health care – Page 4

Mythology of cost: Health care v. the war

Let’s do some simple arithmetic: The heathcare reform legislation approved by the House of Representatives last week — H.R. 3962 — is estimated to cost $891 billion over 10 years, while reducing the federal deficit by $109 billion, according to the nonpartisan Congressional Budget Office. That’s about $90 billion a year.

Compare this with the cost of the wars in Iraq and Afghanistan, which the CBO estimates cost the nation $604 billion during their first six years and have been cost in the neighborhood of $100 billion a year over all.

Basically, we could pay for healthcare — and maybe some other needs — were we to end the disastrous military conflicts and focus our attentions on repairing the cracks in our own foundations, cracks that have been widening with every dollar spent on war.

The discussion of our budget deficit rarely gets framed this way; rather, we talk only about our domestic priorities — heatlh care, infrastructure, the regulatory agencies — as contributing to the ballooning deficit and debt. Money spent on war, however, is a different animal altogether.

This is the point David Sirota makes today in his OpenLeft blog post, commenting on a weekend New York Times story on the costs of an expanded Afghan war:

Kudos, of course, to the Times for even reporting on the unfathomably large costs of intensifying militarism and adventurism. But as you’ll see in the story, there’s no attempt to put the costs into any context – specifically, there’s no mention that an escalation in Afghanistan would mean outlays for the one-year Pentagon budget is approaching the total outlays of the entire 10-year health care bill.

Earlier, in his syndicated column, Sirota sums up a contradiction that blames domestic spending — specifically spending that has a liberal or progressive goal, like eradicating poverty, ameliorating poverty’s impacts or making sure everyone has health coverage — for pushing the federal budget into deficit.

When the House considered a health care expansion proposal that the CBO says will reduce the deficit by $11 billion a year, tea-party protesters and Congress’ self-described “fiscal conservatives” opposed it on cost grounds. At the same time, almost none of them objected when Congress passed a White House-backed bill to spend $636 billion on defense in 2010.

The hypocrisy is stunning — lots of “budget hawk” complaints about health legislation reducing the deficit and few “budget hawk” complaints about defense initiatives that, according to Government Executive magazine, “puts the president on track to spend more on defense, in real dollars, than any other president has in one term of office since World War II.” And that estimate doesn’t even count additional spending on the Iraq and Afghanistan wars.

Sirota blames “skewed reporting” and the lying liars like Sen. Joe Lieberman, who cherry-pick numbers and ignore what might be inconvenient to their argument.

I can but agree, though the failures of the news media are due not to any skewed motivation but rather to a flaw in how journalism is now practiced in Washington and the state capitals. Journalists have become stenographers to power — or boomboxes for the powerful, if you’re talking about broadcast/cable — who do nothing more than regurgitate what they are told by disingenuous politicians.

Add to this the ingrained desire to chase conflict and you have a recipe for lies and distortion becoming accepted wisdom — afterall, to paraphrase a quotation attributed to Vladimir Lenin, tell a lie often enough and it becomes the truth.

Negotiating from weakness

Matt Rothschild offers the most accurate assessment of the healthcare plan unveiled by the House Speaker Nancy Pelosi and House Democrats yesterday. There are good elements likely to improve the system, but it “isn’t near perfect.”

Rothschild offers several points: “it doesn’t allow the government to set the reimbursement rates,” giving insurance companies the power “to negotiate those rates with the government.” That’s a prescription for higher insurance company profits, but not a lot of consumer savings.

And while it creates a public plan, it “would not be open to everybody,” meaning that it cannot act as real competition, making it unlikely that it would keep costs down.

And it doesn’t cover everyone — not the undocumented, who seem to be on the outside no matter who’s writing the legislation, but about 10 million Americans. That’s not just morally indefensible, but foolish. Real reform, as Rothschild points out “must include health care coverage for everybody in America, not just citizens.”

He writes about the undocumented, but his argument is valid for everyone left without insurance, that the uninsured “will end up going to the emergency room for costly care when they could have been treated initially, at much less cost, if they had health care coverage.”

I suspect that the Pelosi will get through the House and then get watered down in the Senate. If that happens, it will once again show that the Democrats do not know the first thing about negotiating — which would leave us with weaker reforms than we need, without much of a chance for a second bite at this apple.

Our best just ain’t good enough

We will have a public option, but it appears that the plan being worked out in Congress will fall short of what it needs to do — leaving more than 10 million Americans uninsured, limiting the public option available only to the currently uninsured and mandating that Americans buy insurance from the insurance companies.

As Dennis Kucinich asked today from the House floor, “is this the best we could do?”

“Is this the best we can do? Forcing people to buy private health insurance, guaranteeing at least $50 billion in new business for the insurance companies?

“Is this the best we can do? Government negotiates rates which will drive up insurance costs, but the government won’t negotiate with the pharmaceutical companies which will drive up pharmaceutical costs.

“Is this the best we can do? Only 3% of Americans will go to a new public plan, while currently 33% of Americans are either uninsured or underinsured?

“Is this the best we can do? Eliminating the state single payer option, while forcing most people to buy private insurance.

“If this is the best we can do, then our best isn’t good enough and we have to ask some hard questions about our political system: such as Health Care or Insurance Care? Government of the people or a government of the corporations.”

Howard Dean may be right that this is a step in the right direction, but with a strong Congressional and Senate majority, the Democrats had a responsibility to stand up for us and not for the insurance companies.

Olbermann takes on healthcare, sort of

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Keith Olbermann’s “Special Comments,” his occasional editorial comment, are often pointed and say things that need to be said.

Some on the other hand, miss the mark completely.

Last night’s, as Mike Madden writes on Salon.com, just fell flat. It was overly long and offered little to the people who watch his show, the vast majority who support reform. It was a good, old-fashioned venting, one he may have needed to perform, but one that we did not need to hear and that did not move the debate forward. Olbermann, as Madden says, “mostly ignored what’s actually happening, in favor of preaching to the choir, rather than explaining the situation.”

The entire hour was dedicated to a “Special Comment” — Olbermann-ese for an editorial — about healthcare reform. But the point didn’t seem to be to pass reform legislation; the point appeared to be to chastise everyone involved in it, on either side, and to declaim about the nature of the system. Where Olbermann could have explained what the legislation would do — and taken on the myths against it — instead he spent his time making solemn pronouncements.

The questions he raised and did not raise, the myths he magnified and dismantled, did not get at the basics of an argument that has gone horribly off track (my Progressive Populist column, which will be published later this month, focuses on this) — the need to expand care to the uninsured and to make sure the insured actually get the coverage they pay for, the need to change how we pay doctors and the need to uncouple health coverage form employment.

Spending an hour spitting venom on a dysfunctional system should have functioned as a call to arms for single-payer, but instead he offered nothing more than an angry salvo in a healthcare battle the contours of which have been decided by politicians without imagination or guts or both.

Wrong approach on health care

I know this is supposed to be good news, and I guess it is. But the reality is that the deficit is a red herring in the healthcare debate. It’s not about the deficit, but about the way we spend our healthcare dollars.

We spend one out of every six dollars in our economy on health care — an astronomical number that is almost 50 percent higher than the average industrialized nation. And yet we have nearly 50 million uninsured and we rank on the lower end of the health scales.

We spend plenty. The questions are who gets the money and what we spend it on. Right now, the bulk of the cash flows through the insurance companies, who skim big money from the top before passing it along to Big Pharma and doctors who push unnecessary drugs, tests and treatments.

The Baucus bill leaves this dynamic place.