Take the Time to Read This From Krugman

Op-Ed Columnist

Willie Sutton Wept

By PAUL KRUGMAN

Published: February 17, 2011

There are three things you need to know about the current budget debate. First, it’s essentially fraudulent. Second, most people posing as deficit hawks are faking it. Third, while President Obama hasn’t fully avoided the fraudulence, he’s less bad than his opponents — and he deserves much more credit for fiscal responsibility than he’s getting.

About the fraudulence: Last month, Howard Gleckman of the Tax Policy Center described the president as the “anti-Willie Sutton,” after the holdup artist who reputedly said he robbed banks because that’s where the money is. Indeed, Mr. Obama has lately been going where the money isn’t, making a big deal out of a freeze on nonsecurity discretionary spending, which accounts for only 12 percent of the budget.

But that’s what everyone does. House Republicans talk big about spending cuts — but focus solely on that same small budget sliver.

And by proposing sharp spending cuts right away, Republicans aren’t just going where the money isn’t, they’re also going when the money isn’t. Slashing spending while the economy is still deeply depressed is a recipe for slower economic growth, which means lower tax receipts — so any deficit reduction from G.O.P. cuts would be at least partly offset by lower revenue.

The whole budget debate, then, is a sham. House Republicans, in particular, are literally stealing food from the mouths of babes — nutritional aid to pregnant women and very young children is one of the items on their cutting block — so they can pose, falsely, as deficit hawks.

What would a serious approach to our fiscal problems involve? I can summarize it in seven words: health care, health care, health care, revenue.

Notice that I said “health care,” not “entitlements.” People in Washington often talk as if there were a program called Socialsecuritymedicareandmedicaid, then focus on things like raising the retirement age. But that’s more anti-Willie Suttonism. Long-run projections suggest that spending on the major entitlement programs will rise sharply over the decades ahead, but the great bulk of that rise will come from the health insurance programs, not Social Security.

So anyone who is really serious about the budget should be focusing mainly on health care. And by focusing, I don’t mean writing down a number and expecting someone else to make that number happen — a dodge known in the trade as a “magic asterisk.” I mean getting behind specific actions to rein in costs.

By that standard, the Simpson-Bowles deficit commission, whose work is now being treated as if it were the gold standard of fiscal seriousness, was in fact deeply unserious. Its report “was one big magic asterisk,” Bob Greenstein of the Center on Budget and Policy Priorities told The Washington Post’s Ezra Klein. So is the much-hyped proposal by Paul Ryan, the G.O.P.’s supposed deep thinker du jour, to replace Medicare with vouchers whose value would systematically lag behind health care costs. What’s supposed to happen when seniors find that they can’t afford insurance?

What would real action on health look like? Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure; limiting the tax deductibility of private insurance plans; and so on.

And what do these things have in common? They’re all in last year’s health reform bill.

That’s why I say that Mr. Obama gets too little credit. He has done more to rein in long-run deficits than any previous president. And if his opponents were serious about those deficits, they’d be backing his actions and calling for more; instead, they’ve been screaming about death panels.

Now, even if we manage to rein in health costs, we’ll still have a long-run deficit problem — a fundamental gap between the government’s spending and the amount it collects in taxes. So what should be done?

This brings me to the seventh word of my summary of the real fiscal issues: if you’re serious about the deficit, you should be willing to consider closing at least part of this gap with higher taxes. True, higher taxes aren’t popular, but neither are cuts in government programs. So we should add to the roster of fundamentally unserious people anyone who talks about the deficit — as most of our prominent deficit scolds do — as if it were purely a spending issue.

The bottom line, then, is that while the budget is all over the news, we’re not having a real debate; it’s all sound, fury, and posturing, telling us a lot about the cynicism of politicians but signifying nothing in terms of actual deficit reduction. And we shouldn’t indulge those politicians by pretending otherwise.

Medicaid and Root Canals in Michigan, Etc.

(c) 2010 F. Bruce Abel

Here we go.

http://www.nytimes.com/2010/03/16/health/policy/16medicaid.html?hp

And deciding on health care for aging parents:

http://www.nytimes.com/2010/03/13/health/13patient.html?src=me&ref=health

Two Columns and Hope

(c) 2010 F. Bruce Abel

Two columns give me great hope today: Brooks and Krugman. Both in the NYT.

Op-Ed Columnist
Health Reform Myths
comments (5)
By PAUL KRUGMAN
Published: March 11, 2010
Health reform is back from the dead. Many Democrats have realized that their electoral prospects will be better if they can point to a real accomplishment. Polling on reform — which was never as negative as portrayed — shows signs of improving. And I’ve been really impressed by the passion and energy of this guy Barack Obama. Where was he last year?
Times Topics: Health Care Reform
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But reform still has to run a gantlet of misinformation and outright lies. So let me address three big myths about the proposed reform, myths that are believed by many people who consider themselves well-informed, but who have actually fallen for deceptive spin.
The first of these myths, which has been all over the airwaves lately, is the claim that President Obama is proposing a government takeover of one-sixth of the economy, the share of G.D.P. currently spent on health.

Well, if having the government regulate and subsidize health insurance is a “takeover,” that takeover happened long ago. Medicare, Medicaid, and other government programs already pay for almost half of American health care, while private insurance pays for barely more than a third (the rest is mostly out-of-pocket expenses). And the great bulk of that private insurance is provided via employee plans, which are both subsidized with tax exemptions and tightly regulated.
The only part of health care in which there isn’t already a lot of federal intervention is the market in which individuals who can’t get employment-based coverage buy their own insurance. And that market, in case you hadn’t noticed, is a disaster — no coverage for people with pre-existing medical conditions, coverage dropped when you get sick, and huge premium increases in the middle of an economic crisis. It’s this sector, plus the plight of Americans with no insurance at all, that reform aims to fix. What’s wrong with that?

The second myth is that the proposed reform does nothing to control costs. To support this claim, critics point to reports by the Medicare actuary, who predicts that total national health spending would be slightly higher in 2019 with reform than without it.
Even if this prediction were correct, it points to a pretty good bargain. The actuary’s assessment of the Senate bill, for example, finds that it would raise total health care spending by less than 1 percent, while extending coverage to 34 million Americans who would otherwise be uninsured. That’s a large expansion in coverage at an essentially trivial cost.
And it gets better as we go further into the future: the Congressional Budget Office has just concluded, in a new report, that the arithmetic of reform will look better in its second decade than it did in its first.
Furthermore, there’s good reason to believe that all such estimates are too pessimistic. There are many cost-saving efforts in the proposed reform, but nobody knows how well any one of these efforts will work. And as a result, official estimates don’t give the plan much credit for any of them. What the actuary and the budget office do is a bit like looking at an oil company’s prospecting efforts, concluding that any individual test hole it drills will probably come up dry, and predicting as a consequence that the company won’t find any oil at all — when the odds are, in fact, that some of the test holes will pan out, and produce big payoffs. Realistically, health reform is likely to do much better at controlling costs than any of the official projections suggest.


Which brings me to the third myth: that health reform is fiscally irresponsible. How can people say this given Congressional Budget Office predictions — which, as I’ve already argued, are probably too pessimistic — that reform would actually reduce the deficit? Critics argue that we should ignore what’s actually in the legislation; when cost control actually starts to bite on Medicare, they insist, Congress will back down.
But this isn’t an argument against Obamacare, it’s a declaration that we can’t control Medicare costs no matter what. And it also flies in the face of history: contrary to legend, past efforts to limit Medicare spending have in fact “stuck,” rather than being withdrawn in the face of political pressure.
So what’s the reality of the proposed reform? Compared with the Platonic ideal of reform, Obamacare comes up short. If the votes were there, I would much prefer to see Medicare for all.
For a real piece of passable legislation, however, it looks very good. It wouldn’t transform our health care system; in fact, Americans whose jobs come with health coverage would see little effect. But it would make a huge difference to the less fortunate among us, even as it would do more to control costs than anything we’ve done before.
This is a reasonable, responsible plan. Don’t let anyone tell you otherwise.

Brooks -- Health Care

(c) 2009 F. Bruce Abel

This is timely and seriously thought-out. Damned if we do, damned if we don't.


http://www.nytimes.com/2009/12/18/opinion/18brooks.html?_r=1&hp

Primary Care Doctors -- Worth Reading!

http://well.blogs.nytimes.com/2009/11/12/giving-primary-care-more-respect/

Krugman -- A Must-Read Today

(c) 2009 F. Bruce Abel

Ok, listen up. Krugman says This is It!


http://www.nytimes.com/2009/10/30/opinion/30krugman.html?hp

Apparantly the Insurance lobby Overstepped in its Ads

(c) 2009 F. Bruce Abel

The overstepping in their ads will make the health bill stronger, Krugman says.

http://www.nytimes.com/2009/10/16/opinion/16krugman.html?_r=1

Health Care -- A View From Canada

"Don't pee on my leg and tell me it's raining."

http://www.theglobeandmail.com/news/opinions/health-care-magnet-for-anger/article1293742/

Brooks -- Health Care

(c) 2009 F. Bruce Abel

Does David Brooks love Obama or what? How he has come around over the last three years, from being a devout Republican to being a supporter of the Democrats under Obama.

http://www.nytimes.com/2009/09/11/opinion/11brooks.html?_r=1&adxnnl=1&adxnnlx=1252667669-QX/AqluK/NGstUpg++Yvzw

Baseline Scenario

The Baseline Scenario


--------------------------------------------------------------------------------
Revisionist History
Healthcare Rationing Is Good
The March of Science and Health Care Reform
Revisionist History

Posted: 02 Sep 2009 07:30 AM PDT



Probably most of you have already read David Cho’s Washington Post article on how the Big Four banks (a) have gotten bigger through the crisis, (b) have increased market share (”now issue one of every two mortgages and about two of every three credit cards”), (c) are using their market clout to increase fees (while small banks are lowering fees), and (d) enjoy lower funding costs because of the nearly-explicit government guarantee.

I just want to comment on this statement by Tim Geithner: “The dominant public policy imperative motivating reform is to address the moral hazard risk created by what we did, what we had to do in the crisis to save the economy.” (Emphasis added.)

Um, no.

There were all those nuts saying that Treasury should have taken over the banks. This would have allowed the imposition of haircuts on creditors and limited moral hazard. There was also the less controversial option of making real, lasting constraints on banking practices a condition of the bailouts; the conditions that were imposed were peripheral and timed to evaporate when the TARP money was paid back. As a result, now Geithner has to bargain with Congress and an increasingly confident industry to get his regulatory reform.

It’s also important to differentiate between September 16-October 14, when you could give the government the benefit of the doubt because of the intense panic and uncertainty caused by the collapse of Lehman, and November-February (when the follow-on bailouts of Citigroup and Bank of America took place), when the government was able to choose among a range of options.

Saving the economy was a good thing. Doing it a particular way was a choice.

That said, I’m glad that Geithner says that undoing this situation is “the dominant public policy imperative motivating reform.”

By James Kwak




Healthcare Rationing Is Good

Posted: 02 Sep 2009 03:30 AM PDT



This guest post was contributed by StatsGuy, a regular commenter on this blog.

In the current healthcare debate, Conservatives warn us that a single payer system will bring government rationing… Progressives argue that we already have rationing, based on wealth. Both sides are right, but both pretend that rationing is bad. Yet as every economist knows, the allocation of scarce resources is the basis of economics itself. The question is not whether we will have rationing – the question is how to structure a system of rationing that accomplishes our goals.

Two primary themes dominate this debate:

The Uninsured: In the past two decades, both the total number and the percentage of uninsured have increased in spite of some modest programs designed to expand coverage (like CHIP). (Original chart is here.)



The graph above, which extends through 2007, has surely worsened since 57% of US citizens are insured through their workplace (down from 63% in 2000) and unemployment increased from under 5% to 9.4% in the last couple years.

Rising Costs: During the same time, costs have increased dramatically. (Original chart is here.)



Part of this is because of the availability of new treatments and technology in the last 20 years… Part of this is because the population in the US suffers greater morbidity than 20 years ago. But much of the increase is due to systemic issues caused by gross market failures in the healthcare market, as described by Baseline here and elsewhere.

However, costs and coverage interact. Businesses (especially smaller ones) drop insurance because they cannot afford premiums. On the other side, lack of coverage drives up costs… The uninsured may overuse emergency room care, delay basic care until a disease worsens or fail to get vaccinated (which harms themselves and others). At the systemic level, administrative costs (which largely consist of managing payments and coverage) are growing much faster than overall costs.

So what can we do?

1) Fix the broken incentives

The current systems for federal and private reimbursement of health care expenses (via Medicare and Medicaid) are rate of return systems – a type of cost-plus regulation. In other words, health care providers are reimbursed for the quantity of care provided. The more they provide, the more they are reimbursed. Only HMOs do not compensate through this structure, and they have been credited with holding down costs vis-à-vis PPOs. (Moreover, they are now equaling or exceeding PPOs on other dimensions than cost.)

Even worse, the reimbursement schedule in existing government programs is broken; Medicare compensates primary care services at rates that are often below costs (which have increased faster than inflation adjustments), while richly compensating certain medications (because the govt. is banned from negotiating prices) and equipment intensive procedures (which have decreased relative to inflation in the same way that microchips have gotten cheaper). We have a vast amount of data that tells us that primary physician care is far more cost effective than treatment by teams of specialists, but the current rate schedule contributes to a substantial undersupply of primary care physicians that is likely to get worse as we see substantial year-on-year declines in the percentage of new graduates entering family medicine. Previous government reports suggesting that everything is fine contradict what many doctors are saying.

The best of the current proposals (the House bill, with summary here) does take steps to restructure rates, but needs to do more. We need to increase reimbursement for basic care, reduce reimbursement for the most expensive care, and set up a rational system for updating fee structures. New legislation should:

Create an independent, self-funded agency with rate setting authority.
Establish a set of advisory commissions to recommend rates and coverage using evidence-based analysis; commissions should be primarily staffed by doctors (with minimal conflicts of interest) that balance across regions, private practice, hospital staff, etc. Primary care providers should be well represented. Patients rights, public interest, and budget-watching public interest groups should also be represented.
Mandate rates that adjust for cost-of-service by region; uniform national incentives encourage over-treatment in low cost regions and under-treatment in high cost regions.
Shift away from a model that compensates purely based on quantity of care. We need a system that rewards cost-effective care (i.e. quality care that is worth the price). What might such a system look like?
In the 1990s, HMOs experimented with capitation – rewarding doctors based on number of patients they managed rather than services. Unfortunately, this incented doctors to under-treat and also to avoid taking on unhealthy patients. To address this, we should deploy a hybrid system that rewards primary care doctors partly based on services they provide (with rates determined as noted above), and partly based on a risk-adjusted capitation model. The fee-portion of the system would ensure that doctors do not lose money on patients that require more treatment than anticipated, but would not drive profits. That way, doctors have less incentive to insist patients come in for an office visit when an email would suffice. The risk-adjusted capitation portion of their compensation would pay providers based on the morbidity of the patients they enrolled (with sicker patients generating more income since they take more time to manage). Electronic records would enable us to measure provider performance based on outcomes. Properly balanced, this would help minimize both the incentives to over treat and the incentives to under treat.

2) Focus coverage-enhancing proposals on cost-effective basic care:

Current proposals that dramatically expand coverage without focusing on cost containment (like the Senate Health, Education, Labor, and Pensions Committee version) had hoped to pay for themselves through efficiency enhancement. The notion was simply this: if we can improve preventative care, lower administrative costs, and teach doctors that better care is not always more care, then consumption will decline by itself. This optimistic view hit a roadblock when the CBO estimated that these proposals would not achieve their cost reduction targets due to insufficient incentives to reduce consumption. The CBO analysis may be pessimistic, but is not easily dismissed.

As an alternative to providing the best care to everyone, an efficiency-focused regime could focus on expanding cost-effective basic coverage for everyone, and allow individuals to purchase supplemental coverage at their own expense. This enables those who want more care to buy more care (wealth permitting); those who cannot afford to buy private supplemental insurance would be subject to government rationing.

Extending cost-effective basic care to everyone would lower costs associated with overuse of emergency rooms, administrative billing, public health issues (like failure to vaccinate), etc. While not overly generous, it could offer a basic social safety net, and for reasons that Baseline has covered, it makes a great deal of sense for a Public Option to exist that covers cost-effective basic care.

Private supplemental insurance would need to be well regulated. In particular, rescission should be banned outright (which would front load application costs), or tightly regulated and managed by accelerated legal review (a 6 month legal delay for a chronically ill person will create serious distortions).

Denial of coverage due to pre-existing conditions must be addressed, but not by simply banning it. Insurance companies will attempt to evade the regulation – for example, by deploying marketing campaigns that target healthy individuals and avoid unhealthy ones (should they advertise in Cycling magazine, or Coping with Cancer?). If we want to subsidize care for people with pre-existing conditions we should do so directly, rather than shifting the burden to insurance companies and pretending we aren’t paying it. Indeed, we’ll end up paying more as insurers spend money on rent-seeking activities to cherry pick patients.

3) Infrastructure

The current proposals do a decent job at expanding infrastructure, so I will limit comments to:

The scarcity of general care physicians is a structural issue that will take time to respond to new incentives. Until this balance is restored, the federal government should provide tuition support (via loan forgiveness) for medical students that enter primary care and remain in primary care for at least 10 years (10% loan forgiveness per year).
More needs to be done on malpractice insurance. Many factions argue the root problem is growth in tort awards. And in the long term the correlation is clear, but since the tort reform movement in 2001 insurance company payouts have actually declined in real dollars, even as rates have spiked by 120% so that the payout ratio is now less than 45%. (also, here) The problem now seems to be the insurance companies more than the lawyers.
We should do more in meeting standards for physical hospital infrastructure and best-practice dissemination that reflect our current state-of-knowledge; this is a public health concern. These types of efforts can have a huge payback.
The current proposals hit the mark on building a nationwide electronic system for managing patient records, and the CBO review does not give full credit to this initiative. While the administrative savings would be substantial, the greater value is in knowing what actually works, what is a waste of money, where the problems are, and which providers are performing well. Imagine monitoring the H1N1 flu in real time. Comparing the efficacy of treatments and drugs with statistically robust samples of hundreds of thousands of patients. Measuring whether costly new procedures yield better outcomes. Tracking drug interactions. Monitoring whether hospitals are following best practices at infection control. The decentralization of information that usually helps a free market system work so well is working against us in health care.
In conclusion…

Some of the proposals in Congress that focus primarily on expanding coverage (especially the Senate HELP committee version) are likely to incur massive costs by subsidizing the growth of a system with underlying structural problems. This is precisely the same critique that Baseline has leveled against the currently weak proposals to fix regulation in the financial system. The House bill does much better (which CBO acknowledges), but should do more. The painful truth is that if we are going to seriously keep health care costs from destroying our federal budget, we are going to need to accept rationing. Unless the political will suddenly emerges to move wholesale to a Canadian system of rationing, health care reform may have a better chance of success by fixing the broken incentive system, focusing public subsidies on cost-effective basic care, and augmenting infrastructure.

By StatsGuy




The March of Science and Health Care Reform

Posted: 01 Sep 2009 08:00 PM PDT



On a Planet Money podcast two weeks ago, economist Charlie Wheelan weighed in on the significance of genetic testing – the advancing ability of science to determine your genetic makeup, including your propensity to develop various serious or costly illnesses. This really crystallizes one dimension of the health care debate.

If insurers know what your projected long-term health care costs are, because they can read your genetic code, then they are going to price accordingly – and that’s exactly what insurers should do in an unregulated market. This produces the dystopian world where not only are some people unlucky because their genes make them more likely to suffer in various ways, but on top of that they can’t get health insurance and therefore health care.

The first-order solution is obvious, and it’s a part of every health care reform proposal: prohibit insurers from engaging in medical underwriting. As is also generally understood, this means that insurers will have to overcharge healthy people, which creates an adverse selection slippery slope – especially when healthy people have scientific evidence that they are, in fact, healthy – that ends when insurance is very expensive, and only rich sick people have it – that is, today’s individual market. So it has to be accompanied by a mandate, to force healthy people to buy insurance and thereby subsidize the sick.

Wheelan points out that there’s a second-order problem, which is that if insurers have to charge everyone the same price, they will compete by marketing to the healthy and trying to hide from the sick. The insurance exchange(s) should limit this problem, but may not be able to eliminate it, since people will have choice on the exchange, and are free to choose the plan that successfully markets itself as the plan for healthy people. Eventually you get to a point where insurers cannot compete on price, and they cannot compete on risk selection, and they start to look a lot like regulated utilities. That’s not terrible – they can still compete on cost – but it’s what happens when you harness the private sector to do something that is essentially redistribution.

In any case, the other lesson is that widespread genetic testing will only make the unfairness of unrestrained competition in the health insurance sector even more glaringly obvious, since it will increase the divergence between rates for sick people and healthy people. And no one will be able to blame the difference in rates on anyone’s “lifestyle.” Which is another reason why we need to reform our health care system, and establish the principle that everyone deserves a basic minimum of care regardless of their genes, before things get much worse.

By James Kwak




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Krugman -- Soooo Good!

The impossible job ahead. And Brooks today is along the same line.

http://www.nytimes.com/2009/08/31/opinion/31krugman.html?em=&adxnnl=1&adxnnlx=1251777889-JDqZFQn8c4OkNHrLKl2rAQ

Kristof -- Wendell Potter! Wendell Potter! Wendell Potter!

(c) 2009 F. Bruce Abel

I vote for Wendell Potter as Man of the Year. Simple as that.





Op-Ed Columnist
Health Care Fit for Animals

By NICHOLAS D. KRISTOF
Published: August 26, 2009
Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.
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“Over the years I helped craft this messaging and deliver it,” he noted.
Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.
He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.
Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.
A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.
“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”
Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.
This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.
“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”
Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.
One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.
As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.
Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.
All this is monstrous, and it negates the entire point of insurance, which is to spread risk.
The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.
Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.
As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.
Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.
•
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Sign in to RecommendNext Article in Opinion (1 of 27) » A version of this article appeared in print on August 27, 2009, on page A31 of the New York edition.
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Wendell Potter, Wendell Potter, Wendell Potter!

You must listen to this on health care!

http://video.pbs.org/video/1201678913/program/1113570149

Krugman -- A Must-Read Today

Op-Ed Columnist
Obama’s Trust Problem
comments (18)
By PAUL KRUGMAN
Published: August 20, 2009
According to news reports, the Obama administration — which seemed, over the weekend, to be backing away from the “public option” for health insurance — is shocked and surprised at the furious reaction from progressives.
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Well, I’m shocked and surprised at their shock and surprise.
A backlash in the progressive base — which pushed President Obama over the top in the Democratic primary and played a major role in his general election victory — has been building for months. The fight over the public option involves real policy substance, but it’s also a proxy for broader questions about the president’s priorities and overall approach.
The idea of letting individuals buy insurance from a government-run plan was introduced in 2007 by Jacob Hacker of Yale, was picked up by John Edwards during the Democratic primary, and became part of the original Obama health care plan.
One purpose of the public option is to save money. Experience with Medicare suggests that a government-run plan would have lower costs than private insurers; in addition, it would introduce more competition and keep premiums down.
And let’s be clear: the supposed alternative, nonprofit co-ops, is a sham. That’s not just my opinion; it’s what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers.
Also, and importantly, the public option offered a way to reconcile differing views among Democrats. Until the idea of the public option came along, a significant faction within the party rejected anything short of true single-payer, Medicare-for-all reform, viewing anything less as perpetuating the flaws of our current system. The public option, which would force insurance companies to prove their usefulness or fade away, settled some of those qualms.
That said, it’s possible to have universal coverage without a public option — several European nations do it — and some who want a public option might be willing to forgo it if they had confidence in the overall health care strategy. Unfortunately, the president’s behavior in office has undermined that confidence.
On the issue of health care itself, the inspiring figure progressives thought they had elected comes across, far too often, as a dry technocrat who talks of “bending the curve” but has only recently begun to make the moral case for reform. Mr. Obama’s explanations of his plan have gotten clearer, but he still seems unable to settle on a simple, pithy formula; his speeches and op-eds still read as if they were written by a committee.
Meanwhile, on such fraught questions as torture and indefinite detention, the president has dismayed progressives with his reluctance to challenge or change Bush administration policy.
And then there’s the matter of the banks.
I don’t know if administration officials realize just how much damage they’ve done themselves with their kid-gloves treatment of the financial industry, just how badly the spectacle of government supported institutions paying giant bonuses is playing. But I’ve had many conversations with people who voted for Mr. Obama, yet dismiss the stimulus as a total waste of money. When I press them, it turns out that they’re really angry about the bailouts rather than the stimulus — but that’s a distinction lost on most voters.
So there’s a growing sense among progressives that they have, as my colleague Frank Rich suggests, been punked. And that’s why the mixed signals on the public option created such an uproar.
Now, politics is the art of the possible. Mr. Obama was never going to get everything his supporters wanted.
But there’s a point at which realism shades over into weakness, and progressives increasingly feel that the administration is on the wrong side of that line. It seems as if there is nothing Republicans can do that will draw an administration rebuke: Senator Charles E. Grassley feeds the death panel smear, warning that reform will “pull the plug on grandma,” and two days later the White House declares that it’s still committed to working with him.
It’s hard to avoid the sense that Mr. Obama has wasted months trying to appease people who can’t be appeased, and who take every concession as a sign that he can be rolled.
Indeed, no sooner were there reports that the administration might accept co-ops as an alternative to the public option than G.O.P. leaders announced that co-ops, too, were unacceptable.
So progressives are now in revolt. Mr. Obama took their trust for granted, and in the process lost it. And now he needs to win it back.
comments (18)

Obama Calls Health Plan a 'Moral Obligation' (August 20, 2009)
'Public Option' in Health Plan May Be Dropped (August 18, 2009)
Alternate Plan as Health Option Muddies Debate (August 18, 2009)
Some Democrats Push for Keeping Public Insurance Option (August 18, 2009)
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Obama's Health Care Mistake?

(c) 2009 F. Bruce Abel

A discussion in the New York Times today with this title. Pretty good. It highlights some of my thoughts, such as What is his health care plan? (There isn't any yet. He's letting Congress define the battle before formally stepping in, although behind the scenes you can be sure Rahm Emanual is active toward ... something.)

http://roomfordebate.blogs.nytimes.com/2009/08/19/obamas-health-care-mistake/

I did sign a petition urging the administration to keep supporting the Single Payer System.

150/80 Blood Pressure:Age + 100 Rule

See the answer by Mrs. Doubtfire! Maybe I'm ok:

http://answers.yahoo.com/question/index?qid=20070604075649AASYYFS

Herbert -- Oh No! (Health Care) About as Successful as Stopping Godzilla at Water Polo and About as Clear as This Picture of a Senior Citizen

(c) 2009 F. Bruce Abel

(c) 2009 Rebecca Worple (photos)

Top photo: Congress slowing down the lobbyists.

Bottom photo: About as clear as this picture of a "senior citizen" (me).

Read the following by Herbert of the New York Times carefully, and read the comments to this article as well, after selecting "Readers' Recommendations."

Op-Ed Columnist
This Is Reform?
comments (72)
By BOB HERBERT
Published: August 17, 2009
It’s never a contest when the interests of big business are pitted against the public interest. So if we manage to get health care “reform” this time around it will be the kind of reform that benefits the very people who have given us a failed system, and thus made reform so necessary.
A new blog from The New York Times that tracks the health care debate as it unfolds.
More Health Care Overhaul News
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Read All Comments (72) »
Forget about a crackdown on price-gouging drug companies and predatory insurance firms. That’s not happening. With the public pretty well confused about what is going on, we’re headed — at best — toward changes that will result in a lot more people getting covered, but that will not control exploding health care costs and will leave industry leaders feeling like they’ve hit the jackpot.
The hope of a government-run insurance option is all but gone. So there will be no effective alternative for consumers in the market for health coverage, which means no competitive pressure for private insurers to rein in premiums and other charges. (Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.)
Insurance companies are delighted with the way “reform” is unfolding. Think of it: The government is planning to require most uninsured Americans to buy health coverage. Millions of young and healthy individuals will be herded into the industry’s welcoming arms. This is the population the insurers drool over.
This additional business — a gold mine — will more than offset the cost of important new regulations that, among other things, will prevent insurers from denying coverage to applicants with pre-existing conditions or imposing lifetime limits on benefits. Poor people will either be funneled into Medicaid, which will have its eligibility ceiling raised, or will receive a government subsidy to help with the purchase of private insurance.
If the oldest and sickest are on Medicare, and the poorest are on Medicaid, and the young and the healthy are required to purchase private insurance without the option of a competing government-run plan — well, that’s reform the insurance companies can believe in.
And then there are the drug companies. A couple of months ago the Obama administration made a secret and extremely troubling deal with the drug industry’s lobbying arm, the Pharmaceutical Research and Manufacturers of America. The lobby agreed to contribute $80 billion in savings over 10 years and to sponsor a multimillion-dollar ad campaign in support of health care reform.

The White House, for its part, agreed not to seek additional savings from the drug companies over those 10 years. This resulted in big grins and high fives at the drug lobby. The White House was rolled. The deal meant that the government’s ability to use its enormous purchasing power to negotiate lower drug prices was off the table.
The $80 billion in savings (in the form of discounts) would apply only to a certain category of Medicare recipients — those who fall into a gap in their drug coverage known as the doughnut hole — and only to brand-name drugs. (Drug industry lobbyists probably chuckled, knowing that some patients would switch from generic drugs to the more expensive brand names in order to get the industry-sponsored discounts.)
To get a sense of how sweet a deal this is for the drug industry, compare its offer of $8 billion in savings a year over 10 years with its annual profits of $300 billion a year. Robert Reich, who served as labor secretary in the Clinton administration, wrote that the deal struck by the Obama White House was very similar to the “deal George W. Bush struck in getting the Medicare drug benefit, and it’s proven a bonanza for the drug industry.”
The bonanza to come would be even larger, he said, “given all the Boomers who will be enrolling in Medicare over the next decade.”
While it is undoubtedly important to bring as many people as possible under the umbrella of health coverage, the way it is being done now does not address what President Obama and so many other advocates have said is a crucial component of reform — bringing the ever-spiraling costs of health care under control. Those costs, we’re told, are hamstringing the U.S. economy, making us less competitive globally and driving up the budget deficit.
Giving consumers the choice of an efficient, nonprofit, government-run insurance plan would have moved us toward real cost control, but that option has gone a-glimmering. The public deserves better. The drug companies, the insurance industry and the rest of the corporate high-rollers have their tentacles all over this so-called reform effort, squeezing it for all it’s worth.
Meanwhile, the public — struggling with the worst economic downturn since the 1930s — is looking on with great anxiety and confusion. If the drug companies and the insurance industry are smiling, it can only mean that the public interest is being left behind.
David Brooks is off today.

Saying No to Grandma

Douthat. Remember his name. This one is good on health care.

http://www.nytimes.com/2009/08/17/opinion/17douthat.html

Krugman -- Health Care in Various Countries

Headlines today indicate that Non-Profit Co-ops are the way the administration is going. Not sure where they fit into the scheme that Krugman is describing today. As usual I agree with everything Krugman says.

http://www.nytimes.com/2009/08/17/opinion/17krugman.html?_r=1

Vermont Has Solved Health Care

http://www.nytimes.com/2009/08/15/opinion/15herbert.html