Health care reform is not passing because the House and Senate votes in favor are too narrow. I remember the excitement then the House passed their HCR, but we were very uncomfortable in how narrowly it passed considering the size of the Democratic Party majority in the House.
In the Senate, the attention on Joe Lieberman's obstruction is giving cover to some conservative Democrats in the Senate who will not take current HCR over the goal line, so the problem in the Senate is not limited to Lieberman - while he remains the most visible problem.
There is no getting around it but there is massive additional Federal and State spending built into the HCR proposals, which has a much higher burden to pass while over 40% of what the Federal government spends today is from borrowing.
Obama and others sold HCR on reducing HC costs to our economy and current reform falls short in significantly reducing health care costs. We would get greater support from conservative Democrats and possibly some Republicans if more were done to significantly drive down health care spending - and thereby actually pass effective HCR.
The country has a major problem with the level of spending on health care. The US spends about 16% of GDP on health care while the other industrialized countries spend 11% and lower of their economy with better health outcomes. The current HCRs will not drive spending anywhere near 11%, and will likely drive the share of GDP spending on health care up.
Many progressives expect far more in cost reduction from reducing/eliminating health insurance industry profits than can possibly be delivered.
The way many people talk about health insurance profits - one would expect these profits to be hundreds of billions of dollars per year out of our $2,000 billion ($2 trillion) per year health care spending.
The size of health insurance industry profits are not hundreds of billion/yr but less than $10 billion/yr. The total profits of the top 14 health insurance companies can be seen here and they are $8.6 billion/yr. Most all health insurance companies in the various states are owned by these 14 companies. It is very clear the country will will not realized hundreds of billions a year in cost savings from removing health insurance industry profits.
More needs to be done to reduce medical costs that are not in HCR. Doing this will make health care much more affordable, and make it possible for more conservative Democrats and a few Republicans to give us the necessary votes for actually passing HCR that will greatly benefits the lives of most Americans.
Here are some ways to reduce costs that I have seen based on the economic analysis of how other counties actually spend less than the US while having very good outcomes. Please propose other ideas for how actual cost reductions can take place:
- Best practices and cost effectiveness controls for medical care as done in most every other country - for base level policies. If people want to pay more for healthcare (either from out of pocket or buying more costly insurance) that is not cost effective, that is between them and their doctor.
- Limit the prices charged for drugs and medical devices limited to the prices drug and device companies accept when selling to European Union countries. There is no need for US health care to subsidize the rest of the developed world in developing new healthcare products. I support the sale of these product at even lower prices to the underdeveloped world on humanitarian grounds.
- Malpractice torts with the same controls, policies and procedures as used in Veterans Administration healthcare. This will make our healthcare closer to what other industrialized counties do. In addition to reducing liability insurance for doctors (in which more than half goes to lawyers and administration), the bigger cost savings come from reducing unnecessary tests. Under the VA programs today, injured patients get their claims settled much more quickly. The lower legal costs and faster process also enable many patients who have smaller claims to get justice - as their claims today are too small for an attorney to take on contingency under today's procedures.
- Change licensing for nurses and technicians so they are trained and licensed to provide more services that are currently done by more expensive doctors - as done in most every other country. This also improves access for those getting Medicare and Medicaid as these opens up the time that doctors have.
- Financial incentives for patients to avoid tobacco, not be excessively overweight or underweight, and not using dangerous drugs outside of professional care. If you don't do these things that damage your health and substantially increase your healthcare costs - you get an annual rebate on your health insurance. These financial incentives are far more cost effective than prescription drugs, don't have the adverse side effects of drugs and need for ongoing tests and reduces our healthcare spending. It is far better to pay rebate someone for managing their weight/tobaco/etc. $400/yr than paying $1400/yr for drugs and related tests. Other counties have better outcomes than the US partly because because of our bad lifestyle choices. Healthcare is not just a matter of what doctors do, it is also what patients do.
- Focus the electronic medical records efforts initially on medical billing and administrative cost reduction as this technology is much further advanced, is much simpler to implement than the real complex health records, and has short term cost savings in reduced administrative costs.