WHAT’S HE SMOKING? Healthcare Reform Hinges on Obama Thinking Like a Non-Smoker

President Obama demonstrates the imaginary box around him that smokers believe keeps this baby safe from third-hand smoke

I watched the televised White House infomercial on healthcare reform last night, and it occurred to me that the President is thinking like a smoker. Whether he’s quit the habit or not, we won’t get real reform until he starts thinking like a non-smoker.

You see, he wants reform that provides high quality care for all Americans, saves money and saves … money. But … BUTT… only if he doesn’t have to change anything for people who are happy with their current employer-provided insurance, i.e., mostly people who have never truly needed their coverage. (And people who work for Google. But let’s face it, we can’t all work for Google.)

This whole situation is reminiscent of restrictions on smoking, in the beginning. Smokers had a RIGHT, goddammit. So the rulemakers said, “If you like what you’re doing, no one is going to make you change, you go right on smoking where you are. We’ll just make these special non-smoking sections for everyone else so they can breathe.” Which of course didn’t work very well because only smokers think the smoke stays in a nice little box around them and doesn’t end up in everyone else’s hair, clothing and lungs.

Smoking rates (first-hand and second-hand) — and attendant cancer rates — didn’t really drop off until rulemakers finally got tough and made rules that guaranteed clean air in public spaces for everyone. Smokers can always take it somewhere else, but everyone else — especially workers, children, and people trying to kick the habit — everyone else suffers the consequences if they don’t.

Herein lies a core problem with the President’s healthcare reform proposal. Predicating reform on the requirement that those who don’t want anything to change must be allowed keep their employeer-sponsored insurance plans just as they are means we can’t clear the air, so to speak (or shovel out the barn, for a more apt analogy).

Because if we keep the existing insurance companies, we keep the $350 billion in wasted healthcare administration costs, and the billions more in profits they extract with that “wasted” paperwork. EVERYONE’S healthcare is that much more expensive. If a patient decides to spend his own money and have nothing to do with insurance companies, the extraordinary costs they foist on the system will still end up in that patient’s medical bills (and the crazymaking medical billing paperwork will still end up flooding his home and dominating his time when he is sick).

That patient can’t really opt for an insurance-free zone, where he doesn’t have to pay the odious insurance-waste-tax, because that waste will remain so long as private insurers remain.

In the forum tonight, President Obama talked about involving all the players: doctors, patients, insurance companies… But doctors and patients are necessary parts of the healthcare system, insurance companies are not, and they should not be afforded the same voice in reform because of their role in bringing our system to its knees.

People have to ask themselves: if your loved one needs expensive, life-saving medical care, and you are given a choice, would you, a) choose to err on the side of giving it to them, even if no one is 100% sure it will be worth it in the end, or b) choose to instead give the money to an insurance company to hire a bunch of paper pushers to screw a whole lot of people just like you for their profits?

Let me say it again: At least $350 billion wasted every year because of private insurance bureaucracy. What part of saving AT LEAST a trillion dollars in three years without spending a cent less on care don’t we understand?

Single-payer is working all over the world. In democracies. In democracies that have far better healthcare access and outcomes than we have. Even though, in most cases, they smoke more. Imagine that.

Sorry, I just CAN’T (Support a Public Option for Healthcare Reform)

I’ve been getting pleas from MoveOn.org to support healthcare reform in the form of a public option that competes with private insurance.  Today, Senators Schumer, Leahy and Durbin blogged about it on the Huffington Post, asking people to sign an online petition to support a public option.

Here’s why I can’t.  (In addition to my latest post on this blog.)

I can’t sign on to a public option, because fighting for a reform that is doomed to failure is worse than doing nothing.

I heard today that proponents of the public option are dismissing a counter proposal by Conservatives to use local insurance co-ops instead.  This is an option that has actually been shown to work in places like Grand Junction, Colorado, where they provided universal coverage, saved money, and got better results (as featured on June 19th Science Friday, NPR radio).  An important aspect of Grand Junction’s reform was to insure everyone with a single, non-profit insurance “co-op” — they never used the word “single-payer”, but that’s essentially what they enacted.  The physician guest from Grand Junction made the point that if government requires everyone to purchase insurance, the insurance must be not-for-profit.

Look, I have no illusions that Republicans proposed regional single-payers-by-another-name.  But if they’re proposing co-ops, that’s what has been shown to work, and that’s what we need to counter with. We should be making the hard black-and-white fiscal arguments.  Ultimately, saving huge amounts of money for our country and freeing our businesses from the extraordinary burden that insurance companies foist on the system, our businesses, and our workers will convince real Conservatives — and there’s no convincing the rest, there just isn’t.  We’ve tried it their way, now let’s fight for what we know will work.

If the compromise is allowing regional single-payer co-ops instead of implementing a monolithic federal single-payer — that could work, too.  But it would still have to be a single-payer framework to save real money.  A public option is not single payer and will not save nearly as much money.

According to a Public Citizen study, we spend less than half of our $2.4 trillion ANNUAL health care economy on ACTUAL CARE, the rest goes to non-care expenses, largely because of private insurers.  We no longer have the luxury of clinging to tired old ideological arguments.  We have to make the case for single-payer within a private delivery system — and compromise on the specific implementation of “single-payer” if it will mean consensus — but if we can’t get that, we must fight for what we know will work.

Without the overwhelming and corrupting influence of private insurers, we will be far more free to improve on whatever system we have in the future.  The public option leaves the insurers in place to work the system to their favor again and thwart meaningful reform.  I’m not going to support squandering our big opportunity at reform.  Our country, our economy, our future, the lives of our loves ones are at stake.

Ask me — and the majority of the public who are for single-payer — to support the right reform.  Stop asking us to support watered-down reforms that won’t work.

Healthcare Reform: Single-Payer vs. Public Option

For the record, I have in the past touted a competing public plan, including writing to Eshoo about it.  I no longer believe it will work.

The reasons a competing public insurance plan won’t work are legion, but the most significant are:

1)  Having a competing plan will do nothing to eliminate the huge bureaucratic structure that burdens our health system to the tune of $450 billion a year, largely because of private insurers.  Doctors and hospitals will by necessity continue to maintain largely the same levels of paperwork structures to deal with private insurers that remain.

2)  This is such a monumental fight because of private insurance interests.  Leaving them at the table will mean they will not only eat our lunch again — they have already figured out how and have implemented some of those measures in the event of the most likely reforms.  They are not sitting around waiting for new rules to fight back, they are an adaptive, negative force in the system.  Their incentives do not and cannot coincide with the public interest.  If we want to be able to make incremental improvements in the future that are in the interest of the public and our nation, we need to fight this battle now, while we can, to WIN it.

3)  If insurers are forced to compete with a public option, they will find easy ways to sue the government (i.e., the US taxpayer) for anticompetitive practices.  And wearing opponents down with the legal system is insurance companies’ stock-in-trade.

4)  Philosophical opponents of reform (such as ideological right-wing) do not differentiate between any of the proposed reforms, they oppose them all.  We should be pushing the only one that has a chance of really WORKING, not setting ourselves up for failure after all this work.

I now believe a government run single-payer coverage within a private health delivery system is the only reform that can save significant costs and allow us to improve quality.

Some of the best arguments FOR single-payer can be found on http://www.pnhp.org Physicians for a National Health Plan.  Read the articles and testimonies by Dr. David Himmelstein, the Harvard doctor and professor whose group did the work that found that now over 60% of personal bankruptcies in this country are from healthcare costs and that the majority of those people had health insurance.  They have also looked at the different reform proposals to see where the cost savings are, and concluded that only single-payer coverage (within a private healthcare delivery system) will result in dramatically decreased costs while allowing universal care and improved quality.

I think the biggest fear people have in moving to single-payer (even though the care delivery system would be the same), is the fear of losing choice in their care.  Right now, choice is really the only power patients have to control quality.  You can tell them all you want that they won’t lose that, but they’ll continue to fear it unless the proposed reform demonstrates it in an obvious way.

I think we should move to single-payer with a three-tier cost/coverage structure:  the first tier that covers everyone and provides for all reasonable healthcare coverage that anyone could envision in a plan, a second tier that covers “extras” and allows more latitude to patients in choosing the avenues of their care, and a third tier that is far more expensive, but allows people even more discretion with their care choices.

In the proper implementation of the single-payer system, the first tier should actually cover everyone so well, that the other tiers eventually become unnecessary.  But some people will cling to them anyway.  And if the system isn’t implemented properly (if we get cheap and start rationing), the people who have the most fear of rationing will be able to avoid it, and still we will get the enormous savings and universal coverage overall.

I think this kind of structuring would appease much of the fear around a single-payer plan, because some people know they can always pay for “more” — and at least we will get the savings of single-payer.  And if we run up against problems, all of us in the public and medical profession can as a whole identify and demand improvements, instead of lone, sick patients and overburdened doctors fighting numerous well-armed profiteers.

A.J.

President Obama, who had the courage to stand up with a small minority of lawmakers and oppose the war in Iraq — knowing that his patriotism would be savagely attacked at a time when he had Presidential ambitions — this fearless and principled leader is for political expediency touting a watered down version of healthcare reform.  I hope he will reconsider and stand up for what is right, instead of forging a Frankensteinian-mashup that has no hope of ever running well:  tacking a public option onto the existing system.

For the record, I have in the past touted a competing public plan, including proposing the idea to my Congressional Representatives about it.  I no longer believe it will work.

We need to move to healthcare on the model of fire and police departments — any sector of the economy where citizens are uniquely vulnerable (such as when they are sick or in a life-threatening emergency) should not be subject to profiteering, because it’s just too easy to shake them down.

The reasons a competing public insurance plan won’t work are legion, but the most significant are:

1)  Having a competing plan will do nothing to eliminate the huge bureaucratic structure that burdens our health system to the tune of $450 billion a year, largely because of private insurers.  Doctors and hospitals will by necessity continue to maintain almost the same levels of paperwork structures to deal with private insurers that remain.

2)  This is such a monumental fight because of private insurance interests.  Leaving them at the table will mean they will not only eat our lunch again — they have already figured out how and have implemented some of those measures in the event of the most likely reforms.  They are not sitting around waiting for new rules to fight back, they are an adaptive, negative force in the system.  Their incentives do not and cannot coincide with the public interest.  If we want to be able to make incremental improvements in the future that are in the interest of the public and our nation, we need to fight this battle now, while we can, to WIN it.

3)  If insurers are forced to compete with a public option, they will find easy ways to sue the government (i.e., the US taxpayer) for anticompetitive practices.  And wearing opponents down with the legal system is insurance companies’ stock-in-trade.

4)  Philosophical opponents of reform (such as ideological right-wing) do not differentiate between any of the proposed reforms, they oppose them all.  We should be pushing the only one that has a chance of really WORKING, not setting ourselves up for failure after all this work.

I now believe a government run single-payer coverage within a private health delivery system is the only reform that can save significant costs and allow us to improve quality.

Some of the best arguments FOR single-payer can be found on http://www.pnhp.org Physicians for a National Health Plan.  Read the articles and testimonies by Dr. David Himmelstein, the Harvard doctor and professor whose group did the work that found that now over 60% of personal bankruptcies in this country are from healthcare costs and that the majority of those people had health insurance.  They have also looked at the different reform proposals to see where the cost savings are, and concluded that only single-payer coverage (within a private healthcare delivery system) will result in dramatically decreased costs while allowing universal care and improved quality.

I think the biggest fear people have in moving to single-payer (even though the care delivery system would be the same), is the fear of losing choice in their care.  Right now, choice is really the only power patients have to control quality.  You can tell them all you want that they won’t lose that, but they’ll continue to fear it unless the proposed reform demonstrates it in an obvious way.

I think we should move to single-payer with a three-tier cost/coverage structure:  the first tier that covers everyone and provides for all reasonable healthcare coverage that anyone could envision in a plan, a second tier that covers “extras” and allows more latitude to patients in choosing the avenues of their care, and a third tier that is far more expensive, but allows people even more discretion with their care choices.

In the proper implementation of the single-payer system, the first tier should actually cover everyone so well, that the other tiers eventually become unnecessary.  But some people will cling to them anyway.  And if the system isn’t implemented properly (if we get cheap and start rationing), the people who have the most fear of rationing will be able to avoid it, and still we will get the enormous savings and universal coverage overall.

I think this kind of structuring would appease much of the fear around a single-payer plan, because some people know they can always pay for “more” — and at least we will get the savings of single-payer.  And if we run up against problems, all of us in the public and medical profession can as a whole identify and demand improvements, instead of lone, sick patients and overburdened doctors fighting numerous well-armed profiteers.