What essential feature must be included in a successful health care reform bill?

My first impression after reading Luanne's fine question, is unless we moderate the liability of everything that is, looks like, walks like, or remotely resembles "successful health care reform," it will remain all lawyers, all the time...ops normal. Until this occurs, the uninsured will remain "the uninsured." I shall now commence to pondering this topic as I swat golf balls in the sunshine laden city of Salem, where it is always blue skies and 72 degrees. Gip

My initial response is, "Not again."  But I understand it's rather like the Major League Baseball season, having progressed from spring training, through a wild and wooly summer, into the fall.  The game goes on.  I don't know if I can narrow it down to one essental feature.  I'll more likely end up listing several, if I can muster the resolve to enter the batter's box one more time on this topic.

 

What essential feature(s) must be included in [several] successful health care reform bill(s)?

 Here's a novel idea. Instead of another 1000-1500 page monstrosity like "stimulus" and Cap/Tax that Congress can't be bothered to read, packed with page after page of govspeak, hidden agendas/taxes and of course the ever present pork, I suggest this:

1. A 20-25 page bill written in english that a high school graduate, who actually learned to read, can understand that covers a top to bottom reform of private sector medical insurance. Important issues to be considered include: Portability of coverage from state/state, job/job. Abolish state borders with respect to insurance companies thereby increasing the available pool and creating more competition and reducing costs. Making insurance coverage available nationwide will eliminate the morass of mandates to insurance providers which is different in every State. Research (sorry Congress people, you might have to do some work on this one) the impact of pre-existing conditions on costs and coverage.

2. Another 20-25 page bill (see qualifications above in #1) addressing torte reform. (sorry again, Congress people, you might have to make your trial lawyer friends mad on this one.) Reasonable reform will reduce outrageous malpractice insurance premiums and reduce the cost of health care for everyone.

3. Still another short...well, you know the drill from above #1 & 2...bill to address the 5% (depending on whose figures you believe) of the population that just absolutely, positively can't afford some kind of coverage for reasons too lengthy to go into right now.  Medicaid, for all of its shortcomings, is in place already and it is not going away anytime soon, so perhaps a modified version of some kind of subsidized coverage can be worked out for much less than a "public" option would cost. Does this sound vague and general? You bet, but it will again give the Congress people something to do besides inventing more ways to flush additional tax $$ into the Grand Canyon.

4. Yeah, another one..... Health care reserve accounts. Give the people the chance to make their own decisions with respect to how the allocate money...their own money. Power to the people!

You see a trend here? Addressing the problems with the medical delivery systems in this country one at a time in lieu of another "omnibus" bill would be more palatable to the citizens assuming there is transparency (remember that one from the campaign? Big chance here!) in the process and at least the appearance that Congress and the President are doing this incrementally and because it will benefit the citizens, not provide the politicians another opportunity for a power grab.

In the past month, the American citizens made it very clear to their elected representatives that they did not want health care reform to be anything similar to the bloated H.R.3200, packed with mandates, government intrusions and sections not understood by much of anyone. It is no big secret to anyone on the panel that I am not a big government guy, but I could live with an incremental, studied approach to the problems that now exist. Leave out the "public option" with the probability that the government would eventually take over the entire system and I believe the citizens and maybe even some of the politicians on both sides will get behind this kind of reform.

Authors note: In 1955 the bill passed by Congress to authorize and build the 40,000+ mile interstate highway system was 24 pages!

 

Nick Prout:

Another 20-25 page bill (see qualifications above in #1) addressing torte reform.

Nick Prout:

A 20-25 page bill written in english that a high school graduate, who actually learned to read, can understand that covers a top to bottom reform of private sector medical insurance.

 

Nick,

This can never happen because of the increased unemployment it would generate.  Just think of the lawyers, accountants and politicians who would not be needed anymore!

Nick Prout:

In the past month, the American citizens made it very clear to their elected representatives that they did not want health care reform to be anything similar to the bloated H.R.3200

Might it be more accurate (and fair) to say that many American citizens have raised questions and objections about what they understand to be included in HR 3200?  How many of them have read it?  How many of their objections are based on what is in the bill?  How many of their objections are based on nonsense that is not in the bill?  How serious have opponents of health care reform been about separating the facts from the fiction? 

A year ago most Americans were calling for major reform of the nation's health care system.  Then the "enemies" were pharmaceutical companies and insurance companies.  I imagine you cringe when reading that because you have been a staunch defender of these industries.  But let's go back to 2008.  Obama did not steal the election with a lot of smoke and mirrors.  He made some clear (albeit ambitious) promises, one of which was comprehensive health care reform.  He won the election fair and square, he is now every American's president (whether they like and acknowledge it or not), and he is determined to deliver on that promise.

Today, a year later, if you listen to the noise from the Right, the "enemy" is the President of the United States and some Democratic leaders in Congress.  What changed?  From the Right: Obama wants a government takeover of the nation's health care system because he's a stinking socialist.  From the Left: opponents of reform, whose fire is fueled and fanned by powerful special interests with deep pockets, have been misled into turning against their fellow citizens and their government.  I'm sort of a moderate, middle of the road guy on this.  I think there are some genuine, legitimate questions and concerns, also a lot of misinformation and misdirected rage, and a fair amount of fake discontent manufactured by the special interests and their GOP friends.

One of the things I like about you, Nick, is your inclination toward clarity and simplicity.  This is a complex puzzle and seems to defy common sense solutions.  Congress probably cannot fix all that is wrong with our nation's health care system in one bill, or in one session.  I don't think the number of pages is all that important.  People insist they want details.  That means more pages.

I disagree with your opinion that any sort of public option probably will "eventually take other the entire sysytem."  Since Virginia Western opened about 42 years ago, other public and private colleges have joined us.  The Roanoke Higher Education Center hosts several institutions.  We all provide something different for the citizens here.  There is room for public, non-profit providers of health care, like education, in the national marketplace.  Options are good,  Competition is healthy.  Is it unfair that you can attend Virginia Western for a lot less than Roanoke College or Hollins University?  No, because we are not really competitors.  We are complementary.  To the extent that we do compete, that is healthy, mutually beneficial, and gives students choices.  Without Virginia Western, thousands of local citizens would have no affordable access to higher education.  We'd have a less educated, less trained citizenry and workforce. 

Is education more important than health care?  I don't believe it is.  Currently we have many citizens without health care because they are not granted that "fringe beneft" by their employer, as you and I are, and they do not qualify for Medicare, Medicaid, or VA benefits, like many of our fellow panelists.  They are left out in the cold.  To me, if the bill does nothing else, it must ensure that every American citizen has access to affordable health care.  I agree with President Obama.  It's not just an economic or political issue.  It's a moral issue.  I believe we are not only the world's wealthiest country; we are the world's smartest people.  We can solve this problem if we stop arguing about what I want or you want for ourselves and imagine some sick person with a curable disease who cannot afford treatment.  True, that is not your problem or my problem.  Or is it?

 

What essential feature must be included in a successful health care reform bill?

 

Talk about a can of worms, where could one even begin with an issue with such depth and scope of complicated issues?

Here again is another issue that I would not, nor could not even begin to address except from a simple perceptive of a senior with disabilities who is dependent on the governments Medicare program.

 

One of just many, if not thousands, of pitfalls of the Government System of Health care is its inability to practically assess the needs of the many different classes of people in the system.

It would be hard to imagine with any revised program, that things would get better, and certainly they would likely get worse.

 

What I’m getting at is:

   For example I went on S/S Disability in 1990.  When I was able to do part time odd jobs to try and make ends meet, given the never ending medical bills, drugs and treatment, I only got deeper in debt.

 

Why take taxes out of our pay checks?  With what little salary that was earned would often then disqualify us for needed benefits.

 

When a person on disability reaches their retirement age, we lose our earned income tax credit and our status with S/S simply becomes as being in the retired group.

 

So we are now in the same class as everyone.  When you consider all the billionaires, millionaires, and the rest of the wealthy retired population, are they concerned or care about cost of living increases?  Yet, for those with serious health care issues and problems our situation only gets worse each year and deeper and deeper in debt with no hope of ever seeing the light at the end of the tunnel with medical bills and needed prescription drugs.

 

So I guess my closing point would be that we need a certain level or number of tiers in the system.  We’ll always have the “Have’s and the Have nots” What the government needs to address is a better system for the “Have nots” when it comes to Health Insurance and Social Security recipients.

 

Nick Prout:

Here's a novel idea. Instead of another 1000-1500 page monstrosity like "stimulus" and Cap/Tax that Congress can't be bothered to read, packed with page after page of govspeak, hidden agendas/taxes and of course the ever present pork, I suggest this:

 

Mr. Nick,

Could we be bipartisan and agree on 92 pages?  Since McDonnell managed to present his plan for revamping our federal system, the Constitution, and the Bill of Rights in 92 pages, this seems a little more reasonable to me. 

Verbose Voice

 

Dave Hanson:

Might it be more accurate (and fair) to say that many American citizens have raised questions and objections about what they understand to be included in HR 3200?  How many of them have read it?  How many of their objections are based on what is in the bill?

I would say that it was an educated public that took the time to show up at the many town hall meetings, bill in hand, to ask pointed questions of their elected representatives, many of whom were not as up to speed on the bill's contents as the citizens. As for what you call "misinformation and misdirected rage, and a fair amount of fake discontent manufactured by the special interests and their GOP friends," you are shortchanging many who did the homework and made the effort to be heard. This is the same tack taken by the media to dismiss and belittle concerned citizens. I have no more received a check in the mail from GSK or the GOP than you have from the DNC or Keith Olbermann.

Dave Hanson:

I disagree with your opinion that any sort of public option probably will "eventually take other the entire sysytem."  Roanoke College and Hollins are getting along fine despite the presence of Virginia Western here in the Roanoke Valley

 

Apples and oranges. I think we went down this road a couple of weeks ago, but we'll do it again. First, VWCC is a state institution which, other than OSHA, EEOC and a couple of other acronyms I can't pull out, has little to do with the Feds. Education at the college level is an "elective" to put it into college terms. No one will get sick and die because of no access to a college education. Medical issues and health care are forever and affect all people. No matter how much you jog, exercise or consume organic food, eventually everyone needs some form of care. Judging from the response last month to "public option" I would say that there is a large percentage of the population that does not wish to lose autonomy when it comes to medical care. They want access, but also want some control. So do the Feds.

Dave Hanson:

Currently we have many citizens without health care because they are not granted that "fringe beneft" by their employer, as you and I are, and they do not qualify for Medicare, Medicaid, or VA benefits, like many of our fellow panelists.  They are left out in the cold.  To me, if the bill does nothing else, it must ensure that every American citizen has access to affordable health care. 

 

I agree, hence my multi-step program (outlined above) which I hope the powers that be will see here on this forum and realize the error of their ways thus far. Seriously, I believe what you stated in this last paragraph is the crux of the whole debate and that it can be fixed without the creation of huge new layers of bureaucracy by faceless people in Washington and at a far lower price to the taxpayers. We have a couple of generations of debt to pay off already without adding more.

Sharron Smith:

Could we be bipartisan and agree on 92 pages?  Since McDonnell managed to present his plan for revamping our federal system, the Constitution, and the Bill of Rights in 92 pages, this seems a little more reasonable to me. 

Sharron,

That sounds like a deal to me. That's much mo' briefer than 1,017 and a better read.

Nick

(Mr Brevity)

 

Mayhap the days of 24 page bills was before there was an entire industry devoted to finding and exploiting loopholes and end runs on any law we have?

1500 pages of a good book is a blessing.  If the bill meets the need and guarantees that Americans can get the health care they need regardless of ability to pay and that they can get health care without losing everything they have worked hard for, care cannot be denied, pre-existing goes away and rescission is no more, I will be a very happy camper.  I can live without a public option but fear the increased cost to expanded Medicare and Medicaid will ruin us even faster.

 

Nick Prout:

I would say that it was an educated public that took the time to show up at the many town hall meetings, bill in hand, to ask pointed questions of their elected representatives, many of whom were not as up to speed on the bill's contents as the citizens. As for what you call "misinformation and misdirected rage, and a fair amount of fake discontent manufactured by the special interests and their GOP friends," you are shortchanging many who did the homework and made the effort to be heard. This is the same tack taken by the media to dismiss and belittle concerned citizens.

"A civil debate about health care" was a previous discussion topic for our panel and I don't want to backtrack, but you brought it up today and I simply responded with what I still think is a more accurate statement.  You wrote that "the American citizens made it very clear... that they did not want health care reform to be anything similar to the bloated H.R.3200."  You are assuming that irate people at a few town hall meetings and other noise-makers are (a) opposed to the bill, (b) well-informed, and (c) representative of "the American people."  In short, your use of "the" excludes anyone who does not fit in your picture.  I think you are making some huge and dubious assumptions.  First, many people at those meetings and other venues were for much of the bill.  Second, there were many questions, hoots and hollers about "death panels" and other nonsense.  Admit it.  Third, the folks at the Boston Tea Party in 1773 made quite a show, and everyone knows about them, but they were not representative of "the American people" then, nor are the noise-makers today. 

Polls show the country more or less evenly divided on the President's plan, with most folks favoring some sort of reform but unable to entirely agree on what form it should take.  The majority of Americans have some sort of private or public health coverage so they have a self-interest in preserving the status quo, despite its glaring flaws.  President Obama tried to make the case Wednesday night for why the status quo is not acceptable.  I think you understand and accept that, but we disagree on what sort of changes are needed.

Frankly, I think there has been an ineffective "reading" of the American people for a very long time in this country.  Many people actually believe that President Obama won the election simply because people did not like Bush or did not like McCain.  The truth IMO is that people were that dissatisfied with the direction of the country from politicians who did not seem to be listening.  And they still are not.  The widening and embarrassing gap between the rich and poor and the literal suffering and unease such a gap causes along with the continuing squeeze of the middle class, stagnation of wages and general feeling of being discounted because we could not possibly understand the world we live in and the challenges we face led us to not only gravitate to Obama but to believe his promises and accept his willingness to take up the banner of bringing us a voice again.  It may have been the bill of goods many have accused me of falling for, but after the speech the other night, he still has my support and faith as strong as ever and those I felt were not listening and were behaving in a self serving manner before are still true to that observation as well.

Nick Prout:

Judging from the response last month to "public option" I would say that there is a large percentage of the population that does not wish to lose autonomy when it comes to medical care. They want access, but also want some control. So do the Feds.

People do not control their own fate now, Nick.  Anthem and my providers decide for me what is best.  I have some choices, but not about how the bills will be paid.  I do not fear "faceless bureaucrats" in federal agencies like you do.  Maybe it is because I've been a government employee (local or state) for my entire adult life.  I don't see federal employees as that much different.  You prefer faceless private insurance company employees,  Private companies want profit.  Good for them, I'm all for an honest profit, but not when it's excessive, and not when it comes at the expense of my health.  Non-profit, government-regulated health care does not frighten me, and I don't think it threatens the entire system or anyone's liberty. 

Regardless, we are not talking about socialized medicine.  We are talking about one option among many.  I understand you dismiss my analogy of public/private education.  Fine.  We have Medicare, Medicaid, various government programs for children, VA health care for our armed services veterans, and we have a very large, robust, and profitable private health insurance industry.  The people not included in any of the above, if covered by a new public option, would not take one dime away from the private insurance companies.  Their fear is that more and more people might choose that option once it is available, which would force them to be more attractive (competitive).

I don't want to see the private health insurance industry collapse.  I do want to see it regulated better.  It's like the railroads a century ago.  They controlled the economy and often did so malevolently.  Congress had to step in, exercising its constitutional authority to regulate interstate commerce.  Now Congress needs to get a firmer handle on health care: limiting malpractice, prohibiting arbitrary exclusions, promoting competition, and protecting consumers. I'm not hung up on a public option, per se, but I don't understand what's so scary about it.  Help me understand your fears.  If it's just the "faceless bureaucrats controlling my health" argument, we have that now.  Ever call someone at Anthem with a dispute over an insurance claim?

Sandi Saunders:

Frankly, I think there has been an ineffective "reading" of the American people for a very long time in this country.  Many people actually believe that President Obama won the election simply because people did not like Bush or did not like McCain.  The truth IMO is that people were that dissatisfied with the direction of the country from politicians who did not seem to be listening.  And they still are not.

I thought about this today when I read a letter to the editor by one of our panelists.  Students have the entire school year for a civics lesson, or many civics lessons.  Why exclude them from a one-time presidential address directed to school kids about the importance of education?  Because it's an unwelcome intrusion?  Because it's political indoctrination?  Maybe it's because a lot of people in this country refuse to accept the legitimacy of Barack Obama as their commander in chief.  That's what is behind the Birther Movement.  Okay, Obama won the election, he was certified by the electoral college, and he was sworn in by the chief justice, but is he eligible to be president?  Is he really a United States citizen?  I have a civics lesson for the parents of our nation's school kids.  It's a lesson for Congressman Joe Wilson and all his newfound fans.  Here it is.

We the people elect a president every four years, not just you the person.  You might have voted for the loser.  Too bad.  Get over it.  The winner is every American's president.  It's been that way since George Washington was elected for the first time.  Yes, Barack Obama is your president, whether you like it or not.  It's your right as a citizen to openly disagree with the president in a lawful manner, but it is also your patriotic duty to respect the office and the person in it.  You might not agree with everything the president says or does.  In a nation of over 300 million people, the president can't please everyone all the time. 

If you can't accept this, maybe your child can.  You can't control your child's mind, and maybe that scares you.  Good gosh, what if your child listens to the president without you in the background denouncing him?  What if your child thinks for himself or herself?  What if your child does not always share your partisan rancor?  If you think it's inappropriate for the President of the United States to say few words of encouragement to your child and others, it's not about the presidency, or Obama, it's about you.  It's about your refusal to accept the most basic, fundamental concept of our democracy: majority rule.  We are not a nation ruled by 300 million petty tyrants who must have their way.  We are a republic governed by elected representatives, including President Barack Obama.