Health Care and Poison Pills

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Bush Administration, Health Care

Awhile back Harold Meyerson wrote a column called “Master of the Poison Pill” in which he outlined the Karl Rove method of taking an issue away from the opposition. For example, in 2002 the Dems were getting traction on their proposal for a cabinet-level Department of Homeland Security, which the White House opposed. When the Bushies decided to flip-flop and create the DHS, they inserted a union-busting poison pill into the bill. Dems balked, and the Bushies promptly claimed the DHS as their own invention, accusing Dems of being opposed to national security.

Sometimes it’s more than just a pill being used to poison a debate. Wingnuts still equate opposition to the war in Iraq with being “soft” on national security, even though Iraq ain’t doin’ a bleeping thing on behalf of national security except draining resources that could be put to better use elsewhere while causing more people to hate us. The Bushies tried to pull something like this with Bush’s Social Security “reform”; Dems were accused of being unwilling to “fix” Social Security because they didn’t back Bush’s plan. Fortunately the American people realized the “plan” was ridiculous.

I’m already seeing signs that the Right is going to use Bush’s utterly absurd health care proposals to claim that Democrats aren’t serious about health care reform. There are two columns in the Washington Post today that say Dems are poopyheads for not even listening to Bush’s “ideas.” One is by the already mentioned and cognitively challenged Ruth Marcus, whom Brad DeLong and Ezra Klein skewer a lot better than I did. The other is business columnist Steven Pearlstein:

… the most surprising and encouraging development is that a president who for six years has only nibbled around the edges of health-care issues has weighed in with some bold ideas to expand coverage, rein in costs and bring some fairness to the tax code. And get this: It actually involves raising taxes on the rich and lavishly insured and giving the money to the working poor and the uninsured.

Given that, you’d think Democrats would have welcomed a politically courageous proposal to put a cap on one of the biggest and most regressive features of the individual income-tax code. But instead, they’ve shifted reflexively into partisan attack mode, mischaracterizing the impacts of the proposal and shamelessly parroting the propaganda from the labor dinosaurs at the AFL-CIO.

“Dead on arrival,” declared Rep. Pete Stark (D-Calif.), chairman of a key health subcommittee in the House, hinting at a dark conspiracy to kill off employer-sponsored health insurance.

In fact, Pete Stark’s web site proudly states:

I’ve introduced a Constitutional Amendment to establish a right to health care for of equal high quality for every American. If ratified, this would force Congress to make health care coverage available to all Americans. My preferred approach to universal coverage is to build on the success of the Medicare program, which provides universal health care for our nation’s seniors and people with disabilities.

Sounds to me as if Rep. Stark has already moved beyond the employer-based health insurance model, and that Steven Pearlstein is parroting propaganda from the policy dinosaurs at the Heritage Foundation.

Pearlstein goes on to sing the praises of Bush’s proposal while accusing Dems of “class warfare.” He also says,

Almost every health economist agrees that the tax subsidy for employer-paid health insurance is not only unfair but that it also encourages people to buy too much insurance, consume too much health care and pay too much for both. Bush deserves praise for having the political courage to confront the issue.

Mr. Pearlstein, meet Paul Krugman.

Some nameless dweeb at Opinion Journal credits Bush for initiating a discussion on health care:

The U.S. has long needed a debate over health care and tax subsidies, and President Bush got ready to rumble last night with his proposal to make insurance more affordable for most Americans.

That was bad enough, but in the very next sentence the dweeb actually wrote “Americans have the most advanced health care in the world,” meaning the dweeb plans to rumble with his head firmly planted up his ass. That should be a sight. Although notice he wrote “most advanced” instead of “best,” and it’s possible he could make an argument for “most advanced.” Years of “market forces” have given us a system that is grand at delivering state-of-the-art, boutique health services to the wealthy, even as poor women lack basic prenatal care and emergency rooms close.

The dweeb puts forth more howlers, such as:

These new [private health insurance] products are also likely to be policies that put individuals directly in charge of more routine spending. That’s because removing the tax advantage would mean it will make less financial sense to “insure” for predictable expenses like several annual office visits.

In other words, he thinks insurers should not be covering preventative medicine, meaning people are less likely to indulge in those gold-plated, frivolous office visits to get their cholesterol monitored or their hearts checked or some such. Unfortunately, skimping on preventative care is a sure way to drive up costs overall.

That in turn could put pressure on health care providers to post–and actually compete on–prices. Such new price awareness might even generate pressure for states that overregulate their insurance markets (New York, Massachusetts) to ease their costly mandates

The “costly mandates” prevent insurers from refusing insurance to people who have pre-existing health problems. In states without these “costly mandates,” insurers can refuse to insure people with health problems. That reduces the insurers’ costs but doesn’t exactly solve the health care problem.

It’s true that additional subsidies might be needed for some people with chronic illnesses who might have a harder time finding private insurance in this kind of world. And we’d also like to see a more national insurance market, with companies able to sell policies over the Internet free of the worst state mandates.

You see the problem. While the dweeb casually acknowledges that a lot of people will need “additional subsidies,” he goes ahead and endorses the very policies that create the pool of people who need “additional subsidies.”

Insurance works by pooling risk. The premiums paid by people who don’t file claims help pay for the claims that are filed. It’s true that many kinds of insurers charge more for people who have higher risks, such as a teenage driver. But essentially what the private health insurance industry wants is to insure pools of healthy people and force those with chronic health problems onto the mercy of taxpayers. If taxpayers are going to be stuck paying for the high-risk pool anyway, one wonders why we need private insurers at all. One big national system that puts everyone into the same pool would be more cost-effective for taxpayers, obviously.

The dweeb concludes,

This status quo won’t hold, and the political race is going to be between those who want to move to a more genuine market and consumer-based health care, and those who want to move toward Canada, Europe and more government control. The Bush plan ought to jump start that debate.

Many nations have devised national health care plans in which people are free to choose their own doctors, make their own decisions, and keep their medical records private from the government. See Ezra Klein’s Health of Nations series for details on what works and what doesn’t. But what we have here is even worse than government control, because citizens still (although barely) have some say in what government does. Instead we have control by the private insurance industry, meaning people with no medical licenses right now are shuffling papers and deciding who gets treatment and who doesn’t.

See also: MaxSpeak, The Carpetbagger, Kevin Drum. Brad DeLong thinks the whole proposal is a bluff:

I believe it is overwhelmingly likely that this is, in fact, a bluff. And it is not clear to me why anybody should be in the business of welcoming things that are not “real solutions.”

We should certainly welcome real solutions. But otherwise it seems to me that we are still in the standard Bush administration game of Dingbut Kabuki. The administration has made no effort to convince us that this will do more good in terms of redistributing income and increasing access to health insurance than it will do harm in magnifying adverse selection problems.

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17 Comments

  1. moonbat  •  Jan 24, 2007 @2:19 pm

    One of the things not talked about in all this, and we saw it back when Bush was trying to privatize social security, is the pitting of the young against the old. The young generally have little use for social security or national health care, and the Bush plan for health care basically gives them a huge tax break. It’s a constant theme of the Republic Party: divide and conquer.

    When I read idiot remarks by the dweeb above, I’ve got to wonder how old this clown is. It’s obvious he’s never had a serious illness or is so rich he’s out of touch with ordinary reality.

    I’m also reminded of that age cohort talked about on this blog several weeks ago whose earliest political memory was with Carter’s failure in Iran and with St Ronald’s promise of hope and euphoria for the country – in other words, people who have very early positive, childhood memories of conservativism. I suspect this cohort is around 40 or 45 or so by now, and has yet to really place demands on the heath care system. Hence their mindless, breathless, flag-waving enthusiams for “the most advanced health care in the world”.

  2. Bonnie  •  Jan 24, 2007 @2:48 pm

    If the Dems are accused of class warfare, they should just throw it back showing how the Bush’s plan is actually the plan based on class warfare. Enumerate all the parts that are literally based on class and keep pounding on the issue until it is understood. This is one more way that Rove wins by calling the Dems on exactly what the Repugs are doing.

  3. sachem515  •  Jan 24, 2007 @4:43 pm

    This piece reinforces yours:

    Health Care Conspiracy

    http://www.tompaine.com/articles/2007/01/24/bushs_health_care_conspiracy.php

  4. Donna  •  Jan 24, 2007 @5:23 pm

    We can be sure that some powerful folks are mostly interested in the pros and cons of a new health care system in terms of protecting profits beyond wage/fee structures earned by the workers in the health field. Think of Bill Frist’s family fortune, and think of insurance industry profits. I am speaking about corporate masters understanding that the health field has been and is very lucative, particularly with automatic payments to them from the government. A new ‘product’ called ‘universal care’ could be a big threat to their bottom line.

    When I read the words of Pearlstein, all I could think was that he’s probably a front man for the profiteers, paid to do a snow job on the public. In other words, whatever his resume or position of ‘expertise’, he plays the role of a paid actor on a commercial. His job is to convince the public to ‘buy’ a system that would protect and increase the health care corporate profiteering instead of ‘buying’ a system that actually serves the health care needs of Americans.
    And there’d be bonus points to the ad-man if the buying public agrees to a new tax on the masses rather than a restructuring of the whole field. Sort of like the oil industry making huge profits while running up the costs to the masses……and getting away with it because ‘expertise’ theorists and pundits get on the tube to create a fog of confusion. Meanwhile, the politicians who enjoy living in the corporate pocket then cite those pundits in explaining their own ‘don’t rock the boat’ position.

  5. Kamachanda  •  Jan 24, 2007 @6:37 pm

    Overlooked in the debate, the American health care system is crooked. A hospital can and will charge the uninsured thousands of dollars more for a procedure than they charge an insurer. When the uninsured patient can’t pay, the hospital claims to have lost that money, yet they make a profit charging insurers much less. This is everyday fraud. Hospitals claim the inflated losses and hide profits behind losses which are 70% fiction.

  6. Ian  •  Jan 24, 2007 @7:01 pm

    An idea I have. Tell me if it’s stupid, I’m tired and I honestly can’t tell.

    Ya know I was just sitting here thinking that I’m glad the insurance company I work for only does property/auto/etc, not medical, because I would not be able to morally justify working for a medical insurance company. They’re a bunch of friggin parasites, and they are undoubtedly one of the primary reasons the US doesn’t already have universal health care.

    And it occurs to me that I don’t think most people actually differentiate between medical/non-medical insurance companies … they’re all just “insurance companies” … which means that as more and more people have worse and worse opinions of the medical insurance companies in this country, that will spill over onto the non-medical insurance companies too.

    Which gives, I think, a very strong motivation for the biggies in property/auto, ya know State Farm, Allstate, Geico, all of em, to collectively start supporting/pushing universal health care… Some solution that would either eliminate medical insurance, or at the least eliminate the aspects of the medical insurance industry that makes everybody hate the fuckers… In order to protect their OWN collective reputations.

    Maybe somebody needs to explain this to them?

    -me

  7. maha  •  Jan 24, 2007 @7:24 pm

    Kamachanda — links, please.

  8. Doug Hughes  •  Jan 24, 2007 @8:50 pm

    According to Wilkpedia, the US ranks number 62 in infant mortality. Don’t talk to me about the ‘best’ health care system in the world. If a huge portion of the population can’t access it, and our society lacks the compassion to make superior medicine available to the unborn, it’s not superior.

    I can only hope that St. Peter at the gates will ask conservatives to square their belief in the sanctity of life, with their opposition to health care for the unborn, who had the misfortune to be conceived by the poor.

  9. abi  •  Jan 24, 2007 @9:05 pm

    I’d go a little further than saying Bush’s health plan is just a bluff. I think it’s an attempt to muddy the waters of the health care debate even more. It’s designed to frustrate and confuse voters, and to make national health care seem like an impossible problem to solve.

    Funny how so many other nations have, in fact, solved the problem, while the greatest nation of all time still can’t figure it out.

  10. Jonathan Versen  •  Jan 24, 2007 @9:45 pm

    I agree with abi. One year, he proposes we go to Mars, something that would cost hundreds of billions (in I.O.U.s, right?). A couple of years later, it’s forgotten. Now, it’s healthcare reform.

    Junior thinks everybody is stupid and easily distracted if you show them something shiny because, well..he’s always seen himself as too clever by half and able to get away with all sorts of sh**, and because he’s pretty easily distracted himself. I don’t see him remaining interested in healthcare reform for long unless he can figure out a way to

    1.use it to hurt unions , such as the nurses’ unions
    (he digs jerking with the less-powerful),

    and/or

    2.somehow make loud explosions necessary to the process.

  11. B. Enlightened  •  Jan 24, 2007 @10:03 pm

    All in the name of “socialism” is what the neocons throw out as the bogeyman. Somebody tell me what’s wrong with that in the name of everyone’s health? What is with the resistance of the so called ‘compassion conservatives’ to have an equitable healthcare system for all US citizens? Ah, the vested interests . . .

    The problem is that we’ve become the country ‘for the corporations, with the corportions, by the corporations’ thanks to the Repugs philosophy.

  12. Jeany  •  Jan 24, 2007 @11:01 pm

    A big part of the cost of our health care comes from the multiple layers of approval, which really is about desperately searching for reasons to deny coverage, which is how insurance companies make their profits. And corporations in the USA are required by law to make profits for shareholders, and as long as our health care system includes for-profit corporations, corners will ALWAYS be cut and decisions will ALWAYS be made that favor profits at the expense of the health and well-being of those who receive services. We will have great access to exotic and incredibly expensive procedures for the very wealthy, and damn little for the rest of us to share amongst ourselves.

    Part of Bush’s plan would gut federal funding to public hospitals. When I read that bit, I understood that the huge corporations like HCA would acquire and plunder those public assets, leaving the poor with fewer choices.

    We really do need to have a robust debate about the function of profit in health care; we really need to discuss what’s at risk if we continue to allow “the market” to determine what sort of health care we have.

  13. k  •  Jan 24, 2007 @11:21 pm

    It is kabuki. Suddenly bush cares about healthcare, deficits, Global warming/energy.. kinda like going to Mars- remember that one? As Hagel called the surge ping pong, this is just more ping pong, empty words no real policy no real plans. Just the knee jerk right wing answer to every thing- make it a tax exemption. meanwhile the real issue is like on every front, they atomize us. Change us from groups negotiating from a position of some power to individuals up against corporations, individuals with no bargaining power at all. Ins is a group thing. Individualize it and watch the market eat us all alive.

  14. k  •  Jan 24, 2007 @11:24 pm

    Also they forget to mention in this – we are now paying higher premiums to cover the cost of the uninsured , We pay taxes to cover Medicaid and Medicare. So taxing it all only encourages employers to drop ins period. It does nothing to help those of us in the middle.

  15. biggerbox  •  Jan 25, 2007 @1:54 am

    I’m not sure it’s completely a bluff, so much as an opening gambit.

    The goal isn’t really to get this plan adopted (though they’d be OK if it was) but it gives them a platform for repeatedly talking about absurd right-wing-think-tank ideas as if they were rational, injecting them into the mainstream, using the pretext of this plan. I’d never heard the term “gold-plated” insurance plan until the discussion of this plan started, and this whole idea that there are some people out there who have “too much” insurance is deeply corrosive, particularly since it’s likely the people they have in mind belong to unions.

    It’s an attempt to use the Rovean divide and conquer tactic to get various constituencies that might be allied and working for a real healthcare solution to start quibbling about who’s being wasteful and using too much when others don’t have enough. It turns the discussion from “how do we take care of everyone” into “how can I get mine and keep from being screwed by them.”

  16. sachem515  •  Jan 25, 2007 @10:26 am

    From the Colbert Report:

    Stephen Colbert: What made [Tuesday's State of the Union speech] so groundbreaking, I think, was all the new stuff we’ve never heard from the president before…like a domestic agenda. Take his proposal to fix the whole health care mess with the only proven cure-all: tax breaks…

    Bush clip: And for the millions of Americans with no health insurance at all, this deduction would help put a basic private health insurance plan within reach.

    Colbert: It’s so simple. Most people who couldn’t afford health insurance also are too poor to owe taxes. But…if you give them a deduction from their taxes they don’t owe, they can use the money they’re not getting back from what they haven’t given to buy the health care they can’t afford.

    Heck of a job Shrubbie!

  17. fshk  •  Jan 25, 2007 @1:17 pm

    I disagree with moonbat: it’s not about age, which I say as a relatively Young Person, but it’s all about class. It’s a stupid, ineffective plan to make Bush look like he’s Doing Something, so that when the plan doesn’t go anywhere, Bush, Rove, et al, can shrug their shoulders and go, “Well, we tried. Clearly, the Democrats don’t want you to have health insurance.” And all of Bush’s rhetoric comes from a place of extreme privilege.

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