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Universal Health Care — It’s Addictive
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Opponents of President Obama's health care legislation were wise to attack it preemptively in the courts on constitutional grounds. If they hadn't attacked now, they would've learned that universal health care systems – sometimes a hybrid of public and private and sometimes single-payer national systems – are wildly popular in other countries. So popular that politicians can do no more than fiddle at the edges, as they have done in Britain recently and are about to do in France. No leader, not even that incontrovertible defender of private enterprise, Margaret Thatcher, dared or even thought, to privatize health care. In the industrial democracies, from Canada to Japan, people complain about their health care systems and would defend them to the death. Once universal health care is introduced and people are relieved of the fear of illness, leading to financial ruin, it is unrepealable. The opponents of Obamacare must know this, or they wouldn't have been so anxious to test it in court on the grounds of the constitutionality of the individual mandate. Kill it before people love it was an imperative. Now it's widely believed, after three days of hearings, in which conservative justices sounded more like they were conducting a congressional hearing than a judicial one, that Obamacare will be thrown out before it has ever been sampled by the public, which wouldn't come until 2014. It's been a bit like the Chinese and democracy: Don't let them try it, they might like it. So how is it the Republicans have been able to so demonize Obamacare? Partly, it's because the administration has done an appalling job of selling its own program. It's almost as though it's ashamed of its offspring because it isn't the child they really wanted: a simpler bill with a public option and such goodies as interstate insurance sales. The administration is frequently bad at trumpeting its achievements. As health care reform is its defining domestic issue, the fact that Obama and his cabinet have not extolled the virtues of the bill amounts to a curious dereliction, a sin of omission. Most people have been persuaded, if they know anything about the bill at all, that it's socialized medicine (it is not); that it will double expenditures on health care (it won't); that it's an enormous new dictatorial intrusion into individual liberty (it's not). It's not a great bill, but a good start. We in the United States spend about twice as much as other countries on health care – about 18 percent of our gross domestic product. Why? Everyone knows there's excessive testing and waste. The quick answer is to defend against lawsuits. Another answer is that doctors have no incentive to save money and through their investments in testing companies, often they have an incentive to order up the tests. Mostly, I suspect it's just indifference; the medical equivalent of not turning the lights off. I don't like Obamacare because it only does half the job and I'm uneasy about the individual mandate. Just two cheers from me. The uninsured should be assigned an insurer and the premium collected through the tax system. That way the insurers would compete for the most desirable prospects, young adults, and a real pool would operate. Another question that isn't asked: As new technology usually brings down costs, why does this not apply in health care? Why are CAT scans and MRIs not getting cheaper, as they would if they were in a different framework? Why not use the Republican idea of health vouchers as an incentive to keep patients from frivolous use of services – not as the substitute for insurance, but rather as an incentive mechanism. Pay them to stay healthy. We suffer from a failure of imagination in health care. There are good reasons to be ambivalent about Obamacare, but it's a start, a building block. Our medicine is without peer, but our concepts of care are quite sickly. – For the Hearst-New York Times Syndicate - no responses
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Now Meet Those Too Big To Be Denied
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We have all heard about “too big to fail.” How about “too big to be denied?”
Step forward two commercial sectors that are certain to get in the way of President Barack Obama’s reform plans: the nation’s health insurers and its defense contractors.
The former are bound and determined to hold their lucrative position in any extension of health coverage to the uninsured. In this way, a new health agenda will be designed as much to accommodate the insurers as the patients and providers.
Likewise as Defense Secretary Robert Gates struggles to reform defense procurement and to cancel some weapons systems, he has to deal with the massive power of the defense giants. In defense, the customer is always wrong; and the vendors, through their congressional sponsors, overwhelm the department and get what they want, not what field commanders need or the national interest cries out for.
Ironically the Clinton administration strengthened the defense lobby, and its ability to push around the Pentagon, by orchestrating the consolidation of defense contractors into a few behemoths, as part of the downsizing of the military in the 1990s. Norman Augustine, chairman and CEO of Lockheed Martin from 1995-97, told me that during his tenure, Lockheed Martin had absorbed 19 small contractors.
The big contractors of today–Boeing, Lockheed Martin, General Dynamics, Raytheon, Northrup Grumman, BAE and the European wannabe EADS—have conscientiously scattered their manufacturing among many states. One program has components made in 44 states. That means jobs, and jobs mean political clout.
The health insurers, who succeeded in sinking the Clinton health care reform effort, are ready for some concessions, but only enough to insure their dominance. The health insurers and their conservative allies are expert in predicting the arrival of creeping socialism, unless the private insurers retain their supremacy in financing and profiting from the health care system. Ironically, they claim any larger government role in health care will lead to rationing. Yet it is the insurers who ration health care now; and if you are in an HMO they ration it severely, cruelly and sometimes lethally.
A favorite argument is that health care reform will substitute the judgment of doctors for the judgment of bureaucrats. One of the more appalling aspects of the current situation is that the insurance companies day to day substitute the judgment of clerks for that of doctors.
The health insurers will not be denied, but they feel it is reasonable to deny the evidence against them. When health care was in the operating theater in the l990s, and Hillary Clinton was poised to plunge in the scalpel, the insurers rose up against anyone who had evidence that the system was serving the companies, not medicine and not patients. They succeeded in banning from the debate what they dismissed as “anecdotal evidence.” They wanted the debate discussed on a level where they could dismiss reports of their own shortcomings, and conduct the debate in terms of capitalism versus socialism.
It is only now, with business crying out for reform, that the issue is being aired again.
My anecdotal evidence is this: I have lived under government-run medicine in England. It works well enough. The young are favored over the old there, whereas here the old are favored over the young here. Now I am on Medicare,which is remarkably like being on the National Health Service in Britain, except I am being favored over the young.
For 33 years, I ran my own publishing company in Washington. After payroll, the biggest expense was health care. To keep the cost down we changed the carrier frequently, to everyone’s inconvenience and a lack of continuity. When one employee had a rare and painful cancer, the insurance company paid for radiation and chemotherapy but denied payment for painkillers.
For years, ATT ran the telephone system and ordained that plugging in a phone could not be performed by a customer and black instruments were all that should be offered. They were, they thought, too big to be denied.
Robert Gates has shown guts in trying to deny the oligarchs of defense. Congress will need bravery in denying rent-takers in health care. Meanwhile, those who are too-big-to-be-denied are pumping dollars into Washington’s K Street, where the lobbyists carry their water.
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President Obama’s Troubles
May 20th, 2013
Guests Brian Kelly, U.S. News & World Report; Olivier Knox, Yahoo! News; Joe Davidson, The Washington Post
The Future of Drones
May 13th, 2013
Guests Claude Salhani, journalist and Amitai Etzioni, The George Washington University
Europe; its Problems and its Promise
May 6th, 2013
Guests Annette Heuser, Executive Director, Bertelsmann Foundation; Darren Gersh, Journalist; Arnaud de Borchgrave, Center for Strategic and International Studies
What’s Ado in Washington
April 29th, 2013
Guests Joe Madison, SiriusXM Radio
A Discussion of the Anti-terrorism College at the National Defense University
April 22nd, 2013
Guests Michael Bell and Sebastian Gorka, College of International Security Affairs, National Defense University