Friday, January 30, 2009

Now Is The Time For Universal Health Care

Paul Krugman in the New York Times:

The whole world is in recession. But the United States is the only wealthy country in which the economic catastrophe will also be a health care catastrophe — in which millions of people will lose their health insurance along with their jobs, and therefore lose access to essential care.

Which raises a question: Why has the Obama administration been silent, at least so far, about one of President Obama’s key promises during last year’s campaign — the promise of guaranteed health care for all Americans?


Good question. I've been wondering about that myself. When my son lost his job a couple of years ago, he tried to start a small business. The COBRA premiums on the health insurance from his former employer were too expensive, so he bought private health insurance. That was during the year after his divorce, and his blood pressure went up, no doubt due to the twin catastrophes, and the private plan doubled his premiums. He was forced to abandon the idea of a small business and take a job with health-care benefits. I wonder how many small businesses do not succeed or are never started due to health insurance issues. It seems to me that our country, where capitalism is valued next to God (or even higher than God!), entrepreneurship is too often stifled because of the pathetic state of our country's health care.

If you're wealthy, or elderly with Medicare coverage, of if you're well-covered by your employer's health care plan, you do all right. But if that's not the case, then you're in a pretty bad way.

Krugman lists several reasons why Obama's advisers may be cautioning him against moving forward on universal health care, which you can read if you click the link. Of the final possible reason, Krugman says:

Finally — and this is, I suspect, the real reason for the administration’s health care silence — there’s the political argument that this is a bad time to be pushing fundamental health care reform, because the nation’s attention is focused on the economic crisis. But if history is any guide, this argument is precisely wrong.

Don’t take my word for it. Rahm Emanuel, the White House chief of staff, has declared that “you never want a serious crisis to go to waste.” Indeed. F.D.R. was able to enact Social Security in part because the Great Depression highlighted the need for a stronger social safety net. And the current crisis presents a real opportunity to fix the gaping holes that remain in that safety net, especially with regard to health care.


I believe that Krugman is correct in his analysis.

26 comments:

  1. Some of my British and Canadian friends who've worked in the States in lower-paying jobs have found the lack of universal health care by far the most stressful aspect of the experience. Here we just take it for granted, and it seems inconceivable that a country that can find so much money to fund its military can't find the money to provide health care for all its citizens.

    But I know I'm preaching to the converted here, and I'm sure there are many things that the U.S. does way, way better than we do in Canada.

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  2. I'm sure there are many things that the U.S. does way, way better than we do in Canada.

    Tim, you Canadians are way too quick to put yourselves down. Your greater reluctance to see military action as the solution to problems is admirable. Plus, and I know that this has been said before, but Canadians are some of the kindest and most helpful folks that I've ever met. Some might call that faint praise, but I consider it a great virtue.

    Of course, you're not really Canadian, are you? ;o)

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  3. Part of the problem I think is that it's not exactly like setting up Social Security. There really wasn't much of an alternative when it was set up, but private healthcare is a multi-billion dollar business with thousands if not millions of employees. How do you tell the stockholders their money has disappeared, the workers your jobs no longer exist cause the gov't's gonna do it all for you? I work in a Pharmacy and much of my day is spent working on insurance. Having everything going through the gov't would make it much simpler, it would also allow my employer to fire some unneeded workers.

    Is nationwide coverage good and/or necessary? Definitely, but producing it is going to cause chaos and I don't think Obama wants more of that right now.
    Of course, I'm in my thirties and don't expect S.S. to be there when I retire anyway(and I don't get full benefits until I'm 72, if there's any money left) so I'm dubious about trusting my healthcare to them along with it.

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  4. I think Krugman is right too, Mimi. I just wish Obama's ideas about health coverage were better than what he described during the campaign. It's not really universal health care. It is more like COBRA for whoever wants it.

    I was just talking about this with a friend who was laid off 2 weeks ago and was shocked at the cost of COBRA coverage. Obama's plan is simply another form of COBRA, IMO. It is not "universal health care" in the true sense of the term. I do not expect it to be affordable to the people who need it.

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  5. Chris H., there will need to be adjustments. Obama's health care plan is outlined here on the White House website. According to the plan, a complete government takeover of health care is not in the works, but rather a reordering of health care so that everyone is covered for a reasonable price. Most certainly, adjustments will need to be made. Some jobs will be lost, but others will be created.

    If this portion of Obama's plan had been in effect, my son might have been able to proceed with his plans for a small business:

    Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.

    I'm on Medicare, and I'm quite satisfied with my health insurance run by the federal government. I'd like to see a single-payer plan run by the government, but that's not Obama's plan. I'm willing to go with his as longs as everyone is covered for a reasonable price.

    Of course, I've talked only about me and my son, but, in the end, all politics is personal, and we simply cannot continue with the numbers of uninsured, which will certainly rise with the recession. It's not right, and it's not fair.

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  6. Chris, I think you've perhaps unwittingly put your finger on part of the problem ... the number of jobs needed simply to deal with the incredible bureaucracy the insurance industry has created in the US. In every health care office there are jobs that exist only because of the immense paperwork burden required by the insurance companies in order to receive payment. The insurance companies themselves have built huge facilities simply to house their own bureaucrats who throw out all of that needless paperwork, mostly in an effort to avoid paying claims.

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  7. Mike, thanks. And let's not forget that the CEO's of the vast insurance industry bureaucracies earn huge salaries and bonuses, much more than any government employee will ever earn.

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  8. Mimi, I lived for 17 years in England and now 33 in Canada - I most definitely am Canadian!!!

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  9. I have two Canadians working for me; they say the major annoyance in Canada is PC social bureaucracy. And Air Canada.

    IT

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  10. Tim, all right. I yield. You're Canadian.

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  11. Without reading Krugman's column this morning, I made a joke at another blog about Obama not having eliminated my need for health insurance after only 10 days in office.

    I didn't realize I wasn't joking.

    Good questions, mind, and I'm as ready for universal health care as anyone, and I'm sure using a crisis as an opportunity is wise or Chinese or something inscrutable. But can we wait until there's no chance of UHCare ever happening before we declare BHO a failure on this issue? Please?

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  12. But can we wait until there's no chance of UHCare ever happening before we declare BHO a failure on this issue? Please?

    Robert, I don't believe that either Krugman or I did that. I confess that I think that Obama and any other Democrat who had been elected will need a goad, from time to time, and I'm willing to be that goad, and I'm willing to support those whose voices are far more powerful than mine, when they call for the Dems to keep promises. Democrats have disappointed me far too many times for me to trust them entirely to do the right thing.

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  13. Mike, jobs were part of the point. The CEO's and stock market were too. The economy is imploding and gov't takeover/changes will cause more job losses and unsteadiness in Wall Street.
    I don't see Obama's savings ideas as saving enough to cover the rest. Sounds to me kind of like putting the country on Medicare part D. There are limits to that too, and people get furious that their $5,000 cancer pill(with no generic available) isn't covered or that Humana charges $39 a month for premiums. And Medicare is the next biggest sinkhole after SSI.

    I think Obama's putting it off: 1. to fight one fire at a time(the economy). 2. because it looks good on paper, but the devil's in the details.

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  14. I was going to make a comment along the lines of Chris - I'm not saying this is MY argument for not moving forward but AN argument for not moving forward. Unemployment is creeping up rapidly with multiple layoffs and the added numbers from an eliminated private insurance industry would add to the total significantly. However, the overwhelming burden placed on business (Sheesh, this sounds Republican, OMH) would also go away, the huge chunk of paychecks that disappears each month to pay for premiums would go away. Talk about stimulus, eh? But if the govt takes over the coverage without taking over health care, will we have gained anything in terms of making health care affordable? If all that happens is that the burden of premiums shifts from companies and individuals to the governmnt sooner or later we will all see it come out of our pockets in the form of taxes. What really needs to happen IMHO is that the bloated and obscene military industrial complex needs to be brought down - then the government would be awash in revenue for these other essentials. Oh yeah and while we're at it (I'm NOT being fascitious) legalize the drugs - starting with marijuana. Tax the hell out it and standardize the production of it, sell them at pharmacies like the good old days (y'know, when Coke actually had some in it? and was considered a medicine?) This would significantly reduce crime and the need for the bloated and obscene prison industry -- and Ka Ching - more money saved in the federal coffers. That would be a start.

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  15. Medicare Part D is a wasteful, horrible mess of a program that was written by the drug companies, yes, WRITTEN by the drug companies and enabled by the Congress and Bush. I know whereof I speak. It should be trashed and entirely redone. It's a terrible example of a government program. If the health insurance companies get to write the health care bill, it will, very likely, be a wasteful, horrible mess.

    Chris H., what is your solution for the millions of uninsured citizens?

    I like my Social Security and my Medicare. Just sayin'. The Republicans tried messing with SS, and it blew up in their faces.

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  16. Yes, Chris, bloated staff and time-wasting jobs will have to go, IMO. But I'd rather see those jobs go than skilled jobs, for example the skilled jobs of the automobile industry.

    The time waster jobs are a large part of the reason health care costs in the US are so much higher per capita than in other countries. The insurance industry is as bloated and corrupt as Wall Street and the mortgage banking industry.

    And yes, renzmqt, the cost will come from taxes. So what?

    We know that business are not shouldering the cost of healthcare out of the goodness of their hearts. Right now we all pay for the cost of healthcare in the price of every good and service we purchase.

    For example, a few years ago General Motors announced that $1500 of the price of each and every vehicle it manufactures goes directly for healthcare for its employees. So when my neighbor, (whose employer does not provide health insurance and who cannot qualify for private insurance because he is a diabetic), purchases a General Motors vehicle, he contributes toward the healthcare cost of General Motors employees.

    Who is contributing towards the cost of his healthcare?

    What would General Motors do if the cost of producing each vehicle suddently dropped by $1500? Would they lower prices and become more competitive that way? Would they include additional fuel-saving measures in each vehicle and become more competitive that way?

    And what if our grocery store bills dropped because we no longer had to pay for the healthcare costs of employees of the store?

    I suspect at the very worst it would be an even trade in terms of how much comes out of our pockets at the cash register versus the tax form. But at least my neighbor would have health insurance coverage.

    Ideally we need some form of single-payer system in order to cut down on the bloat, redundancy, and corruption of the private insurance industry. It could be government-run, but probably should be more like the competitive contracting that is done for administration of Medicare right now. (REAL Medicare, that is, not the ripoff Medicare substitutes that have become more profit centers for the private insurance industry.) Each state has a contracted administrator for Medicare. The contracts are competitive. And frankly, in my experience as a health care provider, Medicare (the REAL one, not the substitutes) has been far more efficient than private insurance for quite some time now).

    Unfortunately this is where Obama's ideas fall short. Costs likely will not decrease with his plan. The bloat, redundancy, and corruption will continue because he does not advocate a single-payers system. He really only wants to make a COBRA-equivalent product universally available.

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  17. Renz, I'm all for getting rid of the bloated military-industrial complex. Jeez! Eisenhower warned us about it in his farewell address in 1960. Eisenhower! A Republican and a military man! Ah, but that would cause job loss in huge numbers, too.

    Marijuana should be legalized, for sure, and taxed.

    What about the uninsured? Anybody have any answers, besides we can't do it now?

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  18. It seemed to me at the time that the collapse of the 1993 health care initiative came about partly because they couldn't somehow find a limited way to constitute it--that everywhere they looked, somebody was making a good argument for the program to be bigger, include more, pay for more, and eventually it loomed so large it couldn't get political support. So my question is what's the minimum the feds could do that would help a lot of hurting people? That approach might get something passed.

    I saw a TV program not long ago that reviewed the circumstances in which Social Security came into being. It took years, with thousands of people in the streets literally asking for help. We might get that kind of situation here due to the economic situation, but I'm not sure it's going to focus on health care, it might instead focus on jobs.

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  19. Mike, I agree! A simple question calling for a simple answer: Why do we need the middle man making a profit in order to have universal coverage?

    We will pay with taxes like the other wealthy countries. My answer to everything: Tax the rich! Not really. The rest of us will have to pay, too, but it's the right thing to do, and we should do it with a single-payer system run by the feds. The government gets things wrong sometimes, but I hardly think we can hold up big business as the model of efficiency and getting it right.

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  20. Mimi asks, "Why do we need the middle man making a profit in order to have universal coverage?"

    Good question, Mimi. There is only one possible answer, of course.

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  21. You don't even want to know what my husband and I pay for health insurance. (Since we're both freelance writers.) And we each have a $2,500 deductible. So we have to pay out almost enough to buy a sub-compact car before we get any coverage.

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  22. Ruth, I believe you. I saw what happened to my son, but, even when they doubled the premium, it was still less than the price of the COBRA.

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  23. Oh, Grandmere: you are definitely touching a nerve posting this item. I am one of the "millions" in this country that does not have health insurance, and can't afford private insurance *because* I am a small (self-employed) business person. And because my business is in a health care field (massage therapy) and I have clients who do have insurance and want me to file for them, I get the benefit of seeing how a large insurer (cough) Blue Cross(cough) will use any and all means necessary to weasle out of paying me for the work I have done on behalf of *their* customer.
    I hope President Obama *does* get off the dime on this issue. I wish that insurance companies, and credit card companies, and oil companies would get a swift two-by-four across the head...and that their CEOs would fork over some of their salaries to help fix our "crisis".
    Unfortunately, President Obama is just one man...and the toddler who preceded him in the presidency really left a mess. And universal health care is a tough sell in a country where the dominant belief among those who *have* insurance seems to be, "Well, I've got mine!"
    Kind of reminds me of Scrooge: "Are there no prisons? Are there no workhouses?"
    Sorry about the rant. As I said, you touched a nerve with this post.

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  24. SCG, I've been feeling glum all day thinking about all the folks who don't have health insurance. It's easier to say we can't do it now, if you have health insurance. That means you tell those who don't have insurance, "You'll just have to wait", and that's not right.

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  25. How to get from our system to a gov't system without it blowing up is beyond me. I don't know how to turn all the companies, hospitals, and doctors into gov't employees without mayhem.
    Suppose the gov't found a way to buy all those people out, as Peter S. mentioned above, part of the problem is that expectations get too big. What is a reasonable basic standard? How to educate people that there will be a price to pay for coverage for all: limits to types of treatments, waiting lists for surgery, lack of hospital beds, doctors on strike, etc. Everyone getting the same care as say, Donald Trump, is impossible.

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  26. Mike I said it was AN argument not mine. Any overhaul of health care in this country will also need to include some form of rationing. A huge percentage of healthcare dollars spent are spent on the final months of an individual's life - countless weeks of ICU care spent keeping a terminal patient alive with no real quality of life, just because we have the ability to keep an organism going doesn't mean we're keeping it living. This is not to discount the other option of eliminating the bloat of insurance company waste. I also read that only 12% of doctors' offices are fully computerize. Lots of room for improvement all around.

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