Blue Mass Group

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Kennedy’s ofc: Health care is “first, second, and third” item on agenda

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In case you thought he might be taking it easy (as would be his right) — Ted Kennedy has been meeting and strategizing with advocates and interest groups, and will make Obama's health care plan the absolute first priority of his committee.

 Nov. 6 (Bloomberg) — Senator Edward Kennedy's staff is holding regular meetings with interest groups to translate President-elect Barack Obama's health-care plan into legislation that can be passed by Congress, an aide said.

Kennedy, a Massachusetts Democrat, will take his “cues from the Obama White House'' and expects that Congress will act on a measure in Obama's first term, said Michael Myers, staff director of Kennedy's Health, Education, Labor and Pensions Committee, at a conference today in Washington.

…

“The question is no longer whether we will pursue health reform, but when and exactly in what form,'' said Myers, speaking at a forum organized by the Washington policy group Families USA. “It's the first, second and third item on our committee's agenda.''

There have been suggestions — even from progressive quarters — that Obama forego health care reform, either because it would require too much money in a recession, or too much “political capital” for a president's first year. I think both of these ideas are silly and wrong.

As for the money: Reforming health care is not like buying a big TV — something to be invested in when the livin' is easy and margins are fat. It's more like making the payment to the retirement fund — paying for a major, permanent investment. If a health care law is intended as a permanent fixture, what sense does it make to say we can't make the investment now? What do we say in 2058 — “Well, we had that opportunity in 2009, but we were too cheap. Too bad.”

Furthermore, a recession is a time when people will actually need the security that health care reform will offer. When did we pass Social Security? Oh right, the Great Depression.

As for “political capital” being expended … let's remember that no such thing actually exists. Either the President and Congress are doing things the public wants done, or they're not. People elect Democrats because they want Democratic stuff to get done. Health care was plainly a big part of the national discussion this year. If the Dems don't deliver, then they'll have some explaining to do to the people who sent them to do a job.

Elections have consequences — or should that only be true when Republicans are elected?

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  1. My only addition is that I hope a provision for an optional government medicare-for-all is allowed, so at the very least we can institute some real competition and, with any luck, lay the ground work for single-payer or something pretty close to it (like Germany’s system).  

  2. We spend more of our money on health care for less result than any other developed country. National reform should yield better value for money. That makes it especially compelling during a time of economic difficulty.  

    • I have often pondered that the best system to transition to to minimize transition pain would be something similar to the public/private competition system in Germany.  Going straight to single payer will have a devastating effect on a huge job sector (private insurance).

      • it would infuse a staggeringly large amount of money into every other field in the private sector, since it would relieve private employers of the burden of paying their employees’ health insurance.  Surely that would open up a few jobs.

        • … is likely to be substantial.  I remember someone mentioning a conversation they had with a small business owner who was complaining about taxes.  Asked if he hired anybody with the money he saved with the latest tax cut, he replied that he bought a boat instead.

          <

          p>Maybe if we can tackle CEO pay at the same time. đŸ˜‰

    • … there are ‘reform’ ideas out there that wouldn’t save a dime because they do nothing to fix the structural characteristics of our system that result in ever-increasing costs.

      • MA Blue Cross and Blue Shield along with the other large insurers and their corporate partners like Jack Connors and Jim Mongan made sure that the MA PLan did not attempt any meaningful structural reform of the health care system (btw these insurers all enjoy tax exempt status as “public charities”).

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        p>The MA mandated insurance plan simply pours more public money into a highly dysfunctional, horribly expensive and obscenely wasteful system and the plan was built on the concept of publicly subsidized coverage that results in enforced poverty for many.  The plan’s employer “fair share” contribution is worse than a joke; it’s a slap in the face. The fact that the MA law did not set any care-share ratios to limit insurance companies’ admin. and advertising spending is a punch in the face. Why aren’t legislators making noise about this?…just follow the money trail and you’ll find your answer.

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        p>Check out http://www.healthcareforameric… for smart positioning to advance meaningful national reform.

        • Looking around their site, I can’t find anywhere where they advocate a specific remedy.  Is that on purpose or am I missing something?  I assume you have some specifics on what you consider ‘smart positioning’ and ‘meaningful national reform’.

          <

          p>I think the MA system has many problems, but I suspect it’s biggest is one of scale and that it still relies too much on the private system.  Mandates are very useful because they are a necessary structural component to spreading risk, which is how insurance operates most cost effectively.  Indeed, single payer can be thought of as a mandate to buy from a single provider (presumably the Gov’t) through taxes.  Of course the nature in which one implements a mandate (on either side of the equation… insurers and consumers) can be mis-handled resulting in many problems, as could be argued has happened in MA.

          • and there’s been a bill to achieve such reform before the MA Lege for over a decade; here’s the link to Senate Bill 703
            http://masscare.org/ma-single-…

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            p>Re my remarks on ‘smart positioning’ and ‘meaningful national reform’, yes, I have specifics in mind, many of which I’ve articulated at length on BMG over the past couple of years but not so much lately. Here’s link to many of these thoughts if you’re interested
            http://vps28478.inmotionhosting.com/~bluema24/userD…

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            p>I’ve been feeling somewhat burned out and beat up from 20 or so years of being an outspoken activist for fundamental health system reform while also working as a nurse in our dysfunctional health care system that often hurts people while ripping us all off royally.  

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            p>I’m weary of watching the “reform process” (Ha!) so closely that I see the moneyed interests routinely buying off most of the “advocacy” groups and then witness those same groups cave and not fight for the reform principles they say they’re all about. Add to that getting grief from the “pure single payer” crowd for my belief that there are opportunities worth fighting for to achieve far-reaching reforms in the financing and delivery system that are not exactly single payer all at once but will go a long way in the right direction.

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            p>The MA Plan has us going in the wrong direction b/c it further treats health care as an insurance commodity to be bought and sold in the marketplace by the individual, rather than treating it as a human service and a public good that we as a civilized society have a responsibility to guarantee for everyone with an equitable and streamlined financing mechanism. Yes, single payer is a type of mandate but not an individual mandate. An important distinction is it’s goal to guarantee care for all, not to mandate the purchase of a crappy product by the individual.

            <

            p>For more on the “smart positioning” to advance reform see http://www.HerndonAlliance.org

          • Somehow I recalled my comment included state-level advocacy for reform but I see, that, in fact, it was about national reform.  Oops (the perils of late night blogging after getting the kids to bed, etc…)

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            p>You’re right, the coalition that I linked to, Health Care For America Now http://www.healthcareforameric… , intentionally does not lead with an explicit policy solution. This is being done to deny the insurance industry a bullseye at which to aim their attack ads.

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            p>Despite not leading with a policy solution, there is a health reform policy proposal that most of the coalition partners are willing to support and to fight for; it’s “Health care for America, a proposal for guaranteed, affordable health care for all Americans building on Medicare and employment-based insurance” by Jacob S. Hacker of the Economic Policy Institute. Here’s link to the policy http://www.sharedprosperity.or…

            <

            p>And here’s a link to Ezra Klein’s thoughts on the Hacker Plan
            http://www.prospect.org/csnc/b…

            <

            p>As I alluded to in my earlier comment, the advocacy work of HCFANow, using the Herndon Alliance messaging, to create the necessary political space–including the public demand–to advance the Hacker Plan is “smart positioning to advance meaningful national reform”.

            • … the Hacker Plan.  I haven’t fully decided about it yet.  In some ways it just adds a new system to compete with private systems.  The only real mandate is for employers to offer it.  Not sure if that, by itself, is enough to avoid the risk to the risk pool of users opting out. I have to get serious and read it in more detail one of these days.    

          • How Universal Health Care Changes Everything
            By Sara Robinson, October 28th, 2008
            http://www.ourfuture.org/blog-…

            … Creating a long-term 21st-century progressive renaissance depends on our ability to bring these same lessons home to a whole new generation in the most vivid and unforgettable way possible. Guaranteed health care will do that. It has the potential to become the catalyst for a new season of American progressivism that could last another 40 years.

            This notion is no secret to conservatives, who figured out 15 years ago that universal health coverage could well become their undoing. In the heat of the 1993 debate over the proposed Clinton health care plan, Bill Kristol wrote a famous strategy memo in which he argued that “passage of the Clinton health care plan in any form would be disastrous. It would guarantee an unprecedented federal intrusion into the American economy. Its success would signal the rebirth of centralized welfare-state policy at the very moment that such policy is being perceived as a failure in other areas.”

            Conservatives are already acutely aware that if we get health care that works, they’re going to be shut out of power and out of the conversation for decades to come. They also know that, come January, they may find themselves too weak to put up a fight.

            Presidential candidate Barack Obama knows it, too, which is why he’s made universal health care a central part of his agenda. If he succeeds, I think people are going to be surprised at the depth and speed of the resulting leftward shift in American values. Seeing the government deliver such an essential and powerful good to so many people will permanently discredit many of the most fundamental assumptions of the conservative worldview-and in doing so, will make it much, much harder for the cons to ever make themselves politically relevant again.

            There’s nothing else that will do so much for so many so quickly-and, at the same time, lay down the sturdy foundation for a long, strong progressive future.

            read the full post and comments (28 and counting) at:
            http://www.ourfuture.org/blog-…

            <

            p>btw CAF (Campaign for America’s Future) was shopping around the Hacker Plan to all the Dem Prez Campaigns 18 months ago and CAF is a leading group in the HCFANow! coalition. I’ve gotten to know CAF’s HC staff at coaltion meetings in DC over the past 3 years and I believe they are pushing the Hacker Plan hard b/c it has strong potential to get the country firmly on track to a real national health program akin to Medicare-for-All.  And HCFANow!’s national campaign director is Richard Kirsch of US Action NY who wrote one of the best critiques of the MA Chapter 58 legislation, aka the MA Mandate Plan, exposing it as fake “reform”. The title of Kirsch’s 2006 piece is “If Wishes Were Horses”.

            <

            p>P.S. Mr. Lynne, thanks for the great FDR quote about “Now make me do it.”–last year I finally got time to read Doris Kern-Goodwin’s bio on the Roosevelts and that “Now go out make me do it” story really stuck with me!  

    • I believe Obama has already identified $15B in savings that are currently being skimmed in the Medicare Advantage plans, so that is $15B that could be used for health care instead.  That should be the first step in reform.

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      p>Collectively we spend about $2.2T per year on health care, although those costs are spread around so that no one entity bears the entire burden.  And with the spreading of the costs come administrative fees and profits each step of the way.  Centralizing the costs will make the elephant in the room more obvious, but would most certainly be more efficient.

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      p>I suggest we do away with the children’s health care program, and add them to the Medicare program as the second step in reform.  

  3. … another thread:

    <

    p>Ezra:

    <

    p>

    The following chart tracks the budget deficit as it’s projected to grow over the next 50 years. The blue line — that’s the one shooting up — is what we expect our deficit to actually look like. Those other lines, the one’s going down (and down means no budget deficit, but instead a surplus), show what would happen if our health spending were equivalent to that of other rich nations like Japan, Germany, and Canada. The difference is stark:

    <

    p>And its not the ‘entitlement’ programs that are bankrupting us, it’s a structural deficiency in our overall health care system that results in ever-rising costs.

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    p>More Ezra:

    <

    p>

    Then there is Medicare. Medicare is a trickier problem. Because it’s not the problem: The American health care system is. As Henry Aaron, the centrist Brookings health care expert has testified, our fiscal threats “derive entirely from projected increases in national health care spending, not from problems peculiar to government health care or entitlement spending.” As such, “materially slowing the growth of Medicare and Medicaid apart from general health system reform is impossible.” In other words: Raising the eligibility age or cutting benefits does not solve the problem. It does not solve the problem for the private sector, of course, but it does not solve the problem for the public sector, either. The problem is driven by rapid growth in health care costs. If you do not arrest that growth — in both the public and private sectors — and you instead raise the eligibility age for Medicare, you will just have to do it again. And again. And again.

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    p>In other words… the Concord Coalition approach isn’t going to help.  What’s required is structural reform.  The kind of reform that is likely to be very disruptive and costly in the short term.  But if we don’t invest, we’ll be looking at the complete collapse of confidence in treasuries.

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    p>Honestly, if Obama did absolutely nothing with his mandate but fix this one issue, he still will have done a great service to our country for countless generations to come.

    • Somebody find me a couple of pie charts.

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      p>1.  Of every dollar spent on US health care, where’s it go?
      * admin
      * billing
      * doctors salary
      * nurses salary
      * infrastructure
      * disposable medical instruments
      * drugs

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      p>whatever.  I have no idea how it breaks down, but I’d love to see.  Then, let’s have a look at the same pie chart for

      <

      p>2.  Germany
      3.  Canada
      4.  France
      etc.

      <

      p>We all agree that it’s too expensive — but what part of it is too expensive?  I know this is the gajillion dollar question, but nobody ever seems to answer it.

      • … is ‘the whole system of insurance’.  The problem is a structural one, non a problem limited to a few fixable components.  

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        p>That being said, there are certainly places where we can improve dollar efficiency, but addressing those without the addressing the structural root of the problem only ‘makes the patient more comfortable while we wait for the inevitable’.  It is striking, however, how much ‘extra dollars’ don’t necessarily lead to better outcomes:

        <

        p>

        The next graph is one of the most famous and powerful in contemporary health policy. It comes from the Dartmouth Atlas Project which graphs Medicare spending against care quality:

        See a relationship? Yeah, me neither. But it’s easy to see how much we’re spending for unnecessary care. The same data manifests in studies of patient outcomes: Above some base level, more treatment does not make us immortal. It does not even make us healthier. It’s useless. But medicine is not a data driven profession. Doctors prescribe what they think will work. And what they think will work is informed by a well-meaning but often inchoate mixture of evidence, half-remembered studies, things they’ve heard, economic incentives, lawsuit concerns, etc. That’s not their fault: No single human being can keep up with something as complex as 21st century medicine. Which is why the sector needs to be relying on modern health information technology that incorporates tremendous amounts of data on not only cost-effectiveness, but simple effectiveness.

        <

        p>I like the idea of compiling the statistics you cite as well, of course.

        <

        p>More on the structural problems:
        here,
        and here.

        • These data are misleading because health policy science and tools lack a readily identified and agreed-upon definition for how “Administration costs/spending” are calculated. I don’t know how other countries deal with this but would be interested to know.

          <

          p>The fact that the U.S. lacks a universally agreed-upon definition for admin. costs makes the 7% slice in this or any other pie chart close to meaningless, plus it hides admin. costs that exist in the other categories.  The layers of bureaucracy in the insurance industry force the creation of parallel layers of bureaucracy in each of the other pie slice categories. This is a HUGE issue that the insurance industry fervently doesn’t want addressed.

          <

          p>There was a study commissioned by the Lege by the LECG group that tracked every dollar in MA health care spending. It concluded that total admin. spending costs in all categories totaled a whopping 39% of all health care spending. The Lege released the reports’ findings in late 2002 between Christmas and New Year, to get maximum media coverage and public attention on the issue, of course.

          <

          p>The state took the LECG report offline but it’s available here
          http://masscare.org/ma-single-…

  4. … will also gett into the health care fight:

    <

    p>

    Later in the conversation, I mention to Baucus that some health reformers believe that the only way Democrats will ever pass health reform is to wall the process off from minority obstruction — in particular, from the filibuster. The way to do that would be to invoke the budget-reconciliation process, which allows legislation dealing primarily with the health of the federal coffers to be fast-tracked through 20 hours of debate and passed with a simple majority. The Clintons hoped to do this in 1994 but were blocked by Sen. Robert Byrd, the self-appointed guardian of the process. Bill Clinton has said that his gravest error in that battle was not recognizing what a blow he’d been dealt when he was denied access to reconciliation.

    But there’s fair evidence that Byrd couldn’t stop reconciliation now. Moreover, Congress in the Bush years normalized the procedure, using it for everything from tax cuts to drilling in the Alaska National Wildlife Refuge. But reconciliation remains an aggressive tool for something as controversial as health-care reform. (It’s also an uncertain one: Republican opponents could use the rule that bears Byrd’s name to mount a parliamentary challenge.) So I ask Baucus whether he could imagine running health care through the budget-reconciliation process. “Yes, I can,” he says without hesitation. “The goal here is to get results. And not just results for the sake of results but principled results. And that means working with the other side where you get principled results and means maybe going to reconciliation to get principled results.”

  5. But don’t you think the ORDER in which Obama pursues things doesn’t matter?  

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    p>I agree he should pursue health care reform.

    <

    p>I just don’t think he should until he’s passed some other landmark legistlation.  

    <

    p>I think he’d want his first big thing to have the chance for some bipartisan support, thereby helping to establish his brand.  That thing is energy.  

    <

    p>It’s easy to imagine an ambitious energy bill, with some components of the Pickens Plan (window and natural gas), has some of Gore’s electric grid stuff, etc, that would separate the “Drill baby” R’s from the Pickens/techno-lover R’s.  

    <

    p>It’s hard to imagine a health care bill, if it were to happen first, that would do that.  And it’s easy to imagine a Harry and Louise rerun that unites R’s.  

    <

    p>Meanwhile, if bipartisan energy passes, it sets the table for health care a bit later.  “I tried to work with them on this issue, just as I managed to do with energy.  But this time the R’s said simply ‘President Obama, there’s no way we will help you on this, because we think we can, in the next election, simply repeat over and over SOCIALIST HEALTH CARE and win.  So you’re on your own.”

    • I think he’d want his first big thing to have the chance for some bipartisan support, thereby helping to establish his brand.  That thing is energy.

      <

      p>I think you are right about this — energy is a good starting point. Some of the more controversial stuff (like card-check, voter registration reform) may be necessary but should wait until at least one reasonably bi-partisan plan is through.

      <

      p>Health care is one of those “more controversial” things, although SCHIP might be one element that could pass through with bi-partisan support (along with stem cell legislation, to the extent that falls into the “health care” category). I’m not sure whether these are better addressed in separate bills or better politically packaged into a larger, more comprehensive bill later on.

      <

      p>But the Dems are at their high point right now — eventually in the next two years, they have to ram something big through. That something big will and should be a big expansion of Medicare such that it gets us closer to Medicare-for-all. There’s a limited window and they need to take advantage.

      • i’d be surprised.  the notion of eliminating SECRET BALLOT?  it’d be a [huge political liability http://www.youtube.com/watch?v… making Obama come across as anti-business.  

        <

        p>that’s why he hired Rahm Emmanuel.  Not to be tough with R’s.  To be tough with D’s.  they’ll figure out a very modest bone to throw labor, something way short of card check.  

        <

        p>good point about SCHIP.  

        • I don’t see card check happening any time soon.  Just another thing the rabid right is all frothed up about for no particularly good reason.

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