Echoes of Social Security Reform in the Health Care Debate

A couple of months ago over lunch in San Francisco Speaker Pelosi was ruminating over how the Dems won control of the House. The problem after the 2004 election was that President Bush’s approval ratings were too high: 58% in January of 2005 and more than 60% of seniors liked his ideas on Social Security. But Pelosi saw an opportunity with Social Security reform – labeling the private accounts tantamount to a privatization of Social Security and waging a war, with the help of vocal outside groups, to take them off the table. By September 70% of seniors were with the Dems and Bush’s plan was in ruins. Pelosi had resisted calls within her own party to put out an alternative plan – risking the label of the Party of No and arguing that Social Security is their plan – in order to later, when the time was right and Bush’s poll numbers were in the tank, reveal the Six for 06 agenda. “I used to say to him, ‘You’re going to 60 cities in 60 days, I want you to go to 120 cities in 120 days and I’ll buy the ticket,’” Pelosi told me. “You are giving us a golden opportunity.”

This week Senate Republicans came out swinging against the proposed public plan offered in most Dem health care reform proposals as an alternative to private insurance. They have labeled such a move tantamount to socializing the health care system. “The idea of a government-run health care plan is a big problem for us. And it’s a big problem because it leads inevitably to a Washington takeover of health care,” Lamar Alexander, the No. 3 Republican senator, told reporters on Tuesday. “Those are two words we hear a lot today, ‘Washington takeover.’ In the case of health care, it’s like putting an elephant in a room with some mice and say, ‘OK, fellows, compete.’ After a while, the elephant has taken over the room, and your only choice is the elephant.”

Today the American Medical Association became the first powerful outside group to come out against a public plan. “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans,” the group said in a statement.

The G.O.P. push, in coordination with outside groups, against the public plan has the same feel to it as Pelosi’s early push against Bush’s private accounts. But this time around there are some key differences, most notably, Pelosi argued, is the character of the president. Bush “was a poor messenger across the board. That’s not going to happen to Barack Obama. He’s not an ideologue. And when you’re an ideologue you insist on things a certain way and then you pay the price,” she said. Another difference is the state of the economy. Yes, Social Security is a large and looming problem, but there was no immediate impetus for reform in 2005. Health care costs are a massive burden on millions of Americans and millions of American businesses. The G.O.P. would have a much harder time not offering an alternative plan or arguing the status quo would be better.

That said, Republicans are taking advantage of widespread concern about government spending too much money. And for all that Obama’s not an ideologue, Dems on both ends of Pennsylvania Ave. are not considering taking the public plan off the table – they won the election after all. But, as Pelosi proved with Bush, all it takes in one effective pin prick in a president’s polls and you risk the whole house tumbling down.

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  • Paul-no not that one

    “60% of seniors liked (Bush’s) ideas on Social Security.”
    .
    Is that accurate? Any tampering of SS has always been unpopular with seniors, I thought.
    .
    That the AMA is lining up against the public plan is not shocking. The entrenched defending the status quo. It will come down to how well BHO can sell the idea.

  • http://phd9.blogspot.com Paul Dirks

    You’ve spent some time creating a ‘mirror-image’ structure here between Pelosi resisting SS reform vs Republicans resisting Insurance reform. But there’s one important way the images fail to align.
    .
    In both cases it’s the Republicans who are selling irrational fear.
    The ‘calling wolf’ aspect is only on one side of the divide….
    .
    Stated another way. Social Security was a solution without a problem, health care is a problem without a solution.

  • rustyreturns

    Thank you Jay for the un-biased reporting in your posting here today. It is indeed very refreshing.
    .
    In my mind we have the big spending Pelosi with her encouragement of more big government programs, to what end? People who know how our government works also know that these huge government run programs do not work, and are far more costly on average. There is absolutely no reason that we cannot have a government backed insurace like we have with the Medicare HMO’s all around us, to provide insurance to those who have none or have a policy that is just simply not adequate.
    .
    With a Medicare HMO type insurance system, run by private insurance companies but the funding is primarily done through the government with oversight on cost, like CMS, then we can also keep the private insurance that those of us have which is far and superior above anything the government will ever be able to provide.
    .
    We have the system in place, we do not need to spend billions of dollars to find out if a “public” insurance plan would be better. We will not be over burdening the tax payer with the huge proposed Obama plan that exceeds 1 TRILLION dollars.

  • yoshiattack

    Stated another way. Social Security was a solution without a problem, health care is a problem without a solution.
    -
    Solution without a problem?
    -
    http://www.washingtonpost.com/wp-dyn/content/article/2009/05/12/AR2009051200252.html?wprss=rss_politics
    -
    Specifically, the trustees’ report predicts that the trust fund from which Social Security payments are made will be unable to pay retirees full benefits by 2037, four years earlier than forecast a year ago. In particular, the trustees single out the financial weakness of the part of the program that subsidizes disabled Americans, saying that fund will run out of money in 2020.
    -
    Yesterday’s report also said the Social Security trust fund will begin to spend more money than it takes in through tax revenue in 2016, one year sooner than predicted a year ago.

  • plukasiak

    You’ve spent some time creating a ‘mirror-image’ structure here between Pelosi resisting SS reform vs Republicans resisting Insurance reform. But there’s one important way the images fail to align.
    .
    In both cases it’s the Republicans who are selling irrational fear.
    The ‘calling wolf’ aspect is only on one side of the divide….
    .
    Stated another way. Social Security was a solution without a problem, health care is a problem without a solution.

    _
    pd, apparently, JNS thinks that the american people are as vacuous and intellectually corrupt as she is — she’s obviously incapable of understanding either social security privatization or health care reform proposals on their merits, so she has to reduce the issue to something that a garden slug could understand.

  • http://phd9.blogspot.com Paul Dirks

    Yes yoshi, it’s not a problem that cannot be easily addressed.
    .
    The fact that the SS trust fund looked like a big pile of collateral just sitting there like a wasted opportunity IS a problem but the fundementals are still quite sound.

  • carotexas1

    The same senior citizens who have found out that we pay more for medicine than countries with a government plan?
    .
    Republicans need to worry about the sentiment that we have spent money on two wars, and bailouts to big business and now it is time to spend some for American citizens and voters.

  • textee

    “A couple of months ago over lunch in San Francisco Speaker Pelosi ….”

    -

    Lunch. San Francisco. Nancy Pelosi.

    -

    Never have so few words made me sick so quickly.

  • xxchalice

    A public plan will not change all things currently wrong with the system, but it could add some sanity to the current situation especially with the awful management (yes we are already managed by the very greed that put us into a recession – corporations). The AMA is an awful arbiter of the case against a public plan, they have very profitable vested interests. The reason the doctors most fear this legislation is because they know people will take to it in droves. I have a great plan myself and know for a fact I would give the government plan a definite look when established, especially if it is as good as the one our legislators currently receive at our expense… I want some of that. Also, yes it will be expensive, but there is so much bureaucracy and BS in the system already the eliminating that and adding some sanity to the reimbursement scheme would do wonders for our overall health. Logical people know this and want a public plan, health is a public issue and it should be managed as such.

  • mccainfluffer

    We should just let the Republicans handle these problems. Just imagine how solvent everyone’s retirement funds would be if we would have had the opportunity to invest our Social Security accounts in the stock market……

    Never mind.

  • John Royal

    That’s funny. My doctor must not have gotten the AMA memo because he was railing against insurance companies today and he thought the public option was the only way to go.

  • vastwastelander

    Okay, what do people know about this so-called “co-op” option that Baucus, et al. are floating? How would these health care cooperatives work? It sounds like they are private non-profit entities . . . can someone explain, please?

  • http://www.inworldstudios.com jayackroyd

    John Royal–
    .
    it’s pretty clear that the AMA doesn’t represent most doctors. Every doctor I know hates the system and would enthusiastically switch to single payer.
    .
    “Social Security Reform”? What does that mean? There’s nothing broken, nothing to be reformed. There are horror stories everyday related to this disastrous health care system, that can be largely laid to profit and revenue maximization strategies rather than a focus on best possible patient outcomes.

    See: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

  • Commenter 2B named later

    The analogy with the elephant and the mice is more astute than Lamar Alexander intended. Elephants are afraid of mice.

  • landof1000dances

    That said, Republicans are taking advantage of widespread concern about government spending too much money.

    Do you have proof that people outside Versailles are worried about this right now?

  • http://www.inworldstudios.com jayackroyd

    what do people know about this so-called “co-op” option that Baucus, et al. are floating?
    .
    No matter what they call it (and the more incomprehensible the name and description, the more this will be true), it is a plan to preserve the status quo, perhaps forcing healthy young people to participate in exchange for govt subsidy of “preexisting condition” premiums.
    .
    The arguments to be made that explain the benefits of either a public option or a path to a single payer are easy arguments to make. Refuting the lies the GOP is telling is equally easy to do.
    .
    Either nobody is making them, or the tradmed is not covering them.

  • http://www.inworldstudios.com jayackroyd

    That said, Republicans are taking advantage of widespread concern about government spending too much money.
    .
    Then why aren’t they proposing money-saving solutions? Why are they only screeching this nonsense and not proposing methods for reversing the enormous Bush deficits? Why do we get this constant stenography that is 1) based in lies and 2) not actually supported by people.
    .
    Why can’t you say what they are really doing? They are trying to scare people into thinking the lady at the DMV is going to telling them what doctor they has to go to. Boehner’s post yesterday was a complete tissue of lies. There was nothing true in it. How can you justify not pointing this out?

  • seanmel

    Private insurers cover nearly 70% of Americans. And the other 30+%? How is having 3 out of 10 Americans denied a basic necessity a positive?

  • stuartzechman

    Hmmm…”AMA”…”AMA”…
    .
    Where have I heard of that organization before?

  • pafro

    If I was Pelosi, I would put a bill on the floor that proposes getting rid of “government run healthcare” such as the VA system, DOD system, Medicare, and Medicaid. Then let’s see if the Republicans are for or against “government run healthcare” and just get everyone on the record.

  • stuartzechman

    Jay Newton-Small:
    .
    The question for journalists will be whether or not they can include the AMA’s well-documented opposition to Medicare when it was proposed in the discussion of its opposition to a public plan now.
    .
    Will “the AMA says” be allowed by the mediators of this debate to be used by Republicans, laissez-faire ideologues and profit-driven interests synonymously with “Doctors prescribe”?
    .
    Again, political journalists will be the deciding factor, because their facile acceptance or clarifying contextualization of “the AMA says” will make the difference in ordinary people believing that they will or won’t be allowed to see their doctors when they need to.
    .
    Good luck with that responsibility, Jay Newton-Small…am I wrong?

  • stuartzechman

    …And another thing, Jay Newton-Small:
    .
    Have you by any chance read this amazing article in Time Magazine online called “The A.M.A. & Medicare”?
    .
    It turns out that, at least according to Time Magazine, the AMA opposes Medicare…vehemently!
    .
    It’s so interesting to read that

    the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs.

    , when the AMA has such an anti-Medicare position:

    The American Medical Association’s 115th annual convention in Chicago last week wound up just in time for the doctors to go home to deal with the consequences of Medicare, the social security-administered medical insurance that so many of them had fought against so vehemently and so long.
    .
    …the new president [of the AMA], Dr. Charles Hudson, a Cleveland internist, counseled moderation. “There are people who think doom is going to fall in on us,” he said. “I think this opinion is not justified. We are not stepping off the brink into a bottomless pit of professional destruction and despair.” He proposed that doctors “make the most of this new program.” If they do, he suggested, they may help “prevent its extension toward a national health service.”
    .
    The delegates’ stance on billing was strong evidence that the majority of A.M.A. policymakers are not yet ready to adjust to the new program. The delegates obviously thought that the fight should and will go on. and to prepare for the future they elected Dr. Milford Rouse by acclamation as the next A.M.A. president. Rouse, who will take office in June 1967, is a Dallas gastroenterologist and a former director of H. L. Hunt’s ultra-right Life Line Foundation. As speaker of the house of delegates, he has already made it clear that he will take a far harder line on Medicare than moderate Dr. Hudson.

    .
    So how about that, Jay Newton-Small?
    .
    Before discussing the AMA’s position on a public insurance option being made available to every American, journalists probably need to ask the AMA about their position with respect to Medicare, since it looks like they’re almost fanatically opposed to it.
    .
    Has anything changed, Jay Newton-Small?

  • yoshiattack

    The fact that the SS trust fund looked like a big pile of collateral just sitting there like a wasted opportunity IS a problem but the fundementals are still quite sound.
    -
    Aw come on PD…I have no idea why you wanted to present an enormous target to me, but suffice to say, wasn’t it one of the greatest moments of the 08 campaign where one of the candidates said something like “the fundamentals of _______ are strong?”

  • http://phd9.blogspot.com Paul Dirks

    Well yoshi, Not to put too fine a point on it, but the reason McCain was wrong is telling. It’s called leverage and the economy he referred to had way to much of it unsecured by actual asset value. The reason Conservatives are panicked over SS is that they’ve been issuing bonds against the trust fund in order to keep paying for their tax-cuts uber alles theory of governance. The SS trust fund is a big pile of green in an otherwise endless sea of red.
    .
    Pointing at Social Security as a big problem is just a distraction from the real problem.
    .
    Note that Obama isn’t doing anything in particular to solve the problem either. But at least he’s promising he’ll get around to it as soon as the recession is over….

  • stuartzechman

    Yoshi:
    .
    The fundamentals of Social Security are strong.
    .
    The problem with Social Security is that the trust fund has been raided by the big-spending (on 12b per month wars, billions in foreign aid to countries that screw us) government, especially in the last eight years.
    .
    Remember Al Gore’s “Lockbox”? That was all about keeping SS funds from turning into a bunch of IOUs. It’s not that the Social Security program itself is fundamentally flawed, it’s that it’s been borrowed from by an increasingly profligate Republican Congress for the past ten years.

  • shepherdwong

    “Again, political journalists will be the deciding factor, because their facile acceptance or clarifying contextualization of “the AMA says” will make the difference in ordinary people…”
    .
    I’m confident that they’ve found sufficient rationalization for why they aren’t responsible for the public policies they enable (see: Clinton impeachment, George W. Bush presidency, Iraq, the Reagan-Clinton-Bush-Greenspan-Paulson Depression, etc.). When Our Masters deny us the efficient and effective health care we need, due the public’s woeful misunderstanding of the facts resulting from the journalistic malpractice we continue to experience, I guarantee they will point their fingers at other people…perhaps, the AMA.

  • yoshiattack

    Maybe so, guys, but a couple of points: 1) Republicans weren’t always in control for the last ten years, and 2) unless I’m mistaken, politicians are still going to raid the refrigerator/lockbox/cookie jar, so we’re still going to have to fix SS sometime.

  • yoshiattack

    Come to think of it, these gigantic deficits we’re running up would suggest…raiding the lockbox, huh?

  • shepherdwong

    “…we’re still going to have to fix SS sometime.”
    .
    Yes, sometime in the next ten years or so. So, all things considered, why in the hell would we worry about that right now?

  • rustyreturns

    Nice history lesson stuart, but I think Jay states the position of the AMA very clearly…
    .
    “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans,” the group said in a statement.
    .
    I do want to point out that the current medicare plan has the lowest reimbursement rate to Physicians than any other insurance plan with the exception of Medical Assistance, another government backed program. I believe the concern is well founded that the only thing Obama is creating is the destruction of the private insurance business, and replacing it with a far inferior insurance program run by government “DMV”-type people who WILL dictate who you will see, when you can be seen and how much of a reimbursement the Physician will be given.
    .
    This is no different than all the other sorts of games Obama is now currently playing with the auto companies and banks. The Obama Administration with all 17 “Czars” are telling the businesses what they can and cannot do. How do you justify that type of arrangement?
    .
    People who do have very good insurance should be very concerned and worried. Big Brother Obama with the assistance of Sister Pelosi from San Francisco are going to limit, if not totally change how you receive healthcare. Consider yourself screwed!!

  • shepherdwong

    “Big Brother Obama with the assistance of Sister Pelosi from San Francisco are going to limit…”
    .
    Just a little piece of advice: save the “Sister Pelosi”, “San Fransico”, “Big Brother Obama” scaremongering usages for your fellow permanently aggrieved, bed-wetting, “conservative” mouth-breathers. To rational people, using them in the manner you do, only serves to make you look like an even bigger lunatic.

  • stuartzechman

    Rustydog:
    .
    introduction of a new public plan threatens to restrict patient choice by driving out private insurers
    .
    As I may have mentioned previously, these sorts of sky-is-falling threats are examples of rank fear-mongering.
    .
    …And bullsh*t talking points.

  • http://www.inworldstudios.com jayackroyd

    SS is easily fixed. Drop the cap. If that’s not enough, remove or reduce income tax loopholes. And cut defense spending in half. This gibberish is very tiresome.
    .
    The gibberish that retaining a failed health care system is not just tiresome. It is actually damaging. A profit driven health care system does not permit effective delivery of services to best deliver good patient outcomes. It is particularly ineffective in providing preventative services that are by far the cheapest way to arrive at good health care outcomes. This is not debatable. The only issue at hand is how to overcome the institutional (read “corrupt”) barriers preventing sound policy.
    .
    There was some doubt about this in 1993. There is none now.

  • rustyreturns

    One person’s “talking point” is another persons rallying cry to stop the fools in Washington from making the biggest mistake since the bailouts and stimulus debacles.
    .
    It is purely big government interference into private industry stuart and you know it full well. It will also be a “government takeover” of our health care which was pointed out in Jay’s posting above that over 70% of the American public HAS insurance.
    .
    That simply means the liberal progressive / socialist want the other 30% who are under or non-insured to dictate to the rest of our society exactly how their health-care will be handled. Handled by big brother Obama and sister Pelosi. I for one do not want to give them one more damn thing to F@ck the hell up as they have so far with the economy and the demise of GM and Chrysler.

  • stuartzechman

    Rustydog:
    .
    Didn’t you read what I mentioned previously?

  • yoshiattack

    Stuart, I was genuinely surprised to find nothing of factual substance in the article you linked.
    -
    To be certain, progressive health care advocates also have well-tuned talking points and polling data at their disposal.
    -
    Why tell us something we already know?

  • omgamike

    To rustyreturns:
    I will simply say that I am a 60 yr old disabled male. I receive both Medicare and Medicaid under a program designed, by the “government” to allow me to stay in my home, rather than in a nursing home. Government saves a whole lot of money by doing so. I have total freedom in selecting my doctors and hospitals, when needed. You cannot say with any degree of honesty, that these government run programs do not work. The only problem with them is that an individual has to wait up to a year or more to get on the program. Without the help from Medicare and Medicaid I would either be crippled in a nursing home, or dead.

  • stuartzechman

    Yoshi:
    .
    I was genuinely surprised to find nothing of factual substance in the article you linked
    .
    In all honesty, could you be more specific?

  • thefoff

    Please explain to me like I’m a third grader how the “Party of Free Market Choice” opposes additional competition in the almost-empty market of health care options in America. We used to have choices. Then a few giant companies, with the help of their Republican protectors, bought all of the options, leaving America with, what?, like three health insurance companies.

    It seems that having additional choices in a managed market means that CONSUMERS (you know, the American people) win. But I imagine that health insurance companies who’ve managed to increase their profits by over 400% in the past ten years (I’m not making that number up) don’t really want to lose their unCompetitive Advantage. After all, they have all of those members of Congress to buy off with the profits they’re making.

    And the AMA actively limits the number of seats at medical schools to ensure that there is always a high demand for doctors–by ensuring that we never have enough. Yeah, I trust them to make a recommendation about health care.

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  • seanmel

    rustyreturns says: “I believe the concern is well founded that the only thing Obama is creating is the destruction of the private insurance business, and replacing it with a far inferior insurance program run by government “DMV”-type people who WILL dictate who you will see, when you can be seen and how much of a reimbursement the Physician will be given.”

    Uh, that’s exactly how an HMO, PPO, EPO, etc. work NOW. A series of byzantine rules enforced by distant beaurocrats determines what should be covered, and more importantly NOT covered, how much physicians will be paid, and which doctors and hospitals, procedures, and medications will or will not be covered.

  • billwatson1

    A common sense blunt fix for health care.

    1. Set up a civilian, VA style, public health care system for delivering all government funded health care and medications free to everyone choosing to use it, no restrictions, rich, and poor, Medicare, Medicaid, etc everybody who wants public care has it free, all services, all medications, free period.
    2. Pay for it with a national sales tax.
    3. Let private insurers and care providers compete for everyone who wants private care, unfettered by government mandates, dictating who must be served, at what level, for what price, and totally unregulated but for safety.
    4. Businesses that choose public care for their employees will have no financial obligations or any other responsibilities concerning health care.

    (The Best Care Anywhere by Phillip Longman)http://www.washingtonmonthly.com/features/2005/0501.longman.html

    Dispensing health care efficiently, and collecting the money to pay for it cheaply, that’s the purpose of the exercise, and no one can compete with the government at these two tasks.

    An OMB study of this dual solution for health care reform compared to any other would show annual savings of hundreds of billions of dollars.

    This is the best that we can do!

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