Anticipated attacks on health care reform

[eridani]

The New York Times
http://www.nytimes.com/2011/01/07/opinion/07brooks.html?ref=opinion

Over all, there is a strong likelihood that the current health care law will face an existential threat over the next five years. Each party should be preparing contingency plans.

After the trauma of the last two years, many people wish the issue would go away. But it?s not going away, especially since costs will continue to rise.

When the crisis comes, Democrats will face an interesting choice ? to patch the Obama system or try to replace it with something bigger. The administration may want a patch, but by a ratio of nearly 2 to 1, according to a CNN poll, Democratic voters would prefer a more ambitious law. Liberals could logically say that the mistake was trying to create a hybrid system, rather than moving straight to a single-payer one.

The Wall Street Journal
ObamaCare Repeal: GOP Should Be Careful What It Wishes For
http://online.wsj.com/article/SB10001424052748704723104576062350518299650.html

Nonetheless, there's a great irony in the Republican assault. The federal government wouldn't be nearly as vulnerable to these political and legal obstacles had the health-care law been built upon the framework of Social Security or Medicare ? public insurance financed by payroll taxes? as many Democrats had initially urged. Not only are these programs enormously popular--"Don't take away my Medicare!" was a rallying cry among some conservative populists during the debates over the health-care law--but they also rest on a more widely accepted relationship among the individual, the government and the market.

Americans are accustomed to paying for public insurance through their payroll taxes. Such payments aren't viewed as federal mandates that encroach upon individual freedoms, or as payoffs to private companies likely to make even more money from mandatory purchases of their products, but as well-deserved entitlements.

Set against this background, the current Republican attack on mandatory coverage is curious because it raises the essential question of how society would otherwise spread health-care risks. If successful--either in Congress or in the courts--a Republican victory could turn into a Pyrrhic one by opening the way to the alternative model, based on the system Americans seem to prefer: payroll taxes and public insurance.

Comment by Don McCanne of PNHP: Above are yet two more examples of a common theme. Conservative New York Times columnist David Brooks and liberal Berkeley Professor Robert Reich both imply that the opposition to the government mandate to purchase expensive private health plans may drive us to a much more logical and effective solution for financing health care: single payer (public insurance financed by taxes).

If so many individuals across the political spectrum believe that single payer is likely the inevitable outcome then why aren't we taking a more serious look at it right now, before people are dragged, screaming and kicking, and then locked into the private insurance exchanges?

Carrying the metaphor further, their screaming should die down by the time they are transferred to the paupers' prisons.

Metaphors are often used to appeal to the emotions. In this instance, it certainly isn't humor. There is nothing funny about a government mandate that forces you to buy an overpriced private insurance product that takes away your choices in health care.

So which emotion? Depression? Anger? Rage? We have just seen once again the potential for tragic consequences of the latter. Please. Let's fix our health care financing system before we're all in a rage.


My comment: Health Care for All--WA has adopted the following title for all of our presentations this year--Push for What We Want; Defend What We Have.

[maryf]

1. k&r

[BzaDem]

2. Actually, no one "across the political spectrum" thinks single payer is going to happen, let alone

David Brooks. Brooks is clearly stating what liberals would say, not that he thinks it is something greater than a pipe dream for them.

The truth is, it would be a huge feat for single payer to get a double digit number of votes in the Senate. Sanders at one point said it would probably get around 5. Let alone the House, which will probably be redistricted into Republican control for a decade. (Remember, we needed a 40 seat majority just to pass what we did pass.)

If this bill is repealed or struck down, the result will simply be that insurance companies will once again be able to discriminate on the basis of pre-existing conditions, and it will likely remain that way for a very long time. After all, there was no huge groundswell for healthcare reform in the first place. A vast supermajority of the insured were satisfied with what they have. This is true regardless of the fact that they should not have been satisfied, and regardless of the fact that many were satisfied out of ignorance of their policies. It doesn't matter the reason. That level of satisfaction with the pre-HCR status quo is not the stuff of movements (let alone movements for single payer).

[eridani]

3. True, the biggest problem with mobilizing a constituency for health care reform

--is that most people will never get expensively sick. They are "satisfied" with their insurance for the same reason they are "satisfied" with their fire extinguishers--and are not ever likely to have a clue about whether either will be there for them in an emergency.

Single payer will likely come if a couple of states can implement it. After all, doctors went on strike in Saskatchewan when single payer was implemented there. They kept their yaps firmly shut after the first year, in which their incomes went up by 30%. Didn't take long for the other dominos to follow afterwards.

[BzaDem]

4. I'm not sure it would work similarly in the US if done only by a few states, given how easy it is

for doctors to move to other states and differences between Canada and the US. I hope for the best for Vermont and others who try to implement it though.

[MedicalAdmin]

5. Whaaaaaat?!!????

So Canadian doctors can't move? Gosh, it must be horrible to live in a socialist totalitarian state like
Red Canada.

On reflection, given how bad it is up there, what with low debt, no sub prime meltdown, high employment, etc. the USA needs to build a fence asap before the icebacks flood our borders and start taking our jobs, flooding our ERs, attending our great schools, mooching off our generous welfare, and raping our daughters. Damn you Red Canada.

[eridani]

6. Doctors are going to want to move IN to Vermont

Their overhead and the total amount of hassle both decrease by a great deal.

[BzaDem]

7. That will be way outweighed by their reduction in annual income.

The truth is, we can't afford the rate of medical cost increase. And despite some posts on this board, most of that increase does not come from insurance companies (though some certainly does) or "hassle." By far, most comes from essentially unbounded increases to providers. (That's why Medicare growth is 2-3 times inflation, despite being a single-payer system for those 65 and over)

Just like doctors make far less in Canada and other countries than they do in the US, they will ultimately make less in Vermont than they do in non-single-payer states. The reduction in "hassle" (while great) is a red herring compared to the reductions in their income. These reductions are ultimately needed if the US is to avoid going bankrupt -- but we shouldn't pretend these large reductions won't happen in a single payer system (or even in a system like Switzerland/the Netherlands/Singapore). Price controls on medical care (either direct or in the form of single payer) exist everywhere except the US.

[eridani]

8. I actually talked to a Canadian doctor who worked awhile in Idaho to make more money

He said that his net income was not all that much larger than in Alberta. He left Idaho in disgust after seeing more leg amputations for diabetics in 5 years there than he had ever seen in Alberta over a much longer career.

Guess what? If you pay $85 to take out a kid's infected tooth, you save the $750K that was spent after it went septic--and the kid died anyway.

[BzaDem]

9. One doctor does not show the aggregate. The point is that we NEED provider costs to go WAY down

or the country will go bankrupt. Healthcare costs in general now are rising around 3 times inflation, while tax revenues (and most everything else) rises at inflation. That isn't sustainable as a simple math problem. Our costs are much higher than basically every other country, and that needs to change. Obviously this doesn't mean every single doctor will see significant reductions, but on average they will under a single payer system (or any other system we end up implementing to avoid bankruptcy).

[Cleita]

10. I've run into a few Canadians who when they

see the reality of our health system, suddenly realize that they have it pretty good.