Forget the spin doctors - lets have a real conversation about health care reform

8 years ago

Stop the madness. Americans have a crucial health care reform proposal moving through the halls of Congress, and we desperately need an informed conversation about its merits. Instead, we're getting people screaming about whether the people screaming at town hall meetings are sock puppets or concerned citizens. We're getting statements from some opponents that grossly distort what's in the bill, and breezy assurances from Pres. Obama that leave important questions unanswered.

Let's have a serious conversation - you and me - about what we want Congress to do when they return from their fall recess. 

First things first. On July 14, House Democrats introduced HR 3200, America's Affordable Health Choices Act of 2009. It's a whopper - 1,036 pages. Open Congress has the full text of the bill available; you can not only read it, you can comment and make your own suggestions for improvements. Here's their summary of what the bill entails:

This is the House Democrats' big health care reform bill. Broadly, it seeks to expand health care coverage to the approximately 40 million Americans who are currently uninsured by lowering the cost of health care and making the system more efficient. To that end, it includes a new government-run insurance plan to compete with the private companies, a requirement that all Americans have health insurance, a prohibition on denying coverage because of pre-existing conditions and, to pay for it all, a surtax on households with an income above $350,000. 


Pres. Obama focused on proposed protections for people with pre-existing conditions, and other consumer protections, at a town hall meeting in Portsmouth, NH today:

Under the reform we're proposing, insurance companies will be
prohibited from denying coverage because of a person's medical history.
Period. (Applause.) They will not be able to drop your coverage if you
get sick. (Applause.) They will not be able to water down your coverage
when you need it. (Applause.) Your health insurance should be there for
you when it counts -- not just when you're paying premiums, but when
you actually get sick. And it will be when we pass this plan.

 Trudy Lieberman, who has been tracking press coverage of the health care debate at the Columbia Journalism Review for more than a year, says when Congress returns in the fall, journalists ought to pay close attention to just how many of those consumer protections survive lobbying pressures and backroom negotiations. On pre-existing conditions, for example, Lieberman warns us to watch for:

Lobbyists inserting language that limits insurers' risks, like the restrictions in the HIPAA law that still make it difficult for sick people to obtain coverage. President Obama has been silent on the question of age rating, which serves as a proxy for using health as a factor in charging higher rates. Older people are likely to present more health risks and cost the insurers money. 

 The welfare of elderly and disabled patients under the proposed reforms has been a big topic of conversation ever since former Alaska Gov. Sarah Palin posted a Facebook note claiming that under the proposed law, her disabled son's health care would be determined by a "death panel." That claim was quckly and roundly rebutted. (see Politifact and the Associated Press for details.)  However, she also expressed a general mistrust of the so-called public option - a proposed government insurance plan for those who can't get private insurance. Megan McArdle is one of the people who worries about the potential unintended consequences:

Once the government gets into the business of providing our health
care, the government gets into the business of deciding whose life
matters, and how much.  It gets into the business of deciding what we
"really" want, where what we really want can never be a second
chocolate eclair that might make us a size fourteen and raise the cost
of treating us.

Economist Brad DeLong says McArdle doesn't know what she's talking about. He pleads:

Could we persuade the Atlantic to replace Megan McArdle with
somebody like David Cutler, Atul Gewande, or Ezekiel Emmanuel who
actually knows and can write about health care for the duration of the
health care debate?

 DeLong also points us this piece by Sounthern Bealle, who took particular exception to Gov. Palin's Facebook note:

You have no idea what it’s like to be called into a sterile conference
room with a hospital administrator you’ve never met before and be told
that your mother’s insurance policy will only pay for 30 days in ICU.
You can't imagine what it's like to be advised that you need to “make
some decisions,” like whether your mother should be released “HTD”
which is hospital parlance for “home to die,” or if you want to pay out
of pocket to keep her in the ICU another week. And when you ask how
much that would cost you are given a number so impossibly large that
you realize there really are no decisions to make. The decision has
been made for you. "Living will" or no, it doesn't matter. The bank
account and the insurance policy have trumped any legal document.

 Under the proposed reforms, insurance companies wouldn't be able to cap coverage. The proposal would also pay for Medicare recipients to have a consultation with their doctors about end-of-life care. It also encourages living wills.

One of the biggest sticking point in the health care debate, of course, is the proposed "public option" -- the proposed govenment-sponsored plan for those who don't have private insurance and don't qualify for Medicaid or Medicare. Conservative critics such as the Heritage Foundation insist that the result would be a "massive erosion of private health insurance." Rather than a federal pool, Heritage suggests there ought to be state-level "health insurance exchange[s]: in which companies can voluntarily participate:

In a truly competitive market based on
real consumer choice and genuine competition, the suppliers of goods
and services would operate on a level playing field and government
would be confined to making and enforcing rules to protect consumers
from fraud and misleading advertising, establishing minimum standards
for health and safety, and enforcing contracts.

An exchange could facilitate that process.

Critics say the Heritage Foundation proposal wouldn't help contain costs or significantly reduced the ranks of the uninsured.

What questions do you have about health care reform? 


  • Jane Hamsher, thinks that Democrats could have done a better job of organizing support.
  • Slate's Timothy Noah likes the Demcratic proposal.
  • Moveon has an ad campaign rebutting "lies" about haalth care reform.
  • Politicact debunks the claim that abortions would get funding  under the new proposal.
  • Salon presents evidence that Dr. Ezekiel Emmanuel, one of Pres. Obama's health care policy advisor, isn't the dangerous nut he's been made out to be.
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