Regular commenter weboy takes on the public option in the healthcare debate, and makes some good points:
Just
to be (slightly) contrary, I do know people who are quite satisfied
with their healthcare - young office workers, mainly, who are largely
healthy and who are comfortably insured by their employers. They are
the people insurers want - people who go to the doctor occasionally,
whose biggest concern is an allergy pill or birth control, whose basic
relationship with the system is a copay at the doctor and another at
the drugstore. Remember, some 85% of the population is insured, and
many may favor a public plan... even though they'll never need it. The
"it's nice... for someone else" may mean that the vague support for a
"public plan" lowers when you get into specifics.
I like Gawande well enough, and he's got some good observations...
but he's a doctor, with a doctor-centered notion of how we fix
healthcare... and the real fixes we need - changes in the way doctors
practice, changes in the way people access care, and even more
fundamental changes to patient expectations - don't favor the status
quo. And they're not easy. We shouldn't oversell what's under
discussion just now - at best, we're creating a new system where some
percentage (though not all) of the uninsured will be able to get
insurance... whether that means they get better, affordable care
remains to be seen... but the possibility that we'll simply expand the
insured without bringing down costs is also very real - that's been the
basic unfolding of the situation in Massachusetts.
A "public plan" is not necessarily the "hill to die on" about what's
under discussion; it's a key piece, yes, but it will be less than
meaningful if, for instance, the subsidies for the working poor aren't
in place to make it possible for people just over the poverty line to
pay for it. Similarly, no one has examined the real elephant in the
room - Medicaid, which, has enormous funding problems, and 50 different
operations across the states, which are not delivering equivalent
operations, or care, to the most needy.
A public plan that "looks like Medicare" is as much a kind of hazy
propaganda as the kind of opposition the right is giving - it's taking
some nice hot button words and stringing them together, without
examining the reality in detail. Medicare has problems - reimbursement
rates for one thing, are an enormous issue that's being deliberately
ignored, and Medicare has not, really, shown itself able to incentivize
"best practices" or really question poor care (remember those "low
administrative costs"? That's because Medicare doesn't have a large
operation to question the billing of procedures). A public plan,
really, is a vehicle to getting closer to a 100% insured population.
Without it, we have no realistic hope of achieving that goal... but the
rest of what it can or might do... is really very debatable.
Comments
Comment of the Week: Another View on Healthcare
Regular commenter weboy takes on the public option in the healthcare debate, and makes some good points:
Just
to be (slightly) contrary, I do know people who are quite satisfied
with their healthcare - young office workers, mainly, who are largely
healthy and who are comfortably insured by their employers. They are
the people insurers want - people who go to the doctor occasionally,
whose biggest concern is an allergy pill or birth control, whose basic
relationship with the system is a copay at the doctor and another at
the drugstore. Remember, some 85% of the population is insured, and
many may favor a public plan... even though they'll never need it. The
"it's nice... for someone else" may mean that the vague support for a
"public plan" lowers when you get into specifics.
I like Gawande well enough, and he's got some good observations...
but he's a doctor, with a doctor-centered notion of how we fix
healthcare... and the real fixes we need - changes in the way doctors
practice, changes in the way people access care, and even more
fundamental changes to patient expectations - don't favor the status
quo. And they're not easy. We shouldn't oversell what's under
discussion just now - at best, we're creating a new system where some
percentage (though not all) of the uninsured will be able to get
insurance... whether that means they get better, affordable care
remains to be seen... but the possibility that we'll simply expand the
insured without bringing down costs is also very real - that's been the
basic unfolding of the situation in Massachusetts.
A "public plan" is not necessarily the "hill to die on" about what's
under discussion; it's a key piece, yes, but it will be less than
meaningful if, for instance, the subsidies for the working poor aren't
in place to make it possible for people just over the poverty line to
pay for it. Similarly, no one has examined the real elephant in the
room - Medicaid, which, has enormous funding problems, and 50 different
operations across the states, which are not delivering equivalent
operations, or care, to the most needy.
A public plan that "looks like Medicare" is as much a kind of hazy
propaganda as the kind of opposition the right is giving - it's taking
some nice hot button words and stringing them together, without
examining the reality in detail. Medicare has problems - reimbursement
rates for one thing, are an enormous issue that's being deliberately
ignored, and Medicare has not, really, shown itself able to incentivize
"best practices" or really question poor care (remember those "low
administrative costs"? That's because Medicare doesn't have a large
operation to question the billing of procedures). A public plan,
really, is a vehicle to getting closer to a 100% insured population.
Without it, we have no realistic hope of achieving that goal... but the
rest of what it can or might do... is really very debatable.
My Dirty Life & Times
Tom Watson is a journalist, author, media critic, entrepreneur and consultant who has worked at the confluence of media technology and social change for more than 20 years. This long-running blog is my personal outlet - an idiosyncratic view of the world. "My dirty life and times" is a nod to the late, great Warren Zevon because some days I feel like my shadow's casting me.
Just to be (slightly) contrary, I do know people who are quite satisfied with their healthcare - young office workers, mainly, who are largely healthy and who are comfortably insured by their employers. They are the people insurers want - people who go to the doctor occasionally, whose biggest concern is an allergy pill or birth control, whose basic relationship with the system is a copay at the doctor and another at the drugstore. Remember, some 85% of the population is insured, and many may favor a public plan... even though they'll never need it. The "it's nice... for someone else" may mean that the vague support for a "public plan" lowers when you get into specifics.
I like Gawande well enough, and he's got some good observations... but he's a doctor, with a doctor-centered notion of how we fix healthcare... and the real fixes we need - changes in the way doctors practice, changes in the way people access care, and even more fundamental changes to patient expectations - don't favor the status quo. And they're not easy. We shouldn't oversell what's under discussion just now - at best, we're creating a new system where some percentage (though not all) of the uninsured will be able to get insurance... whether that means they get better, affordable care remains to be seen... but the possibility that we'll simply expand the insured without bringing down costs is also very real - that's been the basic unfolding of the situation in Massachusetts.
A "public plan" is not necessarily the "hill to die on" about what's under discussion; it's a key piece, yes, but it will be less than meaningful if, for instance, the subsidies for the working poor aren't in place to make it possible for people just over the poverty line to pay for it. Similarly, no one has examined the real elephant in the room - Medicaid, which, has enormous funding problems, and 50 different operations across the states, which are not delivering equivalent operations, or care, to the most needy.
A public plan that "looks like Medicare" is as much a kind of hazy propaganda as the kind of opposition the right is giving - it's taking some nice hot button words and stringing them together, without examining the reality in detail. Medicare has problems - reimbursement rates for one thing, are an enormous issue that's being deliberately ignored, and Medicare has not, really, shown itself able to incentivize "best practices" or really question poor care (remember those "low administrative costs"? That's because Medicare doesn't have a large operation to question the billing of procedures). A public plan, really, is a vehicle to getting closer to a 100% insured population. Without it, we have no realistic hope of achieving that goal... but the rest of what it can or might do... is really very debatable.