I daren’t quote any more due to fair-use regs, but there’s a good five-point plan there that goes beyond cost-control to look at choice, reform, prevention, end-of-life care, and responsiveness. There’s plenty more on Senator Kennedy’s page.
I don’t say much on health care because it’s not an issue on which I can speak with expertise. Quite clearly, health care costs in the United States are astronomical — though much of that can be attributable to our unhealthy lifestyle
(addressed in point three) and extended end-of-life care (point four). Furthermore, six years in Canada makes me suspicious of the very idea of government-run care.
But from nearly every angle and on every issue, employment to small business to education to municipal budgeting, health care has become an anchor. That anchor has a 20-foot chain, and the water’s at 19’11” and rising. Reform is needed. Whether it’s a notable alteration to the current system, or starting over completely, it is needed. The discussion can no longer be among policy wonks — it needs to be in the Capitol.
Our best shot at a productive discussion and needed reform is under the leadership of the most bipartisan member of the Senate, a man who has devoted much of his life for this moment. A man who has been living to get this done.
And he’s right.
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p>As Howard Dean, MD, put it so succinctlyAt the risk of seeming macabre, just why would anyone think that Ted Kennedy himself actually wrote this Op-Ed? He hasn’t been back to work in the Senate since his diagnosis of brain cancer and extensive treatments… I wish the Senator the best but there’s also reason to have well-founded concerns about who is likely to be speaking for him on this issue at this point in time. One of Kennedy’s senior health policy staffers, John McDonough, was most recently the CEO of an organization that is VERY heavily-funded by the insurance industry and that gives cause for worry. Serious worry. Alarm, really. The organization is called Health Care For All MA (HCFA). I know these are not pleasant things to discuss but sometimes the truth is hard to face but must still be confronted and dealt with.
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p>I have previously posted detailed history and facts and figures here on BMG about how deeply tainted HCFA has become. Yes, they still do good work but in full measure it is a sad state that they’re in being bankrolled by the very industry they should be free to criticize. Instead HCFA leads the cheering section of the horribly flawed MA mandatory insurance law.
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p>Blue Cross and Blue Shield MA (BCBS) essentially wrote the legislation that our esteemed state lawmakers, led by their stellar “leadership”, were given less than 24 hours to review all 145 pages of the legislation before the final vote was taken. No cost controls are in the law. McDonough of HCFA said repeatedly in public forums “we didn’t do cost control because we couldn’t get that passed, so we did access. We’ll do cost control later.” Oh really, so forcing everyone to buy a private product or levy fines on them along with forcing taxpayers to subsidize purchase of these often poor quality products for hundreds of thousands WITHOUT ANY COST CONTROL was a good idea, becuase you “couldn’t do” cost control at the same time as expanding access? Because that would require taking on the insurance industry by insisting on transparency, standards and real accountability for where our health insurance dollars actually go.
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p>The MA “landmark” law mandates purchase of private insurance with no requirements nor any standards on how the insurance industry spends that money. Hhhmmmm. And MA BCBS’ (supposedly a “non-proft”) outgoing CEO Bill Van Faasen got himself a nice fat $19Mil payout when he left that post. Now Cleve Killingsworth, the current CEO, pulls down a handy $3Mil or so… And now the major shapers of the national reform bill are looking at the MA mandate to be a component of the national bill (“then people should have a responsibility to buy it for their families”, from today’s Op-Ed).
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p>We should be hearing from Kennedy the kind of leadership statements on health reform that we’re hearing from other Democratic leaders like this one
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p>Isn’t anybody in the media paying attention and connecting the dots here? Maybe some graduate journalism student will take it on.
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p>Actually, someone at Columbia’s Journalism School has taken some of this on and it’s an important read:
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p> Health Reform Lessons from Massachusetts, Part II
Does an individual mandate work? Depends on who’s talking
By Trudy Lieberman, May 4, 2009
http://www.cjr.org/campaign_de…
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p>Part I of Lessons from Mass. is here http://www.cjr.org/campaign_de…
A partial sentence should have been deleted in my editing but was not. My mistake.
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p>”As Howard Dean, MD, put it so succinctly”
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p>I ended up putting Dean’s quote in further down but somehow a fragment of that topic was left in at the beginning of the comment. Eeegadz. In particular, precisely where the stray sentence fragment ended up isn’t good. Sorry. BMG editors feel free to take it out–I would if I could.
What did Dean day that Kennedy didn’t? I read that they both support a public option.
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p>Plus, I don’t see the connection with the MA mandate.
Kennedy’s OpEd had the weak phrase “We’re also hearing that some Americans want…”
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p>Whereas Dean provides strong leadership by stating a strong Medicare-like public plan is a deal-breaker “If [the] healthcare plan gets changed to exclude a public option like Medicare, then it is not healthcare reform. Legislation rises and falls on whether the American public is allowed to choose a universally available public option.”
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p>BIG difference. Now on to the mandate. Obama was stridently against an individual mandate during the campaign, and for good reason. The mandate was the biggest difference btwn Obama’s and Hillary Clinton’s health plan.
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p>Using a mandate typifies an approach that treats healthcare as a commercial commodity rather than as a public good (a collective, not an individual, responsibility) that, yes, we are all responsible for contributing to and should be guaranteed to receive as members of a civilized society just as we contribute to and receive police and fire services, and K-12 public education.
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p>Kennedy used to be against this individual mandate component but now look at what the OpEd now says is his position: “then people should have a responsibility to buy it for their families”. Equitable financing to guarantee quality coverage for all is MUCH DIFFERENT than enacting a legal mandate forcing people to BUY A PRODUCT. The insurance industry has gotten its claws into him, apparently….
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p>Below is a link to an excellent short video of a Small Business Owner on Health Reform that tells it like it is plain and simple. If you’re short on time, fast forward about half-way in (the 2 minute mark) where the small business owner says
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p>
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p>Lastly, I agree with the comments of speaksoftly below.
TP Wonk Room has more, but public option that pays Medicare rate plus 10%. Required participation.
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p>Plus:
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p>Could be changing as the release has been pushed out a week. I’m thinking that they might have some issues with the Medicaid inclusion of 150% of poverty.
In his op-ed published yesterday in the Globe, Senator Kennedy succinctly describes the issue at hand:
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p>Senator Kennedy then goes on to describe a number of reforms to the health insurance industry. His logic, of course, is reasonable, but it rests on one assumption that is crucial, unproven, and often unchallenged: health insurance = health care.
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p>Insurance is a financial contract that redistributes financial risk from the insured to the insurer in exchange for a fee, called a premium. Health insurance is such a financial agreement that is triggered by a health-related event. Healthcare is a service or set of goods and services which cure or prevent illness. Health insurance and health care, however closely related, are not the same thing. Therefore, it cannot be assumed that the answer to the question, “How best can we ensure access to health care?” is the same answer as if the question were “How best can we provide health insurance for all?”
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p>The issue is first and foremost about care; insurance is, at best, a secondary concern, an issue of value only insofar as it provides care.
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p>Many people interested in solving this problem support ‘single-payer healthcare’, or, specifically, something akin to Medicare for all. Many say to let the free market work so as to protect that which it has created, ‘the greatest doctors and medical innovations in the world.’ And many have taken to adopting a putative compromise position along the lines of MA Healthcare Reform/the Kennedy Op-Ed, in which private market insurance reforms are coupled with an individual mandate of purchasing healthcare, thereby redistributing the financial risk of costly, serious illness (‘pre-existing conditions’), to the public at large without raising taxes. All of these ideas have their merits.
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p>As a civilized society, we cannot allow people to die when our society has the resources to save their lives. So, at the end of the day, whatever the free market cannot do to provide people with healthcare, the government must do. A purely free market approach is unacceptable because the free market is interested only in the most efficient outcome, and does not provide a guaranteed minimum provision of any good or service no matter how great the human need.
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p>Consequently, both Medicare for all and the Kennedy/MA proposal would likely be dramatic improvements over the status quo, but both are deeply flawed. If health insurance for all were the goal, Medicare for all or an individual mandate would be solutions. If, however, health insurance and health care are not the same thing, and health care is the goal, than the universal provision of health insurance is merely a costly proxy, which will, no matter its form, add substantial costs in the form of money that will go towards health insurance, public or private, and not necessarily to actual care.
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p>Both an individual mandate and Medicare presume universal ‘insurance’ (casually defined) to be the best solution for the provision of universal health care. With Medicare, the government, supported by taxation, pays for elderly Americans to get care from private health care providers. With an individual mandate, the government requires the individual to purchase, at personal expense, a financial product from a private financial services company, called health insurance, which in turn pays a private health care provider for care. Both of these arrangements are done in hopes that it will make us healthier; it will, but will waste billions of administrative dollars in supporting the proxy rather than the actual solution. No doctors work for Medicare or health insurance companies, just actuaries and administrators (surely, some MDs are there, but they are not there to treat anyone directly).
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p>Medicare for all would be a better option than what we have in Massachusetts because it doesn’t require actual reserves as does private health insurance (it has the full faith and credit of the United States), does or could benefit from huge scale, and doesn’t turn a profit. Further, this option alleviates a strong philosophical conundrum introduced by the individual mandate, which surprisingly hasn’t caused a greater stir among people with all sort of political views, in light of the outrage over a comparably obscure issue regarding a recent eminent domain ruling that prompted public concern over property rights. The government has the legitimate power to deprive us of our assets, through Congress’s power to assess taxes. Yet, the government is not collecting, in the instance of a personal mandate, the tax revenue necessary to ‘provide for the General Welfare’, the insurance industry is. Congress does not have the legitimate power deprive of us of our property ‘without due process of law’. Due process, of course, is subject to some debate, but regarding the issue of how to raise revenue to fund public policy, the Constitutional mandates on taxation are clear: Congress shall tax, not health insurers.
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p>In some ways healthcare is a unique challenge, but there are other services whose universal, free availability are public goods, and we do have time tested models for how the government should address such a commodity. When faced with fires, the government built firehouses and hired firefighters, paid for through taxation; faced with crime, the government built police stations and hired police officers, paid for through taxation; faced with ignorance and illiteracy the government built schools and hired teachers, paid for through taxation.
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p>Faced with disease, the direct, public solution to the problem at hand, is for the government to build health centers and hospitals and hire health care providers such as doctors and nurses.
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p>Fortunately, for an issue of such significance, we need not rely only on conjecture. Medicare, of course, already exists, and we have data to evaluate how it operates. So, too, however, we have a publicly owned and operated system of hospitals. Contrary to what you may expect, not only is this massive government bureaucracy adequate to its task, the Veterans Health Administration is arguably the single best health care system on Earth. And, it is demonstrably better suited to its task than Medicare is. The solution to the lack of availability of healthcare in this country is to gradually build up the capacity of the VHA and gradually expand the population it serves so that if an (indigent) American dials 911 he or she can get police protection, paid for through general taxation; fire protection, paid for through general taxation; and, should an ambulance come with the cruiser or fire truck and take that American for treatment from burns caused by the fire or bruises caused by the criminal, they will get quality treatment, paid for by their friends and neighbors, their fellow Americans, through our government, and paid for, as general government services are, through taxes.