Durbin open to health bill without public plan

Senator Dick Durbin (R-Ill.) always has been a political realist, and he's showing it again by


broaching what most progressive adherents of health reform would consider to be anathem: a package without a government-run plan. (The story is here.)

"I support a public option, but, yes, I am open" to a bill without it," Durbin told CNN.

This, of course, is more than a local story, because Durbin, as the Democratic Party's whip, is the second most powerful person in the Senate. Is Durbin relaying a signal from the Obama White House that perhaps all is not going as well as hoped, and is willing to negotiate a package not as extravagent as originally proposed? Or is it a signal to the White House from Durbin, indicating that in the Senate, at least, the comprehensive health reform package is in deep trouble and that compromise is necessary.

One might assume that it was just a slip of the tongue and that Durbin isn't really prepared to dump the controversial public option. But, as the consumate politician, Durbin doesn't make these kinds of slips. He's such a politician, for example, that when he found it useful, he jetisoned his pro-life position early in his career to become staunchly pro-choice.

From my viewpoint, compromise is a good idea. Let's work on the worst parts of the system separately, such as eliminating pre-existing conditions and expanding opporunties for health insurance for those who want and need it. Turning the entire health care system upside down for the sake of a few legitimate goals is a wasted and wasteful effort.

Would that it would so simple, though. Durbin, politician that he is, suggested that the House and Senate could pass separate health reform bills, and sneak the public option back into the bill during secret conference committee meetings. "Just understand that, after we pass this bill -- and I hope we do --
in the Senate, it will go to conference committee," he said. "We'll
have a chance to work out all of our differences."

But a bill with the public option back in it would be no compromise, even though Durbin would try to sell it as such.


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  • Part 1.

    Problems :

    1. No systematic, expansive Prevention & Wellness Program.

    According to the scoring of CBO on the prevention & wellness program, all fitness centers around the world should close down immediately and all media have to end
    reporting health tips about prevention. Rather, all of the excellent health systems seem to have one feature in common, a expansive, systematic preventative program
    requiring immense investments.
    I think a prevention system works as a 'levee' built against flood by the government, similarly, it also needs non-profit investments from the government 'on a large scale'.
    This might offer us one clue of why all of the free states have public insurance policy in place.

    Surprisingly enough, the system today is designed around treating patients once they become sick. As far as I'm concerned, the congress affected by the special interests
    has turned down the budget request for prevention program in Medicare & Medicaid, which are the most expensive parts of the health program. Let's imagine the astronomical
    costs and invaluable lives following the levee breach.

    2. A pay for each service / volume compensation, & No E-Medical Record.

    As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the
    recipients, and this 700 billion dollars a year can cover a lot of uninsured people, in return, it could lessen the tragic, prohibitive ER cares.
    Medical errors ( No e-Medical Record ) & lawsuits, more profits motive, and indirect payments from employers etc would account for it.

    Supposedly, 'a pay for each service / volume' compensation seems to leave the medical institutes unequipped with the essential IT system. To understand its importance, If
    we imagine the cost difference between the previous and current system in financial institutes, the magnitude of cost-savings and the mess in health care system can
    be easily explained.

    3. Premium Inflation.

    This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
    'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
    government 'BEYOND this recession' , as all across the spectrum agree.

    Insurance premiums have nothing to do with the law of demand & supply and the free / fair market concept.
    Basically, as demand diminishes, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
    consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, cherry-picking, rationing, rapid
    premium increase and the like. And this runaway premium ended up in the collapse of middle
    class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, as all of
    us know. Thereby they could be cited as an objective for anti-trust or anti-corruption. If the public plan sets the same rate of the insurers, it will be another headache.

    Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of
    question. Therefore, I'd say they have nothing to say about deficit unless they are free from the sponsors.
    And the spoiled menu, 'Takeover and Rationing Cliche' is still marching for bankruptcy, as opposed to its motto.

    4. 'Work or Break' health system with no brake or safety system.

    Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system.
    The rising mental stress or illness & 'keep eating habit' , which are the epicenter of a number of different diseases,might be traced
    to this insecure system and exorbitant premiums.

    Part 2.

    The Public Plan:

    1. Thankfully, the health care reform bill currently before Congress makes several key investments including more primary care doctors in preventive care, and those pieces
    of the public plan must be maintained .

    2. The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM, and it will help doctors focus on their patients.

    3. The 'innovative' idea of a 'pay for value / outcome' pack will allow for Quality and affordability
    . If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
    prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary risk-carrying
    Young folks and advocates need to explain the notion of a pay for outcome agreement to the elderly misled by the

    4. The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
    'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably decrease the
    crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.

    5. The creative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
    Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
    make a better decision, and the government won't still have to meddle in the final, actual decision-making
    process as a non-expert.

    6. This New 'Payment Reform' could accelerate the progress in medical science, in return, it will save more cash.
    And this idea will be able to bring 'competition' to the private market, as a result, it can contribute to mitigating premium inflation.

    7. Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
    care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
    wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of revenue-neutral.
    (Please visit for detailed infos).

    8. Through clinic's network, users of its health-care services can keep up with their health information and information for family members, and receive health guidance and recommendations from clinic that is optimized for each person.
    The system also allows patients to upload information from home-health devices such as blood glucose monitors and digital scales. Patients can authorize whether they want to share their health information with doctors or other caregivers, and those caregivers can provide health-care and general wellness recommendations based on the information patients provide.

    9. In case the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the insecure system and
    exorbitant premiums may bend the curve surprisingly.

    10. Clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' lie ahead, these will
    lead to economic recovery.

    Part 3.

    Conclusion ;

    1. The last thing to expect is rallying for premium inflation

    2. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

    3. With the Prevention & Wellness Program as a stable levee in place, the promising pay for value/ outcome reimbursement reform based on IT system could clear the way for revenue-neutral. Some say the installation of IT network will take time, but once this new outcome-based payment system is implemented, the hospitals reluctant to adopt it will most likely rush to introduce it.

    4. The final hurdle looks like a scoring issue surrounding the savings on Prevention & Wellness Program, but I'd like to say
    health clubs and media reports on prevention tips must be maintained.

    Thank You !

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