Health Reform: Ideas At Work vs. Self-Negating Arguments

The opposition to a public health plan option seems to be imploding, victimized by logic which looks something like this:

1. A public health plan will be a nightmare. You won't get the doctor you want. Waiting times will be horrendous. Government pencil-pushers will stand between you and your physician while political hacks decide what treatment you'll get. Everybody will hate it.

2. Public health care will have an "unfair advantage" on price. It will then drive private insurers out of business because it will be so popular that everybody will join it.

What's wrong with this picture?

These self-negating arguments¹ aren't displaying much faith - either in free markets, or in the imagination of people working within the current system. Speaking of which ...

There's a very interesting new proposal from "Health CEOs For Health Reform," a project of the Health Policy Program at the New America Foundation. The "Health CEOs" come from a diverse set of healthcare companies, and their proposal focuses heavily on - in their press release's words - " quality, efficiency, care coordination, and patient-centeredness." The proposal itself emphasizes a radical shift away from today's fee-for-service model, favoring total case care, accountability for outcomes, and new payment models for chronic care. Many of these ideas have been around for a long time, but the proposal seems to go further in some of its global recommendations.²

Yesterday Sen. Kent Conrad announced a new alternative to the public plan option: non-profit health cooperatives. I would argue with Sen. Conrad's timing. We don't need a milder alternative to the public option, since momentum for it seems to be building . And independent cooperatives would not have the research, development, or innovation capabilities that a public plan could muster. This is not the moment to undercut the public plan idea with another fragmented program. That said, Sen. Conrad's "chartered cooperative" alternative could enrich the set of choices reform can offer, even if it's not a substitute for the public plan.

We already have operational health plan cooperatives and other nonprofit groups throughout the country. Some of them incorporate elements that relate to the "Health CEO" proposal, and surveys usually show that their members are very satisfied with the care they provide. The presence of a public plan option doesn't preclude all sorts of imaginative initiatives from the private and nonprofit sectors. It should encourage them, in fact, by germinating new financial and medical models that help them thrive.

It's particularly disappointing to see someone like Sen. Charles Grassley echo the opposition's self-contradicting arguments. Grassley's a Republican who's often been willing to reach across the aisle on health care. His hearings on corruption in medical research have been both courageous and profoundly important. It's time for Sen. Grassley and others to either frame a more defensible and coherent opposition to the public plan option, or step down and let it be enacted.

Why not create a health system that taps into all of our country's resources - government's tools, the private sector's energy, and the capabilities of our growing nonprofit/"social entrepreneurship" sector? After all, choice and competition are basic American principles.

Let's redesign our health system so that it encourages ideas that work. And how will we know what works? In our country's tried-and-true way: by letting the people decide.
_______________________

¹ I may be oversimplifying, but not by much. Opponents may say, for example, that their real concerns involve a long-term scenario where a public plan forces its opponents out of business and then turns dictatorial. But we don't make policy based on hypotheticals, especially extreme ones. Congress can always pass new laws if circumstances change. And private capital will always move in if there's a new marketing opportunity.

.²I should note that I need to study this just-released plan in greater detail, especially its recommendations for an overhaul of Medicare's reimbursement structure. And to be clear, the "CEO" plan is silent on the issue of a public plan option. I don't want to leave the impression that it took a position either way on that subject.

RJ Eskow blogs when he can at:

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Comments

[robrtl]

will the plan be "for all americans" and exclude illegal alien ? if not better build that fence real quick

[textynn]

Single Payer IS the only option.

Health Care for profit is a inhumane tragedy and causes the unnecessary deaths and maiming of tens of thousands of Americans yearly. Don't be fooled. Don't submissively follow the rules laid down by shadowy authoritarian figures who are bought and paid for. Remember the Milgram Experiment. Are you a lever puller or are you someone that can judge for yourself right from wrong and not acquiesce like a submissive child?

http://en.wikipedia.org/wiki/Milgram_experiment

[MeetJohnDoe]

Medicare for all.

[PigLipstick]

As far as step 1. is concerned, all we need do is look at Medicare's 45 year economic and healthcare delivery success to the most expensive segment of the population. Prior to Medicare, seniors with limited financial resources faced very limited healthcare, complete poverty in the event of a catastrophic health problem and abandonment to a county poor farm, a virtual death sentence. The capitalists have always trotted out the socialist boogieman every time one of their cash cows is threatened.

As far as step 2. is concerned, your breaking my heart. If the corporate healthcare Insurance dynasty in this country has virtuous intent of providing affordable healthcare to all Americans, why do they need an army of very well paid lawyers to pass around special interest money corrupting our political system so they can cram their system down our throats ?

Your right in that no one really knows what the new system will be, but if Edward Kennedy's warmed over Massachusetts plan is the template, big healthcare insurers have already won as they continue their policy of cherry picking healthy customers while they dump the most expensive and sickest patients on the public system. Like the Wall Street financial system, they don't want to upset a failed top down system that has devastated the social contract while putting all the wealth in the hands of the top 10% of the population.

[Guitanguran]

"As far as step 1. is concerned, all we need do is look at Medicare's 45 year economic and healthcare delivery success to the most expensive segment of the population. "

http://www.hhs.gov/news/press/2008pres/03/20080325a.html

According to the trustees report, Medicare will be insolvent in about 10 years. I'm not seeing any economic success, if the program is unsustainable. How is that supposed to be addressed?

[PigLipstick]

Good question, if the program is so destitute how can it continue to maintain a 3 to 4% administration cost, this is in comparison to the for-profit insurance companies that have administration costs running 30 to 40%; this is pure overhead that doesn't fund a dime of actual healthcare delivery.

$600 Billion a year and they tell us that few doctors are left that want to participate in the program. Where's the 600 Billion going ? Perhaps much of it is the Part D drug program that has been an enormous windfall for the drug companies who negotiated a fixed top dollar price with no negotiation for large quantity discounts.

All these figures tossed about and little or no specifics. I've paid into this system since it's beginning in 1965 and I've watched the politicians hack juicy chunks off the system and feed them to their private for-profit contributors over the years. Seniors that join Medicare now are forced to purchase additional private supplemental insurance to get many of the services that were originally covered. I don't doubt that additional cost savings could be achieved but keeping private for-profit insurance in the picture is not a solution that will improve the situation !

[imagine0594]

It's an interesting thought: If you could have everything but the label (public option, single payer) would you have the intelligence enough to support it. I'm not saying that's what non-profit coop is, but I do like the words non-profit.

[Ken Clein]

check out this poll about the healthcare debate http://rankkit.com/component/option,com_pollxt/lang,en/pollid,326/task,voting/

[freshnotbitter]

I think we have to face facts at this stage: When Obama handed Congress the job of coming up with a health care plan, everybody on the HIll figured this meant holding hearings at which CEO's would be chastised, their corporate jets examined, following which a few unfortunates culled from the public would be put before the cameras to tell their sob stories so the Senators could fawn over them for the cameras before adjourning the hearings and disappearing behind closed doors and sitting down with the Mega Insurance companies' lobbyists to write legislation satisfactory to the industry.


Instead, talk of a public option became rigeur and the Senators suddenly realized that the job Obama was asking them to do was something they had actually never done in their entire lives: Actually write public policy for the good of the nation.

I don't think Congress has the slightest idea how to proceed with step 1.

[Hoelder]

I do not think we will get any improvement in health care but a washed down non solution. There just too many moderate Democrats' pockets stuffed with health insurance money. The coop option is no option at all, because their plans for the most part do not offer much. Republicans are warming up old ideas in new kettles. Coop is an old system, it does not get any better.

[imagine0594]

I think you're right about the moderate Democrats. For something like single payer to get through, there would need to be more Kennedy type Democrats in the Senate. There's too many Joe Liebermans.

[Conroekid]

What if national health care is competitive, because it enables entrepreneurs?

P.S. Thebigmouth's comment that "Health care = strong National Defense" is spot on.

[freshnotbitter]

The free enterprise system allocates resources such that the "optimal" amount of health care is produced for a given amount of money devoted to the industry. That is not the same as saying that any person who is sick will get treatment for his sickness or that the incidence of disease is minimized in a free market system. If you want to minimize disease and ensure that every citizen receives treatment for sickness, then you will need public policy to intervene.

We can have public policy intervene and leave the so-called "free market" in place if we offer a public option that guarantees treatment to all who subscribe to the option while charging premium for that option in terms of a percentage of the subscribers' incomes. In order to make the public option solvent it might be necessary to mandate "behavior" (or penalized bad behavior by chargingn penalty premiums), rely on electronic records, mandate computer auditing of participating providers to monitor fraud, etc.

[Luvial]

Obama's healthcare reform will mean less access and higher costs. He has not mentioned a single reform of the system, just more money for less access and care.

[vietveter]

If ‘the people’ made the decisions there would be a government ‘option’ plan

And there would be NO GOVERNMENT SUBSIDY for any private plans

But the PEOPLE will not decide, paid for Senators and paid for Congressmen will

If it costs the health care industry a billion dollars to buy the votes

they will buy them. To do otherwise would leave them with only themselves to insure

[FaceReality2]

This is the most fundamental problem we have. Our government is owned lock, stock and barrel by commercial interests, and the politicians represent their interests, not the public interest. Commercial interests will destroy us and the country before releasing their grip on power.

[Joint Then Rebel]

The world is owned by greed and money now, everyone is suffering because of the greed of power and the corruption of mankind. This repeats itself throughout almost every society throughout history. It all eventually trickles down from the top. This all comes from hate between man and ignorance. People do not realize we truly have a world economy and a world society now, people all around the world are suffering. Do people even realize the earth is a living organism that provides us life as well? It seems to be too late to turn it around but, this is my gift to the world before we meet what we have all been headed towards as one people on one earth. http://www.changesjlb.com

12212012

[thebigmouth]

Health care = strong National Defense!

Public health care is a national defense issue. By providing health care to all, we insure that in our hour of need we have strong healthy women & men that are ready to protect our country. Framing health care around strong national defense should have full support from all sides.

[E4B32787]

"There's a very interesting new proposal from "Health CEOs For Health Reform,

I'm very sure that it is interesting - like this part:
"A requirement that individuals obtain coverage, once such coverage is accessible and affordable".

Lets take that idea along with this one: 86% of large corporations (5000+ employees) are self-insured.
http://www.ama-assn.org/amednews/2008/08/25/bisa0825.htm

The reason that they're self insured is, because, once a certain amount of people are insured, then the risk can be calculated to a fraction of a percent, and the need to pay a premium disappears.

So, if everyone in the country is required to insure, it can be most economically done on a self-insured basis.

I love it when we get this CEO (who have a fiduciary duty to enhance shareholder value) espouse cost saving solutions. It is at best, part of the solution, but not the whole solution. The cost problem is in large part because our health care solution revolves around enhancing shareholder value, rather than reducing patient costs.

We ought to just copy a country's system, like Japan, who has a large elderly population, but yet covers their people at 11% of GDP, versus our 16% that doesn't cover 16% of the population. That 11%of GDP for total costs should be the benchmark for success in health care reform. It sticks out like a sore thumb, the lack of cost comparisons with other countries on the corporate nightly news spin.

[hark]

Excellent point. An interesting exercise would involve finding out how the largest health insurers provide the benefit for their own employees.

[andrewmcleod]

I don't see the problem with Conrad's timing. The Senate working group decided that they were at an impasse with the public plan, and so they sent him out to look for a compromise. And he found one.
Co-ops are the best of both worlds; they combine the choice of a market-based system with the democracy of government. They are private entities, but because they are accountable to their members, they don't need to be watched quite as closely. Sure, they can still make mistakes, but at least there is not the same inherent conflict of interest found in investor-owned companies (that is, investors want profits, which come at the expense of consumers).
As for the lack of "research, development, or innovation capabilities" in cooperatives, I suggest that you look into the various international federations that are available to help, as well as this country's rich history of cooperative healthcare. Links to many of these can be found at www.coopgeek.wordpress.com.
Having a public alternative is a nice idea, but ultimately it is not really competitive when everyone has to pay to support one player, while all the others have to fight for the crumbs. Your desire to let people choose would be better served by cooperatives.

[hark]

Not true at all. What are you, a mole?

These co-ops are tiny, fragmented organizations and have no muscle to negotiate. They are a cop out.

A public option is not a "nice idea." It's a strong alternative to the private industry, the only way to ensure competition. If you want cooperatives, throw them in, too. What's wrong with that? But the public option is essential. Without it, there can be no hope of reining in health care costs.

Look, this is really simple. It's the people against corporate America. It's time to serve the needs of the people, and to force corporate America to adapt to those needs. If they are so clever and efficient as you water carriers claim, they will respond with products that better serve the people and still reward their executives and stockholders generously.

That is the way it is supposed to be in any rational democratic society. It is not the job of the people to respond to the needs of wealthy corporations. We've had it half-assed backwards long enough in this country.

[Lorianne]

Key health care senators have industry ties
http://news.yahoo.com/s/ap/20090612/ap_on_go_co/us_senate_disclosures