Health Care "Summit" De-Brief Paul Losch's Community Blog, posted by Paul Losch, a resident of Palo Alto, on Feb 27, 2010 at 8:55 am Paul Losch is a member (registered user) of Palo Alto Online
John Naber--thanks a bunch for your postings on the Vancouver Olympic Games. You have a unique perspective as one who competed and won in the Olympics, is a local community member, and is providing some point of view that goes beyond the platitudes of what is going on. Mazel Tov, I wish I were there!
After the Feb 25 summit at Blair House in DC hosted by President Obama, and a day to digest what the pundits I read and listen to, here are my obervations:
I have been thinking that President Obama needs to take that big old Air Force One airplane and fly it down to Austin, Texas. Before he returns to the White House, his security detail needs to figure out how he can get to Hyde Park, NY.
Austin houses LBJ's Presidential Library. Hyde Park is FDR's.
While flying, Instead of reading the in-flight Air Magazine, he should brush up on “The Prince.”
Some of us can remember the rancor that went on when Lyndon Johnson drove the policies that led to Medicare and Medicade in the 1960’s. Far fewer of us at this point can claim to be live witnesses to what Roosevelt had to do and how he dealt with his opposition when Social Security was enacted.
Visiting these Presidential Libraries, as I have, provides a great deal of enlightenment. FDR and LBJ both were larger than life personalities. And their policy initiatives were often opposed quite stridently by the loyal opposition. Both men cajoled, schmoozed, compromised, and then decided. And enacted major new initiatives.
It has been a long time since I read “The Prince,” and I must admit that I found much of it to be quite disturbing. Still and all, it holds its lessons about what a head of state does.
Unlike his immediate predecessor, President Obama has attempted to take a high road in dealing with Congress and the “other side of the aisle.” As they say, it takes 2 to tango, and the GOP has chosen to take an entrenched, non-cooperative approach to dealing with this President. W ignored the Democrats, and got away with it for most of his term, until his policies were held to the light of day and found to be flawed.
Obama must take an LBJ and FDR approach on health care. And he has to take a W approach on how to get it through. There is no “high road,” there is no middle ground between “starting over,” (how many times have our policy makers “started over” in the last 100 years on this matter?) and enacting reforms that are desperately needed.
Posted by R Wray, a resident of the Midtown neighborhood, on Feb 27, 2010 at 9:53 am
Why stop with FDR and LBJ? Hitler read The Prince avidly and claimed it was "simply indispensable for every politician." He claimed it "liberated" him "from mistaken, sentimental ideas" and from "inhibitions."
Posted by Susan, a resident of the Midtown neighborhood, on Feb 27, 2010 at 1:17 pm
If Obama does suddenly grow some balls, and acts like FDR or LBJ, could you please explain how that would move the cost curve in the downward direction? Or are you saying that costs will continue to escalate, but that the rich should be taxed to pay for it?
Posted by Paul Losch, a resident of Palo Alto, on Feb 27, 2010 at 5:59 pm Paul Losch is a member (registered user) of Palo Alto Online
The most worrisome aspect of our health care system is escalating costs. It is quite apparent that the existing structure continues to go up in cost and I think the objective of stopping such increases is one to which all parties agree.
Quite frankly, I do not know if what Franklin Lyndon Obama proposes will stanch that escalation. I do know that doing nothing will lead to greater cost increases. According to the supposedly neutral CBO analysis, costs will go down compared with the status quo. You can make your own judgment about what the CBO has to say.
Your "tax the rich" comment is gratuitous and I will not respond to it.
Posted by Susan, a resident of the Midtown neighborhood, on Feb 27, 2010 at 8:27 pm
That's OK. And I understand where you are coming from.
I will just pitch it out there for anybody who is interested:
How do we bend the health care cost curve? Personally, I don't think it is possible, certainly not politically. I think we will simply decide to spend a greater percentage of GDP on health care, then resolve it with inflation, a hidden tax that hurts the poor more than the rich.
Posted by R Wray, a resident of the Midtown neighborhood, on Feb 28, 2010 at 9:49 am
This focus on cost is a subterfuge. The real issue is CONTROL. The Government currently pays 50% of the health care costs and, therefore directly controls that half. It heavily regulates the other half. What the politicians and bureaucrats want is 100% control.
Those who are willing and eager to give up their personal control of their health care in the name of saving a few bucks would think about selling their soul to the devil.
Posted by stephen levy, a resident of the University South neighborhood, on Feb 28, 2010 at 1:44 pm stephen levy is a member (registered user) of Palo Alto Online
I agree with Paul. There is not much middle ground. I expect Obama to add a proposal for tort reform and a proposal for experimenting with buying insurance across state lines in addition to removing most of the special state giveaways.
This will probably not be acceptable to Republicans. The administration and Congressional leaders are counting noses. I hope there are enough to do this through majority vote.
The arguments over whether this is good or bad policy are legitimate but as Paul notes the existing situation is terrible and will get worse. It is time to move this forward.
The argument about whether or not this is popular is something we use elections to decide. Republicans pushed on with an Iraq war that was unpopular for most of the years and passed tax cuts that are now unpopular. So now they are being hypocritical about using polls.
Similalry the argument about we shouldn't use a majority vote process is hypocrisy. Republicans used that to pass major tax cuts that were unpopular and had little or no Democratic support.
If we are going to insure additional people and help small businesses afford insurance, that money is going to come from other people--that's arithmetic. The funds as proposed will not come from rich people only. And the tax on "rich" plans is one of the ways to bend the cost curve. I hope it survives.
Beyond that there is a Medicare tax on unearned income, which does not all go to rich families. And the biggest funding source is reducing teh 15% extra subsidy for Medicare Advantage, which does not focus on rich families.
Posted by Susan, a resident of the Midtown neighborhood, on Feb 28, 2010 at 3:42 pm
If Obama had started with tort reform, then added in on top of that, he would be signing a bill. He refused to take on the trial lawyers, and he paid the price. He is a weak leader, IMO, although not a bad man, personally.
I think this whole thing is dead, at this point. Reconciliation is not meant for such big ideas, and even the Democrats in the Senate will not jump over that cliff, because it is a license to eliminate the filibuster. When the GOP comes back into power, they would simply throw everything into reconciliation, including unwinding the Obamacare statutes.
This is an example of the arrogance of power. Health care reform should be taken off the table until after the midterm elections, then brought back with a blank sheet of paper. Then start with tort reform... followed by purchasing pools for indivuals, supported by vouchers from the government (welfare) to those indivuals, plus a requirement for all individuals to have insurance (the basis for insuring pre-existing conditions). On top of all that will be the requirement for rationing (death panels, if you will).
Since none of my ideas will actually happen, at least not in the proper order, expect inflation to provide the final answer, with the attendant tax on the poor, as well as a major increase in government power over the indivdual.
Posted by stephen levy, a resident of the University South neighborhood, on Feb 28, 2010 at 5:19 pm stephen levy is a member (registered user) of Palo Alto Online
The Obama plan is mostly what Susan advocated above.
Obama will include some tort reform as he has said all along. At the summit, it was clearly stated, though, that tort reform is small dollars. Moreover, no Republican as yet has taken Obama up on his offer to work on tort reform.
What Susan called purchasing pools supported by voucehers from the government is exactly what the exchange is. The exchage allows people to pool and private insuranc companies to compete.
The heart of the plan is required coverage in exchange for no pre-existing conditions.
Yes, there will be minimum requirements like states have now.
The claim that reconciliation is not used for big things is just BS. It was used to ram through massive tax cuts for high income households and corporations. What goes around comes around.
Posted by Susan, a resident of the Midtown neighborhood, on Feb 28, 2010 at 6:10 pm
If this thing goes to reconciliation, as is, or nearly as is, it will fail. Why? Because Democrats do want to have to face the revenge of the GOP, once they regain power. The filibuster is there for a reason.
This entire thing should be dropped until after the midterm elections. Then START with SERIOUS tort reform, THEN add my other concepts on top of it. It doesn't work if tort reform is just tossed into the mix as a sweetner. Obama can become a believalbe leader if he takes on his own base (trial lawyers), THEN challenging the GOP to come aboard. It will not work in the other direction.
I agree with Stephen, and others, who understand that accepting pre-existing conditions, as a requirment of insurance entities, REQUIRES mandatory buy in. Otherwise, any fool would wait until he/she has a pre-exisitng condition, before buying insurance. That would be like buying auto insurance only AFTER you have an accident.
Purchasing pools, by individuals, along with tax protection (using pre-tax dollars)and national (international?)competition (beyond state lines)are just common sense. The thing that does not make sense is to get the government to provide a "public option", because no private insurance company can compete with an entity (the U.S. govrnment) that can print money to drive down the price of the policies...this would just mean that inflation will end up paying the bill...and that is a regressive tax on the poor. It would be much better for the government to just provide need-based vouchers (welfare) to individuals to buy insurance from a private pool.
Unfortunately, rationing will also be required. Is Obama up to the task of admitting that Sarah Palin was correct?
Posted by 10th what?, a resident of the Duveneck/St. Francis neighborhood, on Feb 28, 2010 at 7:28 pm
I don't see tort reform as viable.
Is it really constitutional for the federal government to regulate tort remedies for case brought in state courts? If so, how? Please provide an example of an existing case of the Washington dictating state court tort remedies.
Posted by Susan, a resident of the Midtown neighborhood, on Feb 28, 2010 at 7:44 pm
I don't know about the constitutionality of federal tort reform mandates. However, the federal government can do what it always does, and provide the incentive of the federal funds (for medical insurance vouchers)to require the states to change their own tort laws.
Posted by Solutions, a resident of the Greenmeadow neighborhood, on Mar 1, 2010 at 6:27 am
Let's all join Buffet, the richest man in the world, who is asking for govt health care to come about to supplement his businesses..you know, because it is so hard on him to own businesses that have made him the richest man in the world but, poor thing, they have to pay for their employee's health insurance.
This is the same guy who said we needed to do our bail-outs of banks..and forgot to mention we would be supplementing with our tax dollars banks HE owns.
With a show of hands, who wants to contribute their tax dollars to help out those struggling businesses of Buffet??
As for Federal tort form mandates: The question is loaded. I would not support Federal Tort reform mandates, other than the following law
The loser pays all legal fees of both sides.
That would stop the majority of frivolous lawsuits meant for hassle and blackmail.
This requires nothing constitutional...
But would it ever pass? No..why??? Who are the majority of our Congress and Senate?
As for pre-existing requirements: You are right. Who in their right mind would bother paying for insurance when they are well, if they can get it for the same price when they are sick? The incentives are all screwed up.
Again: link something virtually everyone wants to showing proof of health insurance, and you will eliminate most problems with people choosing to not buy insurance...
Example: Want a driver's license or to renew it? Show proof of health insurance.
There, no constitutional problems. Incentives correct.
I see the huge problem being an assumption that only massive government rules and intervention can solve these problems, but a little common sense goes a long way to solving most of the problem.
Never let some dream of perfect get in the way of a really good solution.
Posted by R Wray, a resident of the Midtown neighborhood, on Mar 1, 2010 at 10:40 am
The Constitution establishes a separate judicial branch of the government. Legislative or executive meddling in the court system for "tort reform" raises constitutional issues. Reform should consist of removing federal and state regulations, not adding more.
The Constitution enumerates what the government can do. It does not list forced insurance coverage as a requirement. A logical extension of the method of showing proof of insurance is for the government to issue a patch which must be sewed on a vest that must be worn in public. Remind you of anything?
Posted by Solutions, a resident of the Greendell/Walnut Grove neighborhood, on Mar 1, 2010 at 7:29 pm
R Wray, if you are the usual R Wray, then we usually agree.
However, I suspect you are talking about something different from my post, which was to show proof of insurance if you wish to get a driver's license. I see this as no different from showing proof of auto insurance,..the intent is the same.
To gain a privilege, one must earn it.
One earns it through age, taking tests, and proving that one is not intentionally imposing a burden on the rest of society, in exchange for the privilege of driving.
So, no, this doesn't remind me of anything at all, given that the patch in question was not voluntary, and gave no privileges.
Posted by Matt, a resident of the Downtown North neighborhood, on Mar 2, 2010 at 11:56 am
You're wrong R Wray, life is most certainly a privilege. If life were a right, as you suggest, there would be no death. There would be no fatal car accidents, no miscarriages, no murders. Life is a privilege and those of us who are fortunate enough to enjoy it -- especially those of us in affluent Palo Alto who have very comfortable lives -- should never take it for granted.
Posted by R Wray, a resident of the Midtown neighborhood, on Mar 2, 2010 at 1:55 pm
The context of "rights" is political, not metaphysical as suggested. Per Rand, a "right" is a moral principle defining and sanctioning a man's freedom of action in a social context (for example, as used in the Declaration of Independence).
Individual rights are being increasing attacked today by our government and certainly should not be taken for granted.
Posted by Daniel, a resident of the Embarcadero Oaks/Leland neighborhood, on Mar 2, 2010 at 5:45 pm
TORT reform code words vy corporatists and teabaggers. In Plain English it means preventing regular people who were harmed by doctors incompetence or carelessness or health insurers cruelty from taking legal action. It's un-American, un-constitutional and a major step toward the complete takeover of this country by corporate fascism.
Posted by Sharon, a resident of the Midtown neighborhood, on Mar 2, 2010 at 5:59 pm
The UK has the solution to frivolous litigation, that, according to Harvard Med, accounts for 25% + of our health care costs as it forces MDs to order unneeded tests and practice defensive medicine out of fear of being sued.
In the UK as here, you can sue anyone for anything
BUT-- in the UK if you loose-- then you have to pay everyones legal costs-- they should add court costs too.
This is a simple solution that will deter predatory lawyers from frivolous litigation
It will put some trial lawyers out of biz, the bright side is we will not have a new John Edwards running for President.
Posted by Perspective, a resident of the Meadow Park neighborhood, on Mar 3, 2010 at 4:59 am
R Wray and Sharon: Simple concepts, easy to grasp for anyone..
R Wray is correct. We have the RIGHTS to life, liberty and the pursuit of happiness ( our jobs, our property,our choice of religion, family etc)
We have the PRIVILEGE of living in a country which, so far barely hanging by a thread, we can earn anything we wish to earn, though increasingly every single one of us has fewer job options to earn anything at all, and when we do we are increasingly incapable of keeping much of it.
Our rights of liberty and the pursuit of happiness, even of life, are under constant attack in the name of "greater good"..ie "greater govt control" otherwise known as "stealing from one to give to another".
Sharon: you are right. If the losing lawyer had to pay all the legal costs of all parties, you can bet there would be a lot fewer blackmailing/hassle lawsuits, can't you?
Above is a great link to American Thinker, a public site and posting, with a logical and well written article on the different processes of thinking (or not) inherent between the right and the left. It then ties it into the Health Care Summit process and results.
Here is a teaser from this article
"Joseph Epstein once wrote, ''Disagree with someone on the right and he is likely to think you obtuse, wrong, sentimental, foolish, a dope; disagree with someone on the left and he is more likely to think you selfish, coldhearted, a sellout, evil.'' Throughout the health care summit on Thursday, I was constantly reminded of this observation."
Posted by Perspective, a resident of the Meadow Park neighborhood, on Mar 3, 2010 at 4:30 pm
All of you who think that the Government is the one to rely on for your health "insurance"...you need to really hear this and understand this..
I learned today 2 things
1) All doctors who take Medicare just got a 20% cut in their reimbursement rates....effective 2 days ago, if the Dems don't pass a waiver that delays it awhile.
2) All retired military, who rely on TriCare insurance ( that they paid into, but which is "run by" the government..and which promised coverage for life) just were told by their MDs that Tricare is cutting their doctor payments by 20%...
3) Don't even get us started on how long the lines are and how little coverage MediCal patients get "promised" by govt.
What will this mean? Fewer docs taking medicare and tricare..less care for the aged and retired military.
But the government "promised"!!!
Keep health insurance private. At least there is competition then, and when they try this kind of crap, they die ( unless they are "too big to fail" and are "bailed out").
For example: How well do you think new Anthem subscriptions are going now that they just pulled their latest stunt?
Already, last year, all my docs dropped accepting Anthem because of their horrible reimbursements..how many more are left to even subscribe?
But, I can change insurance!! (and did)
Those with Tricare and Medicare are STUCK....and there is no incentive at all to treat them right.
Stop government taking over yet more of the health care market, please.
Or we will all be wishing we had insurance as good as MediCal in 10 years.
Oh yes,..there are all the fake "white coats" propoganda machine in full display while Obama calls for an up or down vote ( maybe this time they actually showed up with their new little white coats, or were they given them again by the propoganda machine?)
Posted by One of Those, a resident of the Barron Park neighborhood, on Mar 3, 2010 at 6:10 pm
"Fewer docs taking medicare and tricare"
This is why we should do away with for-profit health insurance. Keep the competition, just drop the gouging, and reduce waste. Let's adopt a European system! They have better health care for much less money.
Posted by Perspective, a resident of the Meadow Park neighborhood, on Mar 3, 2010 at 7:48 pm
You don't understand..."do away with" profit means doing away with doctors, nurses, therapists, radiologists, etc because there is no money in it...which means doing away with health care services because there are few people left to serve the many, and whoever IS left, has to ration their time between the many fold more patients.
So, you have it backwards.
"Doing away with profit" means no nursing home beds for 83 year olds with Alzeimers, forcing them to stay home and be cared for by 86 year old husbands...no surgery for kids born with facial disfigurements because it is "cosmetic" and no money for it, forcing them to live a life with facial anomolies,...etc etc.
No thanks. I prefer to keep the system that works better..the one where 90% of are covered right now, and of those covered, 90% are happy with their coverage.
Why the big push to take away what most people are happy with, when they were elected to REFORM, not destroy, the system?
Take a big guess.
So many good solutions that lessen costs and increase availability to those who can't afford insurance now..why aren't they being considered?
Because none of them give more power to the ones in control of our govt right now..that's why.