Review of Remedy and Reaction: The Peculiar American Struggle Over Health Care Reform. By Paul Starr. Yale University Press. 324 pp. $28.50
A liberal United States Senator, let's call him Edward M. Kennedy, dies. When he gets to heaven, he asks God, "Will America ever have national health insurance?" "Yes," the Lord replies, "but not in my lifetime."
Change the name, and the joke applies to just about every decade of the twentieth century. Given the imperfections in and the uncertain fate of the Affordable Care Act of 2010, which faces challenges in the courts and in Congress, it may well keep Americans laughing with tears in their eyes for a long time to come.
In Remedy and Reaction, Paul Starr provides a clear, comprehensive, and compelling chronicle of the health care debate in this country from the Progressive Era to the present -- and a probing and provocative analysis of a costly and complex health care system that leaves tens of millions of Americans unprotected.
He brings superb credentials to the task. A professor of sociology and public affairs at Princeton University and an adviser to President Clinton, Starr is the author of The Social Transformation of American Medicine (which won the Pulitzer Prize), The Logic of Health Care Reform, The Creation of the Media, and Freedom's Power.
Starr is at the top of his game in Remedy and Reaction. The United States, he notes, is the only advanced society that does not provide health care to all its citizens. Although Americans spend two and a half times more per capita than other rich countries treating disease, the World Health Organization has ranked our system thirty-seventh.
Explanations for our failure to fix it include, of course, an animus against government that manifests itself in bitter partisan conflict in Washington, D.C. And yet, Starr reminds us, the American people and its politicians have reconciled their values with government-funded social welfare policies such as Social Security and Medicare. Health care is different, he argues, because the nation has fallen, unwittingly, over the last half century, into a "policy trap." A system has evolved which leaves millions of Americans uninsured against illness while satisfying enough people to immunize it against change. The key elements of the trap include employer-based programs that hide their true cost from beneficiaries and taxpayers; popular government programs for the elderly and veterans, who are well-organized and believe they have earned their benefits; and a financing system that has enriched the health care industry, which has created powerful lobbies to resist reform.
Taking on a subject where the devil is in the details, Starr manages to make his analysis accessible without dumbing it down. And Remedy and Reaction contains important lessons for liberals. Although single payer plans may be simpler and more efficient than the alternatives, Starr makes a compelling case that they were -- and are -- non-starters for Bill Clinton and Barack Obama. In 1994, well before the economy tanked and the Tea Party was founded, he notes, California voters defeated a single-payer initiative by a whopping margin of 73 to 27 percent.
Starr also warns liberals against making "the public option" (a government insurance plan) a litmus test of the worthiness of health care reform. If it were not keyed to low Medicaid rates, he points out, the public option might not be cheaper than private insurance. Nor would it necessarily attract a large enrollment. Moreover, private companies could use it as a dumping ground for people with chronic illnesses and disabilities.
Starr makes a compelling case that liberals should re-consider their lukewarm response to the Affordable Care Act. Rarely, he writes, has so far-reaching a reform been so widely dismissed by those who supported it. Acknowledging that the legislation does not do nearly enough to reorganize how medical care is delivered or to contain costs, Starr shows that it provides coverage to about 32 million people, half through Medicaid and half through private carriers, raising the insured share of the population to 94 percent. Unlike George W. Bush's prescription drug bill, "Obamacare" does not raise the federal deficit.
By delaying implementation of key components of the legislation, Starr argues, the Democrats created a huge problem for themselves. Even though it was originally a Republican idea, the "mandate" (a requirement that every individual purchase a minimum level of coverage) compounds those problems.
In theory, critics who argue that if the government can force citizens to buy health insurance they can force them to buy other things, are easy to refute. After all, Starr indicates, there are "clear grounds" for distinguishing health care from other goods and services. If you appear at an electronics store on Super Bowl Sunday you won't be given a plasma TV on demand, for example, but you can go to a hospital emergency room and expect treatment. In essence, then, we have a mandate now -- but it is inefficient and unfair.
Given our toxic political climate, which pumps oxygen into demagogues and liars, Republicans will surely run against "Obamacare" in 2012 -- and repeal it if they win. They'll get traction, Starr implies, because opposition to reform comes not only from pharmaceutical companies, hospitals, and insurance providers, but from members of an "entitled majority with a privileged position in the public subsidy-system." If "they" -- and I mean "we" -- don't set aside narrow self-interest and summon "elementary decency" toward those with the bad luck to get sick, universal access to health care, which ought to be a basic right in a democracy, won't be enacted in our lifetimes.
When you get to the place with the man with horns, you can look around all you like, but I'm sure you won't find him there.
The right wings problem with attacking the Affordable H Care law (“Obamneycare“) is that they are always unable to come up with specifics only vituperations.
They often quote the non-partisan Congressional Budget Office when it suits their purposes. When it does not, its dumkoff.
“Specifically, the CBO, in a preliminary analysis, said that the law's REPEAL would cost $145 billion by 2019 and $230 billion by 2021, then swell after that, because various money-saving and revenue-raising provisions would be undone.” http://www.washingtonpost.com/wp-dyn/content/article/2011/01/06/AR2011010606159.html
A sample MISREPRESENTATION illistrated by:
http://blog.heritage.org/2011/09/29/morning-bell-obamacares-soaring-price-tag/ An associate of the Heritage Foundation and their “Foundry" web site: and see: www.heritage.org/.../why-the-health-care-law-has-sparked-a-national-debate-over-first-principles
Quote:
“What’s driving those costs? In large part, Obamacare. According to Kaiser Family Foundation CEO Drew Altman, the President’s health care legislation was responsible for approximately 20 percent of the increase in premiums.” (WRONG FALSE)
Here is what the Kaiser Foundation ACTUALLY said:
"The health law enacted last year accounts for 1 to 2 percentage points of the premium increases in 2011, said Drew Altman, chief executive officer of the Kaiser Family Foundation. Other contributors include higher medical prices and insurers raising premiums in anticipation of an economic recovery that would spur greater use of health-care services".
I submit that a good “Public Option” program will, in fact attract a very large number of participants. Perhaps not immediately. But when the clout of such new program is combined with the impact of Medicare, Medicaid, Veterans Admin. care, etc. the providers of care will, perhaps not too gradually, come to realize that their “party is over”; that their charges will have to come down to earth. There will be ubiquitous downward pressure on the charges. Of course, rapacious health insurers will hate it but its inevitable or we are all on the Titanic.
After the Public Option is enacted, the word will be soon be getting around that it offers a great deal with substantially lower rates than the average private plans and that it is essentially non-intrusive, and obiously non-compulsive.
It will revolutionize the cost of care delivery in the same way that the Tenn. Valley Authority revolutionized the cost, efficiency and availability of electric power in the South Eastern U.S.A. Its now taken for granted but it should never be overlooked.
I have seen situations in which Medicare has invested >8months and >$400K in helping a woman's husband get ready for the idea that he is going to be a widower.
The budget for health care dollars can not be just an ever-expanding mountain of cash.
We need to invest in evidence based cost effective medicine.
Most European nations invest about 9% of their GDP in providing evidence based cost effective medicine to about 99% of the population.
We invest most of our health care dollars in futile care trying to fend off death in the final 6-12 months of life.
Death comes for us all. A very unpopular thing to say in the USA, but, as Joe Friday would say: "Just the facts."
Heartbreaking, but we all do have to.
http://www.pnhp.org
What planet is Starr living on? Even CBO says there is a "cost" = deficit to Obamacare.
You can't add almost 40 million Americans to Medicaid, etc and NOT HAVE A COST?
PS....Starr should have investigated what kind of a health care system we will have when Medicaid rates are the norm. Doctors will flee. Hospitals shut down. Medicaid rates will not pay enough to keep our system the best in the world, which it is.
BTW....please list the other 36 countries you'd rather get care in ?......?......?
OR
are they just ignorant of the alternatives because there are NO equivilent structures in the United States that are similar to a low cost, high value, high performing, universal system. I would bet a majority wouldn't recognize one if it fell on them. What a shame!
Vets Loving Socialized Medicine Show Government Offers Savings - Bloomberg.com
“..The care is superb,” said Tanner, 66, a San Diego resident who visits the veterans medical center in La Jolla, California, and a clinic in nearby Mission Valley. The record- keeping, he said, is “state of the art.”
As Congress considers changing Americans’ access to health care, the veterans agency, whose projected budget this year is $45 billion, is evidence that the government can provide care favored by patients that may offer savings when compared with private insurers.
Researchers publishing in the New England Journal of Medicine, the British Medical Journal and the Annals of Internal Medicine in recent years have endorsed the system. A Canadian policy journal, Healthcare Papers, devoted an entire issue to it in 2005..."
NOTE: I'm not a veteran.
Case in point: Doctors don't get paid for suggesting or prescribing home remedies or lifestyle changes, so they usually don't. Despite the fact that many of them work as well if not better than surgery or a pill, and are FAR less risky regarding complications, side effects, drug interactions, and hospital-bred infections. And far less costly.
Case in point: People go into the hospital for one issue, but after a cascade of interventions, side effects, complications, milieu-related difficulties and hospital-bred drug resistant infections, they end up far sicker and weaker after discharge than before. Or dead.
And don't get me started on cost. There's no way to compare costs between providers, determine which hospitals are the safest, or figure out if you're being milked like a cash cow.
I just met a wealthy couple who's moving back to their native Africa, (Africa, for God' sakes), because they've had it with the American medical "system". They say they can afford the best treatment, but because it's profit driven, even they don't get decent care!
Train and pay providers well, but remove the profit motive, please.
Medicine is a calling, not a market.
And because it's ALL now about profit, and nothing else, with very little to no regulatory oversight (that's Big Government Interference and Red Tape), you can only HOPE that flu shot is safe and effective and someone along the way hasn't poisoned or contaminated it trying to cut corners to make another buck.
These days, I don't even like to visit someone in a hospital because most of them don't pay the lower rung staff enough to bother wiping commonly used surfaces or washing their hands often enough. I don't want to catch MRSA off an elevator button.
But when doctors have to make $500K a year, and drug reps and equipment salesmen far more, I guess there's not much left for the janitors, right?
Another part of the blame? LAWYERS. Granted, a lot of the ambulance chasers are now going after Big Pharma, but if there are complications due to a surgery or a treatment, you bet your sweet bippy that there's a lawyer that will convince some of the not-so-educated out there to sue. Up go malpractice insurance premiums that get factored into doctor bills.
Also keep in mind that a lot of the bigger health insurance companies (Anthem, Cigna, United Health Care) are more focused on their shareholders than their customers, since they are publicly traded on the stock exchanges. Even Angela Braly, the CEO of Anthem's parent company Wellpoint (who, coincidentally, is the parent company of National Government Services, one of the biggest Medicare Administrative Contractors in the nation) made it perfectly clear that it's the SHAREHOLDERS, and not the customers that matter.
Just yesterday I heard on Dave Ramsey's radio show, a caller who said he was having trouble making ends meet on 140K a year. A physician, paying back 200K in student loans, but he is paying a mortgage note on a $380K house, 2 new car notes, and private school for his kids. And it sounds like his wife doesn't work outside the home.
Well, DUH.
Solution: Just like the rest of us peons who make far less than 140K, (even at the end of their careers)...buy a fixer-upper house you can actually afford & do the work yourself, buy used vehicles, and figure out how to get your kids into a good public school. And if your wife doesn't work, get her to cook at home. And bring your lunch. And don't go out to eat every night, and don't take the kids to Disney for a week and stay onsite. Stay at Econolodge.
And bust your butt to pay your loans off in 15 years. Pay your house mortgage off, too.
This is who our docs are, catmagnet.
People who can't live on 140K a year.
I have no sympathy.
private companies already dump the sick ,poor and elderly into medicare, medicaid and uninsured status.
In addition to being a politically focused plan, there are university politics at work that are at odds with increasing the provisioning of health care; for example: many university and educational hospitals are moving to a CRNA as a PhD. This adds cost, complexity, and will decrease the number of CRNAs. The salary/income of a CRNA versus an Anesthesiologist is about $350,000; with the CRNA at around $150,000 and the Anesthesiologist at around $500,000.
I'm sorry, people, but this is just not OK.
This is going to get ugly before it gets better, folks.
So again, why is it not okay that she makes $500K (which I am sure she does not because she's not in a geographical location that would pay that high, she chose to stay near her family). Let's re-state and say why is it not okay that she makes $300K a year.
. Individual mandate
2. The amendment that allows doctors to get paid for a consultaion visit to discuss end of life options. This was put in by a Republican, but once Palin dubbed it "death panels" everyone went nuts.
This is just one reason wht talk radio, Fox news and other corporate backed "news" should be held accountable for their lies. Most Americans have no idea of the truth regarding the ACA.
Wrong on consultations. Congressman Blumenauer was the main advocate of it, though Cong.Bustany R from LA did join with him. Blumeneauer is a big time "right to die'er" and from Oregon, one of three right to die states.The Death Panel flogging got it's start BECAUSE of Blumenauer.