Tag: health care

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To paraphrase Joseph Conrad: Healthcare reform, it dead.

I know, the reform effort continues to move forward, but the goal has shifted from transforming the system to tweaking it, from expanding access and improving care to creating a bureaucratic maze that sort of looks like universal coverage but that protects the very people who have made such a mess of things in the first place.

Real reform — otherwise known as single-payer — was never on the table. The politics, everyone agrees, made it impossible. Of course, the politics — otherwise know as the conventional wisdom — is self-perpetuating.

But even without single-payer, we had a chance to make major changes in the system that would have forced the insurance companies to play ball — a public option that would have competed for customers.

Already, the group of six has tossed aside the idea of a government-run insurance plan that would compete with private insurers, which the president supports but Republicans said was a deal-breaker.

Instead, they are proposing a network of private, nonprofit cooperatives.

The public option was no panacea — but with requirements in place preventing the insurance companies from gaming the system as they do now (they would not be able to deny coverage for a pre-existing condition, cap payments or kick people off their rolls), it would have made a huge impact on the way the healthcare system runs.

Howard Dean, the former Vermont governor and a physician, told Rachel Maddow last night that the bill that latest proposal “is insurance reform but it‘s not health reform.”

It‘s not going to—what it will do, I assume there is guaranteed issue and so forth in there, and if that‘s true, if the guaranteed issue is in there and community rating, then it‘s insurance reform.

It‘s not going to do anything to curb expenses. It‘s not going to change the health care system. It‘s not going to insure anybody extra. That‘s what I call the fake public option.

He continued:

This bill is going to cost a lot of money and isn‘t going to do anything if this compromise, this so-called compromise is true. This compromise does nothing except it will reform insurance. That‘s a good thing to do, but they ought to strip the money out of it because we reformed insurance like this in Vermont 15 years ago. It‘s a fine thing to do, but it doesn‘t insure more people.

There is this sense now that it is more important to get something — anything — done and that it have some Republican support. That kind of thinking is similar to one of the great failed football strategies — the late-game use of the so-called prevent defense, which is all about caution, all about playing not to lose (which is not the same thing as playing to win).

What we are witnessing is a Democratic majority more concerned about the insurance lobby and its campaign cash while also being able to share the blame in case their reforms fail to function as advertised, rather than going hard at the end zone — which would require an aggressive reconstruction of the healthcare system in the United States.

The debate over healthcare reform is on the wrong track. Rather than working to craft a logical system that provides adequate care to all, we are worried about how we’re going to pay for it. That’s one reason that Congress (aside from a few members) has taken a single-payer system off the table.

Today’s New York Times outlines the problem — though, it doesn’t portray it as a problem, but as an inevitable outcome of the debate. The problem with this, however, as Sen. Bernie Sanders (I-Vt.) pointed out recently on Air America’s “Ring of Fire” radio program, is that it assumes that new money needs to be raised to cover Americans.

The reality, as Sanders said, is that there is plenty of money in the current system. We pay it now in insurance premiums and copays and other out-of-pocket expenses. A single-payer system would just redirect the money from the inefficient for-profit system now in place to a government-sponsored non-profit system.

The money is there already. I think what we’re dealing with here again is this mythology that people love, you know, everybody tells me, “Bernie, I just love paying 12, 13 thousand dollars a year to a private health insurance company for my family’s health insurance. I just get a great joy writing out that check to Blue Cross Blue Shield or Connecticut General. That just makes me feel great, but I hate to pay taxes.”

So what our Republican friends say is that your taxes are going to go up under a single-payer. True. They will. What they are forgetting? They’re forgetting that you’re not going to pay for private health insurance. They are forgetting that your employer is not going to have to pay a significant amount of money that should be reinvested in their business needs into health care.

They are forgetting that General Motors right now puts more money into health care per car than you do into steel.

So the answer is that health care is going to cost money. Under a single-payer, it is publicly funded, but you’re not going to have to pay private health insurance. And at the end of the day, that is a much more cost-effective way of delivery quality, comprehensive care.

That, of course, should be the goal — not just plugging the holes in the current system and driving down cost, but providing every American with affordable health care.

Too bad the big money flowing from the corporate sector is against it.

Good news from the Senate, according to OpenLeft:

A progressive bloc in the Senate has given the Democratic leadership a blunt choice: pursue a strong public option, or lose 10-15 left-wing votes on health care.

As Chris Bowers wrote in his OpenLeft post,

This has happened because the Progressive Block strategy is starting to manifest itself. Rather than Democratic leaders voluntarily turning legislation into a warm pile of corporate mush in order to appeal to a center-right business, media and political status quo, and then having those leaders browbeating the left into supporting said warm pile of corporate mush because that is just “political reality,” now progressives are determining the limits of political reality themselves. Progressives are offering the leadership a simple choice: pass a strong public option, or you don’t get a health care bill.

Let’s hope they keep up the pressure.

Barack Obama may be willing to go to the mat on his healthcare plan, after all. While I remain dubious that his approach will work in the end — I remain committed to a single-payer plan — it is clear that he is offering the best of what is possible.

The question has been whether he would defer to Congress, allowing them to weaken reform — to remove the public option, to eat away at other necessary reforms — or make it clear that there are elements of his plan that are non-negotiable.

Having just listened to the healthcare forum, I find myself a bit more optimistic about reform’s chances. The president repeatedly talked of the need for a public option, of regulation of the insurance industry and a focus on preventative care — pieces that must be included in any non-single-payer reforms.

Basically, he has decided to take his approach to the public so that the public can then take his fight to Congress. Or so it seems.

Here is what The Caucus blog at The New York Times reported shortly before the town hall started:

The White House is working to intensify a grass-roots push for its health care plan. With Congress on recess this week, the event here in Annandale is one of several intended to highlight the president’s urgent call to reduce costs to the health care system and lower the number of uninsured Americans.

“One of the reasons the president is out there today is for people to get a better understanding of what his health plan will do,” said Robert Gibbs, the White House press secretary, briefing reporters back at the White House on Wednesday afternoon.

He pushed off the suggestion that a single-payer plan would work best by saying that it “works well in some countries” but was “not appropriate in the United States” due to the existing employer-based system. His alternative is a “government-run ‘public option’ to compete with private insurers,” which “would provide ‘competition and choice’ and ‘keep insurers honest.'”

The event, like all of these, featured what I’ll call an “Oprah moment” — the president hugged a cancer patient who had broken down in tears as she asked about her own coverage — designed to humanize the issue and Obama. And there were questions from doctors (about malpractice caps — Obama is against them) and small business owners (about the unaffordability of coverage) and advocates (Health Care for America Now, which is supported by the president).

What was missing were any questions from hardcore critics — whether from the left or the right. But this wasn’t a debate, or intended as a balanced presentation. This was a presidential sales job intended to get the grassroots out and working.

And it was long overdue.

Obama healthcare forum