I'd like to call attention to some comments from New York Governor David Paterson that were in a recent Politico article about the 2 or 3 New York politicians actually sticking their necks out for 'Wall Street'.
"In New York, Wall Street is Main Street," Paterson told a receptive audience at the Museum of American Finance in December. “You don’t hear anybody in New England complaining about clam chowder. If you say anything about oil in Texas, they’ll string you up near the nearest tree. We need to stand behind the engine of our economy in New York and that engine of economy is Wall Street.”
A few points regarding this... First, its 'chow-dah', and its better than that red crap you serve in your state. Second, three-quarters of New England's economy is based on commercial machinery, instruments, chemicals, and transportation equipment. Third, New York City has five Main Streets. And lastly, David Paterson, you are an ill-informed asshole hoping to win re-election as governor of New York despite having the lowest-ever approval ratings for a governor of that state... sounds like you're looking for some handouts to finance your campaign.
Addendum:
For the record, no one in New England complains about clam chowdah because its fucking delicious.
Saturday, January 30, 2010
Friday, January 15, 2010
Happy New Years: '010 (+15/365ths)
I took a break from blogging during the past month for a couple reasons. (1) the middle of December was dominated by end-of-semester nonsense and a multitude of exams, for which I'd never studied so hard in my life (not that that's saying too much) and (2) I've been getting burnt out on email and the internet in general.
I enjoyed my winter break in Rhode Island, helped out with the H1N1 effort there, visited Boston, spent a few days on an island up in Maine soaking up the bitter the cold, and got to see all the best people in the world (missed a couple, see you in March). I also got a RI flag for Christmas that I'm quite excited about, because as one friend here in Berkeley told me, my love for my state is highly unnatural yet pretty amusing.
Anyways, I'm going to try and dispense with the forced essays from here on out, because who has time to read them (I don't have time to write them). I'd like to keep the focus on health and education, but will attempt to keep it a bit shorter and more organic. Besides, my guess would be that about 4 people read this, so I'm just doing it for myself essentially.
Some New Year's related thoughts...
I enjoyed my winter break in Rhode Island, helped out with the H1N1 effort there, visited Boston, spent a few days on an island up in Maine soaking up the bitter the cold, and got to see all the best people in the world (missed a couple, see you in March). I also got a RI flag for Christmas that I'm quite excited about, because as one friend here in Berkeley told me, my love for my state is highly unnatural yet pretty amusing.
Anyways, I'm going to try and dispense with the forced essays from here on out, because who has time to read them (I don't have time to write them). I'd like to keep the focus on health and education, but will attempt to keep it a bit shorter and more organic. Besides, my guess would be that about 4 people read this, so I'm just doing it for myself essentially.
Some New Year's related thoughts...
- How do we verbally abbreviate 2010? 'Ten' sounds terrible. 'Twenty-Ten' doesn't really do it for me either. I like 'oh-ten' ('010), so lets try and get that into the common lingo.
- I got the H1N1 vaccine while I was in RI. I even insisted on getting the 'flu mist' form, which people seem to fear as though its the plauge because its an attenuated (weakened) virus, rather than a killed one like the shot. I'd like to report that I am still alive, experienced zero side effects, and in fact, the vaccine seems to have made me faster, stronger, and better looking. I'd highly recommend it.
- I really missed riding my bike, I think a month away from it made me fatter. I guess New England winter will do that do you anyways because who the hell wants to be outisde?
- Zanzibar (the semi-autonomous island off the coast of Tanzania) where I hope to do my summer internship focused on malaria eradication, has been without power for 3 weeks, and likely will remain so for another month. Their 30-year old undersea power cable from the mainland is busted.
- My New Year's resolution is more of a theme: Discipline. I really have very little self-discipline so I'm going to work on that this year. I've always lived by the Buddha's words: 'everything in moderation, even moderation', essentially giving myself an excuse to party whenever I wanted. Can the concept of self-discipline be reconciled with the second half of that statement? I guess I'll be attempting to be disciplined in allocating my moments of non-moderation.
- I really love technology, to think of how far we've come even in my short lifetime is crazy... rotary phones to iPhones, the Berlin Wall to globalization, typewriters to email, and cassettes to mp3's. However, the social media/Web 2.0 frenzy has got me on the defensive a bit. I'm going to start thinking about how to balance the utility of new technology with the overbearing invasiveness of it. A couple interesting things I intend, but have yet to really check out can be found here and here.
- God have mercy on the people of Haiti right now. I would strongly suggest donating to Partner's in Health, a Boston-based international health nonprofit that has been operating in Haiti for 30 years that has become the model for how to make gains in health outcomes across the globe. There are many organizations in Haiti worth donating to and doing great work, but I think PIH is best equipped to make immediate use of funds sent to them. You can learn more and donate here.
Saturday, December 5, 2009
Health Care Reform Part Deux: Delivery
Progress! That's what I'm making on my promise to write about the big picture with health care reform. As I outlined several posts ago, there's a lot more to fixing our broken-down jalopy of a health care system than just making sure everyone has insurance (and we can't even get that done). Insurance, when implemented properly, can make care affordable to everyone, but we need to take a look at the care we're getting. How far does our dollar take us? Health insurance reform is going to do very little to stem the rising costs of care. Making reforms in the health care delivery system is where we can hope to really make care more affordable and sustainable. Its going to be a long journey though...
As much as the pharmaceutical industry is making a killing in this country, its not where the majority of money in the health care system is directed. But its a big part and I'll get to that shortly. Where is most of it going? To doctors! Who'd have thought...
The root problem to a lot of our overspending lies with a payment system called 'fee-for-service'. Essentially this means that for each scan, test, and diagnostic a doctor orders for a patient, they get paid. And in an age where everyone wants every scan performed to rule out the possibility of each infection and cancer known to man, the costs from this type of system really add up. If I was going to give your car a tune-up and went ahead and replaced the windshield, slapped on new tires, and repainted it, in addition to what you would have expected, such as changing your oil, you'd probably be upset when it came time to pay the bill. Well our health care payment system works in much the same way. We don't pay based on health outcomes, we pay based on each step a doctor takes to get us there, whether is forwards, backwards, or sideways.
Now I don't want to seem like I'm accusing all doctors of blatantly profiteering at the expense of their ignorant patients. I certainly feel that in a payment system such as this, there is a certain subtle, unconscious factor regarding profit incentives to consider, but I'd be a really bad psychiatrist, so I'm going skirt that issue. As mentioned before, many patients actually demand such courses of action. We increasingly live in an era where people are more educated about their health through mechanisms such as WebMD, which leads to a lot of self-diagnosis. Patients show up to their doctors offices armed with articles and ideas about what's ailing them before a doctor can even examine them. In this type of climate doctors are obliged to order a plethora of tests due not only to patient demands, but also out of fear that they will be sued if they miss something that an extra test may have discovered. This is what is referred to as 'defensive medicine', and operating under duress and out of fear is no way to practice medicine.
Tort reform (making it harder to sue doctors) is one of the Republicans' few pet issues when it comes to health care, and I have to say that I agree with them on this one for the most part. I think their claims regarding the cost-effect it will have are overblown, but in the long run tort reform will reduce doctor's fears of being sued and assist in the reduction of over-testing patients. This, however, is just one small piece of the puzzle.
First of all, we have too many people showing up to their doctors' offices very sick, as is highlighted in a recent CDC report on patients not receiving or delaying seeking care due to the cost. Lack of insurance coverage is one thing that keeps people from getting regular treatment, so insurance reform will hopefully help to alleviate some of this problem. But even when people are insured we see this problem. A major cause of this is the simple fact that there are far more 'specialists' (surgeons, dermatologists, cardiologists, etc.) than 'general practitioners' (family doctors). Specialists, on the whole, earn a lot more money than physicians, making these jobs more attractive to medical students with large debt loads. But its detrimental effects are twofold: (1) there are fewer physicians to give patients primary, preventative care (i.e. regular check-ups and good health advice) that would keep them from developing conditions requiring specialists, and (2) it creates a very large pool of individuals who stand to profit from people having serious conditions.
Now I'm not saying that specialists want to see patients get sick so they can make money (though for hospital administrators its great business), but it is easy to see that our system is not aligned with our goals. Preventative care is far less expensive than specialized care, such as chemotherapy and surgery. We need to create more incentives for medical students to enter the general practice field and create more incentives for students unwilling to tackle the commitment of medical school to pursue careers as nurse practitioners, who in many states can provide much of the same type of care that a general practice doctor can.
In addition to increasing our focus and incentives for preventative primary care, we need to do a better job of coordinating that care. What will this look like? Doctors will increasingly work in group, rather than private practices. Institutions such as Kaiser Permanente are great examples of this model. Kaiser does everything in-house. They provide the insurance, they own the hospitals, and they contract with a doctors' group that works exclusively with them. They coordinate care and negotiate prices within their own structure to help keep costs reasonable and efficiently track a patient's health.
In terms of changing our payment methods, there are a few ideas floating out there that warrant some examination. 'Fee-for-performance' and 'episode-of-care' are perhaps the most promising. Fee-for-performance is pretty much what it sounds like... namely doctors are not paid per test performed, but based on overall health outcomes. Episode-of-care means that rather than paying for treatment at a hospital, the going home and having a relapse of some sort, and having to go back to the hospital and pay again, you would only pay once for whatever it is that ails you, and if the hospital fails to take care of that properly, they eat the additional cost. These methods obviously incentivize quality care rather than overtesting.
And lastly, I told you we'd get back to the pharmaceutical industry, which accounts for roughly 14% of medical expenditures in the U.S.. Big Pharma is far-and-away the most profitable industry within the Fortune 500 companies. There is a lot of truth to the argument that we in the United States subsidize pharmaceuticals for the rest of the world; there is no government regulation of drug prices and we pay from 50-100% more for the same drugs as they do in other developed nations such as Canada, France, and Britain. Drug companies will regularly point this out and say that unless we can force other countries into higher prices, the rates in the U.S. are necessary to sustain very expensive research & development (R&D) of new drugs. This is true, but what they don't mention is that they spend about twice that much on marketing and promotion of their products, as detailed here.
As with much of the rest of our health care system, the incentives in the drug industry are misaligned. The industry focuses primarily on therapeutic drugs that people will have to take for the rest of their lives to control certain disease states. Even worse, the proportion of designer drugs (like Viagra) continues to rise. People take these sorts of drugs every day, for long periods of time, ensuring that sales will continue and profits grow. Contrast this to the idea of producing and marketing vaccines, usually a one-time-only products, and you can see why investment in vaccines doesn't make much financial sense. And when much of the vaccine-preventable disease burden is concentrated in the developing world (i.e. no money), the incentives for vaccine research decline even further.
To take a step in the right direction we need to promote the use of generic drugs (inexpensive reproductions of brand-name drugs once their patent expires) and reign in the practice of pharmacies drastically inflating their cost, as shown here. Additionally, we need to ensure that insurance companies provide incentives to purchase these cheaper generics, such as covering their full cost and only a fraction (or none) of the cost of the more expensive brand name drugs. It has been shown that when given the choice (equal copays for generics and brand-names) consumers will almost always choose the more expensive brand-names, contributing to our inflated health care costs. As for vaccine development and the developing world, that's a problem for another post entirely.
As you can tell by the extreme length of this post, there are a myriad of ways that we can begin to reduce our health care costs in this country, and universal coverage is only the first tiny step forward. These reforms will take years, and even decades, but research into these reforms and new programs to test them are already beginning to occur. It is up to the American public to be as informed about the potential of these ideas as it is about the potency of Viagra.
As much as the pharmaceutical industry is making a killing in this country, its not where the majority of money in the health care system is directed. But its a big part and I'll get to that shortly. Where is most of it going? To doctors! Who'd have thought...
The root problem to a lot of our overspending lies with a payment system called 'fee-for-service'. Essentially this means that for each scan, test, and diagnostic a doctor orders for a patient, they get paid. And in an age where everyone wants every scan performed to rule out the possibility of each infection and cancer known to man, the costs from this type of system really add up. If I was going to give your car a tune-up and went ahead and replaced the windshield, slapped on new tires, and repainted it, in addition to what you would have expected, such as changing your oil, you'd probably be upset when it came time to pay the bill. Well our health care payment system works in much the same way. We don't pay based on health outcomes, we pay based on each step a doctor takes to get us there, whether is forwards, backwards, or sideways.
Now I don't want to seem like I'm accusing all doctors of blatantly profiteering at the expense of their ignorant patients. I certainly feel that in a payment system such as this, there is a certain subtle, unconscious factor regarding profit incentives to consider, but I'd be a really bad psychiatrist, so I'm going skirt that issue. As mentioned before, many patients actually demand such courses of action. We increasingly live in an era where people are more educated about their health through mechanisms such as WebMD, which leads to a lot of self-diagnosis. Patients show up to their doctors offices armed with articles and ideas about what's ailing them before a doctor can even examine them. In this type of climate doctors are obliged to order a plethora of tests due not only to patient demands, but also out of fear that they will be sued if they miss something that an extra test may have discovered. This is what is referred to as 'defensive medicine', and operating under duress and out of fear is no way to practice medicine.
Tort reform (making it harder to sue doctors) is one of the Republicans' few pet issues when it comes to health care, and I have to say that I agree with them on this one for the most part. I think their claims regarding the cost-effect it will have are overblown, but in the long run tort reform will reduce doctor's fears of being sued and assist in the reduction of over-testing patients. This, however, is just one small piece of the puzzle.
First of all, we have too many people showing up to their doctors' offices very sick, as is highlighted in a recent CDC report on patients not receiving or delaying seeking care due to the cost. Lack of insurance coverage is one thing that keeps people from getting regular treatment, so insurance reform will hopefully help to alleviate some of this problem. But even when people are insured we see this problem. A major cause of this is the simple fact that there are far more 'specialists' (surgeons, dermatologists, cardiologists, etc.) than 'general practitioners' (family doctors). Specialists, on the whole, earn a lot more money than physicians, making these jobs more attractive to medical students with large debt loads. But its detrimental effects are twofold: (1) there are fewer physicians to give patients primary, preventative care (i.e. regular check-ups and good health advice) that would keep them from developing conditions requiring specialists, and (2) it creates a very large pool of individuals who stand to profit from people having serious conditions.
Now I'm not saying that specialists want to see patients get sick so they can make money (though for hospital administrators its great business), but it is easy to see that our system is not aligned with our goals. Preventative care is far less expensive than specialized care, such as chemotherapy and surgery. We need to create more incentives for medical students to enter the general practice field and create more incentives for students unwilling to tackle the commitment of medical school to pursue careers as nurse practitioners, who in many states can provide much of the same type of care that a general practice doctor can.
In addition to increasing our focus and incentives for preventative primary care, we need to do a better job of coordinating that care. What will this look like? Doctors will increasingly work in group, rather than private practices. Institutions such as Kaiser Permanente are great examples of this model. Kaiser does everything in-house. They provide the insurance, they own the hospitals, and they contract with a doctors' group that works exclusively with them. They coordinate care and negotiate prices within their own structure to help keep costs reasonable and efficiently track a patient's health.
In terms of changing our payment methods, there are a few ideas floating out there that warrant some examination. 'Fee-for-performance' and 'episode-of-care' are perhaps the most promising. Fee-for-performance is pretty much what it sounds like... namely doctors are not paid per test performed, but based on overall health outcomes. Episode-of-care means that rather than paying for treatment at a hospital, the going home and having a relapse of some sort, and having to go back to the hospital and pay again, you would only pay once for whatever it is that ails you, and if the hospital fails to take care of that properly, they eat the additional cost. These methods obviously incentivize quality care rather than overtesting.
And lastly, I told you we'd get back to the pharmaceutical industry, which accounts for roughly 14% of medical expenditures in the U.S.. Big Pharma is far-and-away the most profitable industry within the Fortune 500 companies. There is a lot of truth to the argument that we in the United States subsidize pharmaceuticals for the rest of the world; there is no government regulation of drug prices and we pay from 50-100% more for the same drugs as they do in other developed nations such as Canada, France, and Britain. Drug companies will regularly point this out and say that unless we can force other countries into higher prices, the rates in the U.S. are necessary to sustain very expensive research & development (R&D) of new drugs. This is true, but what they don't mention is that they spend about twice that much on marketing and promotion of their products, as detailed here.
As with much of the rest of our health care system, the incentives in the drug industry are misaligned. The industry focuses primarily on therapeutic drugs that people will have to take for the rest of their lives to control certain disease states. Even worse, the proportion of designer drugs (like Viagra) continues to rise. People take these sorts of drugs every day, for long periods of time, ensuring that sales will continue and profits grow. Contrast this to the idea of producing and marketing vaccines, usually a one-time-only products, and you can see why investment in vaccines doesn't make much financial sense. And when much of the vaccine-preventable disease burden is concentrated in the developing world (i.e. no money), the incentives for vaccine research decline even further.
To take a step in the right direction we need to promote the use of generic drugs (inexpensive reproductions of brand-name drugs once their patent expires) and reign in the practice of pharmacies drastically inflating their cost, as shown here. Additionally, we need to ensure that insurance companies provide incentives to purchase these cheaper generics, such as covering their full cost and only a fraction (or none) of the cost of the more expensive brand name drugs. It has been shown that when given the choice (equal copays for generics and brand-names) consumers will almost always choose the more expensive brand-names, contributing to our inflated health care costs. As for vaccine development and the developing world, that's a problem for another post entirely.
As you can tell by the extreme length of this post, there are a myriad of ways that we can begin to reduce our health care costs in this country, and universal coverage is only the first tiny step forward. These reforms will take years, and even decades, but research into these reforms and new programs to test them are already beginning to occur. It is up to the American public to be as informed about the potential of these ideas as it is about the potency of Viagra.
Thursday, December 3, 2009
Catharsis
I'm not in a great mood tonight, so when I decided to check Politico's website one more time tonight (I do it several times per day), I was naturally infuriated by the arch-enemy of logic, the one and only Sarah Palin, who has cast her lot in with the 'birther' movement. You can read more here.
"I think the public is still rightfully making it an issue" she says. No, Sarah, you are making it an issue. You are not the public. All the proof you could want is documented here, and as you can tell by the exasperated comments of Hawaii public health officials, this attempt to discredit the President of the United States is pathetic.
Sarah, I say this from the bottom of my heart and with the utmost sincerity... fuck off. I have no problem with those with opposing viewpoints, there are millions and millions of them, and I respect a great many of their viewpoints that are validated by personal experiences, religious convictions, and political theory. You, however, are a distraction to constructive political discourse in our nation, where there is precious little to begin with. You are an ill-informed, self-important bimbo who ought to meet the same fate as those wolves you shoot from helicopters. I pity your family who you have put through hell for your own personal gain and I can only hope that God is as merciful as my fellow Episcopalians like to think he is.
"I think the public is still rightfully making it an issue" she says. No, Sarah, you are making it an issue. You are not the public. All the proof you could want is documented here, and as you can tell by the exasperated comments of Hawaii public health officials, this attempt to discredit the President of the United States is pathetic.
Sarah, I say this from the bottom of my heart and with the utmost sincerity... fuck off. I have no problem with those with opposing viewpoints, there are millions and millions of them, and I respect a great many of their viewpoints that are validated by personal experiences, religious convictions, and political theory. You, however, are a distraction to constructive political discourse in our nation, where there is precious little to begin with. You are an ill-informed, self-important bimbo who ought to meet the same fate as those wolves you shoot from helicopters. I pity your family who you have put through hell for your own personal gain and I can only hope that God is as merciful as my fellow Episcopalians like to think he is.
Monday, November 30, 2009
Glacial Pace
Sen. John Ensign
Yes, in regards to the next two parts of my series on health care reform I'm moving about as fast as Congress, its pitiful really. But they're almost done, so I'll continue pretending that people read this and actually care.
It has been an important day however, so I had to make a few quick notes:
- The Congressional Budget Office released a report saying the Dems' health insurance reform plan would reduce premiums for the majority of people buying insurance on their own (non-employer based) and that little would change in regards to pricing for those getting it through insurers. Not perfect, but certainly a plus for the good guys (i.e. those fighting for health insurance reform... not the Dems as a whole). You can see the CBO's report here or read about it in the devious liberal media.
- John Marcotte's petition to add a proposition called the '2010 California Marriage Protection Act' to California's next voting cycle might sound like more conservative prejudice, but rather its a satirical attempt to ban divorce in California. You can see his website here.
- The Republican party continues to implode and John Ensign refuses to resign over his extra-marital affair for the most noble of reasons. Didn't he demand Clinton resign over the Lewinsky scandal? Oh, yes... yes he did.
- They're all guilty: I've never liked Nancy Pelosi. Add another reason to the list... she spends too much government money on flowers. Follow the link to see more examples of line items released in the quarterly listing of House office expenses.
- And lastly, God obviously blessed this year's Haji (I'm thinking he does that every year, but anyways) as the dreaded massive outbreak of H1N1 that was feared never materialized, with only 5 deaths attributed to the disease. Unfortunately, a new strain of MRSA has emerged with a mortality rate of nearly 50%.
Wednesday, November 25, 2009
UC Berkeley Student Fee Protests!
Wednesday, November 11, 2009
Part I: Health Insurance Reform (Finally!)
Like so many amateur bloggers out there I continually disappoint my imaginary readers by failing to follow up on posts in a timely manner. I'm referring to my intended 3-part series on health care reform that has been delayed due in large part to my starting a new research position and the massive protests here at UC Berkeley (more on all that soon).
So, I promise, its coming... really soon. All of it. Seriously.
In fact, here's Part I: Health Insurance Reform
Please be forewarned, this is not intended to be a up-to-date analysis of the latest House or Senate bill. Those damn things change every other hour as our elected representatives are busy making sure there isn't anything drastic enough in there to upset anyone, ever, about anything. Its like ripping all the teeth out of T-Rex: not nearly as effective, what's he going to do, get you with those gimpy little arms? Ha! Yeah right...
What this is intended to do is review several of the key components to effective health insurance reform that are currently being debated (and a few ignored). The next two posts will focus on what needs to happen once we complete the slow, painful crawl towards passing an insurance reform bill.
So, the big thing about the current proposal is that the Dems, and even some Republicans think we ought to have universal coverage, meaning every legal citizen of the United States should be covered by some sort of health insurance plan. The current proposal going forward is to have individual or employer mandates, basically requiring that people have health insurance by law, much in the same way that most states require that drivers have auto-insurance. An individual mandate would mean that each person is personally responsible for acquiring their own insurance, either through their employer, a private plan, or via government programs like Medicare and Medicaid for those that qualify. An employer mandate would mean that employers must provide health insurance for their employees through one of the aforementioned means, the way many businesses currently do. There would be certain exceptions for small businesses and the like due to the cost-burden that comes with this. Some argue this would stifle growth in an already hurting economy, others say (and its been proven) that over the long-term, at least, the costs are simply passed on to the employees in the form of lower wages.
Depending on the final version of the bill, both employers and individuals who do not have insurance will face fines. The government intends to provide subsidies to businesses in the form of tax breaks so that they can afford to provide insurance to their employees, as well as direct subsidies to individuals in the lower-income brackets who cannot afford insurance on their own. The insurance industry is currently all about this plan, because it adds millions of customers to its base. Much in the same way that hot-dog vendors would be really psyched if the government suddenly passed a law saying everyone had to eat hot dogs, or face a fine.
What the insurance companies do not want to see is the emergence of a public option. This is where much of the contention over the final bill lies. A public option would be an OPTIONAL government-run health insurance plan (like Medicare and Medicaid) that anyone could purchase. It would essentially provide competition to private health insurers and force them to keep their costs low, since the government wouldn't be worried about making profits. Much in the same way that the Post Office competes with companies like FedEx and UPS. This public option would, ideally, be financed by the premiums it charges for its customers. An analysis by the Congressional Budget Office determined the bill passed by the House (H.R. 3962) would actually reduce the federal deficit over 10 years. Of course the Dems have been very strategic about what they put in the bill so the price tag comes out at a politically palatable number, meaning some spending related to health care will likely be passed in separate bills. I'd be more comfortable, at this point anyways, that the entire plan will come out roughly even, give or take a few billion dollars.
I'm not going to make exhaustive arguments about why I think there should be a strong public option, since you can easily find those with a Google search. I will, however, say that major health insurers, on average, spend 16-20% of their budget on overhead (pretty inefficient by most standards) and since 1970 the number of health care administrators in the U.S. (not confined solely to insurance companies, but hospitals and other providers as well) has risen 3000% (yes, three-thousand) while the number of physicians in the U.S. has risen just 200%. Something to think about... I'll delve into that more in the next post.
But anyways, the public option would become part of a 'national insurance exchange' and compete with private insurers. But what in God's name is an insurance exchange? Professor Jacob Hacker of Yale's political science department describes it as such...
"It’s a place where individuals can go and shop for a health plan. Today, large employers can select from a choice of plans that spread risk and reduce administrative costs because of the large work force. But the options available to small employers are much more expensive. And individuals find it very difficult to get coverage. The exchange would make a range of more affordable options, including a public plan, available to individuals and employees of small businesses." The full Q&A with Dr. Hacker regarding the insurance exchange can be found here.
There are also those out there who are communist enough to want to go even further than a public option; they want a single-payer system, such as the British National Health Service (NHS). Essentially this would mean that the government is more or less the sole provider of insurance. This is not a political reality on the national stage, but there are certainly reasonable arguments in favor of this type of system. California is one state where there is considerable momentum behind the idea of a single-payer system. While politicians on the national stage don't want to touch anything this toxic for fear of being labeled a Marxist-Nazi, we may see experiments in this type of system on a state level in the coming decade.
Lastly, making these structural reforms is important, but efforts also need to be made to reduce operating costs of insurance companies (remember the overhead cost thing?). If the government is going to force millions more into the arms of insurance companies, they ought to make sure that all that money is being spent efficiently. The same applies to the government, both to its potential public option, and its current Medicaid and Medicare programs. There are several provisions within the current bill aimed at reforming Medicare and making it more efficient, and while many out there would have your grandmother thinking that Obama is going to destroy Medicare, this is hardly the case.
There you have it folks, health insurance reform. We've taken the first steps, but we're a long way off from acheiving anything. The Senate has to force a bill to the floor to be voted on, and even if something gets passed with the unlikely help of a few key 'centrist' democrats and the ever-agitating Joe Lieberman (just another reason to hate Connecticut), the House-Senate conference committee to hammer out final legislation promises to be a circus in its own right.
Parts 2 & 3 of my health care reform series will be posted by weeks' end... but don't hold me to that.
So, I promise, its coming... really soon. All of it. Seriously.
In fact, here's Part I: Health Insurance Reform
Please be forewarned, this is not intended to be a up-to-date analysis of the latest House or Senate bill. Those damn things change every other hour as our elected representatives are busy making sure there isn't anything drastic enough in there to upset anyone, ever, about anything. Its like ripping all the teeth out of T-Rex: not nearly as effective, what's he going to do, get you with those gimpy little arms? Ha! Yeah right...
What this is intended to do is review several of the key components to effective health insurance reform that are currently being debated (and a few ignored). The next two posts will focus on what needs to happen once we complete the slow, painful crawl towards passing an insurance reform bill.
So, the big thing about the current proposal is that the Dems, and even some Republicans think we ought to have universal coverage, meaning every legal citizen of the United States should be covered by some sort of health insurance plan. The current proposal going forward is to have individual or employer mandates, basically requiring that people have health insurance by law, much in the same way that most states require that drivers have auto-insurance. An individual mandate would mean that each person is personally responsible for acquiring their own insurance, either through their employer, a private plan, or via government programs like Medicare and Medicaid for those that qualify. An employer mandate would mean that employers must provide health insurance for their employees through one of the aforementioned means, the way many businesses currently do. There would be certain exceptions for small businesses and the like due to the cost-burden that comes with this. Some argue this would stifle growth in an already hurting economy, others say (and its been proven) that over the long-term, at least, the costs are simply passed on to the employees in the form of lower wages.
Depending on the final version of the bill, both employers and individuals who do not have insurance will face fines. The government intends to provide subsidies to businesses in the form of tax breaks so that they can afford to provide insurance to their employees, as well as direct subsidies to individuals in the lower-income brackets who cannot afford insurance on their own. The insurance industry is currently all about this plan, because it adds millions of customers to its base. Much in the same way that hot-dog vendors would be really psyched if the government suddenly passed a law saying everyone had to eat hot dogs, or face a fine.
What the insurance companies do not want to see is the emergence of a public option. This is where much of the contention over the final bill lies. A public option would be an OPTIONAL government-run health insurance plan (like Medicare and Medicaid) that anyone could purchase. It would essentially provide competition to private health insurers and force them to keep their costs low, since the government wouldn't be worried about making profits. Much in the same way that the Post Office competes with companies like FedEx and UPS. This public option would, ideally, be financed by the premiums it charges for its customers. An analysis by the Congressional Budget Office determined the bill passed by the House (H.R. 3962) would actually reduce the federal deficit over 10 years. Of course the Dems have been very strategic about what they put in the bill so the price tag comes out at a politically palatable number, meaning some spending related to health care will likely be passed in separate bills. I'd be more comfortable, at this point anyways, that the entire plan will come out roughly even, give or take a few billion dollars.
I'm not going to make exhaustive arguments about why I think there should be a strong public option, since you can easily find those with a Google search. I will, however, say that major health insurers, on average, spend 16-20% of their budget on overhead (pretty inefficient by most standards) and since 1970 the number of health care administrators in the U.S. (not confined solely to insurance companies, but hospitals and other providers as well) has risen 3000% (yes, three-thousand) while the number of physicians in the U.S. has risen just 200%. Something to think about... I'll delve into that more in the next post.
But anyways, the public option would become part of a 'national insurance exchange' and compete with private insurers. But what in God's name is an insurance exchange? Professor Jacob Hacker of Yale's political science department describes it as such...
"It’s a place where individuals can go and shop for a health plan. Today, large employers can select from a choice of plans that spread risk and reduce administrative costs because of the large work force. But the options available to small employers are much more expensive. And individuals find it very difficult to get coverage. The exchange would make a range of more affordable options, including a public plan, available to individuals and employees of small businesses." The full Q&A with Dr. Hacker regarding the insurance exchange can be found here.
There are also those out there who are communist enough to want to go even further than a public option; they want a single-payer system, such as the British National Health Service (NHS). Essentially this would mean that the government is more or less the sole provider of insurance. This is not a political reality on the national stage, but there are certainly reasonable arguments in favor of this type of system. California is one state where there is considerable momentum behind the idea of a single-payer system. While politicians on the national stage don't want to touch anything this toxic for fear of being labeled a Marxist-Nazi, we may see experiments in this type of system on a state level in the coming decade.
Lastly, making these structural reforms is important, but efforts also need to be made to reduce operating costs of insurance companies (remember the overhead cost thing?). If the government is going to force millions more into the arms of insurance companies, they ought to make sure that all that money is being spent efficiently. The same applies to the government, both to its potential public option, and its current Medicaid and Medicare programs. There are several provisions within the current bill aimed at reforming Medicare and making it more efficient, and while many out there would have your grandmother thinking that Obama is going to destroy Medicare, this is hardly the case.
There you have it folks, health insurance reform. We've taken the first steps, but we're a long way off from acheiving anything. The Senate has to force a bill to the floor to be voted on, and even if something gets passed with the unlikely help of a few key 'centrist' democrats and the ever-agitating Joe Lieberman (just another reason to hate Connecticut), the House-Senate conference committee to hammer out final legislation promises to be a circus in its own right.
Parts 2 & 3 of my health care reform series will be posted by weeks' end... but don't hold me to that.
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