Web Letters: Healthcare Bottom Lines

According to independent, non-advocater analysis, by Commonwealth Funds, The Lewin Group, CBO and GAO, only single-payer (Conyers HR-676; Expanded and Improved Medicare for All" actually controls total costs and covers everybody (universal) for all care (comprehensive). That is why Baucus keeps pressuring the CBO to fix the numbers for his proposal. That is why they will not allow CBO to do a comparative scoring of single-payer. Because these precompromised plans withb AHIP all explode costs, do not prevent underinsurance and medical bankruptcy (both individual and for the country).

Even if full single-payer is off the table, why not Stark's bill, which let you keep your current insurance if you like it, but offers real and strong public option of expanded and improved Medicare for All? Because any real public option might put the insurance companies out of business. Because the fact is that it is they who cannot compete on a truly level playing field.

The pathetic fact is that we have gone from compromising single-payer and even Stark's strong public option off the table, before starting. Now a weak public option per Obama is being negotiated away for phony public option. Per Baucus and Schumer, the idea is to pre-design a "public option" in name only that does not compete with private insurance. That is designed to not control costs. It is pre-designed to fail and give public option and single-payer a bad name (like privatizing Medicare Advantage and Part D were designed to fail and give Medicare a bad name). At the very least, I want the best reform I can get with fifty-one votes. A year after whatever passes, nobody will care whether it was bipartisan or not.

But the real remaining question is, What will happen when we need health reform 2.0? Something will pass this year. It will not work out well, since costs will explode and people will still not have coverage. Will the right get to point at what happened and say, "See that is what happens when government gets involved"? Or will we be able to clearly point out that this is what happens when you compromise to prop up the insurance companies? Our health, both economic and physical, depends on the answer.

Dr. Steve Auerbach

New York, NY

This article captures the fundamental flaws of the debate as it's currently structured by the Washington, DC, crowd. The most glaring of these errors is in your first point regarding cost control.

It is certainly a need and vital goal of any reform to control future costs. However, your point only refers to reimbursement issues from payers. Reimbursement, regardless of the payer, is not cost--it is price. Controlling reimbursement thus is price control, not cost control. As we all know, price controls ultimately lead to a reduction of supply. This is why opponents are against plans that focus on price control.

To achieve cost control, as you advocate, requires looking deeper at what is truly driving the cost of healthcare. This is more fruitful area of reform. An example of this is how legal concerns by healthcare providers drive significant cost. A doctor or other provider will order numerous tests or procedures that they believe will be 99 percent unproductive in answering the health question at hand but must be ordered nonetheless to protect them from litigation charging that they weren't prudent or exhaustive in their diagnostic actions. Finding a new path on this issue would actually eliminate unnecessary tests and procedures and truly reduce cost in the system.

Until politicians and advocates reframe the conversation around reducing the true drivers of cost, solutions will be ineffective or produce adverse consequenses.

Mikel Dodd

Hinsdale, IL

Our healthcare system, most importantly, should cover everyone free of charge.

Throughout history, civilizations come to an end with famine and disease. People become too sick to work, too sick to grow food, and they perish. We can’t afford not to cover everyone with a fully funded, comprehensive healthcare program. Ignoring the needs of others can ultimately come back as a threat to our own health and safety.

The military presents a wish list every year and we automatically throw a trillion dollars at it. No weapon is too exotic or far-fetched; if the military wants it, then it automatically becomes an issue of national security and we write a check.

If we took healthcare as seriously as we do killing people, the healthcare industry would be fully funded every year. A pandemic as at least as great a threat as international terrorism, and we should treat healthcare as a basic requirement just like we do national security.

Gary Amstutz

Lake Isabella, CA

Mr. Feder has accurately and usefully summed up the minimum requirements of any public healthcare plan that might emerge from the current negotiations in Congress. The essential issue is not so much who pays but that there isn't sufficient money to give everyone ideal healthcare. In a system based on private heathcare provision, this unpleasant reality leads inevitably to differential levels of provision, but since some people can afford to get optimal care, the illusion is created that this opportunity is open to all. So rationing exists, but it is applied by stealth. This is unfair, and it's enormously inefficient because the best care goes to those who can afford it, rather than those who may need it. The advantage of a public system is that the principles of evidence-based medicine can be applied uniformly and transparently, so that resources are put where they are needed, rather than where it makes the most money. Given the enormous amount of money America puts into healthcare (twice as much per capita as compared to most other developed countries), it should be possible to create the best public healthcare system in the world.

Philip Aaronson

London, UK

I remain concerned at the extent to which too many are persuing the Fascist economic mode in forcing people to buy insurance. Any program should be voluntary in the free, American tradition.

John D. Froelich

Upper Darby, PA