Missing Richard Nixon

By PAUL KRUGMAN

Many of the retrospectives on Ted Kennedy’s life mention his regret that he didn’t accept Richard Nixon’s offer of a bipartisan health care deal. The moral some commentators take from that regret is that today’s health care reformers should do what Mr. Kennedy balked at doing back then, and reach out to the other side.

Fred R. Conrad/The New York Times

Paul Krugman

 But it’s a bad analogy, because today’s political scene is nothing like that of the early 1970s. In fact, surveying current politics, I find myself missing Richard Nixon.

No, I haven’t lost my mind. Nixon was surely the worst person other than Dick Cheney ever to control the executive branch.

But the Nixon era was a time in which leading figures in both parties were capable of speaking rationally about policy, and in which policy decisions weren’t as warped by corporate cash as they are now. America is a better country in many ways than it was 35 years ago, but our political system’s ability to deal with real problems has been degraded to such an extent that I sometimes wonder whether the country is still governable.

As many people have pointed out, Nixon’s proposal for health care reform looks a lot like Democratic proposals today. In fact, in some ways it was stronger. Right now, Republicans are balking at the idea of requiring that large employers offer health insurance to their workers; Nixon proposed requiring that all employers, not just large companies, offer insurance.

Nixon also embraced tighter regulation of insurers, calling on states to “approve specific plans, oversee rates, ensure adequate disclosure, require an annual audit and take other appropriate measures.” No illusions there about how the magic of the marketplace solves all problems.

So what happened to the days when a Republican president could sound so nonideological, and offer such a reasonable proposal?

Part of the answer is that the right-wing fringe, which has always been around — as an article by the historian Rick Perlstein puts it, “crazy is a pre-existing condition” — has now, in effect, taken over one of our two major parties. Moderate Republicans, the sort of people with whom one might have been able to negotiate a health care deal, have either been driven out of the party or intimidated into silence. Whom are Democrats supposed to reach out to, when Senator Chuck Grassley of Iowa, who was supposed to be the linchpin of any deal, helped feed the “death panel” lies?

But there’s another reason health care reform is much harder now than it would have been under Nixon: the vast expansion of corporate influence.

We tend to think of the way things are now, with a huge army of lobbyists permanently camped in the corridors of power, with corporations prepared to unleash misleading ads and organize fake grass-roots protests against any legislation that threatens their bottom line, as the way it always was. But our corporate-cash-dominated system is a relatively recent creation, dating mainly from the late 1970s.

And now that this system exists, reform of any kind has become extremely difficult. That’s especially true for health care, where growing spending has made the vested interests far more powerful than they were in Nixon’s day. The health insurance industry, in particular, saw its premiums go from 1.5 percent of G.D.P. in 1970 to 5.5 percent in 2007, so that a once minor player has become a political behemoth, one that is currently spending $1.4 million a day lobbying Congress.

That spending fuels debates that otherwise seem incomprehensible. Why are “centrist” Democrats like Senator Kent Conrad of North Dakota so opposed to letting a public plan, in which Americans can buy their insurance directly from the government, compete with private insurers? Never mind their often incoherent arguments; what it comes down to is the money.

Given the combination of G.O.P. extremism and corporate power, it’s now doubtful whether health reform, even if we get it — which is by no means certain — will be anywhere near as good as Nixon’s proposal, even though Democrats control the White House and have a large Congressional majority.

And what about other challenges? Every desperately needed reform I can think of, from controlling greenhouse gases to restoring fiscal balance, will have to run the same gantlet of lobbying and lies.

I’m not saying that reformers should give up. They do, however, have to realize what they’re up against. There was a lot of talk last year about how Barack Obama would be a “transformational” president — but true transformation, it turns out, requires a lot more than electing one telegenic leader. Actually turning this country around is going to take years of siege warfare against deeply entrenched interests, defending a deeply dysfunctional political system.

Health Care Sad Stories

“This is an email I received depicting our horror stricken health-care system, this story is commonplace, but that does not make it any less tragic.” Dave

Dear David:

 

I want to tell you about my only sibling, my brother Eric De La Cruz.¹Diagnosed with Severe Dilated Cardiomyopathy five years ago and in need of a heart transplant, my brother Eric passed away far too early this July 4th. All because the health care insurance system in the United States is broken.

Click here to attend an event to support real reform – reform with a public health insurance option that prohibits discrimination or denial based on pre-existing conditions. We need to tell Congress to get it done.

You see, unlike most of us (but like millions of others), Eric couldn’t get private insurance. His employer didn’t offer it as a benefit. And his heart condition, while treatable, was a pre-existing condition that no private insurers would cover. Sadly, there was no affordable, public option to protect Eric. So he remained excluded from the basic right to life-saving treatment that all people deserve. Although a heart transplant would save him, without coverage, Eric’s condition needlessly and slowly deteriorated.People don’t realize how vulnerable they are to the devastating costs – both in dollars and in human life – of an insurance industry concerned with one thing: profit. As a TV journalist and correspondent, I’ve enjoyed a public platform few have, but when it came to the health and well-being of my family, I’m as susceptible as everyone else. Despite a national online campaign and celebrity fund-raising that amassed nearly $1 million, and emotional and political support from thousands of strangers, Eric couldn’t beat this broken system. If it can happen to us, with all of THAT support, it truly can happen to anyone. In fact, sadly, it IS happening to thousands all over the country right now. 

 

Click here to sign up to attend an event to support health insurance reform – reform with a public health insurance option to keep the insurance companies honest.

After Eric’s death, I went to Washington this August. I met in the offices of many Senators and Representatives to ask why there is even a debate about passing a strong health care reform bill that would provide all Americans with affordable, guaranteed health care coverage – a bill that would help control the spira

ling health care costs that are bankrupting countless families and forcing people to choose between their money and their lives.Everyone on Capitol Hill was sympathetic to Eric’s story, and most were supportive of legislation including a strong public option, but few seem convinced the American people would lean hard enough on Congress to make sure it happened. We must convince them now.

At this critical time, we need you to stand up for reform that would have benefited my brother Eric, and the thousands just like him who are waiting for help now. Click here to attend an event in your area and help win reform now.

In fighting for Eric’s life, thousands of people joined forces to get him on Medicare, get him into a transplant facility and raise enough money to pay for his treatment. He just ran out of time. But the clock has not stopped for you.Though Eric has passed away, he has not been silenced. Your voice can make the difference. By simply clicking on any of the links in this email, you’ll help ensure what happened to Eric doesn’t happen to your friend, your brother, your neighbor…or you.   

Please don’t forget your insurance can disappear when you least expect it, because insurance companies CAN rescind policies. If you get sick and don’t have insurance now, insurance companies CAN deny you coverage for a pre-existing condition. If you get sick tomorrow, your life can be turned upside down because of your failing health AND runaway medical bills that can force you into bankruptcy. I know you think this could never happen to you. But it can. It happened to us.  We need to get a simple message to Senators: Join with the majority of Americans to support an affordable public option to lower costs, keep insurance companies honest and include everyone, regardless of pre-existing conditions or income.

At this critical time, can you help support reform that the American people want and need? Click here sign up to attend an event in your area.

Help put a stop to these injustices.Fight to make a difference, not just for you, but for future generations.

Thank you,

Veronica De La Cruz

 

 

8 FACTS AND 8 MYTHS ABOUT HEALTH CARE REFORM

8 WAYS HEALTH INSURANCE REFORM PROVIDES SECURITY AND STABILITY TO ALL AMERICANS

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

Learn more and get details:
http://tinyurl.com/nbn5fg

8 COMMON MYTHS ABOUT HEALTH INSURANCE REFORM

1. It’s a myth that reform will mean a “government takeover” of health care or lead to “rationing.” To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.

2. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.

3. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

4. It’s a myth that health insurance reform will affect veterans’ access to the care they get now. To the contrary, the President’s budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.

5. It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.

6. It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare “doughnut” hole to make prescription drugs more affordable for seniors.

7. It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.

8. It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details:
http://tinyurl.com/lyxel4

Blogged with the Flock Browser

Canadain Doctor Health care

A Canadian doctor diagnoses U.S. healthcare

The caricature of ‘socialized medicine’ is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients’ health.

By Michael M. Rachlis
August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.

On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.

These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn’t happen. And perverse incentives like fee-for-service make things even worse.

Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world’s best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?

American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to "in-plan" doctors.

Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

Michael M. Rachlis is a physician, health policy analyst and author in Toronto.

HEALTH CARE STORIES THAT NEED READING

A few weeks ago, President Obama asked you to share your personal story about how the health care crisis has affected you and the ones you love. Hundreds of thousands of stories poured in from every corner of the country. The President and I have read through many of them ourselves — and now I’m encouraging you to do so as well.

Read these powerful, personal stories from people in your area and around the country.

And after you do, please forward this note on to as many people as you can.

For folks who don’t yet understand why health care reform is such an urgent priority, these stories make the case far better than any statistics ever could.

For those who support health care reform but haven’t yet found the time to join our campaign, these stories provide more motivation than any speech any politician could ever give.

So please read these stories, pass this note on to everyone in your address book, and help us show everyone in America why fixing our broken health care system is a necessity that just can’t wait:

http://healthcare.barackobama.com /stories

Thank you,

Vice President Joe Biden