Meet the New Health Care Reform, Same as the Old Health Care Reform

We’re so close to health care reform!  Even Paul Krugman is starting to talk about what comes next.  Me?  I’ve been thinking about what comes next for a long time.  I think this bill will pass.  We will get the incremental reforms we were promised.  Things will likely get better in the short term.  Then, since we didn’t contain costs, we’ll need to enact real reform.  Or, things will go right back to the status quo.

How do I know that?  We’ve been here before.

President Obama said, in his address to Congress, that he was determined to be the last president to deal with health care reform.  That’s not going to happen.  He should have read his history.  At least, he should have read the New York Times.

Governor Romney thought the same thing in Massachusetts in 2006.  I saw it – right there in the New York Times:

The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.

"This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone."

But wait.  I’d heard that before.  In the New York Times.  In 1988:

Massachusetts last week ventured where no state had gone before: It guaranteed health insurance for every resident.

The plan requires that by 1992 every employer of six or more pay $1,680 per worker per year for insurance. The employer may buy the insurance directly for his workers and their dependents, thereby earning a tax credit...The Massachusetts plan recognizes the value of an employer-based approach, which it would expand by forcing more businesses either to insure or pay.

That time was under Governor Dukakis.  He was going to be the last one to deal with health care reform, too.  Just so you know, the rate of uninsurance in Massachusetts was 8.4% in 1988 around the time of the first “unique” reform and 5.5% in 2008, after two times they said they were going to achieve universal coverage.  I don’t think they understood the concept of “fixed”.

And that’s just Massachusetts.  Look at Tennessee.  They went all out with incremental reform in 1994.  There’s that New York Times again:

The Tennessee program, which went into effect last Jan. 1, covers 803,800 people who were formerly on Medicaid and 335,300 who had no health insurance. Gov. Ned McWherter, a Democrat, said that 94 percent of the state's residents were now insured. He predicted, "Tennessee will cover at least 95 percent of its citizens with health insurance by the end of 1994, seven years faster than the most aggressive goal set for the nation under legislation being debated in Congress."

Tennessee’s rate of uninsurance was 10.2% in 1994 and 15.1% in 2008.

Governor Dean, no stranger to the cause of health care reform, “fixed” the problem of health care reform way back in 1992.  Per the New York Times:

Gov. Howard Dean, the only Governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal health care by 1995.

The Vermont law creates a state agency, the Health Care Authority, that will have the power to bargain for health insurance for the state's residents, using what Governor Dean called "enormous leverage" to gain better coverage at lower rates.

Wow.  That sounds like… a public option!  Let’s go to the scoreboard: Vermont’s rate of uninsurance was 9.5% in 1992 and 9.3% in 2008.

Minnesota tried this, too, in 1992.  Of course, how would anyone know about that?  It was only in the New York Times:

Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it.

The legislation, called HealthRight, provides state-subsidized insurance coverage for people of modest income, a provision that is expected to cost Minnesota $250 million a year, along with steps to control the health-care industry's steeply rising charges.

Subsidies to buy insurance.  That must have worked, right? Minnesota’s rate of uninsurance was 8.1% in 1992 and 8.7% in 2008.

Washington State?  1993.  New York Times:

Washington will have one of the most aggressive health-care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state and try to control costs through a cap on insurance premiums.

The plan would require all employers to pay at least half the cost of health insurance premiums for their employees… “We weren't going to create some huge new government bureaucracy, so we took that away from the critics.”

God forbid!  A government system might actually… I don’t know…  do something.  Anyway, Washington’s rate of uninsurance was 12.6% in 1993 and 12.4% in 2008.

Since the administration has put Senator Snowe somewhat in charge of health care reform, you would think they would at least know about efforts in Maine.  Right?  To the New York Times, please!

The Maine Legislature today passed a comprehensive health insurance plan that will make low-cost coverage available to all state residents by 2009.

The legislation will create a semiprivate agency that provides private coverage to the state's 180,000 uninsured residents, businesses and municipalities with fewer than 50 employees and the self-employed. Employers would pay up to 60 percent of an employee's premium.

That looks like it could have come right out of HR 3200.  You’d never know it was from 2003.  How did that pledge to achieve universal coverage by 2009 go? Maine’s rate of uninsurance was 10.4% in 2003 and 10.4% in 2008.

We pretend these problems are new; we pretend that these solutions are new.  Subsidies have been done.  Community ratings are old news.  “Public plans” have been around for a while.  Mandates, both individual and employer, weren’t invented this year.

In 1988, before the first of these plans went into effect, 13.4% of Americans were uninsured.  In 2008, it was 15.4% of Americans.  They don’t work.  Not in the long run.

We need comprehensive reform.  This plan will pass; it won’t be enough.  President Obama will not be the last President to deal with this problem.

We keep doing the same thing and expecting a different outcome.  What does that signify?

 

Read more about health care policy and get your questions answered at Rational Arguments.

Read more at: http://www.huffingtonpost.com/aaron-e-carroll/shuffling-the-deck-chairs_b_320265.html

 

 

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Comments

[PlaceboStudman]

Nothing...­absolutely nothing will change until and unless people start actually taking some personal responsibility for themselves and do what it takes to not get sick in the first place. Everyone talks about the administrative waste in health care, but what about the waste that comes from a kid who sprains his ankle playing football at 15, ends up needing arthritis medication for that joint by 30, and ends up dying of kidney and liver failure caused by the 30 years of medication at age 60?

Nobody *ever* talks about that. What about the medical waste that is caused when a person develops cancer, then needs 10-20 additional supplements and drugs to counteract the negative side effects of chemo and radiation, and those end up causeing kidney and liver damage?

Are we really so desperate to believe that we are being "healed" that we are willing to accept half measures and treatments that end up doing more harm than good in the long run? And THAT fact alone causes costs to go up as much as any insurance predator

[Jollymon72]

Dr. Carroll,

I first heard you on Stand Up! with Pete Dominick a little while back and have really been impressed with your knowledge and outlook. With all the garbage being thrown out in the media by the left and right, its refreshing to see something rational and well stated with attributable facts. Very good read and well researched. Thank you.

[Neaguy]

Excellent analysis, Dr. Carroll. It is truly stunning to watch so many say so many wrong things about health care reform. There are literally tens of millions of people who think they are going to be getting the public option. They are so willing to believe anything they think they hear that they don't even listen when Obama tells them most people won't even be allowed to apply for it.

There's no excuse for the Democrats and their health care lobbyists who crafted this piece of junk. They know what they are doing and it is despicable.

You want to know why we make little progress in country? The Democrats' behavior on health care reform is exhibit A.

[Merrysunshine]

Health care in Israel is both universal and compulsory, and is administered by a small number of organizations with funding from the government. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which organization they are a member of, and treatment under this package is funded for all citizens regardless of their financial means. According to a 2000 study by the World Health Organization, Israel has the 28th best health care in the world.

[AntonioSosa]

The stench of the Obamacare SCAM is so nauseating, even Democrats want distance themselves from it. Obama and his accomplices may paint the scam in different colors and call it by different names, but people understand it's a SCAM, a power grab that will further destroy our health care, our economy and our country.

To solve our healthcare problems, we need to go in the OPPOSITE DIRECTION to Obamacare. The last thing we need is more backroom deals, more corruption, more debt, and more ACORN-type bureaucracy.

[David4562]

Its nice to see someone actually writing articles with facts and statements that make sense. Hope you continue to write, its refreshing to read such an honest work. I will forward your stuff to others, I hope everyone does the same.

[ThePeacemakers]

There is still no defined "public option."

What should people think of the state by state opt out (If that's what it turns out to be)?
That's the carrot on the stick (a frozen, processed carrot - not a fresh organic one) for your votes in 2010 or 2012. Playing politics with health.

[Aaron E. Carroll - Huffpost Blogger]

I think I made my feelings on the public option clear last post. We're all so focused on that, many of us have lost sight of the rest of reform.

Thanks for the comment!

[IPhonehealthguy]

I don't know that I always agree with you, but we definitely need more people like you speaking truth to power.

Keep it up!

[RobStone]

It is clear that anything that passes this Congress will not be sufficient - it won't be universal, and it will not control costs. What's not clear is what the real effect of an inadequate bill will be. Dr Carroll thinks it will probably help a little, but only in the short term, but some argue that a bad bill might be worse than no bill at all. They then argue that progressives should actively work against any bill short of full single payer. It's true that a bad bill could have really bad consequences, but it's also true that the failure to pass any bill could have really bad consequences too. I'm in it for the long haul. I'm happy to critique the public option, but not to actively oppose it. Whatever happens, we will fight on until we have a true universal, affordable, single payer health program.

[JDM73]

Thanks for a great article. Someday, when we've had a bellyful of suffering and dishonesty, we'll get wise.

[SharkUW]

Thanks Dr. Carroll. A great piece filled with real and meaningful statistics. Enjoy reading your posts. Keep up the good work.

[jmpurser]

Agreed. Our health care system doesn't need "incremental" reform. AT LEAST the access portion needs to be scrapped and done over. It was the perfect time for a president with real leadership skills to implement single payer. Instead we got Obama who was more interested in saving the insurance companies than saving American lives.

Oh well. Maybe next generation.

[no body]

The reform will not come only from what you mention, as the Mass model shows. You also need to increase efficiency by using Healthcare IT, but not through a vendor product but through a public-private process and this was passed as part of the stimulus bill.

[Aaron E. Carroll - Huffpost Blogger]

Do you really believe that Health IT, which will likely be much harder to install widely that most imagine, will really be the silver bullet to allow incremental reform to succeed? Can you point me to one study which makes this a compelling argument? I'm happy to read it if you can find it!

[no body]

I sent you an email with the information and at the end are references to a project IBM is doing as well as the technologies used and how to implement it In addition the DOD is doing something very similar for their interactive electronic training manuals. It could easily be implemented across the country in three or four years. It's more like building the inter-state highway system than what people think of when installing a computer system. Feel free to contact me if you have any questions.

[no body]

I resent the email because it coudn't be delivered, so I dropped the attachments and resent it.

[no body]

I can point you to actual implementations not studies.

[no body]

A simple public-private open-source HIT process to answer the Brookings Institute (http://www.brookings.edu/reports/2009/0901_btc.aspx) and IT naysayers. By using the finest physicians, scientists and evidence based-medicine from around the world to come up with “Best Medical Practices” interactiv­e-electron­ic-medical­-workbooks using:
XML (http://en.wikipedia.org/wiki/XML) ,
XML schema (http://en.wikipedia.org/wiki/XML_schema) ,
XForms (http://en.wikipedia.org/wiki/Xforms),
Dita (http://en.wikipedia.org/wiki/Darwin_Information_Typing_Architecture) and
web-services (http://en.wikipedia.org/wiki/Web_service)
(savings Director Orszag's 700b, no medical errors) which are IETM Class V compliant documents (http://en.wikipedia.org/wiki/IETM) that when filled out are checked for accuracy and completeness in real-time and saved to a third-party (local telecom, savings malpractice 100b). The workbooks are created, maintained and continuously updated (always learning) by the regional Health Information Technology Research Centers, CDC, NIH, FDA and HHS in conjunction with the Healthcare Industry to provide an effectivity rating for the different treatments, the ability to produce a prognosis and cost of treatment in real-time. Senator Sanders 400b in administration costs would be greatly reduced because the forms are already filled out and there's nothing to deny. DOD for their interactiv­e-electron­ic-trainin­g-manuals are already using these technologies the CBO can score the savings.

[ValerieJK]

That's just stunning. You'd think at least the NYT might have read their own reporting? Why do we have the MSM again? What are we doing?