never listen to me when i promise to post "tomorrow"...
here in the second half of health care discussion, i'll present the position of barack obama. obama goes into good detail on his site about his health care plan, and outlines it even more in this position paper. his plan was presented initially during a speech in iowa last year, a speech which is the usual cut-and-paste politician speech: start with the depressing story of a local couple, outline in detail and with lots of statistics the issue at hand, give your background and previous accomplishments with regards to the issue, outline your new plan, resurrect the ghosts of political heroes gone by, then bring back the local couple and inspire hope that your plan will save them.
obama plans to insure all americans by enrolling all those without insurance in the same insurance plan open to all federal employees. eligible citizens will receive a federal stipend to join the program. he plans to finance the plan by doing away with the bush tax cut for the wealthy, and by having businesses who don't offer a "meaningful contribution" to employee health care contribute "a percentage of payroll" (i.e. taxing business). i presume this new payroll tax is meant to stimulate businesses to participate in private insurance. he also pledges to support businesses with federal money for catastrophic coverage.
obama also feels there's money to be made by optimizing health care- he (like mccain) supports a movement toward electronic medical records, and focusing on preventative medicine. obama's plan calls for what he calls "incentives for excellence". in his speech and position paper, he speaks of how much money is wasted on suboptimal care and preventable complications. in his plan, providers will be "rewarded for achieving performance thresholds on outcome measures". this is what is usually referred to as "pay for performance" and it is a noble but miserable idea.
[a sidebar on P4P, as it is called in the industry. no payer, whether private or government, has the resources to pay extra. so while it seems nice that providers who perform well will be "rewarded", it means that there will need to be providers who will be "punished"- read: reimbursed less- for not meeting metrics. in a perfect world, we'd make everybody better, and maybe we could all achieve the benchmarks set. but because many patients are either too sick or too non-compliant to ever meet a benchmark, there will be a population of people who will never be "at goal". having too many of these folks in a practice will hurt the bottom line of the doctors who care for them. those doctors don't want to wind up in that bottom group who will be "punished", so they will weed out the "bad patients". the logical path of P4P is a selection by providers of healthy, compliant patients and a spurning of complicated, non-compliant patients who bring down performance numbers. this leaves a pool of people who need doctors the most but will not be able to find anyone to care for them. that's an improvement?]
back to the plan- lots of fluff about protecting kids from lead and pregnant women from mercury (the metal, not the planet), fighting aids, helping disabled americans, and a little blurb about "prevent(ing) insurers from overcharging physicians for their malpractice insurance". not a word about tort reform and reducing frivolous lawsuits though.
there's lots of stuff he wants to do, and even if all he puts through is his national health plan, the costs will be astronomical. i realize that before medicare was rolled out, it was probably met with much the same skepticism, but i just think that if there's a proposal for such a big policy, it should be offered with a realistic "we've all got to pitch in" financial plan rather than "we'll tax businesses and the rich, and it'll be OK" plan.
so when i try to pick a side here, while mccain's plan amounts to really nothing, at least it doesn't set us back. i think obama's plan is a bit overzealous, and the whole P4P thing really frightens me (in case you hadn't guessed). after one round then, the voting so far in the fink electoral poll is mccain 1, obama 0.
please, please follow the links to the candidate's pages and read the policies yourselves. it takes a bit to get through, and a keen eye to read between the lines, but it is well worth it.
this was fun- next topic soon- got a lot to get through before november.
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6 comments:
Fink--I admit that I share the media's adoration with Obama to an unhealthy extent (bad adj. here). However, I do think that "universal coverage" (or as close to it as Obama gets) needs to happen, needs to happen soon, and we need to get started on it. (Honestly, Obama's plan still has a few holes in coverage, but....) McCain's "change little" approach still will cost us plenty, as our present system does, and reimburses nothing for those who care for the uninsured. P4P has worked in our benefit (at a community health center, where we seek out the patients that most others wouldn't want) and EHR's will make this relatively easy to do. Thanks for posting these issues.
Both Obama and McCain site that 47 million in this country are without insurance. That seems like a lot. But, how many of these people are even Americans? According to this census http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm , 21% of the uninsured in '05 were not American citizens. Extraoplating that total to 2007, you are looking at 10 million non-Americans being included in the "47 million" being thrown about.
Another 47% of this total were full-time workers. So, while I am certain a good % of that total are stuck in jobs where health insurance isn't offered to them when they desperately want it, it is also stands to reason that a good portion of this segment purposely choose career paths where their compensation is largely in cash; and thus, are not eligible for employer-provided insurance. Food service, entertainment, construction, etc. are all industries where this occurs.
Again, this may not matter to some, but I think its worthy to at least point out that maybe the issue of just how many uninsured are out there may not be as big an issue as its made out to be.
The larger issue, in my opinion, is the cost of health care. McCain supports, not only tort-reform and real tax incentives to purchase insurance, but he also advocates the availability of health insurance across state lines. Allowing multitudes of carriers to compete against each other brings the free market into play and will surely lower costs.
Regarding Obama's plan, I question whether or not the problem of health care is so severe at this point in time to advocate a "universal" plan that will unquestionably 1) lower the overall quality of care and 2) put a greater financial strain on the average American in these uncertain financial times.
wiley- i'm not sure i get your point about employed people without health insurance. why should that 47% of people be victimized just because they chose careers in cash industries? i see those folks as exactly the reason there should be some kind of afforable health care for everyone.
i tend to agree with TJ- the time is soon for some kind of universal health coverage. this system is held together with chewing gum and duct tape and is ready to collapse. but i get the sense that obama's plan will be so costly that it will collapse under its own weight. (i didn't even get into the contradictions in his plan with regards to cutting the administrative "waste" in the medical system, then starting a huge bureaucratic national health care plan with a P4P system that will only exponentially add to the red tape.)
i do like mccain's plan to nationalize insurances- that will certainly help foster some competition. but i'm not sure he's as much of a supporter of tort reform as he comes off as. he pledges to eliminate suits against doctors who follow guidelines and adhere to "safety protocols". i'd venture that most med mal cases are just the opposite- doctors who gave good care, but didn't adhere to some organization's guidelines. his proposal would have very little impact on the current system.
i'm not a huge fan of either plan, but when it comes down to it, i have to direct my vote towards the person whose plan most favorably affects my life and that of my family. on this issue, that's mccain.
Fink - Many people choose professions where health care isn't offered, but that doesn't mean they aren't in a position to afford it on their own.
At least 2-3 people walk in to my practice per week without health insurance. Many are self-employed and many make a good living (waiters, psychologists, landscapers are examples) yet have made a choice not to insure their health. I'm not suggesting that the entire 47% of the employed fall into this category, but certainly a portion of that 47% does.
My point is is that, while "47 million" seems like a large number, when you consider 21% of this 47 million aren't citizens and another large portion are making concious decisions not to purchase insurance despite their ability to afford it, the real number of people with whom we should be concerned amounts to far less than 10% of the population.
As such, I believe the discussion turns from "how do we get everyone insured"?, to "how do we lower the cost of insurance"? Properly addressing the latter question will go a long way towards addressing the former.
We can debate the merits of a national/universal/socialized system on another day (I personally think it would be an abject disaster), but regardless of where you stand on this issue, I'm uncertain, in light of these facts, as to whether or not the problem is as dire as its made out to be - or at least dire enough to subject the average American to addtional financial strain to support such a system in this uncertain economy.
wiley--acknowledging that your comments were addressed to fink..., what would you do with the millions of patients who don't have insurance nor citizenship? they will still present for care, get sick or injured, work in our economy, etc. (i'm more certain we can implement some kind of universal coverage, than deport 10 million people.) we use our taxes to cover societal needs: police, fire, emergency medical care, disaster relief, military/national security, military/country's best interests, supporting certain industries, schooling/education, etc. The medical profession is becoming lopsided as some providers take the "cream of the crop" of insured. I can't imagine our country standing by as preventable illnesses are ignored. Ultimately, it will need to be a choice whether we feel health care is a right (and what that really means.) We can keep our current system, but health care isn't getting cheaper, and our tax dollars will continue to pay inefficiently for our broken system....
re: uninsured non-citizens-
as tj says, those individuals still will use the health care system. no doubt they will as a population rack up bigger bills than they can pay, and the industry will eat the cost. people smarter than math than us have no doubt computed how much of this cost rolls back to the average consumer buying insurance and the average taxpayer. at some point that amount we are paying will approach the amount we'd pay to provide insurance for them. i don't know when that will be, but the health care economic doomsayers say "soon".
both candidates' plans do focus on making insurance more affordable- mccain by offering tax credits and obama by offering federal insurance to all.
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