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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-21-08 01:15 AM
Original message
Barack Obama and Health Care

Barack Obama and Health Care

by kid oakland
Sun Jan 20, 2008

<...>

When it comes to health care and Barack Obama the person to meet is Harvard Professor and Economist David Cutler. Professor Cutler is the author of the well-regarded book on health policy: Your Money or Your Life. (Yes, it's possible to be a policy wonk and have a sense of humor.) From the Ezra Klein review:

Cutler, a Harvard economist, worked on Clinton's doomed effort and, upon its death, set about reflecting on where they'd gone wrong. His eventual answer was virtually everywhere, but not just in the political sense. According to Cutler, the health-care debate is deeply flawed, myopically mired in issues of cost and access. Both, he grants, are important. But with most Americans able to afford health care, calls for reform based solely on those concerns will continue to fail. The fee-for-service system encourages a reliance on technology-intensive treatments -- the costly procedures that are richly reimbursed by insurers -- while simple, but potentially more valuable, services are often overlooked.
-Ezra Klein, American Prospect

If you want to meet David Cutler outside the glare of the presidential campaign, try this informative profile by Roger Lowenstein written for the New York Times in 2005:

A tweedy, self-effacing 39-year-old, Cutler is a seriously modified lefty. He envisions a system in which everyone could get insurance while free-market incentives would motivate health-care providers to be more effective as well as more efficient. Instead of suppressing the market by rationing care, restraining prices or regulating doctors, he wants to liberate it. It is neither Clinton nor Bush -- but closer to Bill Bradley, whose 2000 campaign Cutler advised. Dr. Robert Galvin, head of global health care at General Electric, says, "David has showed everyone that the way to rein in costs is not to squash innovation."
-NYT

<...>

Edwards and Clinton:

Senator Hillary Rodham Clinton of New York and John Edwards, the former North Carolina senator, support a mandate. It is, they say, the only way to guarantee that everyone is covered and to thereby bring down costs by spreading the country’s insurance risk as broadly as possible.

"The sad reality is that the uninsured don’t just struggle with costs themselves, they impose costs on the rest of us," Mrs. Clinton said in September. "It’s a hidden tax: the high cost of emergency room visits that could have been prevented by a much less expensive doctor’s appointment, the cost of unpaid medical bills that lead insurance companies to raise rates on the rest of us."

Mr. Edwards echoed those remarks a week later. "The reason the mandate is necessary is because you cannot have universal health care without it," he said. "Does not exist, and anyone who pretends it is, is not being straight."

-NYT

Now, here's how Barack Obama put it:

Senator Barack Obama of Illinois sees it a different way. He argues there is danger in mandating coverage before it is clear it can be affordable for those at the margins. While Mr. Obama does not rule out a mandate down the road, his emphasis is on reducing costs and providing generous government subsidies to those who need them. He would mandate coverage for children.

That distinction set off a pointed exchange in the Democratic debate in Las Vegas on Nov. 15. "I don’t think that the problem with the American people is that they are not being forced to get health care," Mr. Obama said. "The problem is they can’t afford it."

-NYT

That seems to be pretty clear and makes a great deal of sense, but it's clearly a marked difference from what Clinton and Edwards are saying. Now, David Cutler worked on Senator Clinton's failed 1993-94 Health Care Task Force, he knows the Massachusetts policy of mandated coverage inside and out. Let's let David Cutler make the case for tackling affordability first:

The main difference between Obama's plan and his rivals' is this, they would mandate health coverage first and fix cost problems later. Obama would do the opposite. While both approaches are problematic, there is a strong case to be made that Obama's plan is fairer - and more politically progressive.

While it's true that Obama's plan won't "cover everyone," neither will anyone else's. Mandates have never achieved 100% effectiveness. The practical design problems of subsidies, exemptions, and benefit levels that accompany mandates are complex and unwieldy. That's why the Massachusetts Authority responsible for that state's plan - which Krugman would describe as "covering everyone" - just exempted an estimated 20% of uninsured residents from the mandate.

-Huffington Post

<...>

Either you like the way David Cutler makes his argument or you don't. He's speaking, like Obama, in very clear terms. And what he's saying is, like Obama's technology agenda, innovative and straightforward. Don't take my word for it.

To cover most (but not all) of the roughly 45 million Americans without health insurance, Obama advances ideas that split the bill between individuals, government and business.

His first step would be to require parents to insure their children. Then he proposes to expand eligibility for government programs for the poor and to offer subsidies to help other uninsured individuals buy coverage through a new, nationwide purchasing pool modeled on the insurance available to federal employees. Finally, Obama would require all but the smallest employers to provide insurance for workers or else pay about 6% of their payroll to help government fund the cost of covering those employees. That last proposal marks a crucial turn in the healthcare debate.

Obama also revived the best policy idea of Sen. John F. Kerry's 2004 campaign: a proposal for Washington to fund most of the bill for high-cost patients once their annual healthcare bills exceed a fixed level. Shifting those catastrophic expenses to government would lower employer premiums. So might Obama's surprisingly sharp-edged proposals to limit insurance company profits.

The best chance for reaching (or even nearing) universal healthcare coverage is a system of shared responsibility that requires government, individuals and business to all contribute.
-Ron Brownstein, LA Times

If that's not enough informattion for you, here's a link to a chart prepared by the Henry J. Kaiser foundation comparing every aspect of both Clinton's and Obama's plans.

more




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The_Casual_Observer Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-21-08 01:22 AM
Response to Original message
1.  free-market incentives can never work with health care.
If it costs X number of dollars to care & treat Y people on average then it will cost 10*X dollars to treat 10*Y people. There is no economy of scale.The "risk" isn't spread out if more people subscribe, all you get is more people who need treatments. There is no easy answer to this problem.
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danielet Donating Member (150 posts) Send PM | Profile | Ignore Mon Jan-21-08 01:24 AM
Response to Original message
2. OBAMA'S VS. ROVE'S VIEW OF CARING FOR EACH OTHER
OBAMA VS. ROVE

I JUST HAD A VERY STRANGE EXPERIENCE SO PLEASE FORGIVE ME IF I SEEM A BIT INCOHERENT; BUT I AM BADLY SHAKEN.

I just heard, on C-Span, Senator Obama speaking from Martin Luther King's Church and then, immediately afterward, I heard Karl Rove addressing the Republican National Committee last Wednesday.

Now keep in mind that both Rove and Obama had a terrible childhood and both were abandoned by their fathers and raised by their lone mothers until these mothers died.

Yet, Obama spoke of HOPE-- not as "false hope"-- but ACTION HOPE as realistic hope that drives you to risk everything to join with others to break down the wall of injustice and suffering imprisoning us all. HE DEMANDED THAT, FIRST AND FOREMOST, WE MUST "SEE" EACH OTHER, THAT WE MUST FEEL THE REALITY OF EACH OTHER. He told the story of a campaign worker named Rachel that, in a round-table of volunteers for Obama's campaign explaining why they were there, she said that she was there because her mother was sick with cancer and at nine years old she sought to convince her parents that she loooovvvveeeddd relish sandwiches because condiments were so much cheaper than meat so that she would not be a burden on her mom. When she heard of Obama's mom and her fear of no health-care insurance coverage she saw Obama and herself as one. She saw Obama and realized that he saw her!

In the next video on C-Span, at an RNC Conference, Rove was introduced by an RNC mechanic. That's the only work those mechanics who make a living delivering the lemmings on election day do; so they work like carnival people, only a few months a year, but make out like bandits. This RNC electoral mechanic introduced Rove, not as an American who understands the suffering of many Americans because he too suffered, but as a fellow alchemist mechanic-- no, better still, as an alchemist who could create electoral Gold out of BUSHIT!

Rove spoke about how the Democrats want to TAKE from those who have and so this election is about PREVENTING the have-nots from taking from the haves. Indeed, Karl Rove, himself once the victim of bad times who made good as an electoral mechanic, was introduced as the gimmick man that could make false hope into true deception.

This meant a lot to me because I saw both sides of the hill as a refugee for more than a decade, one step ahead of the Communist totalitarianism that had eaten my country. When I came to America we were on Catholic Charities Relief. My dad, a doctor and medschool professor back home, stayed in the Midtown Manhattan Hotel room we lived in killing rats with the back of a spoon. Eventually, he got a job as a collaborator with one of America's greatest researchers. And so we moved up in the world, to Harlem. There, I noticed, that, unlike the Midtown people who never had time to help out and so if I got lost I would never find my way back to the hotel, the Harlem blacks had PATIENCE....PATIENCE with my poor English....patience with my ignorance about America....patience with my fear of Communism...Patience with my wish to return to the Europe I knew...Patience with my confusion with their color and their ways. They took me in, their kids became my friends and often their daughters became my dates. In those days, if you liked a black girl, it wasn't like today; FIRST YOU HAD TO PASS THE GATE WITH HER DAD. And even my male friends, when I came to their homes, their parents looked me over head to toe before they smiled and opened their hearts with pity for this lost boy from across the ocean who was sad because he didn't want to be on this continent but whose father had insisted since way back in East Europe that we had to go to America, the "Paradise of Freedom." As I got to know my neighbors they began to introduce me to America. Nobody told me about how WHITE AMERICA screws BLACK AMERICA. Instead, they told me that I shouldn't worry because I was lucky to be in America and if-- like them, I HOPED-- eventually everything would be alright.

There was a particular black girl I had met who took me to meet her family. Her dad was a hard man. But he never saw my color, he was too busy trying to figure out my intentions. When he realized that I became as interested in him as in his daughter, he sort of adopted me and showed me his greatest pride: HIS ARMY DISCHARGE PAPERS. This man had fought in Korea and he was very proud of that because, he told me, it was the FIRST WAR IN WHICH BLACK AMERICANS FOUGHT AS *EQUAL* SOLDIERS. This was my "American dad," for he was the first American to make me HOPE that this America of his would some day make me feel a part of it.

Things got better and we moved to Queens into our own home. But I would still return to Manhattan for intellectual stimulation. I would attend Friday and weekend philosophic discussion groups at the NY Ethical Culture Society. There I met Communist, and more Communists, and still more Communists. I FELT SURROUNDED BY COMMUNISTS. In my heart there was fear, but there was hope that I could overcome my fear of Communists by debating with them the way I had overcome my fear of Americans by living with black Americans. The Communists too had patience with me. But my parents didn't. In panic they reported my "subversive activities" to the FBI. They disowned me because they could never understand that I was not getting swallowed by the Communists but was immunizing myself against fear of Communism by trying to understand them. But though a victim of Communism, when I went to college in Mid-West America, I--- a refugee from Communism-- was denounced as a Communist because I thought them Reds far deeper than the stereotypes muttered by fear-mongering denouncers of "Godless Commies."

Eventually I went to the University of California Berkeley, where I walked into a Commie-led student Revolution, headed by all the NY Commies I knew from the NY Ethical Culture Society activities. But they were NOT fighting for Communism. They were fighting for civil rights and for meaningful dialogue-- revolutionary ideas in America at that time. But when they got back to Commie causes I fought them by invoking the very meaningful dialogue they had demanded. And I got meaningful dialogue from these Commies, just as they had promised. I had also joined with them in fighting for civil rights....But here I was not alone, for CALIFORNIA CONSERVATIVES FOR POLITICAL ACTION was with them in on both causes. For that reason, upon returning East, I joined Young Americans for Freedom (YAF), Bill Buckley's young conservatives movement, to fight Communism abroad. I got to be NY and NJ State Chairman so I came to know the American Conservative Movement pretty well from the inside. What I noticed is that, unlike the right and left idealists of the UC Berkley FSM, these were all organization men. They were not there for cause, they were there to insert themselves into a bureaucracy to nowhere a richly endowed by the corporate establishment. These YAFers didn't seem to care about Goldwater's hopeless quest and the ideas behind it. All they cared about is climbing as bureaucratic cannibals in their rigid organization to nowhere. They didn't discuss conservative philosophy, as some others did, or intellectual struggles for freedom, nor even the realities of Communism as a world movement. They only applauded like seals but they never tried to understand what and why they were fighting against. As I tried to discuss the human side of the Viet Cong terror and American firepower in Vietnam as I experienced it, infiltrating both sides, I found little interest in ideology. Instead, making connections and getting ahead of the next guy and campaign position jockeying in the Nixon and Reagan Campaigns was all they ever got excited about. I FOUND THAT YAF-- LIKE SDS ON THE LEFT-- WAS MADE OF HYPEREMIC ORGANIZATION MEN WHO SOUGHT TO CLIMB THE BUREAUCRACY BY EATING THE MAN ABOVE THEM SITTING ON THEIR HEADS. That's just like the East European Communist Parties I had known-- NO philosophy, NO ideology, NO human hope-- just organization and cannibalistic bureaucratism, just as Eric Hofer, then my favorite author, spoke of in his book on "true believers."

In 2000 I thought Bush a moral savior from Clinton debauchery. So I called Texas and offered full support. Karl Rove called back and was very nice; but he said that they had written off the Northeast from their electoral game plan. I couldn't believe it. So I arranged to retire in time to work for the 2004 Campaign and prove that ALL America is Bush country. After surviving the World Trade Center on 9/11, I dropped all my plans to join the struggle against "terrorism." But by March 2003 I realized that something was wrong, that it was all a fraud. Still, I stayed loyal, thinking: no, it's me, not them; they know what they are doing. But I soon realized what a fraud it all was because friends in DoD and Dos and NSC were leaking to me what a fraud it all was.

With time, I came to realize what a horror the Rove Machine is. But I also realized that it was far worse; the problem was a lot more Americans than Rove, Americans that suffered from the "ain't my kid going to Iraq" disconnect syndrome," willing to see the other guy go fight in Iraq intelligence blind, killing and being killed, so they back home could get cheap oil to fill-er-up their SUVs. NOW MY BATTLE WASN'T WITH GW BUSH BUT WITH ***AMERICANS*** IN GENERAL BECAUSE IT IS THEY WHO LET 9/11 BE AN EXCUSE FOR THE DESTRUCTION OF THE CONSTITUTION THAT SO MANY GENERATIONS DIED TO PRESERVE FOR POSTERITY-- LIKE WHAT MY ADOPTED BLACK AMERICAN DAD WHO FOUGHT IN KOREA HAD FOUGHT FOR.

GW BUSH'S CRIME IS THAT HE IS A FAKE; FOR IT WAS TOTAL ***BUSHIT*** THAT HE WAS THE "DECIDER"...RUMSFLED-CHENEY WERE THE DECIDERS FOR BIG OIL, SWITCHING US FIREPOWER AWAY FROM TERRORISM IN AFGHANISTAN TO OIL THEFT FROM IRAQ.

IN ALL THIS ROVE WAS NOT AN IDEOLOGUE, HE WAS A "MECHANIC." HIS JOB AS THE "ARCHITECT" WAS TO DELIVER THE LEMMINGS FOR BUSH ON ELECTION DAY. HE WAS THE PIED PIPER MECHANIC, NOT AN IDEALIST.

And so, as I listened to Obama today calling for "unity" produced by SEEING each other from within eachother's eyes, I realized that he was calling for an end to HISTORICAL EXCUSES, be they hate of whites for slavery and racism or hate of Muslims for 9/11, so that we could unite to save our country rather than selfishly deplete it in an economic jungle of non-productive shyster "entrepreneurs"-- the French word that means THE TAKER IN BETWEEN. In fear of Islam we abrogated caring for each other-- whether Muslim-Americans, victims of fear, or soldiers sent in repeated tour after tour to fight intel blind in Iraq. Obama is calling for us all to stop fearing each other and to unite as one people, helping each other. America was made by good Samaritans and good neighbors, he insisted, and over the decades we expanded our generosity to include more and more of us in our American compassion....Obama was crying out for unity to reverse the current jungle entrepreneurship by which we can no longer see eachother's pain and eachother's tears. And this he said before both blacks, the victims, and whites, the perpetrators; before poor, the victims, and the rich, the perpetrators. This, insists Obama, IS THE GREAT AMERICAN TRADITION OF COMPASSION OF NEIGHBOR FOR NEIGHBOR. And so, calling for a return to the tradition of neighbor joining with neighbor-- instead of a revolutionary new violation of this tradition through more freedom for the taker in between (the entrepreneur) to prey on his weaker fellow American-- makes Obama THE REAL COMPASSIONATE CONSERVATIVE, calling on us to return to our roots of compassion instead of to the Rove Republicans' corrupt conspiracy of the few using absolute power to bleed the many.

Rove, on the other hand, spoke as if this were 2004, when the Republicans controlled the Presidency, the Congress and the Senate. In 2006, the American people said: "enough!" They felt shame, they felt uncomfortable with the "entrepreneurial" law of the jungle. They saw that greed makes smart men into fools and makes the incompetent rise to the top. Yet in introducing Rove at the RNC Conference I saw on C-Span tonight, the Republican mechanic spoke as if all it takes to win in 2008 is for the RNC's professional mechanics to organize and, with money from the entrepreneurial carnivores, they could capture the lemmings, even while stalking them, running them down and devouring them. Rove spoke of the Dems as wanting to raise taxes on American families in a fit of governmental one-size-fits-all health care that is fiscally irresponsible while surrendering national security to "Islamo-fascism." In other words, Rove thought Americans too stupid to realize how he and his fellow RNC mechanics drowned America in BUSHIT for the last seven years. He didn't care how on to him we all are, for all that was needed is for the RNC mechanics to get together and line up the lemmings for the slaughter. His speech before the RNC this week was EXACTLY like his speech before the RNC during the 2006 Congressional campaign. It didn't matter that the Republicans lost Congress then. To him it is all particle physics; to him we are each mere molecules in Brownian motion, going from solid to liquid and onto gas, depending on the controlled temperature he and his mechanics impose on us. He and the other RNC mechanics, HE INSISTS, are physics technician that convert matter from one state to another at will, based on the thermodynamic energy in campaign funds and organization they infuse in us.

Rove is a psychopath who cannot live outside the "architect's world" he created in his own political mechanic mind. He is a sociopath who could care less about the pain and death he causes. He is not shaken up, he is not sorry. He is only enraged by his failure to control. This is the mechanic serving the RNC entrepreneurial carnivores. This is the kind of YAFers I came to know decades ago-- now all grown up, they too became Rove's mechanics....NOT REAGAN'S DISCIPLES, FOR REAGAN WAS A COMPASSIONATE MAN WHO CARED ABOUT PEOPLE AND, EVEN AS PRESIDENT, NEVER THOUGHT HIMSELF ABOVE ANYONE. Before my dad died he said: "Reagan made me a pauper, but I love that man." Though they never met, after my dad died, Reagan sent my mom a long personal letter of condolences. SO ROVE IS NO REAGANITE, HE IS ***TOTAL BUSHIT***. BUT WHILE BUSH IS A SPOILED BRAT WHO CAN'T UNDERSTAND REAL WORLD SUFFERING AND CAN'T SEE BEYOND HIS OWN REFLECTION IN THE WHITE HOUSE MIRRORS, ROVE IS A MAN WHO SEES ALL THE SUFFERING AND ALL THE PAIN AND SAIS: SO WHAT, I STILL CAN DUPE THEM ENOUGH TO PULL OFF ANOTHER ELECTORAL COUP...IT'S ALL HEARTLESS MECHANICS AND WE ARE ALL QUANTIFIABLE PARTICLES! That's not Reagan, that's not compassionate conservatism. That's sociopathic schizophrenia, like all the "mechanics" bred and raised by College Republicans!

In contrast, Obama spoke, not just like Martin Luther King, but like Jesus Christ; for he called for FORGIVING each other so we can see each other instead of blindly blaming each other. That's the PREREQUISITE, said Obama, to UNITY and REAL Compassionate Conservatism-- the real-- DEMOCRAT TYPE-- compassionate conservatism that the Founding Fathers used to create America; that America was fueled by in absorbing the wretched tired and poor that washed full of HOPE upon its shores, people like me. It's no accident that my "American Father" was a black man in Harlem. Instead of hate for "whitey" he felt compassion for a poor wretched foreigner that washed upon HIS shores. Obama is asking for no less. And in disciplined Christianity-- no, he is not a Muslim as FOXNEWS tried to insinuate to generate hate against him-- he tells us that TOGETHER we can crash the walls of despair that have grown around us, just as TOGETHER, led my Martin Luther King, we crumbled the walls that enslaved black Americans for so long.

So, Republican or Democrat, whenever you rise to take a stand in the course of this 2008 electoral campaign, the first and most important question you must answer is: ARE YOU A PREDATORY SOCIOPATHIC MECHANIC LIKE ROVE-- seeking to polarize us into a 51%-49% wedge majority of frightened entrepreneurial predators-- OR A COMPASSIONATE CONSERVATIVE LIKE OBAMA-- seeking to unite us in a common struggle to save America's tradition of saving ALL Americans?

I weep tears of hope, particularly on this day devoted to Martin Luther King, because Obama has liberated me from tears of despair forced on me by Rove's RNC mechanics and the Democrat Rove wanna-bes, indeed in both parties. God bless you Obama, you did an old man good today. Thank you.

Daniel E. Teodoru



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debbierlus Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-21-08 01:25 AM
Response to Original message
3. No. NONE of them have a workable plan

Because NONE OF THEM will take on the HMOS & big pharm to work for a NOT FOR PROFIT health care system.

Obama stated in the debate 'not practical'.

Nice try. Most of us have seen Sicko & the man who made this documentary, Mr Moore, says his the LEAST viable option.

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Bishop Rook Donating Member (252 posts) Send PM | Profile | Ignore Mon Jan-21-08 03:56 AM
Response to Original message
4. This isn't entirely accurate
While it is a well-balanced piece, Obama doesn't ignore the issue of preventive care as this seems to suggest. I've heard him talk about the issue of preventive care several times before, including at a rally I attended last year in Atlanta. He used the example of a diabetic patient going to the emergency room for a foot amputation that could have been prevented if he'd had long-term access to insulin, and that the latter would cost the health system less, but our current system isn't designed to favor it.

Too tired to look up the quotes, but I'm sure somebody else can.
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-21-08 09:11 AM
Response to Original message
5. Kick! n/t
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-21-08 03:34 PM
Response to Original message
6. Obama and technology
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jan-25-08 05:36 PM
Response to Reply #6
12. Kick! n/t
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jan-21-08 09:15 PM
Response to Original message
7. Kick! n/t
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teleharmonium Donating Member (64 posts) Send PM | Profile | Ignore Mon Jan-21-08 09:41 PM
Response to Original message
8. good thread and thank you n/t
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jan-22-08 09:51 AM
Response to Original message
9. Kick! n/t
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magatte Donating Member (323 posts) Send PM | Profile | Ignore Tue Jan-22-08 02:41 PM
Response to Original message
10. superb diary
k&r
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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jan-24-08 12:19 AM
Response to Reply #10
11. Agree, thanks! n/t
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