We have reason to be angry.
After a year of effort, no comprehensive health reform legislation has reached the president’s desk. Nor have we created a grassroots movement for change. Tragically, we have failed to educate the public about the issues and the approaches embodied in the House and Senate bills or about reasonable alternatives.
Neither legislation nor education. Yet almost everyone, wherever they fall on the political spectrum, is convinced that our health care system is in trouble.
They are right. It is in trouble: 15% of our neighbors are not protected against the financial ravages of ill health; health expenditures, premiums and out-of-pocket costs continue to increase more rapidly than the economy and than our incomes; Medicare — unless we act decisively — faces insolvency within this decade; Medicaid budgets are straining the fiscal health of already impoverished states and localities; and private insurers have the power to affect clinical decisions by standing between patients and their physicians.
Nevertheless, the consensus that things need to change, and by more than a nip here and a tuck there, has not resulted in an agreement on solutions. So we are angry. But anger does not solve problems.
The real question is not how we apportion blame for the situation in which we find ourselves, but what we can do to move forward. What should we do in the face of constraints imposed upon us by the rules of the legislative process? What can we do given the reality that “coming together” is especially difficult in an election year, that we are running a surplus in the budget line labeled “lack of trust,” and that attention and energy must and will be riveted on jobs, jobs, jobs?
Some have suggested that the House should swallow hard, pass the Senate bill — which, though flawed, surely is better than nothing — and send it to the president for his signature. Others have suggested a reconciliation process in which health reform initiatives with budget implications are sent to the Senate floor where, as budget matters, they can be enacted with 51 votes, rather than the 60 required to stop a filibuster. It is doubtful that either approach would garner the necessary votes.
While it may be true that, if enacted, Americans would grow to love the Senate health reform initiative, they are not likely to be even mildly infatuated by the first Tuesday in November. The very complexity of the legislation inhibits understanding and convinces many Americans that this is “change you can’t believe in.” As a consequence, many legislators believe their political prospects would diminish if they were seen as “shoving something down America’s throats” or engaging in political “gimmickry.”
Still, we dare not do nothing. President Obama has stated that if we fail to act, it will be a generation before we try again. That very statement makes for a self-fulfilling prophecy. Having invested so much effort in his first year in office, it is difficult to imagine that he or others would soon support another attempt at comprehensive change. If we do nothing now, we are likely to do nothing for some years to come. And make no mistake: There is no status quo. The human and fiscal problems will grow worse.
I have long believed in and fought for a comprehensive “Medicare-for-all” approach rather than incremental legislation — after all, one doesn’t leap over a chasm in two jumps. So it is not easy for me to advocate enacting legislation that is less than comprehensive. But I have come to believe that this is what we need to do, as well as to begin the difficult but vital task of educating the public so that we can improve and build upon that legislation in the years ahead.
It’s worth remembering Ted Kennedy’s insistence that he would not hold hostage those people who can be helped today to the more elaborate and comprehensive proposals that, for the time being, are beyond our reach. There is no glory in having the uninsured remain uninsured and at risk so that we health-policy advocates (who most often have insurance) can bask in the warm feeling of having stayed true to our principles.
I believe there are useful initiatives that should and perhaps would be supported by a substantial number of Democrats and Republicans. Some deal with the egregious behavior of insurance companies, others would put in place measures that would begin to lower the rate of growth of health expenditures even as they enhance quality, and still others would expand (though in the short run only modestly) the number of people covered by Medicaid.
We should be clear: This would be a far cry from the comprehensive reform we need. Given current political realities, such a legislative compromise would be unlikely to improve prescription drug benefits, provide a ceiling on individual and family out-of-pocket expenditures, deal with annual and lifetime limits on benefits, or provide significant assistance to small businesses for the provision of employee health insurance. Most important, it would not produce the subsidies that would enable tens of millions of Americans to purchase health insurance. Absent agreement on new sources of revenue, we would not be able to tackle the major issues of health disparities and inequities. But things would be a little better.
I hope the president will convene Democratic and Republican leaders to identify areas where there is sufficient agreement to forge a mediated compromise and that he will make it difficult for anyone to refuse to participate in such an effort. Compromise does not mean surrender. Let presidential wrath fall upon those who want so much that they will not settle for less and upon those who prefer to act as if they were elected to obstruct.
No, that which we might achieve would not be universal health coverage. It would not be what many of us have dreamed about and fought for. But, properly designed, it could benefit many, many Americans in the short run and it would be a start toward something that could be improved upon over time. And if we educate and organize, that time will come.
Rashi Fein is an emeritus professor of the economics of medicine at Harvard Medical School and the author, most recently, of “Learning Lessons: Medicine, Economics, and Public Policy” (Transaction). He served on the staff of President Harry Truman’s Commission on the Health Needs of the Nation and on the senior staff of President John F. Kennedy’s Council of Economic Advisors.
The Forward welcomes reader comments in order to promote thoughtful discussion on issues of importance to the Jewish community. In the interest of maintaining a civil forum, the Forward requires that all commenters be appropriately respectful toward our writers, other commenters and the subjects of the articles. Vigorous debate and reasoned critique are welcome; name-calling and personal invective are not. While we generally do not seek to edit or actively moderate comments, the Forward reserves the right to remove comments for any reason.
Why a Rabbi Should Not Marry Outside the Faith
As First Maharats Graduate, Orthodox Women Leap Forward
Barbra Streisand Visits Western Wall After Landing in Israel With Puppy
Montreal's First Jewish Mayor Michael Applebaum Hit With Corruption Charges
Tapping Into Growing Lure of Hidden Jewish Heritage
Copyright © 2013, Forward Association, Inc. All Rights Reserved.
You've successfully signed up!
I think we need to adopt the Venezuelan health care system. All those who are wealthy or friends of Chavez get to pay for their medical care abroad (Iran), while those who are not favored dont get medical care. Some people can live into their 80s without medical care. Not prolonging life also opens up job opportunities that would otherwise be occupied by the infirm
In the world of political reality, Republicans have no reason to compromise. If nothing gets passed, Obama looks ineffective and Democrats stay home in November. If something gets passed, the lines between Republicans and Democrats get blurred and Republicans become less enthuasiastic. The best case scenario for Republicans is the status quo: keep the electorate oonstantly angry at alleged Democratic excesses while making sure the Dems don't actually pass anything.
In the world of political reality, Obama could have gotten a single payer system if he wanted to -- he didn't want to. He was following the interests of his campaign contributors, not the people who voted for him.
As (among many others) Paul Krugman has documented in the New York Times, single payer is popular among the people (over 50% of the public supported it in polls), and it would have eliminated the greatest waste in the health care system -- the 40% of our health care dollar that goes to the insurance companies.
Obama didn't *want* to. His chief of staff, Rahm Emanuel, was the Democratic Party's fund raiser, and his first concern was raising money, not providing his constituents with the health care they want. Obama (like the entire Democratic Party) got millions of dollars from the insurance industry, and the health care industry generally. It was the insurance industry that *elected* him. When progressive Democrats suggested to Emanuel that they put pressure on "moderate" Democrats to support Obama's health plan, Emanuel famously called them "f* retarded."
During the campaign, Obama said he supported single payer. But when he started on his new health care plan, the first thing he did was to take single payer off the table. He didn't even invite John Conyers to his health care conference.
As Physicians for a National Health Program says, the public option was a compromise of a compromise, and now we don't even have that. Obama's current bill is essentially a government subsidy for the private insurance industry. It also compels people to buy insurance from the private insurance industry. It guarantees the insurance industry that they can continue to sell an overpriced, inefficient, unpopular service. The catch is that the premiums will go up.
David Himmelstein, the co-founder of Physicians for a National Health Program, said that if the people want something, and the politicians tell them that they can't give it to them for political reasons -- you don't have a democracy. And we don't.
The people who voted for Obama were suckers. The people who still think he wants to serve our interests are stupid. If you want to stop being stupid, do a Google search for "Howard Zinn."
I don't know whether the current health care bill will make a difference. Physicians for a National Health Program says it won't. Krugman says it will improve some of the worst problems. But it shows that big business runs the country, and if we don't take Zinn's advice, they will continue to do so.
Norman, health care reform is not only your way or no way.
(Parenthetically, that is the criticism many historians have of Zinn's writing - that in the service of his ideological ends he distorts and worse - for instance see http://www.dissentmagazine.org/article/?article=385 as well as the letter by Prof. Armus in http://www.nytimes.com/2010/02/03/opinion/l03zinn.html?scp=1&sq=armus&st=cse)
Rashi Fein's article is important in urging us to look for what is doable and supported by many sectors of the population. That is why I very much appreciate the following from the article:
"I believe there are useful initiatives that should and perhaps would be supported by a substantial number of Democrats and Republicans. Some deal with the egregious behavior of insurance companies, others would put in place measures that would begin to lower the rate of growth of health expenditures even as they enhance quality, and still others would expand (though in the short run only modestly) the number of people covered by Medicaid."
eli, my way is the laws of arithmetic.
Health care in the U.S. is about 16% of the GDP, or about $10,000 per capita (depending on how you calculate it), higher than any other country. The only way to reduce that cost, or even keep it steady, is to stop paying some of that money to the providers who are getting it now. Each of those providers has a lobby that contributed money to the Obama campaign. The biggest waste among them is the private health insurance industry, which takes 40% of our health care dollar for doing nothing. Obama took several million dollars from the insurance industry, and started his health care reform by excluding single payer. Worse, Obama's bill would require every American to buy private insurance, and would subsidize the private insurance industry from taxes. As Physicians for a National Health Program immediately pointed out, there's no limit on the premiums the insurance companies could charge. So people will be forced to buy unaffordable insurance (as they are in Boston). That's exactly what Obama said during his campaign he wouldn't do.
This bill will indeed eliminate some of the worst abuses of insurance companies, like denying coverage for preexisting conditions. To pay for it, the insurance companies will simply raise premiums. It will also modestly expand Medicaid, which is good.
But doctors and economists writing in the New England Journal of Medicine have examined Obama's so-called cost control measures, such as information technology and evidence-based medicine, and they will not reduce (or slow) costs. Every cost is a lobby, and Obama sold out to every one of those lobbies (except the single payer lobby, which didn't have enough money).
Paul Krugman said that we should reluctantly accept this bill because of its (inadequate) reforms.
But we should recognize this for what it is. Health care costs will continue to go up, and continue to drive people bankrupt. Obama broke his promises, ignored the interests of the people who elected him and followed the interests of the people who contributed to his campaign. The Democratic party is run by its fundraisers, like Rahm Emanuel, who serve the interests of those contributors, and actually take delight in insulting the progressive wing.
If you want to vote for people who call you "F* retarded," go ahead. Zinn's alternative is that the people without wealth can also organize and use the democratic process to serve the broad social interests.
Norman If you want a federal single payer system first pass an amendment to the constitution.Otherwise leave insurance to states to regulate.With regard to costs the insurer is the middleman i would think a closer look at providers of both products and services is called for. Yes i'm conservative and the problem wasn't democratic fundraisers.It was lack of transparency in crafting bills it was the false promise of higher quality,lower cost,expanded coverage when most understand if you get 2 out of the 3 you will be doing good. The general public who liberals view as rubes are tired of loose readings of the constitution and moving numbers around in washington.
richard,
You must be a George W. Bush conservative, because you're making up constitutional principles out of thin air.
I've never seen anyone in a published article seriously suggest that Medicare is unconstitutional. Indeed, there is nothing in the Constitution that says so. There are people who read anything they want into the Constitution, but they're not lawyers.
A single payer health care system would extend Medicare for all.
The Canadian system has the equivalent of Medicare for all. They have equal quality, universal coverage, and half the cost of ours. That's 2 out of 3, and we could have had the same.
In case you didn't notice, I'm not defending Obama (or Rahm Emanuel).
Norman Medicare is unconstitutional and i like medicare.The fact is time after time liberals have abused the general welfare clause and the commerce clause to expand federal social programs.The constitution imposes strict limits on the legal authority of the federal gov't.If you want to expand than amend first.Yes the canadians have a great system that is why you see so many in our hospitals. Norman i know your not defending obama or emanuel sorry i didn't make myself clear on that.Until we reform drug patent system we will have high cost passed either to taxpayers or policyowners or as now both in my view. And by the way i don't consider G W BUSH a conservative.
Here is where we really need faith. Is there a traditional prayer in Jewish liturgy for changing the stony hearts of the opponents? An untraditional prayer? Anything?
Norman, I'm in your camp. You'd probably agree with me, it's going to take some heavy duty praying.