The Schrug

Continuing my observations from the previous post …

• Someone needs to take a poll of the American public: “Do you support the idea of having the Federal government create minimum standards for private health insurance policies?” I’m betting at least 60% say yes, and probably a lot more if you point out that the Federal government already does this for things like food safety, workplace safety, auto safety, and so forth.
• Funny to hear Republican Mike Enzi advocating so strongly for keeping Medicare (i.e. socialized medicine) intact.
• Enzi: “I like the exchanges.” Is he going to catch hell for that?
• Just for the record, I own a small business and I provide health insurance for all my employees. (I’m the only employee.) I pay $360 a month ($4,320 a year) for an HMO plan with a $2,000 deductible for hospitalization and other secondary services. I would pay this same rate regardless of my medical condition. I purchase this insurance through the Small Business Service Bureau, which is essentially an exchange. I’m given an option each year to change plans, and I can change between insurance companies or between plans offered by my existing insurance company. I think this is a perfectly acceptable solution and I’m not sure why it’s so hard to replicate this model across the nation.
• Tom Harkin is the first to address the problem of the incremental approach: It’s like seeing someone who’s drowning 50 feet off-shore and you throw them a 10-foot rope.
• Tom Harkin compares pooling to segregation. Yes, that is the only way to make a profit in insurance.
• Odd to hear Boehner referred to as “Leader.” Sounds like we’re in North Korea.
• Republicans’ reliance on state-by-state approaches sounds wrong. People are mobile, and in many cases families cross state lines. We need a national approach.
• Jay Rockefeller: “The health insurance industry is the shark that swims just beneath the water.” Ouch!
• Damn, just missed 10 minutes. What happened?
• “If Jay’s son got hit by a bus … and his father wasn’t Jay Rockefeller …” LOL!
• Obama: We want competition, but we want some minimum standards. Wait … isn’t that managed competition?
• Memo to Biden: Stop talking. Although your point about making Social Security mandated is well-taken.
• Memo to Biden ten minutes later: Seriously, stop talking.
• I hope someone does a fact check on Ryan’s budget stats, and if he’s right, the Dems need to take this seriously and get it fixed. On the other hand, it’s not clear how Ryan’s approach would make the situation any better.
• Obama trying hard to introduce “Medicare Advantage” into common parlance, since that’s the part of Medicare he wants to cut. If he can sell the idea that the cuts in Medicare he proposes are actually cuts in payments to insurance companies, he’s got a winning argument. Grassley has a rebuttal for this. Fact check time!
• Obama to McCain: “I think you make a legitimate point.” McCain is speechless. Nice moment.
• God help us if the CBO is a bunch of idiots.
• Grassley says this would be first time government requires people to buy something. Not really, since our tax dollars are used all the time to buy things that we as individuals don’t necessarily want bought.
• Conrad: Medicare is going to go broke in eight years. Doing nothing guarantees this. Right on.
• Conrad: Five percent of Medicare beneficiaries – the chronically ill – use fifty percent of all the money. Wow. Says solution for this is coordination of care. How much of the problem can be solved this way?
• Boehner thinks his job is to listen. That’s only part of it. The Congress also needs to educate and lead.
• Missed another half hour or so. Drat.
• It seems to me that both parties in both houses select the dumbest and most reactionary among them as their leaders.
• Barrasso talks about how scared people are about what will happen if the bill passes. But he neglects to mention that they’re primarily scared because they’ve been fed lies by opponents of the bill.
• Barrasso points out that people who have to pay out of pocket are best consumers of health care, because they are sensitive to cost. He’s right about this, and a fundamental weakness of the Democrats’ approach is a failure to make people more aware of what their own health care costs.
• Barrasso also right to point out need to eat less, exercise more, and stop smoking. (So will the GOP support tougher FDA regulations on cigarettes? Doubt it.)
• Obama rebuts Barrasso, pointing out that high deductible, low premium plans don’t work all that well for folks making $40,000. So true.
• Everything I’ve heard today just confirms what I think – and what others have suggested: We need a system that makes basic, no-frills care available to everyone regardless of income, employment, residence, etc., and then let the market take care of the extras like brand name prescriptions, treatments that extend life for less than three months, and all the other nice things that our “best in the world” health care providers can offer.
• Roskam makes same point about public reaction to the bill – they don’t like it – but the public thinks the bill contained death panels.
• Republicans probably make a good point that expanding Medicaid is not a great idea. But it may be the best bad idea we’ve got. What’s their alternative? As has been pointing out, you can’t help someone living at the poverty line with HSAs and tort reform.
• Obama: “Neither of these proposals are radical, the question is which one works best.” Yup.
• Obama FINALLY – at 4:35 – points out that the individual elements of the bill are popular even when the overall bill isn’t. Thank you!
• Republicans need to remember that we DID start with a blank piece of paper at the beginning of the administration. What’s the point of starting again … we’d just waste another year. Oh, and they don’t really want to start with a blank piece of paper. At least some of them want to start with the Boehner plan. (Obama made this point at the very end.)
• Again, enough with the anecdotes! We get it.
• Coburn is absolutely right that we need to reconnect the system of payment with the system of purchase. But to a great extent it’s the private health insurance system that inserts the disconnect. Why can’t he see that?
• Pelosi wraps up by saying the key thing is to eliminate discrimination against people with pre-existing conditions. But that’s at the foundation of the insurance model. You try to estimate how likely something is to happen and you charge accordingly so you can make a profit.
• Overall I thought Obama came across as someone who takes this very seriously and listens to both sides but is not receptive to bull. Many (but not all) Republicans came across as simply whining and refusing to play.
• And I really hope this kind of summit happens again and again. Having these people make their cases without filtering them through talking heads. And it makes them do their homework. I loved it.