July 27, 2009, 9:45 a.m.; July 28, 2009, 8:00 a.m.
Forget the "Details," the Devil is in the Basic Concept
(brought to you by FromDC2Iowa.blogspot.com*)
Update July 28: This morning brings more evidence that "insurance" is continuing to win out over "health care," thanks to the six senators who are, in fact, the folks writing America's 21st Century guarantee of their campaign contributors' profits. David M. Herszenhorn and Robert Pear, "Health Policy Now Carved Out at a More Centrist Table," New York Times, July 28, 2009, p. A1 ("Already, the group of six has tossed aside the idea of a government-run insurance plan that would compete with private insurers, which the president supports but Republicans said was a deal-breaker.").
__________
[July 27 blog entry:] Have you, like I, been more focused on the politics of health care, and the "universal, single-payer" systems of civilized countries that is off the table than what's in the plans that are on the table?
This thing is doomed to disaster from the starting gate.
"The Devil is in the details?" Not this time. The Devil is in these approaches from "Be it enacted" through the bottom of the last page.
As Congressman Dennis Kucinich has long and famously said, "I don't want everybody in America to have health insurance. I want everybody to have health care."
What the sickness industry's special interests, and the Democrats and Republicans they fund, are proposing is more sickness insurance. And it's far from clear that everybody is even going to have that.
The sickness insurance companies are the problem, not the solution. You want to cut the costs of medical services? Well, how about starting with the 25-30% of those costs that represent insurance companies' administration (compared to 3% for Medicare)?
The insurance companies, in case you hadn't noticed, are a for-profit operation. How do they increase profits to the levels Wall Street demands? Two ways: (1) continually increase premiums, while (2) reducing coverage, by refusing to insure at all those who might actually file claims, and then refusing to pay the claims of those they do insure.
And how are we going to solve this problem? By requiring everyone to have health insurance?! It would be a hilarious segment of a comedy club stand-up routine if it weren't so outrageously corrupt.
We've used taxpayers' money to bail out the banks and the auto companies. Now we're gong to pour more consumers' and taxpayers' money into the deep dark hole that is the for profit sickness industry.
Unbelievable!
Think I'm exagerating? Take a look at this sampling of three pieces from yesterday's and today's New York Times:
Editorial, "Health Care Reform and You," New York Times, July 26, 2009, p. WK9 ("The health care reform bills moving through Congress look as though they would do a good job of providing coverage for millions of uninsured Americans. But what would they do for the far greater number of people who already have insurance?"); Robert Pear, "Reach of Subsidies is Critical Issue for Health Plan," New York Times, July 27, 2009, p. A1 ("The major health care bills moving through Congress would require nearly all Americans to have health insurance. But as lawmakers struggle to achieve the goal of universal coverage, a critical question is whether the plans will be affordable to those who are currently uninsured."); Paul Krugman, "An Incoherent Truth," New York Times, July 27, 2009, p. A21 ("Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition. . . . [E]ven as they complain about the plan’s cost, the Blue Dogs are making demands that would greatly increase that cost.").
____________
* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
# # #
July 20, 2009, 9:00 a.m.
Two Thoughts on Medical Bills
(brought to you by FromDC2Iowa.blogspot.com*)
There are a couple aspects of "the cost of health care" I'm going to try to put briefly this morning.
1. I believe that those public officials, and the campaign contributors who fund them, who so willingly handed over trillions of taxpayer dollars to some of America's wealthiest bankers this past year are now morally precluded from using "cost" as a reason for continuing to deny health care to Americans.
Am I concerned about sickness costs accelerating at a rate four times wages? Of course. It's not a trivial concern. But there are responses other than voting "No" on any and all proposed solutions.
(a) They talk of the added costs "over ten years." But a trillion dollars over 10 years is $100 billion a year. They gave that much to individual companies! To be able to provide health care to every American for the same amount puts both their prior generosity, and their current miserliness, in a clear, stark perspective.
(b) Where did this idea come from anyway that we can only have the quality of health care other countries provide their people if we can do it for no additional money? Of course it's going to cost money! We don't apply that standard to the defense budget. We don't apply it to earmarks and other corporate tax breaks, subsidies and giveaways. Why does it suddenly become our Polaris of navigation when it comes to keeping America healthy?
(2) "Rationing" health care. One of the arguments of the special-interest advocates, and their purchased public officials, in opposing universal, single-payer and public option plans is the bugaboo of "rationing."
(a) We already have "rationing." The rationing decisions are made by the executives of for-profit companies that make more profit, and pay those executives larger bonuses, by refusing to provide any insurance, or care for some, and denying the claims of others (all the while raising premiums). There are procedures, and drug treatments, they simply refuse to pay for. They try to suggest that there is no rationing in the present system, but that it would be imposed by "government bureaucrats" in the proposed reforms.
Give me a choice between a greed-driven rationing and even an incompetent (but at least not self-interested driven) rationing, and I'll choose the latter every time.
(b) We cannot provide every conceivable medical procedure known to everyone who might like to have it, regardless of cost. We can't, won't and don't pay for that approach whether with the insurance premiums paid to for-profit providers or with the taxes that support a public system.
There needs to be some metric, some way of thinking about, the benefit-cost returns in any health care system, private or public. It is not only economically essential, it is rational and reasonable, for a public system to focus on providing "the greatest good to the greatest number" by insisting that no one go without the relatively low cost procedures and medicines that can provide them more "quality years" of life -- even though the result may be that the very most expensive treatments have to be curtailed as a public expense (while retaining the option of a patient paying for them with cash, or an additional private insurance plan). The point is, that's what we do now. The very wealthiest get care the rest of us do not; we can't afford it, and our insurance policies won't cover it.
The advantage of a public option is that we would save the system money by getting the uninsured out of the emergency room and into a doctor's office (at a fraction of the cost). By providing medical care to all at the onset of disease, or immediately after an injury, by offering relatively cheap routine checkups, we'd not only improve Americans' health we'd also save the far greater future costs of treating more serious conditions.
Would this mean that some of us, some of the time, would not get public coverage of some treatment we might now get with our private for-profit insurance? Probably. But the opposite might also be true; there would undoubtedly be some treatments a non-profit system would conclude are cost-effective than a for-profit system refuses to provide. Regardless, we would have the benefit of a nationwide level of health -- of infant mortality rates, and life expectancy -- that would bring us closer to the standards of the rest of the industrialized world, with all the economic, humane and moral consequences of such a system.
This morning's blog entry was inspired by the following thoughtful, analytical, balanced article in yesterday's New York Times Magazine: Peter Singer, "Why We Must Ration Health Care/'Public Health Insurance Should Pay Up To $__________ For a Treatment That Would Extend a Patient's Life for One Year,'" New York Times, July 19, 2009, p. MM38.
If you're at all interested in this subject you need to read it.
_____________
* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
# # #
