Imperfection is a start

[dtotire]

Wednesday, Dec 23, 2009 20:15 EST

For all its faults, the current bill establishes universal care, and there's no going back from that
By Gene Lyons

Buyer's remorse seems to be setting in among Democrats, even as the U.S. Senate is poised to vote (as I write this) on the most significant piece of social reform since the 1960s.

No less a figure than Dr. Howard Dean, the former Vermont governor and Democratic National Committee chairman, wrote that, were he a senator, "I would not vote for the current healthcare bill. Any measure that expands private insurers' monopoly over healthcare and transfers millions of taxpayer dollars to private corporations is not real healthcare reform."

Dean's reservations have been widely echoed on the left. The healthcare bill's big winners, they complain, are the insurance industry, pharmaceutical companies, hospitals and doctors. Because it lacks both the "public option" (a government-run insurance company competing with private ones to drive down costs) and the Medicare buy-in that was initially highly touted, then quickly shot down by Holy Joe Lieberman, some Democrats fear that the party is both providing inadequate coverage and setting itself up for a voter backlash.

Once the public realizes that the bill mandates everybody to buy private health insurance — pretty much the way everybody has to carry auto insurance — there's sure to be unhappiness not only on the tea-party right, but also among working people who ordinarily lean Democratic. Politics Daily's David Corn saw it coming. "I feel as if I'm watching a cheesy horror flick and some poor unsuspecting person is about to open the wrong door," he wrote last September, "and you want to scream, 'Hey, don't open that door!'"

To be sure, the bill provides generous subsidies for individuals and small businesses currently unable to afford coverage. And it doesn't kick in for a couple of years, when one hopes the current recession will be a bad memory.


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[enlightenment]

1. Ah yes. But Gene is playing the same game as

the rest, conflating the concept of public and private to justify the mandate. Mandates are necessary. However, the difference between public and private control of what is mandated is vast, so conflating the two renders his argument meaningless.

Sure, there's a risk of backlash. The problem is no universal or near-universal health-insurance plan — public or private — can be voluntary. Mandates are, well, mandatory to prevent opportunists from gaming the system: Buying insurance only after they get sick. Nobody can insure "previously existing conditions" if clients come and go at will.

Insurers forbidden by law from canceling policies also need a base of healthy rate payers. Public or private, it's a two-way street; costs can't be cut without a bigger risk pool.

He should have stuck with the argument he made first; that there was no way a public plan was going to come out of Washington. I'm not sure blaming it on the Founders is accurate, but at least he got that part right.

[Hello_Kitty]

2. Blah blah just like car insurance blah blah talking points blah.

They really think we on the left are stupid and that giving a subsidy to people puts money in their pocket to cover the rest.

[northernlights]

3. there can be no universal coverage until there is the infrastructure to support it

and we currently lack that infrastructure. As it stands, the current bill contains the seeds to build the infrastructure.

In the meantime, we have the option of paying the penalty and paying for our health care out of pocket. I plan to use that option, since I've been without health insurance most of my life and when I did have health insurance the corporations left me to die anyway. I realize that's not an option for everybody, but I believe that those who can...should. I'm writing this as a Medical Lab Tech student. Imho, you're all putting the cart before the horse.

A major bottleneck to affordable universal health care is the shortage of facilities and trained providers. And the bottleneck to that education is student funding and the critical "clinical" training. Hospitals can only take on so many students at a time given the need for close supervision with a low teacher:student ratio to prevent medical disasters.

I'm pushing for Bernie Sanders 1350 or so new Community Health Centers (which I understand will also be training centers) to remain in the bill to provide low-cost health care to anybody who walks in the door. Increasing the number 4 or 5-fold (over the existing 350 community health centers) will make health care more available. 10-fold would be sweet! (btw, as an aside, building 1350 community health centers is *major* economic stimulus)

And increasing the grants and loans to students -- so weeding out is based entirely on ability to do the job as opposed to ability to finance learning the job -- is critical. Personally, I'm in a situation along with multiple other students, who may be forced out with one year of training to go due to terminated education loans. It's not our doing and at least 2 of us (myself and one other student) are 4.0s. We could face financial ruin and you could be short several providers as we were blindsided by fine-print rules...that were on a financial aid web page that isn't even public!

The bottom line is that health care is a *Community Service* and should be funded by the community. That means infrastructure and training. Fund the training -- train more providers and stop burdening healthcare students with loans the size of a hefty mortgage -- and service fees will come down.

Without the infrastructure to deliver, universal health care and single payer remain impossible. The fact is that until more *health care* is available, in terms of more trained medical staff and more facilities (beds), both universal health care and single payer will remain out of reach. This is a case where supply-side economics will work.

So I strongly recommend that all of you quit whining about the "sellout," recognize where the real problem lies, and help focus on that. The journey of a thousand miles begins with a single step. And that first step is within reach.

FWIW, I can see a scenario in which, as more and more community health centers come on line, providing lower cost health care while training more and more students, people will start "opting out" of the insurance industry and paying the "fine" (think "tax for down payment on community centers")

[Daveparts still]

5. We have infrastructure

It's called Medicare for everyone. The seeds which have been planted will bear bitter fruit when the working poor find themselves mandated to buy a product that they cannot afford. And who will be waiting in the wings to comfort them? The Republicans, they will put their arms around them and say, "There,there, We told you that big government was bad!"

They've bought in to a Republican solution whose failure will be blamed squarely on Democrats.

[northernlights]

6. with all do respect, Medicare is not infrastructure; it's administration

They are not the same thing.

Medicare does not deliver a single bit of health care. Doctors, nurses and technicians deliver health care.

And as the "universal health care" program in Massachusetts demonstrated for everybody to see, we lack sufficient doctors, nurses and technicians to *deliver* health care. There are doctors there working 7 days/week and unable to keep up with demand.

There is a worldwide shortage of doctors, nurses and technicians. That is a simple fact.

By putting administration ahead of actual deliverers, we are putting the cart ahead of the horse.

Let the politicians and insurance industry fight tooth and nail over who will "administrate" health care.

In the meantime, Bernie Sanders has addressed the *real* problem by adding thousands of Community Health Centers and funding to educate more health care *providers* into the bill.

When there is sufficient infrastructure to deliver healthcare, then the threat of "rationing" (which already happens by pocketbook) disappears.

When health care *providers* aren't burdened with loans the size of a mortgage just to provide what is, at heart, a community service, and when there are more of them to deliver, then their expense will come down.

This is one time when we supply side economics makes sense. We already have the demand. You cannot directly legislate supply. But you can make supply more possible.

[niyad]

4. establishes universal health care? how, exactly, when at least 15 million are still going to be

without insurance?

and, I realllllly want to know what makes anybody think that, after the endless months of this pathetic "reform" attempt, that anything further is going to be done any time soon (like within the next 15 years)