Wyden Predicts 65-70 Votes For Broad Health Reform
To Sen. Ron Wyden (D-OR), health care reform is the great "unrequited love" of progressives. "It goes back to Harry Truman," he told me during a sit-down interview today. "Every 15 years or so, there's an effort to fix health care. Every time, progressives have said, 'This is the moment, my dream of universal health care will be achieved!' ... Something goes wrong, and it goes by the boards."
His realistic assessment of health care's progress during the past half-century made his prediction for 2009 all the more remarkable: Wyden believes there is "a real path to 65 to 70 votes" in the Senate for a health bill that gives all Americans access to "good-quality, affordable coverage".
In fact, he added, major health reform could receive a vote in Congress by the summer. So is it really time for progressives to start believing in love again? Or should we heed Rep. Pete Stark (D-CA), another influential lawmaker on health care, when he says health care should wait until next year?
Wyden made his case cogently. Health care is an intensely complicated issue, he explained, but "Barack Obama's strength is walking the country through the choices" -- a public-relations mission the president-elect is executing with success on the stimulus bill.
And Wyden has another new year's resolution to keep health care legislation from imploding: stick to the committee process. Unlike the so-called 2007 "grand bargain" on immigration, which went down in flames when negotiators defected from the pieced-together bill, the health care package Wyden envisions would be shepherded by two powerful chairman, Max Baucus (D-MT) of the Senate Finance Committee and Ted Kennedy (D-MA) of the Senate health committee.
Early reports from the Capitol have depicted Baucus and Kennedy as potential rivals on strategy and process, quoting Kennedy's camp as focused on a single reform bill while Baucus leaves room for two separate bills. But to hear Wyden tell it, the two old bulls are ready to agree on four principles:
1. "You've got to cover everybody."
2. "You've got to have a new insurance model," one that does not entice insurers to shed risk by refusing coverage.
3. Diminishing inefficiency in health care by promoting health IT and other cost-saving goals.
4. Emphasizing prevention.
As for points of disagreement between Baucus and Kennedy, Wyden mentioned one biggie: the tax code. The Wonk Room, affiliated with the Center for American Progress Action Fund, has pointed to two tax proposals in Baucus' recent health reform plan: limiting the amount of health insurance premiums that can be deducted from wages, and structuring the deduction to benefit lower-income people. This doesn't sound like something that Kennedy would be opposed to out of hand, but we should know more soon ...
2. "You've got to have a new insurance model," one that entices insurers to shed risk by refusing coverage.
I assume there's a typo or a word left out here. Should be something like "does not entice...."
January 12, 2009 5:56 PM | Reply | Permalink
Strange. This is what I see on Option #2 above:
January 13, 2009 8:47 AM | Reply | Permalink
I don't care how they do it, but health care reform has to happen THIS Congress.
Shoehorn it in any damned way they can, and fix it later, if necessary. But it MUST happen, somehow.
Fuck it, I say let's play a little shock-doctrine politics and economics of our own, for a change.
It is TIME.
January 13, 2009 12:00 AM | Reply | Permalink
Thinking about universal health care, I'm always reminded of the Woody Allen joke in which one person says something like, "The food is just terrible here!" And the other responds, "Yes. And the portions are so small!"
Do we really want to make sure everyone gets a portion of the ridiculously expensive slop currently on the menu? Or would we rather fire the chef and shop for some fresher and more healthful ingredients?
Fortunately, in my life, I've been able to afford health insurance. I say “fortunately” though only because it’s comforting to know I have the ability to get treatment, if really, really need it. Like, for example, one time I had to see a doctor because I was in agonizing pain for weeks and my foot was hanging from my ankle like a limp fish. Through magnetic resonance imaging, it was determined that I had a ruptured disk, which was useful to know. But certainly, I dread the thought of ever needing to go again. And it’s not just the illness itself that scares me.
To me, the thought of having treatment meted out by the current, profit-based system is even more horrifying than having to rely on a "government run" system - as some people seem to insist on calling it. If it were up to me, I would call it a single payer system "patient run." We’re all potential patients, after all, and share a common interest in the availability of good and necessary treatment. And if we really wanted to, we could construct a system that would, at least, have the health of the patient as its primary goal, even if it could never be completely perfect.
The point is that there seems to be an unwarranted assumption that the only major flaw in the current private insurance based health system is its lack of universality. It seems to me, however, that the problem is much more fundamental. Moving from Woody Allen to my mother: "If you want to make really delicious soup, the first thing you have to put into the pot, is lots of good will." But where is the good will in a health care system that’s based almost entirely on the profit motive? One the one hand, there's the cost-conscious insurance company, trying to spend as little money as possible on your treatment, and entirely uninterested in your well-being. And on the other hand there are the hospitals and physicians, at least some of whom, may also be motivated by maximizing their own profits through surgeries, procedures and tests du jour.
Did I really need back surgery, or would I have been better off lying flat on my back for a couple of weeks? I still wonder, but will never really know. And, by the way, are there really cancer drugs that are worth $50,000 a year, as I just read in a recent newspaper article. Or are some very greedy drug companies, in effect, praying on sickness and desperation in pursuit of unjust profits?
Before we all decide to pay for something that’s going to consume a good portion of our nation’s resources, it seems to me that we should assume some control over what that something is and also ensure that we have some say as to how much we will or will not pay - before we are faced with no choice because of illness or injury. The only real way we can do this is by implementing a single payer health care system that has good will, rather than the profit motive, as its first and most important ingredient.
January 13, 2009 1:01 AM | Reply | Permalink
I agree with you, but it's also an unfortunate reality that single payer is not going to be enacted this year or next.
To my mind, this makes it absolutely essential that whatever health care reform bill is enacted includes a government run, Medicare-style coverage option that is available to all Americans.
This will provide a direct path to single payer if problems emerge in the implementation of health care reform. Moreover, it will give everyone the option of bypassing the scumbag private insurers and getting coverage from the government right away. And it will force the private insurance companies to change their practices or get out of the business.
It is already clear that this will be the central battle waged by the insurance industry. They have indicated a willingness to accept a tradeoff whereby they will be prohibited from denying coverage to anyone if health insurance becomes a mandate. What they desperately don't want to do is compete with a government-run program that is more efficient, has much lower administrative costs, and no profit motive. That is why they must be defeated.
January 13, 2009 9:03 AM | Reply | Permalink
Max Baucus opposes the public option as a competitive player, and only wants it limited to the elderly, disabled, and the low-income. It's in his white paper which he released.
January 13, 2009 9:32 AM | Reply | Permalink
That sucks. Given that it's Baucus, though, it doesn't surprise me.
January 13, 2009 9:34 AM | Reply | Permalink
Europeans have no problems with socialized medicine. They're taxed for it and everyone gets the same service regardless of income. One can purchase additional insurance for better coverage, especially hospital rooms, service and such, but most people rely on the basic service which is quite adequate for preventive needs.
The US is well known for its cutting-edge use of technology and its reflected in the costs for service. That's where the for-profit angle makes its buck. And that's why so many people are without health insurance - too expensive for out-of-pocket expenses to be reimbursed later after a co-pay and limiting costs for procedures as well as a yearly finite sum for services received. My yearly dental plan allows for $1500 services a year. Anything above that is out-of-pocket - check out the cost of a bridge.
The big question is how to provide effective preventive care at reasonable costs that anyone could afford at any income level while making the effort profitable for the hospitals.
One way would be to levy a tax based on income, much like social security. The trick is how to tax individuals and families so that one group isn't bearing more responsibility than the other. How does one tax an individual or couple without children versus a family of 2 adults and 4 children? Last thing I would want see is individuals being taxed, like property taxes to support schools, when the person is single without dependents. But families would complain they're spending too much disposable income for medical coverage. See how tricky it can get?
January 13, 2009 9:09 AM | Reply | Permalink
And another thing - isn't the thought of having everyone's entire health record on a computer somewhere just a little bit frightening? Or am I misunderstanding this?
January 13, 2009 1:05 AM | Reply | Permalink
There are downsides and upsides to technology but id say the upsides for modernizing health records out weighs the risk. Thats not to say measures shouldn't be in place to lower that risk.
January 13, 2009 2:42 AM | Reply | Permalink
I have the same reaction -- until I think about how many different doctors and agencies (schools, for starters) have had some form of my health records, and how easy it would be to break into any one of their files. It's dizzying, and I'm a fairly healthy 30-something.
All kinds of sensitive information is stored on servers and zapped through the web constantly these days. It should be possible to create relatively standardized model that's also secure, and drag our health IT out of the 19th Century.
January 13, 2009 5:35 AM | Reply | Permalink
One thing no one is considering about electronic medical records is the VAST amount of storage capability required for such an endeavor. Also, when one considers the size of such a storage system, how fast will it be able to fetch a specific record? We're not talking Microsoft Access here, folks.
Just think about the number of individuals, the number of records per individual, various doctors reporting services on that individual (eye,dental,allegry,medical), pharmacy records of medictions and the number of lateral storage sites where info is stored and offsite backup facilities and hardcopy tapes and disks in storage facilities that need to be updated at specific intervals in case of a catastrophic system failure. We're not talking about laptops or PC towers either.
Now think about the landlines necessary to transport those data packets of personal info across the internet prone to people sniffing out and capturing data as it passes thru points along the way.
I would say it will be, at the very least, 10 years befoer they get the bugs worked out and one doesn't need to worry about loss or theft of electronic medical records.
January 13, 2009 9:33 AM | Reply | Permalink
We already store terabytes of medical information online for veterans. Every single veteran has complete VA-generated electronic medical records accessible at any VA facility. My daughter (and my son-in-law) occasionally moonlight at a VA hospital where they find the records invaluable since veterans can go to any VA hospital they choose to. They have quite a bit of justification they need to enter before that are able to access records and every access by everyone is tracked. The system is safe and timely (so far).
There should be no delays in getting the data. Database engines exist to handle far more data than we'll have in medicine. For example, the amount of data coming out of any one run of the new Cern collider dwarfs the medical information needed for the entire US population. Moreover, there won't be spikes as the need for information, most pressing at emergencies, will be spread out during the day and year.
Tangentially, knowing the financial state of my daughter and son-in-law, there's plenty of excess cash going to medical labor. The socialist in me cringes at salaries offered to new attendings. In their state, a beginning attending makes more than 99.5% of university professors, who have the same level of training, hours, and production. And a so-called underpaid resident makes about the average of high school teachers.
January 13, 2009 10:51 AM | Reply | Permalink
No misunderstanding, From my perspective as a primary care doc, however, all I reallywant on the electronic record is labs, radiology reports, medication lists, dictated or hand typed notes, and other clear-cut hard data. Doctor's notes, when recorded electronically, are full of lies. It is too easy to check off a box which doesn't represent just what you did or heard from a patient in order to say I've completed the note....
January 13, 2009 8:57 AM | Reply | Permalink
Are you saying that your colleagues are filling patients medical records with lies? I have found that to be the truth. Everytime I have read my own medical record it misquotes what I said. One time I said "I don't like doctors", the medical record said "avoids doctors", two very different things. An EMR would be no more truthful than a written record after all it is the writer, the examiner all the fields of "SOAP" that are to be noted. Ever tell a doctor you know that another doctor falsified your medical records. I have never seen that written in a medical record or recorded. Are you saying you are so different Dr. Aaron? Uhm, MPMG Board members lie, protect thier own....you are very rare if you are a doctor who
notes this whether it be written or electronically submitted.
January 14, 2009 12:37 AM | Reply | Permalink
A few comments from a UK perspective.
Get SOMETHING on the statute books as soon as you can. Don’t get bogged down arguing over the fine points – you can always go back and fine tune it later.
Just make sure the principle is established that EVERYONE is covered, regardless of their income, state of health, age – anything.
It was the universality of the NHS that prevented the Conservatives from unwinding the whole thing when they got back into power in 1951. Before the NHS, people were genuinely scared of getting ill – removing that fear was the big achievement.
Make sure that everyone gets something tangible to show that they are covered – a membership card, certificate, whatever – just some of physical representation of what their Democrat president and Congress has done for them.
The political problem we on the left have here now is that everyone takes the NHS for granted. Hopefully the upcoming debate in the US will prompt people over here to start realising how lucky they are!
Good luck - and may the spirit of Nye Bevan guide you!
January 13, 2009 5:33 AM | Reply | Permalink
Excellent comments, particularly the emphasis on EVERYONE. Most plans for reform, including Baucus' and Kennedy's, do not include everyone. Just covering more is not enough.
January 13, 2009 9:00 AM | Reply | Permalink
I have known Ron Wyden for 30 years - he began his career in Oregon by working with the Gray Panthers, then a Congressman, then Senator. Health care has been an interest and priority for all of those years. Yes, he's a politican with all that implies, but he has always been progressive, and he has learned how work the system; witness that he finally got the wilderness protection he has fought for for years. If he says he can do it, I'm guessing he is serious.
January 13, 2009 11:19 AM | Reply | Permalink