The Cure That Dares Not Speak It's Name.

[allaboutmary]

In all of the debates about health care reform, one of the stubborn realities is that neither the Obama plan, nor any of the Republican alternatives, will seriously alter the trajectory of relentless cost-escalation in health care. If you look at the Administration's own projections of federal deficits in the next decade and after 2020, virtually all of the alarming growth in deficit spending is Medicare and Medicaid.

And that's only the public part of the health care bill. In 2009, total health care costs increased to 17.3 percent of GDP, with escalating premiums eating into both corporate profits and worker take home pay. The consensus among the usual policy experts is that there is no good solution. The march of technology and demography will just continue to raise health costs.

But you can reach that conclusion only by ignoring how the rest of the club of affluent countries manages to insure everyone for 9 or 10 percent of GDP, and have a healthier and longer-lived population, to boot. They do it, of course, through universal, socialized insurance.

There is no single formula. The Canadians do it with a single payer system for the insurance part, but physicians are private. The Brits have an integrated National Health Service. The Germans achieve near-universal coverage through a system of nonprofit health insurance plans.

What every other nation has in common is that they have taken the commercialism out of their health systems. As a consequence, they can direct health spending to areas of medical need rather than letting the market direct health dollars to areas of greatest profit. And with everyone covered, they can use highly cost-effective strategies for prevention, wellness, and public health. That's how you cover everyone for ten percent of GDP.

Our one island of single-payer medicine, Medicare, is phenomenally popular -- so popular that the Republicans' most effective attack on the Obama plan is that it would divert some money from Medicare. The Republicans, on the one hand, fiercely attack "government-run health insurance," while on the other they defend Medicare (which they would just as soon privatize).

But most Democratic politicians and policy wonks behave as if the option of a national health plan simply did not exist. These blinders are the result of the immense power of the medical-pharmaceutical-insurance complex combined with a failure of political leadership. Sooner or later, mainstream politicians will stumble their way to some form of single payer because there are no good alternatives unless we want to spend half of our GDP on health care.

In that regard, the best things about the still inconclusive end-game of Obama's efforts to enact his plan are that (1) the administration finally broke with the insurance industry, and (2) Obama is starting to get over the delusion of bipartisanship. So if we don't need either Harry and Louise, or John Boehner and Mitch McConnell, as part of the health-reform coalition, we might as well do it right.

With Obama's health summit behind us, there will now be a mad scramble for Democratic votes in the House and Senate to pursue the strategy that Obama should have used all along -- a Democrats-only bill relying on 51 votes in the Senate via the reconciliation procedure.

The problem is that Obama may have missed the moment. The prolonged, enervating battle for health reform, using a badly flawed bill, has scared off both conservative and liberal Democrats in both houses. The bill is politically toxic to legislators facing re-election, for good reason. The original formula, designed to enlist insurance industry allies, required a mandate to purchase insurance, diversion of Medicare funds, and unpopular taxes. Now that Obama has broken with the industry, an entirely different formula should be possible.

Alas, we are too far down the present road to advance single-payer in this legislative session. The president has done nothing to move public opinion in that direction, and has backed away even from the truncated version of it, the so-called public option.

I would put the odds at about one in three of Obama succeeding. Several Democrats who voted for the House-passed bill in November by the narrow margin of 220-215 have now defected, and several more are increasingly gun-shy. I don't much like this bill, but I still hope it passes so that the Republicans don't get rewarded for their relentless obstructionism.

Win or lose, the next great push should be for single-payer, assuming Democrats have a working majority again in foreseeable future. Given the collateral damage of Obama's strategy, that could be a long time coming.

[allaboutmary]

Unfortunately insurance companies don't care about anything but their bottom line. It would have to be so heavily regulated that it might as well be government run. Yes Medicare needs some work on prescription drugs. I see this with my mother. If she didn't have her pension she would not be able to afford her medication. I also feel she is way over medicated though. She was seeing too many doctors and they were not communicating the way they should.  I think we have a handle on that now though. She has received excellent care through Medicare and it's the only reason she is alive today. Unfortunately, her 3 daughters (that care for her) don't have any health care and 2 have serious illnesses that are going untreated.

[ILADVOCATE]

Medicare itself needs to be revamped because of the Medicare Part D plan and the gaps in coverage for many common medications. It is not workable for many people that are elderly or are qualified due to a disability who need Medicare. As for the for profit system part of that comes from the pharmaceutical industry but competition should in the way things work within a capitalist system provide safer and more effective treatment in the end. One problem is that there are so few pharmaceutical companies that there is not room for competition so perhaps some form of deregulation is needed as corporate monopolies detracted from other industries and deregulation has helped (more options as regards phone plans and airline fares). As for the insurance industry its a complete mess and there as well either more competition or more regulation is needed. Either way, the entire health care system should be designed to benefit people with more options included and there is no reason there can't be some for profit element involved.

[allaboutmary]

It's really up to the American people now.  Get educated on health care, on what will work and what won't, and demand it get done.  I don't think getting rid of all incumbents is the answer. The American people are speaking up and Washington hears them, but the message is not very clear. The first thing we need to do is find away to silence the insurance companies, so people can hear facts and truth and not scare tactics. It's sad that many more will die and lose insurance before we wake up.

[flmagi]

MARY ON MAGI'S COMPUTER
I should have posted that this was a copy and paste. I can't take credit for it. I posted it because I thought it was well written also.

[R Glass]

A very well thought through post. More thinking than emotion, I like that.
The other side to this coin “but I still hope it passes so that the Republicans don't get rewarded for their relentless obstructionism” is if it does pass, the Democrats get rewarded for their relentless shoving it down the Republicans throats. This is another reason I feel that politicians should not be the ones building this bill. They are Politicians nothing more and nothing less. As long as it remains a political issue, I don’t think it will ever get resolved.