Robert Reich: Let's fast-track universal healthcare

[babylonsister]

http://www.salon.com/opinion/feature/2009/04/20/reich_spending/


Let's fast-track universal healthcare

Obama will be tempted to bargain for his agenda with spending cuts; healthcare's not the place to trim.

By Robert Reich


April 20, 2009 | It's no accident that as Congress returns this week from its two-week recess and begins debate on the $3.5 trillion budget plans for the fiscal year starting in October -- which may or may not include a provision that fast-tracks Obama's healthcare proposal by allowing it to pass the Senate with a mere majority -- the president has summoned his Cabinet for a first meeting, at which he'll call for more cuts in domestic spending.

Symbolism counts in Washington, and Obama's request that his Cabinet officers come up with $100 million in spending cuts will be played up by the White House as the beginning of a major effort to trim unnecessary government spending. It's part of the president's effort to reach out to Republicans (and calm the nerves of "blue-dog" Democrats) worried about all the money the administration has spent and still wants to spend -- $787 billion on the stimulus, $700 billion committed to the bank and auto bailouts, and, most important, $3.5 trillion for the next 10 years, including universal healthcare. Throw in the cost of a cap-and-trade system to control climate change and you're talking big money.

But Obama would be mistaken to take more than symbolic steps at this point. The economy is still in a depression because consumers and businesses won't or can't spend, and exports are dead because the rest of the world is in even worse shape. Government spending on a large scale is necessary now, and will be next year as well.

Over the longer term, Obama must be careful not to put entitlement programs on the chopping block as part of a "grand bargain" to elicit Republican support for healthcare and cap-and-trade. Social Security is not in dire straits; it can be made flush for the next 75 years by ever-so-slightly lifting the ceiling on the portion of income subject to Social Security payroll taxes (and if Democrats are reluctant to do that on incomes over $100,000, then they could do so on incomes over $250,000).

Medicaid and Medicare are in trouble because healthcare costs are rising so fast, which argues for healthcare reform rather than cuts in these important programs. Yet if healthcare reform has any prayer of controlling the rising tide of healthcare costs, the plan must allow beneficiaries to opt into a public insurance plan -- something Republicans and the healthcare establishment are determined to fight. So it's critically important that the Senate wrap healthcare into a reconciliation bill that can be enacted by a majority vote in the Senate.

Obama should fast-track healthcare and stop trying to court Republicans. Every House Republican and all but three Senate Republicans voted against the stimulus; all Republicans in both houses voted against the budget. During the recess they hosted "tea parties" claiming that Americans are overtaxed. Over the weekend, House Minority Leader John Boehner called the idea of carbon-induced climate change "almost comical."

Republicans are already off and running toward the midterm elections of 2010, even starting to run ads against House Democrats in close districts. They seem hell-bent on becoming a tiny, wacky minority -- the party that denies evolution, denies global warming, denies Americans need a major overhaul of healthcare, and denies the economy needs anything more than a major tax cut to get it moving again.

[salguine]

1. Couldn't have been better said—President Obama needs stop stop trying to

build bridges and make nice with everybody, and start doing what needs to be done. If that means ramming stuff down the Republicans' throats and stepping on their balls, so be it. They weren't accommodating or inclusive when they were running things; in fact, they took pride in what assholes they were. They did all the wrong things, but they got them done.

[seeker4ever]

8. Amidst All of This Compromise...

I really hope he can knock the insurance company dicks out of his mouth long enough to get this done right.

[boomerbust]

2. Medicare D

Needs to be rewritten. Get insurance companies out of the system and and let the government negotiate with drug companies. Free market.

[Lugnut]

3. Yes.

Medicare D is a big bad joke the Repubs played on Medicare recipients to benefit big pharma and insurance companies.

[Faryn Balyncd]

4. & if we allow a mandatory insurance "reform" with NO public option, it will be worse than D (& worse

......than nothing at all.

Any true reform has to be either Single Payer, or one than allows younger Americans to opt in to Medicare, or it will be nothing more than corporate welfare - - - and the biggest of all time.

We should fast track healthcare reform, but ONLY if that reform is either Single Payer, or one that has a public option that all Americans can choose.

And if Obama's plan gets changed so as to eliminate a public option, it needs to be defeated.

If we don't, the insurance companies will grow so strong that it will be impossible to ever reform the system.






(K & R, by the way.)

[MrMickeysMom]

5. EXCELLENT point, FB!

I don't understand why Reich would support universal, since it only allows insurance companies to control the process.

Lots of people confuse the two terms "universal" and "single payer".

Single payer/Medicare for All has the only chance in my opinion. Meanwhile, we are sinking further down the spiral of cost every day by not doing anything.

HR 676?

[Joanne98]

6. I watched the Steny Hoyer healthcare meeting on c-span. It's why I'm up so early.

I'm so infuriated I couldn't go back to sleep. We're getting thrown under the bus on this. The leadership has NO intention of changing the model. I have no idea what we should do but if the insurance companies aren't reigned in, millions of people will die in the next decade from denial of healthcare. It's mass murder.

[northernlights]

7. Why universal health care won't work

Please don't shoot the messenger.

Even without universal healthcare, there is a worldwide shortage of medical staff. With near universal coverage in Massachusetts, there are doctors working literally 7 days/week. That can't continue.

The education is brutally expensive, difficult and limited in the number of students it can accept. There are waiting lists to get in. So the shortage of staff will only get worse with time.

And at least for medical lab techs -- the people behind the scenes that test your blood, urine and tissue samples -- the educational opportunities are fast getting slimmer.

Case in point: I am one of 30+ pre-MLT students vying for 15 slots. In order to boost my chances, I started looking around the country last January for similar programs in areas I'd like to live, so I could transfer as many credits as possible if I got in (or at least on the waiting list) somewhere else.

By March, 3 of the 4 other programs I found last January appear to have been closed. The colleges are still there. Their MLT web pages are gone.

And the program I'm in appears to be in jeopardy. The university was told to give back $8M from this year's already spent budget. Entire programs are on the table, and according to one department head the cuts will be done strictly by numbers, ie. faculty:student ratio. The faculty:student ratio for MLT classes is, obviously, not good at 1:15 (versus 1:30 for other classes).

In the meantime, the selection process, which includes interviews, is ongoing this month, yet 3 weeks into April I've not heard one word, nor have at least two of my chemistry classmates. All 3 of us have completed all of our non-MLT requirements with 4.0, yet have not been contacted.

[theFrankFactor]

9. What Would You Suggest?

SHOW AUDIO FILE:
http://media.switchpod.com/users/jd/TheFrankFactorShow15042009a.mp3

[nxylas]

10. The status quo, I expect

If the poor are going to die, then let them do it quickly, and decrease the surplus population.

[northernlights]

12. not even close

Why would I want to throw away my investment in school?

[northernlights]

13. increase training first

I wrote to Obama's health care transition team ages ago, when they were soliciting input (and before I saw MLT programs disappearing). I strongly recommended funding increased training in existing programs (rather than trying to start new ones from scratch.) And increased funding and support for hospitals that provide clinical opportunities for students. The biggest problem in MLT at least seems to be getting enough clinical opportunities. The only reason the program I'm trying to get into is limited to 15/year is because of the lack of clinical training at the back end. Without it, you can't get certified or hired.

I also believe that health care really should be viewed as a community service, and therefore training should be funded by the communities being served. It's ridiculous to burden students with student loans the size of mortgages, whether they're young and just starting their careers, or mid-life and forced by circumstances to develop a new career.

The fact is that hospital staffs work ungodly hours, are grossly understaffed, and are exposed daily to potentially deadly, antibiotic-resistant pathogens.

Enable more doctors, nurses and clinical staff to be trained, and fund their training so they aren't burdened by huge debt, and more people can be served and at lower cost when there's enough staff to go around.

Edited to add I also advocated strongly for single payer. I sure as heck don't want some insurance bureaucrat involved in my health care decisions.

[Overseas]

11. K&R !! Glad to hear him say no to Republican-appeasing "entitlement reform" !!

I am so tired of Republican appeasement when we are currently drowning in Republican economic policy results. Enough with their Trickle-Up economics. Their policies have led us to disaster. Millions of us are suffering those effects, so I hope Democrats will finally abandon those stupid Republican talking points like entitlement reform. Leave the social safety nets alone already. We have millions more who need them today thanks to Republican mismanagement for the past 8 years.

Democrats who still want to appease Republicans and the corporations who fund them, can keep the maximum SSI payouts at current levels while we remove the income cap for FICA taxes. Tax the full salary of the corporate lawyers, just as we tax their secretaries' full salaries. But keep the maximum payouts from SSI at current levels. If they are really concerned about entitlements, keep the maximum payout the same for a while (indexed to the cost of living). Then they can point to entitlement reform without hurting more of us with too much Republican cruelty.

I liked his observation that medicare costs are rising not due to entitlements but to the rampant rising costs of our quarterly-profit-driven medical care and insurance systems.

If the "free market" (i.e. money-buys-you-influence) worked for health care, we'd have the lowest prices and best care in the world and we definitely do not have that.

If the "free market" works, for-profit medical care and insurance should have no trouble competing with the public option. If the for-profit systems are the best, then they shouldn't worry if some of us want to buy into Medicare for a while. Surely we'll come running back to the fabulous profit-driven system after we experience how awful Medicare can be.