no matter what we do…

Posted on Wednesday 28 October 2009

Joe’s Other Switcheroo
Talking Points Memo

by Josh Marshall
October 28, 2009

Reformers are all up in arms over Joe Lieberman’s new effort to scuttle health care reform, for good reason. What got far less attention was that between yesterday and today Joe completely changed his rationale for why he thinks the public option is a bad idea. Indeed, explanation two contradicts explanation one. And number two is so nonsensical as to suggest he’s making up the reasons for his opposition as he goes along.

Yesterday, Lieberman argued that the public option is a new entitlement that will balloon the deficit. I don’t think it’s a good argument. But there is a logic to it. He was basically saying that the government will start a public option, have the program run into trouble and then have to come in and bail it out,. So more money added to the federal debt. Here’s the quote …
    I think a lot of people may think that the public option is free. It’s going to cost the taxpayers and people who have health insurance now. and if it doesn’t its going to add terribly to our national debt….all the history we have of health entitlement programs, including [medicare/medicaid] is that they end up costing more than we’re prepared to pay.
Again, there are some real holes in that argument. But the idea that the government might later have to get into subsidizing the public option isn’t crazy. But this morning he changed his argument completely. He now says that the public option will work so well at negotiating good deals with hospitals, doctors and pharmaceutical companies that those companies will be out a lot of money and they’ll have to make it up by charging higher rates to private insurers, thus upping everyone’s premiums. Here’s Lieberman this morning on Fox …
    If the public option, the government run health insurance company, negotitates hard to lower the reimbursement, the money it’s paying to hospitals, doctors, they’re gonna have to get that money somewhere, and where they’re gonna get it is from the 200 million americans who today have private health insurance. Premiums will go up. It’s exactly what’s happened with Medicare and Medicaid. My hospitals in Connecticut told me a while ago that they get 70 percent of the average cost of patient care from Medicaid, about 90 percent from Medicare. If that was it they’d go out of business. So they charge the private health insurance companies 130 percent of the average cost, and that’s what would happen with this new entitlement, new government run health care program. It’s just not worth the risk.
Now, that’s a totally different argument and it leaves out the fact that the public option will be competing against the private insurers — at least with a certain number of potential customers. So private insurers will be under a lot of pressure not to allow their rates to get too far out in front of the public option. The key with Medicare and private insurance is that they deal in pools that are totally walled off from each other. Lieberman seems to completely ignore what most assume would be downward pressure on private insurance costs since the private insurers will have to be competing, at least to some degree, with a lower cost competitor. Insurers obviously have a great deal of negotiating leverage too. So it’s not like they simply have to accept dictates from the providers.

Admittedly this is all a bit deep in the policy weeds. But it does point to what experience with Joe suggest — which is that this is opposition for the sake of opposition, the politics of pique. Why else would change his argument overnight?
There’s nothing wrong with his arguments. Joe’s first argument is alarmist, but possible. The second is what you would hear from any private hospital administrator or private physician, and it’s more or less true. What is left out of these discussions of Health Care Reform is what matters, not all the things that are being talked about.

Health Care costs too much, no matter how you look at it. Joe doesn’t get that. It’s not the fault of Medicare, Medicaide, Private Insurors, Doctors, Nurses, Drug Companies, Hospital Corporations, or any other entity. It’s the fault of the whole system combined – all entities involved. The bottom line is simple, Health Care costs too much. Obama knows this. If you listen to him talk on the subject, he always says it, though it’s rarely picked up on by the reporters. The whole point of Health Care Reform is to bring down the cost of Health Care. So, the public option, a sort of Medicare level reimbursment program scares the be-jesus out of the medicine-as-business types. It should scare them because they need to be scared. Either their system changes or they go south.


Why are there so many uninsured people? Why do businesses balk at having to provide Health Insurance? At the risk of being monotonous, it’s because Medical Insurance costs too much, because Health Care costs too much. Health Care Reform proposes to make sure Health Care is available to all people by insisting that everyone be covered. That won’t work if Health Care costs don’t come tumbling down. Okay, I’ll say it just one more time. Health Care costs too much.

Whose job is it to fix that problem? The Health Care Industry is the answer. They are raising holy hell right now, because there’s going to be less money flowing into Health Care, and the system is going to have to adapt. The only alternative is true socialization of Medicine and Americans don’t want that.

So there are three options:
  1. Cut the hell out of medical costs.
  2. Socialized Medicine like England has.
  3. Go on as we are.

The last choice is no longer available. It’s past its prime. Medical Care isn’t going to go out of business. It’s just going to change a lot – a whole lot – no matter what we do. The sooner we all recognize that, the better the inevitable changes will go.

I’m a doctor and a person who is fine with American Free-Market Capitalism, except in Medicine. Sick people cannot "shop." They are at the mercy of the system. So my own views are to the left of what’s being proposed, and I know that America is not going to nationalize medicine like some other Social Democracies have. That would be my preference, but it won’t happen. So my personal views don’t really matter because they’re unrealistic. But I feel like commenting on what is proposed anyway because there’s really no debate any more. We’ve put off dealing with this so long that people are regularly dying because of our dawdling. It’s time to act, to do the best we can. Doing nothing is no longer an option…

By the way, I agree with the Conservatives on one point – Tort Reform is important. Malpractice suits and Malpractice coverage are mega-contributors to medical costs.
    October 29, 2009 | 10:04 AM

    There are two main reasons medical care “costs too much.” The first is what’s being talked about. The second is that it is expensive because of all that we now can do that wasn’t even dreamed about when it didn’t “cost too much.”

    Eliminate organ transplants, exotic imaging techniques, angioplasty, chemotherapy, genetically engineered drugs, and other $1000 a dose drugs, etc. etc. — and we wouldn’t have this problem. And we wouldn’t have it in part because all the people who are alive now due to these things would be dead. And the dead do not utilize medical care.

    So — we should expect that medical care costs are going to skyrocket simply on the basis of new things we can do. This raises questions of who pays for it all, and should there be limits on when, and for whom, to use these new treatments?

    But we have to solve the first reasons (obscene profits and administrative costs for drug and insurance companies, unfair exclusion from coverage, etc.) before we can tackle the ethical and philosophical second questions.

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