"I’m afraid the president squandered a good opportunity."

Questions for Dr. Marcia Angell

By Anne Underwood
Prescriptions Blog
New York Times
August 12, 2009

Jodi Hilton for The New York Times Dr. Marcia Angell, a senior lecturer at Harvard University and former editor of The New England Journal of Medicine, in her office in January.

Dr. Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor of The New England Journal of Medicine. A longtime critic of the pharmaceutical industry, she has called for an end to market-driven delivery of health care in the United States. She spoke with freelance writer Anne Underwood.

Q. President Obama hopes to increase the number of Americans with insurance and to rein in costs. Do you believe any of the plans under consideration by Congress will accomplish those goals?

A. They won’t, and that’s the essential problem. If you keep health care in the hands of for-profit companies, you can do one or the other — increase coverage by putting more money into the system, or control costs by decreasing coverage. But you cannot do both unless you change the basic structure of the system.

Q. Segments of the health care industry — pharmaceutical companies, for instance — are promising to cut costs.

A. It’s not going to happen. These are investor-owned companies. Their fiduciary responsibility is to maximize profits. If they behaved like charities, heads would roll in the executive suites.

Q. But what about market mechanisms for reducing costs? Wouldn’t the public option, for instance, provide competition for the insurance companies?

A. Theoretically it would, but I doubt the public plan will pass. Industry is lobbying against it, and the president has not said this is a “must.” Even if it does pass, I’m afraid the private insurance industry will use their clout in Congress — and they have enormous clout in Congress — to hobble the public option and use it as a dumping ground for the sickest while they cream off the young and healthy for themselves.

<<<snip>>>

Q. If a single-payer system isn’t feasible politically, aren’t the current proposals at least better than doing nothing? Isn’t half an aspirin better than none?

A. I think not. As costs continue to soar, people will not say, “That didn’t work. Let’s try a single-payer system.” Instead, they’ll try to pay for the costs in piecemeal ways, by increasing co-pays and deductibles, by limiting services, by making the system less equitable and less comprehensive. I’m afraid the lesson they’ll draw is that universal care is impossible.

But I’m not convinced that getting a single-payer system now is politically infeasible. The public would be happy with Medicare for all. Polls have shown that the public loves Medicare. The problem isn’t the public. It’s Congress, which caves in to special interests.

Q. If Congress is reluctant to cut out the insurance companies, is that partly because they, like the major banks, are too big to fail?

A. A nonprofit, single-payer system would lead to job losses in this sector, which constitutes 17 percent of the economy. But what about the other 83 percent of the economy? They’re being bled to death. Businesses can’t compete globally because the cost of providing coverage to their workers is so exorbitant. Whatever loss of jobs you might see would be more than offset by benefits and job gains in the rest of the economy.

you could introduce the program incrementally. You could do it state by state. Or probably better, you could do it decade by decade. Medicare kicks in at age 65. In the first stage, you could take it down to 55. Between 55 and 65, people are vulnerable. They’re losing jobs, losing health care. They’re starting to have more medical needs. After a few years, you could drop it to 45, then 35. It would give insurance companies time to adjust.

Q. But Medicare is already hugely expensive. How can we afford such a plan for everyone?

A. Medicare costs are rising at an unsustainable rate because care is provided in a profit-maximizing system. The prescription drug benefit was nothing but a bonanza for the pharmaceutical industry. I would change that. I would also adjust the fee schedule, which preferentially rewards highly paid specialists for very expensive tests and procedures. For the system to work, it would have to be a nonprofit delivery system.

Q. How much could we save in administrative costs?

A. On average, the private insurance industry takes 15 to 20 percent right off the top of the premium dollar for its administrative costs and profits. That’s a lot to siphon off by an industry that adds almost nothing of value. It’s just a middleman. Medicare has overhead costs of less than 3 percent.

With the money in the system right now, we could cover everyone for every medically necessary service. But the system has to be distributed according to medical need and not as it currently is — as a commodity. Today, those who can pay get lots of M.R.I.’s they don’t need, while those who are uninsured can go without ones they do need.

Q. Military historians say we’re always fighting the last war. Is Mr. Obama now fighting the last health care war, in which Congress rejected the Clinton plan partly because it was developed without consulting other interested parties?

A. Yes. Mr. Obama has decided that he will listen to everybody. But it’s not working for him, because the public can’t become enthusiastic about a plan that doesn’t exist. That’s what he’s asking. Now Congress has gone home, and for the next month the special interests will be out there scaring people with stories of rationing and socialized medicine.

Q. Is the president really bringing everyone to the table?

A. He’s bringing everyone to the table except the single-payer people. It’s very odd. When he was a state senator, he emphatically favored a single-payer system. And in his July 22 press conference on health care, he stated that the only way to provide universal health care is with a single-payer system. Then he moved right on, as if that was somehow self-evidently absurd.

Q. So are you opposing this reform?

A. I am, though not for the same reasons as the Republicans and Blue Dogs. I’m opposing it more in sorrow than in anger. I’m afraid the president squandered a good opportunity.

-----------------

entire article at http://www.pnhp.org/news/2009/august/questions_for_dr_ma.php

healthcare reform passes sound pretty damned good.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x472073

10 Awesome Things That Would Happen If Health Reform Passes

We have to oppose less than perfect public policy, even though tens of thousands of people die unnecessarily each year and more than a million are bankrupted by health care costs. The good is the enemy of the perfect and it may take a couple million preventable deaths over the next two decades, but we will get single-payer in 20 years. And all the people that died in the meantime won't have died in vain!

and the current "Health Care" Bills in Congress are very, VERY BAD.

If your number one priority is health care insurance profits and not the health of the American people or the millions who are bankrupted by health care costs each year, then you could make an argument that the bills are bad. If you are, however, a moral human being, you can't really argue that HR 3200 is a bad bill.

Someone with a Harry Reid avatar supporting legislation that will funnel $BILLIONS of taxpayer money into the pockets of the Health Insurance Industry Complex is going to question MY priorities?
:rofl:

I wonder if they're getting paid?

If they are not getting paid, they're stupid.
:hippie:

Like any Democrat would pick a Harry Reid avatar.

to look like a bunch of left wing loonies. I have been following their work since 1998. Everything they have worked at and studied in depth is not fringe politics but what we truly need as a nation in health care reform. It's actually a middle of the road plan. All health care is in the private sector. It's only the collection of taxes and payment of claims that falls to the government, which has been doing a really good job of it under the Medicare program.

They can't address the substance of their arguments, so they crucify them with meaningless labels.

It has worked pretty well. When you have a liberal board cheering for reform written by the health insurance lobby and no basic understood tenets of what a public option needs to succeed (or in some case, what it even means), the kool-aid has been swallowed.

a person. She has twisted every source I have given her into something it's not.

Been there, done that with that particular poster.
Tortured logic, red herrings, straw men, and statistics from Health Insurance Industry propaganda sites.

I've never seen someone work so hard for free.
You would think it was her job or something.

for pointing out that the bill in the House is so compromised by industry influence that it is worse than nothing at all, and that the pharmas aren't ponying up $150 mil in an ad campaign out of the kindness of their hearts.

:applause:

:(

Horse dooky. The public loves the idea of medicare. Medicare however is dying a quick death.

http://www.whitehouse.gov/omb/rewrite/budget/fy2004/danger.html

Medicare is in even worse shape. Its payroll taxes do not even come close to covering its costs, and the gap is projected to get steadily worse absent reform of the system. Medicare’s problems are so much worse simply because its promised benefits grow with the increase in health care costs, which are widely projected to grow much faster than inflation. So Medicare and Social Security must each be refashioned to address the fact that there are more and more beneficiaries per worker paying taxes into these systems, but Medicare must also be reformed to account for rapidly rising health care costs.


Medicare is in dire shape, sure its a great program but the sheeple have no desire to pay for it only to have it. We could fund it but it would mean people paying more taxes and well good luck with that fight.

I think this woman has grandiose ideas that have little or no chance of becoming reality.

Heres what I would like to see happen.

I would like to see the idea of a pool of insurers fleshed out. I would like entry to this pool given to any insurer that desires to participate providing they follow some ground rules. No pre existing conditions, basic care requirements and maximum payment ceilings for the end patient. I want to see these participators all get the same amount of financial support for each individual based on an income/cost of living ratio. Then let them charge whatever they want within that pool.

Say I am going to get insurance through the pool and I make 40k per year. Just as an example lets say the government then kicks in 5k per year toward the cost of my insurance through that pool. I can now choose from insurer a,b,or c each of which charges a different rate but provides the same basic floor of services with perhaps some difference in added coverage between them.

Lets say insurance company A provides the basics at a cost of 6k per year per individual leaving me with a cost out of pocket of 1k per year. Insurer b offers the same for 6.5 k per year and offers the same coverage as insurer A but adds a perc like maybe say private room coverage if you are hospitalized. This puts choice in the consumers hands and encourages competition at the same time. Add in a public option and I think we have a pretty good shot at getting a pretty fair shake for our health care dollar while at the same time leaving the door open for innovation.

Make the billing universal for all participating plans so there is standardized billing and digitize medical records so that patient histories can be accessed universally by the doctors handling the patients care and I think we would have the makings of a great health care system.

There needs to be a floor of basic services provided and billing needs to be totally revamped but if think if we pool them together and let them compete inside that pool for our dollar this can work quite well assuming there is a public option in there to keep them honest.

Capitalism has its flaws to be sure but the drive to innovate is one of its great strengths. So I can envision a very strong health care system being handed to the american people with no need for single payer whatsoever. I can also see instances where a single payer system might not be as great as it sounds.

No matter what something needs to be done, the woman in this article seems to me to be of the opinion that if we don't get what she thinks is the ideal system then we should have nothing at all. She doesn't seem willing to consider alternatives at all and I think thats foolish.

Bunch of whiners! Don't they love America and the free market system?

If they don't like Merica they should move to Europe or some other furing country! They'll wait a year to see a comminist doctor!

is responsible for care of the most needy patients and the private insurance companies are allowed to keep the healthy patients there will be a problem.

Over the next two decades the number of people on Medicare will go from 46 million to 79 million. How then will any proposed savings from efficiencies in the Medicare system be able to subsidize the "public option" plan, that money should stay within the Medicare system.

What is the plan for future funding of Medicare?

That is exactly why we need to have everyone in the same risk pool instead of allowing the private companies to insure the healthier citizens. And now our tax dollars will be used to subsidize the private companies? We need those profits to provide care, not profits for private companies and their investors.

I'm all for choice when we can afford it, at this point I do not see how we can.

Many will "desire" to NOT participate, or to participate for a while, and then drop out when they figure out they can no longer skim off the first 30-40% , as profit.

VOLUNTARY COMPLIANCE is a non-starter for greedy corporations whose only goal is to MAKE MONEY..

A civilized nation should view its health care delivery system as a RESOURCE..a public resource that should be there for all its citizens to use.

Your "concerns" were addressed in the original article.

I need only point to the 36 successful models of Universal Health Care in the civilized World to shoot down your entire diatribe.

The problem in the US is NOT Medicare.
The problem is the For Profit Health Insurance Industrial Complex/Wall Street.

what I understand? Because it will be over my dead body. Medicare has been the only insurance in my life time that I could count on being there when I needed it. The reason it's in trouble is years of Republicans trying to privatize it and the result draining money out of the system with Medicare Advantage programs and prescription drug benefit. The advantage is for the insurers' bottom line not the seniors. They also use the same bait and switch tactics insurance is notorious for. I know, because my husband nearly died because of one of these plans. When we switched back to traditional Medicare he got the care he needed. Most doctors, except the more incompetent ones, won't even touch these plans. This is what you would get with a system that is all insurance. Doctors will refuse to take them and demand cash instead. A sick or elderly person will be forced to deal with the insurers themselves and believe me it's hard for the professionals let alone people who don't know how to do it. Doctors are already starting to demand cash in my area including the doctor I work for.

that it is controlled by the for-profit insurance and pharmaceutical industries whose member corporations have one (and only one) responsibility to their shareholders -- to maximize profits . . . and the only two ways of doing that are by increasing income (e.g. premiums) and by decreasing expenses (e.g. benefits paid out) . . .

until this mechanism is scrapped, nothing much else of substance will change . . . all we'll get in whatever bill is passed is a bunch of smoke and mirrors masquerading as reform . . . when, in fact, all the bill will do is assure continued and growing profits for the insurance and pharmaceutical industries . . .

Q. But what about market mechanisms for reducing costs? Wouldn’t the public option, for instance, provide competition for the insurance companies?

A. Theoretically it would, but I doubt the public plan will pass. Industry is lobbying against it, and the president has not said this is a “must.” Even if it does pass, I’m afraid the private insurance industry will use their clout in Congress — and they have enormous clout in Congress — to hobble the public option and use it as a dumping ground for the sickest while they cream off the young and healthy for themselves.


So where does this leave us then? Does single-payer have a prayer, politically?

would make it, but it has cost-effectiveness and univeral access in its favor, which no other proposal has. Plus simplicity for practitioners. Let your Congresspeople know you support it when the House vote comes, and to support Kucinich's single payer for states.

Stay tuned to pnhp.org, calif nurses, and other organizations for recommendations as the issue moves forward.

We may have to keep a much longer perspective, perhaps the country has not come around yet. And single payer proponents are making huge strides! :)

Obama started at the wrong place in healthcare reform, and look where we are... proposals that protect corporations, again.

And I'll let my Republican congressman know that I am.

But if the current effort results in a public option alongside private insurance, my concern is that the people with the greatest (most expensive) medical needs will get dumped into the government insurance program. While this is better than no insurance at all for these people the public option (because of this cost) will suffer in the political debates to follow, perhaps diminishing the chances for single payer. Comparing government insurance with private insurance made even more profitable by dumping its sickest customers is not a fair comparison, but we know that it will be held up as ehibit A against expanding government coverage.

"As costs continue to soar, people will not say, 'That didn’t work. Let’s try a single-payer system.' Instead... the lesson they’ll draw is that universal care is impossible."

Conservatives will convince everybody along these lines: "See? That didn't work. Thank God we didn't spend even MORE money on a universal plan!"

doesn't have a chance in Hell shows just how scared they are that it could be a possibility. And speaking of prayer, that would help too. It's time for the people of the USA to take back the dialogue and insist that our elected Representatives do as we ask, not what their corporate campaign contributors ask.

Wow, didn't take long to throw the towel in. Astroturf rightwingers, RNC and insurance lobby won.

W.H. backs away from public option

http://news.yahoo.com/s/politico/20090816/pl_politico/26158

opportunity squandered :argh: obama is a younger, darker bill clinton.

Making a profit off of people's bodily needs is obscene.

I'm all for fair recompense for the education and expertise of all medical professionals and for the use of medical facilities and technology and such.

I am NOT for propping up a system that pays for mansions and yachts for insurance executives. They are nothing but parasites who add no value to our health care whatsoever.

sw

that doctors cannot themselves produce, and that's called care for patients.

Insurance companies are nothing more than brokers--the ultimate death panels. The ultimate deniers of care--sorta like the gummint bureaucrats who are allegedly going to take away all of our choice--only much, much worse.

Where does anyone even get the idea that our healthcare system could not function without health insurance companies? Doctors still will have office managers and billing personnel who will bill the government instead of Blue Cross.

What will be missing is the leeches sucking the money and life out of our economy.

Man, she hit that square on the head.

K & R

happening now is not something to improve healthcare. fucked again.

I think not. As costs continue to soar, people will not say, “That didn’t work. Let’s try a single-payer system.” Instead, they’ll try to pay for the costs in piecemeal ways, by increasing co-pays and deductibles, by limiting services, by making the system less equitable and less comprehensive. I’m afraid the lesson they’ll draw is that universal care is impossible.

I think she's exactly right. And it doesn't make me gloat - it just makes me really sad.

The right wing will hate him no matter how much bi-partisan compromise he makes. Now he's pissed of his left wing base.

This is not going to go over well at all.