Thursday, December 17, 2009

Liberals Attack "Government-Takeover" of Health Care!

The seemingly endless noise over what passes as a health care debate gets more bizarre by the day. (Yet there are still people who want to drag it on longer.) Yesterday, the self-described "Tea Party Patriots" came back to D.C. to rant again about "government take-over" of the health care system. At the same time, prominent liberals went apoplectic about the Senate bill, with former governor and DNC chair Howard Dean leading the charge.

I'm confused. If the Senate bill is a government-taker over of health care, as the Tea Party crowd says, and liberals like Dean are opposed to the Senate bill, doesn't this mean that liberals are against a government-take-over of health care?

Of course, I am being facetious. In my view, the House and Senate bills were never about a government take-over of health care, as much as many liberals have hoped and many conservatives have feared.

Both bills give private insurance companies the central role in providing health coverage. The so-called more "liberal" House bill has a public option, but it would be available only to the 30 million or so Americans who lack private coverage, and of those, the Congressional Budget Office says that only about 6 million would end up the public plan, compared to 168 million in private health insurance offered by their employers. The public option, was never going to be big enough program to have all that much of an impact on coverage, despite the over-heated rhetoric by ideologues on both sides.

Yes, both bills will expand the federal government's role by regulating and subsidizing private insurance and enrolling tens of millions of more people in Medicaid, but private insurers were always going to be the way most Americans would get their coverage, just as they are today. Conservatives can and should make the case that there is too much regulation, and liberals can and should make the case that it has too little regulation, but they should both at least stick to the facts about what the bills will and will not do.

Many liberals see things quite differently than Howard Dean. Read this from the New America Foundation, a progressive think tank, and 20 questions for the left's "Kill the Bill" crowd by Nate Silver, founder of the web site.

Columnist Ruth Marcus, writing in today's Washington Post, says it best "The bill isn't perfect, although my worries about it are more about whether it does enough to drive down costs and whether it will turn out to be affordable than about whether it gives too much to insurers. The alternative is not, as Dean would have it, starting from scratch and getting it through the Senate with 51 votes; Senate rules, for better or worse, will not let lawmakers get much done that way. The alternative is squandering this opportunity -- leaving millions of Americans uninsured and without the prospect of getting coverage far into the political future."

Today's question: What do you think about the attacks from the liberal "Kill the Bill" crowd?


Rich Neubauer MD said...

I think that when this whole affair is finished, someone (or perhaps a small village of writers) is going to make a fortune writing the history of the Health Care Reform Debate of 2009-10. "The System" by Johnson and Broder that outlined the Clinton's failed attempt at health care reform was a pretty thick book. The chronicles of these current events may need to be even thicker (perhaps in more than just pages...).

In any case, attacks from liberals who want to "kill the bill" smacks of the same logic that I've heard for years from some circles that physicians should just stand aside, stop expending efforts to avoid disaster (such as the SGR cuts in physician payment), and let Medicare and the rest of our fragile systems of care implode because that is the only way things will really change.

The logic of supporting even something imperfect in the current situation is that we desperately need to take first steps at reform so that we can then progress to further work on the rest of the issues (such as cost control). Like it or not, the configuration of our political process is dictating the course of events. I think the only truly unacceptable outcome would be for no legislation to emerge as a result of the current efforts.

Jerry M said...

The liberals who oppose the bill have not studied the Canadian and the British systems that starve their medical care. I’m concerned that the senate bill has too many unintended consequences. The so called “savings” of 30% on medicare is simply a reduction in what medicare will allow. It is after all your constituency, the internist, who orders most of the tests and sends patients to specialists. They are the ones who are the professionals who read the latest journals. Do they really need the federal government studying comparative effectiveness and developing a best practices commission? What have our subspecialty journals been doing? It is said that this money will go to funding people that have no insurance. This means the internist will have to see 30% more patients to make the same income. Many internists are already not taking medicare patients. This bill will exacerbate the problem. This is why most internists I speak to are against this legislation.
You had gone into detail about how ACP develops it’s political positions by it’s leadership rather then membership polling but did include a small poll. This poll, however, asked specific questions designed to get positive responses rather than asking the membership about their position on the legislation at hand. Senator Ben Nelson said the savings in medicare would be accomplished by reducing what is paid to doctors and hospitals. He like most of the democrats feel that is good but was opposing the bill for other reasons.
I just don’t understand how ACP can support this bill that will reduce internist’s incomes and increase bureaucratic control with a complete absence of tort reform. Supporting the nebulous concept of ”the advanced medical home” is not enough.
If this legislation is passed and results in a significant reduction in my income and an increase in bureaucratic red tape, I will have to reduce my expenses by eliminating my ACP and AMA dues.

Owen Linder said...

to Jerry M: Savy adopters of capitated, severity adjusted, risk rewarded managed care internal medicine will do better than ever. Adherents and defenders of the stouthearted, independent noncoordinated fee for service piece work paradigm will suffer.
This is a new era. The medical schools have to start teaching the possibilities. Else primary care will be as now for older internists; and new immigrants unbound by American Medical School shibboliths propagated by the status quo.

Jerry M said...

To Owen Linder: Well said- During our call-in to the White House recently with 2700 other doctors we were told that the administration wants to get rid of fee for service, however, they had no clue as to a new method of payment. Most other countries use fee for service so new immigrants will not likely be ahead of our graduates. P4P, Episode-based Payments, Accountable Care Organizations and Medical Home have been proposed and tried in other countries as well as Budget targets in Germany and Japan. However, whatever is used, the aim is to reduce medicare expenditures by 500 billion dollars. That will not be good for patients or internists no matter how they game the system.

Arvind said...

I agree completely with Jerry M. Could not have said it better.