Last January, as I understand it, the White House promised Big Pharma, big insurance, and the American Medical Association the moral equivalent of what Joel Halderman allegedly demanded of David Letterman: hush money. The groups agreed to stay silent or even be supportive of healthcare reform, as long as they were paid off.
But now that it's time to collect, the bill is larger than the White House expected, and it's going to fall like an avalanche on middle class Americans in coming years. That could mean an ugly 2012 election (read Sarah Palin).
So the President has to do what Letterman did: Refuse to pay.
Big Pharma is on the road to getting its deal: not only 25 to 30 million more paying customers, but also a continued ban on Medicare using its bargaining clout to reduce drug prices, a bar on genetic drug manufacturers introducing similar biologic drugs until the originals have been on the market at least twelve years, and no public insurance option to negotiate low drug prices. (Big Pharma did agree to $80 billion of cost cuts over the next ten years, to be sure, but its hush money payoffs far exceeded that sum.)
Big insurance is well on the way to getting what it wants: 25 to 30 million more paying customers (many of them young and healthy), a requirement that almost all businesses "pay or play," and no competition from a public option.
Doctors (that is, the American Medical Association) are on the way to getting what they want: Instead of a temporary patch on scheduled decreases in Medicare reimbursements to them, a permanent fix that would change the reimbursement formula altogether and reward them $240 billion over the next ten years.
But when they all get paid off, who will do the paying? Middle-class Americans who are already in a financial squeeze -- whose wages are lower, adjusted for inflation, than they were thirty years ago, and whose jobs are disappearing. They'll face still higher premiums, co-payments, and deductibles; and they'll pay higher drug prices, Medicare premiums, and taxes to cover the rest.
That's because these payoffs make it next to impossible to contain the wildly escalating costs of health care. And 25 to 30 million additional Americans will be covered.
The only thing in the emerging bills that's related to cost containment is a proposed excise tax on so-called "Cadillac" insurance plans, priced over a certain threshold amount (the threshold is now up for grabs). But because the costs of health care are likely to rise faster than inflation, whatever the threshold, the middle class will get socked again.
So Obama has to forcefully weigh in with Nancy Pelosi and Harry Reid as the two try to cobble together passable bills for each chamber -- demanding real cost containment.
The three big means of containing costs: (1) A true public option (better yet, one that allows anyone now holding private insurance to opt into; (2) authority for Medicare to negotiate low drug prices; and (3) lower Medicare reimbursement rates to doctors (in other words, no "doctor fix").
In addition, the so-called "medical exchanges" in the emerging bills (as well as the public option, which hopefully will be included) should give preference to pre-paid heathcare plans, like Kaiser Permanente, whose doctors are on salary and have every incentive to keep people healthy rather than charge for more services and tests.
But if Obama doesn't weigh in forcefully and say "no" to the hush money for Big Pharma, big insurance, and the AMA, America's middle class will get walloped. And if the walloping starts before 2012, Sarah Palin or some other right wing-nut populist will wallop Obama. And after she or he wallops Obama, America will get walloped even worse.
Cross-posted from Robert Reich's Blog
Shannyn Moore: Palin Appoints "W.A.R."
Governor Palin just nominated Wayne Anthony Ross as the new attorney general. He's anti-choice advocate and NRA official, is a blatant pander to the base Sarah Palin is hoping to woo in the 2012 election.
There are only tree countries with single-payer. North Korea, Cuba and Canada.
And canada's system has been ruled as an unconstitutional threat to life, because of Canadians dying on waiting lists up to a year or longer. Does a retired nurse have no concern about this?
http://www.hg.org/articles/article_698.html
That's not Glen Beck talking, It's the Canadian Supreme Court. It's not just the United States rejecting single-payer, it's also England, Germany, France and every civilized nation on earth, except Canada. (I don't see North Korea or Cuba as being civilized).
Oh yeah, Canadians women, age 50-69, are less likely than American women to have had a recent mammogram. That means they die. What good is "free" heathcare if there are no machines to detect YOUR cancer?
MEDICARE is cutting those doctors who are going bankrupt, but you want the same fools to control our entire healthcare system? What am I missing here?
http://PoliticallyHomeless.net "Those of us -- left, right and center -- who hold principle over partisanship."
Most primary care physicians who see Medicare/Medicaid patients are barely surviving due to the already low reimbursements. These patients are often the most ill with numerous health problems and take the most time and effort by the MDs to care for these patients. I know of several primary care physicians in my community who have families to support and are living pay check to pay check.
Implement a public option or single payer system as proposed by Obama and good luck finding enough doctors staying in business or intelligent young people interested in entering med school or any other health care profession.
2) Make medical school free to all qualified applicants, much as science graduate school is currently. Limit interns and residents to 10 hours of work in any consecutive 24 hour period and to 50 hours in any consecutive 7 day period. These two measures will end the pretentious martyr complex physicians currently have, which they use to justify outrageous fees.
3) End all subsidies to corn, tobacco, and sugar production (as well as incentives to not cultivate tobacco). This will end the indirect subsidy to high fructose corn syrup and the dangerous foods and beverages they engender, and end any public support of tobacco production (or non-production). It will also make feedlots economically unattractive and end the pollution, the coliform contamination of meat, and the antibiotic abuse they cause. This will also produce less fatty meat as well as encourage less meat consumption.
4) Allow importation of pharmaceutical products restricted only by compliance with all relevant FDA safety requirements. Remove any barriers to competition in the pharmaceutical industry. Allow companies that are unable to compete to fail.
If the government won't regulate the drug companies, then the only recourse will be additional $3B fines for false advertising claims. Of course, this puts the money in the hands of the lawyers and advertisers. That's were our pharmaceutical dollars go.
With the current approval rating below 20% Americans know that the GOP just does not offer any alternative. However bad Obama is Palin would be infintesimally worse. Having experienced 8 long years of the disasters of the Bush administration Americans know that a Palin administration would make Bush seem like a respected moderate.
Americans couldn't be that stupid again. Could they? Could they???
"Palin would be infintesimally worse"
is this what you meant to say? perhaps you meant "infinitely," which would make more sense in context of the rest of the paragraph?
1) thinks they can sell the table scraps to appease the starving masses (if so, he's not as bright as we think or is far wiser than are we the pundits),
2) is playing his own chess game with a checkmate we cannot foresee, or
3) hasn't gotten the word (not likely) or has been getting the word, but twisted by Rob E (likely)., and hence #1.
Take your pick: I'll take #3.
i had to drop both of my daughter's health insurance last january. it was costing me $250 a month. i have worked only 3 of the last 11 months. one of my kids is bipolar and needs help, but the insurance i had dropped her mental health coverage when she turned 18 (so she will NEVER get help), and now i can afford nothing. i haven't had real health insurance for most of my life, but always covered my children. my kid struggles every day just to find enough resolve to do anything at all.
when i join at least 75 million other people in the streets, not just one time, but every day for weeks, then maybe i will see some small change from the petty bourgeoisie now living like dionysian freaks and slovenly parasites who constantly chant ayn rand mantras while the anything-but-great nation turns into a pile of goo.
i gave obama thirty days. it didn't take that long to see what is now obvious to everyone. the man is in charge of nothing. all the little nero's fiddle while rome is looted and burned. the rest of the world, long under the thumb of the military junta of the us of a, is laughing and waiting.
ever watch scavengers take a fallen corpse?
i do not criticize the govt. worker, they are, in my experience, good people who mostly try hard to do the right thing. but this is not a nation with a true govt., just a political shadow, hiding the country's diseases in the dark.
We are squeezed between rising overhead and stagnant fees. We must spend more time filling out useless forms and employ more people to process our billing. As a result physicians have been in the same leaky boat as the rest of the middle class, no pay increase (inflation adjusted) for the last 35 years. HMO's have utterly failed to restrain the growth of spending (because the Nixon era law created for-profit entities, which have no incentive to be efficient--they gouge just like the rest of the for profit insurance sector).
My humble request is to sequence Reich's third proposal such that any cuts in physician reimbursement follow the demonstration of significant reductions in overhead costs from streamlining the system. As mentioned above, a single payer system is a straight shot to a highly efficient system. With other options it's going to be more difficult to accomplish those efficiencies.
As one of his last official acts, the former President vetoed the children's health initiative. Today, we are speculating that a public option MIGHT NOT pass this year. After our hopes were raised so high, this would be a serious disappointment, but going back to what we had ... ?
Certainly, we should pursue our best interests since we are due a share in what is our country. This is not totally from greed or even ambition, but because our hungry and unemployed citizens wish most of all for the opportunities and strength to serve our country. Given there is a conflict of interests between the most of us and each fraction, some hyperbole is a natural and gratifying response. There is real desperation out there.
I think of a definition of "adventure:" Somebody else having a hard time. Poverty is certainly an adventure and something of a soap. It has to be a hollow comfort, but in these hard times, the stricken are all heroes, both the problem and, as they come through, the solution, the real hope of America as a nation and a people.
We need to stop using Obama's name because it was never about one man... it's our job to let our elected representatives in House/Senate know what we want... They work for US! We the people disengaged and lost to big $$$... Obama needs to "refuse to pay" and we need to remind our public servants who they serve... Every day!