Monday, January 01, 2007

The Debate Over Health Care

Politics is the art of the possible - Otto von Bismarck

Health care is an issue that provokes passionate debate, and that debate is certain to intensify as the legislative session gets underway. Gov. Rell fired the first shot with a proposal that would encourage insurers to provide a low-cost plan to those who need it--but that idea has been attacked as being too expensive for the very poor at a proposed $250/month, and too reliant on the will of insurance companies.

Yet the will to pass real universal health care seems thin. Take these comments from Speaker James Amman, for example:
Although many Democrats have talked about adopting universal health care, Amann cautions that this is a lofty goal for such a complicated issue. Since solving the entire problem is unlikely, the legislature should instead focus on solving one part of the problem, he said.

"If you think we're going to conquer the world next year and get everybody covered, it would be a miracle," Amann said before Rell announced her plan. "I'm sure the governor would love to sign that bill. I think if we concentrate on the kids with a program we have called HUSKY, which is one of the best in the nation, improving that and creating more access and more prevention, we can at least conquer that [this] year." (Keating)

Amann may simply be keeping expectations down, but proponents of universal health care should take this as a signal that they may not, in fact, see any type of universal coverage this year.

Yet I believe it can be done. I've suggested in the past that a single-payer system might be good for Connecticut and for the country (although I have concerns about what the collapse of the insurance industry would do to Hartford, and single-payer systems have problems of their own), but realistically, American governments are not going to pass such a plan any time soon. Such a system was a dramatic failure in 1993, and only 39% of Americans support replacing the current system with a new, government-run health care system (see the Nov. 9-12, 2006, poll on this page). So we're not there, yet.

Therefore, let's deal with what's possible. Amann wants to expand HUSKY to include all children, and I think this is a laudable goal. But I believe we can do better than that. I propose implementing a hybrid plan which would help the poorest afford basic, state-subsidized health insurance, while working with insurance companies to provide a better and more affordable range of options for everyone else. We can cover many people by expanding Medicaid, and the rest can be dealt with through new state programs. We can base our plan on that of Massachusetts, which now requires health insurance for all residents, and provides a subsidy to low-income residents to help them pay for it. One of the options available could be Rell's $250/month plan.

Therefore, Connecticut residents could choose either a state-backed (and possibly partly state-funded) plan, or go with the health plans provided by their employers. As for funding, I suggest that we revisit some of the plans proposed during the gubernatorial race, especially those of Dan Malloy.

We can debate whether actually requiring people to have health insurance is the way to go. But I believe that this sort of hybrid plan, which combines subsidized health care for the truly needy with a wider range of private health insurance choices would extend access to health care to everyone who needs it and help to keep costs level or bring them down for many Connecticut residents.

Better yet, it's actually possible to do. We can create a plan that would make sure all of Connecticut's residents have access to health care. It's complex, but not such a monumental task as scrapping the current system and replacing it with a new one would be. I urge the Speaker and the legislature to create and passing such a plan this year. Connecticut deserves it.

Keating, Christopher. "State Faces Daunting Issues In Legislature." Hartford Courant 1 January, 2007.

Gallup Poll. Nov. 9-12, 2006. N=1,004 adults nationwide. MoE ± 3 (for all adults). (


Matt said...

Here's an interesting chart for you to look at....

The most recent data says we spent $6,102 per capita on health care in the U.S., with the government paying (via Medicare, Medicaid, state programs, etc) 45% of that, or $2,746.

Compare that to France (the nation with a universal health program most like one which might be adopted here in the states), where the government pays 78% of $3,159 per capita each year, or $2,464.

Our government is already spending more on healthcare than universal coverage costs. For this wise spending we get a 2.8 year shorter average lifespan, and a 77% higher infant mortality rate. (Back of envelope translation: 12,300 additional dead babies annually.)

+ + + + + + + + + + + + + + + + + + + +

FYI, Clinton's 1993-94 plan was more or less as you describe your ideal: a public-private partnership that allowed competing HMOs to provide government-regulated coverage through employers. The problem is that Republicans, confident of mid-term gains, revoked their support near the end of the process, and insurance groups (who preferred less-regulated coverage, and a customer base without the bulk purchasing power the government would introduce) spent more to defeat the proposal than presidential campaigns up to that point generally cost.

Bill Kristol lead the charge in convincing the GOP and private industry that if they could exploit distrust of government and convince the public that "passage of the Clinton health care plan in any form would be disastrous," they would damage Clinton's credibility as a moderate reformer, and take control of Congress (power for the GOP, reduced regulations for the insurance industry - Medicare D and S 1955 are just the most recent in a line of GOP initiatives to funnel money and eliminate regulations to the insurance industry).

Both of these things came to pass, and you are still working off of their playbook. Rell's so-called "plan" is designed not to provide coverage for everybody, it is designed to prevent it.

Matt said...

Also, it bears mentioning that Otto von Bismarck went further with healthcare than contemporary conservatives are willing to go:

The year 1883 saw the passage of the Health Insurance Act, which entitled workers to health insurance; the worker paid two-thirds, and the employer one-third, of the premiums.
Wikipedia Otto von Bismarck page

1881 On 17 November, Chancellor Otto von Bismarck reads out the so-called "Emperor's message", the "birth certificate" of the German Social Security system, in the Reichstag.

1883 The Worker's Health Insurance Act comes into effect. The bodies responsible for health insurance are first of all the local Health Insurance Funds, which are founded by the communities.

1894 The "Centralverband von Ortskrankenkassen im Deutschen Reich" (central association of local Health Insurance Funds of the German Reich) is established in Frankfurt am Main.

1911 In the Reichsversicherungsordnung (insurance rules of the Reich), the different branches of social security are recorded in six books. It assigns the primary function of health insurance to the local Health Insurance Funds and classifies the different types. With more than 7 million members, the local Health Insurance Funds represent Germany's biggest type of health insurance fund.
History of the AOK-Bundesverband

Bismarck is largely credited with being the inventor of universal healthcare and social security. In the 1800s. Politics of the possible, indeed.

MikeCT said...

A major part of the reason that the U.S. has the most costly health care in the world is the private insurance industry - the paper pushers, the massive billing and administrative infrastructure, the marketing, the failure to control and negotiate pharmaceutical and other costs, etc. These parasitic profiteers are job killers, making new jobs unaffordable to business. We're not going to reduce costs or have a healthy economy as long as we continue to subsidize a useless industry.

There are all sorts of insurance industries in CT - the health insurance industry is just one. If the only reason to keep them around is as a sort of public employment program, let's drop the pretenses and have a frank discussion about the best places to put people to work - such as actually providing health care. Or just give them a check and send them home, for God's sake. At least we can all have health care then.

The Architect said...

Bismarck did what he did to placate the masses, not because he felt some humanitarian duty to take care of them.

DonCT said...

I have a question:

How would it be possible to to "Force" me to get health insurance? Would they do it the form of a tax or would I have to pay a fine for not being covered?

How does the Mass. plan work?

Matt said...

Architect - No different from FDR in that sense. He adopted the absolute minimum from socialism that would prevent the country from breaking down into panic and revolution. Sometimes the politicians lead the masses, but sometimes the masses have to convince the politicians.

Practical Democrat said...

More health care costs more money. It is that simple. Governor Rell's plan is her standard thoughtless proposal that manages to give the public the impresssion that she is trying. This is the same baloney with her car tax. Amann is the only one being straight. You want more health care, you must provide more money. Other than that, it is just rearranging the chairs on the deck of the Titanic.

Don Pesci said...

“We can create a plan that would make sure all of Connecticut's residents have access to health care. It's complex, but not such a monumental task as scrapping the current system and replacing it with a new one would be.”

It might be more complex than you think. Once you create an out of the box alternativve insurance system, you are encouraging insurance companies to dump their problems into the box. You cannot prevent this without establishing a permanent regulatory structure that will monitor business and provide sanctions for companies that dump, and that means regulations and additional staff, both costly. Then too, if the companies do not wish to be muscled by Connecticut regulators, they can always follow Allstate’s example and pull up stakes, moving into a more business friendly arena. No doubt the Dems have all these contingencies covered.

Anonymous said...

The idiots in the legislature should NOT be rushing into some type of feel good insurance plan. Look at the result of their foray into electrical deregulation, and how much that will end up costing us to have to go back and RE-regulate. In that case, the only people who understood it were the industry people and their lobbyists, who sold a thoroughly confused and ignorant legislature a bill of goods that promised choice and lower rates. It was merely a hand-out to NU and UI to sell off their generating facilities. Now, they will be given huge subsidies to reacquire those same generating facilities because the cost of power got too high and the government has to "do" something.
The lesson is that a government entry into healthcare is a bad idea - they don't understand the industry, they will muck it up and cost us private secotr jobs, doctors will not choose to participate, etc. When you let a bunch of elected officials try to solve the problems of a private industry, only bad things will happen.
As an alternative, just expand the HUSKY program to permit low income adults some sort of preventative care, rather than foot the bill for having them treat at the ER.

Anonymous said...

You all might want to take a course in public health policy at a place like Dartmouth or Boston University. You can't even agree on what's factual and few of you have any facts. Blahg, blahg, blahg!!!!Worthless.

Anonymous said...

This is all such a crock.
Socialized medicine (i.e. government managed/paid for health care) cripples the economy and kills the taxpayer.
Let people pay for their own health care privately - heck even in nations where socialized medicine is available people carry private plans because the system just cannot provide properly for all. You know it and so do I. Let's stop fooling ourselves here for once and be honest.

Can't you people get it in your head that the government is not designed to deal with these kinds of matters.

Do you even know what the purpose of government is?

We already have HUSKY - we already have Medicaid.. anyone else can get off their duffs and get a job that has decent benefits and avail themselves of that. If their job can't provide good healthcare then there are plenty of private pay plans out there to be had, or let them find a job that offers a decent plan. And if there is a need in the market for better plans then let the market fill that need.

As a taxpayer I am quite tired of financing everyone else's stuff. Other people don't need a $5 copay on my hard earned buck, while I have to pay $20 copays and higher.

Government needs to get back to the business of governing and stop trying to take care of everyone's personal problems.

Maybe if we concentrated on lowering the cost of healthcare instead of feeding it we might get somewhere.
How about we start by going after the price gouging drug companies, and the legal system that allows huge obscene medical malpractice settlements? How about we encourage more providers and introduce a bit more competition into the mix? How about we allow people to choose whatever the hell kind of healthcare providers they want to be paid for by their insurance so that if you want to go to a traditional doctor you can - and if you want to use herbs and acupuncture you can do that too.

You all are going about solving this problem from the totally wrong end.
More costly Government is definitely not the solution..

Anonymous said...

And how about going after the rich doctors that constantly game the system and that hurt so many people that there aren't enough trial lawyers around willing to take a chance on contingency basis to sue the doctors.

GMR said...

If the state of Connecticut is going to pass some sort of universal health care plan, it won't be able to touch the salaries of doctors. There are 49 other states out there, and doctors can move to any one of them if we set controls on their salaries.

And there's no way we can control what drug companies can charge either.

Some people claim that if the government took over health care, costs would go down. How? Usually, paperwork reduction is cited, or other administrative efficiencies. Yet how could the government administer this more efficiently? One reason things are so inefficient now is the myriad of government regulations in place.

Anonymous said...

"Gov. Rell fired the first shot" last week....

She is way behind and is just now noticing health care is an important issue.

Anonymous said...

Would GMR just once reference some statistics instead of throwing around the usual broad generalities of an uniformed ideological right winger. Debate involves facts.

Connecticut Man 1 said...

Some people claim that if the government took over health care, costs would go down. How? Usually, paperwork reduction is cited, or other administrative efficiencies. Yet how could the government administer this more efficiently? One reason things are so inefficient now is the myriad of government regulations in place.

Ct State alredy did studies that showed it would save around 1 billion $ about ten years ago.

Thye would administer it better by eliminating the multiple layers of accountants, and people needed to submit claims to the insurance companies, and the profits of the insurance companies. Centralizing the payment system eliminates all kinds of money.

There are 49 other states out there, and doctors can move to any one of them if we set controls on their salaries.

Ask yourself: If this were truely the case, then why do doctors and nurses still practice in Canada? They can easily get work visas to come to the USA in these fields yet most don't.

Why? They make a decent living (Higher standard of living in Canada, ya know?) and they also remain because Canada also worked inot the system a solution to a major problem here in Connecticut:

They have limited liability laws. You can't just sue a doctor for frivolous things in Canada. That is one of the major reasons Doctors are already leaving Connecticut: The insurance for their industry costs them an arm and a leg. Elinminate the frivolous lawsuits, coupling this with UNIVERSAL HEALTHCARE and you will have the answer to why Doctors would gladly stay in Connecticut.

This does not mean eliminating lawsuits completely but it means that, since the State would become liable, it would be in our interest to eliminate HUGE settlements while enforcing stripping of licenses and other measures for malpractice, depending on the seriousness of the mistake.

You see there are already proven answers to your questions.

Other savings are inherrant in the Canadian system as well. Since there is no need for car insurance to cover someone elses injuries there are added savings built into the consumers costs of driving.

There are so many benefits to the Doctors, hospitals (eliminating the bulk of workers needed to run the "insurance industry" opens up more rooms at hospitals for patients and more money for Doctors), the clients (you and me), and all of these add up to huge savings for us and industry as a whole. Manufacturers would chose "Connecticut first!" to set up shop because they would save on providing healthcare as well. Then you start getting into savings on drugs because the state would start negotiating for all of their products as a block...

There are just too many benefits to Universal Healthcare for us, but few for the profiteers of the "health insurance industry".

There are so many reasons that US sytem is a failure, and the insurance and pharmacutical would like to keep it that way because it ain't failing their profits.

Anonymous said...

Doctors can't be sued for frivoulous things in CT and as many doctors are entering CT as they are leaving. Ct is one of the most lucrative markets for a doctor to work in the country, Connecticutman1.

Connecticut Man 1 said...

Then why were doctors displaying signs about how many were closing shop and moving out of state because of their insuarance costs for medical malpractice? Unless this issue has recently been resolved.

Anonymous said...

The doctors were lying!!!!The doctors own the med/mal insurance company.Check the numbers at the DPH and DOI.