More on Healthcare

I wrote this piece yesterday, hoping to finish up this morning. I was waylaid by a cute baby. Most of what I’ve written will likely be moot as the debate unfolds and even this morning there is talk of a Blue Dog breakthrough (CNN, Politico, Fox). If you read nothing else, read this opinion piece in the New York Times (here) that outlines what the reform looks like right now and why, even if you have coverage now, you should want to see reform.

I take some time to enjoy my new baby girl and the healthcare debate appears to go to shit, hijacked by a stupid overreaction in race relations (by both sides, but I assign a higher fault the people who are supposed to be professionals: the cops) and a media desperate for ad impressions. Obama was right to say that the police acted stupidly. We pay them to carry guns and not act petulantly or expect a level of obsequiousness when confronted with the reality that a perceived burglar is in fact present in said burglar’s own home and regardless of what is going on in front of them. Christopher Hitchens over on Slate has a pretty good response (here) and one that I agree with; in short, a person, regardless of skin color in their own home can overreact as much as they want and should not be arrested. Cops did themselves no favors. Gates did himself no favors. I’m not sure this is a teachable moment in a high and lofty way as much as it is a teachable moment in how stupid people can be. That said, on to the greater issue at hand.

Not a single conservative has mentioned with any authority why we shouldn’t reform health insurance in the United States. Not one. Even my ultra-conservatives here in Utah. Still, it appears the more conservative of the Democratic Party are holding meaningful reform hostage.

There was an article on Slate.com a few months back that talked about foregoing consensus altogether. I’m not sure that’s where Obama wants to go in this fight. In my quest to stay on top of the near daily health care swings and sways I found a few articles I’d like to share.

Krugman in the New York Times talks about it here as does Steven Pearlstein of the Washington Post here. Both were linked from a fantastic article on Slate, Why You Can’t Trust Your Health Insurer.

I agree with Pearlstein when he says:

“The problem with the Blue Dogs is that they tend to confuse centrism with splitting the difference between the warring camps, or making policy by choosing one from Column A and one from Column B. The more effective centrists use their political leverage to create a Column C.”

We need a lot of Column C right now.

I also agree with Krugman:

“Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition.”

“By regulation I mean the nationwide imposition of rules that would prevent insurance companies from denying coverage based on your medical history, or dropping your coverage when you get sick. This would stop insurers from gaming the system by covering only healthy people.

On the other side, individuals would also be prevented from gaming the system: Americans would be required to buy insurance even if they’re currently healthy, rather than signing up only when they need care. And all but the smallest businesses would be required either to provide their employees with insurance, or to pay fees that help cover the cost of subsidies — subsidies that would make insurance affordable for lower-income American families.”

“Finally, there would be a public option: a government-run insurance plan competing with private insurers, which would help hold down costs.”

“The subsidy portion of health reform would cost around a trillion dollars over the next decade. In all the plans currently on the table, this expense would be offset with a combination of cost savings elsewhere and additional taxes, so that there would be no overall effect on the federal deficit.”

Krugman states further that the Blue Dogs appear to be in the pocket of of the healthcare industry. Krugman cites data from the Center for Responsive Politics. See the breakdown here. The Blue Dogs don’t appear in a super high grouping in terms of sorting by money in this cycle (2008), but the powerful in both houses do factor highly. John McCain received the most at $7.4 million. The next highest is Max Baucus at nearly $1.6 million. Before the fingers start to point bear in mind that:

“Obama, who made health care reform a large part of his presidential election platform, brought in $18.8 million from the health care sector in the 2008 election cycle–far more than any other presidential hopeful.”

Money follows power. I’m not sure that the Blue Dogs are that heavily purchased by the healthcare money trail.

It appears that there is still quite a way to go before this battle is over. The White House needs to step up its public relations if it’s going to get real reform. (update: Obama’s doing two townhall meetings today in North Carolina and Virginia)

My personal view is that any kind of individual state-only reforms are useless. Only the largest of organizations could wander the maze of 50 separate sets of state regulations with any semblance of coherence. We have that now and it’s an atrocity. Real reform is going to have to happen on a national level. After decades of repeating the worst thing Reagan ever said in his inauguration:

“In this present crisis Government is not the solution to our problem. Government is the problem.”

conservatives have won a huge chunk of mindshare with this line of thinking over the past 30 years. People believe that government is “the problem” and not the solution. Obama has tried to display the opposite. In the six months Obama’s been in office, he’s had an uphill climb. Over the next few years, we’ll see solutions coming from government that help rather than hurt.

It is my view that nobody can fix healthcare except the government. Conservatives citing Canada or other horror stories are being hyper hypocritical. The saddest, scariest stories are right here in the United States. We aren’t trying to be Canada or fix Canada. U.S. elected Republicans and Democrats should be trying to fix problems in the U.S. healthcare insurance system.

Finally, the biggest underlying issue seems to be a problem with the idea of collectivism. The very notion of health insurance was created as a collective, as are things like police, fire and military. The more healthy people that are in a system to help pay for those who are not healthy means the insurance plan will cost less. We’ll spend a lot more than $1 trillion in the next 10 years on defense in the United States. That we don’t spend more to insure everyone is a travesty. Period. We didn’t seem to have a problem throwing money into Iraq under conservative power in Washington, I can’t see why there isn’t a higher moral prerogative being talked about in the media. Whether you want to agree with the government stepping in or how far the government should step in, certainly you can see that healthcare in the U.S. is broken. We no longer lead the world. It’s time to change that.

I’ll be calling my Representative, Jim Matheson (a Blue Dog who received $351,241 from the healthcare lobby/industry in the 2008 election cycle) to let him know how I feel. I encourage you to do the same with your reps.

It’s time for change. We can’t let up until we’ve got meaningful healthcare reform and health coverage for all. There is no bigger issue facing our long term economy and health of the citizenry.

  • imjeffp

    I still have a problem with this:
    >And all but the smallest businesses would be required either to provide their employees with insurance

    Why do we keep tying healthcare to employment? We don’t do that with anything else. Not mortgages, not homeowners insurance, not auto insurance, not car payments, nothing. Can you imagine the mess we’d be in if we had the mandate that everyone with a job gets an employer-provided car?

    I’m no expert, but I think:

    Health insurance needs to separate from employment. “A public plan takes away our right to choose our coverage.” Bull. If you’re like me, you don’t have any choice about your coverage now–you get the plan selected by your employer. Employers would benefit not only from not having to provide coverage, but from eliminating the people needed to administer and shop for their programs. Less money needed for benefits means more money for salaries.

    A public plan doesn’t eliminate private coverage. Take Medicare for example; you still need supplemental coverage for what Medicare does and doesn’t pay.

    How about this? Use Medicare as a model, and cover all citizens with a limited, basic plan. Allow individuals to purchase their own supplemental health coverage, just as they now do for anything else they insure. Competition results in improved plans

    Can’t afford the supplemental insurance? You can still see a doctor without going to the ER (probably the most expensive way to see a doctor now). The doc still gets something from your basic plan. And if you set up a method for doctors having medical school loans reduced in exchange for treating those patients, I bet you’d not have much trouble recruiting young docs.

    Surely there are problems with this. So what am I not taking into account?

    • makfan

      I’m with you on getting rid of the connection between your job and your health insurance plan. I think it came into being years ago as a way of competing for employees, but that hardly matters today. It’s an employer market right now.

      I work for a tiny company (under 10 people), and I had no choice of plan. They also don’t provide any dependent coverage, and since it’s not headquartered in CA, we couldn’t even buy domestic partner coverage out of our pocket.

  • ebarone

    Healthcare should not operate as a profit driven system. Because the only way it makes money is by denying service to its insured clients. One would think most people south of the great white north would have come to that realization by now. The reason things are never perfect here in Canada or any other country that has government run healthcare is simply because humans run it and humans make mistakes. In addition, the overall poor diet of North Americans does not help healthcare costs on either side of the border. Having said that, I will take our Canadian system over the private system any day. That is the one reason why my wife never applied for a job as a nurse state side. The incentives to relocate to Texas were quite enticing, but the things we heard about private healthcare scares us Canadians. To be honest I have not watched Obama address the nation on healthcare as it is too painful to watch it be screwed over again by the right and the folks in private insurance making big bucks for denying service. I am sure Hilary’s blood pressure rises just thinking about it. That my rant for the day.

  • fyrebelley

    John,

    Thank you for the rational thoughts on health care. Much appreciated. I think you are spot on with Reagan’s worst statement ever. I find it heartbreaking that people trust for-profit industry more than the government when it comes to health issues. While I was raised in the 1980′s by Reagan loving parents, I was also instilled by those very parents with a sense of personal responsiblity when it came to government. To me, this personal responsibility translated into a belief in the power of government to do good things, and the responsibility of the government to provide basic services for its citizenry. Why else would I enter that social contract?

    Ugh. I could go on for hours. All I can say is 1 trillion dollars is completely worth revamping the system. We are throwing trillions of dollars around all over the place these days with a much smaller, less affecting, rate of return.

  • Danger

    I agree with imjeffp; healthcare should not be tied to one’s job. It’s an outdated system, and it doesn’t make sense.

  • http://annjeunabashed.blogspot.com/ annje

    I am glad you are writing about it. Perhaps some reform is better than no reform, but personally, I don’t think the proposed plan (from what I have heard and seen) is enough. I wrote about this as well after watching several interviews with Bill Moyers on the subject. I also wrote President Obama and my Rep. I have heard/read that they will be mandating that everyone buy healthcare–people who would buy it now if they could–or face a tax penalty. They will be able to choose from the private companies (can you say “millions of new customers for the health insurance industry?”–they must be giddy). I don’t even want to know what the policies the poor can afford will look like. We need to start from scratch and put in a single-payer system.

    Here is my post, if you are interested, with the links to the Bill Moyers’ interviews, if you haven’t seen them. There was another one last week after I had already posted also excellent.

    http://annjeunabashed.blogspot.com/2009/07/long-post-where-i-get-all-political.html

    p.s. I linked onto your site from dooce–which was recommended to me because of several similarities (I am ex-mormon, UT raised and a melanoma survivor) Both sites are great.

  • steve-o

    It’s one thing to offer a public option, but if a person declines to have coverage for any reason other than they can’t afford it, they shouldn’t be penalized for it. if they get sick, it’s on them. call it a personal responsibility clause.

    Also, not to be a nit-picker, but Reagan’s whole idea of government being the problem goes back the the founding fathers. Don’t believe me, read John Adams biography and see the excerpts from his journal where he demonstrates a fear of government control.

    • makfan

      Yes, but we need young, healthy people to pay into the system now, not wait until they are 40 and have elevated blood pressure, 50 pounds of extra weight, etc.

      If I could change one thing in my past, I would have bought a basic medical insurance and disability plan when I was 20 and perfect weight for my height. But I didn’t know any better and just took the company plans that were offered. When I wanted to run a consulting practice so that I could have more flexible work hours, I couldn’t qualify. I have had to piece together coverage and finally went back to the corporate world and full-time work two years ago to get a decent plan.

  • http://www.cathscorner.blogspot.com/ cath

    as an ameri-canadian, i was concerned about moving to the US after 28 years of excellent health care that cost me practically nothing in canada. however, once i arrived in the US, i was lucky enough to always have a job with great benefits – truly exceptional ones to be honest. but i somehow felt safer and more secure when i returned to canada a couple of years ago.

    all the horror stories americans are fed about delays, etc. regarding centralized healthcare have never proven to be true for me or anyone i know. we get exceptional coverage for the essentials and can purchase reasonably priced insurance for additional or elective costs – regardless of our employment status.

    the canucks may not be perfect, but good lord it beats the crap out of the way things happen beneath the 49th parallel.

    does anyone really think there are people who don’t deserve to have healthcare???

  • nobody

    1. Well, Congressional Republicans have offered health care reforms, just not ones that you like.

    2. Hello, have you noticed that Democrats get a couple of bucks from unions? And, that unions stand to gain enormously from “health care reform”? That’s just for starters.

    3. We’ve had a welfare state for eighty-odd years, but with Obama we’ll finally start seeing solutions that help rather than hurt? In a few years? Isn’t it about time for that?

    The problem is that “reform” is offered as an improvement in efficiency, when the real purposes are to 1) redistribute income to people via health coverage, and 2) fund those redistributions by capturing the large inefficiencies in the current system.

    Why not do this on separate tracks? Do a set of reforms to address the serious cost/quality problems. Do another set for the truly sticky problems, such as moral hazard and the risky clients. And do a program to extend subsidy support for those that truly can’t pay for themselves.

    Answer? Because the Democrats and their constituencies want more redistribution than would be politically supported in a transparent process. So they want a big, jargony, complicated reform, one where everyone needs several days’ study just to know what the hell they’re talking about. They want to talk about some serious but fixable problems, and some marginal but important and really tricky problems, because peopel really care about those. And they’re using them to justify a huge program that sort of helps with the real problems, while taking huge steps toward their redistribution agenda. They’ve got a serious leak in the kitchen, and rather than fix that they want to rip out and reinstall all the plumbing in the house so they can add another bathroom and have it look small in the midst of all the fuss.

    It’s not that I object to helping people. I object to deliberately hiding the extent and manner of it, to deliberately complicating the discussion and exaggerating the connections among problems to advance an agenda. I object to construing moral deficiencies in objections that are essentially technical. I’ve got no problem with you, Jon, or the things you want. But you are giving these people in Congress far more credit than they deserve. That has always come back to bite the trusting.

    • makfan

      The problem I have with framing every freaking thing as “income redistribution” is that people on minimum wage jobs barely have enough for rent and food. What in the hell are they supposed to do? Republicans fight any attempts to increase the minimum wage and then they complain about any attempt to provide a subsidy for the necessities of life. And this with the gap between highest wage earners and lowest wage earners increasing every year.

      Seriously, why is someone working at 7-11 or someone who works two 20-hour jobs not worthy of medical insurance while someone sitting on his @$$ at Google worthy of a gold-plated plan? They both serve the public, just in different ways. If somebody is willing to work, no matter how they structure their hours, they ought to have medical coverage available.

      • nobody

        The first objection is to obscuring the fact that the chief purpose is, in fact, redistribution. If it’s worth doing, it’s worth doing honestly.

        The second is that many of the people getting the redistributions aren’t so much needy as members of politically important constituencies — often while truly needy people are still neglected. The motivation isn’t so much helping the less fortunate as securing votes.

        The more transparent the proposal, the harder it is to shift benefits from needy people to politically important constituencies.

      • http://faydean.typepad.com faydean

        I must point out that Obama blocked raising the minimum wage just a couple of months ago…due to the recession!

        So don’t give me that line that the conservatives continually block it. Bush raised it!!

    • makfan

      Also, we’ve been waiting 16 years for the private insurance companies to improve the situation. Instead, it gets worse every year. They have no incentive to keep premiums down, and they do stupid things like not covering an $80 home blood pressure monitor (while covering a doctor visit every 3 weeks at $50+ out of their funds plus the copay out of my funds).

      I’m tired of waiting for the health insurance companies to provide better options.

      • http://faydean.typepad.com faydean

        Last time I checked the system is getting worse because there are so many uninsured in this country, a huge portion of which are illegal aliens and others than simply don’t have coverage because they don’t want it. Those two groups makes up 2/3 of the percentage of uninsured…the rest of the nation, more than 80 percent have coverage.

        But it’s those that use the system despite this lack of coverage that are making things so expensive. My husband is a doctor and I could tell you story after story of people who aren’t insured and continually get care and now they system must bear that burden, which is then passed on to those who do pay.

        It’s not the insurance companies responsible for this mess…it’s the people who abuse the system or simply take advantage of it!

  • keene3b07

    I don’t have the time (because it is 9 30) or the will power (Im drunk) to really contest this post, but i will give a snippet. You seem to view politics and social issues on an incredibly narrow spectrum, only looking at what the mainstream media and republicans and democrats have to say. I think you said somewhere up there in that post that no conservative has made a good point on why not to reform health care, I couldn’t possibly think of anything more absurd (maybe god). Maybe you haven’t read anything about it because you think Orin Hatch (i think thats his name) is an ultra conservative. Anyway the Ronald Regan thing you said is some pretty dumb shit too.
    Read Some Milton Friedman or Atlas Shrugged

  • missmay

    As a Canadian, there are faults in our system but I feel we have a better chance at fighting for our status-quo lifestyle.

    Case in point: My dad lost both kidneys to kidney cancer and needs dialysis three times a week. Do you know how much it costs in the states for one dialysis treatment? $1500. A POP. That is $4500 a WEEK. This is on top of the 10 pills he has to ingest in a given day. My dad has been a hard-working, tax-paying man all his life as a transport driver. My mother is a full time nurse at one hospital and a part time nurse at another. We’re pretty much smack dab in the middle class with some blue around our necks. But if we lived in the states, my mother would be widowed and homeless in less than a year. It would break our family because those medical costs would become unsustainable. Hell, we have problems just getting groceries sometimes.

    Yes, there are waits; get a grip, life isn’t an episode of ER. There is ONE doctor working in emerge. Some of those waits are necessary: for transplant waits you must wait two years to ensure that cancer does not reoccur. That measure is in place to make sure a perfectly good organ goes to the best candidate. And generally, surgery goes mighty fast. My dad was taken care of as fast as soon as the paperwork was processed and the appointment rolled around.

    Yes we’re in a ton of debt because my dad is off work a lot, but the beauty in this dark cloud is at least we don’t have the stress of hospital bills and expensive treatments/medications. Canadians do have their own insurance plans to cover other things like hospital stays, STD/LTD leave etc.
    My point though is that we are enabled to fight for a new normal. I think it’s a shame coverage like ours isn’t available in the States. How can people misuse the system if they aren’t sick? We have issues where expats come back after twenty years, waving the passport around like “I HAVEN’T PAID TAXES IN TWENTY YEARS BUT I NEED EXPENSIVE SURGERY. GIMME.” but that also boils down to: how does one turn away a sick human being? Life should be taken care of.