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I am disappointed by an under-reported quote in Reuters from incoming Health and Human Services Secretary Tom Daschle.

I supported Barack Obama because I want the health care system to be changed. I have Crohn's Disease. I've been through the mess that is the modern American health care system, and I have the scars to prove it. I've personally experienced, or seen other patients in similar positions experience, everything that is wrong with modern American medicine. I've talked with first-rate doctors who tire of the bureaucratic mess that is the HMO system.

I want change. Now. I want there to be a plan where anybody, regardless of pre-existing conditions, can purchase affordable health insurance and access the treatments they need to be a productive member of society. I want an end to the practice of the chronically ill person being the first one laid off or the last one hired because their insurance premiums are so high. I want the chronically ill to be able to be free to move wherever they'd like to live in this country, and not have to consider whether a state's chronically ill plan is any good. I want a level playing field for the chronically ill and the disabled.

I think Tom Daschle really cares about passing health care reforms. I think he has interesting ideas on how to fix the system, and though I do not agree with all of his ideas, I believe they come from the right place. I praised his nomination when it became news. I was excited, as I believe that his nomination indicates a level of seriousness about the issue.

But I was pretty disappointed when I read Secretary-designate Daschle's remarks to a health insurance industry gathering. Reuters reports on Daschle's latest comments:

"Speaking at a meeting of healthcare industry experts in Denver, Daschle said he would like to "allow the states to be workshops and laboratories of innovation."

I know that the Secretary-designate is aware that there are already vast differences between states on health care. The chronically ill, who often can't find employment where insurance is carried due to high insurance premiums and cannot afford insurance on the private market, have to deal with a patchwork of state high risk pools. Some states are better than others, but common problems remain.

I took Secretary-designate Daschle's comments as, "We may not be in the position to do anything, so it'd be nice if state governments could act on this issue." We'd get an even bigger patchwork of systems if the state laboratory idea was implemented. Patients who are in all respects similar--same profession, same age, same disease--would still be treated differently based upon the state they live in. Because 49 of 50 states are broke, state governments would have little incentive to act in a way that includes patients with serious illnesses (many of us end up on disability and Medicaid). In short, nothing would change. We'd have the same problems of people neglecting the care they need because they can't afford it, only to be bankrupted by the emergency care that is needed after a life-threatening (and completely preventable) complication develops.

I have detailed what I'd like to see as reforms before. I will not repeat that now. I will say that any reforms that are being considered must be federal. There must be a minimum national standard of insurance that applies/is available to everyone at an affordable price.

And to keep health care affordable, we need to have a serious discussion about end-of-life care. We must reduce expensive care that carries little benefit--feeding tubes in dementia patients, life support, etc. Part of the reason that we're 37th in efficiency is that we spend too much money on end of life management.

Update: Partially Impaired, and others, point out that the Reuters article that triggered my disappointment has a quote that is in poor context. I'm not sure what the context actually was. It could be what I'm describing above, or it could be a universal health care plan that, while far from perfect, would be a national standard. Hopefully, someone can find a transcript of what Secretary-Daschle actually said, and the context it was said in.

Originally posted to The Bagof Health and Politics on Mon Dec 08, 2008 at 10:15 PM PST.

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Comment Preferences

  •  Thanks for articulating a concern many of us are (11+ / 0-)

    dveloping.

    How serious are we about making significant improvement to our health care system?  

    What are these improvements going to be?  

    How soon will they  be implementing them?

    Shouldn't we be hearing more details by now, and where different Congresspeople are in their intent to support them or not?

    During the primaries, I was distressed to read a report that several Congressional insiders said off the record that the necessary support did not exist for either Obama or Clinton's plan.

    So what plan are we going to get?

    Letting states experiment for a while an waiting to see what happens isnt the change I was expecting or hoping for.

    The means is the ends in the process of becoming. - Mahatma Gandhi

    by HoundDog on Mon Dec 08, 2008 at 10:26:18 PM PST

    •  Oh, one more thing. Democrats have made (8+ / 0-)

      health care reform, perhaps, one of our most distinctive promises and the average voter has enormous expectation here.

      If we do not start delivering some serious results soon, I believe we will be held accountable in the 2010 elections and 2012.

      This let's wait and see what state fool around horseturds is not going to fly as our primary initiative.  Maybe some variety experiments on the side.  

      But we are going to need some large significant deliverables in the first two years are suffer a loss of credibility, IMO.

      The means is the ends in the process of becoming. - Mahatma Gandhi

      by HoundDog on Mon Dec 08, 2008 at 11:22:09 PM PST

      [ Parent ]

      •  I had forgot about S. 2031 (1+ / 0-)
        Recommended by:
        HoundDog

        It's an OK bill. I think it was kind of designed to appeal to Bush though, so maybe it should be tossed aside in favor of something else (better).

        That said, if you have state or regional plans that have to abide by a common national standard, then that's a lot better than it currently is. Still, I think that asking state governments--who are all broke and who have no money to pay for health reforms--to be the implementers of a new health care system is a bit ridiculous, even with block grants.

        I think a far better approach is to simply eliminate the profit incentive, have insurers compete for enrollees, and have a minimum standard. (The German system). A mandate in that type of system could work. A mandate while UHC's CEO is paying himself $125 million/yr...not so much.

        •  Come on (3+ / 0-)

          That bill sucks, Obama's plan sucks, Hillary's plan sucked.

          The reason why some of us say it has to be single payer is not out of ideological purity. It's because that's the only system that will create a large enough pool to make health care affordable.

          We simply have to get the insurance business out of health care. And the only way to do it is to create a national single payer insurance plan. We even have a starting point with Medicare.

          If you want to see the nightmare that is modern health care continue, let politicians devise yet another complicated scheme that merges government bureaucracy with private insurance and HMOs.

          Obama's plan is a clear case of saying "No, we can't" to powerful big money interests.

          Now, having said that, he may be right. He may have raise a shitload of money from us common plebes, but the senators and congresspeople he has to deal with did not. They are bought and paid for by big insurance and health care.

          I love your diary and message, but I refuse to call these plans anything but what they are: 'No, we can't.'

  •  Sounds like Daschle supports Bernie Sanders' bill (12+ / 0-)

    S.2031: States' Right To Innovate in Health Care Act of 2007

    Cosponsored by:

    Sen Brown, Sherrod [OH] - 10/2/2007
    Sen Whitehouse, Sheldon [RI] - 9/27/2007

    CRS Summary:

    States' Right To Innovate in Health Care Act of 2007 - Amends the Social Security Act to add a new title XXII (State Comprehensive Health Care and Cost Containment Demonstration Projects).

    Directs the Secretary of Health and Human Services to establish a state-based Universal Health Care Coverage Commission to participate in the review of state applications for planning and demonstration grants for the development of a cost-effective delivery system of universal, comprehensive health care with simplified administration.

    Authorizes such grants.

    Requires a state plan to provide: (1) coverage of all eligible state residents, without regard to employment status, income, health status or preexisting condition, or location of residency within the state; and (2) health benefits that are at least actuarially equivalent to the standard Blue Cross/Blue Shield preferred provider option service benefit plan under the Federal Employees Health Benefit Program.

    Allows one or more contiguous states in a geographic region to file a joint application for such grants.

    Authorizes Interstate Compacts of states to conduct joint health care programs under a grant.

    The same bill was introduced in the House by John Tierney.

    House Cosponsors:

    Rep Baldwin, Tammy [WI-2] - 9/7/2007
    Rep Hastings, Alcee L. [FL-23] - 9/7/2007
    Rep Hinchey, Maurice D. [NY-22] - 9/7/2007
    Rep Kennedy, Patrick J. [RI-1] - 9/7/2007
    Rep Kilpatrick, Carolyn C. [MI-13] - 9/7/2007
    Rep Lewis, John [GA-5] - 9/7/2007
    Rep McDermott, Jim [WA-7] - 9/7/2007
    Rep Miller, George [CA-7] - 9/7/2007
    Rep Moran, James P. [VA-8] - 12/13/2007
    Rep Nadler, Jerrold [NY-8] - 9/7/2007
    Rep Olver, John W. [MA-1] - 7/8/2008
    Rep Udall, Tom [NM-3] - 9/7/2007
    Rep Welch, Peter [VT] - 11/6/2007

  •  I sympathise with your inflammatory bowel disease (5+ / 0-)

    Patients like you are like a giant piggybank to big pharma...

    They should give you a consolation prize for all the money you give them.  No other condition gives them more cash.  Inflammatory bowel patients start young, and they don't die early... a whole lifetime of expensive care, where few generic drugs are available...

    Health care reform is going to be part of the stimulus package... That has already been promised.  There are enough republicans to go along with a Hillary-like plan (i.e. Baucus' plan) and a supermajority with Wyden's plan...Something significant will be passed and passed quickly.

    It's rather surprising that, suddenly, after all these years of waiting... we may get something so quickly, but the impetus is there...

    So, we shall see what happens!  Good luck with your care... I hope it improves in the future...

    Comments that say "GM workers should get retraining" without SPECIFIC DETAILS about those "new jobs" that never come are trollworthy

    by LordMike on Mon Dec 08, 2008 at 10:30:02 PM PST

    •  I have my concerns about a mandate (2+ / 0-)
      Recommended by:
      Jagger, thebluecrayon

      That doesn't remove profit from the health insurance system. That is a system ripe for abuses and market manipulation. Something like Germany, where they basically have Obama's plan and they kept the insurers, just made them not-for-profit, is OK with me...even with a mandate.

      But as someone who sometimes needs medicine that costs $32,000 per year (not now, thankfully) and who needs $600-$1,200 of medical supplies per year, I'm worried. I'm worried that for-profit insurers will do what they're already doing--cutting necessary treatments--in order to deal with including the chronically ill.

      For instance, United Health Care doesn't cover ostomy supplies at all on most of its plans. Depending on the person, supplies can run $200 a month. Without proper supplies, a person has ZERO control and craps all over themselves. UHC had led the way on this, and is now being followed by other for-profit and not-for-profit insurers. With stuff like Remicade or surgery, it's even worse.

      So we'll get bogus exclusions and bogus denials if we have a mandate without removing the profit incentive. If we keep the insurers and keep the competition, but make them compete for enrollments, then they'd be likely to actually improve what it is like for the end user. In short, patients would be more than Excel spreadsheet integers if we adopted something like the German system.

    •  Also, I think you're too optimisitic (0+ / 0-)

      on health care being included in the stimulus. There's pressure to get it on his desk on January 20th. If that's the case, they'll be pressure to keep a clean, straight forward bill. The Republicans still have the fillibuster, and I expect they would fillibuster any bill that included health care. (Forcing them to be against health care and an economic stimulus is not a bad idea, politically).

      I think that health care might reasonably be passed by October, or maybe by early 2010. But the reality is that it will take some time to do it. I don't think it'll happen right away.

  •  I think you are being unfair to Daschle (1+ / 0-)
    Recommended by:
    Elise

    at least regarding this comment. I mean, you should provide some context to it. I dont know if there is video or a transcript from the event, but I'd like to see it in its context. Reading the article there isnt anything suggesting Obama would leave healthcare to the states.

    •  Except for Daschle's quote (1+ / 0-)
      Recommended by:
      debedb

      Which indicates it would be left to the states. I cannot find the context of the quote. You may be right, it may be in reference to a Commission or even his town meetings idea (which I support). But all I can find is Sen. Ken Salazar's opening statement to the group. I can't find a transcript. Perhaps one could be made available on change.gov, so we could see the entire context of the statement.

  •  Are you just going to complain for the next 4 (1+ / 0-)
    Recommended by:
    tobendaro

    years? I'm just wondering because I'm trying to keep track of who to put on ignore.

    •  If nothing gets done on universal health care (10+ / 0-)

      Then yes, I will complain for 4 years. Are you going to endlessly defend administration officials who walk back clear and defined promises for 4 years?

      I will be sorely disappointed, and probably even a bit bitter, if there is no movement on health care over the next four years.

      •  We (2+ / 0-)

        WE have to make it happen.  And we will.  No matter who is in charge or what they do, we will make it happen.  There is no other choice for millions of us.

        "Whoever wrote this alternative "plan" shouldn't merely be fired -- they should be fired into the sun." Hunter

        by tobendaro on Tue Dec 09, 2008 at 05:55:20 AM PST

        [ Parent ]

      •  Get to work then... (0+ / 0-)

        you get what you work for.

        •  Uh, I have (1+ / 0-)
          Recommended by:
          cameoanne

          I made thousands of calls and knocked on thousands of doors. I already have worked for health care. What am I supposed to continue to work for politicians without any assurances that they're going to keep the promises that caused me to work for them in the first place?

          Whenever anybody disagrees with you, you and a cadre of people around here question people's commitment and involvement. It is a kind of crappy attitude that made its way into Steve Hildebrand's post. Lots of us already work on health care, and already worked lots on the issue this year (through organizing mind you). Now we have bills to pay, illnesses that we neglected to take care of, and we no longer have the multitude of time that you have to devote to the cause. But don't you or anyone else dare question my involvement. I have more problems than most, and I did more than most.

        •  PS--Working on Health Care involves (1+ / 0-)
          Recommended by:
          cameoanne

          criticizing inaction of officials who have the power to act. There's a big difference between campaigning and governing. Many of us held our opinions in order to win the campaign. We have the right to expect that we'll be represented somewhere at the table, and that the President-elect will hear from us.

          What the transition is doing is continuing to hold this phony house parties. They're still using what worked in the campaign. But the reality--and anybody who works around Washington knows this--is that whatever is discussed at those parties doesn't go beyond an intern, and perhaps a junior staffer to the local Congressperson.

          Meanwhile, when officials are actually speaking, they seem to be indicating that federal action on health care is not forthcoming. So yeah, some of us are going to criticize statements like, "Let's let the states experiment." And you know what that is called? Working on health care.

          You see, those of us that are outside of the administration no longer work for the campaign. We now work for the issues that caused us to support the campaign. If some choose to go work in the administration, then obviously they have a different set of rules to play by. But those of us out here are going to create pressure on people who we supported to act--be it the EFCA, the Iraq War, or Health Care. And part of creating pressure is that sometimes you have to criticize your friends when they screw up. That is the difference between governing and campaigning. I hope you and Obama's people get used to it...

          •  You can do a lot more than criticize (0+ / 0-)

            to help push health care reform.

            •  What part of "I Have" Don't You Understand?? (1+ / 0-)
              Recommended by:
              cameoanne

              What am I supposed to post my resume so you can judge my commitment to the cause? No matter how much you want to dismiss me as an arm chair quarterback who is just criticizing, and doesn't know what he is talking about, I have indeed done a boat load of stuff on health care.

              I lobbied the Congressional delegation on IBD research funding. I lobbied state and local representatives on issues related to the chronically ill. I've written letters to the editor which appeared anywhere from the local paper to CNN's air. I've knocked on thousands of doors and made thousands of calls in support of Democratic candidates who support health care reform. I've talked with doctors in my area about their concerns. I've attended town meetings of doctors and patients, and asked questions about what were the major problems with insurance. I founded a patients for Obama group, and I organized in an online community of people with similar problems. We were able to develop overwhelming support in the community for reforms, which is an accomplishment because patients are frequently suspicious of change, and worried their care might be altered by it. I've written extensively on-line, both here and on my blog, about health care. I've been linked to by other bloggers on the subject. And the list goes on and on. And I did all this even though I have Crohn's Disease, an ostomy, and sometimes suffer from random leaks.

              When you've gone through what I've gone through, and you think I'm not doing enough, get back to me. Until then, don't you dare imply that I'm doing nothing other than criticizing the administration. If you had read this diary and all the links in it, you would see that I praised the selection of Tom Daschle when it was announced. But that doesn't fit with your construct of, "Anybody who dares to criticize the administration is a lazy arm chair quarterback who doesn't actually work for anything, so it's OK if they don't get their way."

              Sorry, I already do a lot on health care. And you might want to say that I can do more. But in reality I can't. I have bills to pay, I have my illness to take care of. I worked hard to elect a Congress and administration that will move health care forward. So when a senior official says that maybe states should experiment first--even though all the states are broke and can't afford it--of course I'm going to criticize that. I've been around long enough to know that this is code for, "We can't get to it now, maybe later."

              Sorry, but this can't wait. People die everyday because they don't have access to health insurance. It's kind of a pressing issue...

    •  a diary where you can't use your pom-poms = bad (2+ / 0-)

      diary!

      wow.

      free speech as long as I like it and I approve it and

      it isn't analysis cuz that is complaining which is negative, bitter, angry ... boo hoo.

      rmm.

      Yond Cassius has a lean and hungry look; He thinks too much: such men are dangerous

      by seabos84 on Tue Dec 09, 2008 at 05:38:53 AM PST

      [ Parent ]

  •  Barack Obama wasn't the leader on universal (6+ / 0-)

    care. He just wasn't. There were other Democratic candidates that spoke to this issue: Dennis Kucinich was for single-payer. John Edwards and Hillary Clinton were for mandated insurance enrollment.

    This is one of the reasons I didn't initially support him in the primaries.

    Obama has never said that it was his goal to go immediately for universal healthcare (other than childern). I believe that's his long-term goal, but it's up to us to make it happen. It's not going to happen overnight, and it may never happen if we clear a place for the insurance companies to sit at the table.

    There is a lot of work to be done. Unfortunately Obama has a very full plate to start. Let's give him some time.

    •  He had a different approach (1+ / 0-)
      Recommended by:
      debedb

      But he very clearly argued for making the FEHB available to all Americans at affordable rates, regardless of pre-existing conditions...He was doing this way back in the primaries. Some of us who are deeply suspicious of how insurance companies would handle a mandate (see my comment above) actually thought his lack of a mandate meant that his reform was better than the Edwards/Hillary plan (they were basically the same plans). That's why I supported Obama in the primary over Edwards and Hillary.

  •  Criminy (0+ / 0-)

    Way to over-interpret.

    Calm the hell down.

    •  Hi Steve! (3+ / 0-)
      Recommended by:
      Jagger, debedb, Acugal

      "Trust us," isn't very convincing. We heard that 16 years ago, and look what happened.

    •  Sorry, I couldn't resist the fun (0+ / 0-)

      after yesterday's full-fledged meltdown (me included). While you have a point that the context may be lacking in the article, I think there are still valid concerns, so I am leaving my diary up.

      •  No worries (1+ / 0-)

        Keep the diary up, it's good to keep pressure up.

        However, I think health care is one of those things where the Obama administration's political future nicely coincides with the need for reform, I'm less worried about this than other things.

        And since you know who I am, who're you?

        •  A Crohn's Patient (1+ / 0-)
          Recommended by:
          cameoanne

          Who trudged through snow, rain, cold, up and down big hills from New Hampshire to Virginia for change. Just another person in a sea of people who got fed up and actually did something.

        •  I think that there's only so much that can (1+ / 0-)
          Recommended by:
          cameoanne

          be done. And there is such a big deficit that any truly major overhaul will face a fillbuster in the Senate, even if it can get through the House. And I wonder if the administration will decide to fight on that, or will they move on to something else. If they do the latter, thinking they can come back to it, and lose/reduce majorities in 2 years, then health care reform is dead for another generation.

          I DO think that it'd be politically impossible for many Republicans to oppose a high-risk pool for the chronically ill. In short, give those who are uninsureable the FEHB, have them or their employers pay the rate that healthy people pay, and subsidize the rest. It's not that expensive, and it's hard to oppose patients getting their medicine politically. That would be a dramatic step forward, and something I could live with...even though it comes no where close to what I'd like to see.

  •  I Hope You Find a Way to Health Care (2+ / 0-)
    Recommended by:
    debedb, tobendaro

    I can't help but be surprised, however, that folks are disappointed.

    There is no money. There never was going to be any money for that. It's fiscally impossible. Our economy started collapsing several years ago.

    Health care was discussed during the campaign many times. But how did folks think that was going to happen? The Iraq war isn't even on the budget, and the budget is still bankrupt without even considering those costs.

    On the bright side, the Canadian system started one province at a time. That may be the way it happens, eventually.

    __________________________
    The problems we face today cannot be solved by the minds that created them.

    by Pluto on Mon Dec 08, 2008 at 11:52:01 PM PST

    •  But if we keep spending money on health care (4+ / 0-)
      Recommended by:
      Jagger, Pluto, cameoanne, thebluecrayon

      And keep getting diminishing results, then what? It should be pointed out that the government already spends billions on health care. Surely, there's a way to reduce costs and expand coverage from the current mess. Or are we soon going to hear "Democrats" make the case that we already have universal care--in emergency rooms.

      If Barack Obama didn't want to be held accountable for delivering on his promises, then he shouldn't have made them. Additionally, pawning off health care to the states is patently ridiculous. 49 of them have even less money than the national government.

      Of course, there'd be more money if we taxed the oil companies and if we eliminated the Bush tax cuts for the wealthy right away. People forget that Clinton's initial tax INCREASE is what drove a decade of economic growth...

      •  Both Obama and McCain Proposed... (1+ / 0-)
        Recommended by:
        Creosote

        ...health care plans. And, they both knew there was no money. But, there was hope that something would stop the inevitable explosion of Greenspan's latest bubble. If we had not let Lehman Bros. go bankrupt -- I don't think we would have entered a crisis until 2009.

        But it still would have happened.

        Mexico has very good and affordable health care -- costs 75% less than the US, plus they have national health insurance that Americans can buy very inexpensively, if they establish a residence.

        For the next few years, that's all there is.

        __________________________
        The problems we face today cannot be solved by the minds that created them.

        by Pluto on Tue Dec 09, 2008 at 12:59:27 AM PST

        [ Parent ]

      •  Then what? (1+ / 0-)

        We have a country full of diabetics, people with chronic liver and kidney disease, and a whole host of conditions that are almost completely preventable with appropriate primary care, and nutrition counseling.

        Maybe the rich are just trying to kill us off.

        The kingdom of heaven is spread out upon the earth, and men do not see it.

        by MasonMcD on Wed Dec 10, 2008 at 05:35:52 AM PST

        [ Parent ]

  •  Daschle got ROLLED by Thugs. He was NOT a (0+ / 0-)

    'leader' against the bastards,

    he was just like nancy and harry -

    the head of the pack of sheep.

    maybe, hopefully,

    (I'd pray but I'm a devout atheist)

    he's lying to them to keep them off guard?

    rmm.

    Yond Cassius has a lean and hungry look; He thinks too much: such men are dangerous

    by seabos84 on Tue Dec 09, 2008 at 05:36:30 AM PST

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