All Life Is Problem Solving

At Huffington Post a few days ago, Michael Brenner, lamenting the current display of plutocracy in Congress, had this to say:

”We vaunt American democracy as a stellar model for the world. The bizarre spectacle now on display in Washington as the White House and the Congress tussle over health care “reform” is hardly an advertisement from our prime export product. Consider the following. The nation’s entire medical system is being reshaped by six Senators meeting behind closed doors for weeks. All we know of the proceedings is through puffs of smoke leaking under the doors. The other 529 members of Congress twiddle their thumbs awaiting the conclave’s outcome. The gang of six composes three Republicans and three Democrats from states that cumulatively contain less than 3% of the country’s population. All are more conservative than the large majority of Democrats who control 60 Senate seats and much more conservative than most Democratic Representatives in the House. They have just killed the “public option” that is favored by 72% of the American public. They have also rejected out of hand the provision for financing the costs of the program via a tax on the rich as approved by the key committee in the House. So, too, for the Employer Mandate that has been at the heart of all serious proposed plans until the gang of six decided otherwise.” [Read more →]

This post is a comment on an exchange with Jason Rosenbaum appearing as replies to ralphbon’s blog post entitled “Seniors Already Have A Public Option. Does It Keep Private Insurers Honest?” Here is the exchange:

LetsGetItDone:

“ralphbon, Thanks for a very good analysis. Jason, in view of Paul Krugman’s recent analysis of the health insurance “market,” and the constraints placed on eligibility for the public option in HR 3200, can one reasonably anticipate that, even if HR 3200 is enacted without major change, it will have an appreciable impact on health insurance costs and price inflation over the next six years?”

Jason:

“Six years? I don’t know. I’d have to look at the graphs again, but I’m not sure you saw a big differentiation between Medicare prices and everyone else’s prices in six years. However, those differences did emerge, as will these. Especially because I’d expect the public option to work so well that the Secretary of HHS would exercise her right to expand the exchange (and therefore the public option) in 2015.” [Read more →]

This will be a pretty short one. First, health care reform proposals that offer a “public option” alternative do not provide “socialized medicine.” That is, all medical care in such proposed systems would be provided by private sector Doctors, hospitals, and other other health care institutions. Government in such a plan doesn’t do any medicine. The only thing it does is give people an opportunity to buy insurance from a public agency. Charges from the right that this is “socialized medicine” are just attempts to use “scary” labels to prevent efforts to bring insurance companies under control. The worst you can say about them is that they provide a “socialized” insurance option, but not that they provide “socialized medicine.” It’s time everyone recognized the distinction between the two. Most of the health care systems in the world that work better than ours are “socialized insurance systems,” not “socialized medicine systems.” [Read more →]

This one is an Open Letter to my Congressman, James Moran (D-VA).

Dear Jim,

I feel entitled to address you by your first name because you’ve been my Representative since 1991 and I’ve voted for you in every election since then.

I think the issue of health care reform is where most Americans live. Those who don’t have insurance are shut out of good care. Those who have it are at risk of losing it, or of denial of service at any time. With each passing year health care statistics show that our American system is failing relative to other well-off western nations. Canadians, for instance, have a life expectancy that’s 3 years longer than our own. Their risk of mothers dying in childbirth is one-half of ours. Their infant mortality rate is much lower than ours. Their positive health results don’t begin to measure the advantages they’ve gained over us since they adopted their Medicare for all program in 1966 in the form of more competitive businesses, reduced bankruptcies, broken families, and needless deaths due to lack of treatment. I don’t know about you, but I don’t want my Grandchildren to live a shorter life because they were born here rather than up North. I don’t want them to have a greater risk of dying in childbirth, or of suffering the tragedy of losing a child, or of going into bankruptcy, or of going through a divorce, or of dying because they lack insurance, than they would have if they were born in Canada or another wealthy country.

You need to do something about this if you want to keep my vote. [Read more →]

Well, maybe not “over” as in “there will be no legislation passed in this session that contains the phrase “public option.” Perhaps there will still be legislation that has a provision with that label. But it will bear no resemblance to Jacob Hacker’s original design for a public option plan, and it won’t provide a public option that can provide any real competition for private insurance companies.

Kip Sullivan’s post of July 20, entitled “Bait and Switch: How the “Public Option” Was Sold” shows this very clearly. Sullivan makes the case that the House version of the public option plan, the strongest public plan being considered has a chicken-egg problem. On day 1 it will have no enrollees, and it can’t successfully market insurance to people, unless it has a provider network that will treat them when they fall ill. However, on day 1, they won’t have a provider network. If they try to sign providers up and create such a network, they’ll have to get them to agree to a discounted pay schedule relative to what private insurers offer them. If they don’t get such a pay schedule, they probably won’t be able to attract people to the public plan. But why should the providers give the public plan a discount greater than they give to the insurance companies unless the public plan can offer them the inducement of a large number of patients they do not have? And that is the chicken-egg problem besetting the most robust public option yet proposed by the Congress. Because of it, the public plan may never be able to get going at all. [Read more →]

Last night, it occurred to me that the public option idea is a disingenuous approach to health care reform. Here’s the argument.

Talking to other progressives, I’ve noticed that they all freely say that single payer will work better than a public option, and that it is the best alternative they know. And then they also go on to say that they are supporting a public option, rather than single payer, because it’s more politically acceptable and will result in a single payer system anyway after a number of years, since everyone will switch to the public option. The question is: would these progressives support a public option, if they thought it would not result in a single payer system? I don’t think so, even though their counterparts in the US Congress are currently fixing to do just that as a recent post by Kip Sullivan (thanks to ralphbon for the reference) shows. [Read more →]

When President Obama posed the above question during his reply to the first question in his press conference tonight, I listened carefully during the rest of the press conference for his answer. I didn’t hear it. Or if I did, it didn’t come through clearly enough for me to understand it.

I did hear something about more efficiency in using information systems and technology. I also heard something about not performing unnecessary tests that don’t make people any healthier. I’m a strong believer in the economies that can be achieved using appropriate technology along with Problem Solving Pattern Management, so I do believe that the kinds of things hinted at by the President can save some money, provided we approach them with good conceptual approaches. However, I’m not sure that introducing changes of this kind will save us that $6,000 the President is talking about. Certainly, I don’t think that other nations have saved that $6,000 by being so much better than we at implementing hospital IT systems, or by being so much better than we at not doing unnecessary tests (though probably some of this last is certainly involved). [Read more →]

The Health Insurance companies and other opponents of government-funded health care have been trying to overcome the statistical evidence of the superiority of public systems by spreading “Fear, Uncertainty, and Doubt” using horror stories and, of course, outright lies about the failures of health care in other nations having such systems. Those of us who favor health care reform, either single payer, or plans with robust public options, have been replying with horror stories about health care here, and testimony from individuals, primarily Americans in Canada, or Canadians, about their own very positive experiences with Canada’s single payer system. The exchange of stories is probably somewhat effective, especially because people here really don’t trust the sources of the anti-Canadian health care anecdotes. Wouldn’t it be a big improvement, however, if we could cut through all the static and win the health care anecdote war? Guess What? I think we can. [Read more →]

WaPo op eds are getting increasingly irritating with the passage of time. Yesterday, this formerly great American newspaper in free fall ran an article by Matt Welch and Nick Gillespie called “What’s Next Mr. President – Cardigans?”  Welch and Gillespie think that Obama’s less than stellar results thus far suggest that he may be reviewing the history of past Democratic administrations to find a “road map” out of his difficulties, and also that “he seems to be skipping the chapter on Bill Clinton and his generally free-market economic policies and instead flipping back to the themes and comportment of Jimmy Carter.” In this way, they begin a transparent framing exercise suggesting that Obama is at a turning point, and that he must stop “running government as a perpetual crisis machine,” and “. . . stop doing harm. Throwing money all over the economy (and especially to sectors that match up with Democratic interests) . . . “ And also that: “. . . there’s no question that Obama’s massively ambitious domestic agenda is at a fork in the road: One route leads to Plains, Ga., and early retirement, the other to Hope, Ark., a second term and the revitalization of the American economy.” And later they say: [Read more →]

Why is there “a free lunch” in Congress? Why are there 180 Republican Amendments for the House Health care Reform legislation, but no guaranteed Republican votes? Why should members be able to get amendments to bills proposed in committee accepted without any commitment from themselves? What kind of negotiation process is that? Why doesn’t the majority party require a guarantee that the amender vote for the bill? Then we might see some “bipartisanship,” or at least a better partisan bill.

Just sayin . . .