For additional help in separating truth from falsehood, check out the St. Petersburg Times’ Politifact.com Truth-O-Meter on policymakers’ health care reform claims.  If you’ve never checked out Politfact.com before, you must.  It won the Pulitzer Prize for National Reporting this year, and you’ll quickly discover why.  I especially enjoy the Pants on Fire section reserved for the biggest lies and misstatements.

In place of the public insurance option, some Democrats are floating the idea of creating new health care cooperatives.  Health care cooperatives would be little more than mutual (owned by policyholders) insurance companies that would negotiate rates with health care providers.  Lest you be confused, this nation has quite a few mutual insurance companies already.  State Farm and MetLife, for example, are both mutual insurance companies.  So this $6 billion proposal is not a reform at all.  Furthermore, writes the New York Times, “the co-op idea is so ill defined that no one knows exactly what it would look like or how effectively it would compete with commercial insurers.”  In other words, some people seem ready to waste $6 billion on a half-baked idea.

In 1994 a nice couple named Harry and Louise convinced us that we didn’t need health care reform.  Back then, Louise was famous for saying:  ”Having choices we don’t like is no choice at all.”  If I had a choice, I would choose the government-run insurance plan.  But this time around the people who brought us Harry and Louise are busy trying to deny me the choice I want.  Why are the same people who were such big champions of choice in 1994 so afraid of giving me the choice I want today?

Earlier this month, Investor’s Business Monthly ran an editorial (in)appropriately titled “How House Bill Runs Over Grandma” criticizing Democrats for wanting to set up a health care system similar to the United Kingdom’s National Health Service.  Not satisfied with relying on dear old Grandma’s imminent demise to make its point, the editorial proceeded to turn renowned physicist Dr. Stephen Hawking, who suffers from Lou Gehrig’s disease, is paralyzed and speaks though a voice synthesizer, into its poster child for the evils inherent in the British system.  According to the original editorial, which conveniently has been edited, Dr. Hawking “wouldn’t have a chance in the U.K.” because his life would be declared “essentially worthless.”

A great argument save for one pesky little detail …. Dr. Hawking is British and receives free health care through the National Health Service.  What did Dr. Hawking have to say in response to the editorial?  ”I wouldn’t be here today if it were not for the N.H.S.  I have received a large amount of high-quality treatment without which I would not have survived.”

This week the Economist includes an opinion piece about President Barack Obama.  My favorite quotation:  ”He has been curiously ill-served by a press short of useful criticism, with liberal America prepared only to debate what sort of water he walks on best, while conservative radio hosts argue over when exactly he became a communist.”  I can come up with no sentence that better captures the left-right media divide – and the utter uselessness of their chatter – better.

Meanwhile, notes the Economist, President Obama is losing the support of independent voters, who are concerned about federal spending, and needs to show leadership on important issues like health care and environmental reform.  ”Back in the honeymoon days,” says the Economist, “Mr. Obama was constantly compared to Roosevelt.  No longer.”

I recently had an opportunity to read FDR’s fireside chats.  FDR would talk directly to the American people about important issues in plain, easy to understand, but not condescending, language.  I think President Obama needs to do more of this.  It’s harder now, with so many media competing for our limited attentions, but he needs to make a conscientious effort to reach us.

In closing, some interesting words from FDR to ponder:

• On stimulus spending: “It is going to cost something to get out of this recession this way but the profit of getting out of it will pay for the cost several times over. Lost working time is lost money. Every day that a workman is unemployed, or a machine is unused, or a business organization is marking time, it is a loss to the Nation.”  14 April 1938.
• On health care: “Whether we come to this form of insurance soon or later on, I am confident that we can devise a system which will enhance and not hinder the remarkable progress which has been made and is being made in practice of the professions of medicine and surgery in the United States.”  14 November 1936.
• On the environment: “If, for example, in some local area the water table continues to drop and the topsoil to blow away, the land values will disappear with the water and the soil. People on the farms will drift into the nearby cities; the cities will have no farm trade and the workers in the city factories and stores will have no jobs. Property values in the cities will decline. If, on the other hand, the farms within that area remain as farms with better water supply and no erosion, the farm population will stay on the land and prosper and the nearby cities will prosper too. Property values will increase instead of disappearing.”  6 September 1936.

The major action on the Senate side appears to be occurring in Democratic Senator Max Baucus’ office.  Over healthy snacks of chocolate-covered potato chips, Oreo cookies, and beef jerky (couldn’t make up this tidbit if I tried), Senator Baucus and his colleagues appear to have discarded the ideas of allowing a government-run insurance plan to compete with private sector plans, mandating that employers of a certain size provide health insurance, and raising taxes on the rich to fund reform.  In their place, the Senators are likely to propose creating a network of nonprofit cooperatives.  I might feel better about this proposal if I didn’t know that Senator Max Baucus recently held a $10,000 per plate (of chicken cordon bleu) fundraiser for the Democratic Senatorial Campaign Committee that was attended primarily by health care industry executives and raised nearly $1.5 million from these same people in 2007 and 2008.  I also can’t help but wonder why the guy is so thin.

Meanwhile, in the House, health care reform efforts seem to be stalled with open warfare between House Energy and Commerce Committee Chairman Henry Waxman and “blue dog” Democrats.  At this point, they appear to be talking, but not agreeing.

This is not the kind of debate I expected when I heard President Obama speak of meaningful health care reform last week.  What happened?  I don’t know, but it certainly doesn’t help that The New York Times is sending me a “breaking news alert” that President Obama’s clout on health care reform is eroding, according to a new New York Times/CBS News poll, even though a careful reading of the article suggests overwhelming support for some kind of reform.

Tonight I’m saying a prayer for the quick recovery of Senator Ted Kennedy, the foremost authority on this issue.  His insights are desperately needed right now.

30 July 2009.  UPDATE: Key House members reach a compromise!

So what is the Special Commission recommending?  Replacement of the current fee-for-service system with a global payment system.  Under the current system, a doctor receives a payment for each service that he or she provides, which incentivizes providing more treatment than is necessary.  Under the proposed new system, networks of health care providers would receive a flat fee for each person in the network, regardless of whether that person only received an annual check-up or spent months in the hospital recovering from a serious illness.  The notion is that the latter approach will encourage preventative care and discourage overtreatment.

There would be many challenges with making such a conversion.  How do you ensure that all networks have comparable participants or that those networks with higher risk participants receive extra compensation?  How do you ensure that networks don’t cut corners, especially with dying patients, in order to maximize profit?  How do you determine what the initial per-participant compensation rate should be and the rate at which it should increase over time?  What impact might such a system have on innovation in a state with some of the best academic medical centers in the country?

Even so, I think the Special Commission is on to something.  The proposal may not be perfect, but it should receive serious consideration.

Why do we need reform?  Forty-six million Americans and 250,000 West Virginians don’t have medical insurance.

What are the major issues?  (1) Health insurance for every American; (2) Meaningful insurance reform; (3) Establish a health exchange that includes a public plan; (4) Reform of the health care delivery system; (5) Financing coverage for all Americans.

What are the options for providing health care for every American?  (1) Expand Medicaid to cover all low-income adults.  (2) Require all large employers to provide health coverage to their employees or pay a fee.  (3) Require all Americans to have health coverage.

etc., etc., etc.

And it ends with a bibliography where I can go to learn more!  Excellent work!

• Employer-Subsidized Health Coverage.  Am I the only person who thinks this is a crazy way to fund health care?  I believe this development dates back to World War II when wage controls prevented employers from increasing wages, so large companies began providing the benefit in lieu of wage increases.  If my understanding is correct, employer-subsidized health coverage is an accident of history, not a carefully thought-out policy decision.
• Free Agents.  The United States has significant numbers of independent contractors and small businesses for whom health coverage is difficult – or impossible – to fund.  Everyone from Daniel Pink (author of “Free Agent Nation”) to Tom Friedman (author of “The World is Flat”) is predicting that there will be more and more free agents in coming years.  It is not good public policy to have a system that doesn’t work for 45 million people.
• COBRA.  I would like to thank the people who championed the original COBRA legislation that makes health care coverage affordable (debatable, I know) for those who recently left employment.  Having said that, I am sitting here staring at my COBRA forms now, and I can’t even figure out how much I’m supposed to pay – and I’m a lawyer.
• Medicare.  I would like to heckle the people who came up with the idea that old people should have to choose from among various health care and prescription drug plans.  Many people my age have had to make these decisions for their bewildered parents.  It’s all well and good to preach the benefits of “choice,” but any system that confuses and worries the elderly is a bad system.
• Medicaid.  I appreciate the Medicaid safety net, but it’s unfortunate that people basically have to bankrupt themselves to benefit from it.
• Government-Sponsored Health Plan.  As I understand it, President Obama wants one of your options to be a government-sponsored health plan.  I don’t understand why so many people are up in arms over this proposal.  If the private sector can do it more competitively and efficiently, people will choose their plans.   As for me, I’ll probably bet on the government if I’m given a choice.
• Cost and Rationing.  I think government should ensure that somehow – someway everyone has the opportunity to acquire the basics of food, clothing, shelter, a certain level of education and a certain level of medical care.  Having said that, I think it’s reasonable for government to draw lines somewhere.  In the education arena, the line typically is drawn at post-secondary education.  I have no objection to the government saying that it will ensure that I receive a treatment that might lead me to live cancer-free, but not a very expensive treatment that, at best, will give me six more months to live.

The health care debate is complicated,  and I don’t pretend to know any answers, much less all of them.  But I am thankful that intelligent people are out there looking for reasonable solutions.  I don’t expect our leaders to come up the perfect system, but I do expect them to try.