Tuesday, October 20, 2009

Live Blog: University of Wyoming Health Care Debate

Here I am at the health care debate between the UW College Republicans and Democrats. I'll be posting updates on this post throughout the evening. If you're following this blog during the debate, simply hit "refresh" every few minutes to see what I've added. Hopefully, readers can fact-check any controversial or questionable claims made tonight.

The program is sponsored by Kappa Kappa Gamma, AAPISA, UW Debate, Criminal Justice Club, Forensic Science Club, Cardinal Key, Alpha Epsilon Delta, Freshman Senate, Student Health Advisory Committee, and FaceAIDS.

Eric Blomfelt, director of Risk Management at UW, is moderating the debate. There are three debaters on each side. Curiously, nobody thought to ask representatives from the Green Party, the Libertarian Party, or other third parties.

I probably won't be able to designate each speaker by name. Instead, I will hold the entire GOP team responsible for everything said by that team, and apply the same standard to the Democrats.

As this debate begins, I wonder if someone will raise the point that, according to today's news, "57 percent of all Americans now favor a public insurance option, while 40 percent oppose it."

College Dems Opening Statement:
120 people die every day because of lack of adequate health care coverage. 62% of bankruptsies. 178,000 small business jobs lost to high health care costs. Insurance companies seeing record profits while the number of uninsured grows. This is due to seeing health care as a commodity. Motive of insurance companies is to increase profit for shareholders. Purchasing health care is not like purchasing a car. Sometimes the "rational economic choice" is to die. Alternate plans don't address uninsured. A public health care option "is the only way to provide for the public good." No system will be perfect, but can't keep leaving health insurance to private market. "Public health is public good."

College GOP Opening Statement:
Our founding fathers built a system that did not require large government. U.S. Constitution limits the government's authority. "Do you believe you know how to best spend your money, or should the government spend it for you? We believe in personal responsibility."
46 million uninsured figure is inflated: 10 million of those are illegal, 18 million have a yearly household income of 50,000 or more. It's their choice; they buy other things like cell phones and internet and cable TV.
We can have reform without an increase in the size and scope of government or deficit. 4 key strategies:
1. Tort reform
2. Portability from state to state.
3. Health savings accounts.
4. Preventative care provision in all health insurance plans.

Dems are questioning GOP on exaggerated savings of tort reform, in light of CBO report. GOP responds it's only one component [a little evasive here] GOP questioning the CBO report's accuracy.
GOP says "would you agree that our healthcare system is the best in the world." Dems respond by saying insurance companies do the scary things the anti-reform crowd says the government will do.

GOP says we should require insurance because it's not like cars: "Health insurance only affects yourself." This isn't true. Other people's sick kids make my kids sick, etc.

Dems say we need a mandate: People need basic coverage and safety net. This is a weak response: the Dems need to unapologetically point out that we all affect each other. The Dems correctly point out that mandating health insurance WITHOUT a public option just gives insurance companies the right to raise their prices to a captive market. Emergency room visits cost a lot because you're paying for other people.

Dems ask: how can market cover everyone if it's profitable to drop people. GOP replies that their 4-step program will lower costs. Some debate over what the CBO says concerning the deficit.

Dems re-state that "public health is a public good." They concede that people make bad choices (eg smoking) but that there are other genetic problems that aren't fairly distributed.

GOP woman: Let's place responsibility where it belongs, on the individual. According to National Association of Insurance Commissioners, 60-80% of health problems are due to personal choice (did I hear those numbers right?). GOP side favors raising premiums on smokers.

Exciting exchange: Dems are pressing GOP on exactly how their proposals would actually INCREASE coverage. One GOP person sarcastically says poor people are already covered by medicaid and "we've seen how good those programs are" (sarcasm? and if so, how does that help their side?)

The GOP doesn't really answer the question because covering all Americans isn't on their moral radar.

GOP says we can decrease costs by "standardizing care for all." Standardized medical forms too. Price disclosure for procedures and drugs. [Should these all come in the form of regulations?] Currently insurance companies negotiate with drug companies, meaning different people get different prices. We need to standardize prices. [So the GOP is calling for standardized prices? Really? How? Government intervention, certainly...]

Dems concede the need for standardization of care--but says market can't do it. Dems would, it seems here tonight at least, be in favor of a single payer system. But Dems basically concede this very curious admission that prices must be standardized. They point out that people are left out of the negotiation process between insurance companies and drug companies--another curious GOP admission.

So as of now, the GOP seems like they're conceding a lot of points that they don't understand hurt their argument, and making a lot of vague references to cost-cutting without taking a position on the imperative of universal coverage. Although the audience may not necessarily agree, so far the Dems seem much more together, and less doctrinaire, than their GOP opponents.

GOP says: Bureaucracy. Dems reply: Bureaucracy is a "buzz word." A GOP guy says "I agree that there needs to be work done with insurance companies." What does that mean?

Dems switched one of their speakers mid-debate, and this guy seems a little late to the game; he's sort of bringing up a bunch of stuff that was already hashed out before he arrived.

GOP: CBO report was flawed: Didn't include payment increases planned for doctors who treat medicare patients. Policy won't kick in until 2019 anyway, meaning plan might lower the deficit before the policy kicks in, but might increase it later.

GOP says the government will tax "Wall Street stock transactions" which they see as unacceptable.

Dems respond that "every legislator in congress" trusts the CBO report. [Is this true? It doesn't seem like this is true?]

The GOP has tagged a new guy in too. As a debate coach, I don't think this is a good strategy.

GOP says a public option will only increase access at the expense of everyone else.

GOP now says that the public option will push private insurance out of business. There will be no private insurance companies left.

Dems: Millions are uninsured or underinsured now. GOP cost-cutting measures don't go anywhere near covering people. The new guy on the Dem side says insurance companies won't be driven out of business.

GOP says "It's not government's job to cover everybody." The person in poverty "made a lot of bad decisions that everyone else in this room shouldn't have to pay for." We shouldn't establish a precedent like that.

Dems respond: Some things are important enough to be a public good. Police example.

The GOP is concerned about privacy. Cited Canadian wait lists--average time of 17.3 weeks over 12 areas of specialization. Canada's "priority list" means this will violate privacy, as well as letting the government decide who should get care. We SHOULD be afraid of government bureaucracy, GOP says. Will lose privacy if we adopt any plan. Then he says "it'll be just like Canada" after prefacing their point by saying "I'm not trying to say that what you're proposing will be just like Canada."

Dems say to GOP: tell me how your 4 point plan will cover every American. GOP replies "we don't need to cover every single American."

Somebody asked a lame question: "Although facts play an undeniable role in policy propositions..." how do each sides' proposals reflect "values."

GOP answers: "To a degree, we need to take care of the poor." The choice to help people should be individual, not governmental. Support programs like medicaid, but Constitution was written as "protection from big government." Anothert GOPer "where does that stop? Electricity...vehicles...money...where does government control stop?"

Dems: This is a slippery slope argument. Right now, the market system doesn't provide health care to individuals. Everyone must be covered. [I still don't think they are making the public good argument very well] Majority support the public option.

Lots of back and forth on most of the points I've already listed. I might not update again until the summary statements.

GOP rightly points out that Baucus bill leaves 25 million Americans uninsured.

Dems are spanking GOP in crossfire section--that insurance companies will continue to cut people from their coverage in the status quo.

Closing statements:

GOP: This debate comes down to the question "what is the role of the government?" Democratic proposals will "increase people's taxes exponentially" [really? "exponentially?"] We should make healthy lifestyle decisions.

Dems: Do we believe in the social contract? We have fire protection, military protection, police protection, etc.



Meg said...

Fact check on GOP numbers

Who Are the Uninsured?

* The large majority of the uninsured (85 percent) are native or naturalized citizens.
* Nearly 1.1 million part-time workers lost their health insurance in 2008.
* Over 8 in 10 uninsured people come from working families – almost 70 percent from families with one or wage earners


The numbers cited by the college GOP come from an oft-criticized Blue Cross and Blue Shield study from 2003. The Census Bureau's surveys - which found about 15 percent of the U.S. population uninsured - is the largest and most regular survey, said Karyn Schwartz, a senior policy analyst at the nonprofit and nonpartisan Kaiser Family Foundation. And according to its findings, "The bulk of the uninsured are U.S. citizens, they're from working families, but they have low incomes and would likely have trouble affording private coverage," she said.


Meg said...

On those personal choice figures. I Googled it & cannot find a source:

Your search - "60-80% of health problems" are due to personal choice - did not match any documents.


* Make sure all words are spelled correctly.
* Try different keywords.
* Try more general keywords.
* Try fewer keywords.

Meg said...

HSAs hurt Americans and decrease coverage according to Harvard medical school.


Meg said...

68% of people trust medicare, 48% trust private insurers

We can test that question with data from a set of surveys known as the Consumer Assessment of Healthcare Providers and Systems. CAHPS is an initiative of the Department of Health and Human Services that developed a standardized survey questionnaire used by virtually all health insurance plans -- public and private -- to assess patient satisfaction. Most private insurers use the CAHPS questionnaire and disclose the data to the National Committee for Quality Assurance in order to receive their accreditation. So thanks to CAHPS, we have a massive collection of data comparisons of how patients experience and rate Medicare, Medicaid and private insurance.

Those comparisons show the depth of Medicare's popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according to the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.


Meg said...

And my health care story:

I don't qualify for any government programs (unless I have a kid) and can't afford insurance. This is unsustainable.

"In 2004, I was in college full time. My health insurance lapsed over summer vacation and I could not afford gap coverage. Memorial Day weekend, I fell ill and went to the emergency room with no insurance. Four ER visits and two weeks later, I was informed that I needed emergency surgery to remove an infected gall bladder.

It is five years later and I am tens of thousands of dollars in debt. I will never own a home. I cannot get utilities without large deposits. I have health coverage through my college that has a $2,500 deductible. I don't answer my phone if I don't recognize the number.

I don't have any money to give to the collection agencies that call every day, at least once an hour, beginning at 8 a.m. and ending at 9 p.m. I would talk to them, but when I do, they ask why I have no money to pay and try to get me to give them every penny I have since the people I owe money to deserve it.

In August, I was in a car accident and nearly totaled my car. I was in pain but I refused the ambulance, knowing I couldn't pay for it. I had to sign a form stating that I was willfully refusing medical treatment and that side effects of my refusal could include death.

Believe me, I know. But at this point in my life, it is more likely that I will not have the money to pay the bill, instead of dying through refusal.

But I still cross my fingers every single time I feel sick. Luck is my comprehensive health insurance policy."


Meg said...

Senators don't all agree on the CBO report:


Meg said...

The system we have now had unrestricted access that raises costs for everyone else - it's called the emergency room. Perhaps if we have a public option to lower costs, people will get preventive care, which the GOP is proposing to lower costs anyways.

Meg said...

Read my story. What bad decision did I make to deserve that hospital bill?

Not everyone in poverty is a victim of themselves. Circumstance, like bad health, can keep a lot in poverty. Are these the same people that advocate going to your church to get charity if you get sick?

Louis said...

(1) The Dems were prepared enough to bring in the CBO report on tort reform (it won't save money)

(2) The slippery slope argument isn't always the best one, a better one might have been "who decides and how." I definitely agree with the argument that punishing people for making bad choices (good in theory) has too many unintended consequences to be a viable policy option.

(3) What the GOP was likely arguing, when arguing against the public option is that it would turn into an unsustainable entitlement: i.e. when people are denied benefits they call their Congresspersons, who in turn see to that their constituents receive the benefits. Over time, you get a costly, and ultimately unsustainable program. The GOP isn't completely off the mark with this argument; however, it does not appear they did a very good job of articulating it.

(4) My main criticisms from reading this are that the Democrats didn't do a better job of explaining the logic of a mandate--insurance operates by spreading risk (unlike the monster we have today)--the only way you get people in one pool, or close to it is by requiring everyone to have insurance. The potential downside is that if it isn't properly implemented, you can have a system in which people are literally required to buy insurance they cannot afford.

Cassandra said...

I'm glad you came tonight, Meg. I wish we had had more time to get into some of the points we had discussed in our planning meeting, but unfortunately we were bound by the format.

The point we were trying to establish was really to get an informed dialogue started about the issue among people within our age group. We may not, by and large, be the people most in need of coverage now, but it is only a matter of time before that is the case.

Anyway, I hope you enjoyed yourself and thanks for sharing your opinions and your story!

Meg said...

I wasn't there. I was having dinner with my brother while I fact-checked as Matt invited people to do. I think my bro was a little irritated, but it definitely was a good comprise - I wanted to be there, but I hadn't seen my brother in months.

Meg said...

This is proof of how insurance can and will screw people over, by the way.


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