Healthcare reform -- Can It Happen Here?

[w¡n9Nµ7 §£@¥€r 123]

August 11, 2008

By PAUL KRUGMAN

The draft Democratic Party platform that was sent out last week puts health care reform front and center. “If one thing came through in the platform hearings,” says the document, “it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care.”

Can Democrats deliver on that commitment? In principle, it should be easy. In practice, supporters of health care reform, myself included, will be hanging on by their fingernails until legislation is actually passed.

What’s easy about guaranteed health care for all? For one thing, we know that it’s economically feasible: every wealthy country except the United States already has some form of guaranteed health care. The hazards Americans treat as facts of life — the risk of losing your insurance, the risk that you won’t be able to afford necessary care, the chance that you’ll be financially ruined by medical costs — would be considered unthinkable in any other advanced nation.

The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it.

I know that’s not what everyone says; some pundits claim that the United States has a uniquely individualistic culture, and that Americans won’t accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have a program — you may have heard of it — called Medicare. It’s a program that collects money from every worker’s paycheck and uses it to pay the medical bills of everyone 65 and older. And it’s immensely popular.

There’s every reason to believe that a program that extends universal coverage to the nonelderly would soon become equally popular. Consider the case of Massachusetts, which passed a state-level plan for universal coverage two years ago.

The Massachusetts plan has come in for a lot of criticism. It includes individual mandates — that is, people are required to buy coverage, even if they’d prefer to take their chances. And its costs are running much higher than expected, mainly because it turns out that there were more people without insurance than anyone realized.

Yet recent polls show overwhelming support for the plan — support that has grown stronger since it went into effect, despite the new system’s teething troubles. Once a system of universal health coverage exists, it seems, people want to keep it.

So why be nervous about the prospects for reform? Because it’s hard to get universal care established in the first place. There are, I’d argue, three big hurdles.

First, the Democrats have to win the election — and win it by enough to face down Republicans, who are still, 42 years after Medicare went into operation, denouncing “socialized medicine.”

Second, they have to overcome the public’s fear of change.

Some health care reformers wanted the Democrats to endorse a single-payer, Medicare-type system for all. On the sheer economic merits, they’re right: single-payer would be more efficient than a system that preserves a role for private insurance companies.

But it’s better to have an imperfect universal health care plan than none at all — and the only way to get a universal health care plan passed soon is to inoculate it against Harry-and-Louise-type claims that people will be forced into plans “designed by government bureaucrats.” So the Democratic platform emphasizes choice, declaring that Americans “should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan.” We’ll see if that’s enough.

The final hurdle facing health care reform is the risk that the next president and Congress will lose focus. There will be many problems crying out for solutions, from a weak economy to foreign policy crises. It will be easy and tempting to put health care on the back burner for a bit — and then forget about it.

So I’m nervous. The history of the pursuit of universal health care in America is one of missed chances, of political opportunities frittered away. Let’s hope that this time is different.

One more thing: if we do get real health care reform, a lot of people will owe a debt of gratitude to none other than John Edwards. When Mr. Edwards dropped out of the presidential race, I credited him with making universal health care a “possible dream for the next administration.” Mr. Edwards’s political career is over — but perhaps he and his family can take some solace from the fact that his party is still trying to make that dream come true.

http://www.nytimes.com/2008/08/11/opinion/11krugman.html

[Ban Hammer 13,282]

The draft Democratic Party platform that was sent out last week puts health care reform front and center. “If one thing came through in the platform hearings,” says the document, “it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care.”

nothing more than a buzzword. i'm still waiting for someone to define what is meant by "affordable"

maybe time for a poll, aj?

[w¡n9Nµ7 §£@¥€r 123]

I wouldn't know what to put as options.

I think that poll should come from someone who has had significant out-of-pocket healthcare expenses. I have not. My insurance has been great from day 1.

[one...two...tree 2,762]

I was watching Meet The Press yesterday morning and the panel on there said whoever is elected president has an enormous task at hand with regard to the economy, which will make it difficult to deliver on too many promises like healthcare reform. We're going to have to stimulate the economy first and foremost - hopefully by investing in renewable energy....then maybe towards the end of the their first term as President, we can move forward on universal healthcare.

[w¡n9Nµ7 §£@¥€r 123]

I was watching Meet The Press yesterday morning and the panel on there said whoever is elected president has an enormous task at hand with regard to the economy, which will make it difficult to deliver on too many promises like healthcare reform. We're going to have to stimulate the economy first and foremost - hopefully by investing in renewable energy....then maybe towards the end of the their first term as President, we can move forward on universal healthcare.

From April of this year:

http://www.visajourney.com/forums/index.php?showtopic=124079

[one...two...tree 2,762]

The draft Democratic Party platform that was sent out last week puts health care reform front and center. "If one thing came through in the platform hearings," says the document, "it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care."

nothing more than a buzzword. i'm still waiting for someone to define what is meant by "affordable"

maybe time for a poll, aj?

It's not that difficult, Charles. You tell Americans that for many of us who are paying high premiums in health insurance - that cost will be deleted from their family's expenses.

[w¡n9Nµ7 §£@¥€r 123]

Steven, I think there is considerable risk in promising huge savings to people in exchange for better service. Actual cost savings due to increased efficiencies of the new system will take time, and will come after an initial period of higher costs (which happens any time you make a big change like this).

[Aubrey 10]

The draft Democratic Party platform that was sent out last week puts health care reform front and center. “If one thing came through in the platform hearings,” says the document, “it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care.”

nothing more than a buzzword. i'm still waiting for someone to define what is meant by "affordable"

maybe time for a poll, aj?

Good point. Several years back, I was paying over $200 out of pocket every month for my insurance at my job with benefits. Then you add co-pays and deductibles... That was "affordable" compared to the private insurance I went to after that job.

I don't see universal healthcare coming anytime soon, tbh. Our best shot was in the 90s when we weren't bleeding cash into 2 wars under Clinton. But nobody supported it back then. The insurance and medical companies have a stranglehold on our government and have no intention of being forced into policies like no pre-existing conditions and affordable rates. It would just mean the government would have to make up the difference and cover everyone that can't get coverage... and apparently people think that'd make us socialists (oh noes! ).

If you want affordable healthcare, rethink your visas and move to Europe.

[one...two...tree 2,762]

Steven, I think there is considerable risk in promising huge savings to people in exchange for better service. Actual cost savings due to increased efficiencies of the new system will take time, and will come after an initial period of higher costs (which happens any time you make a big change like this).

...we really don't have much of a choice...staying the course is contributing to our economic woes.

from American Prospect:

If health insurance were cheap, we could all buy it. If universal health care could get 60 votes in the Senate, we'd all have it. But these two imperatives -- the need to control costs and the need to attract the 60 Senate votes required to overcome a filibuster -- point in opposite directions. This is the central paradox of health reform.

The most intractable policy problem is not, fundamentally, the 47 million uninsured or the fact that insurers have a business model right out of Dickens. It's cost. In 2006, the average family policy cost $13,600. This is why one out of six Americans are uninsured; they can't afford the premiums. An October 2007 Kaiser Family Foundation poll found that more Americans were "very worried" about being priced out of their health insurance than feared losing their job, their house, or being in a terrorist attack. And with good reason: Premiums have gone up 98 percent since 2000. Wages have not.

Corporate America's outlook is similarly grim. Better Health Care Together, a health-reform coalition that includes Intel, Wal-Mart, and General Mills, recently issued a report, Health-Cost Crossroad: Why American Businesses Urgently Need Health Care Reform. The paper warns that "health care cost growth threatens businesses, workers, and the overall health of the American economy," and frets that "if trends continue, health benefit costs will exceed profits in Fortune 500 companies in 2008."

Likewise government. Absent reform, government health spending would be 37 percent of gross domestic product by 2050. (The entire federal government now consumes about 20 percent of GDP.) David Walker, the U.S comptroller general, warns that "we have been diagnosed with fiscal cancer, and we need to start treating it." At the Congressional Budget Office, the normally staid Peter Orszag gives an Al Gore-esque slideshow on the looming threat of health costs that risk bankrupting government finances.

The question, then, is how to limit heath-care costs while still surviving the legislative process. A single-payer system would increase efficiencies, but critics fear that it would control costs excessively, limiting care. Politically, single-payer would mean restructuring about 17 percent of our economy and eliminating multibillion-dollar industries that provide tens of thousands of jobs. It would have to be legislated over the fierce objections of the Republican Party and all conservative Democrats. Conversely, many Republicans, John McCain included, advocate a radical shift of costs onto individuals, controlling spending by pricing care out of reach for tens of millions. Few Democrats or moderate Republicans -- or voters -- favor this course.

http://www.prospect.org/cs/articles?articl...itics_of_reform

Edited August 11, 2008 by Jabberwocky

[Ban Hammer 13,282]

The draft Democratic Party platform that was sent out last week puts health care reform front and center. "If one thing came through in the platform hearings," says the document, "it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care."

nothing more than a buzzword. i'm still waiting for someone to define what is meant by "affordable"

maybe time for a poll, aj?

It's not that difficult, Charles. You tell Americans that for many of us who are paying high premiums in health insurance - that cost will be deleted from their family's expenses.

so you're happy to let the guvmint decide what's "affordable" to you?

care to take a stab at it? what is affordable to you? what's affordable to me? or aj?

[HAL 9000 96]

Affordability may be considered relative to current costs at this time- not doing anything about the current system is imo, worse than supporting the profitability aspect for those making a literal killing in the health care market.

[w¡n9Nµ7 §£@¥€r 123]

care to take a stab at it? what is affordable to you? what's affordable to me? or aj?

The answer to that question will likely not be a nominal dollar figure, but rather a percentage of income.

Kind of the same way banks determine your maximum mortgage amount - as a percentage of pre-tax income or as the ratio of maximum allowable debt over income.

[Ban Hammer 13,282]

care to take a stab at it? what is affordable to you? what's affordable to me? or aj?

The answer to that question will likely not be a nominal dollar figure, but rather a percentage of income.

Kind of the same way banks determine your maximum mortgage amount - as a percentage of pre-tax income or as the ratio of maximum allowable debt over income.

percentage is fine. care to grab the knife and take a stab at it?

[one...two...tree 2,762]

The draft Democratic Party platform that was sent out last week puts health care reform front and center. "If one thing came through in the platform hearings," says the document, "it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care."

nothing more than a buzzword. i'm still waiting for someone to define what is meant by "affordable"

maybe time for a poll, aj?

It's not that difficult, Charles. You tell Americans that for many of us who are paying high premiums in health insurance - that cost will be deleted from their family's expenses.

so you're happy to let the guvmint decide what's "affordable" to you?

care to take a stab at it? what is affordable to you? what's affordable to me? or aj?

It's the big bad guvmint vs. the big bad insurance companies. Charles, it's the lessor of two evils, IMO. Instead of you paying your insurance premiums to an insurance company, we'd all be paying into a single payer system - much more efficient than what we have now. There's no getting around that whoever is the payer of our healthcare will try to control costs, but in terms of efficiency and eliminating profit motive in cutting costs, having a national healthcare system beats private insurance companies hands down.

And for those who want additional private insurance - you can still have the choice to purchase it.

[IAMX 3,055]

While normally being an optimistic person, this is the one thing I remain cynical (yet hopeful) about.

This country needs universal healthcare, and the country's mindset needs to go up one notch of intelligence with the rest of the first world.

However, if it does happen, it will be via individual states. I have little faith people in many states (mostly southern and midwestern) are going to wise up to the fact that the healthcare system this country has now is utter failure.

Just to be COVERED by private insurance you sign a waiver with the insurance agency. If you just happen to have the misfortune of a pre-existing condition which just might require care, there's a good chance for denial. Why? Because it might cost the insurance agency. Then there's the outright denial of care in certain situations, none greater experienced in my life than 3 private insurers my sister's step-dad had, working for NASA, who delayed her chemotherapy and bone marrow transplant for her leukemia because they didn't want to cover her, because treating cancer patients doesn't seem like it's profitable enough.

If this seems reasonable to people, they need a good smack upside the head. However great the doctors and medicine is means nothing if one can't even get insurance. That is, a slight bit less than 20% of working adults don't have insurance. And before someone cites their precious taxes.. guess what? If someone can't afford to pay their medical bills because they have no insurance, guess who pays anyways? Yep. TAXPAYERS.

Time to join the 21st century, America.

Edited August 11, 2008 by SRVT