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Obama’s reform needs a public option


 

As Canadians, it is easy to be astonished by the health care debate in the United States. It can seem surreal at times when viewed from a country like ours, where the principles of universality and accessibility are a given and no one is threatened with bankruptcy when faced with health issues. After a summer of mounting protests, boisterous town halls, and radical polarization, we are left with the impression that Barack Obama’s reform package may be in trouble and that, if he does end up with a bill, it will bring less change than was expected.

The context is clear: Americans acknowledge the need for reform. They are concerned about the exhorbitant profits at health insurance companies and the extent of coverage they provide. Healthcare costs are spiralling out of control and now represent nearly one-sixth of the American economy. Forty-seven million Americans have no health care insurance. Despite the fact the U.S. spends more public money on healthcare than any other country, leading health indicators show a less than stellar return in areas like longevity and infant mortality. Granted, Americans have access to quality healthcare when they can afford it, and the United States is the leader when it comes to innovation and advances in health care treatment. But the general consensus is that reform is urgently needed.

At least five bills have already made it through Congressional committees. Four of the five include a public option—that is, they call for the government to establish a health insurance plan of its own to compete with private plans. The one bill that does not came out of Democratic Senator Max Baucus’s finance committee and is the only one the Congressional Budget Office expects to reduce costs over a 10-year period. Predictably, the left wing of the Democratic party has been critical of the proposed legislation because of its lack of a public option, prompting some to draw links between the health insurance industry and Baucus’s campaign funds. There are currently over 500 amendments to the Baucus bill under consideration and the Republicans see the discord as an opportunity to bring Obama down politically.

Meanwhile, Obama has been all over the media and on the hustings, claiming that real reform has never been closer. He has the votes and, with the state of Massachusetts about to appoint a successor to Senator Ted Kennedy, he will have a filibuster-proof Senate. Yet, things are not exactly rosy for the president. Despite his efforts to find some bipartisan support, it seems unlikely at this point that Republicans will line up behind him. In addition, polls show confusion among voters and a lack of momentum for the proposed reforms. Finally, it is now apparent the real battle will take place among the Democrats, with the conservatives among them having the upper hand at this stage in the process.

There is a growing realization among Democrats that failure is not an option . Should the Democrats not produce a reform bill, it will likely imperil their control of Congress. Most observers believe there will be a bill for the president to sign before the holiday season. But will it be transformational legislation or a transactional kind of reform? Obama has fed expectations his initiative will be historic in scope, something similar to Medicare and Medicaid back in the LBJ days. Real transformational change of the Obama variety must achieve universality, cost control, and greater control over the behaviour of private health insurance companies. After months of debate, and with the stakes higher than ever, it will be difficult to call this real reform if it lacks a public option. The public option, either through co-ops, a government-run outfit, or the expansion of Medicare, is simply the most effective way to challenge the health care industry into lowering costs, changing its ways, and ensuring that Americans are no longer the only major democracy in the world without universal healthcare .


 

Obama’s reform needs a public option

  1. I have lost hope that Obama will bring in a public option . he lost the summer and his message is muddled . No one believes he can a public option without raising taxes . It will be reform-lite.

  2. It is not exactly true that no one in Canada is faced with bankruptcy over health issues.

    While I was not confronted with bankruptcy, I was neverhteless forced to spend over $100,000 of my own money over the past two years to cover chemotherapy drugs and medical treatment for my wife who had terminal cancer. She was covered by OHIP and I had excellent insurance coverage from my employer.

    Many Canadians do not realize it, but not all cancer drugs, nor all cancer treatment or tests (such as PET scans), are covered under OHIP or employer health insurance. Many Canadians would have found such costs prohibitive.

  3. It is not exactly true that no one in Canada is faced with bankruptcy over health issues.

    While I was not confronted with bankruptcy, I was nevertheless forced to spend over $100,000 of my own money over the past two years to cover chemotherapy drugs and medical treatment for my wife who had terminal cancer. She was covered by OHIP and I had excellent insurance coverage from my employer.

    Many Canadians do not realize it, but not all cancer drugs, nor all cancer treatment or tests (such as PET scans), are covered under OHIP or employer health insurance. Many Canadians would have found such costs prohibitive.

    • "Many Canadians would have found such costs prohibitive."

      Many Canadians would find the cost of an appendectomy prohibitive.

      • This Globe article pinpoints some of the problems faced by cancer patients in Canada. For example, in many cases, the co-payment costs for chemo drugs can easily be in excess of $1-2,000 per month. The Ontario Tillium Drug Plan offers assistance, but has tight conditions and other provinces are not as generous.

      • This Globe article above pinpoints some of the problems faced by cancer patients in Canada. For example, in many cases, the co-payment costs for chemo drugs can easily be in excess of $1-2,000 per month. The Ontario Tillium Drug Plan offers assistance, but has tight conditions and other provinces are not as generous.

      • The Globe article referenced by Sisyphus This above pinpoints some of the problems faced by cancer patients in Canada. For example, in many cases, the co-payment costs for chemo drugs can easily be in excess of $1-2,000 per month. The Ontario Tillium Drug Plan offers assistance, but has tight conditions and other provinces are not as generous.

  4. Enjoy your writing, John. But I'm a simple guy. Occam's razor and all that. American politics and, indeed, much of daily life is far more partisan than that of this country. Hyper-partisan even. Why should a national debate about healthcare be less extreme that their discussion about gun control or abortion? On those subjects, both countries share the same spectrum of opinion but here the debates are muted. In America it often seems that the only positions available are at the extreme ends of the opinion spectrum. True controversies aside, the extreme behaviour manifests itself even in seemingly mundane processes like voter registration and drivers' licenses. You name it, it's a source of hyper-partisanship for a significant minority of the American population. Love it or hate it, at least America engages on issues. Here we simple hide from them

    • I see your point, but I don't think there's a real debate on healthcare happening in the US. Sure, there's some good-faith back-and-forth on the best way to implement, but the hyper-partisan debate seems to be between "we need health care reform" vs. "Obama is a Nazi!"

      These are not two extremes on the same spectrum. This does not represent America engaging on the issue of health care.

      If. in an argument, I say to my girlfriend "It's my turn to pick the movie" and she says "f*ck you", are we arguing about a movie? Is there any middle ground there?

  5. "no one is threatened with bankruptcy when faced with health issues."

    Please do some research before printing canards like this, please.

    Americans are lucky that they are having a debate about health care while many Canadians, and most of msm and pols, think they are ostriches and bury head in the sand when health care reform is mentioned.

    "As noted above, medical reasons are quite significant as a primary cause of bankruptcy. Of note
    is that medical reasons are more significant for the younger age group and decline monotonically
    as one grows older. Medical reasons are the primary cause of bankruptcy for 15.59% of those
    aged 55-59; 15.96% for those aged 60-64, but dropping to only 10.78% for those over age 75."

    An Investigation Into The Growing Number Of Bankrupt Canadians Over Age 55, Redish-Sarra-Schabas, 2006, UBC

    • Are those stats due to medical costs, or medical disabilities (including depression and other mental health) that make it impossible to work?

      • "Are those stats due to medical costs, or medical disabilities"

        The study's authors wrote that they can't un-tangle what's what. All they know is that there are plenty of Canadians declaring bankruptcy due to health issues.

        • It's an important distinction, at least for the particular context of Parisella's assertion. Thanks for clarifying.

        • As usual , we get the conservative half truth , noise machine . This is the kind of gibberish Mark Steyn would spew .
          Usually , jolyon is more thoughtful . Would jolyon give up his medicare for no insurance ?

  6. "In addition, polls show confusion among voters and a lack of momentum for the proposed reforms."

    That sentence hits the crux of the problem. As the linked poll notes, most Americans like their health care, but most think the system needs reform. Costs are high and the poor can't get coverage. Yet, most Americans also seem to be quite unenthused about the Democrats' proposals. This is not surprising: prior government-run programs such as Medicare and Social Security are in dire financial straits, and the CBO projects huge deficit increases if the public option is implemented. Add to this the less-than-stellar record of Canadian and British public health care with respect to wait-times, service, and the proclivity of the wealthy to seek care in the US, and the public's skepticism is unsurprising.

    So why not do what several legislators have suggested: eliminate the current restrictions on health insurance providers operating across state lines? The best way to bring down price is to increase competition. Allow companies to offer their services in all 50 states – that way the current situation, where several states have only two providers (in a few cases even a monopoly), morphs into the same competitive marketplace we see for car insurance. Prices drop, more people can afford insurance, and the government's involvement is reduced rather than increased (yielding even more cost reduction). Good all round.

    But ah yes, this would (a) reduce the size of government rather than expanding it, (b) be an approach suggested by Republicans rather than Democrats, and (c) not force everyone to cover certain unpopular procedures (abortions) which the Democrats would very much like to see paid for by the public, willing or no, in order to increase their availability.

    Hence, the Democrats will press forward as Parisella suggests. Not because it's practical or beneficial, but because they have an agenda.

    • Where to begin.

      Let's distinguish between health care and health insurance. Most Americans that have health
      insurance like it. Sometimes that changes when they actually have to use it. And most of them
      have no idea how much it's actually costing them because they are covered through employers.

      There might be a lack of enthusiasm among reform proponents because it has become apparent
      that the current reform is an attempt to achieve full coverage without interfering with insurers' profit
      making capacity.

      • cont'd …
        Insurance is not sold across state lines because insurance is regulated on a state level.
        If allowed to sell nationally they would – naturally – migrate to states with the lightest regulatory
        load. As credit card issuers flock to regulation in South Dakota or Tim Horton's joined the gang
        in Delaware.
        The rest of your post is wrong in so many ways … but it's just occurred to me that the correct information
        is available to you , as it is to me , but you have no interest because of your agenda. And so it goes.

    • "…most Americans also seem to be quite unenthused about the Democrats' proposals."

      From the Times/CBS poll released yesterday:

      "Would you favor or oppose the government offering everyone a government administered health insurance plan — something like the Medicare coverage that people 65 and older get — that would compete with private health insurance plans?"

      Favor 65%
      Oppose 26%

      Interestingly, according to the poll, support for a public option has jumped 5 points since late August and opposition to it has dropped 8 points."

      (from talkingpointsmemo.com)

      The public still supports reasonable heathcare reform. The hard part is separating the public appetite for what the Democrats are *actually* proposing from the mountain of lies they're being fed.

      And seriously, your proposed healthcare reform is to open up sales across state lines? Do you have *any* data to support your assertion that this will fix America's poor health outcomes and provide coverage to 45 million uninsured?

      • Right on TJ . This Republican garbage across lines is garbage . It does nothing to cots . Typical Gaunilon and jolyon gibberish .

  7. It's not just Canada. I suspect every citizen of a first world country shakes their head when they see Americans can even debate this stuff. Probably most of the second and third world, too.

    Screw the public, esp. with the crazed rhetoric they've got spewing from the right down there. Put forth a decent heatlhcare bill with minimal debate, and ten years later reap the electoral rewards. The great thing is even if it fails to make a system even half as good as England or Germany or France or Canada, it'll improve their own by a staggering amount.

  8. I'd take that over a movie. :)

  9. Proposals to limit the ability of insurance companies to deny coverage to those with pre-existing conditions, as well as the creation of a private insurance exchange between states, as well as limits on medical malpractice suits would all increase accessibility and affordability of plans, while bringing down the overall cost.
    No "public option" is actually necessary.

    • I am ready to concede to Joseph that he may have a point . After all , Obama never promised a public option in the campaign . But the pressure of having one may bring the needed reform . joseph 's formula may be meaningful . But a public option like Medicare and self financing should remain on the table for NOW.

      • Offering up 30M new victims to the tender mercies of the insurance companies without
        a low cost government plan to force competition on them will not lower costs to the consumers.

        • Totally agree with you. Even Republicans in a CBS poll agree with a public option.

  10. unfortunately, there has not been sufficient voicing of opinions one way or another on a public option. but the polls say that americans are uncomfortable with the way the federal government has handled this issue and does not trust the government to put a public option in place.

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