I read a book back in residency that changed my life. I know that's cliched, but there's no other way to put it. People tell me all the time that it's hard to argue with me; that book is why. It's Getting to Yes: Negotiating Agreement Without Giving In.
I think the reason health care reform has disappointed so many is that too few people, on both sides of the aisle, have read this book. Here's a critical passage, right from the beginning:
When negotiators bargain over positions, they tend to lock themselves into those positions. The more you clarify your position and defend it against attack, the more committed you become to it. The more you try to convince the other side of the impossibility of changing your opening position, the more difficult it becomes to do so. Your ego becomes identified with your position. You now have a new interest in "saving face" -- in reconciling future action with past positions -- making it less likely that any agreement will wisely reconcile the parties' original interest.
We live in a world where politicians, and the public, are consumed by positions. We are so concerned with them -- what we are "for" -- that we lose sight of what we are actually trying to achieve.
I used to think that the United States had the best health care system in the world. I'd argue against anyone who wanted to seriously reform it. When I attended a conference on universal health care, a proponent of single payer health care so enraged me that I was consumed with proving her wrong. A colleague and I decided to conduct a large study on physicians' views on National Health Insurance. I was absolutely positive we would find robust opposition. When we found a plurality of physicians actually supported National Health Insurance, I was stunned.
Not only did we publish the results, but I also felt compelled to rethink my position. If I was wrong on this, I might be wrong on many other things. And my review of the research, which I'm willing to wager was about as thorough as anyone else has done, found that there was overwhelming evidence that systems with more socialized financing achieved superior results, covered everyone, and still cost much less per person than our system.
There's no zealot like a convert. Since the evidence was so compelling, I found myself arguing more and more for single payer health insurance. That was a new position, however, and I found it difficult to sway those who believed as I used to.
That's when I went back to Getting to Yes. I stopped arguing my position and started negotiating. I'd get people to agree to the metrics on which a health care system should be judged -- access, quality, and cost. I'd get them to agree on how we should measure them. And then I'd have them apply those measurements to the metrics. It rarely fails.
Unfortunately, that's not the way it seems to work in politics. All people seem to care about is positions.
I've spoken more about health care reform and given more interviews in the last six months than I have in the previous six years. And in each interview, eventually, I am asked what I think about reform. I've dodged the question repeatedly, but it's important you know where I'm coming from. Here is my position:
I think it's ridiculous that single payer health insurance was taken off the table so early in this process. I think that it's laughable that we can't publicly have a discussion about it without losing our collective marbles. I think it's the height of hypocrisy that a single-payer system is American-as-apple-pie if you're 65, but a socialist nightmare if you're 64.
I think it's naive and xenophobic to use scare tactics to cloud the fact that almost any other comparable country in the world provides universal health care to its citizens, achieves similar if not better outcomes, and spends far less than we do. I think it's strange to ignore these facts and proudly proclaim the opposite.
I have felt, and continue to feel, that Medicare-for-all would be a far better solution than pretty much anything else that has been proposed. I've said so from the beginning.
Please hear me, though. None of that matters.
I'm not arguing for a position; I'm negotiating for a goal -- a better health care system. I want more people to be covered. I want to see our quality improve. I want to see costs become more acceptable. That -- not an ideology or a position -- is what I want.
Because of that, even though I think more robust reform would be preferable, I am willing to say that the reform we are likely to get does more good than harm. Many more people will get Medicaid. Many more will get subsidies to help them buy private insurance. Regulations will protect the sick and help prevent medical bankruptcies.
It's not single payer. It's not perfect. And it may not feel like a "win." But it's not supposed to; that wasn't the point. In a principled negotiation no one wins, but no one loses either. In a principled negotiation, you try and get your goals accomplished. You try and get a better health care system than you had before.
I think we will.
Read more about health care policy and get your questions answered at Rational Arguments.
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http://www.thenation.com/blogs/notion/510767/single_payer_s_last_stand
What if this represents the last chance we'll have to improve health care for another generation or two if we allow it to pass?
What if this mish-mash of so-called reform turns out to be unsustainable?
What if you're just wrong, and the bill is actually worse than what we have now?
If politics is the art of seizing the moment, the Democratic leadership did so with its hands covered with corporate grease. But the moment is still in play, and we still have the opportunity to seize it ourselves to try to correct the situation.
Healthy but also solvent or at least not broke.
The concern by many, though, is that the fiscal bleed is so deep and constant, any progress the bill brings may be quickly drowned out by the weak repair of the hemmorhage.
A Medicare buy-in (Part E) plan can only be accomplished via reconciliation (bypass DINOS with only 50 Senate votes and a VP tiebreaker).
One good thing about assuming nothing will work as planned is that you are more likely to be pleasantly surprised if just one thing works. Since it’s in the best interests of Democrats to pass the best bill possible, I trust healthcare reform will achieve many of its goals despite your doubts. Politicians like to be re-elected.
Oh yea, any industry that gets 30 million new customers is likely to grow and create jobs. We are going to need a lot of healthcare workers to serve the growing needs of millions of aging baby boomers.
Most of our bankruptcies are medical bankruptcies. Of those, most of them occur to people who had insurance. The senate bill only specifies 60% actuarial value plans. So you'll still be forced to pay 40% of the costs of your medical emergency, even after you've paid for the plan that the government is forcing you to buy. It doesn't matter whether it's through high minimum deductible or high co-pays, you're still going to pay that money. The medical bankruptcy issue is not going to be solved by subsidizing the premiums on purchasing these plans.
There is no provision for Federal supervision in the Senate plan. The House plan specifies a national insurance examiner. The senate plan does not. Members of the House have complained that 50 state exchanges will not be as able to control costs as a national exchange with a national examiner who is responsible for investigation and invorcment.
Health insurers are not health care workers. They will not take care of the baby boomers. They will process paperwork, sell, and collect money. Health care workers do things like treat the sick.
And if you gave up salary in order to get a better health plan than the crummy 60% actuarial value ones that are permitted in the senate plan, you'll be taxed on your good plan.
However, health care lobbyists began circulating emails and tweets saying "WE WON!" Meaning they got nearly everything they asked for and plenty of gifts to offset the few onerous provisions that help real people.
I wouldn't use this health care reform debate as an example of even mediocre negotiating.
The Dems gave away their advantages before the issue was even framed and the public got screwwed.
Well actually the middle class did. That segment of our society which is already living paycheck to paycheck and stretched to its limits is now going to be forced to fork over more money to subsidize health care for the poor. It's not that the poor don't deserve health care, it's forcing the people in the worst financial position to pay for it that's wrong. The rich certainly got the representation THEY paid for out of our politicians; they get to contribute almost nothing.
WTFU
It's like having the chance to listen to good music when you are being beaten up. The tune was nice, but overall, the experience is still pretty horrible.
If they pass that POS Senate Bill, it WILL be the LAST time Congress touches health care, except maybe to repeal it.
This bill will be the end of liberalism.
Their premiums will double and they will be FORCED to buy it anyway and they will blame Obama and the Democrats.
1) The negotiations and compromises are supposed to be between different factions, representing different groups of the populace. And much of this occurs via elections. The Dems won handily. To act as if both parties should have an equal say just out of a misguided sense of politeness, regardless of how the electorate voted, is to disenfranchise that electorate.
2) The current negotiations and compromises aren't between two factions of legislators, but are between a) legislators, and b) corporate interests. Corporations do not have a constitutional right to profit, and are not vote-bearing entities. We should not have to compromise our well-being and our positions with their profits. Yet you seem to be asking us to do this.
3) The legitimate compromise, between competing ideologies, would have been between a) Single Payer and b) something like the Senate bill. It would have included the Public Option (triggerless, starting immediately). I'd be very willing to make that compromise.
So why did the Dems give our compromise away to our corporate opponents?
We have a right to be furious. This isn't about immature people identifying themselves with their positions. This is about life and death -- of ourselves, our families and friends, of innocent Americans, whatever their political ideologies. And I'm convinced that the threatened new bill won't save lives.
We need to demand more and better, now. Please help us do that.
Economics of Destruction" does a good job of showing how dangerous
is the burgeoning power of the Global Corporate Pirates and how little time could be left to stop
the serious threat they cause to our US liberties and well-being.
For this reason, I feel that, rather than acquiesce to "crumbs" and compromises, we must
organize now and find ways to resist the onward march toward national devastation. I don't
think we have much time left. Our jobs are all overseas, and every day they take more of
our taxpayer money for various heists like the financial bailout.
First we want everyone covered; this bill doesn't do that.
Second, we want insurance companies to stop rejecting claims, turning down risky patients and dropping sick folks who actually need their insurance. Two out three on this, and only just barely.
But most of all we want the most health care for the most people at the least cost -- we want efficicacy and efficiency. -- this bill completely fails at that.
Why?
Because insurance companies -- which apply an administrative surchare of 30% (equal to more than $300 billion a year) -- still control the process. Mind you, this 30% has nothing to do with providing health; indeed, it is mostly about creating wealth for the few at the expense of our collective national health. In short, it benefits CEOs and large shareholders.
The flaw in your logic is that this was a "principled debate." It was not. Throughout the debate, the majority of Americans favored a single-payer system. But the insurance companies marshalled some 3,300 lobbyists (more than six lobbyists for each legislator) spending as much as $4 million a DAY on the Hill. That, sir is not a debate, it's a third world oligarchy masquerading as a first world democracy.
Sorry, but you're applying the wrong book to this issue -- Pigs at the Trough would have been better.
Had they been forced to compete against a public option we'd have data. Even a national exchange would give us data. But byzantine state markets give us no information.