OP-ED

Some Thoughts On the Word “Filibuster”

As I noted in another post, the media seems to be turning “reconciliation” into an ugly word.

But “filibuster” is the word with a more unsavory history. (Thanks to HeathBeat reader Barry Carroll who sent me a link to the history of the word.)

“Filibuster” finds its root in the Spanish word “filibustero,” which means “pirate.” The filibuster was originally seen as an opportunity to “pirate” or “hijack” a debate.

In modern American history the filibuster became infamous as a tool used to block civil rights legislation.  This tradition goes all the way back to 1946 when Southern Senators blocked a vote on a bill proposed by Democrat Dennis Chavez of New Mexico that would have created a permanent Fair Employment Practices Committee to prevent discrimination in the work place. The filibuster lasted weeks, and Senator Chavez was forced to remove the bill from consideration.

In 1957 Senator  Strom Thurmond (then D-SC, later R-SC)) set a record by filibustering the  Civil Rights Act of 1957  for more than  24 hours. Ultimately, the bill passed. In the 1960s southern Democratic Senators attempted, unsuccessfully, to block the passage of the Civil Rights Acts of 1964.

Since then the use of filibusters has accelerated. In December of 2009, Senator Sheldon Whitehouse, Democrat of Rhode Island, made this statement on the floor of the Senate :  “We have crossed the mark of over 100 filibusters and acts of procedural obstruction in less than one year. Never since the founding of the Republic, not even in the bitter sentiments preceding Civil War, was such a thing ever seen in this body.”

I wonder—has there has been any time since the Civil War when this country was as polarized as it is now? The division has taken place gradually, over nearly three decades, so that it has come to seem almost natural.  But last week’s Summit on Health Care dramatized just how wide the gap between liberals and conservatives has become. It is not just a matter of what some call “ideology” or “politics.”  It is a difference in very basic values.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

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19 replies »

  1. when you factor in the administration of multiple insurance companies claims by doctors and hospitals could that not be considered part of the cost of healthcare, in effect if not going directly to insurance companies, on their behalf?
    Peter seeing that the federal government pays for 50% of healthcare there is no way imaginable you can say 30% is going to insurance companies. Of total healthcare the correct number would be low single digits.
    “One party payor, one set of rules.”
    FYI Peter one set of government rules that are 10,000 pages long and can send you to jail if you break them is still worse then 1000 sets of rules 2 pages long.
    “treatment caps,”? LOL you think single payor in other countries has unlimited spending? Try looking up NHS and budget. If you want to see what it would look like in America check out Indian Health Services, I think the saying is get sick by june or don’t get sick. When the money runs out they just stop treating people.
    “but thorough auditing based on statistical methods would not cost all that much.”
    That’s becuase it doesn’t accomplish that much. It is only as effective as the programming and that is easy to beat once you know the code. There is still the problem that their auditing is retrospective so once they find fraud the person is already gone and opened up shop elsewhere.
    “number generally used for Medicare of about 5%.”
    Nice liberal slight of hand. FYI 5% of $7000 is greater then 10% of $3000. In liberal logic increasing per member spending to $70,000 would be an ideal outcome becuase you acheived .5% admin cost. The post office doesn’t charge a % to mail an EOB and salaries aren’t paid in % either. The only time %s are used is when liberals wont to cover up how bad it is.
    “In principle there is no reason why charges for services could not originate electronically at point of care with very little, if any review, before submission to a single paying entity.”
    With all our new fangeled technology it is just as easy to send an electronic bill to one person as it is 100. It’s called EDI and the only thing holding it back is provider adoption. HIPAA mandated payors accept claims electronically, in all its legisltive brillance HIPAA did not mandate providers bill as such. EDI for providers is no more complex then Pharmacy PBM billing, you don’t hear them complain about the cost of dealing with 100 PBMs do you?
    “As much “sophistication” as is desired can be built into any automated system.”
    This already exist and has been around for 10 years+. We call it auto-adjudicate and it does wonders to make payors profitable. It also does wonders to attract fraud. There are in existance and working real time payment systems. When I person checks out of their doctors office while they wait the claim is billed and paid before they leave. Sounds great until you get a doctor that decides to clean you out. With no auditing or time to question service performed the door for theft is left wide open. This is where politicians always trip up, they don’t think of the ramifications.
    Fraud is already problem, how does removing the remaining sliver of oversight improve that?

  2. Were I less charitable, I might suggest Dennis is here playing to an audience which has educated itself on these matters by repeated viewings of Sicko.
    I have no doubt there is a role to be played here by more sophisticated software programs. At the same time, it is difficult for me to imagine how such systems could replace skill, judgment and experience in ferreting out fraud, waste and the unnecessary. Dennis, of course, would assure us that the insurers, with their labor intensive processes, simply don’t know what they’re doing. Well, that’s just what he would say, isn’t it? I’ve never been involved in a claim for benefits under a health policy, but I’ve sifted through enough hundreds of thousands of pages of medical bills to know that the quickest road to ruin is to turn providers loose with blank checks. Until we get a handle on how much Medicare is losing by inadequate review processes, I don’t know that these suggested comparisons of “administrative costs” have mch validity. I suspect these losses might well make the insurers’ 5% plus CEO compensation look like peanuts.
    Peter, where are we getting all these “different rules”? I thought one or two insurers enjoyed a monopoly in virtually every state.

  3. “if Medicare examined its claims as thoroughly as the insurers”
    This issue keeps coming up, but thorough auditing based on statistical methods would not cost all that much. The net gain from that would greatly exceed the cost.
    Reportedly CMS administrators have consciously not asked for funds for increased fraud detection and investigation because Congress members with oversight responsibility do not want the money to be spent.
    There are statistics available for administrative costs in countries with single payer/insurer schemes, although I do not have them at hand. As I recall the percentage is quite low, such as the number that Peter found for Canada or the number generally used for Medicare of about 5%.
    The administrative hassles and out-of-pocket costs are as material as they appear to be. All one has to do is look at the size of the staffs in provider entities or look at the cost of contracting with an outside billing agency to see how much money is expended for billing and collections.
    In principle there is no reason why charges for services could not originate electronically at point of care with very little, if any review, before submission to a single paying entity.
    The capabilities of software are such that enabling thorough automatic processing at each stage is not difficult. To what extent data scrubbers would be needed between the source of charge and source of payment, I do not know, but I am certain that the path of charge origination to payer, to processing at payer to disbursement of funds to provider can be better automated, i.e. with better accuracy and lower cost, than it is done now with Medicare, not to mention the significant cost of doing this for multiple payers.
    As much “sophistication” as is desired can be built into any automated system.

  4. I attempted to find administration costs in Canada – a single-pay country. At least in 2005, the year I was able to get info about in a limited search, it was about 4%. I don’t know if that includes administration in docs offices. But I would assume it includes administration in hospital since they are part of the government plan. Here’s the link:
    http://secure.cihi.ca/cihiweb/products/hcic2006_chap1_e.pdf

  5. “Well, Peter, that hardly leaves “universal single payer” as the sole rational option.”
    Oh, but it does, but not completely eliminating paperwork though. One party payor, one set of rules. You think doctor/hosp billing staff and paperwork are the same in single-pay countries – I’d be surprised? Of course the taxpayer gets to keep the 5% profit and million dollar pay scales plus bonuses, while the patient does not have to contend with recission rules, apps, treatment caps, pre-existing or deductibles.

  6. Well, Peter, that hardly leaves “universal single payer” as the sole rational option. I’m sure some of these billing procedures can be standarized, and I have to wonder what provider “administrative costs” would be if Medicare examined its claims as thoroughly as the insurers. I hardly think the remarks in question can pass muster under the “fake but accurate” standard.

  7. Rep. Kucinich has the right idea at least, although my perspective is always that the “populist” stance of Democratic politicians such as he, who berate private insurers for greed, indifference toward suffering, etc. are making a losing argument because that basis for criticism is inaccurate.
    Needless to say pursuing earnings is exactly what a for-profit entity, whether healthcare insurer or something else, should do. It is the prime responsibility of management. Not doing so is dereliction of duty. The same applies to private non-profit insurers, although their goals are somewhat different.
    Presumably Rep. Kucinich is making an attempt to define the portion of private insurer revenues that are theoretically “wasted” when he cites the 1/3 figure, i.e. 1/3 of revenues go to something other than claims reimbursement. But even with that definition he certainly grants himself wide poetic license in the use of statistics.

  8. “The cost of healthcare is hitting everyone very hard and one out of every three dollars is going to who? The insurance companies for their profits, stock options, executive salaries. That has nothing to do with health care.”
    archon, I won’t defend loose statistics but when you factor in the administration of multiple insurance companies claims by doctors and hospitals could that not be considered part of the cost of healthcare, in effect if not going directly to insurance companies, on their behalf? There’s a lot of paper pushing out there.

  9. I trust we are in agreement that this is not the proper venue to rehash the French Revolution or revisit the themes of Political Philosophy 101.
    But speaking of “good faith,” I would suggest the “progressives” are hardly the sole repository of that virtue. I was just listening to Dennis Kucinich being interviewed on “Faux” News, more specifically, during the Health Care Countdown segment. This is a literal quote: “The cost of healthcare is hitting everyone very hard and one out of every three dollars is going to who? The insurance companies for their profits, stock options, executive salaries. That has nothing to do with health care.” There’s no excuse for this sort of thing, guys.
    BTW, perhaps someone might enlighten me concerning whether “progressives” suppose that “faux” rhymes with “fox.” I’ve often wondered.

  10. The Democrats are at such a disadvantage to the Republicans… the analogy is of a child with two parents who are divorced and share custody.
    The mother cares for her child and wants to to well by him; the father doesn’t care one jot whether the child lives or dies.
    The mother will always end up bending over backwards to try to ensure the father doesn’t do anything that will end up in the death of the child.
    The child is America; the father is the Republicans; it’s tragic to watch the spoilt rich boy republicans block anything that’s vaguely useful for the majority of Americans.

  11. archon41: I am simply doing my best to give you a hard time. I always enjoy reading your comments whether I agree or not. I agree with Mr. Spohr, however.

  12. So.. Is a tyranny of a simple minority preferable to majority rule?
    I can understand the need to take the preferences of the minority into account. However, the “party of NO” has no agenda other than to block Obama. The stimulus bill and the health care reform bill both were considerably weakened with Republican ideas but they still failed to attract any Republican votes. When the Republicans start negotiating in good faith, we can take their “ideas” seriously. Until then, they are the minority and deserve to be out-voted by the majority.

  13. WATCH OUT
    When you have such high, intense negatives in a system built on voluntary acts —
    you better watch your back. Sand in the bureaucracy gears is an awful thing to witness.
    Then again, if you have weak work experiences — you wouldn’t know that.
    Barack.

  14. You know full well, Wendell, that I was simply making an allusion to the tyranny of the simple majority. I was wondering how long it would take you to work your way around to “racism.”
    I will cheerfully admit that linguistics isn’t my long suit. I have, though, trudged through the Republic and the Politics in the original. I’ve not since seen much truly novel.

  15. arhcon41: Not sure what the reference to Robespierre applies to, but as usual you might want to dig a little deeper into the events of the French Revolution to apply any of those events metaphorically to the USA political scene – something I presume you try to do.
    Sort of like a cursory look at an ancient Greek to modern English dictionary without understanding the nature of etymology in general or in how words are adopted and adapted from ancient Greek into modern languages.

  16. Vendell,
    Is a constitutional rewrite the solution for all your problems? Just ignore it. That is what everyone else on the left is doing.

  17. Worse connotation even: filibuster < freebooter < vrijbuiter A person who pillages and plunders, especially a pirate. [Dutch vrijbuiter, from vrijbuit, plunder : vrij, free; see prī- in Indo-European roots + buit, booty (from Middle Dutch būte, of Middle Low German origin).]
    However the etymology says much about its current use in the USA Senate. Right-wingers love to refer to the USA as a "republic" in opposition to a democracy. The part of a "republic" that is particularly favored by that group is the role of the USA Senate and its composition that in effect through one means or another, such as the filibuster, permits a small group of Senators, who represent as a rule the wealthy or the racist or some other small segment of the society to thwart any legislation favored by or in the interest of the vast majority of the population.
    Good reason to abolish the Senate or limit its role to the role of the House of Lords in the UK.

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