Rep. John Kline, who recently became the ranking Republican on the House Committee on Education and Labor, issued a searing statement to Democrats this morning, criticising them for rushing a 1,000 page health care reform bill through the committee without proper deliberation.

The bill, which Kline called a “government takeover of our nation’s health care system” in a statement, was approved by the committee this morning.

“Democrats’ stubborn insistence on voting when the ink had scarcely dried on the page belies a frantic rush to ratify unsound policy before its inadequacies – and consequences – could be fully realized,” Kline wrote.

He finished the statement by saying, “The American people deserve better than the Democrats’ frenzied, partisan antics.”

The reaction shows a much more outspoken side of Kline, reflecting his new position as the ranking minority member on a key House committee.

The House version of the bill includes provisions for a “public option,” in which the government offers its own health insurance. At least one other Minnesota representative, Rep. Keith Ellison, is a major supporter of that provision. (See his Youtube video where he interviews fellow House members about why their should be a public option.)

The Obama administration has been pushing for the bill to get passed and House Speaker Nancy Pelosi has predicted it will reach a floor vote by the August recess – though she backed down slightly from that timetable on Friday.

Health care reform is on the agenda at the state capitol and on the presidential campaign trail. And every reformer seems to have a sure-fire plan to rein in health care costs.

But here’s an insight into why controlling health care costs is such a confounding problem.

This recent Dutch study, published in
the Public Library of Science, concludes, in essence, that obesity and smoking reduce health care costs, while preventing those scourges would boost costs.

Of course, we’re frequently told just the reverse. Smarter lifestyle choices would cut costs as surely as they would improve health, it’s often said.

But the researchers here disagree. They are at pains to emphasize that reduced obesity and smoking would indeed lead to longer and healthier lives, and for that reason alone are well worth achieving. But lower health care costs, they say, are not among the benefits to be expected.

Why? Because people who don’t smoke and aren’t overweight live longer, and yet they still get sick, and eventually very sick — and the diseases they ultimately suffer tend to be more chronic and lingering, and therefore more costly, than the conditions that too-often kill smokers and the obese too early.

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Saturday night’s New Hampshire debates were among the more substantive of the campaign.

Health care got a fair bit of discussion, and along the way moderator Charlie Gibson asked a crucial question. Isn’t it true, he wanted to know, that significantly controlling health care costs will ultimately require limiting Americans’ access to some kinds of treatment?

He didn’t get any candid answers. But during a separate portion of the debate, John Edwards invoked a story that illustrates the hard choices Gibson’s question alluded to.

By way of (what else?) denouncing corporate greed, Edwards cited the death last month of 17-year old Nataline Sarkisyan, a California teenager. Suffering from leukemia, Sarkisyan needed a liver transplant after complications from a bone marrow transplant. Her insurance company refused to pay for what it considered, in her condition, an experimental procedure.

The company changed its mind in the face of protest and publicity, but the teen died before the procedure could be performed.

One can find a great deal of red-faced commentary on this case echoing the family’s view that the insurance company murdered the sick girl. Here, though, is a thoughtful report from the LA Times business section.

The essence of the situation appears to be that the transplant promised Sarkisyan a two-out-of-three chance of living six more months. The experts quoted by the Times seem to view its merits as a close call.

This website puts the cost of a liver transplant at between $100,000 and $400,000.

Questions:

Is it perfectly clear that under these circumstances the costs of a liver transplant are justified?

What are the prospects for controlling the growth of health care spending if questions about the reasonableness of this kind of expenditure cannot be raised?

Reports that Americans’ life expectancy now ranks 42nd among nations (while reaching a record high) have generated plenty of reaction.

Predictably, advocates of sweeping transformation of American health care — especially single payer proponents — see the nation’s falling behind on this most basic measure of health as evidence to support their prescription.

Just as unsurprisingly, defenders of America’s (relatively) free market approach to health care argue that the causes of differences in life expectancy are too complex to draw simple conclusions.

It should be possible, of course, to recognize the complexities and still support dramatic change, at least of some kind.

Here, at any rate, is an intriguing report that explores the complications of interpreting life expectancy data in the U.S.

Published last fall by the Public Library of Science using data from 1982-2001, the report compares life expectancy in what the authors call the “Eight Americas.” The essence of their finding is that America is an astonishingly diverse nation — in its health status as in many other things.

One is tempted to conclude that it is nearly meaningless to measure life expectancy for the United States as a whole, because doing so requires us to average the condition of populations that are the healthiest in the world with others that rank among the world’s imperiled.

Here are some highlights of the report:

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Here is a characteristically illuminating paper from the Congressional Budget Office, presenting testimony delivered before the U.S. Senate in June.

(Here’s some additional data that goes with it.)

The subject is health care, and the testimony covers a wide range of issues concerning spiraling costs and what might be done to control them.

The CBO’s perspective touches in many ways on a fundamental dispute about what’s wrong with U.S. health care that was debated here in a series of posts months ago. It’s the question whether America has too much health insurance (as many free-market conservatives believe), or not enough insurance (as many liberals, focused on the plight of the uninsured, contend).

Here are a few highlights from the CBO testimony:

Quite apart from the pain rising health costs cause individuals and businesses, CBO calls them “the nation’s central fiscal challenge.”

If costs keep rising at the current pace, CBO warns, federal spending on the Medicare and Medicaid programs alone will consume 20 percent of gross domestic product by 2050 — about the same as the entire federal budget today.

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The Congressional Budget Office continues to believe that much ballyhooed efforts to negotiate lower drug prices for seniors won’t work.

Both of Minnesota’s senators — Democrat Amy Klobuchar and Republican Norm Coleman — supported an unsuccessful effort to bring the plan to a vote in the U.S. Senate today.

But in this report, delivered to the Senate last Friday, CBO says the Senate version of the Medicare Prescription Drug Price Negotiation Act of 2007 will, like its House counterpart, do little or nothing to reduce drug prices overall. 

The problem, CBO reports, is the same as with the House bill. The legislation prevents Medicare from establishing a restrictive formulary of preferred drugs. Without that, CBO says, the program will have no leverage beyond that possessed by individual prescription drug plans serving the program now.

 

Good Wednesday morning.

The AARP is launcing a campaign today urging the U.S. Senate to give Medicare authority to negotiate prices with pharmaceutical companies.

In Minnesota, the campaign is focused on Republican Sen. Norm Coleman, who has yet to commit himself on the issue, according to an AARP press release.

The campaign includes newspaper and radio ads, phone banks, and e-mail and letter-writing efforts, says AARP Minnesota’s communications director Amy Gromer McDonough.

I contacted Coleman’s office for the senator’s latest thinking on the issue and received a statement by e-mail.

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A happy, civil and substantive Thursday morning to all, 

In our exchanges on this blog about health care issues (here’s a link back for those inclined), we’ve established as a key question the seriousness of the problem of the uninsured.

How grave a crisis is it that millions of Americans lack health care insurance? Should covering the uninsured be the pre-eminent goal of health care reform, or is expanding coverage more properly seen as one objective among many?

Let me stipulate to two points on which I believe we can agree:

 1) Large numbers of uninsured people represent a serious malfunction in American health care,

 2) In a properly reformed health care system everyone would carry a reasonable level of insurance — at least, insurance to protect them from the costs of major illness or injury or the long-term costs of chronic disease.

That said, it seems possible that the way the issue of the uninsured is commonly reported and discussed runs the risk of creating misimpressions and suggesting a worse crisis (and a different type of problem) than really exists.

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As we explore the possibilities of the new two-scribe blog, we hereby inaugurate a new feature, Post/Riposte, in which we will occasionally air contrasting viewpoints in the same piece. If you have any civil and substantive reactions to the concept, the structure, or the first effort, please share them below.

Post, by Eric Black 

A New York Times-ABC poll asked the question this way: 

Which is more serious, providing health insurance for all or keeping health care costs down?

It came out 65-31 percent in favor of “health insurance for all.”

I’m sure it’s possible to quibble with the question design. and it’s only one sampling of public opinion on a complex issue on which most people are not experts.

But when Prof. Tice and I declared a hiatus in our five-part pas de deux on Pres. Bush’s State of the Union health care proposal, we had agreed that one of the differences between liberals and conservatives on the U.S. health care issue is that, as D.J. put it:

Conservatives tend to think America has too much health insurance, while liberals think it has too little.

So when I saw the poll result, (and by the way, there’s about a gazillion other measurements of public opinion on health care and other issues in this poll) I couldn’t help thinking that public opinion seems to have an overwhelming preference for looking at the issue from the piont of view that my esteemed co-blogger had identified as liberal.

Riposte by D.J. Tice

As Mark Twain had the King say to the Duke: “Ain’t we got all the fools in town on our side? And ain’t that a big enough majority in any town?”

No, I don’t think the people are fools. But I do think many are confused about economics in general and about health care economics particularly – not least because of journalistic malpractice.

Yes, the liberal health care battle cry — “Cover the uninsured” – is a swell political slogan. Painless and pleasant as dew drops on rose petals.

By contrast, the conservative formula — force people to face real costs, and thus use market discipline to make insurance more affordable — carries the medicinal odor of complicated reality. This is not good political news for conservatives.

These poll results would be more impressive if it weren’t for questions 28 and 32, in which support for guaranteeing coverage for all drops pretty sharply, to less than half overall, when it is suggested the process might cost respondents something.

What’s more, surely controlling costs and broadening insurance aren’t really alternatives – but rather two interdependent parts of the reforms that are needed? I don’t believe we are fundamentally in disagreement about that.

But all this reminds me of my promise to say more directly about the uninsured, and some of the little appreciated facts about them. I’ll do that in a separate post.

Good Thursday morning Fellow Seekers of Wisdom and Truth,

(This is the fifth and, for the moment final, installment of a D.J. Tice/Eric Black discussion of health care policy. If you’re joining us late and have the time and inclination, here are parts one, two, three and four. The next voice you hear will be that of Doug Tice:

Out with the Bush Plan, in with the Black Plan

It seems we’re getting somewhere in our exchange that began with Pres. Bush’s State of the Union health care proposal.

Let’s set aside the Bush Plan and commence negotiations immediately on the Black Plan.

Your idea — to replace today’s tax exclusion on employer provided health insurance premiums with tax credits, rather than Bush’s tax deductions — has real promise. And, as we’ve discussed, it appears to have considerable conservative support from the likes of Stuart Butler at Heritage.

This approach (under which all taxpayers with health insurance would get the same subsidy) would do strongly what Bush’s plan would do mildly. It would help level the playing field compared with today’s subsidies, which are available only to those who get premiums paid by their employers and which are worth less to those with lower incomes and tax rates and less generous employer plans.

And a tax credit system would still, like Bush’s idea, have the power to make health care costs more visible and tangible to consumers, inspiring more price competition and more prudent use of health care.

You emphasize that the tax credits should be refundable – meaning that they would become a reverse income tax for those whose tax liability is less than the credit. That could be costly — but it is worthy of discussion and it would be useful to see some numbers on it.

The basic point is that, as you note, we have a very large health insurance subsidy system today whose design is the result of wartime conditions that have long since passed. It seems only sensible to think about whether that system still serves the nation’s needs, or whether a redesign might better respond to today’s circumstances.

I can’t help finding it a little ironic that liberals, in this context, are worried about changing a traditional economic and social arrangement for fear that, in some way they can’t quite define, doing so might undermine an important social structure we don’t know how to replace — in this case work-based health insurance.

This is a commendably conservative sentiment. I respect it and am instinctively drawn to it. But another irony is that, in this context, I’m conscious of how such resistance to change can be an impediment to progress.

The inadequacies of the current individual insurance market (i.e., how do the sick get insured?) will certainly have to be dealt with, whatever happens down the road to the employment-based system.

But I don’t see the reason to suppose that employers will suddenly stop offering group health plans. The ability to pool risk in a way attractive to insurers is a thing of value that employers, especially large employers, possess, and can use to compensate employees, who pay lower premiums as part of a group. Competitive forces seem likely to continue to inspire employers to offer that form of compensation.

All this said, I also endorse your identification of a basic difference between us, and maybe between conservatives and liberals generally, that this discussion has clarified.

Conservatives tend to think America has too much health insurance, while liberals think it has too little. That oversimplifies both positions, I know, but there’s truth in it.

Liberals want more insurance mainly in the sense that they want to see the uninsured covered. I propose to leave the Bush plan as such behind for now and return to the health care issue soon with some facts and thoughts on the problem of the uninsured.