Health Care Reform - Universal/Public Option

[Mizzou B-ball fan]

A few years ago, Wal-Mart had a dramatic effect on the cost of drugs with its announcement that all generic 30-day drug supplies would be sold for $4. It dumped the industry on its head and was a huge help to people who previously had to choose between needed drugs and life necessities. That was a true change. We need something dramatic and outside the box to implement a true change in health coverage.

[albionmoonlight]

Originally Posted by SportsDino

My stance, despite loathing the private health care companies, is that this latest 'plan' does not solve the problem. It increases expenditure into a broken system . . .

This resonates with me. We keep hearing (rightly or wrongly) that the American people lack the political will to give up what they have. (i.e. "If you like your health plan, you can keep it."). If, however, the whole system is broken on some fundamental level, then simply giving people another choice to the broken system, while making sure that the "choice" operates on a level playing field with the broken system, does not seem to solve the actual problem.

It may be that what is being proposed is the best solution possible for an American public unable to sacrifice anything anymore. But it does not seem to solve the real problems at the root of the system.

[SportsDino]

Agreed, you don't see these sort of numbers unless something is wrong, or there is a bubble. (which I have not entirely ruled out, evil short monster always looks for new prey after all!)

You also don't see this much dislike of a product (health insurance) without the realistic probability of a dominant competitor strategy. That is, a WalMart deciding to go its own way and sending a shockwave through the market. I guess we could argue the impact or agenda behind $4 drugs, but I know from my very poor anecdotal market research (the number of times my old lady relatives mention it)... that changing the price expectation can drive a number of market decisions. For instance, the grandma who does her grocery shopping where she can get her pills cheap... or the other major stores in the area matching the price to avoid Walmart getting a competitive advantage.

I always think its innovation that drives people's lives getting better, ya health care is crappy right now, but thats just a signal that its time to buckle up and drive some new ideas out there. If its a private company that manages to do it someone will get their billion dollar fortune. If its the government, well yippee for democracy (it does have its successes after all).

[flere-imsaho]

Originally Posted by CamEdwards

This might be the funniest thing I've read on the board in months.

You really need to read some non-political threads, Cam.

[flere-imsaho]

Originally Posted by Arles

There are numerous sources for this, but here's one to read:

RealClearPolitics - How To Lie With Statistics -- Again

I've taken some time to digest this, and my feeling is that this is a very rosy assessment. Ironically, this article not only shows how you can lie with statistics, but how you can base a misleading case on statistics.

First of all, let's look at the raw numbers, taking the numbers you've given as the truth. Out of the 46 million without insurance, let's assume that 10 million could have it but don't know about it and 9 million make over $75K and could afford it. Taking those numbers as truth, that's still 27 million people without some form of coverage. In the world's richest nation.

Now maybe your argument is that we should just target those 27 million people, and "close the hole" as it were. That's fine, a reasonable target and, honestly, probably the most with which we're going to end up, to be honest.

But secondly, honesty. The assumptions the article makes about health care coverage paper over more problems with the system. For one, people who make over $75K may not, in fact, be able to afford insurance due to cost-of-living expenses where they live. For two, people who make over $75K may be able to afford insurance, but may only be able to afford insurance that has huge deductibles and considerable riders so that, should they have a serious accident or develop a serious disease, they'll be unable to afford care anyway.

Those who qualify for coverage but haven't availed themselves of it? The article assumes they're all lazy. What about those who applied and have been waiting months for the coverage to start? What about those in paperwork hell? What about those who have difficulty with the application due to a (think job-related) itinerant lifestyle? What about those who applied for coverage but whose localities are so cash-strapped that they receive little in the form of benefits anyway?

The article also makes some assumptions about those who are covered in that they were "covered within the last four months" or something. As many of us know, a lapse in coverage, even short, can result in a catastrophic financial nightmare should your current insurance company deem something a "pre-existing condition" and decide not to cover it.

Anyway, there are a number of ways at looking at such statistics. I think those of us with good insurance who don't run into these problems look at these statistics and assume they mean most people can have coverage like us, obtained just as easily, and so don't understand the urgency of the issue.

[Mizzou B-ball fan]

Originally Posted by flere-imsaho

But secondly, honesty. The assumptions the article makes about health care coverage paper over more problems with the system. For one, people who make over $75K may not, in fact, be able to afford insurance due to cost-of-living expenses where they live. For two, people who make over $75K may be able to afford insurance, but may only be able to afford insurance that has huge deductibles and considerable riders so that, should they have a serious accident or develop a serious disease, they'll be unable to afford care anyway.

If you are that short on money, you need to make a lifestyle change. Move to a cheaper market where you can afford the cost of living. If you can't move out of market, move outside of town and commute, which is relatively cheap in comparison. Also, there are emergency policies for relatively cheap that will cover the bad situations and they have relatively low costs. I just don't buy the 'no alternatives' when you can make $75K.

The problem is that people refuse to make the needed changes. Denial is a powerful emotion.

Originally Posted by flere-imsaho

Now maybe your argument is that we should just target those 27 million people, and "close the hole" as it were.

I'm pretty sure that 10M of those 27M are illegal immigrants. So you can toss them out as needing coverage. If you aren't a citizen, you're not getting the benefits if I had my choice.

[molson]

Originally Posted by flere-imsaho

In the world's richest nation.

Kind of a threadjack but I was wondering if this is really true, and by how do you measure such a thing.

Obviously the US has the highest GDP (by far). But we rank lower in fancier numbers like GDP per capita (#15), and the Human Development Index (#15) And it's pretty well assumed that we have a lower standard of living, on the whole, than many European countries.

Maybe just something to balance the perspective that we're entitled to whatever we want, no matter the cost.

Though, I'm for any health plan that gives more people access to better care, more cheaply, that as Obama promised, "doesn't add to our deficits". I mean, I don't know how anyone could be against that. Unfortunately, it just seems obnoxiously disingenuous to contend that this is possible.

[flere-imsaho]

Originally Posted by Mizzou B-ball fan

If you are that short on money, you need to make a lifestyle change. Move to a cheaper market where you can afford the cost of living.

It's often not quite that simple. And yes I know we can castigate, to the nth degree, those who make decisions which land themselves in this kind of situation, but all that shows is that the systemic cause for this state of affairs is our lack of compassion, not the chronic mistakes of others.

I'm pretty sure that 10M of those 27M are illegal immigrants. So you can toss them out as needing coverage. If you aren't a citizen, you're not getting the benefits if I had my choice.

OK, so in the best possible scenario, assuming the best of all the statistics, there's only 17 million people without some form (no matter how useless) of health care coverage.

[Mizzou B-ball fan]

Originally Posted by flere-imsaho

It's often not quite that simple. And yes I know we can castigate, to the nth degree, those who make decisions which land themselves in this kind of situation, but all that shows is that the systemic cause for this state of affairs is our lack of compassion, not the chronic mistakes of others.

I couldn't disagree more with your last statement, but I doubt any amount of discussion will change your or my opinion, so we'll leave it at that.

Originally Posted by flere-imsaho

OK, so in the best possible scenario, assuming the best of all the statistics, there's only 17 million people without some form (no matter how useless) of health care coverage.

Well, there's also a large portion of kids in that number that could be covered by the government at a cheap rate if done correctly (as opposed to the way Hawaii did it when they and their citizens managed to bankrupt a state plan to cover all children). That would cut that remaining number by 40-50%. Still not covering everyone, but an improvement for sure.

[flere-imsaho]

Originally Posted by Mizzou B-ball fan

Well, there's also a large portion of kids in that number that could be covered by the government at a cheap rate if done correctly (as opposed to the way Hawaii did it when they and their citizens managed to bankrupt a state plan to cover all children). That would cut that remaining number by 40-50%. Still not covering everyone, but an improvement for sure.

That's not how I read the article. How I read the article already lumped this population in with the people who could have coverage but didn't know about it.

[Arles]

Originally Posted by flere-imsaho

First of all, let's look at the raw numbers, taking the numbers you've given as the truth. Out of the 46 million without insurance, let's assume that 10 million could have it but don't know about it and 9 million make over $75K and could afford it. Taking those numbers as truth, that's still 27 million people without some form of coverage. In the world's richest nation.

That's about 9%. I think we're going to have 5-6% without health insurance independent of our plan. Massachusetts setup a public health care policy (Commonwealth Care) that gave everyone access to health coverage. They still have 5% without (3% on religious reasons and 2% getting some kind of cash waiver option). So getting 100% on health care is as much of a folly as shooting for 100% unemployment. It's nice in theory, but is impossible to achieve.

Now maybe your argument is that we should just target those 27 million people, and "close the hole" as it were. That's fine, a reasonable target and, honestly, probably the most with which we're going to end up, to be honest.

I think if we can get to 5-7% uninsured, we're doing about the best we can. There are always going to be kids in college not on their parent's coverage who have access to university clinics and don't want to pay for coverage. There are going to be a certain number of people who will never choose to pay for coverage (be it they are undocumented, have religious issues with health care or simply are young, single and not working).

But secondly, honesty. The assumptions the article makes about health care coverage paper over more problems with the system. For one, people who make over $75K may not, in fact, be able to afford insurance due to cost-of-living expenses where they live. For two, people who make over $75K may be able to afford insurance, but may only be able to afford insurance that has huge deductibles and considerable riders so that, should they have a serious accident or develop a serious disease, they'll be unable to afford care anyway.

My point is "access to health coverage". If you make over 75K, you have access to solid health care plans. My dad is 61 years old, owns his own business and buys his own health care through a broker (and he doesn't make 75K). If he can do that, I think most people in the 75-100K range can do that if they so choose. Now, he can't afford the Dish or Sunday Ticket and he can't afford to take a ton of vacations, but he made paying for health care a priority and he has a solid plan.

Those who qualify for coverage but haven't availed themselves of it? ...

The article also makes some assumptions about those who are covered in that they were "covered within the last four months" or something.

I snipped these two a bit, but I agree with your points. These are two areas that a health care bill should look into. I think a process of educating people on how to qualify for existing programs (and even setting up "task forces" to register people in major cities) is a good idea. I also think extended, subsidized coverage for those who lose their jobs (maybe 3-4 months more) is another good idea.

IMO, reducing the uninsured through new programs (public or otherwise) has always been a red herring in health care debates. To get true health care improvements, these need to be the focus:

1. Find a way to get people who qualify for existing coverage registered.
2. Extend unemployment coverage
3. Find a way to increase the number of primary care doctors (a prerequisite for any public plan - also needed if more people register for existing programs).
4. Ensure proper funding structure for ER/safety net clinics. Right now, this process is a mess and if a large number of people were added to the covered group - they wouldn't have the manpower or funding to take on the increased load.
5. Look at better ways to bill and define covered services (esp on these existing publicly sponsored plans). We have existing plans per state and federal government to cover uninsured (esp poor and kids). Let's clean up the billing process for these existing programs before starting a whole new program.

In order for us even to consider a public health care option or think about improving the cost for the current private system, we have to take these above steps (if only to have the infrastructure to support it). Take an example of running an after school care business where you are paid by a billing process. Right now, you have 10 kids each day and it takes you around a month to get paid for this week's care for each kid. Imagine if tomorrow you had 25 kids dumped in your class and it was going to take 2-3 months for the billing process to flush out for the first year of transition? You would be immediately forced to more than double your staff while getting paid at a much later time than you are used to. Without proper planning and infrastructure, you would be out of business in a few months. This is what some of these public-based plans are proposing for our health care system and it's amazing to me that people are so gung ho about leaping in the water with both feet knowing it's full of sharks and crocodiles. It's probably worth our time to check the water first

Everyone wants to "do something" to improve health care, but we shouldn't just jump at the first attempt without first defining what problem we want specifically solved and how this attempt gives us a reasonable chance of providing that solution - not mention how this system will sustain over time. In many ways, this is like the initial Iraq war plan where we make a run on Bagdad, get Saddam and then go "Um, what now?". I don't think we want to be in that "What now?" situation in 2 years with a clusterf*ck health care program simply because a bunch of people want to do something (anything) ASAP.

[flere-imsaho]

Good points, Arles, and I appreciate the post. I don't think we agree 100%, but I think we may be closer to agreement on a number of points than not. Thanks.

[albionmoonlight]

Originally Posted by flere-imsaho

Good points, Arles, and I appreciate the post. I don't think we agree 100%, but I think we may be closer to agreement on a number of points than not. Thanks.

+1

[JPhillips]

Arles: But the most difficult problem is cost containment. If you add a bunch of people at the same cost structure things just get monumentally worse. From what I've read that's the heart of the problem in MA. They added the uninsured, but punted on cost containment and now they can't sustain the program.

[Arles]

Originally Posted by JPhillips

Arles: But the most difficult problem is cost containment. If you add a bunch of people at the same cost structure things just get monumentally worse. From what I've read that's the heart of the problem in MA. They added the uninsured, but punted on cost containment and now they can't sustain the program.

That's exactly what I was getting at with the above post. Mass didn't have the infrastructure/business plan to support a state-wide health care program. But, everyone was so adamant about covering more people that they leaped forward without having an achievable goal in mind or a stable infrastructure.

This is what worries me so much about the current debate. It usually ends up morphing into a "how can we setup a plan to cover all the uninsured" instead of "how can we get the country to a point to where we could handle an increased load of new patients and help control the increased cost".

I think if we answer the second question, the first almost becomes irrelevant. If we setup the infrastructure and cost certainty needed to cover more people, then we can easily find ways to increase the number of people covered. Starting with the idea of increasing the number covered and then going "Oh, crap" once doctors are slammed, costs are up and wait times are through the roof is extremely dangerous. That seems to be the current plan many in congress are in favor of.

[SportsDino]

Yep, I think attacking the heart of the cost problem is necessary to solve the insured numbers problem. Going the other direction first can actually be counter productive. Stress an already stressed system and maybe we'll see the health business version of the credit crunch margin call... more short term obligations than real world supply is highly destructive to long term growth (which is what we need, we are currently in a shortage situation).

I think you have hit right on the point, with your list of focus steps (although I'd push in the 4,5,3,2,1 order) and example of running a business (arguably deferred revenues against current expenses can be dealt with, but the scale and timing are just too far off in this problem).

[CamEdwards]

Interesting numbers from Gallup:

As the debate over healthcare reform intensifies, the latest USA Today/Gallup poll finds that more Americans disapprove (50%) than approve (44%) of the way U.S. President Barack Obama is handling healthcare policy. There is a tremendous partisan gap in these views, with 74% of Democrats but only 11% of Republicans approving. Independents are more likely to disapprove than to approve of Obama's work on healthcare.

The actual numbers for independents are 40% approve, 55% disapprove.

[lynchjm24]

Originally Posted by Arles

So getting 100% on health care is as much of a folly as shooting for 100% unemployment. It's nice in theory, but is impossible to achieve.

I disagree Arlie. 100% unemployment might be right in this government's wheelhouse.

[lynchjm24]

Originally Posted by JPhillips

but punted on cost containment

Which is exactly what the issue with Congress' plan. Maybe all the governors calling it an unfunded mandate isn't clear enough?

[RainMaker]

Originally Posted by Arles

So getting 100% on health care is as much of a folly as shooting for 100% unemployment. It's nice in theory, but is impossible to achieve.

Tell that to every other major industrialized nation who has managed to do it.

[JPhillips]

Originally Posted by lynchjm24

I disagree Arlie. 100% unemployment might be right in this government's wheelhouse.

RASMUSSEN!

[Arles]

Originally Posted by RainMaker

Tell that to every other major industrialized nation who has managed to do it.

This isn't true. Canada has numerous holes in their "100% covered" nation. Their prescription drug coverage is extremely expensive in some provinces:

http://www.cmaj.ca/cgi/content/full/173/11/1343#R2-19

The total cost for emergency and hospital care is $15 000 ($5000 for the angioplasty and $10 000 for the hospital stay and services, which include $900 for 3 days of intravenous and oral drug therapy). The cost paid by the patient is zero, regardless of which province he's in — a testimony to the success of the Canada Health Act in facilitating equitable access to medically necessary care across the country. But after discharge, the same medically necessary drug treatment begun in hospital will cost the patient $1400 per year if he lives in New Brunswick, $800 in Saskatchewan and $200 in British Columbia. Why? Because although each province has instituted some form of drug insurance coverage to rectify the gap in the provision of medically necessary drugs, the programs vary in comprehensiveness, eligibility and access. This patchwork of programs results in considerable differences in out-of-pocket expenses for patients with the same health problem

You also have this report:
Fraser: Canadian patients worse off than uninsured Americans | Physicians for a National Health Program

In practical terms, Canadian patients are unable to buy quicker access or better care than what the government health insurance program provides. In this sense, Canadian patients on waiting lists are worse off than uninsured Americans who may legally use their own money or credit to buy health care if they lack insurance coverage.

The Canadian single-payer system is an example of what not to do in health care. The fact is that single-payer systems are probably the worst way to achieve universal health insurance coverage. If Canada is currently witnessing the failure of its own single-payer health insurance system, why would Americans want to adopt such a system for themselves?

Nevertheless, the problem of the uninsured needs to be solved before a “tipping point” is reached and Americans have a Canadian-style health policy disaster foisted upon them by single-payer advocates who are not fully disclosing all the facts about health care in Canada.

The evidence indicates that the best approach to achieving universal health insurance coverage is to make people prioritize their own income toward the purchase of their own health insurance, not to make some taxpayers buy health insurance for everyone through a redistributive, government health insurance monopoly.

Just because people have coverage on paper, doesn't mean they are better off. If you are on a waiting list for major surgery in Canada (can take years in some instances) or are stuck with a $1400 bill for needed prescription drugs, I doubt you would consider yourself "covered" when it comes to health insurance.

We need a system that not only reduces the number of uninsured, but actually functions well for the numerous people currently well-insured. And that's not Canada.

[Edward64]

Canadian's view of their healthcare (note it admits its not a scientific poll)

Poll: Canadians like their health care despite grumbles - Yahoo! News

The online polls surveyed 1,004 U.S. adults July 9-14 and 1,010 Canadians on June 5-7 . They aren't scientific random samples, don't statistically mirror the population and thus have no margin of error. Rather, they resemble large focus groups to help see what people are thinking about a particular issue.

On key questions of care and costs, patients in the two countries clearly see things differently.

Asked about seeing their family doctors, for example, 59 percent of Americans said they could see them quickly when they needed to; 52 percent of Canadians said they could.

The difference in opinions magnified when it came to seeing medical specialists, with 47 percent of Americans saying they can see specialists without long waits. That was nearly twice as high as the 26 percent of Canadians who said they could see specialists without long waits.

Looked at another way, 65 percent of Canadians said they had access to all the health care services they needed at costs they could afford; 49 percent of Americans felt the same way.

That difference probably reflects the costs of health care: Patients pay nothing at doctors' offices in Canada

Interesting, not sure if I am reading this right. It does seem that US gets faster access to doctors but Canadians are more happy? This is attributed to because they do not need to pay (and I guess, think they are getting a good deal?).

[Edward64]

Originally Posted by Arles

This isn't true. Canada has numerous holes in their "100% covered" nation. Their prescription drug coverage is extremely expensive in some provinces:

Just because people have coverage on paper, doesn't mean they are better off. If you are on a waiting list for major surgery in Canada (can take years in some instances) or are stuck with a $1400 bill for needed prescription drugs, I doubt you would consider yourself "covered" when it comes to health insurance.

We need a system that not only reduces the number of uninsured, but actually functions well for the numerous people currently well-insured. And that's not Canada.

Sure, there are imperfections and I don't think anyone is saying that the Canadian system is perfect. The comment still stands though, other countries are able to do it (okay, maybe not 100% precisely), we should be able to also.

The quote said $15K procedure was free but that there was disparity in the medication. Still a pretty good deal to me.

I wonder how Canadian's handle the last x months of life which I've read is where the disproportionate $ are going to. I'll research.

[SteveMax58]

Originally Posted by Edward64

Interesting, not sure if I am reading this right. It does seem that US gets faster access to doctors but Canadians are more happy? This is attributed to because they do not need to pay (and I guess, think they are getting a good deal?).

I think this is the problem with comparisons to other countries...they are highly relative to what they believe is a "good doctor" or a "long wait". They also have differing cultural values and habits that may (or may not) lend themselves to more reasonable costs. US consumers are also notoriously more demanding of "service when I want it" than, dare I say, "any" other county.

We have to find ways to make health care work, within the confines of our society and budget variables...not anybody else's. So where country X can do Y, it doesnt mean country X also does ABCDEF, etc. US consumers expect all (or most) of it...and for the same relative price. And if the U-HC advocators say that's tough, and we all need to get over it in order to help the rest...fine, then at least sell it that way.

[RainMaker]

Originally Posted by Arles

This isn't true. Canada has numerous holes in their "100% covered" nation. Their prescription drug coverage is extremely expensive in some provinces:

http://www.cmaj.ca/cgi/content/full/173/11/1343#R2-19

Supplemental insurance is preferred for a lot of people in those areas and companies typically pay for it. Mine paid for everything

Originally Posted by Arles

You also have this report:
Fraser: Canadian patients worse off than uninsured Americans | Physicians for a National Health Program

You're using an article from a site and group that is debunking it. Scroll down a bit.

Originally Posted by Arles

Just because people have coverage on paper, doesn't mean they are better off. If you are on a waiting list for major surgery in Canada (can take years in some instances) or are stuck with a $1400 bill for needed prescription drugs, I doubt you would consider yourself "covered" when it comes to health insurance.

We need a system that not only reduces the number of uninsured, but actually functions well for the numerous people currently well-insured. And that's not Canada.

What do you consider "better off"? You've already said that the overall health of the country is not a good gauge of whether health care in the country works. So what is your way of judging?

Like I said, I lived there and never had an issue. I never heard of people complaining about it or having to wait all these horrible times. Sometimes you'd have to drive a ways to get a faster appointment with a specialist or to get a test done. But I never remember hearing of people dying in the streets because they had to wait years for major medical procedures.

The waits were almost always for non life threatening issues that you were able to get privately done faster if you wanted to.

[Galaxy]

Originally Posted by SteveMax58

I think this is the problem with comparisons to other countries...they are highly relative to what they believe is a "good doctor" or a "long wait". They also have differing cultural values and habits that may (or may not) lend themselves to more reasonable costs. US consumers are also notoriously more demanding of "service when I want it" than, dare I say, "any" other county.

We have to find ways to make health care work, within the confines of our society and budget variables...not anybody else's. So where country X can do Y, it doesnt mean country X also does ABCDEF, etc. US consumers expect all (or most) of it...and for the same relative price. And if the U-HC advocators say that's tough, and we all need to get over it in order to help the rest...fine, then at least sell it that way.

Bingo. We can't have it "all". With the trillions of dollars in debt we already have, it makes it even tougher. Not to mention we need to provide an incentive to make people want to become doctors.

[Dutch]

Originally Posted by RainMaker

Like I said, I lived there and never had an issue. I never heard of people complaining about it or having to wait all these horrible times.

And I've visited my grandfather in the hospital in Charleston, SC recovering from a bypass surgery where his roommate was from Canada. That guy needed coverage right away, not "univeral coverage" later that year.

[RainMaker]

Originally Posted by Dutch

And I've visited my grandfather in the hospital in Charleston, SC recovering from a bypass surgery where his roommate was from Canada. That guy needed coverage right away, not "univeral coverage" later that year.

There is private care in Canada that you can use at any time.

[Arles]

There's also a problem of scope. The average wait for orthopedic surgery in Canada is 3-4 months. This is for a country of 30 million people with an infrastructure that's been in the works since 1985 for national health care.

We have 300 million people and no infrastructure. It's borderline lunacy to think the US could do even the same as Canada (let alone better) when it comes to wait and quality of service. I just don't see a need to change our system when some very simple steps can reduce the number of uninsured, especially when we lack the infrastructure to even consider a national plan.

[JPhillips]

Far be it for me to defend Canada's poor system, but I never thought I'd see the day when conservatives were arguing that the US could never be as good as Canada.

[Dutch]

Originally Posted by RainMaker

There is private care in Canada that you can use at any time.

If public care is without complaint, I have to wonder why that would be.

[Dutch]

Originally Posted by JPhillips

Far be it for me to defend Canada's poor system, but I never thought I'd see the day when conservatives were arguing that the US could never be as good as Canada.

The argument has never been about the USA vs Canada. It's that private health care is generally better than public health care.

EDIT: Ah, I see you responded to Arles. Makes more sense that you said that, but it's still a poor way to look at the basic argument.

[JPhillips]

Originally Posted by Dutch

The argument has never been about the USA vs Canada. It's that private health care is generally better than public health care.

It's borderline lunacy to think the US could do even the same as Canada (let alone better) when it comes to wait and quality of service.

[RainMaker]

Originally Posted by Dutch

The argument has never been about the USA vs Canada. It's that private health care is generally better than public health care.

What do you use to decide what is better? What is the criteria?

[RainMaker]

Originally Posted by Dutch

If public care is without complaint, I have to wonder why that would be.

Some people prefer to have procedures done faster. Just as if I want better protection for my family than the local police department offers, I have every right to hire private security.

[albionmoonlight]

The Three Things Obama Should Say About Health Care - The Atlantic Business Channel

The Three Things Obama Should Say About Health Care

President Barack Obama will hold a prime-time news conference tonight to sell health care reform to Americans, as support for his trillion-dollar measure is wilting. Health reform is a tricky political sell for a couple reasons; 1) Most voters have health care already; 2) It costs more than a trillion dollars on the back of tax increases; 3) Obama doesn't have a strong enough case that a trillion spent today will bend the cost of health care. So what's Obama's pitch? Here -- with graphs! -- are three ideas Obama should put forth and three ways reporters should push back against his arguments.


I side with Mickey Kaus and Kevin Drum that Obama is going to have act the part of a concerned fearmonger. If he wants to remain above the fray, without endorsing any particular health care bill, the alternative is to highlight, in neon clarity, the breaking cresting tsunami wave that is the health care crisis. Here's how he could do it -- and how reporters should push back.


1) Emphasize the Federal Cost Crisis

Of course we're going to hear a lot about the price tag of health care. But the most effective rejoinder to the cost of reform is the argument that doing nothing to health care will cost us, too. Obama could demonstrate that fact clearly with two graphs, both from the CBO. The first estimates future government spending as a percentage share of GDP. It shows, very clearly, that our long-term budget crisis is fundamentally a health care crisis.



And if you think that Medicare and Medicaid spending is driving America toward a cliff, look at the tailwind provided by all other health care.

Obama could say: "Here's what that sharp, machete curve of "All Other Health Care" means for America's future. It mean higher premiums, and higher co-payments for your family. It means that when you get a job, your employer will constantly tempted to switch to a cheaper, worse coverage plan for you and your family. And if you lose your job, it means the free market health care system threatens to price you out of coverage. That is the cost of doing nothing."


Reporter's rebuttal: First, this graph has health care spending approaching 100 percent, which is absurd, because that would mean that in 70 years, Americans would be subsisting off of band-aids and Nyquil. Also, we hear you talking about the cost of doing nothing. But doesn't Doug Elmendorf's testimony to Congress last week suggest that the trillion-dollar House bill won't make any practical difference to long term costs? Why should "the cost of doing nothing" be cover for any sort of expensive health care reform?


2) Tell Americans Health Care is Stealing Their Pay Check

Of course, government spending arguments are pretty impersonal. If Americans care about money, they care about the money in their pocket. So how about the money in their pocket? We can already feel the depressing impact of health care costs on wages. Obama could brandish this graph:

The hard blue line above is the expected growth in average wages. The dashed-purple line is what's actually appearing in workers' wallets when you account for premiums. Health care is stealing our paychecks. Every year, Americans are paying for the cost of doing nothing, to the tune of about $5,000 per worker per year.


Reporter's rebuttal: But if Americans are going to have to pay higher taxes to extend health care, will that offset whatever benefit they eventually get even if a public option is capable of negotiating down the cost of care? Also, we've heard mumblings that some senators are considering capping the tax deduction for employer-based care. How would the savings from eliminating that tax deduction compare to the increased cost for employers to insure their workers?


3) Tell Americans Health Care is Stealing Their Services


As most politicians like to note every so often, we're in an educational crisis, and we're not adequately preparing our kids for the jobs of a new millennium. What does that have to do with health care? A lot, according to Peter Orszag, Obama's health care budget person, who has argued that health care spending is crowding out education spending across the country. State appropriations on higher education have declined by 15 percent in the last three decades and salaries for public school professors have also declined:



In a nutshell, Obama could use this anecdote as part of a larger argument that rising heath care costs necessitate trade offs and budget cuts that have a negative effect on policies that have nothing to do with health care. Our ability to control health costs is directly feeding our inability to field, among other things, an effective, competitive public education system[FONT=Georgia, 'Times New Roman', -webkit-fantasy].[/font]
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Reporter's rebuttal: But Mr. President, Democratic governors have already said that your health care plan would cripple them with "unfunded mandates" to spend more money on the uninsured through Medicaid. How can you argue that you're reforming health care to save state budgets when the Democratic governors in charge of those state budgets say your plan isn't saving them at all?

[Mizzou B-ball fan]

Brutal stuff here. Wonder who tried to stick this in the bill.

Inside The Health Care Bill - Forbes.com

[RainMaker]

Originally Posted by Mizzou B-ball fan

Brutal stuff here. Wonder who tried to stick this in the bill.

Inside The Health Care Bill - Forbes.com

Not taking a side on the issue, but do find the hypocrisy of some funny. It's free market or bust for doctors and pharmaceuticals companies, but socialism for lawyers.

[Galaxy]

Originally Posted by RainMaker

There is private care in Canada that you can use at any time.

Private care is illegal.

[Galaxy]

Originally Posted by RainMaker

Not taking a side on the issue, but do find the hypocrisy of some funny. It's free market or bust for doctors and pharmaceuticals companies, but socialism for lawyers.

If doctors don't want it and say "f--- it", who's going to treat us?

Why would a doctor be a public provider and earn less, when he can be private and not have any government influence?

[flere-imsaho]

Originally Posted by Galaxy

Private care is illegal.

It's not quite that simple.

[RainMaker]

Originally Posted by Galaxy

Private care is illegal.

No it's not. You just can't double dip. How can you argue about the health care in Canada if you don't even know how the system works?

[Arles]

Originally Posted by JPhillips

Far be it for me to defend Canada's poor system, but I never thought I'd see the day when conservatives were arguing that the US could never be as good as Canada.

Talk about twisting words, they also kick our ass in curling I said that the US would not be as good as Canada at running a public healthcare system because Canada has been setting up the infrastructure since 1985. Perhaps if we spent the next 10-15 years setting up the infrastructure, things would be different.

Of course, the elephant in the room is that no public system will never provide the quality of care and lack of wait time that currently working people get with most private plans in the US.

[flere-imsaho]

Originally Posted by Arles

Of course, the elephant in the room is that no public system will never provide the quality of care and lack of wait time that currently working people get with most private plans in the US.

Surely you mean "no public system that will be set up in the United States", right? Because there are public systems around the world that outperform the United States' private system. Data for that is a relatively easy google.

[RainMaker]

Originally Posted by Arles

Of course, the elephant in the room is that no public system will never provide the quality of care and lack of wait time that currently working people get with most private plans in the US.

What gauge do you use to determine quality of care?

[Galaxy]

Originally Posted by flere-imsaho

It's not quite that simple.

It's pretty complex (as the provinces have a great amount of control over it's health care).

[molson]

I sure hope Obama gives us more info about how what he promises is possible then the "OTHER COUNTRIES CAN DO IT" horse that's been beaten to death in this thread.

I do look forward to his anecdotal stories about individual people across the US with health care issues. That's a staple.

[Arles]

Originally Posted by RainMaker

What gauge do you use to determine quality of care?

I would start with having access to orthopedic surgery in days, not months. I would then move on to advanced equipment and techniques that cause people in Canada to come down to the US (ie, the Mayo Clinic) to have procedures done. Rarely do you see someone leave the US to go to Canada for life-saving surgeries/procedures.

On day-to-day type doctor visits, it is comparable but the US has much less of a wait time (which I think would again impact the quality of care). In fact, I'm struggling to find an instance where a US worker covered by a normal PPO would be better off in Canada than they are in the US. They get quicker doctor appointments, much faster surgeries, access to better top-end hospitals and when you factor the increased tax burden in Canada compared to most out-of-pocket limits, the cost ends up a wash (even for major surgeries).

[RainMaker]

Originally Posted by Arles

I would start with having access to orthopedic surgery in days, not months. I would then move on to advanced equipment and techniques that cause people in Canada to come down to the US (ie, the Mayo Clinic) to have procedures done. Rarely do you see someone leave the US to go to Canada for life-saving surgeries/procedures.

On day-to-day type doctor visits, it is comparable but the US has much less of a wait time (which I think would again impact the quality of care). In fact, I'm struggling to find an instance where a US worker covered by a normal PPO would be better off in Canada than they are in the US. They get quicker doctor appointments, much faster surgeries, access to better top-end hospitals and when you factor the increased tax burden in Canada compared to most out-of-pocket limits, the cost ends up a wash (even for major surgeries).

So it's about speed. Couldn't we just loosen the requirements for becoming a doctor so that we get more doctors and thus more speed? I mean if it's all about speed, who cares how good they are?