Debating healthcare: Two perspectives

September 9, 2009

As part of Reuters’ coverage of the U.S. healthcare reform, asked Peter J. Pitts, president of the Center for Medicine in the Public Interest and Stephen M. Davidson, a Boston University School of Management professor to discuss the issue. Here are their responses.


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Is this the best Reuters can do? The title implies there are only two options, either no reform or pass the Democrats plan?

As if conservatives and libertarians aren’t proposing a myriad of other reform measures that are being ignored by the press and Democrats? Like tort reform, ending tax benefits for employer benefits, allowing portability, ending govt. mandates….

Posted by Tom | Report as abusive

Eventually, the die-hard anti-tax, anti-change mindset will give way to more practical thinking as people realize that it is impossible to bring about change for the better unless we pay for it. All the public services that we take for granted are paid for in large part by tax revenues; it’s how the country can afford to operate. To level such vehement opposition against the potential for positive change, all because of the empty rhetoric and fear-mongering propaganda of the extreme right, is self-destruction on a vast social scale.

Posted by Adrian R. | Report as abusive

We do need health care reform. Health insurers have to deal with the costs of unrestrained law suits over malpractice claims which may give rise to punitive damages. These costs are partially offset by tighter medical underwriting of health insurance denying coverage for preexisting conditions, extensions of cobra, copays, coinsurance, approved panel Physicians, etc. If you want the health care industry to contribute by giving up their cost controls, how about helping by enacting tort reform limiting the payout to ordinary damages? Let’s be reasonable and look at both sides of the issue. Where is the integrity in this debate? Anywhere?

The second issue is that of the normal retirement age of 65. People are living longer- much longer. The number of workers supporting each retiree has become insufficient. Actuaries have been saying for years that the retirement age must be raised to restore solvency to the system. Why is this not a part of this discussion as it’s critical to when medicare coverage begins and employer paid health care ends. Where is the fairness to the insurance industry shareholders?

Posted by John Dicks | Report as abusive

President Obama’s message this evening was profoundly outstanding!

He laid out for the American public what insurance reform should contain. He was clear. His points seemed practical.

He effectively and passionately addressed the skepticism.

And, his references of Ted Kennedy’s letter and efforts brought tears to my eyes.

Yes, America “still believes” in insurance reform now.

Posted by m stephens | Report as abusive

1. My adult son has a pre-existing condition and is uninsured. I am concerned he will have a serious problem that will exhaust my retirement savings.

2. My son-in-law was laid off in January. He continued COBRA health insurance thanks to the 65% Obama subsidy. In July he had knee surgery and now has a pre-existing condition, too. With the 65% subsidy expiring in September, his premiums will be more than he’s able to earn from some part time jobs he’s been able to find.

3. I manage a small business with health insurance. Our plan covers two employees and their spouses. $32,300 a year, and major increases every year.

My son is already uninsured. My son in law may end up uninsured soon. Our small business plan is prohibitive and getting even more costly.

The Republican “idea” is NO and WAIT. We will be will out in the cold, uninsured. We need health insurance reform now.

Posted by George | Report as abusive

” To level such vehement opposition against the potential for positive change, all because of the empty rhetoric and fear-mongering propaganda of the extreme right, is self-destruction on a vast social scale.”

hey, how did you get a hold of the Republican playbook?

Posted by john | Report as abusive

I have heard this debate go on now for 40 years.
It is time to put this subject to rest so this nation can move forward. We have a grate many other pressing obstacles that are screaming for our immediate attention.
It is time the greedy people in this America of ours are pushed aside they are holding every one of us hostage.
Health care is not for debate, we are all Americans.
The people that are employed by the tax payers have no more right to health care than the poorest citizen in America.

Posted by paris bottoni | Report as abusive

Adrian, please refrain from the libelous comments. Did you know that George Washington, Thomas Jefferson, Benjamin Franklin, and other great minds were all as you call it were extreme right. They lacked so much trust in the government they failed at the Articles of Confederation, because they made the central government too weak. Now the pendulum has moved in the opposite direction over time. Now we have to beg the Federal government to let us keep power over our own health care. Look, us right wing extremist would have no problem if Obama wanted to amend the Constitution using the processes set up by the founding fathers. Why should we allow Obama to mandate peoples freedoms away using laws that help a supposed 40 some million, while taking the freedom of everyone else slowly away. If an unrepresented tax on tea was enough to cause a revolution, what would a slightly represented tax on everyone’s health care look like? Lets hope we Americans can look past our differences and debate this openly and honestly, but I doubt that will ever happen with all the name calling.

Posted by Patrick | Report as abusive

I’ve concluded after hearing this week about boycotts in schools over a Presidential message, ridiculous ideological rants rather than working together, and now heckling a US president….we are doomed as a country. Civil war will prevail or we will go down in the books of history as a failed super-power alongside Egypt, Greece, Rome, France, England.

We are so polarized we cannot survive….

Posted by Tired | Report as abusive

I have the solution to the healthcare crisis: simply abolish health insurance. Without a third party footing the bill doctors and hospitals will have to lower their fees or they won’t get paid at all for their services. Laugh all you want at this proposal, but let me ask you, how did people pay for healthcare before insurance companies took over? I’ve never read in any history books about people losing their homes or being so heavily in debt to a doctor or a hospital that they were unable to pay. The insurance companies are the problem. They need to be abolished and their CEOs taken out and caned.

Posted by Mufaso | Report as abusive

I find myself in the interesting position of being able to see value in everyone’s comments! At least there is dialogue happening about this issue. As someone who has lived abroad, I can tell you that government subsidized health care is not always good and it is not always bad. What it DOES have going for it is that it allows people not to go broke over medical conditions. They just don’t think about it, rather like we don’t think about having roads to drive on or schools to attend; it’s part of their daily life and that is that. Oh, and BTW, they also consider themselves free people, not people hamstrung by their governments and without a vote about how to run their lives. All I’m saying is that there are many ways to deal with this problem and we don’t necessarily need to reinvent the wheel. There are other working models out there to consider.

Posted by working stiff | Report as abusive

A stirring speech exhorting Americans to ‘make insurance work better for you’. ‘ If Americans can’t find coverage, we will provide you with a choice’ would certainly have hit a resonant chord. President Obama has placed his mission and survival of his whole Presidency on this important catch phrase, health insurance lifeline! No American can doubt his sincerity.

Posted by Pancha Chandra | Report as abusive

I’m sorry but i find all this ridiculous. I’m a Sri Lankan and here we have a universal health-care system. We never needed an insurance company to decide whether we could afford decent medical attention because believe it or not, health-care here is free. Of course, there are private hospitals but you can reach the best doctors, surgeons at government hospitals. I don’t understand why the US government, being the major superpower of the world cannot afford to provide free health-care for all its citizens while a developing country like Sri Lanka can.

Posted by Sanka | Report as abusive

I´m an American living in Europe. One of my motives for moving here has been health insurance. Although I have a high paying career, it´s not worth my time to worry about whether I will someday lose coverage, much less fighting with insurance companies over fine print.

What is the big deal about a socialized healthcare option? I really don´t understand this. People are so afraid of the word “socialism” without even knowing what it means, or what “democracy” means for that matter.

As a parallel, schools are socialized. They´re public, and they´re paid by tax payers because we believe that every child should get an education. Who would really want to see an education system where all schooling is private? All this would do is increase the gap between the haves and have nots. Healthcare is the same. If we believe that all should be educated, why is it such a big deal to ensure health coverage for all? Personally, I would rather have my health than an education. But that´s not the point.

Americans will realize 20 years down the road that this issue is just like women´s suffrage and civil rights. In other words, an action that no one is going to question when they look back.

I hear the same criticism “well a government health plan is not the answer”. Well then what´s the answer? We´ve tried the all private system and the only people that benefit from it are insurance companies and doctors. Everyone else gets raped.

Posted by alejandro | Report as abusive

Health care simply costs too much to be guaranteed as a so-called “right”. On the other hand, the current insurance system is obviously not working well. Vaccinations and preventative medicine should be free from the public health dept based on the fact that they protect society as a whole. Companies that produce vaccines should be run as utilities with guaranteed but fixed profit margins (as with power companies).

Concerning the “savings” from reforming the current system, the waste comes primarily from two areas. First most US citizens do not take care of themselves as recommended by good preventative medicine. This is mostly a lack of commitment, not a lack of education. I have seen little from the politician plans that looks likely to change this behavior. How are we going to motivate people to exercise, eat right and wash their hands?

Second, fraud in Medicare and Medicaid has been battled for decades. The legendary paperwork required to help prevent fraud is already choking general practitioners (GP) offices as well as hospital wards. So, I am not hopeful of finding significant savings there either.

In order for health care costs to come down, individuals need to start spending their own money for treatment. Then they will start to make cost/benefit decisions that will favor inexpensive but effective treatment. Maybe this means higher deductibles and/or health savings plans.

Finally, I agree with the Presidents recommendation to change the rules of the insurance industry. First, everyone has to sign-up for basic emergency room insurance. Second, insurance companies can not deny coverage for preexisting conditions nor can they drop coverage after an illness is discovered.

Posted by Will | Report as abusive

I’ve just moved from Vancouver to Boston a few months ago. Right in the middle of “town hall meetings” on healthcare reform.
As a Canadian I don’t understanding the rational of either camp in U.S politics, for or against national health coverage.
As a Canadian I’m immensely proud of our moral standing on health care. A universal system with patient interests the primary concern.
Social, economic or immigration status play NO role in our health system. As it should not, most people don’t choose where they are born or the type of illness that befalls them. It is our moral obligation to help the sick whether they pay for it or not.
This is a moral issue, and it’s no surprise to me or my wife (Paris born) many Americans oppose it. Morals does not seem to be high on the American agenda these days.
How this is even up for discussion is beyond me.

Posted by Dutch | Report as abusive

Obama has a supermajority.

So why does he need the republicans to do anything? Obama has the numbers to go forward with whatever he pleases. He doesn’t need to ask permission.

The only issue here is that Obama is afraid. He knows that America elected a president who promised reform. But he doesn’t want to take the risk that his reforms will blow up in his face. If he messes up healthcare, he might be a historic one term president.

So he insists on sitting back and waiting for republican support for a bipartisan deal. In other words, if his crazy schemes for healthcare end up going south, he doesn’t want the democrats to get the blame for the mess.

All the republicans need to do is call Obama’s bluff. Call him a coward and tell him to put his neck on the chopping block. If one claims to be a reformer, then they should be ready to risk their presidential career on making that reform.

The longer Obama refuses to act, the more he looks less like “change” and more like a politician. And the quicker America wakes up from the dreams they were sold a year ago.

Posted by Anon | Report as abusive

Both arguments are full of crap. Nothing meaningful will ever happen in terms of health care until we stop nickel and dimming our idea of health.

Robust health is every human being’s right. Economics is just a contrived system to facilitate exchange. That’s it. Nothing more.

Health is REAL. And death is REAL. We as human beings have a God given right to live in peace, enjoy good health, and enrich our minds and souls.

We live in a world where we are all dependent upon each other for survival but don’t give a good g*d damn about each other because we are too worried about our own garbage. When it comes to the health issue the only “problem” is who is going to pay for it? As if our money were worth anything anyway.

By nature we are social creatures. We need to start thinking like it. How insane is it that we accept the idea of having our taxes stolen to pay for the mess left behind by profiteers, but balk at the idea of paying to ensure that everyone has access to the best possible health care?

I’m not talking health coverage either. I mean honest to goodness real life medical care when you need it.

It’s not impossible to do. We just need to change what we value. Right now we’re being told that greed and selfishness is the way to go. But a quick look around shows you what these things have purchased you and your children. The health care debate is nothing but another lie.

Money is NOT the problem at all. Our own sense of greed and selfishness is. And if you don’t believe me then just trace back any reason given in opposition to the idea of making health care available to everyone. Eventually you will come to a reason that seeks to limit the loss of one thing or another. Seeking to limit loss is the egoistic idea of attachment.

There is nothing in this place that we take with us when we die. And yet we keep wanting to hold on to “stuff”. So we have a financial crisis.

We want to “make money” so we set up systems where people who need medical care have to pay for it. And we get greedy about it and end up with a health care crisis.

And since no one can survive without an education we went ahead and made sure that ever increasing sums of money were involved in making sure people are “qualified” to enter our institutions of “higher learning”. So if you want to live like a human being, it’s not enough to be born one. Now you have be born under the right circumstances. Otherwise you’re relegated to being poor, ignorant, sick, and homeless at worst. Or a narrow minded worker bee at best. We are not animals. And we should not be content to live as such.

Posted by Benny Acosta | Report as abusive

Benny, a few things:

1. Healthcare might be a right, but not universal healthcare. If you see it set out somewhere, let us know. Otherwise, it is simply your say so.

2. Economics began long before healthcare ever existed. Healthcare was essentially a means of taking advantage of prosperity, to give benefits to those who didn’t earn those benefits. So which system is more ‘contrived’?

3. People have the right to have life, liberty and the pursuit of happiness. Not to have someone else pay their bills.

4. Had you any understanding of economics, you would realise that it not only reflects society, but also human behaviour and (to an abstract extent) biology itself.

5. We have a financial crisis because downturns are a natural aspect of the business cycle. Name a financial crisis in history, and you will see greed behind it. That is nothing new. After all, economic cycles runs on greed. Economists figured it out back in the 1700s.

6. Africa and many other areas would laugh if you said healthcare was a right. It is a privilege of the rich, and has been so since the dark ages. The reason you take that privilege for granted, is because you obviously spent your life in a rich nation. When one is spoilt, they tend to mistake their privileges as rights.

Posted by Anon | Report as abusive


“1. Healthcare might be a right, but not universal healthcare. If you see it set out somewhere, let us know. Otherwise, it is simply your say so. ”

What makes some people worthy of health care and others not? Why do some people not have a right to health care? Are they less human?

“2. Economics began long before healthcare ever existed. Healthcare was essentially a means of taking advantage of prosperity, to give benefits to those who didn’t earn those benefits. So which system is more ‘contrived’?”

A patently false statement. Humanity, and as a consequence the art/science of maintaining and improving health (health care),is as old as we are.

Money, if I’m not mistaken has its roots in Sumeria, or about that time frame. And its purpose was solely to facilitate the exchange of goods and services in an equitable manner. It has since been transformed into a tool of enslavement.

“3. People have the right to have life, liberty and the pursuit of happiness. Not to have someone else pay their bills. ”

This statement speaks to the heart of the issue. We absolutely need each other for survival. By nature we form groups and eventually nations. But inside our hearts we care only for ourselves. And so the suffering or lack of care experienced by another means nothing to us. We are more concerned about who’s going to “pay the bill”. Our money is worthless. Humans are priceless and irreplaceable. Yet we value the paper more.

“4. Had you any understanding of economics, you would realise that it not only reflects society, but also human behaviour and (to an abstract extent) biology itself.”

A quick look at the headlines on this site should be enough to demonstrate that this behavior, “biological” as it may be, is occurring unchecked by wisdom or love. Sadly this is our current natural state. But that doesn’t mean that we’re off the hook. We must still make the choice to change. Or it will be made for us.

“5. We have a financial crisis because downturns are a natural aspect of the business cycle. Name a financial crisis in history, and you will see greed behind it. That is nothing new. After all, economic cycles runs on greed. Economists figured it out back in the 1700s.”

And this doesn’t disturb you? Are you suggesting that because the system works on greed that we should simply continue being greedy?
We can already see where this is taking us. And it’s not good. So why the complacency?

“6. Africa and many other areas would laugh if you said healthcare was a right. It is a privilege of the rich, and has been so since the dark ages. The reason you take that privilege for granted, is because you obviously spent your life in a rich nation. When one is spoilt, they tend to mistake their privileges as rights.”

Just because the right to something is taken from everyone and relegated to the few doesn’t mean the rights of the many were false. It is simply persecution and subjugation. So are you saying that because I grew up in a nation who’s ideals were founded on individual freedoms and the right to assemble and cooperate, that I am somehow spoiled?

The fact that I know that I am a human being, the highest life form on this planet, has some how corrupted me? Should I live in ignorance of my humanity? Should I be content to suffer at the hands of those who say they know “the way to salvation”?

Your argument in essence, is that I should simply take my lumps and stop trying to change things. Are you serious?

The time for that mind set has long passed. The acceptance of insanity is insanity itself.

Posted by Benny Acosta | Report as abusive

Thank you everyone for the thoughtful comments. It appears that you are considering all of the logical fallacies that are so common in this debate. I see no reference to “Death Panels” in here which is a huge relief. This idea is so distorted and detached from reality that is only serving as a straw man to distract us from thoughtful debate between many different persepectives.

I enjoyed Benny Acosta and Anon’s exchange and I saw value in each perspective. I am happy to see that neither person started off with telling us which political party they are in. This would likely lead to pre-conceived ideas about the person which would muddy the debate. I wish everyone could converse in this manner.

Posted by Abby | Report as abusive

I suspect that a large plurality of voters has come to understand that all past congresses and administrations have failed consistently and seriously in launching and managing major federal programs — Social Security, the War on Poverty, Medicare, Medicaid — and so the majority of voters do not trust that a sweeping new government program will actually improve things.

We need Health Care reform without question, but the struggles we are all seeing in the Senate and the House — to fashion a Health Care bill that actually improves upon what we already have, while cutting costs — simply demonstrates how complex the issue of Health Care is, and how starkly divergent the agendas are among far left and far right constituencies.

Congress should back off from the current attempts to create an all new “global” health care program at the expense of the existing coverage that some 80-85 percent of Americans enjoy today. They should instead concentrate on eliminating existing problems in Medicare and Medicaid, while extending some reasonable level of Health care to the 10-15 percent of American citizens who currently have inadequate health care insurance.

Once real progress can be demonstrated on these limited initiatives, Congress should then proceed to incrementally add further legislation that could meet with bi-partisan support.

President Obama should back off on his sweeping approach to Health Care, no matter how well-intentioned, and use the power of his office to lead Congress to a series of interim measures, as described above.

Posted by Mike | Report as abusive

Why can’t we vote for National Health Insurance? Single Payer, Medicare for All. Why is there a few Americans making the decisions for all of us? Those people were given bribe money by the Insurance companies. Something as important as healthcare should be given a vote, and the options should include National Healthcare.

Posted by Christine biedul | Report as abusive

Maybe if we were a lot healthier we wouldn’t have these issues

Posted by Drake | Report as abusive

Adrian R is correct. Public services are generally paid for by taxpayers. Health care is presently entirely supported by taxpayers–premiums, out of pocket, deductibles, wages lost to employer-paid premiums, VA, care of active military, Medicare, Medicaid, government employees, ER costs for the uninsured and the indigent. And we spend almost twice what other developed countries spend per capita. And about 30% of your healthcare premium, when paid to private insurers, goes to shareholder profit and administrative costs. If that money were available to provide health care instead we wouldn’t have to increase health care spending over what we spend now! Single payer is what we need, providing what the Institute of Medicine says we need–universal, available, portable, affordable insurance. Whether or not you think health care is a right (and I do), it is shortsighted to deny it to a portion of the public. We need a healthy productive workforce, and we need infection control for all (it’s not possible for just some).
It is distressing that it has been dismissed for so many months as “not feasible”. Only “not feasible” to insurance and drug companies. Very feasible to the American public.
Let’s keep it on the table

Li-hsia Wang, MD

Posted by Li-hsia Wang, MD | Report as abusive

It doesn’t take a genius to see the funding for government health care is a sham. When has any project by any facet of government been equal or less in cost than proposed?

What about the government taking money from Social Security (grabbing initiated by Lyndon Johnson) to fund other things non-related projects? Anyone who has ever dealt with VA hospitals or worker’s compensation programs have been screwed by the system.

One example of how terrible the system is: My sister-in-law fell at work and hurt her back. She has been in excruciating pain for the past six months. Doctors said she needed an operation to correct the problem. Worker’s Compensation repeatedly denying her operation until recently. They finally approved the operation, again after six months! She could have been back to work at least 4 months prior! Talk about a waste of money!

The government has spent $640 for a toilet seat and $436 for a hammer and the National Park Service’s $797,400 outhouse. This is the sort of mindless spending the government has.

Yes, we need health care changes, but not run by government. Politicians are not business savvy, but they are great spenders!

Posted by Alpha1 | Report as abusive

It grossly unfair to take hunderds of billions of dollars from Medicare in order to fund the currently uninsured.
One does not need new laws to fight the waste and fraud in Medicare/Medicaid systems – they are administered by the government anyway.
If anything, the savings from reducing the waste ought to be channeled back into Medicare to cope with the expected inflow of baby boomers into the system.
It is grossly illogical to allocate less funds for Medicare to cope with many more eldery people. Something is terribly wrong with Obama’s math, or is there some hidden agenda?

Posted by Benjamin | Report as abusive

I agree with Peter Pitts. We appear to be trying to use a sledge hammer where a light tap hammer would do well.
Bigger is not usually better and, in this case, would ultimately lead to increased costs for health insurance and corresponding tax increases to help defray those costs.

Posted by Lois Craig | Report as abusive

Children of poor working families and others should be covered. As of today healthcare is impossible without insurance because of the unbundling of services and items and the cost of ER is inflated it would be Like paying 100.00 for a toothpick. But insurance companies do not guarantee they will cover anything even when you pay insurance. The government would do a better job I think of paying the bills. Tax can be added or taken from cigarettes or alcohol,

Posted by ForJS07M378 | Report as abusive