Listen to Maggie on Why Conservatives Are So Upset About Reform

Those who oppose reform understand just how powerful this legislation is. They understand—better than many liberals—just what it means for a medical-industrial complex that has grown fat while profiting from runaway health- care inflation. Going forward, it will be much harder for lobbyists to block efforts to rein in health care spending. Conservatives understand the business of health care; they know just how much money is involved. And they know that while this bill will be good for patients, it will not be good for those who view medical care as a business.

Click on this link to hear a podcast that I recorded yesterday.

4 thoughts on “Listen to Maggie on Why Conservatives Are So Upset About Reform

  1. So Maggie, what universal health care system do you think the US would mostly likely be similar to 10, 15, 20 years down the road? The Dutch, German, Austrian, Japanese, or even French models? From the way things are being discussed, I think medicare would be dissolved or replaced in the future. So that leaves us with a new health care system?

  2. Mike Ben–
    It’s extraordinarily difficult to try to predict history’s narrative
    But given the current legislation, my guess it we we will wind up with something closer to the German or perhaps French models.
    In other words I think we will have a hybrid system with non-profit private sector insurers as well as gov’t insurance.
    Benefits will be good, the level of care will be higher than it is now (fewer hospital errors, more primary care and greater efforts to keep people well before they become sick. )
    I know the French & German system pretty well because I have American relatives and a very close American friend who have lived in each of these countries for many years. I’ve also interviewed German doctors.
    Medicare could well be part of the universal system rather than a separate program for seniors . . . very hard to say.
    And I haven’t thought through whether it would be better to keep Medicare as a separate program that people pay for when they are younger.
    Ultimately,as I have said in the past, I think it would be ideal if we wound up with a system like the system that Ezekiel Emmanuel and Victor Fuchs describe in “Healthcare, Guaranteed.”
    But that’s not going to happen right now because the country is not ready for a new VAT tax–a tax with a European pedigree.
    But if a VAT tax were used to fund healthcare it would Not be regressive, and would make a great deal of sense.

  3. One other issue -
    T.R. Reid said on some program a while ago (I think it was on NPR) that to get to a truly efficient system in America, we would need to have one health care system that is the same for the whole country, i.e., we can’t have a VA health system, a medicare system, an employer based system, etc, all lumped in together — We need one universal system applied across the board to truly save money and be most efficient. Things like electronic medical records would work well if America had one universal model for health care. It looks like this would be hard to get to.
    Have you seen this report by chance which discusses health care rankings in Europe?:
    http://www.healthpowerhouse.com/files/2008-EHCI/EHCI-2008-report.pdf

  4. Mike Ben–
    Both the VA system and Medicare are working pretty well now (the system design of the VA is very good, though it didn’t get the funding it needed through much of the Bush administration. But it’s now getting more funding and going forward, should be working well.
    Medicare is wasteful–but the new Medicare director will be proactive in addressing that problem. Otherwise, most beneficiaries are pretty happy with Medicare.
    IF these two systems working well, there is no reason to merge them. They are large enough to enjoy efficiens of scale and to have clout in the marketplace on their own.
    Also, the VA has its own culture made up of docs who particularly like working with Vets. And many Vets prefer being in hospitals with each other.
    I wouldn’t want to break up that culture.
    The one thing I would do is fold Medicaid into Medicare so that Medicaid patients get the same level of care and so that all docs treating Medicaid patients received Medicare rates (which are higher.)
    Turning to the private sector: With reform, there will be a shake-out among insurers–some will thrive under regulation(some of the best non-profits are likely to do well) others won’t be able to survive.
    Finally, at some point (perhaps before 2014) I suspect that we’ll have a public option.
    This could mean opening Medicare to younger people, but the financing would have to be separate. (You can’t use the money that people have been putting into Medicare all of these years toward healthcare when their cohort is over 65 into health care for younger people.
    And, since you’ll need separate funding and services that younger people need (i.e. maternity),it probably makes sense to let the public option be a separate program.
    Finally, different delivery systems are going to work better in different parts of the country.
    Unlike Germany or France or Switzerland, the U.S. is a huge diverse country, with real cultural differences in different regions.
    I’d compare it to Canada (though the U.S. is even more diverse) where health care is overseen by individual provinces which have different rules.
    Thanks for the link to
    European rankings.

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