Saturday, August 15, 2009

Centrist Politics: Jamieson & Altman on Bill Moyers Journal

DREW ALTMAN: It's part of our democracy, but I think it's actually kind of sad because the left, doesn't like this legislation a lot. They're not really enthusiastic about it. They would prefer a single-payer approach with more government. And on the conservative side, they're not crazy about it either. They would like a market approach, people getting vouches or a tax credit and just shop in the marketplace. This is down-the-middle legislation. And yet we see these fears and concerns as if this were a radical approach. It's not a radical approach. It's just a down-the-middle approach...When you look at the real polls about where the public actually is, what you see is there's been a little bit of a tick down in public support and people are getting a little anxious as they follow the media coverage. But still the majority of the American people are for moving forward with this...And so the language has changed. It's now about health insurance reform and not about health reform.

BILL MOYERS: Health insurance reform. Not health care reform...

DREW ALTMAN: You know, facts are useful here. While this legislation does involve a significant expansion of government financing for coverage for people, it's useful to point out that the lion's share of the coverage is private coverage, which is why many people think the private insurance industry is supporting this legislation and they are because they get more paying customers.

BILL MOYERS: Yes, Drew, but what people on the left say, liberals and people even further left, say that what this legislation threatens to do is to require citizens to subscribe to insurance under the insurance company. And without a public option, the insurance company has a captive constituent.

DREW ALTMAN: One the reasons for that is in order to do the reforms of the health insurance system, how health insurance works, which everyone benefits from. It's the one part of this legislation that helps everyone. So you can't be turned away if you get cancer or heart disease or if you're sick. You'd have to have a big pool, so you spread the risk that way so that those of us who are healthy are subsidizing those of us who are sick because we, too, may get sick some day. So that's the reason for the requirement that everyone's in...

DREW ALTMAN: But there's a bit of a catch here. First, though, that's the biggest challenge they face. Of all the challenges they face, the toughest one is financing, financing, financing. It is coming up with that list of savings measures and new revenues that really is the toughest nut to crack. And that's what they're working away at.

KATHLEEN HALL JAMIESON: I think that you've got a real problem with cost shifting in this country. It's not as large as the administration has made it out to be. But when people come into hospitals without insurance and they are helped in the process, as they should be, that cost goes somewhere and it comes off into the people who are insured through some mechanism. I think we ought to be concerned about what that does economically in the long term, also what it does to the well being of those who come in without insurance and, as a result, get care later with a worse prognosis.

We ought to be concerned about that because we're moral human beings. But when Obama, President Obama, makes the big argument which says our economic future is dependent on fixing this, if he could make that single case, he could justify putting this through even if he couldn't in the process guarantee deficit neutrality across a period beyond ten years. He hasn't persuasively made the case. But imagine if he could persuade you that we've got another kind of economic meltdown coming because we're not fixing this piece of our own economy. And he makes the case to you, we could forestall that. Or if it were to happen, it wouldn't be as bad if we fixed this. Wouldn't you find that a persuasive argument? I think there's a case to be made, and I think it's a challenge to him to make it.


These are excerpts, you need to see or read the whole show if you want a more complete version of the discussion. Even so, I think I have managed to condense this segment down nicely to the essentials with the above quotes.

I have a HUGE problem with the way these two guests wanted to frame the debate in terms of health insurance reform. Let me be clear - I don't want health insurance reform because I want private health insurance companies out of business for 99% of the population. If the top 1% needs still more health insurance coverage, then I guess I am okay with the billionaires wasting their money on whatever suits them best. I think the reforms that are needed now are from top to bottom in every aspect of the way we deliver and pursue health prevention and health crisis care. Maybe it's a semantic game in the end, but one might argue that even single payer would be a kind of health insurance - but if it's run by the government I see it more as a public service or entitlement program. Think about Social Security or Medicare - does anyone really think of those as insurance based programs? No, they don't.

And if affordability is the biggest impediment to progress on health care reform then why isn't single payer being discussed? Is there any way that keeping health insurers between the public and health care delivery a cost saving measure? No, the job of the insurers is to make profits in the billions and they do that by denying people care.

Kathleen Jamieson makes a final absurd claim that people will be reassured if the AMA and the AARP support whatever legislation is finally proffered to the public. Well, maybe that will reassure people that are offensively ignorant (you know, about 49% of your neighbors in the U.S.) but that will make the rest of us deeply suspicious instead. Both of those organizations are deeply invested in the status quo and anyone with even half a brain knows it.

Jamieson and Altman, we see you coming and we don't like what you represent.

I was surprised that Moyers didn't go after these two about some of their assertions and opinions. Ah well, no one said the man was perfect.