I don’t care how low they drive support for this with misinformation. The minute the president signs this bill, his approval will go up. Within a year, when the good things begin to happen, and the bad things they’re saying will happen don’t happen, approval will explode. [The Economist, via Political Wire]
Legislating — particularly on complicated, high-profile issues — is messy business. It’s never pretty, and it often disgusts the American people while the process is ongoing. Poll after poll, though, shows that Americans want health reform. Once it passes, the rancor from the legislative process will fade into the background and the majority of Americans will be very pleased that they got what they wanted.
The right has created a red herring with exaggerated information and some irrational what-ifs.
I have to say, though, in watching this debate play out, the left is now using the extreme righty demeanor as their own red herring.
Yes, there is misinformation out there. But there are also some very valid and thoughtful questions from the non-extremists that go unanswered, such as:
1. Can this healthcare plan be done in a way the doesn’t cripple our future economy like Medicare is on pace to?
2. Speaking of Medicare, and its going bankrupt in 2017 and being a completely unsustainable program, what is healthcare reform without Medicare reform?
3. What about malpractice reform. It drives 2% of direct costs, plus an estimate 7-15% of indirect cost through defensive medicine. That is real money, too.
4. Lots of us see the CBO estimates showing how much this program will cost us, with a pretty “squishy” financial payback. If this program is necessary to DECREASE the cost of our system, why is it costing us $1 - $1.5 trillion a year just to implement?
Let’s ignore the righties crazy rants, and let’s not let the left focus on those rants. They aren’t the issue.
There are real questions to be answered for more ratioal people, and those answers are still hanging in the balance.
Every question you asked is, in fact, a red herring.
Also your claim that democrats use REPUBLICAN behavior as a “red herring” is actually another fallacy.
I’m sincerely trying to engage in a dialogue about a policy change that will affect you, me, and future generations. The questions I ask are not red herrings. I hope someone to the left of center will be open enough to engage in a productive discussion.
The sentiment that questions like these are red herrings is exactly why the Blue Dogs will (thankfully) need to have final say on any policy changes. They are the ones who are demonstrating willingness to consider points of view from across the American spectrum.
DTM, thanks for trying to keep the discussion issue-based rather than emotion-driven. Here are some thoughts, offered in a sense of discussion, not answers.
1) Right now a lack of universal healthcare is the biggest boat anchor on the American economy. Our current system is a drag on entrepreneurial tendencies. Many people who would be willing, all else being equal, to take the risk of starting a new business DO NOT, because the risk of losing health insurance for their families is too great. Health care costs, as a subset of personnel costs, are a huge driver in of decline of public schools. Money that should go to education goes to health care premiums. A single-payer system would both unshackle entrepreneurship and improve education, both of which would feed into a burgeoning and world-competetive future economy.
2) Universal health care done right would eliminate the need for Medicare. Problem solved!
3) Malpractice is a real concern. It would ameliorate a currently bad situation for medical providers. As you’ve pointed out, at 2% it is a relatively small part of overall medical costs. The 7-15% is an estimate and thus can’t be relied on. Much of the testing that good physicians perform may be defensive; but it may also be based on their professional desire to do the best for their patients, leaving no stone unturned, so to speak. Doctors constantly have to balance conservative treatment with thorough treatment; much of this is mistakenly called “defensive medicine.” The truer answer to the malpractice problem would be tort reform throughout the legal system. This isn’t a problem unique to medicine.
4) Think of a computer system upgrade in a business. The reason the new system is implemented is cost savings. The salesman will say “here is your cost now, and here is your cost in the future,” which naturally offers substantial savings. What the salesman doesn’t say is “before you get to the savings, you have to spend a ton of money on new computers, new telecommunication equipment, training costs, testing costs and running the old and new systems in parallel for a time, plus there is decreased productivity until employees get past the learning curve.” It will be the case, though, that with time, the new system will save tons and gobs of money. Computers are the example used here; but the rule applies to any system conversion. Any change as large as universal health care will cost more in the short term with the larger savings coming in the mid- to long-term. It takes courage to bite the bullet.
Relatedly, the cost of health insurance now can be looked at as a tax (fee v. tax?), both on businesses and individuals. For family coverage, this can be a tax of $6000 or $8000 or $10,000 per employee for the business providing health care coverage. In addition, individuals pay their share of the premium (a much smaller amount, generally) plus all out-of-pocket expenses. One simple thought is to take all the money spent on insurance premiums, co-pays and out-of-pocket expenses and use that as the pool to fund universal health care. It would more than cover the cost. The problems with this come up pretty quickly, though. For a business, the premiums are an expense. If the premiums were paid to the government, it would then be a tax, which would cause howls of protest from conservatives despite the neutral cost to the business. And it is more complicated for individuals… If (or when) the government were to provide universal health care, paid for by some new taxing mechanism, would the premiums saved be additional profit for the business, or since the costs are personnel costs, should the savings be an addition to employees’ wages?
Mr Tom - I appreciate your post and think you make several very good points. Your point of investing in a system in the short-term to get long-term savings makes sense to me. I would say that is a capital expenditure, similar to how a business treats it. You buy a new factory, state of the art. It costs millions today but saves millions more over time.
Big up-front expenses that amortize over time are good things to bond for. Or issue debt. Don’t get me wrong, there are lots of stupid operating-budget things we bond for and should not. But if this plays out the way you project, perhaps it should be financed instead of permanently increasing taxes.
Just a thought. I appreciate your points and your tone.
1) the president has said, again and again, that the plan will be defecit neutral.
2) expanding the public health care pool will in fact decrease the cost for all, indluding medicaid
3) Since you’re so fond of Coleman’s “right” to squander money on frivolous lawsuit, I’m not really going to give much credence to this one, except to say that medical malpractice kills 100,000 people per year, and they need a means to address that. 2% seems a smal price to pay, and doctors SHOULD pay more to be more careful.
4) see number one and number 2. because you obviously haven’t paid a fucking bit of attention to the actual facts. Please stop watching glen beck. it makes you retarded.
5) Meh.
So am I to rely on the White House for “actual facts”, or the CBO and other nonpartisan groups who have been studying healthcare for decades? I know I’m not a savvy political operator, but methinks the White House communications may be just a tad spun. But that’s just me, a hillbilly from Minnesota.
DtM,
1) I have said before I would trade substantial tort reform for a strong public option or universal care. What I have learned though, is that states that have tort reform, malpractice insurance has actually gone up! That would indicate that tort reform, at least alone, wouldn’t stop these outrageous costs of doctors.
2) As someone who has studied economics and history, you must know that one of the tell tales of an economy about to collapse is a huge wealth gap. The huge wealth gap is always caused by dramatic tax cuts for the rich, which lead to huge bubbles, which burst into depressions. This is historical fact.
In 1919 or so, they cut the tax cut dramatically and we had the roaring twenties, followed by a huge bubble, followed by a huge wealth gap, followed by the great depression.
Between 1930’s-1970’s they put the top rate at 70-90%. We had a roaring economy, no huge bubbles, and barring the energy crisis, no huge recessions other then the usual cyclical stuff.
Then in 1980 Regan cut the top rate in half. We had a huge bubble, a growing wealth gap, and now the fruits that could have been predicted the day we started it in 1980.
So, the answer, is move back to a tax rate like we had between 1930 - 1970’s.
Reagon was not ushered in to office just because he was an effective communicator. The 70’s was an ugly decade for America economically. Stagflation, a flat stock market, interest rates making it cost prohibitive to invest in basic things. It caused a recession, a farm crisis, etc. It was ugly.
Let’s not be all romantic about the 1930 - 1980 period. Perhaps that are pieces of that economic policy that we should bring back, but it had warts. Our job is to learn from it and re-use the good stuff.
“1) the president has said, again and again, that the plan will be defecit neutral.”
The CBO says the plan will increase the deficits by $240 billion over a decade.
CBS News says that the only way this can be deficit neutral is by raising taxes on a dollar-for-dollar basis to cover the additional costs.
The Brookings Institute and Urban Policy Center agree that the Obama Health Plan would add $3.4 trillion to the national debt by 2018
Lojasmo - when the White House is saying one thing and these nonpartisan sources are saying something entirely different, don’t we owe it to ourselves to reconcile the differences and find truth prior to passing the bill? This isn’t about political positioning. This is about understanding the impact of a major policy change.
This debate isn’t about nutcases storming townhall meetings. This debate is about educated people who have serious questions that have yet to be answered. My idea: Let’s answer them, then decide, then vote.
“This debate is about educated people who have serious questions that have yet to be answered.”
Educated people who have questions about this have spurious, not serious, questions.
DtM, you need to frame your questions differently.
1. Can this healthcare plan be done in a way the doesn’t cripple our future economy like Medicare is on pace to?
How about instead of using scare tactics, you frame the question honestly. Perhaps, “What is the most economically sustainable model for a Health Care system that will provide for the largest percentage of population?”
2. Speaking of Medicare, and its going bankrupt in 2017 and being a completely unsustainable program, what is healthcare reform without Medicare reform?
Unsubstantiated claims and assumptions. Leave those out entirely.
3. What about malpractice reform. It drives 2% of direct costs, plus an estimate 7-15% of indirect cost through defensive medicine. That is real money, too.
Not buying it. Defensive medicine and it’s costs rank right up there with “welfare queens”.
4. Lots of us see the CBO estimates showing how much this program will cost us, with a pretty “squishy” financial payback. If this program is necessary to DECREASE the cost of our system, why is it costing us $1 - $1.5 trillion a year just to implement?
There will be no financial payback, get that out of the argument right now. There will be in the longterm but in the shortterm it will cost us. The payback comes from a healthier society. The payback comes from poor men women and children not dieing from a lack of proper treatment. The payback will come from a moral position of everyone having a minimum level of Health care available to them.
How can Christian’s not support this?
Dan you might actually have a point if the Rightwing had not crated such a mess. It is impossible to unshit the bed… squashing discussion, turning simple proposals into outrageous lies like the “Death Panels” coming out a of doctor/patient end of life discussions… bringing handguns and the signs inferring that you agree with them or they will shoot you… the list is pretty endless.
Now if before all this stupidity was pushed by every Republican talking-head and some Republican leadership, some Republican leader had said “Let’s discuss this… here are my questions…” and told the others to quiet down, you might have a point. But right now you got nothing except lies, exaggerations and playing politics with American lives.
I suppose a shorter way to say it is Fuck you, you want respect then show some.
stay classy, amuseinc.
On the right, we have nutcases who are attending these townhall meetings and not letting public servants interact with their constituents.
On the left, we have people like amuseinc. Nutcases themselves, who thankfully cancel the Bachmans of the world out.
In the middle, we have alot of smart people who are trying to solve problems. Thanks for the good dialogue, MrTom and Alec, who believe in their positions but offer up fact and reason to articulate them.
Sure will… how about you separate yourself from the Republican Party. You know the party of birthers, deathers and teabaggers… ‘cause that is who you endlessly support on this forum. I’m not the one backing Senator Jefferson Sessions the Third and his rude questions to our newest Supreme Court Justice. I’m not the one questioning the honesty, legality and sanity of President Obama. I’m not the one using weasel words to back fringe whackjobs like Grassley or Pallin.
Real nice for you to call for politeness after seeing what depths of BS your chosen party has gone to recently. When Rush Limbaigh,the accepted philosophic leader of the Republican Party, cleans up his act, this lowly poster will clean up his. Until then I repeat… you want respect then show some. So far it seems you will have a long time to wait for that from Republican leadership or me.
I agree with amuseinc, you lying bootlicker.
Today’s news is that the Public Option may no longer be on the table.
The Blue Dogs have saved the nation!!!! It is a great day.
It scares people to hear “health care” reform, and it really isn’t health care reform, it is health payment reform. The care will still all be private, even under a universal plan.
I wish we would now, and should have started out, calling it health insurance reform.
I don’t think anyone could have stood in the way of health insurance reform, which is really what we are trying to do.
Great point. Yes, this really is about the payer of healthcare, not about the delivery system.
I think moderates will get on board if they can see a path where this doesn’t become yet another layer of government entitlement. A great way to do that would be to have the new Public Option, by law, funded 100% from member premiums and 0$ from the treasury. If they did that, this would be done as soon as they return from recess.
yet another layer of government entitlement.
Amazing use of language. ‘Cuz the poor have it so good. The elderly have it so good. All that entitlement. It’s like free money for the idle poor. Food stamps and welfare and social security. It’s a wonder anyone works with all the free money available for the underclass. I’ll go along with you on the entitlements if you agree that the defense budget must be cut by 75%. That is the largest entitlement program of them all after all. How about making the maximum length of time anyone can hold a patent is 3 years. After that, the idea or process or invention enters the public domain. By doing that, drug prices will drop precipitously. Let’s stop giving entitlements to Chinese manufacturers and start defending our own by imposing tariffs on Chinese made products that we can make here. Let’s open up our University’s with free tuition’s and stop giving entitlements to predatory lenders which stops class mobility and brings back the old indentured servent status for college graduates.
You keep trying to bring back that old conservative meme of the “welfare queen” because in your view, the poor need to stay poor and only the elite has any business ruling this country.
You do a nice job, Richard, of articulating 50% of the equation. The side of the equation concerned with what people get. It is damn hard to argue with everyone getting healthcare benefits. It is very difficult to make a case against us educating every kid in the country.
But there is another 50% of the equation that you and other repeatedly ignore. What will it cost. Not only what will it cost today, but what will it cost in a generation, or in two generations. Will we have the GDP to support that kind of drag on the economy? Will my kids?
Dang, Richard — I tell you, I’d love — LOVE — to be able to make these decisions independent of thinking of cost. I’d love to be nothing but purely benevolent 100% of the time. That would be nice. But unfortunately, it just isn’t realistic.
Sorry DtM, but I did outline how it can be paid for. Cut the Defense budget, loosen up patent laws, impose tariffs, and make higher education free. But that’s just me. HR 676 does the same thing without those kinds of crazy proposals. Employers would see a vast reduction in their costs, workers would see a modest reduction in their costs and the Health Care system would see it’s bills paid on time with a vastly simplified billing structure. You make it sound like we’re inventing something revolutionary and brand new when in fact we are the last modern nation on the planet with this old archaic system. Canada, Great Britain, Norway, Sweden, Finland, Denmark, Germany, Switzerland, Austria, Italy, France, Spain and others too numerous to mention all have some form of Universal, single payer Health Care. We don’t because of the Insurance lobby and Big Pharma. Simple as that. As a business owner, don’t you want to get out from under the obligation of providing Health Care for your employees? As a nation, isn’t that obligation, keeping our businesses from being competitive on the world stage?
As a business owner, don’t you want to get out from under the obligation of providing Health Care for your employees? As a nation, isn’t that obligation, keeping our businesses from being competitive on the world stage?
Yes! And if everything you write will come true, my costs as a business owner should decrease, not increase, over time. But I’m not seeing that. I’m seeing all of my existing healthcare costs maintaining, plus another layer of tax (in the form of decreased deductions) to pay for this government program.
The money is in the system, we all seem to agree on that. If there could be a gaurantee that if I’m paying, say 13% of my business and personal income today to cover health for me and my employees, that figure would never go above 13%, I’d be all for it. But I’m being asked to keep doing what I’m doing, PLUS fund a new health plan from tax dollars.
Is there a reason that nobody on the left will commit to the public plan being funded 100% from member premiums? If it will be as efficient as they say, it will still cost a fraction of what an insurance plan does, everyone will sign up for it, and it will essentially become a single payer plan without a penny of new tax revenue. I’d sign up for that.
I’m seeing all of my existing healthcare costs maintaining, plus another layer of tax (in the form of decreased deductions) to pay for this government program.
This is from the HR 676.org website.
There will be no more expensive co-pays or deductibles.
* Every resident of the US will be covered from birth to death.
* No more pre-existing conditions to be excluded from coverage.
* No more expensive deductibles or co-pays.
* All prescription medications will be covered.
* All dental and eye care will be included.
* Mental health and substance abuse care will be fully covered.(1)
* Long term and nursing home services will be included.
* You will always choose your own doctors and hospitals.
* Costs of coverage will be assessed on a sliding scale basis.
* Tremendously simplified system of medical administration.
* Total portability – your coverage not tied to any job or location.
* Existing Medicare benefits for those over 65 will be vastly improved.
* No corporate bureaucrat will ever come between you and your Doctor to deny your care.
This is from the Healthcare Now website.
A study by nationally recognized economist, Dean Baker, of the Center for Economic Research and Policy concluded that under H.R. 676, a family of three making $40,000 per year would spend approximately $1900 per year for healthcare coverage. Currently, (in 2007) the average annual premium for families covered under an employee health plan is $11,000. (National Coalition on Health Care.)
There’s more.
In 2005, without reform, the average employer that offers coverage was contributing $2,600 to healthcare per employee (for much skimpier benefits), or 217.00 per month. Under HR 676, the average costs to employers for an employee making $30,000 per year will be reduced to $1,425 per year; or about $119.00 per month.
Baker’s study reported that HR 676 would reduce health spending in 2005 from $1 trillion, 918 billion dollars to 1 trillion, 861.3 billion dollars, which translates into a saving of $56 billion in overall healthcare spending while covering all of the uninsured. This is a 3% reduction in over-all healthcare spending.
Here’s how it’s funded.
Maintain current federal and state funding for existing healthcare programs; employer payroll tax of 4.5%, an employee payroll tax of 3.3%, in addition to the already existing 1.45% for Medicare; establish a 5% health tax on the top 5% of income earners; 10% tax on top 1% of wage earners, 1/3rd of 1% stock transaction tax, closing corporate tax loop-holes; repeal the Bush tax cut for the highest income earners.
Richard - thanks for outlining that. I appreciate the informative response — those are interesting details and I appreciate reading them.
But I can’t support it, simply because we’re again using the rich as a crutch to fund a permanent program. If it is going to wring costs out of the system, it should do so for everyone. I see a segment of our population, under that bill, that is really going to have it stuck to them.
Let’s create a Public Option that is funded solely through member premiums. A nationwide risk pool. Elective socialism for a common interest, even. If it operates as efficiently as advocates say, it will immediately be the lowest-cost and best options of all Americans. Employers will dump their Blue Cross and UHC in favor of it. It will become the dominant health plan, a de facto Single Payer. Only it won’t be funded through tax dollars, and moderates like me will WHOLEHEARTEDLY support it.
Or you can push something driven by increased, permanent taxes, and have moderates oppose it so it doesn’t pass. Up to you.
DtM, you reveal yourself for the elitist that you are. Here’s a plan with a progressive fee structure, those that can afford more, pay more, those that can’t afford as much, pay less, but everyone pays something. At the end of the day everyone pays less then with the current system. This doesn’t meet your muster because you are committed to the Reagan idea of elitism. Those at the top of the economic pile must be protected and those at the bottom must remain there. The idea of social mobility is an anathema to the right. Imagine health care not being tied to employment. You think entrepreneurs might flourish in that system? Your reservations with this system are weak and as I’ve asked in the past, please just admit it. You are against this system because you’re afraid it might cost you a few bucks. To hell with those who are sick and dieing because they can’t afford health care.
Dan,
Who would pay the premiums in your public option plan. Employers? If that is the case then who funds the premiums of the unemployed if no tax money can be used? Would they just remain uninsured? Or would you suggest that we abandon our employer based system altogether and only offer insurance plans, public or private, to those who can afford them? Would employers turn over the money they currently contribute to health plans to their employees so they could pay for the plans themselves? If health care is not an entitlement then why don’t we turn people without insurance away from our ER’s and let them wait for care until they can afford it?
Your suggestion is a red herring. A privately financed public option is oxymoronic.
No one commenting here has expressed fundamental opposition to reform. That is good.
MrTom said this:
“One simple thought is to take all the money spent on insurance premiums, co-pays and out-of-pocket expenses and use that as the pool to fund universal health care. It would more than cover the cost. The problems with this come up pretty quickly, though. For a business, the premiums are an expense. If the premiums were paid to the government, it would then be a tax, which would cause howls of protest from conservatives despite the neutral cost to the business. And it is more complicated for individuals… If (or when) the government were to provide universal health care, paid for by some new taxing mechanism, would the premiums saved be additional profit for the business, or since the costs are personnel costs, should the savings be an addition to employees’ wages?”
The rants from the right are not the sticking point. This is the sticking point. We currently provide universal healthcare through a convoluted system of cost shifting in hospitals, tax payments, employer funded plans with deductibles and copayments, and individually funded insurance plans or cash for service. If we dismantle that system, how do we pay for healthcare, even if it costs less?
Hospitals will not want to reduce their charges even if they no longer have to provide unfunded care. Many of those who don’t have healthcare now will expect to get it for free. Employers who no longer need to provide healthcare coverage will want to pocket their savings. Employees who get healthcare coverage as a condition of employment will not want to have to pay for it.
MrTom is right that the simplest solution is to take all of the money we spend now, pool it and fund a universal healthcare system. The question is, how do we take it?
Sorry Ron, if I haven’t been clear but that’s what HR 676 does. Every wage earner in the country would no longer pay an insurance premium, they would pay a tax. Every employer in the country would contribute as well, the amount, as a percentage, would vary based on payroll. The sticking point is not the fact a premium would turn into a tax but that the insurance industry would get thrown out of the equation. That is what is frightening that lobby so horribly. That is why that lobby is spending millions to demonize Universal Health Care legislation. They know once a Public Option becomes available it will be the only choice for businesses and workers that makes any sense.
Richard,
Although you say “The sticking point is not the fact a premium would turn into a tax but that the insurance industry would get thrown out of the equation”, the insurance companies don’t vote on this legislation nor do they sign it into law. We don’t need them to agree with this. We need our President and Congress to come to an agreement and act. That is Jeff’s original point and I completely agree with him on this.
I also support every element of HR 676 as you presented it. I would be pleased if this or similar legislation were passed even if there was 0% support from the republican leadership. Unfortunately, there is not agreement between Congressional Democrats and the President on this. I believe that this is because converting premiums into taxes is a small part of converting current funding into universal funding. The complexity of this process provides ample opportunity for fear mongering and the insurance companies are exploiting this. This is a time for elected officials to do what we asked them to do and what they said they would do before they were elected in spite of the heat.
Insuring healthcare when we guarantee it is silly but unfortunately this bad decision was made long ago and we are now living with the consequences. Eliminating the concept of health insurance altogether is ultimately the answer if we want what HR 676 offers. The payment system that would support such a plan could be public or private. Processing bills and writing checks is work to be done and if private business is allowed to contract with the government to perform that service through a competitive bidding process, that may be a reasonable and cost effective option that preserves some of the infrastructure already in place. This is business that the existing insurance companies could compete for but it would dramatically reduce their ability to control the system to their advantage and they will never willingly accept this.
These discussions relate to the funding and payment of health care. There also needs to be reform on the delivery end but much of that relates to integrating technology into the delivery process so that outcomes are transparent and decisions can be made by consumers of health care based on cost effectiveness. Currently, outcomes of treatment are poorly tracked and demand is most often driven by marketing directly to the public. This marketing is rarely based on head to head outcomes or cost comparisons between new and existing products. The insurance companies hold much of the data necessary to achieve this level of transparency but they have not wanted to be partners in this process unless it enhances their ability to deny payment. Why would insurance companies be motivated to decrease the total amount of money spent on medicine. The more we spend, the more they make. Their spiraling profits correlate to our spiraling costs. This is not coincidental.
Finally, frivolous malpractice claims, although seldom successful in court, are often settled out of court at real direct cost to the system and a significant amount of indirect cost related to the practice of defensive medicine. This is hardly the most significant driver of high costs and it may serve some useful purpose in keeping people on their toes, but it is nonetheless a drain on the system and there is room for discussion regarding reform in this area.
Ron, the low hanging fruit on this tree is the payment structure. We can attack outcome based payment, and medical malpractice reform down the road but nothing can be done toward substantive health care reform while the insurance industry is in the room. Typically, I am a firm adherent to the idea that evolution works much better then revolution, but in this case, I am opting for the latter.
Richard,
I agree wholeheartedly with what you are saying. Evolution is at work here and the dinosaur that we know as our employer based insurance funded healthcare system has failed to adapt, has overgrazed its own environment and is about to become extinct. We need our elected representatives to acknowledge this and move on.