Glad to see this "healthy" debate among Brandon, Kate, and Anthony, and probably others (like me) who would be itching to jump into this conversation and interact with everyone's viewpoints--if not for these damn things they call exams.
But just wanted to throw in this article from this week's The Economist (a right-leaning magazine in regards to business/economy, as its name gives away; but I find a very smart, clear-minded, progressive, and not-shy voice in-general): it provides no blanket verdict of "Yay" or "Nay" on the issue of the Medicare-based public plan, but it does succinctly elicit the subtleties and nuances of the whole situation.
Enjoy! And in any case hope U.S. health care gets some form of huge overhaul for the better in the next year(s), otherwise Healthcare itself may become the cause of morbitiy & mortality not only on the growing uninsured, but also on all other sectors of American society by the time we're retired (as the article aptly forecasts).
PS. I have copied the article below, along with all the discussion so far (Kate and Anthony, if you'd like me to remove your responses from the website I'd be glad to do so) on the website:
or if there is any other articles/items you'd like to suggest for the website, please let me know.
A PICTURE of a handsome young man riding a bucking bronco hangs in the office of Max Baucus. The Democratic senator from Montana was a novice in the rough world of rodeo three decades ago, but when challenged he did not hesitate. The nerve-racking ride that ensued foreshadowed his current wild adventure. As chairman of the Senate’s Finance Committee, this relatively unknown figure has emerged as a central force in the struggle over health reform.
Barack Obama has made health care a domestic priority. But rather than designing his own plan, he is leaving it to Congress to take the lead by crafting a bill which he hopes to sign before year’s end. Last month he gathered insurance and health-industry executives at the White House. This week he called in leading Democratic senators working on the issue. And on June 6th Organising for America (a political group that sprang from Mr Obama’s presidential campaign) plans to raise the heat further. Its website declares that “in thousands of homes across the country, we’ll gather to launch our grassroots campaign for health care.”
For the first time since Hillary Clinton’s failed attempt of 1993-94 Congress has taken up health reform in earnest. On May 20th Senator Tom Coburn from Oklahoma and three fellow Republicans (including the up-and-coming congressman Paul Ryan) introduced their version of a health-reform bill. On June 2nd Judd Gregg, a conservative Republican senator, introduced another. An innovative earlier bill by Ron Wyden, a Democratic senator, has a number of Republican co-sponsors. All this, says Mr Gregg, proves that his party is willing to participate in, rather than obstruct, efforts at health reform this time round.
That pledge of bipartisanship may not survive. And it may not matter much, for Mr Obama has made it clear that he will sign health reform as part of the budget reconciliation process if necessary—a controversial manoeuvre that would need only 50 votes in the Senate, not the normal 60. So the reins are firmly in the hands of two senior Democrats: Mr Baucus and Edward Kennedy, the head of the Senate’s Health Committee. Both are expected to deliver their own bills this month. Although Mr Kennedy’s is expected to tilt further to the left, insiders expect that the two will be merged fairly easily. That hybrid bill will be the one that matters.
For much of the presidential campaign, the debate on health reform seemed to hinge on cost versus coverage. John McCain appeared more concerned about reining in runaway health inflation, while Mr Obama seemed more concerned about extending coverage to the nation’s uninsured. Confronted by the financial crisis, however, the new president has made it clear that he now wants to tackle both objectives. Christina Romer, the head of Mr Obama’s Council of Economic Advisers (CEA), believes that “there are linkages in both directions”.
She points out that extending insurance to all can save money because tens of billions of dollars are spent today on the uninsured, who get late and expensive care in emergency rooms. In a new report the CEA argues that any reform that slowed the annual growth rate of health costs by 1.5% would boost America’s economic output by over 2% and increase the average household’s income by $2,600 in 2020. The CEA analysis suggests that universal coverage would lead to a healthier, more mobile and more productive workforce.
Those forecasts are probably a bit rosy, but the report also spells out the implications of failure. The CEA forecasts that health spending, which will account for perhaps 18% of America’s GDP this year, will soar to over one third of output by 2040. More politically salient is its warning that health inflation will squeeze wages hard as an ever larger share of compensation comes in the form of health insurance (see chart). A new report from the Urban Institute, a think-tank, adds that doing nothing means the number of uninsured will grow from perhaps 49m today to 62m in a decade. Taken together, all these factors explain why there is such momentum behind health reform.
Details please
But what will the reformers actually come up with? Although the final details will not be known until the Baucus and Kennedy bills are unveiled, a few important elements are already clear. Despite the hopes of some, there is, in the words of Mr Baucus, “no chance” of a single-payer system advancing in legislation this year. “We’re not Sweden, Britain or Canada,” he says, “and we’ll come up with an American solution” that will involve both government and the private sector.
That points to a fight over some form of government-run insurance plan. Many on the left, including Mr Obama, argue that reform must include a “public plan” that would provide an alternative to rapacious private insurers. But industry types are convinced that any government plan would enjoy unfair advantages, like implicit government guarantees and huge pricing power, and suspect it would serve, in Mr Gregg’s words, as “a stalking horse for a single-payer system”.
Who is right? Neither side, perhaps. Andrew Stern, the head of the Service Employees International Union and an influential labour boss, believes a compromise is possible. But Douglas Elmendorf, the head of the non-partisan Congressional Budget Office (CBO), observes wryly that “the closer a public plan is to a private plan, the less the gain.” Old lags of health reform suggest that some in Congress want to pick a fight over the public plan issue to distract from other, bigger reforms in the works.
One of those is the once controversial notion of an individual “mandate” to purchase insurance. Without such a requirement in place, too many healthy people choose not to pay for insurance. This leaves less money to cover the sick, and some of the uninsured inevitably turn up at emergency rooms. A mandate would need to be coupled with comprehensive insurance-market reforms. This would involve stronger regulation of insurance firms to force them to offer insurance to everyone, the creation of central exchanges for buying insurance, and subsidies for the poor.
Pioneering reforms in Massachusetts have helped win over many liberals to the mandate idea. Mr Kennedy’s bill is likely to be an expanded version of those reforms. And a U-turn by the industry is also winning over Republicans. The health insurance lobbies now say they are willing to live with rules forcing them to accept all patients without regard to pre-existing medical conditions—but only if this is accompanied by an individual mandate. Mr Gregg’s proposal has just such a requirement, while Mr Ryan’s bill has a similar proposal for “automatic enrolment” of people into private insurance schemes.
The other surprising area of possible agreement concerns the most important question: how to pay for these reforms, which may cost $1 trillion or more over the next 10 years. The biggest available pool of money is the tax exclusion granted on employer-provided health insurance. Jonathan Gruber of the Massachusetts Institute of Technology thinks eliminating this distorting giveaway would net some $2.3 trillion over the next decade or so. When Mr Wyden proposed abolishing that tax break to pay for universal coverage in 2006, many thought the notion outlandish, but it now looks likely to happen, at least in part.
Mr Stern warns of a “middle-class riot” if any such reform is seen as a tax increase on working folk with insurance. But as everyone involved in reform piously vows their plan will be “budget neutral”, this cow is suddenly no longer so sacred. Mr Ryan’s bill would end the tax break for the most expensive of these plans. A cap on this benefit is proposed by Mr Gregg, who reckons this is “the most logical way to raise money.” Mr Baucus also supports capping this perk, though not abolishing it. One problem for Mr Obama is that, during the presidential election, he excoriated Mr McCain for exactly this idea. He also opposed individual mandates. This week, though, he hinted in a letter to Democrats at a compromise on both issues.
There are many other good ideas to cut costs making the rounds. They range from investing in prevention to expanding the use of health information technologies to rejigging incentives so that doctors get paid for health outcomes rather than for treatments. Alas, most of these ideas will not get counted by the Congressional Budget Office, which is charged with evaluating such proposals, as savings, either because their pay-off is too uncertain or because they require short-term investments that pay out far off in the future.
Three decades ago, as he got on that bucking bronco, the Western senator was given this advice: “Don’t look at the ground, because if you do that’s where you’re going to end up.” There has been an air of civility and bipartisan co-operation around health reform so far, but it may not last long. Mr Baucus should keep looking forward and hang on tight.
EMAIL #3
On Sat, Jun 6, 2009 at 4:06 PM, Anthony wrote:
Greetings Classmates,
After reading the Action Alert, I would like to make one change:
Update: Support a Medicare-based public plan
I am firm supporter of a move towards a public funding source for health care in this country.
And with no offense intended towards my esteemed acquaintance Brandon, I would like to applaud Kate for helping us all to see both sides before acting on Action Alerts.
Cheers to Brandon and Kate for encouraging us all to think critically about health care as a political issue and educate ourselves about both sides.
I've written some arguments for a move towards a public plan below, with links.
Anthony Accurso, COM 2010
Member: American Medical Student Association
Member: Physicians for a National Health Program
Reasons for a move towards a public plan:
- The U.S. is the only industrialized nation in the world that relies primarily on a for-profit privately funded health care system. We pay more for our system than any other nation, but it lands us between 20th and 30th worldwide in Life Expectancy and Infant Mortality. Frontline.
- Polls show that upwards of 62% of U.S. citizens and 59% of U.S. physicians would prefer a single payer system, publicly financed, privately delivered (resembling Medicare Parts A and B). ABC/Washington Post Poll Question 47, Annals Int Med, p566
- AHIP (America's Health Insurance Plans) and other powerful lobbies have vested interests in sustaining their industry. Data from the rest of the world shows us that public options would likely cover all Americans, ensure choice of doctor, prevent discrimination against people with pre-existing conditions and provide improved efficiency that would help to control costs.
For more information about the potential of publicly funded health care:
- PNHP is a professional organization of 14,000+ physicians who support creation of a publicly funded, privately delivered health care system. Also
PNHP-NY
- California Nurses Association
- PHIMG
EMAIL #2
On Sat, Jun 5, 2009 at 9:42 PM, Kate wrote:
Hello,
I am writing to encourage all of you to contact the numbers below to
encourage our senators to support a government-run insurance option.
I'll try keep my response brief, but there are a few things that I feel
should be addressed.
First of all, President Obama's proposal would not mandate that all
American's enroll in a government run health plan; it would potentially
mandate that all Americans posses some form of health insurance,
private OR public, unless they are found to be unable to pay for it.
Consider the following:
18% of people under 65 in the US are uninsured and rising
The percentage of people with employment-based health insurance has
dropped from 70 percent in 1987 to 62 percent in 2007. This is the
lowest level of employment-based insurance coverage in more than a
decade
Rapidly rising health insurance premiums are the main reason cited by
all small firms for not offering coverage. Health insurance premiums
are rising at extraordinary rates. The average annual increase in
inflation has been 2.5 percent while health insurance premiums for
small firms have escalated an average of 12 percent annually.
Lack of insurance compromises the health of the uninsured because they
receive less preventive care, are diagnosed at more advanced disease
stages, and once diagnosed, tend to receive less therapeutic care and
have higher mortality rates than insured individuals.
The United States spends nearly $100 billion per year to provide
uninsured residents with health services, often for preventable
diseases or diseases that physicians could treat more efficiently with
earlier diagnosis.
The uninsured are 30 to 50 percent more likely to be hospitalized for
an avoidable condition, with the average cost of an avoidable hospital
stayed estimated to be about $3,300.
The majority of us, I hope, entered this field because we are dedicated
to caring for others and serving them to the best of our abilities. I
have no desire to underplay the frustrations we all experience from
being underpayed for our hard work, however we are, as physicians, a
relatively well-off group (I'm looking at you, future anesthesiologists
of America!). In the end, I am certainly more concerned with adequate
coverage and care for all of my family and friends than I am about my
own income, which, even with Medicare/Medicaid reimbursement will prove
adequate.
Please look into this issue on your own. This is a chance for our
country and our profession to provide effective care for everyone.
It's a chance to truly save lives -- and not just the lives of those
who are fortunate enough to be able to pay for the high insurance
premiums that allow private insurance companies to reimburse us more
"adequately."
http://www.nchc.org/facts/coverage.shtml
http://www.nytimes.com/2009/06/05/opinion/05krugman.html?scp=3&sq=krugman&st=Search
EMAIL #1
-----Forwarded by Brandon on 06/05/2009 07:41PM -----
To: Brandon
Date: 06/05/2009 06:16PM
Subject: Action Alert
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Action Alert
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| Update: Oppose a Medicare-based public plan |
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Last week I sent an Action Alert asking you to contact your U.S. Senators and urge them to oppose a Medicare-based public plan. If you have not yet taken action, I urge you to do so immediately. Your action on health care reform has never been more crucial. As a result of developments this week, it appears all but certain that the key Senate committees are proceeding with legislation that includes a public plan option - a government sponsored health plan that would compete with commercial health insurance products. Though the ASA has not taken a stand either for or against a public plan, we have a strong stand against any public plan whose payment to anesthesiologists is based on Medicare rate. Please urge your Senators to reject a Medicare-based public plan, and to ensure that physicians can voluntarily participate. Please contact your Senators today: Recently released documents suggest that key U.S. Senate health care committees-the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee-are likely to propose the creation of a new government plan when they unveil their health system reform legislation in the coming weeks. According to one document circulating around Capitol Hill, this new plan or "public option plan" would be based upon Medicare payment levels. Additionally, participation in the plan would be mandatory. Just days ago, President Obama sent a letter to Senate Finance Committee Chairman Max Baucus (D-MT) and HELP Committee Chairman Edward Kennedy (D-MA) urging inclusion of "a public health insurance option operating alongside private plans."
As ASA has consistently stated, we remain open to a wide range of options for health reform. However, any public plan option considered by Congress must NOT be based on Medicare's unacceptably low payments. As it stands, Medicare pays 33% of what private insurers pay for anesthesia services (according to the U.S. Government Accountability Office - GAO-07-463) and significantly discounts payments for pain services. An extension of this broken payment system would severely damage our specialty.
Further, physicians should be able to voluntarily participate should a public plan be established. For those of you who have already responded to this action alert, thank you. Your involvement in our efforts will help ensure that Congress understands the unique challenges that our specialty faces.
Your ASA Washington Office staff is available to answer questions or provide additional information. You can reach the office at (202) 289-2222.
To stay up-to-date on the latest health care reform news, please use the following ASA tools: We are at a critical juncture. Please contact your U.S. Senators and urge them to oppose a Medicare-based public plan, and to allow physicians and hospitals to voluntarily participate should a public plan be created. |
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Among Dr. O’Hara’s recommendations for healthcare practitioners are these:
