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The problem with Obama's health care reform strategery

DCblogger's picture

Time to play the single-payer card

Many prominent progressives like Paul Krugman and Jacob Hacker have argued that the public option is the key to the whole reform process. The public option will constrain the rapacious insurance companies. The public option will be popular and efficient. The public option will be, at its best, a slippery slope to a single-payer plan. Never mind that critics have pointed out that if the public plan is enacted, the insurance companies will find ways to game the system again. Never mind that the Right has recognized the slippery slope argument, and that is why they are so adamantly against it.

This calls for an obvious change in the Democrats’ strategy. Up to now they have tried hard to keep the voices for single payer out of the debate. They have reassured the Republicans that single payer isn’t even “on the table.” If they want to have a chance to get the public option through Congress, it’s time for a new strategy. Time to play the single-payer card.

Purely from a strategic perspective, the president should put single payer back on the table and start explaining to the people all the advantages of Medicare for All. Then, when the going gets tough in the trenches of Congress, they can compromise and settle for the public option, and a muscular enough public option that it could serve as a model (a slippery slope) for an eventual single-payer system.

Of course, maybe once the single-payer cat is out of the bag, the weight of logic and public support will just push the insurance gang right out of the way.

Never forget our fall back position, no federal solution that precludes states from instituting their own single payer option.

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Submitted by DCblogger on

I was just about to remind everyone. Shall we do a Frontline open thread tonight? It is on at 10 PM in DC.

Submitted by jawbone on

thread? A bit of a problem having different broadcast times, tho'.

NewsHour had segment on about college student who developed problem requriing $1000 worth of prescriptions each month, and, of course, lost his parent's coverage when he graduated. Couldn't find coverage at rate he could afford, so put off grad school to work at Menard's which offered excellent insurance.

Now, he faces downsizing due to the poor economy....

Submitted by jawbone on

mother, for the baby's respiratory problems. Close to $1M. But couple insured by good insurance provided by Microsoft. No cost to employees for the insurance. MS rep says having full insurance aids productivity.

Then look at small businesses and their problems. Heh. One of their staff had $1M babies/pregnancy. Company's insurer raised costs by 78%. Switched companies.

Then follows laid off worker. Guy downsized at 58; didn't take COBRA. $758/month too high and thot wld find different job quickly.... Turned down for individual coverage due to diabetes. Had heart attack while not covered. Sold house and possessions and declared bankruptcy. Moved to IN to live in mother's house; too young for Medicare, too "well off" for Medicaid. He's got two more years for Medicare, then can get heart operation he needs.

CEO of Kaiser is uninsurable in private market, as is lobbyist for Big Insurance. Holy shit!

Now Menard kid's story. $200/month for company insurance.

Prof. Karen Pollitz: "Job lock"-staying in job for insurance. "Slob lock"-staying in marriage for insurance.

Goes into "consumer directed health plans"- cheap enough for almost anyone. Cover woman who left job to take care of mother with Alzheimer's. $7500 deductible; plus 40% of any hospital bills. She had to have an appendectomy; now needs cataract surgery. Waiting until first bills paid off.

Now, the "you think you're covered" crap. Woman took COBRA after husband's death; then went into Blue Cross individual plan. Told broker she'd had breast cancer in 1996; he said only had to go back 10 years. Ha.

Further cancer--operation. Blue Cross rescinded policy; nothing covered. $160,000+. No check of her records until after she'd been diagnosed with the new cancer--she'd had some spotting, which her doctors told her meant nothing since all the tests came back negative.

LATimes reporter Lisa Giran (sp?) has covered recission by Big Insurance. Blue Cross has entire division devoted to investigating rescissions. HealthNet paid bonuses for find reasons for recissions. State went after insurers; some rescinded the rescissions.

Prof. Pollitz: Paying claims labeled "losses" by insurers.

"Guaranteed issues" being required by some states. But some people will not buy insurance, until they need it. Guy at 51 had heart attack--95% blockage. No insurance company would cover him--needs heart meds for life, about $350/month. Premiums soared. Only NY, NJ*, ME, VT, MA. Premium 3x higher than other states, where insurers can cherry pick.

*NJ--Is that why my premium just went up to over $20K/ year? Bcz I'm in NJ?

Sad story of young woman with lupus. In 2001 she had to move back home to TN bcz lupus worsened. Parents couldn't afford her costs. Her lupus could have been controlled, but she was uninsurable and couldn't afford meds and care. Then she got TennCare, but then TN cut back on coverage. She appealed, but was denied. $900K for 26 operations to clean out dead tissue on organs. !0 days after she died, she was told by TennCare she had been mistakenly removed from its coverage. OMG. Her doc says she died of complications of failing health system.

Karen Ignanni, the health insurer lobbyist, is scary. She talks about necessity of covering all. Everyone just has to buy the insurance.... Emphasis on "buy."

Focus on MA couple with children, both parents self-employed. Mandate to buy; cut rate plans not allowed. MA head of plan says MA now has lowest rate of uninsureds.

Still cldn't afford insurance--$11-12K per month. Family of four earning under $60K got help; this family earned $63K. At that income, deemed capable of paying $800 to $1000 per month. But the guideles said they should only have to pay $352/month, but no insurer offered such a plan.

Prof. Uwe Reinhardt--Billing complexity eats at least 24% of each healthcare dollar.

Now, the insurance execs go into scare tactic of rationing.

March 5 healthcare summit, where Obama invited all 'stakeholders." Docs and hospitals, insurers, pols., consumers. No mention that single payer advocates were not invited and had to fight to get in in very small numbers (3, right?).

Thanks a lot, Frontline, for leaving out that important information. Hell's bells.

Submitted by hipparchia on

i'll have to eventually make time to watch it, but i didn't have that luxury tonight.

i like frontline's sick around the world, and have used it as a resource, a lot, but when they talk about how other countries pay for healthcare, those that use 'private' insurance, frontline never quite tells us that there's a huge difference between their private insurance and our private insurance. so yeah, good resource, good on them for doing this, but not quite good enough.

as for mass, they already had one of the lowest rates of uninsured in the country, if not the lowest, before they instituted their deform reform.

*NJ--Is that why my premium just went up to over $20K/ year? Bcz I'm in NJ?

maybe had some part to play, nj is an expensive state for healthcare. probably though, it's mostly because you had the audacity to actually need your insurance.

Submitted by jawbone on

I was a bit disappointed in Sick Around America. Just came across a post at the PNHP site which says the same thing, but explains worse.

Mark Almberg writes:

...filmmaker Jon Palfreman, who also directed the first documentary, concentrates on telling dramatic patient stories that illustrate the utter failure of the present private-insurance-based system. But he offers little in the way of what to do about it.

To the extent that any reform proposal is cited as a possible pathway for change, it is the flawed, mandates-based Massachusetts model. While some of the serious problems of that faltering model are pointed out, viewers are nonetheless left with the impression that mandates may be the way to go. That’s certainly the point made by Karen Ignagni, president of America’s Health Insurance Plans, who makes multiple appearances in the film.

He also offers some comments from the Frontline comments section. I think I'll mosey on over there and offer my 2 cents worth. I think they need a link to Lambert's post about the WH blog censorship, don't you?

One example of the comments:

Thank you, Frontline, for your inspiring programs first on health care around the world and now on health care in the U.S. We should draw three conclusions:

1. As Dr. Delbanco stated so eloquently, the first step is to provide health care to everyone. Only then, and at the same time, should we tackle the problems of cost and quality. If we wait to expand health coverage until we have succeeded in curtailing costs, we will wait forever and acquiesce in the suffering of those without access to the care they need.

2. If we truly want everyone to have health insurance, we need to provide it to them, i.e. to make signing up as automatic and easy as possible. Mandates to purchase health insurance are inefficient, expensive, incomplete, and unnecessary.

3. To make universal health care as efficient and inexpensive as possible, we need to institute a single payer system, i.e. to eliminate the hassle imposed on patients and providers by the private insurance system and eliminate the waste of health care dollars in marketing, claims processing, administrative salaries, and profits. The models are the single payer bills introduced by Representative Conyers in the House and by Senator Sanders in the Senate.

Thank you again, Frontline, for teaching us these lessons.

Paul Sorum, M.D.
Schenectady, N.Y.

Thank you, Dr. Sorum. And Dr. Delbanco.

Submitted by hipparchia on

I think they need a link to Lambert's post about the WH blog censorship, don't you?

i think that's a fine idea.

i followed your link to the comments... here's a reply from the frontline editors --

FRONTLINE's editors respond:

Many viewers have written criticizing this report for not looking at solutions, in particular, a single payer system. Certainly, the topic is another important piece of any examination into the health care system and how it can be improved. And it would warrant a separate program of its own. We would like to point out that we did examine how the single payer system works in many European countries in our program last season, Sick Around the World. You can view this online.We believe that our report this week, Sick Around America, was equally of value in focusing on our current private health insurance system and showing how many Americans are only one or two events away from financial disaster or total ruin because they can't afford this insurance, or because it offers inadequate coverage, or because it suddenly can be rescinded by the insurer for alleged omissions or errors. We also felt it important in this report to look at another major problem with the private insurance system: America's for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.

way cool. single payer advocates are speaking up in all the venues that they can find. this is a good thing.

Submitted by jawbone on

go together. Well, at least healthcare for everyone and humongous profits don't go together. Very subtle! And, yes, it was there, but could be easily missed by those who don't know a lot about the whole healthcare system.

We also felt it important in this report to look at another major problem with the private insurance system: America's for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.

Submitted by hipparchia on

hr 676 isn't just a single payer bill [so many of its detractors and doubters keep spouting this], it's also got provisions to convert all the hospitals, etc to non-profit [just like those evil canadians!]

so yeah, they need to do a program on hr 676 [not just a program on single payer] because conyers' bill would rein in the profit motives on both the provider side and the payer side of the equation.