Everything first!

Hmmmm.

but someone who actually knows what he's talking about on the issue says Obama will push hard to get it done right out of the gate.

Kennedy knows about health care. Kennedy doesn't know about Obama's plans for January 21st. By making these particular statements, he's not necessarily revealing that Obama is going to make health care a priority, but rather that he, Kennedy, thinks (translate: HOPES) that Obama will make it a priority.

i can't see videos at work. how does Kennedy look?

This is wonderful news! And the wishes of a dying man are so powerful.... It will give this a boost like nothing else!

Thank you, Senator Kennedy, for this great gift! May your endorsement of health care now come to fruition. May health care for all become your legacy and your memorial, if need be.

"a dying man"? maybe......maybe not so fast, K?

I must say, amidst all this renewed Cliton talk having Kennedy back on the hill is a relief and brihgs focus back to the issues.

By the way, I'm sure most of you are aware of the now published GQ feature Ted wrote reflecting on Obama candidacy.

Fear of the economic crisis has led many to suggest that ambitious proposals for change need to be scaled back. I say not quite...

In the case of health care, the crisis may have an unexpected effect. It may allow Obama move beyond his modest proposals to something far more comprehensive.

Obama’s existing health care proposals argue for tightly regulating insurance companies, expanding employer-based health insurance, and opening the Federal employee health program to all. But by even the most optimistic estimates this complex plan will lead to coverage of only about 50% of the uninsured and will entail a cost of up to $1 trillion over the next ten years. In a world of $700 billion dollar bailouts, this may not sound like much, but in an economic environment where need is widespread, alternatives should be considered.

As recently as August the President-elect offered his own support for an alternative. “If I were designing a system from scratch,” he offered, “I would probably go ahead with a single-payer system.” The rationale for this idea is simple. The current private insurance based health care system has become a bureaucratic nightmare of buck-passing and profiteering. It is rife with waste that has nothing to do with providing quality comprehensive health care. Eliminate the source of that waste and spend it on health care.

Now, only some 65% of private health insurance premiums are spent on health care. Instead, insurance company executives earn hundreds of millions of dollars while corporate marketing departments spend fortunes selling insurance to the healthy just as their utilization departments resist paying for the care of those who become ill.

On the other hand, Medicare, with centralized funding and near universal enrollment of the population it serves, provides better quality care and higher satisfaction at a substantially lower cost than the private health system. Medicare’s bureaucracy takes up only 3% of its funding. No surprise as there are no resources spent on avoiding care for the sick, marketing, investor relations, or corporate profits.

The economic crisis offers the new President the opportunity most other reformers have not had—the chance to begin from scratch. The American people have voiced an overwhelming desire for change. We have come to understand that business as usual isn’t always good business and that the business models that private systems create don’t always work in the public interest. Perhaps most importantly, however, the economic crisis has sensitized us to the need to pay attention to our money.

As a doctor in the trenches of primary care, I can see no other way forward. For my well-insured patients, a switch to Medicare for all will hardly alter the face of the health care system they currently experience. But it will reduce everyone’s level of economic and health insecurity. None will need to worry if something is covered. There will be no more clinging to unsatisfactory jobs simply to keep insured. The process of paying for care will be simplified.

This is not socialized medicine, but a plan for public finance of our diversified private health care delivery system. An improved Medicare for all offers relief from the waste in the bureaucratic private health care system. It can eliminate a multitude of public and private programs which currently pay for segmented components of health care, eliminate the distinction between health care for the poor and for the rich, and reduce the confusion, waste, and annoyance which providers and patients face in dealing with the 1300 health insurance companies which litter the existing health care landscape

Politics, and political change, has been described as the art of the possible. Remarkably, the crises we face have made the seemingly impossible happen. We have a new President, a man who has inspired our hope. For our health let us begin from scratch. Let crisis and hope lead to real change.

Copyright November 5, 2008
Aaron Roland is a practicing family physician and clinical associate professor at U.C.S.F.