healthcare

Video:: Biden to Obama, “This is a big f*cking deal”

The signing of the healthcare bill last week was significant in more ways than one. I feel it galvanized the Democrats and I also feel it was critical for Obama to make the healthcare bill “personal” and get fellow Democrats to be rowing in the same direction. I think this was quite a challenge, as the liberal factions of the party are ideologically distinct from the more conservative Blue Dog Democrats.

In the wake of the signing, the Democrats got good news in the form of a public opinion poll reporting 49% saying the bill was a good thing, compared to 40% saying it was bad. There was also a spike in donations, with $1M pouring in last Tuesday without a direct ask.

There has been a backlash and alleged incidents of offices being vandalized. The Republicans needed to respond to thwart any momentum, but I’m not convinced their strategy is sound. Sarah Palin started a bit of controversy with her reload and targeting comments in a speech in Senate Majority Leader Harry Reid’s hometown of Searchlight, NV::

The media tried to whip Sarah Palin’s “targeting” and “reload” comments into pageview fodder, but I think the big issue for Republicans is a lack of a message that resonates with a country in the economic doldrums. John McCain claims that Palin’s words are just political rhetoric::

While this all makes for good drama, I’m not sure how effective this type of press coverage is in building support. I can’t help but think of the utter carnage of the 1994 midterm elections. Bill Clinton was weakened by a lack of support in Congress from his own party as a Washington outsider and…Newt Gingrich’s Contract with America. This C-SPAN footage is a bit dry, but it shows a systematic delineation of undermining public support of Democrats and was more successful than many anticipated. The Democrats would go on to lose 8 seats in the Senate and 54 in the House, earning a majority in both.

I think there was and perhaps still is an opportunity for the Republicans to pick up quite a few seats, but there needs to be rhetoric that moderates can sink their teeth into. Without a more substantial agenda resonating, I predict low turnout, as voters sit the midterms out.

Twitterversion:: Post healthcare, Dems get bump in polls & donations last wk. Rep. backlash ensues. Doubtful if 2010 will be another 1994 @Prof_K

Song:: Okkervil River-‘Our Life Is Not a Movie’

I made a trip south of the border yesterday.  I drove all day to South Bend, IN to drop off a proposal and had dinner in Grand Rapids, MI, so I missed Obama’s Afghanistan speech.  I didn’t miss hearing the fallout from both the left and the right.  So, I’m wondering about what’s going to happen in next year’s midterm elections and I’m curious on what my fellow bloggers and the readers have on the subject.

Let’s turn back the clock.  Sixteen years ago, in late November of 1993 and Bill Clinton’s approval rating dipped under 50%.  Recently, Barack Obama’s ratings also dipped below 50%.  This got me thinking about some other trivia tidbits::

• A complex health care reform plan was under attack by William Kristol.  The “Harry and Louise” ads, funded by lobbyists aired to cast doubt on Clinton’s reform, using the catchy phrase, “they choose, we lose.”

• Clinton, a moderate Democrat, was being pushed around by conservative Democrats in Congress.  They felt he didn’t have a mandate with 43% of the popular vote [1] and won only because Ross Perot split the Republican vote.
• The Democrats enjoyed an 82 seat advantage in the House in 1993.  The current margin is 79 seats.  The Democrats had a 56/44 advantage in 1993.  The current advantage is  59/41.
• The stock market was on an upswing in 1993 {DJIA}.  This year, the market has spent the year recovering and is about where it was in 2004 [2].

On the other hand::

• Unemployment was 6.5% in December 1993, not 10.2% {Nov. 2009} [3]
• The Gulf War {Desert Storm} was a fading memory in 1993, while in 2009 Obama is gearing up for a Afghanistan surge at a $30B/year pricetag.

Historically, in 1994 there was a Republican landslide and the GOP took over both the House and Senate {although Clinton won re-election handily in 1996}.  Will history repeat itself?  I’m not sure.  In 1994, there was a clear and concerted effort by the Republicans.  Newt Gingrich and the “Contract with America” captured the imagination of many voters.  I’m not sure the GOP can pull that off in 2010.

While the Obama Administration has faced criticism from the right, he’s also under fire from the left on the issues of the economy and the war in Afghanistan.  While the Democratic Party machine would resist this, will the current circumstances provide opportunities for left-leaning Congressional candidates a rare window of opportunity?  What about the Republicans?  Will they regroup?  What about Libertarians?  Is this an opportunity for them?

Twitterversion:: Politically in the US, it feels strangely familiar to 1993.But,it’s not. What will happen in 2010 midterms? #ThickCulture http://url.ie/3d5n  @Prof_K

I’m on the road in Iowa City, but I saw that this has been floating around the blogosphere {“hat” tip:: LQ}::

So, how do you take this?  Straight-up or with a twist?  Apparently, this caused a ruckus on HuffPo.  Some days are facepalm days over there.

Twitterversion:: #TheHat takes on healthcare in lowfi multimedia glouriousness.  #ThickCulture @Prof_K

Song:: Tymps (The Sick in the Head Song) – Fiona Apple

Anyone curious on how how pro-single payer physicians think about the issues, I encourage you to check out the Physicians for a National Healthcare Program {PNHP} FAQ.  Here’s a list of PNHP single-payer resources, as well.  As stated in an earlier post, I view health care as infrastructure that can spur innovation, creativity, and entrepreneurship and like many in the biotech. industry, I see a single-payer model {public finance of healthcare, as opposed to provision} as important for implementation of genomic medicine.

I won’t go into the healthcare debate and media circus, but will link to an article on a recent NBC poll.  Interestingly, 36% believe that Obama’s reform efforts are a good idea, but 53% support a paragraph describing his plans.  It’s a communication problem.  If you think all of the cacophony at the town halls is helping the GOP, you’re wrong.  The NBC poll reports 62% disapprove of their handling of health care.

The PNHP is highly critical of the administrative costs of healthcare and are no fans of the insurance industry.  Insurance also affects how healthcare providers do their jobs.  I have access to hospital data that’s used to “manage care” to maximize insurance reimbursement.  Moreover, there are powerful incentives in the insurance industry to maximize profits by denying claims.  The PNHP recognizes that a single-payer system will adversely affect insurance::

“The new system will still need some people to administer claims. Administration will shrink, however, eliminating the need for many insurance workers, as well as administrative staff in hospitals, clinics and nursing homes. More health care providers, especially in the fields of long-term care, home health care, and public health, will be needed, and many insurance clerks can be retrained to enter these fields. Many people now working in the insurance industry are, in fact, already health professionals (e.g. nurses) who will be able to find work in the health care field again. But many insurance and health administrative workers will need a job retraining and placement program. We anticipate that such a program would cost about $20 billion, a small fraction of the administrative savings from the transition to national health insurance.”

So, shouldn’t we be concerned about insurance ?  Are they getting a bad rap?  Are they really evil?  Isn’t it a part of financial intermediation, providing the critical function of polling resources and spreading risk?

Malcolm Gladwell in a 2005 New Yorker article did a good job of explaining two forms of insurance:: social and actuarial.  Social insurance pools money from many for a public good, regardless of usage, in order to sustain an infrastructure.  Actuarial insurance is quite different and has been the pathway that US healthcare has been going::

“How much you pay is in large part a function of your individual situation and history: someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan.”

Think pre-existing conditions.  The actuarial model is why biotech. wants a single-payer system.  Genomics identify risks and will eventually match individuals, diseases, and therapies on the basis of genetic information.  Doctors see this on the horizon and Robin Cook, MD offered this NY Times op. ed. on how he had revised his views on universal health care.

But, if you were to craft a business model, which would you choose to invest in, if you wanted to make the most profit?::  {1} social insurance that pools equal premiums from all and allocates care to all or {2} actuarial insurance that charges more for people who have a higher likelihood of becoming ill and can deny care for pre-existing conditions or treatment deemed unwarranted.  The actuarial model can easily align with a set of values of individualism, as well as moral judgments about treating certain diseases {e.g., a smoker with lung cancer}.  I’ve seen people on discussion boards claim that “I can take care of my own” and perplexed why everyone else cannot.  How I see it, the current debates are really about using individualism to protect corporate interests.  I see plenty of incentives for the actuarial insurance industry and politicians to fan the argumentative flames about wild-eyed hypotheticals, as opposed to substantive debates about implementation. The devil is in the details.

Gladwell concluded his article with the following::

“In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.”

Twitterversion:: Who will weep 4 actuarial US health insur. indstry? Are they/backers obfuscating real debates on implmntatn w/histrionics?http://url.ie/28qa @Prof_K

Song:: Pay For It – Lloyd Cole

Notes from north of 49ºN

Update 4 August:: Video on Jack Layton from MSNBC-below.

Jack Layton is the leader of the New Democratic Party of Canada whose riding is the next one over from me, Toronto-Danforth.  Over on the Huffington Post, Jack did a post on the realities of the Canadian health care system.

I have a lot of strong views on health care in the US based on my work in non-profit health and my research on the biotech industry.  It’s worth mentioning that today’s US health care system began as employer perquisites {benefits}, back when health care and pharmaceuticals were cheap.  The private insurance model starts to break down when costs escalate resulting in employers and employees getting squeezed and uninsured rates rising.  Some say a perfect storm of events {recession, rising costs, uninsured rate of 19%, and Obama} is leading to a tipping point in health care.  It should be noted that the US will not adopt a health care system like Canada’s, where the government {provinces} provide health care, but rather a system where the government finances health care delivered by private enterprise.

On the The Huffington Post, Jack makes some compelling points, whether you agree with his politics or not::

“Costs are under control in Canada. We spend similar amounts on public care – around 7% of GDP. For that price, Canada covers everyone, the U.S. just one third of the population. In case you’re worried Canada wastes money on bureaucracy, know that just 2.4% of our total costs go to administration compared to 7% of what your government spends. In end, Canadian care costs $2,500 less per capita – and covers everyone.”

He points out that the system isn’t perfect::

“Our system does have flaws. We need better prescription drug coverage, better remote access to care and better practices in hospitals and clinics. No honest advocate for our health care system would dismiss these things. But Canadian health care works — and works well.”

Does all this mean that the United States should adopt Canada’s health care system?…No. America can no more adopt our health care system than we can swap hockey for baseball as our national pastime. A good health care system reflects a country’s values, and each country’s values are different…But a system with 47 million uninsured, coverage denied due to pre-existing conditions and people thrown off plans when they become ill? That doesn’t reflect American values.”

Unfortunately, there are other competing values in play in the US, making healthcare a contentious issue.  It’s not a simple matter of costs and taxes, but one that also affects innovation and entrepreneurship.  Biotechnology is predicated upon using the human genome to better match diseases, patients, and therapies.  “Pre-existing conditions” and genetic skeletons in one’s closet can thwart innovation in biotech because it adds additional business risk.  If insurance refuses to pay, where are the revenues?

One question on my mind and one I pose to my students, is healthcare a public infrastructure or should it be treated strictly as a business?  The Canadian model is one where the state is the financier and provider, where the provinces oversee a large, integrated health infrastructure.  As stated above, a new US healthcare model is unlikely to be this comprehensive, instead focusing in financing.  The current US model uses market mechanisms heavily, where healthcare delivery, insurance, and pharmaceuticals all having a dog in the healthcare reform fight.  Altering the landscape through healthcare reform will alter business models and likely create windfall gains and losses.  On the other hand, we have that perfect storm of recession, rising costs, uninsured rate of 19%, and Obama.  Another implication of the current model, where healthcare is an employment benefit, is that it limits new business creation, i.e., creates “entrepreneurship lock.”  A recent working paper supports this reasoning::

“Overall we find some evidence that the U.S. emphasis on employer-provided health insurance may be limiting entrepreneurship.  The clearest evidence comes from the regression discontinuity results which create the most comparability in experimental and controls groups.  The finding of ‘entrepreneurship lock’ is important as it suggests that the bundling of health insurance and employment may create an inefficient allocation of which or when workers start businesses.”

Healthcare can also has an affect on the arts in the US in same fashion, necessitating that creatives take on dayjobs with health benefits.  One artist once told me that money {or lower costs} means the freedom to create.  The current system does precious little to create incentives for cash-strapped entrepreneurs and creatives to innovate and create.  Does this matter?  I think it does in terms of sustainable economic growth and treating healthcare as a publicly financed infrastructure, i.e., a social good, paid with {gasp} taxpayer dollars makes more sense than the current system, but the devil’s in the details and good implementation is critical in order for a new system to be successful.  That said, these challenges shouldn’t be reasons not to do it.
Video:: Jack Layton on MSNBC’s The Ed Show, NDP Blog via Twitter

Link

Twitterversion:: Jack Layton of #NDP clarifies healthcare in #Canada. Should healthcare be infrastructure? Implications for innovation & entrepreneurship. #ThickCulture @Prof_K

Song::  Planet Health – Chairlift {Brooklyn, NY of iPod Nano fame}