Health Care

Jay Ackroyd: Who Counts?

77 members in the Congressional Progressive Caucus. They support a single payer health care plan. 51 Blue Dogs. They don't. Who is on your teevee? In your news weekly?

"Not on the table."

Karen Tumulty: Single Payer

Every time I write a story about the state of the health reform debate --like this one--commenters here want to know why I don't include an extensive discussion of a single-payer option, which essentially would be a government-financed program like Medicare for everyone. The reason is that it is not going to pass. The House is not going to pass one; the Senate is not going to pass one; President Obama is not pushing for one.

The most die-hard single-payer advocates insist this means that health care reform is already a failure, and no improvement on the status quo in their eyes. But is that really true? Ezra Klein has an interesting interview with the leading supporter of single-payer in the Senate, Vermont's Bernie Sanders. He sees some paths where it might happen--eventually--within the context of the kind of health reform effort that has a more realistic chance of reaching Obama's desk:

You've implied here that single payer may be the long-term goal. In the shorter-term, what should single payer advocates be looking to get out of the health care process Baucus is running? Are there any concessions that could make that a win?

I am sure that there are some single payer advocates who think the only thing worth fighting for is single payer. What I have also introduced, which we will be fighting for, is a five-state option. That would mean five states would have the option of running pilot programs in universal health care but one would have to be single payer.

I think it's possible this will never happen in DC, but that this country will join the rest of the industrialized world when a state, maybe like Vermont, implements single payer and does it well. And then New Hampshire will be looking over our shoulders, and they will adopt that, and so on through the country. That's in fact how national health care came to Canada, it started in the Saskatchewan province.

The second area of less importance, but important nonetheless, is the fight for a strong public option. In my view, if you had a level playing field and a pubic program and a private insurance program providing the same level of benefits, people would come into the public program because the public program would be substantially more efficient. I think we can make that case, and I will advocate for it in the legislation.

• jayackroyd Says:
  Friday, June 5, 2009 at 10:14 am

  The reason is that it is not going to pass.
  .
  Humbug!
  .
  There is incessant coverage of any number of policies that are not only not going to get passed, but have also been covered so thoroughly that there is nothing new to be said. SS "privatization," overturning Roe v Wade, a "flat tax," deficit reduction, and on and on.
  .
  The constant reprisal of these right wing issues has the effect of shifting the Overton Window. The refusal to air left wing policy issues like single payer health plans, dramatic reductions in military spending, termination of covert CIA operations that undermine governments, an end to warrantless wiretapping, anti-trust actions against telecom and other colluding oligopolies et alia means that these issues,and their merits, are never discussed in public spheres. Air and print is used to push President Gingrich's positions, and for Cheney's daughter to repeat her father's lies.

Sully: You're Doing Better Than You Realize

Ezra Klein makes an interesting point:

[M]ost workers think stagnant wages mean their employer is paying them less. They don't know that the main reason for stagnant wages is that their wage increases are going to pay for their health insurance premiums. If they did -- if they realized that compensation is pretty much a zero-sum endeavor and their employers don't so much buy them health insurance as garnish their wages to pay for their health insurance -- you'd probably see a lot more general anger at rising health care costs.

Krugman: Keeping Them Honest

“I appreciate your efforts, and look forward to working with you so that the Congress can complete health care reform by October.” So declared President Obama in a letter this week to Senators Max Baucus and Edward Kennedy. The big health care push is officially on.

But the devil is in the details. Health reform will fail unless we get serious cost control — and we won’t get that kind of control unless we fundamentally change the way the insurance industry, in particular, behaves. So let me offer Congress two pieces of advice:

1) Don’t trust the insurance industry.

2) Don’t trust the insurance industry.

The Democratic strategy for health reform is based on a political judgment: the belief that the public will be more willing to accept reform, less easily Harry-and-Louised, if those who already have health coverage from private insurers are allowed to keep it.

But how can we have fundamental reform of what Mr. Obama calls a “broken system” if the current players stay in place? The answer is supposed to lie in a combination of regulation and competition.

It’s a sign of the way the political winds are blowing that insurers aren’t opposing new regulations. Indeed, the president of America’s Health Insurance Plans, the industry lobby known as AHIP, has explicitly accepted the need for “much more aggressive regulation of insurance.”

What’s still not settled, however, is whether regulation will be supplemented by competition, in the form of a public plan that Americans can buy into as an alternative to private insurance.

Now nobody is proposing that Americans be forced to get their insurance from the government. The “public option,” if it materializes, will be just that — an option Americans can choose. And the reason for providing this option was clearly laid out in Mr. Obama’s letter: It will give Americans “a better range of choices, make the health care market more competitive, and keep the insurance companies honest.”

Those last five words are crucial because history shows that the insurance companies will do nothing to reform themselves unless forced to do so.

Consider the seemingly trivial matter of making it easier for doctors to deal with multiple insurance companies.

Back in 1993, the political strategist (and former Times columnist) William Kristol, in a now-famous memo, urged Republican members of Congress to oppose any significant health care reform. But even he acknowledged that some things needed fixing, calling for, among other things, “a simplified, uniform insurance form.”

Fast forward to the present. A few days ago, major players in the health industry laid out what they intend to do to slow the growth in health care costs. Topping the list of AHIP’s proposals was “administrative simplification.” Providers, the lobby conceded, face “administrative challenges” because of the fact that each insurer has its own distinct telephone numbers, fax numbers, codes, claim forms and administrative procedures. “Standardizing administrative transactions,” AHIP asserted, “will be a watershed event.”

Think about it. The insurance industry’s idea of a cutting-edge, cost-saving reform is to do what William Kristol — William Kristol! — thought it should have done 15 years ago.

How could the industry spend 15 years failing to make even the most obvious reforms? The answer is simple: Americans seeking health coverage had nowhere else to go. And the purpose of the public option is to make sure that the industry doesn’t waste another 15 years — by giving Americans an alternative if private insurers fall down on the job.

Be warned, however. The insurance industry will do everything it can to avoid being held accountable.

At first the insurance lobby’s foot soldiers in Congress tried to shout down the public option with the old slogans: private enterprise good, government bad.

At this point, however, they’re trying to kill the public option in more subtle ways. The most recent ruse is the proposal for a “trigger” — the public option will only become available if private insurers fail to meet certain performance criteria. The idea, of course, is to choose those criteria to ensure that the trigger is never pulled.

And here’s the thing. Without an effective public option, the Obama health care reform will be simply a national version of the health care reform in Massachusetts: a system that is a lot better than nothing but has done little to address the fundamental problem of a fragmented system, and as a result has done little to control rising health care costs.

Right now the health insurers are promising to deliver major cost savings. But history shows that such promises can’t be trusted. As President Obama said in his letter, we need a serious, real public option to keep the insurance companies honest.

Chris in Paris (AmBlog): GOP more concerned with insurance industry than consumers

But since when did they ever care about consumers? Their arguments about driving private insurance out of business is laughable and so far from reality. I know Republicans don't like to travel beyond their little world, but they might look into a little provincial company called AXA that somehow survives with operations throughout Europe where national health care systems exist. The little venture somehow - who knows how - managed to buy a US insurer despite being headquartered in France. How a business could prosper in socialist central and then manage to expand and buy into a capitalist market is a mystery because we all know that only brave, hot dog and apple-pie eating American capitalists can build world business empires. The plucky little upstart has also managed to be the 15th largest company in the world. Go figure.

Maybe before the Republicans start crying about their friends going out of business they ought to look around and see what is happening in the real world. They are being drama queens when they make such silly statements about driving the insurance business out of business. This is going to be a brutal confrontation and it's clear the GOP will stop at nothing to block reform and change. Telling lies is all they have so more will come but their starting point is completely false and typical scare-mongering.

Opponents say private insurers could not compete with a public plan that didn't have to make a profit. They argue that private health plans would end up going out of business, leaving only an entirely government-run health care system.

There appears to be little room for compromise, with Republicans contending that no matter how a public plan is designed, it would inevitably balloon and crush the private market.

"It's kind of a litmus test sort of thing," Grassley said. "It's just very, very difficult, but I suppose that somewhere out there there's something that's politically realistic that's not a public option that satisfies Republicans and Democrats. But it isn't a government-run system," Grassley said.

What exactly is so difficult about improving health care for Americans? Maybe Grassley and the GOP can temporarily give up their health care program while working through this problem and see what a great system is out there for everyone else.

Ezra Klein: The Health Care Debate Made Very, Very Simple

Matt Yglesias's post on the Blue Dogs' public plan principles is an interesting example of one of the central ironies of the health-care debate. In most cases, individuals arguing that health reform is too expensive are dead-set against policies that would make it cheaper. It's a neat trick: Their opposition to real cost controls makes health-care reform pricey, and then they attack it on grounds of cost. Conversely, the folks willing to accept a pretty costly version of health reform would also be happy to embrace cost control policies like a public plan able to set Medicare rates.

Or look over here: Virginia Postrel is upset that Barack Obama isn't basing his cost control strategy around Medicare reforms. She doesn't appear to have bothered to learn that Barack Obama is basing his cost control strategy around Medicare reforms. Weird!

What you're seeing here are people who fundamentally don't want a universal health care system, and are willing to be flexible in how they argue and advocate for that goal, fighting with people who fundamentally do want a universal health care system, and are willing to be flexible in how they argue and advocate for that goal. A lot of these relatively esoteric policy disputes are simply manifestations of those two underlying impulses.