I was inspired by an article a friend on Facebook directed me to. It's 10 questions to ask your representatives about health care. While I disagree with the tone of the article (the author, Hugh Hewitt, gives his own answers to the questions and asserts that they are what any representative will tell you if they are honest), I agree that there are some important questions we should all be asking.
With that in mind, I present my own take on the 10 questions. I only have 7 though, as I feel that if these seven are answered the remaining three from Mr. Hewitt's list will be answered. (in particular, "have you read the bill and know it will enough to be interviewed on it". If a representative can answer these questions intelligently, then he or she has clearly read the damn thing and understood it.)
1. What will be done to ensure that my employer will not ditch my current health plan in order to go exclusively for the public option? How can I be ensured that I can keep my employer-provided plan?
This is at the root of the question. It's been very clearly stated that you will not be forced off your current plan, but the question of employer decision is a valid and important one.
2. What are the differences, if any, between the coverage provided in the general public health plan and the current federal employee health plan?
If there are no differences, then we can get a good look at what the public option will offer us. If there are, we should know those up front.
3. How will the new health plan impact Medicare funding? Will funds be pooled between the two programs (i.e. will Medicare be subsumed as a sub-program of the larger health system) or will the two be funded and administered separately?
The question isn't, "will the seniors get screwed?" The question is about the relationship between a current, functioning program and the proposed one. Is it possible that the new system break the old? If it is possible, then what is being done to prevent that possibility from happening?
4. If a doctor decides a procedure is necessary or extremely beneficial, can we be sure that the new plan will cover it? If there is not a cap on care, how does the government plan to deal with costs?
Again, let's not make this about he seniors. If Medicare has worked this long, let's assume that things aren't going to change for them or for the Veterans (unless the answer to question #3 shows a danger). The question of caps on are is important on both sides of the coin. Insurance companies just decided not to pay for things. The Public Plan shouldn't have that option, but what *is* in place to ensure that costs don't skyrocket?
5. How will the influx of new patients, waiting for medical services, impact the time it takes to receive the care that is needed?
If we are expanding the base of people who can take advantage of health care services, but not expanding the number of hospitals or medical professionals, this is a valid concern. It doesn't mean that we have the option of not providing health care to people, but we should have our eyes open to the idea that non-emergency procedures might involve greater delays than we're used to.
6. What incentives or requirements will be in place to ensure that doctors don't prioritize patients from private insurance over patients on public insurance?
I'm not entirely sure how this works currently for non HMO-Doctors. It'd be good to find out. The question of doctor compensation is important for a number of reasons, but I'm less concerned about the arguments that anesthesiologists and pathologists are suddenly going to be dropped from hospital staffs because their jobs are less essential. Again, what is the answer to question #2?
7. While socialized medicine is practiced in many countries, there are many reports of long delays and problems (especially in Canada). What systems are being put into place to avoid the pitfalls revealed by other nation's programs?
I'm sick of everyone talking about wait times in Canada, as if they were the only country in the world to have socialized health care. Many countries are doing this, some better than others. I want to know how we're learning from their successes and mistakes and how that impacts our plan.
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here are my additional set of questions. i offer them because it seems to me that your questions are biased towards a definitely private, possibly public/private payers mixture health care system.
i'll be up front about my own biases: i write as a member of the public health coalition EQUAL Health (http://www.centerforpolicyanalysis.org/id42.html), i would like to see the elimination of private health insurance in this country (or at least, like in conyers' bill, the restriction of private health care plans to services not covered by a single payer).
here's my questions:
how many americans will have health insurance under a new system? (currently about 20%-25% of americans have no insurance, and about another 20% have insurance of such poor quality, that they are prevented from seeking initial treatment when it is medically appropriate).
how will a reformed health care system reduce costs? (currently private for-profit and non-profit payers spend enormous amounts of money on advertising and profits. additionally, the current system is best by redundancy as each private provider duplicates administrative efforts that would be unified under a single payer system. there are also gains to be had in reducing the paperwork/administrative costs born by clinicians and hospitals. the current system certainly is good at making pharmaceutical, medical equipment and insurance industry investors and chief officers wealthy on the backs of the sick and injured).
if a new health care system is public/private, will the system be set up so that the private insurers get to cherry pick the least vulnerable patients, thereby inflating the relative cost of the public provider? (a single payer system would maximize the economic efficiency of risk pooling across the entire population. a public-private system necessarily must erode that efficiency).
will the new health system provide choice of clinic and physician? (under the current system, one is typically locked into an insurance provider's "network" of physicians and hospitals. under a single payer system any physician or clinic in the country taking insurance would be accessible. changing employers? or lose your job? you would still have the same clinics, hospitals and physicians available. unlike the current situation.)
i recommend pnhp.org for more info. i can also provide citations and more go-tos if you want to write me.
alexis
Thanks Alexis!
Yes, my questions were based on a private/public model, since that appears to be the foundation of the current bill in question.
these are excellent questions!
ps canada doesn't have socialized medicine. it has a mixture of public and private heath care providers which are funded by a single (public) payer. france, on the other hand, has socialized medicine: clinical practices and practitioners are effectively public employees.
as to waits: with private insurance in the u.s. i have sometimes had to wait 2 months for an appointment. careful about propaganda. :)
pps: there are a number of health care bills and amendments under consideration.. good to reference which ones yer talking about. (caveat: i didn't read the linked article :).
xo,
lex
Yeah, I draw out Canada because it's most often trotted out as the whipping boy by opponents of public healthcare.
I'm fully aware of the wait times in the U.S. My friend Rachel has been having a horrific time with Kaiser over the last two years.
I'm still getting more and more educated on this issue as we go along. Much of my personal questioning comes from a response to the hostile wording of right wing lists, and my own limited understanding of the specifics. Like everyone else, I can stand to get more up to speed on the current bill(s) and amendments.
Dan: It's funny to me to read Alexis' comments, because it seems to ME that your questions are biased towards a a definitely PUBLIC, possibly public/private payers mixture health care system with way more public control/participation in the Health Care market.
And I will also be upfront about MY own biases: I am deeply distrustful of Governmental participation in private markets. I think, in many cases, Government "help" makes things worse, not better [and this can be demonstrated empirically and repeatedly.] I'd also like to cite Alexis' own stats: 20% of Americans without health care coverage means that EIGHTY PERCENT of Americans *do* have health care coverage. Simply because (admittedly) the present system isn't perfect, that does not mean that things cannot be made much, MUCH worse by the wrong kind of action.
I also agree with this from Megan McArdle & Glenn Reynolds:
Megan McArdle -- "Robert Wright notes that “we already ration health care; we just let the market do the rationing.” This is a true point made by the proponents of health care reform. But I’m not sure why it’s supposed to be so interesting. You could make this statement about any good:
“We already ration food; we just let the market do the rationing.”
“We already ration gasoline; we just let the market do the rationing.”
“We already ration cigarettes; we just let the market do the rationing.”
And indeed, this was an argument that was made in favor of socialism. (No, okay, I’m not calling you socialists!) And yet, most of us realize that there are huge differences between price rationing and government rationing, and that the latter is usually much worse for everyone. This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they’re applied to hip replacements and otitis media."
http://meganmcardle.theatlantic.com/archives/2009/08/rationing_by_any_other_name.php
Glenn Reynolds -- "And note [Megan's] point on diffusion of responsibility via rules.
UPDATE: Also, the market doesn’t deny you a hip replacement or a pacemaker because someone in government thinks your political views are “un-American.”
http://blogs.usatoday.com/oped/2009/08/unamerican-attacks-cant-derail-health-care-debate-.html
Given the cronyism and thuggery we’ve seen with the bailouts, etc., I’m not confident this would hold true under a government health program. And I’m absolutely certain there would be a special track for insiders and favorites."
Finally -- this is the criticism of the current incarnation of ObamaCare: that it is a Trojan Horse for "Single Payer" health care, which Americans oppose by a huge margin (57% against, 32% for).
http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/august_2009/32_favor_single_payer_health_care_57_oppose
OK, Dan -- let me tackle one of your questions, here. 3. How will the new health plan impact Medicare funding? Will funds be pooled between the two programs (i.e. will Medicare be subsumed as a sub-program of the larger health system) or will the two be funded and administered separately?
The question isn't, "will the seniors get screwed?" The question is about the relationship between a current, functioning program and the proposed one. Is it possible that the new system break the old? If it is possible, then what is being done to prevent that possibility from happening?
But that's the thing, Dan -- Medicare ISN'T functioning RIGHT NOW. The system is very wasteful and will run out of money soon. The fact is, Medicare is a deeply broken system.
The Obama Administraton's own Council of Economic Advisers' report reveals the deep flaws in the Medicare system. And the challenge I would pose to all Health Care "Reform" Advocates (and any Single-Payer advocates) is: WHY NOT START WITH MEDICARE? That is -- fix Medicare FIRST before taking on the much larger questions.
The estimable Virgina Postrel expands on this idea here:
http://www.dynamist.com/weblog/archives/003001.html
"Think about this for a moment. Medicare is a huge, single-payer, government-run program. It ought to provide the perfect environment for experimentation. If more-efficient government management can slash health-care costs by addressing all these problems, why not start with Medicare? Let's see what "better management" looks like applied to Medicare before we roll it out to the rest of the country.
This is not a completely cynical suggestion. Medicare is, for instance, a logical place to start to design better electronic records systems and the incentives to use them. But you do have to wonder why a report that claims that Medicare is wasting 30 percent of its spending thinks it's making a case for making the rest of the health care system more like Medicare."
rich,
actually, go ahead and call me anarcho-socialist if you want. ;) i appreciate your (fine) tradition of distrust of government. check out this perspective, though.
you wrote: And yet, most of us realize that there are huge differences between price rationing and government rationing, and that the latter is usually much worse for everyone. This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they’re applied to hip replacements and otitis media."
but for group goods (like insurance pooling), we know that the market is inherently inefficient. this is why we have socialized police, socialized fire departments, socialized military, etc. in the u.s.. indeed, for the first two of those institutions market solutions were attempted and abandoned long ago because of their micro and macro inefficiencies (which doesn't mean that the existing institutions are perfect, not by a long shot).
with respect to our current system, we waste about 30% of health care costs on redundant administration, advertising and private profits and compensation.
second item: EIGHTY PERCENT of Americans *do* have health care coverage meaning that we suck compared to england, france, denmark, japan, canada, cuba, etc. ad nauseum. (literally). also: we have effective standard coverage of closer to 60%. that's hundreds. of millions of people un- or underinsured for the sake of private profits, for the sake of severely limiting the choices of provider, clinic and hospital.
things to think about while tracking your other concerns about health care.
best,
alexis
Ok, wow. Lots to chew on here. I'm just going to work down in order:
Rich: The argument about "the market does the rationing" is something I can't go with. The market has no empathy, no conscience, and no concern for the well being of society. I would like an entity with at least a stated goal of benefitting of helping all citizens maintain a basic standard of living to be involved in at least a regulatory role, if not as more established safety net.
And while you can call me a socialist, I prefer Marxist, because I ultimately believe "from each according to their ability, to each according to their need". This doesn't mean that I don't think that people can't work hard to reach a higher standard than the basic, but that people's basic needs need to be met, and that each individual should be contributing to the best of their ability. I.e. not that the government needs to hold all of our hands, but the idea that we have a social contract with our government: we do the very best we can do for ourselves, and you do your best to ensure that if we fail, we will not be abandoned and left to destruction.
That's not classical marxism, but since my philosophy is based on a Marx quote, I'm willing to take that label in the current discussion. I'm not sure what label exists to better apply to my philosophy.
Ok, onward.
Yes, the wrong kind of action can always result in a bad situation being made worse. However, I feel that leaving the the health care to the market has demonstrably been the wrong "action" over the last century, and why I support a different approach.
Back to rationing: I can buy a tomato for 75 cents at the farmer's market at the Fruitvale BART station from local growers. I can't buy truffles or caviar, but I can get healthy food cheaply and affordably with very little effort. Where is the health care equivalent? I don't see the two as being remotely equatable. Gas and cigarettes, are two things that I get away without almost entirely (barring the odd City Car Share rental). Their absence does not threaten my existence. I just don't see how they can be compared to the health care concerns in any reasonable way.
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The update you posted about the hip replacement quote. I couldn't find that in the article you quoted. Was it one of the over 3,600 comments listed on the article? I didn't read them. :-)
Regardless, do you not get police service, fire service, social security, highway service, etc. etc. because your political views don't match the current administration's? Again, I just don't see that statement as more than panicked hyperbole.
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Can we refrain from calling this Obamacare in this conversation? It's not helpful and makes the issue more about whether or not you like the President than about the issues involved. Universal Health, and heath care reform in general has been on the table since Teddy Roosevelt.
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While I find the Rasumssen reports interesting, I have as deep a distrust of phone polls as you do of government interventions. Responses have so much to do with *who* they call, and how they phrase their questions.
Beyond the question of phrasing, there is the question of "how much of the current debate to the people being questioned actually understand"? Given the fact that polls show that a large number of people (predominantly on the right side of the spectrum) still think that Obama is a citizen of Kenya, I'm not particularly convinced that we have a thoughtful and well informed citizenry.
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Thanks for the details on Medicare. Actually, the program appears to be functioning, but not at ideal efficiency and it's horribly in debt... kind of like the country. The issue there is funding. Part of why Medicare is broken financially is because Bush expanded Medicare, while cutting taxes that would fund the expansion. Yes, also more efficiency, better procedures, and all those things need to be implemented (again, I consider this to be true for pretty much everything, private and public).
I would say, in an ideal world, yes. We fix medicare and then we use that model to roll out to the rest of the world. Politically I don't know if that's possible.
The argument, as I have heard it, is that fixing the economic drain that is the current health system is a key element of fixing the economy as a whole. Our economy has tanked, bringing us to the edge of another Great Depression, and we're slowly backing away from that abyss. It's time for big actions, much as the New Deal was a big action. Trying out one small piece, seeing if it works and then expanding works wonders if the overall system is fairly stable. When things have been so horribly mismanaged across the board, we need to make major, sweeping changes.
From everything I've read about successful corporate management... that's sound thinking. Is there risk involved? Yes. But then, the New Deal was risky as well. Every major sweeping social change has been risky.
I really have to wonder if Medicare would be in the straights its in if it had been financially managed well over the last 8 years. If we hadn't been cutting taxes left and right while increasing programs, we (and Medicare) probably wouldn't be in the state we are in.
So the question for me *is* adjusted.
Now my question is "In what ways will a new plan be structured in order to both ensure adequate funding is provided, and how will inefficiencies be monitored and corrected? If these revenues are tax based, will there be a way to ensure that such taxes cannot be suspended in the future in order to curry political favor and put the system at risk?"
dan: thanks for the conversation opportunity.
xo,
lex
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