Before I get started, I'd like to first quote from Robert Reich's Blog since I agree with him -- the current "mandate" nonsense is absolutely counter-productive.
(Reich continues...)
Despite some skirmishing over whose subsidies are most generous, the subsidies are about the same. The major Democratic plans would spend nearly an identical amount of money helping low- and middle-income families because they rely on the same source of general revenue, derived from allowing the Bush tax cuts to expire. Given the myriad ways universal health insurance might otherwise be organized -- single payer, employer mandate, health-insurance vouchers, tax credits -- this Democratic consensus is striking. It also highlights the abject failure of Republicans to come up with any coherent plan.
Take a closer look and even the candidates' positions on mandates aren't all that different. John Edwards has proposed to automatically enroll people in health insurance on their tax returns, but has said this mandate won't apply until premiums are affordable. Hillary Clinton says she favors mandates, but isn't sure there should be a penalty for noncompliance. Barack Obama favors an immediate mandate for children, but doesn't include one for adults. He says he's willing to revisit the issue after making health insurance more affordable and enrollment easier, and is also considering an automatic enrollment with an opt-out for those who don't want to be included.
As a practical matter, the difference between Sen. Clinton's and Sen. Obama's approaches come down to timing and sequencing. Mrs. Clinton wants a mandate first, believing that enrolling the younger and healthier will help reduce costs for everyone else. Mr. Obama thinks forcing people to buy health insurance before it's affordable isn't realistic. He wants to lower health costs first, and is willing to consider a mandate only if necessary.
Depending on who you talk to, we're talking about 2-3% of the population that might fall through the cracks with either Barack Obama or Hillary Clinton's program. I know this is crass, but that 2-3% is the sampling error in our current predicament. Frankly, if we're even close to our goals, it'll be an absolutely huge accomplishment. Let's focus on the 97% first? We can always come back later and make things mandatory if it turns out that people are evading the system. For now, we've got a big enough mountain to climb; we can debate how to reach the last 2-3% once we're at 95% coverage here in the United States. Right now I'm more concerned about the "bootstrap details", how our candidates will address and overcome the political, social, and yes, technical barriers to change.
So, for this diary, I'd like to explain why Barak Obama's health-care plan is not just a bunch of words and policy posturing, but an actual recipe for success.
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The Vision
Quality, Affordable and Portable Coverage for All
Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress. The Obama plan will have the following features:
1. Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions
[note: I've talked to saffers at Obama for America, and there is not a restriction on which companies can participate]
2. Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.
3. Affordable premiums, co-pays and deductibles.
4. Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
5. Simplified paperwork and reined in health costs.
6. Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
7. Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage.
8. Quality and efficiency. Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology and administration are being met.
9. [note: I've talked to saffers at Obama for America, and this refers to a single-payer federally administered program, not some sort of Republican Medicare-D private insurance patchwork nightmare.]
I'm the lead software architect in a small health care software development outfit. Our work is entirely open source software (aka completely free, with no lock-in). We are dedicated to increasing the quality and lowering the cost of medical research. After Dean's loss in 2004, I withdrew from political involvement and got back to heads-down coding (with the exception of a few plugs for verified voting). This all changed last year when I was reading Lessig's Law/Technology Blog, to my surprise, he was actually excited about a candidate who he endorsed as being, as far as politicians go, technologically gifted. And Lawrence was correct, I had never seen a politician include a technology plan that directly talked about how to Create a Transparent and Connected Democracy, among other things. As Robert Reich says:
I’m also impressed by the up-front investments in information technology in Obama’s plan, and the reinsurance mechanism for coping with the costs of catastrophic illness. HRC is far less specific on both counts. In short: They’re both advances, but O’s is the better of the two.
In the last debate both Hillary and Barack mentioned two ways that this new health care initiative will be funded: additional taxes, and dramatic improvements in technology. This should not be taken lightly. Good technology just doesn't happen, it is deliberately nurtured with the correct legal, social and political framework. The majority of technology plans fail to varying degrees, perhaps only 20% of them meet or exceed initial expectations, another 40% are functional but way over budget or are delivered much later than expected, and the final 40% are simply write-offs: complete and utter failure with enormous costs and psychological impact -- people stop to believe. So, what is truly at stake here isn't just political failure, even if we pass the bills and get the public support, there is a vast amount of technical work to turn this dream into a reality. Even a few mis-steps, and we could tarnish the vision of single-payer (the ultimate in cost reduction) for at least another generation.
I support Barak Obama, not for his policy (Clinton's is acceptable), but more since I personally believe he will provide the political environment that will best support this goal.
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Public Involvement, Early and Often
When Obama says that he'll put the health-care debates and up on C-SPAN, I believe him. This isn't just a talking point, it's a central part of his belief in open government. To quote from his
transparent democracy section of his technology plan:
Barack Obama will use the most current technological tools available to make government less beholden to special interest groups and lobbyists and promote citizen participation in government decision-making. Obama will integrate citizens into the actual business of government by:
1. Making government data available online in universally accessible formats to allow citizens to make use of that data to comment, derive value, and take action in their own communities. Greater access to environmental data, for example, will help citizens learn about pollution in their communities, provide information about local conditions back to government and empower people to protect themselves.
2. Establishing pilot programs to open up government decision-making and involve the public in the work of agencies, not simply by soliciting opinions, but by tapping into the vast and distributed expertise of the American citizenry to help government make more informed decisions.
3. Requiring his appointees who lead Executive Branch departments and rulemaking agencies to conduct the significant business of the agency in public, so that any citizen can watch a live feed on the Internet as the agencies debate and deliberate the issues that affect American society. He will ensure that these proceedings are archived for all Americans to review, discuss and respond. He will require his appointees to employ all the technological tools available to allow citizens not just to observe, but also to participate and be heard in these meetings.
4. Restoring the basic principle that government decisions should be based on the best-available, scientifically-valid evidence and not on the ideological predispositions of agency officials.
5. Lifting the veil from secret deals in Washington with a web site, a search engine, and other web tools that enable citizens easily to track online federal grants, contracts, earmarks, and lobbyist contacts with government officials.
6. Giving the American public an opportunity to review and comment on the White House website for five days before signing any non-emergency legislation.
7. Bringing democracy and policy deliberations directly to the people by requiring his Cabinet officials to have periodic national online town hall meetings to answer questions and discuss issues before their agencies.
8. Employing technologies, including blogs, wikis and social networking tools, to modernize internal, cross-agency, and public communication and information sharing to improve government decision-making.
This promise is, frankly, earth-shattering to me. It is exactly what we need -- and, realistically, it is the only way that a very large, ambitious program like this health-care initiative will make it. Active involvement by consumers and technologists is absolutely a critical component of a technology-based health-care revolution; we have to connect consumers and health-care practitioners with those who are defining and building the system. Our country is large and diverse, with hundreds of legal jurisdictions, thousands of hospitals, and millions of providers. Getting us all on the same page is a massive effort, and will only succeed if the process is open.
On a personal level, I'll be writing the code that integrates with this insurance system -- tracking medical history, billing information, and all sorts of pesky details. I will be much more successful in making your healthcare sytem work smoothly if the system is specified out in the open. Closed systems are notoriously faulty not only in scope, goals and also in implementation. Please, help me help you by making the process open.
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Privacy, Confidentiality, and Trust
Although I think Barack Obama's administration could focus more on privacy, their technology plan contains a good start -- at least they are thinking of the issues:
Safeguard our Right to Privacy
The open information platforms of the 21st century can also tempt institutions to violate the privacy of citizens. Dramatic increases in computing power, decreases in storage costs and huge flows of information that characterize the digital age bring enormous benefits, but also create risk of abuse. We need sensible safeguards that protect privacy in this dynamic new world. As president, Barack Obama will strengthen privacy protections for the digital age and will harness the power of technology to hold government and business accountable for violations of personal privacy.
1. To ensure that powerful databases containing information on Americans that are necessary tools in the fight against terrorism are not misused for other purposes, Barack Obama supports restrictions on how information may be used and technology safeguards to verify how the information has actually been used.
2. Obama supports updating surveillance laws and ensuring that law enforcement investigations and intelligence-gathering relating to U.S. citizens are done only under the rule of law.
3. Obama will also work to provide robust protection against misuses of particularly sensitive kinds of information, such as e-health records and location data that do not fit comfortably within sector-specific privacy laws.
4. Obama will increase the Federal Trade Commission’s enforcement budget and will step up international cooperation to track down cyber-criminals so that U.S. law enforcement can better prevent and punish spam, spyware, telemarketing and phishing intrusions into the privacy of American homes and computers.
While functionality and efficiency is very important to a health care system, a very important consideration is confidentiality. With the prevalence of genetic testing and digitized medical records, the sheer opportunity for and damage that could be done by mischief is enormous. Regulations like HIPPA need to be improved, to loosen restrictions where they prevent medical research, and to tighten them when the identity of a patient could be compromised. Sloppy design and implementation is commonplace, and it will take a true dedication, from the top down, to privacy for a system like this to value people's privacy, and gain their trust.
If a health care system isn't trusted, it won't be used or the information in it will be incorrect, or direct mis-information provided by patients.
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Adequate Funding, Investment
Obama seems to understand that this will cost money, and this is a relief. One of the hard aspects of building information systems for the medical market is open competition for grants. I believe From his proposal:
A key feature of Barack Obama’s health care plan is the use of technology to lower the cost of health care. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. Barack Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Obama will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Obama will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies. Obama will make the Veterans Health Administration, the nation’s largest integrated health system, a model in the use of technology to modernize and improve health care delivery. To ensure that veterans get the best care possible, he will improve electronic records interoperability between the Pentagon and VA, expand effectiveness research, promote wellness programs, and use technology to improve the accountability for performance and quality.
Besides technology funding, he's promising more money for NIH, to bring more, and lower-cost health care solutions to the marketplace.
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Leadership and Integration
Too often governmental departments have their own, typically disconnected technology groups, who re-discover the same solutions individually at high cost. Obama is proposing a new IT leadership group in Government that will span departments. While it seems trivial, and obvious, it will probably have a broad impact on the effectiveness of our health-care and patient medical record sharing.
Bring Government into the 21st Century:
Barack Obama will use technology to reform government and improve the exchange of information between the federal government and citizens while ensuring the security of our networks. Obama believes in the American people and in their intelligence, expertise, and ability and willingness to give and to give back to make government work better.
1. Obama will appoint the nation’s first Chief Technology Officer (CTO) to ensure that our government and all its agencies have the right infrastructure, policies and services for the 21st century. The CTO will ensure the safety of our networks and will lead an interagency effort, working with chief technology and chief information officers of each of the federal agencies, to ensure that they use best-in-class technologies and share best practices.
2. The CTO will have a specific focus on transparency, by ensuring that each arm of the federal government makes its records open and accessible as the E-Government Act requires. The CTO will also focus on using new technologies to solicit and receive information back from citizens to improve the functioning of democratic government.
3. The CTO will also ensure technological interoperability of key government functions. For example, the Chief Technology Officer will oversee the development of a national, interoperable wireless network for local, state and federal first responders as the 9/11 commission recommended. This will ensure that fire officials, police officers and EMTs from different jurisdictions have the ability to communicate with each other during a crisis and we do not have a repeat of the failure to deliver critical public services that occurred in the aftermath of Hurricane Katrina.
4. In the 21st century, our economic success will depend not only on economic analysis but also on technological sophistication and direct experience in this powerful engine of our economy. In an Obama administration, the government’s economic policy-making organizations and councils will include individuals with backgrounds in our technology industry.
If work on a secure, reliable, and responsive government computer network is done in parallel to a medical records initiative, it will speed and dramatically improve the likelyhood of a successful single-payer universal health care deployment and adoption.
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A Coda
I'd like to end by discussing the end-goal, a single-payer system. Let's not get caught-up and squabble with how fast we're going to get to our shared objective. What's important is that we map out a road, and start walking. When 40, 50, or 60% of an area's population is using this federal insurance plan, local practitioners will have an opportunity to reduce their paperwork burden substantially -- they can simply put up a sign: "U.S Federal Healthcare or CASH ONLY". When you start to see these signs, the marketplace itself will force single-payer -- there will be no need to legislate it.
What what we should be doing now is looking for leadership that will provide has the vision, the openness, the trust, the funding, and the leadership to make it happen. No More Talk.
YES WE CAN!
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Edit: Due to valid remarks in the thread I've renamed the diary from "BREAKING: Obama Proposes Universal Health Program" to "Obama: Towards a Single-Payer Health Program". I also wanted to point out an excellent link by Tuscany: PNHP's Single Payer resource. How do we get there, from here?
