You should watch this, if you have the time.
Highlights:
"I do not want to yell. I feel like screaming but everybody is screaming, everybody is screaming that this is about rights or freedom or socialism or the president or the future or the past or a political failure or a political success. We have all been screaming, I have been screaming.
And we have all been screaming because we do not want to face, we cannot face, what is at the heart of all of this, what is the unspoken essence of every moment of this debate; what, about which, we are truly driven to such intense ineffable inchoate emotions. Because ultimately, in screaming about health care reform, pro or con, we are screaming about death.
This, ultimately, is about death.
About preventing it. About fighting it. About resisting it. About grabbing hold of anything and everything to forestall it and postpone it, even though we know that the force will overcome us all - always will, always has. Health care is, at its core, about improving the odds of life in its struggle against death. Of extending that game which we will all lose, each and every one of us unto eternity, extending it another year or month or second.
This is the primary directive of life, the essence of our will as human beings, all perhaps that is measurable of our souls, the will to live. And when we go to a doctor's office or a hospital or a storefront clinic in a ghetto we are expressing this fundamental cry of humanity: I want to live! I want my child to live! I want my wife to live! I want my father to live! I want my neighbor to live! I want this stranger I do not know and never will know to live! This is elemental stuff — our atoms in action, our survival mode in charge. Tamper with this and you are tampering with us."
"Because as discovered in a new study conducted by Harvard University and the Cambridge Health Alliance, that's how many of us are dying, each year, because we don't have insurance.
The number is horrible. But when it is contrasted to what faced my father that night, it is unforgivable. Because as Cambridge's summary of the findings put it: "Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease." My father had less to fear that night from bad kidneys than he would have if he hadn't had insurance!
And yet we let this continue.You and I. This society. Our country. Democrats and Republicans.
This is the study Congressman Grayson of Florida quoted, about which the Republicans demanded an apology when they should have been standing there shrieking, demanding we fix this. "Uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts."
People, in short, are dying for the lack… of money.Dying as surely as they did when Charles Dickens wrote about the exact same problem. Of a boy who couldn't get sufficient medical care for his affliction. Of the underprivileged, suffering not just privation but death, as the comfortable, moved silently and unseeingly through the streets of London."
"Death panels? We have them now. They're called WellPoint and Cigna and United Health Care and all the rest. Ask not for whom the insurance company's cash register bell tolls. It tolls for thee."
"We must reform a system that lets my father get better care than yours does, or better care than Mike's daughter does, because by the accident of life, I make more money than he does, or my checkbook can hold out longer than his does, or yours does, as the bills come endlessly like some evil version of the enchanted water buckets in Fantasia.
The resources exist for your father and mine to get the same treatment to have the same chance and to both not have to lie there worried about whether or not they can afford to live!
Afford to live? Are we at that point? Are we so heartless that we let the rich live and the poor die and everybody in between become wracked with fear — fear not of disease but of Deductibles? Right now, right now, somebody's father is dying because they don't have that dollar to spend. And the means by which the playing field is leveled, and the costs that are just as inflated to me as they are to you are reduced, and the money that I don't have to spend any more on saving my father can go instead to saving your father that's called health care reform!
Death is the issue! How can we not be unified against death? I want my government helping my father to fight death! I want my government to spend taxpayer money to help my father fight to live and I want my government to spend taxpayer money to help your father fight to live! I want it to spend my money first on fighting death. Not on war! Not on banks! Not on high speed rail!
Spend our money, spend my money, first: on the chance to live!
And we must be unanimous in this, not to achieve some political triumph for one side against the other, but to save the man or the woman or the child who will be dead by morning, in this country, in this century, on our watch, because we are not spending that money tonight. I will not settle for a compromise bill and I will extend my hand to those who are scared of the inevitability of death but have been told they are scared of reform, those who have been exploited by the others, paid, or forced, to defend the status quo.
And we must recognize the enemy here: an enemy capable of perverting reform meant for you and me, into its own ATM that mandates only that more of us become the slaves to the insurance companies. The monied interests that have bled their customers white, and used their customers' money to buy the system, to buy the politicians, to buy the press, cannot now even be checked by the government."
" Because in one party, in one demographic, in one protest movement, we are all brothers and sisters. We are united in membership in the party that insists that every chance at life be afforded to every American seeking that chance.
We are united in membership in the party that insists on the right of everyone to the startling, transcendent blessings of the technological advance of medical science. We are united in membership in the party that is for life, that is against death, that is for lower premiums, that is against higher deductibles, that is for the peace of mind that can be provided only by the elimination of the fear that cost will decide whether we live or we die!
Because that's the point, isn't it? It is hard enough to recover, to fight past pain and to stave off death, if just for a season or a week or a day. It is so hard, that eventually for you, for me, for this president, for these blue dogs, for these protestors it is so hard to recover, that for all of us there will come a time when we will not recover. So, why are we making it harder?"
What frustrates me is the idea that "health care reform" is one set of proposals you should either oppose or agree with. Aren't there different bills with different proposals in them? Aren't some better than others?
ReplyDeleteMaking it illegal for insurance companies to deny coverage based on pre-exisiting conditions is something I could get behind.
A public option is controversial for good reason. I'm uncomfortable with the government competing with the private sector while also being responsible for regulating it. A debate around this is warranted.
Moving towards electronic records. Well, duh. Does anyone oppose that? A question we should be asking is why the health care industry hasn't done this already.
There are reforms I would love to see discussed (such as moving away from an insurance model for basic preventative care). In his address to Congress on the issue of healthcare, President Obama said that while this idea might have merit it would be "too disruptive" for the system. I'm not sure I buy that.
There is a way to discuss this without screaming. But the debate should center around priorities (is it more important to expand coverage or reduce costs?). I think if we found ways to reduce costs, expanded coverage would be the result. If so, we should focus on cost reduction as a first step.
It should center around probability of success. Will expanding coverage really lead to lower overall health care spending? How much?
The debate should not center around emotion, from either side. On that I think we agree.
Well said, as always.
ReplyDelete"Moving towards electronic records. Well, duh. Does anyone oppose that? A question we should be asking is why the health care industry hasn't done this already."
The answer here is pretty clear, in my mind. Because no one is forcing them to. The health care industry is run by companies who don't care, on a corporate level, one bit about improving quality. They care about making money. Unless you can show them that electronic health records makes them money, they are not going to do anything unless you force them to.
A pharmacy in my town burned down last night. All the people who patronized that place are lost-they have no idea what to do. Individual providers are helping pick up the slack, but there is no systematic response about what to do about this.
There is no reason in the world, in 2009, why you can't have an offsite backup, with a universal coding system, so that other pharmacies, in an emergency situation, can read and access those records. Why isn't there? Because no one is willing to pay for it. Because CVS is afraid there will be some competitive advantage lost if a Walgreens can read their records. Why don't we recycle prescription bottles? Why don't we accept expired prescriptions for proper disposal? Why can't we interoperate patient records? Because no one is willing to pay for it.
It is more efficient that we have 9 different systems competing than if we have 9 different systems that can interoperate to MAKE PEOPLE BETTER.
That's where the government comes in.
Compete all you want-it's the American way.
But when it comes to patient safety, you have to play nice and interoperate. Cooperate for the sake of everyone, so that society benefits.
But I doubt it will ever happen.
You say that the move to electronic records is not happening more quickly because "no one is forcing them to." Yet we know businesses move towards efficiency all the time without the government "forcing" them to. They do it to lower their costs and improve quality, and therefore to be more competitive and make more money. Why is this true in engineering, construction, finance, entertainment, law, and manufacturing, but not in health care?
ReplyDeletePerhaps because health insurance so skews the relationship between the customer and the provider. When huge insurers are the customer, there's a lot less customer mobility and price pressure. It's curious that electronic billing has been established forever, but not paitent medical records. Could it be simply because the health insurers are the real customer, and not you and me?
Let's say you own a construction business and stumble across a way to get buildings built 10% faster. Naturally, you start winning bids when word gets around that you beat everybody else's start date, and you hire more people, and you make more money.
ReplyDeleteNow let's say you are a large pharmacy chain. Someone approaches you and says they want to introduce a uniform data format so that your information can be shared with pharmacies from other companies. Why should you do this? This is imposing a cost (the IT to make sure your proprietary software conforms to this standard) for no gain. (You're really going to advertise this to your customers-you don't have to come back to us if you don't want to?)
(Note: This did happen after Katrina. A database was set up of the destroyed pharmacies' data so that pharmacies anywhere, from any company (those who were given access-you had to prove you were reputable to get access) could look at it.)
One reason why health care isn't a market is because everyone has to participate. All man is mortal. If you don't want to participate in the construction market, don't build the building.
Another reason health care isn't a market is because you can't evaluate it yourself. The Internet has changed this, but not entirely. Health and health statistics are enormously complex-you really need a trained professional to evaluate things for you.
Another reason, as you so wisely point out, is that our system shuts you off from the costs of care. No one knows what anything really costs, because large purchasers so completely dominate the marketplace.
Another reason is the quality conundrum. I think you could agree that a Mercedes is better than a Ford for a dozen different reasons. (Insert whatever brand you want.) I don't drive a Mercedes-I bet you don't either. My car gets me where I need to go. I bet yours does too. There is no "good enough" when it's my Dad, or my kid, or, God forbid, your kid, on the operating table.
In America, we have decided to let the market sort it out in all areas of life. If we're going to do this in health care, too, we should at least be explicit-tell the people we are writing off that we are doing so. It's too cruel to let them think they matter, too.
What I'm trying to say is, businesses move towards efficiency when it benefits them to do so. Businesses do EVERYTHING when it benefits them to do so.
ReplyDeleteHealth care businesses think about quality when they HAVE to-when they are threatened by government intervention or closure, or when they want to make some benchmark they can brag about, or when they need to do it to attract workers, or whenever they think it benefits them. If the return doesn't add up, they don't do it.
Quality and price doesn't seem to matter to health care companies, above a bare minimum, because they can't brag about these things to consumers. Wal Mart didn't take over prescription drugs because people learned that the drug list they offered was ridiculously small. Wal Mart can't brag that their pharmacies are safer because they're not and because they would consider it suicidal to admit an error ever occurs. (Plus it would invite legal and governmental scrutiny they don't want.)
It's the tragedy of the commons-no one will do it until everyone does it. (It doesn't benefit anyone to be the first one to interoperate. Government had to force the chains to work together after Katrina.) And since noone will do it, we never get to everyone doing it.
I meant to say, too, that you are so right in your first comment, too. You can't be against "Obamacare", because there isn't one Obama plan. I suppose you can be against it just because it's an Obama plan, but that isn't really opposing the plan at all.
ReplyDeleteSo why can't Wal Mart brag about quality? Again, because they can't risk admitting that there are any mistakes at all, for fear of being sued. (How many drug errors are acceptable?) Malpractice reform fits in here. We admit that sometimes airplanes don't work quite right, and we both have numerous checks in place to make sure bad planes don't take off, and when they do, we force companies to fix them.
ReplyDeleteWhy can't we do the same with health care? There has to be a bedrock assumption that there is some risk involved with any health care event. Despite the best efforts of everyone involved, it might just not work the way we intend.
And why can't they brag about price? They tried to, with the $4 prescriptions, and it forced other companies to match, and brought down costs a bit. But why can't they brag about all their prices? Because they don't control most of them.
Pfizer has a monopoly on Viagra, and unless you go through a lot of expensive effort to get a prescription changed, Viagra prescriptions have to be filled with Viagra. Pfizer can charge whatever it damn well pleases for Viagra, because no one else can make Viagra until their patent runs out. So Wal Mart can do whatever it wants to do, but it has to buy Viagra from Pfizer. So there is no reason to lower the price, so it stays high.
(And do you know what else they do that is dastardly? The day the patent runs out, Pfizer will run to a judge and slap down a bunch of lawsuits challenging the generic manufacturer's right to use a similar manufacturing process, or a similar color, or whatever. So the judge issues a stay until the case can be heard, and Pfizer collects millions and millions of dollars every day until the case gets thrown out.)
The markets don't work because the usual levers are distorted by the way we pay for health care and the way health care impacts our lives.
Jeanne said: "A public option is controversial for good reason. I'm uncomfortable with the government competing with the private sector while also being responsible for regulating it. A debate around this is warranted."
ReplyDeleteA public option without any funding worries (thanks to bottomless deficit spending) run by the guys who regulate the private insurance industry could easily wipe out the private health industry.
Then we get the nightmare solution: single payer. No choice at all.
This is one reason that the "public option" is a very bad idea: it is nothing more than a trojan horse for single payer.
The supporters of the "public option" most often claim that it is needed to "keep the private insurers honest" through competition.
This could be accomplished easily by removing the unnecessary regulations on where insureres do business that prevent insurers from selling insurance in all states.
Wipe out the private health insurance industry? Health insurance that's actually about human health? Perish the thought!
ReplyDeleteI have made it clear I firmly believe single payer is the best choice. I just as firmly believe that I will be Masters champion before we achieve single payer health insurance in the United States.
Your fears of the public option as a "stalking horse" for single payer is ridiculous. I have grave doubts we will get any health reform at all-we are miles and miles from single payer at this point.
Once again, though, don't you believe that the government can't do anything right? Why are they suddenly going to crush all the private sector companies? Why hasn't the postal service eliminated UPS and Federal Express altogether?
The only reason private insurers exist is to keep money for themselves that should be going to sick people's care. That's the only reason they are involved in health care-their seat at the table is so they can take money off of it. Eliminating them entirely would not bring a tear to my eye.
(And frankly, under a single payer system, they would still exist-they would sell add on policies to companies to cover the things the government plan wouldn't-fertility treatment, let's say, and erectile dysfunction drugs, and oral contraceptives.)
Single-payer is the doomsday option. The worst possible choice. Which is, no choice. You have to put up with the decisions of the monopoly, or leave the country.
ReplyDeleteThere are many great arguments to be made for "antitrust", for preventing monopolies. These arguments apply at least as well to healthcare.
" I just as firmly believe that I will be Masters champion before we achieve single payer health insurance in the United States."
I sure hope that is the case. That this deadly possibility never becomes real.
"Once again, though, don't you believe that the government can't do anything right? Why are they suddenly going to crush all the private sector companies? "
Well, you said yourseif that if they do this, it would be a good idea. Many others think so too.
"Why hasn't the postal service eliminated UPS and Federal Express altogether? "
The postal service has a monopoly on letter delivery. UPS and Fedex are banned from participating, except in certain circumstances such as "urgent" commnications. So yes, the USPS (in the form of the federal government it is part of) has eliminated the competition in that area.
"The only reason private insurers exist is to keep money for themselves that should be going to sick people's care. That's the only reason they are involved in health care-their seat at the table is so they can take money off of it. Eliminating them entirely would not bring a tear to my eye."
It would bring tears due to the deaths caused by the destruction of health care (the single payer doomsday option).
There are some much better ideas. For example, requiring private insurers to be non profit. And other great ideas which preserve choice and competition.
"Your fears of the public option as a "stalking horse" for single payer is ridiculous."
It is very well informed. A large percentage of the Democrats (including President Obama) would prefer single-payer, but now see the "public option" as the only feasible way to get there.
"I have grave doubts we will get any health reform at all-we are miles and miles from single payer at this point."
The more miles, the better. But that does not change the fact of the ill intent of the President and a large percentage of the Democrats in Congress who would really have single payer if they could get it.
Also, I never ever said "government can never get anything right". It can, but the wisest course is to limit the power of the ruling elites and only have government as a last resort.
That's funny, because without hesitation, every single Democrat in power says, whenever they are asked, that single payer is completely off the table. So I don't know where you're getting that idea.
ReplyDeleteAnd what choice do we have in health care insurance? You get to pick which set of bureaucrats are going to say no? What choice is that? Health care insurance is made up of huge regional companies that sell the minimum policy they can get away with for the largest premium they can get away with. They are thieves, every single one of them.
All of this doesn't matter. The lobbyists for Big Insurance have bought and sold this Congress many times over. Nothing that damages their profits will ever see the light of day.
As they say on the ESPN Fantasy Focus podcast, "Put it on the board."
Obama has said several times that if he could start this over again, he'd ask for single payer. There is also a single payer bill in Congress that has many Democratic supporters.
ReplyDeleteThis is H.R 767, and it has 78 cosponsors. 78 Democrats "in power". So much for "none of them" saying that "single-payer" is off the table.
"And what choice do we have in health care insurance? You get to pick which set of bureaucrats are going to say no? "
So, what does single payer do? Makes it just one set of bureacrats that say no. It makes the problem worse.
"All of this doesn't matter. The lobbyists for Big Insurance have bought and sold this Congress many times over"
Actually, they are acting in the public interest by resisting any form of single payer, even its small remnant, the "public option". One of the bright spots of this political year has been the "blue dog Democrats" looking out for the interest of the country, even if it goes against party unity.
Despite the large sums of campaign contributions from such organizations as the SIEU, which stands to get a lot richer if a public option plan passes (which means lots more workers forced into government unions against their will).
"Health care insurance is made up of huge regional companies that sell the minimum policy they can get away with for the largest premium they can get away with. They are thieves, every single one of them."
I agree that this is a big problem. The way to solve it is to get rid of the regulatory barriers so all of the 1,200 insurance companies could then compete against each other. Right now they can't, resulting in the regional problem you name.
Surely, the solution to this regional problem isn't to make it worse: single payer, which covers the entire nation as a region and has no competitors. And thus no accountability at all.
I should have been clearer. When I said, "in power", I meant the leadership-Hoyer, Reid, Pelosi, et al. To a man, (to a woman?) they have said SP is not an option.
ReplyDeleteI really don't get the connection between the SEIU and a public option. How does a public option inflate the number of workers in a union?
Again, single payer does not eliminate private insurance-they are just forced to the margins, covering, let's say, pet insurance and cosmetic surgery and, let's say, fertility treatments.
And a Canadian style single payer plan would give us, the people, say over what gets covered.
But it doesn't really matter-single payer is dead and buried in the United States, no matter how good or bad it may be.