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Our health care system is unbelievably more expensive than any other first world nation. On a per capita basis, we spend over 50% more on health care than the second most expensive nation, Norway. As a nation, we spend more than twice as much per capita on health care than first world countries like Germany, Denmark, Belgium, France, Sweden, the UK, or Australia. If we actually got real health care reform that brought our health care costs down closer to the rest of the industrialized world, their would be no need to grant affordability tax credits on the new exchange.
In 2016, the Senate bill will spend $76 billion on affordability tax credits in the new exchange. The CBO says in 2016,
The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium
Using this data, I can estimate that roughly $210 billion will be spent on premiums in the non-group market in 2016. Of that $210 billion, about 36% ($76 billion) will by paid for by the government in the form of tax credits, and about 64% ($134 billion) will be paid directly by individuals.
If we had a health care system as cost effective as Germany, Denmark, or France, that $134 billion paid by individuals would be more than enough to cover everyone in the non-group market with several billion left over. If we could truly reform our broken health care system and bring its costs in line with the rest of the industrialized world, there would be no need for large government tax credits on the exchange. Think about that for a moment. Even with the government picking up about 36% of the cost, individuals in the new exchanges would still be dramatically overpaying for health insurance compared to the rest of the world.
What this bill does is expand something called “coverage” and adds some new regulations to insures. It is not real health care reform. Because Obama cut sweetheart deals with the hospitals, doctors, and drug companies, true cost-controlling reform became impossible.
Some supporters of the Senate bill have pointed to all the money going to middle class families to help them afford insurance as a great thing. The help is nice, but it only points to how terrible the underlying problem really is. It is simply a strategy of throwing good money after bad. Middle class families should not need government subsidies to afford health insurance. What middle class American families really need is for our government to rein in the different industries ruining our health care system, not pass a bill that will only enrich and empower them further.
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Rule number one: No true health reform bill is over 2000 pages long.
When they whittle it down to 20 or fewer pages, we’ll know they have our best interests in mind.
I dread what is happening in this country.
Amen.
How do Germany, Denmark & France control costs?
BTW, nice job on dn, Jon.
Thanks Jon.
Why oh why is it so difficult to figure out that if they had done the job correctly, middle class families wouldn’t need “all the money”.
Nice work Jon, I’m not sure what they were expecting when they put you and Wendel on the show, but while FD and even me said “Kill The Bill” we wanted effective changes in the bill not just kill it because the political fallout might have never been regained in the near future, prognostications about 2012 not withstanding of course.
If we just end up with a bill that smells less would be agreeable and as you said there many “tweaks” you can make that will make it a better bill though still not a real “PO” in the Hacker mold or Single Payer like the UK.
I would still go for allowing States to start their own Single Payer System without Federal interference because we have started to push again for California bill SB810 which would give California the only other Single Payer system not for military employees and enlisted.
I agree with Fides and we all know if it was Single Payer it would be about 2-3 pages long, why can’t we take a “page” from the Bank Bailout and make our laws and demands SIMPLE, SHORT and TO THE POINT?
Bottom line, the Senate bill takes billions of dollars in tax money and gives it to the health insurance companies, then leaves working families to spend their own money for crappy coverage that still costs more than real coverage in other countries.
“It is simply a strategy of throwing good money after bad.”; since that is seemingly the strategy for our government whether such be related to ‘war’ or ‘healthcare’ or myriad other examples, the modus operandi should not surprise anyone.
what such DOES do is empower those who would seek to do away with government associated with the common welfare.
There’s plenty of people in DC who can connect the dots; unfortunately ,the picture they think they’re drawing is not one the public can relate to.
I think “they know”, the problem is convincing these mostly small State Congress Members that they can get re-elected on the power of Progressive Policy and not depend on Industry fat cats to make sure they have millions of dollars for campaigns or jobs if they vote for such trans formative change and find themselves voted out of Congress.
To respond with an oversimplification, they use the economy of scale to negotiate large-group costs directly with providers.
Sure they can, how many times have you seen CNN, FOX and even MSNBC try to connect the dots? Democracy Now! does a better job of connecting the dots, but they don’t have advertisers to answer too and that’s the biggest difference in who is playing “Connect Four” or “Follow The Money”
All you really have to do is show America where their tax dollars are going, that works great but not done often enough.
AKA price controls. Just as I thought.
Wow, Jon. You were really great on DN.
We absolutely cannot accept that the Senate bill is the best deal our electeds can get for us.
Many argue that this is just one step toward reform, that it is a beginning and not a stopping point. Is this bill a step in the right direction, though?
No. The next logical step in the direction of reform would be investing in a government run option potentially available to all, either Medicare or something new. As you pointed out in this clip, the Senate bill further entrenches privitization into our healthcare system to the detriment of all.
(BTW, you were cute as a button, too. Is that ok to say?)
current events in Iran look like a movie trailer that is soon coming to the US.
Wonder how we rank with Cuba on 1) cost 2) quality
I know we are #37 on quality. Taiwan was first.
Listened to a woman on PBS a while back say she worked in the Triangle of NC. Her husband was a contractor and had no insurance. He had a heart condition that required immediate surgery. They could not afford it. Went to India. The cost was like nothing compared to ours. The technology ,kindness and expertise like nothing compared to ours in the opposite direction. In other words , they received quality health care at minmum cost. The woman said she would go back for non emergency health care.Had not been happy with US health care anyway.
It isn’t just the cost. Our health care system is broken through and through. Free market just does not work in this situation.
the free market killed all the buffalo
“I would still go for allowing States to start their own Single Payer System without Federal interference because we have started to push again for California bill SB810 which would give California the only other Single Payer system not for military employees and enlisted”
Build an American model in California that could be easily exported to the rest of the States by adhering to the adage: “As California goes, so goes the Country”.
http://www.californiaonecare.org/
Jon
I would like to thank you for all the excellent posts over the last several weeks as the debate has heated up. I have linked your assessments to another site and you have been recognized there by some as a fierce defender of true reform. Others there are in the tank for Obama and seem to believe this is the best we can do.
I’m taking a break from posting there and have come back to FDL as the bill moves through conference. Let me say, I do not advocate killing the Senate Bill. This is not because I think it is a good bill, obviously it is more than just flawed, it’s because I have a 30 year old daughter who will not be able to get insurance without some kind of reform. My motives are personal and not just for her but others as well in similar situations.
I do not have the courage some here have to take the chance that better reform can be legislated through our broken political system. My hope right now is that the bill will be improved along the lines of at least some of your 35+16 points.
I wanted you to know that you have been a great policy guy and are appreciated greatly by those of us who are not able to slog our way through this monstrosity.
Thanks
That’s the Senate bill, shorter version!
I’m glad you said, “cute as a button” first. That was what I was going to say — I figured that I’m old enough to get away with it. I too hope Jon doesn’t mind. *g*
Jon, you were great on Democracy Now. I enjoyed your comments and was glad to see how much you and Wendell Potter agreed on the facts. Keep up the good work and you are very “cute”.
that’s the money shot
except for the two thirds rule in the CA legislature that allows a gooper minority to just say NO NO NO.
Jon, ditto on the great work and thanks.
There is huge waste in the HC system, very true.
Pouring taxpayer funds into the for-profit insurance industry and to fuel the pharma marketing binge–flomax and boniva anyone–is nuts. No other country allows marketing of prescription drugs to the public. What do you think happens when you tell people 100 times a day they can have a drug to get a stiffy, or to sleep, or to pee less?
But it goes way beyond health care and has roots in entitlement and the run up in CEO pay, Wall Street entitlement and the excesses throughout our upper class–from yachts, to Bulgari to 500k cars.
Why wouldnt many docs, who spend years in school, want to be paid like these princes? Even if most of them still do it because they want to care for people and love being docs, they still feel they shouldnt take a seat at the back of the upper class bus. Maybe in the middle?
I am not supporting that value, but I see it.
OB seemed to have it right–get some populism in finance and health care and education–but now he seems to be walking away from it.
If you cant get action by harnessing the anger and the evidence that a free market in securities and banking screwed the pooch in the last decade, then how are you going to get action on health care to reduce the incredible amount of money per capita we pour into this necessary service.
Given that the French do it for about half of our costs, you would think you would see bodies littering the streets and the countryside. And if you dont, maybe you would conclude that we are lavishing way too much money on this industry and its parasites.
Granted that is a problem. I am not insisting on CA to become the beacon here. Any 8 million plus size State would offer a large enough risk pool to make it work.
Pick a State (smaller may be even better for the purpose of getting the camel’s nose under the tent), and then let’s all support it like it was our own.
Kill the bill.
Kill the Filibuster.
Start anew with a 50 + VP threshold.
Rule number 1 is being violated because of the decision to leverage reform off the existing private system of 1500 insurere, which nonetheless have significant monopoly concentration in certain geographic markets. The contrary decision would have been to leverage reform off the Medicare system (single payer) or Veterans Administration (public health service) systems. HR 676, a single payer bill was 38 pages; a number of those pages dealt with the disposition of the current private insurance system and the markets in which they could compete; this likely meets your 20-page requirement. To leverage off the veterans administration would require describing the disposition of private providers and the transition of private providers (voluntarily or involuntarily) into the public health service. That purely addresses the technical details of the legislation that must be covered in a straightforward bill.
The logrolling and pork barrel processes add pages as the bill moves through Congress. For example, the Stupak-Pits amendment added a page or two to the House bill. In addition, inserting industry loopholes also adds to the page count of bills.
“What middle class American families really need is for our government to rein in the different industries ruining our health care system, not pass a bill that will only enrich and empower them further.” Ain’t it the truth!
In other words, government monopsony.
A trillion for buggy whip manufacturers, not a dime on roads or cars. What’s a Congress for, I wonder.
lol. I am a huge Jon Walker fan, but the mom in me just squealed when I saw him – adorable !
And California is going to finance that single-payer system with what?
The difficulty with a state approach are the balanced budget amendments in Constitutions of many of them, which in rough times operate in an anti-Keynesian way to create a vicious cycle. And the first things to be cut are social infrastructure — education and healthcare.
If California does this there needs to be a repeal of Prop 13 as part of the legislation.
Dear Kirsten
I’m sorry but the Senate passed a health care bill that is unacceptable, because it is not what the public wanted. Its’ significant weaknesses are lack of cost control. Your colleague Mary Landreu is smoking something if she believes taxing health care plan is any form of cost control.
That’s the same as saying sales taxes force retail prices down. Just stupid.
You were part of that. No money. None. Get a backbone first. No show, no dough.
The enemy of the perfect (benefit to individuals) is the the enemy of the good (for us the industry)
Synoia
——————————————————————————–
From: Kirsten Gillibrand
To: dh (at) Synoia (dot) com
Sent: Tue, December 29, 2009 7:37:59 AM
Subject: Extraordinary difference
Dear Duncan,
I hope you are enjoying time with friends and family during this holiday season. After the last month in Washington, watching Theo and Henry play with toy cars, trains and every kind of Lego set has been a true delight.
Last week was a crucial moment in our nation’s history. By taking a meaningful step forward to reform our broken health care system, we will make an extraordinary difference in the lives of so many Americans. Many of you got involved in politics to fight for this type of reform – no one will be denied coverage because of pre-existing conditions, preventive care will now be covered, and no one will go bankrupt because of one illness. In NY, 2.7 million New Yorkers will now have access to coverage whereas they did not before, and small businesses all across America will receive billions in tax credits to offer quality coverage. Many of us would have loved Medicare for All to be part of this bill, but we must remember this is only the first step of many on a path toward reform.
So much of what we have accomplished was only possible because of your generous support and effective advocacy. Your sustained commitment to our campaign and this fight has strengthened my ability to be a champion for all those who will no longer accept the status quo and a system that is pricing out more and more families each day.
We have 4 short days left before the end of our quarter. As you know, the timing of your support could not be more important or have a greater impact than now.
Click here to contribute as little as $5 to my campaign. It’s the best way to build our strength and win in 2010.
Please know how much I need and appreciate your generous and thoughtful help. We have a midnight deadline on December 31st. Please give what you can before that deadline. Whether your personal maximum is $25, $480, or the maximum allowable $4,800, each and every dollar helps. We hope to raise an additional $100,000 in the next 4 days. Your help will get us there. Maintaining our majority in Congress could not be more important.
Thank you for your generous help today.
Warmly,
Kirsten
Welcome Back
been watching you patiently provide Jon’s facts to counter the so called logic over there. although to the Proprietor’s credit, he includes Jon when speaking of credible voices. speaking broadly, it seemed to be Party over Principles and I’d had my fill of that in the last 9 years :D
Hope-a-rope and short change we can believe in!
Thanks Obama for living up to fewer campaign promises than Kim Jong-Il.
Pick another State with a population of Norway where single payer would have a chance of passing, reduce their individual cost by 40% and use it as a Poster child for a Nationwide overhaul of Health Care.
Baring that:
Kill the Bill, then kill the filibuster, and try again with a 50+1 majority.
agree with this critique in addition to all those similar ones that have preceded it. I tink that without much doubt all here realize the nature of the problem and where the blame lies.
But what I also see is the need to place a requirement on everyone who makes a critique that they in addition offer a solution that does not involve pleading with those responsible for creating the problem to please change their way.
Specifically I am insiting that solutions be put forth that exclude politicians, and the health care industry. This leaves solultions that the public can initiate on their own. Solutions such as boycots, withholding of funds, recall elections, seeking court rulings that ban mandates, and the like.
We have heard more than enough of the rationale for change, I think we all get that and have for quite a while. The question before us is, what do we do now collectively to stop the onslaught that is facing the public as a result of this pending legislation, that does not involve petitioning and pleading with the same government that will inevitably pass this legislation.
If there is not a single proposition about what actions the public can engage in then we are in big trouble. We are admitting that people in this country are powerless to thwart the will of a determined few bent on pillaging the people. Such an admission leaves little wonder as to why that pillaging takes place.
Review this post and all these comments and you will find that not a single proposed solution involving collective action is put forth. Are people here so afraid to take matters into theri own hands?
Population of Norway, eh. Well here are your choices:
Wisconsin
Minnesota
Colorado
NORWAY
Alabama
South Carolina
Louisiana
Kentucky
Oregon
The only block is the provision that the Kucinich amendment was trying to deal with — even if the current health care bill passes.
In some of those states, not only do you have to deal with an insurance monopoly but also with a medical system (combined hospital, specialist practice, testing, primary care system) monopoly. Some are private; others are university-based. Does Norway have the equivalent provider structure?
Exactly! Of course, smart, too!
Jon… Fantastic job on Democracy Now…
KO and Rachel should have you on to calmly and clearly explain WHY the Senate bill is so bad… the several points you made at DN have gotten lost in the fray.
I hope someone gets you onto a wider audience…
The thing I think is most lacking in the Senate bill is regulatory oversight… which seldom gets mentioned in all the bleating about subsidies, 30 million people getting covered, etc.
O’Donnel and Potter did discuss it last week… but it was quite short and sweet.
Someone needs to do an expose about what exactly they will still be able to get away with and compare it to the financial crisis with no regulatory board in place.
Thank you SO MUCH for your hard, tireless work at getting the truth out.
And even if it requires repeating yourself, please keep it up.
As they say in giving a speech, “Tell them what you’re going to tell them, tell them, then tell them what you told them…”
ps… one more thought… graphics go a long way to effectively communicating some of these more obtuse ideas…
Perhaps some graphics to illustrate some of your points today would be helpful…
Even something as simple as a table with before and after the Senate bill columns would be good.
More Jane Hamsher pie fight on Orange:
http://www.dailykos.com/story/2009/12/29/820122/-All-Your-Dkos-are-NOT-Belong-to-FDL!
Are you kidding? Negotiating discounts for products and services is not at all the same as price controls. Price controls are mandated; negotiations are agreements between parties. But I’m sure you know that.
The history of how Taiwan developed their system is really fascinating, and funny; because they started out assuming they should follow our lead (as we were an affluent nation, and their largest trade partner), until they looked into it… then they became dumbfounded with how it was possible we could have such a horribly broken and expensive system.
Pennsylvania is farther along in pushing SP legislation than California, and it does not have the Prop 13 obstacle. Not that the metric really matters, but its population is about 2.5 that of Norway. Frequent coverage and links at Corrente, as well as this and other PA groups.
Lack of a Kucinich amendment (ie, ERISA waiver) is not fatal to such efforts but certainly damaging. The fact that the major SP organizations (PDA, HCN!, CNA/NNOC) have not consistently or even coherently pushed to restore such language into HC legislation in the last two months has been a sobering disappointment for me. Instead, they’ve pushed exclusively for Sanders’s quixotic amendment 2837 (the adaptation of his S. 703). Several days ago, I finally got an email from Mobilization for Health Care for All calling for restoration of the Kucinich amendment in conference committee. Another memo from the Department of Delayed and Ineffectual Gestures.
Underscoring my above complaint, I just clicked on the link provided by the Mobilization email, taking me to a form letter to my legislators regarding the Kucinich amendment. The letter calls for restoration of the amendment to HR 3200, which has been obsolete for two months!! They didn’t bother to update the letter to reflect HR 3962, much less the Senate bill. Ugh.
OK, gonalb, I’ll bite. Here’s an idea:
1. Find a doctor willing to work with a group of patients (it will take approximately 160) who have no health care insurance. Talk the doctor into lowering the rates he charges for his services (40-50% of his current rates). This doctor can not have any patients who are covered by for-profit insurance companies, as his basic rates will have been negotiated among those insurance companies – or he must be willing to give up those patients.
2. Find at least 160 uninsured people (including individual family members) who are willing and able to pay cash for the doctor’s services. Have all these people sign exclusive service contracts with the doctor.
3. The doctor can now lay off most of his accounting staff and all his billing staff, which will save him an enormous amount of money.
4. It would help if this doctor owned his own lab and testing facilities so he could offer deep discounts for these services, or alternatively be able to negotiate lower rates for these services from outside labs on behalf of his patients.
5. The doctor will not be able to negotiate with pharmaceutical companies for lower drug prices, although he may be able to acquire drug samples from these companies. He may also be able to work with a local pharmacy (not a chain) to sell discounted prescriptions to his patients if he guarantees all his patients will buy from that pharmacy.
6. This still leaves hospital costs, which will be almost impossible for the doctor to negotiate on behalf of his patients, unless he works with a non-profit hospital and can also guarantee all his patients will utilize that hospital. Even then, negotiating lower hospital rates for a single doctor will be tantamount to a single engineer flying men to the moon.
7. Also the doctor will have a significant problem negotiating lower prices for any medical devices and supplies required by his patients such as crutches, wheelchairs, pacemakers, stents, catheters, etc., although he may be able to order these from European suppliers if he has the requisite connections.
As you can see, a doctor’s breaking away from the medical/industrial complex in this country will be almost impossible, as his practice is completely bound up in the “system” that has been built to reward, as well as restrict, his alternatives to practicing medicine any other way but through currently approved and protected channels. The days of independent doctors ended in this country decades ago.
Any other suggestions?
I think this is a right step and has merits as a way to deal with the current problem of the uninsured. And such clinics caring only for the uninsured actually exist and seem to be doing well.
And as you suggest there are still plenty of people in need of medical care so the idea has merit.
I would urge that as we seek to deal with the current health care access problem, that we also not lose track of the fact that what is currently being proposed by the government is going to make the current health care situation worse. It will harm the uninsured as well as the currently insured.
So as we deal with ameliorating the current needs of poeple that need care, we should also find solutions that will stop the current HCR plan from getting of the ground.
I think that the case has been abundantly made that the current HCR legislation is a disaster and a diary ought to be presented to seek collective strategies to counter its effects beginning now.
Any other suggestions?
Move to Mexico.
http://www.usatoday.com/news/world/2009-08-31-mexico-health-care_N.htm
None of the health care reform ideas do enough to control overall costs. Why don’t we ever know the costs of health care procedures and treatments? I got a kick out of this fun, short video. Check it out. It makes you wonder why our health care system is set up the way it is.
http://www.whatstherealcost.org/45secondstoshare