Health Care: Hitting the Re-Set Button

Ah crap – wha’ a way t’ be ruinin’ th’ birthday o’ me alter-ego in th’ real world! Now she’ll be havin’ t’ be givin’ up th’ day-long, single-malt binge celebration she were plannin’, an pay attention!
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Th’ President better be sayin’ somethin’ earth-shakin’ FABulous t’ make th’ bloody teetotalin’ worth it – somethin’ ‘long th’ lines o’ “Single payer an’ d*mn th’ torpedoes!”
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I won’t be holdin’ me breath.
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yarr.

Just li’ I won’t be holdin’ me breath fer KT, nor Micheal me lad, nor no one else in th’ “journalism” field t’ actual take advantage o’ th’ reset window t’ engage in any truthful reportin’ an’ advocatin’ fer said truth tha’ mi’ actual’ be worth somethin’.
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yarr.

I agree with your analysis, KT. Things must be much more dire than we realize.

I wonder if the Teabagger Express, which is slowly wending its way across with country for a big rally in DC on September 12th, will now speed up it’s processional to coincide with the President’s speech. That would make for great political theatre.

I got a question for everyone. Who is going to pay if Obama fails?

If anyone thinks that if health care reform gets defeated this will not be seen as a sign by the health insurers that they have keys to the government and can do what ever the f**k they want, You are kidding yourself or burying your head in the sand because that is what most certainly will come to past.

I don’t have to try to scare anyone with what I’m saying because a very sizable portion of this country has already demostrated they think they are fighting for their health care when they oppose reform.

The reality is they are fighting for the status quo and health insurers profits at their own personal and their families expense. But be that as it may. Reform fails and it does fail without a public option, and look the f**k out.

Digby skewers Joe Klein’s favorite politicians as:

“lunatic moderates who put a price tag above morality except when talking about war.”

And this in response to the Politico f@cks who said:

‘The confrontation [the pres. vs. his base] would allow Obama to show he is willing to stare down his own party to get things done.’

Dig: “This makes perfect sense because his problem is that he’s been kow-towing to the left so much that he’s lost the country, what with all the war crimes investigations, the tax hikes for the rich, the crackdown on the banks, the repeal of “don’t ask don’t tell” and the thumbing of his nose at the Republicans every chance he gets. Not to mention the plans for full withdrawal from Iraq and Afghanistan by 2012 and his full blown assault on the health care industry and insistence on a Canadian style health care system. You’d think Obama would have been far, far more cautious so as not to give the Republican freakshow any possible path to demonize them as “far left.” It’s not like they could just make stuff up and a lot of people in America would believe it, right?”

Remember when Congressional Republicans requested one of their leaders, Joe the Plumber, come and give a pep talk?

Boy, it’s almost as if Obama should have started out by proposing single–payer and then could have compromised to the public option.

I wonder how many extra Republican votes he will get if he stabs all his supporters in the back, and sides against the wishes of the majority of people?

I bet that might mean he wins at least one more Republican vote than he has now, making the compromise worth it, as it will be done in the spirit of balance and bipartisanship.

No need to “re-set”, everything’s going according to Kabuki:

1) Put item on urgent agenda: “the current, failed, private-insurance-based health care system is bankrupting the country”.

2) Let Congress develop legislation that addresses key reforms: a) (near) universal coverage, b) reform of worst insurance company practices and c) cost containment.

3) Set the “bi-partisan outreach” narrative and let Republicans take themselves out of the game through mindless obstruction.

4) Make progressives force through a good bill, including a public option, over insurance industry lobbying (“make me do it”).

Crystal Ball Sez: “Signs point to B**e D**s.”

Maybe their “pressing the reset button” photo can correspond with “The Box” movie opening:

As a black male, this issue was the tipping point on whether I threw my initial support to BO or to that lady everyone thought would win until the race card got played (I live in North Fla and wasn’t part of the nominating process anyhow!) But I digress.

I suspected back in ’08 BO didn’t have all his ducks in a row when it came to health care plans. Unfortunately it looks like I’ve been proven right. ‘Tis better to give Congress a little fishin’ line to make it think like it had a hand in this but the minute there was discord, he shoulda reeled it in and told folks prior to August what he really wanted. Prez failed to do that immediately and he fumbled the momentum. Still got time to drive things home, but he can’t afford a gaffe.

I find it strange that it’s perceived as inappropriate to discuss an important issue such as health care reform two days prior to the anniversary of 9/11 (no disrespect intended), but the anniversary of the fall of Lehman Brothers? Geez what a paranoid lot we try to accommodate.

If anyone thinks that if health care reform gets defeated this will not be seen as a sign by the health insurers that they have keys to the government and can do what ever the f**k they want, You are kidding yourself or burying your head in the sand because that is what most certainly will come to past.

the problem is that Obama has already sold out to the health insurance parasites, so if it does pass without an extremely vigorous public option, it will be seen as a victory for the insurance industry.

Has anyone mentioned that your PUMA whinging is grating, pluk? (I mean lately.)
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…think again, pirate! Imagine the drinking game possibilities (single malt scotch?)…even if the swamp posters won’t listen to any of us you can still enjoy your b-day with a gift from Obama: either some public option or (way more likely) enough drinking words to get you properly smashed since a really happy birthday can’t be celebrated sober. Cheers!

…and the Repub’s also have two pageant girls available (Sarah Palin and Carrie Prejean)… and Rush, Beck, RW media, etc. Other than Obama, who’s speaking for the Dems? Or us?

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

Thoughts?

I personally view this as Obama realizing this is a limit to how many bills he can shove down the gullet of Congress. Even with a 60-seat majority…

‘Re-set’? This is when things start for Obama…This is the same play that was run with the American Recovery and Reinvestment Act; lay out the broad shape of it, let the Dem majority craft the legislation, give the Repubs a chance to act in good faith (or enough rope to hang themselves), and step in when it’s near completion to carry the ball over the goal line.

The only explanation that makes sense is that the prospects for health reform are dire.

Nah. It’ll be closer in the Senate than 60 votes, but that’s not ‘dire’.

What’s funny about all this is how frequently Obama is underestimated.

Yeah I noticed that too grape-crush. This media inspired hand wringing was done how many times during the election and how many times were they wrong? But KT is the absolute worst. She hasn’t done anything but push this chicken little meme since he was elected. Personally, I think she’s going to have a heart attack and need health insurance reform when this thing passes. Dire indeed.

gunny – I wonder if the US does need another twenty years of a horrific failed health care system to teach us another lesson about unrestrained capitalism.

You’re spot on, nflfoghorn. It’s a shame that it becomes such a silly game with so much riding on it.
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If Obama lays out a plan too soon, he’s seen as “stepping on congress’ toes”.
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But, if he holds back too long, he’s seen as “not providing leadership”.
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It was crucial to have leadership during August – I hope he can get the momentum back in September.

Forgive the a) naive-sounding idealism and b) subtextual questioning of American exceptionalism (i.e. why does it matter what the Japanese think?), but our new PM here just penned an op-ed (translated in the Times). Excerpts:
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“In the post-Cold War period, Japan has been continually buffeted by the winds of market fundamentalism in a U.S.-led movement that is more usually called globalization. In the fundamentalist pursuit of capitalism people are treated not as an end but as a means. Consequently, human dignity is lost.
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How can we put an end to unrestrained market fundamentalism and financial capitalism, that are void of morals or moderation, in order to protect the finances and livelihoods of our citizens? That is the issue we are now facing….
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Our responsibility as politicians is to refocus our attention on those non-economic values that have been thrown aside by the march of globalism. We must work on policies that regenerate the ties that bring people together, that take greater account of nature and the environment, that rebuild welfare and medical systems, that provide better education and child-rearing support, and that address wealth disparities.”
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Mind you, it’s 4 days since the election here, but given that most Japanese PM’s are as adversarial as Joe ‘Swoon’ Klein when a military man walks into the room… Simply put, if Japan of all unquestioning nations is thinking of recalibrating their economic/military ties (he continues in the op-ed to speak of aligning J with, naturally enough, China as well as the US) … well, wouldn’t it be about time for the US itself to start wondering why they alone seem to be clinging to … fundamentalism?
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http://www.nytimes.com/2009/08/27/opinion/27iht-edhatoyama.html

This should be a great pep talk! The senators and congress folk did such a great job of explaining their reform of health care on their break! The swell of public support is just building more and more! Wait a minute! 2010 is election year, so maybe no one believes public sentiment may be seen in ballot box 2010. Pep talk will get nothing done, again.

neorationalist86:
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Thoughts? you ask?
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I have one: why don’t you take that brain of yours, think about something, and see if it adds up.
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The New Yorker article to which you’ve linked (& was blogged on by Karen Tumulty here when it first appeared) makes a great deal of these key facts, but inexplicably fails to mention the most important piece of information to presumably educated, inquisitive readers. Let’s go over those key facts, shall we, neorationalist86?

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average.

OK, you got that, neorationalist86? A full seventeen years ago, the average cost in the United States was almost five thousand dollars per person per year.

…in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen.

OK, so fourteen years later, the cost of health care has almost doubled in the United States (El Paso’s figure is the approximately national average, which we’ll get to later). Did you read that? It doubled. The author of this piece finds it most notable that the cost has quadrupled in the most expensive country, but the key fact here isn’t actually that. It’s that the rate of inflation for these type of prices over ten years is something we’ve never seen before, like gas prices, like housing prices in the bubble, like bread prices in the Weimar Republic (alright, not that bad), but inexplicable, given that health care isn’t like any of those commodities in any way…that we know of, at least. It’s like the market went nuts. But why? Why would health care costs behave like housing prices? Does the author go on to say?

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen.

Forgive me for the hyperbole, but…Jesus Christ! Fifteen thousand dollars per person! That’s…that’s…that’s not the figure we should actually be concerned about, neorationalist86, even though the author tries so hard to focus us on this comparison between these two counties in the same state.
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Now we get to hear somebody in the Administration (a young, popular, knowledgeable hotshot geek with a knack for speaking authoritatively in public) tell us something about why this is so, but the answer is strangely oblique, don’t you think?

Policymakers have worried that doing so would require rationing, which the public would never go along with. So the idea that there’s plenty of fat in the system is proving deeply attractive. “Nearly thirty per cent of Medicare’s costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level in low-cost areas,” Peter Orszag, the President’s budget director, has stated.

So…If, in the future, we spent thirty percent less in the places we spend more in now, then we would…spend less? You don’t say…
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I guess we can’t rely on the the President’s budget director to tell us exactly why we spend so much money, so we concerned citizens could maybe know specifically how we would be spending less, but maybe he doesn’t know. More likely, the author just didn’t ask this knowledgeable person the question he’s traveling all over Texas trying to interview hospital executives to presumably find out. We’ll never know, though.
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OK, we now know that health care spending has doubled, (and we know that, in one place, it has quadrupled –not that it matters terribly to the rest of us), but we still don’t know why it doubled.

…And we still aren’t getting to the key fact in all of this Maybe the author will address it next? It has to do with quality vs cost…

Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next fifty years) would be solved. The difficulty is how to go about it. Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.

Actually, that’s not the $2.4-trillion question, neorationalist86. Unbelievably, we thoughtful, patient, concerned readers have to wade through eight full pages to get to this non-ultimate question.
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No, the difference in costs of medical care between these two counties in Texas doesn’t really matter that much to the policy debate, although it makes a great detective story for bored Sunday readers on the Upper West Side of Manhattan (with our Hardy Boys author being the hero). The story here definitely isn’t “Physicians in places like McAllen behave differently from others”, despite what these long pages of narrative might have you myopically focus on. That’s because the theory of “Physicians behaving differently” only explains this set of facts, neorationalist86, not any other set of facts that the author strangely fails to mention in these eight long pages.
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You know what might be the real $2.4-trillion question, neorationalist86, if the author could just step outside of this strange quarantine he’s placed his mind in?
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It has to do with the facts the author inexplicably left out of this seemingly comprehensive piece, facts that should be well known to all Americans outside of the most isolated lunatic fringe, if people like our intrepid, Texas-traveling author would do their f*cking jobs and report it.
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It’s contained in this 2007 OECD report ( the OECD being the international club of developed, incredibly wealthy countries (like us, for example) that is devoted to spreading free-market economies around the world, and that sprang out of our Marshall Plan for Europe after WWII http://tinyurl.com/nqmw9b ) on health care spending in the advanced (richest) economies of the world:

http://www.oecd.org/dataoecd/46/4/38980557.pdf
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Total spending on health care, per person, 2007:
United States: $7290
Switzerland: $4417
France: $3601
United Kingdom: $2992
Average of OECD developed nations: $2964
Italy: $2686
Japan: $2581

Did you get that, neorationalist86?
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Somehow, unbelievably, this author failed to mention in all of his reporting, that the low cost of health care in El Paso, TX, the cost to which Peter Orszag assures us we could get all the higher cost counties down, this wonderful, excellent, model cost of health care happens to be twice as expensive as the rest of the developed world pays for their better quality health care.
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This report is available to any reporter willing to look at it and report on it, neorationalist86, but if the author were to include that amazing data in his piece, he wouldn’t be able to make this claim with any credibility:

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for.

Oh, really?
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Think about what this guy’s saying, neorationalist86.
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When he posits that “Physicians in places like McAllen behave differently from others.” as the reason why some places are more costly than others, do you think he’s really prepared to contend that the behavior of physicians in Tokyo is the reason why the entire nation of Japan pays a third of El Paso’s cost? It’s really physicians behaving “differently” that makes us pay so much, and Italy so little? It’s physicians’ behavior in France, too? …Or the UK? …Or Switzerland?
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Really?
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Something’s wrong with that argument, and you know it.
There’s wild, unimaginable, third world-style inflation in the pricing of medical products and services, and it’s just the inevitable result of ordering them? Was the housing bubble just a similar kind of result of “the accumulation of individual decisions” investors made about purchasing real estate?
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Is it possible that these two things: A) the insolvent, shadow credit markets that drove real estate prices un-sustainably higher and higher, and B) the supernaturally high, unaccountably wild rate of inflation in health care costs are actually related?
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I don’t know if that’s plausible or not, neorationalist86, but that’s because I’m left to myself by this author –and, coincidentally, almost the entire press corps– to answer as logically as I can the $2.4-trillion question to which Americans deserve and should know the answer: Where is all of that money going?
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Strangely, the author doesn’t ever think of asking that question. It’s as if he’s living behind the Iron Curtain of health care, as if El Paso and McAllen counties were the only places in the world with which he (and his audience) was allowed to be familiar.

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere.

Actually, something fundamental has changed, but it has nothing to do with fine, pleasing stories about the Mayo Clinic. We just aren’t allowed to know what that something is…and that might be a big part of what’s changed. That “everyone agreed” –which means the people who don’t even know how much their own county’s costs, let alone the outside world’s– is just that much more indicative of nothing in particular. Did “everyone agree” that something had started to go wrong somewhere when El Paso’s costs were discovered to be twice that of the developed world? Something fundamental had probably changed, but what? Why?

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions.

This entire article concludes by telling its readers an amazing thing: that health care policy doesn’t matter.
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Think about that last assertion, neorationalist86. The author basically says that the kind of system the entire country has doesn’t make nearly as much of a difference in our outcomes as “rewarding the leaders”, presumably with even more of the nation’s wealth.
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Public Option? Who cares. Single Payer? Whatever. Employer-based, and millions uninsured until age 65? Just not that important, says the author.
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What is the key to solving America’s crisis of not spending only as much as El Paso (twice as much as every other developed nation), says the author who interviewed countless doctors and hospital administrators for this article? Unsurprisingly , it’s searching for those best, not-as-expensive doctors and hospitals he interviewed, and then paying them more.
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(As an aside for you to consider, neorationalist86, how will we survive as a nation, if this represents the best that the fourth estate has to offer our democracy?)
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So that’s it. If you can, think about the article, and then ask why the best, least expensive care in America is still three times as expensive as Japan’s (even though their population is older, and they live longer), ask when and how medical products’ and services’ prices started to resemble the real estate bubble, ask why a huge majority of Americans don’t even know these basic facts about their world. Do not confine the problem to two neighboring counties in Texas, and your thoughts to comforting stories about doctors who really care about patients’ outcomes.
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Ask yourself the obvious question “Where is all of that money going?“, neorationalist86, and see where that takes you. I don’t know the answers to those questions, but I think that if we could somehow know, then we’d know for certain what do do about health care in this great nation of ours.
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After you get done researching and figuring this out, could you tell us all about your thoughts, neorationalist86?
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Thanks so much in advance, and thanks for reading and seriously considering this.

OK, I’m having a contest with myself to see if I can actually paraphrase anything at all.
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Let’s see how I do…
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“Thoughts”, you ask?

In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average.

Total spending on health care, per person, 2007:
Japan: $2581

Why doesn’t the author tell us why we spent a third more in 1992 on health care than Japan did in 2007?
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How will we know what to do about health care if we, as a nation, don’t know and can’t seem to discuss those facts?

SZ, with that addendum, you may have averted the wrath of Junius.
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And as a heads-up, to give you a bit more context about Japan, my wife and I pay a combined 7500 yen/month, which, at the current x-change rate means about 81$ or say 40$ per person/per mo. This ludicrous amt. (less than a grand a year combined) is in part due to my self-employed/non-verifiable status. In other words, in the J-gov’ts eyes, we’re poorer than we appear, but imagine a place where the truly less fortunate could pay 40$/mo. for excellent health care. No, as you allude to above, imagine a discourse that wholly ignores that such a place exists.
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As you can see, our decision to return here to raise a family was a no-brainer. Teachers and biologists can’t afford the American dream anymore.

“WASHINGTON (CNN) — President Obama and top aides have quietly stepped up talks with moderate Republican Sen. Olympia Snowe of Maine on a scaled-back health care bill, according to two sources familiar with the negotiations.

Sen. Olympia Snowe is part of the bipartisan so-called “Gang of Six” negotiating on health care.

The compromise plan would lack a government-run public health insurance option favored by Obama, but would leave the door open to adding that provision down the road under an idea proposed by Snowe, the sources said.”

Sources: Obama, GOP’s Snowe work on health care compromise

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If true I guess Obama has decided that one lousy Republican vote is worth more than what his liberal base, and the majority of Americans actually want. It doesn’t even surprise me any longer and yes I know, when they ask for my support in 2012 they will be telling me I will waste a vote staying home, if there isn’t another party I can vote for, besides the Democrats, or the Republicans.

See you later Obama.

The liberal base is fading fast! When there are african american grandma’s dragged out of town hall meetings protesting, the opposition is too strong. The lunatic fringe liberal base deludes themselves believing the country wants and needs their guidance on saving their lives by cutting health care money. More beaureaucrats always is better than more money spent with doctors? We can cut the health care money spent by stopping “free” abortions, and wasted money on mortally ill people like Ted Kennedy who spent a million dollars on his last year.

Dear “gysgt213″:

The real questions – still unanswered after all these months and vituperative rancor – are, what if Obama succeeds:

1. Who is going to pay?
2. And how much?
3. And, for how long?
4. How many generations?
5. Why no tort reform? (PS: Of course, everyone knows that answer). But, why should every other “stake-holder” be expected to “sacrifice” somethng?
6. And, to what extent will there be financial “collateral decimation”, including, probable severe deterioration of the U.S. medical delivery system?
7. Now that the Bernie Madoff Ponzi scheme has been exposed, where is the financial fortification and rehabilitation for the “Obama/Pelosi/Reid Ponzi” scheme, also, known as Medicare?

The misguided analysis and absurd projections within the current bills, make the fiascoes stemming from the “Law of Unintended Consequences” look like reasonable error, in contrast. Regardless, whether intended consequences, or not: the current bills are potentially devastating on a number of fronts.

Why not the “Congressional” option for all? Just figure out, who is going to pay premiums? In what amounts? To whom? For those with a “free ride”, who will be “poney-ing up on their behalf?

Why not “Medicare for All”; including a viable dedicated funding arrangement?

Regardless, there won’t be financial viability; without some mammoth amount of “…new skin…” introduced into the game.

Instead, there is the typical Democratic financial legdermain; also, know as the massive fiscal “pea & shell” game, played to the peril of several generations; many of whom have NO “…voice at the table”.

[...] Thursday, September 3, 2009 at 4:56 pm Submit a Comment • Trackback (0) Following up on Karen's excellent post on President Obama forthcoming address to a joint session of Congress on health care reform. Obama [...]

That’s quite the dissertation there, Stuart.
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Without delving into the psyche of the author, I think the questions you pose are rather simple. First, we cannot address the health-care issue without first recognizing the statistics you present. Second, the reason behind the large disparity: insurance companies. Ignoring the egregiously high costs for “good” coverage, think of the money that goes into health-care that is not utilized for actual health-care. How many millions pay their monthly rates without filing any claims? The notion behind insurance is essentially that you provide a company with the monetary monthly incentive to cover you in the event that you need high-cost treatment. The companies, receiving monthly payments from millions of insured, only actually pay out a fraction of what they take in. You pay every month, but do you get sick every month? Injured? More than likely, no. So, largely, out vast sums of money being channeled under the health-care umbrella, only a portion is actually spent on health-care. Hence, the gross figure you cite.

…exiled, well, you asked for thoughts and certainly got ‘em. Both KT and pirate linked the article earlier so I didn’t repeat my thoughts, oops (though you may be surprised…and btw, pirate’s b-day might be next week) The notions behind insurance are intriguing. I always saw ins. as a big bet, like an option or casino. Accidents happen, so we bet against ins. cos. over these. We bet they will happen (even when not desired) and the ins. cos. must pay; they bet they will NOT happen or be delayed (life / death ins.), and WE must pay. “Death bonds” / viaticals are interesting if macabre since the scenarios are reversed: we cash in life insurance to live long and prosper; the viatical cos. pay out and literally want us to die ASAP to maximize profit. Now that’s capitalism.
http://www.businessweek.com/magazine/content/07_31/b4044001.htm