Robert Kuttner: The Cure That Dares Not Speak Its Name

[marmar]

via MichaelMoore.com:



March 5th, 2010 8:14 AM
The Cure That Dares Not Speak Its Name

By Robert Kuttner / Huffington Post


In all of the debates about health care reform, one of the stubborn realities is that neither the Obama plan, nor any of the Republican alternatives, will seriously alter the trajectory of relentless cost-escalation in health care. If you look at the Administration's own projections of federal deficits in the next decade and after 2020, virtually all of the alarming growth in deficit spending is Medicare and Medicaid.

And that's only the public part of the health care bill. In 2009, total health care costs increased to 17.3 percent of GDP, with escalating premiums eating into both corporate profits and worker take home pay. The consensus among the usual policy experts is that there is no good solution. The march of technology and demography will just continue to raise health costs.

But you can reach that conclusion only by ignoring how the rest of the club of affluent countries manages to insure everyone for 9 or 10 percent of GDP, and have a healthier and longer-lived population, to boot. They do it, of course, through universal, socialized insurance.

There is no single formula. The Canadians do it with a single payer system for the insurance part, but physicians are private. The Brits have an integrated National Health Service. The Germans achieve near-universal coverage through a system of nonprofit health insurance plans.

What every other nation has in common is that they have taken the commercialism out of their health systems. As a consequence, they can direct health spending to areas of medical need rather than letting the market direct health dollars to areas of greatest profit. And with everyone covered, they can use highly cost-effective strategies for prevention, wellness, and public health. That's how you cover everyone for ten percent of GDP. ...........(more)

The complete piece is at: http://www.michaelmoore.com/words/must-read/cure-dares-not-speak-its-name

[Speck Tater]

1. 31% of every dollar spent on health care is the cost of paperwork.

It used to be one patient paying one doctor for a checkup. Now that same checkup has to support not just one doctor, but a huge office full of staff people, plus a bunch of middle management people at some distant corporate headquarters, plus all the employees of some huge health insurance company.

So instead of contributing the livelihood of one other person, you are contributing to the livelihoods of hundreds of other people. And that doesn't even count the stockholders who expect to be given money for nothing for the rest of their lives.
It's no wonder health care is so expensive. There are too damn many people with their snouts in the same trough, and that trough is your pocket.

[PSPS]

2. Don't forget the CEO bilion dollar bonuses every year and the myriad bribes for congress.

[Lydia Leftcoast]

4. And if you have a high deductible, most of the paperwork is

telling you that you haven't met your deductible yet.

[liberation]

15. 30% is the minimum, the average is closer to 40%... and most of the paperwork is

for denial of service to boot.

So we spend almost half of our health care dollars on the privilege of being denied coverage. Which makes sense, since this is the same country which spends half of its federal revenues on blowing shit up...

[truedelphi]

32. And do not forget, these paper-shuffling executives have been praised by Obama as providing

This nation with valuable service.

He has stopped short of giving them the Presidential Medal of honor, but with the amount of money the CEO's of the major insurers suck out from our pockets, they can dummy up their own award medals!

[valerief]

23. Only a portion of that is giving people jobs (what you call paperwork). A good chunk, I'm sure, is

going to the wealthy.

[CLANG]

24. Yes, and about half of that is used on the paperwork

called "Bonus Checks".

[annabanana]

3. Every single nickle that goes to a stock holder, every damn dime

that winds up in a CEO's pocket, is money that has been taken away from a patient's care.

[kath]

9. +100

[Mithreal]

10. +1

[jtrockville]

29. Seems so obvious, doesn't it?

[BrklynLiberal]

5. K&R

[WillyT]

6. K & R !!!

:kick:

[leftstreet]

7. K&R

[kenny blankenship]

8. What every other nation has in common is that they have taken the commercialism out of their health

This is what all successful systems have in common and it's what I've been saying here for MONTHS.

You MUST take profit seeking out of any intermediaries between care providers and patients.

You MUST remove the profit taking middleman. If he stays, he must be willing to do the job of administering BASIC ESSENTIAL CARE for no profit - just a chance to make money around the margins of the system. And since doing that would kill our bloated health insurance mafia syndicate, THEY SIMPLY HAVE TO DIE ANYWAY.
You can't sugarcoat the cyanide pill; you can't avoid confronting them head on. THEY KNOW WHAT THE STAKES ARE, even if Obama and others in the Delusional Democrat camp don't get it.

Not only is the Middleman's cut something this society CAN NO LONGER AFFORD in its healthcare delivery, it can't be left around in any vestigial form- middlemen NEED for prices to rise to increase their profits. Publicly traded corporations MUST make more profits each year - year over year - or else they implode as going concerns. Every step of the way the Insurance Mafia have out-maneuvered outfoxed and outspent ALL would be reformers, and if they are left alive, prices CANNOT BE CONTAINED.

It's them or us. They have to die.

[liberation]

16. When you realize there are 300 million of us, and a few thousand (at best) Health Insurance execs

and these same execs have gotten order of magnitudes more return and protection from this (and previous) administration, even as a supposedly "health care reform" is being developed. One has to come to the conclusion that "A Government by the people, for the people, by the people" has long been a rather empty slogan at best.

Anyone defending the current (or future) for-profit system, has to be addressed as a person who is willing to put the entitlement to profit by a few thousand people over the health care needs of a few hundred million people.

[maryf]

37. hear, hear!! nt

[HowHasItComeToThis]

26. CALL THEM THE MUDDLEMEN

[upi402]

11. they can direct health spending to areas of medical need rather than letting the market direct healt

:kick:

[SnowCritter]

12. Economic Illusions

I just finished reading the above title by Robert Kuttner and, while it may be a bit dated (it was published in the mid-80s) many of the points are still valid. Quite a bit of economics shaped by political will.

[Alcibiades]

13. Insurance companies claim to keep costs down: they lie

What they care about, for some reason, is their network of "preferred providers." I had a vasectomy last May. The hospital charged $7,900, but, because we have Blue Cross, it was knocked down to $4,900. The BCBS bean counters are happy: they saved $3,000, and the cost of the procedure was waaay cheaper than another pregnancy, so they imagine themselves to be saving money hand over fist.

Then, while looking online for information about my recuperation, I discovered I could have had the thing done at Planned Parenthood for $200, or free if I had a resident do it. Of course, there's no incentive for me to do that, because we had already hit our catastrophic for the year. So I got someone who, on paper at least, is one of the best urologists in the country, who does up to four vasectomies a day. I have no live sperm, and recovered very well, but that may have been the case if I had gone to Planned Parenthood, instead. $5,000 for a 30-minute procedure, and nobody blinked.

[Aaria]

14. We need to get single payer started with a trickle.

We have a HCB that is total crap and seems to be a boon doogle for the Insurance companies. We all will need health care and we also need a jobs bill, so let's tie the two together. There's isn't a company out there that needs a tax break for an employee that they don't need but if we offer them Medicare for their employees and future retires, then we have people taking retirement that otherwise would stay because they need the health care and companies saving money directly. How do we pay for it, easy, we offer them Medicare for half of what they are paying now for their health insurance and workmens comp. Will the price of half of their old insurance bill cover the cost maybe, maybe it'll be too much and after the first year we can make an adjustment.
This is the little hole in the dike because after the first year, all the small businesses will have learned that they can save money with the plan and everyone will want to take advantage of the system.
Then we would have everyone clamoring to get on the system cause it's only fair, if a small business can do it why can't I. Then comes the problem of paying for everyone else. Well after a year we will have a good idea of what it costs per person and can charge people accordingly. Paying for it is the easy part, you won't have to buy health insurance yourself and your family, so part of that money saved can go to your yearly health care bill. The other source of saving for everyone, small and large businesses, and we citizens, ( that should really be used more) is no more liability insurance bills. Look at your car, home or business insurance bill it's right at the top, we won't need it cause if you in a car accident the injuries will be takin care of , you might get your ass sued cause you f'd up but no medical. Hurt on the job, go get fixed up and get yourself back to work.
But, I like my insurance, well keep it, this system will be voluntary. But Medicare sucks, well I've never heard of anyone being booted from the hospital during their operation while being covered by Medicare. There are no fricking death panels with medicare, like at the insurance companies (yea they actually kill people to make all that money).
What about the poor folk? Believe it your already paying for them, so lets give them preventative medical care instead of paying for them after they are waaay sick. An ounce of prevention is worth a pound of cure. Anyone remember that old one? If you make less then X a year your covered.

It took 11 years to get the first Medicare bill passed so it could take a while to cover the rest of us. This election they have to understand that if they were not for single payer they will be replaced with someone who is.

Flame on and eat your veggies.

[Kermitt Gribble]

17. Wish I could rec this 1000 times... n/t

[avaistheone1]

21. I would like to give another 1000 recommendations if I could.

No doubt,Single payer/Medicare for all is the solution.

[SlingBlade]

18. K & R We Progressives Didnt leave the Party

Bernie Sanders
http://sanders.senate.gov /

Dennis Kucinich
http://kucinich.house.gov /

Contact the White House
http://www.whitehouse.gov/contact

Call the White House
[phone]

Call, Write, Fax and E-mail your Representatives, House and Senate
http://www.contactingthecongress.org /

[RoccoR5955]

19. K & R

I have always said that this healthcare, now health insurance bill, is going to be a massive bailout to the insurance companies.

Capitalism is failing folks, and the capitalists are hanging on for dear life.

[Echo In Light]

20. k/r

[Mopar151]

22. What I can tell you

Our hospitals and clinics are on a building boom worthy of a robber baron. Waiting rooms are expansive, and stocked with $300 chairs. Lots of custom woodwork, especially at the orthopaedist's - like you used to see in banks, in the big shot's office. There's a snazzy floating spiral staircase in the new lobby - the one that most visitors and paitents don't use - near the grand piano (no foolin').
Back when we made stuff here, I was a shoprat, and I had to justify capital equipment on ROI. MRI's & automated lab equipment, optioned-out trauma rooms - those I get. But the endless expansion of offices, rooms, clinics, office parks - it's empire building, bleeding off excess cash.

[progressoid]

25. "assuming Democrats have a working majority again in foreseeable future"

"Win or lose, the next great push should be for single-payer, assuming Democrats have a working majority again in foreseeable future. Given the collateral damage of Obama's strategy, that could be a long time coming."



Too true.

[SanchoPanza]

27. I generally don't disagree with Kuttner on much.

But there are some things that he's not being putting into the equation.

There are pretty substantial transitional costs (in terms of both economic and political capital) related to a massive restructuring of how we pay for medical care. Yes, in the long term, a national health insurance program on the level of Canada's MediCare or France's Securite Sociale is less expensive. But both systems were implemented incrementally, followed a fairly massive realignment of national spending priorities (both systems, and most others, emerged following WWII), and were created at a time when health insurance was a very limited sector of their respective economies. Not merely in terms of %GDP, but in terms of how many people actually had health insurance. Further, even the most comprehensive Single Payer systems in the world have a private supplemental insurance market, and in quite a few cases these markets are very profitable.

There is a credible argument, which Obama has made repeatedly in the form of "If I had to do it from scratch...", that the complexity of health systems increasing over time makes such large-scale changes cost-prohibitive. In other words, some people may like the idea of putting every single private insurer out of business (which likely won't happen anyway), but the practical effect would be a lot of short-term harm. Politically, that's an incredibly difficult item to sell. It's not simply the power of the insurance lobby, its that people will get skittish when you tell them that the insurer they currently have will be replaced by a government agency they know little about. That's a fear that is ripe for exploitation.

The second is that not all private insurance is necessarily for-profit, and this is largely determined by how insurance is regulated at the state level, especially pertaining to the individual market. Minnesota has strict Medical Loss Ratios, Vermont has community rating and guaranteed issue, Hawaii has a very strict employer mandate, Massachusetts has a hydra that incorporates a lot of each, etc. The states with more aggressive regulations generally have better support for non-profits and, as a result, a higher percentage of its population with good insurance. States like Texas and California have no appreciable regulation over insurance companies operating in the individual market, and it's no surprise that Anthem dominates the individual markets in these states.

What does this mean? Two things. The first is that the goal of HCR is to essentially help states like Texas and California become more like Vermont and Minnesota. The 45 million uninsured are not evenly dispersed across the country; in fact most are in the SW and South. The second, and I certainly can't speak for everyone, is that, at least to me, there is very little difference in getting a good deal from the government and getting a good deal from a non-profit. The problem with the status quo is that, unless you live in certain states, you don't get either of those. There is no government program, and there aren't multiple non-profits to chose from.

Single Payer may be "simpler" and better, but this kind of approach gets us toward a social insurance model incrementally. Not in terms of "making the legislation better," but in terms of setting up a framework wherein people gradually shift from employer-based insurance to large-scale risk pools that will be there whether you decide to change jobs or lose your job. That the current system(s) don't allow for that is, in my opinion, the biggest problem. And one that generally leaves people in other countries really puzzled, whether they like their Single Payer system or not.

[DeSwiss]

28. Another truth:

- It would help if we stopped poisoning ourselves. Not to mention the rest of the world.


K&R

[Faryn Balyncd]

30. K&R...Our 1st order of business is to DEFEAT a no-public-option MANDATE, which will destroy us.

:hi:


:kick:

[colsohlibgal]

31. Dead On

Keep the insurance companies ; just get rid of the profit directive outside paying secretaries and bookkeepers and bosses that don't make anywhere near 10 million dollars or even close to a million - and no stockholders expecting the stock to rise. In other words like it used to be here when health care was affordable. Have the government just regulate.

Moyers the other night showed a graphic the other day that showed that there were 39 Well Point executives who made a million or more a year, some of them much more than a million. It's obscene. How many chemo treatments could 9-10 million dollars pay for? How much lower could premiums be? That was the yearly salary of the Well Point CEO and doesn't even take into account the other 38 and the 25 million dollars of resort property they had purchased.

[democrank]

33. K & R

Other nations "have taken commercialism out of their health care systems." Time we did the same.

[amborin]

34. K&R

[Tsiyu]

35. Our "leaders" here in America

get elected by corporations and serve those corporations. We "voters" are merely a nuisance.

Congress - including the pathetic losers from my own state of Tennessee - are greedy, bottom-feeding, gluttonous (sp?) scumbags who enjoy the HELL out of their own health care plan at the same time they run their mouths telling the taxpayer he or she doesn't DESERVE such a nice plan.

They make me sick. You have no idea how angry and bitter I am toward "leaders" who grab all they can for themselves on the backs of those they "lead."

True leadership means you take care of the needs of your subordinates before you worry about your own needs.

THERE IS NO TRUE LEADERSHIP IN AMERICAN POLITICS TODAY.

[PATRICK]

36. Extreme dysfunction

makes single payer and draconic measures not only palatable but even necessary. If our system hadn't been so bad and sane reform so repressed the options and painful progress to incremental reform seen in other countries would be the first step.

But no. Thanks to enormous murderous, nation killing greed of the insurance scam the public option/single payer plans are economical wonders in comparison- a fact that the blatantly unwilling Dems never want to put forward too much- as if the pill to cure the cancer is more expensive than catastrophe and the political boon of actually saving the electorate's lives. The party(minus the progressives being marginalized out of the insane reform process) seems to be actively seeking to make taxpayer giveaways(damn the cost to us) to all manner of big business with no expectation of anything but token service. Now even with my union health plan I can fear for that, my unisured children, my union, my job and just about anything else because of the terrible form health insurance reform is taking.

Aminng other consistent policies since the grand surrender of 2000 when even moderate liberalism was trashed or never defended by supposed Dem leadership.

The irony is if there was another third party or defections in this horror of a political system it usually would come from the unprincipled corporatists and nut jobs in both parties. It seems often that the blue dogs want to make it safer for themselves to switch to DINOs from RINOs in making sure neither party stands for the people.

The blithering ignorance, arrogance and policies of the otherwise lazy Grover Cleveland seem to mirror where all the rest of the party, tearing their hair out at the sidelines, is going to end up except there are no, none, zippo, competent or safe GOP Gilded Age monarchs to hand it off to and expect anyone to survive.