THE PLANK DECEMBER 11, 2008
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At the Chicago press conference, Obama just gave the clearest signal yet that he intends to make health care reform a top priority.
After running through the litany of familiar problems--rising costs, faltering coverage, poor quality--he vowed to tackle the problem "this year and in this administration." Afterwards, he confronted head-on the argument that the rough economy makes this a poor time to try health care reform. He noted that economic insecurity and our health care crisis our inextricably linked. "If we want to overcome our economic challenges, we must deal with our health care challenges."
Once Obama was done speaking, Tom Daschle--now the official appointee to be Secretary of Health and Human Services--took his turn. And his remarks were equally impressive. Calling health care "our largest domestic policy challnege," he said that "Our growing costs are unsustainble and the plight of the uninsured is unconsionable." That may sound like boilerplate, but many health care experts think it's more important to tackle costs before coverage. Daschle's comments are a clear signal he takes both challenges seriously (and, undoubtedly, understands the way they are related.)
One more note: I mentioned briefly, below, the significance of Jeanne Lambrew's appointment. But it goes beyond the fact that she happens to know a heck of a lot about health care. She, too, has a strong commitment to what you might call the "social justice" side of the debate: Making sure everyobdy has insurance and, more important, good insurance. She also focuses heavily on issues like prevention and public health--which get less attention than simply extending insurance to everybody but may, in the long run, be more important when it comes to actually making all Americans healthy.
More later today, after everybody else is done dissecting Obama's comments on the Blagojevich scandal.
Update: In response to the final question, the only one on health care, he said "the time is now to solve this problem. I met too many families in this campaing, even before the economic downturn, who were desperate." He then mentioned the role health care costs played in personal bankruptcies and employer struggles, and reiterated that "this has to be intimiately woven into our economic recovery program. It's not something we can put off because we're in an emergency. This is part of the emergency. We want ot make sure the strategy reflects that truth."
--Jonathan Cohn
12 comments
The flip side of 'it ain't Wall Street' is that non-Detroit working middle class voters can probably more readily 'feel the pain' of other middle class voters that work in Detroit. Not only that, those workers in Detroit probably aren't isolated from that rest of the country. That is, there are a lot more of them than Wall Street bankers, and a lot of them can call friends and family and say 'hey, Detroit collapsing would bring on more hurt than we or anyone else has ever felt' or something like that.
How many middle class have (anti-tax, anti-sensible-regulation, loan shark) Wall Street bankers screwed somehow, I mean how many bankers are there (a lot fewer) and how many of them regularly reach out to the middle class, sit down and sup with them? My guess is not many.
You can also add that the somewhat widely distributed parts network is also starting to feel the heat with layoffs in states with them. And those middle class voters would probably get sympathetic quickly when their plants warn of layoffs.
- jet
December 11, 2008 at 11:43am
"Impressive" is your editorial comment, not an objective statement: ENERGY is the nation's #1 domestic policy challenge. Now admittedly if Obama's health plan is something like Romneys, giving employers the right to shed health insurance by paying far less into some sort of "insurance funding pool" resulting in downgraded insurance for some and at-least-some-insurance for others, it will help the economy and not rob the next generation. If his plan is to use major parts of his stimulus budget to expand health care, that's generational theft.
- Lymon1
December 11, 2008 at 11:55am
I'm not sure how you tackle rising costs WITHOUT adressing coverage. One of the reasons health care costs keep rising is because you have an expanding pool of uninsured coupled with insurance companies that try to reduce their costs by denying coverage to certain individuals (cherry-picking), reducing covered expenses to those that are covered and excluding items that were formerly covered.
It's kind of a yin and yang situation. The current for-profit business model for health insurance is helping to create the very situation it's also trying to get under control. I am a firm beliver in the capitalist sytem and have no problem with companies making an honest profit, but I also see where the present system is creating its own demise.
You can't address costs unless you also adress coverage. The more people that are covered, the larger the risk pool.
- desertdog
December 11, 2008 at 11:55am
'THIS IS PART OF THE EMERGENCY'.... For all the interest in Barack Obama's thoughts on the Blagojevich controversy, the president-elect had some more important things to say about healthcare. Calling an overhaul of the health care system a basic element
- Anonymous
December 11, 2008 at 1:19pm
Jonathon: slightly off-topic, but I thought you might like to know. I'm trying to catch up on my audio CME (continuing medical education programs). This morning, at the end of the August edition of Emergency Medical Abstracts, I heard a plug for your book. The endorsement comes from one Jerry Hoffman, a first-rate physician-scientist and one of the great intellectual luminaries of our specialty. He is a man who is well-known for being, shall we say, not easily impressed. So kudos.
(And, yeah, I like the book too.)
- sullydog
December 11, 2008 at 1:54pm
"You can't address costs unless you also adress coverage. The more people that are covered, the larger the risk pool. "
This is absolutely correct. But it goes deeper.
The problem with the current system is not just rising medical costs per se, it's that the entire approach to compensating care is Byzantine, and it actually costs hospitals and doctors a lot of money up front to simply navigate the system and get paid. Now, this isn't something that's going to go away--not even with single payer--but you can make it simpler.
Anybody who has seen my previous posts here (I know, it's been awhile) knows that I am considerably to the left of Karl Marx when it comes to health care coverage. BUt I am concerned that any system that emerges will be tempted to cut costs by simply raising the bar for compensation. That's not the way to go. The approach to cutting costs in medicine is manifold:
1. Simplify, rather than complicate reimbursement, so that a group like mine doesn't have to spend up to 5% of its revenue just trying to get our care compensated.
2. Promote evidence-based medicine.
3. Promote continuous quality improvement programs at every level--clinic, department, hospital, system-wide, national.
4. Emphasis preventive care and health education.
5. Tax the living fuck out of tobacco and alcohol. These taxes hit the poor the hardest, you say. Yeah, it's true, just as it's true that tobacco and alcohol hit the poor the hardest, and the poor hit the health system the hardest. Funny how it's all connected.
6. Aggressive malpractice reform. Medical malpractice litigation remains a sinkhole for healthcare dollars, not only because of the direct costs, but also for its contribution to defensive medical practice, refusal of specialists to take call for emergency departments and trauma centers, premiums (huge dollars here), etc.
7. Relax the barriers, both commercial and administrative, to the deployment of point-of-care testing technologies.
8. Obliterate, once and for all, the relationship between hospital systems and insurance companies. This, I guarantee you, will save billions in hospital transfers every year.
9. EMS reform. Most emergency medical services are of unproven efficacy, and the vast majority of ambulance rides offer no more to the patient's care than a ride in a yellow cab. I say this as an emergency physician with 16 years experience.
10. Promote REAL medical informatics. This is a sticky wicket. Our system has an electronic medical record and computerized physician ordering system. Neither one helps me practice demonstrably better medicine. To the contrary, both systems tend to suck up my time and pull me away from the bedside. Robust medical informatics systems could help prevent medical errors and promote clinical efficiency. I aint seen one yet.
11. Deploy cutting edge technologies to maximize human and physical plant resources. Other industries are using genetic algorithms to maximize efficiency by predicting changes in demand for service. Hospitals and emergency departments aren't even close to this standard. Most EDs and hospitals are staffed the same on Saturday night that they are on Tuesday morning.
12. Ration care. It has to happen. It IS happening. It's time to do it rationally, on the basis of cost-benefit, rather than ability to pay.
- sullydog
December 11, 2008 at 2:15pm
If his plan is to use major parts of his stimulus budget to expand health care, that's generational theft.
Yes, better to let uninsured children die off, that way only the most healthy and strong will grow to a productive adulthood making America all the stronger. Sorry lymon, I couldn't resist but that is ridiculous. In fact viewing other advanced societies health care systems reveals that they have expanded coverage at lower costs than we do since our whole system is a complete cluster f.
I know I might sound like a broken record but if Japan can produce better outcomes at significantly less costs while facing an even older population, then we damn well better figure out why.
Talking about generational theft seriously damages the issue since it is both a falsehood and a detriment to helping the uninsured. Penny wise pound foolish silliness.
On another point, I was recently informed they are shutting down pre-school for the poor in Pa. as a cost saving measure. Complete idiocy. Beyond freeing up the poor population to work, it provides a significant leg up on poor children's educational levels. Even living in remote and poor Oaxaca preschool is universal beginning at age 3. Freakin Oaxaca is more advanced than Pa. Truly scary. But of course we can't steal from the next generation to provide the next generations education, or health care, or a clean environment, oh no. We can't do that. We must give tax breaks to the wealthy.
- blackton
December 11, 2008 at 2:23pm
One last thing, when I worked in the states at a medium sized printing company I watched my boss devote untold hours to negotiating with different insurance companies trying to find the best value. I worked there 11 years and every few years the insurance changed meaning there was at least one day when there were company meetings explaining what was going on. Complete waste of productivity. There is a better way, we all know it but we are stuck with Republican nimrods.
- blackton
December 11, 2008 at 2:31pm
Wow, it's been a long time since I've had to deal with a blackton false-dichotomy argument. Feels like home!
First deception: I specifically said I wasn't against health reform -- I'm against ballooning a sky-high budget deficit to achieve it. I specifically mentioned Romney's plan as an example WHICH WOULD PROVIDE HEALTH INSURANCE FOR ALL THOSE UNINSURED KIDS AND EVERYONE ELSE, so don't lay that crap on me. If we went that route, we would almost suredly have some Americans sacrificing some of their health care. Japan as I recall (I've been there twice and have friends there) makes far greater use of HMO's than we do -- maybe people would be pushed from PPO's to HMO's or some more elective surgeries wouldn't be covered in their plans or have longer waiting periods.
Moreover, Blackton, you know probably better than most that children's health care is by far the least costly aspect of health care reform -- kids tend to be healthy and there are already substantial programs in place for them. I'm not saying we can't do better there but expanding CHIP isn't what Cohn is talking about. And, as usual, a distortion of what I wrote -- I said spend the stimulus money on energy policy, not to "give tax cuts to the wealthy." As I recall I'm the lifelong democrat and you're the republican (if I have that wrong I'll readily stand corrected).
- Lymon1
December 11, 2008 at 3:30pm
lymon, yes I do miss these. actually, I only took issue with the one line about robbing generations, I think using that language will throw things back since I don't think fixing the system will rob anyone, the rest was just ranting against Republicans. And no, I am a Conservative Democrat, being Pro-life, or at least anti Roe and a fiscal conservative means I vote for my fair share of Republicans. Actually I suppose I can be called a centrist, but the Republicans have moved so far to the right...
- blackton
December 11, 2008 at 5:05pm
Dr. Sully, you say to tax cigarettes till kingdom come (paraphrase). As a dr. you know how addictive cigarettes are. I know people who've quit, others who've tried and failed, and even the successful ones say they'd rather have a cigarette than sex. At what (price) point do you suppose a pack of cigarettes could increase robberies and carjackings to support the habit, as we see with illegal drugs?
- satyendra
December 11, 2008 at 5:17pm
Now *that* (flaming rhetoric doesn't help -- or at least comes with a cost) is woth considering and will be taken into consideration.
Yup, conservative dem is a rare breed (I think there are more pro-life dems than people suspect, but pro-life/fiscal conservative much less so). Centrist Republicans may begin a comeback if Illinois holds a special election: I would put money on Mark Kirk (D-10) to beat any of the names mentioned so far except Valerie Jarrett (if she shifted gears and ran, Obama and his fundraising machine would work hard for her), and even then it would be a race.
- Lymon1
December 11, 2008 at 6:42pm