How Not to Do Healthcare Reform

Health care reform is the issue of the day, and President Obama is blowing it. He's trying to reform the health insurance system, not the healthcare system itself; and doing so on the backs of the rich and of small business owners. Mandates on employers will be disastrous for the economy, and for the popular sense of justice. Obama's "reform," as it stands, will set up an infinitely complex government system of regulations that will be inefficient and that, in the end, will dehumanize patients and doctors even more than the present system does.

The whole point of healthcare reform is that health care, like national defense, is too big and too important to be left to private enterprise, but too big and too important to be managed by government. I don't want the government running healthcare. However, it's perfectly possible to have a government-financed system of social insurance, in which government stands back from any medical or administrative role. In other words, we could collectively pre-pay for guaranteed coverage, with the government collecting the payments and responsible for the paying out the benefits; and retain a market-based system for delivery, with the discipline and quality control that that entails.

In previous columns (here and especially here) I've shown how the right-wing hysteria about the single-payer systems of Canada and Europe is not based on any actual evidence. So I am not now going to get into the statistics that show that single payer actually works quite well, contrary to the Republicans "Canadian nightmare." I'd just like to lay out a few necessary elements for a comprehensive program of single-payer healthcare reform.

1. Subsidized medical education, so that anyone with intelligence, drive and talent can become a doctor or other health care professional.
   
   
2. Salaries, rather than per-procedure payments, for doctors; as is presently the general rule among the best health care clinics and hospitals, such as the Mayo clinic, that put patient outcomes above corporate profits. The salaries don't have to be arbitrary. They can be subject to a very fine-tuned set of criteria, such as years of experience, number of patients seen, specialty, patient outcomes compared with similar practitioners, practice in an underserved area, practice with high-risk patients, patient reviews, etc.
   
   
3. Tort reform, to keep malpractice judgments, and malpractice insurance costs, under control.
   
   
4. Meaningful co-pays, to guard against "moral hazard" (the tendency of consumers to use more of a good than they need when it is free.)
   
   
5. Complete patient choice in doctors, and medical decisions made only by doctors and patients and perhaps hospital boards, but without government oversight.
   
   
6. No denial of coverage for pre-existing conditions or any other reason. Remember that we're not talking about commercial insurance here; we're talking about social insurance.
   
   
7. Financing all of this through new, graduated taxes on income, which for most people would be cheaper than their present health insurance premiums.
   
   
8. Use of the federal government's massive purchasing power to drive down costs of medical supplies. The lack of such a requirement in the Bush-era Medicare prescription plan was a scandal, a pure gift to the pharmaceutical companies at the expense of the public. Obama has said that he doesn't want to require this wholesale discount. Let's hope he reconsiders.

Yes, the young and the healthy would subsidize the old and the sick. That's part of what living in a human society is all about. And it's not even unfair from an individualist point of view, unless the young and healthy believe that they will never, ever be old and sick themselves.

Yes, the employed and the wealthy would subsidize the unemployed and the poor; but we do that anyway, at present, through Medicaid. There are great benefits to all of us from doing so.

Such a plan could really work, and could build, rather than defeat, social solidarity. Roosevelt and the New Dealers insisted that Social Security benefits should not be means-tested. They did this because they understood that if the rich had to pay into Social Security but could not benefit from it, it would become a poor person's program, and would always be politically vulnerable. In making the rich and employers pay for his pathetic "public option" in an essentially private system, Obama completely fails to understand this principle. Health care risks and costs, as well as benefits, should be socialized.

Failure to realize this will come at a great price for Obama. Unpopular, expensive, and overly bureaucratized insurance reform threatens to do for the Democrats what George W. Bush did for the Republicans. We are in danger, in fact, of seeing a far more radical right-wing resurgence than Bush represented, with real reforms discredited and abandoned forever.

Single-payer wouldn't be easy to get, but more and more people are starting to realize that it's the only good option. Against great odds, New York Congressman Anthony Weiner finally forced Speaker Nancy Pelosi to accept a House vote on a single-payer plan. He'll lose this vote, of course; and the right-wing forces will always try to defeat single-payer with lies and distortions about Canada and Europe. But this is a start, and perhaps the attendant debate will educate a few people.

I wish I could say this to Barack Obama: If you're going to risk your presidency, you should at least risk it for something worthwhile, and something viable.

* * * *

Regular readers of this space may recall that I occasionally take issue with Jay Nordlinger, a columnist at National Review who is particularly obnoxious—even for NR—in his smugness, and in his apparent belief that all social democrats are big fans of Fidel Castro. Nordlinger made an observation about multiculturalism the other day that is just too grotesque to ignore.

He writes, here: "There is a kind of 'multiculturalism' I like, and a kind that is poisonous, possibly fatal. May I tell you about a story I saw...? The headline read, 'Sikh soldiers guard Queen Elizabeth II," and I thought, "Uh-oh, watch out, Betty -- remember what happened to Mrs. Gandhi.' But then I read the article."

Here's what Nordlinger read:

Queen Elizabeth II has switched bearskin hats for turbans outside Buckingham Palace, where Sikh soldiers have begun guarding the monarch and her treasures, Britain's defense ministry said Friday.

Signaler Simranjit Singh and Lance Cpl. Sarvjit Singh are the first Sikhs to take part in patrols outside the queen's residence and to stand watch over the Crown jewels at the Tower of London across town.

Guard duties are usually carried out by the Guards of Household Division, famed for their bearskin hats and crimson coats that attract picture-taking tourists in their thousands. The ministry said the Sikh soldiers instead wore turbans and blue uniforms.

Sarvjit Singh, who was born in India and is a member of 3 Regiment Army Air Corps, said he was thrilled to have had the opportunity to guard the queen.

"My experience being a Sikh on the queen's guard is beyond words," said the 28-year-old. "It is a once in a lifetime opportunity. I feel privileged to have this honor."

"Being in London and parading in front of hundreds of people has been brilliant. Being Sikh hasn't made any difference," said Simranjit Singh, 26, from Coventry in central England, who is attached to the 21 Signal Regiment (Air Support).

Nordlinger comments, "You know what I mean? That is assimilation, that is ethnic flavoring, that is harmony -- that is civilization. Unlike . . . lots of other stuff."

I would like to think that Nordlinger is being intentionally provocative here. But, sadly, I don't think he is. I think he is genuinely incapable of seeing what is so wrong with this: The subversion of former colonials to the protection of the symbol of their conquerors, the Great White Mother; a subjugation of other cultural traditions that is so complete it is internalized, worn as a badge of honor. This is Nordlinger's conception of the "good" kind of multiculturalism? As I said, he probably didn't even notice.

I add that I would probably concur with Nordlinger on many "bad" types of multiculturalism. He gives the example of "the blind Briton who refused to budge from the bus, when a Muslim woman was screaming about his seeing-eye dog, complaining that such animals are unclean..." I agree that the Muslim woman's conception of propriety is something we don't need. I am not a cultural relativist, at least not in a broad sense; I believe that we should embrace and encourage those aspects of other cultures that are at least not in conflict with our own democratic values. The Islamic veil, for example, is not compatible with democracy, since it is not possible to be a full civic participant without showing one's face. It should not be encouraged. Any kind of restrictions on speech (including so-called "hate speech") are not compatible with our Anglo-American traditions of liberty, and should not be tolerated, no matter how offended anyone feels.

But for Nordlinger to so confuse colonial dominance—and its nod to, as he quaintly puts it, "ethnic flavoring"—with benign multiculturalism is quite astounding.

Comments

[creolechild]

If you are concerned about receiving "real" health care reform in this country, please take the time to watch a video on our current system. The video was created by Oregon physicians who are advocating for the single-payer option. The video is very informative and helped me to gain a better understanding of various aspect of health care, as we know now it.

https://www.madashelldoctorstour.com/Mad_as_Hell_Video.html

These Oregon physicians are in the process of organizing a caravan designed to inform the public about the benefits of the single-payer option. At last count they will be stopping in approximately 23 states, on their way to demonstrate in Washington. They need volunteers and our support. Please spread the word.

[Brian Ross - Huffpost Blogger]

Your proposal brings in $130 million of campaign money from the lawyers in addition to the $80 million that the insurance, health professionals, hospitals, etc. kick into congress. That's a lot more influence than Obama and every one of us sending in our petitions, cards, letters and emais combined can counter.

These things need to happen INCREMENTALLY. You won't upend the whole system overnight. To get the doctors to sign on, and to a lesser extend, big pharma, you have to migrate into a system that makes some improvements, and clears the pathway for reform in the future. You try to do too much to fast and there's a name for that: The Clinton Health Plan.

[W-31]

Let me get this straight.

We're going to pass a health care plan
written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, signed by a president that also hasn't read it, and who smokes, with funding administered by a treasury chief who didn't pay his taxes, overseen by a surgeon general who is obese, and financed by a country that's nearly broke.

What possibly could go wrong?

[socialtalker]

yeah, pretty much, who else is going to do it?
as has been said for the millionth time now, part of the rising deficit is because of the rising health care bill. we need answers NOW, we have more than enough complainers and rock throwers that REFUSE to answer what should be done.
so come on, give us some ANSWERS. do we just cut off people? do we stop giving the indigent medical care? what do we do? and please dont answer with "well , we should not do...blah" we heard that before.

[nannagal]

It is time to realize that certain things, like health care, fire department protection, public education, etc. should never be privatized. We got into this health care mess because of the GOP push to make it for-profit, rather than not-for-profit (i.e. Blue Cross/Blue Shield of the olden days).

We should start over, and simply have a system like "Medicare for All", with no involvement of big multi-trillion dollar corporate profits driving the system.

If the public option is dead, so is affordable health care, for anybody.

[Cleanerman]

I have always felt single payer makes the most sense. But there is not much sense in Washington. Greed rules the day. I guess that will never change.

[maxfax]

"Single-payer wouldn't be easy to get, but more and more people are starting to realize that it's the only good option."

I've said this from the beginning.

[LewDan]

Yet another post promoting "all or nothing" health reform. A position, I suspect, that is much more easilly held by those not responsible for actually reforming things and those actually opposed to reforming things. More importantly, a position guaranteed to produce the nothing.

The President cannot pass legislation, Congress has the constitutionally mandated monopoly on that. There are too many Republican and Blue-Dog senators to ram extreme reform down everyones' throats.

Pres. Obama won one election. The whole Republican "party of NO" strategy is based on the not unreasonable belief that denied instant gratification enough Obama supporters will abandon him to allow a Republican renaissance. In other words they're depending on people thinking like you, Mr. Larner.

While I agree with your opinion of single-payer plans I believe "that the whole point of healthcare reform" is to improve our healthcare. I agree with going for all we can get instead of wasting time with your all or nothing single-payer.

[RTIII]

The current plan, health _insurance_ reform, is a waste of time.

_Only_ a strong public option has been put forward as a possible means to compel reform through real competition, but it has no support in the Senate. Absolutely no other means of helping control costs has been put on the table. Nothing.
.

[Boikin]

Expand Medicaid to everyone uninsured, and you're done.

[laurieanichols]

Is anyone in the White House listening to anyone besides those congressmen and senators on both sides of the aisle. Over the past several months I've been reading numerous thoughtful and intriguing ideas as to how HEALTH INSURANCE as a whole needs reform, most importantly a healthy dose of competition. Yet, this is the first article that addressed the exorbitant cost of medical education and the obscene cost of malpractice insurance that I've read. Already addressing these two topics changes or at least deepens the discourse. Why aren't we hearing things like this from President Obama or his people? Instead of vagaries, give us substantive ideas, so that the extreme right can be debunked, de-clawed and de-fanged.

[FreedomAgain]

At first I was upset by the headline, but after reading I must concur. Single payer would be the truly obvious solution that would save the most money and make the most sense. But a non-profit public option is a little better than what we have now.

[omnivore]

Quick afterthought : the shift is from seeing healthcare as a social, not an individual or corporate good. Providing healthcare to poor people with TB, AIDS etc is a way of reducing its spread to the smug, middle classes. Treating parents means the money is there for the kids' education, and society benefits in twenty years. Health care has the interesting property of never being entirely individual: sick people, like people whose houses are burning down, affect the society around them disproportionately to the cost of providing remedies.

Americans don't think like that. This can be a strength: in this, it's a weakness. When you get tired of living in a burning building, maybe you'll change your mind.

What any of this has to do with multiculturalism is beyond me, though.

[kgeno]

I agree with DI - a good negotiator will always start with the most radical position (who knows it may pass?) but if not - at least there is always room for maneuvering and move toward something more practical. But you never start with your bottom line. Used car dealers have it down to a science. They start with the highest possible price and then negotiate depending on the skills of the buyer. Who knows maybe some shmack agrees to the asking price. There are enough of those to make this strategy worthwhile and pay for itself.

The principles of negotiations have been established centuries ago. If a leader tries to reinvent the wheel he/she will end up with a much worse outcome.

Obama has already lost the battle by excluding single payer system from consideration thinking that will bring parties to the table. Nothing will bring to the table birthers, deathers, screamers, etc.

Anything other than single payer system will be too expensive, restrictive, bureaucratic and will ultimately be overturned by the next republican administration.

[LewDan]

Two problems with that. Doesn't work if your opening position is so unreasonable no one takes it seriously; and when your opponent's strategy is simply indefinte delays, and he can defeat you by doing so, you just play into their hands if you don't immediately enter into serious and meaningful negotiations.

[RTIII]

Thank you. LewDan has cognative problems recognizing a good and strong argument. The problem here isn't being taken seriously or not it's getting honest media coverage.
.

[omnivore]

I give half marks.

# 4 – Moral Hazard - if there is one thing we know from forty years of healthcare in Canada, it's that this is a ludicrous fiction. Like all Canadians, I have full health coverage but no dental coverage. But, I go to the dentist far more often than the doctor.

The more we "consume" healthcare, the less we get the "good" it produces: our normal, productive lives, which we prefer to doctors offices, tests and hospital wards. No statistical evidence for "moral hazard" in healthcare exists.

#6 – Denial of Coverage - Yes, but no. Certainly, no refusal of treatment for pre-existing conditions.

OTOH, When my father died of leukemia, he couldn't get every out-there treatment: what he got instead was extremely good, responsive, expert treatment with excellent diagnosis, many treatment options, and top-notch end-of-life counselling with palliative care that I thank god for everytime I think about him. Some options were not yet approved, and like it or not, the government determines which.

# 2 – Salaried Doctors - Sounds good, but it doesn't really work that way. A doctor in a private clinic may be on salary, but who pays for the clinic itself? The equipment? The receptionist? We only see salaried doctors in public clinics here, often for people who are at-risk, often in areas underserved by physicians.

People examining doctor performance, determining salaries? The point is to get rid of the cumbersome micromanagement. Not gonna happen, shouldn't happen.

[LauraNo]

Obama completely fails to understand that health care risks, costs, and benefits should be socialized.

Obama completely does understand that. Unlike you, he also understands politics in this country too. I wish they'd go for broke and take an up and down vote on the public option. Then move on to whatever plan they've come up with. Then we could go from there. If people like the private/ public option, fine. If they vote with their money for public, fine.

[pontesisto]

If you would like to help pressure Congress to pass single payer health care in a democratic and constructive way please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php

[W-31]

Let me get this straight.

We're going to pass a health care plan
written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, signed by a president that also hasn't read it, and who smokes, with funding administered by a treasury chief who didn't pay his taxes, overseen by a surgeon general who is obese, and financed by a country that's nearly broke.

What possibly could go wrong?