Thursday, July 30, 2009

Let's have debates on reform

With it now clear that Congress is not going be voting on any particular version of healthcare reform until after the summer recess (it must be nice having a "summer recess," btw), and with polls showing public support quickly waning for what's fast becoming known as "Obamacare" (whatever that means), I'd like to propose a series of televised debates on the subject between the president and whomever the Republicans want to put up.

I will even volunteer to moderate.

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I'd like to know how, precisely, the president proposes to slow cost growth while covering about 47 million more people, without affecting the quality of care for people who already have coverage, or raising middle class taxes. Seriously, I don't understand most of the bills that are being floated by the various committees, and I follow this stuff closely. For example, yesterday we learned that conservative Democrats managed to "cut" $100 billion out of one of the House bills while also getting promises that rural hospitals won't see their Medicare rates drop. Set aside the Washington inside baseball for a moment. Assuming this is the idea that makes it through the House, I'd like to know: Where is this $100 billion? Are these real or phantom cuts? And that's just the tip of the iceberg.

So it's time, I think, for the president to quit making stump-style speeches and just put his cards on the table. Is it too much to ask for him to get specific and just tell us what he wants to do?

I have questions for Republicans, too. Do they have any ideas at all about how to reform healthcare? Anything? OK -- tort reform. I'll give them that. Anything else? They're terrific at shouting "socialism" but what do they actually propose? They ran Congress and the White for six years, and we got, what, exactly, out of them (other than tort reform) in the way of health reform ideas?

So it seems to me that both sides have a lot of explaining to do. Let's do it right by having a series of presidential-style debates, on different aspects of healthcare reform.

What questions would you ask the president or Republicans, if you had the chance?


  1. I am sounding like a broken record- there is more than enough money in the system if you would get rid of insurance companies! They serve no purpose- they do not improve care or outcomes and they do not invest their money in good faith (see NEJM article on the insurance company billions invested in tobacco companies). The ONLY purpose they serve is to provide campaign donations, PAC funds and support the lobbying industry.
    Want a real health care debate? Get David Himmelstein or Quentin Young debating ANYONE that the Democrats or Republicans want to put up against them.

  2. I would like to see such an open debate as well. I would like to see the public actually get involved more deeply in such a debate. All parties that potentially affect delivery and financing of health care should participate; they should be held across the country - rural, suburban and urban areas and televised on C-SPAN. Leaders of large organisations like the AHIP, AMA, AHA, AARP, etc. should be specifically uninvited. Local folks - community leaders, doctors, lawyers, teachers, nurses, small businesspeople should be invited. One WH representative should be invited also.

    There should be official record-keeping, and data should be analyzed on a state by state as well as national level.

    Precise costs of providing health coverage should be honestly discussed. Cost of uncontrolled litigation should be noted; so also costs of voluntary bad lifestyle choices.

  3. while there is a cost associated with the insurance companies there also came the long overdue check and balance system on physicain directed care. The extended lenghts of stay, and evidenced based practice are all insurance company inventions. While I like the care to be advised my health care provider I also want a means of validating the claims of potential outcomes.