Suggested Discussion Outline

[johnkarls]

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SUGGESTED DISCUSSION OUTLINE -- HEALTH CARE/INSURANCE REFORM

A. Financing Health Care/Insurance Reform

A-1. On July 16th, the Head of the Non-Partisan Congressional Budget Office which officially "scores" the budget impact of all pending legislation, testified before Congress that none of the pending bills "propose the sort of fundamental changes necessary to rein in sky-rocketing costs" - touching off the war between "Blue Dog" Democrats and their Congressional leaders that has raged ever since. (A Washington Post report on the CBO testimony is posted on our bulletin board.)

A-2. Ideas for controlling costs =

A-2-a. Lowering the amount per "quality-adjusted life year" ("QALY") that Medicare and Medicaid will pay (an explanation of a "QALY" is posted on our bulletin board and was the first Q&A in last week's Short Quiz).

A-2-b. Charging individuals the extra actuarial cost for smoking and obesity (an article on our web site by the CEO of Safeway Inc. says Safeway saves 38% in this manner) – WHICH IS ONE OF THE RECOMMENDATIONS OF THE BROOKINGS INSTITUTION (POSTED ON THIS WEB SITE)

A-2-c. Republican ideas (per former NYC Mayor Rudy Guiliani on Sep 6 “Meet the Press” panel moderated by David Gregory and including Tom Brokaw, Tom Friedman and Harold Ford Jr.) =

A-2-c-i. Eliminating or severely limiting medical malpractice lawsuits – WHICH IS ONE OF THE RECOMMENDATIONS OF THE BROOKINGS INSTITUTION (POSTED ON THIS WEB SITE)

A-2-c-ii. Permitting inter-state insurance competition (Guliani didn’t explain this but I am guessing that some states do not permit insurance companies to take into account certain things, such as age or pre-existing conditions – and Guiliani would let young people and healthy people buy their policies in other states meaning that the young do not have to subsidize the aged and the healthy do not have to subsidize the sick).

A-2-d. Other recommendations in the Brookings Institution Report posted on this web site.

A-2-e. Other ideas.


B. The Political Aspects

B-1. Seniors view all of the talk about "raiding" Medicare to help pay for the 47 million uninsured as meaning lowering the amount/"QALY" that Medicare will reimburse.

B-2. The overwhelming majority of the population has employer-provided health care and polls show that they are satisfied with it.

B-3. When we studied Saul Alinsky's "Rules for Radicals" 11.5 months ago (his book was the subject of Hillary Clinton's senior honors thesis and President Obama came to Chicago to work as a community organizer for Alinsky), Alinsky's cardinal principal was to NEVER attack the middle class because then you forfeit majority status. However, it would appear that the middle class has become convinced that there is no way to finance even the programs included in the stimulus legislation earlier this year, much less the new health proposals, without taxing the middle class - causing the 20% drop in President Obama's approval rating in just 3 months.

B-4. Other.


C. Congressional Mechanics

C-1. The Senate's 60-vote hurdle with only 59 seats (including 2 independents and considerable qualms from "Blue Dog" Democrats) and no Republican support.

C-2. Using the 51-vote budget-reconciliation process -

C-2-a. The mechanics of using it are extremely cumbersome.

C-2-b. Half a dozen prominent Democratic Senators (including the Chair of the Senate Budget Committee (Sen. Conrad), the longest-serving Senator in history (Sen. Byrd), and Sen. Joe Lieberman - to name only 3) have already announced that they will vote against using this procedure as an abuse.


D. What, If Anything, Can Be Salvaged?


E. Action We Can Take?


F. Other.
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[UtahOwl]

Twp things to add to the outline:
1. Can we control costs of healthcare if it continues to be treated as a commodity?
[I will bring an in-depth study which pretty well says the answer is "NO" - if you want to preview this material, it's from the Dartmouth Atlas of Health Care brief http://www.dartmouthatlas.org/atlases/Spending_Brief_022709.pdf, whose TakeHome message is:

Medicare spending in 2006 varied more than threefold across U.S. hospital referral
regions... Research has shown that some of the variation is due to differences in the prices paid for similar services, and some is due to differences in illness; but even after accounting for these factors, twofold differences remain. In other words, the differences in spending are almost entirely explained by differences in the volume of health care services received by similar patients.

So is there an alternative? Well, we could consider healthcare a public good .... like clean water.

2. Why has the Healthcare debate been taken over by opponents of healthcare reform?
The most concise description I've seen is at HuffPosthttp://www.huffingtonpost.com/drew-westen/why-the-president-has-bee_b_278971.html. Other great references courtesy of Lucidity at [url][url]http://www.democracyforutah.com/node/2714[/url][/url].
See all y'all tonight!