Let’s Do The Easy Health Care Reform
Jan 22nd, 2010 | 81 responses
With the GOP win in Massachusetts there has been a lot of talk about what to do with health care reform. Some on the left pushing for immediate action while others call for stopping all reform now. What I can’t understand is why we can’t at least do stage one of the process.
There are a number of aspects to health care reform that are, as far as I know, quite non controversial.
- Preventing companies from denying coverage due to pre-existing conditions
- Requiring that all plans provide preventative care, like annual physicals, at little or no cost
- Preventing companies from dropping coverage due to a serious illnesses
- Preventing companies from making large rate hikes due to serious illnesses
- Eliminating lifetime caps on coverage
This is just a short list, I’m sure there are other aspects to reform that are also fairly non controversial. So why can’t we agree to pass this part of reform now, allow it to go into effect and see what improvements it makes ?
We could then continue to discuss larger scale issues like providing subsidies to help lower income people obtain coverage, allowing the formation of cooperatives to buy group coverage, possible public options, etc.
But in the meantime it is quite possible that the above reforms could help millions of people.
Yet nobody seems to be willing to do it. The only logical reason for this seems to be that the left doesn’t want to give up an issue and the right doesn’t want to give Obama any sort of victory.
To me this seems like a no brainer.
81 Responses to “Let’s Do The Easy Health Care Reform”
To do something small would be to show weakness. You may try to act like an adult, but politicians are still at the sand box stage. It takes a forceful leader to get the kids together. The Pied Piper, is not the one.
Here's the problem. Doing these 'easy' things costs money. A whole lot of money. In fact, gigantic amounts of money. Where's that going to come from, or are we just going to be sold another free lunch?
There are very few proposals on the table that actually save money. Even the CBO finally said that most “preventive care” does not save money. Yet it keeps coming back up as an argument for cutting costs. So if you expand coverage to all these people who are not currently on the rolls how does that get paid for? Where is the agreement on that?
One of the few proposals out there that actually could lower the costs of care is a major restructuring of tort law. But that hits the gravy train of the lawyers; cough John Edwards cough. The very people claiming to want all this health care for everybody don't really want to pay for it. They want someone else to pay for it. Solve that problem in the real world and everything else will be easy.
The ideas that makes some sense and might lower costs over time is increasing competition in the private sector by increasing portability, allowing sales across state lines, and allowing small businesses to form negotiating groups. It's no panacea, but it might stand a chance of passage. Lowering those costs would allow additional coverage to be extended to the uninsured.
The only problem with scaling back:
New Dem Worry: GOP Taking Credit For Health Care Reform:
I guess when all else fails, turn the issue into a hot potato. Its all about winning, right? Its no wonder why most of America thinks Washington is hopelessly out of touch.
As has been stated before:
If you eliminate pre-existing conditions, than you run into an adverse selection problem where a disproportionate amount of sick people are buying health care, which drives up premiums as insurance companies have to make up the increased cost. So unless you have a mandate to force healthy people to buy health care and share the risk pool, then premiums will go up. But if you have a mandate, you need to provide a way to afford it, which means subsidies. Also you need a way that people can easily shop for coverage, and so you need exchanges.
They are all tied together. Unless you solve the adverse selection problem, the entire thing falls apart.
Now if someone can figure out a way to solve the adverse selection problem without a mandate, I'm sure health care experts are all ears.
Spot on.
Amen
And you also need to enforce the mandate. If the penalty for not buying is too low, people will just pay the fine if they can buy the insurance with no penalty if they get sick. If it is too high, i.e. throwing people in jail for not buying health care, it becomes politically toxic.
Just repeal McCarran-Ferguson and wait a bit.
rowing people in jail for not buying health care, it becomes politically toxic.'
And very expensive, and as an ex-con, you may know that it runs around 50K a year.
If you eliminate pre-existing conditions, than you run into an adverse selection problem where a disproportionate amount of sick people are buying health care, which drives up premiums as insurance companies have to make up the increased cost.
Exactly, Jeffrey. Paul Krugman, Jon Chait at The New Republic, and Ezra Klein have all addressed this idea of doing “pieces” of health care reform, but people continue not to get why it doesn't work.
Pat, you're talking common sense again. Stop it!
As for the theory that if insurance companies can't deny coverage for pre-existing conditions, I find the idea ludicrous that people will simply wait until they have been hit by a truck or diagnosed with cancer to get coverage. Does this really happen, or is it something economists have pulled out of thin air? In real life, what happens is that people who for whatever reason have had gaps in their coverage — often due to something they can't control such as a change of coverage at work — end up with no coverage for their single biggest health issue and sky high premiums for everything else.
I would truly rather have seen a half dozen teeny bills that addressed the major issues of reform and then sorted out what else needed to be done later, than a huge behemoth full of favors to the insurance companies that not even the members of Congress understand all the details.
ex-con? You got the wrong guy or I missed the joke. It's a major life event when I get a parking ticket, lol
Just repeal McCarran-Ferguson and wait a bit.”
My brain is addled trying to figure out how there will be time for programming during campaign time. So could you please explain.
Oh, you are still a conservative?
lol, doh on me
Actually I'm an ex-almost all of the above. Now I'm a moderate. (glances nervously over shoulder checking for TMV Police checking IDs)
Actually, I am a double agent working for KK. Your'e busted.
McCarran-Ferguson allows the states to regulate “the business of insurance”. Which is why you can't buy insurance from across state lines and affects malpractice insurance as well. I was, of course, being overly simplistic. The AMA has been setting reimbursements for specialists that allows many of them to live quite comfortably without working long hours (I heard of one example of $70,000/month working about 5 hours a day). The AMA's own website brags that they set 95% (the other 5% were probably altered by legislator influence) of the RBRVS, a government scale used by Medicare, Medicaid, and many private insurance companies. As I've stated before, a paramedic does surgery for around $20 to $25 in Indiana, but surgeons charge thousands of dollars per hour.
That just might have something to do with the cost of health care.
Then why don't they table health care until after the election and concentrate on jobs? It what the people are demanding, why not listen to the boss for a change. You know “We the people….”
Hey Elwood, it's nice to see someone who knows about the RBRVS. You might also know the AMA committee that sets the scale in composed of almost all specialists, and not surprisingly procedures are rewarded out of proportion to cognitive services (a doctor talking to you instead of doing something to you). As a result the temptation is to do a lot of procedures, since that's where the money is.
Besides encouraging a lot of procedures, it also discourages doctors from going into primary care where more cognitive services are provided.
I don't see how this ties into McCarran-Ferguson though, to me they are separate issues. There is a wide range of malpractice insurance costs but that's due more to specialty and the lawsuit climate in the specific areas.
http://www.aafp.org/fpm/990500fm/23.html
There was a provision in the senate bill to reduce specialist reimbursements in order to increase family doctor salaries. The AMA got the reductions eliminated.
The idea that Republican tort reform will reduce health care costs is a lie. It has been proven to be false in every state where it has been done. Yet conservatives like DaMav repeat it over and over again. No, DaMav, you are not a moderate. No one who has read your posts here is going to believe it except for those other conservatives, afraid to admit how far to the right they've gone, that insist on misrepresenting themselves.
Actually, I think you could require coverage for people with preexisting conditions without adverse cost effects if and only if you relaxed minimum coverage requirements. If you did both, insurance companies would price out numerous policies and offer options. For example, they might create a policy that provides limited coverage for issues related to the preexisting condition for a period of time and full coverage after, or they might be more than willing to offer a catastrophic only policy to someone with a preexisting condition at a reasonable price.
What you cannot do is simultaneously require coverage, eliminate lifetime max's and maintain minimum requirements. The flaw in Ezra's analysis (which is the only of the referenced above I have read) is it presupposes existing minimum coverage. This is because Ezra hates catastrophic only policies but just because he hates them, doesn't mean they couldn't be part of a workable solution.
Regardless of whether tort reform reduces costs, it is still needed for fairness and parity. The present system is more like a lottery where you may have two patients with essentially identically claims, with one settlements of $0, and the other $2 million, etc…The system is far too arbitrary. This is so for a number of reasons: 1) Lay juries are arbitrary to begin with; 2) Lay people are not qualified to understand or make decisions in complex medical cases; 3) Their are a # of practices by trial lawyers which are detrimental to their clients, but increase their own billable hours,i.e., they have an inherent conflict of interest. This includes the practice of shotgun litigation; where every treater who has the slightest link to the case is sued, even if that treater advised directly and repeatedly against the action that is being litigated. I have seen patients having to drop cases with merit bc of the threat and risk of countersuit. 4) Most malpractice attorneys take large #'s of cases on contingency (which they often describe to their patients as “pro bono”), put little work into each case, which they then drop if the case does not appear easy or does not promise a large settlement.
In the interest of disclosure, I'm a retired physician, have never been sued, and have more that once pointed out to a patient that s/he has been the victim of malpractice. My major interest in health care is having a system that works!
I also agree that there must be some source of insurance for patients with pre-existing conditions, and once we have that, we're in an “everybody in the pool” situation; everyone must join; everyone must pay. People who claim they don't want or won't use services end up being a heavy burden on the system eventually most of the time. For the person who asked “Do people really wait to get to get sick, and then try to get insurance?” You bet your a** they do! And if they know they can get away with it, it will be much, much worse! Whenever I see a patient who's driving a Mercedes and has no medical insurance, I know who's eventually going to pay for them: Me. You. Don't kid yourself that we/they can choose for them to get no health care—practically, it just doesn't work that way.
One last thing is that, for most of us, after paying all of our lives for our health insurance, we need something to protect us from our insurance companies breaching their contracts with us the minute we get sick. (Which is what is happening. All day. Every day. And we as consumers have no effective recourse.) This is what health care reform is really about–the average person being protected from breach of contract by our insurers.
Sorry about the misspelling (their->they're). Red face.
BTW, I don't support the AMA and have never been a member. Am Harvard-trained, the go-to physician in my area for medical people, and never netted more than $55K from my practice. Not complaining, but not getting rich, either.
steveinch, I agree with you about catastrophic insurance. Catastrophic events are the best kinds to insure against. Other expenses should be, well, expenses. Way too much of the health care dollar is spent on the ins. cos. acting as middlemen, which is a service of no value.
I'd say I'm one of the few moderates here, but I guess we all have our own differing frames of reference. If you look at the thread starters — they start in the middle and work left. Look at all the articles posted since the CFR decision and find even one token article from even a moderate libertarian or conservative point of view. There are none. But we get one after another after another hysterically denouncing it. 58% of Americans would waterboard the Christmas bomber — wouldn't that include a healthy portion of the… uh… moderates? But the default center here is a meltdown about 'torture'. Almost nobody here is willing to defend something the vast majority of Americans support. That says something about the sample. A lot of liberals prefer to regard themselves as moderate.
Don't get me wrong. I think there intelligent and interesting left wing posters here, and I have said so and enjoyed engaging with them. Sometimes we find points we agree on. But this board is overwhelmingly left. So maybe if I stick out like a sore thumb sometimes, it's because of the environment I'm in. No problem with that. You can call me a ham sandwich if you want. I am what I am. And every once in a while you'll find out I'm not what you think.
I agree that frittering around the margins with tort reform doesn't produce much in the way of savings. But that doesn't mean it couldn't if there were significant changes which is why I referred to “major tort reform”.
You act as if what we're doing right now is not costing us money!
I guarantee you what we are doing right now is costing us enormous, gigantic, unfathomable amounts of money.
The question becomes, do we want to try and control how and where these unfathomable amounts of health care dollars are spent, or do we want to go down like the Titanic–which is exactly where we're headed if we don't do something ASAP.
Mark my words: health care is going to bankrupt this country long before any war or other entitlement gets to us.
And the Reps sit there back slapping one another for stopping any real chance of reform. I am sick, just sick about it.
If any of these people care about this country, they will put aside their partisan differrences and try to tackle this problem.
It's grown-up time, not payback time.
The Democrats can pass a bill without a single Republican vote, or at least could have until last week. They have controlled Congress since 2007 and by large majorities since January 2009. So how is their total failure to come up with a viable bill now suddenly the fault of Republicans?
Republicans did proposed several plans last year that were completely ignored and rejected. That included initiatives on portability, interstate purchase, tort reform, and several others. I put a long post up here a couple months back outlining plans proposed by Republicans with a half dozen links to them. Absolutely ignored by the Democrats in Congress.
There are Republican moderates in Congress. Several of them. But the left wing of the Democratic party drove the health care agenda so far to the left that not only were they unable to attract moderate Republicans, they could only attract moderate Democrats by arm twisting and bribery. Instead of proposing a plan that could have attracted, say 70 votes in the Senate and 60% of the House, they pushed such such a radical proposal that they miscalculated and shot themselves in the foot.
So radical, so far to the left that they spent all their political capital, all their good will, and now have alienated the country with their lack of moderation that even a liberal state like Massachusetts went into rebellion.
And now you want to blame Republicans? I suggest you direct your irate attention to the party in charge and ask how they could possibly have made such a total hash of this.
The democrats have little interest in passing healthcare reform now. They are scrambling for the November elections and will now suddenly, after their defeat, shift focus to the economy. They don't want any bipartisan agreement on the easy stuff to pass, it would just reveal that the GOP can indeed vote for certain areas of healthcare. They would rather promote the lie that Republicans oppose all health care reform and carry these items onto the campaign trail. Far more important to them than to pass reform in these areas where both sides could come together under a responsible bipartisan approach.
In short, the democratic party reelection effort will trump healthcare reform.
Vera,
I think you're wrong. The only part of “health care” that can bankrupt the country at the moment is Medicare. The country isn't really responsible for that much health care. If private citizens spend a lot of money on health care, that's there choice and runs no risk of bankrupting the country.
The suggestion that your list of reforms is “non controversial” is like the suggestion that it would be nice if benevolent pink unicorns escorted our children to and from school each day. It would be swell for me if I could buy insurance after I'm already sick, and then have a god-given right to an infinite amount of spending on my behalf. But such a policy would be absurdly expensive, and I may not want (or be able) to pay that much! What if I'd like (or can reasonably afford) an insurance policy that has some limits on it? Should it really be illegal for me to buy (or the insurance company to sell) a policy with meaningful-but-not-infinite coverage?
Similarly, consider the suggestion that every plan must cover routine annual physicals for free: Assuming those things run about $100, don't you think it self-evident a policy including such a benefit would cost roughly $100 more than a policy that doesn't? What if I make the decision that I'm healthy enough to have only bi-yearly physicals? You want my decision in that regard to be illegal? Seriously?
Thank you, Prof.
So now, we need to add MINO to our lexicon. What do we call someone that denies that effective tort reform will eventually help reduce medical procedures? OMINO: open mind in name only.
CIMO
>>
I personally know of several doctors in Illinois who have up and moved their practices because of a.) the adverse malpractice climate in the Illinois courts system and, b.) the cost of malpractice insurance.
SO what does that do to the cost of health care when there are many fewer doctors.
OB-Gyn are nearly extinct, too.
<<
Which would indicate that you're a family doctor (I'm not sure what a “go-to” physician is). The severe shortage of family physicians, and the AMA's complete disregard for the disaster that they've created and keep pushing, is the reason that I continue to rail on them as probably the biggest, although certainly not the only, cause for breakdown of medical care in this country.
Oh, and welcome to TMV. Until someone replies to your message, you should be able to edit it.
Good post Patrick, been saying that for a long time, just need to get rid of the progressive obstructionists.
Why limit it medical practice? What we need isn't tort reform, but legal reform.
One group that I've heard is trying to do just that is HALT
Delighted to find a moderate discussion.
In my opinion, the national discussion needs to be honest: bettering coverage will cost money. The question is, how much will it cost to get how much coverage, and is it worth it? There are varying degrees of improvement, each with its own cost, all of it high. We need to decide how much we can and/or are willing to afford. The political smoke and mirrors are not at all helpful, and they are getting us nowhere.
Welcome. That's the way the parties like it. Bewitched, bothered and bewildered.
Why limit it to medical practice? What we need isn't tort reform, but legal reform.”
One Mt. Everest at a time.
And now you want to blame Republicans? I suggest you direct your irate attention to the party in charge and ask how they could possibly have made such a total hash of this.”
I just got a chance to read this, for you, it's is very good. As Don Q. (the real one) once said, let's get that windmill, it looks like someone else's ox.
If you're going to fight, go for the jugular, otherwise you'll just make them angry.
Frank Hagan has a similarly themed post at Donklephant
Healthcare: Now What?
http://donklephant.com/2010/01/22/healthcare-no…
Yes this is an opportunity for the parties to take a lesson from the people and actually start working together for the benefit of their employer and not their partisan agendas.
benevolent pink unicorns escorted our children to and from school each day
Hilarious and right on the money.
Oh duck! — MINO, OMINO
Your on a roll today — or a waddle as the case may be
Oh, don't be fooled, we're all extremists here, we're just moderately extreme (except for me — I'm extremely moderate).
You bring up a couple of good points that I'd like to expand on:
1. If you can get people to ask the wrong questions, you don't have to worry about their answers.
The conversation is being narrowly directed toward coverage, lawsuits and insurance profits, which has helped keep people ignorant.
While they're all problems, they're relatively minor factors. If the excess profits of the larger leeches could be brought back in line, and if both private and public insurances had a way of determining when treatment wasn't worth the cost, then both coverage and costs could be addressed at the same time.
2. The AMA has managed to become a virtual monopoly in all 50 states and, like all monopolies, needs to be fixed (both definitions of that word can apply here).
Thank you for going into family practice. As far as I'm concerned, that's our most valuable specialist.
Great link to use to refute the rubbish about “Republicans never proposed anything on health care”
Have you priced any of those lately? Those “catastrophic only policies?” I have and guess what. The insurance industry is NOT gonna cut you a break for those. They're absurdly expensive for a policy that doesn't have to pay out for anything under $5,000. You find a great deal on one, do let me know. I have private individual insurance and have for over 15 years. With ZERO claims last year, they just bumped my premium 20%.
“Tort reform” is DRIVEN by big pharma and big insurers. They would LOVE to be protected from direct civil action against them. So once they own the president, Congress and all the regulatory agencies, the only recourse is civil suit, for those–and I know you know there are many–who have been harmed by negligence, incompetence or fraud. The moneyed interests in health care would love to shut down citizens' right to compensation for harm done to them and their loved ones.
You also know of course, that a recent Harvard study found that only 1/8 of those harmed by negligence actually sue. So the cost of medical malpractice as a part of health care is currently RADICALLY UNDER what it should be. Not over. BTW, malpractice is 0.5% of health care cost. Not much there to save in even the rosiest predictions.
Still laughing about DaMav playing “moderate.” That is a scream, bud. Torture proponent with Tom Clancy delusions about bombing Iran out of existence. Uh huh. Real moderate.
Hey, I read all the pathetic GOP “plans” for health care. I also challenged any of you on the right to sign on to any of them. So I reiterate my invitation. DaMav, which of the GOP bills do you think were what we SHOULD have done???? Don't give me “better than the Dems” BS. Which do you think would have delivered meaningful health care reform and cost control?