Fighting Back Against Bush's Nightmare Healthcare Plans

A few days ago, it came out that a major point in President Bush's upcoming State of the Union address will be promoting his plans to shift the healthcare burden from a risk-pooling insurance system to an every man for himself system of health savings accounts. As many have pointed out, this is nothing short of nuts.

As busy as we are with Alito, warrantless wiretaps, the war, 2006, and the laziness of the traditional media, I would encourage everyone to become intimately familiar with the details of the Bush plan, as the misinformation and spin will be flying fast and furious post-SOTU. The healthcare system in America isn't so hot, but it's far better than this anti-working family, anti-poor, anti-sick, and anti-elderly disaster Bush is about to put his weight behind. This is a serious fight we're going to have to engage in.

Former Senator Tom Daschle has a post up at Think Progress that does a fairly good job of providing a brief primer on the proposal. The links, which I'd suggest checking out, are from the original post.

This is a bad idea for three reasons:

  1. It makes the wrong assumptions about health care. A person with chest pain is not in a position to decide on which tests to take and what drugs he needs. A $1,000 deductible is not going to make a person switch hospitals to get an extra hour of hospital care, which is all that the deductible can buy. Health care is not a commodity. When we buy a car, we don't want to have the parts dropped off on our front lawns. Consumer-driven care just doesn't make sense for health care.

  2. It assumes that individuals can go up against industry and win. Look at the Medicare drug benefit. My mother has to choose from 73 plans. It is impossible for her to figure out which has the lowest prices. Rather than pooling the purchasing power of seniors to leverage lower prices, this drug benefit allows for drug companies to charge higher prices and insurers to profit. So, if you like the Medicare drug benefit, you will love consumer-directed health care.

  3. It pits the healthy against the sick. About 70 percent of costs in the U.S. health system are for the top 10 percent most expensive people. These people's costs are well above the deductible, so a high deducible won't change their behavior.

Ezra Klein also turned in a solid backgrounder piece on Bush's HSA plans a few days ago at Tapped, which I would wholeheartedly recommend for those interested in a bit more in-depth discussion of the issue. He cites a good deal of evidence to indicate that Bush's plans won't even come close to accomplishing their stated goals.

In other words, Bush isn't really interested in improving healthcare. He's only interested in achieving his ideological goal of making sure that the shared burdens of American society are foisted upon individuals, whether or not they can handle them. Every man for himself.

Tags: Healthcare, HSA, Republicans, State of The Union (all tags)



Dem Proposal
Unlike Social Security, on this the Dems must offer their own proposal, universal healthcare. The time is now.

Cover all uninsured, reduce the cost to business.

by Mister Go 2006-01-25 08:13AM | 0 recs
Re: Dem Proposal
You always beg us to do your thinking for ya.
Why don't you get Rove to figure it out for you?
by synthia 2006-01-25 08:52AM | 0 recs
What is the alternative?
Matt Yglesias has a good post up that contrasts the two paths open to us--one that ultimately leads to some kind of universal care and one that leads to people just dying in hospital waiting rooms when thye run out of money.  (Or just dying waiting even if you have insurance because the emergency rooms are too full period, although matt doesn't say it.

In addition to promoting the idea of risk pooling (particularly to the under 40s), as was done with the Social Security debate, we can emphasize how ridiculous it is to expect people to take charge of their own health care decisions (as opposed to taking charge of their own HEALTH, a very different thing).  

There is a commercial that runs on CNBC where a guy is standing in his kitchen with a knife while someone tries to talk him through an operation.  The tag line is that you wouldn;t try do-it-yourself medicine, so why try do-it-yourself investing?  If you thought it would be complicated being in full control of all financial planning for retirement, just look at the Medicare drug debacle to see what Health Segregation Accounts would be like.

This is long-winded way of saying that in addition to risk-pooling, we need to promote the validity and viability of single-payer health care.  We pay more than any other industrial country for much poorer care.  It stands to reason that fragmentation and insurance middlemen are costing billions.  These disappear with single payer.  Doctors are free to practice medicine instead of doubling as accountants.  It can be done by allowing people to buy into Medicare as an alternative starting at age 50 or so, with a tax deduction.  Perhaps allowing big employers such as GM to convert to this system could work. But this is thre direction we need to go in.

by Mimikatz 2006-01-25 08:18AM | 0 recs
The alternative
is a well run government.

LBJ had no trouble implementing medicare.

How come everything you repugs do is smellier than what comes out the back end of a skunk.

by synthia 2006-01-25 08:51AM | 0 recs
Re: What is the alternative?
I work in the health care sector and I think Medicare is a great program.  However, moving people to it from private insurance will do little to address the fragmented nature of care.  The fragmentation problem is that American health care is organized around individual doctors offices and hospitals instead of large multi-specialty group practices where doctors share information about the patients they treat.  An portable Electronic Medical Record would help the situation but is not a cure all.  
by John Mills 2006-01-25 10:51PM | 0 recs
Paul Krugman revealed a major scandal
on the 2 Republicans who brought on this nightmare for seniors, and windfall for the drug companies:

After this bill passed, they left the government for LUCRATIVE JOBS with the DRUG COMPANIES.

This major reporting was not picked up by any of the blogs, who seem on a mission to help out the right wing by suppressing some of the worst shit to hit the fan.  

by synthia 2006-01-25 08:48AM | 0 recs
Re: Paul Krugman revealed a major scandal
Here's a link to the page for Times Select Gift Subscriptions. Under "recipient's e-mail address," use the one I list on my profile page. Thanks for the offer, I look forward to getting word of my subscription.

In all seriousness, what is up with the hostility? It's not as if we're a bunch of pampered elites raking in big money without getting anything done. Lucas is right on the money -- if you see something like this and are outraged that no one's paying attention, post a diary. It's not as if this is a closed community where you don't have a voice.

by Scott Shields 2006-01-25 10:20AM | 0 recs
Re: Paul Krugman revealed a major scandal

few diaries are read that are not recommended.

by synthia 2006-01-28 05:11AM | 0 recs
Re: Paul Krugman revealed a major scandal
A scandal but nothing new.  It was revealed 2 years ago that Tom Scully and Billy Tauzin were cashing in on this bill.
by John Mills 2006-01-25 10:37PM | 0 recs
Conflict of interest
Figure that 20% of the private plan costs are overhead abd a good quarter of the overhead goes to advertising and sales.  Individual accounts would be a boon to the major networks, newspapers, and billboard companies.  Newspapers like the NY Times already drive coverage to "business" because advertisers like it (60 reporters), far more than readers.  Well ....
by David Kowalski 2006-01-25 09:21AM | 0 recs
I dunno
I want to hear all ideas on this.  I'm curious if a plan like this would put me more in control of my health care costs.  I'm looking for savings, and an alternative to any of these outmoded systems.
Offering individuals an opportunity to opt out of the insurance approach to health care, with tax exemptions and other incentives to be much more a steward over your own health can only help.
I want to hear more.
by edsdet 2006-01-25 09:35AM | 0 recs
another point
While consumer-driven industries can sometimes work very well -- e.g., computers and, IMO, e.g., education in some cases -- they have downsides.

What is the problem with US health care: quality, or cost? It is emphatically the second (if you can afford it, our hospitals are state-of-the-art), and thus it seems to me, consumer-driven "solutions" are ultimately wrongheaded.

Of course, this all assumes that Bush is acting in good faith with his proposal. Not exactly the best bet given the last six years.

by sdedeo 2006-01-25 09:45AM | 0 recs
Re: another point
Not really true.  We have pretty serious problems with both cost and quality.  We delude ourselves into thinking that we have the best health care system in the world but it is not true.  According the World Health Organization, we rank 37 in the world on basic health measures because our system emphasizes hih end services rather than prevention and disease management.  We are great at treating cancer and doing heart bypasses but we are terrible at basic and preventive care.

The analogy I always use this car analogy for the US health system - We are the mechanic who is terrific at overhauling an engine but doesn't know how to change the oil or perform a tune up.

by John Mills 2006-01-25 10:33PM | 0 recs
Re: another point
I would say that we know quite well how to perform a tune up in the united states, we just don't do it that often. Why? Because larger more involved procedures are more lucrative. It is no surprise to me doctors will naturally gravitate toward the specialties that will give them the best income. To return to the metaphor, why peform an oil change and make 10-20% profit when you can fix a transmission for 50%? This is especially true when you consider that the paperwork (extra overhead) involved with billing customers (oops, patients) is on a per procedure basis.
by TimThe Terrible 2006-01-26 03:37AM | 0 recs
Re: another point
I have another thought that is a corollary to this: We have to look at what behavior a certain system encourgages.

In the current US health system we force health care customers to pay on a per procedure basis. 20 dollar co-pay here, 40 dollars there. I know from experience this adds up really fast and it has an effect: The incentive is to not go to the doctor unless you are really really sick. This is the exact problem our health care system in general faces, we don't get the early diagnostic care and treatments that would help us avoid major problems later on. (and this isn't even touching dental care, which so many americans also avoid due to cost)

Conversely what would a socialized health system do? I believe that if the health consumer had zero cost for the routine visits to the doctor he/she would go more and likely need a lot less care over the long term. Would there still be heart bipasses? Yes, of course.. but would a significant percentage of such procedures be unessecary due to pervious intervention? Almost certainly. The only question is how many.

by TimThe Terrible 2006-01-26 04:06AM | 0 recs
Re: another point
Agreed.  The financial incentives are completely misaligned in our health system.
by John Mills 2006-01-26 05:31AM | 0 recs
Re: another point

In other countries, people become doctors for the same reasons they become teachers or researchers: a desire to help. Of course, the money is nothing to sneeze at, but it's nothing like the money you could pull in in the States.

I wonder if balance of cure-vs-prevent is different in countries with socialized medicine?

by sdedeo 2006-01-26 04:36PM | 0 recs
Re: another point

Just saw your comment, and thought I'd respond.

If you can afford care, the United States is the best place to receive it. If you have the money. I have a fantastic PPO health plan, and I would receive better care than I would in Canada or the UK, for example.

Need an MRI? The Canadians don't have enough machines, or enough trained technicians, to provide them as rapidly as we do here.

Need surgery? Prepare for long waits -- a friend of mine in the UK had to wait three years to have non-necessary (not cosmetic) surgery (though that was later shortened to one year because the wait was ruining her life.)

Canada and the UK have their problems (IMO, the UK's problems are worse, and Canada is much better.) Our system has a fundamental problem: it is deeply immoral.

We rank so low on the WHO scale because people cannot afford the care we provide so well. Basic and preventative care are still expensive, and people don't have the time, or the money, to attend to them.

I agree that our system is misaligned. But I don't think we "don't know how to change the oil". We do. Other countries rely on our basic research to provide this sort of care to their patients.

Again, my belief -- and I am certaintly not an expert -- is that the problems with health care are ones of cost, not quality. To put it another way: American health care is like the new Intel Powerbook. If you can afford it, it is (among) the best in the world.

by sdedeo 2006-01-26 04:33PM | 0 recs
Re: another point

Sorry but the data does not bear out your beliefs.  We consistently rank low on preventive and primary care measures because we don't emphasize them.  We have the highest rates in the industrialized world of infant mortality, diabetes type II, obesity to list a few.  These are largely preventable with front end intervention.  

After a heart attack, the best way to prevent another one is to put the patient on beta blockers yet less than 50% of people in this situation get them prescribed.  

We are obsessed with expensive procedures like MRIs but ignore the inexpensive things that really make a big difference.  The incentives in the US system are all wrong.

Did you know that tens of thousands of people die each year from medical errors, many of which could be prevented if we moved from paper records to computers?  The Institute of Medicine issued a report on it a few years ago.

Not covering everyone is immoral and does contribute to our poor ranking in the WHO studies but the problem is much deeper.  We have a quality problem with health care in the US whether we want to admit or not.

by John Mills 2006-01-27 05:32AM | 0 recs
Reading the debate pages...
there is much confustion on terminology.  Many are confusing the horrible HSA programs with Flexible Spending Accounts or FSA's.  

FSA's allow an account to be set up, collecting tax free savings for use for any diagnosed medical issue.  FSA's are a good thing, established in 1978 they allow for us high end users of insured health care to spend tax free dollars on copays, drugs (over and under counter)and underdeductable payments. If you have children, have an FSA.

HSA's are a morphed FSA program that make you rely on the tax free account and high deductable insurance plan for your entire health care needs.

I love the timing - Bush touts a new health plan after the Medicare Part D disaster, will he?

by OldManWill 2006-01-25 12:31PM | 0 recs
Just goes to show that...
yet again President Bush, his administration and the Republican party are out of touch with the American people and what they need.

Many people, especially seniors are screaming over the utterly incompetent way the big Pharma pork filled Medicare part D plan has been implemented: phone lines jammed so that pharmacists can't get through to find out patients coverage information; people told that they have no coverage and forced to choose between paying a several hundred dollar co-pay or going without their vitally important medication; tons of plans very complicated plans for seniors to choose from, which is made even worse for them since the information is primarily available online and how many seniors are super net savvy?

Has President Bush and the Republican controlled Congress taken no notice of how badly they've botched things already? Do they really expect Americans, especially American seniors to trust them again with health care issues? And so soon after their utter failure?

Maybe they aren't just out of touch, maybe they're down right delusional.

by Quinton 2006-01-25 01:52PM | 0 recs
A health care SOTU special
From Think Progress, VIDEO: The State of Presidential Credibility:

Senate Minority Leader Harry Reid called on President Bush Tuesday to "come clean" in next week's State of the Union speech and acknowledge "the costs of Republican corruption."

"In his 2000 campaign, George Bush promised to bring `dignity' to the White House but we've since found that he brought Jack Abramoff instead," Reid, D-Nev., said at the Center for American Progress, a liberal think tank, in remarks previewing Democratic criticism of the presidential speech. ...

The 15-minute speech was prefaced by a video reel showing Bush clips from past speeches followed by quotes meant to show his failure to deliver. Reid said the video showed the president "has been giving us doublespeak for years."

Click through to watch the video Harry Reid used to demonstrate his point.

by Gary Boatwright 2006-01-25 03:34PM | 0 recs
Here's the frame

   "If you like what Bush has done with Medicare, you'll LOVE what he's going to do to your health care!!"  


by Master Jack 2006-01-25 03:39PM | 0 recs


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