Pressing the Reset Button
Matt Emerson writes in a comment on Eric’s post about Goldman Sachs:
I find it revealing that neither Commonweal nor America bloggers have seen fit to address the CBO’s analysis of the Democrats’ proposed healthcare legislation.
A snippet from today’s Washington Post article:
“Congress’s chief budget analyst delivered a devastating assessment yesterday of the health-care proposals drafted by congressional Democrats, fueling an insurrection among fiscal conservatives in the House and pushing negotiators in the Senate to redouble efforts to draw up a new plan that more effectively restrains federal spending.”
I don’t pretend to any expertise in economics, but I was struck by an op-ed piece in today’s Wall Street Journal from a former aid to Hubert Humphrey. He is concerned about the direction the President’s domestic agenda has taken and offers a number of suggestions. Here’s one:
Cut back both your proposals and expectations. You made promises about jobs that would be “created and saved” by the stimulus package. Those promises have not held up. You continue to engage in hyperbole by claiming that your health-care and energy plans will save tax dollars. Congressional Budget Office analysis indicates otherwise.
It’s time to re-examine these initiatives. Could your health plan be scaled back to catastrophic coverage for all — badly needed by most families, but quite affordable if deductibles are set at the right levels? Should the Rube Goldbergian cap-and-trade proposals be replaced with a simple carbon tax, with proceeds to be allocated to alternative-fuels development?
The evolving health and cap-and-trade bills are loaded with costly provisions designed to gain support from congressional leaders and special-interest constituencies. In short, they have become an expensive mess. This legislation will not clear Congress by the August recess, as you have requested, and could be stalled for the remainder of 2009. Settle for incremental change: Do not press Democratic legislators to vote for something they fear will destroy them in 2010.
Let it not be said that on dotCom comments go unheeded!
I think we’ve had lots of comments at this blog on health care reform.
As to the “Democratic plan,” it’s final shape is far from clear -let’s ask Sen. Baucus for example.
I think the President, perforce by the intransigence of the opposition, has moved ahead incrementally, sometimes to the dissatisfaction of his party – as the NPR reports of recent mornings have shown.
Perhaps the author cited might consider what the American people think as a whole about what a health care plan should involve -of course, that’s not the same as what the many lobbies can desire and will work hard for.
Long before this economic crisis or the current bunch came to power, it was clear to anyone with the courage to look that the United States couldn’t afford the quality-of-life and health obligations – Medicare, Medicaid, Social Security, government pension obligations – that we had already embraced. Medicare Part D – the prescription drug benefit for seniors – was cynically and irresponsibly passed in full knowledge that we were simply piling one more economically unsustainable obligation atop a rickety pile of others.
If I walk into a public hospital emergency room and grandly proclaim to everyone in the waiting area, “I will pay all your medical expenses!”, I will be a very popular fellow for a short time – until the collections department gets its hands on me. In effect, that is what is happening.
As I understand it, one of the points in the latest encyclical was that economics cannot always be the sole value determining the market. Health care is a prime example. Our motivation has to be what will make people healthy, not what we can afford. Ingenuity will be needed to accomplish that goal, just as ingenuity is needed to create new capital. But a simple “we cannot afford this” is substituting economic values for the true good to be sought in health care reform.
We cannot afford our current system, so incremental change will not work as if by tinkering we could bring it under control. The example above, of catastrophic coverage for everyone, is a prescription for spending more and more on health care as ‘everyone’ comes to suffer from catastrophic conditions. OTOH, providing normal services should prevent many catastrophes by finding cancers early, fighting obesity before it ravages the heart, etc. The ‘less expensive’ incremental plan creates a society full of catastrophically ill people; the ‘more expensive’ plan creates a society of people committed to paying for people to be healthy. Even if we cannot prove the cost benefits of the ‘more expensive’ plan, can we really choose to be a society who values money more than health?
What was revealed by our failure to post what Matt Emerson prefers?
http://tpmdc.talkingpointsmemo.com/2009/07/associated-press-explains-its-thinking–somewhat.php
And the point of this post is…?
David and Grant — buon giorno.
David,
I presume the late hour of your comment accounts for the seeming obtuseness. I’ll take it slow and suggest there are two issues:
1. What if any impact do the findings of the CBO have upon the viability of the health plans currently under consideration?
2. Apropos the WSJ piece (presumably not written by a dreaded “conservative”): are the President’s domestic policies and priorities in need of re-thinking both as to substance and extent?
I don’t pretend to have clear answers; but the issues seem worthy of discussion.
Grant,
Your link seems to speak to the first issue. It would be helpful to me (and, perhaps, to others) if you were to exegete more clearly what you think its import is.
As for “revelation:” I am of the school that restricts the concept to the scriptural witness — a status not yet achieved by dotCom.
I now have one stock comment to all naysayers and hand wringers on all health care reform discussions:
How did every other developed nation in the world manage to come up with a system that covers everyone for less money and better outcomes than ours?
Climate change is hard — no one has figured it out. In comparison, health care is easy, lots of others do it well, using three or four different models — this isn’t a failure of money, it’s a failure of values. Stop taking potshots. Start suggesting solutions and trade offs.
Bravo, Barbara. Our health care system is a mess. The opposition to reform is, in large measure, driven by a callous selfishness. A complicating factor is fear. When the social safety net is as frayed as ours is, then lots of ordinary folk, worried about their jobs, pensions, etc. will fear taxes, hoping to be able to eke out what they need to support their individual families.
To say that the U. S., the economically most powerful country cannot afford decent health care for all its citizens, to say nothing of its legal immigrants is really to say nothing more than that we lack the politicla and moral will to work toward a society that is at least tolerably just.
I’m not sure the CBO report/post speaks for itself, nor am I certain it’s intended to. The key mantra in the CBO report is “under current law.” Of course, the legislative process is still unfolding. I found this piece quite helpful:
http://blogs.tnr.com/tnr/blogs/the_treatment/archive/2009/07/17/orszag-on-cbo-testimony.aspx
So that Revelation does not go unheeded regarding Health Care for The Common Good:
http://www.humanevents.com/article.php?id=32731
Why the apparent dread, not only on the part of politicians, but also our media, to study what other countries are doing, and what we might learn from them? As I understand it, Germany, Switzerland, and France, to name just those three countries, all have variants of public-private programs, all spend far less than we do, and all have far superior results. The Swiss appear to be our closest competitors in per capita spending, but still are far lower than are we. And even if we write off Switzerland as a small country which cannot possibly be a useful example for us, you then have to deal with countries like France and Germany which spend even less than does Switzerland.
My daughter, who works for a foundation that deals with Massachusetts budget issues (health care being a big one of course), tells me that for any politician to say we might learn something from a foreign (gasp) country is the kiss of death. Even if she’s right, why don’t the media do more with this whole question of comparisons? Are they scared, short of people who can do that kind of research, or simply uninterested?
(perhaps the media are full of articles dealing with these questions, but I’ve missed them).
Of all the foreign models, France, Japan, and the Netherlands probably have one that could best be paralleled by the U.S. I think the most interesting thing about Switzerland is that insurers are not permitted to profit from the provision of basic services to individuals. All of their profits must come from the sale of additional insurance, if the individual feels the need to buy it.
I just came back from France, where, fortunately, I didn’t need to use the French health system — but I did need to use the services of the Canadian system for one of my daughters and can report that she received excellent care.
And: for all those wondering, as I did, Who is this Van Dyk character?–someone at TNR did some digging.
http://blogs.tnr.com/tnr/blogs/the_plank/archive/2009/07/17/wall-street-journal-finds-the-perfect-democrat.aspx
F.Y.I.- http://de.sys-con.com/node/1039913
Alas, the light of day, and I am still obtuse. But thanks for the kind words, Bob.
A couple of other thoughts:
-Last night’s news hour on PBS notes the elephant in the room: the vast percentage of health care funds spent on the final weeks of folks lives – an issue politicians want to avoid.
But a wonderful piece on the way the Sisters of St. Joseph approach it in the July 9 NYT shows not only a better view than one gets walking into a hospital and maybe wisdom for us, including a far deeper appreciation of hospice.
Today’s NCR has the issue of dealin gwith the elderly from a caretaker perspective, but again there are model programs of respite care out there that allow care in the home to continue.
I wonder if some of this means a change of heart -when I discused this with my buddy on our hospital board, his ambivalence shown through: if my wife is dying, he said, I’d want her to have only the best.
(Of course, he has top notch medical coverage from his old job.)
Change of heart also has another edge – trust.
HT to the late Walter Cronkite – the man of trust. This morning as i woke, i heard someone say that a poll showed the least trusted people in the US were politicians.
They’ll frame our health care change along with the lobbyists and op-ed pundits.
Change of heart?
Common good?
Mr. Gibson: Is the point of the post really that elusive? You still remain mystified? One clear point (brought to light in the WSJ article to which Fr. Imbelli links) is to stoke discussion about whether the country can handle the President’s massive and costly restructuring of healthcare, particularly when Congress has just passed an $800 billion “stimulus” bill that, by most accounts, is doing little stimulating. A lot of Obama’s supporters — particularly his Catholic supporters — justify their vote for him (and their uneasiness about his abortion positions) by claiming that Obama’s positions on healthcare are wonderful and in line with Catholic social teaching. But, as in moral theology, Obama’s intentions alone are not decisive. We have data — challenged by Mr. Gallicho and others, to be sure — suggesting that the President’s healthcare proposals are going to wreak serious havoc on the economy and our financial system. Regardless of the exact numbers, the issue has to be confronted — by his supporters, especially.
The WSJ article also raises other questions about the first few months of the Obama presidency: about Obama’s agenda, his choices for staff, and the extent to which he may have veered from the promises of his campaign.
In light of all that, can you honestly say that you cannot discern a point in the post? Are those topics off-limits at Commonweal?
Or is it something else? I detect an annoyance from both you and Mr. Gallicho that Fr. Imbelli dared to elaborate on my original post and question the soundness of the President’s healthcare proposals. Is your real dismay that someone has the audacity to doubt this President?
I think the question about how to pay for health care is certainly a good one–and a complicated one.
But the actual question by Matt, and bumped to center stage by Father Imbelli, was not about health care–it was about the good faith of Commonweal and America bloggers in failing to post on this particular issue. The implication of the question, as I read it, is that we, collectively, were deliberately ignoring this issue in order not to cause problems for the President.
In my experience , bloggers don’t post on things for a number of reasons–especially in the summer. I myself, for example, didn’t see the report or the story about the report.
In my experience, as well, the best way to get people to discuss an issue isn’t by suggesting ulterior motives for their failure to discuss it previously.
.
Let us not forget that the fundamental purpose of Health Care, from the beginning, is to preserve Human Life, not destroy it.
Mr. Emerson, leaving aside the matter of Catholics and President Obama, your comments about the economy, health care, etc. seem to amount to the following:
Given the way our economy functions, our tax regime, the way money flows in our political system, etc., we can’t make any significant moves to improve our health care sytem’s performance, especially for the poorest among us, we can’t really deal with climate problems, or energy problems, etc. So, facing these supposedly fixed “realities,” we ought to just suck it up and quit all this agitation for change.
If this does not accurately reflect your position, how would you correct my characterization of it?
Matt,
I think Goldman Sachs might have some extra money. Maybe Obama could ask them to give it to us (I hear they’re friends!), but they’ll probably re-invest it in pharmaceuticals. Then, when the health care bill dies, they’ll post another awesome quarter. But at least the unborn babies will be safe…oh, wait, that won’t happen either.
“We have data — challenged by Mr. Gallicho and others, to be sure — suggesting that the President’s healthcare proposals are going to wreak serious havoc on the economy and our financial system. ”
Possibly, but then the choice is between doing no harm to the financial and economic system doing no harm to the health of the people of this country. It would be hard to convince me that our economy and financial systems should be better protected than our health.
Cathy: I did not mean to suggest ulterior motives or question anyone’s good faith. I do think many of Obama’s supporters are too ready to embrace his agenda without considering its cost or consequences (a comment which, I concede, could be applied to many Republicans during the last eight years). When I said I thought it “revealing” that the pending healthcare legislation had not received commentary on this site, I meant (perhaps inarticulately) to highlight that point, and to voice my dismay that bonuses at Goldman Sachs, and not the President’s own agenda, were the point of concern.
Having said that, you are right to point out the multitude of reasons for lack of commentary, whether on this subject or any other. I may have been too quick to make a point and imply partisan motives where none existed. Your comments are well taken.
Mr. Dauenhauer: I confess to be at a complete loss to understand how my comments can be characterized in the way you present them. In saying that, I don’t mean to be glib. But I haven’t said one word about the tax regime, about how money flows into our political system, about climate problems, and about energy problems, and I haven’t said anything is “fixed.” Nor have I beckoned anyone to just “suck it up” or “quit all this agitation”. (Indeed, I think there are probably some who think I’ve agitated too much.) Can you point me to some particular comments of mine that may shed light on your characterization?
Mr. Bugyis: I don’t follow.
Matt,
Where was all this concern about the fiscal responsibility of the government before they dropped $800 bil. proping up folks like Goldman Sachs? I think it’s, to use your word, “revealing” that saving the credit banking system was an essential and, for the most part, unquestioned government intervention, but now that Goldman and others are breathing easy, it’s time to tighten things back up.
Secondly, as Grant pointed out, the CBO numbers don’t take into account the new tax laws that will need to be in place to pay for the health care bill, which, as I understand it, will mostly affect folks in the wealthiest income bracket. So, Goldman and company will, it seems, be helping us out (or paying us back).
Third, the bit about the pharmaceuticals was meant to suggest that the slight “leveling” of the for-profit health care system might hurt some investors who count on the fact that people get sick and need to buy medicine. If universalizing health care does, as one would hope, increase the general health of the population while subsidizing their care, some people might stand to lose money. Just like giving money to folks who ended up with bum mortgages to keep them from defaulting and going into forclosure would have hurt those who bet on the fact that they would default and the government would have to bail out the investors rather than the homeowners, which is what seems to have happened. (By the way, Nick Baumann’s article in the most recent issue of Commonweal suggests that Obama avoided rewarding this kind of “betting on failure” in the case of the auto bailout: http://www.commonwealmagazine.org/article.php3?id_article=2597).
Finally, I thought I’d throw that bit in about abortion, just because it seems to be the issue that MUST be tagged on to all other political issues regardless of relevence.
I hope this helps.
‘Finally, I thought I’d throw that bit in about abortion, just because it seems to be the issue that MUST be tagged on to all other political issues regardless of relevence.”
Eric, why would you suggest that abortion is not relevent to Obama’s Health Care reform when you know that that is not true?
“I now have one stock comment to all naysayers and hand wringers on all health care reform discussions:
“How did every other developed nation in the world manage to come up with a system that covers everyone for less money and better outcomes than ours? ”
On the other hand, if it’s so simple and the model is so well-understood, why is it that our elected representatives so far haven’t been able to cobble together a piece of legislation that the CBO hasn’t shot full of holes?
“As I understand it, one of the points in the latest encyclical was that economics cannot always be the sole value determining the market. Health care is a prime example. Our motivation has to be what will make people healthy, not what we can afford.”
“Bravo, Barbara. Our health care system is a mess. The opposition to reform is, in large measure, driven by a callous selfishness. ”
We have to live within our means. By all means, let’s reform health care, but in a way we can actually afford. To say that is not callous selfishness, it is simple prudence. Passing a financially unsustainable piece of legislation endangers not only health care but national security, retirement income, public works, employment for millions of government workers, and every other good thing that government does for us.
Really, the bit that strikes me as callous selfishness is the part that runs along these lines: “We will borrow beyond our means of repayment to fund our own retirements and medical care. Our grandchildren will have neither – but that is their problem.” I have yet to read the current encyclical, but that sentiment seems profoundly unChristian.
Jim, reporting on CBO is itself full of holes. If you want to fully immerse yourself, fine, but I’m not doing it here. In general, however, think of it this way:
One side of the poster says “rationing!!! Oh no!!!” and the other says “It costs too much!” If a proposal has provisions to contain costs, you hold up one side and if another focuses more on availability you hold up the other. In neither case do you really care what the objection is, so long as there is one.
CBO made specific recommendations on affordability, such as taxability of benefits, empowering MedPac, etc., none of which those who are singing the CBO song would dream of trying to enact. They are not serious about health care, only obstructing it.
“One side of the poster says “rationing!!! Oh no!!!” and the other says “It costs too much!” If a proposal has provisions to contain costs, you hold up one side and if another focuses more on availability you hold up the other. In neither case do you really care what the objection is, so long as there is one.”
Hi, Barbara, not sure if your use of the 2nd person in that comment was referring to comments I’ve made in the past here about health care? AFAIK I’ve never commented on rationing?
At any rate – in a forum like this where there are so many folks discussing, it’s difficult to keep score of where everyone stands. If anyone is interested, I’m strongly in favor of health care reform. I also am convinced that it can be done in an affordable way. Any comments I make about financial irresponsibility are made, not to scuttle health care reform, but to urge our elected representatives to do the right thing in a financially responsible way.
No, no, this wasn’t in reference to you at all — but to the Congress critters who seized on the CBO comments.
I’d like to say a couple of things about health care financing in the United States since it doesn’t seem to be well understood by the general public. I’ll put out my usual disclaimer that I am an executive at one of the largest health insurance companies in the United States.
Is there enough money floating around in the system right now to finance a decent health care system? Yes. But the financing is currently complex and a major overhaul of the health system would involve a major overhaul of the financing system.
Here is one piece of the problem (looking in this case at hospitals). Right now, Medicare pays about 90 percent of a hospital’s costs. Medicaid pays, maybe, 30 percent. Charity care pays, well, nothing. Commercial private insurance pays about 120 percent of a hospital’s costs, with significant differences between payers in a given market because, despite what people think, there is indeed competition between insurance companies.
If we move towards a government program that will “compete” with the private sector, one of the big questions is “what will the government pay the hospitals”? If it pays them current Medicare rates, and lots of people move out of the private insurance sector into the public sector, the hospitals are going to see a lot of their net reimbursement move from 120 percent of costs to 90 percent of costs. The fact is, if this happens, the current financial structure of the American medical system will collapse.
There are many who see this as a good thing, citing the fact (and it is a fact) that hospitals are among the most sloppy businesses around. (There is a stronger argument to be made that it is in fact the hospitals rather than the insurance companies where there is no real competition.) The way to get hospitals to make even their current levels of care efficient is to cut back what they take in. But from a business point of view this is like saying that the captain of the Titanic should have just turned the ship around before it hit the iceberg. But it was already in an iceberg field. In other words, nice idea in theory, but hard to do quickly in practice, especially because no one knows how many people would move out of private insurance into public insurance or whether these people would tend to be higher risk or lower risk people (the consensus seems to be on the former). You really can’t cut your costs effectively if you cannot predict what your revenue will end up being.
Leaving aside for a moment the problem of paying for people who don’t have insurance now, one of the reasons that people would want to move from private to public insurance is because private insurance is very expensive. And you can now see one of the big reasons why. It would make no sense for them to move to public insurance and pay what they pay now. They would want to pay less. So someone would have to get less. A lot of the current argument is that this “less” would be insurance company profits and overhead. But the less would actually be the differential between public and private reimbursement to providers. This is why the government would have to pay so much, at least in the short run. They would have to make up this difference in some form.
Moving to the public plan with those who are privately insured would have to be at least some of the money that is paying for their premiums now. How does this money get from the private sector to the public sector? Would businesses pay the government as one private insurer? Would businesses get out of the health benefits business and pay their workers more and then have the workers hire the government as an insurer. Would we pass a tax on all businesses or all workers or both to create a pool of money to finance the system as a whole? Each one of these has political problems (although, so what?) and because decisions made here would have a differential effect on different interests, you can see that financing itself is a hotbed even taking out the insurance companies, the providers, and the drug companies.
Then there is the problem of the uninsured. The Right seems to think that the uninsured don’t cost the insured people any money. In fact, the insured are paying for them all right now. Directly through taxes, indirectly through the subsidy I pointed out above, indirectly in lost commercial productivity for the uninsured, most of whom are workers nonetheless and who get sicker than the insured do because they spend less on medical care for themselves. As I said, there is enough, and more than enough money floating through the system right now to take care of everything. But the system as it is set up now is a zero sum game and this is the basis of our problem.
F.Y.I.- http://www.rd.com/living-healthy/18-ideas-to-reform-health-care-now/article101364-1.html
Sharing medical research would not only lead to finding cures for disease but would help in lowering the cost to develop new drugs as well.
Cathy Kaveny writes: “I think the question about how to pay for health care is certainly a good one–and a complicated one.”
I certainly agree which is why I sought some help in coming to grips with it.
I found Unagidon’s remarks helpful in delineating something of the problematic. I would be further helped if he were able to outline the parameters of what he takes to be a viable solution (though he may have done so on other threads — in which case I apologize for missing it).
I am no advocate of Goldman Sachs — not that they miss my advocacy. The almost incestuous relationship between said firm and the firm known as the United States Treasury, under both Republican and Democratic administrations, appears well-established.
Finally, CBO statements seem akin to papal encyclicals — invoked when they correspond with our already set agendas.
Unagidon,
I was an associate in the health law department in a large Boston law firm when Clinton’s health care reform package was being pushed. At the time, managed care in the proper sense (Alain Enthoven) was all the rage –in delivering better, more efficient, and cheaper care through tested standardized treatment protocols and outcome management, and integrated delivery systems to control costs.
I haven’t kept up with all that in a while. Is that still the framework that the people in the field are operating with?
Dear Cathleen,
Managed Care in that sense is widely disliked politically these days. It is still strong in some local markets and has almost disappeared in others. The problem with it is that it is “managed”. When people complain about insurance companies either telling someone what provider to go to or what procedure they will pay for, they are mostly talking about managed care products.
Skating the edge of revealing where I work (which I don’t want to do) my company found some years ago that medical management of the “pre-authorization” type was costing us more to do than the money that was saved doing it. So we stopped, even with our HMO products. Now we are starting to bring it back; in part because we (along with everyone else) is more sophisticated with the data and in part because the UNDERLYING costs of health care (i.e. what the providers get) is rising so quickly that even cutting costs one percent now looks like something we need to do.
Father Imbelli said: “I found Unagidon’s remarks helpful in delineating something of the problematic. I would be further helped if he were able to outline the parameters of what he takes to be a viable solution (though he may have done so on other threads — in which case I apologize for missing it).”
We can’t come to a solution. We just don’t know what we want. Unlike, say, some good old fashioned earmarks where the different politicians can get something they want by supporting something someone else wants for the same price, we haven’t even defined what the end product should look like concretely. And worse, the health care problem, like the abortion problem, is utterly corrupted on both the Right and the Left by the pollution of moral indignation, that uber-vice that masquerades as a virtue.
We could solve some things rather easily. We could set up a government run catastrophic claims coverage scheme for the entire population pretty cheaply and this would end the “I lost my house to cancer” stories. We could also set up a preventative care system that would also be relatively cheap. The problem is the donut hole in the middle; the gap between free preventative care and catastrophic care. But the moral indignation that surrounds this problem causes both the Right and the Left to misrepresent (and I mean utterly misrepresent) what is really going on. So how can we fix it?
In a comment earlier, suggested that the current debate is in the middle innings of a long game that may go into extra innings. Once the current bills are merged; if they pass the House & Senate; then Obama will need to weigh in on the eventual conference committee end result.
Per Unagidon, the task is to basically take a system and stand it on its head:
- coverage for all people – beyond catastrophic or you continue to “waste” money on chronic conditions that could have been managed early on – this would impact CBO projections
- preventive care – will this have teeth?; most chronic conditions have their growth because of “unhealthy lifestyle” choices……will it mandate or incent smoking cessation; what about the US issue of obesity and overweight – incent weight (e.g. Japan does this); what about nutrition e.g. tax on soft drinks; restrict from schools, etc. as examples. Will the plans mandate annual exams or screenings by condition by age groups?
- competition……no one has spoken about one option which is a cooperative pool that offers a number of insurance plans; current insurance industry could be more competitive e.g. most BCBS plans are not-for-profit vs. the Aetna, UnitedHealthcare, CIGNA, Humana, etc. for profit plans. Barbara did mention the Swiss example where all plans are not for profit (non-starter in the US)
- Unagidon……it appears to me that much of the donut hole is shifting costs ……hospitals spend millions each year on covering the uninsured (if they are county facilities); those costs would now have insurance coverage. In reality, 90% of all insurance is currently employer paid and hospitals cover their uninsured costs via their paying customers…..again, it is a shift in the hospital, payor, coverage set up. Not sure that the CBO projection accurately captures this; (will agree – this impacts hospitals; do we have too many in some markets? in behavioral care in the early 1990′s, managed care was so successful but more than 60% of all psych facilities closed)
- managed care; managing chronic medical conditions via coaching, best practices, transparency via LeapFrog associations, records going online, better pharmacy practices, better imaging practices. The insurance industry knows that these methods work….currently, large plans offer these but only a small segment of employers are paying for it
- the CBO projection says nothing about the current system; the reality that medical costs have increased on average 6-10% every year since the late 1990′s….this is unsustainable for US industry to remain competitive…..that cost is not figured into the CBO projections
- IMO, we have the means to provide universal coverage; we have the medical knowledge to manage chronic medical conditions; we have the hospital & MD systems that can make this work…..but, all stakeholders have to be willing to shift paradigms and, in the short term, this may come at a cost. But, we know enought to project that in the long term, it will increase coverage; increase US health trends; decrease total medical procedure costs. It would realign the current way medicine is practiced in the US e.g. significant need for PCPs and preventive/chronic care management practices.
- guessing you work for UnitedHealthcare given your citing of pre-authorization….fact; it did nothing to improve total health; it only restricted access, caused frustration, and resulted in more paperwork. (my wife was the QI director in north Texas where this pilot initiative was tested). The current system has way too much paperwork but are all parties (political, medical, AMA, pharmacy, states, Medicare/Medicaid; etc.) willing to shift gears and move from an insurance claims payment industry to a medical/preventive/total/end-of-life/hospice healthcare system which focuses on health over a lifetime?
Say it again and again: We. Are. Already. Paying. For. The. Uninsured. The payment system is so distorted — think of it as a financial version of the game of telephone — by the time you’ve gotten to the 12th equivalent of the recipient of the story, who knows what something costs or who, exactly, has paid for it — probably everybody, to some degree.
What we are seeing right now, in response to the effort to provide actual payment for everyone, is the financial equivalent of a game of musical chairs — everyone trying to make sure that someone else gets caught without a chair — except in this case, that means, without the hidden larded subsidies that everyone piously screams that they’ve earned because . . . whatever it is that they do is exceptionally valuable, helpful, research, tax-exempt, they take care of the uninsured, their patients are REALLY sick, blah blah blah. Maybe if you’ve heard it 10,000 times it’s easier to screen it out.
Taking care of the uninsured is a moral imperative. My father walked into the ER of a tax exempt academic medical center and was told by a super duper gastroenterologist who didn’t do a single laboratory test that there was nothing wrong with him even though he was in excruciating pain. What was wrong with him was that he was 64 and had retired early hoping to hold out for Medicare. A first year resident at a community hospital figured out what was wrong and he got the bill for the so-called services of the first doctor the same day he got an actual diagnosis of terminal cancer. That could be you if you lose your job or one of your children if they don’t happen to win the professional school lottery.
Whatever we don’t fix the first time, we’ll tinker with, just as we have Medicare and Social Security.
Unagidon,
Your intelligence and technical expertise have been a great help to all of us who follow dotCommonweal’s posts about health care. (And there have been more of these than this particular post might suggest.) But your description of moral indignation as an “uber-vice” that pollutes the debate about health care is uncharacteristically simplistic and polemical. There is, to be sure, a lot of false, ineffectual moral indignation on both left and right, on this and every other important issue, but not all moral indignation is false (see Barbara’s comment right above this one); and so far from its being ineffectual, real moral indignation is often the engine that drives reform (see any number of important political movements, including the civil-rights movement). Indignation is never enough to produce good reform; for that, we need rationality, patience, and prudence as well. But there is a reason, a good reason, for people to be angry with the way our current system works. You are right to insist that the problem is complicated and entrenched, wrong to suggest that for this reason we should throw up our hands and settle for a few discrete and marginal ameliorations rather than an overhaul. You write that we can’t come to a solution because we don’t really know what we want, and it’s true that we don’t all want the same thing. But more of us than ever before want the government to guarantee — and not just to mandate — that everyone is covered, even if this means raising taxes and imposing some cost controls. The main problem isn’t the incoherence of public opinion but the obstinacy of lobbyists and politicians who can’t bring themselves to acknowledge that our system has failed where others haven’t. So why aren’t we taking a close look at those other systems? Yes, America is different from Switzerland and France, but not so different that we can reasonably dismiss their health-care models out of hand as irrelevant to our situation.
I would argue that we do know what we want but we don’t know how to get it. And a prime reason for not knowing how to get it is because the whole edifice is the opposite of transparent, making it virtually impossible to penetrate — and fix — through understanding rather than further obscure through emotionalism. But one very big reason why it is not transparent is because there are so many hidden subsidies and costs, and a primary reason for why there are so many hidden subsidies and costs is because there are so many without means of payment.
So covering the uninsured, in my view, is not only the right thing to do, it is actually the first step in trying to contain costs by removing one of the primary obstacles to being able to see how providers can or should perform. There are a lot of studies about the potential impact of covering the uninsured on costs, but until they are actually covered we actually don’t have a clear view of what could or should be done on the cost front. For instance, I can’t tell you how many hospitals claim that they need more payment because of the burden of providing uncompensated care (and I bet Unagidon could tell you even more than I could).
I do however agree with Unagidon that both left and right traffic in false or at least erroneous outrage. The Natalie Sarkisian case, as tragic as it was, is perhaps emblematic of the kind of incomplete moral outrage that the left believes encapsulates the “real” problem: a young girl in need of her second liver transplant, virtually guaranteed to fail, that a hospital refused to provide without a commitment of payment from an insurer that had already paid for the first, failed transplant (actually a self-insured public agency employer) that balked at the notion of funding such an extreme and desperate and all but certain to fail measure. What it says to me isn’t that insurers (or hospitals) are evil — it says to me that these kinds of decisions can’t possibly be made one person at a time. A rule that makes second liver transplants virtually unattainable would also leave Ms. Sarkisian dead; but it would be a societal determination of limitation. What many find so insupportable about the current system is the estimation that these kinds of decisions are being made for private profit.
And the estimation that these decisions are being made for private profit, in turn, obstructs the view of those who hold up this case from seeing that it’s cases like this that make medical care so unsustainably expensive. It’s tough, yes, but it shouldn’t deter us from moving in the right direction.
http://www.slate.com/id/2223037/
In his new book The Healing of America, the journalist T.R. Reid employs a clever device for surveying the world’s health systems: He takes an old shoulder injury to doctors in various countries….
But the lesson I took away from Reid’s book was somewhat different: Health care systems are not just policy choices but expressions of national character and values. The alternatives he describes work better than ours not just because they’re well-designed and competently managed but because they reflect the expectations and traditions of their societies.
Yes, Historyman, and as more than one person has remarked, it’s not that America is the nation with the best health care, it is the nation in which health care has been most capably exploited for commercial opportunity. It will be hard to walk that back, and we will likely always outstrip other countries in costs for that reason, but that still doesn’t mean it has to be done as inequitably as it is now.
As noted on nPR by Cokie Roberts this morning, the GOP thinks the health care debate is a way to pull the President down.
Interesting op-ed by William McKenzie of the Dallas Morning News, which starts with the same premise essentially, but argues that the GOP needs to dela withs its internal “snake pit”: libertarian thibnkers, siocvial moderates, fiscal conservatives, elected conservatives, and
“E-mail conservatives” who “…take their cues from Rush Limbaugh and the e-mail blasts from GOP headquarters and forward the links.They pounce on anyone on the blogosphere who deviate from the conserbative line. …”
Sound familiar?
Let’s see reaction after Wednesday night’s press conference.
“Half the controversies in the world are verbal ones; and could they be brought to a plain issue they would be brought to a prompt termination. Parties engaged in them would then perceive either that in substance they agreed together, or that their difference was one of first principles. We need not dispute, we need not prove, we need but define. At all events, let us, if we can, do this first of all and then see who are left for us to dispute; what is left for us to prove.” Cardinal John Newman
This quote seems very relevant to our current circumstances when we argue about health care reform. One of the problems of the discussion is that most people don’t actually know how the whole thing works in detail and yet they are being called upon to support solutions. It’s not because they are stupid or uneducated. It’s because the subject is complex and in many ways opaque. One cannot, for example, easily get price and quality information for medical providers. Insurance benefits are hard to understand, sometimes even for people in the industry. There are things that don’t seem to make any sense and seem like they would be easy to fix, like the multiple claims forms that doctors have to fill out for insurance companies. There are many things that can be done better and the reason we know this is that we can see other countries doing them better.
But aside from all of this, the part of Cardinal Newman’s statement that is even more relevant is that of first principles. The Left and the Right both claim to be arguing from first principles in the health care debate. The Left talks about compassion and the human right of people to have health care. The Right talks about prudence and the many dangers of socialism. In this highly complicated discussion on health care, it is very easy for the talk to move to what appear to be principles, because one may not know much about the health care system, but everyone thinks that they know about principles.
In the midst of a sort of technical presentation about how parts of health care financing work, I threw in a strange note about moral indignation being an uber-vice that masquerades as a virtue. I am going to stand behind that statement. The thing that makes moral indignation a vice is not that people have true gut sentiments about morally outrageous things. Moral indignation is a vice because it is the thing that makes us think that we are arguing from first principles when in fact we are not. It is an uber-vice, because thinking that one is having a discussion of first principles when one is not always causes the participants to demonize each other rather than come up with solutions in the sense that Cardinal Newman says above.
Moral indignation always takes half a principle and marries it to half a solution. The “half principle” is a good one, but it is taken out of the context of other principles that really need to be considered in order to solve a problem. It’s parallel is in the virtues, when someone focuses on one or two and not all of them at the same time, which is really what they should be doing. The grabbing of half a principle gives moral indignation its visceral power; the thrilling feeling of self justification. The half solution is then married to the half principle in such a way that one says “if you support this principle you have no choice but to support THIS particular solution.” This marriage of a half principle to a half solution is the rational side of this mutant ethic. It is what creates the feeling that one is both morally committed to something and intelligently pursuing it.
Regarding the principle of health care in the United States, on the basis of first principles we ALL already agree that people should never be allowed to just die in the gutter. We also ALL already agree that we need to be prudent in the allocation of national resources for national needs and as Americans we also always look for best solutions. These things are all in out nature.
Beyond this, the health care problem is, like most public problems, a question of quality and costs. It is a particularly difficult problem because it is such a huge and basis issue, it impinges on ALL costs and ALL quality, especially the quality of individual liberty.
We are all smart people and it galls us to think that we might be getting caught up in a whirlwind of moral indignation. So I will add this quote from Thomas Merton, because I think that he is talking about the same thing I am.
“Propaganda makes up our minds for us, but in such a way that it leaves us the sense of pride and satisfaction of men who have made up their own minds. And in the last analysis, propaganda achieves this effect because we want it to. This is one of the few real pleasures left to modern man: this illusion that he is thinking for himself when, in fact, someone else is doing his thinking for him.” Thomas Merton
Sorry for the typos above. I really need an editor.
Unagidon, I might not know everything there is to know about this issue, but I am certain I am not getting caught up in a whirlwind of indignation. I agree that many comments I see are ill-informed — they tend to focus on what I would call the “last direct act” that most troubled or injured the individual — which means, for many, insurance companies are the focus of anger, with no apparent understanding of how one element simply feeds another.
Nonetheless, you seem to underestimate, or avoid, the degree of sheer calamity that befalls people who have no means to pay for needed health care.
Barbara said: “Nonetheless, you seem to underestimate, or avoid, the degree of sheer calamity that befalls people who have no means to pay for needed health care.”
Believe me, from where I sit, I can see it all too well.
We could put in a fix immediately that consists of universal catastrophic coverage and universal preventive coverage. It would not cost very much and would solve two of the biggest problems now. We could then do the rest over time with specific mandates linked to specific time lines.
But the Left is acting like if we don’t do it all now, we won’t be able to. The Right is worried about doing it all now. In fact, although I hate saying it, the health care debate in its form has become a mirror image of the abortion debate, with the Left taking the hard line this time.
Hi Unagidon, I guess I disagree with your characterization, partly because single payer, being what I would call the most left on the spectrum of possible solutions, isn’t even really on the table. Whatever comes out will already be a compromise from that. Your suggested solutions are not wrong, but the reality is that legislative momentum is what it is, and every proposal I have read already has timelines for implementing any new program that go all the way out to 2013. I do think many underestimate the sheer complexity of bringing a new program to fruition — the Part D benefit took more than two years, for instance.
I want to add my appreciation for Unagidon’s contributions to our health care discussions.
He(?) wrote:
“Here is one piece of the problem (looking in this case at hospitals). Right now, Medicare pays about 90 percent of a hospital’s costs. Medicaid pays, maybe, 30 percent. Charity care pays, well, nothing. Commercial private insurance pays about 120 percent of a hospital’s costs, with significant differences between payers in a given market because, despite what people think, there is indeed competition between insurance companies.
“If we move towards a government program that will “compete” with the private sector, one of the big questions is “what will the government pay the hospitals”? If it pays them current Medicare rates, and lots of people move out of the private insurance sector into the public sector, the hospitals are going to see a lot of their net reimbursement move from 120 percent of costs to 90 percent of costs. The fact is, if this happens, the current financial structure of the American medical system will collapse. ”
In support of that insightful comment, I’d like to call attention to this article, entitled “Bending the curve on health spending” that appeared in yesterday’s Chicago Tribune. The authors are the CEO of the Mayo Clinic and the executive director of the Mayo Clinic Health Policy Center. Readers here probably know that the Mayo Clinic is often cited as a leader in managing health care provision in a way that is both effective and cost-effective.
http://www.chicagotribune.com/news/opinion/chi-oped0719mayojul19,0,2771064.story
Unagidon,
Neither Merton nor Newman were warning against appeals to first principle. Merton was warning against false appeals to principle that replace thought, Newman against controversies that could be avoided or quickly resolved if the principles were adequately defined. A careful presentation of the first principles involved in the health-care debate is actually quite rare and nothing like as easy as you suggest. It is not just a matter of getting people to agree that they all agree about not letting people die in the gutter. To borrow a word from your Newman quote, putting the question that way produces a purely verbal solution to the problem of first principles. We congratulate one another for our shared decency and conclude that whatever the problem is, it can’t be one of first principles. It must, therefore, be technical, which means that ordinary citizens should defer to those with greater technical expertise, most of whom work for one of the industries that have an interest in keeping things as they are. This is the same line of argument we’ve heard in discussions about the financial industry: Everyone agrees on first principles (credit crises are bad; we should avoid them; they cause a lot of innocent people to suffer), so the only questions worth talking about must be technical ones, and the only people really competent to talk about these are the people who work on Wall Street. I think this kind of argument is bad for democracy: it encourages people to abdicate their duties and prerogatives as citizens; it invites indifference and despair.
Instead of talking about indignation, perhaps we should talk about anger at injustice, which is just the flip side of the desire for justice (cf. the Beatitudes). Yes, such anger is only the beginning of engagement, but it is often what gets people to learn whatever they need to learn in order to participate in democratic deliberation. They do not need to learn everything, and they do not need to defer to anyone just because he knows more. The person who best understands the ins and outs of our very complicated health-care system does not get to decide for the rest of us whether and how to reform it. And this is precisely because, at the end of the day, this really is a debate about principles, whose relation to one another is not always obvious. Do we believe it’s more important to ensure that everyone in our country, no matter his income, has access to basic care than to make sure America leads the world in medical innovation? Perhaps we can do both, perhaps not. In any case, we’ll have to decide which is more important; otherwise it will be decided for us by people whose primary responsiblity in this matter is to their investors rather than to their fellow citizens. Or we might ask, with Michael Walzer, whether health care is the sort of thing that ought to go to those who can best afford it, or whether it is instead the sort of thing that ought to go to those who most need it. This is a question about first principles, but the answer isn’t obvious. The principle of distribution for health care may not be the same as the principle of distribution for, say, education; there is, after all, more than one first principle, and we need to decide which one applies here. Justice is often as complicated as fee schedules. I am not so much indignant as bewildered at your suggestion that we all already agree about these basic questions.
I don’t know about the left, but the Democrats certainly aren’t taking a hard line on health care. The hard line (which I thought was also your line) is a single-payer system, and that never even got a hearing on Capitol Hill. Indeed, the gradualist scheme you hint at in your last comment is actually far more radical than what the Democrats in the House and Senate have proposed — if what you call doing “the rest” means eventually arriving at a single-payer scheme.
May I ask a dopey question?
For the sake of discussion, suppose I work for a small business that does not offer a health care benefit to its employees.
Under the proposed legislation in the House and Senate, how would my family receive health care?
Thank you for your discussion, Matthew.
You said: “The person who understands the ins and outs of our very complicated health-care system does not get to decide for the rest of us whether and how to reform it. And this is precisely because, at the end of the day, this really is a debate about principles, whose relation to one another is not always obvious. Do we believe it’s more important to ensure that everyone in our country, no matter his income, has access to basic care than to make sure America leads the world in medical innovation? Perhaps we can do both, perhaps not. In any case, we’ll have to decide which is more important, or it will be decided for us by people whose primary responsibility in this matter is to their investors rather than to their fellow citizens.”
You seem to me to have loaded the statement above in a way that I think demonstrates my point.
I’m not sure where you get the idea that people who understand the health care system are trying to decide whether and how to reform it for everyone else. Surely you’d have to admit that whatever the voters (ultimately) decided would still have to be carried out by people who know how the system operates. Or are you suggesting that the implementation is a matter of principle too?
You have juxtaposed “access to basic care” to “lead the world in medical innovation”. You say that we may or may not be able to do both, but your juxtaposition doesn’t make any sense in the first place. It is actually the very kind of argument made on the basis of moral indignation that I was speaking about. Your next statement which seems to juxtapose “the people” with what appear to be capitalists is the same sort of thing. It is simply a fact that everyone involved in the system is interested in profits. If you think that the so-called non-profit hospitals, payers, and medical groups are not interested in profits and that they do not serve their boards and the people who run these things in exactly the way that public corporations do, then you would wrong. There is no altruistic semi-socialized part of the American medical system yearning to break free from greedy insurers.
I have already suggested, very simply I think, that the government could institute universal catastrophic insurance and universal preventative care insurance for the entire population through a number of different mechanisms and do so relatively easily. I also suggested that if single payer is the way to go (and from a technical, actuarial point of view it is the way to go) we could move towards it over time with the same legal mandates that have been used by us in the past to accomplish all sorts of other things. I am not sure how you think that the first part of what I have proposed above somehow does not equate to basic universal access to health care.
But before we do any of this, we still have to understand how the system actually works, because only then can we understand the political forces involved. Let me propose something hypothetical. What would you think if you heard that physician and hospital lobbyists supported legislation to create a public alternative to private insurance until they found out that the government would not pay billed charges but would instead pay something like the Medicare fee schedule, at which point these same people began to lobby against it?
Thanks to all. especially Barbara, Unagidon, and Matthew, for a civil and spirited — and, at least for me, helpful — exchange. Their contributions have answered, far better than I, the early query regarding the “point” of the post.
As a final contribution on my part: I found a piece in today’s “Wall Street Journal” to be an informative and (to my perhaps naive eye) a non-partisan setting out of the issues, “Ten Questions on Health-Care Overhaul:”
http://online.wsj.com/article/SB124812571962066393.html
Unagidon, I thought about what you said, and I guess my main response is, where is the legislative version that embodies your ideas? If a Republican, alone or inconjunction with Democrats came out with an alternative along the lines that you proposed, that is, immediate universal coverage for preventive care and catastrophic events, never mind the details, that would gain the votes of 80% of each legislative body, and with a commitment to phasing in universal comprehensive health care coverage over a specific time period — I think that could be a good strategy.
But it’s not there because, basically, the Republican strategy is to put their fingers in their ears and scream “nanny nanny boo boo you’re all wrong” without suggesting a constructive compromise. Yes, this bothers me a lot because I think constructive dialogue can often bring about constructive solutions, but no one should have to continually negotiate against themselves and give up things they think are important, and particularly so when it’s fairly clear that the goal is obstruction no matter what is in the legislation.
It really shows how broken our political discourse has become. I am old enough to remember when it was different and I am hopeful that it will change again.
Barbara – unfortunately, just offering catastrophic and preventive care gets us no farther down the road. Catastrophic coverage (as defined by who, limits, etc.) – will only continue the current broken system. Preventive (as defined by who, covers what, etc.)
Jim – realize that multiple proposals are out there but simplistically, employers with less than 25 employees get insurance from a public, state, or some type of cooperative or tax credits. More than 25 employees, company is required to cover insurance in a range from 50-70% of the cost. The employer gets tax credits to offset this insurance cost for up to three years. Some built in limits given employee salaries, etc.
Question – what if the hospital and AMA changes their current support? Well, given the specific proposal, some parts of these organizations are already backing off in support of universal health care. Unagidon makes a good point – insurance companies whether for profit or not for profit still run a business that is expected to make a return; any MD or MD group expects to make a profit. Complex issues – when I talk about turning the system on its head, this proposal needs to change a few basic things:
a) current FFS system – allows or encourages hospital, MD, pharmacy, imaging, specialty MD to run all kinds of procedures and tests – no one is really coordinating the care and the end goal for total patient health. Thus, we have very good medical procedures/technology but out of control spending. Thus, you have Obama’s push for a comprehensive, total health goal where the PCP is the coordinator (not insurance, not managed care, not the plan);
b) current system needs to change so that pre-existing conditions, exclusions, portability of insurance is not completely tied to employers;
c) projects such as Leap Frog need to be built in to the proposal and made mandatory across all 50 states – e.g. state of Penns spent over a $1 billion in hospital deaths that could have been prevented. By changing the procedures, the state saved over $350 million in one year. These steps require online health information; transparency in terms of conditions, surgical success, death rates by condition, pricing by procedure. This is the new wave of managed care vs. the Clinton era (which was very successful for its time – decreased or held medical spending for employers to 0% or less for years). But since 2000, average annual increases have been more than 5%…..no hospital, no MD group, no employer can continue with this system;
d) bell curve – 20% of patients spend 80% of the medical expenses. Proposal needs to look at total care that involves the “new” managed care of medical conditions, requiring lifestyle changes, coaching and monitoring conditions, use of pharmacy to support health and not profits; etc. (this does get into the area of personal health, privacy, but the proposal needs to have incentives to drive folks to healthy lifestyles);
e) hospitals – all over the board. 40% of US hospitals are catholic. Following current position, CHA needs to support universal health care. The devil is in the details – will be interesting to see if CHA continues to support Obama or begins to waver on the need to change the foundation of healthcare in the US;
f) Medicare – remaining issue in this debate. Medicaid is being proposed for increases esp. since its membership will increase exponentially. But Medicare is an issue – will reforming the system save enough money so that the lower Medicare reimbursements provide MDs, hospitals, pharmacies an adequate return?
Unagidon,
You misunderstand me, and maybe that’s my own fault. Reading over the paragraph you quote, I see that it can easily be misconstrued. I didn’t mean that your own technical expertise, or anyone else’s, was to be distrusted if it was allied to profit-making, and I certainly didn’t mean that we can afford to dispense with expertise, either in planning a new system or in implementing it. I meant only that technical expertise alone does not help us very much with the fundamental questions we need to answer before we can deal with inevitable trade-offs. Your expertise, for example, helps you to see that a single-payer system would be the most cost-effective way to provide medical insurance to everyone, but it does not help us answer the question of whether providing insurance to everyone is more important than keeping the government from taking over health care. The disagreement over that question is real and vigorous, and it cannot be resolved with flow charts and cost-benefit analyses. I don’t mind so much being accused of indignation (believe me, I’m used to it), but my “juxtaposition” of universal coverage and medical innovation is really quite straightforward. I did not say that the two were always incompatible; I said that as policy priorities they can conflict. Some of the resources now devoted to research and development or experimental end-of-life treatment could be redirected to providing basic care to those who now lack it. Single-payer systems work only if the government is allowed to control costs, including the cost of medicine. Prescription drugs are more expensive here than anywhere else in the world, and drugmakers plough much of the money they make into research and development. A common reply to those of us who advocate a single-payer system in the United States is that single-payer systems work elsewhere only by using drugs developed by American companies that aren’t as subject to government cost controls. So the connection between breadth of care and innovation is direct, and it runs, like most things, through cost.
Finally, I didn’t say that I thought the first part of your proposal did not equate to basic universal access to care — I like your proposal very much, insofar as I understand it — but since we’re on the subject, it isn’t clear to me that univeral catastrophic coverage and access to preventative care (the first part of your proposal) really do amount to universal basic care, as long as preventative care is understood to mean what it usually means (keeping people from getting sick), and not what basic care usually means (keeping sick people from getting much sicker). Indeed, if the first part of your proposal really did mean providing basic care for everyone, there would be no need for the second part. But maybe this, too, is mainly a verbal problem. In any event, your proposal is much more uncompromising than the Rube Goldberg device the Democrats have come up with. That’s not a problem for hotheads like me, but it doesn’t leave you in a very good position to say that indignation has turned the reformers into hardliners.
Hi, William, I agree with you completely, which is why the basic/catastrophic components could only be preliminary — to stop the bleeding as it were — while more time is spent on reforming things like, in particular, physician compensation, which simply has to be changed for anything really good to happen. The legislative process has become so bowdlerized and toxic, however, that, of course, once the first part was in place various interests would launch a full-scale and relsentless assault to eliminate the rest.
How many of you remember catastrophic care? I do. So do many members of Congress. I sometimes wonder how many seniors who screamed at their delegation about being required to spend $10 a month for prescription drug coverage ended up wondering 10 years later when they were paying so much for prescription drug coverage, why they had ever opposed it. I had a colleague who quite a trade association because of the tactics that were used to try to repeal that first Medicare prescription drug benefit. It was the first tactical use of gay baiting that really showed just how much teeth it could have in all sorts of ways. It’s not just what’s good and practical — it’s what can be done and when. It’s a key component of what Hillary Clinton did not understand in 1994.
To this excellent discussion, the below comments from today’s column may be distracting rather than complementary. But here they are ’cause they address federal politicking.
http://www.nytimes.com/2009/07/21/opinion/21brooks.html?_r=1
Finally, there is health care. Every cliché Ann Coulter throws at the Democrats is gloriously fulfilled by the Democratic health care bills. The bills do almost nothing to control health care inflation. They are modeled on the Massachusetts health reform law that is currently coming apart at the seams precisely because it doesn’t control costs. They do little to reward efficient providers and reform inefficient ones…
Nancy Pelosi has lower approval ratings than Dick Cheney and far lower approval ratings than Sarah Palin. And yet Democrats have allowed her policy values to carry the day — this in an era in which independents dominate the electoral landscape. Who’s going to stop this leftward surge? Months ago, it seemed as if Obama would lead a center-left coalition. Instead, he has deferred to the Old Bulls on Capitol Hill on issue after issue…
Fr. Imbelli, thank you for the link to the Janet Adamy “ten questions” article – well worth reading.
“But the Left is acting like if we don’t do it all now, we won’t be able to. The Right is worried about doing it all now. In fact, although I hate saying it, the health care debate in its form has become a mirror image of the abortion debate”
Yes, all-or-nothing is incredibly frustrating. There has to be a wide middle/moderate ground that makes Blue Dogs less nervous, may attract bipartisan support, and as Barbara says, serve as a starting point for future improvement