OP-ED

Will Victory on Health Care Reform Mean Defeat for the Democrats?

Being a futurist is not really about making predictions, but people ask for them anyway.

So here is one: The way things are trending right now, Obama and the Democrats will succeed in getting a reform bill – and it will cost them the Congress in 2010 and possibly the presidency in 2012. Why? Because it will be ineffective at bringing most voters any tangible benefits soon, and ineffective especially at bringing down the cost of health care.

Obama (along with everyone else) repeatedly talks about “affordable” health care. What the bill is most likely to bring is health insurance reform. This is very important, and will bring tangible benefits especially for those who must go without insurance now because they have “pre-existing conditions.” But there is nothing in the bills that are most likely to pass that will really bring down the costs of health care any time soon. Yet the bills demand that the health plans cover many more people, and the providers treat them, while putting in place no mechanisms that would forcefully and quickly control costs – so costs are likely to go up even faster than before.

Despite the many obvious problems with our current health payment system, most voters are already covered, most have not run up huge costs on their insurance, most have never been kicked out of a health plan, most have not been refused for a pre-existing condition – so they will see no benefit, only continually higher costs. Of those who are not covered, 1/3 are working poor, who have decided that they just can’t afford health care – and now they will be forced to buy it, at current market prices, with minimal help from their employers or the government. Another 1/3 are people, mostly young, who could afford it, but have decided they don’t want to, because it does not seem worth the money to them – and now they’ll be forced to. Yet if these continue to be the kind of plans that the industry loves – high-deductible, high co-pay plans, most of the time it will seem to be of no benefit to them.

So the great majority of voters will continue to see higher costs, many will feel forced into a bad deal, and most will see no benefit. There will be an enormous backlash.

The storm that will gather over the next couple of years is going to be greatly exacerbated by this backlash, and providers will come even more under the gun to find ways to control their processes and get their costs in line.

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50 replies »

  1. we need to start over and do this right. single-payer plan is the only way to bring down costs for everyone. It will eliminate people who dont have insurance using emergency room for instead of regular doctor. that can save billions. the current plan does nothing but bail out insurance companies and betray the voters who worked so hard to get these polititians in office.

  2. OMG! Talk talk talk! If you cannot see what is really happening here, then you are doing exactly what is expected of you as a good socialist drone. It is all about control and the total and complete dismantleing of your freedoms gaurantied you in this great land. I don’t need the government for anything, niether do you. Watch this hand while I enslave you with the other. Go ahead you mindless brain dead zombies and follow that cute little lemming in front of you. Wake up, before it is too late!

  3. As Democrats of the Democratic Party, we are joining together in seeking reform within the Democratic Party.
    Many of our elected representatives within the Democratic Party are no longer following in the time-honored footsteps laid down by the founding fathers of our great Nation. More importantly, we as democrats see our elected representatives within the Democratic Party abandoning the values and principles as set forth within the Declaration of Independence and the Constitution of the United States.
    Nonetheless, this is only the beginning of our problems as Democrats, for the current Democratic Party leadership is tainted by corruption and being taken over by Socialists. These Socialists are clearly a threat to everything we hold sacred in America, and they are gaining evermore control over our Democratic Party, our Nation, and the American people.
    Despite this, we as Democrats can restore control of the Democratic Party back to the party members. All we need to do is cut off donations to the local, state, and national headquarters of the Democratic Party, and to make sure the donations are made directly to patriotic and honorable Democratic Party candidates that are not corrupt and/or Socialist.
    So please help spread the message to everyone of our fellow Democrats. Also, don’t forget to contact and request the Unions and other outside contributors to follow our lead as patriotic Americans.
    Thank you, and God Bless America.
    Website: http://www.democraticreformparty.com

  4. As Democrats of the Democratic Party, we need to join together in seeking reform within the Democratic Party.
    Many Democrats already know their elected representatives within the Democratic Party are no longer following in the time-honored footsteps laid down by the founding fathers of our great Nation. More importantly, we as democrats see our elected representatives within the Democratic Party abandoning the values and principles as set forth within the Declaration of Independence and the Constitution of the United States.
    At the very least, many of our elected representatives within the Democratic Party are no longer abiding to the sole reason the Democratic-Republican Party was founded by Thomas Jefferson – “Strong state governments with a weaker federal government.”
    This is only the beginning of our problems as Democrats, for many of our elected representatives within the Democratic Party have clearly set their own agendas over the members of the Democratic Party, our Nation, and the American people. Overall, many of them no longer think of themselves as being our elected representatives, and now refer to themselves as leaders in the true form of tyrants.
    Most Democrats already know their pleas are only being answered by repeated insult and injury by their elected representatives within the Democratic Party. Despite this, we as Democrats can restore control of the Democratic Party back to the party members. All we need to do is cut off donations to the local, state, and national headquarters of the Democratic Party, and to make sure the donations are made directly to worthy and honorable Democratic Party candidates.
    So spread the message to everyone of our fellow Democrats, for the Democrat members are taking back control of the Democratic Party. Also, please don’t forget to contact and request the Unions and other outside contributors to follow our lead as patriotic Americans. Thank you!
    Web site: http://www.democraticreformparty.com

  5. I’ve seen stats suggest that 85% of those with health insurance are happy with it. This sad saga is simply about dems having control over this industry. That is it in a nutshell. Government usually screws this up and this will be no different. It’s a major mistake waiting to happen.

  6. This is so Past Tinkering.
    There is so much machinery between me and my health care provider I have taken up self treatment for the most part. I have the intellect and I have the money. But, I don’t have the stomach. And it’s not respectful of humanity.
    My self-treatment works– it’s homeopathy.
    It’s not my exclusive tool and I still must rely on allopathic medicine too but only infrequently. I’m 65 and do not take any onging meds. I’m told this is quite rare. BTW, insurance says that doesn’t work and doesn’t cover one time of Homeopathy. But, this is my right isn’t it? I think this should catch on, no?
    It hurts me go see real people who are struggling to do the right thing suffering with this problem. People including children are in pain!
    It hurts me to see our leaders motivated selfishly, like “how does what I say or do affect my position in the party?” I guess, like others who would lose their jobs, they a scared. And, fear evidently causes the compromise of sensitivity and principle.
    my opinions (http://HealthcareHurts.blogspot.com)

  7. A government run health plan is a disaster. Huge national debt will be created. The doctors that the president appeared with were politically reliable, they were selected because they donated to his campaign. Polls are showing that publics support is rapidly declining – http://is.gd/451Sj

  8. YES. I have already contacted my office to change from Democrat to Independant. I voted for Obama; what a lie. We thought he would give us health insurance like Canada or England. Instead he is going to throw the citizens in jail for not buying it and when they comitt malpractice we will not be able to sue. They can give poor care, but you can’t sue the government. This is the worst nitemare I have ever seen in my life. Obama is ruining our country and taking freedom away. You will be thorwn in jail, not free health care. LIES.

  9. While there are many competing theories, explanations and outright blowhards in this crew – I’m betting on the jockey in this race and my choice is Rick.
    Well said and mixes opinion with recent past history. So rare in these days – nice job.

  10. Personally, i think the writer has it correct. How did we vote in a dem congress and dem president (who in 2006 said he favored a single payer plan) and get to the place where we will have little to no health care reform that includes a strong public option? the repubs and independents will have a field day with this in 2010 and again in 2012 and to be honest, I will only blame the dems.
    Weak and spineless…those are the adjectives I use to depict the dems in office.

  11. Dan M the implication is an out of state carrier would not have to offer the same mandates as instate carriers, this easily equals double digit savings in some states. It’s not being proposed to solve the cost of care it being proposed to solve the cost of regualtion.
    If we had blocked Medicare 44 years ago we would still have 13% of our seniors in need of assistance. Instead, after reform, we have 19% of our seniors in need of assistance and something like 34 trillion in unpaid liabilities. A clear example of how blocking reform can be a success. Just imagine if we had blocked Ted Kennedy’s HMO act how much better off we would be. Same with if we had blocked COBRA or made them write it correctly we would be further ahead. Doing something wrong is only better then doing nothing when your a politician.

  12. jd.
    No real offense taken. The poll merely shows that support is eroding over time. I do think the support numbers would be far lower if more people actually affected by the law had been included in the sample. My conclusion that revolt is imminent is based on observations here on the ground. The state has raised a plethora of taxes to support Chapter 58, and the feds are propping it up to the tune of about $11 billion over three years. Meanwhile, other services are being cut left and right (aid to cities and towns, education, social services etc.), and state revenues continue to drop. Tim Cahill, the state treasurer and Deval Patrick’s Democratic rival for the corner office, states bluntly that the reform law is unaffordable. Insurance premiums for small businesses and the middle class continue to rise unabated, and citizen frustration is palpable and rising. I think the comments relative to the survey, while admittedly not a scientific gauge of opinions, bear this out. My gut tells things here are going to get ugly here in the near future. I could be wrong, but I doubt it.

  13. I remain amazed by people who equate “blocking reform” with “success.”
    The $500 billion shortfall in Medicare over the next 10 years is not simply a “possibility.” The trust fund is in the red TODAY, with no Boomers in the program. Unless we want general revenue tax increases to fund the shortfall, something has to be done to pull cost out of the system, and that is the provider side’s obligation to get busy on. The other option is implementing reimbursement cuts that will make the SGR updates seem desirable. So, how is doing nothing a victory?
    Granted there are holes and flaws in many of the models/bills and smart people should find reasonable solutions without overreaching. But something has to start to happen or our economy will exist for the sole purpose of paying for healthcare for the elderly. And that is a National Health Service by proxy.
    Personally, I am for the phase out of FFS Medicare and Medicaid as the first carrot to move providers into greater alignment and efficiency.
    As for insurance reform, you reap what you sew. The carriers brought this on themselves.
    And, can someone please explain to me how letting insurance companies compete across state lines solves the cost of care problem? The national plans already do this. What provider network does Joe’s Health Insurance Plan of New Mexico offer subscribers in Indiana? And what’s stopping Joe from starting an independent plan in Indiana today? Seems like another smoke screen to me.
    Sorry for wandering all over the plantation.

  14. Ad nauseum, we have been writing about, blogging and discussing “reform” with economists, policy experts/wonks, and with physicians who are both health care economists and physicians who are in the trenches.
    Here’s how we see it.
    Mix together the following: i) self-preservation instincts, ii) special interests, iii) resistance to change and iv) a fear of the unknown and what you’ll end up with is a concept of meaningful health care reform that remains a theory at best. If there was ever a chance for reform to succeed that would have held out hope for better healthcare for more individuals at a cost that would not break us individually and as a nation, consider that chance DOA. We’ve “killed it to death” by baking the above ingredients into the cake.
    Those who provide healthcare, led by our physicians, are in disarray because the current system provides both a financial bounty for those who profitably overutilize the system, and a financial deathtrap for those who should be at the front lines of coordinated, evidence-based medical care delivery (spelled primary care physicians). Let’s also be clear, there are legions of physicians out there, primary care and specialists alike who work their tails off doing it right, who are nonetheless caught in this intricate financial morass.
    If you have any reservations about our use of the term “financial deathtrap”, look no further than the recent departure of the President and Chairman of the Dallas, Texas County Medical Society. Here is a Family Practice physician who spent 31 years in Dallas and was revered by patients and employees and respected by his peers. This quality physician has left Dallas to become an employed physician at what is probably the finest medical system in Texas. Why? The answer is found both in economics and in medicine.
    In economics we find that 24 hours a day was simply not enough time to handle the multitasking survival demands of dealing with the bureaucratic hordes that simply kept amputating practice revenues – insurance companies, government and a critically ill economy. How many staff persons did this doctor have to employ just to collect for his services – five was it?
    In medicine we find that this doctor, like so many others, probably just burned out because it became increasingly difficult (if not impossible) to devote enough time to his number one priority – his patients. If a physician tries to devote enough time to his or her patients, he or she will go broke – that’s the reality folks. After 31 years, this doctor (and many like him) deserves a medal for hanging in there for so long, because the last several years have been a slippery financial slope downhill. There will be a heavy price to pay for this.
    So where does this now go, if physicians are resistant to change because it will threaten their livelihoods, because many providers/vendors in the economic food chain refuse to give up the cash cow, and because plain old fear about heading off in a “right” direction (whatever that might be) is a pretty visceral enterprise?
    What we will now have is a system that may get some cosmetic changes, but fundamentally it will remain the same old bureaucratic, inefficient, excessive, overutilized and wasteful horse and buggy we’ve always had – right in the middle of the best equipped, most highly trained professional health care system in the world. This is the same system, readers, that is compared to the systems of other countries that spend far less and yet deliver better care (as demonstrated by the studies of some of our own leading institutions).
    We’ve done this to ourselves because no one has demonstrated the will to produce meaningful change – in the way the health care profession is structured and in the way health care is delivered. We’ve jawboned it to death without enacting any change.

  15. Agree completely. I wrote about this a couple of weeks ago (see http://www.healthpolcom.com/blog/2009/09/17/healthcare-reforms-hurricane-warnings/).
    The Democrats are especially vulnerable since many of the provisions – such as the health insurance exchange(s) – won’t start functioning until 2013. Until then, the Democrats will have to defend the concepts, the spending projections, and the nitpicking on the proposed rules and details through the 2010 and 2012 elections without having much substantive to point to.
    Change is tough – particularly when you are in charge of it – and people are fearful of what it might mean for them.

  16. An interesting take to say the least, and I tend to agree with it in principle if not the timing of the foreseen voter revolt.
    I feel compelled to make a couple of other points:
    1) Health insurance reform IS NOT healthcare reform. There’s a big difference between coverage, and care.
    2) The state of MA is struggling to find an affordable way to sustain its version of “reform”. If this is a problem for a state that only had roughly 600k uninsured citizens to begin with, it has to make you question the sustainability of similar reform for an entire nation that has 75x that # of uninsured.
    3) To the “healthcare is a human right” crowd: How do you define “human right”? And, if healthcare qualifies, why not shelter? Why not clothing? Why not food? Is every citizen of every “civilized” country not entitled to these most fundamental human needs – food, shelter, and clothing? Should their respective governments not provide these basic needs for “free”? Where does it end? Are humans not capable of taking responsibility for their own well being?

  17. Right you are. I have been saying much the same. However, at the moment the Senate Finance Committee is debating the public option and as things are going physicians and hospitals better get ready for more patients and less money.
    If the public figures out what is happening here your projections will be correct. But that is a big if. I spent 47 years as an employee benefits professional and sadly I know the average person does not get it. It is much easier to just blame the big bad insurance company for the ills of the system.
    My views are at http://www.quinnscommentary.com

  18. “extract efficiencies from providers”
    Good luck with that. The unspoken truth is how high your co-pay will be after they make it free. Then the efficiency will be you didn’t go to the doctor in the first place.

  19. Gary, nice final paragraph, but you seem to think the public knows better than it does where to point the finger for cost increases. The public will just demand lower premiums, and the people who know where the bodies are buried (I mean, where the premium costs come from) will then be forced to extract efficiencies from providers.
    You’re right that the pressure on providers is likely to come first from government, and only then will private insurers have the political cover (and competitive need) to point the gun, as you say, at providers.

  20. Joe Flower:

    The way things are trending right now, Obama and the Democrats will succeed in getting a reform bill – and it will cost them the Congress in 2010 and possibly the presidency in 2012.

    According to experienced Democratic insider Paul Begala, if they fail in getting a reform bill passed, it could cost them the Congress. Begala writes in today’s Politico ( “Bet on health care reform passing”):

    The single biggest reason, I believe, that the Democrats lost in a landslide in 1994 was because they failed on health care. More important, congressional Democrats believe it. They know it is their rear ends on the line in 2010, not Obama’s. The press will play a defeat as a disaster for the president, but the voters will visit their wrath on Democrats. That alone may explain the remarkable progress Congress has made in the face of unified and intransigent GOP opposition.

    So, does this mean that the Democrats will lose the Congress in either case? I doubt it.
    Mr. Flower does have it right in the sense that the public will now demand lower costs and that the “providers will come even more under the gun to find ways to control their processes and get their costs in line.” The public also knows that the insurance companies have been unwilling or unable to point any gun at the providers, so will be looking to the government to hold the providers accountable and in doing so will force the insurance companies to become more competitive.

  21. Ron, sometimes I get a little feisty and psychologize. But I do respond to and respect evidence.
    As evidence, I’m not sure what the poll methodology and sample prove. It’s not a huge sample, but for a state level poll I think it’s pretty ordinary, and I don’t see how the population is unrepresentative in any dramatic way that would undermine the results.
    Certainly, nothing that I’ve seen in the poll, or its innards, or the comments to that Globe article indicate anything like your conclusion that “Revolt is imminent in Massachusetts!”
    Since the evidence you presented doesn’t come close to establishing the conclusion you used it as evidence for, the explanation that came to mind was that you wanted this conclusion, and were creatively interpreting what you read in order to believe that it supports your conclusion. If I’m wrong, I apologize. If you have other evidence you are using to draw your conclusion, by all means share it.

  22. Ron, you really have to stop confusing what you want to be true with what is true.
    And since when are comments on an online article (here included) representative of anything? Talk about a skewed sample!

  23. Ron,
    Wow, only 11% want the plan repealed. What about the other 89% who don’t want it repealed? That says something alright.
    Everyone knows they have to do a better job on costs, but that was not the original point of the law. The original point of the bill was to get everyone insured.
    They are attempting to conquer the costs part now. This reform gives them the major motivation to take on the costs. The 40% number you quote are just those who know they have to do more on costs, which they will do. that does not mean the 40% don’t like the bill. In fact, support is still very strong for the bill.
    And by the way the costs have not been that crazy and are within expectations. See my comments above.

  24. Hal,
    Did you read the comments? These offer a truer picture of the situation than the poll, which used a very small sample (501 adults)and was designed to prop up the law. It is significant that only about 3% of the population is uninsured but 11% would repeal the law and better than 40% believe the law is unaffordable. The facts are that Massachusetts has not reduced the cost of insurance nor improved the quality of care. Most of the newly insured continue to use the ER as their primary treatment source. Mandating everyone into a broken system accomplishes very little, but that is what Washington seems poised to do. I have to agree with Joe that this course will prove costly for the Democrats and is unlikely to actually reform anything.

  25. What about the tens of millions of newly insured with a healthcare bill? Do their votes not count for anything?
    It will take time for healthcare reform to evolve. Likely years. I think the majority of the people will know that at least Obama is trying to do something about it. That is pretty big.
    I think if not a single Republican votes for a healthcare bill they have a heck of a lot more to lose.
    If any kind of healthcare bill passes that at least get more people insure and eliminates the ability to drop people for pre-exisiting conditions it will be a big win for Obama and the Democrats.
    What do the Republicans got? Nothing. Nada…
    Most people see that the Democrats are trying to fix the problems and that the Republicans are playing politics and are the party of “No”.
    It will be the Republicans “Waterloo” if a healthcare bill passes, although I think they have already had several “Waterloos”. As much as Obama has taken some hits on healthcare from the campaign of lies and teabaggers, the Republicans have gained nothing from this and, in fact, continue to sink in the polls. The Republicans are just shooting themselves in the foot.
    I see no gathering storm. In fact, quite the opposite.

  26. Joe:
    When you forecast Democrats will lose in 2010 and Obama may go down in 2012 because of the ineffectiveness of their reform in benefiting voters and bringing down costs, I agree.
    One need look no further than the 3 year old Massachusetts experiment in universal coverage to see the ineffectiveness of Obama-type, i.e., top-down reforms, in satisfying voters and reducing costs. According to an April 27, 2009 Cato Institute Report, “Massachusetts-like Reforms Increase Costs and Waiting Times,” Massachusetts has experienced a 46% faster health inflation rate than the rest of the nation, waiting times to see a doctor are now 7 weeks compared to 3 weeks for most of the country, and its voters are saying – reduced quality by 3:1, less affordable care 31% to 27%, and reform failure 37% to 26%.
    Add to that the fact that Massachusetts is an affluent state ranking number 3 of doctors per capita with a low number of uninsured, and it easy to see Massachusetts-like reform would be even more of a disaster elsewhere, like Texas, which has 25% uninsured.
    This is not to say Bay State reform has not succeeded in some respects It has reduced the number of uninsured to under 3% – far below the national average of 15%. But it has failed to lower costs and has ushered in talk about health care rationing to stem the inflation tide.
    If the Democrats and the President go down, it should not be interpreted as a defeat. Obama will have advanced the reform debate, he will have initiated a series of needed reforms, and he will have shown what works – and doesn’t work – in the freewheeling American Democracy and its underlying culture. We will better know the right mix of public policy and marketplace forces, and the limits of left of center governance in a right of center nation.
    Perhaps I can better express this in verse,
    Into the Valley of Health Reform
    Into the valley of health reform
    Bestrode the one hundred senators.
    Comprehensivists to the left,
    Incrementalists to the right.
    Square in the middle sat the arcane,
    Senator Olympia Snowe of Maine.
    Bespoke the comprehensivenists,
    it must be done all at once.
    Evoked the incrementalists,
    no, it must be done one at a time.
    Bespoke the comprehensivenists,
    it must be done right now.
    Evoked the incrementalists,
    no, it must be done right.
    Bespoke the comprehensivenists.
    it must be done now or never.
    Evoked the incrementalists,
    no, now or never is forever.
    Bespoke the comprehensivenists,
    it must include multiple mandates.
    Evoked the incrementalists.
    no, not like the socialist states.
    Bespoke the comprehensivenists.
    it must have a public option.
    Evoked the incrementalists,
    no, that means federal co-option.
    Bespoke the comprehensivenists,
    Tax the private side to pay for it all.
    Evoked the incrementalists,
    no, it is the middle class you tax.

  27. The author’s assessment isn’t all wrong, but it’s not all right either.
    The thing to remember is that long before the 2010 election cycle has begun to attract the attention of mainstream voters, two things will have happened: 1) the healthcare reform votes will be in the rearview mirror, and 2) the economic recovery will be in full swing and unemployment rates will be headed in the right direction. Any political consultant worth his fee knows that the latter is more important than the former, and will correctly be painting the recovery as the result of Democratic fixes to the Bush economy, or something along those lines.
    Also, its worth pointing out that some of the policy fixes that will bring cost-cutting reform to healthcare delivery (as opposed to insurance reform) are already in place as part of the stimulus (ARRA of 2009) legislation and Medicare cuts (MIPPA). To attribute the improvements that come from ARRA and MIPPA to whatever is yet to pass in the America’s Healthy Choices Act (or whatever passes) would be the moral equivalent of the rooster taking credit for the sunrise, but regardless, the voters won’t care why things improved — only that the Democrats were in charge when the improvements happened.
    All that said, I don’t disagree that the Democrats may lose seats in Congress in 2010. That has less to do with any sentiments about “where’s my healthcare reform?” and has more to do with the fact that with two straight cycles (2006 and 2008) when they overachieved, the Democrats face a very tough map to defend. Democrats won some traditionally Republican seats, and these were always going to be tough to keep even if the healthcare reform fight had not happened.
    I don’t doubt that the Democrats will lose seats in the House in 2010, though the GOP still must recruit good challengers, something it has NOT done well the last two cycles. But in the Senate, where few Democrats are vulnerable to a flip, at worst I see a net break-even, since Republican retirements and vulnerabilities paint an equally tough map for them.
    And as to Obama’s chances in 2012, he certainly might face a tough slog against the right GOP candidate — though just as with Congressional recruiting, who the Republicans could successfully run against him is far from clear.
    But Obama’s vulnerability, too, was inevitable in the wake of the healthcare fight. Healthcare reform wasn’t quite a third-rail issue, but those who tried it in the past suffered for it, and those who did not attempt it were not penalized. Knowing that, one could have easily predicted before he attempted healthcare reform that Obama would lose popularity in the bargain. The days of 63-percent approval are well behind him, but he still polls higher than the percentage of people that voted for him in Nov. 2008. By the time it’s all over, he might well slip below the 50 percent line. That’s what it means to spend political capital. His gamble is that it was not a mere expenditure, but an investment that will bear future return. While it might not bear fruit in bending the medical trend in time for the Iowa Caucuses, it may pay other dividends if he can properly capitalize on a promises-made-promises-kept narrative.

  28. There is a lot of wrong headed thinking around health care reform by both Republicans and Democrats. It is because we as a nation,think of health care as going to the doctor and the hospital. Health care is: caring for our health! We all need health care everyday all the time our entire lives.
    Health care, which uses the resources of others is not a right it is a privilege.
    “We have the right to life, liberty and the pursuit of happiness” – Thomas Jefferson.
    As privileges go, it is about as basic as it gets. Any society that cannot support the health of its citizenry is asking to be replaced with one that can. Emergency care, primary care and catastrophic care are the three essential forms of care that every citizen needs. Everyone, rich and poor must have access to these forms of care.
    Access to proactive care, integrative care, health clubs & vacations, healthy food programs, elective care and many other non-essential forms of care can add value to our lives. They can be sold as health care insurance options.
    Individually we pay for non-essential care, Publicly we pay for essential care. Payment is a mix of taxation. Today we are taxed out of our pay check. The money goes to insurance companies instead of the government. Most of us could care less who this money goes to so long as we have access to a quality health care system at a reasonable cost.
    There is a capitalistic approach and a socialistic approach to publicly pay for essential health care.
    The socialistic approach is to use a single payer system. The government can be used to manage the money and guarantee health care for everyone. The single payer approach can slow innovation because it lacks financial reward for replacing workable solutions with better ones.
    The capitalistic approach is to use a private insurance model and allow competition to improve quality and drive down costs. The capitalistic approach works when the system rewards health care providers for quality and efficiency.
    Our current system is approximately 50% socialistic and 50% capitalistic. It depends on market forces to operate, therefore the entire system more closely matches the capitalistic model than the socialistic model.
    Unfortunately, this system rewards quantity of care and ignores quality and efficiency. Quality and efficiency are often in conflict with quantity. This leads to waste, fraud and poor value.
    Realigning the payment system to reward quality and efficiency can make the capitalistic approach far superior to the single payer approach. Changing the payment system to pay fee-for-access instead of fee-for-use corrects the profit motive.
    In a fee-for-access payment system a doctor gets paid monthly on behalf of each patient. He must keep the patient engaged by providing access to health services for healthy patients. When he takes a proactive approach to patient care and develops efficiencies, he can dramatically increase his patient base (income) while reducing overall time he spends with patients. The patient receives more and better health care services than was ever before possible.
    It is a win-win situation that simultaneously improves individual health and drives down health care costs.

  29. “Health reform” should not simply mean “health insurance reform” – yet in much of today’s discussions, this is sadly the case. We need to stop limiting ourselves in this way, exploring broader issues such as how to implement true payment reform, how to reward innovation and care coordination, and how to move into a 21st-century version of healthcare that is open to new models of care. While improving our health insurance system should indeed be part of our larger reform efforts, we absolutely cannot both start and stop there.

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  31. More from Ron’s link:
    “The poll found that 79 percent of those surveyed wanted the law to continue, though a majority said there should be some changes, with cost reductions cited as the single most important change that needs to be made.
    “Only 11 percent of state residents favored repealing the law, similar to last year’s finding.
    “In another question, residents were nearly evenly split over whether Massachusetts could afford to continue with the law as it stands: 43 percent said the state could not, and 40 percent said it could.”
    Just exactly as one should expect: people like having reliable insurance that actually is there when you need it. And people are rightly concerned about rising health costs.
    This is why my own blog has reviewed and winnowed the reform ideas to focus on the best reforms to control health costs over time.

  32. Ron, from your comment I expected a support level under 50%, but, as your link points out, currently Mass residents like the Mass health care mandate and system by a 2 to 1 margin. That’s quite a favorable rating! I think you should take the opposite conclusion from this — that in spite of the heavy rhetoric and politics, Mass has remained surprisingly robust in popular support of Mass health reform. Quite remarkable. I would not have guessed support would remain so high in Mass. We lived there until mid-2008, after reform was already in place, and while I knew reform was liked, I did not expect it to remain so popular.

  33. Having worked as an MD in the public and private for-profit sectors, the oppression and block to creativity is much more likely to be located in the for-profit sector. Public funded health care which is primary care lead does bring down health costs. Resistance to meet health care needs equitably without exorbitant profit is the main stumbling block by the major industry players and medical specialists. See World health organisation health evidence network. http://www.euro.who.int/HEN/Syntheses/primaryvsspecialist/20040115_15
    I wonder if it is US pride that provides the blinkers on what most of the developed world has accepted long ago. Health Care is a human right and collaboration amongst players to deliver this makes for a civil society.

  34. We need to make the present better…so what if he loses if there is a good healthcare.
    Having said that, I would like some futurists to talk about the world without healthcare reform??????
    That is not a scenario one want to experience specially when we just had the trailor with the financial melt down.
    rgds
    ravi
    blogs.biproinc.com/healthcare
    http://www.biproinc.com

  35. Deron S.’s definition certainly is the case most of the time. Who knows what will happen in elections over the next few cycles.
    Not even worth speculating – far too many variables. As Dr. Lippin notes, better to concentrate on generating a more, rather than less, effective bill.
    Pending bills are pathetic in regard to change that is beneficial to patients/payers, but business in general seems to finally register that it is in its interest to back more, rather than less, radical reform.
    I have always advocated an alliance between all of business (absent the subset that benefits from excessive spending on medicine and medical services) and those who want a single payer/insurer system. A natural fit for both. Single payer/insurer proponents have not adequately shown business groups the benefits of such a scheme for them and groups that represent business interests have been too limited by their ideological blinders up to this point to see the benefits to them and to their employees of a single payer/insurer scheme.
    But were business to weigh in heavily now, single payer/insurer could still receive consideration. General business support would instantly overwhelm the current domination of special interests on all aspects of pending legislation.

  36. politics – \ˈpä-lə-ˌtiks\ A process in which ideas are debated, then watered down, resulting in ineffective solutions to the larger problems faced by a nation.

  37. I’ve pointed out also that the delaying of significant reforms until 2013 is a serious error.
    Even major insurance reform could be done in 2010, and largely complete.
    For instance, to solve the political opposition to a mandate, simple either a) set the basic required plan benefits to be less costly, but close loopholes:
    http://findingourdream.blogspot.com/2009/09/republicans-trapped-in-cul-de-sac-of.html
    or
    b) Do something in between a mandate and no mandate. This isn’t hard. For instance, without a mandate, set up a rule that says if you apply for coverage after 2010, then during the first 12 months of such coverage, you must pay 40% coinsurance up to a total of 50% of your average 2008-2010 income. This would provide something of an incentive to get covered sooner, rather than waiting until a serious illness arrives.
    All sorts of new ideas are possible. I can usually come up with 2 or 3 every day. If even 1 out of 20 or 50 brainstorm ideas is a good, workable idea, then we can expect to solve any of the obsticles with a little mental effort.

  38. Well said.
    The proposals all involve doctors working harder for less autonomy, creativity, and income.
    The proposal all involve patients actually getting care inferior to what they get now (nothing worse than being cared for by a doctor who is angry, and they will be with any of the plans). Corners will be cut by hospitals that are barely solvent now.

  39. The American people’s mindset is not ready for National Healthcare! In the U.S. you have a society that has morally dictated that everyone should have access to allopathic healthcare(COBRA laws). Yet, all of the primary players in providing this healthcare are financially motivated and self-serving entities. That will never work! The Idealists need to become the Realists, and the American people need to embrace more complete reform than is currently possible. I predict the current navigation of healthcare reform will simply expand the costs without adding any real reform, and contribute to bankrupt the U. S – but, oh wait, it is doing that already. Joe Flower’s current political assessment is probably going to be correct. Dr. Laursen MD

  40. A few thoughts in response.
    1. The closest thing we can turn to for insight is the Massachusetts plan. Have the voters revolted there? Not that I’ve heard.
    2. The bills I’ve seen have a phase-in period. I expect that very little will have changed by the 2010 elections. There won’t be noticeably higher taxes to pay for subsidies, or much in the way of penalties for being non-insured. So if there is blowback, I really doubt it would occur in 2010.
    3. Even if there is a cost to passing a bill, why not consider that the cost of not passing a bill could be larger than the cost of passing one. Don’t forget what happened to Clinton in the first midterms. Democrats were dispirited and Republicans were energized. Democrats will be in much better spirits if reform passes, even if it is far from complete reform and costs stay high (which they will for the next couple election cycles).
    4. The Democrats can avoid some of the anger you mention if they get AHEAD of the Republicans on arguing that this is not a complete bill, but it is the most complete bill they could pass at this time. They should take this opportunity to say that they welcome another round of reform and believe it is essential. Reform is a war, not a battle. They need to be saying this loud and clear once the final bill is in place and right before the final vote passes it. But if they are not clear about this, they will indeed get hammered by Republicans as tax and spend liberals. But how badly is not clear. If they can pass something to reduce costs in 2011 the price to pay in 2012 may not be bad at all….could even be a net positive.

  41. Two comments
    1)It is not too late to fix these bills
    2)If a health care bill passes this year it will marginalize the republicans even more (because the pubs want nothing) and a energy bill will follow.
    Dr. Rick Lippin
    Southampton,Pa

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