Health Care Reform and You

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The New York Times is running on its editorial page a rundown of the health care reform packaged called “Health Care Reform and You,” which explains very clearly exactly who wins and who loses if the bill in something like its present form becomes law.

Executive Summary

Who loses: The health insurance industry.
Who wins: Everybody else.

I really wish progressives who oppose the present bill because it’s not single payer would read this. People need health care reform to pass asap, and this bill really would make a huge difference to millions of Americans, including people who are already insured.

See also Paul Krugman, “Why Markets Can’t Cure Healthcare“; and Ceci Connolly, “Focus on Health Savings Obscures Other Issues.”

The Latest

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As near as I can tell, the Blue Dogs on the Energy and Commerce Committee are still being allowed to hold up health care legislation. Does anyone have a list of the E&C Committee Blue Dogs? I know that Mike Ross (Arkansas) is their “leader,” but I haven’t seen a list of all seven.

Meanwhile, I think Howard Fineman is wrong about the GOP not having a health care plan.

They have a plan; they just don’t want the public to know what it is. If you check in with all the major right-wing think tanks, they’re all pushing variations of this same plan:

  1. Scale back subsidies to, or else outright eliminate, government health care programs such as SCHIP and Medicare.
  2. Phase out employee benefit healthcare by eliminating tax breaks for employers who offer benefits and taxing the benefits as income.
  3. Encourage states to deregulate so that insurance companies are free to risk-rate at will, cranking up peoples’ insurance premiums as they get older and/or sicker.
  4. Write federal legislation that would allow people to purchase policies in another state. This would allow the insurance companies to set up shop in low-regulation states and market junk policies to the young and healthy with no pre-existing conditions. Everyone else would be left behind in higher-risk pools, meaning most people would be paying higher premiums.
  5. The “solution” for people who can’t afford insurance is to pay for medical expenses out of a Health Savings Account. Yes, people who can’t afford the premiums certainly must have plenty of disposable income to put aside into a savings account.
  6. The other “solution” for being priced out of insurance as you get older is Cato’s brilliant “insurance insurance” plan.

John McCain openly pushed for most of these ideas during last year’s presidential campaign, but since then the GOP mostly has kept its lipped zipped on most of these details except for the “purchasing insurance across state lines” idea.

If I were a reporter I’d be running all over Washington with some of the think tank studies and pinning down GOP legislators on whether they endorse or reject these “ideas.”

Surgical Bypass

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Rep. Henry Waxman is telling the Blue Dogs that if they don’t stop holding back the health care bill he’s going to let the bill bypass his Energy and Commerce Committee and let it go right to the floor.

By all means.

Ian Swanson and Mike Soraghan write for The Hill:

Waxman is now playing a game of legislative chicken with the Blue Dogs. He’s hoping the inclusion of a study on Medicare reimbursement rates in the healthcare overhaul will be enough to placate the centrist Democrats, who say the government program short-changes hospitals and physicians in their rural districts.

If that’s not, the seven Blue Dogs could join with the committee’s Republicans to “eviscerate” healthcare reform, and that’s something Waxman will not tolerate.

“I won’t allow them to hand over control of our committee to Republicans,” Waxman told reporters.

Matt Yglesias:

Something a lot of progressive legislative leaders seem to have forgotten until this Congress actually got under way is that historically congressional procedure is a challenge to be surmounted when you want big change to happen. It’s not actually a fixed feature of the landscape that people “have to” accommodate themselves to. For years you couldn’t get a decent Civil Rights bill because segregationists controlled the Judiciary Committee that had jurisdiction. This problem was “solved” by just deciding to bypass the Judiciary Committee. When you decide you want to get things done, you find a way to get them done.

Do it, Henry.

Update: Related — H/t to Mahareader David Rickard — conservative columnist Thomas Sowell explains at National Review Online why the system of paying for health care through private health insurance has to end:

Insurance companies are another distraction and a scapegoat, because they do not insure “preexisting conditions.” Stop and think about it: If you could wait until you got sick to take out health insurance, why would you buy that insurance while you are well?

You could avoid paying all those premiums and then — after you got sick — take out health insurance and let the premiums paid by other people pay for your medical treatment. …

…When Obama makes the insurance companies the villains for not insuring preexisting conditions, that gives him another distraction and enables him to be another escape artist, like Houdini.

The fact that Sowell doesn’t see his own argument as an admission that private health insurance simply can’t do the job says something, too.

Sowell’s basic argument is that we’d better keep our health care decisions in the hands of the for-profit insurance industry, because we can’t trust the government.

Katrina in Slow Motion

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Steven Pearlstein, business columnist for the New York Times Washington Post, writes,

Among the range of options for health-care reform, there’s one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That’s the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

So the next time you hear someone throwing a hissy fit because health reform might raise taxes on some people, or steer people into managed care, or require small businesses to contribute $2 a day for each employee’s coverage, just remember to ask yourself: And that’s compared with what?

I’ve seen projected costs for the status quo that are much higher than the projected costs of what the Right derides as “Obamacare,” yet somehow the people one sees on cable news are not worked up into a lather about the status quo costs. Just the costs of reform.

Meanwhile, one in six adult Americans have no health insurance. That doesn’t tell us how many millions more have insurance policies that will fail them if they get sick. I read about the Blue Dogs in Congress and Democratic obstructionists like Max Baucus, dithering around and picking the President’s plan to death because they are afraid of political fallout, and I want to break heads.

It’s like New Orleans after Katrina, when people were waiting on roofs to be rescued and the Bush Administration was preoccupied with how the hurricane might be used for political advantage. The lives of millions of Americans are forfeit to the whims of the insurance industry, and Baucus worries about “bipartisanship.” There are parents who daily watch their children struggle with health impairment without proper treatment, and the Blue Dogs dither. People are stuck in dead-end jobs and even marriages because they’re afraid of losing health benefits. And the Republicans scream that a national health care plan would deprive people of “liberty.”

It’s Katrina in slow motion, and we’re all New Orleans.

Let’s Talk About Rationing

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I published the last post at Open Salon also, where a jerk irresponsible person named neilpaul commented,

I think the NYT article on Sunday [the Peter Singer piece I wrote about here] about rationing has to be mentioned here. Jindal is relying on irrational fear of rationing among his followers to blind them to the bullshit aspects of his arguments. When people are terrified, they will believe any damned argument.

When I say fear of rationing is irrational, it is not because there won’t be any in the future. There will be. The fear is irrational because it will happen under any system and because rationing isn’t all that bad. It will actually make the system work better. As for the rationed, it will mostly be the elderly and they already had a good shot at life and have less to complain about than those who died young.

So this genius, have correctly understood that fears of rationing are irrational, goes and ahead and suggests that the right way to go about it is to withhold care from older folks. Yes, that will calm everyone down.

However, since I could not persuade him to STFU about killing off the old folks, let’s talk about rationing.

First, as Singer wrote, we in the U.S. have rationing now. Health care is rationed by ability to pay. As Singer said, we have more rationing here than in nations with government health care plans. There is utterly no reason to think that the plan Obama wants to put forward to make rationing worse, and lots of reasons to think there will be less rationing than there is already.

As I wrote recently in “Ir-rationing Health Care,” the Medical-Industrial Complex is pouring obscene amounts of money into medical treatments that doctors themselves do not believe will provide better outcomes than older, cheaper treatments. The for-profit health industry chases profits, not cures, which may be the biggest reason as a nation we get the worst outcomes for money spent on the planet.

I read in the Los Angeles Times this morning that our wonderful pharmaceutical industry has a new prescription drug out that grows longer, darker eyelashes. Also in the same article is the little tidbit of information that pharma spends more than $11 million a day advertising prescription drugs directly to potential patients, a practice that is absolutely unnecessary to the nation’s health.

The Obama Administration has declared it intends to leave choice of treatments in the hands of physicians, using Comparative Effectiveness Research not to ration, but to see to it that doctors get information on the effectiveness of treatments not from sales reps but from objective sources.

We also need to find ways to discourage doctors from over-prescribing and over-treating patients just to make money.

There are all manner of ways that the health care belt can be tightened. However, one thing is not being considered by anybody (well, except the insurance industry) is making choices about where to put our health care dollars based on the relative “value” of the patient. No industrialized democracy with national health care is denying care to older people as a form of “rationing.”

What nations might be doing is choosing not to treat conditions when treatment provides no real benefit, and prostate cancer is a prime example. As I wrote in the “ir-rationing” article, diagnosis of a slow-growing prostate cancer in an older man usually doesn’t warrant aggressive treatment, because the odds are the gentleman will die of other causes before the cancer becomes a problem. But this is not “rationing”; it’s logical medical practice. The treatments for prostate cancer have side effects that likely will cause more problems than the cancer and not lengthen the patient’s life by even ten minutes.

The important point is that the patient is not being denied care just because he is old. If the same elderly patient had another disease, even another form of cancer, in which treatment would improve the quality or length of his life, then he would get that treatment.

Peter Singer is an interesting guy, but he’s a philosopher. He’s not an economist or a policy wonk. As I wrote in the post about his article, I don’t disagree with Singer but I think his rhetoric was unnecessarily inflammatory. Yes, there are limits to health care as a commodity, but the cost-effective limits we are talking about now do not fit the definition of rationing, which is:

A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity; To restrict to limited allotments, as during wartime.

And that is not what we’re talking about. Nobody is saying any one group of people should have limits put on how much health care they receive. Rather, we’re talking about taking health care decisions away from profiteers and putting it into the hands of medical professionals who will make decisions based on what patients need. That is not “rationing.”

Bobby Jindal, Insurance Industry Shill

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Since Bobby Jindal has about as much hope of being POTUS as I have of being Pope, I hope the insurance industry gave him a good tip for the pack of lies Jindal published in the Wall Street Journal today. He writes,

The left in Washington has concluded that honesty will not yield its desired policy result. So it resorts to a fundamentally dishonest approach to reform. I say this because the marketing of the Democrats’ plans as presented in the House of Representatives and endorsed heartily by President Obama rests on three falsehoods.

However, what Jindal doesn’t tell you is that he gets his “facts” about the Democrats’ plans from UnitedHealthcare, a health insurance company. Yep, the Lewin Group, which Jindal cites as the “study” claiming the public option will drive private insurance out of business, is a subsidiary of UnitedHealthcare, a fact Jindal does not disclose. The study was commissioned by the Heritage Foundation.

Jindal is especially pathetic, considering that the Lewin Group was outed by McClatchy as an insurance company front a couple of days ago.

Congressman Pete Stark of California fired back (page very slow to load):

“The Lewin Group is paid to produce estimates favorable to each client’s position. As a wholly owned subsidiary of UnitedHealthcare, the country’s largest private insurance company, the Lewin Group’s so-called ‘analysis’ is suspect. The Heritage Foundation got the study they paid for, but it is pure fiction.

“The Congressional Budget Office found that H.R. 3200 increases employer-sponsored insurance and less than 10 million people would choose the public health insurance option by 2019.”

Here’s a point-by-point comparison of the Lewin Group claims versus the CBO estimates.

The rest of Jindal’s carnival pitch is the usual right-wing blah blah blah — giving the poor “help in buying private coverage through a refundable tax credit,” for example. His solution for motivating insurance companies to provide more coverage for people with pre-existing conditions is “Reinsurance, high-risk pools, and other mechanisms can reduce the dangers of adverse risk selection and the incentive to avoid covering the sick.” Segregating people into high-risk pools is going to help them get affordable insurance, how?

Basically, Jindal’s op ed is all word salad; lots of the right buzzwords, but nothing that you could string together to make a coherent policy.

Update: see “Health Insurance Industry Spins Data in Fight Against Public Plan.”

Excuse the Mess

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I can’t bring myself to read David Brooks’s latest, which is headlined “Liberal Suicide March.” You can read it if you want to. I just want to link to some of the commentary inspired by the column.

Marc Ambinder writes a genuinely excellent post in which he notes that real reform is hard.

Selling expensive health care reform that doesn’t immediately benefit everyone, that threatens to disrupt the system (flawed as it is to many people) as Americans with insurance know it, that adds coverage for people who don’t have it, that potentially saddles the government with more debt, that requires sacrifice from people who might not derive tangible benefits from it — well, this is the stuff that one spends political capital on because it is the hardest type of lawmaking to do. It requires an extensive leap of moral imagination — a moral argument that the system, as it is, may not be hurting you, but it is hurting your neighbor and will eventually hurt you if it’s not fixed.

When you’re dealing with something as complex as the health care system, truly, there are no quick and easy fixes. Whatever is done will be messy and glitchy and cause some people some inconvenience. Conservatives like to point to the potential messiness as a reason not to act, ignoring the mess-o-rama that is the current system. Conservatives also like “magic bullet” solutions — let’s just enact tort reform, or let’s just deregulate the insurance industry, and the problem will fix itself, they say. They can’t understand why progressives cannot appreciate the simplicity and elegance of their solutions.

Matt Yglesias explains why predictions of “liberal overreach” are wildly overblown. Steve M has a great post on the use of fear as a PR tool.

Democrats don’t do fear — certainly not among themselves — and the principal result of this is that the ideas that are tough sells never emerge with the sheer authority that comes from unity. When a Ronald Reagan or Bush and Cheney ride into town, whatever cockamamie notion emerges from the White House instantly becomes the New Paradigm, the New Normal, not just in the GOP but in the media and the public, all because most Republicans are afraid to break ranks. Invade Iraq? Build a huge sci-fi shield against Russian missiles? Give huge tax breaks to rich people? Sounds … er, reasonable, I guess. There certainly seemed to be a consensus that these ideas were normal.

The possibility exists that the public would still think invading Iraq was reasonable if the management of the war hadn’t been so abysmal. The public certainly still thinks that the radical reordering of the economic order begun under Reagan was reasonable. That’s what fear wins you — a sense that your ideas must make sense because so few people are willing to say they don’t.

Mooned

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Can you believe the moon walk was 40 years ago today? I think if I survive to the 50th anniversary of the moon walk I’m going to start to feel old.

In July 1969 I had just graduated high school and was taking a couple of summer classes at the local junior college. I remember watching the moon walk live on television, with Walter Cronkite providing the voice-over. Sweet.

I had forgotten about the moon conspiracy theories, that the moon walk was faked and filmed in some big movie lot in a western state somewhere. (Wasn’t there a movie about faking the moon landing? Oh, yes, Capricorn One.) I have a postulation that people believe absurd conspiracy stories because there’s something in the story they want to believe. I’d like to know if anyone ever did a social-psychological study of moon landing conspiracy theorists to determine why they wanted to believe such a thing.

I do dimly remember some grumbling about the costs of the Apollo missions, but I think most Americans were proud of and happy about landing on the moon. We thought it was just the beginning of glorious things. If someone had told us that 40 years later the moon landing would remain the pinnacle of manned space exploration, I don’t think we would have believed it. Even though the Vietnam War was going on hot and heavy at the time, the country today still seems so much smaller and shabbier and diminished from what it seemed in 1969.

Conserving Rightie Cognitive Resources

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I remember many years ago being required to copyedit a study of white racists for a social-psychology journal. We’re talking out-and-out, unreconstructed racists, the kind of people who think watermelon on the White House lawn cartoons are funny. Somewhere among the p values and chi squares I picked up the finding that white racists sincerely believe that all other whites are as racist as they are, and if they don’t act that way they’re just being “politically correct” to conform.

The authors of this study also defined “bias” as a strategy for conserving cognitive resources, which I believe may have been the single most brilliant thing I ever read in a social psychology study. Not that I’ve read a lot of social psychology studies, mind you.

This past week, between the Senate Republicans’ performance in the Sotomayor hearings and the Pat Buchanan-Rachel Baddow exchange on MSNBC, there has been about as much unreconstructed racism on public display as I’ve seen since I moved out of the Ozarks. And when Pat Buchanan made the sexist conflation of Sonia Sotomayor with Harriet Miers one did wonder what century Uncle Pat had time-warped from.

And the thing that’s so glaringly obvious from watching all this is that the whole crew of bigots is utterly unconscious about it. They don’t perceive their biases as biases.

Frank Rich also makes the point that the troglodytes don’t realize the rest of White America doesn’t think the way they do.

The hearings were pure “Alice in Wonderland.” Reality was turned upside down. Southern senators who relate every question to race, ethnicity and gender just assumed that their unreconstructed obsessions are America’s and that the country would find them riveting. Instead the country yawned. The Sotomayor questioners also assumed a Hispanic woman, simply for being a Hispanic woman, could be portrayed as The Other and patronized like a greenhorn unfamiliar with How We Do Things Around Here. The senators seemed to have no idea they were describing themselves when they tried to caricature Sotomayor as an overemotional, biased ideologue.

At this point, the die hards of the Hard Right are reminding me of Joe McCarthy in the Army-McCarthy Hearings. McCarthy’s witch hunts against Communism had made him a hero to many Americans who only read about him in newspapers. But by 1954, the year the hearings were held, most Americans had a television set, and the Senate hearings looking into the Army’s accusations of McCarthy, and vice versa, riveted the nation. And when the nation saw the unvarnished, unedited McCarthy in action, they were shocked.

McCarthy appears to have had no idea how he was coming across on television. They hadn’t invented media consultants yet, I guess. After Joseph N. Welch’s famous “Have you left no sense of decency?” comment, and the audience in the gallery broke into applause, a stunned McCarthy turned to Roy Cohn and stammered, “What happened?”

The past few days we’ve seen a lot of unfiltered and unedited wingnutism. Between the Senate Republicans, the Stanford-Ensign-whoever else got caught recently debacles, and the right-wing freak shows known as “tea parties,” I think most of the country is ready to scream, “Have you no sense of decency, sir, at long last? Have you left no sense of decency?”