Bart Mongoven is an analyst with Austin-based Stratfor.com and the author of the Stratfor Public Policy Intelligence Report. In this piece he examines the obstacles facing the Schwarzenegger health care plan on the national and local levels and reaches a contrarian conclusion — the proposal is likely to succeed after a major fight with special interests. Mongroven predicts "a victory within the year" for Schwarzenegger, a bold claim that if true will clearly have major national implications. If you’re unfamiliar with their work, Stratfor is the private corporate intelligence firm founded by political scientist Dr. George Friedman. While most of the firm’s work focuses on national security and foreign policy issues, its analysts also track domestic policy issues — as in this case. You may not agree with Mongoven’s conclusions, but his analysis is insightful and his arguments well worth noting. The piece remains copyright Stratfor.com of course. — John Irvine
California Gov. Arnold Schwarzenegger outlined
a proposal Jan. 8 for a massive overhaul of California’s healthcare system.
In his State of the State speech, the Republican governor only lightly
touched on the core elements of the ambitious plan. But as even a few details
of his proposal have become known, controversy has begun to roil.
At
present, just about no one in California seems happy with the proposal. The
California Chamber of Commerce has called it a tax on employers. The
California Nurses Association condemned it as a gift to big business.
Conservatives call it socialized medicine. Liberals say the
pro-health-insurer GOP has co-opted the proposal.
National interest
groups, meanwhile, have been silent. The voices of business — the U.S.
Chamber of Commerce and the National Federation of Independent Businesses —
have not issued press releases either supporting or criticizing the proposal.
National labor organizations are not issuing press releases, and neither are
healthcare advocacy organizations, like the AARP or Families USA. On the
surface, a number of reasons explain why the national organizations have left
this battle to state lobbyists in Sacramento.
Most observers in
Sacramento agree that the proposal, in some form, will pass through the
legislature in 2007. The current state of the healthcare issue in the United
States strongly suggests that what is happening in California will emerge as
the basis for national policy. With this being likely, it soon will become
untenable for national-level players to allow the California debate to remain
isolated. Some of the major national special interests therefore will find an
advantage in establishing the California debate as the foundation for a
national discussion.
Schwarzenegger’s Proposal
<!–
D(["mb","In his\naddress, Schwarzenegger described a plan that would guarantee every\nCalifornian — legal resident or not — a baseline of medical coverage in\nmany ways similar to the measure Massachusetts passed in 2006. The\ngovernor's plan would require uninsured citizens to purchase healthcare\ncoverage, the cost of which would be shared between individuals, employers,\nthe government and the healthcare industry. Companies with 10 or more\nemployees would be required to provide health coverage or to pay 4 percent of\ntheir payroll to a government health coverage fund. The plan would represent\nsignificant progress on covering the nearly 20 percent of Californians who\nare uninsured and who currently tend to receive some emergency treatment, the\ncosts of which are not well accounted for. The plan also includes "Healthy\nActions" benefits to promote healthy behaviors. Schwarzenegger's\nplan does not represent a significant step toward restructuring the ways in\nwhich medical services are priced or the extent to which customers share in\nthe burden of that pricing. This leaves employers with several large areas\nstill requiring creative solutions at the state or federal level. The\ngovernor's proposal raises the question of what will get modified and how\nthese changes will play out. Opposition to the current proposal runs quite\ndeep. The state Republican Party has opposed the introduction of such\nmeasures for almost a decade; it now finds itself fighting a popular\nRepublican governor on the issue. The California Chamber of Commerce has\nargued the proposal is essentially an additional employment tax that will\nharm business and employment in the state. Physicians oppose the long range\nof controls that the proposal will place upon them. The California Nurses\nAssociation, for its part, has argued that the bill is a gift to the health\ninsurance industry and still does not reflect patients' best interests. The\nstate Democratic Party has expressed concern that the proposal will not\nprovide adequate coverage across the board. And because the proposed law\nwould affect any business with more than 10 employees, the small-business\nlobby is adamantly opposed.”,1]
);
//–>
In his
address, Schwarzenegger described a plan that would guarantee every
Californian — legal resident or not — a baseline of medical coverage in
many ways similar to the measure Massachusetts passed in 2006.
The
governor’s plan would require uninsured citizens to purchase healthcare
coverage, the cost of which would be shared between individuals, employers,
the government and the healthcare industry. Companies with 10 or more
employees would be required to provide health coverage or to pay 4 percent of
their payroll to a government health coverage fund. The plan would represent
significant progress on covering the nearly 20 percent of Californians who
are uninsured and who currently tend to receive some emergency treatment, the
costs of which are not well accounted for. The plan also includes "Healthy
Actions" benefits to promote healthy behaviors.
Schwarzenegger’s
plan does not represent a significant step toward restructuring the ways in
which medical services are priced or the extent to which customers share in
the burden of that pricing. This leaves employers with several large areas
still requiring creative solutions at the state or federal level.
The
governor’s proposal raises the question of what will get modified and how
these changes will play out. Opposition to the current proposal runs quite
deep. The state Republican Party has opposed the introduction of such
measures for almost a decade; it now finds itself fighting a popular
Republican governor on the issue. The California Chamber of Commerce has
argued the proposal is essentially an additional employment tax that will
harm business and employment in the state. Physicians oppose the long range
of controls that the proposal will place upon them. The California Nurses
Association, for its part, has argued that the bill is a gift to the health
insurance industry and still does not reflect patients’ best interests. The
state Democratic Party has expressed concern that the proposal will not
provide adequate coverage across the board. And because the proposed law
would affect any business with more than 10 employees, the small-business
lobby is adamantly opposed.
<!–
D(["mb"," That a proposal can anger so many groups\nfor so many reasons and still be considered very likely to pass shows the\nstark divide between the public and special interests, and also the degree to\nwhich healthcare needs a big fix. All of the special interests with a\nsizeable stake in the healthcare debate know that the system is no longer\neffective for any of the participants — patients, insurers, government or\nbusinesses — and needs to be changed soon. None of them, however,\nwants to be the first to champion a particular plan. And every special\ninterest's solution to the healthcare system's problems threatens many or\nmost of the other interests involved. As a result, whoever lays out a\ncomprehensive plan is pilloried, while those doing the attacking need not\nadvocate their own plan. The political debate has devolved to a level where\nnone of the major players is willing to offer anything positive of any\nsubstance. Instead, they would rather sit back and defend their interests\nwhen others threaten them. Despite the defensive posture of the\nspecial interests, according to observers in Sacramento, Schwarzenegger's\nproposal will in all likelihood lead to a plan passed within a year. That the\ninterests are sniping and protecting their own turf while the political\nmachinery creates change around them shows the degree to which playing\ndefense is no longer tenable for the special interests. An\nAbsence of National Attention The general strategy in debates\nlike this is for the national lobbies — be it the U.S. Chamber or the\nAFL-CIO — to invest as much national money as possible, but to stay out of a\nstate battle publicly and allow state affiliates to lead the fight. Keeping\nout of view is generally a sound strategy. First, it keeps the issue local.\nThe organization avoids the perception of having brought a bunch of hired\nguns to interfere in a state issue. Staying away also provides the national\nlobby with wiggle room, meaning it does not have to go on record nationally\ndue to the efforts of one state. Finally, it keeps the national lobbies from\nhaving to reveal all their strategies and tactics in one state battle.”,1]
);
//–>
That a proposal can anger so many groups
for so many reasons and still be considered very likely to pass shows the
stark divide between the public and special interests, and also the degree to
which healthcare needs a big fix. All of the special interests with a
sizeable stake in the healthcare debate know that the system is no longer
effective for any of the participants — patients, insurers, government or
businesses — and needs to be changed soon.
None of them, however,
wants to be the first to champion a particular plan. And every special
interest’s solution to the healthcare system’s problems threatens many or
most of the other interests involved. As a result, whoever lays out a
comprehensive plan is pilloried, while those doing the attacking need not
advocate their own plan. The political debate has devolved to a level where
none of the major players is willing to offer anything positive of any
substance. Instead, they would rather sit back and defend their interests
when others threaten them.
Despite the defensive posture of the
special interests, according to observers in Sacramento, Schwarzenegger’s
proposal will in all likelihood lead to a plan passed within a year. That the
interests are sniping and protecting their own turf while the political
machinery creates change around them shows the degree to which playing
defense is no longer tenable for the special interests.
An
Absence of National Attention
The general strategy in debates
like this is for the national lobbies — be it the U.S. Chamber or the
AFL-CIO — to invest as much national money as possible, but to stay out of a
state battle publicly and allow state affiliates to lead the fight. Keeping
out of view is generally a sound strategy. First, it keeps the issue local.
The organization avoids the perception of having brought a bunch of hired
guns to interfere in a state issue. Staying away also provides the national
lobby with wiggle room, meaning it does not have to go on record nationally
due to the efforts of one state. Finally, it keeps the national lobbies from
having to reveal all their strategies and tactics in one state battle.
<!–
D(["mb","\nThis battle is different, however. It is a political cliche that\nwhat happens is California is a preview of what is coming to the country. In\nmany ways, the cliche developed for good reason, since California is a large\ndynamic state that is also prone to experiment with policy — even though\nmany of its experiments have failed miserably. These failures give the lie to\nassertions that California moves always provide a preview of federal\npolicymaking, but they do bolster the notion that the states are laboratories\nfor the federal government (and California is clearly among the country's\nbusiest laboratories). In the case of healthcare, however,\nCalifornia's debate is indeed a preview of what will happen at the federal\nlevel. Massachusetts debated the issue in 2006, and passed a significant\npiece of legislation, but the country was not in its present mood and\nCongress was unlikely to address the issue at the time. Since then, Congress\nhas come into Democratic hands at a time when the public is actively seeking\npoliticians who will tackle healthcare issues. Most important,\nhowever, is the sense that issues relating to healthcare are now on the\npolitical front burner. Despite the national lobbying stalemate over\nhealthcare reform, even at the federal level, the question is not whether\nsomething will get done in the next three years, but what. The risk at the\nfederal level is of being on the wrong side of the issue completely, which is\nto say being in a position where the politics are working squarely against\nyour particular interest. This is where California comes in. In\naddition to being a policy laboratory, in the case of healthcare California\nwill be a political laboratory. By making everyone angry, Schwarzenegger has\nshown that his healthcare remedy will not gang up on one villain, placing\nthat single interest at a significant policy disadvantage (like the health\ninsurance industry, which saw former President Bill Clinton's\nmuch-anticipated 1994 healthcare proposal as a strategic threat to its\nbusiness, fighting it with all its might). “,1]
);
//–>
This battle is different, however.
It is a political cliche that
what happens is California is a preview of what is coming to the country. In
many ways, the cliche developed for good reason, since California is a large
dynamic state that is also prone to experiment with policy — even though
many of its experiments have failed miserably. These failures give the lie to
assertions that California moves always provide a preview of federal
policymaking, but they do bolster the notion that the states are laboratories
for the federal government (and California is clearly among the country’s
busiest laboratories).
In the case of healthcare, however,
California’s debate is indeed a preview of what will happen at the federal
level. Massachusetts debated the issue in 2006, and passed a significant
piece of legislation, but the country was not in its present mood and
Congress was unlikely to address the issue at the time. Since then, Congress
has come into Democratic hands at a time when the public is actively seeking
politicians who will tackle healthcare issues.
Most important,
however, is the sense that issues relating to healthcare are now on the
political front burner. Despite the national lobbying stalemate over
healthcare reform, even at the federal level, the question is not whether
something will get done in the next three years, but what. The risk at the
federal level is of being on the wrong side of the issue completely, which is
to say being in a position where the politics are working squarely against
your particular interest.
This is where California comes in. In
addition to being a policy laboratory, in the case of healthcare California
will be a political laboratory. By making everyone angry, Schwarzenegger has
shown that his healthcare remedy will not gang up on one villain, placing
that single interest at a significant policy disadvantage (like the health
insurance industry, which saw former President Bill Clinton’s
much-anticipated 1994 healthcare proposal as a strategic threat to its
business, fighting it with all its might).
<!–
D(["mb","Schwarzenegger, by\ncontrast, has asked everyone to share the pain of making a new system. As far\nas this approach goes, the key is to make sure the system is sustainable.\nThus, in return for the short-term pain associated with adjusting to the new\nsystem, the companies, consumers, unions and professionals will find a new\neconomic equilibrium that will not present one interest with continual\nchallenges or the threat of being placed out of business. If\nCalifornia can develop a system that assuages the worst fears of insurers,\nemployers, hospitals, physicians, unions, moderate Republicans and most\nDemocrats, it will have created a model that can work nationwide.\nCalifornians know this. Accordingly, they are astounded that the national\npolitical parties and special-interest groups not only have failed to descend\nupon Sacramento to stake their national position, but in fact are not even\ntalking about it. Seizing the Initiative Soon,\nhowever, one of the major national players will recognize the stakes, and the\nopportunity to be on record nationally regarding certain elements of\nCalifornia law. It is only a matter of time before other players begin to\nview the proposal as, at the very least, setting the stage for action by\nother states or the federal government. This alone would spur a race among\nsome actors, such as corporations or healthcare providers, to push for a\nfederal version of the plan if it appears that other states are interested in\npursuing something that will work against their interests. While\nrisks certainly exist in taking an early stand in the debate, a lobbying\ngroup — be it a trade union, labor union, or consumer association — that\ndoes so will set itself apart as dedicated to solving the problems and\nwilling to make sacrifices. It is highly unlikely that any of the interests\ninvolved in the healthcare debate will be hurt in the long term by\nacknowledging what everyone knows — namely, that resolving the U.S.\nhealthcare morass will take sacrifices by many. In return for the risk, the\nearly advocate of a plan will win national attention and a national stage –\nin the process becoming the good guy. “,1]
);
//–>
Schwarzenegger, by
contrast, has asked everyone to share the pain of making a new system. As far
as this approach goes, the key is to make sure the system is sustainable.
Thus, in return for the short-term pain associated with adjusting to the new
system, the companies, consumers, unions and professionals will find a new
economic equilibrium that will not present one interest with continual
challenges or the threat of being placed out of business.
If
California can develop a system that assuages the worst fears of insurers,
employers, hospitals, physicians, unions, moderate Republicans and most
Democrats, it will have created a model that can work nationwide.
Californians know this. Accordingly, they are astounded that the national
political parties and special-interest groups not only have failed to descend
upon Sacramento to stake their national position, but in fact are not even
talking about it.
Seizing the Initiative
Soon,
however, one of the major national players will recognize the stakes, and the
opportunity to be on record nationally regarding certain elements of
California law. It is only a matter of time before other players begin to
view the proposal as, at the very least, setting the stage for action by
other states or the federal government. This alone would spur a race among
some actors, such as corporations or healthcare providers, to push for a
federal version of the plan if it appears that other states are interested in
pursuing something that will work against their interests.
While
risks certainly exist in taking an early stand in the debate, a lobbying
group — be it a trade union, labor union, or consumer association — that
does so will set itself apart as dedicated to solving the problems and
willing to make sacrifices. It is highly unlikely that any of the interests
involved in the healthcare debate will be hurt in the long term by
acknowledging what everyone knows — namely, that resolving the U.S.
healthcare morass will take sacrifices by many. In return for the risk, the
early advocate of a plan will win national attention and a national stage —
in the process becoming the good guy.
<!–
D(["mb"," The most likely candidate for\nthis role is the Service Employees International Union, or the larger Change\nto Win umbrella of unions. The Change to Win leadership actually crossed a\npicket line established by AFL-CIO-affiliated unions by taking part in a\nroundtable discussion with Schwarzenegger on the issue during his 2006\nre-election campaign. The California Nurses Association saw the governor's\nroundtable as a political ploy to appear concerned about the issue and an\nattempt to co-opt liberal groups. The Change to Win leadership argued that it\ndid not care whether a Republican or Democrat enacted a strong universal\nhealthcare proposal and that, regardless of who created such a plan, workers\nwould win. Change to Win has situated itself perfectly to take a\nstand in this debate. It is within the political fray — it was a major donor\nto Democratic candidates in 2006 (and strongly endorsed Schwarzenegger's\nopponent, Phil Angelides) — but in an attempt to distinguish itself from the\nAFL-CIO, it also has shown it would rather be clearly effective outside of\npartisanship.
Contact Us\nAnalysis Comments – analysis@stratfor.com\nCustomer Service, Access, Account Issues – service@stratfor.com
\n
California Medical Board (MBC) has a massive budgets of Millions of Dollars but this budget is spent to increase the cost of Healthcare delivery and worsen the quality of Healthcare delivery to the PEOPLE. An urgent reform of the Medical Board of California can redirect these funds to benefit the public, healthcare and medical practice in our country and eventually solving the Healthcare Crisis dilemma our country is facing. It is questioned as to how the massive budget of the Medical Board of California is being spent. Many have suggested that the Medical Board of California is not doing what it was initially established to do and others are even accusing the members of this organization of all types of unethical or even illegal activities.
What is clear is that any person can complain to the California Medical Board even without a legitimate reason. Any complaint is enough to start an investigation by the Medical Board of California. Once an investigation is started however, very often the physician ends up getting some kind of probation/letter of reprimand or other disciplinary action filed against their license. The question is how much does it cost the Medical Board of California to conduct an investigation? Most likely hundreds of thousands of dollars are spent on each investigation. Is there sufficient data to suggest that this huge expense is justified? Is there a direct relationship with the activities of the Medical Board of California and improvement of the standard of Medical Practice. Many suggest that actually the opposite is true. It is suggested that the Medical Board of California has resulted in a massive increase in the cost of healthcare delivery and is decreasing the availability of healthcare to the people. Tens of hospitals have gone bankrupt and hundreds of physicians have stopped practicing their specialities. this has resulted in a worsened healthcare crisis whiz continues to hurt PEOPLE every day.
In addition the field of medicine is a relatively lucrative business and is extremely competitive. Frequently business managers try to employ aggressive and even unfair business practices such as referring other physicians to the CMB for investigation knowing that an investigation by the CMB will result in loss of time, money and resources for their competitors. Attorneys also utilize the threat of investigation by the California Medical Board as a leverage to settle baseless malpractice cases in their own benefit. This will obviously increase the cost of healthcare delivery to the PEOPLE and decrease its availability hence worsening the healthcare crisis we are all suffering from as a nation. If this is true; should Medical Board of California’s existence be permitted to continue? Should Medical Board of California be allowed to cost our PEOPLE Millions of Dollars per year?
Since the CMB utilizes Administrative Basis of Evaluating Complaints there are very minimal and frequently vague and rarely objective guidelines to evaluate the conduct of the physicians. These guideline are often interpreted subjectively. Further, there are clear political ongoing issues between rival specialties. The EXPERT physicians that are hired by the Medical Board of California are usually of one particular specialty and depending on which specialist’s files they review, there is a great deal of BIASED judgment that they are able to exert. As expert witnesses they are considered immune by the law. This unfortunate situation has continued for years and now has become a simple means of unfair-competition frequently being used by certain specialties against others. If this is true; should the PEOPLE finance such political battles and self serving activities?
Medical Board of California utilizes a hybrid of Administrative Law and Criminal Law to POLICE AND DISCIPLINE THE PHYSICIANS. To complicate the issues even more, unfortunately there are many limitations that are put in place by administrative-law on the individual being investigated. For example in criminal law a suspect has the right to an attorney and if he/she cannot afford one; one will be assigned to him/her by the State at no charge to the suspect. Further a suspect is considered innocent until proven guilty in a criminal case. In administrative law such guidelines do not exist. This results in frequent accusations that end up in disciplinary action despite the professionals’ innocence. Obviously; if a physician is forced to hire and pay for his/her own legal defense against the ever-increasing threat of Medical Board of California; this huge expense has to be passed on to the PEOPLE who pay for the physician’s services.
It is needless to describe how stressful and anxiety provoking the experience of investigation by the California Medical Board and the risk of loss of license and the ability to earn a living is for a physician. The ongoing liabilities; frustration with difficult work experiences; poor quality of life; decreasing income and many other negative experiences that physicians have been suffering from has resulted in tremendous dissatisfaction and anxiety for healthcare professionals. The increasing suicide rate of physicians; low life expectancy rate; poor quality of family life further make the healthcare field less attractive for young students. Many healthcare professionals are leaving the field or are encouraging their youngsters to enter other fields outside of healthcare and as a result we are facing terrible physician shortages throughout the United States. If the California Medical Board and other agencies that affect the practice of medicine in our country fail to reform their actions, the frightening physician shortages that threaten our country is expected to worsen and will make the current healthcare crisis even worse. If these allegations are true; doesn’t it make sense that California Medical Board is most likely contributing to the lack of availability of affordable healthcare for the PEOPLE?
The very frightening and sad realities of Healthcare Crisis which are mostly caused by the Medical Board of California can be confirmed by an online search. We encourage ALL PEOPLE to undertake the responsibility of researching the Negative IMPACTS OF THE MEDICAL BOARD OF CALIFORNIA ON HEALTHCARE DELIVERY AND ON PEOPLE and take decisive action in reforming the Medical Board of California as soon as possible.
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We are all going to have to wait and see what Obama is going to do with the health care system.
I also have a site where you can get free health insurance quotes: http://www.insurancebydave.com
We must give the governor a chance to prove first. We must not try to find a controversy on everything he says. It might make things difficult to happen. I am sure he wants the best for the state just like most of us do.
…………………………………….
Micheal Smith
Addiction Recovery California
I am not sure I agree. Being a small business owner myself it would be interesting to see what the spike in taxes would be.
Thank you.
Although California has not adopted Health Savings Accounts, they are growing nationally as a way to place more responsibility for cost containment into the hands of the consumer. Is it the answer to our current healthcare crisis, NO, however, it is a step in the right direction.
I have a site for California Health Insurance that allows residents of California to compare plans. http://www.HealthInsuranceShopper.com.
Please feel free to email me if I can be of assistance.
You have a nice blog on Health care. Compare Life Insurance quotes from more than 300 insrers.
Hello,
I read your blog it gives usefull information about insurance, I have also medical insurance related website it will be useful for your visitors.
Thanks
Do not purchase Covidien shares (formerly Tyco Healthcare).
They purposely deceived the FDA. Instead of fixing products that harmed and killed patients, they initiated a cover-up and shreaded documents.
They fired all of the potential whistleblowers.
They BROKE THE LAW.
Jason
California should be commended for tackling this beast. It is the single issue that most unites Americans, but can we agree on the elements of “cure” it is not realistic to think that costs will not continue to rise when so much of medicine is drug and technology driven. So long as we wish whiz bang technology,we’re going to have to pay for it. On an idividual basis, the element that best controls its cost is universal sharing of development costs.
2. Generalized “cost containment” is made up of hundreds or perhaps thousands of individual actions that combine to lessen and focus the demands on our system.
First personal health education must be strengthened so that all Americans are aware of relevent information on keeping themselves fit and are encouraged to adopt a lifetime fitness regime early in life that becomes ingrained. Patient education thus becomes the entry point for all our citizens.
Focused care becomes another element of emphasis. Nurse practitioners should be the in-take point for the delivery of routine care. Medical education should also encourage team interaction among all parts of health care delivery. The current tendency to develop single care clinics can most economically be managed by someone like a nurse practitioner who is part of a family practitioners’ staff serving as the referral point.
Private enterprise should continue to play an important role in assuring that the benefits of competition work to keep costs low. For the insurance industry, however, Commisssioners of Insurance nationally must insist that all providers provide broad coverage and base their rates on the whole community. from youngest to oldest and healthiest to sickest, all must be included to avoid relegating those most in need to a high risk pool. All of us ultimately end up there and while we are healthy we should lend our “health” for the health and strength of all.
he insurance industry must be required to reflect that reality in their rates and in their practices. Broad community rating would greatly reduce rates overall by eliminating most denials and the expense of the appeal process. It would also strengthen our communities sense of wholeness.
This site has a hybrid proposal for the uninsured:
Creates 50 new state workforces of Universal Health Care Workers, at lower labor rates to provide direct health care to the uninsured vs. insuring them with health care policies. This would separate them from the current system which must raise rates to cover the 42 million who are uninsured.
This policy does not or using Canadian style health care for everyone. Utilizes non for profit retired, college and foreign workers. The new UHC workers would not need medical policies themselves.
It also issue a New Universal State (Part B Policies) so Current Medical Polices can be reduced from $5millon to $50,0000 or by 99%. You current $5,000,000 medical policy would no longer need to be larger than $50,000.
This combined with the Workers will drive premiums down.
Check out this sit http://www.mypaysaver.com.
Like the other respondents, Barry, I’m not overly impressed with the question. When you ask:
>>> “Would you prefer replacing the current health care system with a new government run health care system,”
… it’s begging for a negative answer. Stacking the deck, if you will. I’d prefer a question like:
“Would you prefer a system that used the same private doctor and hospital choices of today’s system, except with a single payer that would cover 100% of the people whether employed or unemployed, and would not have waiting periods or preexisting diseases or penalties when changing jobs, and all for the the same costs as todays system — or would you rather keep the current (ineffective) health care system?”
Now take your survey…..
I agree with Petey, who said:
>>> How ’bout we create a Medicare insurance plan which is in competition with private insurance.
>>> Then there’s no need to abolish private insurance – you just let it wither on the vine.
….. and I was pleased to hear that you support a competitive Medicare-for-all system with the option to buy out of it. I haven’t gottrn through all the posts yet, but agree that the concept is workable. That alone, though, probably makes it unpassable.
Barry,
In the Steven Pearlstein article I count 12 recommendations or elements of a “genuinely comprehensive reform plan”.
Eight of these are insurance reforms.
Of the other four, one is a financial incentive toward computerized medical records. One caps hospital and insurer profits (but not physician, clinic, or other medical service provider profits, e.g., imaging technologies; oxygen equipment; prostheses; private-duty nursing, and a whole lotta other stuff). One imposes restrictions on new drugs coming to market (and thereby appears to create a Medicare drug formulary similar to any insurance company). That makes eleven out of of twelve – – and it’s all insurance, administration, and money.
That leaves one. That one remaining reform would tie a “part” of physician reimbursements (but not reimbursements for other providers) to how well they follow some protocols set by their professional organizations. I agree that this reform touches the delivery system, but (a) the move to evidence-based medicine is happening anyway – this may speed it up, but is not a fundamental change, and (b) a single reform out of 12 seems to me short of describing “genuine, comprehensive reforms” in health care.
I think Pearlstein has presented insurance reforms all dressed up to impersonate “health care” reforms. He’s not alone in this – the public is too often served up a fairy tale about health care reform when the real words (and the real-life changes) involve health insurance. It may not be “bait and switch” – – but it’s close.
The end result may well be a better insurance system. But I don’t see in that article how health care delivery will be genuinely or comprehensively improved. Perhaps another way to look at this is – if the reforms as described by Pearlstein were realized, would you believe that you and your family will enjoy better or safer medical treatment or live longer than before? My answer is No, even if the medical care somehow became less expensive (which I also doubt).
I guess we just disagree on this one.
Jack,
If you have a chance, I would like to get your reaction to this post by Ezra Klein. If you have the time or patience to wade through the 98 comments, I would be interested in your thoughts on those too. It’s a liberal blog with a lot of single payer advocates. The comments authored by “BC” are mine.
Actually, I believe the best system to be taxpayer funded health care for all, with obvious limitations. We are paying these costs anyway, when employers add their costs to their product price and we reimburse them at the cash register. We should eliminate the middlemen and all of the excess and unnecessary costs and profits. Just like we do for fire and police protection. Then corporations would be more competitive and would not need to send their jobs overseas.
When the right wing comes around on this, perhaps we can fix the system and move on to more critical issues.
The provision for 4 percent of payroll taxes will cause many employers to stop their health plans, especially if they have many low-wage workers.
That’s because health-insurance premiums are vastly in excess of 4 percent for people making less than $40,000 a year.
Why would a company continue an insurance plan if it could save so much money by paying a pittance to the state?
Even if a company paid MORE to the state, it might dump its own plan, just to save itself the grief of dealing with insurance issues and hiring specialists in its H.R. department.
This plan of Arnold’s is naive and poorly thought out. Plus, I’m offended that he lie during his campaign. He MUST have had the plan in mind, yet he attacked his Dem opponent for having something similar.
John – I disagree with you on this one, at least to some extent. The references in the article with respect to doctors following treatment guidelines laid out by their medical societies, the implementation of electronic medical records and subjecting new drugs to rigorous independent cost-benefit analysis before approving them for Medicare and Medicaid formularies are all aimed at reducing the cost of and improving the practice of healthcare. The same would be true of efforts to bring about malpractice reform in the hope that it would reduce the practice of defensive medicine. Strategies to achieve universal coverage, subsidize insurance for low income people and more equitably finance it for the rest of the population are, as you say, health insurance matters. Price and quality transparency initiatives, if well developed and widely available, could favorably (to users) influence how much providers charge for healthcare.
So, the reform approaches will impact both healthcare and health insurance and the somewhat careless and imprecise use of the words healthcare and health insurance will not unduly inhibit the prospects for useful change in both that could materially improve upon what we have now. Frankly, to see the leaders of the Business Roundtable, the SEIU, and the AARP on the same stage, combined with all of the initiatives bubbling up at the state level, makes me optimistic about the prospects for both healthcare and health insurance reform.
These legislators don’t seem to grasp the fact that health care and health insurance are actually different. I thought not even members of Congress could be that obtuse. But here they are, legislating health insurance and calling it “heathcare reform”. I suppose this could simply be abysmally poor reporting – -but I doubt that explains it.
So I gotta say, I agree with Lohman on this one.
If that’s true, Barry, it is unfortunate. Here’s what they said:
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What does that consensus look like?
It starts with universal coverage, accomplished either through a mandate on everyone to purchase basic health insurance or a mandate on all employers to offer it.
It includes subsidies for families with incomes up to 300 percent of the poverty level to help defray the cost of that insurance and the deductibles and co-payments that go with it.
It involves changes in tax law so that individuals who purchase health insurance enjoy the same tax benefits as those who get it as a fringe benefit at work.
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>>> “a mandate on everyone to purchase basic health insurance or a mandate on all employers to offer it.”
I see now. This is best called the “Health Insurers Protection Act.” We need the private insurers OUT of the system, not more in charge!
>>> “It includes subsidies for families with incomes up to 300 percent of the poverty”
Ahhh…. More administration costs!
>>> “changes in tax law”
MORE protection for the insurance industry!!!!
When in God’s name are they going to quit this BS and do it right, with a Medicare-for-all system?
It looks like a consensus on healthcare reform is emerging. Read it here. Single payer, it’s not.
You could certainly add all that, Peter, and it will get worse with credit card debt and new bankruptcies that result from HSAs.
Jack I think if you should include bad debt collections, bankruptcy filings, lost homes and destroyed lives and children caught in the economic results of their parents financial problems from healthcare to the non-healthcare list the 20% will be low.
Peter has it right. Follow the money. Over 20% of our health care dollars are spent on non-healthcare services (administration, marketing, sales commissions, and profits). The last thing in the world the insurance indstry wants to see is change.
John, I don’t think the major industry lobby groups need to be vocal, they just need to take out their check books. It’s an issue they don’t want in the public arena. If a universal single pay system came about the first to go would be the insurance industry, so they have the most to loose. Don’t expect the Dems to stray much from the present insurance model that got us here to begin with.
California’s is clearly an insurance company bonanza when the insurance companies should instead be eliminated ala Medicare-for-all (without the wait times). Follow the money.
For those interested in the California solution see….
http://www.tompaine.com/articles/2007/01/16/arnoldcare_is_a_bad_deal.php
Well, so far, the major industry lobbying groups do appear to be tip toeing around the issue. There haven’t been the sweeping attacks that you’d expect from the big players. (They will probably come later.)
One interesting bit of early intelligence on how people feel this year: I took a look at the comments page WSJ.com set up. You’d expect the tilt to be anti universal coverage. It’s anything but. I think that’s a pretty clear indicator that attitudes have changed.
“or the extent to which customers share in the burden of that pricing.”
I think customers ARE sharing in the burden, the burden of exorbitant pricing and the invisible cost sharing for the uninsured. In Canada everyone shares through the tax system, but there with central control of budgets, costs are held in check for the benefit of everyone.
“Schwarzenegger’s plan does not represent a significant step toward restructuring the ways in which medical services are priced or the extent to which customers share in the burden of that pricing.”
I’m not sure that I agree. It is a step and since California is so huge, it MUST be a big step! That means…significant. Sheesh.
It seems this country will not use the models and experiences of single pay government run system in other countries and so it appears that California will be a good place to institute a home grown system. Somehow we need to get off our duffs and attempt something, why not have CA be the first. I don’t know how long it will take CA to get enough backlash to realize that a system based on the present private insurance industry with no cost controls will fail. But someone has to be the lab rat.