Most accounts I've seen have Oregon Senior Senator Ron Wyden playing coy on the public option, suggesting that he might or might not support it. I've had a difficult time figuring out what exactly Wyden's position is on the matter, but he did seem to take a small step towards, "standing in the way [of the public option]," as he said he wouldn't when he signed a letter along with major health care reform roadblocks such as Ben Nelson, Mary Landrieu, Susan Collins, and Olympia Snowe urging a delay in the reform effort. That letter allowed for the push to slow to a halt leading into the August recesses, that allowed the anti-reform brigades time to organize and present their fake populist outcry against health care reform.
I'm not sure what Wyden's position is precisely here, beyond that he understandably likes his own bill. When it was first drafted a couple of years ago Wyden's bill was an excellent roadmap for what passable health care reform might look like given the slim Democratic majority of 2006, with of all people Robert Bennett of Utah as its cosponsor. The thing that's odd about this whole thing, however, is that Wyden won the argument before it began, his Healthy Americans Act was the first coherent presentation that I'm aware of, of the "health care exchange" model that forms the basis of the Senate HELP Committee bill, the House Education and Labor Committee bill, and the Obama outline plan. There are only two major differences that I'm aware of:
1) to Wyden's credit, his bill seems to advance insurance portability a little bit more effectively than the health care exchanges presented in the House and;
2) Wyden's bill contains no public option
Clearly the second is the more contentious issue, oddly given that a public option advances the goal of health care portability more effectively than anything else in the insurance exchanges that are presented in the bills that have been passed out of committee. This is very strange, given that its the first difference that Wyden's bill is more effective on, there may also be some very specific cost-containment measures in Wyden's bill that don't exist in other bills, but many of those could easily be added in by amendment. That the public option has become the point of contention with Wyden is very strange, since a well organized public option that assumes Medicare providers will participate in the public plan, ties reimbursement rates to Medicare rates, and allows for drug price bargaining by Medicare and the Public Option would provide tremendous downward pressure on private health care costs.
Back when he introduced it, Wyden's plan was a good outline for bipartison, effective health care reform that promoted universal coverage. Since that time however, it has become obvious that the goal of the Republican Party on many issues is to block the Democratic majority from any accomplishments, this was apparent from the stimulus debate and from Republican repositioning on the once bipartison Employee Free Choice Act, as well as to block any health care reform. This is part of why the debate has had nothing to do with the actual proposals, with half the debate being about Canada and Britain (solutions that are not being proposed by anyone with power) and the other half being about blatant lies and distortions. While Wyden's proposal could pick up Republican support in 2007 I seriously doubt that it could today. Nonetheless I'm not opposed to having a vote on Wyden's plan, but his waffling on a public option is just plain bizzarre, as Jacob Hacker (linked in previous paragraph) argues compellingly, Wyden's plan too would benefit from a public option. Its time for Wyden to stop playing whatever game he's playing here and get on board with the public option, its hard enough to pass health care reform over the objections of conservative Republicans, they don't need help from progressive Democrats.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Monday, August 24, 2009
Tuesday, January 23, 2007
Cwechblug State of the Union Response
First, excellent Democratic rebuttal by Sen. Webb. There were a few things in the State of the Union that struck me as interesting, bad ideas, or idiotic. First, I was surprised at how little substance there was in this State of the Union. Very few coherent policy objectives, and a lot of fluffy nice sounding rhetoric. The few things that he did propose left me perplexed however. Why did Bush propose the National Guard?
If anyone can tell the difference between what he proposes in this section of the speech and the National Guard, please tell me, because I am still perplexed about why Bush proposed the National Guard tonight.
Moving on to Health Care. This is quite possibly one of the worst ideas I've ever heard. The following is what Bush proposed tonight in regards to health care.
There's been much debate about the problems with Wyden's plan, namely that it doesnt do enough to contain costs. But this is truly rediculous. If you make health care costs tax deductable and do nothing else, you merely give insurance companies the ability to charge any amount of money at public expense. Rather than contain costs as we need to do, insurance premiums would drive straight through the roof. Because once everyone has the ability to deduct health care costs from their taxes, insurance companies will have a huge market available to them for which there is no demand curve. There is nothing to contain costs of insurance. People by health care at price 1, deducting their entire premium from their income taxes, insurance companies raise prices because they can make more money, cost 2 is now far higher than cost one. Consumer purchases health care at cost 2 and deducts it from their taxes. It is a giant Federal gift to insurance companies that seems limitless. I'm also wondering about people who have so little income that they dont pay anything in taxes. Are they going to recieve money back from the government to cover their health care costs. This may be universal, but its a monumentally bad idea.
The proposal to give a Federal grant to encourage States to "find innovative ways to provide private health insurance to their citizens." This is really a way to prevent States from going single-payer on their own and stop the movement at the State level where it is beginning to take shape. This is not encouraging States to come up with innovative new policies, it is limiting them to a narrow set of policy options that are more likely to fail than single-payer. The specification of private insurance here is important.
Finally, Bush once more proposed health savings accounts, which have the fundamental flaw of assuming that health care is a normal consumer item. If I want a banana, I know that a banana is what I need and I can shop at a place in which I can get a good price for a banana. Health care isnt like this at all. If I need an MRI, the only way I know that I need an MRI is that the doctor who is going to make money through the process told me I need an MRI. I cant make the rational consumer choice that I dont really need an MRI, if I choose not to get one I run considerable personal health risks. The money in a health savings account would be limited, so if I develope a major health problem I might run out of money in the account and end up paying out of pocket. Not to mention the question of what one does if they dont have any money to put in the health savings account to begin with. So that's three bad ideas in health care by my count.
Bush also engaged in a little bit of Ron Saxton style rhetoric, claiming that we're going to keep medicare healthy, expand the war in Iraq, cut taxes, create a new National Guard (huh?), and balance the budget. A friend of mine commented "We're raiding Canada," and as near as I can tell that's the only way to do it. We're not going to cut programs, we're going to cut taxes, and balance the budget. It all sounds nice but cant be taken seriously, I guess Saxton's magic "inefficiences" have returned.
A second task we can take on together is to design and establish a volunteer Civilian Reserve Corps. Such a corps would function much like our military reserve. It would ease the burden on the Armed Forces by allowing us to hire civilians with critical skills to serve on missions abroad when America needs them. And it would give people across America who do not wear the uniform a chance to serve in the defining struggle of our time.
If anyone can tell the difference between what he proposes in this section of the speech and the National Guard, please tell me, because I am still perplexed about why Bush proposed the National Guard tonight.
Moving on to Health Care. This is quite possibly one of the worst ideas I've ever heard. The following is what Bush proposed tonight in regards to health care.
For Americans who now purchase health insurance on their own, my proposal would mean a substantial tax savings — $4,500 for a family of four making $60,000 a year. And for the millions of other Americans who have no health insurance at all, this deduction would help put a basic private health insurance plan within their reach. Changing the tax code is a vital and necessary step to making health care affordable for more Americans.
My second proposal is to help the States that are coming up with innovative ways to cover the uninsured. States that make basic private health insurance available to all their citizens should receive Federal funds to help them provide this coverage to the poor and the sick. I have asked the Secretary of Health and Human Services to work with Congress to take existing Federal funds and use them to create “Affordable Choices” grants. These grants would give our Nation’s Governors more money and more flexibility to get private health insurance to those most in need.
There's been much debate about the problems with Wyden's plan, namely that it doesnt do enough to contain costs. But this is truly rediculous. If you make health care costs tax deductable and do nothing else, you merely give insurance companies the ability to charge any amount of money at public expense. Rather than contain costs as we need to do, insurance premiums would drive straight through the roof. Because once everyone has the ability to deduct health care costs from their taxes, insurance companies will have a huge market available to them for which there is no demand curve. There is nothing to contain costs of insurance. People by health care at price 1, deducting their entire premium from their income taxes, insurance companies raise prices because they can make more money, cost 2 is now far higher than cost one. Consumer purchases health care at cost 2 and deducts it from their taxes. It is a giant Federal gift to insurance companies that seems limitless. I'm also wondering about people who have so little income that they dont pay anything in taxes. Are they going to recieve money back from the government to cover their health care costs. This may be universal, but its a monumentally bad idea.
The proposal to give a Federal grant to encourage States to "find innovative ways to provide private health insurance to their citizens." This is really a way to prevent States from going single-payer on their own and stop the movement at the State level where it is beginning to take shape. This is not encouraging States to come up with innovative new policies, it is limiting them to a narrow set of policy options that are more likely to fail than single-payer. The specification of private insurance here is important.
Finally, Bush once more proposed health savings accounts, which have the fundamental flaw of assuming that health care is a normal consumer item. If I want a banana, I know that a banana is what I need and I can shop at a place in which I can get a good price for a banana. Health care isnt like this at all. If I need an MRI, the only way I know that I need an MRI is that the doctor who is going to make money through the process told me I need an MRI. I cant make the rational consumer choice that I dont really need an MRI, if I choose not to get one I run considerable personal health risks. The money in a health savings account would be limited, so if I develope a major health problem I might run out of money in the account and end up paying out of pocket. Not to mention the question of what one does if they dont have any money to put in the health savings account to begin with. So that's three bad ideas in health care by my count.
Bush also engaged in a little bit of Ron Saxton style rhetoric, claiming that we're going to keep medicare healthy, expand the war in Iraq, cut taxes, create a new National Guard (huh?), and balance the budget. A friend of mine commented "We're raiding Canada," and as near as I can tell that's the only way to do it. We're not going to cut programs, we're going to cut taxes, and balance the budget. It all sounds nice but cant be taken seriously, I guess Saxton's magic "inefficiences" have returned.
Thursday, January 18, 2007
Oregon Takes a Lead on Health Care
While California gets most of the press for Health Care reform, Oregon seems to be moving forward with plans to dramatically restructure the State's health care system. And unlike in California it has a chance of passing in Oregon (California has some screwed up laws on budgetary matters allowing a minority to easily block the legislation). The debate is beginning in Oregon, and not just on the topic of whether universal health care is the best policy (it is), but rather about exactly what plan is best to do that, good serious proposals are being made and sent into committee in the Oregon Legislature, there seems to be a growing consensus that something needs to be done and that the health care system as it is today is unsustainable. Former Governor John Kitzhaber is leading this charge with the Archimedes movement.
Its a shame Kitzhaber appears to have no plans to challenge Gordon Smith for the Senate seat in 2 years, but it does little good to dwell on that. What Kitzhaber recognizes that Ron Wyden doesnt is the section I put in bold from the Oregonian article. Wyden seems to think that we cant effectively control the costs but we can ensure access to health care for all. This concedes ground in the debate that doesnt need to be conceded, one of the most compelling reasons for health care reform is the runaway cost of care in the current system. Massachussetts, Vermont, and Hawaii have all drastically reformed their health care systems, if California and Oregon do it too then perhaps the US Congress will begin to really take this issue seriously and do something about a broken system. The Oregonian piece also mentioned that Kulongoski is backing a bill to guarantee coverage for all children, and if we're going to take baby steps toward this thing that's certainly admirable, but it fails to deal with the larger health care crisis in the State and the country choosing instead of focus on select social groups while ignoring the larger problems. If a universal plan cannot get through the legislature than Kulongoski's plan to cover all children would be nice, but if we can make health care in this State more efficient and change its fundamental structure we should.
Former Gov. John Kitzhaber rolled out a bold legislative plan for overhauling Oregon's health care system Wednesday, hoping to leverage a national debate on health care reform that will spread to the 2008 presidential race.
"The health care system today is unsustainable," he said. "It is remarkable we are utterly unable to change our direction."
The plan would pool roughly $7 billion from employer tax deductions for health care and from state and federal tax money spent on Medicare and Medicaid in Oregon. The pool then would be spent in a more efficient and rational system that would provide a "core benefit" of essential health services to every Oregonian, including the 609,000 who now have no health insurance, said Kitzhaber, a former emergency-room doctor, during a news conference in downtown Portland.
...
Kitzhaber's bill will go to the Senate Special Committee on Health Reform, said the Democratic co-chairs, Sen. Alan Bates of Ashland, and Sen. Ben Westlund of Bend. The committee will consider Kitzhaber's plan along with at least three other health reform plans: one developed by a Senate commission led by Bates and Westlund and others from the Oregon Business Council and the Oregon Health Policy Commission.
"What is most significant and shows the true depth of this (health care) crisis is the number of groups that have come together to propose solutions," Westlund said.
...
No plan will work if it does not contain costs, Kitzhaber said.
Like other plans before the Legislature, his would seek administrative efficiencies, include incentives to keep costs low and the quality of service high, and would guarantee Oregonians health care no matter where they work.
Its a shame Kitzhaber appears to have no plans to challenge Gordon Smith for the Senate seat in 2 years, but it does little good to dwell on that. What Kitzhaber recognizes that Ron Wyden doesnt is the section I put in bold from the Oregonian article. Wyden seems to think that we cant effectively control the costs but we can ensure access to health care for all. This concedes ground in the debate that doesnt need to be conceded, one of the most compelling reasons for health care reform is the runaway cost of care in the current system. Massachussetts, Vermont, and Hawaii have all drastically reformed their health care systems, if California and Oregon do it too then perhaps the US Congress will begin to really take this issue seriously and do something about a broken system. The Oregonian piece also mentioned that Kulongoski is backing a bill to guarantee coverage for all children, and if we're going to take baby steps toward this thing that's certainly admirable, but it fails to deal with the larger health care crisis in the State and the country choosing instead of focus on select social groups while ignoring the larger problems. If a universal plan cannot get through the legislature than Kulongoski's plan to cover all children would be nice, but if we can make health care in this State more efficient and change its fundamental structure we should.
Friday, January 05, 2007
Patience My Friends
The health care debate seems to have picked up steam since Ron Wyden introduced a plan for universal health care a few weeks ago. Today, Paul Krugman wayed in on what needs to be done in the short term.
It seems to me that the calls for a national single payer health care program have been getting much louder the last few weeks, which is good. I agree with Krugman however, and have articulated this before (though perhaps not on this blog). In terms of necessity the time for this is absolutely now, today in a perfect world we should institute national health insurance. However, the institutional standing of our country at this moment does not lend itself to this possibility. Before we can institute such a program, Democrats absolutely have to control the executive branch. If we push too hard, too fast for national health insurance without controlling the executive branch we risk losing the argument at a time when there was never any possibility of passage. Bush cannot hold the veto pen when we pass such a program. That's why I believe Krugman is correct here, ultimately we need national health insurance, but in the meantime we cannot possibly get it signed into law today, so we should chip arround the edges of American health care to make some good positive changes for people that we can get passed into law.
Universal health care, much as we need it, won't happen until there's a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.
...
What should Congress do? The new Democratic majority is poised to reduce drug prices by allowing -- and, probably, requiring -- Medicare to negotiate prices on behalf of the private drug plans. But it should go further, and force Medicare to offer direct drug coverage that competes on a financially fair basis with the private plans. And it should end the subsidy to Medicare Advantage, forcing H.M.O.'s to engage in fair competition with traditional Medicare.
Conservatives will fight fiercely against these moves. They say they believe in competition -- but they're against competition that might show the public sector doing a better job than the private sector. Progressives should support these moves for the same reason. Ending the subsidies to middlemen, in addition to saving a lot of money, would point the way to broader health care reform.
It seems to me that the calls for a national single payer health care program have been getting much louder the last few weeks, which is good. I agree with Krugman however, and have articulated this before (though perhaps not on this blog). In terms of necessity the time for this is absolutely now, today in a perfect world we should institute national health insurance. However, the institutional standing of our country at this moment does not lend itself to this possibility. Before we can institute such a program, Democrats absolutely have to control the executive branch. If we push too hard, too fast for national health insurance without controlling the executive branch we risk losing the argument at a time when there was never any possibility of passage. Bush cannot hold the veto pen when we pass such a program. That's why I believe Krugman is correct here, ultimately we need national health insurance, but in the meantime we cannot possibly get it signed into law today, so we should chip arround the edges of American health care to make some good positive changes for people that we can get passed into law.
Monday, January 01, 2007
General 2007 Discussion
Without looking arround very specifically I'm sure nearly every blogger in the universe is doing something similar to this, but I retired for the last week and need to get back in the game, and it strikes me as a good idea to get the first post of 2007 off my chest. This is just a general, uninsightful, semi-meaningless discussion of what awaits us in the coming year.
Iraq
About 5 American soldiers a day have been dying recently, and it sure seems like every day we find a pile of 50 bodies somewhere in Iraq of the recently murdered. A recent informal panel of academics assembled at 12:10 AM today seemed only able to conclude that its a total mess. Josh Marshall has a good observation, as it seems all there are regarding Iraq are good observations and no good solutions.
economy
Paul Krugman recently argued that when economists cant agree on which way the indicators are pointing we're probably shifting directions. At the very least it seems we're at risk of a significant downturn. That said, things are looking up for working people relative to how things have been for the last 6 years as Democrats seem prepared to increase the minimum wage, pass an expansion in workers rights to unionize, and to examine possible solutions to the health care crisis.
sports
USC will defeat Michigan today. The PAC 10 will send Arizona, UCLA, UW, Oregon, and Washington State to the NCAA tournament in basketball. I have no clue who will win the World Series except to say that Detroit looks good again and that Santana and Liriano are one hell of a 1-2 punch. The Mariners will finish with roughly a 0.500 record as they produce runs and Felix Hernandez begins to look like a top pitcher, however a lack of depth in the pitching staff creates too many problems for them to be a real contender.
Oregon
The Democratic Legislature will allow Kulongoski to accomplish something, a nice change from his previous term. It looks like Kulongoski is preparing an aggressive agenda on health care and gay rights, hopefully a coalition can be built to pass some meaningful legislation in these areas among others. The State will enact a plan to build a bypass road arround Dundee, they will toll both the bypass and 99W. Consequently revolution will break out in Dundee requiring the Oregon National Guard to quell the chaos. Unfortunately the Oregon National Guard is in Iraq and unavailable.
Russia
Putin will confirm the trend that Russia is currently headed on by declaring himself Czar after inviting the entire Duma to a buffet of polonium laced food. Its ok though because Bush looked into his soul.
Presidential Candidates
Barack Obama will decide not to run for President, towards the end of the year the primary campaigns for 2008 will be kicked into full gear. The Democratic field will include Kucinich, Hillary, Edwards, Biden, Vilsac, and Richardson. The Republican field will include Newt, St McCain, Huckabee, Brownback, and Romney. I wont comment in this post on who either Party will nominate because that happens in 2008.
Iraq
About 5 American soldiers a day have been dying recently, and it sure seems like every day we find a pile of 50 bodies somewhere in Iraq of the recently murdered. A recent informal panel of academics assembled at 12:10 AM today seemed only able to conclude that its a total mess. Josh Marshall has a good observation, as it seems all there are regarding Iraq are good observations and no good solutions.
If you watch the video of the moments leading up to Saddam Hussein's execution, am I wrong that it bears a certain resemblance to the terrorist snuff films we've watched out of Iraq over the last three years? A dark, dank room. The executioners wear not uniforms of any sort, either civilian or military, but street clothes and ski masks. We now learn that the executioners were apparently taken from the population of southern Iraq, the country's Shi'a heartland, where Saddam's repression was most severe. And in an apt symbolic statement on what the Iraq War is about, two of the executioners who saw Saddam off started hailing Moktada al Sadr in Saddam's face as they prepared to hang him. Remember, al Sadr's Mahdi Army is the force the 'surge' of new US troops is meant to crush next year. That's where we are.
economy
Paul Krugman recently argued that when economists cant agree on which way the indicators are pointing we're probably shifting directions. At the very least it seems we're at risk of a significant downturn. That said, things are looking up for working people relative to how things have been for the last 6 years as Democrats seem prepared to increase the minimum wage, pass an expansion in workers rights to unionize, and to examine possible solutions to the health care crisis.
sports
USC will defeat Michigan today. The PAC 10 will send Arizona, UCLA, UW, Oregon, and Washington State to the NCAA tournament in basketball. I have no clue who will win the World Series except to say that Detroit looks good again and that Santana and Liriano are one hell of a 1-2 punch. The Mariners will finish with roughly a 0.500 record as they produce runs and Felix Hernandez begins to look like a top pitcher, however a lack of depth in the pitching staff creates too many problems for them to be a real contender.
Oregon
The Democratic Legislature will allow Kulongoski to accomplish something, a nice change from his previous term. It looks like Kulongoski is preparing an aggressive agenda on health care and gay rights, hopefully a coalition can be built to pass some meaningful legislation in these areas among others. The State will enact a plan to build a bypass road arround Dundee, they will toll both the bypass and 99W. Consequently revolution will break out in Dundee requiring the Oregon National Guard to quell the chaos. Unfortunately the Oregon National Guard is in Iraq and unavailable.
Russia
Putin will confirm the trend that Russia is currently headed on by declaring himself Czar after inviting the entire Duma to a buffet of polonium laced food. Its ok though because Bush looked into his soul.
Presidential Candidates
Barack Obama will decide not to run for President, towards the end of the year the primary campaigns for 2008 will be kicked into full gear. The Democratic field will include Kucinich, Hillary, Edwards, Biden, Vilsac, and Richardson. The Republican field will include Newt, St McCain, Huckabee, Brownback, and Romney. I wont comment in this post on who either Party will nominate because that happens in 2008.
Saturday, December 09, 2006
Oregon on the Road to Universal Health Care
An Oregon State Senate panel yesterday backed a proposal for Universal Health Care in which individuals and employers would contribute to a pool which all residents of Oregon would be granted access to. Private insurance companies would then compete for the ability to cover the people paid into the pool.
I'm still skeptical that universal health care can really succeed on a State level, but when the Federal Government fails to act, States like Oregon, Hawaii, Massachussetts, and Vermont have no choice but to act. I look forward to seeing how this works out if it passes, but this is definately a step in the right direction.
The commission's draft bill lacks crucial details, such as costs, but it does outline a broad proposal for dramatically changing how Oregonians would buy and receive health care.
"We are trying to do something that has not been done in this state or this country before," said Sen. Ben Westlund, an independent from Bend who co-chairs the Senate Interim Commission on Health Care Access and Affordability. "All eyes are once again on Oregon."
Commission leaders, who met Friday in Wilsonville, say the plan would give every Oregonian a health card that could be used to buy a complete health care package -- including dental, mental health and vision coverage -- for less than most businesses and individuals now pay.
In addition to the goal of expanding access, the plan includes features to control costs and improve quality. The same three goals for comprehensive reform are being pursued by the Oregon Health Policy Commission, the Oregon Business Council and former Gov. John Kitzhaber's Archimedes Movement.
...
The Senate commission's plan would require all employers and individuals to contribute money to a common pool called the Oregon Health Care Trust Fund. Residents who earn less than 250 percent of the poverty level would not have to pay to be in the plan. The fund also would include public employee and federal Medicaid contributions.
...
The plan would collect money, possibly a payroll tax, from businesses. Large companies with self-insurance plans would have their contributions reimbursed.
An 11-member Health Care Trust Fund Commission or board, appointed by the governor, would adopt regulations and administer the trust. Businesses and individuals could choose health plans, which would be paid through the trust with rates set by the trust commission.
The Senate group decided that the trust commission should function like a corporate board, with an executive director and staff. Much of the debate Friday was over who should be represented on the board.
The plan would cover all Oregonians, including the more than 600,000 who now lack health insurance. Individuals who choose not to participate in the plan would lose their personal state income tax deduction. All participants would be required to write an advance directive, describing the level of care they would want at the end of life.
The directive is one of many features in the plan designed to contain costs and improve quality. Insurers, for example, would compete for health-card holders. The state also would increase competition by requiring hospitals and doctors to reveal their charges and costs.
I'm still skeptical that universal health care can really succeed on a State level, but when the Federal Government fails to act, States like Oregon, Hawaii, Massachussetts, and Vermont have no choice but to act. I look forward to seeing how this works out if it passes, but this is definately a step in the right direction.
Subscribe to:
Posts (Atom)
Posts
