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Mike Dennison interviews Ezra Klein

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Blogger: Health care reform coalition faces tough battle

Q: Baucus has said a government single-payer or Medicare-for-all system of universal coverage is not an option for reform. Shouldn't a single-payer system be considered?

Klein: There is a very strong intellectual case for single-payer. But if Max Baucus woke up tomorrow and said, “It's on the table,” that's not going to make it any more likely to pass. It's not going to happen now. You couldn't pass a single-payer system. You just can't. What we found in 1994 was, when politicians say, “We're going to take what you have now away, and you can trust the federal government to do this now” - that scares the hell out of people. Whatever is going to happen this year, for single-payer the case has not been made. It's still a longer-range campaign. The question is, can (Congress) even stick their neck out far on (other reforms)?

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Submitted by lambert on

trying to make it happen. Fortunately, conventional wisdom is almost never wrong.

UPDATE I just left a comment there thanking Ezra for sharing his insider perspective and advocating single payer. Go thou and do likewise -- no registration required.

Submitted by gob on

Because it's crummy, overpriced, untrustworthy individual health "insurance". Yes, I want the Federal government to do this now.

1994 was a long time ago. Things have changed. Maybe we can change too! Yes we can.

Submitted by jawbone on

they'll just lose most of their customers. But if they want a niche market of customers wealthy enough to bleed sufficiently for their execs' humongous compensation packages, let them try to keep it! They can probably offer some coverage for cosmetic surgery, for example.

Just don't tell the rest of us that we must supply the monies for Big Insurance execs' uberwealthy lifestyles.

Doesn't Ezra realize that private doctors exist in the British system? In Canada? (Where one of them let a dying man, well, die in the waiting room? Thank you, Hipparchia, for this post.)

Now, if it were the German approach, where private insurers do supply the health insurance, but are essentially nonprofit managers, making a decent living but not getting into the uberwealthy group, that might work as well. However, we've had long experience with nonprofits "working" the system for wealth creation of some individual upper level managers.

I think reading Ezra's comments will not be good for my blood pressure....

Submitted by Paul_Lukasiak on

From the linked article...

Klein, an associate editor for news-and-opinion weekly The American Prospect, profiled Baucus last fall. He'll be joining the Washington Post as a blogger next month.

and if he need any more evidence that he's put self-promotion ahead of effective and appropriate health care reform, his new gig at Pravda on the Potomac should put to rest any question of what Klein has really been working toward....

Submitted by Paul_Lukasiak on

I was appalled by this exchange....

Q: What are the important items we'll see in congressional Democrats' proposals?

Klein: A real effort to modernize and rationalize the system, such as payment reform. Doctors now get paid for doing more to you. The marginal incentives in the system are toward doing more, in ways that aren't always useful and are always expensive. We're seeing a lot of ineffective treatment happening out there. That is where the system wants to find its changes. Will it? That's anyone's guess.

Klein is on board with an even greater emphasis on denying treatment to people who need it.... and this is the guy that progressives think is an expert on health care?

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Submitted by a little night ... on

of a certain point of view (heavily represented among Obama's advisors, as I understand it): that medical costs are high primarily because of too many unnecessary procedures being performed, and they are performed because of these "perverse incentives" and because we don't have electronic medical records.

I have never seen a link or reference to any actual empirical evidence supporting this view, and now I'm curious. (I don't believe it, but I'm starting to wonder why, apart from philosophical bent, they do.)

Submitted by hipparchia on

the dartmouth atlas project, which is waaaaay cool, but the takeaway message that people, especially the conservadems, just love about it is that it 'proves' -- using medicare billing data [not actual treatment data] -- that 1) we use too much health care, and 2) our old people especially are using too much health care.

i have other objections to the research besides that one. the humble [and so far, frustrating] project i've been working on for ages now is to prove both of those wrong, or at least wrong enough that we should NOT be basing our national health policy decisions on it. a tough job for one lone blogger slogging through stuff on the internet for a few weeks to find enough to counteract 20+ years of research done by a team of phd and md scientists and all their lackeys.

meanwhile here's one of my earlier comments about the dartmouth atlas, and here's an exchange that gqm and i had on using electronic records in medical research [in which i also reference the dartmouth atlas].

Submitted by lambert on

OK, take the study as read -- that wide regional variations in the provision of care without concomitant health care outcomes mean there's excess cost to be wrung from the system:

1. What does this have to do with the single payer, and/or the existence, or non-existence, of the insurance companies? Nothing at all. For that judgment to be made, they would have had to study private systems as well, which they do not.

2. Wouldn't a single payer system make it easier to solve the putative problems that the study points to, now that they are recognized?

On another note, Hipparchia, this looks like it needs to be addressed.

Submitted by hipparchia on

you could look at it in one of 3 ways:

1. people in high-spending areas get too much health care, and the others get the right amount, or

2. people in low-spending areas don't get enough health care, and the others get the right amount, or

3. the spending patterns roughly reflect the actual medical needs of the population, people in low-spending areas spend less money because, as a population, they're healthier.

i lean towards a variation of the third explanation, in part because many of the high-spending areas have more poverty [much more poverty in some areas], and in part because maps of areas with higher cancer rates correspond roughly [though not perfectly] with the dartmouth-generated maps of higher spending. there are some other variables too, but i haven't looked at them in much detail yet.

1. What does this have to do with the single payer, and/or the existence, or non-existence, of the insurance companies? Nothing at all. For that judgment to be made, they would have had to study private systems as well, which they do not.

zackly. without comparing the medicare [single payer] data to private insurance data, we don't actually know that private insurance is better [my thesis: it's far worse, but i'm still working on that].

2. Wouldn't a single payer system make it easier to solve the putative problems that the study points to, now that they are recognized?

doubleplusgoodponybingo! yep, this is why we can see all the flaws in canada's system -- all their data is public. unlike ours, where the insurance companies hide their data [legally, i would add].

short answer to your other issue is that many of those doctors are dropping medicare advantage [part c] patients because of the costs and hassles, but keeping their traditional medicare patients. medicare advantage is the privatized portion of medicare. there were a couple of good articles in the south florida papers on this some time back, i'll see if i can find them.

Submitted by lambert on

Registration is not required at The Missoulian. I wrote:

I think it's great to have Ezra giving us the Washington insider's perspective on what can and can't pass.

But surely the real issue is GETTING PEOPLE HEALTH CARE, not cost?

As it turns out, with a single payer, "Medicare for All" model of "everybody in, and nobody out" not only do we save $350 billion dollars -- since the administrative overhead is 3%, not 30%, as with the private insurance companies -- we can more to more preventive care and save lives too.

I think it makes sense to be pragmatic about solutiions, and leave the politics aside. Single payer works in other countries, so why experiment with other solutions, and fail, like Massachusetts did?

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Submitted by DCblogger on

was the clear contrast of Versailles vs the rest of the country, here is Dennison asking the questions about the real problems of his readers and there is Klein spouting Versailles talking points. I was embarrassed for Klein.