“To take a Republican-sponsored healthcare provision that rather innocently and uncontroversially extends insurance coverage to those that want to create their own living wills and turn it into a declaration that the government will decide every five years whether or not you should be euthanized is something out of the Protocols, or out of Saddam’s Iraq, or a mimicry of the worst and most stupid and most absurd of North Korean propaganda towards their own citizens.” —Hunter, via Sully.
“The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. … Health reform is a test of whether this country can function once again as a civil society — whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done.” —Steven Pearlstein.
“[T]he world’s most mature democracy, informed by the world’s dominant media system, at a time of perceived economic crisis and under brand new political leadership, [is] getting tied up by manufactured misinformation. No matter what party you belong to, you can’t think this is a sign of health for the Republic.” —James Fallows.
“whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off.”
I prefer this quote in the original form…from each according to their abilities, to each according to their needs….
Riiiiight… because any attempt to reform any inefficient-but-entrenched system for the common good is automatically socialism.
What I find the most amusing about this debate is that everything, absolutely everything that the Republicans are using to spread fear about a government health plan has already happened and is already in place in the health system this country has now know as private insurance. Only worse, because we don’t even bother to cover everyone with our craptastic policy a lot of times even the people that think they are covered arn’t. I’m not optimistic that congress will pass a really good bill. But I do know one thing. Whatever they do pass would have to be better than the system we have now. Unfortunately that says more about how broken the current system is than the bill currently under consideration.
Unfortunately, we need to change at a very basic level how we do medicine in this country. Until we do it won’t really matter where the money for it is coming from. I direct your attention here:
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Seriously, if you haven’t read that article I suggest you do. It is Sprawling New Yorker stuff… But it’s good, and it makes a point that it is vital everyone understands.
Spurred on by Joe Loy’s very kind comments on the last thread (I am nothing if not a sucker for flattery), another thought’s been brewing in my head about why so many might be so opposed to this reform.
On the last thread I argued that you get pretty good prices if a giant insurer is negotiating with doctors for you, and if you have a pre-existing condition you might benefit from an attractive actuarial pool, assuming you get insurance from your large employer.
People with pre-existing conditions may also have some protection from the byzantine capricious exclusions of modern healthcare if they work for a giant employer, whether private or government – as long as there’s a big HR department determining which insurer gets into the cafeteria choices during each open enrollment period, big insurers should be motivated to be relatively accomodating with such employees.
I could be mistaken, but when you watch a movie like Sicko or read a blog like Andrew Sullivan’s, the health care horror stories are always someone who a) didn’t have insurance, b) had private insurance but violated some provision like continuity of care, c) had group insurance, but for a small business, or d) had some government insurance, e.g. Medicaid/Medicare.
Seems like you never hear someone say “I had the BCBS PPO through my employer GE, and because my son barely violated continuity of care when I put him on my plan, BCBS let him die without receiving expensive treatment”. That’s a bad story for BCBS to have floating around the cube farm of a giant employer. What’s more, BCBS can probably cover the costs elsewhere in their employee pool.
Of course representatives of the government emphasize that the reform will not change your current insurance at all. But here’s the rub: if you’re that high cost person working for GE, currently insured by BCBS, will they kick you out to ObamaCare once its instituted? We can’t say for sure, since a big part of the answer is whether that becomes industry standard practice (which would protect organizations like BCBS from the wrath of angry HR departments).
But if it happens, I bet most people will be relatively unhappy to be in the unattractive actuarial pool – to say nothing of care delivery decisions made with no fear of their HR department – when kicked over to ObamaCare.
This may be overcooked a bit. But if there are even grains of truth in here, it would illustrate why many fear a reform that, ostensibly, doesn’t impact them at all. The problem for the Obama Administration is reassuring these folks that the law will protect their current health insurance arrangement – its a problem because such reassurance is tantamount to saying the obvious, that ObamaCare could strip away an important provision in their health insurance.
So Jazz, what you are saying is that the only way to have good stable insurance at a reasonable rate is to work for a giant company or the government. This state of affairs seems like a great way to get people to work in small businesses or start their own and other wise start those entrepreneurial endeavors that have built this country.
It seems like we should be able to do better.
dcl – I apologize if I gave the impression that there was anything normative in my last statement. I was simply trying to understand what the underlying motivation is for those so strongly opposed, which motivation, if my assumptions hold, might be understandable.
But I very strongly agree with you that we should be able to do better. Indeed, anything that makes it easier for small business people to compete is certainly in the interest of the nation.
Not sure though if the current health reform addresses these types of issues, which given the ferocity of protest, may be a prerequisite for doing better.
Okay. Gotcha. Makes more sense that way actually.
I also agree. The problem with the health care reform bill is that, well, there just isn’t that much reform in it. Heath care reform is what Nixon did back in the 60’s that has lead to the disastrous private insurance system we have now. And hospitals working on an inefficient broken model that puts patients at risk and cost more.
Health care is an area where we could really do a lot more and a lot better with less money. (While still paying the doctors the same or more than what they get now). But for that it would take a real commitment to fixing the system from the point of service on up. The first thing we need to do is put decision making in the hands of doctors and trust that they are going to do what is right for their patients. The other thing we need to do is salary doctors like the Mayo Clinic does. Salaried doctors mean they don’t worry about how much each individual service costs, but rather that they do good medicine. Salaries also mean that doctors work together instead of protecting their fiefdoms. The other thing we need to do is make sure every American has a primary care physician of their choosing that they build a relationship with. Good primary care is key, it saves billions on the back end. And if everyone has a physician it means that emergency rooms and urgent care centers are really seeing emergencies. Patients not only get treated better and faster but we save money. People with colds will go to their doctor not the ER. They get treated by someone they know and trust. Or better yet, they are getting regular physicals and keeping fit and healthy so they don’t get the cold in the first place. And malpractice needs to be dealt with in a much cleaner and simpler way. People that are harmed by malpractice should absolutely be compensated. But we need a system that gets those harmed compensated more efficiently and fairly and holds the doctor responsible accountable but does a better job of weeding out the frivolous or disingenuous charges. That protects the good doctors and doesn’t drive them out of business from insurance premiums of their own.
In short, we need to get the insurance companies out of medicine and the doctors working together to provide outstanding care for each and every patient they see. And, more importantly, the proportionate and medically relevant care and we must trust the doctors to make those decisions. And not doctors in board rooms, the doctors on the front line making the decision. Once we start doing medicine right we can worry about how we pay for it.
Here’s the sticky word in an otherwise cogent post: “proportionate”
I personally do not want some government beancounter making the decision as to what is “proportionate.” In fact, I don’t want anyone making that decision. I want the best medical care my money/insurance can buy. As does everybody else. That is why Congress refuses to put itself and government workers under this program. That is why the people are coming out to these townhalls. That is why sick people from all over the world where they already have systems with “proportionate” health care come here for treatment.
Look for the sake of arguement, let’s go with the bogus 47 million number of people that are uninsured. Instead of screwing with the 250 million+ of us who have insurance, (the vast majority of whom according to polls are happy with their coverage) why don’t we just find a way to cover the 47 million?
Would you rather have a profit-motivated insurance industry beancounter making that decision, gahrie? (Not a rhetorical question, I’m genuinely interested)
Alec:
Yes. Because a profit motivated company is worried about bad publicity. If an insurance company gets a reputation for bad service or poor coverage people stop buying their insurance. The government bean counter doesn’t care. Under a single payer system (which any honest person acknowledges is the goal) there is no where else to go.
Asprin doesn’t cost $10 a pill because of the insurance companies, it costs $10 a pill because of medicaid billing systems.
You really want to reduce the cost of health insurance and health care? Then pass tort reform and protect the doctors from the ambulance chasers.
I’d start with loser pays.
Under a single payer system (which any honest person acknowledges is the goal) there is no where else to go.
You mean any brain washed right winger right? Because no one is actually advocating for single payer. No one is talking about putting other insurance companies out of buisness. There is no socialism at work here. Unless of course, you think the feds are out to put UPS and FedEx out of buisness too.
If you are going to critque the plan, fine, critque the plan. But if you are going to make stuff up? Why its almost like you are Sarah Palin!
“You mean any brain washed right winger right? Because no one is actually advocating for single payer”
http://www.youtube.com/watch?v=zZ-6ebku3_E&eurl=http%3A%2F%2Fpatterico%2Ecom%2Findex%2Ephp%3Fs%3Dsingle%2Bpayer%26submit%3DSearch&feature=player_embedded
http://online.wsj.com/article/SB124709618142215031.html#articleTabs%3Darticle
“I don’t want anybody making that decision”
Wow gahrie, you really are a moron. Not just normal dumb, a complete moron.
What you are basically saying is that if you got a splinter from the pencil at your desk you would expect or demand your doctor to what? X-rays, perhaps an MRI, a full toxicology report, perhaps you should immediately go on dialysis just to make sure… Clearly you’ll demand the entire area be put into traction and they probably should admit you over night. Just to be sure. After all you don’t want anyone making decisions for you and you want the absolute most your insurance might possibly pay for. You clearly have a medical degree and know exactly how you should be treated for any and all possible injuries.
See, what I’m saying is that the way health care should work (this isn’t the way it works now, or even how it will work under the Obama plan though I still hold out hope we will get a good bill) Is that the doctor treating you makes the decisions for the patients he is treating based on what is medically relevant for that patient. Or would you like to order some viagra and birth control pills to go with that splinter?
I’m not even sure how you said, “Because a profit motivated company is worried about bad publicity” with a straight face. Seriously? The insurance companies do not care about providing quality health care. They care about paying out as little as they possibly can. The only thing they really care about are there large scale contracts and that’s mostly because they don’t want to get sued by someone that actually has the resources to fight them more than anything else. So you know what. Corporate bean counters are making the medical decisions for your right now, not your doctor. And you are a naive retard if you don’t recognize that.
I’m not saying that Obama’s plan is necessarily any better. But what I am saying is that every single scare tactic charge leveled at the plan is just as true for today’s private insurance that is already in place.
And the reason for that is that the big insurance companies don’t want it to happen. It is a threat to their bottom line after all. If everyone is capable of getting together and buying as a group they can’t make as much money by ripping people off and yanking their insurance when they get sick for no reason.
Having read Pearlstein’s absurd hyperbole, it appears that Brendan left out the real “quote of the day” from his column:
As Chief Grady said in Super Troopers, desperation is a stinky cologne. Pearlstein and his ideological fellow-travelers wreak of it. Evidently, if you think that Obamacare might push people out of private insurance or effectively drive much of the private insurance business out of the market with adverse consequences, or that it will causes tax increases despite Obama’s campaign rhetoric, or that the “offsetting savings” that will supposedly bring the cost down may not in fact materialize, or that Obama’s promise that you can keep your doctor and your insurance isn’t a serious one and is not adequately reflected in the current version of the legislation, well then you’re as bad as the terrorists, or at least you’re a “political terrorist,” which perhaps isn’t as bad as an actual terrorist, but the image clearly meant to be conjured up is no less stupid and offensive. That kind asinine leftwing characterization of the dissent against Obama’s health care reform proposals — dissent which is being made by independents as well as the Right — shows a desire to make the critics the issue rather than the health care reform itself. Attempting to tamp down and discredit the dissenters as they try to express their views — whether it’s Obama telling them to “not do a lot of talking” (to which the correct response is, blow it out your ass, Mr. President), or his buttboys in the MSM calling them racists — is not a winning strategy.
According to the Left, the reason most of the public isn’t bowled over by Obamacare is because of all the “misinformation” out there. Figures — that excuse is routinely adopted by proponents of losing initiatives (see GWB and Social Security reform). In reality, the reason is probably much more basic: “It is health-care reform’s own contradictions that are causing it to sink.” You can’t completely overhaul the system while at the same time promise people that nothing will change on an individual basis. People just aren’t that stupid that they won’t figure out the obvious conflict between those competing visions. One of them will turn out to be false, and judging by all the people engaged in
the highest form of patriotismun-American political terrorism, much of the public has discerned which one it is.The power of the interweb compels me to point this out:
http://daringfireball.net/linked/2009/08/10/ibd-hawking
I can’t really quote it without just reprinting the whole thing, so just go read it… But the heights of stupid of republican fear mongering apparently know no bounds.
The power of the interweb compels me to point this out as well:
The major argument of opponents of for-profit healthcare is that such insurers are motivated solely by cutting costs. Cutting costs is important to these folks, no doubt. But their primary motive is growing profits, and as anyone who has managed a profit center will tell you, cutting costs only goes so far.
Growing profits long term is about growing revenues, which in a sensitive industry like health care means growing consumer good will. If you are fortunate enough to be obtaining your insurance in a pool where you can easily poison a lucrative well by spreading bad will, you’re in a pretty good spot.
So the for-profit insurers care quite a bit what you think about their care, particularly if you’re in a lucrative pool. Joe Mama and Gahrie say that the government doesn’t care because it doesn’t have competition. For the first time it occurs to me that Joe Mama and Gahrie are wrong, and that actually because they are wrong, single payor could have catastrophic consequences in the US.
Here’s where I’m at: first of all, health care rationing is an economic fact of life. No one really believes that a first world economy can deliver all the cutting edge treatment that the people want/could use in a cost-effective manner. The economics don’t add up.
So the society has to come to an understanding about who will go without, what will be funded, what won’t. In more socially-conscious cultures like Canada or Old Europe, its comparatively easy to convince folks at the business end of health care rationing to “take one for the team”.
In America? No way.
Asking prosperous Americans to give back their health care advantages is political suicide, even if it might work in other countries. So you know what ObamaCare will end up doing: it won’t ask for sacrifice.
And the cost of healthcare in the US, already high, will go shooting in the stratosphere.
Oh, but, Americans hate paying taxes too.
Been fun sharing this country with you all.
Seems fair that certain care would be outside of what the government plan covers. Boob jobs and tummy tucks are probably things that it would be sensible not to cover (except perhaps in some instances where they might possibly be medically necessary). But that does not stop, nor should it stop, someone form purchasing those procedures separately. I highly doubt that private insurance would cover a lot of the things that fall under the “treatments that are too expensive” banner in the UK. Something we can’t really know because senior citizens are covered my medicare not private insurance and thus private insurers are shielded from the most expensive part of the actuarial table.
None of this deals with the fact that the insurance model of health care is fundamentally flawed in a way that Auto and Fire insurance are not. And that is that everyone gets sick and eventually dies. The insurance model work based on the fact that of a group of people (N) there is a virtual certainty that one of their number will suffer a catastrophic event but the individual likely hood of suffering the event is only 1/N. (Just for simplicity sake. Reality is a lot more complicated). They decide to spread the cost (C) of the catastrophe evenly amongst themselves. Thus each person pay’s in C/N. But if everyone always gets sick and dies. The exact amount it costs to get sick and die might differ (in modern cases dramatically) but the fact that everyone makes a clam makes it real hard to make money at health insurance without charging ridiculously high rates to those without bargaining power and denying as may clams as you possibly can. Or in some cases not necessarily denying the clam so much as “loosing” the paperwork on a regular basis. Perhaps they won’t re-submit, and if they do, well we got to hold onto the cash a while longer an make a little more money.
So in steps medicare. And now the government will cover the expensive part and private insurance can soak up decades of premiums form people that are not nearly as likely to need some of the most heroic and expensive care, and thus make a lot of money. And if someone they cover does get deathly sick, they’ve probably had to quit their job, so they don’t have any insurance anymore and the government will cover the cost. It’s a heads I win tails you loose game.
Megan McArdle:
Okay, leave granny out of this. Granny is already on Medicare, which much to the suppose of many is government healthcare.
I don’t think anyone is seriously talking about messing with granny.
The question is, should every citizen of this country be able to go see a primary care physician to get a physical and when they are sick. Or should they not. That is the question. Is it fair to ration life based on the number of dollars in your bank account.
supposed to say “much to the surprise” not suppose… obviously…
I think perhaps I should clarify one thing.
I just want to be clear on what we are talking about. I’m not trying to make a specific value judgment on how we ration healthcare per-say in comment 22.
We can ration care based on means to payy, based on the quality of your job’s benefits package, how sick you are, what your chances of recovery are, your age, the first name of your mother’s father’s uncles grandson, etc. Whatever we do someone is going to win and someone else is going to loose in the change from the status quo. We can do medicine more efficiently, and better, we can make doctors really focus on what is best for each individual patient they see. But at the end of the day the amount of money we can spend on healthcare as a nation is limited.
So the reality of this debate is fairly simple. Do we improve the quality of medical care for the poor, working poor, and lower middle class at the expense of the middle and upper middle class? This debate makes no never mind to the rich at all. They will still be able to get whatever care they want wherever they want regardless of cost or anything else. And it will still cost them about the same as it does now. So that really is the operative question. When it comes to “socialized medicine”. Of course the Obama plan is trying to have it’s cake and eat it too by keeping the middle and upper middle care the same and improving the poor through lower middle class care. And is trying to do that by making it cost the rich.
Reasonable people can disagree on these things. But lets at least try and be straight about what we are talking about here. I think everyone here is smart enough to see through the propagandist scare tactic crap so lets try and stay focused on what we really are talking about.
Dane,
Points all well taken. The upshot: as responsible citizens of countries like Canada, England or France, we might understand that it is inevitable that our families sacrifice something for the common good.
In America, if you try to take something vital from my daughters, you’re asking for it, buddy…
Solving this is as intractable as solving our culture, which means we’ll likely get scare tactics scare tactics scare tactics scare tactics scare tactics scare tactics death of the initiative.
Jazz,
Point well taken.
As I see it, the US position on health care weakens the competitive edge of the United States. The healthcare weakens small business, is large part of the bankruptcy of the US auto industry and limits the mobility of your average work. If we are supposed to move to an entrepreneurial knowledge based economy mobility is crucial to making that work. To move forward as a nation healthcare cannot be tied to your job.
Though I’d say you are right, it is perhaps, foolish to think that the American mind set will change enough to actually fix the problems we have instead of just throwing on a hastily designed patch.
I think its tough to apply the capitalist model to health insurance, its not like its something people can really choose to go without and take another option, when they go without its usually not by choice. I can choose not to buy a big screen hd tv and be fine. Therefor tv makers have to be competitive for my money. Insurance companies? We need them, so they can be far more absuive to their customers and get away with it. (Kinda like cell phone companies oddly enough…)
David K:
“I think its tough to apply the capitalist model to health insurance, its not like its something people can really choose to go without and take another option, when they go without its usually not by choice”
This is simply not true. According to a report by the census bureau in 2005:
There were 46.5 million people uninsured.
8.74 million of them make more than $75 a year, and another 8.3 million of them make between $50 thousand and $75 thousand. These are people that can afford insurance, but choose not to buy it. You and I may say to ourselves these people are insane, but the simple fact is, people ARE choosing not to buy health insurance, about 17 million of them. Why should my taxes be raised and my health insurance ruined because they are irresponsible?
This brings us to 29 million uninsured.
9 and a half million of them of them are illegal aliens. Even if medical care was a right for all Americans, they wouldn’t be entitled to it, and if you want to give money to a charity to buy them health insurance power to you. I’d just as soon ship them home.
That brings us to 19.5 million uninsured.
Of that number, many are colllege students, or already qualified for government provided health care, but haven’t registered.
The true number of chronically uninsured is somewhere a little south of 10 million people.
From the clips of the NH town hall meeting, it seems like President Obama is fairly tone deaf on this issue, which is surprising given his generally high level of political shrewdness. He’s still singing from the choir book of folks with bizarre insurance exclusions, while the riled-up masses are questioning why Congress has such great healhcare.
The answer, re Congress, is obvious: if Big Insurance is afraid of alienating the HR department of Big Co, they’re afraid of alienating Congress times about 100.
No one, other than maybe anonymous dudes on blogs, will tell the truth that large, group-rated plans are about as good as you’re gonna get in an era of health care rationing. Congress, for obvious reasons, has the best of the best.
The fact that the hoi polloi is screaming for access to Congress-level plans means that the masses understand, even if only instinctively, that health care is an access game, and in an era of rationing, even more so.
Talking about the lady who got excluded by some bizarre byzantine regulation in her private insurance is like Noah, standing on the ark while the rain begins, saying to the folks clamoring just outside, “Hey, guys, its not that bad….I can see people way off in the distance who can’t even trudge through the mud!”
Dumb.
What I find very strange is that people get very up in arms about illegal immigration and all the illegals living in this country. But then when someone suggests actually doing something about the problem they go, oh well you can’t do that.
Put simply illegal immigration is a demand problem not a supply problem. It is simply not possible to stop illegal immigrants form entering the US. You can build fences and put millions of boarder patrol agents on the border and you simply are not going to stop illegal immigration. There are too many methods of entry and loopholes. It is also massively expensive and problematic to round up and deport the illegals immigrants that are already here. Those are simply the natural conditions of the problem.
There is one, and only one, way to stop illegal immigration. You must make it more expensive for a business to hire and use illegal labor than it is to use legal labor. This means serious fines and penalties for those businesses caught employing illegals. And serious doesn’t mean $100. It means at least $1000 dollars per illegal. And each additional instances needs to double the fine with no cap on the maximum amount a business can be fined. If people stop employing illegal immigrants the problem goes away. No job means no money means no reason to enter the US illegally. Of course Republicans seem to not like the solution that has a chance of working, they much prefer to get indignant about a problem the really have no interest in solving.
Amen dcl…hell I’d throw the owners in jail too.
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