Sunday, March 02, 2008

Query on national health care legislation

Kevin Sack, in today's New York Times, offers a succinct summary of the political dynamics of health care as a national issue. Here is the pertinent excerpt:

Polling suggests that at least 9 of every 10 voters in November will be insured. Many will not see universal coverage as a matter of self-interest. The complex economic argument that the uninsured impose hidden costs on everyone else may be difficult to convey in sound bites.

And the electorate may be less receptive than participants in the Democratic primaries and caucuses. A December poll by the Kaiser Family Foundation found that 42 percent of Democrats said their top health policy concern was expanding coverage for the uninsured, while 35 percent said it was reducing costs. The priorities flipped when Republicans and independents were added to the mix, with 41 percent of all polled saying they cared most about reducing costs and 31 percent citing coverage for the uninsured.

This is consistent with polling that I have read over the last six years. When you add in the vested interests involved in the debate surrounding any new legislation, it might explain why it is so difficult to generate a political consensus at the national level on these issues and why no President since Bill Clinton has really tried to do anything significant in this arena.

What do you think? I am not asking you whether you think there should be legislation, so please don't offer a speech on that topic. I am asking whether you think there will be strong political pressure resulting from the general election -- even if a Democrat wins -- to provide the impetus major legislation would need to move forward.

10 comments:

Anonymous said...

Good and provocative question for a Monday morning. My answer has to be, I don't know - but I sure #@$%*&!!! hope so!! And I hope it goes beyond mere coverage/cost concerns to revamping how health care is delivered.

nonlocal MD

Rob said...

Hi Paul,

From my point of view, there seems to be a general consensus within my demographic (18-25, left-leaning, college educated) that there are social and economic implications for everyone if all people do not have equal access to health care. Through the media, it has become somewhat easy to see how these issues could eventually fall (or have been falling) on our shoulders if the current system is not changed.

Rob

Tim Fitzgibbons said...

The country has been divided 50/50 for at least 8 years, 14 if you count if the "Republican Revolution" of 1994 as a balancing force to the Democrat control of the Presidency and both Houses from 1992-1994.

Unless this is a year of extraordinary change, I find it dubious that there will be any way that at least 40 Senators won't find a way to object to any healthcare bill.

40 Senators opposed means no cloture. No cloture means no bill.

I am not advocating one way or the other just trying to provide some objective political analysis.

Anonymous said...

Honestly, no, I don't think so.

It's an academic concern for those whose opinions matter most to the politicians.

The wealthy don't care because they've already got theirs.

The middle class cares, but not enough to be outraged and actually do anything about it since most most employers pay all but a trivial amount.

The corporations care, but only to the extent they can be assured of increasing their profits. Things extending patents to cover expiring drugs (Claritin), or prohibiting negotiation to get a better deal (Medicare).

There are only three groups to whom it really matters: small business and the self employed (of which I am one) who must pay the usurious rates themselves whose numbers and financial influence is small; those who have been under financial strain by an illness or injury whos numbers are also small and whose financial influence is completely diverted to paying medical bills; and the poor, who, as a rule, don't vote and therefore don't count in this situation.

As one example, my health insurance rate this year is going up 50%. In one year. It's going from $428 to $631 per month. I pay 100% of that amount. It's pre-tax, but I'm paying all of it.

My client (a 100-person non-profit) is paying $410 per person. They now require their employees to contribute $20/mo towards that amount.

No one is going to get outraged at $20 per month. That's about 1/5 of a cable or cell phone bill.

Not until the cost of this stuff is brought home in a real and tangible way is any action going to be taken. And that's not going to be for quite some time.

Anthony Cirillo said...

I read the column and it was interesting. Bottom line I do not think much will change. (Sorry to use that word!) The changes need to be so dramatic whether you approach them from the cost or the care standpoint that the lobbying forces and the shock to the system overall would probably negate any real progress. And if you note something else in the article the Republicans would eliminate tax benefits to employers for providing health coverage. Then you are going to see a massive increase in the number of uninsured. Once the rhetoric dies the status quo resumes even if you have major change agents in the office.

Anthony Cirillo, FACHE, ABC

RosesRoses said...

I too read the column and was most struck by the conclusion, about the need for attention to both cost reduction and coverage for everyone. But, this requires less a debate than a discussion. It requires something other than either/or thinking. It calls for a working together approach, and that calls for leadership which may or may not be in place in January

Ian McCarty said...

The next 4 to 8 year period has the potential to see the seating of as many as 4 Supreme Court Justices. Their views on health care as a 'right', along with the views of the rest of the Justices, may become very important. I believe there is a real chance that after repeated failures on a legislative level, the health care debate could move into the judicial realm.
Obviously, the leanings of our next president, who will appoint these judges, may play a large - but somewhat secondary- role in expanding health care.
As Mr. Fitzgibbons points out, even a Democratic president, more likely to favor a 'universal' approach, faces a nearly deadlocked Congress. As an example, the Oregon House of Representatives last week failed to pass a resolution that would add a clause to the state's constitution asserting each Oregonian's 'right to health care.' A national initiative would most likely face the same fate. However, by beginning to frame this issue as a matter of 'rights', a president, through careful judicial selections, may indeed advance (or conversely squelch) this topic further than previously achieved and provide a foothold for further action.

Anonymous said...

Healthcare is a hot issue now, even if the majority of voters are insured. The lucky ones with employer-sponsored plans are paying more out-of-pocket as costs are being shifted to the patient. Businesses, even large businesses, are having trouble keeping up with the rate of inflation for health insurance, especially in the possible face of recession. And healthcare providers are clamoring for change as they watch their reimbursement go down and insurance company profits skyrocket.

The insurance and pharmaceutical industries want to keep the status quo for as long as possible, but it seems to me that change is coming.

leeaase said...

I work for Mayo Clinic, and we are hosting a national symposium on health care reform next week (Mar. 10-11) in Leesburg, Va. We've also set up a blog so people can watch the streaming video and contribute to the discussions. I hope you and your readers will join us.

One of our core principles is that we need to achieve universal coverage through personal ownership of insurance.

http://healthpolicyblog.mayoclinic.org/

Quick Medical said...

Paul, great site. Much of the media blames the high cost of health care on increasing costs of medical supplies and technology. Do you feel this is a legitimate claim? We work in this industry and although costs are increasing, there is so much competition (for certain professional medical products) that you almost have to lower your prices just to stay in the game.