Happy Health Care Reform New Year
Despite the bad economic news and the even worse international news, it looks like 2009 might just result in real health reform. Why will 2009 be different from 1993? Obama is not making the same mistakes the Clintons did, and that is good news for all of us.
Another reason why 2009 might be different is that even more people lack health insurance than in 1993 and the impact on the overall economy is even more severe, so the issue remains at the top of the domestic agenda. Even as I write this, families all over the country are struggling to pay medical bills, delaying care because they don't have insurance, wrestling with insurance companies over what is covered and what is not - in general, just worrying about their health and how they will pay for services if they get sick. In an economic downturn, health care is pretty recession-proof for providers, but it's a huge source of concern for patients.
The Obama team knows all of this and more, and that's why they have been working on how to introduce health reform for over two years. Here are the things they have been doing to keep the idea of health reform alive despite the recession:
1. Obama wisely has placed the locus of activity for health reform where it belongs - in the House and the Senate.
2. Senate and House staffers have already been working on some of the most urgent issues - renewing and expanding children's health insurance; expanding the use of information technology to lessen the paperwork load on patients and doctors; reforming health insurance laws regarding pre-existing conditions; reforming Medicare and the physician payment system.3. Health and Human Services designee Tom Daschle and his White House health reform colleague Jeanne Lambrew have been holding community meetings all over the country to solicit input.
4. The Obama website has asked for input from individuals on what they would like to see changed about the health care system, and the suggestions are pouring in.
5. Meetings with health care providers have been posted on the Obama website so we can all see who is asking for what.
How is this different from what the Clinton administration tried to do?
1. The Clintons kept the locus of activity squarely within the White House. And while Democratic House and Senate staffers were part of the internal discussions, Republicans were left out, and there was a fair amount of secrecy about the details of the reform efforts. Even Democratic legislators felt left out and were angry about the way the White House handled Congressional outreach.
2. The Clinton White House made a decision early on to do health reform "large" and comprehensive, rather than biting off more do-able pieces like covering children. And while it makes substantive sense to tie all the pieces together (paying for care, delivering care, etc.), it was politically disastrous to try to reform a sixth of the nation's economy in one piece of legislation, especially when done from the White House and not Congress.3. Although there was a lot of rhetoric about how secret the process was, the truth is that the working group members numbered almost 500 and thousands of providers streamed into the Old Executive Office Building for months on end, pleading for coverage of their particular part of the health care system. We heard from doctors of all types, nurses, home health workers, pharmacists, dentists, hospital administrators, business and labor leaders -- there were very few providers who could claim they never got to plead their case for why their service should be included and paid for. However, the difference was that those meetings were not disclosed or explained to the American public or the media, so the image of a closed process was the image that everyone remembers even to this day.
4. There was no active internet in those days and no real blogosphere to communicate to or from. Had the Clintons had the resources Obama has today, the process might have been more transparent and thus the support might have been broader and more community-based. As it turned out, organized interest groups in health care had a lot of opportunity for input -most ordinary citizens did not.
5. And maybe most importantly - in the fifteen years since the Clinton effort, the cost of health care has steadily risen; the impact on business has been increasingly devastating; and the number of people without insurance or underinsured is significantly greater. You could make the case that some of the organized opposition to reform now will be less potent precisely because of what has not happened in the past fifteen years. There are several coalitions of rather unlikely stakeholders who have been working to support health reform for over a year -- (only a few of the ongoing efforts). This coming together of diverse stakeholders (business, labor, hospitals, consumers, doctors) promises the potential of stronger support for whatever comes out of Congress.
Ah, you might say - can anything good can come out of Congress? In 1993, there was disagreement among Democrats about what approach would work best and it was no secret that Republicans were wary of letting the Democrats win on the health reform issue.
There is probably less disagreement in 2009 among Democrats than there was in 1993. But Republicans remain wary about what the Democrats can achieve. More substantively, Republicans support a very different approach to health reform -- much more market-driven, consumer-focused and less regulatory -- and that is unlikely to change, even though McCain's rather crazy health reform proposal got no traction in the Presidential campaign.
Even if Democrats manage to come together and agree on a basic approach to health reform in the Congress, will progressives support the compromises that may be made? The Campaign for America's Future - is one of the leaders on the left for progressive health reform and has been central to the design of the Obama health plan. There have been many policy analysts who have promotedthe idea of public plan, including Helen Halpin of UC Berkeley, and Peter Harbage, formerly with the Edwards campaign. David Cutler,Obama's main health care economics adviser, has also supported a public option. Can the progressives hold together their coalition as the details emerge from Congress? Will the single payer advocates support a more gradual roll-out of the elements of health reform if the result is not Medicare for All?
These are the questions that will surface as the 111th Congress gets underway. Health reform will be messy and no solution will please all the interests. Do we even agree on the priorities? There is so much to be done. Can we agree that children need to be covered - now? That individuals who do not have health insurance through their work need access to affordable coverage? Can we agree that we need a better way to pay providers, a way that demands excellence and keeps doctors wanting to stay in practice? An excellent blog on the "myths" of health reform points out the controversy over where to start with health reform, including how much we can and cannot save with the proposals now being discussed. One of the biggest obstacles is what we can afford - now, with the economic situation we face.
As the New Year becomes less new, I remain optimistic that something significant can happen. At least i am going to do my part to keep the discussion going!
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In 1993 I wrote an invited editorial for a medical journal dealing with the entrance of corporations into health care. At that time I made a series of predictions all of which have come true related to massive increases in costs. Pointing out that putting an administrative structure between the physician, the nurse, the healthcare provider and the patient we must then feed the beast with buildings, salaries, CEOs and bonuses etc. I also predicted a new industry to arise; the "coding" industry to extract the maximum in fees. I was sued for many millions of dollars for my editorial to shut me up, but in the course of this legal battle I discovered that the AMA and professional organizations had stakes in the corporate enterprises. Having a solid track record of accurate predictions, I now see that the "Health Care Reform" takes for granted the corporations which have been impediments and cost multiplier
When you introduce profit and shareholders into the health care system, it just does not work. Caring for the sick and profit does not go hand in hand. Priority #1 is to eliminate the profit in the health care system. Priority #2 is preventive care, and alternative care is part of the preventive medicine, it is cheaper and saves money to the government in the long run... Priority #3 is to make sure that nobody gets denied cared due to pre-existing condition or because it can not afford the care.
Even though he was one of Mitt Romney;s principal advisors on health care, our Chairman, John Donahue agrees with you both on the need for reform and how well the coming Obama administration is handling this issue. If you would like to speak to him about the topic, I might be able to arrange an interview.
Sure, Bruce. I would love to talk to John Donahue. Leave me a way to contact you by replying to this comment on the blog.
Any "solution" that includes the "for profit" Health Insurance industry is no solution at all. Repeat after me...healt
While I know healthcare is extremely important, I don't see how Congress is going to approve anything in the next four years, with the economy in such bad shape. I'm glad we have optimists. You gotta believe.
In the last decade several countries have reformed their healthcare systems, making care affordable and accessible to all its citizens. We can learn from these successes how to develop a plan that works for our society.
The time is now and I think the Republicans might be in for a surprsie from their constitutents. Even Republicans get sick, laid off and can't afford to go to a doctor or pay their bills. Healthcare costs and access is one issue I see crossing partisan lines. When a diehard Repbulican's teenage footballer son breaks a leg and Dad can't afford the $5,000 out of pocket costs, party lines begin to blur.
My very red neck rural Republican neighbor was all huff and puff about Obama and why he shouldn't be president.
What most people don't understand is that our current health insurance situation developed in response to a wage freeze during WWII. There's was nothing planned or even organized about it and , like Topsy, it grew and grew into something that's barely recognizable.
Individuals and businesses should be allowed to buy into Medicare or a health insurance plan similar to what members of Congress have. Monthly premiums could be based on monthly incomes.
Our country should not have just national health insurance. When their is a lack of competition, quality problems and other problems are likely to take place. Lousy public k-12 schools in high crime areas are an example of this. We should have more competition in k-12 schools. We should be allowing people to use vouchers to send children to private k-12 schools including religious schools. This would make it easier for students to have "free exercise" of religion (Amendment One of the United States Constitution). More competition in k-12 schools may reduce poverty over time and increase economic growth over time.
Individuals and businesses should be allowed to buy health insurance plans sold in other states. The more people participating in a plan the better the plan may be and the lower the premiums may be.
People should not have to worry about losing their health insurance when they lose jobs which is a problem connected with health insurance connected to employment.
I added to my profile because of feedback.
My website is http://www
I ran for United States Senate from New Hampshire in 2002.
Sincerely,
Ken Stremsky
We are going to have the same national healthcare Mexico has.
A health CARE system based on private, for-profit health INSURANCE companies whose overriding goal is to maximize their profits by DENYING health care services to the maximum extent possible, will NEVER be anything other than the train wreck that the current American health care system is.
Period. End of story.
I applaud some of the individual components of Obama's health care reforms, such as finally getting rid of the pre-existing condition bee ess (and if he can actually achieve even that one thing that will be a significant improvement), but in the long run health insurance companies just have to go.
I totally agree with you. Providers place at the table should only be to provide answers related to problems identified within the system.
They should have minimal input into the healthcare plan on the front end. I realize it will be difficult to design a proposal without involving physicians, insurance companies, hospital administrators, clinicians and others who have a vested interest in the final proposal. The team putting the proposal together should represent the diversity of health care needs of the populace.
I sincerely hope that this country can analyze the existing system and systems in other industrialized countries and try to design one that truly provides the range of health care services needed by our citizens while minimizing barriers to service. I think it is important that the program be cost effective but also that providers are fairly compensated. A continuous monitoring component is necessary in order to gather data which will be useful in evaluating the program. The new program should be designed in such a way that modifications can be made in a timely way when determined necessary and elements which don't work can be discontinued.
Bravo! The for profit system is a huge failure! Why are people so blind to see this? You maximize your premiums and deny care! No wonder why America spends more on healthcare then our European counterparts, and still get less care! Not only do we get sicker, are on more medication, but also die earlier. Maybe it is time for us to stop and look why this system is not working!
In an economic downturn, health care is pretty recession-proof for providers.
Sadly, even this isn't true. State and federal funding is drying up, and it's affecting both public health and private hospitals. Low income clinics are slashing hours, raising minimums, and cutting social services. Hospitals are undergoing massive layoffs and going back to dangerous practices in over time and hours stretching for overworked practitioners.
We desperately need health care reform on the level of individual insurance and service. But we also can't neglect funding to public health programs and hospitals.
You are right. I meant that people not only still get sick in a recession and need services, they may be even sicker because when they do seek care, they are likely to have postponed it because of the cost. There are significant cuts going on right now in all sectors of health care, and that's a situation we should all be worried about.
The best thing that anyone can do in health care reform is move the insurance companies to the sidelines if not out all together. Clinton is beholden and was in 1993 to the insurance fiends, and Obama is not. A really workable public program such as Medicare that permits supplementary policies in the private arena - with good rate control - would work. The Massachusetts plan is a disaster for too many people. You go bankrupt paying the premiums or go bankrupt trying to pay the deductible and out of pocket costs. Either way, middle Americans lose. California had the same plan - affordable pool premiums somewhat subsidized by the state, demanded a FIVE THOUSAND deductible with another TEN THOUSAND out of pocket if you were ill. And that's per PERSON. How would this be 'reform'? Hillary wanted the power of the government to force people to pick one of these disasters, like them or not. Obama, Daschle, Waxman and all the others in the game must STOP this destructive catering to the insurance corporations. It's a disaster if they do not.
Absolutely. The insurance aspect of health care is jot necessary at all. It is just siphoning off money for the insurance providers, not actual health care. Of course the insurance industry has spent billions of dollars brainwashing the American public to think that their way is best and nothing else works.
As the article says, more and more Americans are seeing through this and are open to systems that are successful around the world and here with Medicare. A one payer system is the way to go.
Take the insurance companies out and you immediately save 40-50%.
Health care should NOT be a for-profit industry based on the bottom-line. This WILL be a tough fight, but not as tough as it was 15 years ago. People are fed up.
I want to be able to buy my drugs from Canada instead of China..
I want tax credits of 40% for the people who are coughing up for health insurance.
The business with the 500 tax reduction is a joke, Frankly, that is almost identical to the amount of monthly savings on GAS since the price came down... Use tax credits instead of deductions for the Exemptions and Standard deductions
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