Obama asks GOP: What’s YOUR plan?
Barack Obama asked his detractors: "What are YOU going to do? What's YOUR solution?" He then took a moment to review the abhorrent status quo, a situation for which Republicans have offered no solution.
What KIND of health care?
The raging health care debate "debate" is almost entirely devoid of facts, an issue on which I've previously posted. Instead of discussing fact, then, we tend hurl vague accusations, like calling the reformers "communists" (and you've GOT to see this). I "blame" Obama for this lack of specificity, but I realize that the vicious opposition mounted by huge self-interested insurance companies and health care providers might require that he not play all of his cards at this point. But isn't it odd that our politicians aren't at least clarifying the term "health care coverage" when they refer to national health care coverage? Defining this term would make a huge difference to the public reaction to any national plan. Here are two possibilities (though there are others): A) The national plan will offer gold-plated coverage much like the expensive United Health Care coverage I buy for my family through my employer. For the record, the pre-tax cost of this coverage is about $20,000 per year for my family. Is the Obama proposal to provide every citizen with this kind of coverage? If so, I can see why there is massive resentment to the proposal. Many working people can barely afford health insurance coverage at all, and the coverage many people do purchase is not nearly as comprehensive as the expensive coverage I purchase. Of course people who can can only afford to buy their own rudimentary policies will resent that the government might buy gold-plated policies for everyone else, including many highly irresponsible people. B) The national plan will offer a rudimentary coverage only. It will cover x-rays and casts for broken arms, but not heart transplants and expensive drugs that only marginally increase one's chances of surviving an illness. It wouldn't keep people suffering from terminal illness on life support when there is no reasonable chance that they would ever leave the hospital. It would cover only a small subset of the treatments covered by gold-plated policies. It might be akin to the Oregon Plan. I believe that there would be massive resistance to the national coverage described in A) but far less resistance to the coverage described in B). At least Oregon's legislators had the cajunas to specifically state what was covered under their plan and what was not (Oregon's prioritized list is available for all to see). Oregon had the fiscal responsibility to make certain that they could afford the level of health care to which they were committing. Oregon dealt head-on with the accusation that they were "rationing" health care; absolutely they were, just like private plans ration health care only to those who pay those high premiums. Both responsible and irresponsible health care plans "ration" health care. Therefore, it is not a criticism of any health care plan that it "rations" health care. Here are the guiding principles to the Oregon Plan:
In 1987, the Oregon Legislature realized that it had no method for allocating resources for health care that was both effective and accountable. Over the next two years, policy objectives were developed to guide the drafting of legislation to address this problem. These policy objectives included:Our national conversation regarding health care is so dysfunction on so many levels that it's hard to know where to begin. I'll make only one more point in this post, however. Opponents of current proposals often make accusations that there will be "death panels," indicating that some sick people will be allowed to die. As a nation, we need to grow up and deal with the fact that this happens every day in every hospital in the country: we shouldn't be allocating huge amounts of money to maintain pulses in people who have become living corpses. There are some families who "can't let go" no matter what (e.g., Terry Schiavo), and our national plan needs to have specific guidelines for these situations. In fact, every private insurance plan should have guidelines for determining when further treatment is likely to be futile and a provision for ending coverage at that point. The alternative is to make policies so horrifically expensive that many people can't afford policies that cover tratments likely to make an immediate positive impact on their lives. Only when we put these issues clearly on the table can we begin to have a real conversation.• Acknowledgment that the goal is health rather than health services or health insurance • Commitment to a public process with structured public input • Commitment to meet budget constraints by reducing benefits rather than cutting people from coverage or reducing payments to levels below the cost of care • Commitment to use available resources to fund clinically effective treatments of conditions important to Oregonians • Development of explicit health service priorities to guide resource allocation decisions.
Who would Jesus insure?
Who would Jesus Insure?
That was the slogan on a placard that stole the show at a tea party attended by Michael Krantz yesterday:[T]he Medicare recipients who want nothing to do with government-run health care [were] one of the more amusing right-wing cliches of this long hot August. There were no doubt plenty of them yesterday among a crowd that was predominantly older, overwhelmingly white and, I'd wager, heavily evangelical, a combustive demographic that didn't exactly cotton to the gutsy girl who kept pacing around trying to yell "Health care for everyone!" loudly enough to drown out the repeated death threats and off-topic anti-abortion catcalls that greeted her homemade "Who Would Jesus Insure?" sign. Her question, in fact, was quite a bit more piquant than the ones I was asking.
Health-less
The boogeyman of Socialized Medicine is being dragged onto the field of rhetorical combat to block the move toward anything smacking of Single Payer Health Care in the United States. The argument is old and hoary by now, that adopting a system like that available in Canada or the United Kingdom would lead to a collapse of American health care. Somehow the fact that expenses might be shared and disbursed through the government will render the world’s best health care system somehow crippled inside a generation is not seriously questioned by most people. Because most people don’t know. You can find case after case of anecdotal evidence to support the notion that British health care is worse than ours. Someone knows someone who, as the argument goes. And there is something to that. The waiting periods alone, the pigeonholing of treatment—horror stories abound which we glimpsed here when HMOs were instituted and accountants seemed to be in charge of medicine. There is, in fact, too much information for the average American to digest much less make sense of. Technologically, the United States has an extraordinary medical system. Unmatched in the world, despite some annoyingly negative statistics. That we achieve what we do in a country peopled by citizens who do the least for their own health than in any other country comparably empowered is amazing. Americans eat too much. Medicine can only do so much against a rising tide of obesity related illnesses. The tradition of the doctor giving you a physical and then telling you to eat right and get some exiercise is not a quaint leftover from an age that didn’t know as much as we do—that is sound advice and more than half the battle in maintaining good health. The explosion of Type 2 diabetes in children has been alarming, and this can be tied directly to diet and exercise. We also work longer hours under higher stress than almost anywhere else in the developed world. The need for vacations and long weekends is acute. This may sound sarcastic, but the link between stress and several major illnesses is no joke. We are also a violent society. If one looks at emergency room statistics, it becomes quickly clear that we are a people who like to beat, stab, and shoot each other at higher levels than almost anywhere else. What makes all these factors so overwhelming is that we have the means to do all this. Because a certain percentage, a significant percentage, of the population can afford to go to the doctor and have the consequences of all these lifestyle disasters “taken care of.” I put all this out front because the one factor that is muted in the national debate over the rising cost of healthcare is the fact that we are, collectively, idiots. We do not do, statistically, the simplest things to avert the need for medical intervention. The last detail in this litany has nothing to do with idiocy but with sentiment and perspective. It has been said for decades and it is true—80% of individual health expense in this country is spent in the last two years of life. We are, as a people, loathe to die and we will direct our health services to do absolutely everything to give us another day. In Europe, such people are told to go home and die. That sounds cold, I know, and I’m sure there are people in France and Germany and Italy with the resources to reject this advice. But the nations as a whole are not expected to pay for it. Here we are. Through health insurance.
Dennis Kucinich takes on the Manhattan Institute
What is the deal with single payor? How does the United States compare to Canada on the ability to provide health care services? Rep. Dennis Kucinich is showing his frustration with Dr. David Gratzer, Senior Fellow of the conservative Manhattan Institute. Gratzer had it coming because he presented himself as an expert on the problems with the Canadian system. See here and here. For a clear presentation of why we do need single payor insurance and why we can afford it, see this report by Marcia Angell, M. D., Senior Lecturer in Social Medicine Harvard Medical School.