Friday, December 18, 2009

We didn't get Single Payer. So now what.

We still don't have a health care solution. We still have politicians like John McCain talking about our having the best health care system in the world, even though the objective results of that system are not so good.

I listened to Shields and Brooks discuss this on the Newshour tonight. I thought David Brooks got right to the heart of the problem.
My fundamental problem is that it is a slow, gradual building on the current system. But the current system is so fundamentally messed up. The incentive structure is such that providers are penalized for being efficient. Everybody's got an incentive to get more and more care. We're all separated from the consequences of our choices, and that you can't build reforms on top of what is really a rotten set of incentives.

And so, at the end of the day, the question is, can you pass this and get toward real reform down the road? And I fundamentally don't think so. One of the Medicare actuaries reported I think last week or within two weeks that health care spending is just shooting upwards. Was 15 percent of the GDP. Now I think it's 17.7 percent of GDP. It will be up to 22, 24.

This bill will make it increase slightly faster, not slower. And if you care about things like preschool education, state spending on any other projects, that's all going to be swallowed up by health care. And if we don't address that problem, we have missed the central problem.
So, what are out Senators doing?

Boxer's web site provides a long list of prescriptions, all of which she tells us will not cost us anything. Or if it does, we can deduct it from out taxes... assuming we make enough to be paying taxes.

As for Feinstein, she gives us a list of priorities, but Health Care is not one of them.

Californians, this has been the major topic of discussion for most of the year.  The Senate appears now to be operating under the rule of filibuster, where every bill needs to have a 60 votes rather than a simple majority.  Neither of our Senators is really engaged in the process of making fundamental reform work. And all of the quasi progressive reformists tell us that they have to pass a bad bill because not passing it would be embarrassing.

I've had my differences with Dr. Henry Duke at times, but I think he has his sights in the right place on this one.
Corporate funded Democrats like Obama, Baucus, Clinton, Kennedy, Pelosi, are playing games with you and Obama/Baucus clearly decided in January that for health care reform everything would be on the table -- except single payer or the medicare-for-all real reform supported by a majority of Americans and American Nurses and  Doctors. The people behind this "urgent" blame onto Lieberman and the Republicans are these very same insurance company puppets and shock-troops.

HCAN or Healthcare for America Now is not for single payer, and you can bet they receive lots of Big Pharmacy, Insurance, and Hospital industry money laundered through non-profit 501c3 entities like the United Healthcare Foundation, California Wellness foundation, etc.

Good people but bad politics.

Lets break the co-dependency / addiction circle: ObamaCare, the Pelosi, Baucus, and Reid bill are all not reform, they're more bailout for big insurance finance requiring taxes and mandates for workers and consumers.
 I don't think either of our Senators can give us an answer without checking with their donor list.


Martin Zehr said...

It would have been nice if they had started with the issue of the uninsured and worked out from there. The problem with single payer is that it sweeps in too many others. 10% are not covered. Roll medical allowances into unemployment compensation for a start.

Ross Levin said...

Now we take it to the state level. I know in CA you just need a friendly governor (and since Jerry Brown has said he doesn't want single payer, I guess that leaves a Green or the next governor after the one elected in 2010...) and here in PA we've got a friendly governor and we just need the bill to make it through the legislature.

This is a perfect issue for state Green parties.

Unknown said...

Wes, great post!

I agree with you about what Brooks said.

The incentive structure is such that providers are penalized for being efficient. Everybody's got an incentive to get more and more care. We're all separated from the consequences of our choices, and that you can't build reforms on top of what is really a rotten set of incentives.

Although Medicare for all is not quite single payer, it is close enough. If we have that or a true single payer system -- and we save 25% right off the bat -- we still have not addressed the problem of healthcare cost inflation. At the current inflation trend, the 25% savings is gone in just 3 years. So how do we mitigate the inflation rate for healthcare??

1) We can impose price controls on doctor's fees like the way Medicare does now. However, we would have to force providers to "accept assignment" instead of the current voluntary system.

2) We can ration healthcare to some level below aggregate demand.

3) We can change the incentive structure so that aggregate demand falls naturally based on a healthier population.

4) Combine 2 or all 3 above.

As you may recall, Wes, I introduced my Universal Choice plan on multiple lists many years ago and provided much detail. To summarize, at the federal level it is Medicare for all with an emphasis on the Health Savings account as an option of Part C of Medicare.

Just as HMO's receive a large monthly payment for subscribers now, an American opting for the Health Savings Part C plan would receive a fully-funded HSA and the choice of private or public plans for the high deductible indemnity-style plan.

The HSA removes the middle man that screws up the normal market incentive for users to maximize value by spending less. The HSA provides young adults the additional choice to live healthier lifestyles, due to the large sums of HSA dollars that roll over into their tax-free retirement funds.

If the Democrats had introduced a plan like my Universal Choice idea, then at least a dozen Republicans would have supported it just for the HSA component alone.

As you have heard me say before -- and the key reason why we need the Green Party -- is that the Democrats will always promise the sun and moon but only deliver window-dressing reforms. Unless the Democrats are pressured by the Greens, they will not change.

Until Duverger's Law ceases to exist or by some unlikely stroke of luck the major parties reform the electoral system away from simple plurality, single-seat district winner take all; we are relegated to succeeding only as an effective "pressure party" at the partisan level.


Wes said...

Thanks for the ego boost, Steve. What could be done in CA that can change the game? Anything? Could it become part of the 2010 campaign for Greens?

Unknown said...

Thanks for the ego boost, Steve. What could be done in CA that can change the game? Anything? Could it become part of the 2010 campaign for Greens?

The strategic plan for California healthcare reform that I proposed in the past may or may not need revising depending on the final bill that Obama signs this week. However, let me present the summary based on the current system.

The tax law regarding Health Savings Accounts (HSA) is that the contributions made annually are personal income tax deductible. The cost of the high deductible health insurance policy is also deductible in most cases. The focus, though, is on the HSA.

My Universal Choice plan implemented at the State of California level only:

1) would allow private insurers to offer the high deductible insurance policies in the free market

2) would provide a State Fund high deductible insurance policy (much like the way the Worker's Compensation system works in CA)

3) would provide vouchers to all to fully fund the HSA component and to provide for the purchase of the high-deductible health policy

4) would lower the cost to small businesses by shifting the health insurance mandate off of the the employer

5) would be funded by progressive income taxation and by adding a higher upper-end marginal rate.

The huge primary benefit is insuring all Californians, lowering their costs, and increasing market choice ("Universal Choice").

The huge secondary benefit is shifting tens of billions of dollars from the aggregate of federal tax payments back to Californians!! Remember, the HsA contributions are federal income tax deductible. This boost to the CA economy would be significant at any point in the business cycle, but is critical at the current "economic valley" we will be in for years.

If California were to adopt such a reform, in true bellwether style, other states would follow. Congress would be pressured to address the "tax flow issue." If congress removes the deductibility of HSA contributions, then a polypartisan rage and populist reaction would be likely -- talk about pressure.

If the congress does nothing, the huge sums of tax money involved would pressure most states to follow our lead. The most likely outcome would be Congress and the President disciplined to the market reality and the populist pressure and create a Medicare for all Part C HSA option!

This is pressure politics. This is something that the Greens can lead. It will take the GPCA to change focus and begin growing local organizations for the primary purpose of initiating and running local referundum and initiative campaigns. The network of proficient local orgs can be tied together to initiate and run statewide ballot measures.

This is my vision of how you build the Green Party when the electoral system relegates you to pressure politics.


Edward said...

The problem with SB 810 is that it is not legal without the Kucinich Amendment to HR 3200, which was stripped from the final House bill that passed 220-215. The Kucinich Amendment would provide an ERISA waiver for states that want to implement a single-payer system. The first step is to kill the bills in Congress, because if they pass as is, it will be the death of single-payer at the state level too.