On this eve of the mid-term elections, it’s becoming increasingly likely that Republicans will win a majority in the House and gain a sizable number of seats in the Senate. Some political pundits are predicting that Rep. Joe Barton, R-Texas could take over as chairman of the powerful House Energy and Commerce Committee next year and, according to Kaiser Health News, “the Texas Republican vows to make life miserable for Democratic defenders of the health care overhaul law.”
Between calls for complete repeal (highly unlikely to make it past President Obama’s veto) and rumors that Republicans will block funding for key initiatives, the media is rife with reports that health reform is in danger of death by a thousand cuts.
Despite the fact that the election fervor has been motivated far more by worry about loss of jobs and a lagging economy than health care reform, attacking the legislation has made for good campaign slogans and attack ads. The warnings of “government takeover of health care,” high insurance premiums, harm to small business and the gutting of Medicare have peppered the virtual onslaught of political ads.
The irony of the Republican platform this election season is that even as candidates push for fiscal austerity and champion freedom from government bureaucracy, they solemnly promise to protect the sanctity of Medicare. According to The Daily Caller, a Conservative site, ”while Republicans have gone on the attack against their Democratic opponents for their support of the health care bill, it has come with mixed messages from candidates who decry government intervention in the health industry, then eagerly defend the government-run program of Medicare.”
The Daily Caller continues; “Just two weeks ago, for example, in a Nevada U.S. Senate debate , Republican nominee Sharron Angle had some harsh words to say about Senate Majority Leader Harry Reid’s support for health care reform — but only after attacking the bill for taking money out of Medicare.
“‘Obamacare cut a half a trillion dollars out of Medicare…senior citizens need to have that Medicare Advantage,’ said Angle. Yet in that same answer, Angle also said, ‘We need to get the government out of the process so we can take off those mandated coverages’…‘The solutions to the health care cost of insurance are free market,’ Angle added.
This kind of convuluted thinking has pervaded the election cycle: Repeal health reform, repeal the individual mandate, get rid of independent payment (i.e. rationing) boards, deregulate the insurance market and “hands off grandma’s Medicare!” All this, the candidates promise, without adding to the deficit or delivering significant cuts to the growth of health care costs. Oh yeah, no exclusions for pre-existing conditions and no rescission. At this point in time, it is impossible for me to comprehend how voters actually think this all makes sense. Perhaps they're so busy being "angry" that logic has been temporarily blurred by that firey red haze.
For me, the only explanation is that the Obama administration—and supporters of reform in general—have been largely unsuccessful at communicating the many, many details and provisions contained in the 2,400-plus pages of the Affordable Care Act. And that brings me to the potential bright side to Joe Barton’s threats to regularly haul Kathleen Sebelius and Donald Berwick in front of Congress to answer tough questions about the legislation. I think that the more Americans hear about the specifics of reform and how it will actually improve their care and save money to boot, the better they will understand why it would be so disastrous to pull the plug on the process before the “good stuff” has a chance to go into effect. In health reform, the sheer size and complexity of the legislation have made it a hard sell to a public that prefers the tasty sound bites that have pervaded the midterm elections.
For example, Republicans have tried to convince seniors that Medicare will be gutted and that their care will suffer if the Obama administration succeeds in saving the $533 billion in Medicare spending projected over the next 10 years. They are proposing that the provision that would require Congress to keep Medicare costs under control be struck from the bill. Many seniors are indicating that they put their trust in the Republican promise to protect Medicare: A March CNN/Opinion Research poll asked which party would do a better job of dealing with Medicare, and 48 percent of voters over 65 sided with Republicans, compared to 44 percent who chose Democrats.
The truth is that the Congressional Budget Office predicts that Medicare spending will not be drastically cut by health reform; in fact it will continue to grow annually, at about 5.5 percent instead of 6.8 percent. The savings will mainly come from cutting back on fraud, waste and over-payment for Medicare Advantage plans. Already, hundreds of innovative demonstration projects are being developed and put into play that are designed to test Medicare reimbursement reforms like bundling, physician incentives and paying for an entire illness episode, rather than individual fee-for-service charges.
There are suggestions that President Obama, chastened by the loss of the House and a tighter majority in the Senate, will move “toward the center” as Presidents Carter and Clinton did before him. As Robert Reich, former labor secretary in Clinton’s cabinet writes on his blog;
“Why are Democratic presidents so much more easily intimidated by the ‘move to the center’ rhetoric after midterm losses than Republican presidents?
“Because Democrats think in terms of programs, policies, and particular pieces of legislation. It’s easy to reverse course by compromising more and giving up on legislative goals. Bill Clinton never mentioned the words “health care reform” after the 1994 midterms.”
It would be hugely unfortunate if Obama were to take a similar approach. The Affordable Care Act has already been passed by Congress and we have the possibility of offering health coverage and security to 30 million more Americans. Now the fight begins to make sure that all of the truly innovative—and cost-saving—provisions are funded and moved forward. Obama must make it clear that Yes, the individual mandate is key to the success of the law. Yes, keeping Medicare costs on budget and reforming reimbursement is also fundamental to the program’s ability to remain solvent. As state insurance commissioners are already making clear, insurers cannot be allowed to raise premiums unchecked—in hopes of making a scapegoat out of health reform’s limits on how much these companies’ earnings must be spent on patient care.
There are a wealth of innovations and patient protections buried in this legislation. After the election, it will become clearer to Americans that the Republican plan to reduce government spending (which absolutely must include cutting programs like Medicare and Medicaid since the Bush taxes won’t be repealed) is not going to jumpstart the economy or lead to more job creation. It’s all just an opaque cloud of sloganeering and fear mongering.
As Reich advises; “Message to Obama: Whatever happens November 2, don’t move to the center. Push even harder for what you believe in. Message to Democrats: Whatever happens, keep the courage of your conviction and get even more active.”
The majority of the American electorate says it doesn’t understand what’s inside the health care legislation, to be for it. This same American electorate doesn’t even understand that when this President took office, GDP had grown from -6% to +3%, a nine point swing. We went from losing 750,000 jobs per month to now experiencing seven straight months of private sector job growth. We went from having Wall Street, banking, hotel, airline, retail, housing and the automotive industries on the precipice of bankruptcy to now experiencing solid recovery and, in some sectors, record growth and profits. Credit, previously frozen, now flows again to business and consumer borrowers alike. The policies of this Administration and the majority of Congress have worked. And the majority of the American electorate want to vote back into office the type of candidates that put us in that previous position? Brother!?
First off, there is a difference between any job and a good paying job. If the repubs managed to give everyone who wanted a job a Macdonald’s type job so that the unemployment rate was very low, would we be a happy electorate??
Our leaders over the last 25 years have seen if desirable to allow union busting activities to reach unlimited heights. These activities are mainly to allow illegal immigration to keep jobs paying less, and to allow jobs to be shipped out of country to keep manufacturing costs low. The products are then sold more competitively worldwide, but the good paying jobs they used to produce in the US are gone. I don’t see how tax cuts or prayer or fear mongering are going to bring back good paying blue collar type jobs. So I would not want to be a Repub in 4 years trying to answer why my voodoo economics did not work once again. I suppose they will say they lowered the unemployment rate, but with what kind of jobs. That is the flaw in just using unemployment rates as a measure of prosperity?
I am not sure just what the exact answer to this problem is, but I know it is not Voodoo economics. It took the better part of 25 years to reach this point, and it will take some time and equally strong counter-measures to do much about it!
I recently read an article that when the exchanges go into effect in 2014, that most people will end up in plans with very high deductibles in order that they pay lower premiums http://pnhp.org/news/2010/october/more-evidence-of-the-expanding-menace-of-high-deductible-health-plans. If President Obama would have simply pushed toe extend an improved Medicare to everyone(USING THE TERM MEDICARE AS EVERYONE KNOWS WHAT THAT IS), and if he had pushed for more programs to put people to work and not allowed the Senate Republicans to filibuster his programs, he would be very popular now. With the Republicans being so far to the right, the Democrats would be looking to actually gain seats in Congress today instead of being hit by a tsunami. A lot of people blame the party in power when conditions are bad. It doesn’t do any good for Obama to say that it was the last President’s fault even if that’s so. Obama has been a huge disappointment to those of us whom he promised that his administration would be bottom up instead of top down.
Regarding my last comments, I just want to add that while the stimulus did put people to work who otherwise would still not be working, it didn’t meet the requirements considering the high unemployment. From what I see on the news, the unemployment statistics are hardly improving at all despite some improvement in the economy. I don’t blame the House Democrats led by Speaker Pelosi, but unfortunately Obama and Senate Majority Leader Reid who himself is in trouble now, allowed the Senate Republicans to filibuster more programs to put people to work as well as the public option in the health reform bill. As I said, had Obama done better, the Democrats would be headed for a big win today instead of a tsunami.
It was Joe Wilson of South Carolina who hollered out “you lie” during President Obama’s state of the union address. Rep. Joe Barton, R-Texas who could take over as chairman of the powerful House Energy and Commerce Committee is the one who publicly apologized to BP for the egregious error the company made which damaged the environment and economy of the gulf coast near irreparable damage.
Harry,
Thanks for the catch–noted and changed. I was getting tired last night…
Naomi
Medicare for all would have been a winner, politically and in reality. The next step would have been nationalizing hospitals — the ultimate solution.
Naomi, Walter
Great post Naomi!
I just wanted to weigh in
to reply to Walter.
Walter–
The Democrats would be losing, and losing big, this fall, whatever Obama did.
He inherited an economy that was headed for a wall. I (and and a great many others–eoncomists like Paul Krugman) could see this coming. For a number of years before Obama was elected, people have been saying that we were heading for a 21st century version of the Great Depression. And that is what has happened.
The current recession is the result of two decades of disastrous economic policy. Interest rates were kept artifically low, which helped fuel the stock market bubble, followed by the real estate bubble.
Add to that two terribly expensive wars that were, to a large degree, outsourced to private contractors who ripped off tax payers, plus tax cuts for the wealthy that we could not afford.
Meanwhile, for the psat 25 years, the U.S. has become the world’s biggest consumer, while producing less and less of value.
Imports rose while exports fell. When I was at Bloomberg in the late 1990s, I wrote about the huge ships that came to our West coast ports filled with goods from Asia-and left nearly empty. We had little to sell that the rest of the world wanted or could afford. The Chinese began making their own very good PCs. Dell lost market share in China.
As a result, the U.S. is now the world’s greatest debtor nation, and U.S. households are still sunk in debt. (The whole notion that you can keep an economy going if everyone just keeps on shopping–buying things they reallly don’t need–was a fatal fantasy.)
This has led to the current recession/depression.
It took 25 years to get where we are.
There was no way that Obama could undo 25 years of excess in two years.
Yes, it would have been better if the stimulus were much larger. But deficit hawks on both sides of the aisle would never have allowed that.
Even if they had, we’re not going to get the jobs we need by “stimulating” the private sector. Corporations are not going to hire unless they are assured of fat profits–and U.S. industry is not in a position to generate fat profits.
The only way that we will get the number of decent-paying jobs that we need is if government creates them. I’m talking about public-works jobs like the jobs FDR created under the New Deal. We need teaching assistants in our public schools to help teach classes of 25 -28 students, we need to tear down schools that have deteriorated to the point that they are beyond repair and create construction jobs buliding new schools. We need to build new roads, repair bridges etc. We need workers bulding safe playgrounds in our cities, cleaning up and planting parks. We need subsidized day care centerse. We need roof farming in inner cities. I could go on. There is much that needs to be done–plenty of work for a great many people.
But taxpayers would have to pay for these jobs.
This probably means raising taxes, not just for the top 2% but for the top 10% to 15%–in other words, the upper-middle class would have to pay higher taxes. (The statistical middle class– housholds with median incomes of about $60,000 cannot afford to pay higher taxes. So we’re talking about taxing households with incomes over, say, $125,000–with progressivelly higher rates as you go up the scale to multi-millionaires.
We’ll also need to hike inheritance taxes and gift taxes.
I’m not sure when or how this will happen. Government may begin creating jobs by adding to the deficit–though it will be very, very hard to get a jobs program through this Congress that depends on deficit spending.
The bottom line is this: there wasn’t much that Obama could do to pull us out of this deep recession–or to create the jobs needed–in two years. He tried his best to at least provide a safety net for low-income and middle-income households who couldn’t afford heath insurance.
As for the public option-Most people don’t know (or care) what a public option is. They are not voting against the Democrats because there is no public option.
In a recession, Americans always vote their pocketbook, and that is what they are doing now.
Young liberals are disappointed by the lack of a public option because they don’t have any real understanding of how long change takes. Medicare legislation took years–and was far from perfect when it passed. The same is true of civil rights legislation.
Young liberals who voted for Obama when he was first elected expected miracles. They spoke of him as if he were a comic book super-hero (“The Blackc Spiderman” one person called him.)
And now they are saying “We worked so hard to elect him, and he let us down. So today, we’re not even going to bother to vote.”
This so-called political activists have no idea what hard political work is. They should read some history about the Civil Rights Movement. People actually gave their lives to fight for equal rigihts. And that movement began years before Civil Rights Legislation was finally enacted. The fight would continue for years after the Civil Rights ACt was passed.
A country doesn’t just suddenly transition from 3 decades of conservative government (interspersed with a few yuears of moderate government here and there) to a truly progressive government.
Obama himself was naive to think that the conservatives would compromise with him. It was inevitable that they would fight tooth and nail. And that they would win many battles. They have great wealth on their side–far more wealth than the progressives.
Keep in mind that only 48% of white voters voted for Obama. The majority of “mainstream America” did not support him. He did not come in with a referendum for change.
I still think we are at a point in U.S. history where the pendulum is ready to swing in a progressive direction. But
it will take blood, sweat and tears. It will take great determination.
Young progressives who think that taking one semester off to campaign for someone should have transformed the country
just dont’ know much about politics–or history.
Sorry for the rant, but as I sit here on election day, realizing how many of Obama’s former young supporters aren’t getting out to vote . . .
I agree Maggie, again the Republocrats win the day to keep their status and not correct the ills of the country. Both sides are at fault though in my way of seeing things.
If anything was naive, it was believing anything can be fixed through a broken political system.
Both political parties are the problem, not the answer.
Obama’s problem was healthcare. The minute he pivoted to healthcare, he lost the jobs debate. It was over. Universal healthcare has been a progressive dream since Truman and the population saw right through it. He had a message problem alright. It wasn’t for lack of communication either. He has been on more shows and given more speeches pushing healthcare than any President in history. At this point I fully expect him to be on Tosh.0 next week. The minute it went to healthcare, he lost the “laser beam” focus on the economy. Personally, I think he should have went after energy. He should have pushed for a new economy in sustainable resources. I don’t mean cap and trade or the half measures that have been taken either. By not penalizing existing forms of energy and focusing on renewables ala a Manhattan style project on energy, you own National Security and the Jobs debate. People would have easily understood the message and focus on jobs. When the Republicans ask where are the Jobs, he would then have an answer. The American public can easily remember 4 dollar gas and it is a natural fit for the beleagered construction industry building wind, solar farms and high speed rail. The end result would have taken us to a lower carbon footprint, which is what cap and trade is all about, but you don’t push that or even mention that. Sustainability and where the new economy is going would have been much more easily sold. The country would have bought it hook, line and sinker. Selling it as preventing Global Warming no chance they would buy that. The current message of “We have healthcare! We may not have jobs, but we have healthcare!” is not a winning one.
Joe —
Nationalizing hospitals is not a very good idea because of the enormous costs — hospital infrastructure is in the tens of trillions of dollars — involved in assuming ownership. Also, if a Medicare for All or a good social insurance program is adopted, there is no point in nationalizing hospitals, since costs would be controlled at the payer end. That is the solution of almost all developed (Japan, Canada, France, Germany, the Netherlands, etc.) countries. Many of the few countries that do have nationalized hospitals are in the process of trying to end that involvement (Britain, for example.)
Once there is either a single payer or a set of payers functioning within a highly regulated structure, it becomes the business of the hospitals and other providers to manage themselves to function within the existing structure. It may be surprising to note, if you have been listening to the whining of hospitals and so on, that people in other countries are able to do that very well.
Pat –
‘Many of the few countries that do have nationalized hospitals are in the process of trying to end that involvement (Britain, for example.)
I live in Britain and that’s certainly news to me. Who told you that?
And most European countries have a mix of public and private hospitals (even Britain has private hospitals).
I agree with Jenga that the Recovery Act should have emphasized renewable energy, but I think Obama did indeed try to do that. Unfortunately he did not adequately explain that to the public, who most likely would not have bought it, given that the opposition suggested the alternative of a tax cut. The Republican insistence that more of the stimulus come as tax cuts than energy reform won out.
And call me politically naive, but I don’t buy the argument that a President cannot walk and chew gum (jobs and health care).
I still believe that Presidents lose popularity primarily due to economic conditions, the results least caused by their actions. Furthermore, financial crises do not get cured overnight, as explained by among others, Ken Rogoff, co-author of This Time is Different, Eight Centuries of Financial Folly, a boring 2009 book very few voters have the time or concentration to wade through. Easier to listen to a talking point that claims somebody promised unemployment would remain below 8% if Obama policy was adopted.
That’s my rant for the day.
Maggie, I absolutely agree with you when you said “We’re not going to get the jobs we need by “stimulating” the private sector. Corporations are not going to hire unless they are assured of fat profits–and U.S. industry is not in a position to generate fat profits.The only way that we will get the number of decent-paying jobs that we need is if government creates them. I’m talking about public-works jobs like the jobs FDR created under the New Deal. We need teaching assistants in our public schools to help teach classes of 25 -28 students, we need to tear down schools that have deteriorated to the point that they are beyond repair and create construction jobs buliding new schools. We need to build new roads, repair bridges etc. We need workers bulding safe playgrounds in our cities, cleaning up and planting parks. We need subsidized day care centerse. We need roof farming in inner cities. I could go on. There is much that needs to be done–plenty of work for a great many people.” I read polls before showing that people want this. Obama did have a mandate. He received a majority of the popular vote, and carried such states as Indiana, Virginia, and North Carolina that have not gone to a Democrat in many years, the first two states not since 1964. The stimulus package passed by the House was larger than the bill finally passed by the Senate where the Democrats deleted some funding for local and state governments in order to get the 60th and 61st votes from Maine Republicans Snowe and Collins. I think this was before Al Franken was seated. Obama and Harry Reid wouldn’t do anything to abolish the filibuster, and there’s nothing in the Constitution that allows the filibuster. The Bush tax cuts were passed by a simple majority in a Democratic controlled Senate, and he and Reagan were able to get pretty much what they wanted when they were in office. People are angry about and the economy and unemployment. There are people who if not unemployed themselves, have family members or friends who are. The programs including public works and green jobs, would have put a lot more people to work, even if the recession/depression were not ended overnight. So with whatever improvement we would be seeing now with the unemployment situation with the Republicans being so far to the right because the Obama and the Senate Democrats didn’t allow the Republicans to block progress with their filibuster, the Democrats would be winning seats tonight instead of losing seats. Regarding Medicare, I recall when that was enacted in 1965, that both of my grandmothers were covered the following year. I don’t know what services were not immediately covered then, although I read that people on SSD were not entitled to Medicare until the early 1970’s.
Marc —
I think we are arguing about the distinction between nationalized hospitals and public hospitals. Even the US has public hospitals, in the sense that the hospitals are owned by branches of government at some level despite usually functioning as independent entities.
It is my understanding that the NHS has moved away from a model of national direct ownership and management of hospitals to a model changing hospitals, while still publicly owned, to independent entities which are responsible for their own finances within a setting of being paid by the NHS based on services rendered and patients served.
That is the model for most public hospitals in most countries, with the central government or insurers providing payment and with independent hospitals running their own operations, sometimes but not always under the auspices of local governments, as opposed to a system of national ownership and centralized administration of hospitals.
For the US government to pay trillions of dollars to purchase hospitals from their management and their creditors, to engage in ongoing management of hospitals in terms of capital and operations, and to involve itself in the “health wars” between hospitals that characterize many if not most American cities to make decisions about which hospitals should be favored and which should fade would be foolish. A far better model is to provide or oversee payment and to allow hospitals to sink or swim based on their efficiency, quality, and ability to function within a realistic and rational payment system.
Dear Pat, Has regulation ever worked in the United States to deliver what it is intended to deliver for any length of time? The lawyers/accountants/lobbiests/crooks on the other side always pervert the regulators/regulation process one way or another. Indeed, the regulators often end up being funded by fees from the regulated, fees based on volume of transactions or dollars, either of which end up pushing the regulators to allow more and look the other way.
Or, how about nuclear power? Sure wish the regulatory process hadn’t have stopped that in its tracks decades ago or we might have some answers to our energy needs.
How about the regulations/funding/attention paid to schools by government, has that resulted in better educated students?
Just like the swings we see in all of culture, when any system hangs around long enough it needs to be changed because it gets bad.
Public schools were a good answer years ago, now maybe private schooling could be a better option.
Private hospitals/medical centers/insurers clearly are a problem today, so swing them to publically owned. When that gets too cozy, private hospitals will spring up again.
The issue to me is to accept that change is good and keep our system from preventing change.
I simply can’t understand the argument against nationalizing hospitals because they have debt or value or whatever. From what I can see, many are non-profit anyhow and are as close tp publically owned as can be already. So OK, nationalize the non-profit hospitals let them treat anyone, use medicare $$ to fund them, and watch the for profits do whatever they do to stay alive.
Joe —
Non-profit hospitals would be as difficult to nationalize as for-profits because of the very large amount of bonded debt and the very large amount of capital equipment they have. In order to nationalize the hospitals, the government would have to make good the bonds and would have to compensate the owners (trillions of dollars nationwide. In my little city of 120,000 there is over one billion in bonded debt and in capital assets involved with the three hospitals in town.)
While the owners of non-profits are, by definition, non-profit organizations, they are not in the habit of giving away assets. For the most part they are religious organizations, foundations, or local governments.
If you believe you can pass laws to allow the confiscation of trillions of dollars in assets in the US political climate, or can pass laws providing for trillions of dollars of new debt, have at it. I am not opposed to nationalization on principle, but rather on facts.
As to your assertion that regulation never works, I would have to point out that regulation has worked well in the past and continues to work well now. Historically, many industries, especially utilities, thrived in a high regulation setting. Regulation continues to work fairly well even now, despite efforts of a large part of the political spectrum to crush regulation along with most of government.
Internationally, as I have said, control of health care costs through regulation has worked very well in many places. Canada, Japan, France, Germany, the Netherlands, and many other countries are examples of this.
Finally, as I have said, the nightmare of the government actually owning the health care infrastructure would involve a lot more hands on effort than just regulating payments. Dealing with everything from unions to vendors to competition between hospitals to demands of doctors and patients for access to high tech without having to go more than one or two miles from home are all nightmares, and are actually just the tip of the iceberg.
It is just way better to follow the lead of most developed countries and leave the ownership of hospitals to entities other than the federal government, leaving the government to deal with the problem of providing coverage for all citizens but not getting into ownership of real estate and infrastructure. There are very good reasons why that approach is the most widespread internationally.
Richard K, Joe Says,Walter, Pat S.
Richard K–
You’re absolutely right. Eight Centuries of Financial Folly sounds like a very good book. You might also like my first book, “Bull! A History of the Boom and Bust” which describes how the excesses of the 80s and 90s led to today’s recession/depression. (The bear market of 2000 wasn’t deep enough or long enough to wring out the excesses.) See also my reply to Walter below.
Joe Says–
Please see Pat’s comments.
They’re helplful because they are based on facts–not opinion.
On this blog, people generally try to offer evidence for their views. When the conversation dissolves into opinion, the thread becomes less useful–we don’t learn as much.
Walter–
When Obama was elected, the majority of Democrats both in the House and the Senate were moderates.
I could count the number of true progressives on my toes.
Bush, on the other hand, had both conservative REpublicans and moderate Democrats voting with him. This is how we wound up in Iraq–.
even though it totally clear that Iraq had nothing to do with the 9/11 bombing, that the likelihood of WMD in Iraq was slim to none, and that an invasion of Iraq woudl lead to a replay of the War in Vietnam. This is something that a 10th grader who read a little history could figure out. Those moderate Democxrats let Bush lead us into one of the most disastrous wars in modern history.
Reagan also had a solid conservative majority behind him.
Low-income and middle-income Americans may have wanted Obama to spend money to create jobs, but most of Congress (which was mainly elected by upper-income and upper-middle income Americans) did not.
Most of these voters have jobs and feel fairly secure in those jobs. Most definitely don’t want to pay higer taxes to provide jobs for others. They are far more concerned about the deficit than they are about whehter their fellow Americans have jobs.
Read the Fiscal Times, the newspaper founded and funded by billionaire deficit hawk Pete Peterson.
They rarelly write about jobs. They constantly write about how health care reform won’t work, and how we have to cut back on “entitlements” such as Social Security and Medicare, by raising the retirement age, raising co-pays, cutting benefits, or turning Medicare over to the private sector through a voucher system (which means shifting costs to seniors.)
Keep in mind that only 48% of white voters voted for Obama. The blacks, latinos, Asians and other new immigrants who put Obama over the top do not have much power in Washington.
I’m amazed that, given the politics of the Congress he was working with, Obama managed to push a pretty good health reform bill through Congress.
On Medicare– first it covered only 19 million Americans. And it was passed at a time when the country was far more liberal than it is today.
Health Care Reform will involve huge changes for 32 million uninsured Americans plus tens of millions who are now underinsured. It’s a much, much bigger piece of legislation.
LBJ had to use every bit of political muscle that he had to get Medicare through Congress, and if JFK hadn’t been assassinated it never would have happened. (LBJ reminded the country that a martyred president wanted Medicare–which he did. It was the least hte country could do in his memory. . .
Finally, to win passage LBJ had to hand doctors and hospitals a blank check, agreeing to let them charge Medicare whatever they chose.
Within a few years, it become clear that the program was totally unaffordable . . .
Pat S.
Thanks much for explaining why nationaizing hospitals is neither possible nor desirable.
Maggie, I appreciate your responding. I just would like to mention again that the House and a majority of Senators did vote for a bigger jobs program, which Obama and Reid whom I glad got re-elected, allowed to filibuster. People are concerned about the economy and jobs, which is why the Dems took a shellacking. Although he was better than either of the Bushes, while I didn’t care for him either he said that “It’s the economy stupid.” On Medicare while I understand that these things come in increments, I think that since Medicare was passed for the seniors back in 1965, that after another 45 years it’s not unreasonable for an improved Medicare to be enacted for everyone with no filibuster allowed. People on Medicare like it, and had an improved Medicare gone into effect earlier this year, that plus at least a somewhat better economy would have helped the Democrats. I don’t mean to be argumentative here.
Pat, I must be dumb, but I still don’t understand your point on debt. The debt goes with the hospital. We end up paying for it either way in our healthcare costs, what’s the difference?
Regarding how to do it, there are lots of alternatives, but all of them come down to one thing really, make it attractive for the non-profits to turn themselves over to the public.
Also, if you don’t think a system of public hospitals can work, I guess you are a big proponent of privativing the VA system? If public programs don’t work, I guess you would want to privatize Medicare. And to think of it, private contractors on the battlefield is a concept that is working so very well, why have an Army?
Look, how else can you get hospitals from each trying to one up each other in technology/marketing/services to compete for patients? The issue is competing for patients, not the MRI machines, or the marble floors, or the concierge service or the overbuilding of hospital beds per se.
There are just some things that are not ammeanable to supply and demand, and healthcare is one of them. In healthcare demand follows supply not visa versa.
Pat –
‘It is my understanding that the NHS has moved away from a model of national direct ownership’
No – NHS hospitals are publicly owned although some new ones have been built using a disastrous private financing scheme that commits us to billions of dollars of financing charges for decades.
You’re right though that there are so called foundation trusts, which have more autonomy, but surprise surprise, they’ve been the worst offenders in recent corner-cutting and poor standards.
Joe —
Let me repeat this one more time. I am not opposed to nationally owned hospitals. Yes, the VA’s (and IHS and PHS hospitals) are nationalized hospitals. And no, I do not think the VA’s should be privatized.
My problem is not with nationalized hospitals — they often work fine and sometimes not so fine, but the same can be said for any other model. What I am opposed to — purely on practical grounds — is an attempt to nationalize existing hospitals in the US, simply because there is no demonstrable benefit and there is considerable additional cost.
There is a very good reason why no other developed nation has adopted a health program predicated on nationalized hospitals in the last fifty years. It is simply more expensive to accomplish and more expensive to maintain, plus it involves the government in many additional problems that cause difficulties.
If we could magically turn the entire hospital system in the US into a national system without added costs and added problems, I would not oppose that, but that just is not the case.
As to whether the costs of financing the debt incurred would be less than or equal to the costs of continuing to run the health care system as a single payer or social insurance system, the payment system is very capable of producing significant cuts in costs without nationalization, as evidenced by the success attained in the 90’s and by the success of virtually every other system, whereas the federal government issuing say $20 trillion in new debt is much less attractive.
With that, I will end my discussion of this thread, since we are just running over the same territory over and over.
Walter–
You aren’t being arguentative.
Your comments are prefectly reasonable, and based on solid arguments.
That said, I still would argue that Obama and Reid just didn’t have the votes to halt conservative filibusters.
I hate to repeat myself, but– Obama was working with a conservative /moderate Congress. He didn’t have the Congressional support to do more than he did on haelthcare reform.
(I do think that if he had picked different and better advisors, he could have moved to end the wars in the Middle East much sooner, and he could have created more public sector jobs. (Though that would have depended on getting fudnng from a Congress that probably would not have voted for the needed funds.)
Obama also needed advisors who would have counseled him to begin regulating Wall Street.
But on this blog, I’m focusing on healthcare reform, and in that arena, I really do think that Obama did as much as he could have done,,given the Congress that he( was dealt.
See my next post.)
Marc —
Let me start by saying that I am not a critic of the NHS, which functions far better and more cheaply than the US health care system and gets far better results in terms of health outcomes.
It seems we are making the same point. We are both saying yes, the NHS has (in the immediate past) experimented with moving away from the nationalized model both with private equity hospitals and with locally independent public hospitals. You are saying that that plan did not work well, and you may well be right, since even I have heard of complaints about those changes clear over here in Minnesota.
My concern with the adoption of a nationalized hospital program in the US is not that it might not provide excellent results. It is that the start up would be prohibitively expensive and that it would involve the federal government in a welter of local issues that would be difficult and politically challenging to manage. That is why most other developed nations have avoided the nationalization model in their own systems when they adopted new systems. When Britain accomplished that 65 years ago hospitals were much less expensive, local issues were blunted by the dire state of the country following the war, and there was a need to replace the loss of a large amount of infrastructure destroyed by the German bombing.
I will be following the management of the NHS by the new government of Britain with interest and some trepidation.