Category: health care Page 33 of 35

Let’s spell this out.  You can’t have health care reform which increases the deficit because the borrowed money was all given away to corporations and rich people.  The 15 trillion of bailouts are the case in point, but the lousy Cap and Trade bill is also to blame.  If it was auctioning all of the permits instead of 15% that would have raised 582 billion dollars more than the current bill.

Spending money is a matter of priorities.  Congress and Obama’s first priority is not health care, if it was, they’d be willing to spend money on it.  They aren’t, so it isn’t.  Period.

If find this especially odd given that “protecting Americans”, aka “saving American lives” is supposedly the job #1 in Washington. 22,000 Americans die every year due to not having health care and many more due to inadequate care,, but apparently “saving American lives” is only job #1 when it means you get to spend money on the military, kill foreigners and put American troops in body bags; or when it means you get spy on Americans and torture people.

Al-Q’aeda would need to commit 11 9/11’s a year to kill as many Americans as die due to not having health care.

So, what’s more important than American lives, as measured by willingness to actually add to the deficit for it?

• Killing Iraqis
• Tax Cuts
• Killing Afghanis
• Sending American soldiers to die in foreign countries to “save American lives”
• Bailing out large corporations like Citigroup, AIG and  Goldman Sachs
• Giving money to the IMF to bail out other countries banking systems

What else is more important than saving American lives?  Add to the list in comments.

First it was the AMA supporting health reform, now Pharma. Pharma has spent 4 million on Harry and Louise ads in support, and are considering spending 120 million during the August recess in support.

If both Pharma and the American Medical Association are for something, well, let’s just say that any liberal with sense should be thinking not just twice, but thrice.

Robert Reich noted a while back what Pharma will probably get in exchange for their support:

• Not allowing drug reimportation from Canada
• Not allowing the government to negotiate drug prices

Add to that forced enrollment of Americans into a insurance plans, and I’d lay long odds that Pharma has calculated that they’re going to make a bundle off of the new medical system, much more than the 80 billion they’ve promised to give up (a promise that isn’t worth much in the first place.)

At this point in time the strategy to get through a reform bill appears to be to bribe every powerful interest opposed to one enough to get rid of their objections.  If the goal of this is to significantly reduce costs, every major participant deciding that they’ll make more money under the new legislation rather than less is not a good sign.

The method is simple enough.

Use the Senate conservatives and blue dogs.  Obama may have the ability to move much of this under reconciliation, but it’s clear than neither he nor Reid want to do so.  The Senate HELP bill is weaker than the House bill, and the “bipartisan compromise” coming out of the Justice bill is going to be even weaker (it most likely won’t even have a public option, but instead co-ops, which are too weak to work).

Blue dogs, in my opinion, are the lesser threat.  I believe Pelosi when she says she can move a bill through the House.  I could be wrong on that, but so far Pelosi has proved very good at winning crunch votes.

The only way a good public option will happen is if progressive in the House are willing to buck Pelosi, Rahm and Obama and spike a bill.  There are more progressives than Blue Dogs in the House, more than enough to kill the bill.

The reason conservatives get a much larger voice in legislation is because they are willing to vote it down. Rahm and Obama whip progressives far harder than they whip Blue Dogs.  If progressive representatives actually want a good public option enough to fight for it, they need to make Rahm and the White House whip the Blue Dogs.  If Democrats are unpopular in 2010 because of a failed legislative agenda, it’s not progressives who are going to lose their seats, it’s conservatives in swing districts.  And White House threats to turn off money, staff and volunteers are much more effective against people who run in swing districts.

I know the idea of actually whipping conservative democrats the way progressives are whipped is crazy-talk in modern Washington and to Obama and Rahm, but maybe it’s just crazy enough to work.

Or maybe we’ll just get a lousy health care “reform” bill with no public option or one that’s completely crippled.

A heated argument is going on about the right health insurance model between those those who believe in a public option and those who believe in single payer.

Or perhaps I should say between those who are willing to take what they can get: public option; vs. those who want to hold out for what they consider the best option: single payer.

By way of reconciling what differences can be reconciled, let me ask a question of each side.

A Question for Public Option Advocates

Do you want to eventually have a single payer or a comprehensive system like the French have?  If not, why not?

A Question for Single Payer Advocates

Are you willing to fight for a public option which could eventually lead to single payer or a comprehensive system like the French one? If not, why not?

At this point what I’m seeing is both sides retreating into moralistic screaming.

The public option folks are saying: “It is better to save some lives than none, and if you single payer purists don’t support a public option which will save even a few lives, you’re responsible for those deaths.”

The single payer people are saying: “The public option is so watered down that all it will do is discredit real public reform, aka single payer.  You public option folks are settling for so little that the few lives you might save are outweighed by all the lives you won’t save and the damage to the chance at real comprehensive health care reform.”

Both sides are assuming the other side is operating in bad faith.  The public option folks assume the single payer folks just want to be pure rather than saving lives, the single payer that the public option folks are just sell-outs shilling for a bad bill.

But what I’m seeing, as someone with a foot in each camp, is that both sides are (mostly) sincere.

Now there is one group that can’t be reconciled.  People who want a public option so weak it either won’t survive, or can’t be used as the basis for a comprehensive system.  The usual suspects like Insurance company executives, for example.  But also some people in the Obama administration, such as Health Secretary Katherine Sibelius, the health secretary, who said that the plan would be drafted specifically so that it could never become single payer.

But for everyone else, for those acting in good faith, there should be some common ground from which we can work together. Let’s start by recognizing that the battle over public option vs single payer is a distraction away from what we could accomplish if we worked together.

United we stand a chance.  Divided, we will lose our chance at health care reform.

The most devastating critique I’ve read of the current public option comes from Kip Sullivan. What makes it devastating is that although he’s a single payer advocate, instead of attacking it from the point of view of single payer, he takes it on on its own terms—comparing the House bill’s version of the public option to the one originally proposed by Hacker:

• The PO had to be pre-populated with tens of millions of people, that is, it had to begin like Medicare did representing a large pool of people the day it commenced operations (Hacker proposed shifting all or most uninsured people as well as Medicaid and SCHIP enrollees into his public program);
• Subsidies to individuals to buy insurance would be substantial, and only PO enrollees could get subsidies (people who chose to buy insurance from insurance companies could not get subsidies);
• The PO and its subsidies had to be available to all nonelderly Americans (not just the uninsured and employees of small employers);
• The PO had to be given authority to use Medicare’s provider reimbursement rates; and
• The insurance industry had to be required to offer the same minimum level of benefits the PO had to offer.

What would this mean in effect?  123 million people enrolled, the ability to set premiums substantially below those of private insurers and the ability pay hospitals and doctors less than private insurers, leading to massive cost savings.

But of the five conditions, only  one is met in the new plan: requiring the insurance industry to offer the same plan.  Not a single other requirement of the original public option plan is met.  Not one.  As Sullivan points out, the public plan starts without a single enrollee and has to hire sales staff, negotiate contracts and so on, all while being required to pay back its start up costs within 10 years.

What advantage do you have over the private insurers that means you will be able to out compete them?  The only one I can think of is that you don’t have to make a profit, but that’s only half true, because of the requirement to pay back within 10 years, you effectively do have to turn a profit.

Go read the entire thing.  Sullivans’ argument is, in my opinion, strong enough as to be devastating.  I’ll be discussing this more next week, as promised, but Sullivan has said most of what I wanted to say and said it better than I would have. His argument about why the CBO scoring of only 9 million enrollees is either correct, or even overstates the case is of particular interest.

Yesterday Brett asked why I’ve become negative on health care reform when so many other bloggers aren’t.

Of course, it’s dangerous to speak for other bloggers, but I think the calculus which many are operating under is that if you get a bill with some sort of public option, and some sort of subsidies, some lives will be saved.  Something, in other words, is better than nothing. I also think that people need to believe.  Many bloggers worked really really hard to elect Obama, to get a House and Senate majority, and the that it can’t deliver on something so fundamentally important as making sure every American has the health care they need is something they just don’t want to believe.

Also most other bloggers are not fundamentally econobloggers and econobloggers who don’t buy the “TARP saved the universe” disillusionment started much earlier than for most other bloggers.   For me it started at TARP time when Obama pushed through Paulson’s highway robbery act  Then Obama hired Geithner and Summers as his key economic people.  So I started down the path of “no hope” a lot earlier than most bloggers.

I use the stimulus bill as my model for looking at healthcare.  As with the stimulus bill I think that the House draft bill is the high point.  I think this is the best bill we are going to see.  I think the Senate bill will be worse (Daniel reported last night, as I was writing, that the Senate bill probably won’t have a public option) and that it may well be worse than nothing even if a weak public option is in the bill. In particularly Medicare and Medicaid are being hit to pay for this, people will have deductibles on “non preventative” care (and maybe preventative by the time it gets through) and so on.  The Massachussets experience, which is the closest parallel, has not been good.

There is a counterargument, I made part of it the first day I wrote at OpenLeft.  The public option could drive out private insurance or at least drive costs lower.  Getting people into the system turns them into real patients and suddenly there are doctors and so on who don’t want to lose them, and that gives them a constituency, and above all, you do save some lives and help some people and isn’t that better than nothing?

I’m not a single payor purist, though I think the fact single payer isn’t even on the table is a terrible indictment of the system—however, I’ll settle for a good public option, or even a non-sucky one.  But I’m becoming convinced that any public option will either be too compromised, or non existent, and at that point, all that happens is you have slashes to Medicare and Medicaid, forced purchase of bad insurance, and through those purchases more money being pumped into the system.

Is forcing people to buy insurance the real goal?  The best way to make money, bar none, is to have government force people to buy your product.  It’s a wet dream for any industry, so if it’s going to be done, it has to be done right—it has to be very highly regulated and controlled with rates of return set like utilities.

Will it be?

(Addendum: Before I ride off into the sunset next thursday, I’ll see if I can pull together a post on what is required for a good public option.  One of the reasons I favor single payor is that it has many fewer moving parts. It’s easier to do single payor right than it is to do a public option right.  Not least because there are many different working models of single payer and variations.  Getting the public option right is very complicated.)

He who has the gold, makes the rules

The numbers on how much various medical interests have spent on influencing Congress and the Presidency make clear why health care reform keeps getting watered down:

..the data so far suggest that the second quarter has a good chance of reaching a new high for the health-care lobby. The industry already set records from January to March, when health-care firms and their lobbyists spent money at the rate of $1.4 million a day.

Impressive…  Is anyone on the side of good reform spending that type of money?

Of course they aren’t.  Healthcare in the US costs 5% more of GDP than it should.  That’s a lot of money, and there are a lot of people getting rich off that money.  They’ll do whatever they have to in order to keep the flow coming.  When you’re talking 692 billion dollars (give or take), well, what’s 1.2 million a day to keep the cash flow coming?

The fundamental truth of America’s Congress is that its first and most important function, when you take the time to look at the bills it passes, is to take money from rich special interests and then pass bills which favor them.  The same, I’m afraid, is true of the presidency.  Most of the 15 trillion given, loaned and guaranteed during the financial crisis was to the financial sector, and most of that was given by the Federal Reserve, which if it answers to anyone (questionable) answers to the President.  But even when Congress got into play it’s noticeable that they gave 700 billion for TARP but are now insisting that health reform be “decifit neutral”.  Likewise no one seems to mind giving lots of money to the military.

Interesting set of priorities.  Politicians seem to always be telling us how “protecting Americans” is their most important duty.  Which is how they justify spending money on a military which doesn’t seem to protect Americans from anything noticeable.  And by protecting I assume they mean “save American lives.”  This is odd, because health reform, properly done, would save those lives than anything else except massive reform of the way Ameiricans eat. But, unlike with the military, there isn’t a health-reform complex pushing to save American lives that is nearly as strong as the one pushing to keep the gravy train going.  So suddenly, saving American lives isn’t a priority.

This is a story I had missed.  It seems that insurance companies determined rates for “out of network” medical services by looking at an independent database run by a company called Ingenix, United Health Group.

But the way the database “independently” determined the going rate was by having insurance companies enter data on how much the rate was for given services.  And for a decade they systematically entered prices which were lower than the actual prices being charged by doctors.

The result was that patients would get a larger bill than expected, the insurance companies would redeem the doctors for less than expected, and often the gap would never be made up.  A win for insurance companies, a loss for patients and doctors.

Companies involved, include (but I’m not sure if are limited to):

United, WellPoint, Aetna, Cigna, GHI/HIP, Capital District Physicians’ Health Plan, Independent Health, Excellus, MVP Health Care, HealthNow and Guardian Life Insurance Co

They have all “settled” with NY Attorney General Andrew Cuomo’s office and promised to use a new, more transparent database as soon as one is available.  They have given 100 million to make the new database.  And, of course, none have admitted they did anything wrong.

Bottom line on this is that the amount of money they saved (ripped off) is almost certainly more than their “settlements”.  So the entire scheme has been worth it, especially since no one went to jail.  Just another cost of doing business.

This is how large american corporations operate.  Law breaking and immoral behaviour is simply a cost-benefit matter.  If the money saved by doing something illegal is more than the cost of doing something illegal (including legal costs), too many of them will do it.

I would suggest that the only things which would really get executives to stop doing these sorts of things are to either treat them as criminal matters (and send CEOs to jail) or to treat them as what they are: clear collusive action to use an oligopoly position to control prices, and break them up.  But the second is no longer possible after the Supreme Court ruled that actions which suggest collusion cannot be taken as evidence of collusion, overturning prior precdent.

And, of course, senior executives rarely go to jail for screwing ordinary people, let alone committing massive fraud (or half Wall Street would be heading for the hoosegow) so real criminal charges certainly won’t happen.

I wonder what other scams the insurance companies are running we don’t know about?  What other ways they are fixing the books?  Only a fool would bet they aren’t.