December 2009 Archives
Left Turns on Individual Mandate. This article examines how the Senate Health Care reform bill, introduced by Harry Reid, is quickly losing support from democrats due to changes made to the bill. Foster argues that because of the elimination of the public option, many democrats are turning on the bill becuase of the cost many middle class taxpayers will incur, and because it will force Americans to purchase insurance from the private sector, which is where the problem originated in the first place. Clearly Foster brings up a great point that due to the amendments the bill is taking on, it can no longer be passed due to the extreme condition it would leave many middle and lower class citizens. However, this still may not rule out passage of some sort of reform, as there is still the possibility of passing the bill, and ironing out the differences in conference committee of both houses.
This article shed light on a major issue surrounding healthcare reform, the time table Senator Reid set up. Senator Snowe says in this article that a political deadline doesn't translate into good policy and I think this is true. There should not be a deadline for healthcare reform if it is just to ensure that the Democrats remain the majority in the House and the Senate after the 2010 election year. Policy should be worked out until we have the best bill possible and clearly with the recent dropping of the public option a concrete bill is not in place. It would be incredibly difficult to correctly review the bill in two weeks time. The deadline of Christmas to get the healthcare bill through the Senate is a ridiculous hope. If a bill were to be passed by Christmas, it would not be a well thought-out bill because of all the flip flopping of items like the public option. If this bill is to pass in the Senate, it needs to be cohesive and not just be kicked through to meet a silly deadline.
Before reading this article I had no idea that an opt out option was even on the table for health care reform. Personally I feel that as a progressive state if Minnesota were to opt out it would be a major setback for the entire state not just the 875,000 Minnesotans who would be eligible to use the public option. If we opted out there would still be 519000 Minnesotans uninsured, and we would become a backwards state in the union. While I can see the points being made by republicans, I feel that if democrats let states opt out they are failing and leaving citizens behind. I also think if we opt out it will continue to put pressure on our health care providers as 519000 uninsured will still be using our facilities and we will still be footing their bills, and the bills for other states. I think this issue will make the race for governor very exciting, as it is not Tim Pawlenty who decides what to do, but the next governor. I also think that this issue really shows why it is important that we stay up to date on our state politics not just federal, as health care is especially an issue for the state.
I totally agree with Ezra Klein. I don't think that Rahm Emanuel really has any power over the moderates or the Republicans when it comes to health care reform. They are the ones who have all the power right now. The White House isn't going to try and flex muscle with these members when they all individually could completely block the entire health care reform, not just the public option. The President and major Democrats really just want to get some sort of reform and if they tried to twist anyone's arm that just wouldn't happen. Someone would filibuster the bill stopping any reform from happening. To be completely honest when it comes to health care I think its smart for the White House to not flex a lot of muscle.
This article does a good job of pointing out just how complicated healthcare reform is. There is the complexity of the bill (2000 plus pages of ways to improve healthcare), there is the fact that the bill is ever changing (most news days include some sort of change to the bill), and Boulton discusses how people's contradictory opinions make healthcare reform even more difficult.
The contradictory examples provided ("People are concerned about federal deficit, but think to little is spent on healthcare") mimic the contradictory attitudes about welfare we saw earlier in the year (people were supportive of spending more on the poor, but didn't want to spend more on welfare). The vacillation of the American public really makes it difficult to pass any legislation. Individuals, and their ambiguous opinions, make it hard for the government to form popular legislation. Congressmen will want to please their constituents, but if they get conflicting ideas, they will have a hard time getting anything accomplished.
However, I believe that by going ahead and implementing some of the pilot programs in the bill, we will, in some ways, force people to make up their minds. Boulton talked in the article about how Medicare had only been supported by 46% of the population when it was enacted, but now Medicare is a very popular program. By enacting some of the pilot programs suggested in the healthcare bill, we will be creating a change in healthcare. Maybe citizens won't like this change, but at least then we will know what not to try in the future - and maybe we could then implement the other side of their conflicting ideas.
In Tom Laskaway's article he addresses the issue of the government funded food program called the Supplemental Nutrition Assistance Program otherwise known as food stamps. He continues to argue that the food stamps should subsidize and include healthy choice options for the poor. He claims that healthy food should not just be a luxury just to those who can afford them, but made available to all. He believes that they should be giving an option to make better food choices, yet he understands the government's resistance to further interference with people's lives.
I think Laskaway makes a fair argument that food stamps should include healthy choices for individuals, but I think he forgets in his argument that the government will have to put more money into these programs as well as monitor them closer. It's easy to say we should do this, but it's not so easy to enact it. The government already has a tight budget and as seen through past legislation it's likely to infer that the government will be more likely to make further restrictions on the program and cut funding before adding to it. Laskaway has the right idea, but I think it's at the wrong time as of right now the government's main focus is on healthcare.
According to the editorial ten democratic senators are ditching the "maligned public option" because they believe they can achieve the same goal with a different approach. The proposal is still in it's development stage and the CBO still has to analyze it. The article also touches on the fact that the current public option would be more expensive than the average price of current private insurance policies because it targets only small group of people. It's other weaknesses come from the fact that it has to negotiate it's own rates, instead of using the rates of Medicare.
The proposal of including those 55 and older into Medicare would only include those who are eligible to purchase insurance on the exchanges. Those who choose to enroll that are under the age of 65 would be require to pay around $7600 in premiums, which would hopefully be cheaper than private insurance and help cover a few million people.
The second proposal surrounds the private sector and would require them to create a group of non-profit insurance plans to compete with for profit plans on the exchange. If the insurance companies failed to do this, the government would. These plans would be controlled by the Office of Personnel Management, the same agency that deals with health insurance for federal employees. The weaknesses of these possible plans is there inability to compete in monopolized markets. Until the CBO analyzes these possibilities the future of the proposal is up in the air for now.
I believe this a better attempt at increasing healthcare coverage in the US, but is still not the "magic bullet" everyone is hoping for. The non-profit groups could definitely be strengthened by requiring the insurance companies to create them, instead of offering it as a suggestion to them. If they fail to comply then they would be subject to federal fines or some other reprimanding consequence. This would force them to drive their costs down because they would be forced to compete with their own non-profit plans. The idea of using Medicare as a pathway to increase healthcare coverage is a excellent idea because it uses the current resources and system that we currently have in play. I like the idea of protecting older Americans because they are more susceptible to illness and disease, and require more attention. I think this idea will also be appealing to other people because it isn't too drastic to spark a huge controversy.
This article touches on the changes affecting the healthcare bill as it passes through Congress and also the politicians that support or oppose these changes. The public option, which has been largely watered down from its original version, is still meeting opposition, as it did in the beginning. In hopes of retaining some of the public option "idea," a suggestion to expand Medicare coverage has been proposed. This is also being met with pessimism.
It surprises me how much of a "one step forward, two steps back" path healthcare reform has taken. It seems that when progress is made (such as when Snowe's vote helped get the healthcare bill out of committee), it soon loses support or a new quagmire shows up in the problem (like Snowe's reluctance to now vote yes on the bill). Although the democrats knew Snowe voted yes to move the Senate Healthcare bill out of committee on the grounds that there would be changes and compromises made to it, it seems as if there have been many more compromises than anticipated. The public option's affect has been diminished and this Medicare proposal is not being met with open arms either. In the beginnings of this healthcare debate there was a real move for change, now it is as if the democrats are just trying to push something through for healthcare reform.
The article reflects some of the themes we've been talking about in class - mostly the affect of institutions and groups on legislation. The focus on procuring Snowe and Lieberman's votes shows that in the US political institutions, minorities really can have power to stop something they don't like. In the end of the article, you can also see how groups have affected the creation of the healthcare policy, with American Hospital Association and the Federation of American Hospitals urging their members to contact their representatives to say "no" to the expanded Medicare idea.
Also, this is an interesting article about a move from a public option to expanded Medicare coverage, which the "NO Snowe for the Holidays" article mentions:
In Newsweek, the author, Robert Samuelson, offers some really thought provoking assertions that invite each of us to take responsibility for the health care crisis in our country. The simple facts that by 2008 federal government outlays on health care totaled $752 billion which was 25% of all its spending is halting. Moreover, the fact that in 2006, the sickest 5% of Americans accounted for 48% of health spending is startling. Both facts motivate me to learn yet more about our health care crisis. What is it about Americans and about our health care industry that has allowed our expenditures to grow so exponentially? The author offers a sobering explanation. He calls out our underlying belief systems. He accuses all of us as contributors to the unchecked health care spending because most Americans believe they have a right to health care that is open ended without constraints. After considering his assertion, I must admit that I certainly consume health care services whenever I need to and I certainly expect the same for the rest of my family. This article motivates me to think more about this assumption because I do agree with the author that spending so much on health care outlays effectively means that we as a country have less to spend on other national priorities. Health care spending creates significant tradeoffs requiring us as a country to invest less in other important areas like education. The sheer size of the health care outlays and the rising trend rate of cost increases in the health care sector are two factors that truly make you reflect on the author's assertion that health care is taking over government. In our country, the people are the government so perhaps he is saying that health care is taking over us unless we find the discipline to revise our underlying assumptions about health care consumption.
I agree with
the author that Sweden's single payer health care system teaches us certain
lessons which are important to consider when our country is debating the pros
and cons of a massive health care reform.
Certainly the author accurately explains that in Sweden's single payer
system the government pays for virtually all the monetary cost for medical
expenses to consumers. In return,
consumers have no economic incentive to restrict their consumption of medical
services so the quantity demanded of health care services significantly exceeds
the quantity supplied of health care services.
Therefore, Sweden's single payer system produces an excess of demand for
services which results in consumers waiting a long time to access medical
services. Sweden may have a single payer
system in which all citizens are permitted access but the reality shows that medical
services are rationed to consumers to manage the excess of demand caused by the
"free" nature of public health care.
Though I agree with the author's comment that Sweden's single payer
system does produce rationing of care, I don't necessarily agree with the
author that Sweden's system does not hold down costs. This statement may be true relative to the
level of costs in Sweden but may not be true relative to a comparison with
other countries. According to the 2007
annual survey by Commonwealth Fund, Sweden's per capita expenditure on health
is $3,323which is about 9.1% of GDP compared to the US where per capita
expenditure on health is $7,290 which is 16% of US GDP. So though the free market forces are hard at
work in the US, health care costs on a per capita basis are much higher. This relative comparison shows that health
care costs are high in a single payer system and higher in a private/public
system as well.