Thanks to everyone for the comments on the SPH dinner. Many of you brought up the SCHIP veto so I thought we could extend the dialogue using this NTY article that speculates about how the broader debate on healthcare will fare in the election year given the inability to enact something for low income children. The article can be found at: http://www.nytimes.com/2007/10/06/washington/06health.html
Your thoughts?
PS - Did anyone see the SCHIP parody on the Colbert Report the other day that panned back and forth between a group of children and legislators talking about SCHIP - hilarious!
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10 comments:
I saw this article when it ran last week. Overall, I thought it fairly accurately protrayed the ideological differences between Democrats and Republicans' arguments over universal coverage. It also offered some hope for a compromise - that if we ensure a role for the private sector in providing universal coverage, then maybe everyone will be happy. However, as pointed out in last week's 200C lecture with Halpin, we need to do make sure this is, in fact, cost-effective. For example, Halpin noted that Medicare Advantage costs 12% more than the traditional Medicare payment system. It seems that most of the candidates' proposals involve the private sector (which will likely gain more approval), but we should also consider the implications this will have on costs and efficiency as evidenced by our current public insurance programs.
In addition to the article’s take on the SCHIP issue, it was interesting to read the sound bites about the Democratic candidates’ proposals for health reform. As the last comment indicated, perhaps delineating a role for the private sector will get more Republican legislators and conservative voters on board. It was also good to see that at least some Republicans acknowledge that the “socialized medicine” accusation regarding the SCHIP measure is “outlandish”. One of the major challenges for Democrats in getting reform passed will simply be the spin control they’ll need to manage in response to Republicans’ accusations.
Seeing SCHIP vetoed does make universal health care seem very far off. Reading this article gives me a little hope. I would like to know more about the Democratic candidates health plans. I am interested to see how much they borrow from Medicare because that is a troubled system in many ways. I think another thing to keep in mind, as it was mentioned in 200C, is when these candidates would like to implement their plans. I think in 200C, Halpin said that after the first 100 days, a president doesn't have enough political clout to create broad social change.
I can't help but to wonder...it's wonderful that the kids have healthcare. However, how will doctors sustain themselves? I'm assuming that they won't be reimbursed fully to their regular rates. That would lead them to find alternative ways of meeting their numbers.
A real life example: My cousin and her 9yr old daughter went to the doctor in Boston. She pays $2 for the doctor's visit (excellent!). The doctor dx her with Asthma (although she does not have any history of asthma) and gives her a bunch of drugs. He then gives them a machine for asthma (looks expensive) but makes them sign a waiver/contract that they are liable for the cost of the machine, if the Massachusetts insurance doesn't pay for it. My guess is that the machine is not "essential" medicine and the state won't pay for it. Therefore, my cousin will be reliable for the cost. Would this have happened if this was a regular doctor's appt, rather than a "subsidized" appointment?
It is really discouraging to see this bill vetoed (and to see that they couldn't override the veto). I hope some sort of compromise can be reached to at least reauthorize SCHIP at the levels of coverage it allowed before, but whatever happens, my question is, who's going to hold the policymakers accountable for the consequences? Since so many people who opposed this seemed to do so for very ideological reasons we've debated in 200c and elsewhere, who's going to make sure that they and everyone else see the concrete consequences for children's coverage, and if possible, children's health outcomes? If only one good thing comes from this, maybe it will be an opportunity to collect data on the real value of this program, to inform the larger debate about national health care reform for adults when we get to that point. We may not have enough information by then, but I'm wondering who is going to do this tracking and make sure this issue doesn't go away. Is this a place for consumer advocates to step up? Will the policymakers who pushed for SCHIP make sure this happens? There must be more powerful ways to counter the spin and make sure this has political and policy consequences. I'm just not sure I completely understand who's going to do it.
I agree with Katie, there is definitely a clear ideological difference between the Republicans and Democrats. It is disheartening to see how difficult it is even to get health insurance for poor children. I thought at least there's some level of concensus when it comes to this most vulnerable population. Sadly, that is not the case and this is a foreshadowing of how hard it will be to reach universal care for all Americans. It's great to see that most candidates (mainly Democrats) have proposals on the table on how to reach universal coverage. However, I hope it's not lip-service to what Americans what to hear. Just looking back to the Clinton era it seemed (at that time) that health care was on the forefront and then it failed miserably. I hope this time it'll be different and we'll be careful to take advantage of this "window of opportunity" to make something happen.
I want to respond to Megan's comment and acknowledge that a lot of the SCHIP beneficiaries may be put in the middle--providers pushing the costs to the patients when the government refuses to pay a treatment. Blaming the providers won't solve anything because they have costs to deal with, but I don't think SCHIP beneficiaries (those in need) should pay for something they need that they can't afford. That seems counter to the purpose of SCHIP.
And so perhaps it's time for a health reform, starting with children. The budget's getting tighter, sick kids are not getting better if insurance costs are too high, and health expenses (treatment, etc) are not getting cheaper. But until we get political consensus, what can we do to help the underinsured?
I thought this article did a good job portraying the ideological and practical differences that kept the schip expansion from happening. I appreciated that rather than indulge in divisive caricature, the authors included opinions from Republicans that belied claims that Republicans uniformly considered the bill to be 'socialization.' The range of ideological differences seems to suggest that both democrats and republicans will need to rely on compromise in order to accomplish any substantive reform to the healthcare system. democrats will probably need to consider giving more control to the private sector, whereas republicans will need to agree on some government-level intervention or regulation.
On the Steven Colbert note.. this Daily Show clip from October 4th is equally hilarious where he interviews 19th century Oliver Twist.. " A seven year old shouldn't be get health insurance from the government... they should be getting it from their employers". Quite the parody.
http://www.thedailyshow.com/video/index.jhtml?videoId=109140&title=banned-aid
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