Howard Dean on a Public Sector Option: Why Single-Payer Advocates and Progressives Must Unite

During a recent appearance on MSNBC’s Hardball, former Gov. Howard Dean (D-VT) said that a public insurance option is essential to any health reform effort (Thanks to Igor Volsky for pointing this out on The Wonk Room, and Hat-tip to Dr. SteveB on Daily Kos.)

Here is what Dean said: “If Barack Obama’s bill gets changed to exclude the public entities, it is not health insurance reform…it rises and falls on whether the public is allowed to choose Medicare if they’re under 65 or not. If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again.”

As I have suggested in the past if private insurers are forced to compete on a level playing field with a public sector option (which some call Medicare-for-All ) this means that they will be tightly regulated in terms of what they must cover. It also means that they will not be able to “cherry-pick” by charging some customers more because they are older or because they are sick.

The President’s Budget: Funding HealthCare by Redistributing Income: Universal Coverage Remains a Stiff Challenge

Yesterday, I suggested that the Commonwealth Fund’s recent proposal for healthcare reform underlines just how difficult it will be to build a sustainable, effective, safe healthcare program for all Americans.

Today, President Obama’s budget reinforces the message. His ten-year $634-billion plan for funding healthcare reform depends on “asking the wealthy to pitch in a bit more” (budget director Peter Orszag’s happy phrase), wringing some of the waste out of Medicare and Medicaid (cuts that are needed, but that will not be popular ); and strong-arming drug makers to raise discounts on Medicare drugs from 15 percent to 21 percent. About half of the money will come from changes in government programs, half from tax increases.

The Commonwealth Fund’s Plan for Universal Coverage: Which Tier Would You Be On? Part 1

Last week the Commonwealth Fund published a proposal for a “High-Performance Health Care System” that is ambitious, and admirably honest. Unlike many health care pundits, the lead author, Cathy Schoen, understands our Byzantine health care system from the inside out. As a result, she does not try to paper over the complexities, inefficiencies and inequities of U.S. health care.  She acknowledges them as she struggles to make an irrational system rational.

The Commonwealth Fund’s 90-page report deserves a close reading. But before  I begin to analyze it, let me stress that whatever objections I may raise about the Commonwealth proposal only illustrate just how hard it is to devise a plan that will deliver high quality, affordable, sustainable health care to all Americans.

The President’s Speech: Healthcare and the Deficit

Last night, President Obama diagnosed the disease: runaway healthcare inflation. The cure: “We must address the crushing cost of health care.”  If we don’t we will never be able to bring down our budget deficit—a deficit that Obama pledges to halve by the end of his first term. As Peter Orszag, the president’s budget director, observed in October: “the nation’s looming fiscal gap . . . is driven primarily by rising health care costs.”

President Obama stressed that we must begin Now.  At the same time, he made it clear that he does not have a finished plan in his back pocket: “There are different opinions and ideas about how to achieve reform,” he acknowledged as he called for a summit to begin work on this issue next week.  “I suffer no illusions that this will be an easy process,” he added.” It will be hard.”

Tonight, I hope the President Will Point Out . . .

The New York Times has invited me to be part of a online panel of healthcare experts commenting on the President’s speech. Our comments should be posted here by mid-day tomorrow.

This has led me to think about what I hope the President will say.

Most likely, he will outline a broad plan for universal healthcare.  Then he will toss it back to Congress to figure out how to fully fund reform.

 I say this because the President and OMB director Peter Orszag (who is fast becoming the president’s unofficial healthcare czar) understand that universal coverage will be very expensive. We cannot cover everyone without controlling costs. And this will take time. This is why the President has repeatedly said that he hopes to achieve universal coverage by the end of his first term. Not this year, not next year, but in four years.

The Truth about Medicare and Private Insurers

Today, fearmongers are trying to start a generational war. Their goal is to persuade younger Americans that we cannot afford Medicare. I have always been candid about the waste in our healthcare system. U.S.medicine is inordinately and unnecessarily expensive; we must put a brake on healthcare inflation. But conservatives such as billionaire Wall Street baron Pete Peterson wildly exaggerate the numbers when they suggest that spending on aging boomers will bankrupt the nation.

 Pete Peterson is, I am sorry to say, simply a cranky old man in a pinstriped suit. In a word, he’s a crank –i.e. “an unbalanced person who is overzealous in the advocacy of a private cause.”

 

Comparative Effectiveness Research: Will It Have Teeth? Part 2

My belief that Peter Orszag, director of President Obama’s Office of Management and Budget, (OMB) will play a pivotal role in making sure that comparative effectiveness research stands at the center of healthcare reform was confirmed by an article that appeared on Politico today.

According to the report, Orszag helped “shape the final compromise” on the administration’s first budget last Wednesday and is emerging “as a central figure and key negotiator in the Obama’s economic policy team.” 

“Orszag . . . left a profound mark on the stimulus,” Ben Smith writes, “and the bill spends more than $1 billion on Orszag’s pet cause, research on the effectiveness of medical practices, which he sees as an opening to reforming American health care through sheer analytical will."

In the past, I have written about Orszag’s desire to use this research to rein in health care inflation. As the former Congressional Budget Office director has observed, there is so much waste in the system, “that there are opportunities to reduce costs without impairing health outcomes overall.”  Less costly care does not mean lower-quality care.

Comparative Effectiveness Research: Will It Have Teeth? Part I

One of the most controversial provisions in the economic stimulus bill that President Obama just signed would give $1.1 billion to fund medical research that compares the benefits and risks of alternative medical treatments. 

Ostensibly, progressive health care reformers won this round: the funding was approved.  But now, observers are questioning whether Congress will give Medicare the power to use this research in a way that that matters: to redistribute health care dollars with an eye to lifting the quality and reducing the cost of healthcare.  Wednesday on The HealthCare Blog, Joe Flower suggested that, in the end, the forces of darkness (Rush Limbaugh, et.al.)  will prevail.  Or as he puts it, the “fulminating rage” of those who peddle “fear and ignorance” will overcome both reason and science. 

Here, I have to disagree. As regular readers know, I am hardly a recklessly optimistic voice on the healthcare reform circuit. But this is a subject that The Century Foundation’s Working Group on Medicare Reform has been discussing, and based on our conversations, I believe that Medicare will be able to give the research financial teeth. (For information on the Working Group, and its members, click here)

Divided We Fail: Signs of a Schism

 What Do Healthcare Coalitions and  the Show, Survivor,  Have In Common?

 Despite much talk about bi-partisan compromise and unlikely bedfellows, the truth is that the political debate over healthcare reform will ultimately come down to a battle over money. And the special interests will fight to the death before giving anything up.

A story in yesterday’s Chicago Tribune confirms that coalitions between “Labor unions and business groups that have teamed up in a multimillion-dollar national lobbying campaign to pressure President Barack Obama and Congress for big changes in the nation's health care system” are now “quietly at odds.”

Uwe Reinhardt: “The U.S. is Not a Democracy; it’s an Aristocracy”: Part 2

The Implications for HealthCare Reform– Part 2

We live in a tiered society. And the steps on our five-step economic ladder are both steep and sharp-edged.  Fall even one step, and you will bleed. At one time—in the 1950s and 1960s—white America was largely middle-class.  That is no longer the case.

As I explained in part 1 of this post, income inequality is greater in the U.S. than in any other developed country in the world. And this, says Princeton healthcare economist Uwe Reinhardt, is a major reason why we are the only wealthy nation that does not have national health insurance.  The distance between the lower-middle class, the middle class, the upper-middle class, and the truly rich (a group Reinhardt refers to as “our corporate aristocracy”) has grown so wide that we no longer recognize or identify with each other as fellow Americans.  As Reinhardt  puts it, we lack “social solidarity.”

For this reason, he fears that the  health care “reform” that so many of us are counting on will simply replicate the status quo, creating a tiered health care system where care is rationed according to ability to pay,  just as it is  today.  Everyone will have some form of health insurance, but only the wealthiest will receive high quality health care.