Who Killed Obama's Health Care Reform?

President Obama's health care initiative isn't dead yet. It's not even on life support. It is, however, in grave danger as long as either the approval or rejection of legislation in Congress rests in the domain of political ideologues and their media lapdogs.

Americans want meaningful changes in the way health care is managed and distributed. They want fair and equitable (mutually exclusive terms?) universal insurance coverage and an intelligent way to pay for it. They want all their elected representatives to understand how the "new and improved" health care system would work and then they want those representatives to come home and explain it to them. If they cannot, they will surely be voted out of office this coming election. Americans really don't understand the granular issues of medical rationing and single payer systems. They are demanding that their representatives do, and that their trust in Congress not be misplaced this time.

More and more, Americans are rejecting the pundits, left and right, and their tired polemic. Limbaugh's claim that the current health care reform proposal is tantamount to gang rape and O'Reilly's framing of coverage for the poor as extra-Constitutional are simply devices to exercise their constituents. Matthews' demand for passage of a coverage bill on moral grounds is as specious as Krugman's exhortation to Congressmen that approving any Obama-based legislation without detailed cost benefit analysis is the mark of a true Democrat.

Americans want a bi-partisan effort on health care reform. They want Republicans and Democrats to keep this from becoming a European soccer match with partisan crazies loathing the opposing team and those wearing its colors. More and more I hear from colleagues in the broad center trying to marginalize the fringe. I am listening for respectful appreciation of opposing views from die hard members' political forums and finding that "yellow and blue dogs" and "grand old party" members are looking for compromise. Hopefully that attitude will push upward from the grass roots to Congress.

The current debate on how to fix health care is over thirty-five years old. In 1974, then-President Nixon introduced the Comprehensive Health Insurance Act that mandated health insurance, costs to be paid for by employers and employees. The Act was coupled with an optional federal health care plan paid for by individual contributions based on income levels. At that time, there were 25 million uninsured Americans. There were opposing bills, including one sponsored by Senator Kennedy and founded on the belief that "only the federal government could operate health insurance that is in the best interest of all the people." The genesis of the political differences in approach to health care lies in the underlying question of who should best care for the interest of the populace. Is health care reform best left to the capitalists, or to the government?

These are not appealing choices. They might have been when we still naively believed that both were competent. With apologies to the few good folks who work in these institutions, Americans are more and more afraid that either Wall Street or the DMV will manage their health care choices.

In 1986, then-President Reagan championed the Tax Reform Act, which was intended to be revenue neutral, meaning that as some revenues were added (new taxes) others were reduced (judicious lowering of taxes). In fact, "revenue neutral," is a theory only, and is so dependent upon future estimates of potential revenues based on projected income growth rates that it becomes an immeasurable concept. There is a lesson for health care reform in the concept.

I propose a different approach. Cost neutral. Like balancing the budget, for every new dollar of health care costs the federal government assumes, an equal dollar of health care cost savings must be found. It is impractical to presume that this zero-sum-game cost approach could be implemented ratably during the first few years of any bill, but a time line based on reasonable savings estimates can be crafted if there is the will to have reform linked to a cost neutral proposition. The added benefit to a longer term approach is that fluctuations based on inaccuracies can be smoothed out in future years.

We then need to address issues of profit motivation in the distribution of our services at the insurer level, the drug company level, the hospital level, and the doctor level. Every one of these groups drive up the cost of the service we receive. Americans do not want to eliminate the profit motive in medicine but they do want it managed.

We need to look at the way we educate doctors. We need to open more medical schools, educate more of them at a more reasonable cost, and break the hold that medical societies have on the acceptances and entrance requirements. We don't need tort reform that caps awards; Americans want to be able to sue their doctor or hospital or even their drug company. We could limit the amount of fees their attorneys get but that won't pass muster with so many lawyers in Congress. We do need to do something about the spiraling cost of malpractice insurance which is driving doctors away from some specialties and some out of the profession altogether. We can create low cost government backed malpractice insurance (and therein regulate attorney litigation costs), not unlike flood insurance. We need to have rational discussions about the cost of care for lifestyle illnesses. Should we require people who smoke to pay for private cancer and lung disease insurance? Is the public really served by allowing drug advertising on television? Should we use our emergency rooms for only true emergency care? And finally, what do we do with the millions of people living in America who have come here illegally and now demand health care service without paying for it. It is decidedly un-American to turn these people away. It is decidedly un-American not to demand some form of compensation. But we now have 47 million people without proper insurance in our system.

All these issues and the many like them are not Republican or Democratic. They are American. And it is up to Americans to demand that our representatives address them as they work toward intelligent health care reform that will not bankrupt our country. That will take a truly bi-partisan approach. And that will keep the Obama Health Care Reform agenda alive.

Comments

[Samalabear]

'Americans want meaningful changes in the way health care is managed and distributed. They want fair and equitable (mutually exclusive terms?) universal insurance coverage and an intelligent way to pay for it.'

Totally, totally inaccurate. Americans do not want universal insurance coverage. They want universal health care. This is why there is such a problem in this debate. The people want care, the politicians want insurance policies for all.

[TheKurgan]

Who killed the health care reform? Easy...anyone who is more interested in profit than in saving lives. God, I wish the NRA would declare open season on lobbyists!

[awryly]

In New Zealand, our previous government established a government commercial bank to control the predations of the privately-run banks and incentivise savings for all New Zealanders. It worked a treat.

This is analagous to what Obama is trying to do in your health sector. Set up a public option and watch the privates squirm.

Of course, our fat cats are much less powerful than your fat cats. And our governments wisely take much less notice of the antics of their lobbyists. We also have less corrupt political and business systems than you. According to a Transparency International 2009 survey, we are one of the three least corrupt nations on the planet (along with Denmark and Finland) . The US, of course, comes about 20th and will no doubt fall further in the next survey given more recent events.

All of which makes it a lot easier for us to introduce systems that actually help all our citizens. And many other first-world countries can do the same.

You have to ask yourself whether you want to continue your capture by self-interested, politically powerful vested interests that work against the principles of government "of the people, by the people, for the people".

[ccairnes]

"Americans really don't understand the granular issues of medical rationing and single payer systems." Oh really? I bet they understand these issues better than you'd like to think. Your job, as CEO of a medical business is to hire enough lobbyist to pressure our elected representatives, by any means necessary, to convince them to turn against their constituents and bow to the desires of the profit motivated medical industries at the expense of the public health.

[Marcospinelli]

As long as Americans' health care is 'for profit', with Big Insurance & Big Pharma catered to in this reform, Big Insurance & Big Pharma will starve out the competition, which in this case is public health care.

Big Insurance will lock in healthy young Americans at dirt cheap rates for multi-years (that's what will make it into the bill, out-options only every few years), leaving everyone else on the government plan. This is what monopolies do, what Walmart does, to crush the competition.

Republicans will do everything they can to block money for Medicare, ration the care for those on the public health plan, and, well, we've all seen this movie before, haven't we? Obama just introduced this idea in the last few weeks. He's really turned out to be a crushing disappointment.

This is the method that Bush & Grover Norquist had for ending Medicare & Social Security -- Bankrupt the country into not being able to pay out anymore. When Bush says he think history will vindicate him, this is why -- He thinks he served conservatives well, ending FDR's social programs by back-door bankruptcy.

This is the "death by a thousand cuts" mentality. Contrary to what the proponents of Obama's plan claim, the result won't be the end of private health insurance but the end of Medicare, public health care, & people's lives.

Single payer universal health care now. It's time to get these villains out of our lives, so that we can get on with

[Marcospinelli]

"Americans want a bi-partisan effort on health care reform. They want Republicans and Democrats to keep this from becoming a European soccer match with partisan crazies loathing the opposing team and those wearing its colors. More and more I hear from colleagues in the broad center trying to marginalize the fringe. I am listening for respectful appreciation of opposing views from die hard members' political forums and finding that "yellow and blue dogs" and "grand old party" members are looking for compromise. Hopefully that attitude will push upward from the grass roots to Congress."
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Americans don't want a bipartisan effort on health care reform.

Americans want to be able to get health care at prices they can afford. The only way to do that is to get single payer universal health care.

[knowhelpnow]

I believe that if Health care is neutral financing so should the MIC, we spend more then all other countries together for our military and just what do we receive from this investment? Safety I don't think so, look at 9/11 it didn't help us there, and we sure aren't even close to securing our country while we spend trillions fighting 2 big wars and smaller police actions around the world. We have to much debt because of these wars, so tax the rich for the military for those are the ones who benefit the most for this huge MIC that sounds better then taxing the rich for health care in this super capitalistic country.

[lkimura]

Fixing the healthcare system is easy -

no sane person wants to give every one free health care -

we just want affordable health care.

It's simple:
Install a goverment healthcare institution that follows the exact same model as Blue Cross, or Anthem, or Blue Shield of different tiers, i.e. $5,000 deductble, $2,500, ded. etc.
with the same care - everything would remain exactly the same as it's private counterpart.
This new institution would be a PPO - you could see whatever doctor you wanted.
It would be a voluntary health plan - you could sign up for it if you wanted to. If you didn't, no problem.
The only change would be you would have to sign a waiver to no informed consent arbitration.
The only basis for malpractice would be obvious gross negligence. (i.e. amputating the wrong leg.) Screw the lawyers! (That will cut about 40% off your monthly bill.)

Next, no shareholders to have to worry about. There would be no one skimming that 30% off the top.

Now your left paying .30 cents on the dollar for your new health plan.

For the same health plan that used to cost $1,000 a month for a family of 4 with a $1,000 deductible, you now pay only $300.

Anyone who could not afford this new government health plan, would get a low deductible health plan at no cost to keep them out of emergency rooms,

Free insurance for everyone! WTF! How can that work?

[Osusuki]

Does anybody want to explain to me why we should believe the CEO of a biotechnology corporation when he says Americans don't want to take the profit motive out of medicine? Especially when the profit motive in American medicine results in murder by spreadsheet?

[Jim Jaffe - Huffpost Blogger]

Interesting generally, but puzzling when you suggest that we educate more doctors when there's ample evidence that we already have too many. in medicine, supply drives demand. areas with lots of doctors have much higher per capita spending without enhancing population health. better strategy would be to reduce the number of doctors practicing.

[kimk3]

There are, perhaps, too many specialists but not enough general practitioners. We do need the latter a lot, there is a real shortage of them... plastic surgeons not so much.

[knowhelpnow]

wrong!!!
If we had to many doctors in our capitalist society that would mean prices would come down, and they haven't, they keep going up.
We need more family doctors, that don't send you to a specialist or the ER when you need a little stitching up, they don't do stitches, they don't set broken bones, I'm wondering what they really do. That's what is wrong, it seem family doctors are only the first ring on the ladder, they give you proscriptions and if that doesn't work they send you on to a specialist, they give you antibiotics when you have a cold, they never take a culture that I have ever seen before giving a general antibiotics, I'm not sure what they are really doing except splitting up the ones they thing will heal themselves and those who may not.
I had a swollen gland for months and the doctors said don't worry about it well when I demanded a biopsy it showed NHL cancer on both sides of my body and upper and lower if he had did a simple test when I first brought it to his attention just maybe they would have caught it before it had spread and would have cost so much less for treatment, this is another reason health care is going up, doctors can not look at a patient in 10 minutes and then say don't worry about it, most of us are not hypercondriacs.

[jsarets]

Wall Street-run healthcare. Wall Street-run healthcare. Wall Street-run healthcare.

Just keep repeating and repeating and repeating this phrase until people realize who is really running healthcare in the absence of public financing.

People don't realize that the "private health insurance industry" bogeyman is actually a part of the much more viscerally hated Wall Street bogeyman -- just as the real estate industry and in some respects the defense/in­telligence industry operate as fronts for Wall Street.

The message has to be that health insurance corporations are really investment banks in disguise. We make deposits (premiums) into a fund that pays dividends (healthcare) out of the return on investment.

The difference is that real banks allow withdrawals, while insurance schemes never return accumulated capital, even when paying benefits. They operate on the revenue generated by investing all of the premiums they've ever charged us.

Not only do they prohibit withdrawals, but they demand regular deposits of specified amounts. It's an investment scheme predicated on a steady stream of new investment. Some people call that a Ponzi Scheme, but then again the whole monetary system is a Ponzi Scheme.

The government should create money out of nothing to pay for healthcare. As long as wages are stable, consumer prices will be stable. Besides, economies aren't killed by inflation, they're killed by debt.

[Project4NuBostonTeaParty]

I don't agree with your statement: "Americans want a bi-partisan effort on health care reform."

Three out of four Americans want a public option. With Republicans ruling it out -- no discussion, it's entirely off the table -- how does that equate to "bipartisan"-ship?

Your second miscalculation -- that most Americans want to retain the profits in health care -- is quite a leap of faith. If three quarters of the public want a government-backed plan, that pretty much tells you how America feels about insurance companies and their unethical profits.

You're a well-educated man, Mr. Price, and your article's theme is correct (reform IS being slowly strangled), but you seem to be divorced from Reality. Try again.

[Uselessboy]

There is no lesson for anything other than suicide in anything Reagan did.

And reform can be perfectly revenue neutral even if we retain our doubled spending per capita beyond every other advanced nation that has national health.

All we have to do is make HEALTH + MILITARY revenue neutral.

[Ranta]

Thank you. It's about time that someone uttered anything about limiting the amount of money wasted on our military. Of course taxing those who make more than 335,000 as recently suggested , isn't a bad idea either.

[Daimon]

Should amend to "military industrial complex".

[julianne]

This health insurance mess is coming on-the-heels of Obama's washing of his hands of the economy by handing it over to two historical globalist-corporate losers, Geithner and Summers. This is the general corporate trend of the Administration from the very beginning. An Administration that misrepresented itself to the electorate. The expansion of the guilty-as-sin FED and re-financing of the insolvent banks directly responsible for the coming depression, was allowed by President Obama. Obama isn't a failure. He is a poseur and catastrophe. Obama is a picnic President. He is the wrong Democrat at the wrong time.

[Ranta]

I hate to admit it but I think your right. Obama thinks he can finesse his way around Washington. Those days are sadly gone. Health care is not a "business" decision. It is a necessity.
I don't think he is man enough to put up the fight that is required. A "compromise" might get him a hollow bill passed but we will see through it.
Poor Hillary didn't know what she was up against back in the day. Obama still doesn't. If he loses this battle, he is toast.

[thehoopoe]

I watched the Bill Moyers show last night with the former Cigna Executive who said that the Health Insurance Companies stance is to " appear to be in favor of reform but to stall, question, introduce doubts, to the point where no resolution is possible". They give the illusion of wanting to be helpful.

So the government should give them the illusion that they are being listened to.

Does Obama get that they are not sincere? I'm not sure he does.

[mheister]

I followed the link to Bill Press' website - http://www.billpressshow.com/ - and penned the following to Senator Dianne Feinstein:

Please support President Obama's public option for health care.

It is long past time to make sure that every American has access to affordable health insurance, that the for-profit health insurers cannot refuse coverage or deny claims for pre-existing conditions, that paperwork be simplified, medical records computerized and accessible across insurers and hospitals nationwide.

We need to change the system that needlessly sends people to their graves for lack of coverage or denied claims, and is the number one cause of personal bankruptcy in the United States.

The only way to hold the health insurance industry's feet to the fire is have a viable public option available.

In San Francisco, Mayor Gavin Newsom has proven that government can effectively provide health insurance for everyone.

Conservatives have long argued government is the problem, not the solution, that on a level playing field private companies and industries can provide superior service to the government. Well, let the health insurance industry prove it. Put the public option out there on a level playing field with them, and let fair competition for health care dollars take its course.

The most recent national poll shows 76% of Americans nationwide favor the public option. We have allowed the health insurance industry to rob us blind and leave us bankrupt for far too long.

Senator, I urge you to support President Obama's public option.

[Marcospinelli]

The Public Option by Obama&Schumer&Dems is a ruse, a delaying tactic to fend off the movement for SinglePaye­rUniversal­Healthcare­. Once delayed, to starve the competition (in this case, the US government).

If Obama's plan (public & private health care) were to pass instead of SinglePaye­rUniversal­Healthcare­, BigInsurance would cherry-pick, take the youngest&h­ealthiest, lock them in at dirt cheap rates for multi-years (windows to get out only every few years), leaving everyone else on the government plan. Then Republicans will do everything they can to block money for Medicare (Obama started that a couple of weeks ago), ration the care for those on it. We're already seeing that in state budgets, the end of programs because there's no money to pay for them.

This is the method that Bush & Grover Norquist had for ending Medicare & Social Security -- Bankrupt the country into not being able to pay out anymore. When Bush says he think history will vindicate him, this is why -- He thinks he served conservatives well, ending FDR's social programs by back-door bankruptcy.

This is "death by a thousand cuts". Contrary to what the proponents of Obama's plan claim, the result won't be the end of private health insurance but the end of Medicare, public health care, & people's lives.

SinglePaye­rUniversal­Healthcare now. We'll never have the numbers, the enthusiasm, the organization that we have now. It's time to get these villains out of our lives, so that we can get on with our lives.