Live blog: Meet John Oberlander

We're happy to have health policy expert John Oberlander visiting our Sunday night political salon tonight in Chapel Hill. Here's an interview with him on NPR. I'll try to keep up with what he's saying. If you have questions, please ask.

"No one's trying to scare people with sound bites. I mean, you know, I've not done that, and I don't know any of the leaders in the House and Senate that have done that," Republican National Committee Chairman Michael Steele said on NPR earlier this week. But that's not convincing to many political scientists like Oberlander, who say they're hearing a lot of what they consider to be deliberate scare tactics.

"Fear is crowding out the truth. And the truth ought to count for something in health care reform and American politics. And right now it doesn't," Oberlander says.

The current debate isn't yet over, but so far at least, biology has defeated logic every time.

Should be interesting.


The opposite

The Obama strategy on health care is in reaction to their analysis of what happened to Clinton in 1993. They believe there were several problems. Clinton went too slow and erred in driving from the top down. Clinton also fought a two-front war against small business and against the insurance industry. Everything Obama is doing is in response to what they believe are mistakes on Clinton's part.

The first legislative proposal for health care was in 1916. We may be closer than we were then, but we're also facing major obstacles. First obstacle is cost. Over ten years, we're looking at $1 trillion ... all of which has to be paid for. Where will the money come from? Efficiencies, prevention, medical records, best practices, etc., etc. In this case the Congressional Budget Office says those sources won't deliver what's needed.

Where else to look? Taxes, of course. Where else? Reduce Medicare costs.

The big problem for health care is the US Senate

LBJ and Roosevelt had 68 and 69 Democrat Senators. Obama has only 60. Not to mention the fact that Senator Max Baucus is a moron. (Sorry for the editorial comment.)

House plan on the books

  • Expands Medicaid
  • Creates insurance exchange (like a shopping mall)
  • You'd get subsidies depending on income
  • Insurance companies would have new regulations
  • There would be a public option in the insurance exchange

The Senate version is even more watered down (i.e., useless).

What's going to happen?

Something will pass. Rahm Emmanuel is telling Democrats in the House that if this goes down, they go down.

  • None of the bills being considered offer universal care
  • None of the bills will control costs
  • None of the bills will start covering people for four freakin' years (this is political cowardice)
  • None of the bills have subsidies that will really help the middle class

John thinks there won't be a decent public option

What to look for

  1. Baucus maneuverings
  2. Pelosi's management skills
  3. Do Democrats have the balls to go to reconciliation (and bypass filibuster)

John thinks reconciliation is not likely to deliver all the benefits people want. He also thinks it's a high risk move. Most likely to fall off the table would be insurance company controls.

I'll ask

but I think the answer is political cowardice.

One radiologist says

there is too much profiteering in imaging and radiation. The US does imaging like it's going out of style ... and we're not getting enough value.

A dollar spent on health care is a dollar of income to someone.

At the end of the day, you have to take income away. There's not enough political will to take the actions that are needed to reduce usage.

Look for triggers in the legislation to automatically force cost reductions associated with certain procedures. Every specialization advocates for keeping its slice of the pie.

The insurance market is segmented

Things really suck for small groups and individuals ... big employers are in okay shape.

Regulating private insurers is very difficult. No kidding.

We're trying to put lipstick on a pick by turning the insurance industry into some entity that's less greedy.


My takeaway? We're totally fucked on the healthcare front.

I think the US would do well to provide scholarships

for doctors and nurses tied to a period of mandatory service..kind of like Northern Exposure had in Dr. Joel Fleischman. New clinics could invest in imaging equipment and collect a small surtax from each use to pay for it.

I think it's a good way to up the ante on competition with insurance companies.