By
Next week starts the new Congress, and with it the Tea Party conservatives. What’s their strategy? What will they rally around?
They’ll grouse endlessly about government spending but I don’t think they’ll use any particular spending bill to mobilize and energize their grass roots. The big bucks are in Social Security, Medicare, and defense, which are too popular. And their support for a permanent extension of the Bush tax cuts will make a mockery of any argument about taming the deficit.
Nor will they focus on the debt ceiling. Their opposition to raising it will generate a one-day story but won’t rally the troops or register with the public. Most Americans aren’t particularly interested in the debt ceiling, don’t know what it means, and don’t feel affected by it.
Instead, I expect their rallying cry will be about the mandatory purchase of health care built into the new healthcare law. The mandate is the least popular, and least understood, aspect of that law. Yet it’s the lynchpin. Without it, much of the rest of the law falls apart: It’s impossible to cover all high-risk Americans, including those with pre-existing conditions, unless those at far lower risk are required to buy insurance.
Knowing they don’t stand a chance of getting a direct repeal of the mandate (even if they could get a majority in the House for it, they won’t summon 60 votes in the Senate, and have no possibility of overriding a presidential veto), they’ll try to strip the federal budget appropriation of money needed to put the mandate into effect. This could lead to a standoff with the White House over government funding in general, and a possible government shutdown.
My betting is Tea Party conservatives wouldn’t mind a government shutdown over the healthcare mandate. Unlike Bill Clinton’s showdown with Newt Gingrich, which hurt the conservative cause, Tea Partiers believe this one could be helpful. In their view, it would enable them to stand on principle, dramatize their argument that the Obama administration overstepped with healthcare, and generate a particular event around which they can summon the energy and enthusiasm of their ground troops — all with an eye on mobilizing for the 2012 general election.
Advice to Obama White House: Get ready.
Robert Reich served as the 22nd United States Secretary of Labor under President William Jefferson Clinton from 1992 to 1997. He blogs regularly at robertreich.blogspot.com, where this post first appeared.
Categories: Uncategorized
I think you need to back up and take a new look at the situation. Our healthcare has evolved into a massive industry that has a survival and profit agenda. I think the system could, over time, shift to where the physician and services are covered under a single monthly payment regardless of the care effort. When you are healthy the healthcare professional would get paid. If you get sick the payments can continue or perhaps even stop. Under the present system an ideal patient is one who is sick, never gets well but lives long. This person must live dependent upon medical services. Shifting the motive to real healing not holding people in the ill states to generate business would reduce costs dramatically. This physician would then truly want and need those things that reduce patient illness. There would be no benefit to things that suppress symptoms without finding causes and the longer you lived healthy the more he collects with little or no work. Some people say this is impossible but I say it simply has not been done. Illness may always be with us but with our present system there is no incentive to eliminate it. Just consider the billions we spend on searching for cures. It makes much more sense to search for a cure than to find it. Larger institutes would be funded by collecting the Federal tax then deducting a percentage for the Federal operations then the balance would be returned to the States based upon population to pay for the operation of the hospitals and clinics. Each State could use the money to best serve it’s residents. Or, you could apply the same concept and have the hospital paid with the same subscription concept leaving it out of the tax and government control area. You would subscribe and the hospital would get a payment each and every month based upon the number of subscribers. You could have copay’s to reduce unnecessary utilization. Anyone who is a subscriber would have access to all the services but the hospital would have every incentive to keep you healthy and out of their facility. Yes I know all this is a dream, where would anyone find doctors, clinics, hospitals and insurance companies who are willing to take this risk. Even more impossible is finding a political block capable of putting aside their agenda for the benefit of the people. It is not the Tea Party that is the problem it is the limited thinking of the people in charge who fail to see better ways to serve their constituents.
I don’t understand why people and officials always go through this debate when they can always find ways to compromise. But then again, who wants to compromise when there are greedy creatures that prolong the agony of everyone for their own interests. Politicians never change.
In the past few hours we have witnessed a tragedy in Arizona. Medical care has been the best possible. Outcomes are hopeful. The congresswoman has excellent, government provided health insurance. Thankfully, none was left to lie/die on the sidewalk while their insurance coverage was determined. Who will pay for the care of any who are not covered? If I am part of the payment, I want it to be up front in the form of taxes rather than hidden in inflated insurance premium costs or increased costs for my own hospital/medical care. We all need health care. If we must involve insurance companies (who actually don’t even provide bandaids), then everyone must be covered.
1. 56 billion is the total effect on GDP and would equal tens of thousands of jobs.
http://www.reuters.com/article/idUSTRE67K07Z20100821
Senior U.S. officials expected the deepwater drilling ban to cost about 23,000 jobs and hold up $10.2 billion in investments,
That is direct cost, this doesn’t account for the money taken out of GDP
2. You assume oil will be of value 50 years from now, at the pace solar is advancing its very possible we wont be dependent on oil in 50 years. Nuclear could also replace it in well under 50 years.
3. So CA on its smoggy days, no it doesn’t taste very good. Not sure your point though, how does tar sands equate to New Delhi?
4. Green jobs dont exist, its a made up political term to funnel billions to special interest. How many green job programs have you seen succesffuly ran?
5. No idea where you are trying to go with this argument. Insurance doesn’t address cancer rates, insurance pays for the medical care that addresses cancer rates, something a large population in the country can’t seem to grasp.
THE LIE OF ‘GREEN JOBS’
Gee .. well, if solar is so great — why is China mostly EXPORTING? What do they know?
And if ‘green’ is so WORTHwhile — why don’t the Kennedys bet their billions on it? What are they SCARED of?
Not investing a penny until the KENNEDYS and OWEbama bet their money FIRST.
No one with a brain believes a word the Psuedo-President says, including “the” and “and.”
REPEAL. FIX, with ADULTS in the lead. REPLACE OWE-BAMA.
Nate- ban on offshore drilling was truly a weak attempt. Here it is why
1. 56 billion dollar doesn’t generate tens and thousand of jobs. The rig employs only handful of folks.
2. It doesn’t represent opportunity lost. Oil is not going anywhere and it will just get more precious. 50 years from now when oil will be gone this could be in fact provide national security.
3. Have you visited any area of sand oil? It’s a knock of death for environment. Have you ever breathed air of New Delhi or New Mexico city to feel what pollution is like?
4. Green jobs are more promising because nascent industry is always labor intensive and job conducive. All industries tend to automate and commoditize. That benefits customers but hurts jobs.
5. Don’t know if you study a lot about human anatomy or diseases, but cancer and many other diseases are direct result of carcinogenic accumulations in body. A Canadian
research showed it’s citizens to be repository of BPA even though it has been banned for decades in Canada.
Nothing is for free- you have heard that before, right? You should know, you are paying for it. If you can show that your cheap HDHP can lead to reduction of cancer rates, let us know. We will all nominate you for nobel prize of medicine.
“Another link that does not agree with your position, steve:”
My position is that this statement is wrong, which all cited articles agree upon.
“Still waiting for these Affordability Act Proponents to explain how the legislation excludes those in public office who were the loudest architects for it.”
They must still have insurance that meets the requirements of the ACA. They do not have not to buy through the exchanges. Neither do I. If you want to claim that the White House does not have to buy through the exchange, then you will be correct, but then you should also note that most people will not be buying through the exchange, at least for a while.
Steve
NOT ‘POLITIFACT’
It is ‘Polit-DOPEY’
To claim OweBama’s health care ‘deform’ has nothing to government is so LAUGHABLE on its face, says it all.
All those AMA lobbyists — just hanging around, right?
No one can be that stupid. Politi-LIARs just tries hard. Now, with NO credibility, whatsoever. Just like poor Ray S. on PBS and his puff-piece on Cuban medicine.
Next: T.R. Reid finds up how idiotic his “book” on medicine in Taiwan was (e.g., no blacks or Latinos in Taiwan — duh.)
HOW MANY NEW I.R.S. AGENTS?
14,000? Or 24,000?
REPEAL / REPLACE / USE ADULTS, THIS TIME
Oh, and MediaMutters/Soros as a data source? Only for fools.
—
@ Frank –
“President Harvard Law FOOL rams a 2,700-page steaming pile of BS”
___
906 pages, to be exact. Had you troubled yourself to actually examine it, you might know that. But, hey…
—-
STILL LAUGHABLE
Medicare was debated for EIGHT (8) years in Congress and decades in public.
President Harvard Law FOOL rams a 2,700-page steaming pile of BS in 15 months — and Prof. Harvard of Berkeley says just “live with it.”
Not in this lifetime, pal.
Fight you, every millimeter of the way. Get used to it. That’s on you, Einstein. Destroy the global leader in medical research — you get angry people.
The impact of the delays goes beyond the oil industry. The Gulf coast economy has been hit hard by the slowdown in drilling activity, especially because the oil spill also hurt the region’s fishing and tourism industries. The Obama administration in September estimated that 8,000 to 12,000 workers could lose their jobs temporarily as a result of the moratorium; some independent estimates have been much higher.
The slowdown also has long-term implications for U.S. oil production. The Energy Information Administration, the research arm of the Department of Energy, last month predicted that domestic offshore oil production will fall 13% this year from 2010 due to the moratorium and the slow return to drilling; a year ago, the agency predicted offshore production would rise 6% in 2011. The difference: a loss of about 220,000 barrels of oil a day.
220K barrels a day at $100 a barrel is $22,000,000 a day or 8 billion a year sucked out of our economy. Using an elasticity factor of 7, low estiamte of how many times that money would turn over in a year, that is 56 billion dollars lost thanks to Obama. Feds collect roughly 16% of GDP in taxes so just under 9 billion in loss federal receipts on top of tens of thousands of jobs.
Another link that does not agree with your position, steve:
http://politifact.com/truth-o-meter/statements/2010/mar/26/tom-coburn/health-bill-appears-exempt-some-congressional-staf/
And it is documented at other links that the Grassley amendment was defeated, so, is it a play on words that these ilk are trying to sucker the public with, to later claim the exemptions were valid? With these “people”, I don’t trust them as far as I can spit on them!
Hey, Grassley’s amendment was no big deal, so why denied by 50+ some senators?
Again, deeds not words, steve!
Rather than manadating that everyone purchase health insurance, so that the rest of us don’t get stuck paying indirectly for others’ medical costs through higher taxes and higher health insurance premiums to pay for uninsured care, maybe we should borrow a page from the libertarians here.
My suggestion is that we prohibit everyone who engages in any type of poor health behavior from purchasing health insurance, AND explicitly bar any subsidies to health care providers to deliver care to these people.
Bad drivers, people who don’t exercise, smokers – why should they have any right to purchase health insurance and drive up costs for the rest of us? We already do this in other types of insurance, so why not look at health insurance in the same manner and allow insurers to select only those people who are willing to take good care of themselves?
Let those who choose not to take care of themselves pay for their own health care costs or go without care. I include Medicaid, Medicare and private insurance in this proposal.
Not only would we see a drop in the costs of health care and health insurance, but the shift to healthy lifestyles would be remarkable as well.
This direction would certainly not offend Tea Party conservatives, would it? Let those who are without unhealthly behaviors cast the first stone.
All this money we are going to save on healthcare can cover the additional cost of Oil and foreign goods, maybe there is some logic to this madness? Unemployement is going to stay around or above 10% but that doesn’t seem to hurt the europeans, no reason we can’t learn to live with it I guess.
Vikram jobs aren’t as easy to create when you outlaw industries. You can devalue the USD to nothing but as long as there is an offshore oil drilling ban those jobs are gone. As long as those jobs are gone the tens of thousands of jobs that support and are created by them are also gone. Every dollar we spend on foreign oil is out of our economy forever. If you devalue the USD it makes the oil even more expensive hwich sucks even more GDP out of the economy. Add to this the Shale gas ban and what they did to the CA central valley and thats hundreds of thousands of jobs that aren’t comming back.
@ Frank –
“President Harvard Law FOOL rams a 2,700-page steaming pile of BS”
___
906 pages, to be exact. Had you troubled yourself to actually examine it, you might know that. But, hey…
Here is the actual CBO letter addressing the expected number of people in the exchange. The actual number they expect by 2019 is about 38 million. The number I cited above was just for individually insured people.
http://www.cbo.gov/ftpdocs/116xx/doc11689/Stark_Letter-HR_5808-07-22.pdf
Steve
The issue of Congress, staffers and White House insurance was explained here.
http://mediamatters.org/research/201003250022
Briefly, if you already had insurance, and it meets the qualifications of an exchange plan, you do not need to have an exchange plan. The CBO estimates that by 2019 only about 24 million people will have exchange plans. Grassley did get an amendment approved requiring all Congress members and staff to have an exchange based plan. The White House will still have a FEHBP plan, which, presumably, meets requirements.
Steve
Practically, there is not much difference between conservative & liberal position. It mainly differs in payment mechanism. One is more efficient than other, maybe +-3 to 5%.
The energizer for excess spending is more sicker population with lower health literacy. Hence no matter what, Canada or European countries would also have same issues. Payment mechanism can’t help that.
I have had varied & changing views on root problem of issues. My most recent view is that it is down to-
a. Wrong expectations
b. Blind faith ( in medical system & doctors, not so much in spirituality maybe)
Would need more space to link it to problems.
With reference to theme of this article, it appears to be mere musings. Tea Party had a successful campaign, based upon opposition to President but short of details. No reason it would be changed. There would be opposition to government expenditure & healthcare law & earmarks. Deficit will not be touched.
Politically it wouldn’t matter, because jobs will be key criteria.
That may not be good because getting jobs is always easy. USD just has to be devalued to stop jobs going abroad. But that will wreak havoc in terms of purchasing power due to inflation. Risk is that politicians might find that an easy option.
Jobs, health and healthcare have to be treated organically and diligently. I wouldn’t want an angry doctor for myself.
And yet Reid and his ilk refused to allow the Grassley amendment to “clarify” those omissions? Thanks for the validation to the rationalizing and minimizing you supporters will cling to in ‘justifying’ this legislation is for America, just not the leadership that planned it out!
What is more pathetic, readers? These politicians devise this crap, blind loyalty by these allies to this party philosophy sell it as alleged truth, or people believe it because the lies get said enough to make it believable?
They are all pathetic!
You read the above link and come to your own conclusions. Don’t believe me or the G-A’s, read up, talk to those who are unbiased and objective, and then form educated and sound conclusions. In other words, think and act like reasonable people.
Not the puppets that politicians and their ilk in DC want!!!
STILL LAUGHABLE
Medicare was debated for EIGHT (8) years in Congress and decades in public.
President Harvard Law FOOL rams a 2,700-page steaming pile of BS in 15 months — and Prof. Harvard of Berkeley says just “live with it.”
Not in this lifetime, pal.
Fight you, every millimeter of the way. Get used to it. That’s on you, Einstein. Destroy the global leader in medical research — you get angry people.
Dr. D., there is no explicit exemption in the bill. The only reference to elected officials and their staff is in the section I mentioned above (1312), and it only talks about Members of Congress and all their employed staff.
I do agree with you that it would have been nice if the executive branch and judicial and pretty much all those covered by Federal health plans would have been included. It does look pretty strange that only Members of Congress are mentioned.
Either way, I am 100% sure that whatever coverage they create for Congress it is going to be better than what average middle class Americans have now, or will be able to afford in the future.
I believe many doctors will be lining up at the begining of the year to use up the patients vouchers on thier MRI and nerve conduction, endoscopy etc. When the patient has his heart attack in November there will be no voucher left!! How do the voucher proponents propose to work around that problem.
MS G-A, here it is:
http://www.humanevents.com/article.php?id=36174
Can’t wait to hear the lame rationalizations, denials, and most likely the projections by the usual suspects.
“Same with Social Security and defense spending. Liberals like to argue and project these are off the table becuase they support the fraud and waste prevalent in the current system.”
I have never seen anyone write that they support fraud and abuse. Please provide evidence.
More broadly, the waste and abuse argument is a good way to avoid dealing with the problem of spending. Of course some exists. If it was easy to eliminate, it would be gone already. Every administration runs against it. The actual costs of medical care ned to come down.
“It matters not which party is in power; they will all have to cut spending and there will be blood in the streets.”
Spending is much lower in other OECD countries, w/o blood in the streets.
Steve
Then why did the Senate vote down the amendment, after the House concluded their sideshow, the amendment introduced by the republicans to include the president and the upper echilon of the legislature to be included in this legislation? Seemed like a very public matter to me when it was debated and then discarded by the Democrats.
Yeah, hard to find that little tidbit in the 2400+ pages of garbage created by these hacks, who then sacrificed their young in the November election while all the entrenched slime of the Democrap Party stay in place for 2011. You proponents either don’t get it, or will stop at nothing to prevent the facts of this scumbag intrusion from being examined and scrutinized again. I’ll do the lit search and find the link, and then listen to the usual immature defense mechanisms used by the usual suspects to defend the indefensible. Stay tuned, I know it is out there!
Dr. D, where exactly does the legislation exclude those in public office?
I may be missing something, but all I can find regarding members of congress and their staff is in section 1312, which mandates that Federal government only offers plans that are created under this legislation and offered through an exchange. How is this an exclusion?
An op-ed that cursorily repeats administration talking points and adds absolutely nothing to the discussion…slow news day, isn’t it?
Is this the rally cry of this country:
“…do what you must, at whatever cost…”?
Yeah, as long as the person saying it isn’t paying for it!
It is always easier to spend other peoples’ money, isn’t it, liberal hypocrites!!! You know what I find amazing and repulsive at the same time? The people who scream the loudest for programs and alleged altruism are the same ones equally screaming they be the exceptions to the very rules they demand for the public.
Still waiting for these Affordability Act Proponents to explain how the legislation excludes those in public office who were the loudest architects for it. Yeah, well I am not going to allow your pathetic, inexcusable silence to be successful. Explain how this is so “great” for America yet they don’t want any part of it. Deeds not words folks!!!
Again, American Idiots, let politicians set health care standards. Arrange your graveyard plots while you ponder your health care options as of 2014!
MDaH and DeterminedMD voice some typical concerns, but as typically jaded Americans with self-imposed limits on their horizons, and consequently their imaginations, ignore what dozens of countries, and millions of public health care recipients world-wide have long since internalized: systems, and societies, mature.
The “unsustainable” argument is cynical and disingenuous at best. It’s quite true that some — and to be sure, American hedonism presents a most fertile breeding ground — will pursue the Fountain of Youth at all costs, regardless who’s paying. But this is not a runaway problem facing any of the nations who have successfully provided their citizens health care for decades. It’s certainly not a problem often mentioned here in Canada.
Canadian Doctors for Medicare:
“We all agree that the health care system needs to be reformed, not only to ensure that it is “sustainable,” but also to improve population health and the health care experiences of people in the system. We need to be aware, however, that many proponents of for-profit private care work from the assumption that because health care costs are increasing, the system is therefore “unsustainable.” According to this view, because the system is “unsustainable,” we need to accept the necessity of private funding and abandon the Canada Health Act. This argument is unsound.” – http://www.canadiandoctorsformedicare.ca/health-care-sustainability.html
_Public health care as sustainable as we want it to be_ The Toronto Star, June 1 2010
“It’s true that total health-care spending in Canada has risen in recent years, taking larger shares of both government revenues and budget allocations. This has led to accusations of “crowding out” other public programs by those favouring further privatization of health care.
The data tell a much more nuanced story. The central fact is that, recession years apart, medicare spending — hospitals and physicians’ services — has fluctuated between 4 per cent and 5 per cent of gross domestic product since 1975. After the introduction of medicare in the late 1960s these costs stabilized because universal, comprehensive coverage consolidated expenditures in the hands of a single payer. The cost of health services not covered by medicare has risen from 3 per cent of GDP in 1975 to 7 per cent in 2009.
Today, Canada’s expenditures on health care match those by other OECD countries. The public share of overall health costs in Canada is relatively low for high-income OECD countries, around 70 per cent.” – http://www.thestar.com/opinion/editorialopinion/article/817249–public-health-care-as-sustainable-as-we-want-it-to-be
It can be done. It requires vision, not cynicism. To paraphrase the Vision Statement of the source I quoted first, “A high-quality, equitable, sustainable health system built on the best available evidence as the highest expression of [citizens] caring for one another.” http://www.canadiandoctorsformedicare.ca/vision-and-mission.html
Those of you who remember the Hippocratic oath might do well to ponder its meaning once again.
@DeterminedMD –
A bit of sock puppetry at work here?
http://online.wsj.com/article/SB10001424052748703326204575616721711852594.html
$96,000 for something that might extend life a few months or might cause more harm. And if you try to deny the treatment you spend more then that in court. We have had a lot of prostate surgeries lately, they cost next to nothing for those that just wait it out or hundreds of thousands for those that try everything they can.
Amen to the above comment by MD as Hell. Recently there was an op-ed piece in the Baltimore Sun that talked about how physicians should regain leadership roles in Health care matters, and gee, there is an idea {sarcasm font}. But, the masses who have little of mass above their necks just want quick fixes via quick answers to the problems, so, they think polloc-ticians will get it for them. Well, think again, America. Politicians do not think, act, or really embrace the compassion and discipline it takes to do what is right and necessary to really implement real effective and responsible change.
And also the ongoing articles in USA TODAY about the baby boomer effect on our culture as they hit 65+ echo what MDaH said so appropo: “It will smother under the weight of nursing home patients that are prohibited by their families from dying.” Health care as you all want it is not about living to be 80, 90, 100. For every example of someone who ages gracefully, the next 19 will be examples of how it is really a failure. And, those who take no accountability in their choices at lifestyle and respect for healthy choices, you should not be in line for full court presses!
Said by the 800 pound gorilla in the room!!!
If patients had not been given license to walk up to the treasuryn and withdraw $250,000.00 at their discretion to alleviate a little worry here and a little pain there we would never have had this mess.
I just finished a shift in the ED. I can tell you that healthcare in America is finished. It will crush itself under the weight of people that can no longer take care of a cold or a minor flu. It will smother under the weight of nursing home patients that are prohibited by their families from dying.
No amount of HIT or EHR or any other crap like that will save a penny.
It matters not which party is in power; they will all have to cut spending and there will be blood in the streets.
A far left liberal blogging on what he thinks people he has no understanding of will do, there is a great use of pixels. He can’t even put enough effort into the post to drop the liberal dogma and get some facts right.
“The big bucks are in Social Security, Medicare, and defense, which are too popular.”
Conservatives are such big fans of government waste and inefficency they would never rally behind any bill that attacked the 60 billion plus per year Medicare loses to Fraud.
Same with Social Security and defense spending. Liberals like to argue and project these are off the table becuase they support the fraud and waste prevalent in the current system.
We could flatten spending for 2-3 years eliminating just the overt fraud, if we tackled inefficieny we could go 10 years without any increases.
As a conservative that knows conservatives public pensions are going to be a big deal, we are talking trillions of dollars that don’t exist promised away with no possibility of funding.
Probably vouchers. Not very popular (probably not even amonh many teabaggers), but would cost less and not hurt the priviliged.
“It has also already been ruled to be unconstitutional by a federal judge. Somehow your column seems to have missed this detail.”
It has been ruled constitutional by two other federal judges.
I have no idea what the Tea Party intends to do about Medicare costs. It is rarely addressed by Tea Party folks. I regularly read and participate a bit on some Tea Party blogs. They rarely discuss a positive agenda.
Steve
An op-ed that cursorily repeats administration talking points and adds absolutely nothing to the discussion…slow news day, isn’t it?
Good report. What is Tea Party positions on dangerous HIT regulation of lives, professional work of doctors, and treatments by the US Government? Does any one know?
“Instead, I expect their rallying cry will be about the mandatory purchase of health care built into the new healthcare law. The mandate is the least popular, and least understood, aspect of that law. Yet it’s the lynchpin.”
It has also already been ruled to be unconstitutional by a federal judge. Somehow your column seems to have missed this detail.