I’m on this weekend, so it’s off to work today. I’m looking to see what will happen with health care reform here on the ground. The House has passed a bill, now it goes to the Senate for debate.
It’s not the reform I would have chosen, given my first,second or third choice, but I believe in harm-reduction as a strategy. The Dickensian vision of the anti-reform people I met at the Town Halls, in Warwick, West Warwick and Johnston is not my America. Hearing people say that some who were unlucky or made ‘bad choices’ would just have to die– it’s God’s way– was very discouraging. And this is from a conversation with a man who was holding a ‘pro-life’ sign. Hearing people say that dumping uninsured people on our emergency services was the answer was bad enough–but right wing politicians were saying it too.
If you talk to the good people who work in the emergency rooms, or to people who had no other recourse and are now looking at huge bills for what could have been treated in a doctor’s office–you know. We are already breaking the back of our emergency response, and breaking the spirit of our fellow citizens who lose jobs and security every time the economy ‘corrects’ itself.
From here on the ground the reform effort looks like slow, incremental change. Too slow for many, still leaving in place many of the inefficiencies and inequalities that drain the value from our health care dollar. But I believe in harm reduction as a strategy, and I won’t disparage change for the better. Extending insurance and curbing some of the worst abuses of insurance corporations will help many Americans who have been denied access to health care.
I’m not expecting any fast changes here on the ground, but I’m hoping, and watching.
November 8, 2009 at 11:18 am
The house has passed a health care bill.
There will be a revolt, one way or another.
Best Regards
PoliticalPen
November 8, 2009 at 11:20 am
Amen to that, Nancy. You have been a vigilant voice on this issue and it is much appreciated.
November 8, 2009 at 12:05 pm
A lot of Americans sure have taken the road “more” traveled, haven’t they? It’s a shame the conservatives have influenced our country to this extreme.
November 8, 2009 at 2:00 pm
I’m on the ground as well, albeit different ground. Moreover, I’ve written four columns over the past four weeks in the Herald trying to make sense of the issue in order to see what a solution to the problem might need to be. The fifth column, due on newsstands throughout the city this Wednesday, deals in specific with HR 3962. (OK, shameless plug)
Looking at the contents and impact of the legislation passed last night, I can only say that it’s slightly better than a stick in the eye.
It’s not so much that it’s a weak bill, although it is. And if that’s the only issue, then one could rationalize that it’s at least a start. But it’s worse than that.
There are no real cost containment provisions in the bill. As such, any projections of the possible number of uninsured/underinsured is speculative at best. The positive impact of this bill on the deficit by 2019, according the the CBO, is speculative.
There’s no particular “competition” in the marketplace. Competition is an illusory concept relative to the inelasticity of the good/service provided in the health field. To pretend that this bill addresses that issue is pure fantasy.
Without real cost controls, the impact on premium will be negligible. Thus, businesses, especially small businesses, inspite of the credits offered will over time have problems being able to afford its co-share of premium.
Additionally, individuals will have difficulty paying their share of health costs. One estimate holds that middle-class folks will need to pay 15-18% of their income on premiums and co-pays.
Not to mention the restrictive abortion language that makes the Hyde Amendment look like it was pro-choice legislation.
There are some good things in this bill, such as preexisting condition language and addressing the Medicare Part D donut hole issues. But unless legislation addresses the real economic impact of health costs on individuals/families, businesses and the overall economy, nothing much changes. And that’s worrisome because I fear that in ten years, as the health care situation predictably gets worse, people will point to this as a failed experiment in “socialized” medicine and reject needed reforms that should have been included in the first place.
And this could be the best bill to emerge this year. This bill will not be considered by the Senate. Rather the Senate has its own bill (the combined Finance/HELP committees’ bills) currently being scored by CBO. We don’t know much about that bill as Leader Reid has kept the details to himself. But we do know, because he stated as much just prior to submission for review, that it contains an optional public option.
One thing to watch as the process goes forward: the medical loss ratio. That’s the amount of premium spent on medical treatment/services versus administrative costs, overhead and profits. The House Bill had it at 85/15 – the Senate Finance bill (before combination w/ the HELP bill) had it at 74/26. This is part of the discussion of a “government takeover” of the health insurance industry. Compare that ratio with the more public medical programs (Medicare, etc.) currently.
In any event, the Senate will pass its version and then it’s on to the Conference committee where anything can happen.
So, if a journey of a 1000 miles begins with but a single step, last night we began a journey. Let’s hope that last night’s step is not the best step we take on this journey.
November 8, 2009 at 7:44 pm
Every year I think this ‘system’ is about to collapse, but still it staggers on. I think that President Obama chose health care reform because if we continue to cut people out of access to care and raise the cost on the rest there will be no way to keep a decent standard of living for working Americans.
We need more prevention and smarter use of our resources. A profit-based system is okay for manufacturing cars, but not for saving lives.
November 9, 2009 at 12:22 am
This “system” staggers on because it can do nothing else. In any event, if the President wanted to use health care to stimulate the economy and preserve the middle class, this bill doesn’t seem to do that.
I agree that the health care sector is not a “free market”, which is why attempting to nibble around the edges to stimulate “competition” won’t work in the long run. Without real systemic change, it’s the same ole, same ole.
November 9, 2009 at 8:57 am
Thanks for your comments,Geoff,
I just have to hope that this is a start, not a bait and switch.
When I am doing my job, it’s called nursing. The person receiving the care is called a patient.
I hear the phrase ‘health care consumer’ a lot.
Acquiring human resources to fill a consumer demand for a product is one model, but not one that I think should apply to health care, because without something beyond the profit motive there’s no value on human life or merit in relieving suffering.
I thank you for tackling the economics of this. It’s not my area. I am in a position to witness a lot of waste and stupidity so I’ll report it when I see it.