Now that the Senate health care bill is nearing its home stretch, some are wondering if I continue to support reform.
As a reminder, I wrote back in July that doctors should support Congress’ health care reform efforts, because, “some reform is better than none, and doctors advocating for a free market-based system shouldn’t hold out, hoping for the perfect package.”
There were deuling columns in last Friday’s New York Times, one from progressive economist Paul Krugman, and the other from moderate conservative David Brooks. Both had strong reservations about what was coming out of the Senate.
In Krugman’s piece, he tells radical progressives opposing the Senate bill, like Howard Dean and Keith Olbermann, to put aside their anger and just pass the damn thing. Sure there’s plenty wrong with it, but 30 million Americans will gain coverage, and if it doesn’t pass, health reform will be dead for another generation.
Brooks also cites the proposal’s many flaws, primarily noting the lack of cost controls and the fact that the health system won’t be fundamentally reformed. He’d vote “no” when pressed. I often agree with Brooks, and his analysis is bang on.
So, who’s right? Both of them are.
Health care costs are rising because, as Brooks accurately writes, “Consumers are insulated from the costs of their decisions and providers are punished for efficiency.” Simply paying doctors less, which is what expanding Medicare would have done, isn’t the answer as it simply entrenches a broken payment system. That option has since been removed.
We need to completely divorce ourselves from a fee-for-service payment system, which would then provide the necessary incentives for doctors to become more efficient. There is little such language contained in the bill.
And despite Atul Gawande’s assertion that the myriad of pilot programs contained within the bill will help control costs, the required, sweeping change is lacking.
But Krugman is also right in saying the crux of the bill is giving help to those who need it the most: “The result [of passing health reform] would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically.” That can’t be ignored.
“But what about tort reform?” is a question I often hear.
The lack of any substantive medical malpractice liability reform is why many doctors oppose the progressive approach to health reform. And I agree, much more needs to be done. But keep in mind that, according to the non-partisan CBO, medical liability reform will save only $54 billion over ten years, or 0.5% of the nation’s health spending.
It’s not a huge amount, but certainly not insignificant. Reformers are leaving money on the table here.
And, as I wrote earlier this year in the USA Today, medical malpractice needs to be reformed for the patient’s sake, not the doctors’.
(As an aside, I often wonder why progressive reformers ignore the olive branch that malpractice reform represents to doctors, and choose to antagonize the medical profession by continually harping at how much money physicians make. I firmly believe that more than a few will go as far as support a single payer system – the progressive Holy Grail – if it was explicitly paired with comprehensive medical malpractice reform.)
The question of supporting the current reform efforts, or not, comes down to whether one thinks the status quo is sustainable. I believe the answer is no. The number of uninsured is rising at an unacceptable rate, and, combined with spiraling costs, will lead to the health system’s collapse. Once that happens, more draconian measures will be forced upon us. Measures that assuredly will not be friendly to doctors.
The Senate bill is a flawed, incremental effort, that doesn’t do enough to make primary care the required focus of our health system. Nor does it make any meaningful attempt to reform medical malpractice.
But it brings us closer to universal health insurance coverage, which is a significant achievement. And it does so without significantly expanding government involvement through an expansion of Medicare, or institution of a public plan option, which would have exacerbated the government monopsony on health care.
So, given the choice between seriously flawed reform and none, I’d have to say “yes” to reform.
By the slimmest of margins.
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Have enjoyed reading all of these comments. The question of whether something (a crticially flawed health care bill) is better than nothing, is a difficult question. I do agree that if a bill doesn’t pass soon, nothing will be done (in Congress) for a decade. I agree with the Happy Hospitalists that “the number one priority should not have been access. It should have been cost control.” But is wasn’t. Starting the arduous process all over again will likely provide neither access nor cost control. However, passing a bill, that other Presidents have failed to do, will at least provide some increased access. There is no question that so much more needs to be done, and that the current bill really does little to reform health care. However, I think of passage of this currently proposed bill as the first of many, many steps necessary to change how health care is delivered in our country.
For any suckers out there who actually believes that the government can accurately predict the cost of their bribery, I point you to the truth. You should be afraid. Very afraid about where we are heading.
http://mjperry.blogspot.com/2009/08/dont-trust-government-estimates-of.html
Click on the chart and grab some Kleenex.
Good intentions do not make for good law.
Increasing access for some will increase costs for many + result in less healthcare for more patients.
The 21% SGR fix is not included to make the numbers deficit neutral. Add the 21% fix, + that illusion disappears. Add the assumption that costs will grow at a lower rate than they ever have is another illusion. Add that the actual cost for the first 10 years of operation (most spending kicks in starting in 2014 while taxes etc begin immed) + the illusion becomes more magnfied.
And stating that if we don’t do something now, we won’t be able to do reform for another 10 or 15 years is flawed logic. What is the something that is SO good that you are willing to lose sight of costs, and harms and loss of freedom?
Poll after poll show Americans do not want this version of reform. It is not even close. Why the arrogance that a few know what is best for the majority and are willing to use compulsion to attain their beliefs. If this reform was so great, why the rush to get it done with midnight votes? Why not get SOME bipartisan support as was done with Medicare and Medicaid?
As SarahW said, you would never accept this logic for drugs or procedures; nevertheless, you accept this flawed logic for controlling 16% of our economy. What a shame!
Barry has blown it and will be a one term president for sure. I confess I was one of those idiots who fell for the “hope, change” nonsense. Maybe it was 8 years of dubya that did it.
But like the majority of posters here, I will do my best to send the Chicago crowd back where it belongs. Now all the GOP has to do is nominate someone with a slightly higher IQ than Sarah Palin.
“Why not get SOME bipartisan support…”
The Republicans main goal with health care reform is failure. If the Obama administration succeeds with health care reform, the 2010 and 2012 elections will go to the Democrats. The biggest mistake the Obama administration made was trying to include the Republicans in health care reform. At least Nebraska got a good deal.
And for those of you who wish a truly capitalistic health care system, why are you still accepting insurance payments? Seems kind of hypocritial to blame patients for using a health care system that we pay for in our premiums, taxes and increased prices for products and services. You do have the freedom to go cash only. Are you unwilling to take on the risk of a capitalistic practice? Or do you like the steady stream of patients that the insurance company provides. If you really want to change the system, why are you waiting for the government to bail you out?
To think that people shouldn’t have to pay into the health care system until they are sick is fatally flawed. How do we all get more out than we put in?
G
thanks for the dailykos or huffpo talking points.
you may want to check Mankiew’s Intro Econ book + learn what capitalism is – what you describe is simply diatribe.
“The Republicans main goal with health care reform is failure”.
g, I beg to disagree. Not that I’m a fan of either party, but the Republicans have introduced healthcare legislation ignored by the Democrats. They, too, want health insurance for all, but not at the expense of further bankrupting this country. Sensible reform must contain costs, and the current legislation does nothing to do that. The CBO estimates that so many are fond of quoting do not include the “doc fix” for Medicare, and the costs will truly add to the deficit. Instead of taxing all of us to death to further promote the nanny state, why not incorporate tort reform (money saver per the CBO), go after the true causes of fraud and abuse (fraudulent DME companies), and seriously look at the amount of money spent and wasted on end of life care foisted upon physicians by families who want “everythiong done”. I’m no economist admittedly, but the cost savings from these three issues alone would save enormous amounts of money, and get many more people insured without taxing the rest of this country into bankruptcy.
BTW, as you stated, Nebraska got a good deal. Does that imply your support of the corrupt Chicago style purchase of votes?
Nebraska was bought off. Special insurance rules for their Blues plans…..and Mutual of Omaha. Special Medicaid rates. Florida’s retirees grandfather in their Medicare Advantage plans. Arizona retirees can’t. They have Republican senators. My state has reliable Democratic votes, no one to buy off. So the red states get nothing except to pay for someone else’s bribe. And the reliable blue states get treated just as badly. Not just whores, but cheap whores. Medicare Advantage was supposed to be terrible, and was supposed to be eliminated. But not for Florida. And not for any FUTURE Florida retirees, just the ones already there.
I like the reform effort called HSA’s. Now with five years experience, they have been shown to work. So…..Obama taxes it. But he leaves alone the generous insurance plans used by…..Teamsters.
G’s not worth my time. But Kevin…….do you support the “reform” as it’s being revealed?
Do you really?
“…….If reform fails, the next step will be financial collapse from spiraling health care costs, followed by a forced single-payer, likely Medicare for all, system……”
Sheesh, Kevin, a single-payer system is PRECISELY WHAT OBAMA AND CONGRESS WANT !
They are on record saying precisely that, for years. If they can’t get from here to there, then craft a bill to completely destroy the private system and leave you no choice but to go single-payer.
Kevin, any thoughts on the pilot program that will bundle costs rather than charge a fee-for-service? It’s described by Ezra Klein here:
http://voices.washingtonpost.com/ezra-klein/2009/12/five_cost_controls_in_the_sena.html
I agree that if this goes down to a defeat, meaning no bill passes that provides insurance to many more Americans, nothing will be done for years. I do think that this bill, however it looks at the end will pass, and it will only delay the inevitable single payer universal national health insurance we will end up with. Will whatever the final bill turns out to be help temporarily delaying this eventuality, or speed us toward that end? It will be an interesting decade, but in 2020 I’ll be shocked if we don’t have national health insurance much like the rest of the first world.
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