We're Screwing Up the Health Care Debate

[Joanne98]

by eugene
Share this on Twitter - We're Screwing Up the Health Care Debate Mon May 11, 2009 at 07:59:52 AM PDT
In recent weeks, as news about the status and content of health care reform in Washington DC has come more and more quickly, I've noticed a disturbing trend here at Daily Kos that I believe will damage both the final product of the reform effort as well as our future political fortunes.

That trend is the emphasis of labels and of final passage over the actual content and effect of the reform. In short, people are focusing on the façade and ignoring or downplaying the mechanisms, the foundation, the structure.

To put it briefly: too many people believe all that matters is that something with a "public option" label pass the Congress.

That is precisely the wrong way to deal with the issue. Instead we need to be asking "what do we want health care reform to accomplish?" instead of "how do we put lipstick on a pig?"

eugene's diary :: ::
First, a disclaimer of sorts. I want this diary to be read and taken seriously by as many people as possible, whether you disagree, support, or have any other kind of reaction to it.

Yet I realize there is a certain group I will probably never reach: those who believe that we cannot change "political realities" and so we'll have to just accept whatever the political process gives us. They're the ones who push back against any kind of single-payer based or other criticism of the emerging Senate consensus on health care by saying "well we have to do whatever we can to get the votes." They'll point to Max Baucus, or Ben Nelson, or Arlen Specter, the cloture rule, "political reality", or any other thing to argue against criticism of the way things are going.

Such folks believe that the political process trumps the content of the reform - that we can change the content of the reform to suit the process, but never the other way around. I profoundly disagree with this approach, as I believe it sets up major political risks in the medium-term (perhaps as early as 2012, but definitely 2014-2020).

I write this fully understanding I may never convince those folks to consider or accept a different view. That's fine, I invite them to comment below if they wish. But I would prefer we take this discussion in a more productive direction.

What is Success?

Successful health care reform is not "something that gets Obama's signature." Instead success is something that solves the core problems. So that means we must define what the core problems are, and therefore what our goals should be, before we can assess any possible solution.

Problems and Goals

Problem: Health care is unaffordable. Goal: Guarantee no American ever has to worry about whether they can afford treatment again. The #1 problem, and therefore #1 goal of reform, is that too many Americans cannot afford to get the health care they need. All other problems stem from this one. This has a massive, even catastrophic ripple effect throughout society and the economy, from epidemic disease, untreated illnesses, and the economic consequences of all of this. Any health care reform we produce should make health care affordable to everyone, not by an insurer's promise, but through a clear regulatory and financial mechanism. Many of us believe the only way to achieve this is through single-payer. I am open to other options, but they must demonstrate the guarantee of affordability that we all know single-payer ensures.
Problem: Health care is unavailable. Goal: Guarantee every American has access to the appropriate level of health care they need within or a reasonable distance from their community. This is often a consequence of #1, but also stems from other sources. Many places in America do not have enough doctors, even if you are ensured. I live in such a place - Monterey, California. We are a wealthy community but few doctors accept new patients, and many common insurance plans are not accepted by a surprisingly high number of doctors - ob/gyn in particular. Some "reformers" dismiss this issue or view it as unimportant, but it affects a hell of a lot more people than is generally realized, especially if you're not in the upper middle class or higher. As with #1, single payer guarantees availability. Other options might too, but they must demonstrate this can be done as a consequence of the system they propose, and not out of a promise. In particular, any reform must guarantee that anyone with insurance can get care whenever they need it - care on demand. This requires, among other things, that any "public option" be accepted by any health care provider.
Problem: Costs are rising. Goal: Ensure that costs are handled in a way that does not undermine goals 1 and 2. This is not necessarily a bad thing, but it is something that must be dealt with. Single-payer offers the benefit of ensuring low overhead costs, and because of its mechanisms is likely to produce more preventive care, saving money in the long run. Again, it's possible this could be solved through other means, but that must be demonstrated and not promised. The recent news of health insurers offering $2 trillion in cost savings should not be taken seriously since it is a mere promise, and not backed up by either laws or procedures.
Update <2009-5-11 11:31:46 by eugene>: As explained by DrFerbie in a comment below: Problem - The Healthcare system impacts the entire economic viability of the United States. Goal - Create a healthcare system which contains costs, fosters the ability of employees to change jobs without the the threat of loss of insurance, manages expenses for companies and levels the competitive playing field with foreign competitors. (Note: I'd intended to build this out of point #1, but DrFerbie is right that it should be specifically included here.)
I believe these to be the three primary problems that any health care reform must solve. Many of us single-payer advocates have constructed a rich language to advance these causes - such as the argument that health care is a human right. I fully agree with this, and believe that health care should be provided on demand without out-of-pocket costs of any kind. But I acknowledge those are frames to a solution to the three four problems above. I'm open to other frames and other solutions - but they must address the above problems and meet the above goals. If they fail to do so, they must be rejected out of hand.

The Politics of Reform

continued>>>
http://www.dailykos.com/storyonly/2009/5/11/730073/-Were-Screwing-Up-the-Health-Care-Debate

[pinto]

1. I like this Problem/Goal approach. I work in public health and routinely have to phrase thing in

similar format. For us it's usually 'Goals and Objectives' to meet a specific stated need. (aside)Joanne98, I've cut 'n pasted the Problems and Goals section here to highlight the author's points.

Problems and Goals

1. Problem: Health care is unaffordable. Goal: Guarantee no American ever has to worry about whether they can afford treatment again. The #1 problem, and therefore #1 goal of reform, is that too many Americans cannot afford to get the health care they need. All other problems stem from this one. This has a massive, even catastrophic ripple effect throughout society and the economy, from epidemic disease, untreated illnesses, and the economic consequences of all of this. Any health care reform we produce should make health care affordable to everyone, not by an insurer's promise, but through a clear regulatory and financial mechanism. Many of us believe the only way to achieve this is through single-payer. I am open to other options, but they must demonstrate the guarantee of affordability that we all know single-payer ensures.

2. Problem: Health care is unavailable. Goal: Guarantee every American has access to the appropriate level of health care they need within or a reasonable distance from their community. This is often a consequence of #1, but also stems from other sources. Many places in America do not have enough doctors, even if you are ensured. I live in such a place - Monterey, California. We are a wealthy community but few doctors accept new patients, and many common insurance plans are not accepted by a surprisingly high number of doctors - ob/gyn in particular. Some "reformers" dismiss this issue or view it as unimportant, but it affects a hell of a lot more people than is generally realized, especially if you're not in the upper middle class or higher. As with #1, single payer guarantees availability. Other options might too, but they must demonstrate this can be done as a consequence of the system they propose, and not out of a promise. In particular, any reform must guarantee that anyone with insurance can get care whenever they need it - care on demand. This requires, among other things, that any "public option" be accepted by any health care provider.

3. Problem: Costs are rising. Goal: Ensure that costs are handled in a way that does not undermine goals 1 and 2. This is not necessarily a bad thing, but it is something that must be dealt with. Single-payer offers the benefit of ensuring low overhead costs, and because of its mechanisms is likely to produce more preventive care, saving money in the long run. Again, it's possible this could be solved through other means, but that must be demonstrated and not promised. The recent news of health insurers offering $2 trillion in cost savings should not be taken seriously since it is a mere promise, and not backed up by either laws or procedures.

4. Update <2009-5-11 11:31:46 by eugene>: As explained by DrFerbie in a comment below: Problem - The Healthcare system impacts the entire economic viability of the United States. Goal - Create a healthcare system which contains costs, fosters the ability of employees to change jobs without the the threat of loss of insurance, manages expenses for companies and levels the competitive playing field with foreign competitors. (Note: I'd intended to build this out of point #1, but DrFerbie is right that it should be specifically included here.)