8.18.2009

Watching as reform goes up in flames

I must admit to being relatively pessimistic that health care reform of any real value is going to emerge from the rat's nest on Capitol Hill. With the death of the public option (and I think its prospects are looking pretty damn grim these days) and the lack of a coherent message, I'm feeling a combination of curiosity and dread at what the final bill is actually going to comprise.

I think Howard Fineman's analysis of what went wrong is pretty good. Of particular note, I agree with this:
Focusing on the have-nots
From the beginning, some of Obama’s shrewdest (outside) political advisors have been telling him — almost waving their arms — that the sweet spot on the issue is clamping down on abuses by insurers.

In other words, the White House all along should have been focusing on the fears of the 85 percent who have insurance, not on the 15 percent who do not.

Freddie at Ordinary Gentlemen said something related recently:
Heath insurance is a little different. Very few people go for long without getting some kind of compensation for their contributions to health insurance. But, again, most people pay in more than they take back out; if that wasn’t the case, there would be no health insurance industry. Couldn’t be. We pay in, or should, understanding that we may end up paying far more than we will get back out, because in the event of catastrophic illness or injury we need comprehensive coverage. This, incidentally, is what is so utterly criminal and disgusting about the conduct of health insurance companies that seek to ditch patients because they get sick or wiggle out of covering major expenses. That’s what everyone who pays for health insurance is paying for. (It would be constructive if some of those opposed to reform were more upfront about how incredibly poorly behaved many insurance companies and HMOs in this country have been.)
If Obama had focused on such winning issues as increasing insurance industry transparency, mandating more comprehensive coverage and eliminating so-called "pre-existing condition" obstacles to coverage (which, to be fair, are included in the chop suey currently being debated), he'd have more support and a cleaner bill. By taking care of the under-insured, he could have laid the groundwork for later success in covering more people who currently lack any insurance at all.

I hope that things improve, and that we don't get too distracted by the lunatics with guns who keep showing up at rallies. But I worry that we'll be getting a mediocre bill pushed through by a weakened President that accomplishes less than it needs to in order to make people's lives notably better.

14 comments:

  1. Why don't we have that conversation? If you don't like my original question, let's back up a bit and find out who ought to be convered and why.

    Who exactly will be eligible for a public option? Citizens, clearly. Legal immigrants? Illegal immigrants? Tourists? Can we really turn down illegals who show up at the ER doorstep?

    Why should we have a right to medical care and not a right to food? Food is a more basic human need than medical care. Shouldn't we have a public option for food, nationalize the groceries, and have a National Menu Planning Council to be sure everyone is making the best use of our finite food resources before we tackle Healthcare? I'm perfectly serious; how can we leave food to the market, supplemented by programs to help out the poor, if we don't think that cuts the mustard for healthcare?

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  2. gj, wow, what country do you livei in? Have you never heard of Food Stamps? You know, that thing that provides...um....food for those that have no money. I would like to say I was stunned at your ignorance, but it is pretty par for the course.

    As to the Public option, it is meant to be self funding and self sustaining. The people who pay the premiums would be funding it, the only reason it would be cheaper than for profit is lack of overhead for advertising, and no incentive for profit. Of course it makes sense to sell it to everyone who is willing to buy it, since it will increase the risk pool (again, your ignorance of the concept of insurance matches your general ignorance) but likely will be only for citizens and legal permanent residents.

    charo

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  3. as to health care, I favor health insurance vouchers for the uninsured poor, akin to food stamps, to be used for the public option or private agencies. No need to go off on idiotic rants about nationalizing groceries. Obama is not talking about nationalizing health care, however the US already has one of the finest nationalized health care systems in the world by virtue of the US military, something every Republican conveniently ignores.

    honestly, debating gj is like reasoning with a 3 year old, anyone can win every argument but the 3 year old will never understand.

    charo

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  4. Hey, charo, I live in the US. What country do you live in? Here in the US, we have a medical program (Medicaid) that provides care for those with no money, just as we have a food program (Food Stamps). I'm sure if you ask Mr. Google, you can find out more information.

    As far as the public option you mention, it sounds optional ("everyone who is willing to buy it"). If so, and since I'm certain that it will not exclude anyone for pre-existing conditions, I'll just wait till I need insurance before signing up. No sense spending money when I'm healthy, right?

    Which military program as you talking about? The VA?

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  5. medicaid has a two year waiting list in some places, try waiting two years without food. And it also has a very high threshold to enter, so that many lower middle class have no option for insurance.
    The VA is not the military, it is a separate department with its own Secretary. Scary you don't know that. I suggest you try consulting google yourself. The Military program I am talking about is the actual military, the kind that shoots and blows up things.
    As to your last concern, that is what the individual mandate is for. If anything, that is probably the one thing that will pass since it will guarantee an income stream for many insurance companies. Believe it or not, I have reservations about the mandate, but your reservations are pretty silly. What, you think you will be able to sign up when you walk into an emergency room after an accident? Such a problem can be easily remedied by dunning you for the rest of your life, garnishing your wages, etc. until that bill is paid off. You might get lucky and never get sick, but not even you are so stupid as to think that. This is also why I favor vouchers financed by taxes. You will already be paying for it, so only an idiot wouldn't use it.

    I must say, your last post brought you up to a level of a 5 year old. It had a few intelligible questions.

    charo

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  6. by the way gj, I know it is 5 o'clock somewhere but don't drink a 5th of vodka before posting. I have never written anything as stupid as "nationalize groceries", so do yourself a favor, if you don't want to get utterly pulverized step it back to a two martini level of coherence. (and I set you up with that retort about the VA nicely, you don't think I knew you would bring that up? It took me one second to differentiate the two. C'mon, we all know the VA has always been treated like the forgotten stepsister, this because of Repub. cheapness, it isn't a shiny thing like the F-22 so no need to spend money on it)

    charo

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  7. Glad to hear that anybody that owns a gun is a lunatic (I have never heard that before).

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  8. anon, Drdanny's point is not owning a gun makes you a lunatic, sporting a gun to a political rally does. I have a question for you. Would you wear a gun to church? Let us say it is at an outdoor revival meeting, would you wear it then? Or do you have a double standard, do things for Jesus one hour a week but pretend you are dirty Harry the rest of the time. I support gun ownership, but a political rally is our civic equivalent to a church gathering. The loonies on the left and right don't understand this, the loonies on the right even less so by packing a gun to one.

    charo

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  9. Last-to-first...

    Sure, I'd wear a gun to church. Haven't you heard of crazies shooting up churches? And wearing a gun to a political rally can be a form of protest if done legally. All the reports I've heard to date are of legal carry.

    If nationalizing grocieries is stupid, imagine how stupid nationalizing healthcare is! Food is a more important social good than healthcare, so how can we leave food to market forces yet insist medical care must be a government-led program? Note that there may be a reason, but to date you haven't articulated any reason.

    Who said the VA was military? Not me. I was asking about the nationalized program the US had "by virtue of the military" as you put it. The VA certainly qualifies, and ought to be part of any conversation about government run healthcare, don't you think?

    Finally, if Medicaid has a two year waiting list, isn't that relevant to the conversation? So far, we have at least two government healthcare3 programs that are not very good (VA, Medicaid) against one that is (US military healthcare). Perhaps if we could get all physicians, nurses, and healthcare executives to work for military officers' wages, we'd reduce costs. And I also recall that there are no unions in the military, so that would be another cost saving. Hey! Maybe you are on to something here; all we need to do is pay peanuts to the people who work in healthcare, and Bob's your uncle. I'm sure the AMA, SEIU, and an alphabet soup of other organizations will be happy to go along. Right?

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  10. how can we leave food to market forces yet insist medical care must be a government-led program?

    Ha ha ha ha ha. My god, you do live on another planet. Did you ever hear of the Department of Agriculture? Or price supports? Where in the world do you come up with this nonsense?

    Nice denigration of the military doctors by the way. They don't work for peanuts, they work for America. One solution is to go from fee for service to a salaried one, and do some tort reform.

    Why not give me the choice of what I want to do with my own goddamn money. Why force me to give it to a for profit insurance company. So goddamn what if it sucks it away from the for profit insurance companies? They use the same damn argument when it comes to school vouchers, but with school vouchers your tax dollars will go towards supporting my son going to a private school so at least there is some logic to being opposed, forcing me to buy a from a for profit insurance company when a publc one exists is simply wrong. You know what, I will be happy to even pay higher premiums than for a private company because I will know when I need it it will be there.

    How dare you deny me freedom. Answer this question, why must I buy from a for profit insurance, and don't give me bullshit about how every doctor will quit, charge me fucking more then.

    Take a look at our Public schooling, do teachers starve? Are they paid peanuts? Are they not government run? Yet don't private schools still exist? it is amazing how Republicans are so in favor of vouchers for Private schooling, where your and my tax dollars will support private schools, but are so against my own choice about buying into a public health option WITH MY OWN MONEY. GODDAMN hypocrites. For the record, I am in favor of both. I see nothing wrong with poor kids having the chance to go to private schools, why should it only be the province of the rich?

    The point is that we can have a well run public option, those areas where we don't we improve it. Why can't you see such an obvious thing?

    Answer those questions if you can. You can't.

    charo

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  11. As to your wearing a gun to church. You are just being stupidly provocative. I guarantee you that you never would, that you would be ostracized by your church as a dangerous lunatic, and you know this, so stop that idiotic pretense. I will tell you what, then go to a church carrying a hunting rifle and have your picture taken. Say it is for protection. I can guarantee it will make the news, so just do it, otherwise shut the fuck up about that.

    charo

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  12. Charo, stop with the foul mouth. Dan doesn't like it. I suspect Elizabth doesn't like it. I think it makes you look like a muddlehead who is out of ideas and can't cope with disagreement. Talk like an adult and we can have a civil conversation. Channel Rage Boy and I will just MoveOn.org.

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  13. "If Obama had focused on such winning issues as increasing insurance industry transparency, mandating more comprehensive coverage and eliminating so-called "pre-existing condition" obstacles to coverage (which, to be fair, are included in the chop suey currently being debated), he'd have more support and a cleaner bill"

    I listened to a representative of the health insurance industry yesterday and he said that the industry as a group had agreed to do all of the above, plus tort reform, but the administration and Congress is not listening to them.

    The reason is quite simple - The health care debate is really an ideological debate. Those in positions of authority in the Administration and Congress want to nationalize the delivery of health care in this country.

    The public-option and the co-op option are just steps along the way.

    Even without these options, the Pelosi bill contains enough language where medical coverage would become so controlled that we basically have the industry working at the strict direction of government. What form of an economy is this, certainly not the hybrid Free Market economy of the US.

    Davod

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  14. out of ideas? muddlehead? wow, such stunning rebuttals. completely convinced me. That, sir, is your complete and utter surrender. As such I accept it.

    charo

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