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The Quickest Win For Healthcare Reform: Say “Yes” To Drugs

Dear Mr. Obama and all of you congress folks:

I know you have been arguing about how to fix our system (and it really does need fixing).  I know there is not much you can all agree on.  I know it wasn’t all that much fun to face those yelling people at the town hall meetings.  The press hasn’t been nice, and the polls aren’t good either.  You guys are having a rough go of it.

So I am going to do you a big favor.

What you need right now are some quick wins – some things you can do that will make people happy quickly, and things that can be done without much cost.  This is low-hanging fruit that can be picked without a high ladder; it is fruit that will sweeten things and make swallowing the more bitter pills a little easier.  Here is what you need to do first:

1.  Allow Medicare Patients to Use Drug Discounts

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*This blog post was originally published at Musings of a Distractible Mind*

Why Healthcare Is A Civil Right

Is healthcare a right?

DrRich has visited this question before, but it keeps being raised by readers of this blog, some of whom have decidedly settled views on the matter (either to the affirmative or to the negative), and who angrily accuse DrRich of having the wrong view (that is, either to the affirmative or to the negative). DrRich is sorry to have confused so many people regarding his stance on this important question.

So, is healthcare a right? Well, to paraphrase the last president who was widely held to be a paragon of nuanced speech (who, Lincolnesque, once noted that the truth of some assertion or other “depends on what the meaning of is is”), it depends on which meaning of “right” is right.

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*This blog post was originally published at The Covert Rationing Blog*

How Many Uninsured Are There?

In his Big Speech, it was noticed that President Obama hedged a little bit in his language regarding the numbers of the uninsured. Despite the fact that the newly-released Census data reflects conventional wisdom, that the number of uninsured totals around 46 million people, the President cited “over 30 million” as the number of the uninsured.  OMB director Peter Orzag has a typically wonkish post explaining their numbers — about 39 million uninsured citizens & legal residents.  Some of those — a few million, it seems — are eligible for various public health care insurance programs but for a variety of reasons are not enrolled.  So they settled on the vague but defensible “over 30 million.”

Anthony Wright expands on this a bit over at TNR’s The Treatment, pointing out that, depending on how you count, the numbers could be much higher indeed.  For example, the “millions” of people who are not enrolled in Medicaid and CHIP often are not because the states that administer the programs have in many cases raised administrative obstacles to enrollment, delayed enrollment and even closed enrollment, in order to reduce the strain on their budgets.  And if you count the number of non-elderly Americans who at some point in the past two years were uninsured, the number is over 86 million — one out of three people.   While at any given point in time, the numbers may be much lower, overall, the population of people at risk of being without healthcare coverage is quite large.

Yet, voices from the right continue to dispute even the more conservative census figures.

Yes, Those Uninsured Numbers Are Legit | The New Republic

It seems the attack on the 46.5 million doesn’t just seek to undermine the facts; it seeks to both minimize the problem, and place the blame for being without coverage on the uninsured themselves. […] But this pervasive argument by health reform opponents, made by Sen. Orrin Hatch on Meet the Press, or Rep. Dan Lungren at a town hall meeting here in Northern California, suggests their true stance… that most of the opponents simply don’t see a big problem in the first place.  President Obama should not avoid this rhetorical fight. If opponents want to deny the established Census figures describing the health crisis, to minimize that the problem isn’t that bad, or to blame the victims of our broken health care system, that’s a debate I am confident health reform supporters will win.

I think this is right.  The uninsured may not be the best sales pitch, because most people don’t see themselves as a member of that group, but reminding people that reform offers security & stability in healthcare coverage is a compelling promise.  Moreover, as opponents of reform try to resurrect the “America has the best health care” argument, it’s handy to remind them that the health care system in the US really is terribly broken and in need of reform.  As the specter of rationing is raised to scare voters, the fact that we are already rationing by income should not be forgotten.

*This blog post was originally published at Movin' Meat*

Funding Health Reform From Savings Associated With Curtailing Waste, Abuse & Fraud?

beforehand lotionWell, I lead a double life but it isn’t out dancing in formal wear!

“There is time for only fleeting thoughts about that dance you’ll attend during off duty hours.”

There isn’t even time for that.

Besides, who attends a dance during on duty hours?

Well, I guess the most important thing is that our hands are “soft, smooth and free from redness” because “your patients like it and your date expects it”.

Oh yeah?

The day they use a hand sanitizer thirty times in a shift and wash their hands another twenty, they can talk to me about soft hands.


My husband won’t watch football with me because I tend to get hyped up and throw things at the TV when I get upset.

That explains why there were Notre Dame pom poms and a Cleveland Browns jersey at the base of the set this weekend.

I also like to talk back at the President when he is speaking on TV. Usually it’s things like “Say WHAT?” or “Give me a break!” “Get. A. Clue!” is usually a good one.  This last speech, the one to Congress about health care, was no exception.  My first comment came a bit into the speech when I noted a few times that “I haven’t heard a single thing I disagree with yet” and “he’s right on that point”.

I was afraid hubby was going to need smelling salts.

But I’m like, “let’s hear how he is going to pay for this…let’s hear him out”.

And then I heard it.

And then he lost me.


There were two comments that I could not let go. I looked them up in the text of the speech to make sure I had heard them correctly.

“…we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse.”

“The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud…”

Hundreds of billions of dollars? Billions? With a capital “B”?

Waste. Abuse. Fraud.

This means that in order to pay to the proposed health care reform, we have to find enough waste, abuse and fraud to cover expenses.


But I have some questions.

What is the definition of “waste”? To the extent that “waste” means inefficient bureaucratic practices that use up monetary resources, I can get on board with that.

Abuse?  What kind of abuse? Using the system inefficiently, like calling an ambulance for a stubbed toe? Remember, the President is using the term “abuse” to represent a potential income stream for the new system, so it would have to encompass behaviors that spend money that should not be spent.  Money is spent on patient care, so is he talking about patients abusing the system?

And then there’s fraud…

That’s a crime, folks.

Hundreds of billions of dollars in waste and fraud?

The President must think that there are an awful lot of criminals in the health care system.

So what’s my point?


My point is this: funding for the new proposed health care system (see “most of this plan…”, above) is based on finding waste, abuse and fraud.

What happens when all the waste is taken out, all the abusers are stopped, the fraudsters jailed and the system needs more funding? Does that not make it imperative that we keep finding waste and abuse and fraud? Does that not mean that what constitutes waste, abuse and fraud must be constantly expanded to make up for rising costs?

This can’t be good.

I am in total agreement that our system can be streamlined, big time.

And maybe we could find enough money in waste, abuse and fraud to make it pay for itself, but I doubt it.

If we could do that, wouldn’t we have done it already with Medicaid and Medicare? The budgets for both are getting slashed on a regular basis. Drop the waste, abuse and fraud in those programs and then come back and tell me how much better their budgets are.

If  we  can’t do it in an existing government-provided system, how on earth do you expect us to believe it can be done on a larger scale?

*This blog post was originally published at Emergiblog*

Eight Quick Reactions To Obama’s Healthcare Speech

Eight quick reactions to the President’s speech:

1.  It was a good speech.  Reaction around the blogosphere and elsewhere seems to be dependent on how you felt about reform plans going in.  If you were in favor, you thought it was terrific (warning strong language at the link); if you were against, you thought it was disingenuous.

2.  The interesting question is how people who weren’t sure will react.  By this I mean people who are anxious that reform will affect their health care in ways they don’t like.  There is still the mixed message that created this anxiety in the first place.  On the one hand, the President repeated “Nothing in this plan will require you to change what you have. “  Sounds like no big deal.  On the other hand, he quoted Ted Kennedy as saying the plan “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”  Sounds like a very big deal.  Which is it?

3.  The boorish Congressman who screamed “you lie!” at Obama during the address must have been confused and thought he was at a town hall meeting.  But I’ve always thought it would be cool if we had a “Question Time” like they do in the UK.  Presidents would have to face much more interesting and uncomfortable questions than they otherwise get, and it would make for a terrific spectacle.  Obviously this wasn’t the time or place for that sort of thing.  And if we ever do get an American Question Time, representatives will have to come up with better questions than “you lie,” too.

4.  The President talked about “30 million American citizens who cannot get coverage.”  This is different from the 46 million “uninsured” he usually talks about.  The Associated Press thinks the other 16 million are people who could buy or otherwise get coverage but choose not to, as compared to those who want coverage but can’t afford it.

5.  I was surprised to hear the President give more than just a nod to the Facebook health care status update meme.  I mean he quoted it directly: “in the United States of America, no one should go broke because they get sick.”  This must be the first time a President has ever quoted something from Facebook in an address to Congress – it’s some kind of a milestone for social media.  Thoughts on that meme are here.

6. The President talked about the uncompetitive insurance market, noting that “in 34 states, 75 percent of the insurance market is controlled by five or fewer companies.”  It sounds like he’s not just talking about the “public option” when he talks about creating competition in these markets.  His idea of insurance exchanges and a federal health insurance regulator seem to be direct challenges to the state-by-state system of insurance regulation.  It will be interesting to see the reaction of state insurance regulators to this speech.

7.  I was right: the President didn’t talk about the three things I said he wouldn’t talk about.  In fact, he said almost nothing about the delivery of care- it was all about how to pay for it.

8. The President got some laughs with his comment that he thinks “there remain some significant details to be ironed out.”  He’s right, and there’s the rub.  Whether and how that ironing out happens was the question before the President’s speech, and it’s still the question today.

*This blog post was originally published at See First Blog*

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