Paul Starr: "Remedy and Reaction"
http://thedianerehmshow.org/shows/2011-10-20/paul-starr-remedy-and-reaction
Health care has been one of the most contentious issues of President Obama’s time in office. Democrats view the passage of the Affordable Care Act as his finest hour. But Republicans are determined to repeal it. For most of the twentieth century Americans debated whether health care should be a right of citizenship. To understand why the issue is still such a flashpoint, we go back to the debate’s origins with Pulitzer Prize winning author, Paul Starr. In his latest book he examines America’s unique struggle with health care, and explains why we have become trapped in a costly and complicated system.
Guests
Paul Starr
professor of sociology and public affairs, Princeton University; co-founder and editor, "The American Prospect"; and author of "The Social Transformation of American Medicine."
Comments
Please familiarize yourself with our Code of Conduct and Terms of Use before posting your comments.
.
Good lord did Monte write nothing?!? Wha....
I had a comment on the dropping of the "Class Act" from Obama care. Seems the spender and chief last I heard was trying to revive it because of liberal outcry. In any case it typifies the utter stupidity and deception of "The Affordable Care Act" The Class Act is or was one of the bigger lies that were fed to us as a medical cost savings.
After watching the republican debate last night and the reactions to the notion of Defense cuts I can only come to the conclusion of hopelessness. People I normally agree with predict nuclear war if meaningful cuts are made. Where did this insane dependence on government come from?
For those that don't know about the Class Act read this (Washington Post)
(Toby Melville - Reuters) “CLASS” stands — or stood — for “Community Living Assistance Services and Supports.” The idea was simple, or seemed to be: a voluntary insurance program that would cover home health-care options for adults who become disabled. It was Sen. Ted Kennedy’s brainchild, but the White House was cool to it in public and hostile in private. “Seems like a recipe for disaster to me,” wrote one aide in a subsequently released e-mail.
The problem with CLASS was well understood. It frontloaded its savings and backloaded its costs. As the Congressional Budget Office wrote (pdf), “the cash flows under the new program would generate budgetary savings (that is, a reduction in net federal outlays) for the 2010-2019 period and for the 10 years following 2019, followed by budgetary costs (an increase in net federal outlays) in subsequent decades.” No mystery there.
Let the courts invalidate the Affordable Health Care Act. Then let's do the simple thing that should have been done in the first place - Medicare-for-All. There's no room in health care for any for-profit insurance,
monte was speechless in the first round because Granpaw had just requested a diaper change, and monte was the only one in-da-house.
So you got the Bible demanding you be stoned if you glimpse Daddy's privates and Social Services Elderly Protection pursuing you for bedsores and pressure abrasions. Good God, what is a caretaker to do?
I can tell from comments here that these nihilists here have not faced up to the custodial care of their elderly relatives and affines, have not explored the deplorable conditions in America's rest homes, have not decided what they must do to prepare for their own disability in old age.
It is amazing that Edward Moore Kennedy, a privileged and entitled playboy, understood how we home caretakers struggle with costs and eligibility, with unrelenting attendance to a helpless person's vital needs, and with the cruelty of employers who threaten termination when we must take our loved one to the doctor.
Recently I have been on dialysis, recovered and suffered a deep vein thrombosis (leg slammed in car door) with subsequent infection in the hospital. I know helplessness firsthand. If you rugged rascals value money over human life please state that explicitly and we can move forward knowing what you are. At least envision Rick the Stick Perry onstage and shout "let 'em die!" in usion so the "lifepro rally" can begin.
You're absolutely right that Medicare for All is the common sense way to go and much more efficient. Medicare as it is now is a single-payer system (albeit for seniors only) and it has 3% overhead as compared to the private insurance racket which averages over 30% overhead/profit. Then again, it's no surprise that private insurance rackets are so expensive, when they have to figure in a huge profit and have an economic incentive to deny coverage.
That's why the sign in the photo is so funny. We ALREADY have rationed care by unaccountable insurance bureaucrats.
Judge Grady's Verdict: No one holding high office, not President Obama even, has had the courage to go against the moneyed interests and explain our health care and medical situation honestly to the public. The fact is that we live in a vulnerable situation with pandemic and food borne illness ready to emerge at any moment. The truth is our antibiotics are failing from overuse in medicine and the meat industry even as Big Pharma is extorting higher prices for their products and refusing to produce the tools that keep us alive. The truth is that the profit motive and stinginess toward health care workers has produced a callous and undependable care system, even as doctors play the system for jackpots. Failure to curb the profit motive in medicine is a key cause of the ongoing collapse of civilization. And we could begin to fix things with universal single payer, but those who benefit from unnecessary suffering continue to conceal and distort the truth. We must be zombies to tolerate this travesty.
Healthcare and "for profit" is a conflict of interest. Our household survives on one income and even with premiums at $400 a month, all of our visits and prescriptions are out of pocket until our deductible is met. At $2500, the deductible isn't met until late November/early December which means that in addition to paying premiums, we're paying out of pocket all year.
Of course, according to Cain, it's not the fault of insurance corporations that I am essentially uninsured. It's my fault that I'm not a millionaire. I'm so busy working and raising my family, I don't have time to get that fourth part-time job and make my millions. Unlike Cain, my daddy wasn't a chauffeur to a CEO that could pull some strings. My dad was a soldier. And according to Romney, insurance companies are people, too. Why are corporations people, too? Well because the millionaires that pay for our laws decided that it would be less risky and more profitiable for them if their business enterprises had that status. That's the problem with politics, it's run by millionaires who are out of touch with 99% of Americans that vote (or apparently have not been voting). Our leaders put profits ahead of prosperity and believe that money drives all motivations. Of course they all care so much about their own children that they make sure to hire the best nannies. Interesting perspective.
I watched and recommend the PBS special "Obama's Deal". A great documentary about how the insurance industries top lobbyist came to the OBama table early on demanding the mandate and no public option.
Can you discuss how Insurance companies passed legislation I believe back in the 50's that protects them from being busted up.
Over at PBS Frontline
Obamas deal
A sobering look at the push to reform health care, revealing the realities of American politics, the power of special interest groups and the role of money in policy making.
The mandate was necessary to back off the power and control of the insurance companies. They demanded the mandate and demanded that the public option be taken off the table
Ideally, we would do away with for-profit health insurers altogether (except for those providers/users who wish to "opt out" of a government system), but I think they're intractably wound into our system - at least for now. As an alternative, I'd like to see health insurance relegated to a role akin to that of the home or auto versions; for what I label "tertiary" issues like accidents and diseases that involve hospitalization, expensive/protracted resolutions (like chemotherapy), rehab/home health care, etc.
The other types of insurance don't cover painting your house, new gutters, changing the oil, tires, and so on; if health insurance only covered the exceptional issues, it could be drastically reduced in price.
"Primary" and "secondary" levels of care being delivered in a non-profit model (national health or single-payer) would have a major impact on reducing overhead expense, as so much of the costs are located here.
I've yet to hear any proposal or discussion of such a "hybrid" system for the public at large in any forum on this topic.
I am for universal health care. I am medicare. Who on Medicare will give it up? No one. Medicare is a wonderful program. I was hospitalized several times this year and it was affordable, even on my fixed low income. It is the private pharmacy companies that I have had to buy meds this year that have made me sell property, borrow, and thinking of bankrupty.
The people who are satified with their policies feel safe, but they are not.
Former Aetna Executive Wendell Potter has been a guest on numerous MSM outlets. He has described the millions spent manipulating the publics opinion about the public option and the mandate as well as the millions spent by insurance companies with public relations companies to beat down Micheal Moore's film Sicko.
How can our health care system really shift if the multi billion dollar insurance companies always end up controlling not only the purse strings but controlling peoples perceptions about changes to the health care system
oops Cigna executive
dirtboy: Our corrupt courts have not only made corporations people, they continue to fortify them as legally invulnerable creatures going so far as to say they can bankroll genocides overseas for monetary gain. A corporation has extremely limited liability for the owners and that is what shields them from accountability and makes stock ownership desirable. It is a primary tool of Oligarchy.
I can see why working class families would not buy the flawed and inadequate product we call health insurance. The T-party's point of no compulsive purchase remains at least partially valid until we get our money's worth.
So the only fair and viable compromise is universal single-payer without profit motive. (But then there will always be fools who will cut off their own noses to impress the billionaires they worship.) Now we can see how our desperate need for medical care was used to divide and conquer the People. The same manipulation is duplicated in energy (vs. environment) and in education.... by offering only flawed but profitable alternatives. They teach the Baby to cry for candy as they feed it mush, and we never develop an appetite for fruits and vegetables.
Awhile back I read about how insurance companies had been able to pass legislation which exempted multi billion insurance companies from anti trust laws back in I believe the 50's. Looking for that legislation right now
I don't understand why the members of the government are the ones who are allowed to vote for healthcare. They have much better benefits with their jobs in the Senate and the House of Representatives than the average person could ever hope to have their job. Why hasn't the healthcare been brought to the American people for a vote?
Can your guest please discuss the little known fact and seldom discussed issue... that health insurance companies are exempt from the antitrust laws.The McCarran-Ferguson Act of 1945 was passed at the end of World War II, it exempts health insurance companies from the federal anti-trust legislation that applies to most businesses. This law gives states the authority to regulate the business of insurance without interference from federal regulation.
How can anything really change as long as multi billion dollar profits being made by insurance companies that can not be broken up control the nations health insurance system?
Please discuss
Diane,
The way I see it (having lived and worked in a country with socialized medicine for awhile) there is going to be Government involvement one way or another no matter WHAT we do to get our arms around the Healthcare cost issues.
Approach A: Socialized medicine.... high government involvement
Approach B: Government strictly limits Profitteering in Private Medicine
No matter what we do, even if we come up with some hybred system...it dictates controlling corporate greed with Governmental oversight.
Having lived under a socialized medicine infrastructure for awhile I can say first hand that it was absolutely WONDERFUL for 70% of the kinds of medical problems that afflict us...and not so good at all for the other 30% because (as has been argued many times before) it seems "profit motivates progress" in the most difficult areas of medicine.
That said, everyone in the socialized system had affordable access to medicine at EVERY PHASE of their life. That meant that the system probably got a head start in catching problems before they ended up in the 30%.
Of course where I live the society placed a priority on staying healthy through exercise ...and than made a big difference.
No matter how much flack President Obama and company are getting over his plan at least he pushed hard enough to get the ball rolling on this subject. Prior to this it seems we just kept saying "it's such a big problem to get our arms around".
I was researching a State law the other day...I was struck by how many Amendments it had over the years. We should not forget that this is how our laws usually work...we HAVE TO START SOMEWHERE (albeit after solid research) and then revise as we learn what does and doesn't work in practice.
What about Vermont. They enacted a single payer system. Is it working out? Must be good since we hear very little about it.
All of these issues can be resolved by the U.S. changing its tax laws.
If the EARNED INCOME TAX was gradually replaced with a National Consumption TAX , all of the many issues facing the U.S. today could be solved, including the healthcare issue.
This could be started this year by enacting a 1 penny on the dollar NCT. After 1 year, we would know how much NCT it would take to replace the EARNED INCOME TAX.
Most of the wealthy people get their income from UNEARNED INCOME which would not be affected.
The working people would get an immediate increase in spendable income, and everyone would pay NCT according to their ability to pay. Then the NCT could cover everyone for health ins. coverage.
This would also fix the illegal immigration problem as well because everyone would be paying into the system when they purchase anything.
Encapsulating ths show's message:
Civilized human survival is Socialist.
What does that statement imply?
The reciprocal: Unregulated Capitalism is certain premature death.
And premature death not only for the losers, but ultimately for the victors too.
(We're sawing off our own behinds to get rump roasts for the rich.)
The republicans are wholly obstructive, not constructive. This healthcare reform was not Obamas' objective, the current reform was created by the obstructive republican party, utilizing Lobbists. The republicans are not concerned with what is real and needed for our country, just winning a political blackmail policy to keep them in power.
Things you lose with universal medical care (in most countries that have it):
--no worker compensation system (medical coverage and disability programs are for all, not just those 'on the job' at the time of injury/disease)
--concomitant reduction in the number of attorneys 'working' the work comp side of things
--ALL liability related insurances are far cheaper or non existent...your house, your car, employer umbrellas, etc are far cheaper as the health care aspects are covered under universal care
--NO PHARMACEUTICAL ADVERTISEMENTS meaning a dramatic reduction in the American Drug Overuse patterns which kill as many as car crashes, annually. Doctors can diagnose and treat instead of responding to patient impressions from the teeeee veeeee
--NO doctor or medical staff time spent on the phone or writing letters of justification to health insurance goons
The above matters are rarely discussed but were concerns that I fought for fifteen years as a patient advocate in a major hospital system
dsmith: True or False....
Republicans get lung cancer too.
Republicans like cantaloupes and catch listeria too.
Republican women get pregnant and have children (or abortions), too.
I once called myself a Republican and worked for a Republican Senator,
so please don't lump us, never lump Democrats either. Even party hacks can learn and grow. You can too.
That is also the way I perceive it needs to be, it does not have to be all or nothing. We can make the constructive changes needed, if we are willing to do so. Work together; what a concept. Socialism is what is done for everyone in our country, not a political party.
Let's call the law what it is: The Affordable Health Care for America Act.
Let's treat each other with respect as Americans.
Let's work together to make and act upon the difficult decisions we are facing in this country. It's not easy to have a democracy work, and it's not free.
Let's put aside our labels, our party affiliations, and our countries of origins.
Let's be the American Citizens the constitution enables us to be.
I have serious back problems . But my insurance pays mostly only for pills and surgery. Massage is a huge help, but I have to pay for it out of my pocket.
Our 20-something recently went back on our health insurance policy for a short time, but they have found one reason or another not to cover her medical costs.
I know a couple whose newborn was kept over a week in pediatric intensive care for reasons their pediatrician finally said he can't figure out. They suspect it's because they have good insurance.
I just met a well-to-do productive, entrepreneurial couple who are moving back to Africa to get better health care.
Yep you read that right. Africa. They feel while they've been naturalized American citizens, they've been subjected to unnecessary tests, superfluous hi-tech procedures (and the increased risks that go along with them), mainly because the providers feel they can afford to pay. They say they've gotten sloppy care in general, from missed diagnoses to mixed up records to double-billing. They say because reaping maximum profits has replaced the Hippocratic Oath, there is little accountability to any group of patients in American-style medicine, be they rich, middle class or poor. So they're selling out and moving back to where they say medical care is better. Where it's a "single payer", government-administered system. Where medicine truly is a system, not simply a market.
To Africa, people.
They're moving back to Africa.
We as Americans should be mortified.
When anyplace in Africa beats us in medical care for people who can afford to pay for the best, it is WAY past time to wake up and smell the coffee on health care.
Regardless of politics, we need to revisit this issue and push for single payer, pronto.
Correct, obviously I am only referring to those participating in the obstructive aspects pertinent to the discussion by the leadership of the republican party who are in power and allowed to have a voice. All republicans are not being represented by those in power in the republican party allowed to have a voice, they have been efectively silenced by those in power in the reublican party that do not support the partsan dogma. Not all democrats are defending the issues based on what is needed in the country either. Not all the people who voted for the changes we can beleive in, supported Obama after he was elected ( who are probably both democrats and republican who beleive in the changes he advocated, that we know we need). The parts of any changes that do not work can be constructively changed for the good of the people of the country. You are incorrect in assuming that I am lumping anyone and everyone into any one perspective. I vote based on what and who I feel is attempting to do the most good for eveyone in our country regardless of party affiliation. How ever currently I do not feel there is enough diversity in the republican party objectives, but to only stay in power inour country, not what is constructive and right for our country, catering to a failed trickle down policy which obviously does not work. It is a abstract failure. The Bush Administration proved that and is also the reason the Obama Administration won on "changes we can beleive in" And "Yes we Can" make the needed changes for all who are willing to change and constructively progress (both republicans and democrats, all of us, even me and you)