Staff Writer Alix Walker examines the causes of Obama’s slipping healthcare poll numbers.
Alix Walker, Staff Writer
Ideology: Moderate Conservative | Writing in: Madison, CT
President Obama’s approval ratings are dropping. All of the drastic changes he has been pushing for are gradually starting to evaporate. His expensive efforts to push an unrealistic health care bill are costing him support and credibility. There is a disconnect between what he is saying to the public and what Congress is presenting in their bills. The result? Public distrust.
The health care bill has been a continuous headache for the President, who still fails to bring any clarity to the country on how the bill will be successful. Although his approval ratings are still above 50% thanks to his speaking capabilities, his ratings for overall job performance are dropping, and dropping fast.
The House Energy and Commerce Committee voted 31-28 on Friday to approve legislation to overhaul the US health system, clearing the way for a pivotal vote in the fall. The House and Senate, set to go on recess next Friday, will head home without meeting President Barack Obama’s goal of passing a major health legislation this summer. This project is a core commitment of the new presidency, and as any politico knows ,when a bill isn’t passed before summer recess it is a sign that it has issues that are unpopular and need to be resolved. Historically, when a bill isn’t passed before summer recess it is a sign that it is losing ground, and won’t pass at all.
Falling support for healthcare may be because of three issues: expanding coverage, new employer requirements, and new taxes.
The expanded coverage seems to be the most important of considerations because it sets up a government-run program to compete with private insurers. Many feel this is unworkable. About 87% percent of the country has health insurance and is happy with it. They don’t want to see it change and they do not want government to control it. They’re worried about increase in costs and co-pays, no question.
Under the bill, employer requirements mandate that businesses with annual payrolls of over $500,000 must offer employees coverage or pay a penalty to the government, which may or may not use those funds for payment of the uninsured. These added expenses might force small businesses to cut back employment or go out of business all together.
The third problem is an imposition of new taxes. The budget office has said this program will cost over a trillion dollars over the next 10 years and Obama is saying it won’t. Who do you believe? Like in any estimated cost the total cost comes out to be considerable more than expected. (Of course this would add to the deficit.)
To pay for expenses, the bill will cut into Medicare and then ration out medical care for the elderly, young children and terminally injured or ill. Buried somewhere in the 1,000 plus pages is a provision to severely limit what Medicare pays for CT and MRI scans performed in doctors’ offices. This would force elderly patients, for example, to go to the hospital for their radiology — where there are often lengthy waits. Patients in rural areas, who must travel long distances to get to hospital-based testing facilities, may be discouraged from getting the tests done at all.
These are the things hidden in the 1000 plus pages of this bill. Thank prudent judgment by some that this has not been passed. Lets hope that this judgment will be used over the next few months to thoroughly analyze this bill. Every American citizen has to ask the question “how much control of my life and health am I willing to give to the government?”
My answer? Very little.
The little things hidden in the bill will start to come out one-by-one over the summer recess. For example, worse care for seniors, trouble attaining care of those with “pre-existing conditions” etc.
These things will be the death-blow to universal healthcare.
All in all, I think we’re going to end up with a reform of the insurance companies and how they do business, sort of like the tightening of restrictions we saw on wall street following the collapse.
I know that your post is criticizing the Bill specifically, but I think you brush past the fact that there are TONS of problems with the health care system now, and they need to be fixed.
Health care is ridiculously expensive, and basically unaffordable if your employer doesn’t offer insurance. Maybe it isn’t so bad for the young and the healthy, but if you have cancer, HIV, or any other long-lasting and risky disease, it is very unlikely that any company would choose to insure you at all, and if you’re lucky, you’re looking at approximately $1,000 a month.
Beyond cost, the notion of a “pre-existing condition” isn’t something new in this bill, in my understanding, a major goal of the bill is to stop insurers from being able to deny coverage of a pre-existing condition, something that happens now and is downright criminal. As if it is a person’s fault that he developed cancer.
The desire of the government to help the uninsured and to make health care more affordable to the masses isn’t made out of some desire for government control. People who are privately insured and happy with it can keep it. This reform is built out of compassion for those who pay too much and get too little care.
The fact that it cuts into medicaid is because the Republicans on the committee refused to allow any money for the Bill to come from outside the health care sector… where else do they have to look?
The entire idea of “universal health care” is a utopian pipe dream that neglects that the world has only finite resources.
Getting rid of “pre-existing conditions” and other mandates will simply increase premiums for everyone. Health insurance is one of the lowest-profit sectors of our economy and the money must come from somewhere. It will come from EVERYONE who has insurance.
If you have cancer or HIV, you are terminally ill. It is great that people feel sorry for those people, but there is no amount of care that can help MOST people with cancer or ANYONE with HIV. These are illnesses that kill people and the reality that we must one day face is that we simply do not have the resources to assure everyone cutting-edge care that saves a small amount of people compared to the millions that die every year from these terrible illnesses.
It is an unfortunate reality that we face, that no matter how progressive our tax system, and no matter how much people may “need” to consume such an important service as health care, the world’s resources are finite and we simply cannot give away the American standard of living for free to anyone who comes out with open arms.
There is a reason why people from throughout the world come here for health care. We might not be the world example for egalitarian utopia on account of having a (largely) private health care system, but we do have the highest survival rates in the world for some of the most serious illnesses because we are the tip of the spear when it comes to care.
We also continue to develop the most advanced drugs that the world has ever seen, while subsidizing the rest of the world’s use of those drugs, because someone must bite the choke, and the “universal health care” systems of other economies are really just “monopsonies” that force firms to sell below marginal cost.
We will never solve this economic problem unless we face the facts. Unfortunately, that’s not politically palatable so I don’t see any of this going anywhere anytime soon.
Tim, I do appreciate your economy based perspective, and you’re right, health care for all will be expensive and if we wanted to do it right, we’d have to raise taxes. That’s how they do it in Europe. However, your information about HIV and Cancer is incorrect, and its not a mute point because those two diseases are at the core of the health care problem injustices.
HIV is not a death sentence at all anymore, it hasn’t been since the early 90s. There are drugs that can keep people alive for a completely normal life-span, its called the triple cocktail. They cost $14,000 a year in the United States and about $500 a year everywhere else. The price here is because of patenting laws. Because they are so expensive, insurance companies do not cover them, and anyone with HIV is considered “too expensive” to insure. I’m sorry, call me a softy, but it doesn’t sit well with me to leave people to die because they can’t afford over-inflated prices.
Cancer in most forms is not a death sentence either. While a big killer yes, chemo and radiation save huge amounts of people every year. Another thing not always covered by insurance. And say you beat cancer and then try to get insurance 5 years later, pretty unlikely anyone will cover you, you are too high risk.
It is a myth that seems very popular in the states that socialized medicine in European countries causes sub-par care. Maybe it isn’t state of the art, give me an MRI whenever I want, but people are healthy, with just as long life-spans, and living without fear that an accident or disease will bankrupt them for life.
I recently went to the doctor in the Netherlands for an asthma inhaler. I paid 40 euros total, and I didn’t bother with my insurance. That would have been free for a Dutch person, and would have cost me a $40 co-pay in the States. Without insurance, it would have been hundreds. There is something wrong with the US system. Perhaps this bill wont fix it, but we need advocate that this change.
“It is a myth that seems very popular in the states that socialized medicine in European countries causes sub-par care.”
This is certainly not a myth. Europe has a much lower cancer survival rate than the United States overall. What nobody wants to realize about the European and Canadian health care system is that extensive rationing keeps the prices low for everyone. A year of life has a specific monetary value and if your care costs more than this, you will not be given the care and you will either seek care in the United States or die.
There are a lot of problems with our health care system, most of which, I think, stem from our 85%+ insured population that consumes almost endlessly, while the rest suffer, denied access to the system entirely.
While reform is necessary, it does not follow that the government must run a public health care insurance company or mandate that everyone get coverage. We need to fix the delivery system far more than we need additional people’s access to the system.
Guys, gals, others, the erroneous information masking as fact in both the original post and Tim’s response is so overwhelming it would take me far too long to respond. Here are just a few tidbits:
Walker original post: “To pay for expenses, the bill will cut into Medicare and then ration out medical care for the elderly, young children and terminally injured or ill. Buried somewhere in the 1,000 plus pages is a provision to severely limit what Medicare pays for CT and MRI scans performed in doctors’ offices. This would force elderly patients, for example, to go to the hospital for their radiology — where there are often lengthy waits. Patients in rural areas, who must travel long distances to get to hospital-based testing facilities, may be discouraged from getting the tests done at all.”
Across all sectors of the health care system – the AMA, the AAMC, the AHA, AARP (look up the acronyms and learn something) – there is consensus that Medicare (as well as private insurance) must be changed because it rewards VOLUME over quality outcomes. Please read the series in the New Yorker to help you understand the consequences of VOLUME over outcomes in Medicare spending: http://www.newyorker.com/search/query?query=gawande&queryType=nonparsed&submitbtn.x=0&submitbtn.y=0&submitbtn=Submit
There is NO proposal in bills currently being debated to cut into current Medicare benefits NONE!, no one in Medicare will lose any benefits, and there is no proposal to ration medical care in the current versions of any bill. That is scare-mongering, and worse, supporting this rumor is CRUEL and UNFEELING. Elderly people face horrible and gut-wrenching difficult decisions about their health care, and the only part of the bill you could possibly be referring to is the proposal to reimburse physicians for private conversations with anyone who wants to talk about a living will to make their own wishes known to their doctors. In the status quo, a doctor has to volunteer their time to do this. Is that right?
The reason to limit what happens in doctors’ offices is because it is perverse, market-distorted incentive for doctors 1) buy an MRI machine (when a perfectly good MRI is down the street at the hospital) and 2) then order MRI on every patient who comes in 3) bill Medicare (AKA THE TAXPAYER) for every MRI scan and pocket the dough. Again, please read the New Yorker series to educate yourself.
And rural docs? People in rural communities already travel days just a for a physical, much less specialty care or tests, because there are no doctors anywhere in rural America! Please google “shortage of primary care physicians” and see what you get. One of the few things that EVERYONE agrees on is the need to provide funding to alleviate the loans of new MD graduates to encourage them to go practice in rural areas. That will solve the issues you bring up. Believe me, every person I know in a rural area applauds this provision.
As for the Tim comment, gosh where to begin. A good start is a dose of reality: try the World Health Organization statistics that show the US spends more money per capita with outcomes that are about equivalent to a developing country. A developing country!
Did you know that insurance companies spend nearly 20% of your premium on figuring out who to disqualify for pre-existing conditions? And 17% for executive compensation? And about $1000 of an annual family premium is jacked up due to the cost of covering the uninsured? Someone without insurance goes to the ER and by law receives treatment. There is no free lunch…the costs get passed to those who can pay – THIS IS A HIDDEN TAX. I’d rather have my taxes overt. Even a clear market-based advocate as yourself must see that the current system is a collection of archaic, perverse, dysfunctional market signals that need clarity.
One last thought: we already have GOVERNMENT RUN insurance – it is called MEDICARE. And because Medicare sets the rates by which private insurers benchmark their reimbursements, our entire system is premised on the GOVERNMENT. Check out the column by Krugman to learn more..here is an excerpt:
At a recent town hall meeting, a man stood up and told Representative Bob Inglis to “keep your government hands off my Medicare.” The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program — but the voter, Mr. Inglis said, “wasn’t having any of it.”
It’s a funny story — but it illustrates the extent to which health reform must climb a wall of misinformation. It’s not just that many Americans don’t understand what President Obama is proposing; many people don’t understand the way American health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance.
And that government involvement is the only reason our system works at all.
http://www.nytimes.com/2009/07/31/opinion/31krugman.html
We should not be using Europe as an example of good healthcare!
People in Europe may be living without fear that an accident could leave them bankrupt for life but the poor care they receive is midieval at best. It is one thing to pick up prescriptions but it is another thing when you need to be hospitalized.
I had far more visits to the hospital than I’d like to admit while living in Europe, for serious injuries and I would have been better off going to my horses vet for help. In many cases I should have had an MRI and my problems could have been fixed by simple operations. But the doctors were to lazy or just didn’t care. Instead, I waited till I moved back to the States to get second a assessments and found out that there wasn’t much that could be done now and action should have been taken just after the accidents.
I know situations are similar in the ER here in the states but, the doctors are much more thorough and if you need an MRI you get one and it could be the difference between walking normally or being in pain for the rest of your life.
“As for the Tim comment, gosh where to begin. A good start is a dose of reality: try the World Health Organization statistics that show the US spends more money per capita with outcomes that are about equivalent to a developing country. A developing country!”
Or you could consider that perhaps their methodology of measuring such things is questionable, and look at the analysis of a Nobel Prize-winning economist, which is available free of charge right here:
http://www.becker-posner-blog.com/archives/2009/07/mortality_from.html
Essentially, once you account for our risky lifestyle (which is a consequence of being the richest nation on Earth, and our own personal choices), it is clear that we are by far the healthiest people and receive the best cutting-edge care in the world. To try to argue that we do not have a functional health system for those who do have access is illegitimate. Our system is not bad at saving the lives of sick people. It’s just bad at controlling costs, which can partially be blamed on technological advancement (cutting edge care is more expensive) and partially from administrative costs that are very high compared to other systems (where they have universal coverage, but also FEWER people).
Many health insurance companies aren’t run for profit. Your argument that it is the health insurance industries’ interest in preserving “profit” is exploiting people and driving up the cost of care is questionable at the very least, and possibly totally dishonest.
Yes you are correct that the current system may have corruption and inefficiency. That is an argument for more oversight and more competition, not an argument for a government-funded health system where the referee plays in the game.
Medicare is 20% of our current health care spending at most. In addition, we already have a program for the desperately poor–Medicaid.
What we need is a more competitive, robust, functional market. None of these are arguments FOR a government-run and mandated insurance program. In fact, they are arguments against these types of bloated bureaucracies that will decrease efficiency and raise prices for everyone.
See my own blog, here, for a beginning, fundamental level discussion on this issue:
http://timnuccio.wordpress.com/2009/07/29/problems-with-the-public-option-and-fixing-health-care-in-america/
Fortunately for all of us, we’re too smart to allow our government to run any more of our health care system. Some progressives think otherwise…but fortunately, this has been defeated every time it’s been tried since 1912.
Alix, you’ve obviously never been to an inner city emergency room lately, if ever. Enough said on that.
Tim, let’s see if I understand your argument:
* Our current system is “good” at saving the lives of sick people but “bad” at making people healthy.
*Our current healthcare system is good at providing cutting edge care, which is only needed in the rarest of cases.
* Our current system is adequate for those with access — in other words, money — but you take issue with characterizing it as profit-driven.
* Our current system is marked by generous-minded insurance companies, many of whom do not seek profits, and yet all insurance companies have a business plan, shareholders and a board of directors that think otherwise.
* Our current system is bloated and plagued by inefficiencies because it has grown up without being part of a government bureaucracy that’s bloated and plagued by inefficiencies.
* We should be smarter than to entrust our government with taking an active role increasing access to and the quality of our health care but we should perfectly content to stick to less important things like waging wars, transportation safety, environmental protection, food safety, our energy sector, etc.
That’s far too many internal inconsistencies to even take you seriously.
To me it’s simple: the capitalist system exists to serve people, and not the other way around. If – when – the system can’t deliver, then we have to figure out how to fill the gaps. We’ve clearly seen how profit mongering and human greed can derail the monumentally flawed “trickle down theory” and as a result, we can, and must, look to the government for solutions.
As an aside, while the blog you mention provides excellent insight into the minds of two white men of privilege, the grumpy ramblings of a single Nobel winner in no way diminishes the science and methodology of the WHO, which features – literally – dozens of Nobel laureates.
As another aside, many good ideas, like ending slavery, allowing women to vote, allowing members of the same sex to get married were voted down for many years. That doesn’t mean common sense, decency and the will of the people won’t ultimately triumph.
“Our current system is adequate for those with access — in other words, money — but you take issue with characterizing it as profit-driven.”
This could merely be a function of its cost. Profit for the insurance companies is merely a subset of the cost of care. If you’re advocating a world full of doctors that work for nothing, then we’re making a different argument. Other than that, the existence and success of nonprofit health insurance is a counter to your assumption that if we could just reduce profit, that additional services would follow. The fact is that this is a red herring and has very little, if anything to do with the inefficiencies of our health care system.
Your so-called “business plan” is that they must stay afloat. This is based on the scarcity principle; that the world has only finite resources. The same is true of government, it has just, as of the last 30+ years, been willing to spend into deep deficits to subsidize consumption beyond our means. If you want to live in a world beyond what we can pay for, I’m with you, but the fact of the matter is that this is unsustainable even in the short run and has no solution in sight.
“Our current system is bloated and plagued by inefficiencies because it has grown up without being part of a government bureaucracy that’s bloated and plagued by inefficiencies.”
On the contrary. 20% of health care is already on the teat of government, and that continues to rise. If allowed to continue to rise in perpetuity, it will bankrupt our government in short order.
“We should be smarter than to entrust our government with taking an active role increasing access to and the quality of our health care but we should perfectly content to stick to less important things like waging wars, transportation safety, environmental protection, food safety, our energy sector, etc.”
This is a straw man. The government has a responsibility to enforce the law and create an environment in which a market can function, but the existence of government “meddling” in the markets that you mention does not imply that it should continue to “meddle” where it obviously does not belong and will not enhance social welfare.
“That’s far too many internal inconsistencies to even take you seriously.”
No, you’ve simply lied to yourself about my position so that you can dismiss me and continue believing as you did before.
“To me it’s simple: the capitalist system exists to serve people, and not the other way around. If – when – the system can’t deliver, then we have to figure out how to fill the gaps. We’ve clearly seen how profit mongering and human greed can derail the monumentally flawed “trickle down theory” and as a result, we can, and must, look to the government for solutions.”
Wrong. The capitalist system exists to find the most efficient way to allocate resources. It cannot create consumption out of thin air. We either have it or we don’t. Borrowing to support an unsustainable level of consumption is morally unacceptable and only screws over future generations, who will have to suffer more because our generation could not produce enough to sustain its level of needs and wants.
I have never mentioned any “trickle down” theory. It is you who brought that up, which I want to make clear right now.
“As an aside, while the blog you mention provides excellent insight into the minds of two white men of privilege, the grumpy ramblings of a single Nobel winner in no way diminishes the science and methodology of the WHO, which features – literally – dozens of Nobel laureates.”
When you find a way to eliminate scarcity, let me know. Scarcity is central to every economic problem, not just this one. As soon as you do, I’m out of a job, so I’d like to be the first to know.
“As another aside, many good ideas, like ending slavery, allowing women to vote, allowing members of the same sex to get married were voted down for many years. That doesn’t mean common sense, decency and the will of the people won’t ultimately triumph.”
I have never advocating ideas like these to popular vote. But if you’re suggesting that a world in which our economy lacks the output to produce can exist by popular vote, you need only look at eastern Europe to see how false this is.
You are clearly enamored of, but unfamiliar with the business world if you think ANY private sector insurance company strives to merely stay afloat. They strive to make profits and return value to shareholders. They do that by maximizing the amount customers pay in and minimizing the costs they pay out to customers. Strong underwriting helps, as does “favorable claims experience” quarter over quarter but the most tried and true method is to deny coverage to high risk cases, deny claims and/or make it difficult for customers to actually use their benefits.
A nonprofit health insurance system would break their hold and force the business model to deliver on its promise of actually covering claims. If they want to make a profit, they will actually have to provide services and values people want. Currently, that is not the case.
And spoken like a true child of privilege, you bring the “scarcity principle” into the world of healthcare. We have the resources for all in this country to have stellar care while still bankrolling the medical profession. The current insurance system, however, simply cannot profit from good health, only from sickness and your much beloved cutting edge care for 1% of the population.
I don’t want to live in a world beyond what we can pay for, I want to live in a world where I GET what I pay for. And where all citizens get what we pay for.
Despite your theatrical turn of phrase, that 20% of health care on the teat of government is actually the only thing that’s keeping care available for those who need it most, and for those whom, without this teat, would clogging of ERs and driving up the costs of care for you, I, and businesses.
As for your straw man concerns, a phrase most often used by the floundering, the government has a responsibility to enforce the laws and create an environment of OUR choosing. It has nothing to do with the market, which is simply a term we apply to profit mongering. I, and many others, want accessible quality healthcare to part of the environment created by the government I invest with that power and fund with my labor and taxes. In the end, it will better support business – by keeping the workforce healthy – and lowering costs for all of us (except, perhaps, the insurance companies) when people aren’t forced to go without care only to seek out the heroic and overpriced “cutting edge” treatments as a last resort.
I don’t consider that meddling any more than I consider ensuring food safety meddling. I do considering spying on citizens meddling, but luckily those days seem to be behind us. What’s obvious to you is far less obvious to me and seems almost guaranteed to enhance social welfare.
Pretty sure I haven’t lied to myself any more than you are lying to yourself; your statements do not match up with your own logic model. But that’s ok. Clearly, you need more real world experience. Otherwise, how to explain your belief in a capitalist system that somehow magically exists alongside us. It only “exists” because we allow it to exist. It isn’t actually a real thing. And since it clearly is not allocating resources efficiently – think of the Enrons, the Bernie Madoffs, for example – it is the system that is creating scarcity. So it is the system that must be changed.
Borrowing to support an unsustainable level of consumption has nothing to do with morals. Allowing a flawed system that prevents access to quality healthcare does have something to do with morals. Which is why many of us are endeavoring to change the system.