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Today on Health Care Reform

Michael Steele, chairman of the Republican Party was interviewed on NPR yesterday. I'm trying to make sense of what he's saying, but he contradicts himself a lot. Take a listen.

10 ways to fix Health Care. How can you argue with these things?:

1. Make health insurance mandatory, but make coverage compulsory for insurers. The insurers can’t survive if they don’t have the healthy people on their rolls as well as the sick, and the healthy young people often opt out. (As it is, the rise of DNA testing is going to change the insurance industry as people use their DNA test results to decide whether or not to buy insurance and what kind to buy. In the future, without mandatory health insurance the system will collapse.)
2. Make everyone pay something – employers, employees, and the unemployed, but make the premiums reflect true costs. Medical care is expensive. Subsidize those who truly can’t pay. Become tranparent about the costs of medical care.
3. Regulate insurance companies like utilities, and do it nationally. Allow buyers to buy across state lines.
4. Negotiate with drug companies nationally.
5. Put a limit on jury awards and on legal fees in medical cases.
6. Go back to the days of banning law firm and drug company advertising. We have created an artificial demand for drugs that treat overactive bladder and restless leg syndrome by re-defining annoyances as sicknesses and creating pills for them at great expense.
7. Make computerization of medical records mandatory within a few years, and subsidize (i.e., tax credits) record conversion to get it done. Introduce uniform applications, medical records, and claims forms nationally, preferably open source.
8. Increase the number of doctors and nurses by providing subsidies and tax benefits to both students and medical educational institutions. Provide some form of loan forgiveness for primary care docs , pediatricians and geriatricians. Not every doctor visit should be to a specialist.
9. Put everyone under the same system. No separate deals for Congress, Federal and State employees, high paid executives, or special groups like retired railroad workers.
10. Basic coverage for everyone, with 5 star benefits only for those who can pay. Not everyone can have a Cadillac.

Map

Here is a cool map that shows who the largest health insurers per state are. Now after you have looked at this map, listen to the CEO of Wellpoint Angela Brawling being interviewed on NPR today. Sounds like she hasn't seen the map. Also, she says that 1 penny of every dollar spent on health care goes to insurance profit, which sounds like very little, until you realize that 16% of GDP each year goes to healthcare. GDP last year was $14.2 trillion, so 16% of 14.2 trillion is $2.27 trillion, and 1% of that is $22.7 billion dollars. Not too bad. That's a lot of profit. The NPR interview is pretty awesome, and the Wellpoint CEO comes across as sounding like a hack.

One idea that I have heard that could lower costs would be to tear down state barriers and allow people to buy insurance from other states. That would change the map above quite dramatically. Combine this with decoupling insurance from employment and I think you have a real possibility there. It would be like auto insurance, except you would need to have a federal law that requires insurers to cover people regardless of their medical conditions. Oh, and recissions have to go.

And now let's read about National Debt basics.

Medical bills that make no sense

h the bills I see from my insurance company say that they doctor charged x, but the insurance company only paid y.

My feelings about Obama

I have some really mixed feelings on Obama. I don't consider myself to be an extreme left-wing progressive, but I do feel like I am centrist who is left-of-center on some issues and right-of-center on others. So shouldn't I be okay with what Obama has done since he has been in office? No. He has been quite terrible, actually. He has been way to nice to the banks. He hired the wrong people to be his economic team. He fumbled on health care. He is keeping the Bush policies on torture intact. He has done little for the environment. I have very little hope that he is going to come out having done okay come January 1. Things are going to have to get REALLY REALLY BAD before things can get fixed. I'm talking 9/11 bad, but with health care, or the financial markets. That is the ONLY WAY people in this country will change. I'm starting to conclude that if anyone says otherwise then they aren't worth my time because they are just wrong. I hate saying that, because that means we are all going to get hurt really bad before we can start to get better and get on a different track. Some say that he has been too fast. I disagree. You HAVE to be fast otherwise the really powerful people who have run and continue to run things (large campaign contributors) move so much faster that you don't realize what happened until after the fact. So I don't think speed is the issue.

Oh, and if it's not already obvious that our government is broken, Democrats don't know how to use a majority in Congress.

Mr. Black

In the 39th minute, Black says that Larry Summers is completely wrong and has been wrong his entire life, and that is why the banks are still doing the same things. Because he has Obama's ear. It's pretty awesome. This guy is a great curmudgeon.

Healthcare myths and truths

After his great article on Goldman Sachs, Mr. Taibbi takes a look at healthcare. s

Daniel Gross has some great gems in his Slate piece today:

Funny how you don't hear any complaints from worthies about taxpayer-funded health insurance when it's covering them, their staffs, and their loved ones. For many of these people, especially the older ones, there literally is no affordable alternative. Insurance companies prefer to insure healthy people, not sick people—that's how they make money. And older people are more likely to run into health trouble requiring expensive care. Dick Armey, who is suing to get out from under the tyranny of Medicare, is apparently under the illusion that insurance companies are really eager to cover 69-year-old men at a low cost. House Minority Leader John Boehner is a 59-year-old smoker whose skin has an orange hue. What do you think Aetna would charge him per month for a good policy?

UPDATE: So I heard part of the radio interview that Obama did today with Michael Smerconish and one of the questions asked was why has Congress stated that they won't join the public plan if it does get passed, that they will keep their current health care plan. Obama danced around this and mentioned that he wants to do something similar with his "health care exchanges". Now what he didn't say, is that that the reason Congress won't join is because their plan is really good, and the fact is, their plan is Single Payer. Who pays and negotiates premiums for Congress? The Federal Government! Shocker!! Does Senator Grassley realize this? Single Payer people!!!

Crosscut blog with an article by a doctor who has worked in both American and Britain.

In other news, today in Obama's webinar with his volunteers, he stated that the public option will be one of the options avaiable to people who don't currently have health insurance. Sounds like they are back on message.

UPDATE II: What You Need To Know About Healthcare

Call to Arms (or, It's all our fault)

Robert Reich makes a great point here. And he is right. This is our fault. It's not that things got this way because of what we did. Things got this way because of what we didn't do. We didn't take action. We didn't hold our officials accountable. If things break down, it will be because we did nothing.

UPDATE: What is the difference between Wallstreet and Health Care. Nothing, as far as Obama is concerned. He's making the same deals and giveaways to the Health Care companies as he did to the Wall Street companies. WHY WHY WHY????

Howard Dean can get intense, and I don't always agree with him, but he is right on the money with this. Oh, and before my company was bought out, my family and I were on Group Health Cooperative, which Dean mentions and it was awesome. Their electronic medical record system was really something to see.

Waterloo + Links!

So, if we pass health care reform (or now health insurance reform, because apparently we can't say that some doctors are greedy or hospitals are problematic) and it turns out that the reform that was passed does NOTHING except compel those without insurance today to go buy insurance, then I agree that that should be Obama's Waterloo. We HAVE to change how insurance, hospitals, doctors, and patients behave in this country, or the whole thing will crash down.

So here's where I got the idea for mentioning health care reform as Waterloo.

And here is Obama getting ticked off at the death panel rumors in Colorado.

And last but not least here is the Daily Show mocking the crazies at the town halls. Funny stuff. Plus, I love how they mock Obama's analogy of health care and a government option with UPS, FedEx, and the Post Office. Obama almost looks like he realized how bad that statement is after he finishes saying that. I would say that he went way off message there.

UPDATE: So after I finish my post here, I see this. I am not alone in my thinking!! (I bet millions of Americans think like me on health care.)

And now, to blow your mind in a different direction:

Conservatives I agree with (mostly)

If the conservative leadership were are sensical as David Brooks and David Frum, then I think we could have a very great debate in this country. We could disagree, but still be friends at the end of the day. We would not agree with each other on everything, but I think it would be safe to say that the country would be a lot better off and we would not be so divided. Of course, this means that the extreme left would have to get sense as well, don't get me wrong. But I read David Brooks regularly, and until tonight I wasn't as familiar with Mr. Frum, but I'm now a fan.

While I disagree with some of Mr. Frum's ideological stands, he is a very calm voice from the right. Here he is on tonight's Bill Moyer's Journal, aking a great point: What happens if thealth care reform dies? How do that help the conservative cause? This country WILL be consumed by Medicare and Social Security spending and nothing else in 2 decades. The deficiet will explode. How does that not hurt conservatives?

Obama sellout to Big PhRMA

So it is confirmed from a leaked internal memo that Obama made a HUGE concession to Big PhRMA. This SUCKS, and goes completely against why I voted for Obama.

The deal, as outlined in the memo:

Commitment of up to $80 billion, but not more than $80 billion.

1. Agree to increase of Medicaid rebate from 15.1 - 23.1% ($34 billion)

2. Agree to get FOBs done (but no agreement on details -- express disagreement on data exclusivity which both sides say does not affect the score of the legislation.) ($9 billion)

3. Sell drugs to patients in the donut hole at 50% discount ($25 billion)
This totals $68 billion

4. Companies will be assessed a tax or fee that will score at $12 billion. There was no agreement as to how or on what this tax/fee will be based.

Total: $80 billion

In exchange for these items, the White House agreed to:

1. Oppose importation

2. Oppose rebates in Medicare Part D

3. Oppose repeal of non-interference

4. Oppose opening Medicare Part B

This makes me so mad...Why would the Administration do this, then go on the road saying that costs are crazy. The costs are SO HUGE, that $80 billion in "promised" savings is a drop in the bucket. It's worthless. Its like Bill Bavasi is running things (Mariners' in-joke). I hope this seriously damages the White House in such a way that they cancel this stupid deal and get some backbone. But now, how can they be trusted? This is really bad news.

Michael Brenner is also thinking along these lines.
Drew Westen is also pulling the wool from his eyes.

Single Payer

Single Payer. Single Payer. Single Payer

Medicare for All!!

Doesn't that title grab you as a good idea? That's how we should be framing the Single payer debate. Because then, if you say that, who is going to say that that is a terrible idea? Then you would have seniors against you and it would make opponents look even more foolish.

So here is a great explanation of just what the heck Palin and Gingritch are talking about:

http://politics.theatlantic.com/2009/08/the_death_panel.php

They're taking Emanuel's academic point about health care values, assigning it to Emanuel as if Emanuel were advocating for something he isn't, then jumping over the entire health care colossus, and they assign this distorted belief to Barack Obama by implying an argument that actually disproves the linkage they are trying to make.

And today in Portsmouth, NH Obama had this to say about rationing care:

"Right now, insurance companies are rationing care. They are basically telling you what's covered and what's not. They're telling you, 'We'll cover this drug but we won't cover that drug. You can have this procedure or you can't have that procedure. So why is it that people would prefer having insurance companies make those decisions rather than medical experts and doctors figuring out, you know, what are good deals for care and providing that information to you as a consumer and your doctor so you can make good decisions?"

As far as the debate goes about health insurance reform over health care reform, I want both fixed. It should be illegal for recission to occur unless something truly fraudulent has occured. An independant panel should be the one determining fraud. Fee for service should be abolished, as it justs wastes care. Critics are saying that medical school applications are down, and that proves that government regulation is scaring people away. What does that truly mean? Does that mean that only people who want to cure the sick are applying, while the get rich quick folks are leaving (perhaps going into finance?) or does that mean that people who want to help the sick are afraid that they won't be able to with the coming changes in health care? I've been googling that topic, and it doesn't sound like the Chicken Little scenario to me. Besides, I think that becoming a doctor or a nurse will be a great employment opportunity for the next 20-30 years as the baby-boomer generation goes into retirement. Health care and medical is still one of the fastest growing fields. How would this change in the next 20 years even with reform? Demand will continue to go UP, not down regardless of reform.

So now Minyanville has an article about why single payer won't work, but the article doesn't really say why it won't. It goes after wait lists, but then concludes that perscription drugs should have approval levels and screening clinics for drugs would be better to treat chronich illness and we are going to run out of doctors. OK, I like the clinic idea, but don't we have wait lists now?

And now, for something NOT called Medicare for All, but something that makes sense and keeps private insurance going: The Healthy Americans Act, a bipartisan bill brought to you by Senator Ron Wyden, an Oregon Democrat, and Senator Bob Bennett, a Utah Republican.

Having a 'public option' is still popular, according to the latest polls. Analysis here.

We live in a Crazy World

Ok, so this is just nuts. Sarah Palin is claiming that the current health care reform legislation contains a 'death panel' that allows a committee of doctors to decide to euthanize patients who are sick. So this means that Palin's youngest child, who has Down Syndrome would have been killed if this were enacted. Terrible, right? Except NONE of the current legislation contains any type of 'death clause'. Sheesh, it must be good for Alaskans that she is no longer governor. This is all part of the inane rumors about the government 'rationing care'. It won't ration care. Our care is 'rationed' right now, by what health insurance you have and what your coverage is. This rumors are crazy, crazy, crazy.

Now, to call out to Obama, who seems to have completely lost control of the health care debate and might in desparation to get something passed, make things worse than they are now. Where is the Accountability? Is Big Pharma just too powerful to push around? Is Obama going to sellout just like every other politician? That is not what I voted for. This is like Bush Administration, part II.

So now neither party is good. I don't know if either party ever was good, but this is just bad and bad.

Letter to my Congressman, Adam Smith

Dear Mr. Smith,

In a short time, you will be voting on the health care reform package that the House has been working on during the past couple of months. I strongly urge you..no, I demand that you give your full consideration to and vote in favor for Congressman Andy Weiner's single-payer plan that Speaker Pelosi has agreed to debate over and vote on the House floor. I am assuming that this plan was given floor time for a debate and vote because Speaker Pelosi believes that it does not have a chance at getting passed. Please be one of those courageous Congressman who stand up for what is right, for what you know in your heart is the right thing to do. I want to be able to look my son (who is18 months-old) in the eye someday and tell him that yes, in some small way we did the right thing and we fixed health care.

You are probably getting all sorts of views from our fellow citizens on this issue. Let me help you with some facts. A single-payer system is socialized medicine. What is wrong with that? Medicare is socialized medicine, although many of our citizens don't realize that. Bill Moyer's Journal ran an excellent interview of Wendell Potter, and I urge you and your staff to take time out of your busy schedule to watch his program. It is a lie that our current health care system is the best in the world. It is not. The US Healthcare system ranks as #37 on the World Healthcare Organizations list of 191 countries. According to a study done by the American Journal of Medicine, in 2007, 61% of all bankruptcies in the U.S. were because of medical related expenses. All the talk about the Canadian healthcare system as being a 'bad' idea that limits choice is simply false. Most recently, a Canadian doctor wrote about the differences between the two systems in an LA Times op-ed. I encourage you and your staff to read it. My company recently switch from an HMO to a PPO health care plan. That means I can no longer see the doctors in the HMO without paying higher deductibles and co-pays. How is that not limiting my choice? Our current fee-for-service payment system to doctors and hospitals means that it is more important to provide as many tests as possible to patients even if some of those tests are not necessary or even needed. This system is very strong because in addition to making more money from doing more tests, this system also provides cover to doctors who fear malpractice suits. That is the American system.

How is our current system even remotely fair? I am lucky that both my wife and I are employed and I am able to get health insurance through my provider. But I live in fear that if I lose my job, I will either have to go on COBRA which would be financially devastating, or I would have to chance the private insurance market. Private insurance is even more scary because my 18-month-old son has a congenital heart defect that could require surgery down the road. Unless I am employed at the time my son needs the surgery, or we have managed to get my son added to my wife's plan during the enrollment period, my son could, COULD go without the medical care that he may need. Now that scenario isn't certain, but it could happen.

President Obama has been very disappointing for me since he entered office. He has not allowed the single-payer debate to be discussed, saying that our current system is too complex and it would be too disruptive. My response to that is "isn't that the point?" Our current health care system IS too complex. It needs to be disrupted. Healing sick people should not be a Wall street for-profit business. If politicians insist on using fear tactics, the truth should be the most fearful thing being said. What isn't true is that the free market system is the best way to contain costs. This is simply not true. Free markets contain costs to increase profit, but when cost means treatment like in health care, the best way to contain costs is to deny treatment, which is what we see in our system today. If the bottom line in the system was to provide the best care and not highest profits, then the free market system works. But that is not how the free market system works.

I applaud your legislation to streamline healthcare IT for chronic medicare and medicaid patients to reduce cost and improve patient care, but a lot more must be done. Simply keeping the current system in place while subsidizing the 47 million Americans who don't currently have care might win you points in the next election, but it will certainly lead our country to economic ruin before my lifetime is up. It's time for you to serve your constituents in the best interest. It is obvious that some of your collegue's are nothing but parrots for the private health insurance industry. Take Rep. Mike Ross of Arkansas who boasted:

We ensured that if there is a government option, it will be just that -- an option -- and it won't be mandated on anybody. If it had been based on Medicare rates, I can assure you that it would have eventually ended up resulting in a single payer-type system, because Medicare has really good rates, because they're negotiating for every senior in America. Private insurance companies could not have competed with that.

In summary, the best way to provide universal health care and rein in spending is to go to a single payer health care system. Now it is true that there are other ways to provide universal health care through private industry, but none will be as effective at reducing costs and saving jobs. Please give single payer your full consideration.

Thank you

Angry mobs and losing hope + Links

So I saw a couple clips on CNN which showed crazy, angry, and yelling mobs at a couple of Congressional town halls yesterday. What saddened me the most is that most of the outraged people were white and older. I interpreted this as people who will or already are eligible for Medicare. So why are these folks so upset? Not one of the proposals currently in Congress talks about cutting benefits or changing plans for Medicare or Medicaid. I'm saddened because most of the folks in these town halls seem as misinformed as the gentleman who told Obama to "keep the government hands off my Medicare." Paul Krugman takes a stab at the town halls in his op-ed piece today.

Then there's this article in Businessweek that makes the very strong case as to why any "reform" coming out of Congress is just another windfall for the insurance industry.

My hope for acutal reform is dwindling day by day. And where is Obama in all of this? Nowhere. Obama has been more and more disappointing to me. I think he blew it on the bank bailouts, the environment, and now health care.

UPDATE: Here is a really awesome new perspective on the whole employer health care coverage idea.

UPDATE II: Planet Money talks about health care in their podcast.

UPDATE III: Please don't ever tell me that government run programs are worse than the private sector. I know government can really screw things up, and our politicians are crap, but what year are we in again, 1908? From the video linked here:

Rep. Mike Ross of Arkansas :

We ensured that if there is a government option, it will be just that -- an option -- and it won't be mandated on anybody. If it had been based on Medicare rates, I can assure you that it would have eventually ended up resulting in a single payer-type system, because Medicare has really good rates, because they're negotiating for every senior in America. Private insurance companies could not have competed with that.

Must Reads

So I have a couple of great book recommendations:

Supercapitalism by Robert Reich, former labor secretary under Clinton. He gets pretty wonkish, but his ideas on why we are all to blame for our current mess is hard to argue with. He also has a lot of good ideas on how to get our financial and government systems on the right path again.

Bailout Nation by Barry Ritholtz. This book is a terrific read. I think I have talked about it on the blog before, but it's worth mentioning again. Read this book.

The Two-Income Trap by Elizabeth Warren and Amelia Warren Tyagi. I am a huge fan of Mrs. Warren, and here she and her daughter lay out the case as to what caused the middle class to get into such a bind along with some ideas on how to get us out of it. What is the trap you ask? Here's a hint: How do you get your kids a good education and keep you and your family healthy?

Bankruptcies are UP

Hey, look at that. Bankruptcies are at an all-time high. So that means bankruptcy critics will start crying foul again. The credit card companies and their congressional friends already won a huge battle in 2005 when they changed the bankruptcy laws, making it harder for people to file for Chapter 7 and instead file for Chapter 13. That means that debts that would get wiped out, debt like credit cards now has to be paid back in a 3-5 year period. More money for the credit card companies! Congressional proponets claimed that bankruptcy was being abused by people who would run up debt and then use bankruptcy to escape their obligations. This has been proven to be false. So get ready to hear a bunch of blow hard congress people scream about rampant abuse, even though we have high unemployment. These critics think that people going into bankruptcy are irresponsible people who just go into bankruptcy like it's a trip to the grocery store. A trip to the store that you can only make once every 7 years. A trip that follows your credit report for the next 10 years. A trip that will have lasting effects on people and their families for a far longer time than 10 years. These critics are people who will never experience the fear and shame of being unable to provide for their family even though they did follow all the rules. These critics are wrong.

Putting the nail on the head

Paul Krugman

Uniquely American

Canadian doctor talks about the differences between US and Canadian healthcare

Holy Smokes! An honest approach to fixing Social Security!