White House to Abandon Public Option?

[Falkenhayn]

Robert Gibbs saying Obama still supports the public option.

[The Romulan Republic]

I honestly don't know what to say about this except that this pretty much proves that the Democratic Party is congenitally unable to live up to its promises, and that this fight is the most important of Obama's presidency because it's going to set the tone for the rest of it. The Republican Party and their tea-bagger allies are effectively being rewarded, and richly so, for tactics of shameless lies and assaults on civil society. Every time a Democratic Party initiative comes along in the next few years we can probably expect a similar mobilization of corporate-funded astroturf and fabrications. President Obama flubbed this and he's going to face political consequences for it.

No doubt he'll face consequences for it if he falls short here, but I'm tired of people saying, six months in, that this will define his entire Presidency. Its six fucking months in, for Christ's sake. Who's the last President who was remembered primarily for the first eight of their first term?

And at worst, he will have simply failed where pretty much every one of the last dozen Presidents has failed.

[Duckie]

Bill Clinton. Gays in the Military ruined any support he had in congress, and the failure of Health Care at the hands of the industry and republicans paved the way for the 1994 revolution, his remainder ineffectually vetoing law after law passed by the new republican majority, and the eventual witchhunt looking for ways to strongarm the president out of office for a political circus show.

And that's why Obama's strenuous attempts to not reenact 1994 by appeasing republicans and avoiding culture war issues keep looking more and more like an alternate history reenactment of 1994

[Pablo Sanchez]

No doubt he'll face consequences for it if he falls short here, but I'm tired of people saying, six months in, that this will define his entire Presidency.

And I'm tired of discussing things with people who lack elementary historical perspective. Do you know what happened last time health care reform came up, in 1993? Apparently not.

Its six fucking months in, for Christ's sake. Who's the last President who was remembered primarily for the first eight of their first term?

Don't conflate the things for which presidents are remembered with the defining event of their term, because they're not often the same thing. Bill Clinton is best remembered for getting a blowjob, but that's hardly the most important event of his presidency. That would probably be the '93 health care proposal, the Republican defeat of which played a major role in their electoral victory in 1994. The defeat of his health care plan killed Clinton's momentum almost as soon as he got started, and he spent the next seven years basically trying to run a government against legislative opposition. If he had passed a solid health care reform package the Democrats might not have lost in '94, or at least wouldn't have lost quite so badly.

Other presidents whose careers were critically influenced by the first year of their office would be George W. Bush (9/11), George H.W. Bush (Iran-Contra Affair, fall of the USSR, and his efforts at controlling the Reagan deficits), Reagan (the popularity boost from the Hinckley assassination attempt, firing the air traffic controllers, and passing the ERTA), and Ford (pardoning Nixon). I could name more--Hoover is probably the example of all examples. A president sets the tone for his term soon after taking office, in the decisions he makes, his leadership style, the way he negotiates with the opposition, and so on.

Health care reform is, as it was for Clinton, Obama's single biggest issue. Iraq and Afghanistan are basically on autopilot at this point, with the plan being to draw down our involvement in Iraq and ratchet it up in Afghanistan. If health care reform is defeated or watered down sufficiently to represent a Republican victory, how could it not strongly affect his presidency? It's going to be the roadmap for GOP-Obama relations as long as he's in office, for one.

[The Romulan Republic]

And I'm tired of discussing things with people who lack elementary historical perspective. Do you know what happened last time health care reform came up, in 1993? Apparently not.

I am aware that the attempt failed, if that's what you mean. If I didn't know about if before last year, I certainly do now, as Hillary Clinton's involvement in that failiure came up as a critique of her during the Primary campaigns, which I followed rather closely.

Don't conflate the things for which presidents are remembered with the defining event of their term, because they're not often the same thing. Bill Clinton is best remembered for getting a blowjob, but that's hardly the most important event of his presidency. That would probably be the '93 health care proposal, the Republican defeat of which played a major role in their electoral victory in 1994. The defeat of his health care plan killed Clinton's momentum almost as soon as he got started, and he spent the next seven years basically trying to run a government against legislative opposition. If he had passed a solid health care reform package the Democrats might not have lost in '94, or at least wouldn't have lost quite so badly.

Other presidents whose careers were critically influenced by the first year of their office would be George W. Bush (9/11), George H.W. Bush (Iran-Contra Affair, fall of the USSR, and his efforts at controlling the Reagan deficits), Reagan (the popularity boost from the Hinckley assassination attempt, firing the air traffic controllers, and passing the ERTA), and Ford (pardoning Nixon). I could name more--Hoover is probably the example of all examples. A president sets the tone for his term soon after taking office, in the decisions he makes, his leadership style, the way he negotiates with the opposition, and so on.

You may be right, to a point. You are of course correct that what a President is most remembered for is not always the same as what had the greatest impact on their Presidency.

Health care reform is, as it was for Clinton, Obama's single biggest issue. Iraq and Afghanistan are basically on autopilot at this point, with the plan being to draw down our involvement in Iraq and ratchet it up in Afghanistan. If health care reform is defeated or watered down sufficiently to represent a Republican victory, how could it not strongly affect his presidency? It's going to be the roadmap for GOP-Obama relations as long as he's in office, for one.

Here's where I believe you are mistaken. Given the continually-worsening situation in Afghanistan and the still-precarious state of the economy (the issue which almost certainly pushed Obama over the top to the win in the general election), I don't think one can point to one defining issue on which he will be judged.

Of course, a pessimist might conclude that Obama's success or failiure in office depends on success in all of these areas, not just one. He went in with extremely high expectations for "change," after all.

[SirNitram]

Correction, Walkback, public pressure.. Who cares? The 'READY TO DROP!!!!' is firmly put to rest here.

Link

An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius "misspoke" when she told CNN this morning that a government run health insurance option "is not an essential part" of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president's view, the most important element of the reform package.

A second official, Linda Douglass, director of health reform communications for the administration, said that President Obama believed that a public option was the best way to reduce costs and promote competition among insurance companies, that he had not backed away from that belief, and that he still wanted to see a public option in the final bill.

"Nothing has changed.," she said. "The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals."

A third White House official, via e-mail, said that Sebelius didn't misspeak. "The media misplayed it," the third official said.

Appearing on Face the Nation, press secretary Robert Gibbs said that fostering competition and choice were non-negotiable, but the specific mechanism designed to do so was up for discussion. That's been interpreted as a signal that the White House is getting behind the idea of adding publicly owned health cooperatives to the menu of choices that consumers without insurance will recieve. Still, this isn't exactly a walk-back -- the White House, Gibbs included, have mused favorably about the co-ops before.

On Saturday, Mr. Obama defended the public plan before an audience in Colorado Springs. At the same time, he said that the government option was not the single critical element of reform, pointing instead to the provisions preventing insurance companies from discriminating against people, requiring them to offer plans to everyone, and capping premium increases.

"The public option, whether we have it or we don't have it, is not the entirety of health care reform. This is just one sliver of it. One aspect of it," Obama said.

This has been a refrain the White House has used for weeks, but not until Saturday did Mr. Obama voice it so explicitly.
The perception that the White House had backed away from the public plan has roiled many prominent Democrats, who took to their blogs, and to Twitter, to protest.

There, you can breath now.

[MKSheppard]

I agree that our health care system does need reform -- but the government should not become a major provider of end user health care -- -- because that way lies massive health care budgetary expansion, leaving no money for anything else -- e.g. the UK model in which NHS becomes a cancerous tumor slowly eating away at HMG's budget -- we're already experiencing this right now, with the growth of medicaid/medicare/social security in the US Budget from 1960-2009.

The Democrats and Obama did however, fumble this round pretty damn badly, ruining any chance of real reform for a while, mainly through their own hubris.

The health care bill is pretty damned big, apparently like over 1,000 pages; and the amendments to it fill several legal boxes easily; a lot of people are concerned about passing into law such a gargantugan bill without:

A.) Having a chance to discuss it.
B.) Having a chance to see what the hell is in it.

Obama should have instead of presenting a pre-made 1,000 page bill to the general public, used the pulpit of the Presidency to start a national discussion using a basic five or six page bill presenting some basic ideas/approaches towards reforming health care; and then implemented the best of the suggestions resulting from the national debate in a consensus bill of no more than 20 or so pages.

Some Ideas I had:

Idea 1: Tort reform would be a good starting point for reforming health care; perhaps a cap on malpractice lawsuit damages might work in containing insurance costs for doctors.

Idea 2: Overall, to become a doctor is pretty big money, about like $50k per year for three years in medschool. What if we increased med school federal grants? Over their working lifetime, a doctor would save many times the money we spent on his grants in preventive care on his patients.

Idea 3: We could look into reductions of the burnout rate of med school interns by passing regulations regulating how many hours a week the hospitals can run them like slaves....put bluntly, there are rules in place now limiting the specific number of hours a locomotive crew can "be on the job" driving a 3,000 ton freight consist. If they go over that number of hours; the consist is deadlined at a siding or on the line until a relief crew arrives. If this can be applied to people who drive 3,000 tons of immovable force; why shouldn't it be applied to those who deal with issues which can screw over people worse than a train accident? For example, mixing blood pressure medication and anti poison ivy medication is bad -- as in random blackout kind of bad. I sure don't want a half-dead engineer driving a freight full of 3,000 tons of hydrochloric acid through a mainline which passes through richmond; and I don't want some half-dead intern acting as a "free doctor" for teaching hospitals. As a corrollary to this; if you have such a shortage of doctors or interns that you need to work your interns like slaves, doesn't that cause them to burn out and then drop out, in turn feeding back into the same cycle of "need to work them like slaves?"

Idea 4: We could look into creating a new grade of primary care provider. Right now, we have Nurses, Techs, Physician Assistants, and Doctors. There's a sort of mismatch right now -- you don't need a doctor for a lot of the things that hospitals deal with; but at the same time, the skillset required is a bit above a nurse's level. So why not create a lower grade of doctor to handle non threatening medical conditions.

Idea 5: We could pass legislation reforming the rules on insurance companies which prevent truly national insurance companies. We've got the equivalent of 50 different insurance pools, because each state has it's own specific regulations; and so the insurance companies have to make all this overhead to deal with that. Reducing this to 12 or so regional pools, or even allowing states to pair up (like MD/VA) in their rules; would significantly reduce paperwork overhead.

[Ryan Thunder]

I agree that our health care system does need reform -- but the government should not become a major provider of end user health care -- -- because that way lies massive health care budgetary expansion, leaving no money for anything else[...]

This is blatantly false. Look at Canada; we do exactly that, and we still have money for Liberal Party social experiments whenever they're elected. (jk)

[Superboy]

The Democrats and Obama did however, fumble this round pretty damn badly, ruining any chance of real reform for a while, mainly through their own hubris.

You really think the democrats are more to blame than the republicans who spread outright lies and tried their best to scare the public about things that weren't even being proposed? You really think it's the democrats who are killing health care reform?

Your ideas for reform may lower the price of health care a little (though it would be a drop in the bucket), but it would do nothing to help those people with pre-existing conditions or those who get screwed out of their insurance by dishonest insurance companies. It will never be profitable for an insurance company to take on a seriously ill patient, and serious government intervention is necessary unless you think these people should be sold down the river.

[MKSheppard]

This is blatantly false. Look at Canada; we do exactly that, and we still have money for Liberal Party social experiments whenever they're elected. (jk)

You mean like how crashes of CH-124 Sea Kings are in Colour now, instead of black and white?

[The Yosemite Bear]

hey if we have public option, then those uninsured and under insured won't be driving up the rates for the rest of us suckers, and then maybe unionists like me can find something else to do, besides trying to fight to keep our pensions and health coverage, since the randians have long ago decided we should be good debt slaves, and work harder for less.

[Pablo Sanchez]

I agree that our health care system does need reform -- but the government should not become a major provider of end user health care -- -- because that way lies massive health care budgetary expansion, leaving no money for anything else -- e.g. the UK model in which NHS becomes a cancerous tumor slowly eating away at HMG's budget -- we're already experiencing this right now, with the growth of medicaid/medicare/social security in the US Budget from 1960-2009.

Yeah, a big health care budget might compromise our ability to fight and win simultaneous wars against every country in the world. Can't have that. We need 11 CSGs, especially when the sum total of potential enemy combatants (e.g. owned by nations with less than friendly relations to us) is equivalent to like 1/2 of a CSG. Fuck the two-power standard, we need to maintain the "all powers" standard.

Idea 1: Tort reform would be a good starting point for reforming health care; perhaps a cap on malpractice lawsuit damages might work in containing insurance costs for doctors.

Simple caps aren't functional for the purposes of malpractice because of the range of problems that malpractice can cause. On one end you have somebody who gets a botched tummy tuck which looks icky when they're shirtless, and on the other hand you have somebody rendered quadriplegic or brain-damaged by medical error who requires expensive lifetime care. The second person needs a big goddamn settlement just to afford to live. I'd be in favor of having malpractice settlements set by trained civil servants for fair economic compensation in each case, but just saying "you get $250k max" isn't a realistic solution.

There's also the issue of what "fixing" the problems with our medical malpractice system would actually do to fix health care in general. I'm betting not much.

Idea 2: Overall, to become a doctor is pretty big money, about like $50k per year for three years in medschool. What if we increased med school federal grants? Over their working lifetime, a doctor would save many times the money we spent on his grants in preventive care on his patients.

I don't know what problem this is intended to solve. The USA has more physicians per capita than the UK and Canada. Maybe we have too many specialists as opposed to general practitioners, but that's only tangentially related to their debt load.

Idea 4: We could look into creating a new grade of primary care provider. Right now, we have Nurses, Techs, Physician Assistants, and Doctors. There's a sort of mismatch right now -- you don't need a doctor for a lot of the things that hospitals deal with; but at the same time, the skillset required is a bit above a nurse's level. So why not create a lower grade of doctor to handle non threatening medical conditions.

You mean like a nurse practitioner?

Idea 5: We could pass legislation reforming the rules on insurance companies which prevent truly national insurance companies. We've got the equivalent of 50 different insurance pools, because each state has it's own specific regulations; and so the insurance companies have to make all this overhead to deal with that. Reducing this to 12 or so regional pools, or even allowing states to pair up (like MD/VA) in their rules; would significantly reduce paperwork overhead.

There are a lot of states that would oppose this vigorously for various reasons. Some have laws that improve the position of their citizens, other have laws that benefit insurance companies. It's also a quixotic notion to think that making insurance companies, the same entities that have been running our non-functional health care system as it lurches towards collapse, larger and more powerful, is a good solution to the problems.

[bobalot]

I agree that our health care system does need reform -- but the government should not become a major provider of end user health care -- -- because that way lies massive health care budgetary expansion, leaving no money for anything else -- e.g. the UK model in which NHS becomes a cancerous tumor slowly eating away at HMG's budget -- we're already experiencing this right now, with the growth of medicaid/medicare/social security in the US Budget from 1960-2009

Budgetary expansion? Let's have a look at spending per Capita.



And of course, healthcare spending as a proportion of GDP.



If anything, adopting a UK/Canadian/Australian/etc. system will bring significant cost savings. Healthcare expenditure is rising all around the industrial world regardless of which system is used. It can empirically be shown that the U.S is the most expensive in the industrialised world.

The U.K system is one of the cheapest on that graph. The current U.S system is almost twice as expensive. Costs in the U.K are rising at 4.2% per annum and 3.6% per annum in the US. But you must take into account, in the UK, everybody is covered unlike the U.S. I don't how anybody can claim with that a Universal system along the NHS lines will end up costing the U.S government more.

[The Yosemite Bear]

because they are dumb and programmed to think that way.

[MKSheppard]

Fuck the two-power standard, we need to maintain the "all powers" standard.

The Pacific Theater in WWII taught us that -- having a force ratio close enough to 1:1, that a surprise attack can swing it to parity is bad for stability -- if we had never done the absurd Arms Limitation Treaties, spent money fortifying our pacific holdings, as well as building the SoDaks and Lexingtons, the Japanese would never have even thought about Pearl Harbor or even attacking us. The costs would have been high -- for peacetime yes -- but immeasurably cheaper than what we DID spend fighting the PTO.

But I think we're getting sidetracked here.

Tort Reform

Simple caps aren't functional for the purposes of malpractice because of the range of problems that malpractice can cause. On one end you have somebody who gets a botched tummy tuck which looks icky when they're shirtless, and on the other hand you have somebody rendered quadriplegic or brain-damaged by medical error who requires expensive lifetime care.

Perhaps a set of scales could be worked out for "minor botch" up to "world class fucked up botch"?

I'll answer the rest tomorrow, it's late over here.

[Uraniun235]

Shep, even if you try to address reducing costs, you're still leaving a big gaping hole: ruthlessly dishonest companies lawyering their way out of having to pay for procedures that should be covered.

[Pablo Sanchez]

The Pacific Theater in WWII taught us that -- having a force ratio close enough to 1:1, that a surprise attack can swing it to parity is bad for stability -- if we had never done the absurd Arms Limitation Treaties, spent money fortifying our pacific holdings, as well as building the SoDaks and Lexingtons, the Japanese would never have even thought about Pearl Harbor or even attacking us. The costs would have been high -- for peacetime yes -- but immeasurably cheaper than what we DID spend fighting the PTO.

WWII is fine, but what's our competition now? The only aircraft carrier operated by a country that would even speculate about sending it at us is the Kuznetsov, and its CAG is only like half the size of an American one. Even in an unlikely attack by every country with a carrier group that isn't already an explicit ally of the USA (basically Brazil, India, and Russia) that's like three obsolescent carriers with a total CAG complement basically equivalent to 1.5 American CAGs (in numbers of aircraft, not in sorties or combat effectiveness, which makes it even more favorable). This is without mentioning NATO allies who would be assisting us if we needed help. Even in a worst case scenario we wouldn't need 11 CSGs.

But I think we're getting sidetracked here.

Fair enough.

Perhaps a set of scales could be worked out for "minor botch" up to "world class fucked up botch"?

I think caps are going about it backwards. Actuarial science is used every day by insurance companies to determine how much an injury will cost over the subjects lifetime, it's just a matter of having actuaries who work for the court and are in charge of determining damages.

[SirNitram]

In terms of fixing costs, Tort Reform is fairly worthless. As this article points out, Malpractice payouts are all of.. 2% of healthcare expenditures.

[Stargate Nerd]

The U.K system is one of the cheapest on that graph. The current U.S system is almost twice as expensive.

Of course the healthcare expenditures are a higher part of the US's GDP. After all all the population of the US is much higher than any of those countries.


Seriously though, it's only logical that single payer would be cheaper than the system we have now even without analyzing extensively why our system is more expensive. It's something that the normal American can actually relate to - if you buy in bulk, you get a discount. That goes for most anything that's for sale, whether it's food, insurance, parts etc.

[The Yosemite Bear]

what part of percentage scaling do you not get?

[applejack]

what part of percentage scaling do you not get?

He's joking. It's from this thread

[bobalot]

I'm looking forward to MKSheppard's evidence for his assertion that adopting a British style healthcare system would increase costs on the government.

[Mr Bean]

I'm looking forward to MKSheppard's evidence for his assertion that adopting a British style healthcare system would increase costs on the government.

I've got one
Adopting a British style heath care system means all our savings in cost and over-head are eaten away by paying for expensive useless "alternative" treatments since the British system is happy to pay for both magic water(Homeopathy) and Magic Fingers(Remote Manipulation).

[bobalot]

I'm looking forward to MKSheppard's evidence for his assertion that adopting a British style healthcare system would increase costs on the government.

I've got one
Adopting a British style heath care system means all our savings in cost and over-head are eaten away by paying for expensive useless "alternative" treatments since the British system is happy to pay for both magic water(Homeopathy) and Magic Fingers(Remote Manipulation).

Even with these ridiculously stupid 'treatment's, it's still can be empirically proven to be cheaper. Adopt the system and eliminate these shitty 'treatments'. That way you will be copying their system and improving it.

[SirNitram]

Yes, I mean it's not like the American government funds an entire center for alternative medicine of all kinds, or have specific guidelines for what alternative medicines the government will pay for(Medicare and VA will cover at least some, and Medicaid is by-state).

And it's not like a Senator stood up and said this about the National Centre for Complimentary and Alternative Medicine.

“It is time to end the discrimination against alternative health care practices.

“It is time for America’s health care system to emphasize coordination and continuity of care, patient-centeredness, and prevention.

“And it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.

“This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care. It is about improving health care outcomes. And, yes, it is about reducing health care costs. Generally speaking, alternative therapies are less expensive and less intrusive – and we need to take advantage of that.

“The United States currently spends more than any other nation on health care – 16.5 percent of GDP – yet we still experience poorer health than most other developed nations and even some developing countries. We need a paradigm shift that places a much greater emphasis on preventing disease and keeping people healthy rather than merely treating people once they become sick. Integrative care can help us achieve this goal.

One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.

Yes, it's the BRITISH who spend too much on whackaloo medicine..