What Exactly are they fighting to Preserve?

Here’s an interesting link from Foreign Policy. We’ve joined China, Russia, and wait for it, wait for it … that bastion of global civilization …Turkmenistan on the list of the World’s Worst Health Care Reforms.

I understand why Republicans are fighting progress on Health Care Reform because they don’t like progress of any sort, but what about those democrats who want to reinvigorate health insurance industry profits? What exactly are they supporting? Continuation of failure?

System: Employer-based private coverage, with an under-regulated private insurance market, and

government-subsidized public plans for the poor, elderly, and disabled

Reform: The United States has the rare distinction of being both one of the world’s richest countries and having one of its least-functional health care systems.

Americans spend around one in every six dollars on healthcare. But, in aggregate, they’re not getting much bang for their buck. People in the United States are as likely to die from diseases like lung cancer as citizens in all OECD countries – which, on average, spend less than half as much per capita. Some 47 million lack any health insurance coverage. An estimated 600,000 people file for bankruptcy every year because they cannot pay their medical expenses. Indeed, the United States is the only rich country without universal coverage.

The U.S. government has repeatedly tried to create a more coherent plan and to make sure more Americans are insured. Reformers have scored piecemeal victories — such as the 1997 creation of the State Children’s Health Insurance Plan, or Massachusetts’ recent implementation of universal coverage.

But for the most part, the history of health reform in the United States has been a history of failure. The last attempt at comprehensive reform — the 1993 bill derided as “HillaryCare,” during the administration of Bill Clinton — floundered in Congress. Since then, costs and premiums have doubled, a lower percentage of employers offer coverage, and millions more are uninsured.

I just used the red bold there to indicate where you should be seeing red. Evidently Senator Henry Waxman may be seeing red too. Today’s NYT reports that Democrats’ Divide Fuels Turmoil on Health Care.

Dissension among Democrats flared anew on Friday as a top House Democrat threatened to bypass his own committee to speed passage of a bill to provide health insurance for tens of millions of Americans. But by the end of the day, Democrats said they were trying to patch up their differences.

Ezra Klein of the WaPo says health care reform is looking more like a prisoner’s dilemma.

You can take Waxman’s statements one of a couple ways. His willingness to bring the bill directly to the floor undermines the bargaining power of the Blue Dogs: It means they don’t have veto power over the bill. This could, in other words, be a negotiating tactic on Waxman’s part to soften the Blue Dogs’ position. But if that doesn’t work, it could also mean exactly what it says: That he’s going to push the bill straight to the floor.

That would ensure some bad headlines, and an angry Blue Dog caucus. But versions of this bill have passed two other committees. Energy and Commerce isn’t strictly necessary. Waxman’s threat to bring the bill to the floor means that Pelosi and Waxman think they have the votes whether or not Energy and Commerce approves the legislation. And that may not be such a bad outcome, either for the Democrats or the Blue Dogs.

Some sources are speculating that the Blue Dogs are getting cold feet as they watch Max Baucus dither. Many of them felt burned by the hard and damaging vote on the cap-and-trade bill, as it looks like nothing will come of it in the Senate. Committing themselves to a health-care bill before the Senate shows its hand carries similar risks, and they’re no longer in a risk-taking mood. The worst outcome for conservative Democrats in the House is that they’re on record voting for a health-care reform bill that dies in the Senate and is judged a catastrophic example of liberal overreach.

I have to say, I’m not sure I would support this health care reform at this point. It appears to not address reduction of costs and it locks many of us into private insurance just because that industry is afraid to compete with a public option. How is this good for any of us?

If you really want a good read, hope on over to Mark Thoma’s Economist View’s thread From 1983: Health Care Reform in Canada. It reviews the fight for health care reform in Canada that happened like 25 years ago. Some of the arguments then are the same weirdish things we hear coming out of Republican’s mouths today. That is despite the horrible nasty statistics we continue to see on our broken down health care market.

You can also review my piece here on how terrifically costly and inefficient the current system distilled from the Journal of Economic Perspectives. In both cases there’s this discussion of how doctors are provided incentives to do things not necessarily based on health factors.

Another interesting feature mentioned in this article was that ”incentives embedded in physician payment mechanism” appear to be part of these higher costs and contribute to over-utilization. An example of this is that in Japan, doctors earn additional compensation for prescribing drugs and therefore Japan has the highest antibiotic consumption rate in the word. In the U.S., physicians earn money by prescribing additional diagnostics like imagining studies so the use of these things has experienced a 10% annual growth rate in recent years.

It appears to me that this bill only extends and perpetuates current problems which have been basically caused by the insurance industry and misdirected incentives. How is bringing more folks into an ineffective, costly system going to really create reform? I want to provide health care to every one but why make us all feed the third party payers when a single insurance option would be far more efficient and cheaper? Imagine, one set of paperwork to fill out, one set of billing, one set of formularies and protocols to follow.

Is it just me or are we just perpetuating the chaos to get something out there quickly? Some one with credibility needs to have a national discussion on this issue. Some one that’s not beholden to the insurance industry and the current system. Where can we get some real leadership on this issue instead of some patchwork Rube Goldberg bureaucracy that traps those of us that have insurance into our current, overpriced plans while taxing us to trap others into a similar situation. Why not just look around the world, from all those examples of health care delivery that are more adept than ours, and borrow it wholesale?

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