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Politics : Stockman Scott's Political Debate Porch -- Ignore unavailable to you. Want to Upgrade?

To: elpolvo who wrote (34877)	1/12/2004 10:53:58 PM
From: laura_bush	Respond to of 89467

Health Insurance: The Cruel American Lesson By Philippe Pignarre Le Monde Thursday 08 January 2004 Americans debated their health insurance model all through the year 2003 on the instance of the installation of a system for medicine cost reimbursement for low-income elderly people without private health insurance. Up until now, their hospital expenses have been paid by the state within the framework of the Medicare program, however, outside the hospital, drugs remained entirely for the patient’s own account. This debate could be most enlightening for the French public. The American and French health insurance systems are situated at opposite poles of a spectrum that goes from most private to most collective. All the reforms considered in France today to resolve our problems tend to make our system more like the American system. Consequently, it is important to know what its effects are. In order to do this without being accused of anti-American bias, it’s best to allow American observers to speak for themselves. In the United States, the big pharmaceutical laboratories freely set the prices for their medicines. From now on, every time the American government negotiates a commercial treaty, it tries to include a clause extending this free-pricing system and withdrawing other nation states’ ability to negotiate the price of medicines. Australia is the first target. Frightened by the electoral consequences, its government has up to now resisted these attempts. However, that’s only putting off the battle. How can the pharmaceutical industry’s complete power be limited? If the laboratories set their prices freely, we effectively risk watching prices for the most important medicines double, even triple. Why should they discomfit themselves with any limit? That would be a way for the companies to guarantee maintaining the high profit levels they’ve promised their shareholders up to now while the rhythm of innovation has slowed down seriously. That would rapidly explode the reimbursement systems. Pricing freedom is only possible when there’s no national social security of the European, Australian, or Canadian models (translators note: these are comprehensive health and welfare insurance schemes that include, but are not limited to a pension system like U.S. Social Security), which can only function if expenses are controlled and prices consequently set by government powers. But with what would you replace such a social security system, since no one wants a system without insurance that would bring about- besides political disorder- a considerable drop in consumption and the companies’ ruin? The idea is to have the social security system managed by competing private health insurers. They may, each for their own account, negotiate prices with the manufacturers. The private insurance companies negotiate price rebates on the free public prices with each manufacturer. How do they succeed? The insurers have a pressure tactic: they establish "forms" where they write down the medicines for which they will pay (others will not be reimbursed, except after a long procedure at the completion of which a provisional authorization in a specific instance may be accorded). What is the size of the rebates obtained this way? It’s a secret, but estimates vary from 20-50%. Following the same logic, the insurers have been lead to create networks of doctors and hospitals that their clients are obligated to consult if they wish to be reimbursed. They go so far as to dictate the length of their consultations to the doctors. In the plans for French reform, that’s called a "basket of services." Therefore, it’s only by limiting the list of accessible medicines and, more generally, the available care, that Americans succeed in controlling their prices. To free the price of medicines, the states must be brought to dismantling their systems of health coverage. Or, inversely, dismantling Social Security makes future medicine price liberation possible. This system has an immediate exclusionary impact: the partial price controls only affect people who are insured. Those without insurance-often the poorest, those working in small businesses where there are no benefits- pay for medicine at its listed, highest price. This is where all the difference between a system based on solidarity, which must benefit the poor, and an insurance system that limits risks as a function of the investments each individual can make really shows. It’s the difference between the Providential State, the Welfare State, and what certain theoreticians have taken to calling the "Enabling State", the state "which makes the individual capable". The Enabling State proposes a veritable social revolution. The state abandons all its social protection functions: retirement, unemployment, health insurance, and hands them over to private companies. All specificity is removed from companies organized as mutual funds, the source of all socialized forms of distribution. Mutual funds are legally obligated to function according to the private insurance company model. The state doesn’t intervene any more, except to dispense tax reductions, which are necessarily unequalitarian. That’s the road France has taken on retirement pension reform: the "supplementaries" that everyone is called on to subscribe to from now on will give the right to an income tax reduction. Tough luck for the poor, who don’t pay any or hardly any tax: the state will not be able to help them put together a nest egg! For Americans, the political choice is: have access to all medicines, but at very high prices, or limit the prices, but only have access to a limited number of medicines. This is the epitome of the kind of alternative liberalism likes to lock people and wrongly naïve governments into. Every other solution comes to seem beyond reach. The trap closes. The feeling has been created that there is no rational way to escape from an infernal alternative. The more powerful the insurance companies are, and the larger number of insured they represent, the better position they’re in to obtain fat rebates. Who profits from these rebates? It’s not possible to assess because their size is not publicized and, moreover, big companies who pay for their employees’ medical coverage- like Ford- complain more and more about the "misappropriation" of this money to the sole profit of the private insurance companies. The poor insured are consequently not only faced with the giants of the pharmaceutical industry, but also with the giants of the insurance industry, if not their own employer, all the time more reluctant to pay the insurance premiums. Three against one! How is one to believe that competition will redound to their benefit rather than that of the insurers or the drug manufacturers? If they’re employed by a company that pays for part of their medical coverage, that part tends to decrease over time. A big company like Wal-Mart insured only half of its million employees in 2003. Consequently, the insured will in all likelihood emerge as the victims of this joke. It’s not surprising that Americans see their health expenses take off year after year and represent at present 14 % of their GDP ( vs. a little more than 9 % in France), for a service which overall is less good than that provided in most European countries, as OECD statistics attest. The excess cost of having private companies take over Medicare could approach 50 %! In its competition with the insurers for its share of the cake at the expenses of the patients, the pharmaceutical industry is fighting several fronts. First of all, it has obtained from the U.S. the right to advertise prescription medicines in the newspapers and on television- which remains prohibited in Europe. This has allowed the growth of patient pressure on doctors and insurance companies to issue certain medicines which had not been accepted on the forms. It has also had to prevent the creation of any counter-power capable of obligating it to reduce its prices. That’s one of the objectives of the reform adopted by the American Congress: Medicare is prohibited from any price negotiation. Moreover, in order to benefit (from 2006 on) from the very partial takeover of their medicine cost, elderly people will have strong incentives to join a private insurance company which will be subsidized by the state and to which will be delegated Medicare’s management. Up to now, Medicare entirely managed its business without private sector involvement. One of the principles of the reform is to balkanize what still remains national in Medicare. One could therefore imagine that Medicare’s insureds who will chose a private intermediary would enter into the limiting forms system, the only way to make prices go down. But there, again, under pharmaceutical industry pressure, the new law prohibits the establishment of such lists in this case! Private insurers will therefore not be able to obtain the same price rebates they get for their other clients. The pharmaceutical companies won a point against the insurers, but in any case, the patients are always the losers. The system therefore risks becoming totally unmanageable. As the government budget devoted to this program may in no case exceed 400 billion dollars over ten years (2006-2016), the only solution will remain to increase the portion the patient pays, their monthly fees, or to change the deductible) Congress budget commission has already calculated that deductibles will be increased by 10% from 2007). It was believed that the reform aimed to help elderly people with limited resources. In fact, it will serve only to generously distribute 40 billion dollars a year to the pharmaceutical industry in the first place and to the insurance industry in second place. Following the most optimistic calculations made by the American press, that amounts to a 33% overall reimbursement of medicine costs, even if the conditions offered could differ according to which private company was chosen to manage each state’s system and vary from one state to another and one year to another. Is this the road down which France should travel? truthout.org -------

To: elpolvo who wrote (34877)	1/12/2004 11:41:53 PM
From: stockman_scott	Read Replies (1) \| Respond to of 89467

The Other Doctor in Dean's House Shuns Politics ___________________________ By JODI WILGOREN THE NEW YORK TIMES January 13, 2004 nytimes.com BURLINGTON, Vt. — Eddie Kasperowicz, 74 and retired from the Seabrook, N.H., auto plant that Howard Dean was touring the other day, had a question unrelated to his union's hot-button issues of trade and health care. "When," he wondered, "will America have a chance to meet your bride?" No time soon, Dr. Dean told him, "unless you get sick in Shelburne, Vt., in which case she'll probably see you." In 23 years of marriage, 18 of which Dr. Dean has spent running for, or serving in, office, his wife, Judith Steinberg Dean, has developed an unusual role for the political spouse: invisible. During Dr. Dean's two years of relentless campaigning for the Democratic presidential nomination, Dr. Steinberg has stood by her husband's side at a political event exactly once, at his official announcement speech here in June. A country doctor who still makes the occasional house call and attends PTA meetings, Dr. Steinberg has given about a dozen interviews — none televised — two fund-raising letters and a cameo on a half-hour advertisement. She has never been to Iowa. It is a reprise of her performance as first lady of Vermont. When Dr. Dean became governor, Dr. Steinberg reluctantly danced through the first two inaugural balls, in 1993 and 1995, but that event was soon cut from the state capital calendar and replaced with an open house, which she skipped. Dr. Dean, for his part, rarely uttered her name, even to say thanks, in public speeches. "I think a lot of couples are like us, where they have two career-couples, and both careers are very important to the individuals," Dr. Steinberg, 50, said in an interview this fall. "Each individual has to do what works for her. What works best for me, and what I'm best at, is being a doctor." Watching one of the nationally televised presidential debates at Dr. Dean's headquarters here, Dr. Steinberg laughed at her husband's old jokes, clapped when he scored a zinger and cringed as he tried a line she hated about how he did not become a teacher because of the long hours standing without bathroom breaks — a line he soon stopped using. In their nightly telephone chats, Dr. Dean calls his wife "Sweetie" as she updates him on everything from their two children to his dry cleaning. "I do not intend to drag her around because I think I need her as a prop on the campaign trail," Dr. Dean said last week in Iowa. "If she wanted to do it, it'd be great, but she doesn't want to do it, and therefore if she does do it, it won't be great. I just think she should do what she needs to do for her own happiness and satisfaction." Some Dean backers see Dr. Steinberg as a role model for independent women balancing careers and children, but others in the campaign increasingly regard her absence as a potential liability for a candidate who is known for his reluctance to discuss his personal life or upbringing. Yet the topic is all but off-limits with the candidate. Voters also have begun to ask about a marriage in which the partners are so often apart — she skipped Dr. Dean's birthday-party fund-raiser, the family-oriented Renaissance Weekend, even the emotional repatriation ceremony of his brother's remains in Hawaii. Political experts say spouses often help humanize the candidates they are married to. A spouse, the person presumably closest to the candidate, also provides a window into a politician's character, they said, and acts as a kind of validator. "The whole thing has just struck me as a little odd," said Myra Gutin, who has taught a course on first ladies at Rider University in New Jersey for 20 years. "There may be some voters out there who say, `well, why isn't she here? Why isn't she supporting him?' It's the most outward manifestation of support." In her book, "The President's Partner: The First Lady in the 20th Century," Ms. Gutin outlined three broad categories: "ceremonial" (Bess Truman, Mamie Eisenhower), whose White House role was mainly entertaining; "emerging spokeswoman" (Jacqueline Kennedy, Pat Nixon), who seized the podium to promote issues important to them; and "activist" (Eleanor Roosevelt, Betty Ford). Dr. Steinberg, she said, fits nowhere. The wives of this year's other prominent Democratic contenders — Gert Clark, Elizabeth Edwards, Jane Gephardt, Teresa Heinz Kerry and Hadassah Lieberman — have all spent significant time on the campaign trail, both by literally standing by their men and by headlining events on their own. While the other spouses are key consultants on both strategy and policy, Dr. Dean said he kept the news that former Vice President Al Gore would endorse him secret from Dr. Steinberg for nearly three days. If Hillary Rodham Clinton was controversial for being her husband's full political partner, some analysts say that Dr. Steinberg's lack of participation might prove even more problematic. "The other candidates will come around with their wives and say `here we are,' and then there will be these questions," said Lewis Gould, a University of Texas historian emeritus who is editing a biography series, "Modern First Ladies." "This is the most important office in the world and you ought to have an interest that your husband is doing it. So, where are you?" Most of the time, wearing sensible slipper-flats and no makeup or earrings, Dr. Steinberg can be found in an unadorned medical office she shares with two colleagues in the suburb of Shelburne, where the snapshots under the desk's glass top have not been changed since it belonged to her husband, before he became governor in 1991. Or she might be puttering around their five-bedroom ranch-style house near Lake Champlain, writing a list of chores — fix the toilet, change the light over the stoop — for Dr. Dean to tackle on his rare days home. Or racing through Hannaford's supermarket in sneakers at 10 p.m., her list of bananas, milk, wheat bran, low-fat fudge bars, aluminum foil, tea bags, Gatorade, lemonade and grapefruit ordered according to aisle location. "I'm very happy doing what I do," she said. "He's happy doing what he does. I think that he's doing a great job, and I think that he thinks what I do is a great job." Dr. Steinberg said she is simply too busy to get involved in the campaign. Along with her work, and a bimonthly book group, she has volunteer commitments at Burlington High School, where the Deans' son, Paul, 17, is a senior (their daughter, Anne, 19, is a sophomore at Yale). Lacking cable television, Dr. Steinberg tries to get to headquarters for watch debates, though she skipped at least one to do laundry. Show up on the campaign trail? She doesn't even keep track of the schedule. "He has so many events each day that I'd have to take an hour out of my day to follow it," said Dr. Steinberg, who grew up in the Long Island town of Roslyn, N.Y., the daughter of two doctors. Dr. Dean has spent, on average, just four nights a month here in Burlington, for nearly a year. Though Dr. Steinberg and their children are Jewish, he campaigned through Yom Kippur, and recited the Rosh Hashanah blessings via cellphone. He calls home nightly unless he is on the West Coast and fears waking her, but rarely shares tales from the trail. "I don't talk politics," he said, "with people who aren't interested in politics." Dr. Steinberg said: "I couldn't be more supportive, but I don't show my support by traveling with him. I'd rather be seeing patients." Her patients joke, now, about chartering a bus to Washington for checkups, while the pundits muse about how the Secret Service would handle privacy concerns. Dr. Steinberg said she planned to keep practicing medicine if her husband is elected, but she had seen enough episodes of "The West Wing" to know that were she to become the real-life version of Stockard Channing's Dr. Bartlett — wife of the fictional President Bartlett — she would "certainly have to do some public events." "I'd do the ones that Howard would think were most important," she said. The couple met at Albert Einstein Medical School in the Bronx, doing crosswords in neuroanatomy class ("She got a 99, I got a 35," he said. "34 was passing.") Their first date was dinner at his parents' Park Avenue apartment. She followed him to Burlington after he failed to get a residency in New York, and they practiced together for a decade in Shelburne. Before he ran for lieutenant governor, in 1986, "we took a long walk, which is what we do when we discuss big issues," Dr. Steinberg recalled. "His take on it was, he decided he should run," she said. "My take on it was, we decided that if he wanted to run, I had said it would not hurt the family. The next day, the reporter called me and said, `What do you think of him running for lieutenant governor?' I was a little surprised. I didn't know he'd gotten to the next step." Friends here said the couple hardly socializes, except to attend their children's sporting events. They don't cook much, either — at least not since the early 1980's, when Dr. Dean decided to bake apple pies for the neighbors, which took all day, "and the apple pie was not that good," she said. While voters like Mr. Kasperowicz wonder when Dr. Dean will introduce his wife, others like Helen Grunewald a photography professor from Blairstown, Iowa, applaud the path they have taken. "I just want to say I'm glad your wife is your wife and I'm glad she does what she does," Ms. Grunewald, 53, told Dr. Dean at a recent forum. "We don't all need Laura Bush and mommy in the White House." Anita Dunn, a Democratic strategist, said that though "the country has come a long way in terms of what they think the model of a first lady should be like," the couple would need to appear together if Dr. Dean progresses. "It can be a very controlled kind of thing, but they do need to look for a few places where she can talk a little about herself, about her husband," Ms. Dunn said. But nothing of the kind seems to be penciled in on the schedule that Dr. Steinberg says she does not follow. "If I get elected," Dr. Dean said the other day in Iowa, "you'll meet her in the White House."