At the risk of re-offending Ms. Palin, anything short of single-payer health coverage is merely lipstick on a pig.

I am disappointed when I see Senator Wyden and Former Gov. Kitz (apparently) willing to settle for the usual incremental changes such as "decoupling from employment" or "portability" or "universal access". So long as the medical insurance industry continues to exist, they will continue to game the system and succeed in their mission to offer less coverage for higher premiums and higher profits for themselves. I don't care whether I am screwed through an employer-based plan or a fully portable plan, I am still being screwed.

Hopefully Obama, Wyden, Kitz and the rest of the progressive movement will embrace a single-payer system based upon the existing Medicare model. But I won't hold my breath, because I probably don't have suffocation coverage on my $1200 per month medical plan.

I work as a nurse and I've seen the potential savings Orzag is talking about. Uninsured people who are hospitalized because they couldn't get primary care. So, a relatively minor problem untreated turns into an extended hospital stay. This frequently ends up bankrupting the patient, and costing the hospital hundreds of thousands of dollars to care for that uninsured patient. So tragic from the human perspective and so wasteful from the financial aspect.

As we would all like to have something to be Thankful for should we be ignoring the lost decimal. Yes, it slipped. Because the seven hundred billion dollar bailout is in reality more than seven trillion seven hundred billion. And it began fifteen months ago. Change that we can believe in? No.

The Saudi princes have something to be thankful for. How do you think they will show their appreciation now that any meaningful change has been taken off the table?

Thank you Greg D. As my sainted grandmother used to say, "From your lips to God's ear."

We have a candidate who was elected on a platform of change (albeit, I admit, not this one). We have an economic tsunami of frightening proportions. We have the detritus of thirty years of people who have tried to hack away at the social safety net to try and clear away and put back in working order. We have a two-term criminal regime exiting the scene.

If we don't do this now, when will we ever have such an opportunity again? We MUST do this. We cannot piss away our national being into the corporate void any longer. This has to end now.

Obama will be speaking to the American people on a number of occasions in the future. While this article is not germane to this thread it is worth understanding to appreciate Obama's public addresses.

I want the same health insurance plan that is offered to members of the U.S. Congress and I want to pay the same co-pays/premiums they pay (zero!).

I also want reparations.

As long as a major chunks of the health care infrastructure (i.e. hospitals, pharmaceuticals) in this country are being allowed to run on an unregulated for-profit basis, health care costs are going to continue to blow through the roof.

The health care industry needs to be regulated just like public utilities.

"To be fair, this is the basic problem faced by just about every other plan as well. It's relatively easy to think of ways to reallocate costs today and subsidize care for those who can't afford it. It's much harder to project that forward five or ten years if health insurance costs continue to rise several times the rate of general inflation."

How has Kitzhaber's formulary showing the effectiveness of various drugs for the same ailment worked out?

What about Dr. Bates as a doctor trying to find out the cost of a particular procedure and being told "depends on who the insurance carrier is", so he made it part of his crusade for better health care as Sen. Bates?

Or the system of health care where a store has a customer injured in an accident because they didn't get a spill cleaned up in time? The store's insurance tells the injured person that a claims adjuster can't tell the store how to approve their safety record, but the injured person must have whatever medical care done and then be reimbursed, hoping the injured has their own insurance because that way it would be simpler than telling an uninsured injured person "we would probably approve this claim, but we would need you to take on the expense yourself first, and provide us all the medical records we ask for". Some may say that is because of too many lawsuits. It may also prompt the injured party not to go to court but never to darken the doorway of the store ever again.

What about the power of the insurance lobby while Republicans were powerful in DC?

http://blog.oregonlive.com/mapesonpolitics/2008/11/racicot_lobby_job_victim_of_d.html

and what Billy Tauzin did after Congress passed the Medicare Part D written by Tauzin and others to be favorable to the drug industry?

There may be a system which makes prevention a priority and doesn't make some companies rich on the backs of ordinary people. But if it isn't something like the Wyden plan or some form of single payer, then advocates had better start talking about the specifics of their plan rather than just screaming SOCIALIZED MEDICINE any time anyone questions the status quo.

Does not insuring family members of workers, or not insuring retirees, or any other plan of leaving out a group of Americans who don't have access to good health care really improve the health of this country? Or is that secondary to making some in medicine and insurance wealthy? To listen to some of the argument about the auto bailout, it sounds like "if only the UAW were dissolved and auto workers or their families were not given health care as part of their pay packages, auto companies would be more competitive. Yeah, right, when Ford and GM pay their CEOs more than 15 times what the head of Toyota, a much more successful company.

I just saw on the news tonight about a hospital that charged $100 for a bottle of Tylenol. There has to be a better way.

At least this selection by Obama is more encouraging than that of Geithner and Summers.

Details I wonder about... The initial cost to cover all the probs. that people have that they have deferred from treatment for years, and the inequality in local coverage, as it stands.

Basic question, demonstrating my ignorance...what all is involved in "health care". Does that cover infrastructure like hospitals? They've been largely taken over by corporate raiders that will jump ship if they don't see a quick way to make a fraudulent buck. A big chunk of increased prescription costs in the last 10 years has been to treat syndromes (they're not diseases) made up by marketers. Are we going to fund every treatment they want to make up?

How about transport? Last time I was in Louisiana you had to have a pre-existing account with a private ambulance service to get the hospital!

And finally, how will any reduction in the profit motive get more physicians into rural areas? I agree; it has to be single payer, but there has to be a big cocoon around it or those that have kept us without reasonable health care so long will bleed the chinks in the armor.

Indeed, the Wyden plan now has a fighting chance to fix the coverage side of health care. His plan succeeds in covering everyone whereas the Obama/Kennedy/Clinton/Baucus plans fail to do more than cut it in half. And the best part is that it is budget neutral. More for less.

The only question now is can the Senate rally behind the less powerful Wyden to support the better proposal. Hopefully Orszag can help convince them. After all this time, we deserve a crafted proposal, not a series of political arguments stitched together.

Correction: Obama's plan only cut uninsurance in half.

There is no question that designing a national single payer health care system will require some level of personal sacrifice toward "the greater good". That concept is highly repugnant to many of my Repub friends and quite a few of my Dem friends too. After decades of encouraging the US public to live a "me first, screw you" lifestyle, it may take a near catastrophic event to force the US public to accept any degree of personal sacrifice. Are we there yet? I don't know. Is it worth trying to achieve? Absolutely.

Kari, I think you are arguing that Wyden's plan is a step forward and it is doable because it has seven Republican sponsors. I think it is a step away from the real (i.e. single payer solution and the fact that it has seven Republican sponsors ought to be a heads-up warning.

For example.

"After that, Wyden predicts, employers would voluntarily continue to pay workers at the higher rate, but they also would be responsible for contributing to employee premiums for private health plans."

Yes, employers are known for voluntarily paying workers at higher rates. That's sure to work out.

And again:

"Although employers would no longer offer insurance under Wyden's original legislation, he is working on a modification, requested by a recent co-sponsor, to allow employers to provide insurance to those workers who want it.)"

So again it appears we will have the multi-tier health insurance model where some people are covered for some things and some people are not, depending on their employer, depending on their union, depending on their contract, etc.

Health care is a human right. Period. It does not depend on your ability to pay. It depends on society's ability to provide. Your life is not more valuable because you are a member of the UAW or a member of Congress or a CEO or on Medicaid. Civilized individuals all over the world know this. Any health care plan starts with this principle: universal egalitarian coverage.

My company pays for our approximately 90 employees to have health insurance, but we don't pay for their families or spouses. I am not anxious to reveal my identity since I am MUCH more liberal than my clients or co-workers, but I will say that we purchase our insurance through the Multnomah County Bar Assocation.

None of the "portability" or "universal coverage" options make any sense to me. As prices rise, my company will probably review whether or not to renew coverage for our employees. As market conditions change, perhaps we won't need to offer medical insurance as a benefit in order to attract to quality candidates, as long as we pay an adequate cash salary. People can be idiots in certain situations.

I am waiting to be convinced that the Kitz / Wyden / Obama / Ted K plan(s) make sense for our country. I just don't see it. If you leave the choice of medical coverage and related costs to greedy employers like me, they (we) will choose the lowest cost option.

We need single payer national insurance. Anything less is a waste of time.

Happy Thanksgiving!

Happy Thanksgiving.

I get really nervous when anyone brings this debate down to details. That can't be helpful. That would assume we know the general plan, agree on the risks, criteria for success, etc. We haven't. We're still at the big question. Social Security is still attacked because FDR didn't take enough of the public along conceptually. We have to stop that. Let's get real for once and talk about the legitimate concerns from the opposition, while strongly defending the reasons it has to happen.

Pros: medical staff have been trained to replace clinical inference with reference to the Diagnostic Related Groups. Since they don't think anymore they'll go along with whatever the insurance form asks them. Also, the cost to deal with issues that arise from not having it are approaching the cost of having a universal single-payer system.

Cons: To work there has to be a level or regulation that, against traditional definition and practice, really is un-American (tough, I say, but it is, if we're honest); long standing systems done by great thinkers are today unqualified abominations.

We can overcome that, but we have to admit it. If you want to get good and scared, read stores from the the Brit NHS, which you can find daily. The mind boggles at what passes for casual reality every day. Just glanced, knew I wouldn't be disappointed. A guy that had an initial screening for a lump put off for 8 months fell over dead from a massive maligant tumor. Autopsy shows it was operable and would have had 95% chance of no remission. Penalty? Staff have to write an "I'm sorry" letter to the widow. And we are talking about restricting the profits of a very lucrative piece of the public sector. Those are the warts. I know I am way too idealistic, but I say we have to admit that up front and address it at every step. And promise to go backwards if it's a disaster. And the whole while we should be promoting a universal, single-payer system with no qualifications!

These are fantastic news. Obama will change the world.

"zara", you sound like someone who showed up a while ago and suffered a huge piling-on, "infb" or some such gather of initials. Are you that person? Looks choosing the right avatar/moniker provides one protection! Welcome-ish.

Zara, your argument seems to be that England's NHS has had major difficulties. This is true; the Canadian model, in my opinion, is demonstrably superior. But, both the Canadian and English models have this much in common: the problems they exhibit, while lamentable and sometimes tragic (as the one you pointed to above) are accidental and ultimately correctable by deciding to fund the system at a higher level. That is, single payer's problems are extrinsic to the model.

In a for profit system as we have here now, corporations make money by externalizing their costs, that is, by taking money from healthy people and offloading as many sick people as possible. Each and every story that ranges from inconvenience to tragedy in a single payer system is, philosophically speaking, as nothing compared to what happens every day here in the USA, not by accident, but as the perfect expression of what the industry really is.

This cannot be solved by new leadership or new laws or new attitudes. Consider: if Martin Luther King or Gandhi redivivus took over at Blue Cross and decided that no one would be turned away, he would simply be (a) sued by the stockholders and (b) removed from his office in short order. The evils of our present system are intrinsic. They don't depend on the goodwill of individuals. They MUST maximize shareholder value above all other considerations. That's the law.

Incrementalism is not going to work. Of course we will make mistakes, but these will be mistakes that will lead to honest political debate over what care society can afford. That is not a bad thing.

Consider: if Martin Luther King or Gandhi redivivus took over at Blue Cross and decided that no one would be turned away, he would simply be (a) sued by the stockholders and (b) removed from his office in short order.

You mean like the director of an international bank deciding he was going to make the core business $5 loans, without terms, to women in Bangladesh? Imagine trying that in America!

Other than that I think we're in violent agreement.

Kari, I have (and I daresay others have as well) read the website to which you've pointed and also looked at some of the commentary that the proposal has generated.

I wonder if you might respond to my two objections above (Nov. 26, 9:23a) about Senator Wyden's plan.

Then I wonder if you might respond to the more general difficulty I and perhaps some others have with plans of this type: by fetishizing "choice" in the model, Senator Wyden has introduced planned inequality and guaranteed the same genre of failure that we have now, that is, the search for ways to "insure" low cost healthy citizens and the concomitant search for ways to offload the costs of sicker individuals.

The website you point to declares: "Private insurance plans would compete on features and price but would have to offer benefits at least equivalent to the Blue Cross "standard" option."

If they are PRIVATE plans and if they are COMPETING on FEATURES and PRICE, then, the only variable left is cost. Thus, once again there are powerful intrinsic incentives to find ways (and I think that you and I might agree that capitalism is relatively ingenious at finding these ways) to leave people out of the system, to delay treatment, to undertreat symptoms, etc. The "choice" system sees this data as efficiency. Human beings experience it as needless suffering and inequality.

The ways that the plan seeks to prevent this that are described in the plan do not seem to be nearly robust enough to accomplish their goal.

I know that Australia is bankrupting b/c of the richness and variety of social programming - huge family leave, family stipends, such a strong universal health plan that those with private opted for the govt plan at high rates -- but still, I wonder if we should not look at one such vaunted and popular system and then work backwards from there? Quality and Access are the key issues in America. Access is impacted by copays (my current plan has high copays and high deductibles and I am back out in the chaotic private practice world) as well as specificity of Plan offerings, of course. And blocking folks with conditions (often comorbidities to lack of timely or adequate treatment as a result of the current system we do have!) that require attention instead of autopilot care.

I wish we could think about looking at Cadillac systems and then pare DOWN from there, instead of trying to take the existing shit product design and gussy it out with lace. Retooling towards a completely different paradigm may not be as difficult, mechanically, to do as we THINK. And in that "think" is the real problem: providers whine, but they are making very good money and have status and position to protect. I see providers abuse their power against little paper pushers every day, sadly! Nurses whine, but they make very, very good money and it is getting better all the time. Medical providers are offered brief-period service programs that erase their debt entirely.

I know this is a service minded profession, but it's also one that has its darker side if you are considering the callousness of leaving out the needful based on ability to pony up.

I agree with Joe, I see the same mix of elements, and they are not arrayed differently enough to promote internal catalysts to shift or change.

I think we think too much too. The Dutch fund outrageous things, by our standards, like sex change operations, but they're solvent because they're totally results orientated.

We really don't know what best practices are because it has become the domain of corporate marketing. It's like privatizing the Pentagon and thinking you still have to get that toilette seat from the same contractor that's charging $250. I think the hassle factor, like Aussie, UK and Canadian wait times, stem from it being a top down system. The Dutch are inherently bottom up. The State may make policy, but implementation starts with each gemeente, basically what we would call Metro.

If we went radically American with it all and let the individual patient be their own local implementation, their preferred method of treatment will ebb and flow to better balance availability. If I know that wait time for my developing thyroid irritation is 6 months to a GP, I might try a nutritionist in the meantime, and be pleased with the results. Bottom line, tax payer monies should fund aiding people to get/stay well, not whatever HMO to stay profitable. If they can fill a legitimate need and run a responsible business, they will make money.

Just a thought.

Wyden's "Healthy Americans Act" is Wrong Model for Health Reform

http://www.pnhp.org/news/2008/february/wydens_healthy_ame.php

Note especially how Wyden's plan is based on the same elitist, pro-corporate health insurance industry idea of forcing working people to contribute to the profits of private health insurance industry as Massachussett's recently enacted plan. The MA plan already is facing economic failure even as elitist supporters talk about sticking it to working people again by charging them even more.

Lessons from the Netherlands

An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System

Re: http://jhppl.dukejournals.org/cgi/content/abstract/33/6/1031

After almost three years of this experiment, what has happened? Health care costs have continued to grow well in excess of the rate of inflation. Health insurers attempted to keep their premiums affordable in order to gain market share, but because of insurer losses, premium increases have been greater than would have been anticipated based on the market competition theory. In spite of these premium increases, insurer losses have been increasing. Insurers with less penetration in the marketplace are now facing the necessity of consolidation.

Although there are many policy lessons for us in the Dutch experiment, there is one predominant message that the U.S. policy community must understand. Everyone agrees that costs absolutely must be contained, and we need to do that in a manner that repairs our fractured health care delivery system. The primary reason for the Dutch reform was this need for cost containment. But what is their position now?

According to Rosenau and Lako, "In the face of initial failure to control costs, the reaction of the Dutch government has been to reiterate its faith in the free market for health insurance and to argue that cost containment was not an important rationale for the Health Insurance Act in any case (confidential personal interview, April 13, 2007)."

With the insistence that the mandates of political feasibility require that the ideology of private plan competition displace sound health policies, the path that our national policy makers are currently negotiating places at grave risk both our finances and our health.

The Dutch seem to like to go regressive every now and then, and since the assasination of Theo Van Gogh, they've been doing it with abandon. Bottom line, I'd judge their results by the overall last 30 years data more than their current rhetoric about it at the moment.