You’ll remember that last week the “Max Baucus” health reform bill moved from a Senate subcommittee to the full Senate Finance Committee. This week, debate has continued in that committee about the many amendments that have been offered for the bill.
Yesterday saw the defeat of two amendments to add a public option to the bill, one offered by John D. Rockefeller (D, WV), and the other by Charles Schumer (D, NY). Remember that a public option would offer people who do not have employer health benefits the choice between buying private insurance or buying government operated health insurance.
Of the two amendments, the Rockefeller amendment was more “robust,” in terms of strong competition to insurance companies. It would have paid providers the same rates as Medicare, plus a bonus for those providers already seeing Medicare patients. The Schumer amendment was more of a compromise, offering a public option, but not allowing the government to set rates. Instead, rates would have to be negotiated with providers, just as private insurance companies now do. The Schumer plan would not have had as much power as the Rockefeller plan to keep insurance rates low.
Despite the 13 to 9 vote majority of Democrats on the Finance Committee, neither amendment passed. Once again, the conservative Democrats on the committee are responsible. True, every single one of the Republicans voted against the amendments, but that is to be expected in this super-partisan climate.
Baucus himself voted nay, citing his need to present a bill that would pass the whole Senate.
Just in case you’re interested, here are the Senate Finance Committee members and how they voted. Those who voted against both amendments are in colored print. Those who voted only against the Rockefeller amendment are in red. As you can see, two Democrats voted for the Schumer amendment who did not vote for the Rockefeller amendment. Some see this as a hopeful sign that perhaps there is room to move some votes. To that end, phone numbers are included below.
DEMOCRATS
1. MAX BAUCUS, MT Phone: 202-224-2651 Toll Free: 800-332-6106
2. JOHN D. ROCKEFELLER IV, WV Phone: 202-224-6472
3. KENT CONRAD, ND Phone: 202-224-2043 Toll Free: 800-223-4457
4. JEFF BINGAMAN, NM Phone: 202-224-5521 Toll Free: 800-443-8658 (NM only)
5. JOHN F. KERRY, MA Phone: 202-224-2742
6. BLANCHE L. LINCOLN, AR Phone: 202-224-4843
7. RON WYDEN, OR Phone: 202-224-5244
8. CHARLES E. SCHUMER, NY Phone: 202-224-6542
9. DEBBIE STABENOW, MI Phone: 202-224-4822
10. MARIA CANTWELL, WA Phone: 202-224-3441
11. BILL NELSON, FL Phone: 202-224-5274
12. ROBERT MENENDEZ, NJ Phone: 202-224-4744
13. THOMAS CARPER, DE Phone: 202-224-2441
REPUBLICANS
1. CHUCK GRASSLEY, IA Phone: 202-224-3744
2. ORRIN G. HATCH, UT Phone: 202-224-5251
3. OLYMPIA J. SNOWE, ME Phone: 202-224-5344 Toll Free: 800-432-1599
4. JON KYL, AZ Phone: 202-224-4521
5. JIM BUNNING, KY Phone: 202-224-4343
6. MIKE CRAPO, ID Phone: 202-224-6142
7. PAT ROBERTS, KS Phone: 202-224-4774
8. JOHN ENSIGN, NV Phone: 202-224-6244
9. MIKE ENZI, WY Phone: 202-224-3424 Toll Free: 888-250-1879
10. JOHN CORNYN, TX Phone: 202-224-2934
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Cartoon of the day
Wednesday, September 30, 2009
Friday, September 25, 2009
Pie in the Sky
Despite lengthy closed-door negotiations in a subcommittee, Max Baucus (D, Montana) released his “Baucus Bill” to the larger Senate Finance Committee last week with no Republican support from his panel. Both the Left and the Right have declared this version of health care reform a disaster. The Right doesn’t seem to want any health care reform during this administration. The Left is concerned that the bill is a giveaway to health insurance companies and that it doesn’t include a public option. Already the bill has attracted nearly 600 amendments, many aimed to slow down the progress of the bill. If votes on the amendments proceed at the pace they started, it will be months before the bill will make it to the Senate floor.
At the moment, instead of jumping into this briar patch, I’m going to sit back and approach health care reform from a different angle: what is it that I think I really want our system to look like? Sure it’s pie in the sky, but sometimes figuring out our dreams, even if they can easily be labeled unrealistic, is a good exercise. So I’ll tell you my dreams, and I’d love it if you’d tell me yours. Use the comment feature—please!
Pie in My Sky
1. Set an overall goal of the best health for each person with the greatest choice for the least cost.
2. Make health care universal since it is a basic human right. I’ve written about this on August 28 and August 27.
3. Make health care reform about much more than insurance, which is currently the focus of discussion.
4. Share the responsibility for health. More can be done to encourage people to be educated health consumers. Providers have a responsibility to be honest and respectful presenters of options.
5. Put great brains to work on how to deliver health care efficiently. Dr. Jim Yong Kim at Dartmouth says, “In my view, the rocket science in health and health care is how we deliver it.”
6. Rebuild medical education. We need enough doctors, especially primary care doctors, meaning that we somehow need to make being a primary care doctor as attractive as being a specialist. Hand in hand with this, we need to figure out how to make medical education less expensive.
7. Revamp the way doctors are paid. We need doctors who are not penalized for taking time with patients, who are encouraged to work preventatively, and who,when faced with problem cases, can think outside the box. This may mean finding alternatives to the current fee-for-service system, which often results in cramming as many patients as possible into a doctor’s day. We need providers who are rewarded for their success at keeping or making patients well, requiring more thought about the whole person instead of just malfunctioning parts.
8. Figure out a better balance between overuse of expensive hospital services on the one hand and the rights of individuals to the best possible diagnostic, preventive and treatment options. Experts on health care reform are now kicking around the term, “Supply-driven health care,” saying that when facilities have all those expensive machines and procedures available, the tendency is to use them even when they may not need to be used. Yet a patient struggling with a complex problem will want no stone left unturned. This may be the toughest health care finance problem of all to solve.
9. Maintain market incentives for research and development while enabling serious negotiation on the cost of life-saving products. At present, there are huge rewards for coming up with something that can be patented—a drug, a device, a bio-solution, a material. That’s been a driving force behind research and innovation. We don’t want to lose that capitalistic motivation. However, use of these products may be untenable if there is no way to cap costs. Also, when providers automatically turn to patented solutions rather than considering less costly alternatives such as supplements, dietary changes, or physical therapies, the cost of medical care obviously rises.
10. Sever the financial links between manufacturers of drugs and equipment and the providers who are rewarded for using these products. This would include eliminating company-sponsored continuing education hours for providers.
11. Share responsibility for costs of health care, deciding payment by income. Those who can pay more should. Those who can only pay a little should. We have tremendous inequities in wealth and earning power in the U.S., so this is the only way I can see universal care working. People who become ill or have an accident should not be penalized financially. A reformed universal care system will, I believe, still cost the average taxpayer less than is projected for our current unreformed system.
In addition, consumers should know up front how much visits and procedures will cost. In no other arena are consumers so uninformed about prices.
12. Sever the link between employment and health insurance. One of the reasons companies are in so much trouble in the U.S. right now is because of the burgeoning cost of health insurance. Companies should still bear some of the cost burden, but this could be done more equitably with taxes (Oh, dreaded word!) In the long run, under a reformed insurance system, companies would probably pay less in tax than they are presently paying in premiums. If health insurance were not tied to employment, it would also give employees more flexibility about changing jobs and could add to their job satisfaction.
As you can see, I haven’t laid out solutions so much as raised problems—problems that mostly remain unaddressed by any of the health care reform proposals in Congress.
I’m not sure that the pie in my sky could even begin to be achieved by anything other than a single-payer system like Medicare—along with a number of other reforms. For instance, isn’t there a fundamental conflict of interest between insurers, whose goal is profit, and my number one goal? The conflict is not in keeping people healthy—insurers profit if people don’t get sick. The conflict is in keeping costs down, providing choice, and making sure that people aren’t penalized when they need help the most.
That’s a nutshell version of my utopian health care dreams. What do you like and dislike about this? What’s your vision? Do you have any great ideas about how some of these problems can be solved?
==============
Cartoon of the day
At the moment, instead of jumping into this briar patch, I’m going to sit back and approach health care reform from a different angle: what is it that I think I really want our system to look like? Sure it’s pie in the sky, but sometimes figuring out our dreams, even if they can easily be labeled unrealistic, is a good exercise. So I’ll tell you my dreams, and I’d love it if you’d tell me yours. Use the comment feature—please!
Pie in My Sky
1. Set an overall goal of the best health for each person with the greatest choice for the least cost.
2. Make health care universal since it is a basic human right. I’ve written about this on August 28 and August 27.
3. Make health care reform about much more than insurance, which is currently the focus of discussion.
4. Share the responsibility for health. More can be done to encourage people to be educated health consumers. Providers have a responsibility to be honest and respectful presenters of options.
5. Put great brains to work on how to deliver health care efficiently. Dr. Jim Yong Kim at Dartmouth says, “In my view, the rocket science in health and health care is how we deliver it.”
6. Rebuild medical education. We need enough doctors, especially primary care doctors, meaning that we somehow need to make being a primary care doctor as attractive as being a specialist. Hand in hand with this, we need to figure out how to make medical education less expensive.
7. Revamp the way doctors are paid. We need doctors who are not penalized for taking time with patients, who are encouraged to work preventatively, and who,when faced with problem cases, can think outside the box. This may mean finding alternatives to the current fee-for-service system, which often results in cramming as many patients as possible into a doctor’s day. We need providers who are rewarded for their success at keeping or making patients well, requiring more thought about the whole person instead of just malfunctioning parts.
8. Figure out a better balance between overuse of expensive hospital services on the one hand and the rights of individuals to the best possible diagnostic, preventive and treatment options. Experts on health care reform are now kicking around the term, “Supply-driven health care,” saying that when facilities have all those expensive machines and procedures available, the tendency is to use them even when they may not need to be used. Yet a patient struggling with a complex problem will want no stone left unturned. This may be the toughest health care finance problem of all to solve.
9. Maintain market incentives for research and development while enabling serious negotiation on the cost of life-saving products. At present, there are huge rewards for coming up with something that can be patented—a drug, a device, a bio-solution, a material. That’s been a driving force behind research and innovation. We don’t want to lose that capitalistic motivation. However, use of these products may be untenable if there is no way to cap costs. Also, when providers automatically turn to patented solutions rather than considering less costly alternatives such as supplements, dietary changes, or physical therapies, the cost of medical care obviously rises.
10. Sever the financial links between manufacturers of drugs and equipment and the providers who are rewarded for using these products. This would include eliminating company-sponsored continuing education hours for providers.
11. Share responsibility for costs of health care, deciding payment by income. Those who can pay more should. Those who can only pay a little should. We have tremendous inequities in wealth and earning power in the U.S., so this is the only way I can see universal care working. People who become ill or have an accident should not be penalized financially. A reformed universal care system will, I believe, still cost the average taxpayer less than is projected for our current unreformed system.
In addition, consumers should know up front how much visits and procedures will cost. In no other arena are consumers so uninformed about prices.
12. Sever the link between employment and health insurance. One of the reasons companies are in so much trouble in the U.S. right now is because of the burgeoning cost of health insurance. Companies should still bear some of the cost burden, but this could be done more equitably with taxes (Oh, dreaded word!) In the long run, under a reformed insurance system, companies would probably pay less in tax than they are presently paying in premiums. If health insurance were not tied to employment, it would also give employees more flexibility about changing jobs and could add to their job satisfaction.
=================
As you can see, I haven’t laid out solutions so much as raised problems—problems that mostly remain unaddressed by any of the health care reform proposals in Congress.
I’m not sure that the pie in my sky could even begin to be achieved by anything other than a single-payer system like Medicare—along with a number of other reforms. For instance, isn’t there a fundamental conflict of interest between insurers, whose goal is profit, and my number one goal? The conflict is not in keeping people healthy—insurers profit if people don’t get sick. The conflict is in keeping costs down, providing choice, and making sure that people aren’t penalized when they need help the most.
That’s a nutshell version of my utopian health care dreams. What do you like and dislike about this? What’s your vision? Do you have any great ideas about how some of these problems can be solved?
==============
Cartoon of the day
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