In our last conversation, you made so many important policy points that I was inspired to spend part of Labor Day weekend reading serious articles about how to fix the health care system. I made my husband read them too. So if you detect a little coolness next time you see him, don’t take it personally.
One thing is certain. Washington is now swimming with really attractive red herrings — ideas that Obama can’t propose and Congress won’t pass.
Washington is swimming with health care ideas that Obama can’t propose and Congress won’t pass.
We’ve spent months now watching Congress struggling with this issue, and if we’ve learned anything it’s that these people will not pass a bill that takes anything away from their constituents. That’s too bad. Their constituents would be better off if their representatives were willing to take away a little in order to get a big reform.
But here we are, where we are.
The Republican leadership is now saying: “Scrap the whole thing and start over.” This translates into: “Scrap the whole thing.”
David Goldhill, whose article in the Atlantic you’ve been touting, wants to give every American catastrophic insurance and a health safety account to pay for everyday medical expenses. This presumes that consumers can make reasoned decisions on how to use their health care dollars, the way they can when they’re looking for a new blender. But let’s pretend he’s right. That would still require a sweeping, top-to-bottom transformation of the current structure of the health industry.
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If we’re going to go for something that radical, I want to go back to the beloved single-payer option. Which we don’t talk about because it can’t pass.
From what you’ve written, it sounds like you’d like Obama to break loose, stride out to the podium Wednesday night and endorse the bipartisan Wyden-Bennett bill.
Wyden-Bennett is almost as hard to explain as the big health care hairball Congress is currently rolling around. It involves universal coverage, health insurance exchanges and vouchers. It might make the whole system much more rational, tidier, and very possibly cheaper.
And it, too, would be about as hard to pass as the single-payer system we’re not supposed to discuss because it’s impractical.
True, Wyden-Bennett has bipartisan roots. But if Obama actually embraced it, those roots would dry up fast. The right is already attacking it for having too much federal control. The Democrats don’t like the idea of getting rid of Medicaid and employer-based insurance. There’s plenty in it that the talking heads could demonize.
As soon as Wyden-Bennett became possible, it would become impossible.
Obama should ask Congress for the strongest bill he thinks he can get.
You can see this now in the debate over a cap-and-trade bill to control global warming. Republicans like John McCain supported cap-and-trade before. Now they’re running away as fast as their little legs can carry them because A.) the Democrats have added stuff they don’t like and B.) the sucker might actually pass.
I hope Obama asks Congress for the strongest bill he thinks he can get, one that greatly expands medical coverage, protects people from the worst abuses of the insurance industry, and at least sets up some structures that will make it easier to move toward cost control in the future, even if it doesn’t do much right now.
Then, I’d like him to say something like this:
Over the summer, we’ve seen how difficult it’s become for Americans to talk sensibly about big, serious subjects like health care. There are some people in our news media, and some people sitting in this very chamber, who have lost interest in doing anything except whipping the public into hysteria and going in for the kill. Shame on them.
So far, my biggest failure as a president is that I haven’t brought the country the kind of civil politics I promised. So while I’m going to be working very hard with Congress to give you health care reform this year, I also am going to start preparing the ground for the much harder work on this subject in the future. Getting there will require us to talk to each other like adults.
To set an example, I’m going to tell my own party to stop running brain-dead scare ads like the one we’ve got up now in several states saying the Republicans want to end Medicare.
After that, every time a politician or a TV commentator says something that’s both incorrect and insanely divisive, I’m going to hold a five-minute press conference and denounce it. I’m going to be like a stern parent, making the kids put a quarter in a jar every time they say a swear word.
The American people are confused about health care, but they’re very clear about the kind of political discourse they want to see. And it doesn’t look like anything they saw this summer. We’re going to do better, beginning now.
David Brooks: Gail, far be it from me to offer anyone marital advice, but forcing one’s spouse to read serious articles on health care reform strikes me as a very risky move. My own spouse has managed to preserve her self-respect by ignoring the Op-Ed Page on Tuesdays and Fridays and telling her friends that I sell refrigerator warranties.
Whether it’s a single-payer system or a consumer-driven one, both options are better than the status quo.
Starting with your Obama speech, it would be great if he gave it but I’m not sure anybody would believe it. In this case, actions have to precede words. During the 2008 campaign, John McCain proposed a very serious health care reform plan with a risky central plank — cutting the employer tax exemption on health care benefits. Obama proceeded to demagogue the hell out of that, despite the fact that many of his major advisers were on record supporting the idea.
It’s hard to behave opportunistically when it suits you and then once in office call for an all-clear.
On the broader legislative landscape, I’ve become similarly disenchanted with the health debate. The impression one gets is that the country will never accept any benefit cuts. I don’t know if that’s true, but the politicians are acting as if it is. If they are right we are on a one-way ride to Spengler-land because great nations decline when they get buried under their own debt.
That said, I think there are some things that are practical that we can do today. In a recent column I mentioned a Brookings report called “Bending the Curve.” That report took a lot of ideas that are floating around in miniature in the current bills and it implemented them. That proposal would get us a big step toward real cost restraint. I am told, by the way, that the president has read that report and he will be pushing harder on many of the ideas. The crucial test there is whether he is willing to cap the tax exemption on benefits.
Over the long term, I’ve become more and more convinced that we have to make a choice. We either have to go down the road to single payer, as you’d like, or we have to go down the road to a consumer-driven system, as I’d prefer. I like the latter because I think the health care economy is simply too dynamic and complicated to be regulated and driven from the center. Nonetheless, I’ve lived in Europe and I don’t regard single-payer as a civilization-ending disaster.
Both of these options are better than the status quo. And I’m afraid the status quo (in obese form) is where we are headed.
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From 1 to 25 of 119 Comments
1 2 3 ... 5 Next »
1.
1. September 9, 2009 1:00 pm Link
TORT REFORM and OPEN MARKET private insurance will solve the healthcare cost issue!!
— Jeff Crocket
2.
2. September 9, 2009 1:04 pm Link
I wish Obama would stop trying to win over the Republicans in Congress. He’s wasting his time, and losing his momentum.
— Heron
3.
3. September 9, 2009 1:09 pm Link
We need a national insurance system to provide low-cost egalitarian coverage to all citizens.The hospital system should remain mixed and the pharmaceutical and medical equipment manufacturers should remain private but with responsible regulation.
The key is to provide everyone with high quality healthcare. Therefore there are two steps that need to be accomplished. One is access the other is quality.
Only public insurance can provide universal access at affordable prices. While private companies perform medical services and produce medical products at higher quality than a public company would because they, driven by seeking profit, innovation constantly.
Therefore we need socialism in insurance(access) and capitalism in healthcare (services/products). The process to getting this is to mandate the inclusion of the PUBLIC OPTION!
— Dylan Young
4.
4. September 9, 2009 1:10 pm Link
There is a huge difference between single “payor” and single “administrator.” Food stamps are a somewhat imperfect analogy; but one reason they work is that we can produce lots of food inexpensively, so that there is more than enough to go around at prices people can afford.
The freaky thing to me is that there seems to be an unstated assumption from some that everything a person earns “belongs” to society and that a person is merely allowed by society to keep some of it themselves.
— Joe
5.
5. September 9, 2009 1:13 pm Link
Good Lord, did David actually post a link — without comment! — to the Institute for Historical Review????? Wow! Surely he could have found a more reputable source of information about Oswald Spengler!
— JEB
6.
6. September 9, 2009 1:16 pm Link
Yesterday I went to a surgeon to discuss repairing a tear in my abdominal wall, which was the result of an error made in a previous surgery.
The new surgeon ordered a CT scan, which I refused. The radiation from one abdominal CT scan is the equivalent of THREE YEARS of background radiation, and there is a cancer risk.
I explained that I did not want to add to my already excessive radiation exposure, and asked if I could have an MRI instead. He said “Your insurance probably won’t pay for it, because it costs four times as much as a CT scan.” With an MRI there is NO radiation involved! Unlike a CT scan, no cancers will develop as the result of an MRI, but it costs more. To save money, I’m being asked to turn the roulette wheel and see if I will be the statistic.
There has been a lot of negative talk about “unnecessary” and “expensive” tests being a burden on the system. But damn it, this is my life we’re talking about. It is perfectly reasonable that I do not want to do anything which will increase my odds of developing cancer again.
I’m not sure how this type of situation will be handled under the Obama health plan. Does anybody have an answer?
— Claudia Chapman
7.
7. September 9, 2009 1:21 pm Link
That Brooks is considered an important voice says volumes about how pathetic and superficial the level of political discussion is in our culture. He’s merely a right-leaning sophist.
— Sam
8.
8. September 9, 2009 1:29 pm Link
Great health reform ad at a time when we need some humor.
http://axisofreason.com/2009/09/09/health-reform-worries/
We need to lower the temperature of this debate. Perhaps then, constructive, rational exchange will result in much needed reform.
— Policy Hack
9.
9. September 9, 2009 1:29 pm Link
The national discussion has devolved intto mere ideology when one side only pretends to negotiate, in an effort to gum up the works and also fans civic un-rest; no greater testament of this exists than a grand total of zero votes for reform.
The scenario is reminiscient of the same discussion in the 90’s, when GOP Senators voted against bills which they had sponsored and which had the Senators’ names on them..
Past failures of special interests in Western democracies to deal in economic reality has led to multiple declines in their power.
— robob18
10.
10. September 9, 2009 1:31 pm Link
Joe–I think the food stamp analogy isquite misleading. We produce a large surplus of food, and the price of food, low though it is by historical standards, would be much llower still without government price supports. Providing food stamps, in effect providing very low-cost food for everyone, doesn’t change these basic dynamics. Health care is quite different. We have no surplus of doctors, nurses, equipment or facilities; kjust the opposite, in fact.
In this sort of market, adding tens of millions of people to the system must either increase the cost of scarce services, or, in the absence of a price mechanism, to a supply shortfall, in which medical servces will have to be rationed.
This may or may not be the morally correct thing to do, but pretending that there will no cost to pay for the benefit of making medical services more widely available is ridiculous. O’s problem is that his pretence that we can increase coverage and simultaneously reduce costs is widely disbelieved, and it’s disbelieved because it’s not believable. No speech can change this.
— Bob Royfills
11.
11. September 9, 2009 1:33 pm Link
I’m always fascinated when someone yells out that tort reform is going to save health care. I think that we desperately need tort reform so that folks are not always trying to extrort money from anyone. On the other hand, doctors are not policing themselves. The medical associations are nothing but old boys clubs that serve to protect each and every one of them. Who is going to make them wash their hands unless the threat of being sued isn’t going to hang over their heads. And what happens to the poor souls that get malpracticed on? A half-hearted apology isn’t going to sustain them for the rest of their ruined life.
Come up with something better.
— bb
12.
12. September 9, 2009 1:35 pm Link
What does David mean by a “consumer-driven system”? That is what Republicans claim we have now, yet it has collapsed as surely as the revered “capitalist” economy. Since David has no real opposition to Single Payer, let’s pass it and get on with solving other problems like the out of control military industrial catastrophe and the collapsed job market. Time for Democrats to take control or become another laughing-stock bunch of dorks. We are tired of this.
— Mark
13.
13. September 9, 2009 1:37 pm Link
Tort reform? For doctors (and their families) the cost of medical malpractice insurance premiums and the statistical likelihood of at least two med-mal lawsuits over the course of their careers is a modern-day sword of Damocles. (Or, for the mythology-impaired, meat cleaver of the judges on “Chopped”). Yes, there are frivolous lawsuits out there–but the existence of malpractice insurance is what’s driving most of them. I’m willing to bet that incompetent doctors who “go bare” and also don’t have deep pockets don’t get sued nearly as often as conscientious ones with big fat malpractice policy limits or vulnerable assets. At any rate, the cost of malpractice litigation–contrary to what conservatives would have us believe–contributes less than 1% to the nation’s total health care expenditures, public and private. (I’m a lawyer married to a doctor, so I’m familiar with both sides of the “tort reform” issue).
Tort reform is not a red herring. It’s a red guppy.
— Sandy in Chicago
14.
14. September 9, 2009 1:38 pm Link
As a self-employed individual, I am tempted to agree that employer tax exemptions on health care should be curbed or eliminated. Why do people who work for companies receive greater health benefits at lesser cost than I do, when I am also a hardworking, taxpaying, productive member of society?
Alternatively, you could require health care companies to provide me with comparable benefits to those companies who “buy in bulk” — and provide me with additional tax benefits based on the cost of my health care.
But when push comes to shove, neither of these alternatives will stop the rapid rise of health insurance rates. I am a healthy 26 year old, and I pay $145 per month for piss-poor benefits. (Two years ago, this same plan cost me $90 per month, and no, I haven’t graduated into a new age bracket.)
What we really need to do is provide consumers a competitive government plan that will keep these costs from rising. I pay more for health care benefits that I don’t use than I do for the food that I eat — and were I to really become sick, I would still have to fork over several thousand dollars before meeting my deductible. Something about that isn’t right, and nothing less than a drastic overhaul will fix it.
— Lynda
15.
15. September 9, 2009 1:38 pm Link
The idea of taxing health care provided by an employer is insane. My husband works for a municipality, earning $35,000. Take home pay is $25,000 a year. Our local property taxes, which keep going up to accommodate the education budget, are now $6,000 a year. How can Obama even think of taxing us on the “income” we receive in the form of health insurance, which I might add we make a substantial contribution to?????
— Todd Fox
16.
16. September 9, 2009 1:41 pm Link
Give the conservatives “tort reform” (they’ll find out what it means when a relative is harmed by a health care provider), then go for broke. Lawsuits have a negligible impact on the overall picture - - just look at the numbers - - but they have attained mythical status among conservatives and doctors/nurses. Pull the rug out from under them and THEN let them explain the absurdly high charges that have ruined the economics of health care in this country.
— Steve B.
17.
17. September 9, 2009 1:43 pm Link
Can’t the Times find anybody worth reading ? I want my two minutes back .
— nat turner
18.
18. September 9, 2009 1:44 pm Link
We should have the right arguing for a consumer-driven approach, the left arguing for single payor, and both agreeing on the need for a radical reform.
Instead, we’ve got them all putting useless parches around the current system. It’s sad, and it will send this country the way of California.
— Dan Wilde
19.
19. September 9, 2009 1:44 pm Link
Cut all federal agency budgets by 20% (except for law enforcement and consumer protection agencies) and reduce the deficit. Stop illegal immigration and balance the budget.
— Kevin
20.
20. September 9, 2009 1:44 pm Link
The details confuse most of the people. Obama should simply posit this as a debate between a government sponsored welfare program (with its associated problems) vs. a free market approach (with its associated problems). Pick your poison. It is really a matter of who you trust or distrust the most.
— Larry
21.
21. September 9, 2009 1:45 pm Link
I’m encouraged that meaningful insurance reform has bipartisan support. We’ll be well on our way to something like justice if insurers are made to cover people with pre-existing conditions, allow people to take their coverage with them when they change jobs, and leave practicing medicine to physicians.
I’m a seven-year breast cancer survivor and I just lost my job. My last adventure in COBRA involved a $750 monthly premium, $4,000 annual deductible and $500 out of pocket for meds every month. Anthem Blue Cross Blue Shield encouraged me to reapply when I’ve been cancer-free for 15 years.
My former employer has to swallow a 40 percent premium increase and part of it was my fault — insurers now “rate up” small businesses who employ somebody who would not qualify for individual insurance. I don’t think they laid me off because of the insurance cost, but it certainly didn’t help.
They truly want us to slink away and die. Instead, we’re going to the barricades and telling our stories and I’m very encouraged by this.
— Lisa
22.
22. September 9, 2009 1:46 pm Link
Obama Health Care Speech Intercepted, It’s a Fumble
Read the Article at Unbelievably Great Music
— aratunes
23.
23. September 9, 2009 1:48 pm Link
What should have occurred is that members of Congress take trips to countries that have single payer systems and study them really really hard — all the nooks and crannies. Members of Congress should have also gone to their community hospitals and looked into what ails them and the doctors and staff. They should have opened up appointments with their constituents “one at a time” to listen to their concerns — not just the big donors, which is now the case for most, or in larger “community meetings” where only a few can speak. Instead we had a few non-elected and untrained people yell and scream over public airways and rile up a small number of people (almost all older and white, and almost all lower to lower middle class) who made rational public discussion impossible and whose increasingly bizarre “arguments” were not strongly challenged. Now we need full public disclosure of campaign contributions from medical insurance interests. Otherwise we will get a Procrustean Bed health care delivery system and a further impoverishment of our working and middle classes.
— sfbbmom
24.
24. September 9, 2009 1:52 pm Link
Sam, You are much to harsh. Name someone better.
— appaled again
25.
25. September 9, 2009 2:00 pm Link
Can someone explain to me what the rush is all about? Obama is in such a hurry, why? Anyone with half a brain has to be suspicious as to why he insists on shoving “his way or no way” health reform down our throats? When it takes him 6 months to pick out a dog, but he’s rushing a nations health to be signed into law ASAP, you got to wonder, what’s really going on. I haven’t heard of one country’s health care program that has been applauded by it’s people. We, the people of the United States, must stand together and demand the kind of health care WE want, not what this clown of a president wants. He could care less. Anyone who elects Czars like he picks out flavors at Baskins and Robbins and doesn’t limit their power, limits peoples’ practicing of their Christian faith, elects self asserted communists as part of his government (Jones, Czar, who did resign), does not care about what kind of health care you, I, or our families will have access too. Hopefully, the American people are waking up, seeing what this person really is and can be impeached before it’s too late, and our United States turns into the Divided States of America. Gloria K., NJ
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