But look! Commenter "mgoodfel" wrote under my article: "You could call it Medicare." Ding! What do we have for the winner?
Fame and glory I guess, although I'll bet mgoodfel, who's a steadfast opponent of the Democrats' health care reform, doesn't seek much glory from a move that could help Dems push through a bill with a public option ... or whatever its called. My response to his comment is here:
M, I know you probably don't mean to be terribly helpful to the pro-reform movement, but I think you're right about Medicare as a name. People like Medicare. Scratch that, they love it. So why not name an extension of government-sponsored care something similar. UniCare is taken by a big company. But CommonCare, Publicare, NationCare ... not horrible.
If you are going to mention my name and credit me for anything in this debate, you might repeat my comment as well:
Lots of people need health care. The ones that aren't insured, or are turned down by insurance, get it via emergency rooms or private payment. Some go bankrupt and some die for lack of care.
I can see that this situation needs improvement. But the biggest, most basic problem, is the dramatic rise in spending. If you don't control that, you don't have a plan.
So my hostility to reform isn't because I don't see a problem, it's because Democrats are pushing something that won't and can't work. When you object, they scream at you, or put their fingers in their ears and say "la, la, la, I can't HEAR you..."
Well I hope you don't think I distorted your point. You ARE a "steadfast opponent of the Democrats' health care reform." That's to say nothing of the general threat of health care inflation, or the need for improvement. It's simply to say what you've said.
When you just describe me as "an opponent", you don't credit me with any reasons. You just lump me in with Republicans who don't care about the details -- they just want Obama to fail.
I think we should encourage more retail medicine. Dentistry, eye care, plastic surgery, and other areas where people pay cash (like alternative medicine) don't show anywhere near the rise in costs that the insured, hospital-based system does. If you want to control costs, you not only need consumers to be aware of costs, you need everyone in the system to be worrying about costs. When it's all paid for by third parties, no one has that attitude.
Second, I'd really like to see a comparison of primary care standards from 1987 and today. That was not primitive medicine back then, and yet it cost half as much (in inflation-corrected dollars.) My intuition says you should be able to deliver that same care for the same price now. In fact, it should be less now, since medications available back then are generics now, and the cost of electronics (for everything from X-rays to MRIs) has dropped.
Third, we need to look at what actually works in other systems around the world. There's no need to reinvent the whole system from scratch. I don't see why TV news programs aren't doing tours of the English, French, Japanese, etc. health care systems, to educate Americans about what the standard of care abroad really is.
Fourth, I want to know where the money is going in our system now. Clearly it's being spent on something. People make it sound like insurance companies heat their offices with $100 bills. In fact, health insurance is not a particularly profitable industry. I read that "uncompensated care" (emergency room care for the indigent) is only 2.2% of the bill. I read that malpractice premiums are small. I read that drug company profits are only a small part of the total health care bill. Etc., etc. So where is the money going? Despite all the press attention to this topic, I've yet to read a definitive breakdown of where we spend the money.
Lastly, when someone like me says "you can't keep spending money like this", either prove me wrong, or give me a sensible answer for how your alternative will work. Just waving your hands and saying "we'll solve that problem somehow, because we have to", is not a plan. Saying that "of course, there's cost control in ObamaCare" even as the Senate rolls back Medicare cost controls is as I said, "sticking your fingers in your ears..."
I'm similarly curious about where the money goes. I do have a few ideas:
Regarding the standard of primary care in 1987 compared to now, things are incredibly different. One of many, many examples is our treatment of HIV. The HAART anti-retroviral regimen began sometime around the mid-90's and has vastly improved outcomes for HIV patients. However, the complexity of the disease process masks the problems this presents. HAART does not effect a cure for HIV, merely slows it down. Consequently, people are able to live much longer, and because HIV progresses to AIDS and a lack of immunity, dozens of diseases emerge in those afflicted with the disease. This concept works for multiple diseases, from cancer to autoimmune diseases. Essentially, the problem is that after the huge benefit to longevity from relatively cheap antibiotics from around WWII (although I'll address some problems with cost there in a moment), the cost for increasing life span increases exponentially.
Also x-rays (to say nothing of CT scans, MRI, Ultrasound, and Nuclear Medicine scans) from the late 80's have nowhere near the quality of scanning or resolution we have today, which helps in diagnoses. Ironically, however, if a better scan allows you to detect something that used to be undetectable, that means there is also something to treat that would have gone untreated were it not detectable. This is obviously not true in every, or possibly even half of the cases, but it does still factor in to increasing costs.
As far as generics are concerned, this works in many cases but antibiotics pose a huge dilemma. Studying Tuberculosis earlier (I'm a second year medical student), I came across a slide in the presentation from my professor discussing one of the largest problems with Tuberculosis treatment: compliance. The body's mechanism of fighting Tuberculosis is to wall it off, which results in isolation from antibiotics and cessation of symptoms. The isolation mandates extended antibiotic treatment lasting for 6 months, which isn't all that expensive because first line drugs are cheap. However, when the symptoms stop, there are many people that will also stop taking the medication, leaving some tuberculosis alive and allowing it to gain resistance to the cheap, firstline drugs. When infected with resistant tuberculosis, second line drugs cost between $80,000 and $100,000 dollars per person for a full course of treatment.
This is another principle that, at least to some degree, is transferable to all antibiotics. MRSA infections cost much more to treat than the non resistant strains. On top of the drugs costing more, many of the more complex antibiotics are IV only, mandating hospital treatment, and many have much more serious side effects, requiring palliative care.
The drugs also account for some of the differences in spending. In the US, we honor the patents. Europe does not, tells the pharmaceutical companies what they will pay, and the companies allow it, because they know other countries will simply manufacture their own version if the companies don't comply.
Regarding malpractice, the insurance itself is not necessarily expensive (with some exceptions), but the type of medicine it inspires may also be a huge driver of cost. Practicing defensive medicine may translate to ordering the MRI instead of just using an x-ray in an effort to stay out of a courtroom. As an EMT during college there were constant complaints from the nursing staff about ER physicians that would keep patients longer than necessary or order multiple unnecessary tests (both of which results in more work for the nurses, hence the reasonable irritation) just to cover themselves. This seems like a hard thing to quantify, however.
Even with all that, however, I still wonder where the money goes, and would also be curious to see a breakdown. I do suspect much of it goes towards unnecessary testing and imaging, whether it be defensive or simply because a physician is also trying to be an entrepreneur with his own imaging equipment that results in overusage, as Dr. Gawande implicated (among other things) in his NY Times article. There is also the issue investigated by the Dartmouth Study about disparities in Medicare spending by as much as 30% in different areas of the country with no discernible differences in health care outcomes. I would really enjoy some focus on that to determine what the difference is, and how we can emulate the lower cost areas.
I also agree with you that the consumer needs more exposure to costs in order to control them 100%.
Senator Robert Taft, probably the most conservative Republican to ever serve in the Senate, solved this problem ages ago when he advocated catastrophic health insurance. Let the health insurance companies sell cheap policies that cover minor illnesses, drugs,prevention and checkups, but if you are diagnosed with one of the big time killers, the government picks up the tab. A good name would be CrisisCare. To fund it, use a VAT dedicated solely to this service.
This is an idea whose time has come. It would be very popular amongst Americans, forcing congress to adopt it.
Richard,
We do have crisis care - it's called bankruptcy.
"Let the health insurance companies sell cheap policies that cover minor illnesses, drugs,prevention and checkups."
Private insurance companies suck at this. The emphasis on expensive procedures and specialists, rather than preventive care and checkups, might be profitable in the short term, but it costs everyone a lot of money in the long term. In fact, this is the biggest problem with a hyper-privatized system such as ours. Insurance companies have gotten better recently about compensating for things like routine checkups and doctor/patient discussions regarding preventative care, but this is only because they've realized that it costs them less in the end. This proposal would disincentivize private insurers to provide adequate preventative care even more than our current system does. A system such as the one Senator Taft proposed would have us rely on private insurers for preventative care and checkups, both of which they are terrible at, while expecting the government to pick up the tab. In short, this would most likely result in even worse care than we have now for even more money than we currently spend.
Not to mention, preventative care isn't something you typically use insurance for, and is part of the problem. The employment based insurance model has gotten people so used to not paying for any medical care whatsoever, that's what they associate with insurance. In any other field this would be ridiculous. Imagine sending a claim in to Geico for getting your oil changed or tires rotated. Preventative care isn't an unexpected cost, it's something about which the public needs to be educated so they realize this type of care will save them money too.
So, mgoodfel, what is your plan for solving the problem that you have identified? Sometimes it just, plain and simple, costs money to solve problems. It isn't right for our society to just stand back and watch the proverbial child next door die from lack of medical insurance. It isn't right to have as the premise of our nation's health care system that if you get sick without insurance you better hurry up and die.
I think we should tax all health care benefits as income, at all economic levels. After all, they are income, we do have an income tax and this would really let people know the cost of what they are getting. I say to all those with nice company paid plans don't think of what is best for you, but instead think of what is best for the country as a whole.
There is so much in a name. The R's have been brilliant in terms of hanging emotionally powerful names onto the various ideas they are either for and against. The D's are really lousy at branding. I like the idea of calling it Medicare and selling it as a simple enlargement of Medicare.
Peggy Noonan offered up this idea way back in July - speaking as FDR:
"And then, and only because you've all made so many institutional and structural changes, you'll have to give Medicare a new name. I'd suggest 'The National Health Service.'
"Voilà. You now have the single-payer system you wanted.
"Everybody wins. You get expansion, Republicans get cost control, the system is made more secure, and the public for once isn't terrified.
http://online.wsj.com/article/SB10001424052970204619004574320743837417378.html
2 out of 3 aint bad?
I agree with mgoodfel that "the biggest, most basic problem, is the dramatic rise in spending". However, we cant ignore some of the other big flaws in the current healthcare system, namely 1) the unbalanced and many times abusive power that medical insurance companies wield and that do affect many american's lives and 2) that an important percentag of americans are unable to afford healthcare.
So, if Obama's reform plan is at least addressing two of these concerns, doesn't that count for something?
Unfotunately, if we dont succesfully address the rise in health care costs its all a moot point. Whether or not this reform goes through the public will always be paying for the under/uninsured through the less obvious cost-shifting that takes place.
Now, if we could only do something about the deficit....
Well, I think the problem with the 2 out of 3 theory is the concern that those last 2 will make the first 1 much, much worse. On the other hand, solving the first resolves the 3rd to a great extend.
I don't understand why we continue to call this health care reform. Very little about health care is changed under any of the proposals, and in fact I imagine that is part of what mgoodfel finds objectionable. It is health care expansion and health insurance reform.
Also, to which of the unbalanced powers of insurance companies are you referring? I'm not trying to say they don't have power, but some are necessary and some are excessive, so I'm trying to understand which you think are which.
To me it's more of a philosophical and political point of view. Do you believe that everyone has a "right" to healthcare or should it be a "survival of the fittest". This may be viewed as "socialist"... well, who am I kidding, it inherently is. That's why it sounds so much like Medicare. They are programs specifically designed for the "social welfare" of the nation. It does NOT mean that it should replace private insurance or a private medical system.
I DO think you're right, 2 and 3 may make 1 worst, but it's a start. What we cannot allow is for it to be the end. If passed people may think the job is done and forget about the many other problems that need attention.
As for the insurance companies there are certain practices that need to be stopped. Example, paying employees based on amount of denials, not covering "pre-exsting illnesses" (to a certain extent), stopping coverage becuase someone's illness suddenly became to expensive and denying coverage even when there is good sound medical judgement behind the treatment.
But it's a start in the wrong direction. I do not understand why we can't start with reform. The legislation is not set to go in effect for 3 years. Why not engage in health care reform in those 3 years?
I do not think health care is an inherent "right", but I do think the citizens of this country believe in providing health care to those who cannot afford it. Which is why we have Medicare and Medicaid. Not only do I not have a problem with that, but I wholly support it.
As far as the insurance companies, I absolutely agree, but these seem like easy problems to fix. I think detaching health care from employment would to a large extent repair the pre-existing condition problem, although I believe there are already some safe-guards in place for that (some of which can be improved). The stopping coverage, or rescission, is a deplorable practice but one that occurs much more rarely than most people think. Either way, that also seems easily fixable.
Well, Richard, although I like the idea you presented as at least a good step towards solving the health care crisis, I'm not certain whether or not its the final solution nor am I willing to speculate. I'm just saying it could work, but as an uninsured american that should but never goes to the doctor due to insane cost and lack of ability to pay.....something definitely needs to be fixed. ESPECIALLY when we're the ONLY western country with no sort of national health care plan for its citizens and we're ranked BEHIND Ecuador and other 3rd world countries in health care quality and accessability.
you also said: "This is an idea whose time has come. It would be very popular amongst Americans, forcing congress to adopt it."
while that view is nice and all, it's unrealistic. As you should know congress does NOT represent us, their constituents, but the person/special interest/corporation with the deepest pockets and best lobby. Even if 99% of people favored that plan, you still have to fight through the top 1% of the economic food chain that are making money on the current system and will spare no expense legally bribing (lobbying) congressmen and women to keep things exactly the way they are.
If you want real progress and representation in this country, the solution is clear: outlaw lobbying and make congress represent US for a change.....
Why not just call it 'Medicare', but to have it actually be Medicare?
Yes, I do mean simlpy extending the present eligibilty requirements for this well known and trusted program, to include the categories of the people who would be eligible for the "public option" being debated now.
This would reduce greatly the fear of unknown that is understandable for a huge change like is being proposed, and it will stop wasting time on (and loosing) the discussion of government taking over our great health care industry.
How would you like to pay for that? Also, what do you propose to do about the increasing percentage of Medicare patients struggling to find a primary care physician because physicians can no longer afford to take Medicare patients and maintain a practice at the same time?
Smart? So now its 'smart' to trick and deceive? Oh puhleeze.........
First off, changing the name of a turd does nothing to change the actual turd. The original 'name' of this ridiculous healthcare sham put out by the dems was called 'Socialized Medicine'. Yes, its Socialism, clear and simple. How many times they change the 'name', in an attempt to defraud the american public, is irrelevant. The entire proposal is a disaster, and will be overturned regardless when the repubs take back power in 2010.
I really think a majority of the public isn't going to be fooled by name change buffoonery. Its far too late in the game now. People know the current administration is trying to promote Socialism, how could they not with so many in the administration professing to admire both socialism and communism? And most Americans know what dismal failures those two economic systems have been. Why would anyone want that?
Van Jones was just the start, sadly there are even more pathetic and reckless characters who soon will fall as he did. Is Chairman Mao one of the great heros of Your life? These clowns only need be shutdown until next year. While it may be too late to save the american economy, due to mounting debt and shrinking dollar, americans can still stop nobama from ruining the american healthcare system.
The public is not as blind as the dems would want. This administration will go down in flames, and be remembered for being the most radical and ill-qualified ever ever.
O One
B Big
A Ass
M Mistake
A America
Socialism or social democracy. There is a difference Sundamon, a big one.
I don't see it.
AmeriCare
Interesting that so much is made of the cost to handle a clear, vsisble national crisis like health care for Americans, when the same critics will say nothing about bloated defense spending that underwrites a very poor record of defining threats to the nation by our defense establishment.
If we consider that defense spending is intended to benefit all americans while at the same time we are denying health care to many americans we can easily see that the defense spending all americans pay for really protects the interests of only those americans who are lucky enough to have their means of survival taken care of. How raw a deal is that?
we can easily see that the defense spending all americans pay for really protects the interests of only those americans who are lucky enough to have their means of survival taken care of
Like you, for instance? Do you not understand that there are people in the world whose goal in life is to kill as many Americans as possible, and the only thing keeping them from succeeding in your case and mine is the US military?
Don't tell me it's all Bush's fault, either. I'm talking about islamic extremists who couldn't care less what our foreign policy is or who is leading our country. One of them is in the news today. Obama's apologetic foreign policy doesn't seem to have softened Tarek Mehanna's heart, does it?
You're right, it's not all Bush's fault. He shares responsibility with all of his predecessors going back at least as far as Kennedy. Our history of propping up murderous dictators in exchange for regional control and access to resources is the reason that so much of the world hates us. There are undoubtedly nutjobs who would jump at the opportunity to kill lots of people, in our country and the islamic world, but they have been given voice and resources by a movement that is based in opposition to very real grievances. It's no surprise that many are unmoved by Obama's attempts at diplomacy, because they are just attempts. It's unrealistic to expect that one president can change the entire thrust of American foreign policy.
sundamon, bush already has that title. and second, why is it whenever someone tries to do something that would benefit everybody, repubs default to the old scare tactic of calling it socialism and communism and trying every ism in the book to scare the hell out of people, it's bs.
Add to that our canadian neighbors have been socialist for quite some time, they don't seem evil, communist, or anything the r's would have us believe. I'm not saying we should be socialist, but we certainly don't have anything to be afraid of from it and we may be able to even pick up an idea or two from it.
It seems however that you would rather just let people die from lack of care, rather than face up to the fact that our health care system is a massive failure that is long overdue for overhaul. As for the deficit, you caon't blame that on obama, he inheireted from bush the largest national deficit our country has EVER had in its history.....
Bait and switch: How the “public option” was sold
http://pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%E2%80%9Cpublic-option%E2%80%9D-was-sold/
They should frame this public option and the CITIZEN'S OPTION.
I think mgoodfel is absolutely right that out of control medical costs will, if nothing is done to contain them, doom reform, and that the most likely version of reform to emerge from the conference committee won't do anything much about that problem.
A public option, however, *would* do something towards reducing costs--if in no other way, then at least by introducing an option that has much lower overhead than all of the private, for-profit options in the so-called exchanges.
The ability of the public option to contain costs beyond this, which is potentially quite large, would be roughly proportional to: a) how many enrollees it attracts and b) how free it is to use the resulting monopsony power to bargain down the prices charged by hospitals, drug companies, and doctors.
Given this, if the Democrats want to make mgoodfel happy, they should go considerably beyond calling the public option something like Medicare. They should just call it Medicare, and in fact have it be Medicare (say Medicare Part E or some such thing). In particular, they should stipulate that: a) anyone can sign up for the public option (not just those not covered by employer plans now), and that b) it and Medicare will be free to pool their purchasing power and jointly negotiate prices with all providers.
The U.S. health care system costs us, per capita, well over double the average of comparable first-world systems (OECD figures). It does so because it is the most privatized system in the world--i.e., because of the market power possessed by industry players, and the vast economic rents that this power allows them to extract from the rest of us. There is no way to change this without a massive new dose of countervailing power. A very robust public option--joined at the hip to a newly-liberated Medicare purchasing authority--would be a very good way to get there.
The name would indeed be politically popular. The substantive reality would be even more popular. And it would (for that very reason) strike fear into the hearts of the insurance/provider complex that presently keeps costs so absurdly inflated.
The reason our health care system costs more is because it's the best. We must be doing something right.
I disagree with your assertion that a public option would contain costs. Even if lower prices were negotiated w/health care providers without putting them out of business, those savings would be more than offset by administrative costs.
One reason Medicare has lower overhead is because it is much less aggressive about turning down claims. Private insurance has to worry about fraud. Medicare would like to combat fraud, but it's not really a bottom line problem for them. They don't have a bottom line!
Progressive Talk Show host Thom Hartmann has been suggesting something like Medicare-E (Medicare for everyone) for months now. I thinks it's a pretty good idea for branding.
Either way people are so polarized on this issue and with so may opinions, and all the money floating around from different interest groups, my prediction is that absolutely NOTHING will be done about health care and with all this fighting and arguing, it will end up being a waste. nobody can come to a good consensus on what should be done in or out of congress, and with all the propaganda flying about, etc.... I'm not expecting anything whatsoever to get done......ever....short of a huge event like revolution or massive protests....but that's just my prediction.
Why not call it Medicare Part E (for everyone).
How about PublicCare? Or...Ready for this? AmeriCare.
I think it should be branded as the Citizen's Option
That's as good a translation of 'Comrade's Option' as any. :)
I like it, but it is hard to call it AmeriCare when about half of the country doesn't seem to care what happens to people after they are born and simply suggests that they hurry up and die if they get sick without insurance.
As far as the cost, we spend 2x per capita what the top rated country in the world spends, and 3x or 4x more than the rest of top ten. It seems to me the further we get from our current system, the more we will save. On the average, a doctor has to have two staff people to deal with insurance company billing, so each doctor spends what, maybe $120k per year on his or her billing staff. And the insurance companies spend probably that much too on each doctor trying to keep him from being successful in getting paid. Such an efficient system, eh?
How much time/money do you think they spend handling Medicare claims?
When you say doctor, do you mean individual practices, or just primary care doctors, or what? I'd be really interested to see where you get the numbers on requiring 2 staffers per doctor for dealing with insurance companies. It is certainly an administrative cost, and I don't know what the cost is, but I don't think you can generalize that it requires doctors to average 2 staffers apiece.
Also, you need to take into account the innovation this country pays for and gives away for next to nothing to the rest of the world. This certainly doesn't account for all or even 1/3 of the difference, but it is significant.
Also, most people will dismiss you out of hand when you make blatantly ignorant comments like that in your first paragraph. Just because people don't agree with the current legislation does not mean they don't want things to change and get better.
sundamon said... "when the repubs take back power in 2010."
LOL!
I thought winning in 2008 was great, but I've got to admit - the daily whining, drooling, and crying by its ilk since then has made a sweet victory just that much sweeter. I do love it when they cry. Please 'sundamon'... do continue your moaning, it seems to be helping. The GOP now counts only 20% of Americans among its ranks as it speeds toward utter irrelevance.
'sundamon' - don't want to participate in AmeriCare (nice choice Lakuma)? By all means, please don't.
And to demonstrate his integrity, Sundamon won't accept a drop of the milk of socialism: he won't sign up for Medicare and Social Security when he hits the age.
Senate Rejects ‘Doc Fix’ Spending Bill, as Some Democrats Side With Republicans
http://prescriptions.blogs.nytimes.com/2009/10/21/senate-rejects-doc-fix-spending-bill-as-some-democrats-side-with-republicans/