Listening To Doctors or Right Wing Editorial Writers on Health Care

When opponents of health care reform aren’t admitting to ignorance to what is being proposed (as with Michael Steele) they generally publish outright lies about what is being proposed. Common right wing lies include claims that this is a “government take over of health care” or some form of socialized medicine. Conservative pundits such as William Kristol are making up any arguments they can to kill health care reform (and don’t believe for a minute they will come up with any real alternatives).The absurdity of the conservative line can be seen in an op-ed in today’s Wall Street Journal.

The Wall Street Journal, perhaps because they are starting to believe the falsehoods they publish on health care every day, is shocked that AMA would endorse the House health care proposal. I noted some of the reasons this should not have come as a surprise in this post.

The arguments given show the usual right wing intentional ignorance of the realities of health care. They claim in the subtitle that “The AMA signs its members up to be civil servants.” This is a complete falsehood. Does anyone really believe that the AMA, which has opposed most reform measures in the past, would go along with anything of this nature? Do they really think that the leadership of the AMA has suddenly gone insane?

The health care reform measures being considered preserve the private practice of medicine. Doctors would not in any way be civil servants. The reality of health care practice is that when government pays the bills they hassle doctors, and interfere with our decisions, far less than when private insurance is paying the bills. While nobody is really advocating socialized medicine in this country, the reality is that what conservatives consider socialized medicine leaves patients and doctors far more free than we are under corporate health care.

The op-ed claims that “Medicare’s administered prices are already 20% to 30% lower than those of private insurers…” I wish that private insurers were paying me than much more than Medicare but it simply isn’t so. The initial proposals for a public plan spoke of paying ten percent more than the Medicare fee schedule, knowing that this would likely receive the support of doctors who would see this as paying more than we receive now.

I’m certain that some high priced surgical procedures are paid at this much above Medicare’s fees, but one goal is to reduce this discrepancy. Generally private payers well under ten percent more above Medicare. It isn’t all that rare that some plans, due to various restrictions on payments, wind up paying significantly less than Medicare. In addition, the overhead in dealing with Medicare is relatively low. I’ve avoided accepting some plans as they would significantly increase my overhead by needing to  hire more staff to request prior authorizations and handle their increased paperwork. Medicare pays very reliably after submitting claims electronically.

The bottom line is that the AMA knows what is far better for doctors that the biased editorial writers at The Wall Street Journal. In addition, they realize that health care reform is also better for our patients.

Is It Possible For America To Look At Health Care Reform Like Adults?

So far we are seeing a lot of predictable political posturing on health care reform but few are willing to approach the issue like adults. The Republicans are uttering the usual talking points, while Michael Steele provides an example of how little they have to say on the actual issues. Obama is pushing hard. Unfortunately the Democrats have been promising a free lunch, and now voters are getting nervous as they realize they might not receive this.

Earlier polls showed voters were willing to support health care reform even if it meant paying taxes. Obama should have taken advantage of this this and appealed to voters’ better instincts–as well as sticking with reality. Instead he tried to claim that health care reform will save money. The problem is that measures such as preventive medicine and computerization of medical records will pay not for health care reform. This might save money in the long run but it will take longer than Obama can Constitutionally remain in office to see real savings from these measures. In the short run (i.e. Obama’s first and potential second term) it will be necessary to spend more money to expand health care coverage to all, increase the provision of preventive medicine, and overhaul the system.

Claims that we can change the health care system without spending money upfront are no more reality-based than the claims we could go to war in Iraq without it costing us very much. We can no more pay for health reform from future savings than we can pay for the Iraq war out of imagined oil revenues.

The Democrats are trying to also say they can pay for this by only taxing the wealthy but there simply might not be enough wealthy tax payers to pay for this.

What Obama should have done back when people were saying they were willing to pay more for health care reform was to come up with a plan where the cost was discussed honestly. Then Obama should have promoted the plan based upon the value to everyone (including but not limited to the near 100 million who are under-insured or uninsured). The selling points would include:

  • Everyone would be assured that they can purchase affordable health care coverage, regardless of their age and regardless of their medical condition
  • Everyone would be assured that they would not lose their insurance because they became ill, or lost their job
  • Insurance prices would likely go down over time, ultimately offsetting initial tax increases

Sure the first two provisions are included in the pending legislation but I wonder how many really understand this. If you want people to support a plan based upon these benefits it is necessary to promote these features which benefit all. Democrats cannot allow the Republicans get away with framing health care reform as primarily a  measure to force those with coverage to pay for the coverage for others (or claim this is a government takeover of health care).

Reassurance that one can obtain and keep affordable health care coverage is of benefit to everyone, both the insured and the uninsured. When we look at the number of bankruptcies in this country due to losing health care coverage and the difficulty in purchasing coverage on the individual market, these are  things everyone can benefit from. As everyone benefits, everyone who is able to should pay the taxes needed to finance this should be paying in. A broad based tax to cover this provides the best chance of actually paying the costs.

Americans want to continue to have among the best subspecialty care in the world, but we cannot continue to have the worst delivery of health care in the industrialized world. Besides access to care, American also desire to continue to enjoy the amount of choice they have had (assuming they had the coverage) and want neither the draconian restrictions of some foreign countries or of some American HMO’s.

Someone needs to talk to the American people as adults about health care in this country–including the need to pay the costs to have the type of health care system most Americans want. Barack Obama has the ability to communicate the information. He needs to talk to Americans like adults instead of pretending health care reform can pay for itself or can be paid for simply by taxing the rich.

One Example Of Why We Can’t Take The Republicans Serously On Health Care


Michael Steele, Chairman of the Republican National Committee, has been attacking the Democratic health care reform plans as a “reckless experiment” that’s “too much, too fast, too soon” but he doesn’t seem to know the fundamentals of what the debate is about. In the above clip (hat tip Talking Points Memo) Steele was asked if Republicans support an individual requirement. Steele responded by asking, “What do you mean by an individual requirement?” When this was explained to him he still dodged the question saying he doesn’t “do policy.” Apparently his role is to attack Democratic policy proposals without having any idea what they mean or having any alternative policy proposals to offer.

I’ve often derided Republicans for statements which lump together everything from increased government regulations of the insurance industry to outright government run health care as in the United Kingdom in their attacks. I’ve considered this a strategic decision to try to confuse the issue by lumping together quite different ideas. In some cases, such as with Steele, it might just be that they have no understanding of the issues. Either way it shows why it is pointless to pay attention to the Republican talking points on health care which have no relationship to the real issues being considered.

Beginning The War on “The War on Drugs”

Mother Jones Drug Cover

It takes a long time for public opinion to change on some issues but sometimes we reach a tipping point where old ideas begin to be abandoned. In 2006 the Republicans won in many states by making an issue of same sex marriage. Today many see their opposition as being a factor which has caused young voters to abandon the party and speed up their decline. Other aspects of the culture wars will take longer to change. At this point we seem to be far away from ending the war on drugs but there is increased discussion of the issue and some signs of hope that it will be possible in the foreseeable future for politicians to discuss change. Mother Jones has devoted an issue to the topic and began with noting any absurdities of the drug war:

…the drug war has never been about facts—about, dare we say, soberly weighing which policies might alleviate suffering, save taxpayers money, rob the cartels of revenue. Instead, we’ve been stuck in a cycle of prohibition, failure, and counterfactual claims of success. (To wit: Since 1998, the ONDCP has spent $1.4 billion on youth anti-pot ads. It also spent $43 million to study their effectiveness. When the study found that kids who’ve seen the ads are more likely to smoke pot, the ONDCP buried the evidence, choosing to spend hundreds of millions more on the counterproductive ads.)

What would a fact-based drug policy look like? It would put considerably more money into treatment, the method proven to best reduce use. It would likely leave in place the prohibition on “hard” drugs, but make enforcement fair (no more traffickers rolling on hapless girlfriends to cut a deal. No more Tulias). And it would likely decriminalize but tightly regulate marijuana, which study after study shows is less dangerous or addictive than cigarettes or alcohol, has undeniable medicinal properties, and isn’t a gateway drug to anything harder than Doritos. (Watch Clara discuss the Doritos theory at the 00:12:54 mark of this video, and see “The Patriot’s Guide to Legalization.”

So why don’t we have a rational drug policy? Simple. Forget the Social Security “third rail.” The quickest way to get yourself sidelined in serious policy discussion is to stray from drug war orthodoxy. Even MoJo has skirted the topic for fear of looking like a bunch of hot-tubbing stoners. Such is the power of the culture wars, 50 years on.

After skirting the issue in the past they are now willing to address it, as others occasionally do. There’s still a long way to go before public opinion changes, but at least the process is starting to move a little more towards the mainstream.