Monday, March 22, 2010

Random Thoughts on Health Care Reform

The one thing clear about the passage last night of the Obama-Democratic health care reform bill in the lower house of Congress is that a political Rubicon has been crossed.  It my have passed by only three votes but let me remind you that George W Bush was elected and served as President in the 2000 election by an even slimmer margin of electoral votes. And since the Democrats were going to be blamed anyway for trying to pass reform, they at least now have the advantage of actually having it signed into law.  


Now thing I know about the country I  am fortunate to live in: Americans in general  love people that can get a job done, and don't give up and make excuses and quit. The newest Gallup Poll shows that President Obama's approval ratings have done back up to 50 percent favor ability again and will likely increase. This is because Obama and Speaker Nancy Pelosi got something major they set out to do and got it passed. 


 Many people objected to Ronald Reagan draconian politics on welfare recipients, cutting school lunch programs  and practicing the politics of excessive-individuality,  but he always won grudging admiration for sticking to his guns.       

 This is nothing less than a new era in dealing with a private-treatment system that has put profits over caring for indigent sick people.  Health care insurers like Wellpoint and Blue Cross are now on notice---the days of desperate sick people showing up at a public clinic with few resources or a overcrowded emergency room  for care because they aren't good customers for their stock-holders and CEOs is soon going to be over. 


Yes, health care reform is controversial and the Democrats who voted for this are not all going to be reelected.  But many of these legislators were already targeted by the Republicans and conservative and right-radical groups because  they were in traditionally Republican districts anyway!  Elections matter as we in the  Democratic camp have been reminded over and over again by conservatives since Nixon's landslide victory in 1972 and all through the Reagan-Bush years.  We were told to give up and adapt to a new conservative mantra of less regulation and more  free markets as a way to solve everything from health care to banking regulations (or non-regulation)  of fighting foreign wars.  


Well, we've been taught  the lesson--and now it finally appears that our elected Representatives in the current Senate and House are finally ready to teach the class to the masters.    


Sure, there will be charges of unconstitutionally and all the usual back and forth of those who see change and are threatened by it. But I think in the end most of this bill will be set and standard law in a few years... and more and more of the public will accept this law not because its about bigger government but because its about a greater fairness and protections for working and middle-class families.  Over sixty percent of bankruptcies are now caused by excessive health care billings.  No other developed nation in the world allows parents to deal with a sick child, for instance, and also the loss of a family home.We Americans need to get with the modern world!    

Paul Krugman in the New York Times pointed out the latest part of this year-long battle and the Republican agony:  

" 'Yes, a few conservative policy intellectuals, after making a show of thinking hard about the issues, claimed to be disturbed by reform’s fiscal implications (but were strangely unmoved by the clean bill of fiscal health from the Congressional Budget Office) or to want stronger action on costs (even though this reform does more to tackle health care costs than any previous legislation). For the most part, however, opponents of reform didn’t even pretend to engage with the reality either of the existing health care system or of the moderate, centrist plan — very close in outline to the reform Mitt Romney introduced in Massachusetts — that Democrats were proposing.

"Instead, the emotional core of opposition to reform was blatant fear-mongering, unconstrained either by the facts or by any sense of decency.

"It wasn’t just the death panel smear. It was racial hate-mongering, like a piece in Investor’s Business Daily declaring that health reform is “affirmative action on steroids, deciding everything from who becomes a doctor to who gets treatment on the basis of skin color.” It was wild claims about abortion funding. It was the insistence that there is something tyrannical about giving young working Americans the assurance that health care will be available when they need it, an assurance that older Americans have enjoyed ever since Lyndon Johnson — whom Mr. Gingrich considers a failed president — pushed Medicare through over the howls of conservatives.' "


Medicare, passed in 1965, was supposed to be "the end of freedom", as Reagan put it when he was entering national politics. The same was said of Social Security thirty years earlier by the proto-Reagans like Herbert Hoover, William Randolph Hearst  and Father Coughlin (a radio pundit much like Rush Limbaugh). 


  Instead of the crack of doom happening, Medicare and Social Security are programs that has helped eliminate much of the poverty that haunted  older people.  They are settled programs that are seen as part and parcel of the structure of the political landscape.


There are many flaws to this bill of course---much of the paying for it has been put off and some of the benefits for 32 million uninsured people are not going into effect for three or four years.  But, what may I ask, was so good about the status quo?  How many more incremental and anemic changes were we going to make in health care without confronting the need to  reduce costs and bring more people into the preventive care system?       


 Unless you make $250,000 dollars a year or have a "Cadillac Health Plan" provided by a union or a corporation, this new bill will not add a significant increase to anyone's taxes. Far from being "socialism", this, for better or worse is simply American pragmatism---we have a problem that has lasted for decades.  We are finally on the first steps to correct the massive medical industry and put matters on a more humane track.     

44 comments:

  1. I thought about writing a post on this subject...but now I don't have to as you've encapsulated my point of view beautifully. Thanks!

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  2. I hope I didn't steal all your thunder on this Shedrick... but I am gratified you thought well of my brief remarks. Thanks as always!

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  3. Well, the cuts in Medicare will help pay for it. We who get SS have already felt part of that, with no pay increases this year or next. Maybe into a farther future than that too, who knows?
    This plan still leaves a lot of people uninsured. I'm not sure just how it breaks down, but when will EVERYONE be insured?
    Comparing the US to Europe isn't a good idea, I think. We're different, no longer European, we're American now. We fought a war about that, sorta, if I remember right.
    I listened to all of the rhetoric yesterday, politely called "debate". It was awful listening to the republicans doing their fearmongering. I couldn't believe some of the outright lies they were telling. The thing is, they "debated" all day yesterday, and it was all wasted time. Minds were already decided, and no one was planning to change theirs in that 10 hours. Maybe it was required, I dunno. If I had EVER, and I have NEVER, thought about being republican, it would have ended yesterday. I could not believe my ears, no could I believe that anyone with any sense would believe the lies, rhetoric and hyperbole being espoused yesterday. I didn't know that people could really believe their own lies until I saw that.
    I was amazed!

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  4. Most of the cuts will be in the "Medicare Advantage" part of the system as I understand it, Jacquie, which does not have to so with most recipients. There will also be a closing of the "doughnut hole" in Medicare Part D-the prescription drug plan.

    I don't feel we need a European system--there is no one system over there by the way. The reason all the people can't be insured is that we have to start from where we are which is a long way off from a "socialist" model. That's just not part of the American mainstream --we have to adapt the private-public models we have.

    Switzerland has a largely private system, but its open to all, for instance, which is much different than France. And we certainly adopted ideas from Europe when we created the Constitution. My point is that we have to stop letting people fall through the cracks--to do that we can take the best of all the less-expensive health plans all over the world and add a few ideas and programs we already have.

    Some members of the GOP quite flipped lids on the floor of the Congress yesterday I agree. And some of the Tea Partiers around the capital went racist and homophobic of course. No, I'm tired of all the hyperbole and fears myself. Let's put this aside and move on someday I hope to other matters.

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  5. Yes, a lot of the cuts will come from the Medicare Advantage part, but that puts us back to an 80/20 payment system. Oh well, I suppose it doesn't really matter anymore. It's done now, and now those of us on Medicare will have to figure out how to come with with our 20% of the bill. I get some state help, so maybe I'll be a bit better off, although, if the states lose their lawsuits, they may take my state assistance away too.
    I dunno, all I can do is wait and see.
    The donut hole was ridiculous to begin with.

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  6. Your entire article was very well said and very encouraging Doug

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  7. From a European perspective I've long marvelled at how a wealthy nation founded on a model of freedom and liberty could for so long ignore the poorest least able in it's own society. The recent debate, I'll call it that rather than a long winded exercise in exchanging lies at the top of their voices, has been most unedifying. The most powerful nation on the planet apparently, and the one that a huge part of the worlds population looks to for guidance seemed to be having the most awful public fight over what we see as a basic human right.

    I've been looking at some of the comments from the other side of the debate, from their perspective it would seem that America is no more, it's time to leave and find a new home apparently? I'm shocked that something as important as looking after those less able to should provoke such hateful responses.

    Come on America, isn't it time to be the world leader again?

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  8. Very insight Doug the first that I have seen that have been wrote within this manner.

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  9. Sad part is all thy had to do was lower the income limits on medicaid to insure all the poor. but that was too simple. Our state has over 93% covered and has a pool for the uninsured with existing conditions so they are covered and without high costs and yes we pay a higher tax. but each state should be able to do what they do and not have the government screw it up.. . but that also was too easy.

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  10. That is frustrating Jacquie. I would hoppe this state lawsuit stuff will peter out once the bill starts taking effect in the next few months, but right now it''s sore loser time for a lot of red states politicos.

    I would love to have told Bush where he could stick that donut.

    My parents had a heck of a time picking and then getting bumped off Medicare health plans. The drug plan was even more complex--so many choices for coverage that came and went by every year so my dad had to pick a new one that would cover his area and my mom's doctors .

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  11. Thanks Mike. Good to see you stop by.

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  12. Good analysis Jim.

    American Republicans (at least those in office and some of the wingnut end of the Tea Party Movement or Freedom Works or whatever) have to me a warped idea of social justice. They go on and on about liberal "moral relativism" yet are seemingly blind to the esperation caused by layoffs and general unemployment. It's not that they think the social movements of the 1960's are awfu land should be forgotten, they also of late have tried to frighten their cadres and independant voters back to an era where you can trust big corporations implicitly. I understand the skepticism toward the federal government; what I can never quite get my mind around is how they feel that a half-dozen enourmous for-profit health care insurers are best left unregulated. The fact that we have an under- 65 years of age population the size of Canada's without health insurance seems to not bother these guardians of individual liberty much at all! The whole Republican plan would have covered at the most 3 million more people over 10 years. This just won't do unless they are planning to all move to Iceland or something.

    And, yes the catawauling on the consevative blogging sites and news posts is something awful. It's like Little Nell is dead all over again ;-)

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  13. Yes, this is a new beginning but not an end. The program take years to unfold Tess and we all know that this debate goes on.

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  14. Glad you like this Jack. I really feel a bit nervous this might still get mangled up a bit but at some point you get to declare victory and defend your turf and I think the mainline of Democrats have done that. I've waiting for this to happen for a long time.

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  15. I agree that extending Medicaid would have been much simpler but I guess neither Wall Street or Washington does simple very well. Your state sounds in better shape than a lot of places. As of two years ago, Oregon had 200,000 plus kids not insured for primary care at all, not even counting parents and single people.

    The Oregon Health Plan has gotten bigger but a lot of that might go away when the federal stimulus stops. Many states dealt with health care in isolation, and some entities had politicans that just didn't seem to care.

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  16. You kidding me Doug I have just finished writing and literally it's a very touchy area. I have been waiting to see this day happen Doug since I was in my late 20's. I kid you not.

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  17. My thoughts were, to put everyone that's under 50 and uninsured , on Medicaid and everyone over 50 and uninsured on Medicare. I would put the insurance companies out of the health insurance business; they make enough money off of auto insurance, life insurance and mortgage insurance.
    Neither Texas nor Florida have a state income tax, and you don't DARE suggest it! Holy cow! I came from a state with a state tax and we had medical care when I was younger. Both Johns Hopkins and University of Maryland had terrific clinic, as did some other hospitals. They were sliding scale by income and they were very fair. The only 2 hospitals in Texas that I know of that has these kinds of clinics are Parkland Memorial and John Peter Smith. They both also have neighborhood clinics, all based on a sliding scale.
    Funny how taking care of the poor equals out to a loss of freedom. I'm still working on figuring that one out!

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  18. Yeah, I just changed plans this year. Hopefully, we'll still have them, otherwise, some of us on Medicare may not get the healthcare we need.

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  19. There's never,so far as I know, been "social justice" in America. If you aren't rich, too bad, it's your own fault and we just don't care is the attitude and always has been, far as I can see.

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  20. I can't argue with that Jacquie.

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  21. all children in Minnesota are insured, if not it is because parents do not follow through.
    We complain about the taxes but we pay them for the good of the people. I just do not see why the feds have to stick their noses in and fix something that is not broke.

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  22. It's not just the children that need insuring. Parents do as well. People are going bankrupt from cancer and other diseases, even WITH insurance! They're losing their homes and can't pay their bills. This isn't good!
    It is broken, I'm just not sure this is the fix for it.

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  23. I think the system is broken for a lot of people who don't have jobs--not because they are lazy and ill-educated but because of this deep recession. My health care premium costs have gone up 66 percent in the last five years at my job,and that's little faster than overall inflation I'd say. I'm hardly alone in that area either.

    The government has to step in because too many health insurers put profits ahead of patients--they have increased premiums and employ bureaucrats just to figure out how to kick customers off the rolls when they get sick. We are talking life or death issues in many cases--what is the government for if not to protect life and property of ordiinary Americans?

    I know things are better in Minnesota than in most states but you have a lot fewer die-hard conservatives up there than some states.

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  24. The reason the federal government has to get involved may be because most of the states were not getting the job done? And the reason we need laws to regulate the insurance industry is the same reason we need laws to regulate every other industry. To protect the every day people from greed and provide boundaries for big business so that they do not destroy themselves like mortgage companies did in the banking crisis, mortgage crash or whatever you want to call it.

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  25. my thoughts to living in Germany on the French Swiss border -

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  26. like I told many times tee if you don't like it turn your SS and Medicare in --or maybe your sate would like to cecced from the union

    sorry doug but after having seen so many bad meliciouse remarks on here today well all I say is if these people don't feel the Fed. Gov. is good turn in your SS and Medicare and maybe your passport while your at it-

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  27. greece made their own bed no let them figure a way out--really Greece is so very corupt -feel for the ordinary Greecean but they again elected their people so -Greece has been in trouble actually forever nothing new their-and actually their health care is okay available for all-

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  28. You've said it better than I could Mary Ellen. That's exactly right in my book.

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  29. I'm always amazed people have more faith in a multi-national bank or a health care outfit than they do a government whose elected officials they can completely change in six years, Heidi, and with just three peaceful elections.

    Plus Republicans aren't used to ever losing anything. The Reagan afterglow is finally over. That's where a lot of this anger comes from--the world is moving on.

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  30. You know, after Bush's second election, I was seriously reading up on Canada and if I could have found some one to relocate with me, I might have made the move. But now I am glad I stayed. The people who are upset now will have their turn to voice their vote for the other side. I hope those of us who voted this administration in will turn out again in the fall and keep this country moving in the direction it is but others will have chance to change things again. It is not necessary for them to have so much emotional energy expending right now. Although I do understand how upset they must be as I was so many times in the eight years the Bush administration was messing things up. So I try not to gloat. But want to express the positive to show not every one is of teabagger mentality.

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  31. I heard a lot about emigration enquiries into Canada in 2005 myself .I don't think Canada is really an answer for a lot of people unless someone has friends and family up there or have a doctorate in something technical that they want...I agree with you Mary Ellen, those in support of this bill need to conserve our emotional energy for a few months to let this play out. I felt the country was going in the wrong direction several times in the last eight years, and I feel we must respect men and women on the other side. I sure many of these people are not like wingnuts who called Congressmen dirty names outside the Capitol, but simply apprehensive folks used to their own way being the law of the land. As long as they are civilized about expressing their opinions, I'm on their side in letting them criticize any part of the new reform system.

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  32. I agree we needed to do something. I am not sure this is going to accomplish everything the Democrats think it will. It is a start in the right direction.
    As far as the hate mongering go both side do a pretty good job slinging rhetoric mud. I am cautiously optimistic this will help the people it was intended and not put any more burden on our already insurmountable deficit

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  33. I agree with you Fred--we needed to do something.
    Nothing that encompasses seventeen percent of the economy like the medical industry is going to be simple nor can we tell the true effects in say five years out. But it is finally a step in the right direction.

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  34. Parents are too, if they do not fit guide lines or are refused by insurance companies , Minnesota has a insurance pool that is not expensive.. Of course I am proud of my state and the way we handle things. maybe that is why I do not get the government mandating.it should be states that care for their own. I worry more about the children and their parents that are going to bed hungry tonight in the USA, well to bed that is if they still have a home or a bed. I give to food shelf, even on my limited budget I can find something to give.i give clothes to neighborhood centers where poor people do not have to pay anything for the stuff.

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  35. Thanks for posting your view on the health care reforms Doug. I am away from home right now and therefore my access to the internet is short and sporadic I will write more when I get back at the end of the week. I am glad that you see these reforms as reasons to be more optimistic about life in America Doug, I hope they live up to your expectations, paradoxically the situation here is going the opposite way with massive cuts in public spending and the collapsing pillars of the welfare state. I think this is an improvement I hope it proves adequate to the task. I'll come back on this when I can access the net more easily, but in the meantime congratulations on getting something you want and need from central government,that makes a refreshing change for most of us I think!

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  36. Thanks for posting your view on the health care reforms Doug. I am away from home right now and therefore my access to the internet is short and sporadic I will write more when I get back at the end of the week. I am glad that you see these reforms as reasons to be more optimistic about life in America Doug, I hope they live up to your expectations, paradoxically the situation here is going the opposite way with massive cuts in public spending and the collapsing pillars of the welfare state. I think this is an improvement I hope it proves adequate to the task. I'll come back on this when I can access the net more easily, but in the meantime congratulations on getting something you want and need from central government,that makes a refreshing change for most of us I think!

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  37. Just out of curiosity, where is "here"?

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  38. Look forward to any further observations, AA. The opposition to what is really a good first few steps toward reform has been so hysterical in some quarters of the country. There have already been death threats against Congress people, party headquarters smashed by vandals, et al. Still ,I am more optomistic--cautiously right now, but this is a blueprint for others to build on.

    The economic meltdown has taken a heavy toll on the social sectors I'm afraid---the British public might appreciate what they have more if they observed the runaway spending on fee-for-service medical care we have over here during the recent past ---a good deal more with less access and little if any improvement in medical care or life expectancy for the population at large.

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