There has been a great deal of introspection among leading Democrats after the bruising defeat in the last election — much of its directed at the impact of the Affordable Care Act (ACA) or “Obamacare.” It has ranged from Schumer’s view that the law was political blunder to Harkin’s view that it was a poorly drafted mistake. This week, the highest ranked Democrat, Senate majority leader Harry Reid, said that the Obama Administration may have doomed Democrats in Congress with its poor management and blunders in the rollout of the program. Now the person ultimately responsible for that mismanagement and failure, former Health and Human Services (HHS) Secretary Kathleen Sebelius, has her own prognosis: bad brand name.
At the time of the failed rollout, I believed that the most obvious response was at a minimum to fire Sebelius, the subject of a past column. However, the Administration and Democrats circled the wagons and Sebelius kept her job.
Now Sebelius explained on Wednesday that “Obamacare, no question, has a very bad brand that has been driven intentionally by a lot of misinformation and a lot of paid advertising.” I would not say that, after hundreds of millions of wasted dollars and hundreds of “fixes” to a poorly drafted law, the problem is the name. However, it reminded me of a story that I heard while attending the University of Chicago. This may be apocryphal but it is too good a story to check as they say. The story goes that Coca Cola was struggling with loss of market share against 7UP due to the appeal of the “uncola” in the anti-establishment environment of the 60s. So the giant corporation hired a counterculture icon from the University of Chicago (Severn Dardan is often named). The story goes that the cultural guru disappeared with a huge upfront fee to “study” the issue until the company demanded that he appear at a board meeting to give his recommendations for the future Coca Cola. The man walked into the board room in overalls and simply said “change the name” and walked out.
Now, while the hippy story may not pan out, I have an easy substitute from Sebelius. Just change the name. Problem solved.
Source: Politico
The original Medicare estimates were wildly wrong.
The ACA claimed it would lower costs for families and single people. Fail.
Pardon me if I don’t bother to read it, Inga.
http://pnhp.org/blog/2013/07/31/friedman-analysis-of-hr-676-medicare-for-all-would-save-billions/
Economics Professor Gerald Friedman analysis of HR 676: Medicare for All would save billions.
The experience in all single payer systems (from my 2006 article):
Long waits and reduced quality. In Britain, over 800,000 patients are waiting for hospital care. In Canada, the average wait between a general practitioner referral and a specialty consultation has been over 17 weeks. Beyond queuing for care or services, single-payer systems are often characterized by strict drug formularies, limited treatment options, and discrimination by age in the provision of care. Price controls, a routine feature of such systems, also result in reduced drug, technology, and medical device research.
Funding crises. Because individuals remain insulated from the direct costs of health care, as in many third-party payment systems, health care appears to be “free.” As a result, demand expands while government officials devise ways to control costs. The shortest route is by providing fewer products and services through explicit and implicit rationing.
New inequalities. Beyond favoritism in the provision of care for the politically well-connected, single-payer health care systems often restrain costs by limiting surgeries for the elderly, restricting dialysis, withholding care from very premature infants, reducing the number of intensive care beds, limiting MRI availability, and restricting access to specialists.
Labor strikes and personnel shortages. In 2004, in British Columbia, Canada, a health worker strike resulted in the cancellation of 5,300 surgeries and numerous MRI examinations, CT scans, and lab tests. Canadians have a shortage of physicians, and the recruitment and retention of doctors in Britain has become a chronic problem.
Outdated facilities and medical equipment. Advances in medical technology are often seen in terms of their costs rather than their benefits, and investment is slower. For example, an estimated 60 percent of radiological equipment in Canada is technically outdated.
Politicization and lost liberty. Patient autonomy is curtailed in favor of the judgment of an elite few, who dictate what health care needs and desires ought to be while imposing social controls over activities deemed undesirable or at odds with an expanding definition of “public health.” Over time, government officials will claim a compelling interest in many areas now considered private.
To reduce health care spending, officials in a single-payer system would likely increase controls over what previously were personal health choices. Traditionally, promoting public health referred primarily to controlling or preventing communicable diseases. However, private behavior is no longer simply private behavior when taxes are paying everyone’s health bills. Smoking, overeating, and using alcohol become quite arguably everybody’s business. Under a single-payer system, government officials would arguably have a direct interest in one’s personal vices, including choices of food and drink.
Further, the demand for compliance in “public health measures” might engender a relentless expansion of government rules, such as requiring weigh-ins for the overweight or universal blood tests for drugs and tobacco. Indeed virtually any personal activity could be viewed through the public health care lens, and government officials might decide to forbid, favor, or penalize anything that could reasonably be seen as a matter of “public” health.
Pogo Hears a Who, I’ve been asking isaac that and I get no answer.
And the partisan sniping continues….
A surgeon general’s job is not to attack the 2nd amendment, or make doctors report on their patients’ gun ownership. The nominee is an activist with very little experience, rather than a qualified candidate.
Keep the government out of the doctor/patient privileged relationship.
The private health care industry is nothing more than a parasite.
issac, I like many of your comments on this blog. I think you really do give an individual opinion, and don’t just parrot what you’ve read elsewhere. But I simply don’t know how to reply to an assertion like the one I’ve just quoted. So I won’t.
What I will do instead is offer you a general outline of why I prefer the US system to others (which is not to say that it’s impossible to improve HI regulation, b/c it is).
1. Measuring the quality of health care isn’t easy; we have to use proxy measures. People who think the US system underperforms look at average life expectancy across countries. I happen to think that’s a flawed measure for several reasons–for example, genetics and consumption and behavioral patterns differ quite a bit across countries. I think the five-year survival rate for cancers is a much better measure, b/c it’s an indicator of the effectiveness of treatment rather than an indicator of the incidence of disease. And on that measure, the US is far and away the world leader in health care.
2. People who think the problem in the US is high cost look at shares of GDP spent on healthcare. But, as I’ve said several times on this blog: (1) “expenditures” are not an indicator of “cost”. They’re the product of price and quantity (or quality).
3. Your criticisms of the health insurance and healthcare industry apply generally to all sectors of the economy. But “classic” socialism” (state control of the “commanding heights” of the economy) has been tried in many countries, and abandoned in all the ones I’m aware of except Cuba and North Korea. Why go down a path that has been abandoned by those who’ve already tried it? You, and others, will point to Canada or the UK as places where single-payer hasn’t failed, but in fact there’s plenty of reform talk in both places, esp. the UK.
4. What about the two-tiered systems of Germany, Switzerland, etc? As I’ve already pointed out (and is the main point of the book r̶e̶c̶o̶m̶m̶e̶n̶d̶e̶d̶ ̶t̶o̶ required of us by Joan), the US already has a variant of that. Could a better dual system be designed? Almost certainly. Would substantial inequities in HC be politically acceptable in the US? I think not, and at least one liberal commenter here has agreed w/ me about that.
5. For all these reasons, I prefer a reform of HI regulation to (a) eliminate the subsidy to employment-based insurance, (b) figure out a way to make policies issued under differing state regulations to be portable across state ones, and (c ) set up a national high-risk pool for people who lost their coverage and have pre-existing conditions.
I think that strikes the best balance b/w fixing the safety net and not expecting the federal gov’t to be able to run a complex and major sector of the economy.
Isaac:
“Single payer/universal health care insurance is the intelligent solution.”
If you think it’s such a great idea, then put together an honest bill and let it pass or fail on its own merits.
What did Obama do? He lied about every crucial point. It cost middle class families many thousands of dollars instead of saving them $2500/year. They could not keep their plan. They lost doctor choice because good doctors can’t afford to keep the doors open with what it pays.
We were all Grubered.
Who knows? Maybe uninformed voters have not learned their lesson yet, and can get Grubered a second time, falling for Single Payor.
It’s worked out really well with the VA. How many people died on the only single payer system we have in the US? How much fraud and waste? When does government run anything efficiently?
But, you know, there are some who hear about people dying while waiting 9 months to see a doctor on a single payer system, 8 VA cardiologists doing the caseload of a single private practice cardiologist, because of the sloth and inefficiencies produced in the government employee system, and they think, let’s force everyone to go with single payer! Let’s repeat the same experiment and expect a different result.
Why is it that socialists, in viewing the debacle of yet another socialist program, determine that the core problem was ‘needs more socialism’?
Something to do with having a hammer and everything looks like a nail, mixed with a religious faith in their lord and savior, Karl Marx.
At a minimum, they so easily look past and blithely ignore that the statists could not even bring off the easiest portion of ACA, a functioning website.
I await their explanation why their inability to master the modestly complex recommends them the master the extremely complex?
You’re welcome Joan, glad to hear it!
Typical political solution.
They smacked the middle class by making health care unaffordable to people who used to have insurance they liked.
And their solution is not to actually fix this problem, but just call it a new name in a classic spin.
How typical.
Inga,
Thanks for this link. I am a member of Doctors for America but will probably join this group as well. As you may know, Doctors for America was founded by the current US Surgeon General nominee (on permanent hold thanks to some members of Congress)
Democrats did indeed circle the wagons and spare Sebelius her job. Democrats in general oppose anyone getting fired for cause, in that their major political donors are unions who inevitably make it impossible to fire anyone. Case in point is that it takes years in court and hundreds of thousands of dollars to fire a teacher for cause, including convicted pedophiles. That’s why they retire with full benefits instead of getting fired.
Democrats also doubled down on Obamacare. Only the GOP voted against it consistently. The voting record is public knowledge. They sang its praises until the polls made it clear they had earned a rebuke from the public, a rebuke they could not escape at the voting booth.
Good luck to Dems when the employer mandate hits. Call Obamacare whatever you want. People do not forgive a bill that costs middle class families thousands of dollars a year and took their doctor choice away.
The name change is too simplistic.
I would argue that the position that the ACA was flawed but an important first step is a mistake.
From a PR perspective it could be more damaging in a sense that the fallout generated from the ACA will actually represent a step backward.
It is possible the public will view any new measures proposed by Congress and The Presidency as dubious and not trust them to enact a solution that will work based upon the past events. That might stall progress in enacting a solution.
A possible mitigation of this could be to show the voters that the Obamacare act will be discarded completely and a new program that has been extensively thought out and has broad support of all stakeholders will be proposed. I believe if the ACA is patched up it will be viewed with high amounts of skepticism because the entirety of the act is unpopular, even if many of the measures are held over from the ACA perception is another matter at times.
Ms. Sebelius does have a valid point that the Obamacare name as a brand is ruined yet it will take much more than window dressing to accomplish what needs to be done to reform a dysfunctional health care system.
Chip and Steve
Statistics have been available for years illustrating that on average, per capita, Americans pay two to three times as much for health care as do those in comparable countries with comparable health care systems. You can google this. Those same statistics point out that the largest difference is found in the administrative costs, in the US this is the private, for profit, health care insurance industry. The redundancy of workers is also graphically illustrated when one simply compares the single administration in the government run systems to the hundreds of administrations all supposedly competing for the same dollar to be found in the private sector.
By the way, a dozen years or so ago magazines like Forbes, and other private enterprise champions used to present statistics that showed the advantages of private health care insurance over government run programs. They don’t do that anymore. In fact they have been admitting that it does cost more in the US. Another argument that has been dissolving includes tales of people dying on the steps of Canadian hospitals or in their emergency rooms. I am intimately aware of the opposite.
On two occasions I have had to resolve differences between the doctor’s office and the insurance company. In both instances the insurance company pulled a fast one and left it up to the doctor and myself. In both cases the doctor agreed that their office had not followed to the letter the procedure set by the insurance company. The doctor gave in. He explained that for every doctor and nurse in their office they employ four office workers, primarily to handle the hundreds of options by all of the different insurance companies. This is a dog’s breakfast, chaos, created by the private sector for profit, profit paid for by the consumer and in some cases the doctors.
No one is saying that the government will be perfect. It is not perfect. However, the same health care system that exists today in the US has nothing to do with the insurance industry. The private health care industry is nothing more than a parasite.
Chip S., Here is another single payers who want to force their views on others should read.
http://en.wikipedia.org/wiki/United_States_Constitution
isaac, You already agreed that we don’t use free market in the healthcare industry so why do you keep bringing up crony-capitalist examples. You have no capitalist healthcare system to compare your utopian Euro style healthcare system to.
Like Chip S. pointed out, it is amazing that somehow we buy food, cars, electronics all on our own without a govt. mandatory system. Will there be companies trying to screw you over? Absolutely, put liberty also requires personal responsibility to choose wisely and do your homework. Even then, if you still get screwed you have a legal system to help you. Sorry but, you are not going to convince me to like socialist ideas.
I haven’t heard any partisan sniping in the last several comments Chip, not sure what you are referring to.
I’m trying to avoid partisan sniping, Inga. The first step is to ignore partisan snipers.
Because the private health insurance industry has done such an exemplary job, right?