Covering the Really Important Stuff
How can six senators who all come from overwhelmngly rural states — Montana, Wyoming, New Mexico, Iowa, and Maine — come up with health care reform legislation that addresses the needs of Americans living in large metropolitan areas? You will not even see that question asked — much less answered — in this New York Times article, titled “Health Policy Is Carved Out at Table for 6,” by David M. Herszenhorn and Robert Pear. Herszenhorn and Pear have a great deal to say about the food in the conference room where the senators work:
On the agenda is the revamping of the American health care system, possibly the most complex legislation in modern history. But on the table, in a conference room where the bill is being hashed out by six senators, the snacks are anything but healthy.
Last week, there were chippers — chocolate-covered potato chips — described on a sign as “North Dakota Diet Food.” More often, there are Doritos, pretzels, Oreo cookies and beef jerky: fuel to get through hours of talks on topics like the actuarial values of private insurance plans or the cost-sharing provisions of Medicare.
the color of the walls and what’s on the walls; the six senators’ personalities and working styles:
“The talks are free-flowing,” Ms. Snowe said. “Max is very inclusive,” she said of Mr. Baucus.
Members of the group methodically work through issues. When they reach a tentative agreement, Mr. Baucus asks, “Can I put down a ‘T’?”
“It’s very businesslike,” Mr. Conrad said. “Everybody participates. One senator might carry a discussion. Others chime in. Senator Baucus, the chairman, is the leader, but he rides with a very light rein.”
Typically, they gather at 10 a.m., break around noon for meetings, lunches and votes, and then resume at 2:30. Each senator now claims the same seat — “just like kids in school,” Ms. Snowe said in an interview.
Then, there are the refreshments. The coffee, brewed in the office, is roasted in Montana, usually the Grizzly or Buffalo blends.
I know we have seen many complaints from media pundits that bloggers are dangerous because they act like they’re real journalists when actually they can write anything they want and are not subject to the ethical and professional rules and standards to which real journalists are held, and they have no one to supervise them and make sure they are representing all points of view, but hell’s bells! I for one am sure glad we have bloggers like Matthew Yglesias around to ask the questions that real, important journalists like Herszenhorn and Pear can’t be bothered to ask because they’re too busy admiring the wall hangings.
63 Responses to “Covering the Really Important Stuff”
GS, like everyone I agree it's a complex problem, and I don't pretend to have all the answers. I've already stated my views in more detail several times on this forum, but I'll try to summarize:
1. Decouple insurance from employment by levelling the tax advantages. My preference would be to give the tax break to individuals and self employed, but if that's cost prohibitive then removing the pretax advantage for employers to purchase insurance would be acceptable to me.
2. At the same time, add the ability for individuals to enter pools to improve their bargaining power, and add some regulations concerning preexisting conditions so that it's not impossible for sick people to get covered.
3. I'm not opposed to expanding Medicaid to those of incomes slightly higher than currently eligible, but this would have to accompany serious reforms in Medicare/Medicaid to address costs. I'm doubtful this will ever happen due to the powerful senior lobby, but the fact is that Medicare payments under the current system are unsustainable since we don't have the demographics to support it and costs of care per individual are now much higher, and people are living longer.
An alternative to expanding Medicaid would be to provide tax credit/vouchers to the working poor to help them purchase private insurance.
4. Something that is rarely addressed by anyone, and completely essential- increase supply of providers. Expand med schools to increase the number of graduates, and provide financial aid in exchange for working as GPs and in geographical areas in need. Expand the potential duties of PAs and train more of them as well. Expand the supply of med tech facilities and hospital beds by ending the rules for CONs which virtually guarantee that there's no competition (that's actually stipulated as a condition for licensing under the current system.)
5. Tort reform to reduce malpractice expenses and practice of defensive medicine..
6. Ultimately too I think that we need to move away from a system where we think health insurance should pay for minor needs, and encourage people to buy catastrophic health plans and use HSAs for everyday needs. People would become much wiser consumers of general healthcare and would have a built in incentive to improve lifestyle choices to stay healthy.
One method of financing the costs of above would be to tax the 'gold plated' insurance plans which do not fit the profile above. I think that's reasonable- if you prefer to finance your own healthcare that way, you'll not only pay more for your own extra coverage but you'll help finance those who don't have coverage at all.
CStanley–
I think your answer is pretty good. I see you're even in favor of additional taxes on those with “gold-plated” insurance.
So I'd like to know who–groups, politicians–is pushing the reforms you want.
I see Obama and most Democrats pushing for reforms that will address a big problem. I see conservatives trying to stop those reforms for mostly political reasons. (I'm very sympathetic to concerns about costs and I understand their legitimacy, but I'm also well aware of the hypocritical Republicans who voted for Bush's spending without a qualm.)
If the Democrats' reforms fail, how fast will your back-up plan go into effect?
“Something that is rarely addressed by anyone, and completely essential- increase supply of providers.”
A good point, and ultimately what it's all about. Concerns about high costs are really concerns about short supply. There are only so many doctors and nurses around, and they can only work so many hours a day. If we want twice as much health care available for Americans to consume, we need more providers, and/or we need to get more mileage out of the ones we have. Otherwise consuming more will translate directly and immediately into higher prices or other forms of rationing.
Spending more addresses the supply only indirectly, in the sense that raising salaries encourages more people to enter the field or move here. But nurses are overpaid already. Rather than paying them even more, we should do more to reduce the barriers to entry for them and other providers. You may count on unions to resist tooth and nail.
So I'd like to know who–groups, politicians–is pushing the reforms you want.
Quite a few of the elements of the plan I outlined were in McCain's healthcare plan.
Sen Paul Ryan pushed for, and got certain elements of it in the form of HSA's, and he was trying to help get more lower income workers covered that way via tax credits (the last time I brought this up, some criticized the amount being offered as insufficient, which may well be a fair criticism but that doesn't undermine the soundness of the idea itself.)
I'm pretty sure all of the GOP bills that addressed this were voted for along party lines (as Sen DeMint recently commented, Obama voted against them and refused to participate in negotiations.) Yet for some reason, I didn't hear people complain that the Dems were obstructing healthcare reform or that they were the party of 'no'.
If the Democrats' reforms fail, how fast will your back-up plan go into effect?
Unfortunately I don't have the power to implement anything nor do I have magic ball powers to foresee how all of this might take shape.
I do know that Rep Ryan wrote a bill earlier this year which is languishing in committee. If there's a sea change in 2010, I imagine that much of it would form the basis for a GOP healthcare reform option, if the Dems haven't already taken it in another direction.
If anyone is interested, previous discussion of the Ryan proposal is here.
It's possible, CStanley, that if the Republicans seized power that they would implement some of their own ideas such as Ryan's proposal. I think there would have to be a sea change in the actual Republicans in Congress however as well, as I have very little expectation that a 2010 Republican Congress would do much of anything at all on health care. My perception is that there's about 20 Republicans in Congress who want health care reform but their own ideas, while all the rest want no change period.
“Seizing power” makes it sound a bit like an impending coup, but aside from that I do take your point. I think that's been largely true regarding apathy at best or outright opposition among many GOP in Congress- but I think that voters really are demanding that the issue be addressed and I don't think the GOP will win a majority unless it shows that it will serious address the issue. I think they have a chance of doing that if they focus on the need for cost control, not just increased coverage. They can say that ultimately we want to do both, but we can't possibly cover everyone in a fiscally sustainable manner unless we address the real underlying cost problem- and making a bogeyman out of evil insurance companies who make profits isn't a serious way to address it.
Kathy continues her _dredging_… [sigh]
Not only is so much of the public increasingly (all but the pathetic core of fools who want Something, Anything!) concerned about the details of this health care foolishness as well as by the behavior of the Dems, but even a number of Dems are now concerned — not only because of the defects of what has been sought to date, but because the rightful public concern affects their re-election prospects.
Whining pathetically in whatever way one can try as one stoops so low accomplishes nothing.
* * *
As for the whining about the “undemocratic” Senate (why wasn't it, too ordered changed or abolished in Baker v. Carr?), that's nothing new. A pathetic whining lefty some years ago wrote a book about this “undemocratic” institution and envisioned a scenario where the People! [tm] take action and it is abolished, claiming as their justification something I cynically predicted, for it's the resort of losers: the Preamble.
(In the scenario, California threatens to secede from the USA unless it gets votes in the Senate corresponding to its proportion of the US population. The House passes a resolution abolishing the Senate, and gets approval in a “national” referendum.)
OK, back down to the current stuff…
“Heavens we wouldn't want cooperation and centrism to succeed. We'd better start criticizing it.”
What else do you expect from so many lefties on this lefty Web site (that calls itself “Moderate”)?
Kathy,
The word “this” in the part of my comment that you have quoted was meant to refer to the quote that follows it. You're right that pronouns generally refer to something that came before the pronoun, but not always, as in the following common usages:
“What do you think of this? Let's go to dinner first, and then a movie.”
or
“You're not going to believe this. Some guy from Montana actually thinks he knows what it's like in the big city.”
But, I understand that the written word sometimes obscures part of the meaning since you can't hear the tone of voice. Next time I'll try to make a special effort to make sure the antecedent for my pronouns is abundantly clear.
pacatrue,
You have a point there. Those who say that Republicans don't have any ideas aren't paying attention. However, it is true that they (the Republicans) had quite a long time to pass those ideas and there was never any motivation on the part of Republicans as a whole to do anything about the problem. Now that Democrats are in power, Republicans are complaining about not being heard. For the sake of the country, I hope they (the Republicans) will be heard, but from a purely political perspective, they don't deserve it.
CStanley, the system is too inter-related to really do this, but I wrote a post on my own blog recently that I'd like to see us use cost savings to fund expanding coverage. If we only expand coverage successfully and fail at the cost controls, then we are in just as much trouble if not more in a decade. One way to prevent that course is to pay for expansion with the savings as they materialize. Yes, this means only a slow growth of coverage, but, as you say, we are in the middle of the Great Recession. One great flaw however with this notion is that issues of coverage and cost savings are not really independent.
Paca, I think there's some sense in your idea but I too am not sure how it would be implemented. I think that a lot of people are hung up on the idea that expanding coverage DOES decrease . For example, a lot of folks here today are throwing out at me the claim that we'll save so much by covering the poor people who currently only get treatment at the ER- when actually most analyses have shown that it will cost more to give access to primary care- notwithstanding that it is still the correct moral thing to do- not less. And that leaves aside the other part that is largely ignored- the effect of increasing demand without increasing supply, which is a sure recipe for raising costs, not lowering them.