Rational Arguments

A reader responds:

In your Feb. 1 post, you claim that Rep. Price’s authored bill, H.R. 3400, is “the Republican proposal” for health care reform.  It’s one of several that has been sponsored by Republicans, and most importantly isn’t the one that made headlines this fall from such a “grim” CBO review. That bill was H.R. 4038.  Your post misleads your readers and implies that: there has only been one Republican proposal, and that this is it.  Maybe you made an honest mistake, but words are important and your biases rarely hide themselves. In your words, I look forward to you correcting the record.

First of all, I always love when someone tells me my “biases rarely hide themselves” – as if they’ve caught me trying to hide my preference for a single payer health care system.  Or my disdain for rhetoric.  Or my impatience with politics over policy.

Let me say it for the zillionth time.  It’s not hidden.  I think that the available data and evidence show that such a system would be much more cost-effective.  I think that the media (and others) have done a terrible job of describing the details of proposed policy.  I think that too many people want reform to succeed or fail only because they want Democrats or Republicans to “win” or “lose”.  Even worse, I think that some people want it to succeed or fail merely because of personal feelings for politicians, which is so petty it makes me sad.

If you think I’ve got some other “bias”, please do let me know.  I’ll address it here, in the open.  I’ve got nothing to hide.

As to the idea that HR3400 is not “the Republican proposal”, it’s the one that Rep. Price was talking about when he spoke to President Obama.  It’s the one he said had more co-sponsors than any other health care reform bill in the house.  It still doesn’t.

Although it does have more co-sponsors than HR4038, which has only 23.

But if it makes this reader feel good, then I will say – again – that there has been more than one proposal.  I have talked about them in a number of posts.

None of this changes the fact that the health care reform bill with the largest number of co-sponsors is HR676 – Medicare for all.

Here’s one mistake from last Friday’s Q&A, which has been all-the-rage this last weekend.

Rep. Tom Price said (emphasis mine):

Mr. President, multiple times from your administration there have come statements that Republicans have no ideas and no solutions, in spite of that fact that we’ve offered, as demonstrated today, positive solutions to all of the challenges we face, including energy and the economy and health care. Specifically, in the area of health care, this bill, H.R. 3400, that has more cosponsors than any health care bill in the House.

He’s correct that HR 3400, the Republican proposal for health care reform, has more co-sponsors than the Democrats’ bill.  But he is incorrect that it has more co-sponsors than any health care bill in the House.  Know which health care bill has more?

HR 676.  The United States National Health Care Act or the Expanded and Improved Medicare for All Act.  It’s a bill for single-payer insurance.

It has 87 co-sponsors.

Since the Republicans are obviously proud of their number of co-sponsors, I’m sure they are going to be impressed by this fact.  I’m also going to assume that Rep. Price isn’t lying, and that he just doesn’t know.  I’ll look forward to his correcting the record.  And I’ll look forward to the media reporting any of this to anyone.

I doubt anyone in Congress is enjoying themselves right now.  Recently, Senator Sanders withdrew his amendment for a single-payer system.  He didn’t seem too happy about it.

But it appears he didn’t give up and actually got something into the Manager’s Amendment:

A $10 billion investment in community health centers, expected to go to $14 billion when Congress completes work on health care reform legislation, was included in a final series of changes to the Senate bill unveiled today.

The provision, which would provide primary care for 25 million more Americans, was requested by Sen. Bernie Sanders (I-Vt.).

He said the additional resources will help bring about a revolution in primary health care in America and create new or expanded health centers in an additional 10,000 communities. The provision would also provide loan repayments and scholarships through the National Health Service Corps to create an additional 20,000 primary care doctors, dentists, nurse practitioners, physician assistants and mental health professionals.

Very importantly, Sanders also said the provision would save Medicaid tens of billions of dollars by keeping patients out of emergency rooms and hospitals by providing primary care when then needed it.

Sanders has worked with House Majority Whip James Clyburn (D-S.C.) to include $14 billion in the House version of the legislation.

Sanders is also working with Sen. Ron Wyden (D-Ore.) to improve language already in the bill to provide waivers for states that want to provide comprehensive, affordable health care and curb rapidly-rising costs for money-making private health insurance companies. The waivers could clear the way for a state-run, single-payer system.

When people ask how we will accomodate so many new people into the system – this is how – 20,000 more primary care professionals.  New or expanded health centers in 10,000 communities.

And he’s still pushing for state-level single payer programs.

Good for him.  This is how progress is made.  You don’t give up.  You keep trying.  And – sometimes – you succeed.

I was on Stand Up! with Pete Dominick this afternoon, and a caller asked a question I get asked all the time.  Basically, he was citing the “fact” that doctors would quit being doctors if there was major health care reform because they won’t make as much money.  Or something.  But it all gets down to the same thing – doctors hate single payer, right?

I can’t even count the ways this is untrue.

Let’s start with my own research showing that doctors in the United States would support national health insurance:

Methods: We randomly sampled 5000 physicians from the American Medical Association Masterfile. We sent each physician a survey asking 2 questions: 1) In principle, do you support or oppose government legislation to establish national health insurance? and 2) do you support achieving universal coverage through more incre- mental reform? Question 1 was identical to the one we used in our 2002 study (3). Respondents answered using a 5-point Likert scale. We also gathered data on physician membership organizations and demographic, personal, and practice characteristics.

This was the largest mail survey of physicians ever done on health care reform.  It was a follow up study of work we had done five years earlier.  And what did we find?

Look at that.  59% of all physicians supported government legislation to establish national health insurance.  A majority of every specialty except three supported national health insurance.  Every specialty we measured in both 2002 and 2007 increased support for national health insurance (except pediatric subspecialists which stayed the same at 71%).  Almost twice as many physicians support national health insurance as oppose it.

That’s 59% for national health insurance.  Remember that when people start saying physicians oppose reform.

Another popular form of this argument is that “doctors are flocking to the US from Canada”.  You can’t imagine how many people I meet who claim to know such a doctor.

Well, it’s true that years ago there was a net influx of docs into the US from Canada.  No longer:

What you are looking at is data from the Canadian Institute for Health Information.  The important line is the yellow one, which is the net loss of docs to Canada.  Even in the worst year, fewer than 700 more docs moved to the US than moved to Canada.  But, since 2003, there has been a net movement of docs into Canada from the US.

It’s not that docs are fed up with Canada and moving to the US.  If anything, it’s the opposite!

When people want to demonize single payer systems, they always wind up going after rationing, and more often than you’d think with hip replacements.  Here’s Rep. Todd Akin (R) on the House floor yesterday:

“I just hit 62, and I was just reading that in Canada [if] I got a bad hip I wouldn’t be able to get that hip replacement that [Rep. Dan Lungren] got, because I’m too old! I’m an old geezer now and it’s not worth a government bureaucrat to pay me to get my hip fixed.”

Sigh.  This has been debunked so often, it’s tiring.  But here:

“At least 63 percent of hip replacements performed in Canada last year…were on patients age 65 or older.” In 2006-2007, an additional 1,577 hip replacement surgeries were performed in Canada on patients over 85.

It’s not true.  They don’t deny hip replacements to the elderly.  But there’s more.

Do you know who gets most of the hip replacements in the United States?  The elderly.

Do you know who pays for care for the elderly in the United States?  Medicare.

Do you know what Medicare is?  A single-payer system.