Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts

Thursday, November 11, 2010

More light, less heat

That's sort of a theme around my workplace. We do light-emitting diodes and want more luminous power and lower resistivity (losing energy to heat). But it applies just as well to discussions of policy.

It's crossing my mind -- now that the midterm elections are over -- to wonder what will really happen given the Republicans larger role in governing, as well as the possibility that they may take the Senate and/or the presidency in 2012. How will they govern? Assuming continuing gains for the GOP in 2012, the composition of the House and Senate still will not likely be very different than 2004 (including the fact that many of the members of Congress will be the same exact people), ergo compromising will be a necessity, right?

How will we fix the crushing budget deficits, whose causes are well-established? If you don't already realize this, the major pieces of the federal budget are: (FY 2010)

1) medicare/medicaid (20.90%)
2) social security (19.63%)
3) dept of defense (18.74%)
= ~60%

The President's budget for 2010 has total spending of the gov't at $3.55 trillion. Our budget deficit for 2010 is $1.2 trillion, or almost 1/3 of that amount.

So basically 3/5 of our entire federal budget goes to these three things (not counting special appropriations for the wars). If politicians aren't serious about cutting these three programs in careful, smart, but serious ways, then we literally cannot balance our budget.

The the long-awaited deficit reduction commission's draft report will send recommendations to the President that include extending the age of retirement and means-testing to save Social Security, overhauling and simplifying the tax code while lowering rates for the wealthy, and some other interesting items. They couldn't get enough agreement on the proposals to make it a final report, because 14 out of 18 members couldn't agree on this. Paul Krugman thinks that lowering income taxes even further on billionaires is a ridiculous way to balance the budget. I'm not expert enough to analyze the merits of these recommendations on the economics. What I do know, however, is that Social Security has always been the "third rail" in politics -- touch it and you're dead.

Introducing the proposed changes into Social Security that will basically give the shaft to lower-income people, regardless of the fiscal merits, is simply not going to happen. It is a political non-starter. And, surprisingly to some of my conservative friends, this is *even more* true of Republicans than Democrats. Listen to SC Republican Senator Jim DeMint -- one of the most right-wing of all Republicans, if not *the* most right-wing -- commenting on Meet the Press about the concept of overhauling Social Security:
GREGORY: I want to be very specific, because going back to 2008 spending levels will not get anywhere close to balancing the budget. So, you're saying that everything has to be on the table. Cuts in defense. Cuts in Medicare. Cuts in Social Security. Is that right?

DEMINT: Well, no, we're not talking about cuts in Social Security. If we can just cut the administrative waste, we can cut hundreds of billions of dollars a year at the federal level. So, before we start cutting -- I mean, we need to keep our promises to seniors, David. And cutting benefits to seniors is not on the table.

GREGORY: But then, but where do you make the cuts? I mean, if you're protecting everything for the most potent political groups, like seniors, who go out and vote, where are you really gonna balance the budget?

DEMINT: Well, look at Paul Ryan's roadmap to the future. We see a clear path to moving back to a balanced budget over time. Again, the plans are on the table. We don't have to cut benefits for seniors. And we don't need to cut Medicare -- like the Democrats did in this big Obamacare bill. We can restore sanity in Washington without cutting any benefits to seniors or veterans.
Mark my words: while people may loathe Democrats and accuse them of having a "tax and spend" mentality, Republicans will be bigger spenders,just as they always have been, but without the honesty of even trying to balance the budget, just as they always have been. Compare the two parties' approaches to health care:

When Republicans passed the Medicare drug benefit (Part D) of 2003, they lied about its costs and just pretended it didn't have to be paid for. Pop quiz: which costs more -- the GOP's Part D or the Dems' health care reform?

Ans: Part D. Part D is estimated to cost $951 billion over the decade 2009-2018. (See Table III.C.19, page 120, shown below) In addition, the cost of that plan only grows with time as our aging population increases. Almost every penny of that is pure deficit spending.



Republicans wrote the bill so that big pharma companies get far more money from Medicare Part D for the exact same drugs than the Dept of Veterans Affairs pays for them. In the House, only 25 Republicans voted against the budget-busting bill while all but 16 Democrats voted no. The main player in writing the legislation in the House left his job and took a $2 million a year lobbying job with...a pharmaceutical company...(all facts that have been documented pretty easily by lots of principled people)

What about the other major political party and their health care reform bill (ACA)?

The Dems' plan requires $382 billion of spending total over the period 2010 - 2019 to expand insurance coverage and close the Part D "donut hole". (See Table 2, page 18 of the PDF, shown below)



These costs are financed in part by cutting wasteful spending to private insurers for Medicare "Advantage" plans and raising Medicare premiums on those making over $250,000 a year. Those revenues combine to give back the government $525 billion during that same period, thus *lowering* the deficit by $140 billion! On top of that, in the next decade, it is estimated to save far more!



When Dems passed the Affordable Care Act they used CBO scoring and raised some Medicare taxes on the rich to pay for the costs associated with expanding coverage. They pushed to allow drug prices to be negotiated. The bill lowers the deficit by over a hundred billion dollars in the first decade.

In short, if you believe that Democrats are the party who spends too much, or adds more to the deficit, you're simply living in a fantasy world. Facts are hard, cold and stubborn things.

Ed Brayton has an interesting view on this. He thinks that Republicans are able to get away with this bullshit for strategic reasons:
For all the Republican rhetoric about smaller government and "tax and spend liberals," the fact is that over the past 50 years the size of government has grown more under Republican presidents than under Democratic ones -- and so has the size of the debt because of their reluctance to raise taxes.

From 1962-2001, the average growth in total federal spending under Republican presidents has been 7.57%; under Democrats, 6.96%. Bush certainly did not help those averages any after 2001. During that same period, the average yearly deficit under Democrats was $36 billion; the average under Republicans was $190 billion. So under Republicans, spending grows more but revenues grow less because they always insist on tax cuts.

And that means taxes must go up at some point to pay the cost of the deficit spending plus the interest on that borrowing. I think part of the GOP strategy for the past 50 years (40 at least) has been to drive up the deficit intentionally by raising spending and cutting taxes, knowing that when the Democrats are in control they will have to raise taxes. Then they can say, "See, the Democrats are always raising your taxes!" -- but without acknowledging that it was made necessary by their own borrow and spend policies.

The fact is that neither party has any interest in actually reducing spending. The difference is that the Democrats are generally more willing to pay for it with taxes while the Republicans refuse to do so. And I think that is a deliberate strategy on their part.
Perhaps...

Tom Toles is spot on:

Thursday, March 25, 2010

As Big as the New Deal? Sure, it's a big fuc*ing deal

They finally did it. I guess the money I sent in to Obama and the time and energy I spent supporting his election does pay off.

Congrats, Dems. Now go work on all the other problems that Republicans either ignored or helped create: financial regulation, energy, consumer protections...

Friday, March 5, 2010

It's happening

Back in November, during the heated phase of Senate filibustering, I pointed out some simple logic:
Given the fact that the Republicans are already going after supposedly "centrist" or "moderate" Democrats, painting them as wild-eyed liberals hell-bent on destroying America, perhaps their penchant for ass-covering and concern for election prospects need a new perspective. The idea that they'll win over "moderates" by supporting a Republican filibuster on healthcare reform is insane. The people who want them to support a GOP filibuster are the same people who will vote Republican anyway. I think that all of the "Blue Dogs" and the center-right Dems in the Senate should do a simple thing: support reform behind-the-scenes by voting for cloture and progressing a bill through the legislative process, and turn around and attack opponents from the left side of the debate.

Attacking Republicans from the right, or, insanely, attacking Dems from the right, will not net these Democrats a single vote. And liberals like me don't want to support candidates who act and sound more like Republicans than Democrats.
We're now seeing this point supported by evidence:
A conservative group, the League of American Voters, has announced it will be running advertisements in the districts of 13 vulnerable Democrats who voted for health care reform in November. The goal is to pressure them into voting "no" on the Senate bill when it comes up, presumably later this month.
If Democrats who voted for the health care reform bills the first time think they're somehow going to win their election by torpedoing it now, they're insane. If they change their vote now, do they really think Republicans won't continue to run these ads?

Wednesday, March 3, 2010

Health care links

Here's a nice list of links if you're interested in doing some research on health care.

Comparisons of various health care reform bills:
http://www.kaiserhealthnews.org/Graphics/2010/022310-Bill-comparison.aspx

National Academies of Science ("America's Uninsured Crisis:
Consequences for Health and Health Care" (2009)):
http://www.nap.edu/openbook.php?record_id=12511&page=1

Why can't health care be a "free market" service? Why does the gov't
need to be involved at all?
http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/
http://www.nytimes.com/2009/11/24/opinion/24brooks.html
http://www.pnhp.org/news/2009/september/harvard_study_finds_.php
http://prescriptions.blogs.nytimes.com/2010/02/26/deaths-rising-due-to-lack-of-insurance-study-finds/
http://www.nytimes.com/2010/02/28/weekinreview/28abelson.html

Medicare is going bankrupt:
http://www.ssa.gov/OACT/TRSUM/index.html

What is driving premiums upward?
http://www.nytimes.com/2010/02/19/opinion/19krugman.html
http://views.washingtonpost.com/healthcarerx/panelists/2010/02/altogether-now-we-need-comprehensive-reform-if-we-really-want-to-cover-everybody.html
http://www.theatlantic.com/business/archive/2010/03/are-obamas-new-gop-health-ideas-any-good/36971/

Exemptions from antitrust laws protect insurance companies from competition:
http://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act
http://www.examiner.net/news/x1914248650/Health-insurance-companies-exempt-from-anti-trust-laws
http://www.nytimes.com/2010/02/24/opinion/24reich.html?em

The House just passed a repeal of these exemptions:
http://www.speaker.gov/blog/?p=2164

Basic overview of both Congress' and President's proposals:
http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/overview
http://www.nytimes.com/interactive/2010/02/22/us/politics/0222Health.html
http://www.theatlantic.com/politics/archive/2009/11/a-milestone-in-the-health-care-journey/30619/
http://www.nytimes.com/2009/07/06/opinion/06krugman.html?em
http://www.nytimes.com/2009/07/26/opinion/26sun1.html?ref=opinion&pagewanted=all

Adverse selection in health care insurance (see esp box 22.1 on p. 231):
http://books.google.com/books?id=MvWYdUjmuzcC&pg=PA227#v=onepage
http://www.nytimes.com/2010/01/22/opinion/22krugman.html
(scroll about halfway down Krugman's column for the relevant portion)
http://www.politico.com/livepulse/0210/Report_Top_five_insurers_made_12_billion_in_profits_last_year_dropped_27_million_people.html?showall

A 4-minute highlight reel of the recent "Health Care Summit":
http://prescriptions.blogs.nytimes.com/2010/02/25/video-the-health-care-session-in-4-minutes/

Some results from this summit:
http://www.whitehouse.gov/blog/2010/03/02/president-obama-follows-thursdays-bipartisan-meeting-health-reform-0

How much does the gov't already pay for medical bills, versus private insurers?
http://krugman.blogs.nytimes.com/2009/12/26/numerical-notes-on-health-care-reform/

Medical "rescission" of health insurance (dropping sick patients)
http://articles.latimes.com/2009/jun/17/business/fi-rescind17
http://krugman.blogs.nytimes.com/2010/03/17/demons-and-demonization/

A critical review of the GOP's proposals:
http://www.tnr.com/blog/the-treatment/state-denial
http://www.businessweek.com/magazine/content/09_39/b4148030880703.htm
http://www.rollcall.com/news/40164-1.html
http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_th.html

Some insight from liberals about conservative criticisms of the bills:
http://voices.washingtonpost.com/ezra-klein/2010/03/paul_ryan_and_the_true_cost_of.html
http://voices.washingtonpost.com/ezra-klein/2009/12/to_repeat_the_cbo_found_that_p.html

A critical review of Dem proposals:
http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022504074.html
http://www.juliansanchez.com/2009/12/15/checking-in-on-the-healthcare-debate/
http://douthat.blogs.nytimes.com/2009/12/17/obamanomics-and-health-care/

Some of the interest groups lobbying on both sides of the current debate:
http://www.washingtonpost.com/wp-dyn/content/article/2010/02/27/AR2010022703253.html?nav=hcmodule

PS: Here's a humorous video:
http://www.funnyordie.com/videos/041b5acaf5/protect-insurance-companies-psa

And if you want some context from me, check out my health care posts.

Thursday, February 25, 2010

Update: Health care antitrust laws

Robert Reich makes the case for ending the antitrust exemptions for health insurance companies that I mentioned in the "competition" section of my note on health care reform economics:
This can’t be the whole story, because big health insurers are making boatloads of money. America’s five largest health insurers made a total profit of $12.2 billion last year; that was 56 percent higher than in 2008, according to a report from Health Care for America Now.

It’s not as if health insurers have been inventing jazzy software or making jet airplanes. Basically, they just collect money from employers and individuals and give the money to providers. In most markets, consumers wouldn’t pay this much for so little. We’d find a competitor that charged less and delivered more. What’s stopping us? Not enough choice.

More than 90 percent of insurance markets in more than 300 metropolitan areas are “highly concentrated,” as defined by the Federal Trade Commission, according to the American Medical Association. A 2008 survey by the Government Accountability Office found the five largest providers of small group insurance controlled 75 percent or more of the market in 34 states, and 90 percent or more in 23 of those states, a significant increase in concentration since the G.A.O.’s 2002 survey.

Anthem’s parent is WellPoint, one of the largest publicly traded health insurers in America, which runs Blue Cross and Blue Shield plans in 14 states and Unicare plans in several others. WellPoint, through Anthem, is the largest for-profit health insurer here in California, as it is in Maine, where it controls 78 percent of the market. In Missouri, WellPoint owns 68 percent of the market; in its home state, Indiana, 60 percent. With 35 million customers, WellPoint counts one out of every nine Americans as a member of one of its plans.


Yesterday, the House passed this exact repeal, by a 406 - 19 margin!

I think this is a hopeful sign pointing towards changing the system, but we'll wait and see...

Wednesday, February 24, 2010

The case for health reform

Partisanship aside, the underlying question of why health insurance premiums are so high in America can be explained fairly easily by textbook economics. The solution to the problem is universal coverage, as has been known for decades, by lowering the average risk of the insured. The fact about the way that all insurance works is this: there are only two ways to reduce average premiums -- 1) increase the number of people who are in an insurance pool, 2) reduce the cost of the service/good being insured. Those who disagree aren't just wrong politically and morally, but are ignorant of basic economics. Krugman and Pollack explain the economics of recent increases in California insurance premiums in plain language, below are the economics concepts to consider:

Tuesday, December 15, 2009

The problem with being responsible

From Yglesias:
Can’t liberals be just as stiff-necked as Lieberman? Sure, they could. But liberals members do have an incentive to compromise—the tens of thousands of people who die every year for lack of health insurance. The leverage that Lieberman and other “centrists” have obtained on this issue (and on climate change) stems from a demonstrated willingness to embrace sociopathic indifference to the human cost of their actions.
Why is it that liberals keep having to concede on health care, watering down valuable reforms and cost-saving measures in the bill? Why is it that "compromise" isn't to some political center but rather a fraction of a hair to the left of business-friendly, anti-consumer conservatism? Because of f*cksticks like Lieberman who will filibuster the bill to death rather than allow it to come to a vote and then voting against it. The grown-up party realizes that failure in reforming the broken health care system literally is not an option, and so has to cater to these few Senators' every whim and fancy, as well as literally bribe them for their vote. As I've said before:
We're already bankrupting the system because of the issue of how the system is right now. The government already pays 46% of all health care expenses in the US. The private insurers pay about 37%. The rest is out-of-pocket.

The entitlements problem will continue to grow with our top-heavy population chart (more old people than young). But if we can reign in health care costs by overhauling the system then we can possibly prevent total fiscal collapse. This is a problem that Republicans kicked down the road every single time they held office and could do something about it. Everyone knows our entitlements are literally headed for failure and something must be done about it. No Republican has had the courage to face the issue since Newt Gingrich's proposal for drastic cuts in Medicare in 1995.

Let's assume the House bill passes the Senate just like it is (it won't). Paying $1.2 trillion over 10 years works out to approximately two-thirds the cost of the Bush tax cuts, half of the long-term cost of the Iraq War (including long-term health care for vets, not just the annual supplementals to the budget), and about 15% of our defense budget. That's right, we pay about $1 trillion dollars or more *every year* in defense spending, a *huge* part of that right now for two wars, the rest of which largely ends up as pork and wasteful spending and research for technologies that are completely useless (think missile defense, "Star Wars"...). Meanwhile, over 45,000 people die annually in the US from lack of access to basic medical care, ten times the casualties on 9/11. A new Harvard study estimates even higher numbers, that every 12 minutes someone dies from lack of adequate care, meaning every three weeks more people die from lack of health care than from 9/11.
Now, the GOP just can't be persuaded by these facts and reasoning, not by the specter of massive insolvency, nor by the moral burden of being the only industrialized country in the world that allows its citizens to die and go bankrupt because they get sick. What bothers me the worst is that they're quite willing to see reform completely die, that Liebeman and a few other Democrats are willing to help kill it via the filibuster, and Paul Krugman was right in characterizing them as "the party of Beavis and Butthead." It's no coincidence that these few people willing to kill the bill all receive large payouts (campaign contributions) from insrance executives. Meanwhile the "responsible" Senators have to basically give up every important change in the bill and turn it into a gift to the insurance industry to satisfy the tyranny of these four (or five) because failure is not an option.

Wednesday, November 25, 2009

The bottom line on health care reform

Whether you argue health care reform is really about moral values or the fact that the current system is literally going bankrupt, it's difficult to logically oppose changing the system. A recent analysis by Ron Brownstein in The Atlantic finds that health care economists across the political spectrum agree that the Reid bill being debate in the Senate is the best shot we have at fixing the broken system:
When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won't succeed unless it "bends the curve" in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. "The bottom line," Nichols says, "is the legislation is sending a signal that business as usual [in the medical system] is going to end."
More from Steve Benen at Political Animal.

PS: Republicans love criticizing the length of the bill, as if that's a valid argument. Legislative bills are printed up with huge margins, large font, numbered lines and double spacing. This causes them to be much lengthier than typical reading material. A recent analysis by the AP finds that the length of the healthcare reform bill is actually about 209 normal pages:
Actually, Leo Tolstoy's tome [War and Peace] is longer than either bill. Full translated versions are nearly twice as long.

The bill passed by the House is 319,145 words. The Senate bill is 318,512 words, shorter than the House version despite consuming more paper. Various versions of Tolstoy's novel are 560,000 to 670,000 words. Bush's education act tallied more than 280,000 words.

By now, the full draft of Reid's bill that had circulated in the corridors and landed so prominently on Republican desks has been published in the Congressional Record in the official and conventional manner.

The type is small and tight. No hernias will be caused by moving this rendering of the bill around. Unfurling it on the Capitol steps would not be much of a spectacle.

It's 209 pages.
That's less than Palin's new 400+ page book.

Monday, November 23, 2009

Follow actual principles, "centrists"

Given the fact that the Republicans are already going after supposedly "centrist" or "moderate" Democrats, painting them as wild-eyed liberals hell-bent on destroying America, perhaps their penchant for ass-covering and concern for election prospects need a new perspective. The idea that they'll win over "moderates" by supporting a Republican filibuster on healthcare reform is insane. The people who want them to support a GOP filibuster are the same people who will vote Republican anyway. I think that all of the "Blue Dogs" and the center-right Dems in the Senate should do a simple thing: support reform behind-the-scenes by voting for cloture and progressing a bill through the legislative process, and turn around and attack opponents from the left side of the debate.

Attacking Republicans from the right, or, insanely, attacking Dems from the right, will not net these Democrats a single vote. And liberals like me don't want to support candidates who act and sound more like Republicans than Democrats.

Steve Benen lays out what I think is a much smarter strategy for vulnerable Congressional incumbents:
Matt Yglesias raises a good point: "A lot of members of congress spent 1993 and '94 spiking the Clinton legislative agenda and then went down to defeat in November 1994 anyway. Wouldn't it make more sense to turn the 111th Congress into a substantive success, hope you can persuade the voters that these are good ideas, and if you fail at least manage to have gone down fighting accomplishing something important?"

If I were a campaign strategist for Blanche Lincoln, I'd go a little further -- I'd encourage her to become the biggest champion of bold, progressive health care reform in the Senate. I'd urge Lincoln to show some major leadership, get out way in front, and position herself as a Kennedy-like guardian of those suffering under the status quo.

Look, Lincoln isn't going to out-conservative the Republican candidates in Arkansas. No matter how she votes on reform, the entire Attack Machine is going after her as some kind of radical leftist. It doesn't matter if it doesn't make sense, and it certainly doesn't matter if she votes with Republicans on the big issues of the day for the next year.

So why not go big? Why not announce that too many Arkansas families are being screwed right now by a dysfunctional health care system and Blanche Lincoln has decided to do something about it? Why not run ads saying, "I don't care what the insurance companies and their candidates say: I'm fighting for the families who can't afford their premiums, the workers who can't get coverage, the Arkansans with pre-existing conditions, the small businesses that can't afford insurance for the employees...."?

In other words, show some confidence. Voters can recognize fear, so stop being defensive. Arkansas has a high percentage of low-income families, struggling to get by, who are terrified of their health care situation. They're not going to vote Democratic on cultural and/or social issues, but they're open to the Democratic message on economic policy -- looking out for working families' interests. A candidate who positions herself as a populist people's champion has a better shot than an apologetic Democrat who hopes Republicans won't mind her party affiliation.

When Republicans accuse her of supporting an overhaul of a broken system, Lincoln might want to try saying, "You're damn right I do. Why don't you?"
Exactly.

Saturday, November 14, 2009

Framing health care reform

So Republicans now use the phrase "government takeover" to describe changes to the private insurance industry's practices of denial of coverage based on pre-existing conditions, rescission during sickness and offering a voluntary public option (a Medicare-like plan) to a small segment of the population. The logical and evidential problems with their arguments don't even matter to opponents of reform. It's as simple as, "Government = bad. Reform = government. Reform = bad!"

It seems many CEO's aren't so stupid:


From the BRT report:
"The report also shows that reform done wrong ... could make a bad situation much worse, in which case Business Roundtable could not support the bill," Eastman Kodak (EK.N: 行情) Company Chairman and Chief Executive Antonio Perez said in a statement accompanying the release of the report.

Obama said it was further evidence that the U.S. healthcare system is broken.

"If we don't pass comprehensive reform, the report finds, health care costs that are already squeezing our businesses will continue to rise, and in 10 years, employment-based spending on health care for large employers will be fully 166 percent higher per employee than it is today," the president said in a statement.

"The yearly health insurance costs for the average employee will rise to a staggering $28,530," he added, citing a finding by the report.

Companies represented by the Business Roundtable, which includes such giants as Verizon Communications Inc. (VZ.N: 行情), The Boeing Company (BA.N: 行情) and Exxon Mobil Corp. (XOM.N: 行情), provide health insurance to more than 35 million workers and their families. The group has been a major force behind the healthcare overhaul push.

Of course, the fact that businesses support real reform doesn't help the lies and propaganda effort to kill change by the GOP, so they're pretty pissed about it.

Thursday, November 12, 2009

Anybody have a puppy who can talk?

I was sent two videos to watch by my very conservative, Faux-News-watching mother in an email: part 1, part 2. She wrote:
You wonder why we are worried regarding the health care bill. If you can't look at how the govt. has handled medicare, etc. and be afraid of this I don't know what it would take. My premium raised to 624. monthly with higher deductibles and copays so I am quite aware of the fact that reform is needed. I would start with buying ins. across state lines and tort reform. I would not throw out the baby with the bath water. If you have an open mind, I dare you to read this. Remember, you, * and * will be seniors one day. Also, I don't think this can be paid for. But you probably won't listen just like you never want to hear the other side, only send me links regarding your side which I do listen to and read. Double dog dare you. Triple dog dare you, love mom
As I watched it, I was immediately struck by how this old man talking "from the heart" about health care reform reminded me of Rep. John Shadegg's (R-AZ) use of a baby the other day during a floor speech. In both cases, the people have terrible arguments and try to compensate for that via emotional appeal.

Anyway, I started to compose a reply after watching the video but realized it would do nothing to persuade her of her folly. I tried when she sent me Christian Nation bull crap emails and she just flatly refused to acknowledge the facts. People like this don't let the facts get in the way of a strong belief. That's why they're religious too. So I decided instead to post my reply here:
Generally speaking it isn't very effective to call someone narrow-minded and then use "dares" to goad them into reading or watching something that represents a different point of view than their own.

I feel sorry for Bill Crawford. His rambling was incoherent.

Starting at the beginning...

He was taught to unquestioningly respect "leaders" like a dog rather than expect them to earn respect. That's definitely present in religious thinking. Yes Medicare has problems but I'm quite sure Bill doesn't bother to worry about those problems every time he uses his "government run" insurance. He also repeats a GOP talking point that the government is "taking over" health care and that a bureaucrat will "get between you and your doctor"...let's see Bill...when you use your Medicare do they call a government agent and ask them for permission to take care of you? Um, no. As it is right now, though, my private insurance requires "pre-authorization" for certain medical care. A private insurance agent gets "between me and my doctor" right now.

Bill is also confused about the name calling. The people likening health care reform to Nazism, death camps, etc., are *all* opponents of reform trying to scare old people like Bill. Glenn Beck loves to compare Obama to Hitler, Stalin, Lenin. It worked, obviously, and confused him. Who exactly called seniors names? I'd love it if he could point out one Democratic legislator calling opponents to reform Nazis. Perhaps he's referring to Speaker Pelosi's factually-accurate observation that some people are bringing "swastikis and symbols like that to town halls".

Bill is exactly right that people can "get health care" by going to the ER and that all of us have to foot the bill for it. One catch, though: the only guaranteed care is "life-threatening". Which is what an ER is for. Not getting antibiotics and preventative care and screenings...Which is a good reason to want to change the system. This means that those without insurance end up often having to wait until their problems become catastrophic before being able (or willing) to go to the ER.

Bill is full of shit about not getting heart transplants and cancer treatments. Period. Spin it however you want, but a lie is a lie. There is nothing, *nothing* in any bill that says that you will get "death counseling in lieu of treatment"...it's just complete hysterical nonsense from a frightened old man. Find a way to make sense of that lie. I'd love to hear it. The "death panels" BS that idiots pass around is just sad. The bill provides a reimbursement to doctors for *voluntary* counseling as a service. End of story.

If you want to read the language of the bill that just passed the House regarding this counseling, here it is (HR 3962 Section 1233):
`(3) An individual may receive the voluntary advance care planning care planning consultation provided for under this subsection no more than once every 5 years unless there is a significant change in the health or health-related condition of the individual.

`(4) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that effectively communicates the individual's preferences regarding life sustaining treatment, is signed and dated by a practitioner, and is in a form that permits it to be followed by health care professionals across the continuum of care.'.

(b) Construction- The voluntary advance care planning consultation described in section 1861(hhh) of the Social Security Act, as added by subsection (a), shall be completely optional. Nothing in this section shall--

(1) require an individual to complete an advance directive, an order for life sustaining treatment, or other advance care planning document;

(2) require an individual to consent to restrictions on the amount, duration, or scope of medical benefits an individual is entitled to receive under this title; or

(3) encourage the promotion of suicide or assisted suicide.
But yet the myths continue because propaganda outlets that Bill trusts continue to promote falsehood under the pretense of "giving time to both sides of a 'debate'..."

Like many people, Bill is angry and confused and needs to be consoled. That doesn't mean that he makes any valid points.

The GOP alternative that was voted down just hours before the House bill passed was pretty funny. Did you read about it? No requirements to protect people from "pre-existing conditions" clauses. No protections from rescission. No real improvement for people who are uninsured.

As for your premises about why health care reform "can't be paid for"...think again. A lot of people use very poor logic in asking the question, "How can you spend money to save money?" That's like me arguing that if you want to save on energy costs in the long term the only solution is to cut down the thermostat. If this isn't possible, or a good option, you could invest in energy-efficient windows and a central air system. Although it requires up front investment, you save money over the long term. That's the case with health care...

We're already bankrupting the system because of the issue of how the system is right now. The government already pays 46% of all health care expenses in the US. The private insurers pay about 37%. The rest is out-of-pocket.

The entitlements problem will continue to grow with our top-heavy population chart (more old people than young). But if we can reign in health care costs by overhauling the system then we can possibly prevent total fiscal collapse. This is a problem that Republicans kicked down the road every single time they held office and could do something about it. Everyone knows our entitlements are literally headed for failure and something must be done about it. No Republican has had the courage to face the issue since Newt Gingrich's proposal for drastic cuts in Medicare in 1995.

Let's assume the House bill passes the Senate just like it is (it won't). Paying $1.2 trillion over 10 years works out to approximately two-thirds the cost of the Bush tax cuts, half of the long-term cost of the Iraq War (including long-term health care for vets, not just the annual supplementals to the budget), and about 15% of our defense budget. That's right, we pay about $1 trillion dollars or more *every year* in defense spending, a *huge* part of that right now for two wars, the rest of which largely ends up as pork and wasteful spending and research for technologies that are completely useless (think missile defense, "Star Wars"...). Meanwhile, over 45,000 people die annually in the US from lack of access to basic medical care, ten times the casualties on 9/11. A new Harvard study estimates even higher numbers, that every 12 minutes someone dies from lack of adequate care, meaning every three weeks more people die from lack of health care than from 9/11.

Yet I definitely don't remember hearing that we couldn't afford the Bush tax cuts, or the Iraq War, and we don't hesitate to throw billions and billions of dollars at a remote possibility that a few thousand people *might* die from a terrorist attack. And of course if you don't support every facet of a defense bill, including ordering planes that cost a billion dollars each to make and research on laser weapons then you're a cowardly liberal who hates their country. Or something.
I could write more but I got tired. I think I'll teach my baby how to read from posterboards and talk into a camera so I can make my own propaganda videos.

Tuesday, July 28, 2009

Crazy conservatives redux

Glenn Beck calls Obama a racist who hates white people (@1m19s into video). Popular media conservatives really are getting more and more unhinged.

Feldstein tells us that Obama wants single payer. That's news to me.

On another note, Orally explains that Canada doesn't have better healthcare than us, we just have more people. Their higher life expectancy is just a figment of statistical manipulation, see...

Great minds think alike

Early this morning, I wrote a post complaining how the Gang of 6, as they've come to be known, is essentially holding healthcare reform hostage to their whims. I tallied up the combined population they represent in the Senate and found it to be under 3% of Americans.

At around 10:40, Matthew Yglesias published an almost identical piece.

Great minds think alike. (H/T: Krugman)

What is "representation" in the Senate?

The notion of a Senate body in which each state gets equal voice pisses me off to begin with. Wyoming has the same "weight" in the Senate as California, though it has 1.45% of the population of the state. That's right, CA outweighs WY by a factor of 69 in population but is equal in terms of Senate representation. The concept of democracy is majority rule with inalienable minority rights. But does that mean the minority's voice has to be equal to the majority's when the latter is 70:1 larger than the former? We all know that when it comes to getting things done in Washington, the Senate is the place that lobbyists target because it's easiest to gum up the works.

And that's part of the problem. I know that everyone thinks the Founders were infallible and their wisdom about this system of checks and balances is inerrant. But when you look at the fact that the GOP has turned filibustering (another "check" on the majority party) into standard procedure, and the relative difficulty of passing bills that have huge public support, it should make you wonder.

In reading today's NYT report about how the six members of the Senate Finance Committee all but hold the healthcare reform effort hostage to their own desire, I am angry at how these 6 Senators, 3 Dems and 3 GOP, are supposed to "represent" me and the rest of the country. Let's look at what states they hail from and how large those states are in terms of their population percentage of our nation of around 304,059,724 people**:

baucus - montana (0.318%)
conrad - ND (0.211%)
bingaman - NM (0.653%)

dem total: 1.18%

snowe - maine (0.433%)
grassley - iowa (0.987%)
enzi - wyoming (0.175%)

repub total: 1.60%

rep + dem = 2.78%

That's right. The six people who have all but decided a public option isn't necessary and a surtax on millionaires to pay for reform is just too much, despite the absurd inequality that the Bush tax cuts brought about that these "fiscally conservative" hypocrites helped vote for, come from states with a total of under 3% of the US population. That just sucks.

Remember David Brooks' remark,
"It’s not that interesting to watch the Democrats lose touch with America. That’s because the plotline is exactly the same. The party is led by insular liberals from big cities and the coasts, who neither understand nor sympathize with moderates."
Republicans can remark that the Democratic party is full of "insular liberals" from urban areas all they want, since those same areas hold the majority of the population of this great nation.*** We members of the Urban Archipelago make up the majority of the nation in population terms, and tend to be more progressive in politics. And so the majority of us aren't as "moderate" as all the talking heads want everyone to believe, it's just that the way the Senate skews power moderates are literally holding us all hostage to what they think is right. And those of us with voting power will remember that, despite how much our constitutional right of representation gets fuc*ed by the system.

(Gail Collins also made this point about Baucus' perverse amount of power, "Nothing is going to happen on health care without the approval of Baucus, whose vast authority stems from the fact that he speaks for both the Senate Finance Committee and a state that contains three-tenths of one percent of the country’s population.")

**All data from 2008 figures at census.gov

***World Bank data,Table A2 Urbanization, p337 for the US shows the 2005 population of our country is 80.8% urban and that by 2015 it is expected to be 83.7% urban. From the same table, in 2005 43.3% of our national population resided in cities with a population of over 1,000,000 people.

Sunday, July 26, 2009

NYT Healthcare Editorial

Here's Krugman on why the free market can't fix healthcare: 1) the unpredictability of the need for healthcare and the potentially devastating costs make insurance necessary, and so "consumer choice" doesn't exist between doctor and patient, and 2) experience, price comparison and other market dynamics don't work in healthcare.

Here's a good editorial of the reform effort as a whole, pros and cons, consequences and risks:

Sunday, June 28, 2009

...to follow up that last post...

I love reading Krugman's blog:
Um, economists have known for 45 years — ever since Kenneth Arrow’s seminal paper — that the standard competitive market model just doesn’t work for health care: adverse selection and moral hazard are so central to the enterprise that nobody, nobody expects free-market principles to be enough. To act all wide-eyed and innocent about these problems at this late date is either remarkably ignorant or simply disingenuous.
When it comes to most markets, it seems to me that the most expensive things result from "add ons" which are usually non-essential. For example, leather seats in a car with built-in DVD players. Or a 120-Hz processor speed on a giant LCD-TV. Or buying organic vegetables. With health care market dynamics, it's the most essential things that are most expensive, like a heart transplant and cancer surgery.

The market has obviously not solved the major problems with health care in our country, and while some would blame ambiguous "government" for this, Medicaid/Medicare have tiny administrative costs in comparison to traditional insurers and pay out far less for most procedures, which keeps their costs down rather than passing the buck to the consumer.

Saturday, June 27, 2009

Healthcare Reform

I will leave hardcore political blogging to those better equipped. But after I read this article by Wendell Potter, a former healthcare insider, who mentioned Remote Area Medical's trip to Wise, VA (also here) as a motivator for abandoning his former job and lobbying for real healthcare reform, I had to link to it. These volunteer doctors, originally intended to do drop-in medicine in the Amazon and Congo, spend 60% of their time doing work inside the USA. Potter worked for CIGNA, who used to be our insurer, and he has two important things to say about healthcare:
  1. big for-profit insurers have hijacked our health care system and turned it into a giant ATM for Wall Street investors
  2. the industry is using its massive wealth and influence to determine what is (and is not) included in the health care reform legislation members of Congress are now writing
A lot of people recognize these things already, but it's important to have someone like him testify to them before the Congress. Potter says,
What I saw happening over the past few years was a steady movement away from the concept of insurance and toward "individual responsibility," a term used a lot by insurers and their ideological allies. This is playing out as a continuous shifting of the financial burden of health care costs away from insurers and employers and onto the backs of individuals. As a result, more and more sick people are not going to the doctor or picking up their prescriptions because of costs. If they are unfortunate enough to become seriously ill or injured, many people enrolled in these plans find themselves on the hook for such high medical bills that they are losing their homes to foreclosure or being forced into bankruptcy.

As an industry spokesman, I was expected to put a positive spin on this trend that the industry created and euphemistically refers to as "consumerism" and to promote so-called "consumer-driven" health plans. I ultimately reached the point of feeling like a huckster.
And,
...when I heard members of Congress reciting talking points like the ones I used to write to scare people away from real reform. I'll have more to say about that over the coming weeks and months, but, for now, remember this: whenever you hear a politician or pundit use the term "government-run health care" and warn that the creation of a public health insurance option that would compete with private insurers (or heaven forbid, a single-payer system like the one Canada has) will "lead us down the path to socialism," know that the original source of the sound bite most likely was some flack like I used to be.

Bottom line: I ultimately decided the stakes are too high for me to just sit on the sidelines and let the special interests win again. So I have joined forces with thousands of other Americans who are trying to persuade our lawmakers to listen to us for a change, not just to the insurance and drug company executives who are spending millions to shape reform to benefit them and the Wall Street hedge fund managers they are beholden to.
I really, really hope Obama doesn't cave on the public insurance option. So does Krugman.

Wednesday, February 18, 2009

A few thoughts on healthcare

Some professors at Harvard Medical basically said that single-payer is the only viable option in the face of the failure of the Massachusetts model for healthcare. (I've said this before.) This is similar to what I wrote to a friend who is a recent med school grad in an email last Christmas Eve:
It may be a long conversation to get into the pros and cons of different policy approaches, and I certainly am no expert. I do however consider myself a quasi-informed citizen, and as such am willing to stake out a few opinions:

1) I think that going to a single-payer system (government) for routine health care is the optimal long-term strategy. It may be that the industry gets fractured between primary care and specialized medicine, the latter still requiring insurance and therefore remaining problematic in the sense that it isn't "universal" and its costs may remain too prohibitive for direct payment from patient to physician. I think insurance is more a problem than a solution when it comes to health care, and I say that as someone who has had a fair share of bullshit to deal with for fairly minor matters.

2) Apropos (1), since the vast majority of health care concerns, if addressed early and well, don't require a specialist I would think that nurse practitioners would be fine in working in such a system alongside generalists). With the reduced burden in terms of insurance/paperwork/bullshit that a single-payer system brings, the cost of this policy would be far less than a lot of people realize and a lot higher in quality through preventative and diagnostic expansion.

3) The costs for insurance for specialized medicine should plummet if primary care was provided for with tax dollars. Specialists like you and your wife may end up becoming should still thrive if the single-payer system applied only to primary care as a more pervasive and effective primary care system would make it easier on you as well.

4) In addition, one would think that insurance could get "lean and mean" and your side of things (providing specialized care) would probably grow in efficiency as well because a lot of the hassle and bullshit could get dealt with at the primary level.
I wrote him in response to this article by Ezra Klein about the crisis of primary care in America.

Tuesday, September 16, 2008

Politics stuff

This is your GOP government in action:


Keep an eye on the TED spread to see how bad things will get. It is basically a quick snapshot of the liquidity crisis. It shot up to 2.01 within a few hours yesterday from near 1.0. That's a bad sign.


A few points:
  • The collapse on Wall Street can be laid squarely at the feet of people like Phil Gramm, who inserted deregulation language covertly into finance bills:
    If McCain wants to hold someone accountable for the failure in transparency and accountability that led to the current calamity, he should turn to his good friend and adviser, Phil Gramm.

    As Mother Jones reported in June, eight years ago, Gramm, then a Republican senator chairing the Senate banking committee, slipped a 262-page bill into a gargantuan, must-pass spending measure. Gramm's legislation, written with the help of financial industry lobbyists, essentially removed newfangled financial products called swaps from any regulation. Credit default swaps are basically insurance policies that cover the losses on investments, and they have been at the heart of the subprime meltdown because they have enabled large financial institutions to turn risky loans into risky securities that could be packaged and sold to other institutions.

    Lehman's collapse threatens the financial markets because of swaps.
    Don't forget McCain's role in the Keating 5 scandal was basically to deregulate the market, which ended up costing taxpayers about $165 B total in the S&L scandals. And don't forget how people like McCain cheered as bankers took chainsaws to the regulation laws that King W and congressional Republicans did away with. Their libertarian philosophy tells them, "all regulation bad," but reality tells a different story, doesn't it?

  • The DNC has a great "Count the Lies" site up documenting McCain's mendacity. As others have noted, he's basically trying to reinvent himself, going from "honorable man who happens to be a politician" to "sleazy dishonorable politician who will fulfill W's 3rd term"...

  • Even David Brooks thinks Palin is not the woman for the job:
    Sarah Palin has many virtues. If you wanted someone to destroy a corrupt establishment, she’d be your woman. But the constructive act of governance is another matter. She has not been engaged in national issues, does not have a repertoire of historic patterns and, like President Bush, she seems to compensate for her lack of experience with brashness and excessive decisiveness.

    The idea that “the people” will take on and destroy “the establishment” is a utopian fantasy that corrupted the left before it corrupted the right. Surely the response to the current crisis of authority is not to throw away standards of experience and prudence, but to select leaders who have those qualities but not the smug condescension that has so marked the reaction to the Palin nomination in the first place.
    Preach it brother.

  • Bob Herbert's column on McCain's disastrous health care "plan" is worth reading in its entirety. Here's a snippet:
    Talk about a shock to the system. Has anyone bothered to notice the radical changes that John McCain and Sarah Palin are planning for the nation’s health insurance system?

    These are changes that will set in motion nothing less than the dismantling of the employer-based coverage that protects most American families.

    A study coming out Tuesday from scholars at Columbia, Harvard, Purdue and Michigan projects that 20 million Americans who have employment-based health insurance would lose it under the McCain plan.

    There is nothing secret about Senator McCain’s far-reaching proposals, but they haven’t gotten much attention because the chatter in this campaign has mostly been about nonsense — lipstick, celebrities and “Drill, baby, drill!”

    For starters, the McCain health plan would treat employer-paid health benefits as income that employees would have to pay taxes on.

    “It means your employer is going to have to make an estimate on how much the employer is paying for health insurance on your behalf, and you are going to have to pay taxes on that money,” said Sherry Glied, an economist who chairs the Department of Health Policy and Management at Columbia University’s Mailman School of Public Health.

    Ms. Glied is one of the four scholars who have just completed an independent joint study of the plan. Their findings are being published on the Web site of the policy journal, Health Affairs.

    According to the study: “The McCain plan will force millions of Americans into the weakest segment of the private insurance system — the nongroup market — where cost-sharing is high, covered services are limited and people will lose access to benefits they have now.”

    The net effect of the plan, the study said, “almost certainly will be to increase family costs for medical care.”

    Under the McCain plan (now the McCain-Palin plan) employees who continue to receive employer-paid health benefits would look at their pay stubs each week or each month and find that additional money had been withheld to cover the taxes on the value of their benefits.

    While there might be less money in the paycheck, that would not be anything to worry about, according to Senator McCain. That’s because the government would be offering all taxpayers a refundable tax credit — $2,500 for a single worker and $5,000 per family — to be used “to help pay for your health care.”

    You may think this is a good move or a bad one — but it’s a monumental change in the way health coverage would be provided to scores of millions of Americans. Why not more attention?

    The whole idea of the McCain plan is to get families out of employer-paid health coverage and into the health insurance marketplace, where naked competition is supposed to take care of all ills. (We’re seeing in the Bear Stearns, Fannie Mae, Freddie Mac, Lehman Brothers and Merrill Lynch fiascos just how well the unfettered marketplace has been working.)

    Taxing employer-paid health benefits is the first step in this transition, the equivalent of injecting poison into the system. It’s the beginning of the end.

    When younger, healthier workers start seeing additional taxes taken out of their paychecks, some (perhaps many) will opt out of the employer-based plans — either to buy cheaper insurance on their own or to go without coverage.

    That will leave employers with a pool of older, less healthy workers to cover. That coverage will necessarily be more expensive, which will encourage more and more employers to give up on the idea of providing coverage at all.

    The upshot is that many more Americans — millions more — will find themselves on their own in the bewildering and often treacherous health insurance marketplace. As Senator McCain has said: “I believe the key to real reform is to restore control over our health care system to the patients themselves.”

    Yet another radical element of McCain’s plan is his proposal to undermine state health insurance regulations by allowing consumers to buy insurance from sellers anywhere in the country. So a requirement in one state that insurers cover, for example, vaccinations, or annual physicals, or breast examinations, would essentially be meaningless...
    How's this even a close race? Do people care about the issues? Sadly, I'm starting to conclude, "No."