Wednesday, August 12. 2009
Fred Mann: Tiahrt gets warm response at area town halls. Similar reports on Reps. Jerry Moran and Lynn Jenkins. On the other hand, the sole Kansas Democrat in the House, Dennis Moore, called off his town hall meetings after receiving death threats. (Scott Roeder, the guy who assassinated Dr. George Tiller, resided until his arrest in Moore's district.) Tiahrt is the worst of the worst. People urge us to write to him, call, go to his events, but he's so far gone it's pointless trying to reason with him. I've seen him do his town hall thing, and it's a complete waste of time -- one reason he hears so little reason. Still, there is something relatively new here: his crowd is getting out in front of him, pulling even harder to the right:
In some sense this doesn't matter, because Tiahrt is already bought and paid for. But it's starting to look like Obama's has lost not just the fight but his political courage. It's hard to sell a bill full of compromises and loopholes designed to undo the benefits originally promised. It's hard to sell a bill when you yourself admit that something else -- single-payer -- would do the job better.
Robert Reich: How the White House's deal with Big Pharma undermines democracy. As bad as the private sector health insurance companies are, it's not obvious to me that they are the biggest problem, either in terms of health care quality or excessive cost. Big Pharma is way up there, and the megacorp profit-oriented health care providers may even be further up there. The main reason I see for focusing on insurance first is that it not only solves a couple of major problems -- lack of coverage for people who have inadequate insurance and no coverage at all for large numbers of people excluded from the present system -- but that beyond solving those problems it provides purchasing power leverage on the rest of the system. The other nice thing about the insurance companies is that we don't need them at all, so cleaning up that problem should be relatively simple. On the other hand, the health care providers are needed -- the workers, anyhow, if not all the financiers -- which makes it harder to sort out. Drug companies are in between, but the problems can easily be separated out. For starters, rewrite patent law to eliminate monopolies and to regulate drug prices. More importantly, publicly fund research and development, and make all of the planning, procedures, and testing transparent, so you can put an end to drug companies spinning test results and covering up problems (cf. Vioxx). And put some strict regulations on drug industry marketing; better still provide transparent public forums for disseminating information about drug performance. One goal here is to make all drugs generic, reducing the industry to manufacturing. And make this system international, so that research, development, and manufacturing anywhere in the world is available anywhere in the world. Even with new investment in R&D, these few simple changes should result in savings of 50-75% of what is currently spent on pharmaceuticals. That in itself would be a big chunk of cost savings which would help out everywhere else.
The same sort of thing can be done with any other medical technology. One big thing that drives up the cost of health care is that nearly all of the new technologies and procedures are monopoly-priced under patent protection. Which is to say that every new whizzbang development gets to ask the question: how much is your life worth? Most are marketed with ridiculous gross margins, the most successful ones becoming huge bonanzas. Public funding of research and development would if anything outproduce the current private system. For one thing, it would encourage competing groups to build on each other's work. Public testing would make it possible for anyone to spot a problem and come up with a better solution. One of the big hidden costs of the current system is liability: what it costs when a product does unexpected damage. That costs would get wrung out of the system real fast.
Admittedly, private insurance has some easy cost targets too: they currently spent something like 30% of their gross on marketing and administration, whereas a single-payer system like Medicare only spends 3%. The difference could easily pay for universal coverage. But that sort of change is more than Obama will allow himself to consider. Instead, he's pushing a set of regulations on private health insurance which will make it less unpalatable but also more expensive. Then he's shackling those reforms with a requirement that they be deficit-neutral, which opens his whole program to charges that he'll inflict some combination of higher taxes and service restrictions. Cutting this deal with Big Pharma just digs himself a deeper hole.
Personally, I would prefer an approach where we started talking about how the system fails qualitatively, then figure out how to improve on that, introducing savings only once we ensure that no quality will be lost. This means educating people pretty much from scratch about how it all works, and how it currently malfunctions. At some level Obama must understand this, but instead of tackling the problem head on, he keeps trying to skirt past problems by making deals with established interests. That's why he keeps losing. That's why it feels like we wound up with the Clinton administration we voted against.
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