Wednesday, July 8, 2009

Health Care Wednesday: Growing a Pair

ChrisinParis: Coffee...sweet, sweet coffee
Another great benefit of coffee and one of my favorite veggies (broccoli) is also in the mix once again. It does remind me that I need to do more with green leafy vegetables.
Coffee drinkers will be clinking mugs in a toast to new research suggesting that just two strong cups of the black stuff a day can reverse the effects of Alzheimer's disease. Dr Gary Arendash of the University of Florida showed that coffee not only helped to reverse symptoms in mice but also staved off production in the brain of abnormal protein plaques, which are the hallmark of Alzheimer's.

In the UK the Alzheimer's Society is anxious not to suggest that everyone develop a caffeine habit but says that if further research confirms its benefits, coffee could become part of a lifestyle prevention plan for the disease.

So what else could be in the armoury? Researchers at Columbia University in New York recently found that a Mediterranean-style diet high in fish oil and vegetables prevented people with mild memory loss from getting full-blown dementia, and also seemed to prevent memory decline in the general population. Blueberries, kale and broccoli seem particularly helpful.

Atrios finds Some Good News
Reid apparently has figured out that sacrificing 15 Dem votes for 2 Republican ones is a bad idea.
  • digby: The Plot Thickens
    Roll Call - Reid to Baucus: Stop Chasing GOP Votes on Health Care


    Tuesday, July 7, 2009

    Senate Majority Leader Harry Reid (D-Nev.) on Tuesday ordered Finance Chairman Max Baucus (D-Mont.) to drop a proposal to tax health benefits and stop chasing Republican votes on a massive health care reform bill.

    Reid, whose leadership is considered crucial if President Barack Obama is to deliver on his promise of enacting health care reform this year, offered the directive to Baucus through an intermediary after consulting with Senate Democratic leaders during Tuesday morning’s regularly scheduled leadership meeting. Baucus was meeting with Finance ranking member Chuck Grassley (R-Iowa) Tuesday afternoon to relay the information.

    According to Democratic sources, Reid told Baucus that taxing health benefits and failing to include a strong government-run insurance option of some sort in his bill would cost 10 to 15 Democratic votes; Reid told Baucus it wasn’t worth securing the support of Grassley and at best a few additional Republicans.
    Wow. He can count. Good news.

    Update: And the progressives in the House weigh in:
    The Honorable Barack Obama
    President of the United States
    1600 Pennsylvania Aye, N.W.
    Washington, D.C. 20500

    Dear Mr. President,

    I read with alarm and dismay the article in the July 7th edition of the Wall Street Journal, “WhiteHouse Open to Deal on Public Health Plan”. In particular, White House Chief of Staff Rahm Emanuel stated in the article that one of several ways to meet your health care reform goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own.

    I want to be crystal clear that any such trigger for a strong public plan option is a non-starter with a majority of the Members of the Progressive Caucus (CPC). As the CPC has repeatedly stated, its Members cannot support final passage of any health care reform bill that does not include a robust public plan option, akin to Medicare, operating alongside the private plans.

    Public opinion polls show that 76° o of Americans want a robust public plan option and I will stand in solidarity with them. Moreover, I consider it unacceptable for any of the cost savings that you are negotiating with hospitals and other sectors of the health care industry to be madecontingent upon a robust public plan option not being included in the final legislation.

    Thank you for your thoughtful consideration.


    Raul Grijalva
  • Josh Marshall on A Crackdown?

    From a knowledgeable source on the Hill ...

    Now that they have 60, Reid and Durbin need to remind Dem members that when your Leader files cloture, you support him. If you want political cover, vote against final passage. Fine. But opposing cloture means you're supporting a filibuster of your party's agenda.

    From what I hear, they started delivering that message, if a softer version of it, earlier today.

Yglesias: French Health Care Costs

Bruce Bartlett emails to point out that it’s probably not right to say, as I quoted Kevin Drum saying this morning, that France spends half of what we spend on health care. If you look at it in terms of percent of GDP, they spend about two thirds of what we spend. Here’s a chart of OECD data on the subject:


Now I think that’s a pretty striking chart. Politics is politics, and that means change that’s fairly incremental. But looking at that chart, and abstracting away from the practicalities of it, you’ll need to show me overwhelming evidence that the United States is getting better health outcomes than these other countries are before I stop thinking that a hefty dose of socialism is what the health care sector needs.

UpdateTo be clear, Kevin's not wrong to say that the French spend about half of what we do. If you look at health care spending on a per capita basis, that's what you get. But I think looking in percent of GDP basis creates a more enlightening comparison; otherwise you just get the conclusion that richer countries spend more money.
  • Drum: Cheese-Eating Healthcare

    When I reviewed Jon Cohn's Sick a couple of years ago for CJR, I concluded with this:

    The format of Sick almost begs for narratives about overseas health care systems. The book is basically a tour around America, with each of its eight chapters named after the place in which its story unfolds. So why not include chapters on Manchester, Malmö, and Marseilles, each of them highlighting in narrative form both the good and bad points of the British, Swedish, and French systems?

    Naturally, then, I'm delighted that Jon found someone to fund exactly that:

    Last year, I had the opportunity to spend time researching two [] countries: France and the Netherlands. Neither country gets the attention that Canada and England do. That might be because English isn’t their language. Or it might be because they don’t fit the negative stereotypes of life in countries where government is more directly involved in medical care.

    ....In the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren’t filled with stories of people going bankrupt or skipping medical care because they couldn’t afford to pay their bills. And they did all this while paying substantially less, overall, than we do.

    Forget Canada and Britain. Neither one is even remotely close to the kind of system we'd ever put in place in the U.S. France's system, however, is surprisingly American in its basic underpinnings. And while no system comes out tops in every single metric, French healthcare, as Jon says, is better than ours on almost all of them and does it for close to half the cost.

    Now, the fact that the French spend about half what we do doesn't mean that we'd cut our costs in half if we adopted a French-style system. We wouldn't. There's too much path dependence and too many cultural differences for that. But what it does mean is that if we adopted something close to their system, we could certainly achieve high-quality 100% basic coverage — with the ability to purchase extra coverage for anyone who wants it — for no more than we spend now and possibly a bit less.

    We won't, of course, because too many people are still convinced that healthcare in the United States is better than it is in France — or anywhere else. It's not. It's worse and more expensive. Somebody tell Max Baucus.

    UPDATE: Matt Yglesias says that Max already knows. I figured as much.

  • Yglesias: Telling Max Baucus What He Already Knows

    Kevin Drum thinks someone should tell Max Baucus the truth about foreign health care:

    Now, the fact that the French spend about half what we do doesn’t mean that we’d cut our costs in half if we adopted a French-style system. We wouldn’t. There’s too much path dependence and too many cultural differences for that. But what it does mean is that if we adopted something close to their system, we could certainly achieve high-quality 100% basic coverage — with the ability to purchase extra coverage for anyone who wants it — for no more than we spend now and possibly a bit less.

    We won’t, of course, because too many people are still convinced that healthcare in the United States is better than it is in France — or anywhere else. It’s not. It’s worse and more expensive. Somebody tell Max Baucus.

    The trouble is that as I’ve had occasion to note before the evidence suggests that Baucus already knows this:

    Afterward, Sen. Ken Salazar, D-Colo., who has since become interior secretary, noted that other countries saw a conflict between profits and health. How could the United States possibly persuade insurance companies to give up profits? [Author T.R.] Reid answered that Switzerland, home to many powerful insurance companies, had done it in 1994 when it adopted the Bismarck model. The insurers fought it tooth and nail, of course, but now they compete energetically to sign up people for basic care on a nonprofit basis because they constitute a customer base for supplemental insurance that they’re allowed to sell on a for-profit basis. This answer didn’t satisfy Baucus. “Perhaps you don’t know how much money [U.S. insurers] have,” he told Reid.

    As I’ve said before, it’s as if Baucus doesn’t realize that he’s the single most important person in Congress on this issue. He could just decide not to listen to the insurers no matter how much money they have. Instead we get things like Rahm Emannuel floating compromises about introducing a public insurance option only after a “trigger” test has been passed. This really only makes sense if you think protecting the profits of insurance firms is an independently desirable policy goal. You’re open to the possibility of a public plan, but you want to err on the side of avoiding its introduction because . . . well . . . because . . . it’s not really clear.

Krugman: An unknown country

A correspondent writes in, denouncing my latest column, and says that if things go my way we’ll end up with the government providing health care to everyone, which will “destroy the American way of life.”

Hmm. There’s a country this correspondent — and many others who denounce “socialized medicine” — should look at. It’s a country where there is, indeed, a substantial private health insurance industry, which pays 35 percent of medical bills. But the government pays a larger share — 46 percent. (Most of the rest is out-of-pocket spending.)

The country is called the United States of America.

C&L: Dana Bash Centers Canadian Health Care Story Around Mitch McConnell Talking Point

CNN's Dana Bash does a report on the Canadian health care system, and as its center piece she features the person Mitch McConnell has been using in his Senate floor speeches as an example of what's wrong with Canadian health care. How many similar stories of people in the United States being denied coverage because they don't have any health insurance at all does anyone think CNN could be doing if they went out and looked?

In fairness, Bash does point out those that disagree with the generalizations about the system, and that the Democrats are not trying to get universal health care here in the United States. That said, seeking out the person McConnell has been citing in his Frank Luntz talking points on health care as the main portion of the segment strikes me as nothing short of Republican propoganda.

As our own Jon Perr has more on McConnell fear mongering about the Canadian health care system:

In his demagoguery regarding President Obama's health insurance proposals featuring a "public option," Senator McConnell trotted out horror stories from Canada and the UK to illustrate "health care denied" by "government-run" systems. But as the New York Times suggested, McConnell's examples of Canadian Shona Holmes and Briton Bruce Hardy in essence made his opponents' case for them:

What Mr. McConnell did not disclose was that Ms. Holmes paid for her treatment, at the Mayo Clinic in Scottsdale, Arizona, on her own - an option that is available to patients with financial resources all over the world regardless of their nation's health insurance system...
As for the case of Mr. Hardy, the particulars seem to make it hard to tell how his situation differed from the countless Americans who battle their private insurers every day for access to the newest, most advanced and most expensive treatments.


Despite Mitch McConnell's grandstanding, Americans' health care is frequently denied - even when they are already paying for it.

And so it goes. Back in 1993, GOP propagandist William Kristol famously mobilized his Republican colleagues, warning that Bill Clinton' success with health reform could lead to a Democratic majority for a generation. His talking point then was "no crisis." 16 years later, Mitch McConnell is frightening Americans with dark visions of a future system where health care is denied, delayed and rationed.

The future is now.

Transcript below...

hilzoy: The Ice Floes Are Crowded

There's one piece of persistent dishonesty in the debate over health care that I would like to see vanish once and for all. It concerns the word 'rationing'. You can use it in several ways. On the one hand, it can refer to any process that determines who gets some scarce commodity. Here's an econ textbook quoted by Uwe Reinhardt:

"Prices ration scarce resources. If bread were free, a huge quantity of it would be demanded. Because the resources used to produce bread are scarce, the actual amount of bread has to be rationed among its potential users. Not everyone can have all the bread that they could possibly want. The bread must be rationed somehow; the price system accomplishes this in the following way: Everyone who is willing to pay the equilibrium price gets the good, and everyone who does not, does not. [Italics added.]"

If that's what rationing means, then health care is already rationed, since it is not free. Moreover, since no one is proposing that it become free, everyone agrees that it should be rationed somehow.

When some people talk about rationing, they mean something scarier: the idea that someone, possibly the government, allocates quantities of something, and forbids anyone to obtain more of it. Thus, if the government rations gasoline in wartime, you get your gas coupons, and you are not allowed to buy any more gasoline, period. (That's why black markets are illegal.) Likewise, when reselling tickets is illegal, ticket vendors are, in this sense, rationing tickets.

No one -- no one -- is proposing to ration health care in this way. Not Barack Obama, not Bernie Sanders, no one. Every serious proposal I'm aware of would allow people to purchase whatever health care they want, so long as a doctor is willing to prescribe it. And not only that, they can purchase supplemental insurance, like those add-on plans for Medicare.

What proponents of a public plan are proposing is, well, a public health insurance plan that would compete against private plans. I assume that, just like every private plan I know of, the public plan would not cover literally anything a patient might take it into her head to want. It might not cover unproven therapies, for instance. It might not cover therapies whose benefits did not warrant their costs. If this sounds bad to you, try to imagine a really big cost and a really small benefit: a billion dollar treatment for hangnails that offered only the most minute advantage over bandaids and nail clippers. As long as the fact that this is not covered is disclosed in advance, I don't see a problem with it.

Some people seem to think that decisions which are routinely made by insurers somehow become affronts to liberty when carried out by, say, Medicare. This is silly, but it's not flat-out dishonest. The same cannot be said for the following move, from an op-ed by Charlotte Allen:

"Here's a way for America to cut its spiraling healthcare costs: ice floes.

This idea isn't mine. It's President Obama's. (...)

"Evidence-based medicine" (...) can be helpful to doctors in deciding what treatments would be best for their patients and maybe save them some money. But Obama and his healthcare supporters do not want to stop there. Their implicit proposal seems to want to turn comparative effectiveness research into the "rules" that Obama was talking about on ABC: one-size-fits-all procedures that physicians would have to follow at the risk of not being paid by the government. And the government would increasingly be the payer if Obama's proposed "public option" health insurance crowds out, as it inevitably will, private health insurers forced to compete with a tax-subsidized government entity. A pacemaker for your otherwise tough-as-nails 99-year-old mother? Forget it, Mom, you die."

Wrong. Let's assume that a public plan passes. This would not necessarily crowd out other insurers:

"In many areas of American commerce, private and government programs comfortably co-exist. FHA insured loans and non-FHA loans, Social Security and private pensions, public and private universities--all have long thrived side by side. Each side of the divide has strengths and weaknesses, but in every case the public sector is providing something the private sector cannot: A backup that's there if and when you need it; a benchmark for private providers; and a backstop to make sure costs don't spin out of control."

But just because I'm feeling generous, let's assume that the public plan proves to be so popular that it does crowd out its competitors -- that is, health insurance plans that aim to be people's mainstay, as opposed to supplemental plans. And let's further suppose that this government plan will not pay for a pacemaker for your 99 year old mother. Does that prevent her from getting one?

No. It doesn't. Your mother might have a supplemental insurance plan that does cover for it. Or she could pay for a pacemaker herself. Unless we actually ban both private insurance and the private purchase of health care -- and why anyone should find that a remotely likely prospect is a mystery, since we haven't done anything of the kind with Medicare -- your mother is perfectly free to buy herself a pacemaker. The government is no more preventing her from getting a pacemaker than it is preventing me from getting a Ferrari by not giving away free cars.

Ah, you might say, but medical care is expensive, and a lot more necessary than a Ferrari! If your mother doesn't have supplemental insurance, and doesn't have enough savings to spring for a pacemaker, it's pretty cold to say: well, mom, you're still free to buy one! If she can't afford a pacemaker, and she needs one, you might as well be putting her on the ice floes.

Since I'm still feeling generous, I'll play along with this, and agree to say that anyone who cannot get medical care at a price she can afford is being "deprived" of health care. But note what follows: the 47 million people who are presently uninsured are now being "deprived" of any non-emergency care that they cannot afford. And "non-emergency care", here, includes managing their diabetes so that they don't end up having their leg amputated, getting the antipsychotics they need to be sane, and getting HIV medication or chemotherapy. In short, it includes a lot of things that are pretty important.

If Obama's plan counts as putting your mother on the ice floes by by failing to cover her pacemaker, then our present system counts as condemning a whole lot of people to an early death, or amputated limbs, or untreated psychosis. After all, even though the uninsured can purchase these things, they cannot afford to.

No one's mother is going to be prevented from buying any medical care she needs, so long as a doctor is willing to provide it. No one's mother is going to be prevented from buying supplemental insurance, if she thinks that her main policy, public or otherwise, is too stingy. We can, if we wish, describe people as "prevented" from getting medical care whenever they cannot afford to purchase it. But if we go that route, we have to recognize that a whole lot of people are "prevented" from getting medical care right now.

This is not a scary new development that Obama's plan might unleash on us. For 47 million of us, it's our life right now. And even if we assume the absolute worst remotely plausible scenario -- private competitors to the public plan wither, the public plan sets its cost-benefit limits too low, etc. -- the Obama plan could hardly be worse than the situation we have right now. At the very least decisions about what to cover would bear some relation to costs and benefits. Everyone would have their chronic diseases managed, their lifesaving operations covered, and so forth. Questions would arise about expensive treatments whose advantage over less expensive ones is unclear, or new therapies whose benefits are unproven, not about whether it's a good idea to keep someone with high blood pressure on antihypertensives.

No comments:

Post a Comment