Ezra Klein addresses the rightie myth that American liberals consider Canada’s single-payer health care system to the best in the world. I’ve observed this same phenomenon, which is more evidence that righties have no idea what we lefties really think.
Category Archives: Health Care
Ralph Nader — Right or Wrong?
I just want to be sure I get these links on the blog somewhere so I can find ’em when I need ’em — see “Thanks, Ralph!” by Avedon and these posts by Teresa Nielsen Hayden — “An Odd Thought Concerning Ralph Nader” and “Fckng Ralph Nader, fckng Public Citizen.”
Please read these, especially if you are still a Ralph Nader admirer.
Je m’amuse.
David Brown writes at the Washington Post that the nation’s hospital emergency rooms are hurting.
Emergency medical care in the United States is on the verge of collapse, with the nation’s declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.
That’s the grim conclusion of three reports released yesterday by the Institute of Medicine, the product of an extensive two-year look at emergency care.
Long waits for treatment are epidemic, the reports said, with ambulances sometimes idling for hours to unload patients. Once in the ER, patients sometimes wait up to two days to be admitted to a hospital bed
The causes of the crisis are not hard to understand. A law passed in 1986 provides that ERs must at least evaluate and stabilize everyone who seeks help from the ER. However, since 1993 the population has grown, and the percentage of Americans seeking health care from ERs has grown even more, but the capacity of emergency rooms has declined. “In that same period,” writes Brown, “425 emergency departments closed, along with about 700 hospitals and nearly 200,000 beds.”
Brown doesn’t say this, but the number of uninsured Americans using emergency rooms for “non-urgent care” is going up, up, up. The rising number of uninsured Americans results in a rising number of patients with nowhere else to go for medical care. This adds to the stress of emergency room care considerably. And because emergency rooms are supposed to maintain expensive technological gizmos (and staff trained to use the gizmos) to treat catastrophic injuries, heart attacks, strokes, etc., ERs are expensive. Sending the poor to ERs for basic health care is probably the least cost-effective way to provide basic health care, which is a big part of why the United States pays more per capita on health care than any other nation on the planet.
As expensive as emergency room treatment is, patients are dying because they have to wait too long to receive treatment. Brown writes:
The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.
This is terrible. Yet, I am amused. Why? Because once again, righties conform to my expectations. Last February I wrote in a post called “Obliviousness” —
Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?†Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad†example of a system with problems.)
Today James Joyner comments on the David Brown article, and what does he do but argue that Canada and Britain have problems, too.
As I wrote in “Obliviousness” and other posts on health care, both Canada and the UK face problems with their single-payer systems. In a nutshell, the British system is scraping by on the cheap (see Figure One; the Brits are spending less than one-third per capita on health care than we are). Canada may have to revise its system to permit citizens to purchase private health insurance if they can afford it.
But as I’ve also written elsewhere, study after study of the world’s health care systems point to France as a nation that seems to be getting it right. Ezra Klein wrote about this last year. Very briefly, France provides health insurance that covers everyone in the nation. But unlike most Canadians, the French may purchase private supplemental insurance, and Ezra says that about 85 percent of the French have done so. Whether they have supplemental insurance or not, French citizens can still choose their own doctors, doctors are not government employees but can establish their practices wherever they choose, and patient-client confidentiality is respected. Further, France has more doctors and more hospital beds per capita than the U.S. does. And France spends about half per capita on health care than we do (see Figure One). You can read more about the French health care system here.
So I’m pleased Mr. Joyner writes that France and also Belgium “do ER care better in the aggregate.” According to WHO,
Belgium has a compulsory health care system based on the social health insurance model. Health care is publicly funded and mainly privately provided. The National Institute for Sickness and Disability Insurance oversees the general organization of the health care system, transferring funds to the not-for-profit and privately managed sickness funds. Patients have free choice of provider, hospital and sickness fund.
A comprehensive benefit package is available to 99% of the population through compulsory health insurance. Reimbursement by individual sickness funds depends on the nature of the service, the legal status of the provider and the status of the insured person. A distinction is made between those receiving standard reimbursement and those benefiting from increased reimbursement (vulnerable social groups).
Substitutive health insurance covers 80% of self-employed people for minor risks. Sickness funds offer the insured people complementary health insurance. Private for-profit insurance remains very small in terms of market volume but has also risen steadily as compulsory insurance coverage has declined.
The federal government regulates and supervises all sectors of the social security system, including health insurance. However, responsibility for almost all preventive care and health promotion has been transferred to the communities and regions.
The United States is the only industrialized nation on the planet that does not have some kind of universal health care provision for its citizens. The thirty-something (or more) nations with universal health care have come up with many different ways of delivering that care, and some nations are doing a better job than others. Single-payer is one way, but not the only way. It appears that the most successful health care systems allow for private insurance to supplement the public system. This can create inequities — people with supplemental insurance may have a wider range of treatment options than those without, for example — but these inequities are minor compared to the inequities that exist in the United States.
America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).
To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.
I think a mixed public/private system like France’s would be a lot easier to sell to the American public than a pure single-payer system like Canada’s, or a National Health Service as in Britain. This is true even though economists seem to like the British system for its cost-control measures. I think it’s counterproductive to get hung up on creating a purely egalitarian system. In the real world, people with money will always find a way to get better stuff than people without. The important thing is to be sure everyone has access to decent health care, regardless of income.
One other thing — Mr. Joyner writes,
The fact that someone else pays most of our medical costs takes away any incentive to cut costs, especially when combined with a tort system that further distorts the economics.
Frankly, I don’t buy the idea that giving people insurance takes away incentive to cut costs. Very few people seek health care treatment for the fun of it, and few of us demand tests and treatments that our doctors didn’t suggest first. And who does cost comparisons for, say, open heart surgery? Who gets on the phone to various hospitals and doctors to get quotes for an appendectomy? The insurance companies themselves act as arbiters of cost, often refusing to pay for treatments they deem inappropriate (even if nine out of ten doctors disagree) or putting a cap on what they will pay for some procedures. This results in a system in which clerks, not doctors, decide course of treatment.
As for tort reform — the Right’s panacea for all health care system problems — in spite of the mighty efforts of conservative think tanks to crank out studies “proving” that rising health care costs are mostly the fault of greedy ambulance-chasing lawyers, the actual impact of litigation on overall health care costs is minor. According to a study published in the May 11, 2006, issue of the New England Journal of Medicine — “Claims, Errors, and Compensation Payments in Medical Malpractice Litigation” (not available online to non-subscribers) — only 3 percent of malpractice claims were found to be completely frivolous — involving no verifiable medical injuries. Claims that turned out not to involve errors accounted for 13 to 16 percent of the malpractice system’s total monetary costs, and plaintants rarely receive compensation in these cases. Rightie claims that the courts are flooded with frivolous claims are way overblown.
The primary myth in the medical malpractice debate that needs to be exposed is the myth regarding the effect of those costs on the health care system. Tort reform proponents have bamboozled the public and many legislators into believing that the cost of medical malpractice lawsuits is a significant factor in driving up the cost of health care. In 2003, the U.S. spent $215 million on liability insurance premiums, and doctors, hospitals and other health professionals paid only $11 billion in medical malpractice insurance premiums. That same year, the U.S. spent more than $1.5 trillion on health care. Something that costs less than 1 percent of total health care costs simply doesn’t have any meaningful effect on access to health care. If we want to address the real problems with the cost of health care, we should start with the evidence, not the myth.
“Tort reform” or health savings accounts or other little tweaks are not going to put a dent in our health care problems. What we need is a total overhaul of the system. But until we can get past the righties screaming about “socialized medicine” or fixating on Canada’s or Britain’s systems as the only models for universal health care on the planet, not much will be done.
The Left Is Right on Health Care
Awhile back I wrote about rightie obliviousness on the national health care issue —
… the Canadian Model is a bugaboo of the Right. Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?†Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad†example of a system with problems.)
Here’s a juicy example, although to be fair the rightie discusses the British system first and then switches to Canada. And then he throws in Cuba and comments,
The three socialized systems cited above are the cream of the crop when it comes to government controlled medical care. Clearly, your best bet is not to get sick.
Actually, they are not the “cream of the crop.” The British system has big problems, in large part because Tony Blair’s government is trying to get by on the cheap (see this PDF document, Figure One). The Canadian system also has some problems, which I discussed in the earlier post linked above. But there are several dozen countries with national health care; it isn’t just Britain, Canada, and Cuba. In fact, the only industrialized democracy in the world without national health care is the United States. In fact, just about every place on the planet where the average person owns a microwave has national health care, except the United States.
To righties, all of these systems are just one system, called “socialized medicine,” and they’re all bad, and they’re all just like Hillarycare. But in fact there are huge, whopping, substantial differences among the several systems.
There are some systems, like Britain’s, in which the government employs doctors and runs hospitals and acts as a “gatekeeper.” To use the National Health Service you go to NHS doctors, and since the Brits have very tight cost control some feel the “gate” can be a tad too narrow, as it were. Other nations have a mix of public and private systems. In France, for example, most of the doctors and hospitals are private sector. The government pays for health insurance that a citizen can take to the doctor of his choice to get basic care, and if he wants he can purchase private supplemental insurance to pay for first class treatment.
Righties seem to think that “national health care” means the British system, where you have to literally go to the government for treatment when you get sick. I personally would prefer something like the French system, in which the government doesn’t get involved in health care except to pay bills.
Last year Bradford Plumer wrote,
… the health care debate in America is never going to get very far so long as the conventional wisdom is that health care alternatives in other countries suck. Good point! But it’s also worth asking why this is the conventional wisdom. To some extent, it’s because conservatives, spearheaded by the insurance industry, have bamboozled us into thinking it’s so. … [But] Media coverage of national health care systems in other countries is dismal. … And, as a result, few Americans have even the vaguest idea of what French health care, or Canadian health care, or Swedish health care, is really like.
Recently at TPM Cafe, Matt Yglesias wrote that one reason we get nowhere in our health care debates is that the options presented to us are too limited and narrow.
Arguments against single-payer health care here seem to be two-fold. One, the idea is old and the debate about it therefore “stultified.” Two, the idea represents one pole of the debate and the name of the game is to find third way ideas. The first objection is obviously silly — that an idea is old has no bearing on its merits. The second objection, meanwhile, is easily met. Simply define the “left” pole in the debate as not something like the French or Canadian system, but something like the even more statist system they have in the United Kingdom. The “right” pole continues to be “veneration of free markets.” Ergo, the “center” position is now one in which the public sector provides health insurance but the private sector provides health care and we reject the “false choices” of those who insist we must choose between the NHS and and pure laissez faire.
Alternatively, you can define as your left pole a system like Canada’s where the government provides everyone with insurance and bans private health insurance, leaving the centrist alternative a system like France’s where the government provides everyone with insurance and then lets you buy additional insurance on top of the baseline from the private sector. Everyone can play this game.
France seems to fall between the poles either way.
“Hillarycare,” btw, was based on the German system according to Ezra Klein. It sounds way complicated.
Until we get a progressive majority in Washington ’twill all be but a dream. But in the meantime, just remember that it’s possible for a rightie to see the light and realize the U.S. system isn’t that great, after all. All it takes is for the rightie to lose his health insurance.
Single-Payer Health Care
Obliviousness
This is a follow up to “Touching Innocence,” below. A blogger named Russell Roberts writes,
Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.
The New York Times reports that the Canadian system is imploding. …
You already know where this is going … the Times report discusses problems with the Canadian system, and says some private health care is rushing in to pick up the slack. Whereupon blogger Russell gloats a bit about how superior the U.S. health care system is, and how fortunate Canadians will be when their public system breaks down entirely and they can have a health care system just like ours.
Russell goes off track with the first sentence — “Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.” Although I’ve met such people, in fact the Canadian Model is a bugaboo of the Right. Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?” Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad” example of a system with problems.)
And, I’m sorry to say, I also run into uninformed lefties who seem to think our only choices are a Canadian-style single-payer or the overblown mess that is the U.S. “system.”
As I wrote earlier today, just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system, with the exception of the United States. And every nation has worked out its own system; it is not true, as the uninformed would have it, that there is only the Canadian Model or ours. People who have looked at the myriad systems on the planet say that Canada’s is not necessarily the model we should be emulating. Other countries (notably France, whose system is ranked #1 in overall performance by the World Health Organization) have mixed public and private systems, with public “universal coverage” supplemented by private insurers and hospitals for those who want to pay for them. This may be where Canada is heading now.
Ezra Klein wrote a series of posts on the health care systems of various other countries. France’s system, he says, is not only more cost-effective than ours, it also provides better care for most people.
France’s health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.
So France spends less, gets more, and does so through a public-private hybrid that’s heavily, heavily public.
Also,
The hospitals offer about 8.4 beds per 1,000 people (America, btw, offers 3.6. Ouch.) The public sector provides 65% of the beds, private hospitals — which operate on a fee-for-service basis — make up the rest, and primarily concentrate on surgeries. French citizens choose which one to go to and get the same reimbursement at either. How’s that for choice? Not good enough? The French also get to choose their physicians, their physicians get to choose where they practice, and there’s patient-client confidentiality.
Everyone I’ve ever met who’s lived in France even a short time sings the praises of the French health-care system. This is not to say that Americans with lots of money or top-notch insurance don’t get as good, or better, care. But, I’m told, if you don’t have lots of money or insurance, try to arrange to have your health problems in France.
The Canadian health care system is slowly breaking down, The New York Times says. The U.S. system, by contrast, is not slowly breaking down. Parts of it are already broken, and what’s left of it is hurtling toward disaster at breakneck speed.
Once again, Jane Bryant Quinn:
America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).
To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.
Here Sebastian Mallaby explains why Bush’s health savings accounts will make our system even worse. In another column, Mallaby concludes,
Beyond the imperative of restraining prices, the biggest challenges in health care are to get insurance to everyone and to create incentives for preventive treatment — even though prevention may pay off 30 years later, by which time the patient will have gone through multiple switches in health plans. The most plausible subsidizer of universal insurance is government, and the only entity with a stake in lifelong wellness is the government. Is the administration ready to see that?
See also “Single-Payer Health Would Increase US Competitiveness” by Hale Stewart at BOP News.
This is a huge topic, and this evening I don’t have the time to go into the detail the topic requires. But whenever I see a rightie snicker about the problems of other health care systems, I wonder what it’s going to take to get them to see that our system is a disaster in progress. Corpses in the streets? Oh, wait, we’ve been there already. I’m afraid it’s what Quinn says — the shock of being dumped out of the “winners” rank. Until then, it’ll take major surgery to get their heads out of their butts.
Touching Innocence
This is a sorta kinda followup to the last post, which discussed matters of life and death, space and time, religion, law, morality, and what it is to be human. Which was a tad ambitious now that I think about it. But I request that people not add comments disagreeing with this post until you’ve read that one. This will save us both a lot of time.
Anyway, I see that some righties are upset about a British court ruling that will allow physicians to impose a “do not resuscitate” order for Baby Charlotte, a desperately ill two-year-old, against the wishes of her parents.
The rightie blogger of Stop the ACLU asks,
Is this the direction America is headed? Is this where the ACLU, and the “right to die†folks will take us?
Kim Priestap of Wizbang blames socialized medicine:
Baby Charlotte’s health is fragile normally, so she will go through health scares like this again. This will cost Britain a lot of money. Since Britain has a nationalized healthcare system, funded by taxpayer money, it’s in the state’s best interest to let her die.
What’s going on here? As a mother myself I’m very uncomfortable when government interferes with family decisions like this. I tend to think that when the family is agreed the patient should be resuscitated, the doctors should respect the decision and not involve courts. I don’t know enough about Baby Charlotte to be able to judge whether there is a compelling reason to make an exception in her case. I infer from news stories that the doctors consider her case to be hopeless and that keeping her alive is just making her suffer. And her parents see things very differently.
I argued in the last post that humans need to struggle with hard choices. When governments or other institutions swoop into our lives and make our choices for us, it makes us less human. And this is true even when we make “bad” choices (within the law, of course). Our decisions may be less important than the process we go through to make them. So in that respect I’m sympathetic to the rightie point of view.
However … the title of this post doesn’t refer to Baby Charlotte. It refers to the righties who are oh, so innocent of the facts of life and death these days.
Nearly a year ago us “culture of death” liberals took up the cause of Sun Hudson, a Texas baby whose life support was terminated against family wishes. Although their diagnoses may differ, the legal situations of Baby Sun and Baby Charlotte seem to me to be nearly identical. If anything, Sun’s case was more extreme than Charlotte’s. His mother (father unknown) wanted aggressive medical care to continue, but the law sided with physicians who decided enough had been enough. Baby Sun’s breathing tube was removed on March 15, 2005, and he died of asphyxiation within minutes.
My understanding is that Sun Hudson’s prognosis really was hopeless. But then, so was Terri Schiavo’s.
Sun Hudson died three days before Terri Schiavo’s feeding tube was removed for the last time. Some of you might recall that righties got a tad excited about the Schiavo case. However, they were mostly silent about Sun Hudson — slipped their attention, I guess. Were it not for liberal blogs I wouldn’t have heard about Sun Hudson either.
Why were righties so oblivious to the Sun Hudson case? One explanation is that the law that allowed his life to be terminated had been signed by then-Governor George W. Bush.
The federal law that President Bush signed early yesterday in an effort to prolong Terri Schiavo’s life appears to contradict a right-to-die law that he signed as Texas governor, prompting cries of hypocrisy from congressional Democrats and some bioethicists.
In 1999, then-Gov. Bush signed the Advance Directives Act, which lets a patient’s surrogate make life-ending decisions on his or her behalf. The measure also allows Texas hospitals to disconnect patients from life-sustaining systems if a physician, in consultation with a hospital bioethics committee, concludes that the patient’s condition is hopeless.
Bioethicists familiar with the Texas law said yesterday that if the Schiavo case had occurred in Texas, her husband would be the legal decision-maker and, because he and her doctors agreed that she had no hope of recovery, her feeding tube would be disconnected. [Knight Ridder]
The Sun Hudson story came out just as the VRWC media echo chamber was working overtime to promote George W. Bush as a champion of life. Faux News’s Bill O’Reilly first commented on the Sun Hudson story before he discovered the Bush angle, forcing him to flip-flop harder than a trout on a hot pier. While Terri Schiavo’s parents were depicted as noble and pure of heart, Sun Hudson’s mother became a deranged black woman who couldn’t face reality. Never fear; O’Reilly had flip-flopped back by April when he attacked the ACLU for (perhaps) being behind “infanticide for impaired babies.”
Let’s go back to the Texas Advance Directives Act of 1999, which is the law under which Sun Hudson’s life was terminated. Put very simply, the law allows a health care facility to discontinue life support against the wishes of the patient’s family. The law requires the facility to jump through a number of hoops before it can do this, which ensures there is an overwhelming medical consensus that the patient’s condition is hopeless before the plug is pulled. The family has the option of finding another medical facility willing to continue life support. But other medical facilities are unlikely to take such a patient, especially if the patient will be a drain on the budget.
In other words, if the family is wealthy enough to pay the costs of Grandma’s care and make a generous contribution to the hospital building fund, Grandma lives. If the family’s insurance is capped and they’ve already spent the second mortgage to pay her medical bills, she dies. To paraphrase (well, OK, mock) Kim Priestap of Wizbang (see above), Grandma’s care will cost hospitals a lot of money, so it’s in their best interest to let her die.
There are two issues to be addressed here, both involving rightie inability to face reality. The first is regarding health care and how it is paid for. Just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system. The exception is the United States. In a recent Newsweek column, Jane Bryant Quinn (hardly a socialist) said that America’s health-care system is turning into a lottery.
The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).
To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.
Years ago there was a joke in circulation that said a conservative is a liberal who got mugged. The new joke is that a liberal is a conservative who’s lost his health insurance.
The point is that all the evil, inhumane things going on in Other Countries That Have Socialized Medicine are happening here, too. Righties just refuse to acknowledge them. Among those Other Countries, Britain is a good “bad example” because they’ve underfunded their system for years. Meanwhile, we in the U.S. spend far more per capita than other nations (see this report in PDF format; note especially Figure 1 on page 3) but we’re getting worse results (see Table 1, page 4). By some measures we’re getting even worse results than those cheapskate Brits.
And the moral is, people whose health care system is a broken down mess shouldn’t be pointing fingers at other peoples’ health care systems.
The other issue I see here is the touching innocence of righties regarding hopelessly terminal patients. Physicians have made decisions not to aggressively treat hopeless patients, especially suffering hopeless patients, since Hippocrates. Generally they’ve done it quietly and without drawing attention to themselves, but they’ve done it. For example, since the 19th century physicians have prescribed larger and larger doses of opiates to ease the pain of dying patients, knowing that eventually the dosage will be fatal. And as far as the family ever knew, it was the cancer that killed Grandpa, not that last dose of morphine.
Just about any health care professional will confirm this. I’m sure such decisions are being made all over America even as you read this.
The reason we’re hearing about such cases these days is, IMO, multifold. First, in the past medicine wasn’t all that effective. It was easy for doctors to make a show of “doing all we can” because in truth there wasn’t a whole hell of a lot they could do. But now we can do so much more. We have medical technology that will retain life in a body even when the person that body once sustained has long since dissipated, as in Terri Schiavo’s case. The line between life and death itself has blurred.
Second, because of the technology, more and more families refuse to accept a hopeless prognosis. I understand even anencephalic babies are sometimes put on life support these days, even though those babies have no hope of survival. In earlier times, the only choice offered parents would have been whether they wanted to hold the baby while it died, or not.
And third, mass media and our “reality TV” culture make sure the more controversial decisions get global publicity. In earlier times, these matters wouldn’t have been been discussed outside the family. Today, people with less than a half-assed idea of the facts can plaster their uninformed opinions all over the Web.
As individuals, as a nation, as a society, as a species, we’ve got hard choices to make. These choices involve ourselves and our loved ones. We need to make some mature, non-politicized judgments about how to pay for health care. We must think rationally about how much of our health-care resources should be spent on futile care. We need non-hysterical discussion about if, or when, governments should intervene in family decisions. These are all complex issues. Reasonable people will disagree on many points. But we’re going to get nowhere until we’re able to face some hard realities.
Which means we’re going to get nowhere as long as righties dominate the discussion.
Staggering Incompetence II
See Kevin Drum.
Left Behind
“In 2004, which was touted both by the Bush administration and by Wall Street as a year in which the economy boomed, the median real income of full-time, year-round male workers fell more than 2 percent.” — Paul Krugman, today’s column
Today Krugman’s column focuses on Delphi, once the parts division of General Motors and now an independent company. Delphi has filed for bankruptcy. It is asking workers to take drastic wage cuts and may default on pension obligations. “The rest of the auto industry may well be tempted–or forced–to do the same,” Krugman writes. “And that will mark the end of the era in which ordinary working Americans could be part of the middle class.”
In the case of Delphi,
Why were large severance packages given to Delphi executives even as the company demanded wage cuts? Why, when General Motors was profitable, did it pay big dividends but fail to put in enough money to secure its workers’ pensions?
An editorial in today’s Washington Post looks at pension reform.
The story begins with the hole in the nation’s defined-benefit pension plans, the type that — unlike 401(k) plans — promise a fixed proportion of salary upon retirement. The rules governing these plans are dysfunctional: They allow companies to promise workers lavish benefits while setting aside too little money to pay those benefits when the time comes. Rather than keep workers happy with wage increases, which would have to be paid for with real money, financially pressed firms often bribe them with false promises of big pensions. When these firms go bust, employees get smaller pensions than cynical managers had promised them. And taxpayers, who guarantee pensions up to some $45,000 per retiree, have to rescue the bankrupt pension plans.
For years companies have been padding the balance sheets by shorting employees. Years ago I worked for a division of Simon & Schuster, then part of Paramount Communications. Corporate communications routinely sent letters to employees explaining that profits were stagnant so wages had to be frozen, and by the way we’re upping your health insurance deduction. Then the next day those of us who were also stockholders were told that profits were up and Paramount’s future never looked brighter. The employees, needless to say, developed some attitude.
And government, of course, is lookin’ out for the robber barons instead of us.
In regard to pension reform–giving credit where credit is due, the Bush Administration in January proposed legislation that would require companies to fund pensions properly and to pay the government a fair insurance premium for guaranteeing benefits. But after Congress got done with this proposal it was unrecognizable. The House pension committee watered it down a bit, then the Senate Finance Committee watered it down more, and the Senate pensions committee produced something even more watery.
Then they hit a speed bump. In the Senate, which had already thrashed out two bills, passed them through two committees on a bipartisan basis and produced a “final” compromise, Sens. Mike DeWine (R-Ohio) and Barbara A. Mikulski (D-Md.) upset plans for a floor vote by demanding still more dilutions. These lacked majority backing, so the senators exploited the Senate’s absurd rules to block the legislation indefinitely until their business allies got what they wanted.
All of this diluting was done to please lobbyists, of course.
You get a taste of the relationship between senators and lobbyists from an e-mail sent out by the American Benefits Council on Oct. 7. “With the active support of the Council, Senator Mike DeWine (R-OH), along with Senator Barbara Mikulski (D-MD), continues to press for an amendment,” the group reported to its members. “DeWine called the Council to personally thank us for our steadfast support,” it continued. That same day another business lobby, the ERISA Industry Committee, informed its shock troops: “Sen. DeWine has directly asked for our help in getting cosponsors” for his diluting amendment. Mr. DeWine and other senators will no doubt be rewarded for their efforts. On Thursday the American Benefits Council will host a thank-you lunch for Sen. Mike Enzi (R-Wyo.), the chairman of the Senate pensions committee. The invitation includes a line that reads: “Requested contribution: $1,000 PAC/$500 personal.”
So the enemies of reform bogged down the legislation. Sen. Charles E. Grassley (R-Iowa), one of the authors of the Senate reform bill, complained that the DeWine-Mikulski maneuvers would worsen underfunding and “put more workers’ pensions at risk.” But then something else happened. On Tuesday the Congressional Budget Office published an analysis showing that it wasn’t just the rogue amendment that would do that; both the Senate and House bills were so diluted that they would make the pension crisis worse, just as happened with the legislation that Congress passed last year. The same day Rep. George Miller (D-Calif.), the ranking Democrat on the House pensions committee, leaked an analysis by the Bush administration, which reached the same conclusion. So it turns out that legislation that had once been close to passage does the opposite of what’s intended. Nobody in Congress was told this until it was almost too late.
Although the White House had, for once, done the right thing in proposing the initial legislation, WaPo was critical of its role in the fiasco.
This, unfortunately, says a lot about the Bush administration: about its incompetence in handling economic issues and its cowardice in dealing with Congress. At some point in the past fortnight or so, the administration must belatedly have done enough analysis to understand that the Senate and House bills were going in the wrong direction, but it didn’t breathe a word. The idea of publishing numbers that would have forced it to veto a bill written by Republican committee chairmen appears to have been too much for the Bush team. Remember, Mr. Bush is the first president since John Quincy Adams to have completed a full term in the White House without vetoing a single bill.
Dubya may seen tough on the outside, but he has a soft, chewy center.
So, no pension reform. And wages are being squeezed as well. Back to Krugman–
Now the last vestiges of the era of plentiful good jobs are rapidly disappearing. Almost everywhere you look, corporations are squeezing wages and benefits, saying that they have no choice in the face of global competition. And with the Delphi bankruptcy, the big squeeze has reached the auto industry itself. …
… America’s working middle class has been eroding for a generation, and it may be about to wash away completely. Something must be done.
Last week I wrote about grand themes the Democrats ought to be addressing. A couple of them apply here– Make Work Pay and Protect Retirement Security. And as Krugman points out, national health care would relieve corporations of the burden of providing medical benefits, which would go a long way toward keeping them profitable.
Democrats (excepting Senator Mikulski) should be all over these issues, not only advocating a square deal for workers but also educating voters of the link between our overexpensive mess of a health care “system” and the cost of doing business in the U.S. They should be driving these themes home now in preparation for next year’s election campaigns. So far, I’m not hearing much.
Screwed
Our government in inaction–hurricane survivors who had jobs with benefits before Katrina, but who lost their jobs and benefits because of Katrina, now find they don’t qualify for assistance with health insurance.
Ricardo Alonso-Zaldivar writes in today’s Los Angeles Times,
Like most of those whose lives were upended by Hurricane Katrina, 52-year-old school bus driver Emanuel Wilson can thank the federal government for the fact that he has money to pay rent. He’s also been given food stamps to make sure he can buy groceries. And if he had young children, the government would almost certainly be helping them get back to school.
But what Wilson needs is chemotherapy, and that is something the government seems unable to help him with. Wilson was being treated with monthly chemo injections for his intestinal cancer before the hurricane.
He has been denied assistance largely because, before the storm, he had what the government says it wants every American to have: health insurance….
… Wilson can’t reinstate his health insurance — which expires at the end of this month — because the storm wiped out his job. The government says he doesn’t fall into any of the rigid eligibility categories for federally sponsored Medicaid.
More than half of the Louisiana households displaced by Katrina who applied for Medicaid were denied. There is a bipartisan bill in the Senate that would open Medicaid for Katrina survivors for up to ten months, but the Bush White House opposes it. Why? It would create a “major new entitlement.”
I guess it’s more important to give tax cuts to billionaires than to give chemotherapy to a hurricane survivor.
Newt Gingrich thinks that instead of Medicaid, the Katrina survivors should be given vouchers to buy private health insurance. I suppose that would be all right as long as the insurers will accept new customers with pre-existing conditions, although I suspect the Medicaid route would actually be more cost-effective for the government.
But seems to me something needs to be done right now. I’m sure a lot of these people have medical problems that need treatment sometime this decade.
Speaking of health care–via Kevin Drum, be sure to read this column in the Dallas Morning News (registration firewall alert) about a urologist promoting a national health-care plan.