A lot of people watched yesterday's town hall meeting with elation, indeed, Obama is a great orator, but as somebody who has been lied to a lot in my life, I know the signs of a speaker trying to draw out the length of a response, in the hopes of evading some anticipated, but yet unasked question. If I could have asked Obama a question yesterday, it would have been this. AFFORDABILITY. Why isn't the administration tracking and publishing a comprehensive analysis from the end user's viewpoint, of affordability - those damn COSTS. And the other pros and cons.. ALL OF THEM.
Of course, the bureaucrats and politicos already have an answer to this, they will claim that "its impossible" to give us any idea of premium costs, etc, because "every situation is different".
Well, I have an answer to them. THATS NOT TRUE...
Sure, in many countries, with single payer, people know in advance what their out of pocket cost is going to be for health care, its because its always the same, its often free, paid for by modest, progressive taxes, not by user fees, to the end user. Or, in places like Holland, its a fee paid by everybody.. (there, its around $160/month)
We need the specifics..we need to explore the plans, and ask the cost questions, under a wide variety of typical and untypical situations, and we need to know the answers BEFORE we make these decisions, BEFORE we support the various plans. After all, they may not help US, at all. Or they may, but not enough to make them feasible for us to BUY.
We can already get a good idea of how much single payer would cost, other countries have had a lot of experience with it. It saves a lot of money all around.
(Note: We are supposedly intelligent animals, right? Well, adaptability and flexibility are survival traits.. The administration is not being flexible and they are trying to conceal that by accusing others of it! Ha ha... Well, they aren't fooling anybody. THEY need to realize that since single payer works, and its known to work, IT is basically what we must fall back on if the other approaches fail to.. In order to be considered, other plans really do need to clearly exceed single payer in an open, fully transparent competition, a level playing field, on their ability to meet our affordability and universality goals.
Those are our goals, arent they?
Uh oh... BIG Problem... Guess what? Some of the folks behind the scenes clearly have OTHER goals that they don't want to discuss. For example, they may feel threatened by true affordable healthcare for all, for some reason they dont want to discuss..
You know, there are a lot of these ugly hidden reasons..
Id prefer not to discuss them but we need to.. maybe because they don't like the idea of "their" employees not having to think about health insurance in making their job decisions.... But that is a problem, because wages have been almost flat for over 20 years.. and people cant afford the healthcare they have now.. its not enough to slow the rate they are rising, they have to go way down.. OR people will keep dying...
Some others may not want workers to be able to go to the doctor without fear when they have work related injuries, especially chemical exposures, as its been shown that those exposures can cause significant injuries, and they don't want to pay the true cost of them, (currently, many interests are receiving, in not so obvious ways, what is in effect a highly profitable subsidy to continue unsafe practices at the expense of their workers health.)
There is no doubt about it, when a nation gets real universal healthcare its health improves because people can go to the doctor when they get sick. Period.
When people are no longer afraid or unable to go to the doctor - they are freed of fear of unexpected, uncovered costs.
They are freed of the fear of becoming uninsurable, they are freed of the fear of sudden disruptions, care improves, people's lives improve, the whole economy improves, and many practices that negatively impact the poor and middle class, health wise, change.
If people have hidden goals, they need to figure out a way to honestly argue for including them.
Out in the open. Because we, as a nation, will be paying for them.
We need to get these hidden goals out in the open, and if they wont discuss them - to hell with them..
We need to say, sorry.. if you want "THAT" and thats SO important that you think we need to adopt your plan because of it, because of your goal, you want us to prevent a whole nation from having real affordable healthcare, its just not going to happen.
YOU JOLLY WELL BETTER GET OUT THERE AND ARGUE YOUR CASE FOR IT LIKE A MAN (or woman) if you think its that important.
We can't let the special interests prevent the change we need for secret reasons..
We need to get the pros and cons of each approach out on the table and out of the smoke filled rooms..
If there is a reservation, thats a consideration, it needs to get out there into the light of day. We need to ALL be at the table, and we need to put those issues OUT ON THE TABLE..
If somebody is going to carve up our futures, we deserve a say in it.
We need to put the proposals, single payers, private plans, public options, private options, do nothings all side by side.
When we know how much they all cost, and to who, and what they give us in strengths and weaknesses in other areas, the tangibles and intangibles,we will be far better able to decide what approach is best. We know that single payer covers people with an assurance that there wont be big uncovered costs. But, with public option, and new private insurance plans, in each plan how would uncovered costs be limited, and at what level. Or, will they be limited at all.
We need to create a forum for running standardized simulations, and try to make those simulations as accurate as we can, for all alternatives..
What we need is to create a spectrum - at least twenty or thirty, or more, hypothetical people, "use cases" in software lingo - with a realistic, wide range of different, both typical, and atypical health needs, taking care to make those cases contain as many examples of people who the current system fails, as possible..
Then, we should take each new proposal and each change that is proposed in committee, and parse it to extract its impacts, especially the most important pieces of information necessary to its success or failure, how it plays out- cost and benefit wise for people.
THAT is what we should be doing during the August break period, designing a transparent process by which ALL health care proposals, from both sides of the aisle, can be evaluated, in practical terms, on a level playing field.
Sort of like a scoring system for healthcare changes, a level playing field.
We would take these proposals, these many use cases, and then analyze the cost for Americans of each aspect. We would do it on a web site, with (and the user community would be able then, to set up parallel structures to critique the proposals based on the main web sites content)
All terms that people didn't understand, could be defined, in an information rich environment (a web site would be the best way to make all this information publicly viewable.) Ideally, there should also be a way that people could discuss - in uncensored but civilized manner the pros and cons..
There could be a section for lobbyists, and a section for corporations, and a section for politicians, and a prohibition against "people" (as corporations are considered people) posting in sections that were not the appropriate ones- (for example, lobbyists could make their cases on issues in the lobbyists area, not pose as patients/citizens.)
Using this mandatory and fair evaluation process, we would gain from a FAR more open and transparent health reform process. By using a sufficient number of appropriate patient use cases we would hopefully avoid hidden pitfalls and dramatically improve our chances of ending up with acceptable health reform, one that was affordable for all and which dramatically improved measures of health and access, and restore the financial security that Americans once enjoyed before the blight of skyrocketing healthcare costs attacked our futures.
How to do use cases.. Look at the software development examples..
This way, we can and WILL address the need for specifics, we will know how the changes play out.. for example, we will know how many families are impacted by changing a subsidy cutoff point or level.. we will know why people will or wont be able to afford a plan if they have a certain cronic health issue..
we will know why...
Now, nobody has an excuse to not supply them. Any politician who is unwilling to put the time and ennergy to defend their proposal in a public forum, with mutually agreed upon use cases, is trying to hide something.
If we let them get away with that, and then can't afford the outcome, we have been very stupid