Prescriptions in the Healthcare Debate

John Stewart complained to his guest, Rep Howard Waxman (a Dem leading on healthcare legislation) that Democrats aren't clearly and briefly explaining what they're trying to do with their reform bills--that in fact, Stewart had "fallen asleep for four minutes" during Waxman's last answer. (I don't know how boring it was--I'd zapped over to SportsCenter for a minute myself).

Even given that the clarity of shouting and lying by Republican and insurance funded thugs showing up at town hall meetings is hard to beat, it's a fair point. Waxman is mostly boring, as (it pains me to say it) is Sec. Kathleen Sebelius. The most effective interview I've seen recently was by Sen. Debbie Stabenow of Michigan. She said reform was needed so that your doctor doesn't have to call up your insurance company to see if they'll pay for the treatment you need. She had a few other pithy quotes. I elect her spokesperson for healthcare.

Nevertheless, I have some longwinded notes here from two notable articles. One is in the LA Times, on the Canadian health care system, written by Michael M. Rachlis, a Canadian doctor and health policy analyst. The side-by-side comparisons are so extreme it's enough to make you weep:

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.

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.

He admits there are some problems in delivering good and timely care, but most are problems just as bad in the U.S., while others have nothing to do with the single-payer system. How about choice? "Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors."

So if it's so great, why doesn't everybody admit it? "Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience."

Vested interests? That would be the insurance companies paying out $1.4 million a day to defeat healthcare reform, and that doesn't include all the lobbying and political payoffs. But actually they aren't paying it. The people buying their insurance are. You are. Apart from making some executives very wealthy, that's what the profits are for. That's why you're allowed to pay them their ever-increasing premiums, but risk getting your insurance cancelled if you have the temerity to get sick and actually ask them to insure you.

Okay, next exhibit: an economic analysis by Alexander Hertel-Fernandez on why a public insurance plan is essential to the success of reform. The points track pretty well with what President Obama has been saying: for example, that the public plan introduces competition into a healthcare "market" that pretty much has none anymore:

This lack of competition is a major source of the United States’ uniquely high and rising health costs. A public plan option would force private insurers to compete on efficiency and quality, rather than on their ability to enroll the lowest-cost workers and firms. Furthermore, a public plan would introduce competition to currently monopolistic or oligopolistic insurer and provider markets—three or fewer insurers account for at least 65% of market share in 36 states.

A public plan would reduce costs and foster innovation, the article says, and serve as a benchmark for the insurance market:

Public-private competition is a longstanding feature in the vast majority of advanced postindustrial economies, particularly in health care. Private and public insurers each bring different strengths and weaknesses to the marketplace, complementing one another. One of public insurance’s key strengths is the ability to set a high standard for cost, quality, and access within a national marketplace, to the benefit of private and public insurers, providers, and enrollees alike. If enrollees are unsatisfied with the public plan, they would be able to easily switch back to private insurers."

Not as colorful as big fat idiots screaming big fat idiocies, but a lot more pertinent. Although in the unlikely event that there is a town hall meeting in my neighborhood, I'm seriously considering standing in front of the podium shouting La salute non si paga! Health is not for sale!