I'm a single payer advocate, but I believe Obama is taking the right approach to health care reform

[BREMPRO]

He has said many times he believes single payer (or as the right wing has portrayed it "bureaucratic national socialist nazi eugenics government takeover rationing death panels") is the best system IF we were starting from scratch. Obama is a political realist and knows that a radical restructuring and elimination of an entire industry (private health insurance) would be too disruptive and politically impossible. He believes in achievable evolution, rather than idealistic revolution. How insurance is paid, whether public or private is not the only issue (read The Cost Conundrum: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande )

I agree with Obama that we need to find more efficient models of delivery to lower costs, such as the mayo/cleveland clinic etc..where doctors are on salary and share info rather than independent contractors with income based on fee for service. We also need to have a public health insurance option to compete with the out of control private insurance industry, have a larger pool to negotiate for lower costs of drugs and services, and to cover the uninsured (who we are paying for at inflated costs anyway). And we need to have, as he's said, better preventative care and access for regular checkups to catch problems before they require expensive interventions. He's also talked about unnecessary subsidies to the private health insurers.

Another thing that comes to mind, and related to prevention, is personal responsibility. This debate should not just be about the system we create for health care, but about how many in our country live their lives locked to computers, driving and not walking, eating too much, and not exercising regularly. I grew up in the 60's and we had President Kennedy's physical fitness initiatives in our elementary school. As a result, I learned early on to exercise and take care of my body. Think of the skyrocketing rates of childhood obesity and diabetes now without childhood phys-ed being emphasized as a public health concern. Think of the enormous long term costs associated with neglecting this aspect of public health. I think Obama could easily resurrect these initiatives and save us health care costs in the long run.

I would also like to see Naturopathic and Alternative Medicine be covered by insurance. I often find their services more effective and MUCH less expensive. With this provision, the traditional medical establishment would have competition for health services, further lowering costs and expanding consumer choice.

Another thing Obama hasn't talked about yet and i wish he would add to this debate is the corporate food industry's use of chemicals that are addictive and making people sick and obese. The farm subsidy of corn has caused the use of high fructose corn sweetener as a cheap additive that has very detrimental effect on health. I'm guessing he realizes that taking on the corporate food industry at the same time as the corporate health industry is political suicide. Smart guy. One step at a time....

[ProSense]

1. Excellent post.

Maybe Obama through the new FDA can address your last point.

[BREMPRO]

2. Thanks, Great idea to delegate the food additive issue to the FDA

[Laelth]

3. I disagree. I don't think we can get to single-payer by strengthening insurance companies.

The bills now being considered in Congress will do exactly that--strengthen insurance companies by giving a massive government handout to the insurance companies.

I would rather Democrats pass no bill than to pass any bill with the "individual mandate." No person, just for being alive, should be forced to buy anything, much less be forced to purchase the product of an evil insurance company.

Forcing people to buy insurance is no more the solution to a failed health care system than forcing people to buy houses is the solution to homelessness.

:dem:

-Laelth

[dflprincess]

4. What you said

and I'll add that the public option (that won't be an option for most of us for years) and the "insurance exchanges" are closer to starting from scratch than single payer would be. Even Obama has said it will take a few years to get the public option or exchange up and running and have anyone covered by them (2013 at the earliest).

It took 11 months to start Medicare "from scratch" after it was passed.

Medicare gives us the structure for single payer - expanding it based on need or population group at the beginning makes it doable. It could be paid for by a payroll tax and, to be fair, that could be based on income. Even with an increase in some kind of tax I'll be most of us would either break even or come out ahead if you add up what we're spending now on premiums, copays and deductibles.

[BREMPRO]

11. Are there any bills out there that consider utilizing the existing structure of medicare

as the "public option"? The bureaucratic structure already exist, has proven to be efficient, and could be expanded to include an affordable public option.

Your response simply deals with the insurance aspect of my post. My other points and some echoed in Obama's positions, were that we've become SO focused on who pays, the panacea of single payer and the "evil" health insurance industry, that we've lost sight of the bigger picture and all the other issues we need to address in this debate.

If you haven't already, please read the article linked in my post- it's very enlightening and opened my eyes to look beyond the mono-focus on insurance to show how the "fee for service" incentivized model for care is more the core of the problem. If we could get all communities to operate like the Mayo/Cleveland clinic, We could have a system that is affordable, inclusive of all, and of high quality.

[ProSense]

5. Disagree.

A bill with a robust public option will not strengthen insurance companies. Currently, they have no competition. You cannot say that introducing a competing option strenghtens insurance companies.

[Laelth]

6. The insurance companies will get 40+ million new customers.

All of them will be forced to buy their products. If they can't, the government will pay the difference (i.e. the subsidies). How will this not strengthen the insurance companies?

The "public option," if it even exists in the final bill, will be weak and will be designed to provide absolutely no challenge to private insurance (it will have to operate on a "level playing field"). If there is a "robust" public option, I will be truly surprised.

Either way, it seems the goal at the moment is to strengthen the private insurance companies. That, I believe, is what the bills under consideration will do. Passing such a bill will make it much harder for us to get single-payer in the long run.

:dem:

-Laelth

[ProSense]

7. Nearly 50 million uninsured people will get coverage.

A public option becomes a choice.

[Laelth]

8. Be honest. 50+ million people WILL BE FORCED to BUY coverage.

Those of us who are currently uninsured because we can't afford insurance are none too thrilled with this plan.

Ignore my warning at your peril. This will be a disaster for the Democratic Party. It would be better to do nothing.

:dem:

-Laelth

[ProSense]

9. Wait, you actually believe that people are uninsured because they don't want to buy coverage?

"This will be a disaster for the Democratic Party. It would be better to do nothing."

Ludicrous.

[PatSeg]

10. Some insurance companies actually

DO cover alternative medicine. They are smart enough to realize that these procedures are much cheaper than many traditional ones.

[mvd]

12. I'm open to Obama's approach not because we can't start over, but..

because we lack the votes. And we can make the plan better later. The public option needs to be able to succeed, and I'd like Obama to make a strong public option one of his no-compromise items. Do it as much as he mentions that it must control costs and expand coverage.

[BREMPRO]

13. totally agree with you

he knows he can't get the votes and would be hit harder than he is now by the insurance industry and the RW media if he advocated a single payer system. I don't see it as a lack of political will or courage, just a practical and wise approach. I wish he would have crafted the bill rather than leaving it to the catbox of congress. But if he can make it a no compromise pledge and herd them and the public by his rhetorical skills to have a public option plan-someone suggested medicare could be just expanded- it doesn't have to be perfect. It can be refined later when it becomes clear to the fearful segment public that it's not going to "kill granny" or be some crazy eugenics program and actually covers all and is at least budget neutral.