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Friday, August 21, 2015

What Hillary Actually says about Healthcare

My Friends divide into three camps. Those for whom Hillary Clinton is their champion believe in her, but people from both left and right spin her words into dark conspiracies. Oddly I hear polar opposite charges about her from left and right. People on the left tell me she's "against single payer" and a stooge for the drug and insurance companies. The ones on the left tell me she's a socialist and will collectivize health care. All three sides can muster arguments and quotes to promote their point of view. And it seems everyone is looking for a fearless leader on the one hand and to demonize the other sides. Where is the reality?

But first, my own position is that health care is:

"With respect to monopolies other than the monopoly on land", I believe that "where [genuine] free competition becomes impossible, as in telegraphs, railroads, water and gas supplies,"... and health care provisions...., "such businesss becomes a proper social function, which should be controlled and managed by and for the whole people concerned, through their proper governmental, local, state or national, as may be."[Georgist const]

I guess that makes me a Post-Georgist on that subject, especially since the Georgist movement rejected Henry Georges' formulation on the subject. A single payer system is designed to ensure that;

  • doctors get paid a reasonable income.
  • That suppliers of drugs, tools and consumables get paid.
  • and that all folks get the healthcare they need to be productive and comfortable human beings.

When one is dealing with rigged markets (including Energy, Health Care, Banking and Finance) one is dealing with a business that needs to be treated as a "property social function which should be controlled and managed by and for the whole people." The bait and switch of "Free Markets" advocates that somehow there is such a thing in such markets, absent the invisible hand of having cops and judges present and rules and measures being enforced. Moreover, for some public goods, if the public isn't made to pay for them all the individuals will play the game of "it's a great thing, but I don't want to pay for it, let Joe pay for it." And unless they are governed as a "social function" furious cycles of investment and privateering will be followed by disinvestment, profiteering and neglect. We see it all the time. I live next to the Great American Chesapeake and Ohio Canal, which was the victim of such a cycle more than 100 years ago. Some public businesses has to be paid for and neither charity nor privateers will pay for them -- or execute them -- adequately. To the extent that our health systems are private -- only the well heeled even get access to them.

The Cry of Socialism!

But then who am I? The monied interests from among Doctors, manufacturers, insurers and their parasites and lawyers (oxymoron?) seem to have more say on this subject than the rest of us. Because money talks and thanks to the corrupt SCOTUS is "privileged, free speech." Even so I think most Democrats are on the side of delivering the above 3 items.

Hillary on Health Care

Most Democratic politicians are between a rock and a hard place on this. If they openly support Single Payer. They will get scourged by the Con Artists as Socialists. That is why only one current candidate can openly advocate for single payer, Bernie Sanders. But that doesn't mean the others aren't for it. Just they know that only Bernie Sanders can get away with doing so openly.

Lying through their teeth

Because Hillary is unable to be as direct as Modern Day Yellow Journalists would like to be on Health Care Reform. Some folks are having a field day, inventing statements she never made. For example Huffington Post's Eric Zuesse, who claims to be an "Investigative Historian" cuts the entrails out of a Speech that Hillary Gave to HIMS and claims:

"Hillary Clinton has confirmed, to a paying audience of 20,000 sellers of electronic health records systems, that she supports Obamacare, and opposes single-payer health insurance." [InvHist]

This Real Life Eric Cartman claims that this quote comes from her speech to HIMS. He does take some quotes from it that seem to support his contention. But not really. Rather his statements are one nonsensical non-sequitur after another. For example it doesn't follow from her saying:

"We don't have one size fits all; our country is quite diverse. What works in New York City won't work in Albuquerque." [InvHist]

...that she's criticizing the Canadian System, at all! She doesn't even mention Canada at the HIMS conference, and what she said about the American System doesn't contradict anything about the weaknesses of our current system.

Finding Common Cause.

What she actually says is in context important for the rest of us to pay attention to.

It's hard to remember but at one time there were points where we could find common cause. For a time around 2005 I participated in a "Telehealth Group" where we were the facilitators for "Subject Matter Experts" pushing electronic health records. Creating and controlling these was, for a time at least, a major bi-partisan project. It produced Dividends. And Hillary was able to team with some unusual subjects to push it:

"When I got to the senate one of my goals was to promote EHRs. I teamed up with Newt Gingrich and Bill Frist to spread the word about health IT. Bill Frist and I worked on legislation in the Senate. It was a commonsense idea that I thought everybody should agree on. Today thanks to legislation that has been passed and implemented over the years and new technology, we are finally seeing the promise of EHRs, leaving behind the outdated obsolete 20th century — in some cases, 19th and 18th century – ways records were kept." [HIMS]

Bill Frist eventually left Congress under a cloud of scandal. But as a Millionaire Doctor he was intimately familiar with the privateering way that Health Care companies and some professionals have been extracting money from everyone. Newt, of course, is a hero in his own mind and a fountain of ideas. Dems like Hillary could channel them into things useful to the general good.

Technology as Driving Better Outcomes

So yes she was Wowing he HIMS14 Crowd. Some of my friends and former colleagues were there. She praised their efforts;

"None of this is possible without the right infrastructure or attitude." [HIMS]

The "Right infrastructure" is another area where our system is currently failing. For profit hospitals are a monstrosity.

But on the other hand, Once Patient Data is available to doctors in electronic form it can be used as part of diagnostic and treatment tools. For that reason she was able to say:

"Technology specialists are no longer focusing solely on making patient data accessible to providers. You’re now playing a leading role in making sure medical teams have the data that can be used to yield new insights and efficiencies." [HIMS]

And this is true. The Military, Civilian, Veterans Admin Doctors, IT professionals, and others have given their lives. Many of them without money as a prime motivator. The drive? to using technology to drive better medicine. And they (we really) have made a convert of Hillary Clinton:

"I am a believer in the idea that good data helps to make good decisions. It’s true in life." [HIMS]

If we want better outcomes we need to be using our brains. and that starts here:

"It’s important to be guided by evidence about what works and what doesn’t…not ideology or personally held beliefs." [HIMS]

Hyper-Partisan Fighting

On the other hand, ideology comes in once you have the evidence, when you decide what to do about it:

"Unfortunatley we’ve seen too often in Washington recently that many of our public debates take place in an evidence-free zone. (Applause) That is bad news for anyone who wants to get something done who would rather choose common ground over scorched earth. (Applause)" [HIMS]

I don't agree that both sides are equally liable for blame on the hyperpartisanship but the "scorched earth" analogy is apt, because the Cons, by cutting access to health care and funds to health care providers are killing people. They aren't conservatives they are privateers and cons making war on the common good.

"For example, the hyper politicized debate from the beginning has been often more about ideology than about data and what we can learn. The scare tactics have not necessarily helped us understand how best to improve care, lower costs, expand coverage…but to keep what works at the same time. That’s why we need what you’re doing so badly. To get back to evidence based policy debates. And to use that when we need to fix things." [HIMS]

And that is the key. Winding up with a Single Payer system and a non profit system is just an outcome of looking at the evidence and thinking with one's heart and mind in sync.

"We need more transparency in our health care system…we need to drive improvements in health IT…to make it easier to get data on how much treatments cost so providers, payers and consumers can make better, more informed decisions." [HIMS]

The patient should have custody of his /or her own copy of one's own record. The originating provider of his work. All that should be available as needed, when needed. Then we get better decision making. And it's not a matter of ideology, but of heart:

"But if things aren’t working, we need people of good faith to come together and make evidence based changes. That’s what I hope you can help us do." [HIMS]

I worked for DHIMS for nearly 3 years. And still have a high opinion of anyone involved in the Health Care Field. It was one of the proudest moments of my life. And the reason is that we were fighting to save lives. Sometimes against ideological adversaries such as with Traumatic Brain Injury/Post Traumatic Stress, where many macho military folks refuse to even admit there is an issue. Evidence based reasoning helps surmount such prejudice.

"I think that is one of the great missions that anyone can be part of. Because of your focus on innovation HIMSS is in a position to help us see over the horizon." [HIMS]

Sink the Pirates and Go to Commonwealth!

And the horizon is better healthcare, not more expensive healthcare. And one key to controlling costs is to replace the privateering:

"Ultimately, how might we replace once and for all our fee for service model with provider-led community wide care that can compete on quality, value over volume? (Applause)" [HIMS]

To do that we need a Health Care Militia, with the Federal Government ensuring, with collaboration from the States and localities, that States train providers as needed and that we've got enough resources to meet the needs of the market. That is quite a challenge.

"After everything I have seen and learned around the world, my faith in this country is deeper than ever. Yes, we have challenges ahead of us. It will take us working together to solve those problems. We will have to be willing to work with people we don’t agree with…even political beliefs. That is one of our great strengths." [HIMS]

There is nothing pinging other countries. Just an emphasis on the importance of crafting a system that works for all:

"I want to see us have a debate where our differences are fully aired. We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque. We have to have people looking for common ways of approaching problems using evidence, but leaving their gaming, blaming and shaming, and their point scoring, at the door. (Applause)" [HIMS]

Of course, the blaming, shaming, scoring and using health care as a tool to frighten people continue.

Against Single Payer??? No.

Eric then quotes a 2008 New York Times interview to claim that against Single payer because she said [in 2008!]:

"Talking about single payer really is a conversation ender for most Americans, because then they become very nervous about socialized medicine and all the rest of this." [InvHist]

But what she actually said in that conversation was much more nuanced than Eric makes it. And at the time, 2008!, true! The New York times:

"we had to do what would appeal to and actually coincide with what the body politic will and political coalition building was. So I think if you look at most public opinion surveys, even from groups of people who you would think would be pretty positive towards single payer, Americans have a very skeptical attitude. They don’t really know that Medicare is a single payer system. They don’t really think about that. They think about these foreign countries that they hear all these stories about, whether they’re true or not, which they’re often not. And so talking about single payer really is a conversation ender for most Americans, because then they become very nervous about socialized medicine and all the rest of this. So I never really seriously considered it." [New York Times]

This was true in 2008. Obama and Hillary Clinton might have been able to Argue for Single Payer or Public Option more successfully by more aggressively pointing out that Medicare is such a system, but they tried, and the Tea Party won a majority in Congress in 2010 partly by demagoguing the word "Socialism", so Hillary was talking about reality, not her own druthers.

This article was shared in a group by someone I really respect. The person trusted that the author wasn't using sleight of hand. I'm sure if she'd seen the quote was from 2008 and not 2014-2015, she'd have not used it. It was a hit piece, pure and simple. And not even historically accurate, but instead replete with non-sequiturs, straw arguments and anachronistic quotes. And the Next quote shows that she was not against Single payer!

"...I think what we would be offering would be a Medicare-like system, which is something people are familiar with, and you know whether we would call it Medicare 2.0 or whatever we would call it. And we’d see whether people want that or not. And where it morphs to, I think this whole system will morph. I mean, look at where Medicare started and where it is today. In large measure, some of the problems we have are because of the way it evolved. But I think from my perspective, having this Medicare-like alternative really does answer the desires of people. And there’s a significant minority who want quote a single-payer system. It at least gives them the feeling it’s not for profit, they’re not paying somebody a billion dollars for raising their premiums 200 percent and all the rest of the problems that we face with the for-profit system. You get the costs of overhead and administration down as much as possible. I believe in choice. Let Americans choose and what better way to determine that than letting the market have some competition and you know see where it does lead to." [New York Times]

People like Eric Cartman I mean Eric Zeusse, must really think we are stupid.

Further Reading

http://holtesthoughts.blogspot.com/2015/08/the-georgist-constitution.html
Eric Zuesse
http://www.huffingtonpost.com/eric-zuesse/hillary-clinton-likes-oba_b_4881399.html
Actual HIMSS:
http://healthpopuli.com/2014/02/26/hillary-clinton-wows-the-himss14-crowd-of-20000/
Actual NYT:
http://www.nytimes.com/2008/03/27/us/politics/27text-health.html?pagewanted=9&_r=0

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