James Pethokoukis

Politics and policy from inside Washington

Same old, same old from Obama on healthcare

Sep 2, 2009 18:38 UTC

What is POTUS going to say that is any different, really. The risk of the Tune Out factor is growing. This, from a pro-ObamaCare blogger:

The problem is – Obama has already been specific about nearly all of this — frequently! The 8 insurance regulations he favors are not only in both bills, they’ve been the centerpiece of the “Health Insurance Reform” attempt at rebranding in August. Obama has already specified his preferred way of paying for reform — a cap on charitable deductions for those making over $250,000. And he spent an entire presidential campaign saying that he didn’t want to raise taxes on those making less than $250,000. None of these items are particularly suspenseful, and it would indeed be a surprise if he deviated from what’s been his normal script.

Granted, he hasn’t before specified the level of subsidies he wants to give to the uninsured. But if it’s 400% of the federal poverty line ($88,000 for a family of 4), it’s no surprise as both the House and the Senate Health, Education, Labor and Pensions Committee provide subsidies to that level. If it’s less than that – say the 300% that the Senate Finance Committee is rumored to be toying with – then it would be a surprise. It would also be a bad policy concession.

5 scenarios for healthcare reform

Sep 2, 2009 13:28 UTC

Former Bush White House economist Keith Hennessey lays some odds on how healthcare reform will proceed from here:

I see five possible paths for the President and Democratic Congressional leaders.  I will list them in the order in which I think they will be considered, and I will assign my subjective probabilities to each.

  1. Cut a bipartisan deal on a comprehensive bill with 3 Senate Republicans, leading to a law this year;  (10% chance)
  2. Pass a partisan bill through the regular Senate process with 59 Senate Democrats + one Republican, leading to a law this year;  (10% chance)
  3. Pass a partisan bill through the reconciliation process with 50 of 59 Senate Democrats, leading to a law this year;  (25% chance)
  4. Fall back to a much more limited bill that becomes law this year;  (50% chance)
  5. No bill becomes law this year. (5% chance)

And here is his bottom line:

You can’t make the insurance “reforms” work by themselves.  In addition, insurance reforms without the individual mandate would cause insurers to awaken from their confused slumber and enter the debate with vigor (in opposition). … For this reason, I think it’s easier to “build up” to a smaller bill.  There will clearly be a bipartisan consensus to increase Medicare spending on doctors (the so-called “doc fix”).  I will guess that this path leads to $100B — $200B of spending over 10 years:  more Medicare money for doctors, combined with expansions of Medicaid for the poor.  To offset the deficit effect, they would cut Medicare Advantage and nick at other Medicare providers, and maybe do some of the Kerry tax increase proposal.  This would be an “incremental” package that advocates would argue is a small step in the right direction.  I would oppose such a package, but it might be able to get 60 votes, and could almost certainly get the 50 votes needed through reconciliation, and without any significant procedural hurdles.  … This is what Democrats do when all else has failed, to make sure the President has something to sign.  It’s a failure path that they would unconvincingly argue is a first step toward a larger reform.

COMMENT

~ WHEN THE LAUGH OF $ATAN WA$ HEARD IN THE PEOPLE$ HALLS OF U$ CONGRE$$ ~

THIS OLD WORLD ORDER OF ABUSE AND NEGLECT OF OUR POORER AMERICANS NEEDS ENLIGHTENED POLITICAL MINDS AND HEARTS TO VIEW GOD DIFFERENTLY THEN $$$…. NO MATTER WHAT THEIR POLITICAL PARTY AFFILIATION ???

WHEN WILL OUR WEALTHY ELITE AMERICANS ABATE THEIR ASSAULT ON POORER AMERICANS WITH THEIR MONETARY CONTROL OF OUR IVORY TOWER U.S. CONGRESSIONAL LEADERS OF THE NEW WORLD ORDER ???

THERE ARE NOT MANY MORE DISTRACTIONS LEFT WHICH ARE AVAILABLE FOR OUR WEALTHY ELITE AMERICANS TO HIDE BEHIND IN NOT TAKING PROPER CARE OF ALL OUR AMERICANS IN A HUMANE FASHION !!!

RALPH NADER ATTEMPTED TO EDUCATE AMERICAN VOTERS ABOUT U.S. CORPORATE POWER IN AMERICA AND HOW THEY CONTROL OUR CONGRESSIONAL PEOPLE THROUGH THEIR POCKET BOOK (POLITICAL DONATIONS). * WITHOUT THE DOUGH $$$ THESE U.S. CONGRESSIONAL LEADERS OF THE FREE WORLD DO NOT GET RE~ELECTED TO CONGRESS.*TO STAY IN POLITICAL OFFICE IN AMERICA,ONE HAS TO BARTER YOUR VOTES IN CONGRESS AND REPRESENT POWER INTERESTS IN RETURN FOR THE BUCK$.

POORER AMERICANS HAVE NEVER HAD THE $$$ LOBBY TO INFLUENCE THIS CORRUPT POLITICAL CONCEPT (of horse trading political votes for political contributions) TO ACHIEVE PROPER HEALTH ~CARE OR LEGAL REPRESENTATION FOR ALL OUR MIDDLE ~ CLASS AND WORKING POOR AMERICANS.

AMERICAN IVORY TOWER U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE PASSED FEDERAL LEGISLATION IN WASHINGTON DC TO SPEND 50 BILLION AMERICAN TAX $$$ ON THE INTERNATIONAL FIGHT AGAINST AIDS OVER THE NEXT FIVE YEARS WHILE THEIR OWN AMERICAN CITIZENS ARE BEING TOLD BY THIS SAME U.S.CONGRESS THAT NATIONAL HEALTH CARE AND PROPER LEGAL REPRESENTATION FOR MIDDLE CLASS AND WORKING POOR CITIZENS IS UNAFFORDABLE.

*** WEALTHY ELITE AMERICANS (WHO ARE ONLY 1% OF OUR USA POPULATION) SADLY ALSO CONTROL HOW OUR U.S.CONGRESS SPENDS THEIR BUDGET TRILLION$ AND HAVE OBVIOUSLY FOUND MORE WORTHY INTERNATIONAL CITIZENS THEN OUR OWN DESPERATE AND NEEDY POOR TO ASSIST !!!

~Poorer Americans Nationwide only get 400 million $$$ per year for legal representation allocated them by CONGRESS~

Middle Class and Working Poor Americans are unable to afford proper legal representation in their Civil, Criminal and Family Courts of law all across America causing tremendous hardships nationwide,but these great minds and callous hearts in our American Congress have found others Worldwide more needy then their own citizens who are being falsely incarcerated,wrongfuly executed,losing their homes or apartments,losing child custody or visitation with their children etc�

Not being afforded proper legal representation by our U.S. Congress has created a total breakdown of the American judicial system for our poorer Americans because the our U.S. Courts punish all of us little people if we are not assisted with proprer legal counsel.*It is a known fact that our average Middle Class and Working Poor Americans without proper legal representation in all of our American Courts of law lose their legal cases to the better financed who are able to afford lawyers.

Lawyers For Poor Americans is now actively in the hunt for International Countries and Leaders Worldwide to help raise 5 Billion Dollar$ for our slighted poorer Americans who have had their own American Congress turn their backs on their desperate needs in not affording them proper legal representation.

Troy Davis and Mumia Abu ~ Jamal are 2 perfect examples of American citizens who never had proper legal representation or defense investigations afforded them by our U.S. Congressional Leaders Of The Free World in their initial criminal trials in (Georgia and Pennsylvania) who might very well have to pay the ultimate price of possibly being completely innocent and falsely executed in the near future.

These two poorer Americans are among tens of thousands of legal cases nationwide that never were afforded proper legal representation or proper defense investigations at their initial trials……**We the public really have no idea if these men are innocent or guilty until they both are given fair legal representation at their new future trials.

Improper murder trials take place in Third World Countries all the time. *** Why should average Middle~Class and Working Poor Americans in the Wealthiest Country Of The World be treated as if they are living a Third World Life Style ??

This is the first of many www International pleas by Lawyers For Poor Americans for other leaders and countries to help raise the needed monie$ to correct these blatant injustices that have been inflicted on poorer Americans for the last few decades.

Lawyers For Poor Americans has many other written articles that can be viewed with any www search engine by our name or our telephone number.

Lawyers For Poor Americans is a www lobby group of volunteers that sing out about the decades old neglect,abuse and injustices being inflicted on our poorer Americans that have become Crimes Against Humanity issues for the International World Court to investigate.

lawyersforpooreramericans@yahoo.com
(424-247-2013)

Posted by LAWYERS FOR POOR AMERICANS | Report as abusive

Where healthcare reform is heading

Aug 28, 2009 11:51 UTC

Karen Tumulty of Time opines:

The bill most likely would attempt to cover children who have not received coverage under other federal programs, and possibly their parents. It might also expand the Medicaid program to low-income people who do not currently qualify.  … If the Senate decides to pass the bill under parliamentary rules that prevent a filibuster, it may also have to get rid of other provisions that do not directly affect federal spending, such as those that attempt to encourage wellness programs and more preventive care.

Another problem with trying to write a scaled-back bill is that so many elements of health reform are interconnected, politically and substantively. … Making an individual mandate work requires subsidizing people who could not buy insurance on their own, and that is expensive. Cut the subsidies and the mandate back too far, and insurance companies — deprived of the millions of new paying customers promised under broader proposals — could end their support of the deal, which would include new requirements that they sell affordable policies to people with pre-existing conditions.

Me: This is what I have been saying. A rump bill passed in the senate under reconciliation would expand children’s health insurance (SCHIP) and expand Medicaid and perhaps pay for it all with a surtax on upper incomes, though some Dems think they can push through a public option, too. Anything else — regulations, health exchanges — would have to pass in a separate bill. But  a hard-line move by Dems would through Congress into an uproar and I doubt anything else would pass.

COMMENT

From the Tumulty article: “may have to get rid of other provisions…….that attempt to encourage wellness programs and more preventative care”

Good. The American people know these types of “programs” are always where major pork is buried.

Posted by Elizabeth | Report as abusive

No trillion-dollar healthcare tribute for Kennedy

Aug 26, 2009 17:32 UTC

The pleas for politicos and pundits to refrain from politicizing the passing of Sen. Edward Kennedy are actually quite charming in their naivete. The so-called Last Lion of the U.S. Senate was not even dead half of a day when the politicking began. Proponents of Democratic efforts to reform overhaul America’s troubled healthcare system quickly began urging passage as a tribute to Kennedy’s lifelong efforts on the issue.

Just a small sampling: Sen. Robert Byrd, Democrat from West Virginia, said he hoped that when legislation has been signed into law, it “will bear his name for his commitment to insuring the health of every American.” Andy Stern, president of the giant Service Employees International Union, noted Kennedy introduced his first healthcare reform bill 39 years ago: “Let us continue his cause. Let us take action this year to pass healthcare reform.” And in the Twitterverse, influential liberal blogger Markos Moulitsas used 58 characters this way: “Honor Kennedy’s legacy by passing real health care reform.”

Maybe they could even call it the Trillion Dollar Tribute for Teddy. But it will take more than nostalgia and sentiment to get healthcare reform passed. A new survey from Public Opinion Strategies finds that just 25 percent of Americans favor President Obama’s proposals, comparable to the scant 23 percent who favored Bill Clinton’s healthcare plan in 1994 as it imploded. Betting markets put the odds of passage of a public option at just one in three. And in its lead editorial today, the Washington Post said the new budget deficit numbers mean the Obamacrats should start from scratch and develop a more affordable approach.

The cold, hard politics of the situation is this: Kennedy’s death makes passing healthcare reform tougher not easier. His seat will likely remain vacant until late January since there will be no interim appointment in Massachusetts and state law calls only for a special election to be held within 145 to 160 days. That is one extra tough-to-find vote Democrats will need if they try and shut down any GOP filibuster attempts. And if Democrats try to ram through a bill under reconciliation, a special budget procedure, Kennedy could have been helpful in rallying squeamish Dems and lobbying groups for the tough parliamentary battle, points out veteran Capitol Hill watcher Pete Davis, who tracks Washington politics for financial institutions.

But maybe as the Kennedy tributes continue to pour in, someone will notice his role in deregulating the transportation sector in the 1970s. As a result, both the trucking and airline industries were exposed to market forces that lowered costs for moving both people and goods across the country. Likewise, more fully exposing the U.S. healthcare system to market forces is essential to lowering costs and ensuring continued technological innovation. Now that would be a fitting tribute to the totality of the Kennedy legacy.

COMMENT

To see the true Health Care Tax forum you must stop thinking in 3-D,This multi tax forum is against a $100 Trillion Dollar system.. …
To force pay into another system of failures within Health Care Insurance Groups.
This economy will not balance with this concept of a tax forum against the Health Care System. The issue of how to force pay into this system of Health Care may have worked but I am still troubled over the progressive tax forum within this Bill. It covers so many items and Countries that it only forces the system to adjust itself. In some areas, increases against the people and the troubled economy, and in other areas, less effects will be felt.
But this is my big problem, Government Officials seek help and they are to proud to ask us, “the true working force of Government.” It is understandable they have failed the People and within the United States Of America all we ask is to see us as who we are and not try to bring us into this world of the intellectual. I guess our Prime Directive is that of Star Trek, so it must be understood that for millions of people we are just as happy as can be making $13.00 per hour and we have no interest in this world of politics, and how to be a Enstine. Government Officials must understand that there is a level of people within different parts of this Country, that seek to be only that they find to make them happy.
As for this economy well, it is said that the U.S.A. Arms Division has created enough arsenal to destroy every last creature in the world 2 times over,built with tax dollars. This would be funny if not for the irony of it. And now as time has passed Government Officials keep failing. Before 9/11 all the way to today.
As it is in a world of a system, when employees continue to fail, one or two things happen, one; you get fired, two; if you see into a person a good, then it is political correct to implement a penalty or roll back in pay. But this implement of penalty is more favored in the course of action in the Federal Employment World. So how to fix the economy and unite it with the Health Care issue. It would be in the Countries best interest to implement a 10% per cent penalty against every State, County and Government Official within this Matrix of failures. Hey what is that old saying, what is good for the Goose is good for the Gander. I am serous about this, it is past due to show that our Government Officials they have failed, their system failure reaches into this world of warnings that they brush aside as if the information is not worthy noting. From Pearl Harbor to 9/11/2001 to 3/07/2010 of our tax system and Health Care Reform. This 10% per cent penalty should go into the Health Care Forum.
The big problem that Government Officials have is that they have no street credit. President Obama still has some but if he does not take his family and step away from these dueling Parties, that fight over this Health Care Dollar, and stand with Us he will lose all credit from the streets to the county.
President Obama, I would say to you, you have one last chance to regain the hopes and dreams of the American People. To reach out in a concept that states, if there is 250 million people in trouble because of these failures, I would give all my money to them and then I would say to all that I gave money to, “I have no money left, would you all please give me $1.00 back and then I would have $250. million dollars to start all over again.”

As for this $100,trillion dollar in site………….
Results 1 – 10 of about 685,000 for net worth of medicine development industry
Just to show how deep this Health Care Tax split petition reaches. The term split petition is used because of the Tax factor plan that is not seen because of the intent not to show a capital Taxing of close to a $100 trillion dollar package, a yearly system income, not profit…..

Some have stated that I clam to have spiritual in site or something of the sort. I assure you this is not true, so when I state that I asked God to help, it is my way of saying hey Bobby show me how to work on theses Chevy engines. But I do thank you for the consideration. Consider me a cross of Jethro Bodine from the Beverly Hill Billies with my 10th. Grade education and Vin Diesel from the move Pitch Black.
So drop on by and see page 100 at our site and follow the blue pill link

Health Care within a moral value, is to ,

{ GIVE LIFE TO HOPE WHERE THERE IS NONE }

Henry Massingale
FASC Concepts in and for Pay It Forward
http://www.fascmovement.mysite.com on google. yahoo, and Aol.com
please take the time and visit all my new friends on the net and if you wish to post with FASC Concepts you will be most welcomed. So join us and share your ideas as one in one voice.

Kennedy’s death and the future of healthcare reform

Aug 26, 2009 14:16 UTC

My friend Washington analyst Pete Davis give his always-insightful two cents:

1) Senator Kennedy’s death is quite a blow to hopes for health care reform. No only could Kennedy rally the troops for the tough parliamentary battles ahead, his seat will sit vacant until late January.  Under Massachusetts law, a special election must be held within 145 to 160 days to fill the vacancy and there will be no interim appointment in the meantime.  That robs Senate Democrats of a vote until then, leaving them one short of the 60 they need to overcome a filibuster.

2) Reconciliation may be pursued, but it’s a tortuous path. President Obama and Senate Democratic leaders have talked about using reconciliation to pursue a  Democrats only health reform.  That would allow Senate passage by a majority vote, but it comes with a lot of downside risk.  First, it guarantees no Republican would support it, and there are some Democrats who oppose using reconciliation too.  So that could be a close vote as well.  Second, making health reform work under reconciliation is not easy.  The Senate Parliamentarian would work day and night to decide what provisions are “extraneous,” meaning they don’t affect the budget and must be jettisoned.

3) I’ve been surprised in recent discussions with Senate Democratic staff at how much they think they can get past the Parliamentarian, like a Medicare Advisory Council, but a lot of insurance reforms etc. would have to pass in a separate bill.  If you end up with one bill and not the other, you’ve got a mess.  Finally, using reconciliation in such a partisan manner would impair its use in the future to reduce the deficit.  That has always been its intended purpose, and we will surely need it.

COMMENT

Teddy Kennedy was a noxious drunk, a sexual deviant and an unrepentant murderer posing as a U.S. Senator. The world became a better place the moment he assumed room temperature.

For the media to attempt to gloss over his despicable character and promote Kennedy as a hero is akin to posthumously promoting Michael Jackson as a champion for the defense of little boys’ virginity.

The ONLY thing worse than trying to lionize Teddy Kennedy is the puerile and vulgar attempt to shame the Republican legislators into going along with the railroading of socialized medicine down the throats of Thinking Americans all in the name of Honoring this Fable.

http://www.wheresthehope.wordpress.com

Posted by Bruce W. | Report as abusive

The strange Republican embrace of Medicare

Aug 24, 2009 15:08 UTC

Chris Edwards over at the Cato Institute is also unsettled by how the GOP is endorsing the status quo with Medicare spending to score political points:

Yet the taxpayer costs of Medicare are expected to more than double over the next decade (from $425 billion in 2009 to $871 billion in 2019), and the program will consume an increasing share of the nation’s economy for decades to come unless there are serious cuts and reforms. Even the Obama administration talks about “bending the cost curve” to slow the program’s growth.

Yet Republican National Committee chairman, Michael Steele, takes to the Washington Post today to defend Medicare against any cuts, while at the same time criticizing the Democrats as “left-wing ideologues:” … Steele uses the mushy statist phrasing “our seniors” repeatedly, as if the government owns this group of people, and that they should have no responsibility for their own lives.

Fiscal conservatives, who have come out in droves to tea party protests and health care meetings this year, are angry at both parties for the government’s massive spending and debt binge in recent years. Mr. Steele has now informed these folks loud and clear that the Republican Party is not interested in restraining government; it is not interested in cutting the program that creates the single biggest threat to taxpayers in coming years. For apparently crass political reasons, Steele defends “our seniors,” but at the expense of massive tax hikes on “our children” if entitlement programs are not cut.

Turns out U.S. healthcare system is actually, like, really good

Aug 20, 2009 14:20 UTC
University of Pennsylvania researchers Samuel Preston and Jessica Ho have looked at the low-life expectancy numbers in the United States and asked the question: “Is the health care system at fault?” Here is their answer (bold is mine):
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. …  We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
So if not the healthcare system, then what?
But measures of population health such as life expectancy do not depend only on what transpires within the health care system – the array of hospitals, doctors and other health care professionals, the techniques they employ, and the institutions that govern access to and utilization of them. Such measures also depend upon a variety of personal behaviors that affect an individual’s health such as diet, exercise, smoking, and compliance with medical protocols. The health care system could be performing exceptionally well in identifying and administering treatment for various diseases, but a country could still have poor measured health if personal health care practices were unusually deleterious. This is not a remote possibility in the United States, which had the highest level of cigarette consumption per capita in the developed world over a 50-year period ending in the mid-80’s (Forey et al. 2002). Smoking in early life has left an imprint on mortality patterns that remains visible as cohorts age (Preston and Wang 2006; Haldorsen and Grimsrud 1999). One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston, Glei, and Wilmoth 2009). Recent trends in obesity are also more adverse in the United States than in other developed countries (OECD 2008; Cutler, Glaeser, and Shapiro 2003).
COMMENT

So, the USA is #1 if you eliminate the worst demographics from the statistics? Woohoo!

Uh, wait a second. That’s nothing to pat yourselves on the back about, guys. That’s just disingenuous playing with statistics for purposes of propaganda. If you remove the worst demographics from ANY country’s statistics, its overall ratings improve. Placing the USA’s doctored statistics against other countries’ undoctored statistics is a dishonest comparison.

If the USA’s healthcare system were any good, it wouldn’t have the lowest satisfaction rating or the highest cost per capita of any industrialized nation (it has both!). You also wouldn’t need to be dishonest with statistics to make it look good.

Posted by Benjamin Pyke | Report as abusive

GOP uses Dem playbook to kill healthcare reform

Aug 19, 2009 20:27 UTC

What’s good for the donkey is good for the elephant — or at least as politically effective.

For years, Democrats hampered Republican efforts to overhaul Social Security by making three main arguments. First, reform was a just a euphemism for kill, thus Republicans were violating the social-insurance contract with older Americans Second, building a new Social Security system around personal investment accounts would subject peoples old-age to the vagaries of the financial markets. Third, there was no Social Security crisis, only a successful, decades-old program that merely would need a couple of tweaks down the road (presumably when Democrats again controlled the White House and Congress).

Did these argument hold water? Not really. Various Republican ideas would have changed the program only for younger people. And if you don’t think the stock market is a good long-term investment, then you’re also betting that the American economy will underperform, thus calling into question the country’s ability to meet its long-term Social Security obligations. Finally, it is indisputable that Social Security is underfunded and benefits will need to be cut or taxes raised sharply.

Whatever the accuracy of their arguments, Democrats were able to stymie Republican efforts to fix Social Security, most notably President George W. Bush’s 2005 attempt. Now Republicans are using the same playbook to stop President Barack Obama’s plan to reform America’s healthcare system.

Today’s arguments are similar to those from 2005. Healthcare reform would eviscerate Medicare for the elderly by making cuts to pay for expanded coverage for younger Americans, and that’s unfair since seniors have paid for their benefits. Treatment decisions would be left to the vagaries of Washington bureaucrats. And hey, there really is no crisis since a) polls show most people are satisfied with their current healthcare plan, and b) even if healthcare spending takes up a greater share of GDP in the future, it’s not a big problem since the entire American economy will be much bigger.

But Republican arguments are just as flimsy as the Democrat version four years ago. Rising costs mean less take-home pay for American workers, and Medicare, to a great degree, is what’s driving those costs since it makes using pricey, premium medicine seem cost free to seniors. (And despite Republican claims, the average senior will get $100,000 from Medicare than what he puts in.) What’s more, the U.S. could be spending far less on healthcare, including Medicare, and getting equally good results. Still, those economic realities are just a distraction when your goal is more about political victory than solving a national problem.

The politics may be dicey, but anyone truly serious about overhauling the American healthcare system needs to acknowledge that total spending must be reduced and that any aspect of the system — including Medicare and employer-based health insurance — that distances patients from the true costs of their healthcare is part of the problem. Republicans could even, theoretically, support a bare-bones public option if it had low premiums but high deductibles and co-payments to increase consumer awareness. (Just as Democrats should be able to support a system based on more private health insurance if there were substantial subsidies for the poor.)

Of course, that would be sound economic policy and the current debate has precious little to do with that.

COMMENT

I’m against the public option and I may not agree with everything here but it’s refreshing to see some non-confrontational replies (except from “Nancy”) from both sides. I wish it was always like that.

Posted by Rick D. | Report as abusive

What Americans really want in healthcare reform

Aug 19, 2009 18:11 UTC

This is a great analysis of healthcare polling by Humphrey Taylor, head of The Harris Poll (via The Health Care Blog):

However, if you study all the polls, as opposed to cherry picking them as many politicians do, a  clear picture of public opinion emerges:

  1. Most people are unhappy with the current health care system and favor reform.  They want to have a system that gives them affordable access to quality care for the rest of their lives.  International surveys show that Americans are more dissatisfied with the U.S. health care system than are people in all, or almost all, other developed countries.
  2. Most people think that some kind of government intervention is needed to fix the system, to expand coverage, and to contain costs.  However, support for government intervention does not, in most case, translate into support for a “government-run” system.  (Though what people understand by that phrase is far from clear.)
  3. While most people believe that fundamental changes are needed in our health care system, only a minority wants to completely rebuild it.  Most people favor building on the present system and the bits of it that seem to work well.
  4. There is substantial support for health care reform not only among the public but from large majorities of almost all major interest groups.  Only small minorities of doctors, employers or insurers think that the system works pretty well now.  However, they also have different interests and tend to see very different problems and support or oppose different proposals.
  5. Most people are at least reasonably satisfied with their own health insurance (if they have it) and with the quality of care that they receive.  However, that does not mean that they like the system.  Most people believe that the costs are too high and that everyone should be covered.
  6. More people think that both the total cost and the out-of-pocket costs of care are too high, but their perceptions of why this is so are different from those of most health economists.  They often blame greedy insurers and pharmaceutical companies and think there is a lot of fraud and abuse.  But they are less likely to focus on over-utilization, the impact of fee-for-service incentives and the relatively (compared to other countries) high price of medical services.
  7. Few people seem to worry much about the unfunded liability for Medicare that economists tell us is a huge problem.
  8. Proposals that people believe will take away the health insurance they have now, or force them to change doctors, that “ration” care, or prevent them from getting the treatments they think they need are deeply unpopular.
  9. There is no consensus on the appropriate roles of the government, employers and individuals.  Half of the population thinks that health insurance and health care should be “an entitlement paid for by taxes,” while a third believes that it should be like other products and services, where you get what you can pay for.
  10. Republicans and Democrats are highly polarized on many aspects of reform.  Most Democrats think that this is a very important issue and focus on expanding coverage and limiting out-of-pocket costs.  They tend to favor an expanded role for government.  Most Republicans focus on cost containment and oppose a bigger role for government.  Democrats are much more likely than Republicans to think that health care is a “right.”
  11. There are many things that many people do not want.  They do not want to pay much higher taxes and out-of-pocket costs.  They don’t want to damage the economy or increase unemployment.  They dislike the idea of rationing and oppose anything that they think might reduce the quality of their care or limit their choices.
  12. Most people do not think or talk about the issues that are the focus of much debate among policy wonks, think-tanks, and legislators.  They rarely mention health information technology, comparative effectiveness reviews, a health information exchange, reimbursement reform, pay-for-performance, quality measures, or outcomes research.  When asked about these issues, the public’s replies vary dramatically, depending on whether the language used is that of the proponents or opponents of proposals.  For example, a new agency to provide information on which treatments work better or worse sounds pretty good – but not if it is used to deny care that a doctor or patient wants.
  13. Most people do not seem to see a conflict between giving patients every test and treatment they and their doctors  want, however expensive, and containing costs.
Me: I think this shows that the White House has done a poor job educating people on this issue. Nor have Americans done a good job educating themselves, which is inexcusable in the Internet Age. For his part, Taylor thinks the issue is just too complex. Maybe, then, we need simpler solutions.

COMMENT

Equation !

$1.042trillion (cost of reform) + $245bn (cost to reflect annual pay raise of docs) = $1.287bn (actual cost of reform).

$583bn (the revenue package) + $80bn (doughnut hole) + $155bn (savings from hospitals) + $167bn (ending subsidies for insurers) + $277bn (ending medical fraud, a minimum of 3%) = $1.257trillion + the reduced tax on the wealthiest = why not ? (except for magic pill, an outcome-based payment reform & IT effects and so forth)

In relation with medical fraud, please visit http://www.npr.org/templates/story/story .php?storyId=111967435, you will be stunned ! Thankfully, in May 2009, the Obama administration announced a new task force made up of officials from the Department of Justice and the Department of Health and Human Services to work on health care fraud.

Thank You !

Posted by hsr0601 | Report as abusive

Obama and “W”

Aug 19, 2009 17:43 UTC

Not that “W’ (as in the 43rd president), but a W-shaped economy.  I was on CNBC today talking healthcare with Howard Dean, and he said he thought the economy would improve and then worsen again. Would that be good or bad for the Obama agenda? Certainly it was a weak economy that got Obama elected and helped him push through the $800 billion American Reinvestment and Recovery Act. But high unemployment has been sapping his popularity. And that has been bad for his agenda, especially healthcare reform. If Dean’s forecast is correct, the Dems better pass healthcare while they can. There might be a lot fewer of them in Congress after 2010.

COMMENT

Jim Murtaza,
You are aware that the deficit has quadrupled since BO has taken office, So we could also say that we can study the reason that pig excrement smells (Part of the stimulus spending bill)but can,t provide health insurance,if the dems really wanted to insure people ,they easily could have added it to the stimulus plan. Whats another couple hundred billion dollars anyway. Have you pondered the 54 million human abortion deaths (in the US since Roe vs Wade)that your party supports,with the call of “Freedom”. Is that a genuine human cause or a zygotic problem?
Bill Nichols

Posted by Bill Nichols | Report as abusive
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