Thread: Reforming the U.S. health care system. BOB &CAL

Health care reform: Start cutting

Bob and Cal agree that the Obama administration and Congress must tackle the cost issue if they want Americans to buy reform this time around.

Cal Thomas is a conservative columnist. Bob Beckel is a liberal Democratic strategist. But as longtime friends, they can often find common ground on issues that lawmakers in Washington cannot. They co-wrote the book Common Ground: How to Stop the Partisan War That Is Destroying America

Today: Reforming the U.S. health care system.

Bob: People talk about Social Security being the "third rail" of American politics — touch it and expect a jolt of electricity that will knock your shoes off. But the truth is, health care is the real third rail. Just ask Hillary Clinton. But this isn't a new conversation. President Obama is simply finishing the work that FDR started.

Cal: I don't think I like where this is headed.

Bob: It's true. During the Great Depression, the Roosevelt administration studied the idea of national health insurance, but the economic tsunami and 25% unemployment carried the day. Health care reform was allowed to tick along for the next, oh, seven decades with incremental improvements.

Cal: Such as Medicaid, Medicare and the Children's Health Insurance Program?

Bob: And don't forget the prescription drug benefit added by President George W. Bush.

Cal: Of course. Well, if incremental has worked to this point, do we really need a massive government intervention today?

Bob: I've got 46 million reasons why the answer is yes. That's how many Americans don't have health insurance at a time when costs have continued to soar. Today's system is unsustainable, and government guidance — not a takeover, mind you, but guidance — can provide a better way. Obama gets that, and he's wise to set an Oct. 1 deadline for Congress to complete a bill.

Cal: OK, so we agree reform is necessary, but it's important that the diagnosis be right before treatment is prescribed. The No. 1 reason why health care is so expensive has less to do with the insurance companies and the uninsured than with how hospitals are run and the waste and inefficiency that is rampant in so many of them. Cure that problem and you will reduce costs and improve the quality of patient care.

Bob: Hospitals, doctors and insurance companies all waste resources. Patients overuse the system. But I think you're right to focus on costs. Unless the American people believe that the president and Congress are going to present a sustainable health care system, as they say down South, this dog won't hunt.

Cal: Controlling costs is the real challenge. The Congressional Budget Office numbers released last week on Ted Kennedy's version of comprehensive reform should give plenty of folks pause. The verdict? It would cost $1 trillion over 10 years and leave nearly 30 million uninsured. And off we go.

Bob: No one said this will be easy. Nothing worthwhile ever is, but what we must avoid doing is throwing up our hands every time we hit a stumbling block. So the first numbers look blood red. Now what? President Obama has pledged to make any health care reform proposal pay for itself.

Cal: Then let's hold him to that. What we've seen so far — and granted, we're just wading into this pool — has not been promising.

Bob: Obama proposes long-overdue cuts in Medicare and Medicaid programs. He's also open to taxing employer-based insurance plans, which would also be one more step toward making insurance portable. Obama opposed this tax when Sen. John McCain proposed it during the 2008 campaign, but it appears the president is changing his position in a very common-ground kind of way. He's put forth money to study which medical procedures are most effective and will get the most bang for the buck. That's just for starters.

Cal: If costs are the primary concern, we need to get back to the hospitals. It's been estimated that 40%-50% of the work performed by doctors and nurses in hospitals is wasteful. This is caused by mistakes in routine procedures, overtreatment and unneeded treatment (in part to avoid malpractice lawsuits, which should be addressed), errors in medication, infections, lost time because of inefficient organization and failure to focus on the needs of the patient. Addressing these bad practices would substantially reduce costs and lead to a reduction in the price of insurance.

Bob: And what about the choices people make about their medical care? Aren't we contributing to the runaway costs?

Cal: Of course. When "insurance" pays for something, Americans are conditioned to believe that because they pay premiums, the sky's the limit. Well, we're finding out what that limit is. Whatever reform we end up with needs to give people ownership of their health care spending. What do I mean? If those 40 million or so uninsured don't have any skin in the game, and "the government" — i.e., taxpayers — is footing the bill, the sky's the limit. They'll crowd the doctors' offices with a mere sniffle, and the demand for health care will swamp the system as costs continue their rise. That's my fear about a true "government" option.

Bob: And that's where the real fight is going to take place. Some Democrats are pushing the creation of a "public" insurance option like Medicare that would compete with private insurance companies for clients, especially among the 46 million uninsured. This is opposed by the big health care insurers for one reason: It would force them to lower the price of coverage or lose market share to the government-backed plan. Nothing wrong with that from my side, but your side, Cal, of course will line up with the insurance boys to oppose and probably kill such a plan and with it meaningful health care reform legislation.

Cal: Anyone who has ever had to go up against the federal government as a criminal defendant knows the government has an advantage because of unlimited financial resources. If the government is in competition with private insurance companies, it will be a short time before the government puts those companies out of business by offering cheaper premiums and subsidizing the true costs of hospital care. That also means rationing to control costs with a bureaucrat deciding whether you get life-saving surgery based on age, productivity, cost, etc. This is one that you and I won't agree on, but there's plenty that can be done to improve the system without pulling this trigger.

Bob: Before I give up on it, there is a viable alternative. Sen. Kent Conrad has suggested the formation of non-profit health care insurance cooperatives along the lines of rural cooperatives for power, telephone service and agricultural products. These co-ops are owned by the insured members, and because the co-ops receive no profits, they could lower the cost of medical insurance. This would keep the federal government out of another Medicare-type entitlement and put the ownership of the insurance program in the hands of insured citizens. Good idea, right?

Cal: It has some strong appeal to me if a wall can be erected that is higher than the one your side wants between church and state.

Bob: Now that's progress!

Cal: Before we declare victory and go home, what's missing in much of this conversation is the individual. The government this, the government that. What about families helping the elders in their golden years? What about individual responsibility for healthful living? What about kids exercising and getting their lives off on the right foot?

Bob: What are you suggesting?

Cal: President Obama is fond of being compared to the great Democratic presidents of the past. Let's try John Kennedy this time. Kennedy really put some energy behind the President's Council on Physical Fitness, a program started by his White House predecessor, Republican Dwight Eisenhower. Ike created it by executive order and called it the President's Council on Youth Fitness. JFK took a good Republican idea — common ground circa 1961! — and made "vigah" cool again. Maybe if we wear the kids out with physical education, they'll be too tired to need what is taught them in sex education! Serving a more balanced diet in the school cafeteria and getting rid of junk-food vending machines and sugary soft drinks would also help kids get in shape.

Bob: Then we'd be tackling health care for the ages. Kids today are assaulted from all sides by junk food that leads to obesity, which causes myriad health problems down the road. This will not just save money in the years ahead; it will save lives.

Cal: And that, ultimately, is what meaningful health care reform should be about. We can get bogged down in the talk about the government and mandates and cost control and partisan saboteurs. But we're talking about something very personal.

Bob: Which is why you and I agree that if ever there was a time to put people before politics, it is during this debate over the country's health care system.

Posted at 12:16 AM/ET, June 25, 2009 in Common Ground, Forum commentary, Health care/Insurance - Forum
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look how the government takes care of our vets. The money they spend on illegals should go to our vets. The money they spend on illegals would be almost enough to offset the cost of medicare.

You also have to take in the fact that alot of these 46 million are foreigners and people in between jobs. Also, they have to take in consideration that one insurance policy is not a one size fits all. I don't think men need maternity care or older people. I think the policy should fit the needs of the insured. I think money should be put into prevention, but I don't want the government to dictate what that should be.