With the August recess looming ahead and the Sotomayor hearings no longer grabbing every headline, national and Congressional attention turns to the health care debate. The proposed national health care plan is long, with 1,000+ pages in the House bill and a 35-page summary (PDF). The debate is framed in many ways, including the old standard of universal health care vs. socialism. Cost is another buzzword, sometimes framed as (family) bankruptcy vs. (national) deficit, but also including the complex negotiations that have resulted in widely trumpeted health industry promises to cut some area of costs and to support the bill in exchange for less-publicized favors. A third area of (over)heated rhetoric centers on rationing, which seems to come down to the idea that any way of allocating health care other than “you get what you can afford to pay for” is evil “rationing.”
Who pays? Who benefits?
Both Republicans and Blue Dog Democrats sound the alarm over cost, saying that the nation cannot afford a national health care program. Both rhetoric and reporting have distorted and exaggerated the cost of the plan.
Robert Reich notes that, “Political efforts to buy off Big Pharma, private insurers, and the AMA are all pushing up long-term costs.” Among the contributing factors cited by Reich for cost increases:
The Senate health panel’s bill protects biotech companies from generic competition for 12 years after their drugs go to market, which is guaranteed to keep prices sky high. …
Private insurers, for their part, have become convinced they’ll make more money with a universal mandate accompanied by generous subsidies for families with earnings up to 400 percent of poverty.
Reich points out that any bill has to pass with some provision for payment. His recommendation: a surtax on the wealthiest Americans.
The rationing scare
The more wild-eyed opponents of national health care insist that the government is going to have bureaucrats deciding whether doctors can provide the kind of care they deem necessary for patients. Of course, that system already exists – it’s called private health insurance, and the horror stories abound.
“Comparative effectiveness” research is one of the targets of health care opponents. This research involves side-by-side studies of different medical treatments to determine which work best. Democrats insist that the research will not be used to determine who gets what care:
Sen. Christopher Dodd of Connecticut said the insurance industry already rations health care by limiting payments and denying coverage to people with pre-existing health conditions. Dodd said there is a need for comparative effectiveness research, but quickly added, “I don’t know of anyone that believes for a single second that we ought to be rationing care to the point where we deny benefits to someone.”
Because, of course, there are good reasons to oppose any direction to health care professionals to use the most effective treatment methods?
President Obama and Senator Kennedy
Pushing for passage of a national health care plan before Congress’s August recess, President Obama has stepped up the communication blitz, with statements on July 18 and 20, and more expected at his nationally-televised press conference on Wednesday. Among the recent Obama speeches: a June 15 address to the AMA; a July 20 address to the Children’s National Medical Center; and a nationally-televised press conference coming up on Wednesday night.
On July 20, Obama said:
This isn’t about me. This isn’t about politics. This is about a health care system that is breaking America’s families, breaking America’s businesses, and breaking America’s economy.
And we can’t afford the politics of delay and defeat when it comes to health care. Not this time. Not now. There are too many lives and livelihoods at stake. There are too many families who will be crushed if insurance premiums continue to rise three times as fast as wages. There are too many businesses that will be forced to shed workers, scale back benefits, or drop coverage unless we get spiraling health care costs under control.
On July 18, Obama insisted that:
That’s why any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans – including a public option to increase competition and keep insurance companies honest – and choose what’s best for your family. And that’s why we’ll put an end to the worst practices of the insurance industry: no more yearly caps or lifetime caps; no more denying people care because of pre-existing conditions; and no more dropping people from a plan when they get too sick. No longer will you be without health insurance, even if you lose your job or change jobs.
President Obama’s efforts got a boost from Senator Edward Kennedy this week, when Kennedy’s health care manifesto was published in Newsweek. Kennedy cited his own health problems and the excellent care that he has received:
But quality care shouldn’t depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to. This is the cause of my life. …
For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society. Now the issue has more meaning for me—and more urgency—than ever before. But it’s always been deeply personal, because the importance of health care has been a recurrent lesson throughout most of my 77 years. …
My family has had the care it needed. Other families have not, simply because they could not afford it.
Kennedy acknowledges the frustrations of the decades-long struggle for national health care, and of not being able to pass single-payer health care. But, he says, “If we don’t get every provision right, we can adjust and improve the program next year or in the years to come. What we can’t afford is to wait another generation.”
And in Minnesota
MPR’s UBS Forum featured an hour of conversation with Minnesota health care professionals about the prospects for change. One doctor praised Minnesota’s health care system, citing statistics to show that, “Minnesota is the healthiest nation state in the world,” with France coming in second.
Minnesota’s success could hurt, warned the Minnesota Hospital Association last week, as it voiced objections to the one percent across-the-board reduction in Medicare payments to hospitals agreed to by the American Hospital Association:
“It locks in the inequities that are in the current system, that reward some organizations that are providing lesser quality care at higher cost. And we just don’t think that’s right,” he said.
Congressmember Betty McCollum predicted Monday that the health care plan will pass, but also said the bill must address inequities that “penalize Minnesota and other high-quality, low-cost states.”
As for the rest of the Minnesota delegation: Senator Al Franken backs the plan, Senator Amy Klobuchar is on the fence. Republican representatives, joined by Blue Dog Dem Collin Peterson, have opposed the plan, though Peterson’s name was missing from the most recent Blue Dog attack on the plan. Democrats Keith Ellison, Betty McCollum, James Oberstar and Tim Walz are counted as supporters, even if they think it less than perfect. Ellison, for example, like Senator Ted Kennedy and many Minnesotans, backs a single-payer national health care option, but that’s not on the table. Oberstar is counted as a supporter, but “says he’d vote against it if it pays for abortion services.”
Constituents and lobbyists will be burning up the phone lines in the next few weeks. Here are the phone numbers:
Senator Amy Klobuchar phone 202-224-3244 fax 202-228-2186 http://klobuchar.senate.gov
Senator Al Franken phone 202-224-5641 fax 202-244-1152 http://franken.senate.gov
Representative Tim Walz phone 202-225-2472 fax 202-225-3433 http://walz.house.gov
Representative John Kline phone (202) 225-2271 fax (202) 225-2595 http://kline.house.gov
Representative Erik Paulsen phone (202) 225-2871 fax (202) 225-6351 http://paulsen.house.gov
Representative Betty McCollum phone: (202) 225-6631 fax: (202) 225-1968 http://mccollum.house.gov
Representative Keith Ellison phone 202-225-4755 fax 202-225-4886 http://ellison.house.gov
Representative Michele Bachmann phone (202) 225-2331 fax (202) 225-6475 http://bachmann.house.gov/
Representative Collin Peterson phone (202) 225-2165 fax (202) 225-1593 http://collinpeterson.hous.gov
Representative Jim Oberstar phone (202) 225-6211 fax (202) 225-0699 http://oberstar.house.gov