After a resounding Democratic Presidential election win, a terrible recession, and a bruising year of politics, it would be just like America that a crazy election result torpedoes the health care reform bill. It would be the first Republican Senator win in 43 years in Massachusetts, a state that’s bluer than blue, and the actual seat being elected on Tuesday hasn’t been won by a Republican since 1947!
But it’s becoming more and more possible, and the latest polls are all over the map.
Let’s play out what happens if we go back to a 59–41 Senate. The current Senate rules basically allow the minority to shut down proceedings. Harry Reid has in fact performed miracles to keep Lieberman, Nelson and some of the rest on board. Obama, Reid & Pelosi are now working the deal out with the unions and all the rest to make sure that what’s a pretty slim majority in the House will essentially accept the Senate bill—with some sop to the unions on the “Excise tax”. There are some other technicalities about the Exchange et al, but in the end we have a fair idea of what’s going to be the result.
Unless …
Now the right just don’t care about the uninsured—or least not as much as they believe in protecting the health care industry’s ability to do what it’s been doing for 50 years, combined with their desire to hand Obama a defeat.
Much of the left and a plurality of Americans (polling data bears this out) believe that what’s in the bill is not enough—and because the Senate is not a democratic body, they’re angry enough to sit this out.
Almost inconceivably, but not surprisingly given their records of veracity, via AHIP the major health plans (with the very vocal exception of Kaiser Permanente) have been playing both sides of the street and have given money to the US Chamber of Commerce to oppose reform, while Karen Ignagni has always maintained that AHIP was in favor of reform. And of course several sensible commentators on THCB disagree with me and think that the current bill doesn’t do enough to fix America’s health care delivery crisis to be worth the cost of fixing (some of) its uninsurance crisis.
So there are lots of people who think that the current mealy-mouthed compromise is bad for one reason or another. But if the vote happened right now it’ll pass the Senate with 60 votes.
If, and only if, the 60th is the new Democratic Senator from Massachusetts. If the Republican wins I cannot see a way for a compromise bill that will get Snowe or Collins (the two most liberal Republicans) to be the 60th vote, while keeping the mainstream Democrats in the House on board.
And remember what this means for the health of the health care system and of America.
No bill means we’re not coming back here again until we are forced back. It means that the number of uninsured will go up—way up as states run out of stimulus money and start cutting back on Medicaid (as has been happening in California). And more and more people will continue to lose insurance at work.
There won’t even be any of the pilot programs buried in the Senate bill for reforming the delivery system payment mechanism. I know I’ve derided them, but they’re better than nothing. And of course if the 2010 elections are as bad for the Democrats as many predict, the ability of the Feds to muster the will to change even Medicare alone will be gone.
To sum up: no bill means in 5–10 years a huge rise in uninsurance, no reform of the delivery system, and no prospect for a rationalization of health care spending. That will mean the collapse of large parts of the health care system in a spasmodic unplanned fashion.
After the next serious downturn the health system will crash rather than soft land. The bubble will truly burst and the most likely result will be an austere single payer system.
I’m not sure that’s what the opponents of reform want, but it’s pretty much out of their hands. Unless of course the voters of Massachusetts—who ironically already have a health system much like the Senate bill promises the rest of us—decide that they’re angry enough about, well, everything and nothing to do something crazy.
Filed Under: Matthew Holt
Tagged: Election 08, Massachusetts, Policy, Policy/Politics, Reform Jan 18, 2010
The negatives of this bill, individual mandate requiring people buy “private” insurance policies, large government subsidies to “private” insurers, new restrictions on abortion, unfair taxing of high-cost health plans and cuts of $43 billion in Medicare payments, are just too much to bare. This is not health care “reform.” This is a “private” insurance company hand out!
“Unthinkable” doesn’t begin to describe what you are speculating about. But unthinking is in the fabric of extremists at both ends of the issue. If Barack Obama’s increasingly maligned gift of compromise and reconciliation does nothing more than avert this bleak scenario his election will have been justified.
I listened on C-SPAN to a town hall meeting with Bart Stupak two days ago and was totally impressed with his grasp of the big picture and ability to communicate with a crowd of constituents, many of whom clearly would have been hard to handle by a less competent speaker. He did not rely on any field marshals and was prepared with an excellent power point presentation. He spoke without notes and answered questions in a way the revealed a far better appreciation of details than most drive-by politicians.
But handling the matter of federal money for abortions, the issue with which his name will forever be linked, I had the equally clear impression that he was a man trapped between what he understood and what a core group of single-minded, single-issue constituents could not. And as an elected representative he finds himself on the horns of a dilemma, torn between responding to instant demands and what would better serve a larger constituency in the long run.
As the debate has unfolded a growing number of people have been hit with a creeping sense of dread, knowing that doing nothing is really worse than swallowing one compromise or another. The dilemma faced by Stupak is a microcosm of the larger picture.
One other twist remains. Even Republicans know that universal health care and insurance reform are as inevitable as the end of a pregnancy. The only thing worse than a partisan loss, in this case, would be a partisan win. And since Obama obviously got all the big players on board from the start — the players that any other time would be allied with the GOP — if this effort fails then some future GOP sponsored plan with many of the same provisions (tweaked, of course, but not too much) could be advanced as a big victory for Republicans. In other words, if this pregnancy ends stillborn, the next time it could be alive and well.
I don’t think this outcome is a possibility because those who think the Left is pissed now haven’t seen it really pissed. But the possibility of that catastrophe is alien thinking to single-issue crowds.
Mr. Ballard,
Many pregnancies are aborted. This bill should be cold and dead like an evacuated 12 week fetus.
Abortion is not pregnancy reform and this is not healthcare reform.
This bill is merely political cover for cutting Medicare. Period. And make no mistake, Medicare needs to be cut. It is out of control and cannot survive.
But the politician who guts Medicare also cannot survive unless he has a new base of support. Young people. Cheaper to maintain and can be loyal for generations. With young people in the fold they can kick the old expensive short-timers under the bus. That would be you, baby boomers.
But the sad fact is either this bill is cold and dead or the Constitution and the country it defines is cold and dead.
Reid, Pelosi and Obama even have Blagojevich embarrassed with their corruption.
I’m not in the whole reactionary, frustrated kill the bill vote for Republicans group. I think there have probably been some good fixes in conference and I am looking forward to this bill going into law.
A strong supporter of the public option it was whittled down to nothing. However I do like the national exchanges. The Dems by letting the Senate get out of hand could loose their seat in Mass. That would be something else to hang around Lieberman’s neck.
He of course loving to grab center stage forgot to look at the big picture. The public option was nothing at that point but he made a big stink about it and here we are with voter fatigue, and anger at the sheer stubbornness of those politicians completely sold out to the status quo.
All that being said if this bill brings down cost for the middle class and says to the 1% uber wealthy – you need to contribute to the well being of this Country that has been so good to you – with its military, infrastructure and system of laws, and this bill makes them contribute their fair share – based on the giveaways they have enjoyed the past decade then I can support this bill.
The bottom line is that there is wide agreement across a broad market sector of the public, doctors, and business that the monopolies the insurance companies currently enjoy have abused our economy for decades.
In a Country based on a system of checks and balances we have to restore those checks and balances to the Insurance Industry.
Rolling back the anti-trust exemption and putting the power of the people onto the bargaining table not chopped up into 50 little pieces but through a “national” exchange is one way to do that.
Better times are on the way and more money in our ‘national” pockets will make for a better more vibrant market and Country that can better compete globally than just the 1% getting richer and richer and richer and being the only ones benefiting from our laws.
That we might help single working mothers and those less fortunate than ourselves is the real mandate from above. It will be a better world for all when we all start doing the right thing….right Joe
Paul Burke
Author-Journey Home
Very true. There’s no guarantee that a health care bill will pass.
I agree with a previous poster that this bill does have a lot of flaws. However, it’s much needed help for Americans struggling to secure coverage.
So the “will of the people” is being thwarted by the Machiavellian intrigues of the insurers? How droll. Do you suppose they are also the “unseen hand” behind the ominous developments in Massachusettes?
So what are we to say of the tens of millions who feel threatened by the legislative monstrosity being crafted? That they have been “brainwashed” into believing that the costs of health care for themselves and their families is going to rise? That “sweetheart deals” are being cut with the Acorn/SEIU/Kosite cabal? That the Rube Goldberg schemes for reducing provider costs is “pie in the sky”?
I once asked, on this site, why we were not focused on providing an adequate level of care for the indigent by means more cost-effective than buying insurance for them. The only response was from a Chavez thinkalike, to the effect that the wealthy had magnanimously decreed that both the poor and the wealthy are permitted so sleep under bridges. This is not “socialism,” as that concept is suspiciously eyed by most Americans? As for “pre-existing conditions,” I suspect that I’m not the only person wondering why the uninsured should not be required to exhaust their own resources, and so qualify for Medicaid, before inserting their hands into my pocket. Life is full of misfortune, most of which has nothing to do with medical expenses. But pay me no mind–I’m just a drug cartel “plant.”
Questions for those who do not support health care reform:
Twenty years ago our cheery toddler was diagnosed with cystic fibrosis. Afraid, we dug into the medical research to understand the disease that threatened his future. We healed through optimism, roused by the news eight days after his diagnosis that the gene that causes CF had been found, opening the door toward a cure. We knew that our heroes, the researchers and his doctors, would continue to find ways to protect his future. We were no longer afraid of CF.
The fear that woke me in the night was of losing our health insurance because our son was on every insurer’s no-fly list. While my husband’s profession was periodically roiled by layoffs, he decided against the security of opening his own firm because the cost of carrying coverage for our eldest son was too high, the thread on which his health care dangled too slight.
With luck, we made it through our son’s childhood without a gap in coverage. Now 22, he’s kept his health thanks to his medical care and his own glorious determination not to allow CF to cramp his style. He earned his black belt, went to college, joined a fraternity, and drives a 1961 Buick LeSabre. He spent a year in China, learned Mandarin, and discovered that even the drug that enables CF patients to digest food couldn’t help him digest raw sea cucumber. He backpacked through Thailand, had his wallet and passport stolen, but managed to hang on to his meds. This spring he will graduate with a degree in chemical engineering from UMass Amherst’s honors college, with a concentration in biochemistry. His resume includes summers researching the transmembrane conductance regulator, the protein channel in our cells that, when malformed, causes cystic fibrosis.
We can’t wait to see what this kid is going to do next. Next, however, has filled me with that old middle-of-the night fear. Our son will age off our family policy in April. He must shape his future not according to his dreams and ability, but in ways that will ensure that he keeps his health insurance. He must find an employer with health benefits that will hire a new college graduate in a poor economy. Or he must extend his full-time student status until he’s 25, putting off career plans and his desire to support himself. Despite his wanderlust and world-wide opportunities, he must remain a resident of Massachusetts, an isolated island where CF patients are not pariahs to health insurance companies.
I tell our story not because it is unique. Other families have been harmed, rather than merely threatened, by the ruthlessness of American health insurance. I tell it to ask a question. It is for you, the person reading this who does not wish the current effort to reform health care to succeed, who calls it “Obamacare” and “socialized medicine”. Help me understand your position, because I am mystified.
Are you a parent? Do you know that the bill under debate will prevent insurers from dumping people with pre-existing conditions, like my son or, perhaps, someone in your family? Do you believe that anyone who needs health care can get it somehow, or that illness happens only to other families?
Are you a fiscal conservative concerned about cost? Do you realize that the current system discourages small business development and blocks young adults’ opportunities to succeed, the foundations of a growing economy? Do you believe access to health care is not as essential as access to education in preparing our next generation of skilled workers?
Are you are an insurance executive? Do you devise new ways to make it difficult for my son to obtain prescriptions and services as cost-saving measures? Would you prefer to cover the cost of his lung transplant, because he has not been able to get the treatments he needs to stay healthy? Or have you decided that the ultimate cost-saving measure is to let CF patients and other chronic burdens to your bottom line die young?
Help me understand why, rather than reforming the American health insurance system, we should turn our backs on my son and the promise he and other young Americans like him offer all of us.
Your statement, “Now the right just don’t care about the uninsured,” is way off. At issue here is that most of the legal, unisured citizens already qualify for some sort of government program. For the few that dont, there should probably be a solution. The problem is that everyone thinks this is a “take it or leave it” situation – and it’s not – there are, and must be other options out there that won’t cost us dearly. This is just a back door to taxing us, and if it’s not good enough for the Unions (who have better health care than many of us), then why is it good enough for the rest of us? Sounds like a mini-Congress. Put them all on our plan.
I’ve got a question for you: what tangled line of reasoning leads you to the conclusion that insurers can be made to insure all comers at standard rates and remain solvent?
CF Mother,
The vast majority of people are either healthy (no pre-existing condition) or over 65. As long as that is the case, there is very little incentive for the majority to pay higher insurance premiums and taxes to subsidize the few who are unfortunate to be unhealthy and under 65.
Perhaps if Medicare did not exist, the over-65 population would be in favor of a bill that protects the sick and guarantees coverage. However, because Medicare already does this for this age group, they are secure with the status quo and simply have no incentive to care. They are in fact the demographic group most strongly opposed to reform.
Unfortunately, this is the character of the majority of people living in this country, and it’s unlikely to change any time soon. Next Tuesday, Massachusetts will confirm this and end any hopes of reform.
The next time we revisit healthcare in 15-20 years with a new generation of less-greedy youngsters, perhaps we might actually be able to get something accomplished.
Whatever ends up being passed — and something will be passed — will be much different than the original bill, and for that we can be thankful. It’s just too bad that the Constitution is being circumvented by the “necessary and proper” clause once again. That’s a slippery slope.
CF Mother makes very good points.
Despite the fact that my family will be bankrolling subsidies for many, waste and all, I have to hope that something passes. It can be ‘improved’ down the road.
If you don’t have a health problem you don’t fully understand the noose that our current system has around the necks of those that do.
EllenR,
I currently don’t have a health problem (and have very good health insurance), but I have had a close encounter with cancer in the past, and as a result, I do understand how predatory the system is on sick people.
I strongly empathize with CF Mother and others in similar situations. Unfortunately, most people are healthy and find it more convenient to believe the ads on television. If their conscience nags them a bit, it’s easier to believe that the uninsured may have some other alternative, or are too lazy to work, or perhaps are here illegal. Maybe they don’t exist.
I would vote in favor of any plan that mandates 1) guaranteed-issue insurance 2) mandatory coverage 3) and subsidies for those who can’t afford premiums. However, it won’t happen this year. We’ll have to wait for another generation.
The accusation of “greed” does not sit well on the lips of those who have become so obsessed by partisanship that the very mention of “tort reform” is perceived as pretextual obstructionism.
Greg, do you pay attention to what you say?
“…unfair taxing of high-cost health plans and cuts of $43 billion in Medicare payments, are just too much to bare.[sic] This is not health care “reform.” This is a “private” insurance company hand out!”
So, getting taxed for their most expensive products and reducing the amount of revenue they receive for Medicare are examples for you of insurance company handouts? The handouts are in the subsidies and mandates to get people insured. Period. This other stuff is, you know, the opposite of a handout.
As for Matt’s point, I think right now Democrats in leadership know that they have to pass this or else they are absolutely screwed. You don’t spend 9 months hyping something and making it your top priority, make compromises that turn off half the base and most independents, then fail to get it enacted. If so, those who hated it still will resent the Democratic leadership and the base will not be motivated to turn out. Independents will be left with a bad feeling and gravitate towards Republicans, as lunatic as they are becoming. And Republicans will be energized and optimistic, and will turn out in large numbers in November.
The only way Democrats keep this from being a bloodbath is to pass the bill now. This will end up being more popular than Medicare Part D. And if there is a brain cell alive in the Democratic party they will present this as a step towards the reform we need, not the totality, so that they can agree with those who will be clamoring for cost control reforms and use the sentiment to press the advantage against very powerful lobbies.
If they pass this, Republicans gain 0-2 seats in the Senate and less than 25 in the House. If they don’t pass it, all bets are off.
paolo, your analysis misses on one point. If Mass voters do elect to send in the clown, it won’t be from a greed based disregard of the other. Instead it will be from a fear based on personal finances. Believe it or not, *most* American households are currently on the edge financially. And of course, this includes mostly households that still have their jobs/income. They are on the edge. So when political fabrications or myth-based views tell them reform will cost them in the future, their reaction is literally a fear reaction — possible personal bankruptcy looming on the horizon. The mind then expands the consequences. Can the marriage survive? Will my kids still want to visit when they are 30?
So instead of callous disregard, the actual impetous for Brown is boot-quaking fear.
It is so easy to fabricate illusions against reform. Obama has some serious communicating to do about the real effects of reform.
This bill is the typical American splineless political solution for difficult problems – give everyone what they want (especially rich political contributors) despite the cost to the deficit or the taxpayer, and pass the real problem on to future generations. This bill does not solve or reform healthcare, and it will be difficult going forward to not just increase subsidies and access to exisitng free programs when we still have a cost control crisis. An earlier post of mine predicted that Obama will sign whatever pieced of crap is put before him because, as jd says, “or else they are absolutely screwed”. But I think they’re screwed anyway as who’s going to jump to their rescue at the poles; disgruntled non-rabid Republicans who voted Obama when they finally realized they voted for the wrong guy/regime afterall, the left who get nothing substantive from this bill, independents who hoped congress would finally understand fiscal sanity, those getting more access to Medicaid who don’t vote anyway, the young who usually don’t vote but who now will be mandated to buy expensive insurance (real and perceived), people like me who won’t get a subsidy or tax write-off for healthcare but who wanted real reform to cut provider/utilization costs and some semblance of a public option or Medicare buy-in (as an offset to a mandate) but who now get totally screwed from both ends because Demoncrats (sic) think our votes don’t count and we’re an easy source of cash, or those who will come to realize that $8000 a year even after “reform” of health insurance is still outrageous and unaffordable?
My take anyway, if tcoyote is out there I’d appreciate his view.
Basically, I’m with jd on this one, but I think that even with the bill passing, the loses in November will be bigger and even if there are no loses in November, I don’t see how the President adds anything to the current bill between now and 2012. What we have now is pretty much all that Democrats can do with the current numbers in Senate and I can guarantee that no Republican will be crossing the aisle before 2012 on any legislation.
Considering what’s in the bill and considering the fantastic PR from the far right and considering the outlook on the economy , I think Mr. Obama’s chances for reelection are as bleak as the chances for meaningful health care reform any time soon.
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Hal Horvath, you are right that people are financially strained, and under such circumstances, they oftentimes look after themselves first. In Massachusetts, this is also true at another level since residents already enjoy the benefits (and costs) of health reform and see no benefit in subsidizing it for the rest of the country.
However, it is not always the case that a society in crisis ends up looking inward. In the 1930s when we faced a much bigger crisis, we did not act like now.
A generational change will be needed before we tackle the health care (and other important) issues in a serious manner.
Tax-exempt “not-for-profit” hospitals are paying their execs Wallstreet salaries and percS. Thanks to AHA lobby they are flying well under the radar screen of health care reform. Poor governance, passive oversight and cronyism are rampant. Senators Grassley and Baucus don’t drop your initiative. You are right to expect more accountability. Billions of dollars in tax revenue are lost due to cyncial exploitation of the public trust. What is the real cost of hospital services? Demand greater transparency!
One would think that the “plan” you support is like a new automobile, with all the available options which are now being “tweeked” so it is absolutely perfect to fit those who don’t own or have access to a car.
A little bribe here and a little union concession there and a large cut in Medicare [which will explode over the next 9 years since the first "baby boomer" arrive last New Years Day; and every thing is going to be alright!And increasing Medicaid by 13 million more [but not until after the next Presidential Election is a nice touch.]All being done while Medicare and Medicaid fraud are at historic levels and drain $100 to $200 billion a year off funds meant for care to the poor or elderly. Don’t worry be happy since whatever fraud can’t be found or recovered will just be subtracted from Medicare!
Don’t look now, but there are a few details you don’t note, like the lack of wheels, brakes and roads on which to drive yiur “New Ride” as the President would call it.
All Americans will agree to many things on healthcare reform, but most of what is in the current “model” simply won’t work, such as having enough healthcare professionals to service millions more “customers” mainly ones who are sicker due to age and lack of care in the past.
archon 41: Tort reform is an insignificant issue and one that has already been adopted by most states. I would be happy to support a health care bill with or without tort reform. I really don’t care. The Democratic leadership would be crazy not to add more tort reform to the current bill if it would to deliver a single Republican Senate vote. But it won’t.
Tort reform is just an excuse to pretend that there is an alternative health care plan when there really isn’t.
Yes, Senor Senior. That makes a lot sense. Since there aren’t enough healthcare professionals to “service” everyone, let’s make sure the system services only the wealthy and healthy, and not the poor and sick.
My point goes to partisan inflexibility, Paolo, but you knew that.
Good to hear that “defensive medicine” is no longer an issue.
I do think there are many good things in the bill, but what I most dislike is the dishonesty in the financing. As Robert Laszewski points out in another post, there are 6 years of benefits but ten years of taxes, and only through this slight-of-hand does it look deficit-neutral. Only politicians can do this with a straight face and call it “reform.”
The nasty comments about the insurance companies really reflect the reality that, unlike the government, they can neither force people to be in the system nor can they deficit finance. For every sick person who gets insurance there have to be 10 healthy people to pay for them. When those healthy people stop buying insurance — as has been happening for years — premiums go up to pay for the remaining (sicker) people, and insurers try to not get stuck with people who come in knowing they will have higher expenses (and want the other insured to subsidize them). This is not evil, this is simply avoiding being a charity.
Some honesty about financing — public and private — is greatly needed but very unlikely to be forthcoming.
Matthew; Your summary is a little overwrought,
“To sum up: no bill means in 5–10 years a huge rise in uninsurance, no reform of the delivery system, and no prospect for a rationalization of health care spending. That will mean the collapse of large parts of the health care system in a spasmodic unplanned fashion.”
The American people seem to believe the current reform bill would raise premiums for the insured, mandate individuals and employers to march to the beat of the federal drummer, bankrupt state treasuries, ration than rationalize care, saddle their grandchildren with an unpayable debts, drive doctors out the system because of being unable to keep their practice open with low Medicare and Medicaid payments.
The cornerstone for health care reform needs to be passed now. If this bill goes down then it’s time for activists to mobilize the Uninsured and bombard the emergency rooms of the most US prestigious hospitals like Ronald Reagan UCLA Medical Center and Duke University Medical Center to demand medical treatment now. Only when Congress is shaken out of their comfort zone do they act.
PaineSense,
You are clueless. You can go to any ER right now, since 1986 in fact, and get a medical screening exam for any complaint you have and get stabilized and treated, without anyone asking for money or insurance.
What do you want? Delivery? Fries with that order?
With 30 million more people at the ER, you will be waiting longer. A lot longer. Bring food and a book.
For me, the irony of Ted Kennedy’s seat being filled by a Republican that could then derail this pending train wreck is wickedly welcome to me. As this farce of alleged representation from Washington has played out, I know now that the system of American is broken, and we foolishly pay attention to just specifics and get lost in examining the whole. Worry about Health care reform, the auto industry, the housing bubble; well, these are issues, but what about the foundation of the culture that supports these businesses/professions/industries? Come on, folks, we are so out of touch living as a connected and concerned culture, I really feel these failures are somewhat deserved. So many of us are just spending most of our time sitting in front of screens, whether it be computer, TV, video games, the term social is archaic!
For a moment of frank, and to me equally some brutal quality as well, honesty to the whole process of being a member of a “free” society, do you support health care reform as now presented because you truly think and feel it will improve care and make it realistically affordable, or are there selfish and ignorant agendas that you won’t admit to others, or just don’t see?
The status quo of where health care stands is unacceptable, no argument to that blatant fact from me. But, I do not and will not accept that politicians are the primary source to turn to in enacting responsible and effective change. Think of it per this analogy: would you want to seek out safe passage through a town that is predominated by the Hatfields and McCoys, each side shooting at anyone not wearing their family colors nor preaching one’s side philosophy to the entrenched debate of hate?
That is what the political process in this country has become. Hatfield/McCoy = Democrat/Republican. And in the end, anything created in the midst of a war is not thinking of the needs of the many, in this case moderation and negotiation.
And it is nothing less than pathetic to read and listen to dogma that is party focused, not people focused. Hence why you aren’t reading many doctors of authority speaking out strongly for this legislation. Because we know better. And as history shows, patients and third parties invested in the health care system seem to show less effort to want to learn and change.
Careful what you wish for, America, because when the train is at full speed, boy is it ugly to watch it wipe out when the tracks have ended!
Good commentary from Mr. Holt, as is the usual case. Reminder to him that unlike in UK English, USA English treats collective nouns as singular rather than plural.
Accurate prediction of the effects of no healthcare reform bill being enacting into law:
Higher costs, significantly less access to any medical care for the poor, for those without employment and for many with employment where benefits continue to be cut back while ever more of the medical service or insurance cost is borne by the person insured.
archon41: please return to commenting in the WSJ where your commentary fits. This website has by and large escaped your kind of idiocy, so please go away unless you can make comments that are based on facts or exhibit rationale analysis, rather than repeat the stereotypical nonsense from the extreme right-wing.
ExhaustedMD: I am sympathetic to your argument, but the federal government has to “intervene”, i.e. at least theoretically try to represent society’s interests, in any number of areas of social activity, because the alternative of leaving a presumed “private”, non-governmental set of actors to promote social welfare does the opposite, is injurious to society’s interests, although of course beneficial to the private party’s own interest.
This is most clearly evident in the healthcare system, defined primarily as medical service delivery and its financing.
Ad nauseam repetition of the basic fact, but by and large the market for medical services and the funding for those simply does not satisfy the conditions for a competitively-determined market to function.
Ergo the overwhelming need for governmentally-set entities on both the financing and the delivery sides, not to mention on the promotion of activities that enhance health status of a population outside of the medical sphere. The need for exercise and for healthy, i.e. life-lengthening (as opposed to life-shortening), nutrition, proper hygiene, abstinence from smoking and other activity similar to the “apple a day keeps the doctor away” folk prescription for good health.
“Worry about Health care reform, the auto industry, the housing bubble; well, these are issues, but what about the foundation of the culture that supports these businesses/professions/industries?”
The foundation of the present culture is corporate subsidies/deregulation/influence followed by massive corporate bailouts. Too many Americans continue to want to believe that either Republicans or Democrats are the enemy, but the real enemy, that controls the political puppet strings, is a heavily lobbied corporate America. I too would welcome a Republican win in MA that would defeat this “train wreck” of a bill. Democrats forget that if the bill passes then all blame for future healthcare failures/collapse will be placed on them and their bill, rightly or wrongly. But by then the present band of political corporate shills will be comfortably settled into their new lobbying jobs.
“Ad nauseam repetition.” Couldn’t have said it better myself.
Wendell Murray
There can be no free market in anything with the government sticking its paws in it. The guvmint needs to butt out of health care. Period. In fact, it needs to butt out of matters rightly left to the states.
Matthew’s “better than nothing” statement is the crux of the issue, on all sides of the argument.
The “get your gov’t hands off my Medicare” crowd (who obviously are low on their irony supplements) doesn’t get it, the insurance industry doesn’t WANT it, and those of us who are uninsured due to a previous trip thru the medical-care car wash (in my case, breast cancer, which either results in being flat-out declined, or quoted at $2,000/month with a $6,000 non-HSA-compatible deductible) aren’t GONNA get it.
It, this instance, being the opportunity to regain health care coverage.
States-rights rears its ugly head in this discussion, too, since most states regulate which health insurers can operate within their borders.
Peter hits the nail squarely on the head when he says that the only real beneficiaries of the current health care insurance rules are the lobbyists who fight on the side of the big guys, the ones with the big lobbying budgets – Wellpoint, UHC, Cigna, et al.
Real health care reform will only happen when we, the patients, wake up and realize WE ARE THE CUSTOMER. Act accordingly by shopping for health care the same way you buy a car, or a house.
And please, for pity’s sake, separate health insurance from employment. Small business owners can’t afford their OWN policies once they’ve paid the premiums on their employees’ coverage.
Pass the damn bill, which will put something on the books that can at least get the system moving toward some kind of REAL reform. Doing nothing, letting the bill die, just keeps the insurance lobby in charge.
I continue to be amazed that anyone can call this Health Control Bill a Health Reform Bill. It does nothing to reform but only to disguise taxes and government control of WE THE PEOPLE. A real reform would fix the alleged fraud in Medicare, clean up Medicaid, enact a strong tort reform, guarantee portability, allow people to opt out, and a myriad of other useful things. I stand with MD as HELL. I work ER, and anyone can get care any time they need it already. What ever happened to personal responsibility!?
This is a terrible bill. The issue is cost reduction, and until that is tackled costs will be out of control. Covering more people etc is a pipe dream until you control costs. Where is tort reform, the democrats are in the trial lawyers pocket, where are the drives towards efficiency in terms of automated medical record sharing and access. Congress just passed reforms to HIPPA making it far easier to sue and for larger amounts. How does this help? How about competition across state lines and forcing states to adopt cnsistent policies and regulations regarding medications, treatments, paperwork etc.
Everyone agree we need healthcare reform. All the current bill does is attempt to stick a finger in a swiss cheese dike.
If the bill fails it will be sad event. So many champagne bottles will be opened in so many rooms. If only they knew what they achieved.
As long as there is human misery the reform bill will keep coming back and everyone is going to have an instance in their life where they will wish they did not oppose the bill.
This bill is very important to me because it makes better coverage of chronic illnesses more likely, though I will believe it when the bill has passed into law and regulations. I think the situation is analogous to the 1965 Voting Rights Act passed after a big effort from Johnson. The bill itself didn’t change all that much, but it laid the groundwork for better voting rights for many citizens. I’m hoping this imperfect bill will change the foundation of how we do insurance in a similar (positive) way.
Read the bill. It does nothing to give anyone better coverage. Passing an imperfect bill is idiocy, because we will all be stuck with the higher costs ($3-trillion extimated over 10 years after it goes into full effect), rationing of care, and loss of literally thousands of docs who will change carreers to escape the socialist structure. You think health care is expensive now? Wait until it’s “free” and see where we are with theis bill. We need to go back to the start and actually have people sit down, rationalize what needs repairs and why, then get to work with appropriate, well thought-out, intelligent fixes, not accept a flawed set of rules which only give more power to Congress and the President.
Right on!
“…loss of literally thousands of docs who will change carreers to escape the socialist structure…”
RMichael, would you please explain what part of this bill is creating a socialist structure as far as doctors are concerned?
Also, just out of curiosity, what sort of career changes are you envisioning for these doctors?
Wendell, you are right there can be no free market with the government “Sticking its paws in it.” You probably realize the government directly pays for roughly 50% of health care. It is nearly impossible to calculate all the money paid in subsidies, but you can easily add another 10%. With government paying for at least 60% of health care in this country and with the the costs escalating much faster than inflation, the health care bubble is destined to bankrupt the country and explode.
The financial impacts will hit all aspects of life: Health & well-being, Banking & finance, National defense and energy will be the hardest hit. The Government itself could collapse.
Corporate stakeholders have become thoroughly entrenched in our government. They use the government as one of their tools to stifle the free markets. We need to yank them out of government and eliminate laws and regulations that stifle markets and restrain trade. For example, Patent & copyright laws are designed to protect corporate interests by eliminating competition. Pharmaceutical stakeholders feast on these laws.
The greatest fear of our founding fathers is being realized: “We the People”, who were given the reigns of government, are losing our grip on the government.
We do not yet have to resort to violence as our “Founding Fathers” did, but we are walking down the same path. If we don’t learn from history we are doomed to repeat it.
“Yes we can!”
Let us create a universal system of health care, which uses free markets to deliver real value for our health care dollar.
It is a shame most of the people fall into a non educated group who don’t have any idea of what health really is for the human body. If our politicians hadn’t taken bribes to make laws prohibiting the things of GOD that heal. To give an example my wife was healed of arthritis and colitis which our doctor still says is impossible. Even doctors can’t believe with there eyes because there trained to believe in drugs. Drugs don’t heal they just cause side effects and cancer in lab animals
While its likely that House will pass Senate version of bill just in case it doesn’t happen, then let’s look at consequent scenario. We are then likely to see next a Republican President. We would have a tort reform bill passed by 2014 and some other sundry things. Next time healthcare will be an election issue would be 2016, assuming economy and war allow it to be an issue.
Around that year, 30 million uninsured would be 60 million. High deductible plans will be very much in vogue with average deductible around $10K at that point. Average family annual premium could be around $20K. % of folks with pre-existing conditions such as obesity, asthma, diabetes, pneumonia etc would be around 30%. Medical tourism would be a rage.
Hard to say if that would be enough to motivate another large scale reform but somewhere rubber has to meet the road.
Margalit Gur-Arie:
Many doctors are near retirement. About 1/3rd of practicing docs in several parts of the country are at a point where they could leave the field if it becomes problematic. I am sure you will recall that Socialism is defined as “social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy.” The bills presented all are currently void of what the coverage (benefits) and limits will be, leaving it to the government (under HHS) to “develop” the structure within the following year. Every panel described in the structure of the “advisors” to the HHS secretary includes labor, politicians, and usually one or maybe two medical people (which the government will pick).
I am seeing colleagues already attempt to move out of practice and into other areas like managed health care (work for the insurance people), to pharmaceutical companies, move to para-medical areas, moving to Australia and New Zealand, etc. I think it not unlikely that a lot of the experienced doctors out there will think twice before staying in a system that is set up by the government, ruled by the government, and structured like the post-office or DMV.
Some docs will stick around – the majority for a while anyway – to see how it plays out if it passes. But I can promise you a lot won’t if the patient-doctor relationship is interfered with too much.
Is this bill flawed? yes of course it is but what bill wouldn’t be and it is a start? How many people remember that when SS was passed it originally excluded nearly all jobs that were done by African Americans? Does the doughnut hole in the Medicare RX bill make sense? Should we cancel it?
Should we be concerned about the election in Mass? Yes of course but I would expect that the bill will be passed before anyone new is seated who might vote against it.
Last time I checked we lived in a country where a simple majority is supposed to win so even if Mass goes Red that doesn’t mean that we won’t see or some rogue Congressman (McDermott) introduce a measure to change the filibuster majority to 55 from 60. (He announced he would this past Sunday at a community forum in Seattle)
Focus on community and state based solutions that work in tandem with the private sector and we all just might end up with something that works.
Sherry-
RE: “Last time I checked we lived in a country where a simple majority is supposed to win …”
Last time I checked, the majority of Americans OPPOSED this bill.
The majority of Americans oppose death panels, socialized medicine, government take over, bureaucrats interference with their doctors, Marxism, Communism and a host of other preposterous notions that the far right media is peddling in conjunction with this bill, with the sole purpose of subverting the democratic process.