After a three-hour meeting at the White House on Tuesday, fiscally conservative Democrats in the House of Representatives — the so-called Blue Dog Democrats — got a tentative agreement on an addition to the health reform bill. The new provision would give an outside panel of health policy experts and stakeholders the power to make cuts to government-financed health care programs.
Although brushed off by some as a “pint-sized breakthrough in an ocean of concern,” Peter Orszag, the White House budget director, called it “probably the most important piece that can be added” to the health care bill in the House.
I could not agree more. Such a provision, if part of the final bill, would be the proverbial camel’s nose under the tent for a more rational approach to America’s health policy.
The talking heads on cable TV panned President Obama’s Wednesday press conference. You see, he didn’t offer a lot of folksy anecdotes.
Shame on them. The health care system is in crisis. The fate of America’s middle class hangs in the balance. And there on our TVs was a president with an impressive command of the issues, who truly understands the stakes.
Mr. Obama was especially good when he talked about controlling medical costs. And there’s a crucial lesson there — namely, that when it comes to reforming health care, compassion and cost-effectiveness go hand in hand.
To see what I mean, compare what Mr. Obama has said and done about health care with the statements and actions of his predecessor.
President Bush, you may remember, was notably unconcerned with the plight of the uninsured. “I mean, people have access to health care in America,” he once remarked. “After all, you just go to an emergency room.”
Meanwhile, Mr. Bush claimed to be against excessive government expenditure. So what did he do to rein in the cost of Medicare, the biggest single item driving federal spending?
Nothing. In fact, the 2003 Medicare Modernization Act drove costs up both by preventing bargaining over drug prices and by locking in subsidies to insurance companies.
Now President Obama is trying to provide every American with access to health insurance — and he’s also doing more to control health care costs than any previous president.
I don’t know how many people understand the significance of Mr. Obama’s proposal to give MedPAC, the expert advisory board to Medicare, real power. But it’s a major step toward reducing the useless spending — the proliferation of procedures with no medical benefits — that bloats American health care costs.
And both the Obama administration and Congressional Democrats have also been emphasizing the importance of “comparative effectiveness research” — seeing which medical procedures actually work.
So the Obama administration’s commitment to health care for all goes along with an unprecedented willingness to get serious about spending health care dollars wisely. And that’s part of a broader pattern.
Many health care experts believe that one main reason we spend far more on health than any other advanced nation, without better health outcomes, is the fee-for-service system in which hospitals and doctors are paid for procedures, not results. As the president said Wednesday, this creates an incentive for health providers to do more tests, more operations, and so on, whether or not these procedures actually help patients.
So where in America is there serious consideration of moving away from fee-for-service to a more comprehensive, integrated approach to health care? The answer is: Massachusetts — which introduced a health-care plan three years ago that was, in some respects, a dress rehearsal for national health reform, and is now looking for ways to help control costs.
Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.
Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.
As a practical, political matter, then, controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither . . .
"If the Department of Defense can't figure out a way to defend the United States on a budget of more than half a trillion dollars a year, then our problems are much bigger than anything that can be cured by a few more ships and planes," Gates said in a wry and sometimes stinging address to the Economic Club of Chicago.
Sen. John McCain wants to remove the $1.75 billion recently inserted into the proposed 2010 defense budget for more fighter jets from Lockheed Martin. . . . The extra money would extend production of the F-22 beyond the 187 aircraft that Defense Secretary Robert Gates says are needed.
Summary: Despite the lies the gay-marriage media tell you, the F-22 is freaking awesome!!!!!!!!! Plus I fear for my political life if cuts are made at Hill Air Force Base.
I guess that ends the suspense though . . . her being Governor was getting in the way of her book deals and her celebrity ambition. I really hoped we had seen the last of her. Oh well . . .
Wendell Potter has served since May 2009 as CMD's Senior Fellow on Health Care. After a 20-year career as a corporate public relations executive, last year he left his job as head of communications for one of the nation's largest health insurers to try his hand at helping socially responsible organizations -- including those advocating for meaningful health care reform -- achieve their goals.
Iranian twitterers are claiming victory in a coordinated series of blackouts during Ahmadinejad's televised speech yesterday:
The protesters had earlier pre-arranged a call for Iranians to plug in heavy power load household devices such as dryers, irons and toasters at 9:45pm local time, as Ahmadinejad's speech began. Online Twitter feeds claimed blackouts were achieved in East Tehran, Sari, Tabriz, Isfehan, Rodehen, Saghez, Lavasan, Ahvaz, Khoramshahr, Dezfol, Jahrom, Khomini Shahr, Shahin Shar, Folad Shahr, Kashan and some of Rasht.
Some sample tweets:
Iron Tactic tonight: Call for Black Out During Ahmadinejad Live at TV , Tehran Time 21.30...
Yes It Worked!
Ghazvin went in Black Out, People Chanting" Death to Dictator" on the roofs in many cities...
Key quote: My critics will want me to explain why, then, Europe can do it cheaper. The answer is threefold. First, most European nations have better governance than we do--the American political system is a Public Choice disaster. Second, they pay people less money in a way that's hard to replicate here (and even if it wasn't, would be a one time savings that wouldn't check the rate of growth). Third, we're still driving quite a bit of product innovation. Our messy, organic, wasteful, unfair, irrational system allows experimentation, and they cherry pick the best results. If we stopped doing this, their system would stop looking so good.
Key quote: The bottom line: Low administrative costs are not to be confused with high administrative efficiency. In other words, administrators are not necessarily a deadweight loss to the system.
Key quote: I believethat the most sensible source of financing for universal coveragewould come from reducing the expensive, regressive, and inefficientsubsidization of employer-sponsored insurance. Scaling backthe exclusion would be highly progressive and would have theadded benefit of reducing the incentives for overinsurance andexcessive health care spending. This win–win solutionwould ameliorate a fundamental flaw in our current system whileraising the revenues required to cover the uninsured.
Key quote: Some critics contend that behavioral economists have neglected the obvious fact that bureaucrats make errors, too. But this misses the point. After all, wouldn’t you prefer to have a qualified, albeit human, technician inspect your aircraft’s engines rather than do it yourself?
Key quote: Over the course of a month, I spoke to just about everybody I could find who might know something about these healthcare systems: Elected officials, industry leaders, scholars - plus, of course, doctors and patients. And sure enough, I heard some complaints.
But in the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care.
A statement by the group, the Association of Researchers and Teachers of Qum, represents a significant, if so far symbolic, setback for the government and especially the authority of the supreme leader, Ayatollah Ali Khamenei, whose word is supposed to be final. The government has tried to paint the opposition and its top presidential candidate, Mir Hussein Moussavi, as criminals and traitors, a strategy that now becomes more difficult — if not impossible. . .
“This crack in the clerical establishment, and the fact they are siding with the people and Moussavi, in my view is the most historic crack in the 30 years of the Islamic republic,” said Abbas Milani, director of the Iranian Studies Program at Stanford University. “Remember, they are going against an election verified and sanctified by Khamenei.”
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