Some Common Ground In The Health Care Debate?
By Justin Gardner | Related entries in Health Care
Jason over at Poligazette sends over a worthwhile post about the ins and outs of the health care “non-debate” and identifies 4 key points that he feels are potentially consensus building.
- Serious fees imposed on employers that drop health coverage to dump employees on to the government plan. These fees would have to be sufficient to make up the cost to the government of the new additions.
- New budgeting procedures that ensure providers have incentive to account for future as well as current demand in research as well as equipment investment.
- Tort reform to relieve doctors of fear about being sued for failing to do every test available.
- Market-based mechanisms like co-operatives that could pool some of the 47 million uninsured without dropping them directly onto an already overstretched government program.
To my knowledge, some Dems have proposed #1 and #4, but not #2 and #3. Repubs have definitely proposed #3, but I’m not sure anybody has proposed #2.
Obviously tort reform (#3) is especially contentious in Dem circles given their allegiances with trial attorneys, but if we’re going to set specific guidelines for medical costs, having some limits on damages people can receive on botched medical procedures makes sense too.
However, do you really think Republicans would ever accept fees for employers who dump their coverage (#1)? I have serious doubts about that because it would be quickly positioned as “anti-business,” even though it’s designed to prop up private insurance.
Last, I think #2 hasn’t been brought up because health care is still a lucrative industry (despite all the misinfo) and there aren’t any good reasons to stop research and development. Remember, we’re not talking about single payer, government run health care here. Obama and the Dems simply want to get everybody in the system and increase competition so costs can be controlled. And this could be accomplished by #4.
In any event, what do you think? Could both sides agree on these? Could these 4 simple things really keep costs under control?
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August 13th, 2009 at 1:48 pm
With all due respect to point #3, much of what has gone into tort reform focuses on limiting punitive damages… and much of what I read has indicated it has never worked. I will refer you to The Medical Malpractice Myth as one source that has detailed this.
If one is going to focus on tort reform, it needs to be meaningful. Contrary to popular belief, those who file medical malpractice suits aren’t all thinking about how much they can get in punitive damages, but usually do so because they cannot reach an agreement with the doctor regarding what responsibility should be assumed for mistakes.
If we are not referring to punitive damages, but the actual damages the plantiff suffered, all I will say is this: If a doctor makes a mistake for which he was genuinely incompetent or negligent in the performance of his duties, he must be held accountable for all costs associated with correcting the mistake. Reducing that number is a bad idea.
August 13th, 2009 at 2:17 pm
There will be absolutely no Republican support so long as there is a public option in any way, shape or form included in the package. You can count on that. That being said, the last time I counted there were a supermajority of Democrats in the House and Senate, therefore there is no need for bipartisan support to pass anyhting.
August 13th, 2009 at 3:28 pm
I think that the Democrats’ insistence on a “public option” amounts to a slippery slope to single-payer reform for a couple of reasons, Justin. First, provisions already exist in at least some of the Democratic proposals that limit or prohibit the writing of new private-sector health insurance policies. Thus, those that already have private insurance may be able to keep it, as the President says, but over years to come those would gradually dissolve away as people changed jobs and new workers joined the system. The end state would be a single-payer health care system, under such versions of the “public option”.
But even if those provisions are stripped out, the fact that the government program would be subsidized and exempt from regulatory constraints that would hang on private insurers like an albatross means that it is unlikely that a truly mixed public/private system would be sustained for long.
And let’s not forget that many single-payer advocates have been pushing for a “public option” for a long time with the explicit intention to use it as a transitional step to a fully single-payer system.
For these reasons, I think it is essential to deal with items like #2 in recognition of the probable future direction of any reformed health care system proposed and passed by a Democratic Congress, signed by a Democratic President, and influenced by Democratic interest groups and activists that have long been committed to single-payer health care.
August 13th, 2009 at 5:22 pm
Okay folks…then what’s the alternative to some form of public option that can compete with private industry? I’m all ears.
Also, some questions…
- If we have the best health care in the world, why don’t we live the longest?
- Related to the first question, why are we not #1 on those lists for the least amount of diseases per capita?
- Why do we allow private insurance companies to do the exact same things right this minute that critics are saying a government run option WILL do in the future?
- What makes you think that medical innovation will stop? Everybody gets stick. There’s still an insane amount of money to be made to find cures. How is that motive taken away because of a government option?
Looking forward to the answers.
August 13th, 2009 at 7:01 pm
Justin
First, your questions…
1)Demographics, obesity, and young black men who like to shoot each other. Why do people live to be 80 in Hawaii and only 73 in Mississippi under the same health care regime?
Remeber the old Milton Friedman line? A Swede told Friedman that they didn’t have poverty in Sweden. Friedman replied that Swedes in America didn’t have poverty, either.
2)Why should we be #1? If 30% (real number) of America’a population is officially obese, and 8% (“internet statistic”) of Japan’s population is obese, which population is going to have a higher incidence of diabetes, coronaries, strokes, etc.?
3)I can quit my insurance company at any time. Not so much my gov’t… I got smart and de-coupled my health insurance from my employment 20 yrs ago -through 14 different changes in employment, I have had three insurance providers.
My objection is not w/ a public option per se, but the regulatons surrounding it. All health plans will have to cover “first dollar” on “preventative medicine”- effectively eliminating the “hi-deductible” ($5k/yr $2 million total limit) catastrophic care plan that I love.
I haven’t had a “annual check-up” (nor a medical bill not due to injury) in 28 years- why do I want to pay for one I won’t need or use in my insurance coverage? And if I do eventually go get my colon scoped, why not pay cash?
4)So, the “public option” which is going to “bend the cost curve down” partially because taking the blue pill is cheaper than the red one, is also going to pay an insane amout of money for these new cures… Look at Medicare reimbursement rates- most doctors limit the number of Medicare patients because they lose money on each. Why would a Pharm want to invest a billion in bringing a new drug to market if the Gon’t will only pay 750 million?
Regards Fletch
August 13th, 2009 at 7:07 pm
If you take out fatal car accidents and homicides, we do in fact, lead the world in life expectancy. Apparently, we need more reform in civil engineering and law enforcement, but that is a different town hall meeting.
My guess? Too many Mexicans. Just kidding. Don’t ban me. Maybe some more shenanigans with collecting statistics? The WHO certainly does it with infant mortality
because the scope and scale of those bad things are worse under socialized medicine, and a single payer system would be a beurocratic monopoly that will likely become to inflexible to change for the better.
If the government option becomes a hegemony and fixes prices like medicare does, profits for pharma and medical tech companies will go down (isn’t that what you want?), and there will be less private investor capital for available for new R&D. Most of the worlds drug companies rely on the U.S. market to generate their profits before their pattents run out. The governement will then be burdened not only with funding more of the health care, but also more of the research, that is, if we want to continue to innovate.
August 13th, 2009 at 7:25 pm
ADDENDUM:
The government doesn’t allow the private industry to compete with itself. Obama has promised that the public option will be portable and available to everyone. Is there even a single private insurer in the country that is allowed to be portable and available to everyone in the same way? So we should:
1) Decouple insurance from employment completely. Give individual citizens the ability to deduct a health insurance plan they buy themselves from their own taxes, instead of their employer, who would then pay the full compensation in cash.
2) Allow citizens to shop for health insurance across state lines. There should be no state licensing.
3) Reduce government mandates on the insurance industry so that they provide insurace for catastrophic injury, congenital defects and chronic disease only. Routine care or mild, acute ailments should be paid for out of pocket.
4) Allow for small health clinics to emerge that take walk in appointments for routine care – which would probably cost no more than a co-payment costs today. Almost all pharmacies are attatched to some convenient store or Walgreens or something. There should be clinics like that around the country.
These line items have all been proposed by republicans in congress, but apparently they don’t count, so people like Justin can continue smearing them and saying they “simply don’t want health care reform.”
August 13th, 2009 at 8:11 pm
*Emperor Fletch’s Health Care Plan*
1)Mandatory catastrophic care for all plans as I mentioned above- including eliminating Medicaid entirely (Huge cost savings!), and taxing employer provided insurance as income. This allows us to generously subsidize the poorest with a cash voucher equal to their plan’s deductible w/ a sliding scale up to 200% poverty level- and it’s cheaper than what we have now. If you want something similar to your current plan, you pay for it.
2)Tort Reform
3)Allow insurance companies to “pool” nationally, rather than by 50 individual states -which merely limits “pool sizes” and “market sizes” in favor of the insurance behemoths that can afford to structure and maintain reserves for a plan in each state.
4)End the domination of the AMA in med school enrollments, licensing, and medical regulations.
I stepped on a nail last week. Went to the corner “doc in a box” because I hadn’t had a tetanus shot in a while. The nurse cleaned the wound, then I sat there for 15 minutes until the doctor came over- she looked at it for ten seconds and told the nurse to give me the tetanus shot the nurse had already prepared. Why was that doctor necessary? (The State says so!) How much extra did I pay for that 10 second consultation?
47 million “uninsured” all suddenly getting “free” health care… Do we have enough doctors to prevent waiting lists?
5)Health Care IT improvements. It won’t save any money, as all those correlations discovered between treatments and outcomes are just as likely to raise costs as lower them, but knowledge rocks.
(Who knew that patented plaque busters and “balloon angioplasty” were more effective than a daily nitroglycerin pill?)
——————————————————————-
I think that’s a rational plan for the beginning of a reform. We can assess the effects, and find changes for the “unintended consequences”.
(My CAPTCHA words are Teamsters and McMahon) I see union thugs talking like professional wrestlers! :o)
August 13th, 2009 at 8:13 pm
Jimmy types faster than me! :o(
August 13th, 2009 at 8:24 pm
Jimmy:
And people who can’t afford insurance?
How about people who can’t afford the routine out-of-pocket care? Why shouldn’t they just stall until the problems crosses the threshold into covered territory?
What about pre-existing conditions?
What about cherry-picking insurers all chasing the most profitable (healthiest) clients and pricing sick people out of the market?
How do we ensure that employers don’t just pocket the savings?
Drugs?
August 13th, 2009 at 8:31 pm
Jimmy:
Oh, and preventative care? Who’s paying for immunizations — a hepatitis shot costs a few bucks, hepatitis itself can cost hundreds of thousands. Colonoscopies? Skin cancer screening? Childhood immunizations?
What about responses to epidemics. Let’s say the flu shot costs $20 but you figure you’re healthy and since you’re on minimum wage that $20 represents three hours of your labor. And Jimmy already made you spend $150 for your statin and your blood pressure meds, so hey, why spend the $20?
What happens when you lose your job and can’t pay your premiums?
What happens if you only clear $700 a month and your premium is half that? Or you clear 1500 a month and your premium is half that so that any out of pocket at all is enough to bankrupt you?
August 13th, 2009 at 9:05 pm
Pay for it with your raise in pay that everyone gets becuase their employers now pay all your compensation in cash. The change from employer benefits to individual coverage would be revenue neutral. Plus, you now have the option to shop for a cheaper plan.
I suppose you don’t get covered. Unlike today where everyone who loses their Job instantly loses coverage. Or there could be some temporary system, like unemployment compensation that could keep you afloat. You don’t need single payer to do that.
Your insurance company would pay for it, there are lots of them that already do (my insurance covers colonoscopies and dermatology); or you could qualify for a government program to provide you for your vaccinations (they aren’t that expensive). You might not need to worry since costs would come down so much that you could get your colon inspected practically for free! No public option needed here either.
Is this the worst case scenario? I’ll take it.
August 13th, 2009 at 9:42 pm
Jimmy:
I assume you’re not really this clueless:
Pay for it with your raise in pay that everyone gets becuase their employers now pay all your compensation in cash.
You do know that many employers — almost all at the lower end — don’t pay for health insurance at all, right?
Your insurance company would pay for it…
Except: no, they don’t. Maybe yours does, most don’t.
Is this the worst case scenario? I’ll take it.
Brilliant. Who cares about epidemics? Epidemics are fun!
Jimmy, you have nothing here. Not even a fig leaf. Which does not differentiate you from the rest of the What Me Worry? Republicans.
Nothing is important unless it’s happened to you.
August 13th, 2009 at 9:51 pm
“Pay for it with your raise in pay that everyone gets becuase their employers now pay all your compensation in cash.”
That was hilarious. No, no companies are going to just pocket the difference and leave their employees at the same compensation level they’re currently at. No, not one. OK, that was right. It won’t be one. It will be thousands.
August 13th, 2009 at 9:54 pm
Jim:
Clearly you have fallen victim to cynicism.
August 13th, 2009 at 10:38 pm
What if they had to.
So pick mine.
So you are saying the only possible way to vaccinate people is a through a single-payer system?
Of the 46 million uninsured, 17 million make over 40K, and 9 million are illegal immigrants. That leaves about 5% of the American population legitimately uninsured, and nearly half of all uninsured only go without coverage for 4 months or less. We can find a way to help them out without a government takeover.
August 14th, 2009 at 7:21 am
ADDENDUM:
On second thought, maybe you are right Mike. That polio outbreak of 1997 was devestating. If only we had single-payer healthcare, or a government option 60 years ago, we could have avoided this tragedy.
August 14th, 2009 at 9:37 am
First a response to Justin’s proposals:
1. Serious fees imposed on employers that drop health coverage to dump employees on to the government plan. These fees would have to be sufficient to make up the cost to the government of the new additions.
This implies there will be a government plan. AKA: the public option. There’s no way in hell the GOP will go for that.
They know the left wants a public option, they also know that in 2010 turnout will be 35%. If the they can thwart the public option they’ll rally their base, and discourage the Democratic base, assuring that the majority of that 35% is Republican.
2. New budgeting procedures that ensure providers have incentive to account for future as well as current demand in research as well as equipment investment.
What does this mean?
I tried to go to PoliGazette for an explanation, but I got a 404. :-(
It sounds nice, but given that I’ve never heard of it I’d bet that a) it’s a brand new idea somebody pulled from his ass, and therefore we haven’t had much opportunity to examine, or b) it’s total BS.
3. Tort reform to relieve doctors of fear about being sued for failing to do every test available.
This has been tried many, many, many times. Most states have implemented it at least once. It simply does not work.
I’m not opposed to it in principle, so if you could convince that the GOP would support something sensible as long as it included tort refoirm I’d do it in a heartbeat.
4. Market-based mechanisms like co-operatives that could pool some of the 47 million uninsured without dropping them directly onto an already overstretched government program.
In point 1 you said there’d be a Public Option. It’s theoretically possible to have both a co-op and a public option, but given that the Blue Dogs only dreamed up the co-ops as an alternative to the Public Option…
If you’re talking real co-ops I’d be somewhat interested, especially if they could use MediCare rates. I’m very uncomfortable with the whole idea, tho. One of Conrad’s models is Ocean Spray, and a health Insurance co-op on the Ocean Spray model is not a co-op of patients, it’s a co-op of insurance companies.
August 14th, 2009 at 9:53 am
1) Decouple insurance from employment completely. Give individual citizens the ability to deduct a health insurance plan they buy themselves from their own taxes, instead of their employer, who would then pay the full compensation in cash.
Good idea, but politically impossible. The Dems need unions, and unions will only support ending the employer-based system if we switch over to Single-Payer.
The GOP won’t do it because the business community is only just now starting to figure out that the employer-based system is really bad for them.
2) Allow citizens to shop for health insurance across state lines. There should be no state licensing.
3) Reduce government mandates on the insurance industry so that they provide insurace for catastrophic injury, congenital defects and chronic disease only. Routine care or mild, acute ailments should be paid for out of pocket.
That’s an extremely radical model.
I can’t support because I don’t think it would work. People would skimp on the primary care that costs very little, and insurane companies would then be on the hook for huge medical bills.
The only way around that is their current model of throwing sick people off for no good reason, and then refusing to charge said sick people reasonable rates
People really hate the pre-existing conditions clauses, and that sick folks get charged more. So good luck getting that through the Senate.
4) Allow for small health clinics to emerge that take walk in appointments for routine care – which would probably cost no more than a co-payment costs today. Almost all pharmacies are attatched to some convenient store or Walgreens or something. There should be clinics like that around the country.
Is there anything stopping that from happening now?
August 14th, 2009 at 10:13 am
1)Mandatory catastrophic care for all plans as I mentioned above- including eliminating Medicaid entirely (Huge cost savings!), and taxing employer provided insurance as income. This allows us to generously subsidize the poorest with a cash voucher equal to their plan’s deductible w/ a sliding scale up to 200% poverty level- and it’s cheaper than what we have now. If you want something similar to your current plan, you pay for it.
I wouldn’t oppose something like that as long as there was a public option.
Preferably also standardized terminology so non-lawyers could finally understand exactly what their policies cover.
2)Tort Reform
It’s been tried. It doesn’t work unless you restrict actual damages. And if you did that there’d be tearful stories on TV about the poor guy whose Doctor screwed up, causing a $50,000 ER visit, a $400,000 hospital stay, $350,000 in rehab, needs $60,000 a year to pay for medications, etc. But under the new Tort reform he has to be happy with $50,000, minus attorney’s fee, minus Court costs, etc.
Politicians know that, so they never even try. And every decade or so there’s an uptick in malpractice insurance costs, the Doctors go ballistic, and a new round of tort reform fails utterly.
3)Allow insurance companies to “pool” nationally, rather than by 50 individual states -which merely limits “pool sizes” and “market sizes” in favor of the insurance behemoths that can afford to structure and maintain reserves for a plan in each state.
It’s nice to see this coming from a rightie. most of them don’t seem to understand how insurance works. You do.
This could increase competition in the insurance market. In the long term it probably wouldn’t — a risk pool of 50,000,000 is more efficient than a risk pool of 5,000,000. That means mergers. Lots of mergers.
Given that insurance companies negotiate with hospitals individually it’s also possible that we’d keep de facto state monopolies and duopolies. Why would a hospital in Nome, Alaska offer a discount to an insurer whose patients all live in LA? Why not tell them to go jump, and then charge a mint when one of those poor Angelinoes shows up in the ER?
Which is, of course, another reason for that LA insurance company to buy one of Nome, AK’s major insurers before it tries to negotiate prices there.
4)End the domination of the AMA in med school enrollments, licensing, and medical regulations.
How would would this help?