This week, I have written two posts for TPM Cafe, where I am a regular contributor.
They are part of what will be a three-part series (with the third part going up early next week) titled “The Politics of Health Care Reform.”
I have written about some of this here, on HealthBeat, but I’ve been refining my thoughts, and have added some new material after reading a brilliant piece in the Journal of the American Medical Association by Dr. Ezekiel Emanuel, director of Bioethics at the National Institute of Health (and, as it happens, the brother of Representative Rahm Emanuel of Illinois, the leader of the House Democratic Caucus).
If you go to TPMCafe, you will find part 2, which I just put up today, at or near the top of the page. At the bottom of that post, you’ll find a link to part 1. (I suggest reading part 1 first).
You may also be interested in the reader’s comments . . .
Maggie,
I thought your Part 2 post was excellent.
One thing that often troubles me when liberals advocate for improvement in social programs like healthcare, education, housing, food stamps, etc. is that they try (usually successfully) to come across as well intentioned, compassionate and interested in bringing about a fairer and more socially just society, but they never squarely face up to how much their proposals would cost and who should pay. Moreover, when the programs don’t work despite the best of intentions, they rarely if ever admit failure. They often blame the problem on a failure to “invest” enough “resources.” If we just spend more money on the problem, maybe then it would work.
As it relates to healthcare, it is absolutely critical that we tackle cost growth aggressively either before or on a parallel track with any attempt to bring health insurance coverage to the currently uninsured and under insured. For single payer advocates, I think it is important for them to think about what would happen if they are wrong about the ability of such a system to increase coverage and reduce costs at the same time. Even though the (government / taxpayer) single payer does not have to worry about making a profit, their monopoly power means they wouldn’t have to worry about providing good service or generally satisfying customers or providers because there would be nowhere else to go. I don’t think CMS’ record to date of overpaying for some procedures, underpaying for others and covering new drugs, devices, procedures and treatments whether they are cost-effective or not is one that we should trust with any more power than it already has.
Barry–
Thanks.
I do think that liberals make a huge mistake when they try to
ignore the math.
This is why some people
call them soft-headed
liberals.
I also think the next administration needs to do a demonstration project–reforming Medicare in a way that reduces costs and improves quality. MedPac has laid out a bueprint as to how to do this.
Then, reformers can turn to conservatives and taxpayers and say: here is how it can be done.
Ideally we would simultaneously reform Medicare, reduce waste, and roll out universal coverage.
But I just don’t see that happening. And I fear that someone will try to
roll out universal coversage, and that it will be shot down by opponents who point to the costs (without explaining that there is, in fact, a lot of money sloshing around in the system that could be spent more rationally.)
Or, even worse, the legislation might be enacted–and then blow up because it is the program is unaffordable. (Think
Massachusetts.)
It’s so nice, Barry, when you and I agree.
I do think you help keep this blog honest.
I just wish that sometimes you would think twice before writing a comment that begins “I don’t really have any numbers to support this, but I just wonder if . . .”
This then forces me to spend quite a bit of time researching the numbers to respond to your question. (If I don’t, other readrs may be mislead, and we could wind up with a whole
thread based on your initial “I just wonder if . .”
I respect your intellectual
curiosity. But you would be
doing me a Huge favor if you Googled some of these issues first, to find out whether there really is a solid basis for speculation
on the issue you have raised.
Cheers, Maggie
Barry–
Thanks.
I do think that liberals make a huge mistake when they try to
ignore the math.
This is why some people
call them soft-headed
liberals.
I also think the next administration needs to do a demonstration project–reforming Medicare in a way that reduces costs and improves quality. MedPac has laid out a bueprint as to how to do this.
Then, reformers can turn to conservatives and taxpayers and say: here is how it can be done.
Ideally we would simultaneously reform Medicare, reduce waste, and roll out universal coverage.
But I just don’t see that happening. And I fear that someone will try to
roll out universal coversage, and that it will be shot down by opponents who point to the costs (without explaining that there is, in fact, a lot of money sloshing around in the system that could be spent more rationally.)
Or, even worse, the legislation might be enacted–and then blow up because it is the program is unaffordable. (Think
Massachusetts.)
It’s so nice, Barry, when you and I agree.
I do think you help keep this blog honest.
I just wish that sometimes you would think twice before writing a comment that begins “I don’t really have any numbers to support this, but I just wonder if . . .”
This then forces me to spend quite a bit of time researching the numbers to respond to your question. (If I don’t, other readrs may be mislead, and we could wind up with a whole
thread based on your initial “I just wonder if . .”
I respect your intellectual
curiosity. But you would be
doing me a Huge favor if you Googled some of these issues first, to find out whether there really is a solid basis for speculation
on the issue you have raised.
Cheers, Maggie
“I respect your intellectual curiosity. But you would be doing me a Huge favor if you Googled some of these issues first, to find out whether there really is a solid basis for speculation
on the issue you have raised.”
Maggie,
I will make a greater effort to do that in the future. I think I (and others) probably don’t fully appreciate how much time you need to spend finding answers to some of these comments and questions as well as the research that goes into your original posts. The reason for that is that like most people who are very good at something, as you are at healthcare research and writing, you make it look easy.
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