Jonathan Chait: Health Care Reform And Our Myopic Polity

[ProSense]

Health Care Reform And Our Myopic Polity

Jonathan Chait

One day, I hope, we will look back at the health care debate as a low point in our national political psyche. The Obama administration and its allies in Congress are on the cusp of bringing some measure of reason to the health care system -- a system so profligate, irrational and cruel that nearly any reform born of deliberate intent could not help but improve it significantly. It's a reform designed in the mold of classic moderate Republicanism, melding fiscal responsibility and compassion for the poor and sick with a series of bold experiments to nudge medicine toward efficiency. But across the political spectrum, myopia is the order of the day. A few recent items give expression to this myopia.

<...>

The right, meanwhile, has whipped itself into a spiraling rage of ideological fanaticism and grotesque partisanship. Republicans have convinced their base that a close replica of the 1993 Senate Republican health care plan and Mitt Romney's Massachusetts reform is socialism and the end of freedom in America, and as the base spins further out of control, it drags the party still further into scorched-Earth opposition. Thus the Republicans who saw the need for reform were whipsawed one by one by the base and the party leadership into abandoning all negotiations.

<...>

In the lonely center of this howling vortex stands the Obama administration, diligently pushing its morally decent technocratic improvements. For this, the salons of establishment thought have given the administration little but grief. Sunday's Washington Post editorial offers a fair summary of the response from the center. The editorial does allow that Obama's plan would be ever so slightly preferable to the status quo. The Post editorial page is disappointed that Obama agreed to delay a tax on high-cost health care plans, and to replace the lost short-term revenue with a tax on the rich: "We think that it is not asking too much," demands the editorial, "given the dire fiscal straits, for Washington to show that it can swallow distasteful medicine while, and not after, it passes out the candy." Centrist critics have habitually used terms like "candy" and "dessert" to describe the provision of medical care to those currently suffer physical or financial ruin by the lack thereof. It is one of the most morally decrepit metaphors I have ever come across.

<...>

I don't mean to be too glum. Heath care reforms still stands a good chance of passage, and it hardly lacks for supporters. Still, the general thrust of elite sentiment has been, as I said, depressingly myopic. It's natural to focus on improving a piece of legislation whose details remain in flux. The problem comes when the desire to improve becomes the dole focus for evaluating it. Nearly any of the great political advances in American history, viewed from ground level, looked like a pastiche of grubby compromises and half measures. At some point the imperative is to take the broader view. If they ever do that-- whether health care reform succeeds or fails -- the critics from the delusional left, the hysterical right and the sullen center will feel ashamed.

Bravo! Watching history in the making is amazing!

[zipplewrath]

1. NAFTA of health care

This article, and many like it, presume this bill can't be a net sum loss for this country, or the people it claims to help. It is actually possible for bills like this to get worse over time, not better. NAFTA is a great example. The damage it is causing is actually making things worse for this country. But I guess that will just get me labeled as "the delusional left".

[ProSense]

2. Do people realize the silliness of that analogy? n/t

[zipplewrath]

3. Why don't you explain it.

After all, this is a discussion forum.

[Think82]

6. Sure! HEre you go:

NAFTA: this dealt with LOOSENING regulations regarding trade from Mexico to the US to Canada. This lead to greater ability for companies to outsource.

HEALTH CARE: is TIGHTENING regulations on health insurance companies, so that they can't deny you care for a pre-existing condition or rescind benefits by nit-picking something from your past when you need it most. It also provides subsidies ot people who can't afford insurance and brings more healthy people into the pool, thereby spreading out the risk, and thereby bringing costs down if the insurance companies choose... which they will need to do, because HCR also sets up exchanges so that insurance companies will have greater competition with each other. I believe there is also a max 15% overhead cost in the bill as well and some rate hike limitations, as well as preventive care incentives, etc.

Yah. They're not similar AT ALL dude.

Get some knowledge.

[zipplewrath]

7. However

NAFTA was presented as something that was imperfect, but would be improved over time. That argument sound familiar? Not all starting points will move towards improvement, and they can be the beginning of a shift away from the ideal.

[Think82]

9. So was social Security and Medicare.

and they did improve over time, and they are more relevant to the healthcare debate than NAFTA.

This bill needs to pass.

[zipplewrath]

11. This bill establishes the need for Insurance companies

The two previous programs you mentioned put the government in the drivers seat for those activities. It made them directly involved in the delivery of healthcare. This bill attempts to separate them from that action. It could as easily lead to the privatization of medicare as it will to anything else. The whole point of the public option/single pay was to EXPAND their involvement in the delivery. This is a move AWAY from that and towards the model of LESS involvement. It is an attempt to handle the health care problem through regulation instead of through direct delivery. THAT is my primary concern about passing this bill. That model, in the hands of the GOP could be a disaster. With medicare and social security, the structure prevented that kind of mischief unless they were willing to "destroy social security". It's why Bush got nowhere with his attempt. It's what makes SS the "third rail". This plan could make single payer, or any other "government run" plan another "third rail". It's the free market/trickle down approach all over again.

Heck, even Obama bragged that it was a system dreamed up by Dole and Baker to avoid any government run healthcare program.

[ProSense]

13. "This bill establishes the need for Insurance companies" Absurd.

"It could as easily lead to the privatization of medicare as it will to anything else."

More nonsense. The non-profit plan could lead to a wholly non-profit system. It may be facilitated by tighter regulation, including this:

The president’s bill would grant the federal health and human services secretary new authority to review, and to block, premium increases by private insurers, potentially superseding state insurance regulators. The bill would create a new Health Insurance Rate Authority, comprised of health industry experts that would issue an annual report setting the parameters for reasonable rate increases based on conditions in the market.

link

[zipplewrath]

16. So it's a matter of trusting it to work out

I said it could "easily lead" and you suggest that it "could lead". Sounds like we're talking the same language from different sides. You're asking us all to "trust them" to regulate this into something workable. Mind you, many folks inside and outside the system are suggesting that the nonprofit proposal is so fragmented it very likely won't be workable. Of course everyone could be wrong, but again, there's a huge "trust me" factor here. And this "new authority" is the same kind of regulation approach most of the states have been trying for a couple of decades, only at the federal level. So you're asking folks again to "trust 'em" to regulate us towards goodness, just like they did with the banking industry.

As I said, the model here is to codify insurance companies into law. Even the nonprofit companies are intended to work on the industry model, merely removing the profit aspect. And many states may merely contract out the service to a for profit company to operate as a government contractor. This whole bill, and Obama himself, represents any real government running of our health care industry, or even portions of it, as "unworkable" and undesireable. But these are the people we're suppose to "trust" to improve the basic system over time. I really don't see any more reason to believe that these DLC adherents will improve this over time than they did NAFTA.

[ProSense]

18. No, it's a matter of not making absurd claims. n/t

[zipplewrath]

19. Even though we are saying similar things?

We're both saying similar things. It's merely a matter of whether one trusts the proposed system to work.

[ProSense]

21. I understand the need to latch on, but comparing the health bill to NAFTA

is silly, and I said nothing remotely silly.

[zipplewrath]

22. You don't understand the simile

We were told that NAFTA would/could be improved after passage. That's buying a pig in a poke. If it's bad, it's bad and one can't trust the DLC to follow through and "fix" things.

[dflprincess]

10. The problem being, that the income limits for who can and cannot afford COVERAGE are pretty low

and the subsidies get smaller as your income goes up until they disappear completely.

The subsidies are only for premiums - not for out of pocket expenses (premiums don't count toward your max annual out of pocket), nothing in the bill guarantees that you'll actually be able to afford care, only that you'll be required to have "coverage". And, as the growing number of underinsured know, "coverage" and access to care have nothing to do with each other. That's why so many people with "coverage" wind up declaring bankruptcy.

As far as the 15% goes. First, it's the limit the insurance companies wanted and even supporters of bill admit that the crooks will find ways around it especially as there's not a whole lot of enforcement built into the bill. Medicare, when administered by the government, has a 3% overhead limit - but Medicare isn't paying any CEO millions and isn't making any large "contributions" to any of "our" representatives.

[Think82]

14. I agree, but....

We're not getting Medicare for all (yet). It's this bill or the status quo for 10-20 years, and this bill is WAAAAAAAAYYYYY better than the status quo. Also I believe there must be some non-profit companies on the exchanges.

And the limits on recisions and pre-existing conditions should go a long way to reducing medical bankruptcy.

[ProSense]

15. Exactly. n/t

[zipplewrath]

17. I'm not sure why you assert that.

This merely mandates that everyone purchase health insurance. It doesn't do anything to ensure that they can afford the care. People with insurance still go bankrupt. Nonprofits ran hospitals for years. It's how we got to here. I'm not really sure why you think that a health insurance bill dreamed up by Bob Dole and Howard Baker is going to be any sort of net sum gain for the American people.

[dflprincess]

23. This bill is the status quo

It's main point is to transfer large amounts of public and private cash to the for profit crooks who contribute nothing to the health care system (but plenty to politicians) and who stand between people and care.

Most medical bankruptcies are filed by people who have "coverage". It's the out of pockets and ever increasing premiums that bankrupt people. That will not change with this bill. The out of pocket limits in the bill apply only to covered expenses. There is nothing to keep the crooks from jacking up premiums and cutting back on what they consider covered expenses.

[brentspeak]

4. I, for one, realize the vacuousness of your "rebutal"

[ProSense]

5. It's "rebuttal" n/t

[Hansel]

20. Apparently not. Some of these arguments are lame beyond reason. nt

[Cha]

8. It is a lowpoint in national psyche..

and I feel lucky to not be among them. This too will pass..When The Fuck, I don't exactly know.

[NJmaverick]

12. K&R