| Mr Khan said: Patience will be a killer for this sort of thing. All the more need to ram it through now, imperfect as it is, then it can be tweaked later. If the bill fails, then it'll be decades again before the political capital is mustered to try, and some of the stuff in the bill is stuff we definitely need (like stopping very predatory industry practices that encourage denial of care, and regulating prescription drug prices)
Its imperfect, but ultimately the choice is do it now, or in 25 years (or so).
mrstickball's idea would have a better impact, because the components of this bill are pretty much all common sense stuff, but together it makes it something that the fearmongers can easily point to and demonize with their demagoguery |
Here's the problem, Khan:
If you pass a large bill like this, the areas that need fixed will NOT be fixed.
Look at other government programs:
- Social Security
- Public Education
- Welfare
- Medicare
All were passed under sweeping changes, but have taken decades to actually fix when something has gone wrong. President Johnson was the one that enacted welfare laws for his 'great society'. It took 30 years later, under Clinton, until major issues with Welfare (such as the requirement of working after so much welfare has been given to able-bodied people) was passed. Social Security is still largely unfunded and being used to fuel government, instead of helping those that put income in the system. Public education has so many entrenched groups, there is no way that it can be reformed easily. Likewise, Medicare was passed without understanding that the 2% taken out of paychecks would NEVER be enough money to fund actual medical care decades down the road. Now we cannot enact meaningful MC reform without cuts - cuts that have to take place, or MC will continue to be underfunded, if not unfunded.
That is why you can't propose sweeping legislation. It needs to be much smaller and focused on specific areas to have any effect. Thats not saying that a bill that effects a lot of things cannot be enacted, but that if its designed to implement an entire new feature....It rarely works. You can't enact legislation worth hundreds of billions of dollars and hope it is efficient or works at all from the get go. Its not the way business or industry works. Business and industry work with start ups, and tweaks to ensure growth. Likewise, the government could enact small, meaningful reforms to ensure that things are a little bit better 2 years from now, and do that for the next 20 years - rather than pass a bill in 1 year, and spend the next 19 years trying to make it work.
Ultimately, my belief on healthcare is this:
Make it affordable first. Ensure that the cost of insurances is managable for businesses, people, governments, and whomever else needs it. Drive the price down to where almost anyone can afford it. Then look to make it universal. If you do that, then when the universality comes, the engines will make sure it stays cost-effective and works well, as you'll have a higher number of people naturally on insurance since its more affordable. If you do it ass-end first, you get a smelly bill. Remember: government healthcare costs between $7,000-$9,000. Thats private/public hybrids (medicare) and competely public arenas (VA). Private care is far less. If you add 31 million people to that $7,000-$9,000 insurance plan...Your not making the situation any better.
I know I didn't work a whole long time for the inner workings of healthcare, but when I worked as a medical transport officer, the one thing I always felt was this:
Our system is not ready to handle universal healthcare, and not by a long shot. Most facilities I went to were poorly staffed. I caught nurses sleeping under desks because they were forced to work 16 hour double shifts. I read trade magazines for nurses as I was interesting in the field. Many hospitals are begging for nurses and doctors, and are willing to pay tens of thousands of dollars in bonuses to come to their hospital. In a world of supply and demand, there is too much demand as is. If you add another 31 million people, there will be rationing, higher prices, and lower quality of care. That is regardless of how you cut it.
As stated, I think you need a very pragmatic approach:
- Enact reform to ensure competition between every insurance company out there. Make plans compete nationwide so that BCBS has to go head-to-head with private firms. Insurance companies will be forced to make less money as they try to stay alive in a more competitive environment.
- Tort reform. Doctors can't get sued every time something dumb happens. A significant amount of money is required for doctors to carry malpractice insurance. It can be big money....That is all wrapped up in the cost of a doctors' visit.
- Education reform. What kind of education does it require to become a worker in the healthcare field? As I stated, it takes ~12 years of education and clinicals to become a medical doctor. At most colleges, this means a $100,000 burden for every doctor. That cost is translated to patients. I believe that we need to end the stranglehold the doctors' unions have on the healthcare field, and make it more comeptitive - nurses can take some responsibilities from doctors that could greatly lower costs (nurses make about 1/3rd that of doctors in the US, yet a doctor is required to sign off on most medications and perform many kinds of checkups....Again, that is a huge cost for skills that most nurses have). I believe there is a lot of credentialed BS in the medical field. I knew LPNs that could do RN jobs, RNs that could do MD jobs, yet absolutely could not unless they had a paper that said they paid tens of thousands of extra dollars for college. We need a more flexible system.
- Medicare reform. Medicare needs to cover the most desperate, not everyone that paid in the system. This would be really, really hard, but it needs to be done. Every American pays into this system, and only a few can benefit. Either this needs to be removed as an income tax and used more as a welfare program, or something needs to happen to ensure that every geriatric patient isn't on this (and many, MANY were when I had to fill out their paper work).
Those would be 4 areas I would tackle, by parsing up (especially education) into various sub-groups, and fixing them one part at a time.
Back from the dead, I'm afraid.
