As I understand it, the GOP has recently presented Pres Obama with a list of requests that they would like him to agree to, so that a new bipartisan debate can begin. The list is below. Personally, I think we have nothing to lose and everything to gain from accepting.
- "Assuming the President is sincere about moving forward on health care in a bipartisan way, does that mean he will agree to start over?"
- "Does that mean he has taken off the table the idea of relying solely on Democratic votes and jamming through health care reform by way of reconciliation?"
- "If the President intends to present any kind of legislative proposal at this discussion, will he make it available to members of Congress and the American people at least 72 hours beforehand?" (should be law, and the time period should be even longer)
- "Will the President include in this discussion congressional Democrats who have opposed the House and Senate health care bills?"
- "Will the President be inviting officials and lawmakers from the states to participate in this discussion?"
- "The President has also mentioned his commitment to have 'experts' participate in health care discussions....(Obviously, not his own Secretary of Health and Human Services, though)
Will those experts include the actuaries at the Center for Medicare and Medicaid Services (CMS), who have determined that the both the House and Senate health care bill raise costs?" (He should also invite experts like Harvard's William Hsiao who helped Taiwan successfully transition to single payer)
- "Will the special interest groups that the Obama Administration has cut deals with be included in this televised discussion?" (All deals should be made void and a true fresh start should e made that does not result in Americans still paying several times what citizens of other nations pay for drugs)
- "Will the President require that any and all future health care discussions, including those held on Capitol Hill, [be televised]?" (That should be required by law)
Now, the 800 lb gorilla in the room is affordability. We absolutely cannot achieve affordability at a high level or even acceptable level of quality without single payer. WE are wasting more than half of the non-government healthcare dollars we spend on insurers, brokers, and billing the insurers, which is an ordeal for providers, and very costly) More than half. Any plan that exists alongside of insurers basically cannot achieve real savings because of that waste's being preserved for the majority.
Ezra Klein suggests that Obama accept, completely on the condition that the legislation be voted on cleanly, without the usual GOP procedural tactics and filibustering. I think that is an excellent tit for tat. This will let everyone save face, and we could end up with a good system, (Many experts on single payer think the US is very well positioned to transform into a world class single payer system because we are younger than many other nations- plus, it would solve all the Medicare problems.. it would solve all the problems..)
HOWEVER the legislators just need a way to claim it was out of their control to their real bosses.
It amazes me that so many people here make it a point of ignoring the most basic facts about insurance and the way it is financed, and especially, ignore the huge lessons from the out of control cost increases in Massachusetts.
The private insurance first, public interest secondary approach that the Dems have tied themselves to is legally higtied. It is doomed to continue increasing in price relative to other nations that negotiate prices directly, and there is every reason to believe that this will necessitate the dumping of the entire thing very soon. Premiums and drug prices, particularly in Massachusetts, have been rising uncontrollably.
Single payer is the only acceptable answer, for both left and right.
Here are some papers from PNHP.. there are many more at the above URL.
- Administrative costs consume 31 percent of US health spending, most of it unnecessary.
(Woolhandler, et al "Costs of Health Administration in the U.S. and Canada," NEJM 349(8) Sept. 21, 2003)
- Medical bills contribute to half of all personal bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick or injured.
("Illness and Injury as Contributors to Bankruptcy," Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.)
- Taxes already pay for more than 60 percent of US health spending
Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.
(Woolhandler, et al. "Paying for National Health Insurance — And Not Getting It," Health Affairs 21(4); July / Aug. 2002)
- Despite spending far less per capita for health care, Canadians are healthier and have better measures of access to health care than Americans.
(Lasser et al. "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey," American Journal of Public Health; July 2006, Vol 96, No. 7)
- Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is "privately financed" (60 percent is paid by taxes and the remaining 20 percent is out-of-pocket payments).
(Carrasquillo et al. "A Reappraisal of Private Employers’ Role in Providing Health Insurance," NEJM 340:109-114; January 14, 1999)
- For-profit, investor-owned hospitals (link 11, 22, 33, & 44), HMOs5 and nursing homes6 have higher costs and score lower on most measures of quality than their non-profit counterparts.
1. Editorial by David Himmelstein, MD and Steffie Woolhandler, MD in the Canadian Medical Association Journal
2. Devereaux, PJ "Payments at For-Profit and Non-Profit Hospitals," Can. Med. Assoc. J., Jun 2004; 170
3. Devereaux, PJ "Mortality Rates of For-Profit and Non-Profit Hospitals," Can. Med. Assoc. J, May 2002; 166
4. Himmelstein, et al "Costs of Care and Admin. At For-Profit and Other Hospitals in the U.S." NEJM 336, 1997
5. Himmelstein, et al "Quality of Care at Investor-Owned vs. Not-for-Profit HMOs" JAMA 282(2); July 14, 1999
6. Harrington et al, "Himmelstein, et al "Quality of Care at Investor-Owned vs. Not-for-Profit HMOs" JAMA 282(2); July 14, 1999," American Journal of Public Health; Vol 91, No. 9, September 2001
- Immigrants1 and emergency department visits2 by the uninsured are not the cause of high and rising health care costs.
1. Mohanty et al. "Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis," American Journal of Public Health; Vol 95, No. 8, August 2005
2. Tyrance et al. "US Emergency Department Costs: No Emergency," American Journal of Public Health; Vol 86, No. 11, November 1996