New Medicaid Chief and the State of Health Care Reform

Friday, July 09, 2010

Paul Starr, professor of sociology and public affairs at Princeton University, co-founder of The American Prospect, and a senior health policy advisor under President Bill Clinton, discusses the appointment of Dr. Donald Berwick to oversee Medicare and Medicaid, and where health reform measures stand today.


Paul Starr

Comments [17]


This is what is meant by "transparency".

Jul. 16 2010 12:44 AM
Pordy from Madison

Incidentally, searching to see who else is covering this, first hit I get is Glenn B@ck saying: "The second most dangerous man in America — his name is Don Berwick. NPR called him something of a rock star in health policy circles."

Jul. 10 2010 12:37 AM
Pordy from Madison

Great segment on an under-reported event. Sounds like another outstanding choice by the president and maybe exactly what is needed to make this complicated, controversial, risky health care revamp succeed.

Jul. 10 2010 12:27 AM
amalgam from Manhattan by day, NJ by night

@ Hugh - I completely agree that market failure is a constant economic reality that many free market fundamentalists don't like to recognize. They fight for free markets rhetorically, but in implementation, they recognize that failures often occur and that intervention is sometimes needed.

The U.S. health care system is case in point...

Jul. 09 2010 10:46 AM

1 Why do we name the Health Care policy 'Obama Care'? Obama didn't come up with the plan - Congress did. Obama Care is a right wing negative buzz word. Be careful how you use it.

2. When we buy car insurance or homeowners insurance we are not paying for routine maintenance - we're paying for accidents. We are responsible for all upkeep and inspection fees.

When it comes to our bodies, why do we expect insurance to pay for routine maintenance? Like simple doctor's appointments and routine checkups? Health insurance should be for care that requires hospitalization - not because we need a check up or a simple prescription. When health insurance tries to cover everything - it encourages over use of doctors and drugs and discourages people from taking good care of themselves and runs up health care costs.

2 Those who cannot afford expensive health insurance are being rationed right now.

Jul. 09 2010 10:33 AM
Kathleen from Woodside Queens

The market has not worked in Queens where 2 hospitals have closed - Mary Immaculate and St. John's. Or has it? Catholic charity healthcare can never compete with for-profit health systems.

Jul. 09 2010 10:29 AM
Hugh Sansom

We don't have competition based medicine _anyway_.

Berwick is exactly right about the failure of markets in American medicine. Even most conservative economists will admit this.

Markets fail.

But conservatives _oppose_ free markets in health care. They oppose allowing us to get medicine from Canada or France. They oppose allowing free travel of doctors and patients to provide or get care.

The free market language about American health care is just hand-waving my kneejerk right-wingers.

Jul. 09 2010 10:26 AM
amalgam from Manhattan by day, NJ by night

I realize I wrote "bench appointment" and meant "recess appointment." He is not being appointed to a judgeship or the bench...

Jul. 09 2010 10:25 AM
RJ from Prospect Hts

Another starting point is this: If doctors were asked whether they want to spend time reviewing options, communicating with their patients, discussing the difficult issue *compared to* spending that time arguing with insurance companies over coverage and approach, I'd guess a significant majority would pick the former.

Doctors who serve Medicare and Medicaid patients don't *only* work with them--they see patients with *many* different insurers and have to deal with all the classic insurer-related rationing we've been trying to talk about for years.

The restructuring of Medicare and Medicaid cannot be done in isolation from the rest of the health care system.

Jul. 09 2010 10:22 AM
Anil Nigam from Stamford, CT

I just heard you describe the new healthcare plan as 'Obamacare'. This is another instance where media adopts as neutral, or natural, names that were introduced by political operatives. Please be careful about how you choose to name specific programs. Remember that we do not refer to the Iraq-Afghanistan war as the "Bush War".

Jul. 09 2010 10:21 AM
David from Manhattan

My father had Lou Gehrig's disease and had his visiting nurse was withdrawn because he was "not terminal enough". He died less than a month later.

Jul. 09 2010 10:20 AM

Contrary to what your guest is saying, the US already has rationing. How often does this _obvious_ point have to be stated? We ration according to wealth and employment. I pay for insurance, but I do _not_ have health care because my private, for-profit insurer rejects _every_ claim.

Where does Berwick stand on opening up international markets for pharmaceuticals? Obama made a backroom deal with Big Pharma to eliminate any such move from his reform plan.

This is a perfect example of the violent hypocrisy of the right-wing. Conservatives bleat about free markets. Why, then, do they oppose a free market in which patients can choose where to buy their medicines?:

Jul. 09 2010 10:17 AM
amalgam from Manhattan by day, NJ by night

Berwick is certainly no radical, a rather risible statement, especially since he enjoys support from many right-of-centers/right-wingers and is known as one of the most distinguished health care experts:

The fact is that while I believe more transparency and scrutiny over appointees is good and necessary, ability to govern is equally as important. Appointees are being filibustered and not being confirmed purely for political reasons without compelling evidence to do so.

The fact is that as much as I hated, GW Bush, for instance, there comes a point when appointments must be made and governments run, and these bench appointments are necessary in extreme political times, just like now. Presidents are elected, for better or worse, so let's get on with governance...

Jul. 09 2010 10:14 AM
Hugh Sansom

Berwick spent some time, I think, at Harvard Community Health Plan (not affiliated with the university, as far as I know) -- a _non-profit_ health insurer.

Massachusetts was notable for non-profit health insurers like HCHP and a few others. Nationwide, non-profit insurers have consistently gotten far higher marks for quality of service.

In New York, for example, Empire BlueCross BlueShield _was_ non-profit and got top marks in the state. Then it was bought by Angela Braly's WellPoint and quickly became one of the worst-rated insurers in the state.

Jul. 09 2010 10:13 AM
Hugh Sansom

If I remember right, W Bush set a new record for recess appointments. And Democrats rarely opposed even his most right-wing nominees.

There's no point at all in Obama presenting Berwick to the Senate because Republicans will oppose _any_ nominee from Obama.

Jul. 09 2010 10:08 AM

radical how? or are you just making this up?
is it radical for women to control their own bodies??

Jul. 09 2010 08:23 AM
Ed from Larchmont

Wasn't he a recess appointment that never faced questioning? Isn't he very radical?

Jul. 09 2010 08:17 AM

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