The Health Care Reform That Wasn’t

Confused about what’s happening with health care reform? Join the club. After months of buildup and debate, endless meetings and daily pronouncements, we’re still waiting some clear outline of a reform plan to emerge. Instead, the picture seems to get fuzzier with every passing day.

At the American Medical Association convention in Chicago this afternoon, the President called health care expenditures a “ticking time bomb” for the nation, and told eloquent stories of families, small businesses, and even doctors who are being crushed by these spiraling costs. The rest of his speech catalogued the most uncontroversial elements of any proposed reform–encouraging more preventative care, promoting “best practices,” eliminating waste, reducing junk food consumption, instituting electronic medical records. Who could possibly object to such things, other than perhaps the manufacturers of potato chips and Wite-out?

Meanwhile, the speech offered only the vaguest clues as to how Obama proposes to resolve the most contentious—and important—issues in any possible reform plan. The best insight into this ongoing state of irresolution came after a meeting last Wednesday at the White House, where the President called together a group of senators from both parties to hash out their differences. The Associated Press reported:

A senior Republican who recently criticized Obama also sounded positive. “The president, I thought, was very flexible except on one thing, and that was getting it done,” said Sen. Chuck Grassley, R-Iowa. “When the president is flexible on controversial things … I think that that’s good news.”

Given all this “flexibility,” the senators at the meeting—Grassley and Max Baucus (D-Mont.), ranking members of the all-important Senate Finance Committee, plus HELP Committee leaders Mike Enzi (R-Wy.) and Chris Dodd (D-CT), who has stepped up in Ted Kennedy’s absence—agreed they could bring a bill to the Senate floor in July.

In other words, expediency has replaced essence when it comes to the Obama administration’s position on health care reform, and strategy has replaced substance. What matters is not so much what kind of health care system we end up with, as long as we end up with something that looks like reform—preferably, before the end of Obama’s first year in office. What this is, of course, is the perfect formula for a health care reform that is uncontroversial, weak, and expensive.

What is shaping up here is a replay of the credit card legislation: Under a propaganda blitz heralding sweeping reform, we get legislation that reins in some of the very worst abuses, while making no significant change at all to the underlying flawed system. So, for example, we may see insurance companies required to provide coverage in spite of pre-existing conditions–something Obama referred to in his AMA speech, with moving references to his mother’s own battle with cancer. We might see what the President today called “more efficient purchasing of prescription drugs,” which presumably means more power to haggle with Big Pharma over drug costs, as well as speeding up approval of generics. We will see health care providers given incentives for more cost-effectiv–and, we can hope, better–treatment. These things are not meaningless, and they will provide a modicum of help to some struggling Americans. But they do virtually nothing to strike at the basic American system of health care for profit. And at the same time, they offer only a fraction of the savings a single-payer system could offer.

With no clear vision emanating from the White House and no bottom line, everything is up for grabs when it comes to the details of this tepid reform. It’s no wonder, then, that new balls keep coming out of left field every day. As Obama prepared for his AMA speech, the Washington scuttlebutt was that he would seek to reduce costs by accepting limitations on malpractice suits. In the speech, the President said he was “not advocating caps on malpractice awards,” but wanted to “explore a range of ideas” to reduce the malpractice threat. The New York Times reported this morning:

In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits—a goal of many doctors and Republicans—can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

It is a position that could hurt Mr. Obama with the left wing of his party and with trial lawyers who are major donors to Democratic campaigns. But one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a “credibility builder”—in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table.

It’s in this same spirit of seeking “broad support” that the so-called public option–a government-run alternative to private insurance, which could at least have begun to show up the insurance companies for the bloodsucking middlemen they really are–seems to be dying a slow and painful death. In fact, it looks more and more like the public plan may have all along been a straw man, set up only to be knocked down. On the one hand, it has served as a temporary panacea to single-payer advocates and other critics of medicine-for-profit, including important Democratic constituencies like labor unions. On the other hand, it is now a major bargaining chip, or “credibility builder”–something that the administration can give up, in what looks like a generous concession to its opponents.

TOMORROW ON UNSILENT GENERATION: What the not-so-public “public option” could look like.

One response to “The Health Care Reform That Wasn’t

  1. Marilyn Howells

    We need Univeral single payer health care. The insurance companies are scary. In fact, they have something new and very, very scary !! I wonder if anyone has ever hear of this or had it happen to them. My employment related insurance that covers actives and retirees, now is proposing that we have to PROVIDE END OF CARE DIRECTIVES (Advance Directives) or PAY HIGHER PREMIUMS than those that do provide this. This should and may be unconstitutional. While I don’t disagree with someone’s right to have and End of Care Directive, I’m outraged that the insurance company wants to financially coerce us into providing the paper to them or some third party registry, WHEN MANY WOULD ONLY WANT THIS FORM IN THE HANDS OF THEIR FAMILY OR THE PERSON WHO THEY DESIGNATE AS MEDICAL POWER OF ATTORNEY. What are the chances one of the forms will get enacted before the family even gets there if you are in an accident. What are the chances one John Smith’s forms will be mixed up with another John Smith’s form. Or some of the middle pages will get switched with someone else’s middle pages. After all none of us have ever be mixed up with someone else, received a bill or piece of mail that is wrong etc. Of course there will be mix ups. However, if you die because of it, you won’t be around to straighten it out. Then what will happen over the years. will the insurance companies dictate the wording on these directives, raise your premium even more if you don’t sign one, withhold services if you don’t sign, or drop your insurance if you don’t sign.Or maybe eventually, they won’t pay for certain services if you don’t sign one. But if they know you have a directive or even the content, will services you might want be withheld, or withheld prematurely. Eventually, will this lead to insurance companies to put pressure on you physicians and family, or on your family through the pressure the insurance company puts on the physicians. Will the insurance company or some supposed mediator or adviser presume to interpret the living will? They already withhold antibiotics on the very sick sometimes. What if you have a slow cancer, like prostate and are only in for tests and could like for years on lupron, and choke on you dinner steak? Will you not be resuscitated because technically you are terminal. How can we trust insurance companies in this. End of Care / Do Not Resuscitate Directives are very serious and every word is open to interpretation. It should NOT be the insurance company where CEO’s make up to 124 million based on company profits, who interpret these living wills, or their flunkies or any third party entities they choose. These should only be interpreted by the family in conjunction with your physicians. Once the precedent is set the even one insurance company require proof of a living will and it affects your payment, then how long until others follow suit???? Obviously, if this gets started other insurance companies will jump on the band wagon, and a lot of people will be mislead into signing dangerous broilerplate directives, that don’t protect them adequately and are wide open to interpretation, and could be misused, and more poorly worded than you would think. If we don’t stop the insurance companies now, it will be to late later. As far as I know neither Medicare, Medicaid, VA, Federal Employees Insurance, nor any private insurance of anyone I’ve asked requires this or ties it to premiums. The whole idea makes one think of 1984 (by James Orwell), Make Room, Make Room (by Harry Harrison, think Soylent Greeen the movie), or Logan’s Run. Anyone doing an Advance Directive would want to be real careful into whose hands they put it and when. I doubt if they can legally force you to make on, or if you have one force you to hand it over to get care. some feel that this should only be trusted to a group of several relatives to decide when to hand it over. Many feel it’s best to have it give someone medical power of attorney to interpret your wishes, so some bean counter won’t. You certainly want your relatives to have time to find and consult with specialist and physicians of your and their choosing.After all no one ever went to several doctors over several months or years until they finally got the right diagnosis or treatment. Anyway this gives new meaning to the phrase BURY IN HASTE, REPENT AT LEISURE. They may be planning to have us store our End of Care/Advance Care Directive at a Central Repository. One national one out in California does not require Social Security Numbers, but they are optional as someone people object to giving it out. After someone sends them their living will, they are sent a special identification card with an assigned number that a physician can use to call the company and have the Advance Directive Faxed or emailed. But if the person doesn’t have the card, the hospital can order it by name and SSN, or if the person didn’t give the repository their SSN, the hospital can get it by just giving the patient’s name and birth date. How long until one John Smith is mixed with another. How many people in this country have the same name name as someone else, and maybe even are about the same age. Google your name and also run it on yahoo people search,, and don’t forget to use alternate spellings (especially of your first name), and nick names. Think you won’t be affected because your insurance company doesn’t require this? Think again. You never filed an End of Care Directive with a repository. You’re in an accident and are taken unconscious to a hospital, which calls a few repositories with you name and birth date, and a match is found, faxed, and used to withhold care. But it was only the directive of someone with the same name.Too late, R.I.P. Please post on this site if you’ve ever heard of an insurance company requiring you to Provide an End of Care Directive or pay a higher premium if you don’t. Also if you know of any web sites about the dangers of misuse of Advance Directives/Living Wills, or problems with interpretation of these documents, and tips on wording them please post those site. Below I’m listing a couple of sites found in a quick search with some 2006 Federal law, and concerns about wording of this type of document, or misuse. While one might not support every word at sites they provide a lot of helpful information, concerns, and example.
    For tips on writing living Wills and Advance directives, and pros and cons of language.
    Before You Sign On The Dotted Line
    Federal law about Advance Directives that prohibits requiring one as a condition of treatment. See Advance Directives, 42 CFR 489.102 (a) (3) (2006).
    You might want to read or skim it all, but it reads in part:
    489.102 Requirements for providers (a) Hospitals, critical access hospitals, skilled nursing facilities, nursing facilities, home health agencies, providers of home health care (and for Medicaid purposes, providers of personal care services), hospices, and religious nonmedical health care institutions must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care, or patient care in the case of a patient in a religious nonmedical health care institution, by or through the provider and are required to: . . . (3) Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive

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