The Democrats celebrated an overtime victory in the health care Super Bowl in subdued fashion--no champagne corks popped in the Oval Office, no one dumped Gatorade on Nancy Pelosi--a suitable response to winning by not losing.
When the cry of "baby killer" at Bart Stupak had faded and the last vote was counted, the significance of a year-long struggle was that Republicans had failed to bring down the Obama Administration with a crushing defeat.
In our cut-your-losses age, this is no small matter, but passing a convoluted package of "reforms," most of which won't kick in for years, is hardly the equivalent of bringing Americans Social Security and Medicare, as Democratic leaders claim.
The bill, says a New York Times editorial, "represents a national commitment to reform the worst elements of the current system...Our hope and belief is that this reform will in the end accomplish its great objectives. Right now, the good news for all Americans is that despite all the politics and the obstructionism, the process has finally begun."
There is much to be said for "hope and belief," but as with the economic stimulus and jobs bill, this Obama accomplishment will be a long time in putting bread on American dinner tables.
That said, the President deserves credit for not wavering in the face of Tea Party rage and the Scott Brown surprise in taking over the seat of Ted Kennedy, whose widow praised the House victory in his memory.
But not losing is far from winning and, in the months ahead, Democrats will have to work hard to persuade dispirited voters that, despite total Republican obstructionism, something is better than nothing.
If they had lost yesterday, it would have been a political disaster.
Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts
Monday, March 22, 2010
Thursday, January 21, 2010
Radical Surgery for Health Care
Once, under local anesthesia on an operating table, I overheard doctors in heated disagreement on what to do next. It was not reassuring, but compared to Washington squabbling over health care reform after the Massachusetts debacle, restful.
The Surgeon-in-Chief wants to "move quickly to coalesce around those elements of the package that people agree on. We know that...health insurance companies are taking advantage." He cites the need for "essentially a patient's bill of rights on steroids."
As he complains about "a fixation, an obsession in terms of the focus on the health care process in Congress," the President still insists "I'm not going to get into the legislative strategy...my job is to as president, is to send a message in terms of where we need to go...to set direction."
But how do you set direction for an unharnessed team of horses going every which way while tethered to another that is dug in not to move at all?
Paul Krugman translates Obama's prescription as “Run away, run away!" but when the finger-pointing is over, there will have to be a fallback consensus. In the Washington Post, Ezra Klein proposes something "real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy."
But it's unlikely that anything "real simple" will pass in today's climate. If Congress wants to get back to basics, there are elements of reform that would have widespread public approval--among them, the requirement that insurance companies spend at least a fixed percentage of premiums on patient care rather than maximize profit; that they stop cancelling people out for pre-existing conditions; and, perhaps, most crucial of all, that everyone have access to some form of affordable catastrophic insurance to keep families from going bankrupt when serious illness strikes.
That doesn't seem like too much to ask but, as Washington quacks keep gabbling to make political points rather than heal the health care system, who will get them to focus on the operating table?
The Surgeon-in-Chief wants to "move quickly to coalesce around those elements of the package that people agree on. We know that...health insurance companies are taking advantage." He cites the need for "essentially a patient's bill of rights on steroids."
As he complains about "a fixation, an obsession in terms of the focus on the health care process in Congress," the President still insists "I'm not going to get into the legislative strategy...my job is to as president, is to send a message in terms of where we need to go...to set direction."
But how do you set direction for an unharnessed team of horses going every which way while tethered to another that is dug in not to move at all?
Paul Krugman translates Obama's prescription as “Run away, run away!" but when the finger-pointing is over, there will have to be a fallback consensus. In the Washington Post, Ezra Klein proposes something "real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy."
But it's unlikely that anything "real simple" will pass in today's climate. If Congress wants to get back to basics, there are elements of reform that would have widespread public approval--among them, the requirement that insurance companies spend at least a fixed percentage of premiums on patient care rather than maximize profit; that they stop cancelling people out for pre-existing conditions; and, perhaps, most crucial of all, that everyone have access to some form of affordable catastrophic insurance to keep families from going bankrupt when serious illness strikes.
That doesn't seem like too much to ask but, as Washington quacks keep gabbling to make political points rather than heal the health care system, who will get them to focus on the operating table?
Tuesday, November 10, 2009
From "No" to "Boo!"
In the battle over health care, the Republican Right, after months of saying no to every Obama initiative from stimulus to bailouts, has gone on the offensive to slice and dice Americans into warring factions--young-old, men-women, rich-poor, anywhere fear and hatred can be stirred up.
Sarah Palin, bless her feisty heart, started it all with "death panels," but naysayers are now working the other side of the age divide. After warning the young that ObamaCare will kill their Granny, they are now goading them with worries that Granny will impoverish them by raising premiums at their expense.
In the House bill, they have driven a wedge into well-settled policy over abortion that would expand restrictions on what the President yesterday called "the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions” but, in his diplomatic way, said he wanted to make sure “we’re not restricting women’s insurance choices."
On a broader front, the Wall Street Journal uncovers, on the basis of a New Yorker writer's blog post, the sinister purpose of it all--"to further redistribute income by putting health care further under government control, and in the process making the middle class more dependent on government."
As the fear-mongering escalates, little wonder that Gallup finds "no clear mandate" while Americans struggle to understand what's in thousands of pages of proposed legislation and Republicans keep crying "Boo!" at every turn.
Someone should tell them that Halloween is over and that it's time to get serious about bargaining over legislation that will affect us all for a long time.
Sarah Palin, bless her feisty heart, started it all with "death panels," but naysayers are now working the other side of the age divide. After warning the young that ObamaCare will kill their Granny, they are now goading them with worries that Granny will impoverish them by raising premiums at their expense.
In the House bill, they have driven a wedge into well-settled policy over abortion that would expand restrictions on what the President yesterday called "the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions” but, in his diplomatic way, said he wanted to make sure “we’re not restricting women’s insurance choices."
On a broader front, the Wall Street Journal uncovers, on the basis of a New Yorker writer's blog post, the sinister purpose of it all--"to further redistribute income by putting health care further under government control, and in the process making the middle class more dependent on government."
As the fear-mongering escalates, little wonder that Gallup finds "no clear mandate" while Americans struggle to understand what's in thousands of pages of proposed legislation and Republicans keep crying "Boo!" at every turn.
Someone should tell them that Halloween is over and that it's time to get serious about bargaining over legislation that will affect us all for a long time.
Monday, October 12, 2009
Health Insurance Parasites Unmask
After months of conning the President with promises of cooperation, the thieves who siphon off one out of every three dollars spent on health care are finally out in the open as reform legislation comes up for its first Congressional vote.
"In a blistering new attack," the New York Times reports, "the health insurance industry said Sunday that health care legislation drafted by Senate Democrats would drive up premiums, rather than making coverage more affordable, as the White House contends."
The industry lobby, America’s Health Insurance Plans, gave its verdict on the bill to be voted on by the Senate Finance Committee after weeks of wrangling and watering down:
“The overall impact will be to increase the cost of private insurance coverage for individuals, families and businesses above what these costs would be in the absence of reform.”
Wrong, but only what was to have been expected of the profiteers who hold Americans' lives hostage to their greed.
As late as Saturday, in his weekly address, President Obama was touting industry cooperation: "What's remarkable is not that we've had a spirited debate about health insurance reform, but the unprecedented consensus that has come together behind it."
Critics will call this naïveté, as unrealistic as Obama's hopes for bipartisanship on other issues, but it may be seen as going the extra mile to reach out for "consensus" that never comes at moments of decision, even after lip service to cooperation.
Now, the White House and the Democrats who control Congress can end the charades and get down to old-fashioned bare knuckles politics in pushing through what remains of health care reform.
"In a blistering new attack," the New York Times reports, "the health insurance industry said Sunday that health care legislation drafted by Senate Democrats would drive up premiums, rather than making coverage more affordable, as the White House contends."
The industry lobby, America’s Health Insurance Plans, gave its verdict on the bill to be voted on by the Senate Finance Committee after weeks of wrangling and watering down:
“The overall impact will be to increase the cost of private insurance coverage for individuals, families and businesses above what these costs would be in the absence of reform.”
Wrong, but only what was to have been expected of the profiteers who hold Americans' lives hostage to their greed.
As late as Saturday, in his weekly address, President Obama was touting industry cooperation: "What's remarkable is not that we've had a spirited debate about health insurance reform, but the unprecedented consensus that has come together behind it."
Critics will call this naïveté, as unrealistic as Obama's hopes for bipartisanship on other issues, but it may be seen as going the extra mile to reach out for "consensus" that never comes at moments of decision, even after lip service to cooperation.
Now, the White House and the Democrats who control Congress can end the charades and get down to old-fashioned bare knuckles politics in pushing through what remains of health care reform.
Wednesday, September 16, 2009
Health Care Reform at the OK Corral
Max Baucus' Gang of Six has turned into the Gang That Couldn't Shoot Straight by blowing enough holes into the health care bill to leave it bleeding on the Senate Finance Committee floor, the OK Corral of the new politics.
The bipartisan bunch has broken apart, with the last Republican, Maine's Olympia Snowe, holstering up over a proposal to tax high-cost medical insurance, which is prevalent in her state.
For his pains in trying to placate Republicans, the Chairman has, at least temporarily, lost his own Doc Holliday, Jay Rockefeller, who calls himself "probably one of his best friends among Democrats," for Baucus' concessions to win the now-gone GOP members of the Gang that killed the public option and scaled back affordability provisions for the poor.
Yet somehow, something will emerge from the Senate Sausage Factory packaged as health care reform and, after more bickering, bartering and butchering in both houses of Congress, leave all sides unsatisfied but allow the White House to claim victory in what the President calls solving eighty percent of the problem.
Wyatt Earp would have turned in his badge and left town.
The bipartisan bunch has broken apart, with the last Republican, Maine's Olympia Snowe, holstering up over a proposal to tax high-cost medical insurance, which is prevalent in her state.
For his pains in trying to placate Republicans, the Chairman has, at least temporarily, lost his own Doc Holliday, Jay Rockefeller, who calls himself "probably one of his best friends among Democrats," for Baucus' concessions to win the now-gone GOP members of the Gang that killed the public option and scaled back affordability provisions for the poor.
Yet somehow, something will emerge from the Senate Sausage Factory packaged as health care reform and, after more bickering, bartering and butchering in both houses of Congress, leave all sides unsatisfied but allow the White House to claim victory in what the President calls solving eighty percent of the problem.
Wyatt Earp would have turned in his badge and left town.
Wednesday, September 02, 2009
Obama's Blackboard Jungle
As summer vacation ends, the President is looking like the principal of a dysfunctional high school, trying to quell yelling in the corridors and fist fights in the auditorium and get the student body to pay attention to what's going on in class.
Shades of "The Blackboard Jungle," in which an idealistic teacher struggles to educate a rowdy mob that controls the school! In that classic 1955 movie, the hero has to take away switchblade knives before he can inspire rambunctious students to start paying attention.
In today's Washington, the learning curve is at a standstill, and it's unclear how much lecturing can get through the clamor of an undisciplined crowd. But the former law school professor will give it a try with an address to Congress next Wednesday to confront critics and stimulate supporters of health care reform.
Meanwhile, the parent body is losing confidence that anything constructive is going on in Obama High, and the President is already taking steps to connect with the next generation through a national address to students the day before he tackles the invincible ignorance of Washington lawmakers.
Shades of "The Blackboard Jungle," in which an idealistic teacher struggles to educate a rowdy mob that controls the school! In that classic 1955 movie, the hero has to take away switchblade knives before he can inspire rambunctious students to start paying attention.
In today's Washington, the learning curve is at a standstill, and it's unclear how much lecturing can get through the clamor of an undisciplined crowd. But the former law school professor will give it a try with an address to Congress next Wednesday to confront critics and stimulate supporters of health care reform.
Meanwhile, the parent body is losing confidence that anything constructive is going on in Obama High, and the President is already taking steps to connect with the next generation through a national address to students the day before he tackles the invincible ignorance of Washington lawmakers.
Wednesday, August 26, 2009
The Kennedy Brother Who Died in Bed
At the age of twelve, he pestered his family to let him contribute to a memorial volume about his oldest brother, Joe, who had been lost in World War II. What Teddy Kennedy chose to remember was how, after hounding Joe into letting him crew in a sailboat race and failing to help him win, he found himself thrown into icy water, only to be lifted back up seconds later by his brother's strong arms.
That fierce Kennedy will to win, coupled with even fiercer family love, marked the life of the man who died today, the only one of four brothers to survive into old age and fulfill the promise of those other lives cut short by the violence of a world in which they never stopped competing.
Remembered by President Obama as "a great leader, who picked up the torch of his fallen brothers and became the greatest United States Senator of our time," Edward Moore Kennedy, for those who lived through those times, is also proof that redemption is possible, that there are second and even third acts in American lives.
Expelled from Harvard for cheating, becoming a Senator at 30 through nepotism, being disgraced by Chappaquiddick, Ted Kennedy overcame all that and more to morph in his last years into "the lion of the Senate," fighting fiercely for the rights of those with less privileged lives than his own.
Ironically, he leaves this world in a time of debate over the value of preserving lives indefinitely as a reminder that there is no expiration date on the human spirit. Ted Kennedy won't be here to vote on health care reform, but he will have made a vital contribution to what he called "the cause of my life."
That fierce Kennedy will to win, coupled with even fiercer family love, marked the life of the man who died today, the only one of four brothers to survive into old age and fulfill the promise of those other lives cut short by the violence of a world in which they never stopped competing.
Remembered by President Obama as "a great leader, who picked up the torch of his fallen brothers and became the greatest United States Senator of our time," Edward Moore Kennedy, for those who lived through those times, is also proof that redemption is possible, that there are second and even third acts in American lives.
Expelled from Harvard for cheating, becoming a Senator at 30 through nepotism, being disgraced by Chappaquiddick, Ted Kennedy overcame all that and more to morph in his last years into "the lion of the Senate," fighting fiercely for the rights of those with less privileged lives than his own.
Ironically, he leaves this world in a time of debate over the value of preserving lives indefinitely as a reminder that there is no expiration date on the human spirit. Ted Kennedy won't be here to vote on health care reform, but he will have made a vital contribution to what he called "the cause of my life."
Tuesday, June 23, 2009
Left, Right and Wrong on Health Care
If you doubt that liberal and conservative have lost all meaning in the health care debate, consult the New York Times' columnists of those persuasions.
On the left, Paul Krugman predicts reform "will be undermined by 'centrist' Democratic senators who either prevent the passage of a bill or insist on watering down key elements...
"What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs."
On the right, David Brooks insists: "We’ve built an entire health care system (maybe an entire government) on the illusion of something for nothing. Instead of tackling that basic logic, we’ve got a reform process that is trying to evade it."
Brooks argues for a plan by Democrat Ron Wyden and Republican Robert Bennett to repeal tax exemptions for insurance premiums and provide universal coverage. "The Wyden-Bennett bill has 14 bipartisan co-sponsors and the Congressional Budget Office has found that it would be revenue-neutral," he claims, but Senate Committee leaders of both parties are concentrating instead on "grand rhetoric and superficial cost containment."
The political hot air on Capitol Hill is filled with nonsense from both sides of the aisles, and so far the White House has been unwilling to make them stop the political blather and face reality.
On the left, Paul Krugman predicts reform "will be undermined by 'centrist' Democratic senators who either prevent the passage of a bill or insist on watering down key elements...
"What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs."
On the right, David Brooks insists: "We’ve built an entire health care system (maybe an entire government) on the illusion of something for nothing. Instead of tackling that basic logic, we’ve got a reform process that is trying to evade it."
Brooks argues for a plan by Democrat Ron Wyden and Republican Robert Bennett to repeal tax exemptions for insurance premiums and provide universal coverage. "The Wyden-Bennett bill has 14 bipartisan co-sponsors and the Congressional Budget Office has found that it would be revenue-neutral," he claims, but Senate Committee leaders of both parties are concentrating instead on "grand rhetoric and superficial cost containment."
The political hot air on Capitol Hill is filled with nonsense from both sides of the aisles, and so far the White House has been unwilling to make them stop the political blather and face reality.
Wednesday, June 17, 2009
Obama Fatigue
After five months in office, his whirlwind presidency is taking a toll on the President in more ways than one.
Worrying about the economy "keeps me awake at night," he told an interviewer yesterday.
At the same time, signs of Obama Fatigue are showing up among his own party in Congress over the massive muddle of health care reform. His tireless cheer-leading has failed to paper over Democratic differences and delayed markup this week of competing bills to expand coverage and rein in out-of-control costs.
In what could be a Summer of Discontent, worries by and over a President who, depending on critics' politics, has too much on his plate or is overreaching keep surfacing daily.
"I am concerned," he admitted yesterday, "about our long-term debt because if we don't get a handle on that then there's no doubt that at some point whether it's the Chinese, the Koreans, the Japanese, whoever else has been snatching up Treasuries are going to decide that this is too much of a risk."
Meanwhile, as he prepares to announce a new plan for regulating the financial system, there are reports of in-fighting among the regulators even after efforts to achieve a broad consensus outside the White House.
At the rate that Barack Obama is spending his mandate, even his most ardent admirers will soon need time to catch their breaths for the marathon of Change in the three and a half years ahead. The headwinds are getting stronger.
Worrying about the economy "keeps me awake at night," he told an interviewer yesterday.
At the same time, signs of Obama Fatigue are showing up among his own party in Congress over the massive muddle of health care reform. His tireless cheer-leading has failed to paper over Democratic differences and delayed markup this week of competing bills to expand coverage and rein in out-of-control costs.
In what could be a Summer of Discontent, worries by and over a President who, depending on critics' politics, has too much on his plate or is overreaching keep surfacing daily.
"I am concerned," he admitted yesterday, "about our long-term debt because if we don't get a handle on that then there's no doubt that at some point whether it's the Chinese, the Koreans, the Japanese, whoever else has been snatching up Treasuries are going to decide that this is too much of a risk."
Meanwhile, as he prepares to announce a new plan for regulating the financial system, there are reports of in-fighting among the regulators even after efforts to achieve a broad consensus outside the White House.
At the rate that Barack Obama is spending his mandate, even his most ardent admirers will soon need time to catch their breaths for the marathon of Change in the three and a half years ahead. The headwinds are getting stronger.
Monday, June 15, 2009
Health Care Horse Trading
In President Obama's house call on the AMA today, the medicine may be coated with a little sugar for doctors that will be a bitter pill for lawyers, setting limits on malpractice suits.
Such horse trading is par for the course in politics, but when the legislation gets into the final stretch, bedside manner won't be able to sooth away the critical issue--a public plan to keep private insurers honest.
Today's Wall Street Journal plays Paul Revere, sounding the alarm that "The 'Public Plan' Would Be the Only Plan," arguing that "It's impossible for private insurers to 'compete' with government." Such despair over free markets is unusual for the Journal and will certainly come as news to FedEx and e-mail providers who never should have challenged the federal postal system.
The air will be filled this week with similar pitches for sticking with old-time elixirs and, for the first time in quite a while, voters have a chance to lean on their Congressional barkers with messages through all channels about their wishes.
One of my own, Joe Lieberman, asserts there is "a real opportunity to do this year what we've been trying to do for years...reform American health care. I think the one thing that will stop that is pressure on the so-called public option. Let's get something done instead of having a debate."
I'll be sending back Dr. Lieberman's snake oil prescription with one of my own, hoping that millions of others, including the Physician-in-Chief, will do the same for Washington's political quacks.
Such horse trading is par for the course in politics, but when the legislation gets into the final stretch, bedside manner won't be able to sooth away the critical issue--a public plan to keep private insurers honest.
Today's Wall Street Journal plays Paul Revere, sounding the alarm that "The 'Public Plan' Would Be the Only Plan," arguing that "It's impossible for private insurers to 'compete' with government." Such despair over free markets is unusual for the Journal and will certainly come as news to FedEx and e-mail providers who never should have challenged the federal postal system.
The air will be filled this week with similar pitches for sticking with old-time elixirs and, for the first time in quite a while, voters have a chance to lean on their Congressional barkers with messages through all channels about their wishes.
One of my own, Joe Lieberman, asserts there is "a real opportunity to do this year what we've been trying to do for years...reform American health care. I think the one thing that will stop that is pressure on the so-called public option. Let's get something done instead of having a debate."
I'll be sending back Dr. Lieberman's snake oil prescription with one of my own, hoping that millions of others, including the Physician-in-Chief, will do the same for Washington's political quacks.
Monday, June 08, 2009
Health Care Sellout
The table is set for the Senate to cut the heart out of health care reform, with an ailing Ted Kennedy pitted against Max Baucus, recipient of $3 million from the industry over five years with a platoon of former staff members working as lobbyists for them.
Unless the White House rallies constituents to rise up, the Senate sellout will come from lawmakers hiding behind surgical masks--so-called compromises that will effectively kill what the President has called a public plan "to keep the insurance companies honest."
Former Labor Secretary Robert Reich lists some of them:
"One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to the states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they've been doing for years. A third is bind the public plan to the same rules private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers."
All these ploys, plus others to give lip service to a public option but keep it on ice indefinitely, are being lined up to placate voters but serve the interests of the health insurers' and medical providers' lobbies.
If the President is serious about Change, here is his chance to prove it by going head to head with the bought-and-paid-for Senators of both parties who are still playing their old games and counting on real health care reform as being too complicated for the American public to understand.
Nothing will shake up the power of Washington lobbyists more than an uprising on this issue, and the President will have to stand shoulder to shoulder with Ted Kennedy in what he told the Democratic Convention last summer is "the cause of my life."
Unless the White House rallies constituents to rise up, the Senate sellout will come from lawmakers hiding behind surgical masks--so-called compromises that will effectively kill what the President has called a public plan "to keep the insurance companies honest."
Former Labor Secretary Robert Reich lists some of them:
"One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to the states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they've been doing for years. A third is bind the public plan to the same rules private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers."
All these ploys, plus others to give lip service to a public option but keep it on ice indefinitely, are being lined up to placate voters but serve the interests of the health insurers' and medical providers' lobbies.
If the President is serious about Change, here is his chance to prove it by going head to head with the bought-and-paid-for Senators of both parties who are still playing their old games and counting on real health care reform as being too complicated for the American public to understand.
Nothing will shake up the power of Washington lobbyists more than an uprising on this issue, and the President will have to stand shoulder to shoulder with Ted Kennedy in what he told the Democratic Convention last summer is "the cause of my life."
Friday, June 05, 2009
Ghosts of Harry and Louise
The Senate Republican leader is channeling a couple of GOP golden oldies to oppose a public option in the health care reform pending in Congress.
Unlike Harry and Louise in the 1993 TV commercials to torpedo the Clintons' initiative, Mitch McConnell's protagonists are real people--sort of--Bruce Hardy of England and Shona Holmes of Canada, who have been brought out to personify the horrors of "socialized medicine." But their stories have been as edited as a TV commercial to make the point.
Hardy had to pay for a new cancer drug for two months before it was approved. McConnell's take: “The government bureaucrats who run Britain’s health care system denied the treatment, saying the drug was too expensive...that Bruce Hardy’s life wasn’t worth it.”
About Holmes, who paid for her own surgery in the US as she could have in Canada, the GOP leader finds this lesson: "Here’s how Shona described her plight: ‘If I’d relied on my government, I’d be dead,’ Shona’s life was eventually saved because she came to the United States for the care she needed.”
This Harry-and-Louise flummery is part of a last-ditch effort to persuade Americans that the choice of a public plan to, in President Obama's words, "keep the insurance companies honest" is no less than a takeover of the entire industry.
As Paul Krugman notes, there are two lessons in the current debate: "(1) Don't trust the insurance industry. (2) Don't trust the insurance industry...The insurance industry will do everything it can to avoid being held accountable."
Including manufacturing a new generation of Harrys and Louises.
Unlike Harry and Louise in the 1993 TV commercials to torpedo the Clintons' initiative, Mitch McConnell's protagonists are real people--sort of--Bruce Hardy of England and Shona Holmes of Canada, who have been brought out to personify the horrors of "socialized medicine." But their stories have been as edited as a TV commercial to make the point.
Hardy had to pay for a new cancer drug for two months before it was approved. McConnell's take: “The government bureaucrats who run Britain’s health care system denied the treatment, saying the drug was too expensive...that Bruce Hardy’s life wasn’t worth it.”
About Holmes, who paid for her own surgery in the US as she could have in Canada, the GOP leader finds this lesson: "Here’s how Shona described her plight: ‘If I’d relied on my government, I’d be dead,’ Shona’s life was eventually saved because she came to the United States for the care she needed.”
This Harry-and-Louise flummery is part of a last-ditch effort to persuade Americans that the choice of a public plan to, in President Obama's words, "keep the insurance companies honest" is no less than a takeover of the entire industry.
As Paul Krugman notes, there are two lessons in the current debate: "(1) Don't trust the insurance industry. (2) Don't trust the insurance industry...The insurance industry will do everything it can to avoid being held accountable."
Including manufacturing a new generation of Harrys and Louises.
Saturday, May 30, 2009
Obama in the Operating Room
Today's joint statement by Sens. Max Baucus and Ted Kennedy promising to “seek common ground on health reform legislation” is, in essence, a declaration of war over inclusion of a public insurance plan to compete with private companies.
As chairmen of the two powerful committees shaping the legislation, Baucus (Finance) and Kennedy (Health, Education, Labor and Pensions) will be jousting over the core issue that the Obama Administration has been tap-dancing around but will eventually have to face head-on in what promises to be a serious test of the President's toughness and resolve.
After failing to get more than a glimmer of bipartisanship on the stimulus bill, the President up to now has been wooing both the health care establishment and its Republican mercenaries, but the public option (Medicare-for-all) is the deal-breaker he will eventually have to face.
Baucus' Finance Committee, to get Republican Chuck Grassley and his crew on board, has been bending over backward with compromises that would give lip-service to a public plan but "only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years."
Kennedy and 28 other senators are not buying that, insisting, as are large numbers of House Democrats, on a public plan in the bill that would be sent to Obama, who has said it is needed to “keep the private sector honest,” but thus far has signaled only his vaunted pragmatism if the eventual showdown materializes.
Today's statement is an attempt to put a Band-Aid over Senate differences, but health care reform is ready for the operating table and the Surgeon-in-Chief will have to decide soon about where and how deep to make the incision.
As chairmen of the two powerful committees shaping the legislation, Baucus (Finance) and Kennedy (Health, Education, Labor and Pensions) will be jousting over the core issue that the Obama Administration has been tap-dancing around but will eventually have to face head-on in what promises to be a serious test of the President's toughness and resolve.
After failing to get more than a glimmer of bipartisanship on the stimulus bill, the President up to now has been wooing both the health care establishment and its Republican mercenaries, but the public option (Medicare-for-all) is the deal-breaker he will eventually have to face.
Baucus' Finance Committee, to get Republican Chuck Grassley and his crew on board, has been bending over backward with compromises that would give lip-service to a public plan but "only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years."
Kennedy and 28 other senators are not buying that, insisting, as are large numbers of House Democrats, on a public plan in the bill that would be sent to Obama, who has said it is needed to “keep the private sector honest,” but thus far has signaled only his vaunted pragmatism if the eventual showdown materializes.
Today's statement is an attempt to put a Band-Aid over Senate differences, but health care reform is ready for the operating table and the Surgeon-in-Chief will have to decide soon about where and how deep to make the incision.
Thursday, May 28, 2009
Ted Kennedy's Health Manifesto
For the coming political battle, the last Kennedy of his generation is sounding the trumpet for health care reform.
"Over the last year," he writes in a Boston Globe OpEd today, "I've seen our healthcare system up close. I've benefitted from the best of medicine, but I've also witnessed the frustration and outrage of patients and doctors alike as they face the challenges of a system that shortchanges millions of Americans."
In his manifesto, Kennedy hits all the notes of Obama's proposal for change and, albeit in a somewhat tentative way, for the highest of all. After promising more transparency in health insurance plans, negotiation for lower premiums and regulation to prevent denial of coverage for previously existing conditions, Kennedy writes:
"We're also hearing that some Americans want the choice of enrolling in a health insurance program backed by the government for the public good, not private profit--so that option will be available too."
That wording presages the crucial struggle to include a Medicare-for-all provision in the bill that would put pressure on private insurers to compete in the health care market instead of maximizing their profits.
Since his medical crisis last summer, Ted Kennedy has been fighting his own battle to survive. Now he clearly intends to leave a legacy that will give other Americans better odds in theirs.
"Change," he concludes, "is never easy, but the status quo is no longer acceptable to any except those who profit from the current broken healthcare system.
"We cannot afford to wait--or to fail. And we will do neither.
"And when successful reform takes hold, the American people will wonder what has taken us so long."
"Over the last year," he writes in a Boston Globe OpEd today, "I've seen our healthcare system up close. I've benefitted from the best of medicine, but I've also witnessed the frustration and outrage of patients and doctors alike as they face the challenges of a system that shortchanges millions of Americans."
In his manifesto, Kennedy hits all the notes of Obama's proposal for change and, albeit in a somewhat tentative way, for the highest of all. After promising more transparency in health insurance plans, negotiation for lower premiums and regulation to prevent denial of coverage for previously existing conditions, Kennedy writes:
"We're also hearing that some Americans want the choice of enrolling in a health insurance program backed by the government for the public good, not private profit--so that option will be available too."
That wording presages the crucial struggle to include a Medicare-for-all provision in the bill that would put pressure on private insurers to compete in the health care market instead of maximizing their profits.
Since his medical crisis last summer, Ted Kennedy has been fighting his own battle to survive. Now he clearly intends to leave a legacy that will give other Americans better odds in theirs.
"Change," he concludes, "is never easy, but the status quo is no longer acceptable to any except those who profit from the current broken healthcare system.
"We cannot afford to wait--or to fail. And we will do neither.
"And when successful reform takes hold, the American people will wonder what has taken us so long."
Wednesday, May 13, 2009
Exposed: HMO Torture Memo
As Dr. Scott Gottlieb, "a partner to a firm that invests in health-care companies," explains that the "surest way to intensify flaws in the delivery of health care is to extend a Medicare-like 'public option' into more corners of the private market," it seems only fair to balance the debate with a secret memo from the files of one of those enterprises in which the good doctor has such faith:
TO: Claims Prevention Department
FROM: President, HMO
Bills are being processed and paid without full use of our avoidance procedures. Such negligence impacts your company’s bottom line, let me review our guidelines:
1. Use the response “require more information from physician” to its full extent. Some providers fill in code numbers, diagnoses and dates of treatment. But who are these people? Can we trust them with the health of our insured not knowing when and where they went to medical school, how long they have been practicing, and whether they rent or own their Lexuses?
2. Handle phone queries properly. Quick answers deprive members of full participation in their care. For the persistent, employ your half-hour hold capability and, if that fails, tell them the computer is down and promise to call back. That will keep them close to their phones and away from doctors’ offices.
3. Don’t confuse claimants with data overload. Just indicate service is not covered because of a,b,c,d,z or some combination. Our forms make definitions of a,b,c,d,z easily comprehensible with the aid of a magnifying glass and legal dictionary.
4. Use “pre-existing condition” as a disqualification. If enrollees are treated for back pain or headaches, assume they had backs and heads before signing up. Are we to pay for problems that should have been treated in the past?
5. When all else fails, deny reimbursement with “This claim has been previously considered.” By the time the patient, physician, laboratory and hospital check with one another, no one will be sure who sent or received what. We should not pay twice or, better yet, once.
We will soon have new tools to aid in your work. A revised schedule of “customary fees” will reflect the global economy by factoring in provider charges of emerging nations. And our accountants are number-crunching the promising concept of a receding deductible.
Our new non-discriminatory policy of hiring applicants regardless of IQ, education or Attention Deficit Disorder will insure better performance in the future. Remember: A claim denied or delayed is a drop of lifeblood to the health of our organization.
Dr. Gottlieb and others may claim the memo is a hoax, but millions of Americans will testify that it understates the reality of what he glorifies as "inherently personal transactions between doctors and patients."
TO: Claims Prevention Department
FROM: President, HMO
Bills are being processed and paid without full use of our avoidance procedures. Such negligence impacts your company’s bottom line, let me review our guidelines:
1. Use the response “require more information from physician” to its full extent. Some providers fill in code numbers, diagnoses and dates of treatment. But who are these people? Can we trust them with the health of our insured not knowing when and where they went to medical school, how long they have been practicing, and whether they rent or own their Lexuses?
2. Handle phone queries properly. Quick answers deprive members of full participation in their care. For the persistent, employ your half-hour hold capability and, if that fails, tell them the computer is down and promise to call back. That will keep them close to their phones and away from doctors’ offices.
3. Don’t confuse claimants with data overload. Just indicate service is not covered because of a,b,c,d,z or some combination. Our forms make definitions of a,b,c,d,z easily comprehensible with the aid of a magnifying glass and legal dictionary.
4. Use “pre-existing condition” as a disqualification. If enrollees are treated for back pain or headaches, assume they had backs and heads before signing up. Are we to pay for problems that should have been treated in the past?
5. When all else fails, deny reimbursement with “This claim has been previously considered.” By the time the patient, physician, laboratory and hospital check with one another, no one will be sure who sent or received what. We should not pay twice or, better yet, once.
We will soon have new tools to aid in your work. A revised schedule of “customary fees” will reflect the global economy by factoring in provider charges of emerging nations. And our accountants are number-crunching the promising concept of a receding deductible.
Our new non-discriminatory policy of hiring applicants regardless of IQ, education or Attention Deficit Disorder will insure better performance in the future. Remember: A claim denied or delayed is a drop of lifeblood to the health of our organization.
Dr. Gottlieb and others may claim the memo is a hoax, but millions of Americans will testify that it understates the reality of what he glorifies as "inherently personal transactions between doctors and patients."
Monday, May 11, 2009
Life-and-Death Games
The health-care finals start in Washington today with the Obama home team hosting the all-stars who have made the American medical system one of the most expensive and least effective in the world.
The name of the game is cooperation as insurers, drug makers, hospitals et al come to the White House reportedly to announce "a voluntary plan to hold costs down, which health care industry officials involved in the effort say could save a family of four $2,500 a year in the fifth year, and a total of $2 trillion for the nation over 10 years. But there is no way of ensuring that the providers keep their promises, beyond publicizing their performance."
As a basketball fan, the President should recognize a fakeout when he sees one but, just in case, Paul Krugman has a head's up for him:
"What’s presumably going on here is that key interest groups have realized that health care reform is going to happen no matter what they do, and that aligning themselves with the Party of No will just deny them a seat at the table. (Republicans, after all, still denounce research into which medical procedures are effective and which are not as a dastardly plot to deprive Americans of their freedom to choose.)"
Behind all the trash talk this week will be the crucial contest over whether Congress will enact health-care reform that includes a government-sponsored option (Medicare-for-all) to give consumers a chance to buy care directly and pressure private insurers to improve what they offer.
Without that, they're just playing the same old games.
The name of the game is cooperation as insurers, drug makers, hospitals et al come to the White House reportedly to announce "a voluntary plan to hold costs down, which health care industry officials involved in the effort say could save a family of four $2,500 a year in the fifth year, and a total of $2 trillion for the nation over 10 years. But there is no way of ensuring that the providers keep their promises, beyond publicizing their performance."
As a basketball fan, the President should recognize a fakeout when he sees one but, just in case, Paul Krugman has a head's up for him:
"What’s presumably going on here is that key interest groups have realized that health care reform is going to happen no matter what they do, and that aligning themselves with the Party of No will just deny them a seat at the table. (Republicans, after all, still denounce research into which medical procedures are effective and which are not as a dastardly plot to deprive Americans of their freedom to choose.)"
Behind all the trash talk this week will be the crucial contest over whether Congress will enact health-care reform that includes a government-sponsored option (Medicare-for-all) to give consumers a chance to buy care directly and pressure private insurers to improve what they offer.
Without that, they're just playing the same old games.
Sunday, May 03, 2009
Obama's Grandmother and End-of-Life Care
How much time on earth is enough? How good does it have to be? What price are we willing to pay for it?
For decades, Americans have been debating when life begins, but now come the questions about the last days, as Barack Obama raises the hard fact that "those toward the end of their lives are accounting for potentially 80 percent of the total health care bill."
As usual, he sees the issue in human terms, recalling that "when my grandmother got very ill during the campaign, she got cancer...terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
"So now she’s in the hospital, and the doctor says, Look...maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that--you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
"And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly...things fell apart.
"I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether...society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question."
Yet it is sitting there at the heart of health-care reform, as Obama anticipates "a conversation that is guided by doctors, scientists, ethicists" followed by a "democratic conversation" among all Americans.
"It is very difficult," he says, "to imagine the country making those decisions just through the normal political channels." An independent group can give guidance without being determinative, but politicians will ultimately have to find some answers.
One of them, Arlen Specter alluded to it on Meet the Press today. The 79-year-old senator, who has been battling Hodgins lymphoma for more than four years, said, "I would support advanced directives, where we find so much of medical care is paid for the in the last few hours or few days of a person's life. Not to tell people what to do on their care at that time, but have them, have them think about it."
It's going to be a difficult and emotional debate, not only for those of us who are directly affected, but for generations who love their parents and grandparents. It is time to start.
For decades, Americans have been debating when life begins, but now come the questions about the last days, as Barack Obama raises the hard fact that "those toward the end of their lives are accounting for potentially 80 percent of the total health care bill."
As usual, he sees the issue in human terms, recalling that "when my grandmother got very ill during the campaign, she got cancer...terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
"So now she’s in the hospital, and the doctor says, Look...maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that--you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
"And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly...things fell apart.
"I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether...society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question."
Yet it is sitting there at the heart of health-care reform, as Obama anticipates "a conversation that is guided by doctors, scientists, ethicists" followed by a "democratic conversation" among all Americans.
"It is very difficult," he says, "to imagine the country making those decisions just through the normal political channels." An independent group can give guidance without being determinative, but politicians will ultimately have to find some answers.
One of them, Arlen Specter alluded to it on Meet the Press today. The 79-year-old senator, who has been battling Hodgins lymphoma for more than four years, said, "I would support advanced directives, where we find so much of medical care is paid for the in the last few hours or few days of a person's life. Not to tell people what to do on their care at that time, but have them, have them think about it."
It's going to be a difficult and emotional debate, not only for those of us who are directly affected, but for generations who love their parents and grandparents. It is time to start.
Friday, April 24, 2009
Aborting Health-Care Reform
As the legislative battle begins to get medical attention for millions, Senate Republicans are stalling Kathleen Sebelius' confirmation to lead the Obama reform agenda as Secretary of Health and Human Services.
Barren of ideas, they are in a late-term effort to win the hearts of right-to-lifers by making an issue out of campaign contributions to Gov. Sebelius by a doctor who heads an abortion clinic.
Michael Steele, the GOP chair, has emerged from his Rush Limbaugh fiasco to harrumph: "Significant questions remain about Gov. Kathleen Sebelius’ evolving relationship with a late-term abortion doctor as well as about her position on the practice of late-term abortions. The Senate should not vote, nor should Gov. Sebelius be confirmed, until these questions are answered fully and completely."
The problem is that, during the Senate hearings, there were few questions on the subject and, if any remain, the Governor answered them this week by vetoing a Kansas bill to restrict late-term abortions, saying, "The provisions in this bill that would allow for the criminal prosecution of a physician intending to comply with the law will lead to the intimidation of health care providers and reduce access to comprehensive health care for women, even when it is necessary to preserve their lives and health.
"While I agree that we should try to reduce the number of abortions, it cannot be at the increased risk to the life or health of women."
Clear enough? Majority Leader Harry Reid let his spokesman nail Steele: “This is nothing more than a baseless attack from someone desperate to stake a claim as the leader of the leaderless Republicans and get right with the right-wing of his party.”
And a misbegotten one at that.
Barren of ideas, they are in a late-term effort to win the hearts of right-to-lifers by making an issue out of campaign contributions to Gov. Sebelius by a doctor who heads an abortion clinic.
Michael Steele, the GOP chair, has emerged from his Rush Limbaugh fiasco to harrumph: "Significant questions remain about Gov. Kathleen Sebelius’ evolving relationship with a late-term abortion doctor as well as about her position on the practice of late-term abortions. The Senate should not vote, nor should Gov. Sebelius be confirmed, until these questions are answered fully and completely."
The problem is that, during the Senate hearings, there were few questions on the subject and, if any remain, the Governor answered them this week by vetoing a Kansas bill to restrict late-term abortions, saying, "The provisions in this bill that would allow for the criminal prosecution of a physician intending to comply with the law will lead to the intimidation of health care providers and reduce access to comprehensive health care for women, even when it is necessary to preserve their lives and health.
"While I agree that we should try to reduce the number of abortions, it cannot be at the increased risk to the life or health of women."
Clear enough? Majority Leader Harry Reid let his spokesman nail Steele: “This is nothing more than a baseless attack from someone desperate to stake a claim as the leader of the leaderless Republicans and get right with the right-wing of his party.”
And a misbegotten one at that.
Tuesday, April 21, 2009
Unbundling Health-Care Derivatives
With a goal of passing legislation by June, Congress is getting serious about health care reform, and advocates of change are more nervous about their allies than about lobbyists defending the current failed system.
"More than 70 House Democrats," the Washington Post reports, "recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan."
Their action was prompted by suggestions that the Obama Administration may be willing to compromise on that aspect of providing universal coverage.
The health-care crisis, like the home-mortgage meltdown, has no simple solution but there are similarities in their origins--the greedy intervention of third parties to profit from what used to be transactions between buyers and sellers.
Like the derivatives that wrecked the housing market, profit-seeking insurers have created a convoluted system that siphons off one out of every three health-care dollars for themselves, giving Americans less care for more money than any place else in the developed world.
In reform legislation, it's crucial to include what has been called a Medicare-for-All option that would give consumers a chance to buy care directly and pressure private insurers to improve what they offer.
Without such a choice, health-care "reform" could turn out to be like Wall Street bailouts that shovel money to Citibank, Bank of America and AIG and leave all the decisions about spending it to their discretion.
"More than 70 House Democrats," the Washington Post reports, "recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan."
Their action was prompted by suggestions that the Obama Administration may be willing to compromise on that aspect of providing universal coverage.
The health-care crisis, like the home-mortgage meltdown, has no simple solution but there are similarities in their origins--the greedy intervention of third parties to profit from what used to be transactions between buyers and sellers.
Like the derivatives that wrecked the housing market, profit-seeking insurers have created a convoluted system that siphons off one out of every three health-care dollars for themselves, giving Americans less care for more money than any place else in the developed world.
In reform legislation, it's crucial to include what has been called a Medicare-for-All option that would give consumers a chance to buy care directly and pressure private insurers to improve what they offer.
Without such a choice, health-care "reform" could turn out to be like Wall Street bailouts that shovel money to Citibank, Bank of America and AIG and leave all the decisions about spending it to their discretion.
Wednesday, April 08, 2009
Medicare-for-All Goes Mainstream
The health care reform that dares not speak its name edged out of the shadows yesterday with a New York Times editorial suggesting:
"A new public plan--to offer consumers greater choice, keep the private plans honest and, one can hope, restrain the relentless growth in health care premiums and underlying medical costs--seems worth trying.
"Any new public plan would constitute only part of a much broader effort to provide coverage for 46 million Americans who currently are uninsured and many more who may soon join their ranks. Other major parts under discussion include strengthening employer-provided coverage, expanding existing public programs such as Medicaid and creating a national health insurance exchange where individuals without employer coverage, small businesses and possibly others could buy policies at inexpensive group rates from qualified private plans and, we hope, from a new public plan as well."
This tiptoe approach to what has been called Medicare-for-All is symptomatic of the political minefields surrounding what experts consider the best solution to health-care reform--a single payer system, which has been gaining the support of doctors, nurses and unions since Rep. John Conyers introduced a bill in the House last year but is not part of the Obama Administration's "incremental" approach to reform the system.
In fact, the downfall of Tom Daschle, the President's first choice for health czar, derailed the faint hope that such a solution would be considered, since Daschle had written a book advocating just that.
Meanwhile, private insurer profits and "administrative costs" keep draining one out of every three dollars spent, making US health care one of the most expensive and least effective operations in the world.
Getting Medicare-for-All on the agenda to compete with that system would be a start toward sanity.
"A new public plan--to offer consumers greater choice, keep the private plans honest and, one can hope, restrain the relentless growth in health care premiums and underlying medical costs--seems worth trying.
"Any new public plan would constitute only part of a much broader effort to provide coverage for 46 million Americans who currently are uninsured and many more who may soon join their ranks. Other major parts under discussion include strengthening employer-provided coverage, expanding existing public programs such as Medicaid and creating a national health insurance exchange where individuals without employer coverage, small businesses and possibly others could buy policies at inexpensive group rates from qualified private plans and, we hope, from a new public plan as well."
This tiptoe approach to what has been called Medicare-for-All is symptomatic of the political minefields surrounding what experts consider the best solution to health-care reform--a single payer system, which has been gaining the support of doctors, nurses and unions since Rep. John Conyers introduced a bill in the House last year but is not part of the Obama Administration's "incremental" approach to reform the system.
In fact, the downfall of Tom Daschle, the President's first choice for health czar, derailed the faint hope that such a solution would be considered, since Daschle had written a book advocating just that.
Meanwhile, private insurer profits and "administrative costs" keep draining one out of every three dollars spent, making US health care one of the most expensive and least effective operations in the world.
Getting Medicare-for-All on the agenda to compete with that system would be a start toward sanity.
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