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Health Care Reform — A Republican View
Senator Chuck Grassley
The health care system has serious problems. Costs are rising at three times the inflation rate. Many Americans are uninsured. Millions more fear losing their insurance in a weak economy or because of preexisting conditions. Doctors are ready to close their doors because of high malpractice insurance costs and low government reimbursement rates.
Everyone agrees that something has to be done. But the reform proposals pending in Congress would make a bad situation worse. These bills would cause us to slide rapidly down the slippery slope toward increasing government control of health care. They contain the biggest expansion of Medicaid since the program’s creation. They impose an unprecedented federal mandate for coverage backed by the enforcement authority of the Internal Revenue Service. They will increase government spending by nearly $2 trillion when fully implemented. They give the secretary of health and human services the power to define benefits for all private plans and to redefine those benefits annually. From a new health-choices commissioner to a center for comparative-effectiveness research, these bills create dozens of new bureaucracies, increasing the federal role in health care. All of this amounts to a lot of power over people’s lives.
The House bill includes a government-run plan; the Senate’s bill may yet. A government-run plan would eventually drive private insurers out of business and lead to a government takeover of the health care system. A government-run plan is not necessary for health care reform unless your goal is to use the government’s power to drive down costs by rationing care and slashing payments to providers. In addition to limiting health plan choices and infringing on the doctor–patient relationship, a government-run system would guarantee U.S. taxpayers a staggering tax burden for generations to come.
Even worse, the bills fail to solve the fundamental problems in health care. They take no serious steps to reduce costs, either for the health care system or for individuals. The bills will cause insurance premiums for scores of people, especially those who are relatively young and healthy, to go up, not down. They tighten the allowable price variation for insurance rates, so that millions of people who are expecting lower costs as a result of reform will end up paying higher premiums.
The bills also impose new fees and taxes that will be pushed directly onto the consumer. Totaling about a half-trillion dollars over the next few years, these fees and taxes will cause premium increases as early as 2010, even before most reforms take effect. Then, after forcing premiums to go up, the legislation makes it mandatory to buy health insurance.
The bills also make problematic changes in Medicare. According to the Congressional Budget Office (CBO), the legislation imposes higher premiums for prescription-drug coverage on seniors and the disabled. The Senate Finance Committee bill creates a new, permanent Medicare commission with broad authority to make further cuts in Medicare. The damage that this group of unelected people could do to Medicare is unknown, although the top actuary at the Department of Health and Human Services recently concluded that cuts of this magnitude will limit benefits and decrease access to care for Medicare beneficiaries.
These points are good examples of the philosophical difference between the two sides. Some of us want to reduce the overall cost of the legislation, try to reduce the government’s role, make it harder for illegal immigrants to get benefits, allow alternatives to the individual mandate and harsh penalties, and reward states with extra Medicaid dollars if they pass medical malpractice reform. Instead, the prevailing plan is to move millions of people from private coverage into public coverage and create new taxpayer-funded subsidies for families making close to $100,000 a year. Yet even with all the changes, after raising billions of dollars in new taxes, cutting a half-trillion dollars from Medicare, imposing stiff new penalties on people who don’t buy insurance, and increasing costs for those who do, 25 million people will still not have health insurance under the Senate Finance Committee bill, and 18 million people will not have it under the House bill, according to the CBO. I don’t think this is what the American people had in mind when the President and Congress promised to fix health care.
It’s not too late for bipartisan legislation that builds on common ground to improve coverage and affordability, increase quality, and decrease costs. I’ve worked for years on bipartisan legislation that would change Medicare so that it paid not for the volume of services provided but for the quality of the care delivered. There’s also widespread support for health insurance exchanges and for ending discrimination based on preexisting conditions to make coverage more affordable and accessible. Allowing individuals to purchase insurance across state lines and enabling small businesses to band together when shopping for insurance are also proven methods for reducing costs and should be included as part of comprehensive reform.
Tort reform is another necessary component, since it would reduce abusive lawsuits that drive up costs and limit access to doctors. The CBO estimates that comprehensive medical liability reform would reduce federal budget deficits by roughly $54 billion over the next 10 years. The Democratic Congressional leaders have shown little interest in creating an environment in which doctors don’t have to engage in defensive medicine just to keep their practices open. The medical community should continue to argue for reasonable reforms that would cut down on unnecessary medical tests that serve no purpose other than to reduce malpractice premiums.
On several occasions, Republicans tried to take the legislative substance in a different direction. We tried to ensure that the President’s pledge not to tax middle-income families, seniors, or veterans would be carried out. We were rebuffed every step of the way.
And amendments offered by Republicans on the Senate Health, Education, Labor, and Pensions (HELP) panel and the Finance Committee to provide consumers with a lower-cost coverage alternative, similar to the high-deductible health plans and health savings accounts sold today, were consistently defeated. Those alternatives would have allowed more people to keep their existing coverage. The defeat of these amendments and the forthcoming pressures on employers and individuals mean that despite the President’s promises, a lot of people aren’t actually going to be able to “keep what they have.” In fact, given the long list of new benefit mandates and strict new actuarial-value requirements, a lot of people are going to end up paying more to meet the government’s new definition of health insurance.
Congressional Democratic leaders are advancing their extremist health care reforms with the bare minimum of votes. I disagree with that approach. Health care is one sixth of our economy — as large as the entire British economy. The legislation Congress is considering will affect every American, at every level of health and at every stage of employment. When the debate began, interested legislators of both parties set forth benchmarks that were no-brainers: Health care reform should lower premium costs, reduce the deficit, and bend the cost curve the right way. The bills before Congress don’t do any of these things.
It’s not too late to step back and start again. If both sides can set aside some philosophical differences and refocus on the principles that brought us to the table months ago, we can implement health care reform that improves the quality of life for those Americans who are suffering under the current system and that doesn’t degrade the quality of life for everyone else.
Financial and other disclosures provided by the author are available with the full text of this article at NEJM.org.
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Source Information
Senator Grassley, an Iowa Republican, is the ranking member and former chairman of the Senate Finance Committee, which has jurisdiction over most federal health care programs.
This article (10.1056/NEJMp0911111) was published on November 18, 2009, at NEJM.org.
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Other
Worth Illinois, USA
Disclosure: None
I am not a doctor but I can see how the low rates of reimbursement by Medicare and Medicaid could lead to a destruction of medical care in the US.
The goal should be to slow down the rise in medical costs, cut down on Medicare and Medicaid fraud. There should be more severe penalties for those that defraud Medicare and Medicaid and funds taken illegally from Medicare and Medicaid should be recovered. Perhaps it would be best to forgo the government option because the government has not shown that it has been an efficient admistrator. Why not keep the present insurance companies. The government could negotiate with them for lower premiums based on large groups of people being enrolled in health insurance companies. It would not be too bad to offer subsidies to those who cannot afford to pay the full amount of the premium. Everyone should pay what they can afford with the government paying the difference in order to avoid the system being subjected to abuse as it is right now.
Physician
Montreal , Canada
Disclosure: None
Government assumption of the role of single payer does not equate to rationing of services. In Canada, provincial governments might try, but would get kicked out of office in the next election if they were unreasonable. What control do Americans have over insurance companies?
As a Canadian physician, I have yet to see an access-to-care problem that I could not solve. And all of my patients’ health care is provided through their tax dollars, and not on a point of care basis. None of them has had to go into debt, or mortgage their home, to finance health care. If they are indigent and don’t pay taxes, they are still fully covered.
If Canada, and most other industrialized countries in the the world can do it well, I’m sure the US of A can do it even better! What are you waiting for?!
Other
Old bridge New Jersey, USA
Disclosure: None
Tort reform is a buzz word created by the insurance companies and adopted by conservative politicians to help the insurance industry make higher profits. There is not an iota of empirical evidence that tort reform (i.e., limiting lawsuits) will save physicians one dime in malpractice insurance costs, but it would abridge the rights of our citizens to seek redress for wrongs.
Nobody wants to get sued. It is not a pleasant experience. But before we swallow the insurance industry and U.S. Chamber of Commerce backed propaganda, ask what the human costs will be to implement “tort reform” if there is no corresponding benefit to the doctors, lawyers, and other professionals that pay exorbitant premiums that will not be reduced.
Other Health Care Professional
Fort Collins Colorado, USA
Disclosure: None
Senator Grassley:
Thank you for a rare statement of common sense in what has become a completely partisan and increasingly irrational debate. The Democrats seem determined to pass whatever legislation they can concoct in order to claim that they have “reformed the health care system.” It is instructive, I belieive, that most of the “reforms” do not become effective until after the 2012 election. They apparently believe this will insulate them from the inevitable political backlash that will occur once the realities of the legislation become widely known. I think they are sadly mistaken.
Physician
Creve Coeur Missouri, USA
Disclosure: None
Both political parties criticize the costs of medical care today in the United States. In large part, these costs are driven by political factors, beginning with Medicare, which fixes prices for the delivery of medical services for the elderly and which has created a very large, very expensive governmental bureaucracy to manage those services. In fact, those costs for Medicare alone promise to be in the tens of trillions of today’s dollars when projected over the next several years.
It is an obscenity that medical care in the United States has come down to a debate over how the Congress should expropriate dollars from the American people rather than whether they should. If there is to be an honest debate about medical care in America, the government needs to extricate itself altogether and protect the authentic individual rights of its citizens so that they can, privately, negotiate the terms of their care with physicians.
Other Health Care Professional
Grand Rapids Michigan, USA
Disclosure: None
Exremely well written – and I agree 100%. What is happening presently doesn’t make any sense.
Physician
Ann Arbor Michigan, USA
Disclosure: None
In publishing in an academic journal, Mr. Grassley misses a prime opportunity to offer substantive evidence for his arguments. Unfortunately, all we get is the same rhetoric that anyone could find in partisan websites and publications. While he tries to build reasonable arguments, he contradicts himself, sometimes within the span of a few sentences. “A government-run plan is not necessary … unless your goal is to use the government’s power to drive down costs by rationing care and slashing payments to providers. . .take no serious steps to reduce costs. ” Which is it? While he argues that the bills don’t sufficiently reduce costs, he argues against the measures that are intended to reduce costs (the Medicare commission, comparative effectiveness research). Mr. Grassley’s misses the opportunity to bring any substance to the arguments against the current legislation.
Other
New York City New York, USA
Disclosure: None
Healthcare Reform Offers us an Opportunity to Build Smart/Intelligent Infrastructure Services for Smart Grids, Broadband, Transportation Systems, and Healthcare IT. We can used Inrastructure Service for New Jobs Creation and Economic Recovery.
Proper Deployment of Health Information Technology (HIT) Solutions and Training can Increase Productivity (i, e, medical data mining/warehousing, risks treatment, service delivery), Efficiency (i, e, medical errors, redundant and inappropriate care), and have a Costs Savings of around 20-30% of our Annual National Healthcare Expenditures ($2.4 Trillions).
The Engine of Economic Growth in 21st Century is “Broadband.” we can start by Deploying Packet-based, All Optical/IP, Multi-Service Transport Infrastructure “Network of Networks.”
This “Network of Networks”, in addition to New Jobs Creation and Economic Recovery, can Serve as Business Driver for: e-Healthcare, e-Commerce, Energy/Transportation Systetms, Social Networking, etc
Physician
Highland Heights Ohio, USA
Disclosure: None
Tort reform shouldn’t be a GOP position, since it has universal appeal. We all know the arguments against it. Caps deny compensation to the truly needed. Loser pay provisions would deny deserving individuals access to the court system. The medical profession doesn’t provide adequate oversight over rogue practitioners. Etc, etc. All of these issues are easily outweighed by the negative consequences of the current medical malpractice system. Here are a few points which are not given serious attention by fans of the status quo.
(1) The current system tortures the medical profession. Innocent physicians are ensnared and can remain trapped there for months or years.
(2) Repeated legal skirmishes adversely affect our doctor-patient relationships
(3) Billions of dollars are wasted on defensive medicine
(4) Patients are exposed to risk (and expense) of unneeded medical care
Does this sound like a system worth preserving? See http://www.MDWhistleblower.blogspot.com under Legal Quali
Physician
Houston Texas, USA
Disclosure: None
Senator Grassely has not engaged in an honest debate on health care reform. Here is what he said at a town hall meeting earlier this year:
“There is some fear because in the House bill, there is counseling for end-of-life,” Grassley said. “And from that standpoint, you have every right to fear. You shouldn’t have counseling at the end of life. You ought to have counseling 20 years before you’re going to die. You ought to plan these things out. And I don’t have any problem with things like living wills. But they ought to be done within the family. We should not have a government program that determines if you’re going to pull the plug on grandma.”
End of life counseling gives patients more autonomy and allows the patient to make decisions for themselves. The notion that this equates to “pulling the plug” is maliciously dishonest.
Senator Grassley’s claim that he now wants a principled discussion lacks credibility.
Other
Indianapolis Indiana, USA
Disclosure: None
All political endeavors can be addressed by answering 2 questions: Who gets what? How much do they get? Healthcare is no exception.
All actionable endeavors are limited by exactly 3 constraints: Definition of a successful outcome; available resources; time.
With the increase in scope of success defined by this bill, either time or resources will be severely impacted; possibly both. But, who gets the what? I submit the voters/tax payers aren’t the beneficiaries of this bill – not by a long shot; it’s the politicians who are benefiting. What/how much are they getting? If they convince enough voters that they solved a problem (of their own creating), enough voters may rehire them indefinitely. It’s not about healthcare – that’s merely the vehicle and the distraction. It’s about power.
Physician
Hamilton 3216 , New Zealand
Disclosure: None
It is interesting to see how little the supply of medical care has changed in the USA over the last fifteen years. At that time a group of physicians et al from New Zealand and Australia went over to see what could be learnt from the North American system. We found that there were centres of excellence and those the opposite. Nothing seems to have changed. Medicare was there to cover those there who didn’t have the knowledge or ability to look after themselves or who couldn’t afford adequate insurance cover. This is still very much the same internationally. What Senator Grassely is suggesting would probably really make little difference, although the Democrats bill appears to cover the bottom end of the populace . A combination of a broad education along with an adequate medical safety net + some insurance may be the only means of achieving the sort of inevitable compromise required.
Other
Lincoln Nebraska, USA
Disclosure: None
The total cost to the economy to provide health care will be what it will be, no matter whether it is paid for by insurance premiums or taxes or loans from the Chinese. The only way to lower the total cost to the economy is to make the components of health care cheaper. This is what the price mechanism does. Free market competition tends to drive prices down. Bureaucrats spending other people’s money do not generally succeed at that. But free consumer choice based on price and quality requires information. The current system disguises the true cost of care behind layers of bureaucracy and a maze of negotiated payment systems. It also disguises the quality of care behind the smoke screen of privacy. Maybe if we knew how much our care really costs, and how good it really is, we could decide for ourselves what we are willing to pay for. Or we can just keep on complaining while we let someone else pay for it.
Other
Shawnee MSN Kansas, USA
Disclosure: None
I think what you’ve done to medicare is a travesty to those of us who have taken care of our parents, our children and our debt to society. Our generation believed and trusted in our government…..can the younger generation say the same??
Physician
Altoona Pennsylvania, USA
Disclosure: None
Tort reform is missing in the current political debate. I am offended every time I see a lame defense of the current system from those who continue to profit from it – the legal profession.
The house and senate are loaded with individuals who have profited from the current status quo.
The most telling imformation from the docs perspective: what specific section addresses tort reform in the bill and why? What remedy is offered other than telling those evil doctors who lie to say they are sorry.
Studies are cited regarding relative cost between physician reimbursement here and over seas, then innacurately quoted. Other studies are cited, as supportive of our litigators – shameful, but what can one expect from a non-scientific field like law.
To have the arrogance to state they really know and belittle the human cost to patients, providers, and ultimately payors or CYA medicine. The is only one person on earth who knows the cost of a tort happy society on my patients.
ME!
Physician
Chicago Illinois, USA
Disclosure: None
I hope the senator’s perspective is mainly and primarily on improving quality of care and reducing cost of health care- that is cost of care that does very little to improve health and or reduce premium. If it is a partisan view point
as the statements I read look so and very little change from existing situations where insurance companies and drug companies and by extension others related are the benefitiaries where is the change?. I have no doubt that whether privately run or government run or both, change will be met with some initial draw back and some inefficiencies. That is where the congress and the senate would need to stay on top to prevent and eradicate inefficiencies and missing of targets. It would have been perfect if it were a bipartisan legislation not just for sharing blames if there failures should happen, but to keep working at it like a joint investment. Who would like to see their investment failing!!
Other Health Care Professional
Toledo Ohio, USA
Disclosure: None
I am appalled that a scientific journal of the caliber of NEJM would allow such a piece of political propoganda to be published in its pages. I counted a minimum of 19 assertions of “fact” in Senator Grassley’s article, not a one of which is supported by a single shred of evidence. I hope your readers contrast this article with the one which follows by Kellermann and Lehman which also contains a number of assertions of “fact,” nearly all of which are supported by evidence and citations. Needless to say, I find this article to be much more compelling than Grassley’s. There has been so much exageration, obfuscation, and prevarication by both sides of this debate. It is really sad that NEJM has allowed itself to be part of the problem and not part of the solution.
Physician
Des Moines Iowa, USA
Disclosure: None
Senator Grassley states: Heathcare is one sixth of our economy- as large as the entire British economy. Yet the British have a national healthcare system. Something is wrong? We have danced around this question for decades; we can dance no more. Free clinics are popping up all over. Why? Because all people need coverage while more money is being wasted. The free markets have never been in the business of lowering prices i.e. homes, cars, food, clothing. Buying cheap from China to sell here is not lowering prices and we can’t do that with healthcare. A single payor system is a must but it can be done with the existing insurance companies if they would provide “insurance” for everyone without regard to profits. Yes, malpractice reform, electronic updating are both necessary for the system to work but first we must provide every America (legal and illegal) coverage, period!
Medical Student
Denver Colorado, USA
Disclosure: None
Senator Grassley,
Medical students today, from my own school to the AMA-MSS which proposed the cover the uninsured campaign, have a very strong opinion about the course of this debate that you would be wise to look into. Many of us believe that medical care is a right that should be extended to all. EMTALA explicitly states this ethical mandate regardless of citizenship or ability to pay. It only makes sense to codify this agreement by extending insurance to all by making it affordable and a requirement (just like we require car insurance, nothing new here). The US already rations care, but only to those that can’t pay. There is no easy fix as health care does not follow standard economic market theory. Comparative effectiveness, evidence based medicine, tort reform, restructured incentives, competitive insurance, taxing unhealthy behaviors, etc are all necessary to decrease costs. If you see some of these missing start reform part II, don’t just complain! Get going on that bill
Other Health Care Professional
phila Pennsylvania, USA
Disclosure: None
Must the insurance companies define and control our access to all health care?
Consider car insurance. We cover the car only for exceptional events, like a car crash. But we don’t insure our car to cover expected and unexpected maintenance expenses.
As a society, I would prefer we agree to purchase insurance for exceptional events but leave health maintenance as a fee-for-service that is paid for by individuals and potentially direct from employers to service providers, when employers choose to offer such a benefit.
For example, a young family could purchase catastrophic health insurance but pay for annual check-ups out-of-pocket. Consumers choose providers, whose fees, and drugs fees, are listed publicly, just like any other business, and negotiated.
Alas, it’s likely to be too late to convert society to such a model. The insurance and pharmaceutical companies stand to lose too much to agree to this model.
Physician
Dataw Island South Carolina, USA
Disclosure: None
Senator Grassley highlights some important issues regarding our health care and many of his colleagues do the same. So why is there such polarization in the debate? The problem seems to be similar to the colloquial differences between statistics and tragedy. If someone unknown to us dies in a faraway land, it’s often considered a statistic; on the other hand, if someone that we have known and cared for dies, it’s a tragedy.
We need to reformulate our discussion metaphor: let’s see the health care as care for an individual that we know and simply multiply that concern by 300 million. Systems science allows for this perspective, because each individual in a society represents a system-within-a-system and simultaneously outlines a framework along which meaningful health care restructuring could proceed. Currently, the U.S. health care is an incomplete system located at the outer edge of chaos, where disorganized complexity prevails, as plotted by the Dynamic Systems Model (see below).
Janecka IP: Is the U.S. Health Care an Appropriate System? A strategic perspective from systems science. Health Research Policy and Systems 2009, 7:1
http://www.health-policy-systems.com/content/7/1/1
Physician
new york New York, USA
Disclosure: None
Let’s look at some of the assertions without any evidence of their veracity.
1.”A government-run plan would eventually drive private insurers out of business and lead to a government takeover of the health care system.” Why can the government-run plan drive insurers out of business if the insurers can offer more efficient and better plans?
2.”In addition to limiting health plan choices and infringing on the doctor–patient relationship” Why would a government plan limit choices? A new plan seems to make more choices available. How would a government plan infringe on the doctor-patient relationship any more than a for profit insurance plan which already dictates what is and what is not reimbursable. (try getting an experimental chemotherapy from an insurance company).
3.”The bills will cause insurance premiums for scores of people, especially those who are relatively young and healthy, to go up, not down.” What is the evidence for this?
There are many more but space is limited
Physician
Providence Rhode Island, USA
Disclosure: None
For 6 years Republicans held the White House and both Houses of Congress. They did nothing to bring about universl health care. They did nothing to control costs. They introduced drug benfits to the elderly and did nothing to pay for the benefit other than adding it to the deficit. Now they make a media display of claiming that Democrts are trying to cut benefits such as mammagrams before the age of 50, when the experts in the field have told them that mammagrams before the age af 50 are a waste of money. Their strategy is geared to defeating the Democrats with no interest in fixing anything.
Physician
Menlo Park California, USA
Disclosure: None
I am shocked that a prestigious medical journal such as the NEJM has allowed publication of Senator Grassley’s letter – seemingly without any editorial review whatsoever. The line between honest fact-based scientific discussion and the relative data-free zone of politics has clearly been blurred with this piece. The Senator makes statements and claims they are based in fact, but why do we not have a single citation to support such claims? I am not opposed to politicians submitting to the NEJM, but a little scientific rigor would be appreciated before publishing this.
I also find it appalling that he claimed NO conflicts of interest and even more disgusted that the editors did not question or mention this memory lapse or outright blatant misrepresentation. Senator Grassley’s top political contributor by sector is the healthcare industry (see citation below).
http://www.opensecrets.org/politicians/industries.php?cycle=2010&cid=n00001758&type=I&mem=
Other
philadelphia Pennsylvania, USA
Disclosure: None
Just a quick response to what Stephen Martin MD, Physician of Montreal , Canada said. You say “what are you waiting” for and speak of how great the health care reform can be, but then why do Candians hate the universal health care? The come to the US for medical care of they can! And the US has tons of more illegal immigrants than Canada, tons! Don’t you think that will affect things just a bit?
Other
Goshen New York, USA
Disclosure: None
I don’t know what kind of health care reform will come out of this session, but I strongly suspect it won’t be much. There is, however a silver lining behind this very dark cloud. I am reminded of the Civil Rights Act of 1957. Don’t be embarrassed if you’ve never heard of it, there really isn’t a hell of a lot to remember about it; a mere pittance, really – a scrap of leftovers tossed out to “American Negros” (in the parlance of the age) in order to appease them. But it made the passing of the Civil Rights Act of 1964 – the one we remember – all-the-more easier seven years later.
We’ll live to fight another day.
Physician
Boise Idaho, USA
Disclosure: None
The premise that government by entering a field of enterprise will prohibit new private entities from attempting innovation or drive out existing entities from a field of service does disservice to the entrepreneurial capabilities of the American people and and the vitality of the American tax directed capitalistic system.
Can anyone compete with the United States Postal Service ?
This question should be posed to FedEx, DHL, etc. .
Other
Philadelphia Pennsylvania, USA
Disclosure: None
You have said what the proposed plan is going to do, but you have not said how all of that is going to happen. You have said that you and other Republicans have solutions that will fix problems such as poor coverage and high costs, but you have not said what those solutions are. You have made claims about the damage the proposed plan will cause, but you have no valid arguments to demonstrate that any of that will actually happen.
I would like to say that, in short, your comments are all style and no substance, but the fact that the statement is so poorly written precludes me from granting you even that.
But keep trying, Senator!
Other Health Care Professional
Fort Collins Colorado, USA
Disclosure: None
I’m baffled by two things. First, why has John Iglehart, with his obvious bias, been provided with such a bully pulpit on this subject by NEJM? Second, how is it possible that, given the amount of attention this issue has received, so many people still don’t understand the nature of the legislation being proposed by the Democrats? It has nothing to do with controlling health care costs. It will serve only to force more people into the health care system (many of whom choose not to be insured) and further complicate an already hopelessly convoluted system. This will allow Congress to tick one of the boxes in the list of Obama campaign promises and claim that they have “reformed health care.” The cynicism of not implementing most of the reforms until after the 2012 election is now evident to even the most naive of the electorate, and the American public has now made it clear that they are not interested in the current effort. Thank God we have an election in 2010.
Other
Rehoboth Delaware, USA
Disclosure: None
New England Journal…Thank you for allowing such a broad spectrum of your apparently large readership to comment on Sen Grassely’s article….It is obvious that there is more to be done to move our healthcare reform legislation forward and thank you for pushing the debate to the center…
Physician
Houston Texas, USA
Disclosure: None
Senator Grassley’s comments are nothing more than a regurgitation of Republican boilerplate. He criticizes while offering no substantive solutions. For example, tort reform is supposed to save everyone money, but here in Texas, it has only helped the insurers. Health insurance rates have soared out of control since tort reform and physicians have seen little of the supposed savings.
Every Canadian I have spoken with has been, for the most part, very happy with their system. Senator Grassley – put aside your talking points and tell us why the Canadian system cannot work here.
Physician
Chicago Illinois, USA
Disclosure: None
First, Canadians love their health care system. Ask any Canadian what they value most and the majority will say their health care system. So it’s a myth that they all come down for care. Very rarely do Canadians come down for care. Yes, you’ll here about the few who come down every year but that is a drop in the bucket if you look at the statistics. Second, why shouldn’t the government get into health care?The insurance companies already dictate what I can and cannot order. Government isn’t going to do that. Third, by providing universal insurance, we will make it CHEAPER for businesses to operate, improving their bottom line. Health care costs have risen and they no longer have to provide this benefit for their employees other than supplementary plans (for dental, etc. that would not be covered under a universal plan). Just look at Canada. If any politician were to talk of dismantling their health care system for one like ours, they will be kicked out of office–fast.
Physician
Altoona Pennsylvania, USA
Disclosure: None
I think before we complain about Senator Grassley’s contributors
How about this one?
http://www.opensecrets.org/races/indus.php?cycle=2008&id=PRES
Other
Davis California, USA
Disclosure: None
Grassley starts from wrong premise of govt intervention will create havoc. Insurance companies are the ones which deny coverage & bail out thru pre-eixting conditions. The GOP is nothing but an obstructionist, fear mongering party, which offer little effective alternatives. They (& some Dems, Nelson, Lieberman, Baucus) are beholden to insurance lobbyist as is “they’ll kill your gramma” Grassley. I would support tort reform and reductions to defensive medicine, but prevention must be stressed as well. He disagrees that medical costs are 1/6 of GDP yet offers no explanation. As usual with GOP they throw out a fact as gospel without support. The GOP method is a virtual mafia-like protection scam. They cannot ever be trusted to care for the interests of 98+% of the population. They work thru fear mongering, & enlist lunatic blowhard (Hannity,Beck,Rush) to exhort people to violent antics. NEJM should not publish the tamed (he is far worse at town halls) rants of this fear monger.
Other Health Care Professional
Manitowoc Wisconsin, USA
Disclosure: None
It was an unfortunate read this article. I was hoping for a few solutions to the problems with health care in the US and not another litany of objection and obfuscation. Other than tort reform, as pointed out previously no empirical evidence exists that this is a major problem, Sen Grassley produces no new ideas; no solutions. Time for the Republicans to put up or shut up.
Physician
Denver Colorado, USA
Disclosure: None
The responses to Senator Grassley’s article demonstrate the problems of health care reform. Most respondants clearly have their minds made up and wear their party loyalty on their sleeves. There is a certain reflex arc that kicks in when they see an article by the other side. This has been the case for the past 40 years and the reason why reform has not occurred. There is a concensus that something must be done but no agreement on what that something should be. The American people are split down the middle on this also. Thus, I will make a prediction: if the Democrats manage to pass a bill they will lose the 2010 and 2012 elections. There will be too many people who will suffer from the current legislation and they will take out their frustration on the party in power because they have been lead to believe the new plan is better and cheaper. It is neither. We can devise a much better plan than the status quo but not a cheaper one. Think Switzerland…
Physician
Omaha Nebraska, USA
Disclosure: None
It is remarkable to me that NEJM would publish what is little more than an unreferenced political diatribe, replete with undocumented assertions about the dire consequences of the health reform bill. Whether one agrees or not with this bill, the point of achieving an education is to be able to use it to make informed judgments. Nothing in Mr. Grassley’s diatribe gives me anything more than I have read a dozen times elsewhere in far more informative terms and in a much better-balanced format. Shame on NEJM for permitting itself to become a Republican platform for denying honest debate(yet again!). If politicians cannot be responsible for documenting their assertions let them have at it on Oprah! Hopefully, the climate change debate will not occasion a spate of similarly irresponsible articles in this journal.
Physician
Chicago Illinois, USA
Disclosure: None
The Grassley essay is exhibit article A of a health insurance industry/Big Pharma/ Big Medicine bought shill who essentially argues for the status quo. Big commercialized medicine and the satisfied American middle class have nothing to gain by reform. Once the middle class has determined that they might have to dole out more money for insurance to help cover for health service provision for the -Oh My Goodness – poor and uninsured, the thumb points down. The Obama bill will certainly enrich the health insurance industry by the mandate. Mandates of course are necessary to make insurance work as it should without adverse selection and attendant moral hazard. The old cry that Medicare extension puts us on the slippery slope to ’serfdom’ is of course without any evidence and is part of the hoary Neanderthal US right wing thinking; namely – anything private property commerce can do for a big fee but for the sake of – hmmm ‘the public good’ -must be part of a Communist plot.
Other Health Care Professional
Madison Wisconsin, USA
Disclosure: None
Mr Grassley transparently begins with a misleading statement: ” Many Americans are uninsured. Millions more fear losing their insurance in a weak economy or because of preexisting conditions.”
It is many millions of citizens without insurance – 40,000,000 people is equivalent to a column of people marching 8 abreast in ranks three-feet apart extending 2,800 miles, coast to coast – with many millions more in fear. No thanks for the analysis dear republicant leader.
Danville California, USA
Disclosure: None
Senator Grassley’s “article” is like the diatribes posted in the Wall Street Journal editorial pages in the back pages of section A . . . . looking more and more like the National Enquirer. . . “Free spending aliens landing in the USA abduct physicians, now mandated to treat illegals without pay”, accompanied by a grainy picture of a floating saucer and dangling stethoscope.
Physician
Fitchburg Wisconsin, USA
Disclosure: None
From: http://www.sunlightfoundation.com/presscenter/articles/2009/08/31/grassley-campaign-contributions-hold-no-sway/
“Grassley has received nearly $1.3 million in contributions from health industry interests over the past six years, according to Maplight.org…. Only six senators have received more campaign money …Grassley projects himself as a public watchdog. But some Iowans…said his heavy health industry fundraising has the appearance of influencing his positions. … I find the Senator’s statement on the disclosure page of the Journal, “Senator Grassley receives campaign donations from a variety of sources, possibly including health care interests. However, his campaign operations and his senatorial operations are completely separate. This piece and the opinions herein are solely the product of his senatorial operations,” rather disingenuous..