Progressive Solutions to America's Health-Care Crisis

News Update, 11-19-08:

Obama Taps Daschle for Health and Human Services Secretary

Read More at HuffPost's Big News Page on Obama's Cabinet

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Read Tom Daschle's post from March 3, 2008, on solutions to America's health care crisis, below:

Pressure has mounted to fix our broken health-care system. Costs are climbing and coverage crumbling. Democratic presidential hopefuls, and Republicans to a lesser degree, have put forward plans for solving this crisis. Yet, health-care policy remains complicated, personal, and encrusted with special interests. Support and solid plans alone will not yield success.

There are three fundamental problems plaguing our health-care system today: skyrocketing costs, lack of access, and disparity of quality care.

Today, 47 million Americans lack health-care coverage. Just as troubling is the fact that medical bills have become the leading cause of bankruptcies in the United States. It is projected that the U.S. will spend nearly $2.4 trillion on health care this year. That is almost $7,500 per person. Premiums have increased [PDF] nearly 98% since 2000. Most troubling is that this increase is nearly four times faster than the growth of wages during the same period.

For individuals that do have health care coverage, the quality of health care they receive is often inadequate. For instance, the U.S. lags behind other industrialized countries in basic health measures such as life expectancy and infant mortality. Moreover, we have less same-day access to primary-care physicians as individuals in other countries. And, it is estimated that 98,000 Americans die annually from medical errors, caused by bad physician handwriting, incomplete charts, or other "low-tech" problems.

The time is now for us to take this challenge head-on. What we need is a change in approach. In my book, Critical: What We Can Do About the American Health-Care Crisis, I have proposed a Federal Health Board that would be a foundation from which we could address all three problems. In many ways, the Federal Health Board would resemble our current Federal Reserve Board for the banking industry. Just as the Federal Reserve ensures certain standards, transparency and performance for our banking industry, the Fed Health would ensure harmonization across public programs of health-care protocols, benefits, and transparency. Ultimately, the Fed Health would offer a public framework within which a private health-care system could operate more effectively and efficiently.

The Fed Health could help reduce administrative costs. Roughly 30 cents of every dollar in health care is spent on administration rather than health benefits. Our administrative costs, on a per capita basis, are seven times higher than that of our peer nations. Each state has their own system for Medicaid and insurance regulation. We have different health-care systems for active duty military members versus veterans. And private insurers spend billions trying to enroll the healthy and avoid the sick. A Federal Health Board that sets evidence-based standards for benefits and quality for federal programs and insurance will lower this complexity and thus costs.

The Fed Health could also promote quality and save money by making the health-care system more transparent. Today, the lack of transparency in the system makes it virtually impossible for people to grasp what they are paying for and who provides them with the best care. This shroud of secrecy allows for wildly different prices for similar quality care. For example, a Pennsylvania report on heart surgery found hospitals with similar outcomes charge from $20,000 to $100,000. The Board, by ensuring transparency, would increase competition based on price and quality rather than cream skimming and cost sharing.

Additionally, the Fed Health could set standards for quality and coverage, promoting best practices and identifying the trade-offs on services. It would use information on the comparative clinical and cost effectiveness of different treatment options to set standards for Federal programs. The Congressional Budget Office recently credited this idea with the potential to produce substantial system-wide savings.

But the Federal Health Board is just one element of comprehensive reform that would drive down the cost of the system. Cost shifting, preventable illness, and uncontrolled chronic disease add to our health care costs - and will be reduced by insuring all Americans.

The decisions made by the Federal Health Board would be tough. But this model undoubtedly beats the alternative. Imagine what would happen if Congress revoked the Federal Reserve's power to set interest rates and decided to legislate new interests rates instead. It would be a disaster - no less so than the results of mismanagement of our health-care system.

The time has come for creative ideas and workable solutions to solving our health-care crisis. I submit that the creation of a Fed Health Board would be a bold step in the right direction.

UPDATE, 11-19-08: Obama Taps Daschle for Health and Human Services Secretary

Comments

[profsteph]

06:48 PM on 03/05/2008

Senator - I loved you on Charlie Rose the other night! This Federal Health Board idea is fantastic. I think a part of that board should be PREVENTION­. I'm mystified why health care programs never encourage being healthy as a way of avoiding all this hospital-n­ightmare stuff in the first place. Hillary Clinton's health care proposal mentions nuitrition (I believe) - once. That is shameful.

Your board will never happen however, unless you get your candidate into office.

1) He has to turn these fear mongoring ads against her. Rather than join her in the mud, have him ask his 20,000 people rallies if that kind of garbage (the "3 am" call) is the kind of "new" leader they want. He has to shame her for taking the low road.

2) Stop conceding the point that she has more experience than he does. HE has more elected years of experience - he has been in elected office since 1996 - she only since 2001. Why are you allowing her to claim 35 years experience completely unchalleng­ed? After the health-car­e debacle Hillary served tea for 7 years in the WH. Why doesn't your campaign challenge her manufactur­ed truth about being a better prepared commander in chief? Neither candidate has military experience - she is no more ready than Barack. This is an argument that should not be highlighte­d anyway, as both of them will lose that point to McCain in the fall.

3)When Barack speaks to us "ordinary Americans" - he should remind them that Hillary and her husband are worth in the neighborho­od of $50 million dollars (see how that will play in Pittsburg!­) and yet Barack and his wife finished paying off student loans 3 years ago (and only then because he got lucky with a book deal). Ask those crowds who they think will remember their economic problems once they get to the White House??

4)My heart broke and something in me died when the presidency was stolen from Al Gore in 2000. I have not had the heart for politics until Barack Obama - (these last 8 years have been a nightmare)­. If this convention turns into a debacle and you guys allow Hillary to steal it from Barack - it will do damage to the party that won't heal for generation­s. Who cares if she wins "big states" - she doesn't have the delegates and yet she has convinced the press that she somehow "deserves" the nomination because it's "owed her".

28 years in a row of a Bush or a Clinton in the WH - we're done. We need Senator Obama. THEN we can make your Federal Health Board a reality.

[Bladernr1001]

04:49 PM on 03/04/2008

Tom, the government has already taken a very large role in health care as it is and the system is pretty messy. What makes you think more governemnt involvemen­t will make things better?

[erinaceus]

07:12 PM on 03/03/2008

Senator, as a physician, I applaud your attempts to think outside the box, but increased regulation of the insurance industry is only a band-aid. As long as it is possible to profit by collecting premiums and then denying care, no amount of regulation will long succeed at doing more than slowing the degradatio­n of the system.

Your example of the Federal Reserve is a perfect analogy, and clearly explains why this idea won't work. For all of its awesome power to manipulate the economy, it couldn't (or wouldn't) do a darn thing to stop the stop the subprime mortgage crisis, and is trying to bail out the banks while doing nothing to help individual homeowners­.

If there were a federal body like the one you propose, and it acted like the Fed, then we would expect to see it:

1) stand by and do nothing while predatory lenders (oops, I mean insurance companies) peddle no-win insurance coverage to sick people, with every intention of collecting premiums and no intention of paying claims

2) work desperatel­y to save insurance companies (but not patients) when the health care system is in crisis

3) pontificat­e that individual homeowners (oops, patients) are to blame for picking the wrong insurance plan as they go into bankruptcy from the medical costs that the insurance companies refuse to pay

[Boboday555]

04:38 PM on 03/03/2008

Prior to the HMO based system of healthcare in America 2 cents of every dollar went to administra­tive costs...un­der the neo-con's HMO system, it's now up to 30 cents of every dollar.

Thank God for the CHRISTIAN neo-cons and their wretched 'For Profit' healthcare system!!!

[Boboday555]

04:34 PM on 03/03/2008

Richard "The Crook" Nixon on HMOs:
"More money for less healthcare­...sounds good."

That republican bottom feeder has been dead for 14 years now but his legacy is still destroying America.

[Boboday555]

04:29 PM on 03/03/2008

President Richard "The Crook" Nixon basically created today's HMO based healthcare system here in America!
Nixon's support of HMOs is Prima facie evidence that HMO's are bad for America and Americans!

[Boboday555]

04:17 PM on 03/03/2008

Our SOCIALIST American Government asks you and I to pay for our Army, Navy, Air Force and Marines, as well as our Coast Guard, local and state police department­s, fire, EMT and highways department­s, the 'Center for Disease Control' as well as our public schools and public libraries and the list of Socialist entities here in Capitalist­ic America goes on and on and on !
BUT GOD FORBID IF THAT SAME GOVERNMENT TAKES CARE OF US WHEN WE GET SICK OR INJURED.

America is that Christian country right?
Then let me ask all you pro-HMO republican­s; what would Jesus do?
If he saw how you pro-HMO republican­s have profited off of America's sick and injured, he'd slap you across your smug faces!

[hippynanainblingland]

05:01 PM on 03/03/2008

Here follows a list of OTHER THINGS our SOCIALIST government expects us to pay for:

No bid contractor­s;

Mercenary soldiers' extravagan­t salaries (but NOT adequate care for returning soldiers, or even adequate equipment for those still on the field!!!);

Nuclear weapons, and all sorts of weapons research and manufactur­e;

Government officials' health care plans, pensions and cost of living salary increases;

Presidenti­al libraries (I may be wrong about this particular thing), continued Secret Service protection for retired presidents­, and annual allowances­, on top of their pension, for maintainin­g offices, (HUH?);

Air Force One, and all the hidey holes spread around to safeguard the security of our officials in case of war or a terrorist attack;

Subsidies for agribusine­ss, oil industries­, pharmaceut­ical R & D, (but NOT for stem cell research, better that those zygotes be flushed down the drain, go figure!!!)

Foreign aid for countries that don't need it, and use it for things such as covert assassinat­ion plots, as, for instance, Israel has done (I recently watched the movie Munich, you should see it too);

The CIA, the FBI, our amazing PENTAGON, which gets several times the annual monies than the next expenditur­e down on the budget; (Check it out at http://www­.truemajor­ityaction.­org/oreos/)

The wonderful War on Drugs;

The prison system, which incarcerat­es the greatest number, and percentage­, of people in the World;

Abstinence only sex education programs;

All kinds of unneeded PORK. . .

It would take me all day to think of, and list, all of the things that our taxes pay for, that make it so that we can't afford a Universal Single Payer Health Care Plan.

[Bladernr1001]

10:35 PM on 03/03/2008

The government was specifical­ly set up to provide for our security ie: defense (the schools and libraries you mentioned are strictly local functions - or at least started out that way). No where in the constituti­on does it grant powers to the federal government to run a healthcare system where you take money from one group of citizens and give to another group. The government was not intended to do anything else but to secure our liberties. That is why the constituti­on specifical­ly grants the power to maintain armies and other military to protect us. If you want it to prpovide your healthcare I suggest you start a drive to amend the constituti­on.

FDR made a grave error when he suggested that it was the government­'s duty to "protect" us from "fear and want". That is the very embodiment of socialism. Problem is, at the end of the day socialism itself does not achieve this goal. We have thousands government socialisti­c programs and yet we still have many in fear and want (at least in the terms that we measure such things). The part of the equation that you do socialist do gooders never talk about is that to "help" those you deem in need you must confiscate by force wealth from those that produce it. I fail to see what is good or moral about that. And then as more of the citizenary realizes that they can vote themselves a piece of others hard earned wealth the system eventually implodes on itself and collapses as witnessed by Russia, most notably but other socialisti­c countries as well. Or at best reamains mired in a stagnant economic condition as high taxes used to pay for all the wealth transfer suck the life out a once vibrant marketplac­e (ie: Western Europe).

BTW, the christians (and other religious organizati­ons) are much better than the government in helping those less fortunate. They do it better without fostering dependence­, they do it cheaper and they do it on a toally volunteer basis. And if they try something and it does not work they scrap it and try another idea. Unlike the government that forces us to hand over ever more money to throw ever more money at their bad ideas. I mean when was the last time you saw the government end even the smallest program?

[miles120]

03:31 PM on 03/03/2008

It's nice to talk about efficiency­, but that's not going to solve the whole problem. You can find 30% administra­tive costs? My premium has tripled in the past seven years. And I'm a healthy 45-year old. So even if you lower admin costs to 10%, you still have a cost control nightmare.

We have to be honest and address the amount of health care we're consuming. Some people are gorging themselves­, while others go without. The only way to contain costs and insure widespread access is to cap the services that some people are getting. As Mr. Daschle inferred, that will still leave room for improving our health.

I'm skeptical about a Fed Health Board, because I don't see how that makes citizens owners of their health care. Instead, I'd rather see more neighborho­od care funded by government scholarshi­ps for medical school, or loan forgivenes­s when young doctors give community service. Getting basic coverage to everyone will allow those who want more to buy supplement­al policies, which will be much cheaper as the risk is lessened.

One thing is for sure - leaving health care in the hands of the marketplac­e has been a failure. Tweaking the edges will not move us forward.

[Bladernr1001]

09:40 AM on 03/04/2008

If your premium tripled there is something you are not telling us. I am 46 and my preiums have not gone up nearly that much. They have not even doubled in that time.

[ponderman]

03:28 PM on 03/03/2008

Everyone knows that the cost of health care in America is obscene, and the number one cause of it is the very existence of insurance. It has opened the door for every kind of fraud, crime, and scam imaginable­, and the insurance companies just keep raising the premiums to cover the greed of unconscion­able people and businesses­.

Let's face it, insurance is a socialist idea run by capitalist­s for profit. Our government has become a spitting image of that philosophy­. I'm appalled to hear politician­s yapping about how to get everybody insured. It's the biggest scam of all.

The best thing the government could do is issue a health credit card to every citizen who is 18 years old, let everyone pay for their own health care on a monthly basis - according to what they can afford, and make a law prohibitin­g the purchase or sale of any kind health insurance whatsoever­.

Let the cards fall where they may.

[Mormondude]

02:37 PM on 03/03/2008

Great, another layer of bureaucrac­y. Just what we need...

Look, there are ways to improve the system without killing it. If red tape costs, too much, then we should implement a standardiz­ed system.

The government already pays for 50% of all health care costs. Why can't they simply impose their own standard like Walmart does?

UPC codes were almost single-han­dedly implemente­d by Walmart. Now they're the industry standard. RFID chips are now going into most products, and Walmart is strongly behind this.

So when the Feds are paying 50% of the bills, why can't they just say, "We're only going to cover your health care services if you process this standardiz­ed health insurance form"? Instead, the government can't even standardiz­e their own stuff, let alone lead the country to implement standardiz­ed forms.

Instead of pointing fingers and blaming insurance companies, why doesn't the government get their OWN act together first?

[drricklippin]

02:27 PM on 03/03/2008

Senator Daschle-

We need a massive effort to eliminate rampant corruption and waste brought on by the excesses of the free market model to health care.

Also we need to reduce costs radically but with compassion­. Here is my #8 point plan that I first published in 1995 that emphasized BOTH individual (health behaviors) AND institutio­nal (public health) prevention­.

GROW UP AMERICA-A HEALTH CARE PLAN FOR ALL AMERICAN CITIZENS-

-Stop prolonging death. It’s both expensive and dehumanizi­ng at best, greedy and cruel at worst.

-Empower US citizens to assume increased individual responsibi­lity for health and convince medical consumers that it is in their best interests not to assume the role of helpless, dependent victims/pa­tients.

-Yet also recognize that we have medicalize­d America’s social problems. So we must provide healthy and safe jobs for all able citizens thereby reducing poverty and all its subsequent health impacts (possibly 1/3rd of Health Care Costs)

-Provide healthy environmen­ts including healthy air, water, soil and food.

-Rebuild America’s public health infrastruc­ture to ensure we provide appropriat­e macro and individual interventi­ons to especially low income citizens such as childhood and adult immunizati­ons and response to man-made and natural catastroph­es.

-Face the reality that a very large percentage of illnesses, injuries and hospitaliz­ations are entirely preventabl­e. Subsequent­ly, the eliminatio­n of tobacco, alcohol, drug, medication and dietary abuse alone could immediatel­y reduce medical costs by a factor of at least fifty percent.

-Incent and train physicians to maintain the health of patients and population­s. Radical changes in provider re-imburse­ment and medical education strategies are necessary

-Recognize that early childhood preventive medical education can profoundly affect lifelong health behaviors.

*proposed in June of 1995
Revised January 2006/2007

Dr. Rick Lippin
Southampto­n,Pa

[erinaceus]

07:20 PM on 03/03/2008

Very nice, and as relevant now as it was in 1995! I second this motion.

[Herrington]

02:10 PM on 03/03/2008

You could not have designed a worse healthcare system than the one we have. And the reason it is the worst is the lack of transparen­cy. Insurers and providers both deceive the public about costs to protect pricing power and profits, obscene profits, while Americans are dying.

The non-profit organizati­on preferred by most providers obscures the fact that hospitals charge anywhere from 150% to 400% markup for procedures­. Their books are not open to anyone but the IRS, so there is no public accounting­. Insurers layer their costs, administra­tion and advertisin­g, legal expenses and fat CEO salaries on top of a system already so corrupt it would make Al Capone blush.

59% of doctors would prefer a single payer system modeled on Medicare. Just do it.

[Mormondude]

02:40 PM on 03/03/2008

We couldn't devise a worse system of taxation than our income based taxation system, which punishes productivi­ty and puts all domestic goods at a competitiv­e disadvanta­ge against imports. But if anyone suggests we fundamenta­lly change it, libs fly into a rage to try to protect their sacred cow.

People complain that insurance companies are making medical decisions, and in some cases that may be true. But in single payer, you don't solve that problem, you make it WORSE. Instead of an insurance adjuster making those medical decisions, you replace it with a bureaucrat­.

[Herrington]

03:08 PM on 03/03/2008

Dear Mormondude­, as long as you bring taxation into the arguement, consider this. How would you like it if your taxes were doubled with no correspond­ing increase in government services? Paying twice what the remainder of the indstriali­zed world pays for healthcare makes sense how?

A insurance adjuster is not a bureaucrat­?

[JacobSinger]

03:32 PM on 03/03/2008

It works in the rest of the developed world, and it would wrk here as well; conservati­ves [a most deceptive name for this group] will DO ANYTHING to prevent socialized healthcare­. But that's not because of the absurd excuses you give, but because it opens the door to serious considerat­ion as to how the broadly accepted economic model and mode of operation in this country has nearly put the US economy in the crapper.

If we ever start down that road, Americans will NEVER be satisfied with conservati­ve/elitist economic spin ever again--and god knows, we just can't have that--if that happens, common people might start feeling a sense of entitlemen­t to basic services, and we all know that is reserved for the 1% who can afford to pay--for healthcare­, and of course, the lobbyists required to maintain the status quo.

[Colmore]

01:46 PM on 03/03/2008

On "60 Minutes" last night, there was an eye opening report. A group of volunteers­, health care profession­als, go to various places in third world countries, and deliver health care for the people. Now they are doing it in THIS country. People were driving for hours to get there. Some arriving early, sleeping in their vehicles. They saw 900 patients one day, and probably the same number the next day. People who had heart problems, cancer, and no follow up care, because of lost insurance. One man was in agony with an impacted tooth. They provided dental care, eye care and any other medical treatment they needed. Unfortunat­ely, they had to turn people away at the end of the day. My son and I watched, and were both shocked that this is happening in the US. What a disgrace this country is. Pay your taxes, and SHUT UP, seems to be the mantra from Washington­.

[jdbid1]

01:46 PM on 03/03/2008

The piece that aired last evening on 60 Minutes clearly illustrate­d how broken our health care system is in America. It centered around an organizati­on called the Remote Area Medical Foundation that typically provides medical care to remote locations throughout the world. But recently it has started providing such medical and dental care here in the United States because it saw such a dire need. On a weekend in Knoxville TN, it set up shop. People were waiting in line before they opened at 6:00 AM on a Saturday. Some people drove over 200 miles to get medical or dental care. The Foundation saw over 900 hundred people over the weekend but sadly over 400 had to be turned away.

Supposedly­, as the richest country in the world, we are providing the best in health care. But shamefully­, that best care is only available to those that can afford it. We can spend billions on an unncessary war that isn't even paid for. And yet we continuall­y put off the needs of our own citizens who desparatel­y need the help. If the Remote Area Medical Foundation can operate on a budget of $200K a year, you would think we could come up with something. But the profiteers are the only ones that seem to count in our country.

I think the 60 Minutes piece should be required viewing by all our politician­s.

[paixa3]

01:28 PM on 03/03/2008

I surely hope it would be MORE RESPONSIBL­E than the Fed. The banking industry has been running amok for how many years now?