Posting in Government
What is clear is that on this issue the public is deeply split, that the split is reflected in the positions of the two parties, and that compromise among Democrats will be difficult, with Republicans impossible.
Their final offer is a modified version of what the Senate has already passed. Absent any Republican support majority leader Harry Reid seems willing to use a majority rules process called "reconciliation" over two months if necessary, to overcome a filibuster.
The plan is to have the House vote for the Senate plan, use reconciliation on the Obama amendments, and then have the House agree to those, according to the Los Angeles Times.
Analysts like Amy Walter of The Hotline think this can be a winning play. Voters are suspicious of government, but also of big business, she writes.
A tracking poll from Kaiser Health sees support for specific elements of the Senate bill, like changing how health insurance works, creating an insurance exchange, and closing the Medicare "doughnut hole. Even Republicans like these ideas, although they are not in the game plan GOP leaders will run tomorrow.
Liberals appear exhausted, warning that the final bill may still fail in the House over abortion, that the most popular part of the original proposal (a public option) is left out of the final bill, and that they have lost patience with the process.
What is clear is that on this issue the public is deeply split, that the split is reflected in the positions of the two parties, and that compromise among Democrats will be difficult, with Republicans impossible.
Republicans are already in active campaign mode. Democrats hope the theatrics of tomorrow and final passage of a bill will generate enough enthusiasm in their base that voters may reconcile themselves by November.
In other words no one likes the sausage factory while everyone craves a nice hot dog. But, quiet, they're coming out of the time out.
This whole thing would be a lot more fun if John Madden hadn't retired.
Feb 23, 2010
224 for the rule means 216 for the final bill. But the atmosphere outside was admittedly colder than Green Bay in January.
After 15 years of international experience in healthcare reform, my response when asked about what is transpiring in Washington was, "monkeys in the space capsule." They are inspired by the technological wonder they ride in but have no idea what the buttons do. How many national health systems have they or their "fine expert" advisors reformed? Answer is none. I have done four. So I have some notions. First there are the core issues. If you don't get them right, the rest won't matter. Forget single payer or government run systems. None of them work and, if you want to talk about Canada, refer to the surveys done with inpatients (actual users) not the general population that is healthy and thus clueless about the system. I have done in country evaluations of most of the major ones and they are so flawed they can't be fixed. If you are going to make mistakes, make new ones. Forget mandates. Anytime you have to mandate something it means you haven't done your homework or you are a control freak. consider the core: 1. all healthcare expenditures should be fully tax deductible for everyone. God doesn't discriminate everyone gets sick, everyone dies. The US Gov is less qualified and should not be interfering with our "struggle to live" to buy votes or increase revenues. 2. every man, woman and child in the US is afforded a tax credit equal to the price of a basic health plan. This price will be actuarially determined and based on real costs. 3. all insurance carriers are required to offer this package at a national price. However, they can also sell any packages the market will bear. No bureaucrat a thousand miles away can determine how much healthcare or insurance you need. Only you can. 4. no exclusions due to preexisting or high cost illness will be permitted. The price on the basic plan is an average so an insurer with lower risk must contribute the different which is given to the insurer accepting higher risk. (not rocket science, Holland has done this for the last 15 years.) 5. plans now run by the government will be rolled into the basic plan. You can't have fair competition where the referee belongs to the other team. 6. Disband means testing for the poor. If their combined tax credits exceed their taxes owed, we know exactly how much assistance they need. Since their insurance card is the same as everyone else in the plan they will not be treated as second class citizens by providers. 7. Allow individual underwriting for lifestyle choices e.g. smoking. We are adults. If we choose to increase our risk, we should not expect others to pay for the consequences. There, considerably less than 2,000 pages. No mandates, freedom of choice, no longer tethered to your job for health benefits, all citizens treated equally, everyone covered, providers fairly compensated, the competitive playing field leveled, and financial incentives for healthier lifestyles. If you want to know about how to fix the pharmaceutical or malpractice problems, I'd be glad to comment later.
Over the last generation politics has become theater. We don't need cameras in the sausage factory -- we need sausage. The posturing at the Summit was of a piece with the whole last generation. John McCain got most of the air time on the news, for reciting a speech that was irrelevant to the questions at hand. It was theater. But to be fair, others also engaged in theater on the Democratic side, especially those who like Tom Harkin prefaced their remarks with some constituent anecdote. This preference for theater over process is general, and I'd like to see some pushback on it. Bring back the smoke-filled room if it will result in policy. The idea that you need a super-majority to pass a bill but only a bare majority to go to war is insane. As is the present health care system.
The summit did have some surprises but still ended as expected- with a stalemate. I am not a tea party type nor am I locked into any of the current political philosophies. I am an idealist and an optimist. I grew up in a time when the US fought the Viet Nam war, expanded the interstate highway system, planned, developed and accomplished man space flight to the moon. We are no longer capable of doing that much and we are having trouble finding the money to fix the potholes and we will have to bum rides to the space station in a couple of years. The US is on the sidelines watching other countries solving problems that are politically intractable here. We are basking in the shadows of our own accomplishments while other countries are building on top those accomplishments. We have so much potential to solve problems and we spend our time whining and argueing about spin. The problem is the people who can make change happen are satisfied with the status quo; the status quo still works for them.
You bring up a relevant point. Democrats see Republicans as villains in this case. Republicans see Democrats as villains. Having gone through a highly divisive and ideological generation, there is no longer any middle ground in which to craft compromise. On anything. Most countries have parties that are at least as sharply divided as ours. But in a parliamentary system, the majority simply passes its program and then either calls a snap election or waits for the next turn of the wheel. Our system is gaining many attributes of a parliamentary democracy because both sides (and this goes right down to the grassroots) see the other side as engaging in political villainy. Thanks for demonstrating it.
To many Obamacare supporters are still drinking the koolaid. Since the Democrats lost the Kennedy seat (because of the "Healthcare" plan (an oxymoron), they now can blame Republicans for failure. What idiocy!!! The Democrats could have passed whatever they wanted prior to losing the Kennedy seat. So they can't blame the Republicans. First healthcare is not a "right" defined by the constitution. Second, most of what is being proposed won't be implemented immediately, so what is the rush for putting together a "reasonable" plan? Third, your taxes will be increased immediately to cover the costs. Fourth, the BS that insurance companies deny too many procedures is smoke. Medicare, a GOVERNMENT run program has a higher denial rate than all major insurance companies. A plan to cover everyone will be even worse than government run Medicare. Obama is getting rid of the Medicare Advantage plans as being too costly. Over 600 billion was spent last year for all Medicare plans to cover approximately 45 million people. Medicare Advantage plans (run by private insurance companies) were given 110 billion for 10 million people on Medicare. The other 490 (plus) billion covered the other 35 million people. The Advantage plans cost 11,000 per person. The straight Medicare plan (government run) cost 14,000 per person. It seems Obama doesn't know how to do elementary arithmetic. Strange that $14,000/year is LESS than $11,000/year. Must be the "new math" he learned in school. One last point, if the Democrats go the "reconciliation" route, I want to see them scream (along with their mainstream media hacks) when the Republicans regain the presidency and congress and used the same process to confirm an extreme conservative to the Supreme Court.
At the Summit the President indicated a willingness to accept, in some form, most of the ideas the Republicans brought to the table -- specifically tort reform and interstate competition. The reason the gap can't be bridged is because of something else he said. It would be hard for Republicans to now vote for anything, given the rhetoric and the mood of their members. I think he looked directly at John McCain, who faces a tough primary, when he said this. So the procedure will be for Nancy Pelosi to get 218 votes for the Senate bill, and for the Senate to then take up amendments under reconciliation. Those changes might have to sunset -- as the Bush tax cuts passed under reconciliation are sunsetting -- but they would have time to work.
The republicans have an opportunity to suggest changes at Obama's health care summit. The republicans have already said that they don't think there will be any progress. This is a self fulfilling prophecy or the bald face of political cynicism. This problem is not just an aversion to change. It is the idea that "the devil you know is better than the one you don't know" that throws up an automatic opposition to change. Political debate has become so polorized that discussion is shut down before it can start. This is the status quo and it is failing us. It looks like it is fourth down and the dems are going for a long field goal to put points on the board.
Dana, You are a joke. You are like all liberal democrats. Put the blame on anyone but themselves. You are so smart and know so much that Obama should hire you or better yet you should tell him he needs you. The democrats are just as much at fault as the republicans for this mess we are in. People like you, whether democrat or republican, are the problem. Don't you get tired of going around all day crying "Yes We Can".
There are no cost controls in any Republican plan, other than going after the lawyers. There are cost controls in the Democratic plan. We need standard formularies, based on evidence, guiding clinics and hospitals toward the most cost-effective treatments. We also need to eliminate conflicts of interest within the market. The present plan does that. Nice of you to mention Florida. Costs are rising steeply there because their regulators demand insurance pay for what doesn't work. State regulation of insurance had led, in practice, to politically- based decisions on what must be paid for. Science and evidence, not lobbyists, should be making that determination. Insurance costs keep rising not because of insurance company greed, but because healthy people are priced out of the market, leading to a shrinking pool of bad risks. Guaranteed issuance in exchange for mandated coverage reduces costs by spreading them around. It's math. Your claim that you can't increase the pool and lower costs is false. Every other industrial country has a wider pool and lower costs. I asked for proof. You gave rhetoric. I'm tired of rhetoric.
I'll agree with you on your claim that Obama's plan will change the cost of health care from the current 17% of GDP - Yes, it will be going up. It's a know fact that you can't add coverage for all the uninsured with increasing cost. There will be no corresponding increase in GDP. The language in Obama's "bill" does include federal tax dollars for abortions. The Stupek will not be part of any final bill. ?I'm glad that you want your tax dollars to pay for abortions, but the bottom line is that most Americans, including myself, don't. Your one example of Texas costs is great - I'm not sure it's accurate, but I am sure it is very limited. I understand that every state that has something similar to Obamacare has deep financial overruns and similar to the Federal Medicare and Medicade, is drive the respective governments into the deep red. Now, about tort reform - the only people that make money on tort cases are the lawyers. The injured party hardly ever sees anything. According to my information, Alabama is probably the best example of EFFECTIVE tort reform. Florida did something in 2004, but it can hardly be called effective. By the way, if you review all the post above, you will not one theme - you are wrong - My suggestion is give this one up and try again!
Republicans claim to want a reduction in costs, but they oppose absolutely every measure that could reduce costs. They call life panels death panels, they condemn comparative effectiveness. Standardized formularies for care? Nope. I could go on. Republicans were in power through most of the decade and did absolutely nothing to control costs. Now you claim they "have always agreed health care costs need to be reduced." I call that an extraordinary claim. Proof, please. Extraordinary proof, not rhetoric. Not boilerplate. Facts. And please don't say "tort reform." It was done on the state level and didn't reduce costs. Costs in Texas are higher today, and have gone up faster, than before tort reform came in. Cross-state competition? Nice idea, but then why oppose a national market? Without a national market, cross-state competition means coverage is designed by the worst case scenario. Just as credit card companies moved to South Dakota to avoid usury laws, cross-state competition without a national market means "coverage" is eventually defined as covering nothing. You have objections to President Obama's plan, and the use of reconciliation, which Republicans repeatedly used in the past to get their programs through. That's fine. But be intellectually honest about it. As to "taxpayer funding of abortions" -- that is simply false. There never was such a thing in the bill. What the Stupak Amendment does is prohibit anyone who buys on the exchange from getting any abortion coverage in the private market. It's a coat hanger amendment pure and simple. It limits a legal procedure to only those rich enough to pay for it with cash. It murders women. Let's have an honest debate, shall we? Stop posturing, please. Canada covers everyone at 11% of GDP. We leave out coverage for 17% of Americans and pay 17% of GDP. That's the reality. That needs to change. The President has a plan to change it. You do not.
The Republicans in congress have always agreed that health care costs need to be reduced, but they maintain there can't be a government takeover. They also object to taxpayer funding of abortions and the "public option" that will destroy the health insurance industry. These objections are included in President Obama's latest attempt to gain passage. As I noted in my local paper, President Obama's draft includes the worst of the House and Senate bills and calls it a compromise!
This is what elections are for. You and the Tea Party run your candidate. Democrats will run theirs, and Republicans theirs. Whoever wins gets to rule. Majority rules. I know that last is hard. It may mean reform is passed. But that's how Bush got his tax cuts, and how Clinton got his, and how Reagan got his. This is a financial matter, with grave impact on the budget.
SHOULD START OVER WITH CONSTITUTIONAL AMENDMENT Some Democrats claim the general welfare clause gives the federal government authority over health care; but if that were the case why are enumerated powers listed? For over 200 years the Federal government did not involve itself in health care. That is why the States and not the Federal government regulate health insurance companies? MANDATED PURCHASE IS ILLEGAL The Constitution grants the federal government authority to tax but not to require citizens purchase a good or service with after tax dollars. There would have been no need for a clunkers program; the government could just tell everyone to buy a new car! But Ma and Pa cannot just print more money and have to balance a checkbook. What would define disposable income? How could families plan their budgets? And historically the federal government has never attempted to tell citizens how to spend after tax dollars. HEALTHCARE FOR PHARMA NOT PEOPLE Speaking of donut holes, if the objective is to reduce the cost of health care, why not encourage and facilitate importation of foreign generic equivalents? WHERES THE BEEF: Does a new poll show the American people have changed their minds about a government takeover of healthcare? Last I heard the majority opposed! With all the sincerity of a soap opera, Obama complains how the Supreme Court?s decision will remove all restraint on the influence of corporate special interest. Meanwhile he presses forward on health care and Cap and Trade, despite polls the majority of citizens do not want either. If politicians will not acknowledge the will of the people, what does it matter if corporations control newspaper chains and broadcast networks? But if our lawfully elected federal employees will listen and represent we the People, a well written handbill can trump a million dollar campaign. Do you remember the New Coke advertising campaign? Despite spending millions it failed, because people did not like New Coke. And that is why grassroots is gagged and the corporate press is exempt!
The reason the health care bill ran to thousands of pages was it was trying to do what you advocate -- deal with the whole system. What the Administration failed to understand from the beginning was that Republicans would resist the very idea of reform, the very concept of private markets failing. Critics picked apart pieces of the puzzle, starting with the most important -- comparative effectiveness -- then threw marketing-driven charges against the pieces. After the pieces were discredited in this way, the charge was the bill was no good, the bill was too big, What's amazing to me in the Kaiser survey is that the pieces of the solution remain popular, even among Republicans. Yet the whole is now seen as unacceptable. The President will say tomorrow that the whole consists of pieces you like -- you including Republicans. What he'll get in response is that the bill is no good, the bill must be re-done from the beginning. At which point they would start picking at the pieces again. The Republican party, from its grassroots on up, is unalterably opposed to the need for reform, even if individuals have complaints about specific market failures. And given the rules of the Senate as they evolved over the last 20 years, this unity gave the minority the power to stymie, and checkmate, the majority. Getting through all that will be hard. It won't be entertaining. It will put people to sleep, and cause TV viewers to switch channels. So I can't pretend to know how to solve the problem. All I'm reporting is how the Administration and Congressional leaders propose to solve it. Then have a sense of humor about it and stand back.
Your response shows the essence of a systemic failure. I read an analysis recently that talked about secret, binding agreements between suppliers and hospitals. If hospital A gets a certain item for $100 under an agreement and hospital B gets the same item for $80 but can not divulge that information to anyone outside of the supplier or hospital B. With more secrets on costs then the market itself does not have enough information to become efficient. This is the counter to the magic of the market meme. I also read an article about the deficit hawks in congress. The mantra is to cut costs unless those costs turn out to be a benefit for the deficit hawk's constituents. The systemic failure includes the inablity of our system to deal with entitlements, real or imaginary. We have the best example of absurd entitlement in the financial industry. The people who brought the economy to its knees expect to be paid a huge bonus in spite of the massive loss that crippled (and is still crippling) our economy. My point is that unless congress can look at the whole picture they will not be able to write a bill that will work over a longer period than their stay in office. I think that people need to get more involved with the process rather than oppose solutions they don't like.
I did a piece at ZDNet Healthcare that may be relevant to your statements about pricing power. http://healthcare.zdnet.com/?p=3361 Health care is a large and complex market, with many moving parts. Without incentives to cut costs, costs aren't cut. Right now there are no incentives to cut costs. Every other industrial country has such incentives. Whether it's a national budget, or national regulation of insurance rates, everyone is in the pool and costs are a lower percentage of GDP. I talked a few years ago with Ralph Snyderman, former Duke Chancellor. He created a wellness program, got people enrolled, and bent back the cost curve. But anyone who tries to do this as a hospital is toast, he said, because reducing the costs of health care means cutting the hospital's income. The moral here is that cost control must come from the buyer's side. And if buyers lack power, someone must put their finger on their side of the scale. Insurance companies have tried for two decades, and have been unable to do this. That's what "managed care" was about. Conservatives talk about the "magic of the market," about price transparency forcing prices down. But there is no evidence that, as an individual consumer, that works. Just wishful thinking.
You may be right on public opinion, although I haven't seen a poll showing 2/3rds against. But if you looked at the links, you would find the individual pieces in the current proposal are popular -- even among Republicans. As to control addicts, I think that's endemic to Washington. One can argue all recent Administrations did things that controlled the lives of the people, whether that's sending them to war, forcing them to take standardized tests, or the policies of Bush Sr., Reagan, and even Carter. That's in the nature of government. You see problems, you seek solutions.
Health care is like the military/industrial complex. There is a mix of medical suppliers, health care providers (doctors and hospitals) and health care insurance. If the cost of medical supplies goes up then the cost of medical care goes up and the cost of inurance premiums go up. By focusing on the insurance industry, congress is failing to deal with the rising costs of medical care. Hospitals have to treat patients who can not pay for that treatment. Hospitals generally add this cost to the bills that are charged to the people who can pay for treatment. Part of the problem with rising costs is that the suppliers use confidentiality agreements to assure their sales. The agreements ban the hospitals from sharing their prices with other hospitals. Insurance companies also can form similar agreements with hospitals for preferred care. If the pricing information is secret, then the information needed is not available for the market to make decisions. The status quo is failing because rising costs are pushing more people out of access to health care. It is in our selfish interests to be surrounded by healthy people, sick people spread disease to others and if not controlled this becomes an epidemic. If you are healthy but are surrounded by sick people, the odds increase that you wil get sick as well. Getting sick is part of life, but having to become sick because of an inability to stop an epidemic with preventive care is silly.
It will save the voters the trouble of having to do it to them! What kind of arrogance does it take to pass a law that 2/3rds of the people don't want, and whose historical track record ALWAYS shows the quality of health care declines afterwards? Only control addicts, who are as addicted to controlling the lives of others as an alcholic is addicted to his or her liquor, would have the utter lack of common sense to pull a stunt like this.