Ellington

This past week I learned something surprising and encouraging about the health-care reform bill in the Senate -- something that you may not know if you've only listened to mainstream media coverage. (If you're listening to right-wing talk radio or FOX News about health-care reform then, well, bless your heart.)

Did you know that the Senate bill would actually do a great deal to contain health-care costs? (click here to view a summary and the full version of the bill)

We've heard that the bill will further regulate insurance companies, forcing them to cover people with pre-existing conditions and make it more difficult to drop coverage. We've also heard frequently that a "public option" will help drive down the costs of insurance policies by setting a baseline for price competition and universal availability. And we've heard that people will be required to buy insurance policies (those that can't afford them would, ideally, get subsidies to help them) meaning that most everyone who walks into a hospital or clinic would have coverage of some kind.

But we've also heard frequently that the bill doesn't do enough to "contain costs," and that's why many Republicans and some blue-dog Democrats oppose it.

Except, well, that's not true.

Let me start, though, by mentioning something at the top that's also lost in this discussion. In the United States, we already have universal health care. It's true. The entitlement already exists, and we're already paying for it.

It's this simple: Anyone who walks or rides into an emergency room in this country gets care. Then, we get the bill.

Unfortunately, that's also the least efficient way to do it, leading to increases in taxes and insurance premiums for those of us who bear the costs of those expensive urgent-care services. A more comprehensive, better-managed solution will cost all of us less.

The Senate bill is drawing favor from moderate economists on both sides of the aisle, writes Ronald Brownstein in The Atlantic. Jonathan Gruber of MIT has been a skeptic throughout the process, and was part of a group of economists earlier in the fall who wrote President Obama telling him that health-care reform needed to "bend the curve" on costs if it was going to make a difference.

In the story, "A Milestone in the Healthcare Journey," Gruber now says: "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here."

In that letter to Obama, economists, led by Stanford University's Dr. Alan Garber, focused on four "pillars" of reform that needed to be in the bill in order for it to be fiscally responsible. Those were: a tax on "Cadillac" insurance plans; an aggressive pursuit of new, performance-based standards for physicians and hospitals (instead of straight fee-for-service); an independent Medicare commission looking for innovative cost-and-efficiency solutions; and a rating from the Congressional Budget Office that the bill would raise enough revenue to be deficit-neutral.

(The actual CBO estimate shows the bill reducing the deficit over 10 years.)

Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush, says: "It has got all four of those elements in it. They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go."

When the mainstream media focuses exclusively on the "horse race"—whether or not there will be a public option, the fight over an abortion restriction—it then fails to dig deeper into the actual legislation. While no one expects Congress to write a perfect bill, it's worth noting that this one has some good stuff in it—and it's a great place to start with desperately needed reforms.

Perhaps more to the point is the lesson that can be garnered from sitting back and thinking rationally about government for a moment. Here's what I take away from it: Ideologies don't solve problems. If you're ideologically married to the idea of a public option, you might vote down this bill, even if it really offers strong solutions in other areas.

Likewise, if you're a politician ideologically opposed to health-care reform at all (or anything Obama wants), you might want to consider whether you're simply abdicating your responsibility to govern.

As I watched the Senate cloture vote this past weekend (yes, I did—we happened to be in the office, and there wasn't an interesting football game on) it fell hard on my ears when the name next to the last "No" vote was read aloud … our very own Senator Wicker, cursed by his placement in the alphabet.

Republicans acting in lockstep as the "Party of No" may not find that tactic to be an ideal long-term solution to their electoral woes. Right now the GOP not only needs a leader, but in the wake of the past eight years, the GOP needs to prove it has an actual interest and ability to govern.

Yes, the GOP may pick up seats in November 2010. But, in the meantime, they're essentially sitting out an important, intelligent, involved health-care debate. By blocking every and any attempt to govern—and by standing a little too close to the fire that is the "teabagger" syndrome—the Republicans may be putting themselves on a path back to being the "Cocktail Party" that the GOP was for a generation from the 1930s to the 1950s—particularly if programs like health-care reform actually work.

Locally, Gov. Haley Barbour may not be the shining star to follow through this debate. In an interview with Chris Matthews recently, he defended his health-care record by pointing to tort reform and how he thinks it has lowered medical malpractice premiums in Mississippi. But he failed to bring up another statistic—Mississippi is 51st overall behind 50 states and D.C. in providing health care to its citizens. We're 49th in access, 49th in prevention and 51st in healthy lives.

Damage caps do not equal health care, Governor.

As we roll into another legislative session in 2010 and elections later in the year, I encourage voters to bear this thought in mind—who is actually trying to govern instead of simple promoting an ideology?

I say we encourage the folks who are working to solve the problems, not block solutions.

Previous Comments

ID

153668

Comment

Amen. The Senate version of the bill has also gloriously omitted the Stupak-Pitts amendment and the Section 1713 "fertility" visits, two attacks on women's rights that appear in the House version. In every respect I've seen, the Senate version of the health care bill is superior to the version the House passed. I've heard a rumor that Pelosi is considering just bringing the Senate version up to a House floor vote, rather than trying to reconcile the two versions in conference; I hope she does that. (I realize Pelosi isn't the only decisionmaker involved in that process, but she's the most powerful; if she backs the Senate version verbatim, I would personally give it favorable odds of House passage.)

Author

Tom Head

Date

2009-11-26T03:33:13-06:00

ID

153708

Comment

Todd, Thanks for the link and the eloquent commentary. At this point I don't know how many undecideds there are. Most of the people I speak to and hear appear to have made up their minds, either ideologically (Obama and Democrats = bad vs tax the rich = good?) or based upon their personal experience with the health care system. In my experience, those who are happy with their insurance and health care have not been put in the position of having to really depend upon it. I've been utilizing my wife's health care coverage to the hilt for the past year, and will probably have to continue to rely on it for years to come. I am very, very, very, happy with the "Cadillac" coverage we have been blessed with, but my perusal of the bills and invoices and co-paymets and perscription drug prices from my friendly pharmacy proved to me that the current system is unsustainable. We the people now have the opportunity to make a difference. I put a lot of hope for the passage of this reform bill is that the undecided and independent voters usually get it right. And this time there are fewer opportunities to not count votes, jerry rig and or selectively withhold voting machines or stack the Supreme Court. Just my opinion

Author

FrankMickens

Date

2009-11-29T09:03:23-06:00

ID

153709

Comment

Todd, Clarification..I know the general public will not be voting directly on this bill. Their elected representatives will. So I guess I should add the proviso.. My hope for passage is based upon my belief that the ideological, undecided and independent voters in favor of the bill will let their elected officals know what they want. On second thought, I wouldn't put it past the Republicans Party of No to try to mess with the voting infrastructure in their own house/chamber. They did after all "out" (or defended the outing) of their own CIA operatives. :-)

Author

FrankMickens

Date

2009-11-29T09:23:11-06:00

ID

153750

Comment

It appears that no one is addressing the question, who's going to pay for this? I have worked long and hard for the ability to earn insurance on my own right. It is not something that should be given away at the expense of the taxpayer. Odds are, if you pay taxes, you have insurance. I don't believe that my insurance company should be compromised by government provided "healthplan" that Obama says himself he will not use. Isnt this a double standard? We already have a government provided plan called Medicare/Medicaid and we can all see, by the latest statistics, all the fraud involved. If the government cant deliver a vaccination from the "government flu" what makes you think they can run an additional health care program. For that matter, name any government run program that operates efficiently? Anyone? Cash for Clunkers is another example of misuse and shows just what a joke the program was. Not to mention the United States Post office, hundreds of millions of dollars lost, lost I say. Is this the group of people who you want managing your health care?

Author

thornton72

Date

2009-11-30T14:14:58-06:00

ID

153813

Comment

Thorton: Thanks for your post. Some thoughts: The USPS argument is actually a wonderful jumping off point for this discussion. Did you know that the USPS gets no tax dollars for its operations and hasn't since the 1980s? None. It makes its money on stamps and services. And, in point of fact, it's a pretty remarkable institution. I deal with the post office every day. I rely on it for checks to come in, invoices to go out, subscriptions to go out, packages to come in and so on. All in all, it does a pretty darned good job. It has competition -- UPS, FedEx, Airborne (I guess...are they still around?) and, while the USPS is actually struggling during this recession, it does remarkably well considering its mandate. You see -- even though it gets no tax dollars, it's still mandated to cover everyone with "postal care" -- reaching way out into rural areas, offering late service (9 p.m. downtown), one day turnaround in many cases, Priority Mail and so on. And at the same costs to everyone. Is the post office perfect? No. Is it better than UPS? In my experience, yes, it is -- it's quicker and more reliable. It's not as good as FedEx, but you get what you pay for. Medicare operates at a 4-5% overhead compared to 15-25% for overhead and profit-taking in for-profit insurance companies. Yes, there's fraud in Medicare and Medicaid, but there's fraud going in both directions with for-profit insurance companies as well. None of them are perfect. What would be ideal would be access to both. I think the best possible "public option" plan would be to (a.) require medical coverage and (b.) allow anyone to buy into Medicaid at any age. It wouldn't be the best plan or most comprehensive -- just like USPS is slower with a .44 stamp than FedEx is for a $10 letter -- but it would offer coverage for people who didn't have access to other plans, and it would mean that everyone is covered for those emergency room visits (and, ideally, for preventive care to avoid those visits), which would lower the cost burden for those visits to taxpayers and ratepayers. My biggest concern is that pure ideology -- with no basis in actual logic -- will stop the public plan from getting through the Senate, which could mean that many of us don't realize savings in our health plans. Indeed, the recent CBO assessment suggests that premiums will stay the same for most people or drop slightly, but I assume that's with the opt-out public option in the mix. My hope is that, one day, you'll have the option of "Post Office" medical coverage if that's what you can afford, or "FedEx" coverage if that's what you want to pay for. We're not there yet, but that future would be a bright one.

Author

Todd Stauffer

Date

2009-12-01T11:46:50-06:00

ID

153818

Comment

Nice analogy. Another similar analogy that could be made is that market controls are necessary to provide stability to the market system. Some things are too important to leave to chance, which is why we have, for example, banking regulations and a federal reserve. While some may argue about which way is the best way to regulate the markets, ours is a capitalist system that is being regulated and it provides security to the very capitalists that profit from it. Health, many argue, is even more important than money. Should we leave it simply to the whims of the market? Should we allow, for example, flu vacines to be sold to the highest bidder? Of course not, so then the question isn't about there should be government control, per se (ideology), but about what is the right amount and kind.

Author

gwilly

Date

2009-12-01T12:24:12-06:00

ID

153821

Comment

itodd and gwilly, I agree with both of you guys. In support I offer the following. In my opinion and as cited in the Preamble of the Constitution, the purpose of government is to provide for the :common welfare" good. 1) USPS vs the private sector (FedEXand UPS). The private sector "cherry picks" the most affluent part of the market and allows no discounts or considerations to those unable to pay their high rates. I agree with their attitude, as they exist to over charge for their serrvice. Their over charge is called their profit. Profit has been defined in some quarters as the reward for taking a risk. The USPS on the other hand exists to provide for the good of the (common welfare). If the USPS wanted to be eficient they should patent and/or copywrte their systems utilized by the private sector, and cahrge the private sector a royalty. Now thats's efficient. 2) Why didn't we have the H1N1 vacine in sufficent quantities when needed? Because the US govm't, in the name of efficiency, bowed to pressure and relied upon the private sector to predict, prepare for and produce the neeed vaccine on time and in sufficent quantities. End result, the low bidder selected, again utilizing free market thinking, was unable to fill the bill on time. Who gets blamed by the media..why the Federal government..as they should have been blamed. The providing for the public welfare is often sometimes not very efficient. Look at the cost of war as an added example. 3) In my opinion, Mississippi would not have one half of the telephone and electrical service it now enjoys if the Federal government had not mandated the inefficient provision of these survices to rural and less affluent residents upon the utility companies, in the name of the good of the public welfare. 4) The US distribution of Federal tax dollars to Mississippi in greater portion than the Federal tax dollars Mississippi contibutes to the Federal coffers is in-efficient. You like the doctor you have?, the medicare benefits you enjoy? Well without the inefficient distribution of Federal tax dollars to Mississippi, we Mississipians wouldn't have the number of choices, all be it still comparatively low numbers of choices, we now enjoy. From my 32 years of experience of being a resident of this state, when the state has full responsibility for funding services to its residents, Mississippi, because of it's inability to have an efficient progressive personal income and corporate tax structure (imo), the services either don't exist or are subject to crippling cuts when budgets get tighter than usual. Vet school (or do we now have one)?, burn center? be prepared to go to another state. Sad but true.

Author

FrankMickens

Date

2009-12-01T13:48:21-06:00

ID

153823

Comment

Dear Frank: MSU has had one since 1974, with the first class in '77. Welcome to the 20th century. :D IG PS: oh, something on the health debate? I'm not a fan of 10+ years of unprecedented National Debt. Sorry.

Author

Ironghost

Date

2009-12-01T14:24:44-06:00

ID

153825

Comment

PS: oh, something on the health debate? I'm not a fan of 10+ years of unprecedented National Debt. Sorry. So you weren't a Republican in the 2000s, right? ;-)

Author

Todd Stauffer

Date

2009-12-01T14:37:23-06:00

ID

153826

Comment

Seriously, Iron. CBO. Senate Health bill. Google it.

Author

Todd Stauffer

Date

2009-12-01T14:38:01-06:00

ID

153830

Comment

Seriously, Todd, I did. Those figures are hideous. Oh, and new taxes for the middle class! Small Business owners (you guys) have 'em as well, up to $3k per person. Sorry, No. It doesn't add up. No, I'm not a republican so much as a Conservative. I disliked Reagan's buildup in the 80's, and haven't been impressed with deficit spending anytime. My sympathies lie with Governors, not Presidents.

Author

Ironghost

Date

2009-12-01T15:29:36-06:00

ID

153834

Comment

The CBO rates the Senate bill as bringing down the deficit over ten years. Could factors change? Yes. In fact, the CBO won't rank many of the potential savings because they're new programs that they can't pin -- conservatively -- to past performance. Yes, there are taxes in the bill. Welcome to a post "W" world. Sorry, but sometimes you've got to pay taxes, particularly after a decade of yet more of the ridiculous trickle-down theorizing and old-industry subsidies that have decimated this country's economy. The Bush Administration was wildly, irrationally irresponsible for cutting taxes on the people who could most afford them at a time of national crisis, when they deemed that two massive war efforts were necessary. And while I don't blame the Bush Admin outright for the credit crisis and derivatives debacle, I do blame Congressional Republicans, particularly Phil Gramm, for a rampant and irresponsible deregulation of the banking industry essentially on the heels of the savings-and-loan crisis. We've been on a 30-year bender of ideological drown-government-in-a-bathtub experimentation and we can see EXACTLY where it's gotten us. So, ya gotta tighten things up, and that's going to include some regulation and some taxation. They're doing health care first, which is going to take regulation and taxation, particularly if we insist on sticking with our (rather bizarre) employer-centric system. ... And, no, the way I read it my small business will not be affected because (a.) we already offer health-insurance to full-time employees who want it and (b.) we're under 50 people. I don't *love* this bill; I like it. I'd like to see a strong public option, preferably Medicare for all ages, which I believe would do more to hold premiums in check across the board and I think it could substitute for some of the fees and taxes the Senate bill has in order to appease their donors and avoid a public plan. ... And if you sympathize with Haley, go for it. His healthcare plan was implemented a few years back -- cap med-mal damages and move as many people to Federal programs as possible. Funny thing that -- my health insurance premiums haven't gone down as a result. Yours?

Author

Todd Stauffer

Date

2009-12-01T15:51:14-06:00

ID

153845

Comment

Ironghost, Congratulations on the Vet School for the care of animals! Denatal School, go to UMC. Burn Center? Check into River Oaks for a quick transport to Georgia. Two out of three ain't bad. Typical for Mississpippi.

Author

FrankMickens

Date

2009-12-02T01:57:09-06:00

ID

153850

Comment

Frank: The Vet school is great, from what I hear. I've been to the dental school at UMC, wasn't bad. The burn center thing is one that irritates me. We have a need for one, there's just no one willing to sacrifice in government to fund it.

Author

Ironghost

Date

2009-12-02T09:23:03-06:00