How The Health Care Debate Has $hifted

Interesting overview. So much of what gets done (or not done) is really about how the discussion is framed.
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As for number 1 of your four reasons, is that the thing that Senator Clinton and -of all people- Newt Gingrich were pushing a couple of years ago?
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Lastly "centers on something that affects everyone"--effects? Or am wrong?

I am curious about Ben Nelson. Yes, he has never met a health company exec's check that he didn't make sweet love to all night long. But... I think he gets away too much because he gets labeled as a "moderate" in the Broder sense of the word.
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Does the "middle" in Nebraska really want what he is selling? When did moderate become a synonym for selling out the public for corporate overlords? I used to think that moderate was about being a careful, considered incrementalist. Today, it seems that if you shaft your constituents, that means you are practicing high Broderism.

hmmm, great minds. I just took you to task for ignoring the fact that the discussion of health care reform is completely off track, and here you are sorta implying just that.
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a very large part of the problem lies with the media, which never bother to mention the millions of dollars that Baucus gets from the special interests who are opposed to effective health care reform, and acts as if its perfectly natural that the finance committee is taking the lead on this issue (and not even the subcommittee of that committee dedicated to health issues.... Baucus is running the show himself, and the question is why he is so involved in this process, and why he is the recipient of so much special interest money....)

Thanks KT, I should have looked it up myself. Lazy and stupid is no way to go through life, P-nnto.
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In the Curran story he lays out ideas in use-
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While wellness is an admirable goal, the more likely path for both industry and government — both under siege — is tighter allocation of healthcare benefits. In the Towers Perrin survey, for example, many companies report that they are taking steps to tighten provisions on their prescription drug plans, increase employee cost sharing, and tighten or increase enforcement of dependent-eligibility provisions
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certainly most have seen some or all of these already. At some point the the healthcare INDUSTRY will need to put some skin in the game that isn't from those covered.

on those four "big changes"....
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Orzag is full of crap -- he (and, consequently, you) are spinning the real problems of wasteful spending, rather than addressing the biggest problems.
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a comprehensive look at California's rising costs, (see http://tinyurl.com/ofgqwv ) shows us that the biggest problems are
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1) unncessary procedures and hospitalizations that are driven by availability. The higher the number of specialists and hospital beds per person in a given area, the more money is spent on specialists and hospitalization with no significant improvement in outcome
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2) extremely high administrative/overhead costs in the private sector. While the emphasis is on "computerization of medical records", the real costs are incurred in dealing with the multitude of billing practices and procedures of the insurance companies. Indeed, overhead in the "private system" is more than 10 times that of Medicare (which is around 3% of costs).
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3) prescription drug marketing, which creates demand for super-expensive newer drugs for which there is no generic alternative when older, generical-available drugs are just as effective (or much more efficient in terms of cost/benefit ratios.)
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these are the real issues when it comes to rising cost of health care, but neither Orzag or the media is willing to frame them honestly, because by doing so the real culprits become evident.
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2)

But Max Baucus is still one of the only names that matter for getting health care reform passed.

http://www.political-buzz.com/

pluk: think it sort of gets at the same things.
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Karen, we already know what the problems are -- we don't actually need more study. For instance, simply banning ads for designer prescription drugs aimed at consumers would save billions of dollars each year, but Orzag (and the media) refuse to acknowledge that. And we know from the existing studies that most newer drugs are not significantly more effective at treating problems than the generics -- the "advances" tend to be about reduced incidence of serious side effects -- and its those side effects that are the focus of the ads (increasing awareness of potential side effects increases the incidence and severity of the reports of those side effects), and as a result doctors prescribe the more expensive drug rather than deal with patients who complain about the "side effects" of the generics they are taking....
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Providers now get paid according to how much care they provide, rather than how good it is. If a botched surgery lands you back in the hospital, for instance, that means more profit for the health-care industry. "They are often penalized if they provide more efficient care, if they reduce readmission rates," Orszag says, adding that changing that kind of perverse incentive will be a major focus of health-care reform.
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The great thing about this paragraph is that it is way more generally applicable than just within the health care debate. Anywhere where we can ask ourselves "where are there situations where the optimum business decision is one that resuts in harm?" After all, you can't ask and should never expect businesses OR individuals to do anything but what is in their own best interest within the law.
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This is the one thing that "Church of Reagan" zealots look right past. There are things that markets are good at doing and other things at which the really suck! Failure to consider that possibility is precisely what's brought us to our current brink.

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If a botched surgery lands you back in the hospital, for instance, that means more profit for the health-care industry.
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if this was really a problem, don't you think that the health insurance companies would be at the fore-front of efforts to ensure that bad surgeons are denied licenses---and would be backing lawsuits by victims of botched surgeries?
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The fact that this is not the case -- that health insurers don't make an issue of incompetent doctors, tells us that either there is collusion between the insurers and bad doctors, or the costs associated with malpractice are minor.
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indeed, the california study I cited above says that the problem of "too many procedures" is related not to incompetence, but to supply -- the more specialists and hospital beds available, the more appointments with specialists and days spent in hosipals there are per person with no appreciative difference in outcomes
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I don't know who Orszag is working for, but it sounds like he's taking his marching orders from the special interests... (Orszag's work on Social Security "reform" tells us that his priorities are completely bogus....)

I agree with Karen. It looks like the focus of discussions is trying to correct as many of the problems that exist in the healthcare system without actually reforming it.
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But isn't now the time to be bold? - POTUS has approval ratings in the 60s, 59 seats in the Senate and a healthy majority in the house. Surely he could spend some political capital on a proper reform package.
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Tax payers are going to be footing the bill anyway, so why not at least hold some open discussion of a government-managed alternative?

btw, KT: I finally read the New Yorker article that you to the other day. Quite interesting. I'm slightly more optimistic (albeit from a baseline of extreme pessimism...)
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http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande

KT, it will be interesting to see how differently the House and Senate approach the subject. It's probably fair to say that Baucus' and Pelosi's perspectives on healthcare reform are going to be different. Without a strong referee in the background it could quickly become an inter-party mess.
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By the way POTUS has just had a photo-op with the Dem House Leadership after his meeting with them. They all seem to be smiling.
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http://thepage.time.com/2009/05/13/health-care-hat-trick/

Ex-pat (American) London-based Avedon Carol has it right:

Depending on what poll you read, anywhere from 60% to 80% of Americans like the sound of single-payer, and the same is even truer of physicians. But every effort is being made to keep single-payer off the table. This is because, we are told, Americans want to keep paying insurance company bureaucrats to try to prevent them from getting healthcare rather than cutting out the middle-man and the profit motive (and get their health insurance from a less avaricious and cold-hearted source. And because some people actually believe the stories they hear about how bad all that "socialized medicine" in the rest of the world is. I'll tell you for free that there is nothing superior about commercial medicine in America to the genuinely socialized (not just single-payer) system in the United Kingdom. Yes, some UK hospitals aren't as good as they should be, and yes, some UK doctors are jerks, and yes, you might not get elective surgery scheduled within a week of asking for it, but that's even more true in America Under the NHS, though, you don't have to spend weeks or months on the phone with the insurance company trying to convince them that they should deliver on getting you healthcare you actually need and have been paying for - and you don't have to worry about what it will cost. There is no arguing between your doctor and bean-counters, and there's no co-pay, either. You will get the treatment your doctor recommends in reasonable time. But, as with so many things, we've got the memes running in the other direction until we don't even know how many Americans are in agreement with us.

"...the other goal of health care reform, universal coverage. Of course, many health experts argue that it is impossible to achieve the former without the latter. But curbing the cost of health care is a more politically saleable argument, because it affects everyone, not just the 47 million or so (and growing) uninsured."
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KT, as others suggest, there's "universal coverage" and then there's universal coverage. If you put everyone under the current private for-profit regime, cost savings are likely to be incremental at best because you add a lot of cost giving more people medical care but don't change the incentives of the insurer, which is merely to make a profit. If we don't somehow make the provider incentive the wellness and health of it's customers and bring everyone we can into the system, we're missing the best opportunity for cost savings.
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I will say that it is theoretically possible for profit-seeking entities to make wellness a priority and I've seen some progress in that regard (probably because someone figured out that it reduces costs in short enough order to fatten the bottom line and because they see the sword of regulation or even government competition hanging over them). But if we can't create that incentive system-wide and give everyone access to the system, we'll be trading the cheaper alternative of keeping people well for the enormously expensive status quo of trying to keep sick people from getting sicker.
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I'll also add the the purest form of free market would be for patients to be able to shop for health and medical care providers directly, with the least amount of intervention from the payer and that also turns the current insurance-based model on it's head. Stick that in the "conservatives'" and liberatians' pipes and let them smoke it.

KT:
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There are also other ways in which the debate has shifted, as pointed out so ably by Ruth:

No More Place To Hide?
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The sudden decision by healthcare industry members that they can begin to take smaller bites out of suffering U.S. citizens has a poetic quality. The reckless profit taking of the industry has resulted in growing numbers of bankruptcies. That figure of half of all bankruptcies resulting from health problems no longer even needs to have a link attached, it's common knowledge.
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The continuing robbery of consumers is suddenly unacceptable even to the industry, in view of the collapse of our entire economic system.
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The consumer has been decapitated and the economy is in the ditch, because of lack of restraints, and/or of regulation. Now it's becoming increasingly obvious that health costs climbing overboard into unsustainable territory won't be continued. The attempt to keep from regulations bringing them in control has struck fear in the hearts of the mogul horde.
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Regulating costs may be hard, as is moving to a health-oriented industry from a profit-driven one. It may take a few years to effect, but there are no excuses for letting the industry write its own rules. The years of doing that have brought us to the bad place the country is in.

About 50 million people without health care insurance, and, essentially, health care; $6,000, the low, rounded number of per capita cost.

That means we spend $300 billion annually for health care that doesn't get delivered. We waste $300 billion a year under the present system.

Obama, Pelosi, Reid, Baucus and Dodd need to be screaming to stop the $300 billion rathole cost. They should be asking every Republican to refund the money to the American people now.

$300 billion wasted. Who gets it?
$300 billion wasted. What else could we do with that?
$300 billion wasted. How many cancers treated? How many heart attacks prevented? How many lives prolonged, for $300 billion?