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Nothing from nothing leaves healthcare reform?

The great pianist and songwriter Billy Preston once sang, “nothing from nothing leaves nothing.” Although over 15 to 16 months I have seen the promise of health care reform start with single-payer and then morph into some sort of public option which, were it robust, should be able to contain health-care costs. This is kind of what the House passed. The Senate, on the other hand, is one confusing mess. Senator Max Baucus was given the keys to the city. I’m not sure what exactly he came up with. As chairman of the finance committee, he was in charge of coming up with a health care bill that was attractive to at least a couple of Republicans. Olympia Snowe and others were courted with sweeteners which seem to have eaten away at the core of health care reform. Senator Kent Conrad decided that he would introduce his own health-care legislation which was some sort of co-op. Although he sold this idea on the Sunday talk shows and pushed it hard for 6-8 weeks, thankfully (hopefully), it is died a quick death.

The public option is been tossed around like a medicine ball. In junior high school, we were asked to throw a medicine ball in order to build up muscle strength and coordination. Every other throw, the ball was dropped, kicked and then picked up and thrown again. This is exactly what has happened with the public option. What was once a robust counterweight to private health insurance has turned into something that states can opt in or opt out of, depending upon the whims of their legislature. Oh, and it seems that opposing healthcare is a great way to get on TV and increase your image/status… as in the case of Bart Stupak.

I have stated both on my radio show and on this blog that health-care reform must include something that is cost-effective, portable and increases access to healthcare. Currently, we are looking at a health-care bill that seems to do none of this. Many progressives have decided that they cannot support this bill. They want something else done. I understand the sentiment. I find this whole process extremely frustrating. Democrats seem to be completely unable to stick to their principles and stand up for the middle class. It seems like the only difference between Republicans and Democrats is that Democrats know what is right but can’t do it. Republicans have no idea what is right and won’t do it. BTW, President Barack Obama is a leader-come-lately. Look, I love this man, but I’m telling the truth. Where was he in the middle of the heat of the summer when healthcare was taking the big hits? He needed to be out of front stating that we HAD to have a robust public option. Alas, he wasn’t there.

Here’s my problem. Washington seems to be controlled by big business. Lobbyists from K St. seem to surround the Capital like locusts. If we scrapped the health-care bill and start all over, how are we going to come up with a different outcome? We’re going to have the same politicians, the same White House and the same lobbyists. As a matter of fact, the lobbyists will be better armed to combat arguments they’ve already heard. They will probably be armed with more money. I’m afraid that starting over will leave us with a bill that’s even worse than what we’re looking at now — if that is possible.

We’re spending $2.4 trillion on health care every year (we spent that much in 2008). Isn’t that enough money? Why do we need to pay any more? Everyone agrees that insurance does not add any value to healthcare. Why is Washington coddling the insurance companies? The whole reason for their existence is not to improve health care, to help doctors deliver better care or to help increase access to doctors by patients. Instead, their whole deal is to simply make money. They make money by not paying claims.

$2.4 trillion is enough money to take care of all 300 million Americans. Combine Medicare and Medicaid and SCHiP and all of the state-run programs into one program. Medicare for All! The government will set up a system to negotiate prices with pharmaceutical companies and medical device/product manufacturers. Premiums are paid out of our taxes in a graduated fashion. The more you make, the more you pay. Let’s extend patent protection for pharmaceutical companies by 2-5 years. Since the government is negotiating drug prices, pharmaceutical companies can recoup some of their losses through this mechanism. Doctors will be awarded for opening early and staying open late and on the weekends. This way, Americans can go to their physicians without having to take off from work. This increases access. Anyway, Medicare for All, at least for now, is a pipe dream. Right now, I’m good to try to work with my congressional representatives to try to get the best bill possible.

Billy Preston was right. Nothing from Nothing leaves nothing. The Senate is trying to sell us nothing and tell us it is something. They need to do better.

By |2010-03-09T08:24:56-04:00March 9th, 2010|Congress, Healthcare|Comments Off on Nothing from nothing leaves healthcare reform?

Conservative solutions for healthcare reform

I know this sounds like an oxymoron, but stay with me. Joe writes, “…common sense health insurance reform will cost the government little to nothing.” I always liked these common sense solutions. They make me smile. The reason I smile it is that if they were so simple and easy we would’ve tried them already. Congress has been desperately looking for something simple and easy to try for the last 25 years. During this time both Republicans and Democrats have controlled the House and the Senate and could’ve passed “common sense” solutions. Especially, especially if those common sense solutions didn’t require insurance companies or pharmaceutical companies to lose money. Congress would have been all over it.

1. Allow people to band together to buy group health insurance without being an employee-based group.

This sounds nice. You have to find a way to get millions of people to band together, not just a few. As far as I know, Americans have not banded together to buy gas or to buy groceries. Small bands of Americans (a couple thousand) would be almost the same as a small business and its employees. The reason any given small business has stopped covering employees, as a rule, is cost. There’s no way a small band of Americans is going to be able to figure out how to decrease the cost. Now, the exception would be small bands of young healthy Americans. They could easily band together and cover themselves for little or nothing. Basically, this is Kent Conrad’s idea, which has been thoroughly vetted. This is about co-ops. Co-ops will not be competitive because they don’t have the numbers to negotiate drug prices and fees for service.

2. End exemptions for a self-insured plans.

If we are going to end exemptions, why isn’t that the case in the healthcare exemption? The benefit of health insurance is not taxed. Our treasury loses $110 billion every year because of this. This seems to be a much fairer solution, don’t you think?

3. Standardized insurance forms and information systems.

This will cost millions. It will cost insurance companies and doctors’ offices and hospitals millions of dollars to change from what they have to something else. Who’s gonna decide what the standard is? Clearly, we’re not gonna trust the government to do that, so we are going to wait for business to come up with a committee to do this? Expect a decision in three to four years… and a voluntary implementation of this will never happen. There’s no incentive for business to do this. Unless you want to pass regulations — no way. Conservatives hate regulations.

4. End cost shifting.

Cost shifting doesn’t end. Just because you tell them to stop it, doesn’t mean it will end. Hospitals and doctors have incentives to continue cost shifting. They get paid. Personally, as a physician, I’ve been down this road, where we “aggressively” go after those without money and those who don’t pay. The bills simply never get paid off. They end up spending a lot of money trying to track down people who have moved out of state. They end up spending a lot of money on people who are paying $25 and $50 a month on bills that are $50,000 and $100,000 or more. Neither hospitals nor physicians will willingly take this hit.

Remember, we are obligated to provide medical care for those people who are dying. This isn’t like a car dealership. No matter how badly you want a car, if you don’t have cash or financing you don’t get that car. If you come in to the emergency room because of a heart attack or a bleeding ulcer, we take care of you. This is the way it should be. It also should be that we get paid for the services that we render. How we get paid by those who don’t have money to pay is a question that society needs to answer.

So far, none of the suggestions that have been made by some conservatives that I’ve reviewed here amount to any significant cost savings. None of the suggestions will control costs. With healthcare costing $2.2 trillion in 2007, I’m sorry to say that these solutions are weak at best.

By |2009-12-13T02:21:33-04:00December 13th, 2009|Healthcare|Comments Off on Conservative solutions for healthcare reform

Public Option gets beat up in Senate Finance Committee

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So who was surprised that a committee chaired by Max Baucus would vote down the public option? Who? I’m not. Max hasn’t supported the public option from the start. Then you have Kent (“I love me some co-ops”) Conrad. He has also be anti-public option. Add Blanche Lincoln to the mix and the outcome of the vote was predictable.

McJoan has an update of where we are in the Senate after day’s voting:

One thing that that’s clear from today’s Finance Committee votes on the public option: Kent Conrad is the problem for the Dems. He provided the cover today for Lincoln, who was virtually invisible, to vote against the Schumer “level playing field” public option that would have done away with Conrad’s supposed problem with Rockefeller’s amendment–that it was tied to Medicare rates. If that was truly Conrad’s big problem with the bill, he should have had no problem with Schumer’s bill.

The action is going to take place in conference. At least that is what I see happening. This is where the action has always been. Once Obama supported the public option the only way that the Senate could support the much more liberal (thoughtful, American worker friendly) House version was in conference. The Wonk Room agrees:

Obviously, he’s the anti-public option problem in the Democratic caucus, if you take Baucus at his illogical word that he supports the public option, but had to vote against it because it didn’t have enough votes. But, on the other side, the most conservative of the committees to take up healthcare reform had 10 Dems supporting some form of public option–that’s more than I think anyone thought they’d get. Rockefeller told Ed Schultz today that he was suprised to have gotten eight votes for his.

Bottom line, the Finance Committee is going to pass out a bill without a public option, unless Rockefeller and Cantwell do indeed decide to oppose it and can find a third Dem (assuming Snowe will vote with the majority). But it’s also coming out of SFC with a strong majority of Democrats who will vote for the public option on the floor.

By |2009-09-29T20:45:39-04:00September 29th, 2009|Congress, Healthcare|Comments Off on Public Option gets beat up in Senate Finance Committee
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