Pages

Friday, February 26, 2010

 

Miles Mogulescu

Posted: February 23, 2010 05:44 PM

The Real Reason Obama's Plan Doesn't Include a Public Option

The reason Robert Gibbs gives for President Obama's health care plan not including a public option -- that despite majority voter support, it can't get 51 Democratic votes in the Senate -- doesn't hold up. The real reason is that Obama made a backroom deal last summer with the for-profit hospital industry that there would be no meaningful public option.

This is one of the great under-reported stories of the health reform saga. Much has been written about the Obama administration's deal with big Pharma to continue to block Medicare from negotiating for lower drug prices or to allow consumers to buy cheaper drugs from Canada, in exchange for Pharma running pro-Democratic ads and giving campaign contributions to Democratic candidates. That's the reason, under pressure from the White House, that Senate Democrats voted down an amendment that would have allowed consumers to buy cheaper drugs from overseas.
But Obama's deal with the for-profit hospital lobby to insure there would be no public option has, as best I can tell, only been reported in two articles in The New York Times. On August 13, The Times reported that while President Obama had presented himself as "aloof from the legislative fray," particularly in connection with the public option, "Behind the scenes, however, Mr. Obama and advisors have been...negotiating deals with a degree of cold-eyed political realism potentially at odds with the president's rhetoric." One of the deals reported in The Times article was the Pharma deal. The other was a deal with the for-profit hospital lobby to limit its cost reductions to $155 billion over 10 years in exchange for a White House promise that there would be no meaningful public option.
According to The Times:
"Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying-Medicare rates...or controlled by the secretary of health and human services. 'We have an agreement with the White House that I'm very confident will be seen all the way through conference', one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter...Industry lobbyists say they are not worried [about a public option.] 'We trust the White House,' Mr. Kahn said."
Mr. Kahn's lobbying group, with whom the White House made the deal, represents America's investor-owned, hospitals whose profits could be diminished by a public option with the negotiating clout to negotiate lower prices. To say that the deal included ensuring that any public option would not be "controlled by the secretary of health and human services" is code for saying it would not be national in scope and would lack negotiating clout--In other words, the Obama administration made a deal that a national public option on day one comparable to Medicare was off the table.
On September 9, a few weeks after The Times reported Obama's deal to gut the public option, President Obama gave his big health care speech to a Joint Session of Congress. In the speech, Obama said one of the programs he was considering was a "not-for-profit public option available in the insurance exchange." Supporters of the public option took this as a sign that Obama was on their side.
But Washington insiders noticed that Obama parsed his words very carefully. The New York Times noted that:
"Mr. Obama's call for a public plan, however, omitted any discussion of what rates it might pay or who might control it...'He worded it really carefully, because he said 'not for profit' and he didn't say it had to be controlled by the government,' Mr. Kahn [the hospital lobbyist] added. 'The way he described it, we could support that!"
In other words, Obama signaled the private health care industry that his deal that there would be no meaningful public option still stood.
Throughout the process, the White House has given vague statements supporting the public option -- enough to keep liberals and progressive on board -- while repeatedly undermining the public option in practice. Jane Hamsher has written a useful timeline of White House efforts to undermine the public option.
There is no evidence that President Obama has ever twisted the arm of a single Senator to support a public option and plenty of evidence that he has assiduously avoided doing so, sending a message to Senators that he doesn't want a public option. When the Senate passed its version of the health reform bill, the reason the White House gave for there being no public option was that it couldn't garner 60 votes. But Joe Lieberman, who could have been the 60th vote, insists that the Obama administration never pressured him to support either a public option or a Medicare buy-in. And Sen. Russ Feingold blamed the demise of the public option in the Senate on the White House's failure to push for it.
Now the White House is saying they're not including a public option in Obama's plan because they can't get even 51 Democratic votes in the Senate. Does anyone really believe that if President Obama really wanted a public option -- if he hadn't dealt the public option away in a backroom deal with the for-profit hospital industry -- he couldn't get 51 out of 59 members of the Senate Democratic caucus to vote for it?
As a long-time supporter of single payer, I'm not the world's biggest fan of the public option and I've written about its limitations in these pages many times, included here. But at this point, when it comes to health care reform, the Democrats face a Hobson's choice of their own making between two suboptimal alternatives. Either they can use reconciliation to pass a defective health care bill that's supported by only 1/3 of the voters. Or, as in 1993, they can let health reform die for this year. The first choice means passing an unpopular bill, but at least it would show that when Democrats set out to accomplish something, they actually have the strength to do it. The second choice means admitting that their year-long efforts to pass health reform were a failure.
The most popular aspect of health care reform is the public option, which is supported by nearly 60% of voters while the overall bill is supported by only about 33%. Adding a public option to the final legislation may be the only thing that can boost its popularity among voters.
Will the Obama administration continue to cling to its deal with the for-profit hospital industry to block the public option, even at the price of public support? Or will it finally release at least 51 Democratic Senators to include a public option in the final bill through reconciliation? Its decision may be decisive in determining whether President Obama and a Democratic Congress can govern.


Yes, Obama did campaign on the public option

PH2009122203792.jpg
Oy. I'll defend the argument that the health-care bill that looks likely to pass is structurally similar to the health-care proposal released by the Obama campaign. But it's impossible to defend Obama's statement that "I didn't campaign on the public option." For one thing, it was in his campaign plan, which is to say, he campaigned on it. The proposal (pdf) assured voters that Obama's plan will "establish a new public insurance program available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers."
The White House argues that they didn't emphasize it in public speeches, and according to Salon's Alex Koppelmann, that's true. But speaking as someone who did a lot of reporting on their health-care plan, they emphasized it privately quite a bit. It was, in fact, their answer to a lot of the other flaws in their proposal. So whether Obama used it in his speeches, his campaign purposefully pushed it to, at the least, some reporters, which is to say they worked to ensure that people knew about the public option's important role in their health-care thinking.
Obama's latest statement on this is hair-splitting at best and misleading at worst. That's even more true given how often he mentioned the public option after he got elected. And it's a good example of why the left is losing its trust in Obama. Obama could have given an interview where he expressed frustration that the math of the Senate forced his administration to give up the public option but nevertheless argued that the rest of the health-care bill was well worth passing. Instead, he's arguing that he never cared about the public option anyway, which is just confirming liberal suspicions that they lost that battle because the president was never really on their side.
Photo credit: Bill O'Leary/The Washington Post.




 Comments with a similar take on Public Option


Ezra, good to point out this and glad that you still bat 'straight'.
There is little of humility missing here on President's part. He is doing more of 'mission accomplished', 'Iraq is the front of terror war' and 'we fight Al Qeda in Iraq so that they do not attack us at home' kind of stuff. It is all heady in President Obama's head. I guess something happens with White House - an occupant of it becomes this 'head strong, arrogant and dishonest person' with no trace of humility.
Let us start:
1. Stimulus package - it worked, but it is time for him to acknowledge that WH was way too aggressive in their assumptions and they should have listened to many other outside experts in being more down to the earth; especially while selling that package to Americans.
2. Obama could have said that HCR could have waited in this Great Recession but he still wanted to pursue for (fill in the blanks) reasons. However, he needs to acknowledge that it took more time than what he thought and that kind of eaten up time in focusing on Economy.
3. PO, he did support and he did want it. He is on record, but he needs to say simply that it is sacrificed for now so that overall the bill moves forward.
4. Iran - diplomacy has not worked and there are no chances that it would work. Task is cut out in terms what needs to be done.
5. Israel does not see merit, for wrong reasons, in American position of stopping settlements and hence we are stuck.
These are all solid blockages President Obama has encountered in his first year and he better be upfront and honest about those.
Otherwise, another most important reason why Public backed Obama - absence of foolish arrogance of Bush Presidency - will very much whittle away.
Remember, it is our this Camelot who said he expected people to hold him accountable. President, time of deliverance is here.

Ezra...I recall Obama always saying he preferred a public option but it was not essential, and you admit yourself that they played it down. I think the exchange idea that is in the bill is a much more politically sound way to go. There were really a lot of questions about how feasible a public option was, who would run it, how it would be paid for. I am disappointed that the Medicare expansion did not go through (thanks Joe Lieberman), but to suggest this bill is "window dressing" is BS. And it's a start. I am a true blue Liberal who still supports the efforts of our President. I wouldn't listen to PUMAs such a Jane Hamsher, as reflective of most Democrats. Last poll I saw had Obama's approval ratings twice as high as GWBs. He still has great support.

Dialing Into Health Care Debate

 A focus group in Philadelphia made up equally of democrats and republicans talking about the health care summit it is interesting and valid for what WE THE PEOPLE feel about the health care reform. And even though it was on Fox News with Hannity it was still good. 


USA ranked 37th in the World (not Impressive)

If anyone can find newer rankings that show us any higher please let me know. I have looked and looked this is where I am




The Truth-O-Meter Says:
Hipp

The U.S. ranks 37th in the world for health care.

Paul Hipp on Wednesday, September 9th, 2009 in a YouTube video

Rocker in viral video mocks U.S. for 37th-best health care in world




In a music video, Paul Hipp says the U.S. ranks 37th in the world in health care.
With biting sarcasm, singer Paul Hipp says the United States should be proud of its global ranking on health care.

"We're No. 37!" he sings in a YouTube video released Sept. 9, 2009. 

With some electric guitar riffs and topical references to the summer's vitriolic debate over health care reform — including Rep. Joe Wilson's "You lie!" heckle of President Barack Obama — the satiric romp "celebrates" the United States' standing:

We're No. 37
We're the U.S.A.
We're No. 37
And we're so proud to say
We got old people crying at the pharmacy
Pay your deductible
This ain't the land of the f-f-f-free Grandma
We're No. 37

We're the U.S.A.

The number refers to the World Health Organization's ranking of the United States as the 37th best health care system in the world, out of 191 countries. In a cheeky countdown, the video shows viewers a cross-section of nations that ranked better than the United States in WHO's tally — a mix of industrialized nations in Western Europe, Scandinavia and Asia; wealthy oil producers from the Middle East; tiny realms of prosperity such as Monaco and Luxembourg; and some seemingly unlikely nations such as Colombia, Cyprus, Morocco, Dominica and Costa Rica.

It's an anthem for health care reform that even shows its sources: Hipp includes a shot of himself looking at WHO's report. So he wins points for transparency in sourcing.

But as hummable as the song is, we thought it deserved a bit of scrutiny. How did WHO arrive at the numbers? And how widely accepted is the health organization's methodology? Ultimately, did Hipp choose a good benchmark on which to base his song?

Observers generally agree on two things about the report. It was a landmark study that attracted a lot of attention around the world. And its conclusions have inspired controversy for nearly a decade.

We should point out that the ranking is actually not new. WHO, an arm of the United Nations, published the international comparison in its World Health Report 2000 , and it hasn't been updated since. (Other groups have offered their take, as we explain below.)

Five factors went into WHO's calculation:
• Health level, as defined by a measure of life expectancy, which shows how healthy a country's population is. This factor gets a 25 percent weight.

• Responsiveness, which includes factors such as speed of health services, privacy protections, choice of doctors and quality of amenities. This factor gets a 12.5 percent weight.

• Financial fairness, which measures how progressive or regressive the financing of a country's health care system is — that is, whether or not the financial burdens are borne by those who are economically better off. This factor receives a 25 percent weight.

• Health distribution, which measures how equally a nation's health care resources are allocated among the population. This factor receives a 25 percent weight.

• Responsiveness distribution, which measures how equally a nation's health care responsiveness (which we defined above) is spread through society. This factor gets a 12.5 percent weight.

Once these statistics were collected, the WHO combined them into two summary rankings. One, called "overall attainment," is the basic weighted average of the five factors listed above. The other, called "overall performance," took that number and adjusted it for how well a country's health system was doing compared to how well WHO's experts believed it should be doing based on education level and economic resources.

Using the second of the two ratings — overall performance — the United States does indeed rank 37th. But using the first factor — overall attainment — the United States does better, finishing 15th. One might be tempted to downgrade Hipp's song for cherry-picking the less favorable number, but Hipp seems to be on solid ground here. The WHO itself considers overall performance to be the more important ranking of the two. In a news release accompanying the original report, the WHO placed the 37th-place ranking right near the top and never even mentioned the 15th-place ranking. So it seems fair to us for Hipp to focus on that number.

Of course, any ranking — whether it's U.S. News and World Report 's ranking of universities or the WHO's ranking of health systems — is subject to disputes over what factors should be included. In his 2009 book, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care , journalist T.R. Reid finds value in the WHO's study even as he acknowledges that it is "all but impossible to design a single rating scale that would accommodate countries ranging from Monaco (population, 33,000; per capita income, $30,000 per year) to Nigeria (population 101 million; per capita income, $310 per year)."

Despite some quibbling on technical matters, most observers broadly agree that two of the WHO's five measures — health level and responsiveness — are reasonable. The first statistic gauges health outcomes, which are obviously a health care system's No. 1 goal, and the second seeks to measure how well a health system works when interacting with patients, another widely agreed upon mission.

But there is far less consensus over the other three factors. Concerns stem from a mix of methodology and ideology.

Glen Whitman, an associate professor of economics at California State University at Northridge, offers one critique in a paper for the libertarian Cato Institute. "Suppose, for instance, that Country A has health responsiveness that is 'excellent' for most citizens but merely 'good' for some disadvantaged groups, while Country B has responsiveness that is uniformly 'poor' for everyone," he writes. "Country B would score higher than Country A in terms of responsiveness distribution, despite country A having better responsiveness than Country B for even its worst-off citizens."

Whitman also joins other conservatives in taking issue with the assumption that the rich should pay a similar percentage of their income for health care as the poor do. Because basic mathematics suggests that those with smaller incomes will naturally spend a larger share on highly important items such as food and health care, doing well in WHO's rankings almost requires a steeply progressive tax structure.

WHO officials make no bones about their desire to push countries in the direction of aiding the have-nots. They gave the controversial factors that reward socioeconomic fairness 62.5 percent weight, compared with only 37.5 percent for the broadly accepted factors of health level and responsiveness.
Tweak the weighting a little bit and a country such as the United States rises or falls in the rankings. For instance, judged on responsiveness alone, the United States ranked No. 1 in the world. A bigger weight for that factor — and a smaller weight for financial fairness, where the United States ranked 54th in the world — would have given the country a much higher ranking.
Adding other factors could also change the results. A 2001 paper in the journal Science found that adding just one more variable into the mix changed the rankings dramatically for 79 of 96 countries studied.
Meanwhile, Whitman also raised questions about the WHO's "overall performance" measure — the one in which a country's health ranking is adjusted for its education level and economic resources. (This is the category in which the United States finished 37th.) The implication from the WHO itself as well as subsequent news reports, Whitman wrote, "is that the United States performs badly ... despite its high expenditures." In fact, he writes, in the WHO's statistical model, America's first-in-the-world expenditures for health care actually hurt its ranking in overall performance by setting the theoretical bar it had to reach very high. "A more accurate statement is that the United States performs badly because of its high expenditures, at least in part," Whitman writes.

Finally, a number of other critics say that WHO listened to the experts but did not measure public satisfaction with health care.

A paper published in the journal Health Affairs found the rankings did not necessarily reflect whether people were happy with their country's health coverage. For instance, Italy finished second in WHO's study, even though only 20 percent of its citizens say they were satisfied with their health care system. Meanwhile, Denmark ranked 16th in the WHO report even though 91 percent of Danes say they were satisfied.

So while Hipp is right that the United States ranked 37th in the most widely known barometer in the WHO study, it ranked 15th by another WHO ranking and, for one factor (responsiveness) it actually ranked No. 1. Still, this is a rock song, and a well-sourced one at that. So we find Hipp's claim to be Mostly True.

PolitiFact.Com

Truth-O-Meter Statements about Health Care

There are 13 pages and I can not put them all here so take a peruse and see how some statements and talking points fared.
 Here are the first four


Statements about Health Care

"The costs for families (in the individual market) for the same type of coverage that they're currently receiving would go down 14 percent to 20 percent."

The CBO found that the House Republican health care plan would lower premiums by "up to about 10 percent" and, for purchasers in the individual market, "those cost savings could even be higher."

"Since 1981, reconciliation has been used 21 times. Most of it's been used by Republicans."

The Democratic health care plan is a "government takeover of our health programs."

Tort Reform by a Republican Congressperson

Opinion Contributor
Bipartisan health care reform must include tort reform


Now that his yearlong partisan push for government-run health care has so far failed to produce legislative results, President Barack Obama wants Republicans to join him for another White House summit to see if he can salvage his proposals. But unless the president and congressional Democrats address the need for tort reform as a critical component of cutting health care costs, a bipartisan solution seems unlikely.

The unsustainable path of rising costs is a serious national problem. Currently, health care spending exceeds $2.5 trillion per year. By 2019, it is expected to top $4.7 trillion per year. Any hope for cost containment would involve comprehensive medical malpractice reform to end the practice of defensive medicine, close the loopholes that allow frivolous lawsuits to clog up the system, and set reasonable limits on jury awards.

The president seems to think that eliminating wasteful spending alone would get Americans on track to more affordable coverage. But the government’s track record of recouping its losses from waste, fraud and abuse leaves something to be desired. In 2008, for example, the government recovered a meager $35 million from criminal prosecution of fraud once enforcement costs were factored in. Real savings would start when Congress tackles the billion-dollar problem of defensive medicine.

Defensive medicine — when doctors order unnecessary and usually expensive tests and procedures in order to avoid lawsuits — is a major contributor to skyrocketing health care costs. As much as $210 billion is spent on defensive medicine annually — equal to $700 for every U.S. man, woman and child. This helps drive up insurance premiums that are already too high for many Americans. And the excessive malpractice litigation inevitably leads to physician shortages — especially among obstetricians, neurosurgeons and emergency room physicians.

Fewer doctors mean reduced access to medical care for everybody. New Jersey, for example, will be short 2,800 family doctors and specialists by the year 2020, according to a recent report from the New Jersey Council of Teaching Hospitals. The reason for the shortage, council President Richard Goldstein says, is a “morale problem” because of the state’s “hostile” environment for doctors and the heightened threat of malpractice lawsuits.

As long as out-of-control malpractice premiums are built into medical costs, many will never be able to afford coverage. Shamefully, it is estimated that the cost of defensive medicine and the associated liability-based medical care costs account for at least 3.4 million uninsured Americans.

Moreover, the current system is studded with irresponsible lawyers’ fees associated with malpractice claims that do not involve injury or medical error. A large share of the awards goes to pad the pockets of plaintiffs’ attorneys. Recently, the Manhattan Institute concluded that approximately 10 cents of every dollar paid for health care services goes to cover malpractice premiums, defensive medicine and other costs associated with excessive litigation.

Tort reform that reduces frivolous lawsuits and caps outrageous jury awards is a critical component of any solution to bring the cost of health care within reach of every American. So far, however, the president has barely mentioned it.

If bipartisan support is what he’s after, the president needs to do more than host Republicans at the White House for a chat. He’s going to have to get serious about the damage being done to U.S. health care by frivolous lawsuits and the cost of defensive medicine, which real reforms could correct.

Rep. Darrell Issa (R-Calif.) is the ranking member of the Committee on Oversight and Government Reform.