Posts
I finished Howard Dean's Prescription for Real Healthcare Reform. I have three items.
1.
On page 113, Howard Dean disagrees with the notion that illegal
immigrants drive the United States' uninsured problem. Dean argues that
American citizens make up the bulk of the uninsured and that illegal
immigrants "have significantly lower per-capita healthcare expenditures"
because they lack "a usual source of care" and usually cannot enroll in
Medicaid and S-Chip.
I wouldn't be surprised if illegal immigrants play some role in driving up the cost of health care (see here),
however. They are uninsured, and they use emergency rooms, and
hospitals then pass on the cost of treating them to everyone else. I
think it would be inhumane not to treat them, though.
2.
On page 115, Dean argues against the notion that requiring employers at
large companies to provide health insurance or to "pay into a fund that
[would] help finance health insurance for their workers" would result
in large companies dropping health insurance altogether. Dean says
that, in Massachusetts, the employer mandate has not resulted in
employers dropping health care for their employees during the first year
of health care reform.
But Dean earlier in the book says that
health insurance is burdensome for large companies, which is why some of
them locate in Canada, where the government takes care of health
insurance costs. If that is the case, why wouldn't companies drop their
private insurance plans and tell their workers to enroll in a public
option (if it exists) or Medicaid (if the workers are eligible for
that)? (And I'm not saying it would be bad if people were covered by a
public option.)
3. In Chapter Twelve, Dean goes into how different
countries handle health care. Some have the government pay for it, and
others have a fairly effective health care system in which private
health insurance companies compete and yet are under certain
regulations. On pages 105-106, Dean discusses Great Britain's system,
in which the government pays for a lot of the health care expenditures.
Dean quotes Ezra Klein as saying: "In the case of ill health, they're
actually in much better health than their American counterparts, though
that's a function of lifestyle more than hospital choice. You're
probably better off getting your breast cancer treated in America and
getting your diabetes treated in Britain. In the aggregate, however,
the evidence is fairly clear that the British are better off."
What
Klein says coincides with what some have told me: that countries with
national health insurance are better in terms of preventative care,
since people are not afraid to go to the doctor on a regular basis. But
the United States reportedly has superior technology and is better at
treating cancer. Can we have our cake and eat it too? Does America
have to have a system in which people fall through the cracks in order
for it to have superior technology?
Showing posts with label Howard Dean's Prescription. Show all posts
Showing posts with label Howard Dean's Prescription. Show all posts
Saturday, September 15, 2012
Friday, September 14, 2012
Howard Dean on Health Care Reform 3
I have three items for my write-up today on Howard Dean's Prescription for Real Healthcare Reform.
1. On page 81, Howard Dean takes on the argument that the public plan would reimburse health care providers at a low rate, and thus the providers would shift the cost difference onto Americans who have private insurance. This is actually a concern that has been raised about Medicare and Medicaid: that they do not reimburse doctors adequately, and so doctors have to make up the cost difference by passing the cost on to consumers, resulting in higher health care prices. Or the fear has been raised that doctors may not be able to make up the cost difference and thus will quit. Moreover, there are doctors who currently do not accept Medicare and Medicaid patients. Dean, however, refers to a study by the Medicare Payment Advisory Commission that says that financially pressured hospitals that operate efficiently are actually able to make money off of Medicare patients. His point may be that the problem is not Medicare but rather the inefficiency of health care providers.
2. On page 82, Dean refers to the fear among pharmaceutical companies that the government will use its "huge purchasing power" to bring down the prices of pharmaceuticals. This may explain to me the whole concept of Medicare negotiating for lower drug prices. The idea may be that, because Medicare is such a huge customer, it is able to bargain with pharmaceuticals about what the prices should be. A fear among some conservatives, however, is that this will reduce the amount of money that pharmaceutical companies make, and thus cut research and development and hinder innovation, since people may not innovate new drugs once they realize that they won't make a lot of money (see here). How, then, can we solve the problem of rising drug prices?
3. On pages 90-91, Dean disputes the conservative argument that tort reform will significantly bring down the cost of health care. Dean says that malpractice "constitutes just 0.46 percent of total healthcare expenditures" and that only a small number of people are suing their doctors. Dean acknowledges, however, that "the increasing costs of malpractice insurance premiums are hurting doctors", but he does not believe that is a significant cause of rising health care costs. I wouldn't take tort reform (of some kind) out of the equation when it comes to health care reform, for malpractice insurance premiums probably are a burden on doctors, and I can envision doctors doing defensive medicine out of fear of making a mistake and being sued. At the same time, I do not think that tort reform is the end-all-be-all. Texas has it, and the cost of health care continues to rise (see here).
1. On page 81, Howard Dean takes on the argument that the public plan would reimburse health care providers at a low rate, and thus the providers would shift the cost difference onto Americans who have private insurance. This is actually a concern that has been raised about Medicare and Medicaid: that they do not reimburse doctors adequately, and so doctors have to make up the cost difference by passing the cost on to consumers, resulting in higher health care prices. Or the fear has been raised that doctors may not be able to make up the cost difference and thus will quit. Moreover, there are doctors who currently do not accept Medicare and Medicaid patients. Dean, however, refers to a study by the Medicare Payment Advisory Commission that says that financially pressured hospitals that operate efficiently are actually able to make money off of Medicare patients. His point may be that the problem is not Medicare but rather the inefficiency of health care providers.
2. On page 82, Dean refers to the fear among pharmaceutical companies that the government will use its "huge purchasing power" to bring down the prices of pharmaceuticals. This may explain to me the whole concept of Medicare negotiating for lower drug prices. The idea may be that, because Medicare is such a huge customer, it is able to bargain with pharmaceuticals about what the prices should be. A fear among some conservatives, however, is that this will reduce the amount of money that pharmaceutical companies make, and thus cut research and development and hinder innovation, since people may not innovate new drugs once they realize that they won't make a lot of money (see here). How, then, can we solve the problem of rising drug prices?
3. On pages 90-91, Dean disputes the conservative argument that tort reform will significantly bring down the cost of health care. Dean says that malpractice "constitutes just 0.46 percent of total healthcare expenditures" and that only a small number of people are suing their doctors. Dean acknowledges, however, that "the increasing costs of malpractice insurance premiums are hurting doctors", but he does not believe that is a significant cause of rising health care costs. I wouldn't take tort reform (of some kind) out of the equation when it comes to health care reform, for malpractice insurance premiums probably are a burden on doctors, and I can envision doctors doing defensive medicine out of fear of making a mistake and being sued. At the same time, I do not think that tort reform is the end-all-be-all. Texas has it, and the cost of health care continues to rise (see here).
Thursday, September 13, 2012
Howard Dean on Health Care Reform 2
I have two items today for my write-up on Howard Dean's Prescription for Real Healthcare Reform.
1. To be honest, the health care plan that Howard Dean prescribes for the entire country reminds me of Paul Ryan's plans for Medicare, which concern the elderly. (And, by Ryan's plan, I mean the version that was described on ABC News on August 14, 2012.) Howard Dean wants a system in which private health insurance companies would compete with a public option (which would be like Medicare), people would be free to select from a variety of options (or stay on their current plan), and people would receive subsidies based on need so they can purchase health insurance. And Paul Ryan supports giving the elderly vouchers to purchase health insurance from government-approved private plans, while allowing them to choose traditional Medicare if they so desire.
The plans sound similar, but are they? Howard Dean would probably say "no" and would argue that Ryan's plan is deficient because it puts on seniors a financial burden of paying for health care, greater than what seniors currently bear. And Dean would probably have a point. But it seems to me that both sides are inconsistent, at times. During the health care debate, when the public option was on the table, Republicans were saying that the public option would be a terrible idea because private health insurance companies would not be able to compete successfully against it----they'd be run out of business. And yet, Newt Gingrich, and now Paul Ryan, propose to have private health insurance companies compete with Medicare.
I still have questions about Ryan's plan, though. Ryan's plan is designed to save Medicare and to make it solvent. I am open to correction on this, but I think that Ryan hopes that more seniors will take their vouchers and enroll in private health insurance plans. But what if most of them choose instead to stay in Medicare? In that case, would Ryan's plan change anything, or simply land us back to where we were before? But suppose that a sizeable number of seniors do choose to enroll in private plans. Would Medicare then have enough money to help those who choose to stay in it?
2. Howard Dean says that information should be provided to physicians about what are the most effective treatments, in terms of health and costs. That way, they can make informed decisions. Dean anticipates an argument that I have heard or read from conservatives when he states on page 54:
"To be sure, comparative effectiveness research cannot be applied too rigidly. A small percentage of patients will respond to one drug better than to another, despite the similar chemistries." In short, what is considered to be the most effective treatment----in terms of health and cost----may not work for everyone. Consequently, for Dean, the decision should rest with the physician about what is best for the patient.
But I have a question: What would prevent physicians from choosing the costlier treatments because that would make them more money? Perhaps Dean would respond that his plan promotes preventative care and rewards doctors who keep or make their patients healthy, and so doctors under his plan would do the right thing.
1. To be honest, the health care plan that Howard Dean prescribes for the entire country reminds me of Paul Ryan's plans for Medicare, which concern the elderly. (And, by Ryan's plan, I mean the version that was described on ABC News on August 14, 2012.) Howard Dean wants a system in which private health insurance companies would compete with a public option (which would be like Medicare), people would be free to select from a variety of options (or stay on their current plan), and people would receive subsidies based on need so they can purchase health insurance. And Paul Ryan supports giving the elderly vouchers to purchase health insurance from government-approved private plans, while allowing them to choose traditional Medicare if they so desire.
The plans sound similar, but are they? Howard Dean would probably say "no" and would argue that Ryan's plan is deficient because it puts on seniors a financial burden of paying for health care, greater than what seniors currently bear. And Dean would probably have a point. But it seems to me that both sides are inconsistent, at times. During the health care debate, when the public option was on the table, Republicans were saying that the public option would be a terrible idea because private health insurance companies would not be able to compete successfully against it----they'd be run out of business. And yet, Newt Gingrich, and now Paul Ryan, propose to have private health insurance companies compete with Medicare.
I still have questions about Ryan's plan, though. Ryan's plan is designed to save Medicare and to make it solvent. I am open to correction on this, but I think that Ryan hopes that more seniors will take their vouchers and enroll in private health insurance plans. But what if most of them choose instead to stay in Medicare? In that case, would Ryan's plan change anything, or simply land us back to where we were before? But suppose that a sizeable number of seniors do choose to enroll in private plans. Would Medicare then have enough money to help those who choose to stay in it?
2. Howard Dean says that information should be provided to physicians about what are the most effective treatments, in terms of health and costs. That way, they can make informed decisions. Dean anticipates an argument that I have heard or read from conservatives when he states on page 54:
"To be sure, comparative effectiveness research cannot be applied too rigidly. A small percentage of patients will respond to one drug better than to another, despite the similar chemistries." In short, what is considered to be the most effective treatment----in terms of health and cost----may not work for everyone. Consequently, for Dean, the decision should rest with the physician about what is best for the patient.
But I have a question: What would prevent physicians from choosing the costlier treatments because that would make them more money? Perhaps Dean would respond that his plan promotes preventative care and rewards doctors who keep or make their patients healthy, and so doctors under his plan would do the right thing.
Wednesday, September 12, 2012
Howard Dean on Health Care Reform 1
During the past five months or so, I have read and blogged through
books by Presidential candidates for the year 2012. I blogged through
Barack Obama's Dreams from My Father, and also books by
Republican candidates Newt Gingrich, Herman Cain, Michele Bachmann, Rick
Santorum, Ron Paul, Rick Perry, and Tim Pawlenty. I also read a
biography about Mitt Romney which struck me as rather sympathetic even
as it acknowledged some negatives in his record.
From this point up to the election, and maybe beyond then, I'll be blogging through other books on politics. My focus will be on the economy, but I will probably get into other issues as well. The books that I will blog through are largely from a leftist perspective----think Howard Dean, Robert Reich, Arianna Huffington, George McGovern, and Paul Krugman. But I will also blog through a book by Bruce Bartlett, an economist who served in the Reagan Administration who has written about the failure of Reaganomics. I will get into the free trade debate, as I blog through a liberal book that promotes free trade, and a book by arch-conservative Pat Buchanan that is critical of it. And, if time permits, I will blog through other books: a book by Lou Dobbs on the war against the middle-class, a book by Democrats James Carville and Paul Begala in 2006 about how the Democratic Party can improve its image, and a book by Sheila Suess Kennedy about how serving in the ACLU coincides with her Republican beliefs.
Some of you may have gotten tired of me plowing through books that extol tax cuts, less government spending on social programs, and free trade, even as they criticize public-sector unions. Well, from this point, I'll be blogging through books that have a different perspective (though there will be cases in which a book may overlap with conservative ideas). And, while I will probably be more sympathetic to these books that I am about to read than I was towards the Republican books, since I tend to lean left these days, I will still try to be rigorous in identifying what I consider to be the strengths and weaknesses in their arguments and policy proposals, as well as ask questions.
The book that I just started was Howard Dean's Prescription for Real Health Care Reform, by Howard Dean, Igor Volsky, and Faiz Shakir. (But I will say "Dean says" or "According to Dean" rather than "Dean, Volsky, and Shakir say".) There were a variety of noteworthy items in my latest reading, such as Howard Dean's discussion of his medical and political career, and what Dean says about the shenanigans of private health insurance companies. What I want to highlight in this post, though, are four items.
First of all, Dean believes that health care reform is actually pro-business. The reason is that health insurance costs businesses a lot, especially as health care costs continue to rise. Dean says that this is why there are companies or plants that choose to locate in Canada rather than the U.S.: in Canada, the government pays for health insurance, and so the companies don't have to do so and can thus use their money for production. I have some questions. Do the high taxes in Canada discourage businesses as well? Well, perhaps not, for the corporate tax rate in Canada was only 16.5 per cent in 2010 (see here). At the same time, there is in Canada a 50% tax rate on realized capital gains (see here), and I wonder if that puts a clamp on the income that corporate people in Canada can make. I also was curious as to whether Howard Dean's plan to pay for health care reform----which he defines as competition between private insurance companies and a Medicare-like program that would include all who want to join it----would encourage companies to leave the U.S. Dean later in the book (I peeked ahead) endorses a carbon and gasoline tax as a way to pay for health care reform. But remember the conservative argument that such a policy can encourage businesses that have a lot of carbon emissions to flee to countries where there are not as many restrictions. Dean does not think that the taxes would be a problem, however, for businesses would love saving money on not having to provide health care to their employees, and people wouldn't mind paying a little more at the gas pump if health care costs were no longer as much of a problem for them.
Second, I appreciated Dean's discussion of employer-based health insurance. According to Dean, employer-based health insurance is pretty good because, in big companies, a large number of people are contributing to the insurance plan. Consequently, the insurance is reliable in the sense that it's there when the worker gets sick, and people aren't dropped for pre-existing conditions. The problem is that, when people change or lose their jobs, they no longer are covered by the insurance. Then, if they find themselves in a situation in which they are too young for Medicare and have too much money to qualify for Medicaid, they look for individual coverage----and that tends to be more stingy in terms of paying for treatment and even covering new applicants (who can be rejected for having pre-existing conditions, or poor credit, or whatever).
Third, Dean appears to think that there is a problem in some of the services that we pay for. He states that other countries "hold down health care costs...by not performing as many procedures", and he says that "In Canada, for example, a coronary artery bypass graft (open heart surgery) is done one-third as often on a per-capita basis as it is in the United States" (pages 17-18). According to Dean, this operation costs $60,000, and a Canadian study indicates that it doesn't even prolong life, even though it improves the quality of life. Whereas, in Canada, a person with chest pains due to heart problems would "be treated medically for four to five years before undergoing surgery", in America people cut to the chase and get the surgery done immediately. Dean states that this "is but one reason why our healthcare costs are more than 60 percent higher than Canada's" (page 18). Dean makes important points here. And yet, some may fear that rationing of health care could result from that sort of mindset, as bureaucrats decide which treatment is acceptable and which is not. Private health insurance companies do so while keeping an eye on their profits, as Dean notes, but couldn't the government end up doing so while keeping an eye on restraining or cutting government spending in order to get rid of a deficit? I should note, however, that Dean----like many others on the right and the left----is a proponent of health care reform that encourages preventative care, which could prevent people from having to get expensive surgery at the outset.
Fourth, Dean talks about what to do about people in their 20's who feel invincible and thus want to spend their money on something other than health insurance premiums. Dean proposes that they be given health insurance for free, and he notes that they're inexpensive to insure, presumably because they don't have as many health needs. Dean may believe that the government should provide that insurance, for he goes on to talk about how Vermont (where he was governor) offered health insurance to everyone under 18 in exchange for a "modest premium". I wonder if Dean's plan would work. I thought that one of the ideas behind the health insurance mandate was to have the healthy people in their 20s pay into the system, and that would take care of the sick people with pre-existing conditions. But if the healthy people are not paying into the system, what happens then?
From this point up to the election, and maybe beyond then, I'll be blogging through other books on politics. My focus will be on the economy, but I will probably get into other issues as well. The books that I will blog through are largely from a leftist perspective----think Howard Dean, Robert Reich, Arianna Huffington, George McGovern, and Paul Krugman. But I will also blog through a book by Bruce Bartlett, an economist who served in the Reagan Administration who has written about the failure of Reaganomics. I will get into the free trade debate, as I blog through a liberal book that promotes free trade, and a book by arch-conservative Pat Buchanan that is critical of it. And, if time permits, I will blog through other books: a book by Lou Dobbs on the war against the middle-class, a book by Democrats James Carville and Paul Begala in 2006 about how the Democratic Party can improve its image, and a book by Sheila Suess Kennedy about how serving in the ACLU coincides with her Republican beliefs.
Some of you may have gotten tired of me plowing through books that extol tax cuts, less government spending on social programs, and free trade, even as they criticize public-sector unions. Well, from this point, I'll be blogging through books that have a different perspective (though there will be cases in which a book may overlap with conservative ideas). And, while I will probably be more sympathetic to these books that I am about to read than I was towards the Republican books, since I tend to lean left these days, I will still try to be rigorous in identifying what I consider to be the strengths and weaknesses in their arguments and policy proposals, as well as ask questions.
The book that I just started was Howard Dean's Prescription for Real Health Care Reform, by Howard Dean, Igor Volsky, and Faiz Shakir. (But I will say "Dean says" or "According to Dean" rather than "Dean, Volsky, and Shakir say".) There were a variety of noteworthy items in my latest reading, such as Howard Dean's discussion of his medical and political career, and what Dean says about the shenanigans of private health insurance companies. What I want to highlight in this post, though, are four items.
First of all, Dean believes that health care reform is actually pro-business. The reason is that health insurance costs businesses a lot, especially as health care costs continue to rise. Dean says that this is why there are companies or plants that choose to locate in Canada rather than the U.S.: in Canada, the government pays for health insurance, and so the companies don't have to do so and can thus use their money for production. I have some questions. Do the high taxes in Canada discourage businesses as well? Well, perhaps not, for the corporate tax rate in Canada was only 16.5 per cent in 2010 (see here). At the same time, there is in Canada a 50% tax rate on realized capital gains (see here), and I wonder if that puts a clamp on the income that corporate people in Canada can make. I also was curious as to whether Howard Dean's plan to pay for health care reform----which he defines as competition between private insurance companies and a Medicare-like program that would include all who want to join it----would encourage companies to leave the U.S. Dean later in the book (I peeked ahead) endorses a carbon and gasoline tax as a way to pay for health care reform. But remember the conservative argument that such a policy can encourage businesses that have a lot of carbon emissions to flee to countries where there are not as many restrictions. Dean does not think that the taxes would be a problem, however, for businesses would love saving money on not having to provide health care to their employees, and people wouldn't mind paying a little more at the gas pump if health care costs were no longer as much of a problem for them.
Second, I appreciated Dean's discussion of employer-based health insurance. According to Dean, employer-based health insurance is pretty good because, in big companies, a large number of people are contributing to the insurance plan. Consequently, the insurance is reliable in the sense that it's there when the worker gets sick, and people aren't dropped for pre-existing conditions. The problem is that, when people change or lose their jobs, they no longer are covered by the insurance. Then, if they find themselves in a situation in which they are too young for Medicare and have too much money to qualify for Medicaid, they look for individual coverage----and that tends to be more stingy in terms of paying for treatment and even covering new applicants (who can be rejected for having pre-existing conditions, or poor credit, or whatever).
Third, Dean appears to think that there is a problem in some of the services that we pay for. He states that other countries "hold down health care costs...by not performing as many procedures", and he says that "In Canada, for example, a coronary artery bypass graft (open heart surgery) is done one-third as often on a per-capita basis as it is in the United States" (pages 17-18). According to Dean, this operation costs $60,000, and a Canadian study indicates that it doesn't even prolong life, even though it improves the quality of life. Whereas, in Canada, a person with chest pains due to heart problems would "be treated medically for four to five years before undergoing surgery", in America people cut to the chase and get the surgery done immediately. Dean states that this "is but one reason why our healthcare costs are more than 60 percent higher than Canada's" (page 18). Dean makes important points here. And yet, some may fear that rationing of health care could result from that sort of mindset, as bureaucrats decide which treatment is acceptable and which is not. Private health insurance companies do so while keeping an eye on their profits, as Dean notes, but couldn't the government end up doing so while keeping an eye on restraining or cutting government spending in order to get rid of a deficit? I should note, however, that Dean----like many others on the right and the left----is a proponent of health care reform that encourages preventative care, which could prevent people from having to get expensive surgery at the outset.
Fourth, Dean talks about what to do about people in their 20's who feel invincible and thus want to spend their money on something other than health insurance premiums. Dean proposes that they be given health insurance for free, and he notes that they're inexpensive to insure, presumably because they don't have as many health needs. Dean may believe that the government should provide that insurance, for he goes on to talk about how Vermont (where he was governor) offered health insurance to everyone under 18 in exchange for a "modest premium". I wonder if Dean's plan would work. I thought that one of the ideas behind the health insurance mandate was to have the healthy people in their 20s pay into the system, and that would take care of the sick people with pre-existing conditions. But if the healthy people are not paying into the system, what happens then?
Subscribe to:
Comments (Atom)