Pull “The Trigger”

Certainly President Obama’s health care proposals fall short of what most of us want — national single payer — but at least there’s a public insurance plan that promises to provide coverage for many Americans now locked out of private insurance, either by lack of money or a “preexisting condition.”

Although I expect many Americans would still fall through the cracks and remain cut off from health care, I believe the public option would be a great help to millions who don’t have health insurance now. If that option is removed from the reform package, however, what’s left will amount to feeble tweaks of the current system that would make little tangible difference to anyone. Well, anyone but health insurance executives.

Naturally Republicans are fighting the public plan tooth and nail. Now there’s a “compromise” option championed by “moderates” that effectively would remove the public plan without officially killing it.

My definition of a “moderate” in this context — politicians who vote against the interests of their constituents not because of lunatic right-wing ideology, but because they’ve just plain been bought off.

“Moderate” Republican Senator Olympia Snowe came up with the idea of a “trigger” that would postpone the public plan to some hazy place in the future unless private insurance fails to meet certain benchmarks. Then the public plan option would be taken off the shelf and put into effect.

This means there never will be a public plan, except on paper. Even if private insurance misses the benchmarks, you know that Congress will come up with fine excuses for them so that the public plan doesn’t happen.

Ryan Grim reports for Huffington Post that a pack of Blue Dog Democrats are backsliding on earlier pledges to back the public plan and are coming out in favor of the trigger. Although the Blue Dog Coalition (click here for member list) hasn’t officially declared support for the trigger, it may be heading in that direction. If enough Democrats sell us out for the “trigger” option, health care reform is dead.

And, once again, the Democratic Party will have failed us, and once again, special interests and not the people will set public policy.

No Magic in the Marketplace

In 2006, Massachusetts mandated health insurance and initiated subsidized insurance for people who couldn’t afford private insurance. This suddenly gave a few hundred thousand people access to standard health care who didn’t have it before. However, Massachusetts now has a shortage of primary care physicians to tend to those people.

There are several reasons for this, but a one is that young doctors at the beginning of their careers carry whopping student loan debts, which inspires them to gravitate to higher-paying specialties like surgery. Another is that primary care physicians tend to have higher administrative costs.

(BTW, I’ve seen the primary care physician shortage held up as a reason to avoid universal health care — if everybody can see a doctor, then there will be waiting lines. Like in Canada. I know you love that argument as much as I do.)

At the Boston Globe, doctor and novelist Stephen J. Bergman writes,

THE REASONS for the shortage of primary-care doctors have been clearly described: low pay, long hours, the crossword puzzle of insurance forms required to get paid – which leads to three administrative assistants for every doctor. But the issue is being framed using a classic tactic of the private insurance industry: in order to make ends meet, cut payments to higher-paid specialists and redistribute to primary-care doctors. This pitting of doctor against doctor is a classic tactic of the disastrous healthcare system in which we find ourselves

I would add that if the only way supply can meet demand is by artificially tweaking the system — either by redistributing pay or by keeping large numbers of people uninsured, thereby suppressing demand — does this not tell us that a “free market” solution to the health care crisis will not work?

I want this paragraph on a lot of billboards —

The issue isn’t that primary-care doctors get paid less than cardiac surgeons, but that the system of healthcare rests on insurance companies and their CEOs making huge profits. No amount of cost-cutting can save enough money to support a for-profit system. The only solution is a universal, government-run healthcare system. Surveys suggest that a majority of Americans and doctors desire this. Any plan that puts private insurance in anything other than an optional, “concierge” system for the rich is just whistling past the graveyard of American healthcare.

See also Robert Reich.

What Is the Purpose of a Health Care System?, Part II

Last week I proposed there were two answers to the question “What is the purpose of a health care system?

A. Provide health care
B. Support a profitable health care industry

I’m not opposed to a health care system that does both, but not if Purpose A is compromised.

Apparently Sen. Chuck Schumer is attempting to craft a “middle ground” that compromises Purpose A in order to support Purpose B. A New York Times editorial explains Schumer’s plan:

Any competition between a new public plan and private plans would be waged on a regulated field of battle within a new health insurance exchange. Most reform proposals envisage the exchange as a place where individuals unable to obtain coverage at work and ineligible for existing public programs like Medicaid could buy policies that would be available to everyone without regard to pre-existing medical problems. Low-income people would get subsidies to help buy a private or public plan.

Opponents of a new public plan have raised the specter that it might have unfair advantages that would enable it to draw customers from private insurers and ultimately drive them out of business, leaving virtually all Americans enrolled in a full-fledged single-payer system, like Medicare. That prospect could be mitigated by appropriate ground rules.

Now, get this part:

Senator Schumer, a Democratic member of the crucial Senate Finance Committee who was assigned to study the issue, has come up with some reasonable principles to ensure that any competition between a public plan and private plans would be a fair fight. In general, he suggests that a public plan should have to comply with the same rules and standards as private plans.

Because, you know, we cannot be unfair to the private insurance industry, even if it means compromising the health of citizens.

The public plan could not be supported by tax revenues or government appropriations but by premiums and co-payments. It would have to maintain reserves, like private insurers, and provide the same minimum benefits as all other insurers in the exchange. It could not compel doctors who want to participate in Medicare to also participate in the new public plan. And it would be run by different officials from those who run the insurance exchange to lessen the likelihood that federal officials would give unfair advantages to their program.

Because, you know, we cannot give unfair advantage to a public system, which means the public system will be priced out of reach for many people. Yes, it says “low income” people may qualify for subsidies, but we sort of have that now. It’s called “Medicaid.” The income ceiling for qualifying for Medicaid is so low that vast numbers of people who can’t afford health insurance don’t qualify for Medicaid, either. I am not hopeful that low-income subsidies for public health insurance would be any different. Let’s forget about putting people through the indignity of qualifying for subsidies and make the bleeping insurance less expensive, period.

I just sent Sen. Schumer — one of my senators — a message explaining to him why he can go to hell, btw.

And the New York Times editorialist is no less clueless:

Mr. Schumer is on the right track. It should be possible to design a system in which public and private plans could compete without destroying the private coverage that most Americans have and for the most part want to keep.

I don’t think most Americans give a hoo-haw about private versus public coverage, as long as they can see a doctor when they need to. People who have insurance now and can see a doctor when they need to don’t feel a need for change, but if their insurance was publicly funded and they could still see the same doctors they are seeing now, I very much doubt there would be riots in the streets because the government isn’t being fair to the private insurance industry.


During my recent adventures in physical therapy, I overheard an elderly woman, also in physical therapy, talking about a relative who had received bad medical care while traveling in Italy. Then she shook her head and made a disparaging remark about “socialized medicine.” I wanted to ask her if Medicare paid for her physical therapy, although I didn’t. I suspect that if I had told her Medicare was “socialized medicine,” she wouldn’t have believed it.

I thought of this woman as I read Joe Conason’s article in Salon called “Stop ‘Hillary-care’ now!” He calls the Right’s attempts to scuttle health care reform pathetic, and on many levels they are. But that doesn’t mean they won’t work.

Conason writes that the Right’s strategy is to stoke fear of government bureaucrats.

But as his memo indicates, that task is becoming more difficult as the actual conditions that Americans confront grow worse. No longer is it sufficient to deny the reality of crisis in the healthcare system — and if Republicans continue to do so, the overwhelming majority of the American public that is demanding reform will dismiss them. What Luntz urges his party to do instead is to redefine the crisis not as an existing problem of millions of uninsured families and unaffordable care, but as a looming threat of government medicine run amok.

Maximizing fear is the true message of the Luntz memo: fear of government-run healthcare, fear that bureaucrats will intercede between doctors and patients, fear that those same faceless bureaucrats in Washington will deny lifesaving procedures to helpless people. He urges the Republicans to promote “horror stories” about care delayed and denied in countries with national health insurance. If they heed his advice, we can expect to see ads warning that “your child could die” because government bureaucrats held up a critical operation until it was just too late.

Of course, bureaucrats at private insurance companies have been doing these terrible things for years, but we’re not supposed to notice.

Conason reports something said by Republican Senator Jon Kyl: “Imagine needing a new hip that will make it easier to get around, but just because you’re over 75, the government denies you that surgery. We can’t allow that to happen in America.” But Medicare pays for hip replacements all the time. So won’t Americans notice how absurd the GOP’s arguments are? I say some will. But some won’t.

The Right has done an amazing job of turning Americans into people with bifurcated brains. There’s a clear cognitive disconnection between “big expensive government programs” and “programs I like (that are run by the government).”

Remember this Bushism from the 2000 presidential campaign?

We trust individual workers, and so our plan says we’re going to keep the promise to our seniors. But we’ll allow younger workers at their choice to invest some of their own money in the private markets to get a better rate of return so that the Social Security promise will be kept.

And this frightens some in Washington. Because they want the federal government controlling the Social Security like it’s some kind of federal program. We understand differently though. You see, it’s your money not the government’s money.

Of course, Al Gore pounced on that remark, and in a sane world candidate Bush would have been hooted out of the campaign. But Bush was not hooted out of the campaign, and I think that’s partly because many of the people who heard the “like its come kind of federal program” remark didn’t catch the problem with it.

And I know in my bones that you could find people who have been denied care by insurance companies, or who have no insurance at all, who are opposed to “socialized medicine” because they don’t want “government bureaucrats” making decisions about health care.

Conason writes,

In a typical Luntz language memo such as this one, he commands Republicans to repeat certain words and phrases over and over again, on the humiliating assumption that both they and their constituents will behave like mindless stooges. His underlying aim is to strip words of their meaning to evoke automatic responses — and to shut down rational thought.

Yes. And y’know what? They are really good at stripping words of their meaning to evoke an automatic response. Think of what the Right has done to “liberty” and “freedom” for example. They play “freedom” like a trump card. It doesn’t matter what they’re defending, including torture and warrantless wiretapping; once “freedom” is thrown on the table, the trump card is supposed to win the hand. But within the context of the ideas they are defending the word “freedom” has no meaning.

On the other hand, I can think of times in which a majority of the American people saw through the sham. I’m thinking of the privatized social security scheme Bush tried to sell, and the Terri Schiavo debacle. I’ve thought for years that eventually the percentage of Americans with really bad experiences with the health care system would grow into a critical mass. And when that happened, I thought, maybe we could get reform.

But then there are lobbyists. Someone should work out a citizen-to-lobbyist influence ratio, as in how many irate citizens does it take to cancel out the influence of one lobbyist? It would be a really big number.

Then again, citizen opinion must count for something, or the Right wouldn’t even bother to scam us, nor would the insurance industry have paid for those “Harry and Louise” ads of yore. Perhaps all is not lost.

What Is the Purpose of a Health Care System?

This is something of a follow up to “Why Is There an Economy?” The Center for American Progress has an alarming report on the number of Americans losing their health insurance every day. The rate of uninsured Americans is growing in every state, and most of the uninsured have jobs.

Matt Yglesias comments,

Right now, a person who develops a serious medical problem can continue to enjoy health insurance coverage if and only if he or she is able to maintain health insurance continuously. But if you lose your insurance because you get laid off, and then can’t find a new job for a while because of generally bad labor market conditions, then even though you’ll be able to get a new job when the economy revives, you’ll now find that your illness means you can’t get coverage for your medical problem. That’s totally rational business practice, but it completely defeats the purpose of a health care system which is precisely to ensure that sick people can get health care.

If you pay close attention to right-wing arguments against national health care, you notice the underlying assumption: The purpose of a health care system is to support a profitable health care industry. For example, regulations that mandate insurance companies insure people with pre-existing conditions are bad, because they are bad for business.

On the other hand, if your underlying assumption is that the purpose of a health care system is to provide health care to people who need it, you must be a liberal.

I did a news google looking for a right-wing argument against national health care, and this is the first one that came up. It’s not as strident as many. It does begin with the straw-man assumption that people who want a national health care system expect it to be free. I have never met anyone who thought that.

The author also falls back on the assumption that “government bureaucracies” always are more expensive and inefficient than private enterprise. But the American health care “system” already is the most inefficient on the planet. We spend much more on health care per capita than any other nation and get poorer results.

In any event, the argument that government bureaucracies always are more inefficient than private enterprise simply is not supported by facts. Any large organization, whether a business or a government, can be run well or poorly. It’s true that consumer products companies work at being cost effective in order to survive. But notice a lot of them aren’t exactly surviving these days.

And as I’ve pointed out elsewhere, the laws of supply and demand do not apply to health care in the same way that they apply to mp3 players. People don’t shop for health care in the same way they shop for toasters. If you want to buy a toaster, you go to a retail store and pick out the nicest one you can afford. This provides an incentive to toaster manufacturers to make better toasters that cost less. However, with health care, it’s more like you buy a membership in the retail store — your health insurer — and the store decides what toaster you can have, and even whether you will get a toaster at all.

The author of the anti-national health care article writes,

Advocates of national health insurance argue that preventive care is cheaper than trying to care for patients who have become seriously ill. This is true, but preventive care is more expensive than no care – which is what uninsured people usually choose. If we adopt universal health insurance, people who normally do not go to the doctor will go, and some one will have to pay for that care.

Kind of stunning, yes?

Social security insurance and Medicare have worked to provide more money and better health care for the elderly. But as a consequence old people live longer, collect more social security, and need more Medicare. Both programs have become vastly more expensive than was originally projected.

See, if we could just let more people die younger, it wouldn’t be such a strain on the system.

The author then brings up the awful specter of rationing health care, without noticing we are already rationing health care — if you don’t have insurance, you don’t get health care.

The author is correct that one reason health care is more expensive than it was many years ago is that medical science has developed new technologies and therapies that are excellent, but expensive. A century ago, if you broke your leg, the doctor would diagnose this by feeling your leg. Then we went to X-rays. Now there are MRIs. Very expensive stuff. But for that very reason, the old system of letting people pay the doctor however they could doesn’t work any more. And the more recent system of providing health insurance through employment is breaking down, also.

The author doesn’t bring up right-wing arguments against so incremental a step as a public insurance program that might compete with private insurance. Such a public program might be able to provide lower cost insurance by widely pooling risk and through subsidies. And that’s not fair to private insurance companies. See, it’s better to let millions of Americans go without decent health care than to not be fair to private insurance companies. As I said, to the Right, the purpose of a health care system is to support a profitable health care industry.

There’s nothing wrong with profits, and those nations that have the best health care systems as measured by cost per capita and results tend to have mixed public and private systems. It’s not just the government pulling the whole load; there is still a place for private enterprise. But those nations with the most cost-effective health care systems have the crazy idea that the purpose of a health care system is to provide health care. Radical.

Good News

First, one more reminder that tonight at 9 pm EST I’ll be on web radio at Buzz Tok. You can participate in the show by going here. You can also call in at 724-444-7444; call ID is 35186#. The planned topic is the politics of torture.

That wasn’t the good news. Eric Kleefeld writes at TPM Cafe that the NY-20 special election is now officially over, and the Democrat won. Scott Murphy takes over in the seat once occupied by Kirsten Gillibrand, who was appointed to replace Sen. Hillary Clinton in the Senate.

But here’s the real good news — Jonathan Cohn writes,

It’s been in the works for a while and now, according to senior Capitol Hill staffers, it’s a done deal: The final budget resolution will include a “reconciliation instruction” for health care. That means the Democrats can pass health care reform with just fifty votes, instead of the sixty it takes to break a filibuster.

Here’s why this is a big deal: Under Senate rules, it takes the votes of 60 Senators to close debate and actually vote on a bill. Thus, the 41 Republicans in the Senator can filibuster away and stop a bill from passing by not allowing it to come to a vote. Senate Republicans have been very clear that’s what they intend to do with a health care bill.

However, the Senate Budget Committee can add language to the budget bill, called reconciliation language, that instructs specific other committees to produce certain bills with specified spending targets. The committees send the bill back to the Budget Committee, which makes the bill part of an omnibus bill. The omnibus bill gets 20 hours of debate and then is voted on by the full Senate, where it needs a simple majority to pass. A simple majority should not be a problem in either the Senate or House.

The House version of the congressional budget resolution contains the reconciliation language. Until tonight, however, the Senate version did not.

Republicans frequently used the reconciliation language to forward their legislative agenda from 2003 to 2006, while they were in the majority. You might remember that some tried to end the filibuster altogether for judicial nominations in 2004 and 2005. Now, suddenly, some of these same senators speak of the filibuster as the last bastion of democracy. Typical.

Anyway, this step makes it much more likely that a health care reform bill will actually get written and passed in Congress this year.

According to Cohn, the reconciliation language gives the Senate until October 15 to pass a bill in a bipartisan way. But if there’s no bill then, the reconciliation language kicks in, and a bill can be passed without obstruction from the 41 Republicans.

Possible bad news: There is speculation that in order to get the reconciliation in the budget bill, a deal was stuck that would allow conservatives to mess around with Social Security. For this, see Matt Y. and Ezra.

However, right now I would think mucking around with Social Security–especially to privatize any of it–would be slightly less popular than prostate cancer. I am not too concerned, yet.

Signs of the Times

Paul Krugman writes in his column today that Ireland appears to be sinking into a genuine depression And he says the rest of the world could follow.

… to satisfy nervous lenders, Ireland is being forced to raise taxes and slash government spending in the face of an economic slump — policies that will further deepen the slump.

And it’s that closing off of policy options that I’m afraid might happen to the rest of us.

How did the Irish economy get into such a slump (emphasis added)?

By being just like us, only more so. Like its near-namesake Iceland, Ireland jumped with both feet into the brave new world of unsupervised global markets. Last year the Heritage Foundation declared Ireland the third freest economy in the world, behind only Hong Kong and Singapore.

BTW, if you want to see a study in psychotic denial, check out the Heritage Foundation issues page on the economy.

In other news, Ceci Connolly reports for the Washington Post that a downtown in manufacturing has caused a big bump in the number of North Carolinians without health insurance. One-fourth of the state’s residents have no health insurance, and another 9 percent are underinsured.

As a result, emergency rooms and nonprofit health services are being swamped by people needing basic medical care who cannot pay for it. Thanks to federal stimulus money, many nonprofit clinics are meeting the demands, but there are long waits.

Health Care Scare

Ezra Klein talks about “zombie lies that will not die.” He links to a ridiculous Bloomberg article by Amity Shlaes, who raises the dreadful specter of “government-run health care,” which I assume is a system in which heartless government bureaucrats decide what medical treatments you will receive. This would be a huge departure from our current system, in which heartless insurance company employees decide what medical treatments you will receive.

Shlaes writes,

The administration seems almost to relish the sinister aspect of government-run health care. Otherwise it wouldn’t have created a position called “National Coordinator of Health Information Technology.” That’s a title worthy of Rhineheart, Neo’s boss, who tells him, “This company is one of the top software companies in the world because every single employee understands that they are part of a whole.”

Ezra writes,

This idea that the stimulus bill “created a position” called “National Coordinator of Health Information Technology” got its start in another Bloomberg column written by Betsy McCaughey. She called the National Coordinator of Health Information Technology a “new bureaucracy.”

But this just isn’t true. It’s not sort of true or arguably true or caught in arguments about the nature of truth. George W. Bush created the position of National Coordinator of Health Information Technology in 2004. Five years ago. The current director of the office is a Bush appointee by the name of Robert Kolodner. He has served there since 2006. He exists. If you prick him, he will bleed. If you touch him, he will recoil, because he is subject to our laws of space and time and as such was not somehow created by President Obama back when George W. Bush occupied the Oval Office.

What passes for “opinion” in wingnut world comes from the Pan’s Labyrinth dreamworld they live in. Don’t even try to make sense of it.

Elsewhere in Bloomberg News, John F. Wasik writes a nice piece about single-payer.

In a “Medicare-for-all” program, care would be publicly financed and privately delivered. You would keep your own health- care providers and hospital. The government wouldn’t dictate who your doctor is or choose your hospital. It would be acting more like a huge purchaser bargaining for the best treatment and drugs at the lowest price. …

…There would be a national market and regulation for health policies and no one could be denied affordable coverage. No more “cherry-picking” of only the healthiest people and rejection of the sickest or those with chronic conditions.

Wow, think of that.

Of course, even if their ideas are absurd, the fact that the Right is proposing changes means that we’ve progressed from the position they held as recently as the 1990s, and probably into the 2000s, which was that the health care system we have is just fine the way it is, and if it ain’t broke, don’t fix it. I believe George H.W. Bush used those very words in his re-election campaign against Bill Clinton.

With wingnuts, things have to get this bad before they acknowledge there’s a problem. On the other hand, they are grand at making up phantom problems (e.g., Saddam Hussein is going to nuke us) and flogging them ceaselessly. But real problems are uninteresting to them.

In other words, they get worked up over imaginary monsters under the bed and don’t notice the roof is coming off the house.

That’s why Tom Friedman shouldn’t be surprised. He writes today about the financial crisis:

Friends, this is not a test. Economically, this is the big one. This is August 1914. This is the morning after Pearl Harbor. This is 9/12. …

… Yet I read that we’re actually holding up dozens of key appointments at the Treasury Department because we are worried whether someone paid Social Security taxes on a nanny hired 20 years ago at $5 an hour. That’s insane. It’s as if our financial house is burning down but we won’t let the Fire Department open the hydrant until it assures us that there isn’t too much chlorine in the water. Hello?

See also Paul Krugman, “Can America Be Saved?”

The Health Care Rant

I haven’t done this for awhile, but I decided to post the health-care rant I’ve been working on at Alternet PEEK. Go give it some love. I will probably cross-post it here and a couple of other places tomorrow. I’m not hearing anyone else plainly say how radical and untested the “conservatives'” cockamamie “consumer-driven” idea really is, so I’m trying to get the word out.