Is there any way out for Obama on health reform?

October 13, 2009
Is there any way out for Obama on health reform?

Link here: http://www.pnhp.org/news/2009/october/is_there_any_way_out.php


By Leonard Rodberg

Progressives worry that, if President Obama’s health reform plan (the “Plan”) fails to pass, a latter-day right-wing Gingrich movement will take over the Congress in 2010 and the White House in 2012. What I have not heard, but what I am increasingly coming to believe, is that if the Plan passes in any of its current forms, things will go just as badly for him. Why is that?

The general reason is that the Plan is a dog. It is a terrible, complex plan that will accomplish almost nothing. Relatively few people will benefit from it, while everyone who has to use health care will continue to experience the mess that is, and will continue to be, the American health care system. And, because of the new requirements built into the Plan, health care finance will become even more complex and confusing.

More specifically:

1. The large majority of people, who receive their insurance from their employer, will see no benefit whatsoever from the Plan. Most will, in fact, find their premiums rising as new requirements imposed by the Plan (e.g., the elimination of lifetime limits) raise the cost of insurance. And, of course, to their undoubted surprise, most of them will not have access to the public option, even if there is one.

2. Most provisions of the Plan will not become effective until 2013. This gives four years for Republicans to criticize the Plan, including (a) its use of cuts in Medicare reimbursements and Medicare Advantage premiums as principal sources of funding, (b) its lack of any real or believable mechanism for containing costs, and © its bureaucratic complexity.

3. The taxes on high-cost insurance plans, the other principal source of funding, will cause those who now have good insurance (called, pejoratively, “Cadillac” plans) to find these plans heavily taxed and their employers given a strong incentive to cut back on their benefits. Instead of reducing underinsurance, this part of the Plan will increase it. (And the rest of the plan does little about underinsurance at all.)

4. During the four years of waiting for the Plan to take effect, costs will continue to rise. By the time the Plan takes effect, costs are likely to be at least 25 percent greater than now. Even more people will find insurance and health care unaffordable. People will ask “What was health reform about?” The disillusionment will be great.

5. The complexity of the plan, including (a) federal rules regarding what kinds of employer-based insurance plans are “qualified,” (b) new income-tax forms that will be needed to implement the individual mandate, and © the process of determining income eligibility for everyone, will all lend themselves to criticism and even ridicule.

Is there a way out? Not, in my view, as long as Obama sticks with this worthless and unworkable Plan. Only if we were to adopt a much simpler plan that would benefit everyone — a Medicare for All plan — would he be seen as actually addressing the problem and really offering a workable solution. Short of that, he, and all of us, are in real trouble.

Leonard Rodberg is professor and chair of urban studies at Queens College, City University of New York, and research director of the N.Y. Metro Chapter of Physicians for a National Health Program (www.pnhp.org).

a time of war that taking four years at 122 deaths a day from lack of health care to implement a health care act is very questionable.

to implement, how much time would it take to just expand it to include all? Bet less than 4 years anyway!

done.

Your distress flag is certainly appropriate for this situation and others!

next election to get Progressives elected.. if he fails to call this a polished Turd and refuse to sign it.. his way out of office will be provided in the next election.. and our country will be destroyed by the ReThuglican mafia.

there will be 'Anti-Torture Kits' on info-mercials ..double strength Cyndie pills, $19.95, order now and get 3 more free for your alleged co-conspiritors... we will need them the NeoCons are pissed off there will be a purge in the next eminent Shock Doctrine cycle..

--just open Medicare to voluntary enrollment, dammit! That is a very visible and concrete benefit that could be in place before next year's election.

The only reason I can see to not eliminate the health care insurance corporations is the workers; HR 676 takes care of the workers for two years, salary and retraining...Medicare for all is doable!

--I find that I can get further with them by suggesting making Medicare buy-in voluntary. Not at all ideal because of the adverse selection, but it would at least create more of a popular demand for HR 676. The organizing problem here is that most people will never get expensively sick.

doesn't take much to be expensive, I had my appendix removed this summer, simple operation, it hadn't ruptured, bills to date: 25,000. Luckily I have really good insurance, who can realistically afford that kind of expense?

The current system is unsustainable, and everyone knows it. I would prefer to wait until 2011 and push for single-payer then.

:dem:

-Laelth

let's not wait, however, I say keep pushing for single payer now to prepare for 2011!

Medicare-for-All is the real answer.

and tax the wealthy & corporations to pay for it. It really is not rocket science...

Has a lot more to do whether people believe ALL should have health care or not. That is where the big fail comes in.

I love the codicil in HR 676 where every stock transaction gets taxed .01%, a dollar on every thousand; not a whole lot on the broker, but the total would generate billions....

Of course, as you say, the sad part comes in when people don't care if others are covered, "not me, I don't care"...

:hi:

What it would do is allow the uninsured, and all other Americans, access to FAIR & TRANSPARENT PRICING.

Currently those denied insurance are billed 250-600% more than insurance companies pay.

The current system is an opaque, price-gouging racket.

Dealing with the problem that there are some who could not pay even the premium rates that Medicare would need to charge younger Americans (and still break even) is a minor problem, compared to the major problem of price-gounging and denial of access.

A major problem that would be created by opening Medicare to all in a mixed (private and public insurance) system is that the insurance companies would use pre-existing condition denials to force all the expensive patients into the public plan, either making the premiums for the public plan much higher, or forcing the taxpayer to pay. This should be addressed by requiring all plans, public and private, to have community ratings with open enrollment (no pre-existing exclusions). This would force the insurance companies to compete by creating value (ie, lowering costs) rather than denying coverage to sick patients.

Such a plan could be written in 2 paragraphs:

1. Authorize the Secretary of HHS to perform an actuarial assessment and offer younger Americans an opportunity to buy in to Medicare at revenue neutral premium rates.

2. All entities, public and private, which offer health insurance policies must offer community ratings with Open Enroillment.

Medicare is a tax like Social Security, there would be an additional 3.3% increase to most everyone's medicare tax, with an additional tax on the extremely wealthy. Despite this, nearly everyone's cost would decrease, and I do believe there is an exemption for those making little...for businesses there would be a substantial savings to property taxes as municipalities and school districts would save a great deal. There are really some very conservative (in the true sense of "saving") aspects to Medicare for all... :)

The reform plan is deeply flawed. It doesn't control costs.
It could hurt a lot of people who aren't too well off.

But many people have learned a lot recently about the health insurance issue.
Now if only they would learn more about the costs, and
the need to improve public health--obesity, lifestyles--
then we might get something pretty good out of all of this.

Maybe Obama could say, "I don't quit. Nor am I reckless.
We're going to get this done right."

President Obama didn't create the health care mess -- he inherited it from bush & co. After 8 years of screwing it up, it may now be so ruined that it can't be saved and a completely new system must be built from scratch. This is why we should be going straight to single payer.

But, even as they screwed up the old system, the repukes have prevented us from having single payer. So we're going to end up with a sub-optimal system.

It's time for President Obama and the Dems to begin laying the blame for bad health care legislation on the repukes. We need to start campaigning for 2010 by pointing out that it was the repukes who messed up health care and it was the repukes that prevented the President and Congress for fixing it.

democrat or republican. Time for President Obama to take the wheel and follow through on what we elected him to do. I know some of you simply care about reelection and all that goes through your mind is strategy. So, think of it this way - if the candidate can deliver on health care 2012 is smooth sailing.

The point is that all should be covered by health care. Period.

I have tried hard to analyze the current plans, realizing that none are in their final form, and I don't think any of them will help most people.

I am sorry to say that I think the entire approach is flawed. To reform health care we can either correct the underpayments in the government insurance plans (which will raise taxes) or go to single payer, but this idea that we can achieve reform without really doing anything to reform the system is not going to work.

Mind you, this was not the conclusion I wanted to reach and not my original take on the issue.

The other thing that worries me is that mandating that people purchase a product from the most hated industry in the US is bound to be a public relations nightmare.

Sadly its not just the health care system that needs reforming but the whole damn system (or maybe that's what you meant?)

The nation is growing older, the boomers are reaching retirement age, and total health care spending will continue to rise -regardless of what private health insurers do or do not do.

The rational thing to do is to accept that a larger portion of the average American's income will go to health costs -because the average American is getting older, and older persons tend to spend more on health care. The government should be encouraging more people to become doctors and nurses and should be encouraging the increase of facilities such as hospitals, clinics, and testing facilities because we are going to need them over the next 20 or 30 years. All the focus on holding down costs in the short run just makes it that much more difficult to prepare to meet the future needs.


Yes, it would be nice if there were something like 15 workers for every retiree, and it would be nice if the average age of the workforce were something like 30, but that is not the world we live in. The below link shows the demographic wave that is the baby boom.
http://www.nga.org/Files/ppt/0611SENIORWEBCASTKREPCIO.PPT


As these boomers move into retirement and start drawing on the benifits they paid into since the Great Society, the government will go broke -unable to sustain the payments and unable to borrow to cover the deficits as we are tapped out on our credit line.


What is needed is a Ross Perot-like presentation of the facts to the American people. Just tell the unvarnished truth about the long term, and short term, viability of our retirement and health(Medicare, Medicaid, governemnt pensions, and even private pensions) programs.

Is this going to happen? I very much doubt it (at least not until there is a real economic collapse in which the government defaults, or comes dangerously close to defaulting, on interest payments). The game the president in playing is demonize everyone else (greedy insurance companies, greedy and stupid seniors who don't want their "socialist" benefits touched, and selfish taxpayers who don't want to pay more and more and more) rather than admit that the government programs designed many years ago can't deliver as advertised.

Why can't the administaration admit that the government programs designed many year ago don't work? After all the current administration didn't design them? Because the repubs will use that as evidence that goverment is incapable of solving the problem.

The President is caught up in a catch 22, he can't tell the truth because the other side will bash him mercilessly for admitting government's failures, and he can't fix the problem without owning up, how else will he get seniors and soon to retire boomers to accept the royal screwing they are about to receive? But if he admits the failures of the past, how will he convince younger workers to pay more now for future promised benefits?


Instead he is wasting precious time going down the incrementalism path. Even if this round-about path to single payer (let's not kid ourselves what the President's end game is) were to work, then all the responsibility for providing health care would fall on the govs already overburdened shoulders. All the hard choices for deciding who will receive what services will fall on government, all the blame now directed to private insurers that refuse service for a particular treatment will fall on government.


We are witnessing a trajedy, wrapped in political drama, inside a train wreck.

is to forget the crazy notion of bipartisanship for the sake of having one repub name on the bill. He must use his bully pulpit to press for REAL reform. HR 676 has been floating around the House for years, he must work with House Dems to steamroll that through Congress and then sign it. This is the only chance we will have.

K&R

Thanks dajoki! :pals:

It's like watching a train wreck in SLOW motion.