Who says Congress doesn’t accurately reflect the will of the American people? The public has spoken about health care reform, and the message is clear: “Whatever.”
If you’re a politician who believes that soaring promises soothe voters, while the painful tradeoffs involved in voting for an actual proposal can only bring trouble, the latest figures from the11th annual Health Confidence Survey of the respected Employee Benefit Research Institute (EBRI) have got to be good news.
The public is practically demanding inaction! Asked what they would do to fix health care, an overwhelming 87 percent favored health tax credits, similar to the health plan of Republican presidential nominee Sen. John McCain, CQ Health Beat reports. On the other hand, a nearly-equally-overwhelming 83 percent favored letting people buy into the same health care system government employees get, the option trumpeted by Democratic presidential nominee Sen. Barack Obama.
Indeed, one might say the public and the politicians are in sync about the urgent need to pay lip service to the notion of health care reform. So, while a whopping 71 percent of respondents endorsed "major change" or “a complete overhaul “of the health care system, it finished a distant third to the economy and energy costs as a priority. Only about half as many people think health care is as important a crisis as the cost of gasoline (13 percent vs. 24 percent). And should the war in Iraq or some other issue heat up, one can expect health care to continue to finish well back in the pack.
Finally, there was the fine print: About half the respondents said they are “very” or “extremely” satisfied with quality of care. And while hardly anyone had a good opinion about health care costs, the key figure to look at is the personal saliency of their concern. The percentage of Americans reporting an actual increase in their personal health care costs dropped to 55 percent from 63 percent.
I just got a call from a reporter at one of the major news organizations to talk about the chances for health care reform.
We both commented on the almost surreal environment we are all in. I’m not sure if my friends and neighbors are in denial or just numbed by the recent cascade of events in the financial world. Up on the Hill and in the presidential campaigns it’s business as usual when it comes to extending the Bush tax cuts, spending on alternative energy, or the imperative to do health care reform.
The reality is we are now headed down an unavoidable slope into a recession. The only question is how bad. Today, Dr. Phil told his audience to stop spending money, get their credit card debt paid off, and hold cash–"Cash is king." They are and they will.
Over at the Huffington Post, Michael Millenson walks us through McCain’s plan to end employer sponsored coverage, noting that it would apply faith-based economics to one seventh of the US economy, and pointing out that its as radical a ploy to foist on the innocent bystander American people as any bomb-thrower ever cooked up.
It’s vintage Millenson: erudite, an airtight argument, gleefully presented, and making no apologies for its partisanship. A fun and informative read.
See also: An analysis of the about-face the McCain camp made suddenly regarding funding for his health plan. He’ll now keep the payroll exemption and cut $1.3 trillion from Medicare and Medicaid to pay for his tax subsidies.
As CEO of Harvard Pilgrim, I find I do a fair amount of public speaking. Over the past ten days or so, I’ve been on several panels with a variety of public policy, health policy and industry types. We also represented a pretty broad collection of political philosophies – some Democrats, some Republicans, some liberals, some moderates and some conservatives.
What really struck me, though, was the amount of cross-over support several policy ideas had in the “what do we need to do about health care” arena. To listen to the media, one would conclude there is no common ground between the parties on this issue – and, frankly, a lot of the stuff the people I was with were talking about hasn’t really showed up on the national debate scene at all.
So – at the risk of over-simplifying what my fellow panelists and I talked about during these discussions – I’d offer up these four national policy ideas – all of which seemed to have pretty broad ideological support.
Sen. Barack Obama’s attack on health insurance reforms proposed by Sen. John McCain shows that Obama’s not for real change in health insurance.
Obama wants more government-sponsored health insurance schemes, like
the VA health care system, Medicare and the unaffordable Medicaid scheme
that’s bankrupting the states and the Feds.
Obama wants to keep employers involved in the insurance markets,
even though they limit consumer choice, increase costs for consumers
and make their workers buy expensive policies they don’t want nor need.
Merrill Goozner has been writing about economics and health care for many years. The former
chief economics correspondent for the Chicago Tribune, Merrill writes the blog Gooznews.com, where this post first appeared.
It must be disconcerting to health care economists to see one of their pet peeves about the inequities of the employer-based insurance system so poorly used by the Republicans, who would repeal it. I’m referring, of course, to the tax deductibility of health insurance premiums.
Gov. Sarah Palin repeated Sen. John McCain’s promise to give every American household a $5,000 check to buy health insurance. They would raise the money to fund the program by repealing the deductibility of employer-based coverage. I can’t recall if she gave one of her trademark winks when she said it, but she certainly gave an enthusiastic nod. Health care will become just like Alaska! The government will be sending you money every year so you can go out and buy your own insurance.
There is an argument that can be made in favor of repealing tax deductibility. Like the home mortgage deduction, the higher your tax bracket, the more valuable the tax deduction. So if your employer buys you a gold-plated health care plan that costs $15,000 and you’re in the highest tax bracket (around 30 percent), you get the equivalent of a $4,500 tax break from the government. But if your employer buys you a plan that only covers hospitalization and serious illnesses for $7,000 a year and you’re in the 10 percent income tax bracket, the tax deduction is only worth $700. Repealing all tax deductibility and distributing the revenue equally to buy individual insurance policies seems simpler and more equitable — both appealing traits.
Each presidential candidate offers a blueprint for health care reform. Neither can expect to see his plan enacted whole—legislators will leave their fingerprints all over any proposal. And, if truth be told, neither plan is perfect. Each proposal is blinkered in its own way; each ignores just how difficult true reform will be. I very much doubt that national health insurance will become a reality in the next year.
That said, I believe that we can take steps toward reform in 2009 if we begin thinking clearly—and honestly—about exactly what it is that we want and what it will cost. To that end, I believe that in-depth analysis of each candidate’s proposal can help underline the core ideological differences between conservatives, libertarians and progressives, and highlight the economic realities that any reform plan will have to face.
Recently, opponents of each plan have offered their critiques in Health Affairs (here and here) and supporters have defended their favorites here and here. Inevitably, many readers found the critiques too partisan. At the same time, they complained that rebuttals from the home team “read more like a stump speech with details glossed over and facts overlooked.”
The New England Journal of Medicine and Harvard University teamed up to bring you this compelling, hour-long nail-biter of Gail Wilensky and David Cutler discussing their respective candidates’ health plans.
I wonder if the NEJM has had to buy more bandwith to support the flood of viewers?
In all seriousness, I think it’s great the NEJM is sponsoring this type
of dialogue. It probably won’t reach many people, but it might reach
and influence those who have the potential to influence others — legislative staffers,
journalists, doctors and health care leaders.
There have been calls recently for more serious coverage of the candidates’ health care issues. We need a mix of coverage. This kind of wonky dialogue and the kind that ordinary folks read and watch — yes that 800-word explainer story with a few pithy quotes.
When campaigning politicians talk about reforming America’s health care system, they’re understandably quiet in identifying who will take the pain that will ultimately be allocated between the three basic groups involved –- patients, providers and payers.
If politicians ever get serious about reform, their big challenge will lie in finding a balance that at least two of these groups find tolerable. They’re not serious yet.
A new analysis this week by the Tax Policy Center confirms that, giving neither presidential campaign credit for doing anything to cap costs and sensibly concluding that the bottom line here is that insuring more people requires spending more money (Obama’s plan, it concludes spends more money more efficiently to insure many more people).
So the current spate of ads on the topic may seem a bit puzzling. Here’s how to decode them.
The presidential candidates, Sen. Obama and Sen. McCain, and the
vice presidential candidate, Sarah Palin are showing in their comments
on the financial crisis that none of them understand the crisis, the
economy or what’s behind the financial crisis.
They all need to sit down with their financial advisers and learn
what is going on so they can at least pretend to be smart about markets
and the economy.
What they are saying and the ignorance they’re displaying is simply appalling.