Monday, July 03, 2017

Miscellany: health insurance, cost control, and California single payer

Obviously, the number one priority over the next few weeks for people who think the government should ensure that medical care is available to all citizens is to sink the Republican Senate Obamacare repeal. Can this be done? We'll find out. Making noise strategically and even unstrategically must continue.

Aaron Blake at the Washington Post passes on this data from Pew Research which shows pretty clearly that just about everyone except the well off GOPers think providing health insurance coverage to all is simply the government doing its job. As he summarizes: The biggest winner in the current health-care debate [is] single-payer.
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Meanwhile, Josh Barro at the Business Insider points out, I think correctly, that what voters want more than any complex, bureaucratic scheme that arranges for payment is simply for medical care to cost less. And he provides an interesting list of possible policies that would actually reduce cost, once politicians are dragged into accepting that government must do its job of ensuring universal access.

  • Impose price controls on prescription drugs.
  • Block hospital-system mergers, so healthcare providers have less power to raise prices.
  • Offer a Medicaid-based public option, so people can buy insurance that enjoys Medicaid's low negotiated payment rates — and that can therefore offer more affordable premiums and deductibles.
  • Break up state medical cartels. Force states to allow nurse practitioners an appropriately broad scope of practice, to recognize other states' medical board certifications, and to honor foreign medical degrees. Abolish "certificate of need" requirements that make it hard to open new medical facilities. Issue more visas to foreign doctors and nurses. These changes would make it easier to find a medical provider and put downward pressure on prices.
  • Ban surprise medical bills. A hospital that's in your network shouldn't be able to stick you with an astronomical bill for an out-of-network anesthesiologist you didn't even know was going to treat you.
  • Move more drugs and medical devices over-the-counter. [Senator Elizabeth] Warren and Sen. Chuck Grassley, a Republican, have a bipartisan bill to allow some hearing aids to be sold without a prescription. Some forms of hormonal birth control could also be made available OTC.
For decades, healthcare policy has mostly been about who gets what: Who will be eligible for free or subsidized insurance, how big the subsidy will be, and who will be taxed to pay for it. People are terrified they will come out on the losing end of changes to that system. They are wary of handing control over the allocation of those resources to their cultural enemies.

The great thing about this cost-reducing agenda is it makes anyone who consumes healthcare into a winner. ...

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Don't get me wrong, I totally support a single payer system in which government pays all medical bills, regulates providers so they don't gouge, and taxes us all progressively to pay for the care we need. But California single payer advocates, led by the California Nurses Association and some Sanders-campaign offshoots, ran a scam on the great mass of their supporters this year by pushing legislators to pass a state system that lacked any realistic funding source, would require non-existent federal cooperation, and which would have required a constitutional amendment by initiative, at best, to get off the ground. Advocates had to know this was symbolic political theater, but they sold it as a real thing. And that's rotten political behavior. David Dayen dissected this play at the Intercept.

With so many single-payer supporters in California and across the country unaware of the facts, playing this cat and mouse game is at best a sin of omission, at worst the kind of dishonesty that breeds cynicism in the public when it learns it was conned.

When asked straight-up about the obstacles, CNA Director of Public Policy Michael Lighty pointed to language in SB562 that would stall adoption of single payer unless adequate funding was available. He called it “a failsafe mechanism.”

Lighty is implicitly saying that SB562 can never create a single-payer system. The failsafe will always be triggered unless the state constitution gets changed at the ballot, because there will never be enough money under the current iteration of Prop 98. Saying that out loud would depress enthusiasm and lessen CNA’s perceived power. So they hide the ball.

... The entire debate is one big game of passing the buck, with single payer’s loudest champions earning plaudits from the liberal base but doing nothing to advance universal health care.

I feel personally pissed off by this because I was asked by a friend just getting started in political agitation how she could work on health care. I hadn't been paying attention except in a general way, so pointed her to the California single payer campaign. She's no dummy and she shouldn't be conned. This sort of exploitation of people's greatest hopes leads to disillusion and drives away too many political novices. Stop playing games!

1 comment:

Rain Trueax said...

A friend of mine wrote this on Facebook. He is not a far rightie but probably considers himself a conservative, retired career military and he's one of the few I've met online and also in RT. I thought it was a good take on what needs to be considered with all this. It's not simple.

"Interesting points from a canadian author this morning, talking about the Canadian health care system and the decisons Canadians made to get them there. Essentially he said that there are tradeoffs that must be made, and that Canadians decided they wanted health care for all, which means they couldn't have the most modern hospitals, the latest diagnostic tools, the most advanced drugs, etc. Essentially he said they settled for less than great health care to enable it to be given to everyone. He said the problem in America today is that we aren't willing to have that conversation - some of us want health care for all, but we also want the best medical care available, the most advanced techniques and medicines, and we want it quick and responsive. Like a lot of economic decisions, to get to a solution you have to set priorities and make trade-offs. I think he's right. So, what are our tradeoffs? If you believe health care is a right, are you willing to forego those MRIs and the latest cancer drug and a longer wait list for orthopedic surgery so that your fellow citizens can be covered?"

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