Health Care Reform

[Voronwë the Faithful]

I'm not trying to be difficult, but I do need to point out that the Bush tax cuts was the type of thing that the reconcilliation process was designed for. The Health Care reform is not, and I think they would need to do some fancy footwork to justify it. Sen. Byrd himself (the creator of the rule that determined when reconcilliation can be used), insisted that it could not be used when Clinton was trying to pass health care reform in the 90s. It's hard to see how that will change this time around.

[Primula Baggins]

Sen. Byrd did not approve of using reconciliation for passing tax cuts, either (link).

I am just wondering how much continuing damage we are all supposed to absorb just so Obama can claim to be more bipartisan than the previous administration, and how long Democrats in Congress should continue to give the losing party veto power over the agenda of the party that actually was voted into power rather decisively. An agenda that a large majority of all voters, not just Democratic voters, strongly support. That's bipartisanship, too; it doesn't just mean making Mitch McConnell happy.

[Voronwë the Faithful]

Um, that statement that you link to is all about how Sen. Byrd doesn't support using reconciliation to pass health care reform this year. Yes, he mentions in passing that reconciliation is not meant to be used for tax cuts, but at least that was a budget measure, not a highly complex program like health care reform. Moreover, as he points out, any provisions passed through reconciliation will sunset after five years. That's a quick fix, not a permanent solution. I agree that it will be a lot harder work to obtain meaningful health care reform without using reconciliation, and probably require more compromises, but unless that hard work is pursued, any victory on health care reform will be a Pyrrhic one.

[Primula Baggins]

I did say he didn't approve of it for tax cuts, either.

I sincerely believe that there will be no compromise that even a few Republicans will vote for. If they were presented with a completely gutted, utterly useless bill that they could have dictated themselves, one that changed the status quo not a bit or even made things better for the insurance companies at voters' expense, they would still vote no, and it still would not pass with 60 votes. That way Obama fails, which I suspect is the actual objective here.

I don't think the choice for Obama is between being "partisan" and being "bipartisan"; I think it's between getting an effective bill passed (though not in the best possible way) and achieving nothing at all.

[Voronwë the Faithful]

Do you think that something that would expire in five years would be worth doing? That it would be an effective bill?

[Frelga]

Well, if it were an effective and popular bill, it very well may garner more support in five years. If it were effective and popular, and passed over the head of the Republicans, there might be a bullet-proof Democrat majority in five years.

[Primula Baggins]

What Frelga said. And I think the Republicans fear that as much as the insurance companies fear the public option. I remember reading a quote from a Republican advisor or analyst or official at the time the Clintons were trying to get reform through, saying essentially that it had to be stopped at all costs because if it passed, it would be so popular with voters that the Democrats would be winning elections for decades to come.

I'll try to find a link for that tomorrow.

[Voronwë the Faithful]

Or it could result in a backlash against the Democrats because of the inevitible initial increase in the deficit, and the inevitable fits and starts in implementing, with the end result of no lasting health care reform AND a new Republican majority.

I want to see health care reform, too, but I want to see it done in a lasting, meaningful way, not a desperate win at all costs way, short-term way. Just because that is how the other side has played the game doesn't mean it is the right way to play the game.

[Frelga]

Nor does it mean that sometimes it isn't.

Even if we got more heavily regulated insurance industry, removed the pre-existing conditions restrictions, closed some loopholes that now result in the denial of coverage, the insurance companies would still find ways to avoid paying up. Their business is making money, not providing health care. And even in the best case, regulating insurance companies is not going to address the fundamental flaw of having health coverage tied to employment.

I think the voters will forgive the growing deficit if they, personally, don't have to shell out $$$ every month.

[Primula Baggins]

Or if they no longer have to lie awake worrying about what will happen to their sick child's care if they're laid off, or how to scrape together the cash for an ER visit for their husband's abscessed tooth, or what kind of future they can hope to build for their family if they're shackled to a dead-end job because it's got some minimal health benefits. Relief from worry and fear is probably even more important than cost.

[Frelga]

Nor does it mean that sometimes it isn't.

Even if we got more heavily regulated insurance industry, removed the pre-existing conditions restrictions, closed some loopholes that now result in the denial of coverage, the insurance companies would still find ways to avoid paying up. Their business is making money, not providing health care. And even in the best case, regulating insurance companies is not going to address the fundamental flaw of having health coverage tied to employment.

I think the voters will forgive the growing deficit if they, personally, don't have to shell out $$$ every month.

[Dave_LF]

So here's a hard question that needs to be addressed by whatever plan is proposed: given that the resources don't exist to provide every person with every drug, treatment, or procedure that might improve or extend his or her life, how shall we ration care and who should make the decisions?

[Primula Baggins]

Presently it's the insurance companies rationing or planning care for the covered, and lack of coverage and money rationing care for everyone else. I think we can choose another mechanism and be no worse off.

And if preventive care is freely available to everyone or almost everyone, that in itself will help contain costs. Some preventive expenses such as prenatal care pay off big. Not having to wait until a minor medical issue becomes a life-threatening emergency or a chronic debility, and then going to the ER with it because there is nowhere else, will also save money.

[Voronwë the Faithful]

Prim and Frelga, the only real answer to your concerns is a single-payer national health plan. Either we eliminate the insurance companies altogether, or work within parameters that work for them. The whole idea of a 'public option' is a flawed substitute for the politically-untenable single-payer system. Either the public option is a short-cut to getting to single-payer system or it is doomed to fail.

[Primula Baggins]

A successful public option might lead to single-payer in time. I can think of much worse things (such as the status quo).

But it might not lead to it, either. It didn't in Canada, and their system is stable.

[Voronwë the Faithful]

Really? I was under the impression that Canada did have essentially a single-payer national health plan. If not, what is their system like?

[elfshadow]

And if preventive care is freely available to everyone or almost everyone, that in itself will help contain costs. Some preventive expenses such as prenatal care pay off big. Not having to wait until a minor medical issue becomes a life-threatening emergency or a chronic debility, and then going to the ER with it because there is nowhere else, will also save money.

Prim, this post really touched on something important. Two of the major problems with health care today are that 1) there aren't enough primary care providers, and 2) there aren't enough people who go to primary care providers for their regular source of care. Not only do PCPs provide an excellent resource for preventive care, but it is much cheaper for both patients and insurance companies to go to PCPs for nonurgent care than to go to emergency rooms. In the last several years, the ER has become the de facto usual source of care for millions of Americans--mostly those who are uninsured or underinsured. This creates a whole host of problems, such as ER overcrowding, increased costs of both insurance and health care, etc. When a patient can't afford to pay for their visit to the ER, it is often up to the hospital to cover the bulk of the cost (as far as I know). This is one of the reasons that the cost of health care keeps rising.

We definitely need to overhaul the insurance process in the country, but there are other major problems with health care that need to happen at the same time. Creating a bunch of new laws about health insurance won't help in the long run unless we can find viable ways to lower the cost of health care in general. If we continue to have private insurance at all, the insurance companies have to be able to make money somehow.

[Primula Baggins]

I was wrong: Canada has single-payer. What it does not have is a system where healthcare providers are government employees. It just pays private doctors and hospitals to provide care.

So it's single-payer, but not a national health service.

Elsha, the insurance companies will have to adjust their business models or go under. They have been profiting from lucrative near-monopolies in many states for decades now and have been pretty much free to operate as they choose. That can't continue, nor should it. So profits will go down unless efficiency goes up.

Which is fine with me. I don't think the well-being of health insurance providers, no matter how large, should outweigh the well-being of the economy as a whole or the American people.

[Dave_LF]

It's true that lots of things could be done to lower the cost of healthcare, but nothing is going to lower it to the point that everyone can have all they want. As it gets cheaper, people will demand more until a new equilibrium is established. If that equilibrium it at a point where more people can receive essential care then it was worth it, but it will still be true that some requests will have to be answered with "no" or "wait". Who will make that decision and how?

[Primula Baggins]

I don't think anyone is denying that this would be necessary, Dave. Some kind of rationing already does happen, for most people, as I've said. The mechanism would presumably be built into whatever public plan is adopted. Or, if there is no public plan, we'll go on as we have been, paying more money for less care with every year that goes by.