a distraction, at least so far as the bill's ultimate fortune is concerned. The chaos of August didn't change a single vote. The Gang of Six didn't net firm bipartisan support. The president's speech didn't end the controversies. The deficit reduction embedded in the bill didn't assure a large majority.”
Or: “One of the costs of not passing health-care reform, it seems, is that policies in the individual market will cost about 23 percent more than they will under reform. A vote against change is, in effect, a vote for that.”
Or: “We've had wars of necessity, wars of choice, and the escalations of those wars stretching across both good and bad economies, and both Democratic and Republican presidents. And none of them have been paid for. The political system is learning to think of war as an off-budget expense, which is bad both from the perspective of the deficit, but also from the perspective of forcing us to confront the costs and tradeoffs of war.”
Or this interesting insight into media and politics.
Doughnut Hole
Such a fun name for such a horrendous policy. Mmmm doughnut hole.
A friend who opposed HCR recently lambasted Medicare because her parents were caught in the doughnut hole. I told her that the health care reform legislation would fix that. Suddenly we stopped talking about the doughnut hole.
The point is, it IS a big bill. And it takes on a lot of problems. Lots of people will end up benefiting in small ways and large. Some new challenges and problems will be created. And it will cost a lot. But at least this President believes in paying for his big new programs.
Remember, the Doughnut hole was created as part of Medicare Part D, brought to us by a Republican administration and Congress that decided a $700 billion program financed entirely by deficit spending was a good idea. We really need to put those folks back in charge of the government.
A friend who opposed HCR recently lambasted Medicare because her parents were caught in the doughnut hole. I told her that the health care reform legislation would fix that. Suddenly we stopped talking about the doughnut hole.
The point is, it IS a big bill. And it takes on a lot of problems. Lots of people will end up benefiting in small ways and large. Some new challenges and problems will be created. And it will cost a lot. But at least this President believes in paying for his big new programs.
Remember, the Doughnut hole was created as part of Medicare Part D, brought to us by a Republican administration and Congress that decided a $700 billion program financed entirely by deficit spending was a good idea. We really need to put those folks back in charge of the government.
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