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March 20 forum on health care invites participants

CLAUDE PEPPER LIBRARY PUBLIC ISSUES FORUM ON HEALTH CARE

This spring, the Claude Pepper Library at Florida State University in conjunction with the Kettering foundation would like to extend invitations to those interested in participating in a public forum discussion on National Health Care. The forum date has been set for Tuesday, March 20th from 5pm-8pm with the room location to be announced (the forum will be held within the Pepper Center Building on Call Street). The topic for this forum will focus on National Health Care and is titled: “Coping With the Cost of Health Care: How Do We Pay for What We Need?”

Click here to download the application to participate.

Included below is a brief summary of the forum as well as the three “approaches” that will be discussed by the participants:

Nearly three out of four Americans today worry that their income will not keep up with rising prices…These worries outstrip anxieties about losing a job, terrorist attacks, crime, and losing savings in the stock market.

The questions we must address are: How can we get the health care we require, in the face of rising costs? How can we pay for what we need?

There will be three approaches to be discussed:

  • Approach #1: Reduce the Threat of Financial Ruin
    Proponents of this approach say we need to make health insurance that covers major medical expenses available to everyone.
  • Approach #2: Restrain Out-of-Control Costs
    Health-care costs are too high for too many people. This approach holds that they should be reduced directly through price controls and other means.
  • Approach #3: Provide Coverage as a Right
    Proponents of this approach say that health care coverage is something every citizen is entitled to

If you are interested in participating, please contact:

Robert Rubero (rlr02e@fsu.edu)

Burt Altman (baltman@fsu.edu)

Click here to download the application to participate.



Our broken conversation (as told through a week in the life of Newt Gingrich)

Welcome to today’s Purple Post (why not go on over and read it at Purple, John’s about to write about tomorrow’s rapture, which will probably not be boring):

This week’s brouhaha surrounding the newly-minted candidacy and ensuing political missteps of Newt Gingrich provides an opportunity to understand just how wacky our civic conversation has become. Here’s how the apparent crash and burn started:

DAVID GREGORY (Meet the Press): “…Do you think that Republicans ought to buck the public opposition and really move forward to completely change Medicare, turn it into a voucher program where you give seniors…”

GINGRICH: “I don’t think right-wing social engineering is any more desirable than left-wing social engineering. I don’t think imposing radical change from the right or the left is a very good way for a free society to operate… I think what you want to have is a system where people voluntarily migrate to better outcomes, better solutions, better options, not one where you suddenly impose upon the–I don’t want to–I’m against Obamacare, which is imposing radical change, and I would be against a conservative imposing radical change.”

Essentially Gingrich had just staked out a semi-populist/smidge libertarian middle position that appears now to be similar to that of the majority of the American people (who don’t quite like either Ryan’s or Obama’s).

The right’s reaction was predictably based on Gingrich’s lack of loyalty rather than a recognition that he was riding the cresting public opinion wave while the rest of the party was likely being cumulatively tugged under it. This was so predictable because we’ve gone tribal, Shia and Sunni style, where no one on one side is ever going to advisedly take an opinion (publicly) against their own “tribe”, never mind what they actually think. The condemnation was round and swift, ending the week in the traditional conservative perp walk to the Rush Limbaugh show where countless Republicans have found themselves after saying ridiculously obvious things such as… no, Limbaugh isn’t the head of the Republican party, he’s an entertainer (Rep. Todd Tiahrt, R-KS and RNC Chair Michael Steele) or that Limbaugh throws bricks (uh, duh) (Rep. Phil Gingrey R-GA). Gingrich did the standard prescribed perp dance too, trying to say he didn’t say what he clearly said.

Of course none of this has ever been about reality, Gingrich just had to pay his tribal dues. Then again having paid them, it won’t make a bit of difference because in tribal politics like ours, he a goner. No “Sunni” would ever have supported him no matter how reasonable he became measured against their positions and he’s politically dead to the “Shia” now having disagreed with them on 1 (one) topic.

Indeed, over at America’s other political tribe, I heard precious little discussion of whether Gingrich had a point or possibly a bit of political courage, notably not by the people who ought to have thought he did. Ridiculing him has become sport, so why stop when he says something that presumably makes sense to them? Gingrich couldn’t buy a friend, even while representing a majority opinion in America. Instead most liberals didn’t seem able to resist taking general cheap shots. If you lean left and are resisting my point, think of the syndrome suffered by talk radio where no matter what position a Democratic leader takes and how close it is the position espoused by conservatives, the talk-radio crowd will tie themselves up in twisty illogical rhetorical knots to stake a position against him/her even if they have to argue against what they’re always arguing for. Hypocrisy is just so last season these days.

Liberals did that to Gingrich this week. It’s all because we lead now with our tribal anger.

Queue up Gingrich’s official spokesman’s statement, maybe the most bizarre I’ve ever heard, and you’ve got the three-ring circus at full-freakish tilt (you can also watch John Lithgow’s dramatic reading of the statement, starts about 3:30):

“The literati sent out their minions to do their bidding,” Tyler wrote. “Washington cannot tolerate threats from outsiders who might disrupt their comfortable world. The firefight started when the cowardly sensed weakness. They fired timidly at first, then the sheep not wanting to be dropped from the establishment’s cocktail party invite list unloaded their entire clip, firing without taking aim their distortions and falsehoods. Now they are left exposed by their bylines and handles. But surely they had killed him off. This is the way it always worked. A lesser person could not have survived the first few minutes of the onslaught. But out of the billowing smoke and dust of tweets and trivia emerged Gingrich, once again ready to lead those who won’t be intimated by the political elite and are ready to take on the challenges America faces.”

And so it goes.

Barely a peep this week in the way of an articulate conversation on health care and about whether Gingrich’s point had any merit at its heart. You see, we aren’t actually trying to solve any problems anymore. Keep this up and we’ll be getting exactly the public policy we deserve.

Ask the Shia or Sunni how well this has worked for them.

(Illustration credit: Jared Rodriguez / t r u t h o u t)



Republican Senator Tom Coburn does Village Square

Senator Tom Coburn (R- OK) made comments in a town hall last week with a little bit of something for everyone. For The Village Square, Republican Coburn stuck up for rival Democrat Nancy Pelosi, calling her “a nice lady” to a crowd that didn’t want to hear that.

But what was most interesting was to watch the coverage of different aspects of Coburn’s town hall depending on which network covered it.

At The Village Square we have observed an attendance pattern at events: People tend to come to the forum that interests them, therefore we get more conservatives when we talk taxes and and more liberals when we talk environment. We’d like to reverse the trend, for the sake of improving the civic dialogue. So… in that spirit, please note the reading instructions for this blog post:

For Republicans, please read this:

“What we have to have is make sure we have a debate in this country so that you can see what’s going on and make a determination yourself,” the Oklahoma senator said in remarks to a home-state town hall meeting… “So don’t catch yourself being biased by FOX News that somebody is no good. The people in Washington are good. They just don’t know what they don’t know.”

“I want to tell you, I do a lot of reading every day and I’m disturbed that we get things… that are so disconnected from what I know to be the facts. And that comes from somebody that has an agenda that’s other than the best interest of our country. And so please balance and be careful.”

And here is the reading assignment for Democrats:

“The motivation is not to fix health care,” Coburn told about 40 people at the Miami Civic Center. “The motivation is to put the federal government in charge of health care.

“This sounds somewhat paranoid, but I think they know this is going to fail,” he said. “Then they can say, ‘See, the government needs to be in charge of all prices doctors (charge) at all levels.’ ”

Rigging the system to fail will pave the way for “single-payer, government-run, rationed health care,” he said.

(Photo credit.)



All I know is that the seesaw of destructive anger is going back and forth

‘People are trying to understand a really complicated bill that keeps changing all the time… I think it’s a danger for Democrats to treat this like “the bad guys are coming to get us. They’re racists, they hate Obama… They’re better off trying to explain the bill.’ — The New Republic’s Michael Crowley on Morning Joe (commenting on Democratic Senator Sheldon Whitehouse’s comments about the vitriol on the right toward President Obama, implying that opposition to health care is fundamentally based on their their fury.)



My Purple Essay: Healthcare gets the Purple Treatment (and may live)

purple-state-of-mind-logo-small.jpg

(The latest in the contributions we’re making to our friends discussion over at Purple State of Mind. Feel free to head on over and weigh-in too.)

At the Village Square, we started out knowing not-so-very-much about healthcare.  Then, over the last 4 months, through the wonder of the internet and a little old-fashioned elbow grease, we became students of the health care debate.  We’ve spent time with experts, read policy-wonk-ish studies until our eyeballs bled (requiring us to need – uh – health care) and even invited 200 people to dinner to talk about it all (Take 2 Aspirin, Fix Health Care & Call Me in the Morning.)  
 
As the Congressional debate ramps up, as we can expect a run of confusing and an increasing volume of plain dumb, we thought you might just be in the mood for a non-ideological primer on healthcare, written specially for our friends in the purple crowd.  (With all the health care studying we’ve done, we’re probably smart enough to do single day surgeries by now, but too bad for you we’re long distance.)  So here, with affection, is our non-surgical gift to you:
 

    Doing nothing really isn’t an option. The rising costs are unsustainable; they bankrupt individuals, handicap small businesses and even hurt larger businesses competing in global markets.


    Free market forces simply aren’t working in health care. The pro forma partisan argument between offering a market solution and a governmental one misses the salient point: The incentives that drive down cost & increase quality in a market economy are inverted in health care. The current system encourages more treatment over better care; we need to flip it. Fixing convoluted incentives is a complex task that requires grown-ups to come to the table, not the five-year-olds who seem to usually show up.

    Advertising pharmaceuticals probably ought to stop.  Heavily advertised allergy, hair loss and erectile dysfunction medications create a huge health care bill for things we often don’t really need.  It builds a consumer-driven demand effectively, yet consumers don’t directly pay for what they’re demanding.  It’s like if the mall management started paying for your teenage daughter’s shopping, a situation that doesn’t tend to produce rational decision-making and restraint. This doesn’t mean some of us don’t need these medications, but our doctor will guide us to them when we do.  Winning with the endless-erectile-rama isn’t just Big Pharma, it’s also the networks selling them ads.  Losing is – uh – taxpayers (and good golly gosh our kiddos who have to listen to 15,000 Cialis ads an afternoon).

    Common sense lawsuit reform needs to stop being a political football and start happening. There are measured voices on the left (among them Governor Howard Dean and President Obama) who admit that excessive malpractice awards can’t help but weight the practice of  medicine towards overutilization of testing.  Democrats have to just wake up and smell this coffee.  And Republicans need to stop pretending that the health reform sun rises and falls with tort reform.  It doesn’t.

    Cost-control is the big gorilla in the room.  No real advice here, because this gives me a headache.

    Rome wasn’t built in a day.  Whatever reforms we try will be imperfect and will need to be incrementally improved.  That’s as it always has been.  Good results can start with imperfect beginnings.

    Grow up and lose the breathless good and evil story lines.  At some point the body politic needs to stop searching for a villain. Every interest in the health care fight has skeletons in their closet and owns a part of what has to change.  We’d like to see them stop throwing stones from their glass houses and – in the words of President Obama – “grab a mop.”   There are even skeletons in the closet of the vaunted American citizen. Which leads me to a last bonus health insurance insight…

    We are overweight.  70% of health care costs are lifestyle dependent.  We want to eat, drink and be merry then we want someone to give us a pill to fix it when our chickens come home to roost.  And if somebody expects us to pay for the pills ourselves, we’re going to vote them the heck out of Dodge.

—–
If you read only two articles on health care reform, here are The Village Square picks (both long, both well worth it):



More info on Democrats’ anti-trust charges against health insurance companies

Take 2 Aspirin web

One of the personal conclusions I came to in my study of health care leading up to our “Take 2 Aspirin” health care forum is that a for-profit model simply doesn’t work in health insurance. (I want to make the clear distinction between for-profit and nonprofit here. Nonprofit insurers are a horse of a different color.) The true customer of a publicly traded company is the shareholder and the interest of shareholders and the company’s insured patients are largely directly opposite.

This plot has just thickened.

In yesterday’s incarnation of the titanic health care struggle, Democrats and health insurance companies were at it again, after their first round battle over whether the reforms will raise insurance prices, as the insurers have charged in a report they commissioned. Yesterday Democrats began talking about eliminating the anti-trust protections enjoyed by insurers. Under the 1945 McCarran-Ferguson Act, insurance companies are exempt from federal anti-trust regulation. The law doesn’t mandate state regulation, but allows it. Here’s a quickie primer on the Supreme Court case that ultimately decided that insurance didn’t qualify as interstate commerce to be regulated by anti-trust laws:

The South-Eastern Underwriters Association controlled 90 percent of the market for fire and other insurance lines in six southern states and set rates at non-competitive levels. Furthermore, it used intimidation, boycotts and other coercive tactics to maintain its monopoly. The question before the Court was whether or not insurance was a form of “interstate commerce” which could be regulated under the Commerce Clause of the United States Constitution and the Sherman Anti-Trust Act.

Here’s what the feuding parties said yesterday:

According to the Dems (Chuck Shumer – D NY): “The health insurance’s antitrust exemption is one of the worst accidents of American history,” Schumer said. “It deserves a lot of the blame for the huge rise in premiums that has made health insurance so unaffordable. It is time to end this special status and bring true competition to the health insurance industry.”

According to the insurers: “McCarran-Ferguson has nothing to do with competition in the health insurance market. The focus on this issue is a political ploy designed to distract attention away from the real issue of rising health care costs.”

Here is a fascinating argument that the monopoly insurers enjoy is much bigger than just health care costs, but was fundamentally involved in our fiscal meltdown, particularly AIG:

…insurance is essentially unregulated and, when [insurance] companies were allowed by the Gramm-Leach-Bliley Act of 1999 to expand into banking, the lack of transparency inevitably led to the subprime mortgage crisis of 2007 and will ultimately result in more financial services and insurance company bankruptcies. Repealing McCarran-Ferguson is an essential first step to fiscal regeneration in this country…

Please jump in if you have any further insight into this issue. Seems like a big one to me? It gives rise in my mind to a number of questions I currently have no answer to:

  • Would this problem be solved by the Republican’s recommendation that we allow insurers to compete nationally? (Note that Dems said this would just make it so all the insurance companies would base in the states with the least regulation.)
  • If we’re trying to control health insurance costs, eliminating anti-trust exemption seems like low-hanging fruit. So why in the world hadn’t this come up before? Had the administration made a deal with the devil (for purposes of argument, the for profit insurers) that was broken when the insurers released their report suggesting steep cost increases under the current legislation?
  • With long-standing federal anti-trust laws in our country, why the heck would insurance be exempt? Am I missing something?


Politifact: How long would it take to read the health care bill?

thumbnail politifact

Apparently there are all sorts of complex calculations that go into how long Congressional leadership gives members to read a bill, beyond the standard meme that they’re trying to pull one over on the other political party. Turns out they try to avoid giving opposition to the legislation time to pull cherry-picked quotes out of the gargantuan bill and warp its meaning. Find this and Politifact’s estimate on the length of time it might take you to read this bill HERE.

Oh, and clear your calendar for the weekend.



A little stick in the eye of both rugged individualism and the notion that competition in health care will bring down costs

cowboys

As a public option was voted down in the Senate’s powerful Finance Committee yesterday, Uwe E. Reinhardt – a professor of health economics at Princeton University – says that competition doesn’t work to bring down health care costs. If he’s right, uh, oops…

Find Reinhard’s assessment of the German health care model here, which relies on heavily regulated non-profits, lots of government involvement and only a tiny for-profit market for high-income earners.

Reinhard also had sharp words for our American frontiersman self-image (and he might just have a point):

Eighty percent stay in the traditional Medicare plan rather than choosing the private Medicare Advantage. Although the American people appear unaware of it, government is the only institution they really trust deep down. It’s utterly ridiculous to say they don’t trust the government. Where do Americans turn for help when they get into trouble? Do they run to the private sector? Even big bankers run to Washington. With a public plan, you would get something like Medicare. Just try taking Medicare away from the elderly. In the decades I have lived here, I have discovered this about America’s legendary rugged individualists: when the going gets rough, the rough run to the government.

Ouch.



Even the “individual mandate” is utterly complicated

In our three month crash course on health care reform we learned while we’ve been spinning in circles of factual inaccuracies in our public debate, the reality of health care reform is terribly complicated.

If we were pressed on naming a general consensus, we’d have to say it’s the growing sense that we’ve got to get most people insured, make insurance portable (not tied to job status), make it illegal to deny coverage based on preexisting conditions and to rescind coverage once there is an illness (a practice called “recision”).

We essentially already pay for catastrophic insurance for the uninsured today, at no cost to them, because if any of them walks into an emergency room bleeding, we treat them. Unless we’re going to stop treating all bleeding people, it is sensible to require people to step up to share some level of responsibility for the benefit they get.

Ah, but the devil is in the details and universal coverage comes with a direct price tag that’s hard to compare even-up to the indirect price tag society pays for the uninsured today.

From yesterday’s New York Times:

This is not the question of whether the proposed health care legislation is affordable for taxpayers and the federal government — an issue that seemed to be answered when the Congressional Budget Office said the Senate Finance Committee’s bill would eventually help reduce federal budget deficits.

The affordability question vexing Democrats is whether those with moderate income will be able to afford health insurance, even with the subsidies the legislation would provide and all sorts of new rules aimed at controlling costs.

The current Senate Finance Committee plan requires middle-income families to pay up to 12% of their income to health insurance before subsidies kick in. There are amendments pitched at decreasing this percentage, but they start to rub against the cost ceiling for the health care reform package set by Obama.

So even the no-brainer part of health reform isn’t no-brainer at all…



Flu, facts and fury

swine flu porky pig

I happened to tune in yesterday to a few minutes of Sean Hannity to hear him rant about those controlling government folks again and their infernal state-run media, the Associated Press (which would probably come as a big surprise to the White House). This time it was in relationship to the flu vaccine and the government’s bent toward wanting to kill off all the old people. (Maybe everyone who works for the government was spawned – and probably by you-know-who – and doesn’t have parents themselves who might be among the killed-off?)

Hannity demonstrated his aptitude for flipping reality on its head while never needing to even pause to keep up with all the distortions. I’ve got to admit a grudging admiration for whatever talent that demonstrates. He implied (but didn’t quite say, which is probably his loophole) that the government was going to withhold life-saving flu vaccines from the most frequent victims of flu, our elderly parents. He quoted a couple of octogenarians saying it was OK with them, they’d had a good life and all and were willing to take one for the team. It all sounded so preposterous that I decided to look it up myself.

Here’s one of the AP articles:

The new swine flu seems no more deadly than regular winter flu, which every year kills 36,000 Americans and hospitalizes 200,000. But there’s an important difference: This H1N1 strain sickens younger people more frequently than the over-65 population who are seasonal flu’s main victims. So children are among the priority groups who are supposed to be first in line once swine flu vaccine starts arriving next month, and many schools around the country are expected to offer mass vaccinations.

Turns out that here is what is true:

  • The role of the CDC and public health is – and has always been – identifying the most at-risk populations and addressing those needs first, then less priority needs after. How’d you like to manage a public health issue without the them? (Think the AIDS crisis, during which I’d argue we saw true heroism from those government bureaucrats Mr. Hannity likes to rail against.)
  • Most years during the normal season flu outbreak, the most at-risk people are seniors both in contracting the illness and severity once contracted. Younger adults take their turn in line every year during flu season after the high risk elderly get vaccinated.
  • This time, seniors aren’t the most vulnerable, young people are. (I ran into my doc last week and he said that so far he’s calling the swine flu the “piglet flu” – not so severe and contracted mostly by younger people.) Older people seem to have immunity to H1N1, so they drop in priority.
  • The government (yes, government) along with drugs companies (yes, “big pharma”) get us our flu vaccines every year. Have no idea how they do it, but they do. Without them, the flu might just mow us all down.

Feel free to do your own sleuthing and give a yell if we’re missing something. I never could find any of Hannity’s quotes from government love-slave seniors willing to cash in their chips to save us $6.50. Please share if you can source them. Hannity’s implication is that millions and millions of Americans who don’t see things his way politically would actual be OK with denying their very own parents health care. Sheesh.

At some point, telling everyone that black is white becomes damaging. I’d say we’re there.

Don’t get your health news from Sean Hannity.

(Cartoon credit.)



To support our first piece of guiding wisdom on healthcare: Doing nothing is not an option.

business roundtable healthcare costs

From a report from The Business Roundtable titled “Perils of Inaction: What are the Costs of Doing Nothing:”

“Without significant marketplace reforms, if current trends continue, annual healthcare costs for employers will rise 166 percent over the next decade, from $10,743 per employee today to over $28,000 by 2019.”



Take 2 Aspirin: A Draft of Guiding Wisdom, Part 2

Take 2 Aspirin web

Here’s the rest of our draft ideas about health care reform. See the first part of the list HERE.

  • We “ration” now; the main question is whether we want to ration by what really works or by running out of money.
  • Americans bear some personal responsibility for the rising costs; we’ve gotten heavier & heavier…70% of all health care costs are lifestyle dependent.
  • The current system encourages more treatment over better care; we need to flip incentives to de-incentivize quantity and incentivize quality.
  • Reform requires increased power & choice by consumer; has to be patient-centered both in an economic and a clinical sense.
  • Consider the concept of incremental improvements. Good results start with imperfect beginning.
  • Lose the search for a villain; it’s not helping us address the dysfunctions.
    There is no magic bullet; one solution won’t do it and real change won’t come easy.
  • Everyone – hospitals, insurers, doctors, patients, attorneys, the government – has skeletons in their closet. The solution needs to have many fronts.


Take 2 Aspirin: A draft of guiding wisdom, part 1

Take 2 Aspirin web

Here is a draft of wisdom drawn from our work learning about health care. It doesn’t yet incorporate last night’s input from our very wise panel. We know it will be hard, but part 2 is tomorrow.

  • The current rising prices of health care are unsustainable; doing nothing is not an option. Rising costs hurt us as consumers, they hurt small businesses, they hurt larger businesses competing in global markets.
  • It is important to avoid using anecdotes as a basis for reform rather than examining evidence in a more systematic fashion.
  • Free market forces are not functioning properly in health care to find efficiencies.
    • Insurer between doctor and patient pays bill; no incentive for conservative care and no supply and demand curve.
    • Patient lacks specialized knowledge and adequate information to function fully as informed customer.
    • Who bargain shops for their triple bypass?

  • We have a concerning shortage of primary care physicians because it is not financially rewarding compared to specialization. There is potential for other physician shortages with a larger pool of insured subsequent to potential reforms.
  • Potential point of consensus: Combine individual mandate for insurance with portability and prohibition for both excluding pre-existing conditions and recision of policies.
  • If there is a pubic plan, there has to be a level playing field; it cannot pay 80 cents on the dollar as Medicare does. Better model is federal employee’s health plan.
  • Single payer is not the same as socialized medicine. Single payer replaces private insurance as the source of payment; socialized medicine means all physicians are employed by the government, which also operates hospitals.
  • This problem requires long-term thinking. Politicians will always think in 2,4, and 6-year cycles. It’s us, the people, who have to think 50 years out and insist that they do too.
  • The health care industry is full of structural distortions; people respond rationally to the economics created by the distortions.