Keep It Simple and Practical

“A few timid people, who fear progress, will try to give you new and strange names for what we are doing. Sometimes they will call it “Fascism”, sometimes “Communism”, sometimes “Regimentation”, sometimes “Socialism”. But, in so doing, they are trying to make very complex and theoretical something that is really very simple and very practical.” Franklin Roosevelt, on Social Security, June 28, 1934

The White House is feeling the pushback from the Left over talk of dropping the health care public option, and Michael D. Shear and Ceci Connolly report for the Washington Post that the White House is surprised.

“I don’t understand why the left of the left has decided that this is their Waterloo,” said a senior White House adviser, who spoke on the condition of anonymity. “We’ve gotten to this point where health care on the left is determined by the breadth of the public option. I don’t understand how that has become the measure of whether what we achieve is health-care reform.”

“It’s a mystifying thing,” he added. “We’re forgetting why we are in this.”

Another top aide expressed chagrin that a single element in the president’s sprawling health-care initiative has become a litmus test for whether the administration is serious about the issue.

“It took on a life of its own,” he said.

I don’t know that I can speak for anyone else, but for me, a plan that creates a big, national risk pool; that doesn’t have to make a profit; that can streamline administrative costs; and which cannot refuse applicants for any reason, is the one part of the bill that holds out real hope of meaningful change. By itself it won’t do enough to cut costs or expand health care delivery, but it would bring immediate relief to millions of Americans.

WaPo‘s Steven Pearlstein argues that a good bill can be passed without the public option, and liberals ought to be willing to let it go. I respect Pearlstein’s opinions, but I fear “co ops” and “exchanges” will turn out to be mirages — programs that look like reform from a distance, and which sound great on paper, but which turn out to be useless for most people who need help. I’ve run into too many programs like that already, and I suspect most of you have as well.

Although I’d rather have single payer, I’d be happy with this: Everyone, younger and older, sick and healthy, in one risk pool. Easy applications. No preconditions to be met. Just say, hey, I need insurance. Where do I send the premium checks? And poof, you are insured. End of process. Simple and practical.

The more complicated it is,the more hoops citizens have to jump through to make it work for them, the bigger the cracks through which to fall. And when I hear “exchanges” and “co ops,” I hear “hoops to jump through.” Maybe I’m being stubborn. But the time has come to be stubborn.

The insurance co op idea was being floated as a possible alternative to the public option, and now the Republican leadership in Congress has rejected it. So, screw ’em. Why are we wasting any more time trying to please them? No matter what the Dems do, the Republicans are going to reject it.

Indeed, Carl Hulse and Jeff Zeleny report for the New York Times that Democrats now seem inclined to “go it alone.”

Steve Benen says,

This week, however, we seem to have reached the tipping point. A variety of GOP leaders explained that Dems could drop the public option altogether, and it wouldn’t make any difference. Sen. Chuck Grassley (R-Iowa), who’s become increasingly belligerent about the very idea of reform, said he’s prepared to vote against his own compromise bill. Senate Minority Whip Jon Kyl (R-Ariz.) announced that Republicans will reject reform no matter what’s in the bill.

Fine. Thanks for being honest. Now, get out of the way.

31 thoughts on “Keep It Simple and Practical

  1. Actually ALL of the plans (even what we know of the finance committee’s) outlaw denying coverage for pre-existing conditions, dropping coverage for anything other than non-payment of premiums, stop-losses and huge co-pays.

    And it’s actually the HIEs that create large risk pools (though not necessarily national).

    The public option would compete within the HIE, and it’s only real advantage would be that it is genuinely non-profit (although it also can’t lose money – it must pay for itself).

    The WH (and Ezra Klein) have been right all along – the public option is icing, not the cake. Though I would say that a future R administration would have a harder time loosening the ins. co regulations if one were in place.

    • And it’s actually the HIEs that create large risk pools (though not necessarily national).

      “Health information exchange (HIE) is defined as the mobilization of healthcare information electronically across organizations within a region or community.” (Wikipedia)


      I’m not opposed to HIEs, but seems to me we’re talking apples and oranges here. They’ve been explained to me as a means to help consumers find the best insurance plan. So I can get on the state of New York insurance department website NOW and get information on all the private insurance plans and public programs available in New York. What I learn is that I’m not eligible for any of the programs, and the plans I like cost more than I can afford. “Exchanges” are worthless when there is nothing useful to “exchange.”

      Maybe I’m not understanding what HIEs are, but I am reasonably bright, and if I cannot understand something I suspect the people explaining it to me don’t understand it either.

  2. I’ve managed not to become upset over this horse trading on the public option, because at the end of the day, it’s all noise, and the final bill must include it. How we get there isn’t as important, and if it helps to play rope-a-dope with the Republicans to get them to discredit themselves (again) then great. It’s certainly worked out well enough so far, Obama practically offered to give up the public option for insurance reforms in order for the Republicans to oppose even that, so now we are free to go back to do things the right way and tune out their bad faith objections.

  3. Get out of the way, indeed. The Co-ops don’t control costs. My understanding is they just create a big enough pool that insurance companies have to lower the costs. It’s still the supply and demand of the marketplace. So, instead of purchasing $1,500 a month insurance you get to purchase $1,200 insurance, with the govt. paying for those that can’t afford it. We’ll be bankrupt in a few years. Why don’t we just expand Medicare to include the uninsured. Why should we continue to play by the insurance companies rules. The House needs to pass a bill with the public option and then shove it down “moderate” Democrat Senators throats, by whatever means necessary.

  4. I’m with you on the mirage of the co-ops. Didn’t Blue Cross/Blue Shield start out this way?

    I get what Pearlstein is saying – we’d get universal coverage & no denial of pre-conditions – but without the public option to force down costs, it’s really a giveaway to the insurance cos.

    It’s disappointing that the WH is surprised over the pushback regarding the public option. Repeatedly, through the banking bailouts/giveaways and now this – I get the wingnuts frustration that the government is out of touch with the grassroots – I feel it too. I just think it’s bad strategy instead of being evil.

  5. Maha – by HIE I meant Health Insurance Exchange. These are regional (or one national one). They have 2 purposes: so small state residents can join large groups; and to get around the fact that insurance is regulated by the states without being accused of a federal power grab (state’s rights and all that).

    To a certain extent, the public option was a bright shiny object to distract from the fact that we’re talking about a completely new way of regulating health insurance. It might have succeeded too well, or maybe the R’s have overreached and we get to keep it.

  6. Current thought and even healthcare strategy are probably way out ahead of me on this but wouldn’t the insurance companies love to have a dumping ground for less profitable customers? …namely the sick and those who come down with Cancer or other conditions requiring costlier treatment? It just seems like some accompanying standards (formerly known as regulation) for the insurance companies will need to be legislated.

    As much as I hate to reflect on it, any surprise in the Obama adminsitration regarding the pushback was predicted to a “T” in a number of articles by Paul Krugman long before Obama (who I voted for) was elected. ThoughI can’t recall and will likely research, those articles may have been the ones from which the characterization OBambi arose.

    I wish Obama all the success we need, as I did Bush though I’d entertained no hope with Bush. I still think there is something untapped by Obama and a lot of support that could be rallied by someone who cmoes out swinging at some point. Will we see OBambi or O-Bam-Them? waiting…

  7. I am a 55+ years old, long time Independent, free thinking, informed voter. If one must pigeon hole me, I guess you could say I am a Moderate and I like to make up my own mind about things.

    I’m very confused about this “health care debate” on a number of levels. How can it be a debate when what people are saying and writing is NOT part of the governments debate? These concerns and questions were raised way before the first reported “outbursts” at a town hall, yet there is no mention by ANYONE of there actually being a debate in congress on the pros and cons of the proposed bills.

    I am an IT professional. When we need to address an issue with a complex software and or hardware problem, we break it down into each of the small components that comprise the problem. Then we apply the 80-20 rule to each component. (80% of all the problems listed can be partially corrected, if not resolved completely, by addressing the top 20%). This can also be called the K.I.S. (Keep It Simple) Principle. I do not see where the existing health care bills are doing this.

    To me all the bills are ignoring some basic facts. The first of which: There is no government on this planet that is rich enough to do everything for everyone under every circumstance All The Time. The second one being: The biggest, most talked about reasons for health care problems are not only, not really a part of the health care industry itself, they have not been addressed in a logical manor in any of the existing bills to date. Including HR3200 and the Senate HELP bills.

    That said what I hear as the major problems is the exclusion by insurance companies of pre-existing conditions, the climbing costs of health insurance, including the “high risk pooling” based on one’s job, delivery and supply costs (RX, medical equipment, etc.), and the lack of access to basic health care in rural areas and for the no to low income citizens (I stress citizens), that citizens are strapped for cash over all, hence the cry for no new taxes, higher taxes or more debasement of the dollar.

    Applying the 80-20 rule, a few simple and logical bills could correct and or reduce the impact of most of these “common” complaints.

    – Congress could pass a bill telling insurance companies that they must provide at least one low cost basic health care plan that cannot be higher than the average cost of ALL lowest cost existing health care insurance plans of the previous year. That each subsequent year the cost of this plan cannot exceed the average cost of these new Basic plans by 2% (or whatever percent they come up with). There will nothing stopping the consumer/patient from obtaining additional health insurance supplements that they wish to pay for as long as they are not currently receiving any subsidized health care provided by any government program. The collecting of this cost data can be provided by existing non-government and non-industry public statistical firms.

    – Next Congress could pass a bill stating that health insurance companies can no longer exclude pre-existing conditions from these low cost basic health care plans. They can no longer pool people into higher costing plans based on the danger of their job. They can increase cost, but not exclude, people with dangerous hobbies.

    – Congress could then pass a bill requiring all recipients receiving government supplied/subsidized health care to enroll in one of these new low cost basic health care plans, which the government will pay for, in place of any existing system currently supplying health care insurance funds.

    – Now Congress could then pass a bill stating that for any existing health care providing system that is government run, sponsored and or subsidized, the government will only reimburse the health care provider, no more than the average cost from the previous year for any said RX, medical procedure, medical supply, etc. or the going cost, if it is less than the average rate of the previous year. This law would also state that no person who is a U.S. Citizen can be excluded from basic health care (as defined in the previous basic health care insurance bill) from health care based on age, sex, race or income. Again, The collecting of this cost data can be provided by existing non-government and non-industry public statistical firms.

    – Congress can pass a bill that revokes, amends the current laws that prevent organizations like Doctors Without Boards from crossing state lines within the United States to provide medical services, including vision and dental, to the no to low income citizens of the United States.

    – Last but not least the Congress can pass a bill that will require the Judicial System to define “within the scope of modern medical science” guidelines for addressing all malpractice judicial claims and will review this standard each year with a Medical Science board of Medical Scientists. IE: If the injury, illness, death and or pain and suffering of a patient was due to neglect by the medical practitioner and or provider or due to the lack of Medical Science to anticipate/predict, treat and or prevent. If it is outside of Medical Sciences current ability to predict, treat or prevent the case will be thrown out of court.

    The passing of these six (6) bills can be done quickly, take affect in less than two (2) years and do not require new taxes, increased taxes or government interference with the doctor-patient decision processes and options. These bills would address accessibility in both rural and urban areas, as well as, access to low cost basic health care insurance and care. These bills would also enable existing public organizations to more effectively address the issues and allow free enterprise to rein in the escalating costs of health insurance, supplies and health delivery, by itself – with no major government involvement and or growth.

    When Germany enacted these Health Insurance Company laws, it sparked a free enterprise competition/campaign between all the companies in the country to provide the plan selected by most of the country! Talk about free enterprise at work. Within the first years that the laws were in effect, health care insurance costs stabilized, stopping the rapid cost increases, more people could afford health insurance and there was a cost reduction to Germany’s own version of no to low income health care system.

    These six (6) bills would also eliminate the top facets of the multiple faceted issues that the U.S. has with today’s overall system, enabling any future “reform” by the government to be less convoluted and thus easier and simpler to address.

    So why is my government not doing this and is wasting all this tax money and time debating a set of bills that if implemented, are bound to be unsuccessful because they do not address all the outside of the health care industry issues, yet alone the base issues inside the health care industry?

    I’ve read up to page 711 of HR3200 and then used a comparison sftw program to do the rest. I have repeatedly emailed and snail mailed my government officials and the President asking the following questions. I have attempted to get appointments with my congressional representatives to discuss my questions. I have attended Town Halls – STILL NO ANSWERS. All I want is to know where to read these things for myself so I can make my own decision? I don’t want ANYONE telling me their view or how I should think, I want to make up my own mind. Please help me.

    All I can gather so far is that the government seems to be telling the medical profession HOW to do what they do, instead of zeroing in on the support industries that are driving the costs up so people cannot afford health care and or health care insurance. It also seems that there are to many loop holes that can allow the government to actually RUN and DICTATE HOW the actual health care givers do their job and even appears to limit patient and physician choices.

    Where (page, section, line number) in the existing HR3200 bill and the rest that comprise this “reform”, is the following discussed and explained in detail?:

    – Availability – rural, no to low income citizens
    – Quality of Care – choices of the doctor and consumer/patient?
    – Health Care Rationing possibilities, Limiting patient/doctor choices? (I have seen many loop holes in bill)
    – Insurance, pre-existing conditions, “High Risk” pooling (higher insurance costs) based on job
    – Malpractice – (I only found one (1) reference on page 263 in HR3200) Unrealistic claims for illness, injury, death and or pain and suffering for conditions outside of the Medical Science Field to predict, anticipate, treat or cure?
    – Cost – So where exactly are the funds to pay for HR3200 coming from? Can this lead to higher deficits in the long-term? Where do the funds for all the boards, committees and councils come from?
    – Medicare/Medicaid Reform – (Welfare, state sponsored Blue Cross/Blue Shields) – Why are we duplicating existing systems and their expenses? Very little of this is addressed in the bill that I see.
    – Status of current health care insurance plans/participating physicians over the short and long terms – Projected limitations of current and future health insurance policies seem to be the “theme” of the bill.
    – Where are ALL government officials (including the president) and their families, required to be participants of this plan? If my government won’t enroll, why should I?
    – Just what are my tax dollars funding under this plan, under ANY circumstance? (abortion, right to die)
    – With the health care system being so complex and dependent on so many, outside of health care issues, Why are we not addressing each of these complexities separately in separate bills?

    Please answer my questions. If you cannot or will not – I cannot support any of the existing bills currently before congress.

  8. The devil is in the details as they say and Bob Herbert’s recent NYTimes column wherein he lays out just how bad Obama’s deal the Big Pharma really is ought to be illuminating for where this health care bill will go if we simply “trust” the White House on this. The $80 billion “savings” in that deal, which looks more and more vaporous the more we see of it, are not unlike the phony Medicare reform that bush rammed through Congress a few years ago and which has been the cause of much of the sudden rise in Medicare expenditures in recent years – along with the other privatization aspects of that fiasco.

  9. I don’t care if it is “icing”, I want it, and I haven’t seen a good reason for giving up on it, since dumping it won’t get a single GOP vote, and probably no Blue Dogs either.

    Look, what we get here is gonna be it. We aren’t going to get another big health care bill for a long time. We get it now, or we don’t get it, maybe for the rest of my life.

    What I want is to know that, if my employer suddenly folds, or decides I’m not needed or cost too much, that I won’t be left stranded without access to health insurance. Maybe I can trust HIEs and for-profit insurers, with the regulation that is also in the bill, to provide me with an affordable option despite my preconditions (two-time cancer survivor with long-term side effects from radiation and chemo), but I’d feel safer knowing we were also creating an organization that had the public good, and not profits, in mind. Call me crazy, but I think it matters. Not just for me, but as a marker that America believes sick people shouldn’t be a profit center.

    I want it. Now, not later. We’ve been waiting too long already.

  10. I say public option – full bore – or forget it. The reason is timing. If it doesn’t happen in 2009, it doesn’t hppen at all.

  11. Criss — the information you are looking for is publicly available. However, I believe I can speak for most people here when I say I don’t have the next few hours to spend finding all the references and links for you. You can do some of this yourself.

    Frankly, you pissed me off big time when you wrote, “To me all the bills are ignoring some basic facts. The first of which: There is no government on this planet that is rich enough to do everything for everyone under every circumstance All The Time.”

    Of course not, and nobody is overlooking that. Do you think everyone else in the world is stupid but you?

    The problem isn’t that everyone isn’t getting everything they want. The problem is that increasing numbers of Americans are getting little or no medical care at all. Many estimates say 18,000 Americans a year die because of lack of health care. I think that estimate is low. This is the failure of the private, for-profit health care industry, not the government.

    Second, health care costs are rising considerably higher than inflation and eating bigger and bigger amounts of our national wealth. As Steven Pearlstein, business writer at WaPo, says, don’t just look at health care reform in terms of taxes and government spending. Look at the whole picture, the impact of health care cost on our entire economy. The system we have now is eating our economy alive.

    Must read: “Imperfect Health Reform Still Beats the Status Quo.”

    I take it you believe the bullshit that medical malpractice is a big factor in health care cost. It isn’t. Several states have enacted draconian tort reform laws that have just about shut down malpractice suits in those states, and it has had no impact at all on health care costs in those states. It doesn’t even slow down the rate of increase. The entire costs of malpractice litigation and claims comes to something like 1 percent of the nation’s total health care costs. If we eliminated those costs tomorrow, no one would notice.

    If you want to know another reason for rising health care costs, read:

    Adding Up the Reasons For Expensive Health Care

    The article linked above also touches on why the claim that doctors practice “defensive medicine” because of fear of malpractice is way overblown.

    Did Warren Burger Create the Health Care Mess?

    Finally, a lot of your suggestions that would require regulation of health insurance have been made hundreds of times over. If you haven’t seen them, you aren’t looking very hard. The health insurance industry fights such suggestions tooth and nail because they say, for example, they can’t make a profit and insure people with pre-existing conditions. Old, old, old news. Do catch up.

  12. The Pearlstein WaPo article has one special fact I think we should all think about. It tells us that although doctor-owned labs cost 20 to 30 % less than hospital tests, the doctors who own those labs order 2 to 8 times more tests. At best, a 30% reduction on a 200% increase still costs more.

    It is hard for me to believe much from anyone who has an income stake in this game. On NPR yesterday, Karen Ignagni, head of the health insurers group, was allowed to present the idea that insurance companies are doing us a favor by keeping doctors and hospitals solvent, since Medicare and Medicaid pay discounted rates. As if we thought insurance companies paid full fare!

  13. OK, if you’re goint ot go it alone, go do the Medicare single-payer for everyone that you stupidly took off the table before negotiations even began.
    Let ’em scream, let ’em cry, let ’em stomp their little feet. Git ‘er done!

  14. “So, screw ‘em. Why are we wasting any more time trying to please them? ”

    Right, it don’t matter what the bill is the publicans will vote against it. Any bill that passes short of eliminating medicare can be spun as an Obama victory, they can’t let the colored fellow win.

  15. Criss’s “comment” clearly wasn’t written for this comment thread, but rather reads as being reproduced and posted in lots of other places– in other words, it’s spam. Since it’s a phony comment to begin with, my instinct is to question the veracity of its content. I smell lobbyist.

  16. joanr16 …I think you are right… Criss wants to solve the riddle of the universe before we can proceed with any health care reform.. It seems to me also like an attempt to overwhelm with complexity..

  17. Joan – there’s nothing wrong with your nose. Consider his conclusion.

    “Please answer my questions. If you cannot or will not – I cannot support any of the existing bills currently before congress.”

    Bottom line – he’s asking people to doubt & do nothing,

  18. And he doesn’t even have the 80 / 20 rule right. It’s 80% of the problems can be fixed with 20% of the effort.

  19. I still think there is something untapped by Obama

    There is. Obama is leaving an immense power untapped. I’m reminded of his saying..”we are the ones we have been waiting for”. I know the righties had a good chuckle ridiculing what he was trying to communicate, but the fact remains that his ability to articulate a vision and inspire people is perhaps his greatest asset. To me, he has the potential to rise above the Congressional clowns and greedy corporations that are stifling progression and get the American public to respond to a vision of a viable health care system for all Americans.. He’s got to get out there and start pushing for what America needs…Not trying to accommodate people who don’t want to go along.

  20. I don’t even buy the idea that “There is no government on this planet that is rich enough to do everything for everyone under every circumstance All The Time.” I’d like to see an actual estimate of what that would cost, criss. Would you please get back to me with that number? Then let’s see how we are currently spend that amount of money.

  21. Also, being in IT, Criss should know that users have other things to do (like their jobs) instead of dealing with IT people. Who’s got the time to wade through and answer all these questions?

  22. Humm, since 1972 we used the 80/20 differently … so maybe I am behind the times on that one. As for the “No government on this planet is rich enough to do everything for everyone under every circumstance all the time.” I still stick to my guns on that one. What government can support it’s entire population so no one has to work and can still have everything they want? If our government is voting on this bill then why haven’t they “waded through” all my questions? I mean if they are going to impose this “reform” on us, shouldn’t they know it and be able to answer these questions? If my comment implied that you, the readers here, should answer this – I am sorry. I just copied what I have written my congressional people for the past several months.

    By the way – love all the opinions here!!!! I may not agree with all of them but I love the diversity.

  23. Yo, Criss. Government is us. We are the government. So are we rich enough to provide all that we want to ourselves? Of course we are. Do we have to do some work to get it? Of course we do. What makes you think people who work for the public interest aren’t working, though?

  24. What government can support it’s entire population so no one has to work and can still have everything they want?

    None, of course… and no one is asking for anything even remotely like that. As the kids would say: “Rhetoric FAIL.”

    Also, Criss, spam comments = not cool.

  25. Hey, I got an idea!..what do you say that we shift 200 billion of our 600 billion plus yearly defense budget over to health care. Seems to me that it will all stay in the family but just be allocated to a need where it might be better spent.

  26. Actually we have examples of quite a few gov’ts that can support their people. Saudi Arabia, for one. Typically doesn’t produce a particularly nice society, but that’s beside the point.

    The current bills do define a base, minimal plan. They also outlaw PECs, recission or dropping coverage for any other reason than non-payment.

    Your #3 looks like trying to kill Medicare and Medicaid. Will never happen.

    Your #4 appears to outlaw inflation, at least in the medical field. That won’t happen, either.

    Fine with #5.

    See maha on #6. It simply doesn’t lower prices.

    And I apologize, I looked up Pareto Principle (the 80/20 rule) and your formulation is acceptable.

  27. Swami,
    Here’s the way to sell it: And the money taken from Defense and given to health care will mean millions of more healthy sodiers for the next military fiasco!
    See? Two bird’s, with one stone.

  28. Gulag.. What do you mean by the next fiasco? Aren’t the two we a currently involved in sufficient? I hear that there are 132,000 contractors in Iraq…What percentage of those do you suppose are without full U.S taxpayer paid medical coverage? I’d reckon none!

    I know that not many people want to hear it, but our military budget expenditures are insane. I just think we could get a more tangible benefit by investing in the well being of the American public.. There’s plenty of fat that could be trimmed from our military budget and applied to quality health care of Americans.

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