The “Health Insurance is a Corporate Bailout” Fallacy

There’s a recent comment that reminds me of a deplorable line of argument I’ve seen repeatedly but don’t I’ve ever addressed:

Nobody has universal healthcare. Not even after it’s fully implemented will it be honestly “universal”.

Obama handed corporations billions of dollars in enforced customers that hopefully will be better than having no healthcare at all.

Creepy how Obama supporters never did the math on how much corporations could be expected to profit from Obama’s plan until there was fear that the Supreme Court might eliminate it.

Suddenly there were pseudo-liberals trying to explain how bad the elimination of Obamacare would be to _corporation’s profitability_.

And yes, that’s closet Republicanism: Corporations profiting from expanded government.

Liberals, true liberals, know that it would have been more efficient and cost-effective to go straight to any of a dozen superior healthcare models that the rest of the industrialized world uses: Namely, telling corporations to go F# themselves.

While stated in crude and extreme form, this became a fairly common routine among leftier-than-thou critics of the ACA (and/or NFIB v. Sebelius.) John Roberts was just “bailing out” the health insurance industry or some such. (The theory that John Roberts is the only Republican in America sensitive to corporate interests is…not plausible, but moving right along.) I understand perfectly well that single-payer would be a superior system, but in the context of American politics, this is beside the point — if you have further complaints, direct them to James Madison.

There are two obvious problems with this argument. First, it proves too much. By the same logic, progressives should oppose food stamps because they’re really just bailouts of Big Food and Big Retail, and the federal government shouldn’t try to help poor people get food with anything but rations provided by state agencies. The fact is, when you get money into the hands of poor people, a lot of it is going to end up in the hands of Wal-Mart or Target or whatever. This is a really bad argument for opposing welfare programs. Second, I don’t think these claims that private health insurance are worthless are remotely credible. Do you have health insurance through your employer? Would you give it up for an increase in wages? I sure wouldn’t. Does anyone really think that health care is no more accessible for middle class people in Massachusetts than it is in Mississippi?

The same fallacies can be seen in Connor Kilpatrick’s assertion that not only does Obama not favor radical means, he doesn’t even favor progressive goals. Apparently, the endpoint progressives should be fighting for isn’t “making healthcare universally accessible” but “sticking it to corporations.” Not only is this exactly the wrong priority, but as long as #2 is your main goal American political institutions mean that #1 is will be permanently off the table unless the South is planning on seceding again.

297 comments on this post.
  1. RPF:

    I’m…unsure about how this is going to turn out. If the insurance plans available in the exchanges are really like this, the ACA isn’t going to become a beloved thing. I hope Obama and Sebelius do their best to keep such crap out of the federal exchange, at least.

    Academics with good group insurance plans would do well not to extrapolate their experience of health insurance to the individual market, which really is a different animal.

  2. Malaclypse:

    Commonwealth Care, which is an actual existing exchange, provides pretty good coverage.

    Hard to believe that someone who thinks lambert strether is a good choice for a co-blogger doesn’t anywhere discuss any actual example of an exchange, in a post about what the exchanges will be like.

  3. joe from Lowell:

    By the same logic, progressives should oppose food stamps because they’re really just bailouts of Big Food and Big Retail

    And also, progressives should oppose tax breaks and Department of Energy loan programs aimed at expanding the solar energy industry, because Solyndra.

  4. rea:

    I’m…unsure about how this is going to turn out.

    Well, yeah, we don’t know for sure how it’s all going to work out, until we do it. “Get the thing up and running and spend the next 30 years or so tinkering with it” is a more practical approach than “do nothing until we can pass a perfect program.”

  5. Both Sides Do It:

    I love that Colbert’s just been shoe-horning Solyndra into completely unrelated topics, and then shouting “SOLLLYYYYYYYYNNNNNDDRRRAAAAAAAAAAAA!!!”

  6. UberMitch:

    I think the commenter’s mincing of “fuck yourself” would look better with a sharp symbol than a number sign.

    Compare

    F♯ yourself

    with

    F# yourself

  7. Hogan:

    And where’s the bailout for America’s mom and pop auto manufacturers? Why did all the money go the the big guys?

  8. Hogan:

    “I got two words for you–Benghazi Solyndra. I don’t know what they mean.”

  9. David W.:

    It’s interesting to bring up Massachusetts as an example, because the system there has in place for years and voters there haven’t revolted against it. In fact, they seem to like it.

  10. sharculese:

    I’m deeply shocked that a dude who calls himself Cartman turned out to be an angry contrarian weirdhead.

  11. joe from Lowell:

    I think it’s reasonable to conclude that Ted Kennedy got out of his sick bed and went to Washington to cast the final vote of his career for a corporate bailout for the insurance industry that did nothing to help expand health care access.

    That’s Teddy in a nutshell, amirite?

  12. Njorl:

    I think it is a reasonable suspicion to have, but the behavior of the markets should be taken into account. After the ACA decision, health insurance company stocks dropped noticeably. It could have been the case that the rules were written so that the companies would profit, but it’s not.

    One group is hurt by the ACA. Healthy, young, single, men who could afford insurance but chose to free-ride by foregoing preventive care and relying on the general public to finance their catastrophic care through bankruptcy are paying more now.

  13. Njorl:

    Once you hit middle age, your “Fuck yourself” declines by about a 30 degree angle.

  14. anniecat45:

    Insurance companies will get a lot of money — and then they will spend large amounts of it on paying claims.

    There are 3 main ways insurance companies minimized their exposure in health insurance:
    exclusion (of people with pre-existing conditions); rescission (canceling insurance when somebody actually got seriously ill) and capitation (those lifetime limits on beneift payments that you ignore when you’re healthy but suddenly smack you in the face when disaster comes to call).

    Under ACA, when it takes full effect, all of those are gone, and insurance companies are on the hook for quite a lot of money in benefit payments.

    Most of my experience in this comes from working personal injury law. IIRC, a fairly simple trauma — a broken limb that has to be pinned under a general anesthetic, with two follow-up doctor’s visits and 6 to 10 sessions of physical therapy following surgery — will cost around $100K. A severe accident, for instance a car wreck which causes internal injuries and loss or damage of limbs, can cost $1 million or so in one month. Real disaster — trauma that causes severe brain or spinal injury — can use up $1 million in a week, given immediate trauma care plus the kind of surgery needed to rebuild a spine that’s been smashed.

    I don’t have recent information about how much cancer care costs but I assume it’s not cheap either — anyone want to chime in on that? And yes, I know insurance companies negotiate much lower rates with hospitals and doctors’ groups, but even “less of a lot” adds up.

    We talk sometimes as if insurance companies are not run by geniuses. They’re not. (How anyone can look at the past few years of business performance and think that these people are that brilliant eludes me, but that’s another discussion.) I think they were so mesmerized by a stream of premiums that they did not totally game out that future stream of payments.

  15. matthew frederick:

    In addition to assessing the market behavior, assessing the political behavior of the health insurance industry (i.e. campaign funding for politicians opposed to ACA, astro-turfing much of the Tea Party “movement”) leads me to believe that the health insurance industry did and does not think of the ACA as a corporate bailout or corporate welfare for the industry. If ACA was/is such a good deal for them, then the health insurance companies would have been for it, right?

  16. rea:

    Suddenly there were pseudo-liberals trying to explain how bad the elimination of Obamacare would be to _corporation’s profitability_.

    . . . is particularly annoying if you can remember what the argument before the Supreme Court was, namely, that the mandate was necessary to create a big enough risk pool to enable coverage of pre-exisiting conditions. Somehow that gets translated into supposed concern for corporate profits.

  17. JKTHs:

    That’s because all people from Massachusetts are corporate shills who’ve been deluded into a fantasy in which having private health insurance versus no insurance is a good thing.

  18. Chatham:

    In the end we need single-payer. That’s probably going to have to happen at the state level, like gay marriage and marijuana legalization. I’m hoping more people will join that fight whenever they finish refighting the battles of the past four years.

  19. Sly:

    It also ignores the fact that not every private health insurance provider in the country is a for-profit corporation.

    Unless the leftier-than-thou will only be happy once the people running various non-profit providers around the country are not only free from the demands of shareholders but are forced onto the GS pay scale, “Obama is just forcing us to buy from greedy for-profit corporations” is an asinine argument.

    In fact, a great deal of the insurance regulations were designed to cater to non-profit providers (who, for instance, have low administrative overhead and won’t be hurt by MLRs) at the expense of companies like Aetna, WellPoint, and Anthem. Plus the multi-state plans administered by OPM must, by statute, include non-profit options.

  20. Stan Gable:

    The stock market doesn’t directly correlate to actual corporate performance, so there’s no way to look at a drop in stock price and conclude that the ACA is bad for the bottom line.

    In terms of your group who is hurt by the ACA I don’t buy that either. If they were well-off enough to afford insurance in the first place, then their catastrophic care would still bankrupt them in a non-ACA world. If they’re too poor to afford insurance in the first place, then the ACA subsidies mean that they probably aren’t going to be paying anyways.

    Picking the “losers” in the ACA world is not that simple. Maybe pharma is a little worse off, maybe not. Maybe insurance companies are worse off, hard to say. High end taxpayers? Probably worse off.

  21. joe from Lowell:

    Or at least quiet about it.

  22. joe from Lowell:

    The stock market doesn’t directly correlate to actual corporate performance, so there’s no way to look at a drop in stock price and conclude that the ACA is bad for the bottom line.

    You could compare the performance of health insurer stocks as a category to the rest of the stock market, and look at the difference.

    There are enough health insurers that their aggregate performance would be meaningful, as oddball events cancel each other out.

  23. Stan Gable:

    You could do that after the fact and make some assumptions. In the short term, you’re just looking at opinions & assumptions.

  24. matthew frederick:

    I guess one could argue that the health insurance industry was sort of quiet about ACA, but quietly and rather forcefully against ACA. The money it spent on astro-turfing, PACs, etc. was an immense amount.

  25. Outlier:

    Because health care finance is so unintelligible, picking out winners and losers isn’t easy. Each industry group had to sacrifice something in the process and ultimately some will do better under the new system and others wont. I.E. Health insurance companies get more oversight (rate review, rebates to consumers) in exchange for more customers (individual mandate). Hospitals are no different, they got more people with insurance and higher volume of patients but in return had to give up a sizeable DSH funding stream and have to make hundreds of changes to keep up with the new pay for quality regime. Pharma had to provide hundreds of millions in drug savings, in return they got a promise of no Canadian drug importation. Some call that buying off, others call it negotiating.

  26. Dave:

    OTOH, looked at objectively, the US healthcare system will still be ridiculously expensive after Obamacare, but shit, that’s the country you’ve got, not the country you’d like to have, eh?

  27. Hogan:

    We still have the greatest health care system that isn’t really a system in the world.

  28. david mizner:

    The ACA bill can be adequately defended without resorting to painfully bad analogies.

    Big Retail? Big Food?

    Scott — and you — want us to believe there’s no difference between government directly providing services to citizens, who then pass on money to private companies, and government compelling citizens to buy a product from private companies — private companies that are a barrier to the sort of system we all agree would be best.

    Say what you will about WalMart (or for that matter, your local market), there are not many people advocating for a national government food system to replace all markets. On the contrary, I’m pretty sure that all of us would like to see a government health care system to replace the private insurance regime.

    But the ACA, whatever its merits (which are real) strengthens and further entrenches a system that needs to be wiped out.

    I don’t think the ACA is closet Republicanism; I think it’s a kind of corporate liberalism that’s not nearly as good as the real thing embodied by Social Security and Medicare.

  29. Josh G.:

    We need a lot more doctors in the US. Their training needs to be shorter and less expensive, and they need to be paid less (particularly the specialists; General Practitioner salaries aren’t too out of line). Open more medical schools, streamline the curriculum, and ditch the “residency” which is pretty much a hazing ritual. The existing process forces prospective doctors to go through Hell, and having done so (and incurred six-figure debt in the process), they understandably believe that they’re entitled to rake in the big bucks. This has to stop. Even if it means paying off each and every existing doctor to go along with it, it would save money in the medium and long run.

    We can’t keep running medicine like a medieval guild while everything else is exposed to cutthroat 21st-century competition. No wonder it’s eating us alive.

  30. timb:

    In the end, I believe it will happen with this system, which won’t work THAT well. Insurance companies are terrified and that makes me hope they are on their way out

  31. scarshapedstar:

    Not sure I follow the ‘food stamps as mandate’ argument at all.

  32. timb:

    Beyonce’s name for a second child?

  33. Steve H:

    I support the ACA, but I don’t think it’s only the young and healthy uninsured who are hurt by it. I think the young and healthy insured are also going to be hurt to some extent, because the insurers will be restricted in their ability to use rating to make premiums correlate with risk.

    If insurers can’t charge old people and women several times more than they charge young healthy men, even though both groups are likely to require more medical treatment, then the insurers will raise premiums on the young healthy men.

    (I am not saying this is a bad thing, necessarily, but I can see the young healthy mean not liking it.)

  34. timb:

    Why, David, why?

    The horse is dead, but you still keep beating it.

    Yours truly,
    Ben Nelson

  35. david mizner:

    Agreed, and that, I believe, is what happened in Canada: experimentation at the local level led to a national system.

  36. timb:

    permanently off the table unless the South is planning on seceding again

    Even then, there are enough corporatist Democrats to defeat it….now

  37. timb:

    I continue to maintain that the historical analogy of this is the CRA of ’57. Opponents of health insurance, like opponents of Civil Rights, attempt to scare people into imaging a change to the status quo will destroy their lives. Once it does not, real change becomes easier.

    The ACA is an incremental step forward toward an eventual, successful system

  38. JL:

    We need a lot more doctors in the US. Their training needs to be shorter and less expensive, and they need to be paid less…

    Nurse Practitioners (maybe with beefed-up training) for primary care, perhaps? A model of healthcare better suited to primary care anyway, no need for years-long (Medicare-funded) residencies, salaries that are solid but less than what doctors make, and no strict med-school-regime-imposed limits on the supply of primary care providers.

    Or at least, that’s what I’ve been thinking would be the right idea for a while now.

  39. Sharon:

    And this is the frustrating thing about the ACA. We pay more and get less for it because we’re in thrall to “Teh Market.”

    Big ups for neoliberalism.

    Yes, it’s better than the no health insurance regime that my S.O. is living with now, but wow, the bar is low.

  40. joe from Lowell:

    Scott — and you — want us to believe there’s no difference between government directly providing services to citizens, who then pass on money to private companies, and government compelling citizens to buy a product from private companies

    Do you not understand that the ACA spends many billions of dollars a year in “government directly providing (funds – I don’t think you mean ‘services’) to citizens, who then pass on money to private companies?”

    Do you think that the bill begins and ends with the mandate?

    But the ACA, whatever its merits (which are real) strengthens and further entrenches a system that needs to be wiped out.

    Never mind that the actual health insurance companies are losing value, and went to war to stop it. David Mizner just knows that it’s a great boon to them.

    Oh, and you can lecture me about “painfully bad analogies” when you apologize for comparing holding a different opinion about Obama’s negotiating strategy to believing his birth certificate was faked, Captain Projection. (Seriously, he actually did this on the fiscal cliff thread).

  41. Incontinentia Buttocks:

    I was very surprised to see Rick Perlstein–who’s a pretty brilliant historian and certainly someone who understands political pragmatics–repeating the ACA-as-corporate-bailout view on FB a few months back.

    Like a lot of wrong ideas, this one has some kernels of truth in it:

    1) Insurance companies would certainly prefer the ACA to single payer (but single payer is, as the OP says, not on the table at this point).

    2) A mandate to purchase health insurance without the exchanges or additional regulations regarding, e.g., preexisting conditions would indeed be an insurance company’s dream. However, that’s not the ACA…and it even seems extremely unlikely that the ACA would have been semi-repealed so it looked like this had the GOP taken the White House and the Senate earlier this month.

  42. mpowell:

    I actually agree with this and was going to comment the same. I completely agree with Scott’s larger point, but this is a terrible analogy. The problem with the private health care market is that it is tremendously wasteful and hurts consumers. The ACA had to include legislation just to get healthcare plan’s ‘loss ratios’ above, what was the number, 80%? Say what you will about Wal-Mart’s labor practices, but they do run at very slim margins and it is very unlikely that there is an alternative way of delivering the same goods to consumers at lower prices.

  43. BigHank53:

    Gosh, I wonder how much trouble it would have been to nationalize every hospital and medical clinic (thereby removing those properties from tax rolls as well as disrupting the Dow Jones), fire every single employee of every single insurance company’s health care division (more market fun!), and force everyone from phlebotomists to breast-enhancement surgeons onto the federal payroll?

    Should we have single-payer? Probably.
    Can we have single-payer? Don’t start holding your breath.

  44. Njorl:

    If they were well-off enough to afford insurance in the first place, then their catastrophic care would still bankrupt them in a non-ACA world.

    This group tends to have high income and high expenses, but few assets. Bankruptcy does not harm them significantly. Avoidance of bankruptcy was not worth the price of purchasing health insurance.

  45. david mizner:

    Actual health insurance companies went to war to stop it? I will grant that the impact of the ACA on the strength of health insurance companies is ambiguous, but you pulled this claim our of your arse.

  46. Njorl:

    The stock market doesn’t directly correlate to actual corporate performance,

    This was a significant 1-day drop in value on the day the ACA was announced.

  47. Njorl:

    …the day the ACA decision was announced …

    I should say.

  48. Murc:

    Apparently, the endpoint progressives should be fighting for isn’t “making healthcare universally accessible” but “sticking it to corporations.” Not only is this exactly the wrong priority, but as long as #2 is your main goal American political institutions mean that #1 is will be permanently off the table unless the South is planning on seceding again.

    Err… wait, hold on.

    Scott, you’ve been a strong voice advocating that the ACA, like other social programs, is going to get tweaked and modified and expanded and made better over the years. And you’ve made some convincing arguments for that.

    But at some point in order to that, we are, in fact, going to have to stick it to corporations. In fact, a whole host of changes that are necessary to stop us from turning into a Banana Republic and/or rendering the planet uninhabitable for humans are going to REQUIRE sticking it to corporations.

    And if that’s impossible, doesn’t that mean we’re basically fucked?

  49. Malaclypse:

    You do realize that single-payer and Britain’s NHS are not, in fact, the same thing, right?

  50. joe from Lowell:

    Are you high?

    The health insurance companies poured vast fortunes into the 2010 elections, and into the tea party movement in 2009-2010.

    Just because you don’t know something, david, doesn’t mean it isn’t true.

  51. mpowell:

    I don’t believe these numbers are accurate. Even major surgeries do not normally cost $100K, although costs can exceed that number with extended hospital stays. I can’t speak for extensive trauma cases. There is also a huge difference, frequently a factor of 2 or more, between what the hospital puts on the bill and what the insurance company pays them.

  52. Njorl:

    True. I was considering only those “forced” to buy insurance.

    Another group who will be harmed are those in good group plans, like me. My rates are currently subsidized by insurers defrauding individual policy holders of their justified claims. By stealing money from individual policy holders, a company can afford a more competitive bid on a group plan.

    I think this is another “harm” which is worth inflicting.

  53. mpowell:

    No, we simply need more doctors. We are graduating fewer per capita than we did 20 years ago. This is insane.

    On the other hand, I don’t know how you’re going to reduce the traning time and expense of specialists. That’s how they become specialists. But a lot of the cost of that training is other existing specialists’ time. So if you eat up additional expense in the short term, you may be able to reduce it in the long term.

  54. joe from Lowell:

    http://www.fiercehealthpayer.com/story/ahip-donated-86m-lobby-against-health-reform-law/2010-11-19#ixzz2Dja5xlCc

    America’s Health Insurance Plans (AHIP) provided the U.S. Chamber of Commerce, a business lobbying group, with $86.2 million to oppose the health reform law–while it pledged general support for reform.

    The Chamber, which was one of the biggest detractors of President Obama’s healthcare overhaul, used the funds to advance a market-based healthcare system and advocate for fundamental reform that would improve access to quality care while lowering costs. The $86.2 million paid for advertisements, polling and grass roots events to drum up opposition to the bill, according to Bloomberg.

    Tax records disclosed this week revealed that AHIP’s donation accounted for more than 40 percent of the contributions the Chamber received in 2009, which totaled $205.4 million.

    40% of the U.S. Chamber of Commerce’s entire annual budget!

  55. Chatham:

    Pretty much. From what I understand, at least 2-3 years of the four years of medical school is spent in the clinical part. From what I’ve seen of the clinical part, the med students seem to be doing a good deal of work. It’s ridiculous that students graduate with six figure debts.

    Medicine, like law, is an area where we really would benefit from some deregulation.

  56. Malaclypse:

    Clearly, AHIP has mastered the winning strategy of Heightening the Contradictions.

  57. Sherm:

    Never mind that the actual health insurance companies are losing value

    JFL — check the five year charts for the large health insurance companies (CIGNA, United Healthcare, Aetna, etc.) — their stocks are way up from prior to the passing of the ACA, and the upward swing started with the passing of the bill. Yes, there are other factors involved in the stock prices (including the improvement of the market overall after it bottomed out in early 2009), but it is simply not true that the companies are “losing value.”

  58. grouchomarxist:

    a fairly simple trauma — a broken limb that has to be pinned under a general anesthetic, with two follow-up doctor’s visits and 6 to 10 sessions of physical therapy following surgery — will cost around $100K

    That is completely insane.

  59. CaptBackslap:

    If we had price transparency for medical services, you’d see prices drop pretty quickly. Insurers would find ways to reward customers for finding lower-cost services, such as scaling co-pays based on cost percentile for the service rendered.

    It strikes me that this could be accomplished on the state level with a ballot initiative.

  60. matthew frederick:

    Some call that buying off, others call it negotiating.

    Exactly. Every significant piece of progressive social legislation passed by an American Congress and signed by an American president at least since Social Security through the Civil Rights and Great Society legislation of the ’60s to ACA have involved, to varying degrees depending on the comparative political power of the entrenched interests at the time, “buying-off” of these entrenched interests.

    Politics is the art of the possible — not the art of the perfect.

  61. joe from Lowell:

    Yes, there are other factors involved in the stock prices (including the improvement of the market overall after it bottomed out in early 2009)

    Yeah, no kidding. Other than that, Mrs. Lincoln…

    If you want to edit my terminology, feel free, but the point remains.

  62. rea:

    Most of the young and healthy aren’t really hurt, because most of them are going to be old and decrepit in the long run. The only ones with a legitimate complaint are those who are young, healthy, and plan on being killed instantly in an accident before that changes.

  63. bradP:

    Its also giving Massachusetts the highest health care premiums in the nation and beginning to make insurance companies and their management very wealthy.

  64. david mizner:

    The health insurance lobby played both sides — publicly championing reform while at the same time secretly providing financial support to its opponents, probably because they themselves weren’t sure how it would turn out. They wanted the mandate but no public option, which is why the health insurance lobby was Ben Nelson’s biggest donor. Hell, if there’s a single author of the bill, it’s former Wellpoint VP Liz Fowler, who was Max Baucus’s aide.

    To say that the health insurance lobby “went to war” against the bill is just hogwash.

  65. joe from Lowell:

    Whoops, cut out the important part – the numbers: since the passage of the bill, stocks overall are up 40%, but Aetna (the first one I googled) is up 20%.

    Over the past five years, stocks overall are about even with November 2007, but Aetna is down 30%.

    Clearly, this has not been a good time for their corporate values. Far from the gains we would expect to see if the health care bill benefited the insurance companies, we have seen them show much worse performance than the overall market.

  66. Malaclypse:

    Yes, there are other factors involved in the stock prices (including the improvement of the market overall after it bottomed out in early 2009), but it is simply not true that the companies are “losing value.”

    That bolded part is glossing over quite a bit there.

    But to your larger point, a look at three-year balance sheets shows CIGNA and United Healthcare gaining quite a bit, while Aetna is barely treading water.

  67. Sherm:

    The point remains that they are losing value, market capitalization notwithstanding?

  68. bradP:

    With the noticeable exception of the 30,000 immigrants who had to sue to get their coverage back after Mass dropped in response to budget problems.

    http://www.cjr.org/campaign_desk/legal_immigrants_win_in_massachusetts.php

  69. joe from Lowell:

    publicly championing reform while at the same time secretly providing financial support to its opponents

    Follow the money. You want to talk about “hogwash?” Paying attention to the spokesmodels while the important people hand out checks is hogwash.

    Noting that the bill the industry went to war against was written by someone who worked in the industry doesn’t mean a whole lot. Giving the Chamber of Commerce 40% of their annual budget to defeat the bill that Liz Fowler wrote tells us a great deal more about what they thought about that bill.

    And no, they haven’t been “playing both sides” for quite some time. For a while, the industry was championing reform (of a certain kind), and making an effort to cozy up to the administration, but then they turned sharply against it.

  70. joe from Lowell:

    Ah, so you don’t have an argument, just a semantic quibble.

    Quibble away, self-appointed editor!

  71. Malaclypse:


    When we look at employer health insurance premiums as a share of household income, in both 2003 and 2009, we find Massachusetts is among the least expensive states when considering the proportion of one’s income required to pay for health insurance (and Arkansas is among the most expensive).

  72. Sherm:

    Going back to 2007 is silly under these circumstances. Go back to the debating and the passing of the bill in 2009. United Healthcare is up approximately 100% since the Summer of 09.

  73. Bitter Scribe:

    You had me until the last sentence of your post. I’ve read it four or five times now and still have no clue what it means. For starters, what is Priority #1?

  74. Sherm:

    Hey, I went to Quibble School for three years. How do you think I got my JD?

  75. bradP:

    One group is hurt by the ACA. Healthy, young, single, men who could afford insurance but chose to free-ride by foregoing preventive care and relying on the general public to finance their catastrophic care through bankruptcy are paying more now.

    Premiums for healthy individuals who handle their healthcare appropriately will increase as well.

  76. tonycpsu:

    Behold reality, with its well-known liberal bias!

  77. Whispers:

    Seems like an argument to me.

  78. joe from Lowell:

    Going back to the summer of 09 is equally silly, because those insurance companies are, in fact, insurance companies, parts of the financial sector. They all bottomed out during the meltdown, like the rest of the financial sector, owing to their involvement in the era’s risky investment practices, and spent 2009 recovering.

    What would be most useful would be to look at what they have done since the passage of the bill in December 2009 – and that timeframe shows the insurance companies significantly underperforming the overall market.

  79. Malaclypse:

    Everybody is healthy, until they are not.

  80. Njorl:

    From what I remember of being young, I had little money at the time, but was sure I’d have vast amounts of it later. The “time-value of money” gets an extra distortion for the young.

  81. joe from Lowell:

    So what you’re saying is that a group of people who never would have had coverage if they weren’t in Massachusetts ended up getting it, because they live in Massachusetts.

  82. Malaclypse:

    I’m confident that private insurance would never wrongfully drop coverage. The Magic Market would prevent that!

  83. Sherm:

    Except that the prices were also impacted during 2009 by proposals of a single payer system and a public option. Such options were off the table by the summer if memory serves.

  84. joe from Lowell:

    Hey, Sherm:

    JFL — check the five year charts for the large health insurance companies (CIGNA, United Healthcare, Aetna, etc.)

    Going back to 2007 is silly under these circumstances.

    Dood, wtf?

    Also:

    and the upward swing started with the passing of the bill.

    is not even close to true. The upward swing began at the end of 2008, like the upward swing in the rest of the stock market, including especially the financial sector.

  85. Cody:

    According to the most recent version of Glenn Beck we have by far the greatest national healthcare in the world!

    If you talk to Glenn Beck 10 years ago though, it was truly awful. I’ll note that was the Glenn Beck who just had his appendix removed.

    I’m sure there are several Beck’s to be had inbetween.

  86. Malaclypse:

    proposals of a single payer system

    Surely you can link to these proposals (plural in original).

  87. Whispers:

    That’s because it doesn’t really make sense.

    Yes, in both cases money is going to private corporations. But in one case the money is entirely coming from the government, and there is no mandate to give it to private corporations. In the other, the money is not (for the most part) coming from the government and there is a mandate to give it to private corporations.

  88. joe from Lowell:

    Except that the prices were also impacted during 2009 by proposals of a single payer system and a public option.

    Not to any noticeable extent.

  89. Cody:

    He isn’t addressing the “mandate” per se, but the outrage over giving more money to “capital” in exchange for more people having health insurance.

    So because of the ACA there will be more revenue for health insurance companies, just like because of food stamps there is more revenue for Wal-Mart.

  90. Cody:

    I think the crux of this line of thinking is a lack of understanding about the ACA. We spend so much time talking about the mandate, the real purpose falls off.

  91. Whispers:

    Please don’t compare ACA to civil rights legislation. There are too many levels of wrong there to summarize.

  92. Sherm:

    You guys don’t believe that the possibility (slim, of course) of a single payer system or a public option didn’t impact insurance carriers’ stock prices in 2009?

  93. bradP:

    What, Mal, its good because there are a lot of rich people in Massachusetts who can afford it?

    What about all those who can’t?

    Bankruptcy fodder?

  94. joe from Lowell:

    It’s true; there is no mandate to spend your food stamps at private companies.

    You could starve.

    Or you could spend them at the concession stands at National Parks.

  95. Cody:

    I think you’re misreading what he is saying. He isn’t saying we should avoid sticking it to corporations. He’s saying that being Progressive isn’t about sticking it to corporations.

    Our goal is to make everyone’s life better. If we gotta screw over some corporations, fine. If you’re a Progressive because you want to stick it to corporations, you’re really just an anti-capitalist.

  96. Chatham:

    “But the ACA, whatever its merits (which are real) strengthens and further entrenches a system that needs to be wiped out.”

    David Blumenthal actually just said the same thing on NPR 10 minutes ago. Well, not the “needs to be wiped out” part, but how it further entrenches (I think he used the term “enshrine”) the current system.

  97. Malaclypse:

    What about all those who can’t?

    Per the link that started all this off, most of them get decent subsidies. To the point where 95.9% have found themselves able to afford it.

    Bankruptcy fodder?

    Per that very link:

    Though Massachusetts saw a 51% increase in medical bankruptcies over the 2007-2009 period, that rate was below the national average rate of increase; the state has historically had a lower rate of medical bankruptcy.

    Keep fucking that walrus.

  98. Cody:

    for isn’t “making healthcare universally accessible” but “sticking it to corporations.” Not only is this exactly the wrong priority, but as long as #2 is your main goal American political institutions mean that #1 is will be permanently off the table unless the South is planning on seceding again.

    #2 is “sticking it to corporations” and #1 is “making healthcare universally accessible.”

    I can understand how that is hard to connect. I had to re-read it a few times to see what he was numbering.

  99. NonyNony:

    Priority #1 – “making healthcare universally accessible”

    Priority #2 – “sticking it to corporations”

    Final sentence means if #2 is more important to you than #1, you’re going to be disappointed by life.

    The South secession bit is just a gag based on the recent talk of Lincoln-Obama fanfic. I’d be surprised if Scott actually thought Southern secession would really make it easier to do anything that “sticks it to corporations”, since corporations have plenty of representation in Congress that doesn’t come from Southern states.

  100. Johnny Sack:

    shut up glibertarian

  101. Sherm:

    Though Massachusetts saw a 51% increase in medical bankruptcies over the 2007-2009 period, that rate was below the national average rate of increase; the state has historically had a lower rate of medical bankruptcy.

    That’s pretty fucking depressing.

  102. Cody:

    I would applaud your quick fact-finding, but I’m just so disturbed that is a good number in the US.

  103. T. Paine:

    Whaaa? You mean, like allowing the professional associations to set all the accreditation and education standards? Or do you mean streamlining so that the barriers to practice between states are smaller? Because either way, I do not think “deregulation” means what you think it means.

  104. mark f:

    Is it possible that some sort of HHS directive/ruling made filings easier in the Obama era as compared to under George Bush?

  105. Hogan:

    How many investors thought that single payer was a real possibility? Or that the insurance companies had no chance of lobbying down a public option?

  106. matthew frederick:

    IIRC, a fairly simple trauma — a broken limb that has to be pinned under a general anesthetic, with two follow-up doctor’s visits and 6 to 10 sessions of physical therapy following surgery — will cost around $100K.

    FWIW, in my experience working personal injury cases, this kind of injury and resulting medical care bill (especially for an uninsured victim) is within the realm of typical.

  107. Malaclypse:

    Oh, Brad was the one who found that number. He just hoped that nobody would read all of the words in the link he provided.

  108. spencer:

    I used to hang out at the Magic Market all the time when I was in middle school. They had a “Punch Out” machine and a “Front Line” machine, as well as cheap slurpees.

  109. david mizner:

    We don’t need to stick it to corporations (just) because it’s fun to stick it to corporations but because it’s a zero-Sum game. Less power and less money (if that’s not redundant) for corporations means more power for people, more democracy. No kind of liberalism can prevail in a country where corporations have this much power.

  110. JKTHs:

    Maybe but I also think it makes it easier to enact single payer. Not only is the baseline for coverage higher, but the cost of enacting single payer goes down since the number of people already on government-subsidized health insurance goes up.

    From a political perspective one could say that it’ll make insurers fight harder to avoid single payer but also the employer mandate ensures that single payer becomes relatively more attractive for large corporations.

    That’s just my two cents but I can understand arguments to the contrary.

  111. scott:

    Yes, Pangloss, our health care system is The Best Possible Health Care System in this best of all possible worlds. Nothing more could possibly have been obtained or even attempted. As with NaderRantTm!, somehow I recall hearing this one before, but the freshness of being told again and again and again (and again) that we can’t hope or try for anything better never diminishes. Good work!

  112. Sherm:

    Probably not many, but it would defy credulity to maintain that the uncertainty regarding a potential bill had no impact on the market. But that’s besides the point. My point was simply that the large health insurance companies have not lost value since the passing of the ACA. That they have seems to be a misconception caused by media reports concerning their stock prices going down when the law was upheld by the Supreme Court. But overall, the insurance companies’ values are up, and the ultimate impact of the ACA on the insurance companies remains an open question.

  113. Hogan:

    I don’t have recent information about how much cancer care costs but I assume it’s not cheap either

    I was halfway through a twelve-month course of interferon injections when my insurance company decided that all injectables would be covered not through major medical (which was paying the whole bill for me), but through the prescription drug benefit. Since interferon was not in my plan’s formulary (and don’t get me started on that or we’ll need new furniture), I would have been on the hook for fifty percent of the cost, which was something like $4800 for the last four months. That’s, what, almost $30K for the whole year? My nurse-practitioner (among many others, I’m sure) pushed back and got the insurance company to grandfather treatments that had already started.

    That’s not counting surgery, tests, scans, etc.

  114. cpinva:

    really bradp? where is that stated, in the cited article, because i sure didn’t see it? if you’re going to lie, and that’s what you did, you should at least make some effort to make the lie look believable, you were too damn lazy to even do that.

  115. cpinva:

    ouch!

    Beyonce’s name for a second child?

  116. Malaclypse:

    Probably not many, but it would defy credulity to maintain that the uncertainty regarding a potential bill had no impact on the market.

    What was uncertain? Nobody ran on single-payer in 2008, nobody proposed it in 2009.

  117. bradP:

    Of course Massachusetts had a lower growth in bankruptcy rates. It consistently outdid national unemployment rates by a couple of percent.

    It also important to get an idea what amount Massachusetts was better than the average, and the piece linked to in that article spells it out:

    Moreover, although the number of filings in
    Massachusetts has increased sharply during the current recession—a 51% increase between 2007 and 2009—this
    increase is smaller than that experienced by 54 of the 93
    other federal bankruptcy jurisdictions. Thus, the state’s per
    capita medical bankruptcy rate remains lower than the nationwide rate.

    So despite this being a novel health care system rolled out in one of the wealthiest states in the nation, 41% of all bankruptcy jurisdictions (none of which have a comparable system) had a rate of medical bankruptcy growth lower than Massachusetts.

  118. Sherm:

    my insurance company decided that all injectables would be covered not through major medical (which was paying the whole bill for me), but through the prescription drug benefit.

    That is complete fucking horseshit.

  119. wengler:

    If California does it, the country will follow. I am more skeptical that even a well-run single-payer system in Vermont will have much impact at the national level.

  120. tonycpsu:

    Can we just end this tangent if we admit that the possibility of single payer / public option probably had a vanishingly small impact on the market? Obviously investors try to look at all perceived threats to their investments, so yeah, maybe an institutional investor or two buys 9,950 shares instead of 10,000 shares during the three days where it seemed like maybe a public option could have been placed in the same room as the negotiating table.

  121. Rick Perlstein:

    Incontinentia Buttocks, did I? I think your referring to a post in which I made another mistake, not this one (I’m going to write about this soon): that the Republican governors who are not creating their own exchanges are doing Obamacare a favor by hastening us toward a federalized system (they’re not; I’m wrong; more later).

  122. heckblazer:

    About 8 years ago I was uninsured and had pretty much that exact treatment – surgical implantation of a plate in my arm followed by around three days in hospital. The bill for the surgery and hospital ended up being around $10,000. Of course, this was a non-profit religiously affiliated hospital and I lucked out in qualifying for a charity program for indignant patients. IOW, if the hospital was billing someone other than their charity fund I expect the actual total on my paperwork would have been much higher.

  123. Hogan:

    Is it possible that some sort of HHS directive/ruling made filings easier in the Obama era as compared to under George Bush?

    Bankruptcy filings were probably way up overall between 2007 and 2009. whether it was up more or less than medical bankruptcies I don’t know.

  124. Malaclypse:

    Of course Massachusetts had a lower growth in bankruptcy rates.

    Funny you managed to imply otherwise. Your true-but-deceptive charades are always a crowd-pleaser…

  125. cpinva:

    do you often conflate two entirely different things, in the very same sentence, or is this a special occasion?

    On the contrary, I’m pretty sure that all of us would like to see a government health care system to replace the private insurance regime.

    bolding mine.

    the health care system, and the health insurance regime, are two entirely different, yet related, entities. the former provides actual medical care, the latter pays for some or all of it. if you can’t even make that simple distinction, you have no credibility on anything else.

    nowhere has the obama administration proposed a national health care system, yet people, such as yourself, and all republicans, keep claiming he has. what idiots.

  126. mark f:

    Yes, I had a recession brain fart on that one. Makes sense that there would be an increase.

  127. Malaclypse:

    whether it was up more or less than medical bankruptcies I don’t know

    From Brad’s link:

    Illness and medical costs contributed to 59.3% of bankruptcies in 2007 and 52.9% in 2009.

    So non-medical bankruptcy increased more.

  128. Sherm:

    What was uncertain? The details of the ultimate bill prior to its passage.

    But I don’t know why this is an issue here. I only brought it up as an additional reason why the stock prices might have been deflated prior to the passing of the ACA. If you and JFL believe that the stock prices were not lower due to such uncertainty, then my point regarding the value of the companies going up after the bill passed is only stronger.

  129. StevenAttewell:

    Medicaid expansion, Medicaid expansion, Medicaid expansion.

    Why does this get ignored? 1/2 of those newly covered will get health insurance through a government program.

  130. STH:

    I remember my father telling me years ago that when he got his hip replaced, just the prosthetic joint by itself was $40,000, without the surgery, hospital, PT, etc.

  131. Malaclypse:

    I think stock prices were down in 2009 because the stock market had just crashed. That’s why I looked at Balance Sheets below.

  132. N__B:

    I don’t care how many you throw in the deal, I’m not buying any of them.

  133. wengler:

    There are a number of things that need to be done.

    We need to turn law schools into medical schools.

    We need to take private insurance totally out of the basic healthcare market.

    We need to clamp down on the vile prescription drug industry, ban their television advertising and cut their prices by at least 75 percent.

    We need to make the number of bankrupt people due to medical problems 0.

    Until these things happen we will be living with a system that is incomprehensibly expensive, socially regressive, and financially unfeasible.

  134. rea:

    I lucked out in qualifying for a charity program for indignant patients.

    They have programs for that? :)

  135. STH:

    indignant patients

    Totally best typo ever.

  136. wengler:

    Yeah and it will become a political problem because even if you are saving money on the overall system, the numbers on the federal balance sheet will go up.

  137. Hogan:

    Self-injectables, I should say. But yes, that was my thinking as well.

  138. rea:

    Or you could spend them at the concession stands at National Parks.

    They don’t cover prepared ready-to-eat foods.

  139. nixnutz:

    The analogy is not a great argument but it’s a fitting rebuttal to particularly poor arguments like the quoted which is essentially saying “real liberals would rather see poor people suffer and die needlessly than see corporations profit from serving them,” which is really awful on at least two obvious levels.

  140. rea:

    Corporations are NOT people. They are tools.

    Regulate corporations. Stick it to plutocrats.

  141. cpinva:

    does a quadruple bypass qualify as a “major surgery”?

    Even major surgeries do not normally cost $100K, although costs can exceed that number with extended hospital stays.

    the total cost, including 5 days in the hospital (thanks to a staph infection that had me hallucinating) ran over $60k, and that was 8 years ago. no doubt, it’s more than that now.

    however, as i understand it, the ACA also requires that the insurance companies spend 85% of their premium revenue on claims, any amount spent below that must be repaid to customers. so it’s going out one way or the other. bear in mind, the bulk of insurance company revnues isn’t coming from premium payments, it’s coming from investment income, on required reserves. that’s what killed them in 2008-2009, not losses from claim payments.

  142. Brien Jackson:

    And to add: the same people who bemoan the so-called corporate giveaway of the mandate went absolutely apeshit when the “caddillac plan” tax was proposed. I guess some massive subsidies of private insurance companies are okay with Our Progressive Betters?

  143. Sherm:

    But “cadillac plan” is a complete misnomer.

  144. Brien Jackson:

    Which is a big part of the reason I put it in quotes. You knew what I was talking about though, right?

  145. cpinva:

    this does seem to be a huge disconnect with many people, a disconnect which is, for the most part, intentional.

    You do realize that single-payer and Britain’s NHS are not, in fact, the same thing, right?

    this is, in part, where the whole “concept” of death panels gained credence, by conflating ACA with a national health care system. although, in palin’s case, i suspect she truly doesn’t know the difference, she’s just that blindingly stupid.

  146. Sherm:

    Yes. But it just seems that today is bad analogy day at LGM. Now I have to go google cadillac to see which one of us is spelling it wrong.

  147. cpinva:

    there isn’t any such animal, i assume you meant the federal budget.

    the numbers on the federal balance sheet will go up.

    which would presumably affect the surplus.

  148. Brien Jackson:

    It’s not an analogy at all, and the specifics of the proposal aren’t even relevant. The fact of the matter is that the existence of the tax preference for employer provided health insurance is a MASSIVE subsidy to insurers, far larger than the mandate or anything else in the PPACA. Your view of the policy, or anyone’s else, can be whatever it may be: the point is that the people who decry the latter as a giveaway to corporations vigorously defended the former when they saw an opening to attack the bill. They don’t actually believe this shit in any meaningful sense, they’re merely starting from the premise that Obamacare is bad, and looking for any line of argument that they can come up with to attack it.

  149. Cody:

    You should try reading what Scott writes instead of what you imagine him writing.

    Do you even read his articles, or just the title and insert your own narrative?

  150. Anna in PDX:

    Wow, I have very good insurance, and recently broke my ankle, no third party or anythign like that, all paid for with the insurance policy. I saw the bill and it was less than $20,000 all told for the actual surgery. That includes the casts they made for me and three follow up visits. If you consider my many office visits for physical therapy at $100 a pop (I only have a $10 copay for them) you could get an extra couple thousand but it will still be way, way, way under $30,000. I assume personal injury suits would be counting things like loss of income as well? Even so this seems like a lot given the actual cost of the medical part of the crisis.

  151. wengler:

    The number of people enrolled in Medicaid. See ‘Food Stamps President’ smear to see how this is used in politics.

  152. Scott Lemieux:

    1)The PPACA doesn’t allow junk insurance on exchanges, and 2)the fact that people with insurance wouldn’t drop it makes it pretty clear that it’s dumb to think that private insurance is worthless a priori.

  153. Scott Lemieux:

    Yes, but 1)at a time at which health care was cheaper, in which the free rider effect was less pronounced, and 2)national health care was the result of a parliamentary system, which prevented the providers and other interests who hated socialized insurance from stopping it.

  154. joe from Lowell:

    Comparing an increase in rates without looking at the underlying absolute numbers is pointless.

  155. Scott Lemieux:

    Seriously, where and when it counted the insurance industry was strongly opposed to the ACA. The fact that they started out favoring reform in the abstract is completely meaningless, and you wouldn’t possibly be this naive about corporate motives in other contexts.

  156. Sherm:

    Correct me if I’m wrong (and I’m sure you will), but isn’t the employer health insurance tax preclusion more of a subsidy for employers and employees than for the health insurance companies themselves?

  157. joe from Lowell:

    You guys don’t believe that the possibility (slim, of course) of a single payer system or a public option didn’t impact insurance carriers’ stock prices in 2009?

    Sure, I believe in the possibility. That’s why I looked it up. Having done so, I do not believe in the reality.

  158. Scott Lemieux:

    Yeah, but if corporate interests really opposed the PPACA they would have sued to get the Supreme Court to strike it down.

  159. Scott Lemieux:

    by proposals of a single payer system

    Can you point me to the specific time frame in which there was a single payer proposal that anyone thought would pass, and trace that to decreases in stock values? Thanks!

  160. Brien Jackson:

    I suppose you could look at it that way, but ultimately you end up in the same place: it’s a subsidy for employers to purchase health insurance from private companies.

  161. Scott Lemieux:

    Obviously, the analogy is inexact. But given that nobody who knows anything about American politics thinks that the destruction of the American health insurance industry was on the table, it retains considerable force. The fact that private insurers will in some ways benefit from the PPACA is a terrible reason to oppose it.

  162. joe from Lowell:

    “Pangloss?”

    Those last five letters should be “-cakes,” and you’re not fooling anyone.

  163. Scott Lemieux:

    The “entrenches” argument implies that in the absence of intervention the American political system would just magically gravitate to single payer. There is no remotely rational basis for this belief.

  164. joe from Lowell:

    Yeah and it will become a political problem because even if you are saving money on the overall system, the numbers on the federal balance sheet will go up.

    I wish all of our political problems were like this.

  165. Bruce Baugh:

    I’m not sure this is all that sound an argument. Kennedy didn’t make a lot of big mistakes in his Congressional career, but then there is No Child Left Behind and its atrocious consequences.

    I support ACA pretty vigorously, given the realities of American politics, but “IF Kennedy-supported THEN For-sure-no-big-fuckup” doesn’t work.

  166. Scott Lemieux:

    RIght. For all intents and purposes, there’s a “mandate” to spend it at private corporations unless you don’t use the benefit. The fact that a government policy results in more customers for private companies remains a remarkably dumb reason for opposing a policy.

  167. matthew frederick:

    AnnaPDX,

    This is my experience only with medical bills and not accounting for damages in addition to medical bills.

    If you are insured, then your insurance company (or Medicare … especially Medicare) has made an agreement with the health care provider on the prices of a host of different treatments, procedures and medication.

    Even for the very same services, a hospital’s or clinic’s bill for these services rendered can vary by huge amounts depending on whether and by what insures the patient.

    Medicare is especially effective at keeping prices low because of its leverage. “Take it or leave it” says Medicare to healthcare providers. Most healthcare providers take the deal, because the volume of transactions makes it worthwhile (profitable) to the healthcare providers.

    If a patient is uninsured by Medicare or by a premium policy from a private insurer, then the medical bill for the same services will be a whole lot higher.

    (This has been my experience, anyway.)

  168. Sherm:

    Can you point me to the specific time frame in which there was a single payer proposal that anyone thought would pass, and trace that to decreases in stock values?

    No. I can’t. I’m simply trying to establish a fair baseline for the large health insurance companies’ value as per market capitalization prior to the passing of the ACA because JFL argued that the companies’ values have gone down due to the ACA.

    JFL — We’re splitting hairs for no reason, and as my 14 year old daughter likes to remind me, I am fast approaching a time when I can no longer afford to do so.

  169. timb:

    Johnny, Brad’s politics might be off, but he is a reasonably intelligent and articulate commenter for what is — essentially — nonsense (libertarian thought).

    I’m glad he is here

  170. BigHank53:

    You do realize that single-payer and Britain’s NHS are not, in fact, the same thing, right?

    Yep. I am afraid the the original inane comment made me all shouty.

  171. Sherm:

    (This has been my experience, anyway.)

    You have understated your case. This is precisely how our fucked up system works.

  172. david mizner:

    But it’s a decent reason to doubt that it’s the greatest piece of legislation since —-. No one’s suggesting Medicare for all is around the corner, but whether the ACA moved us closer or father is an open question.

  173. Malaclypse:

    Yep.

  174. Scott Lemieux:

    Yes, but did the Medicaid expansion stick it to big banks? Did the Brookings Institution oppose it? Without knowing the answers to these questions, I can’t tell if it’s progressive or not.

  175. Scott Lemieux:

    I can’t tell if it’s a mean parody of Holden Pattern or jeer9.

  176. Brien Jackson:

    And also mostly irrelevant to anyone who cares about anything more than “winning.”

  177. timb:

    I’m comparing a political process/societal change in a democracy.

    Secondly, since I believe healthcare is a human right and civil rights legislation AND the ACA address fundamental human rights, I STILL don’t get your point

  178. timb:

    I thought that too….I was saddened to learn I was wrong

  179. timb:

    what the french use?

  180. timb:

    What a fantastic comment

  181. Scott Lemieux:

    I don’t see why. Personally, I think how much something improves the status quo is more important than how close it is to an ideal system that isn’t viable. I also don’t see how this should affect a comparison of the ACA with other legislation of the last 40 years, none of which moved us closer to single payer either.

  182. timb:

    Nonetheless, any reference to Candide must be respected….even if it is wrong

  183. Bruce Baugh:

    This is bullshit. Even if there were no pricing cartels, and there are, the fact is that patients are seldom in a position to make anything like an informed decision about specific costs. It’s just another way to dump shit on random people that is properly the job of trained professionals applying expert information to a wide variety of cases.

  184. matthew frederick:

    Standpoint epistemology, I suppose. :)

  185. Sherm:

    You don’t try to negotiate the price of each test or procedure recommended by a doctor, or at least comparison shop before undergoing the test or procedure? Clearly, it is uninformed consumers like you who are driving of up the cost of healthcare for the poor insurance companies.

  186. Keaaukane:

    Insane, yes. But also about the going rate, barring complications.

    That’s for adults, children’s injuries generally go for less (they heal easier).

  187. charles:

    So, as I take it, what you are advancing is that the proper position amongst egalitarian liberals/progressives is something like this: “I would have much preferred a government run health care system, something akin to medicare for all, however, since that option was not attainable, ACA is the best option/must be supported, despite the fact that it is clearly a giveaway to corporate/special interests, because the law makes universal access to healthcare a reality” (giveaway is not meant to mean the same thing as bailout ). Is this your position, or do you truly believe that the ACA is in no way a giveaway to the corporate interests of health insurance companies? If you agree with my formulation of your position, then I understand completely the tradeoff you are making. And it makes perfect sense.

    This sort of argument within egalitarian liberal/progressive circles over ACA reminds me of the constant arguments that take place within classical liberal/libertarian camps regarding gay marriage. Most all classical liberals/libertarians are in favor of same-sex marriage/marriage equality laws, while a small subset of hard libertarians disagree and can only regurgitate “the state has no business sanctioning/defining/being involved in the marriage business.” On a theoretical level I agree with that sentiment and personally wish that the state would get out of the marriage business altogether. However, the state IS in the marriage business. Therefore, since the state will not be getting out of the marriage business for the foreseeable future, people are currently being denied equal protection of the law, and same-sex marriage laws rectify the problem. Your post makes similar arguments to my mind: “Single payer was not an option, doing healthcare reform without corporations was never going to happen, so lets put our ideal policy outcome (sticking it to corps.) off to the side for now and focus on making access to health care nearly universal.” I think this might be a more apt analogy. Curious to hear your take.

  188. Steve S.:

    By the same logic, progressives should oppose food stamps because they’re really just bailouts of Big Food and Big Retail

    In my hometown I live walking distance from, or have easy access to via public transportation, dozens of food providers ranging from farmer’s markets, co-ops, mom-and-pop stores, locally owned grocery stores, medium-sized regional grocery stores, and corporate-owned supermarkets. All of them stock their shelves with products from small farmers and businesses, co-operatives, medium-sized businesses, and mega-corporations, including some that are produced in more sustainable or less cruel ways and I can choose to purchase them. Even when I shop at the mega-corporate supermarket some portion of my food dollars goes down the line to local family farmers, craft brewers, etc.

    My health care dollars go to the world’s most expensive providers, insurance executive salaries, and an army of underpaid bureaucrats in cubicles. Otherwise, your analogy is spot-on.

    The ACA can be both a corporate giveaway and an improvement on the status quo ante. Some of us can hold both thoughts simultaneously.

  189. Substance McGravitas:

    I tend to look at the TSA as an employment program…

  190. matthew frederick:

    heckblazer,

    I’ve had several clients in awful auto accident cases where the other driver isn’t insured a basically judgment-proof for whom I’ve assisted in these indigence claims/declarations/etc. to get hospitals to eat at least some of the costs. The “sticker price” for healthcare for an uninsured or poorly-insured patient is jaw-dropping. Every line item of the hospital bill is the proverbial “five-dollar aspirin pill.”

  191. Chatham:

    Somehow I don’t think that’s what David Blumenthal was implying.

  192. CaptBackslap:

    Obviously, there would be provision for services to assist people in making comparisons. The bare existence of information isn’t transparency if people can’t make use of it. And prices for similar procedures can vary quite a bit. There’s no other market where people would accept the ridiculous pricing situation in medicine.

  193. david mizner:

    OK, so that clarifies it: you don’t support Medicare-for-all (now there’s a program that got us closer to single payer) because it’s not “viable.”

    You don’t think we can do better than the ACA. You should have just said that instead crapping out smelly metaphors.

  194. RedSquareBear:

    If you start from an position that markets and market effects are axiomatically bad it isn’t an unreasonable conclusion.

    Whether it bears a relationship to what most people observe is, as with most hermetic positions, of secondary importance.

  195. Scott Lemieux:

    We don’t need to stick it to corporations (just) because it’s fun to stick it to corporations but because it’s a zero-Sum game. Less power and less money (if that’s not redundant) for corporations means more power for people, more democracy. No kind of liberalism can prevail in a country where corporations have this much power.

    So, in other words, corporations are so powerful that they prevent progressive goals from being achieved even through somewhat less efficient means, so we need to have a more viable program of destroying corporate power directly through unspecified means? I find this…unconvincing.

  196. Brandon C.:

    Ya I’m using that if you don’t mind. Thats excellent.

  197. Chatham:

    I’m not sure either of those will stop it from happening at the state level.

  198. Scott Lemieux:

    Well, I don’t actually think it’s a “giveaway” to corporate interests as compared to the status quo, and if you don’t believe me ask the relevant corporate interests themselves, who were harshly opposed to the ACA. But I also think the question isn’t really relevant; if the legislation 1)improves the status quo and 2)was the best that was available not only in that legislative session but in the foreseeable future — and both of these things are true — even if it was a corporate giveaway progressives should support it.

  199. Scott Lemieux:

    Here’s a question — do you think that the majority of food stamp money is spent at major national corporations, or local co-ops? Here’s a second question — does the answer affect your opinion about whether food stamps are a good program or not?

  200. Keaaukane:

    Yeah, but the funniest commentator is JenBob, and everybody is mean to him/her

  201. Scott Lemieux:

    You guys don’t believe that the possibility (slim, of course) of a single payer system or a public option didn’t impact insurance carriers’ stock prices in 2009?

    Of course
    I don’t believe this. For one thing, there was no significant single-payer proposal, and the chances of single payer passing topped out a 0%.

  202. Robert Waldmann:

    Given Roberts’ rules of federalism it is painful to type this, but the quoted leftard ignored the Medicaid expansion. Under the original pre-Roberts court PPACA, about half of the expansion of health insurance coverage would have been single payer government Medicaid.

    The CBO guesses that even post Roberts it Medicaid expansion will still be about half of total coverage expansion. Yet leftier than thou types almost completely ignored the issue except when Ben Nelson and John Roberts made trouble over it.

    To me this is enough to convince me to ignore them (which mainly means my hotlist goes straight to Tbogg and skips the rest of firedoglake.com)

  203. Scott Lemieux:

    No, I support single-payer; a single-payer system is clearly better than the American satus quo, even after the PPACA is implemented. Whether single-payer is political viable is an entirely separate question, and wishing doesn’t make it so.

    Do you think that single-payer could pass Congress today? If not, does that mean if you don’t support it? This is a silly claim.

    Now, it certainly is true that I don’t believe in holding the uninsured hostage based on the unfounded hope that doing so will somehow lead to single-payer. To conflate this with “not supporting single-payer” is really silly, and this kind of heighten-the-contradictions is grossly immoral.

  204. Anonymous:

    So nineteen year old motorcycle riders.

  205. Brien Jackson:

    This was also true of the fight over the public option pony. It would appear that Our Progressive Betters don’t think Medicaid counts as public insurance. I do wonder why on Earth that could be!

  206. Davis X. Machina:

    No love for G ?

  207. Davis X. Machina:

    It’s still Medicaid — it’s not an NHS-USA. The bricks and mortar aren’t state-owned, the medical personnel remain private employees for the most part.

    Just not good enough.

  208. Ed:

    I think the standard will have to be better than “pretty good” for this to work. I am fortunate enough to have very good coverage, not Cadillac level but above average, and my out-of-pocket expenses are still considerable. I’d hate to think what they would be if I were chronically a/o catastrophically ill.

    I understand that medical bankruptcies are as likely to happen to people with coverage as people without, because it’s chronic/disastrous illness that is the most costly. Families with sick children are especially vulnerable. A few horror stories could make the new system look very bad very fast.

  209. Richard:

    I would estimate that less than 5% of the population would support a NHS-USA system. And with good reason IMHO.

    I’m all in favor of single-payer (although it has absolutely no chance of coming into being in my lifetime) but I would strongly oppose any NHS system where doctors became federal employees.

  210. Brien Jackson:

    Well, you also thought the replacement referees weren’t that bad.

  211. heckblazer:

    D’oh! I might have been indignant as well as indigent except I was on a quite a bit of Vicodin at the time.

  212. heckblazer:

    I worked for a PI firm once upon a time, and I absolutely believe you. I was trying to give some concrete support for how overpriced that is, since I expect what I saw was much closer to the actual costs of the procedure. I can also add that shopping around for the best price for an orthopedic surgery is *not* fun.

  213. StevenAttewell:

    Ok, but that’s not relevant to the question of ACA being a sellout to health insurance corporations.

  214. heckblazer:

    I forgot to add that the only reason why I was able to stomach that job (my boss was like a cross between Gary Condit and Joe Isuzu) was that insurance companies are absolute scum, and fighting them was self-evidently righteous.

  215. StevenAttewell:

    Heh. I remember having virtually the same argument on the floor of the California Democratic Party Convention in 2010, trying to explain that “Medicare for half,” while not “Medicare for all” is better than “total corporate sellout.”

    I’m beginning to think that we need to start with pushing for consequentialist ethics within the progressive movement if we want to make this “next democratic majority” worthwhile.

  216. StevenAttewell:

    Yeah, that attack was really successful.

  217. StevenAttewell:

    Well, the Cadillac plan tax actually involves the loss of massive equity on the part of workers.

  218. StevenAttewell:

    I think by the laws of blog threads, you owe me a coke.

    But among the many things that passed in big part because progressives shut the hell up about them, I wish we had added lowering the Medicare age to 55. That would have been big, but we blabbed and Lieberman got all sniffy.

  219. joe from Lowell:

    I could never bring myself to knock out Pizza Pasta.

    He looked just like my grandfather.

  220. Brien Jackson:

    But the soundness of the policy is neither here nor there for this point. The point is merely that you can’t say that one thing is bad simply because it uses public policy to subsidize insurance companies after you went to the mats to fight even a marginal rollback of another public policy that subsidizes the exact same insurance companies.

  221. Richard:

    And I was wrong about that one. Dont have any problems admitting mistaken judgments. Dont think I’m wrong about all doctors and nurses becoming federal employees though.

  222. StevenAttewell:

    Given that even doctors often aren’t sure about the relative merits of different approaches, that’s not easy to do.

    Also, emergency care? How many people who have to be rushed to hospital in an ambulance are in a position to comparison shop?

  223. StevenAttewell:

    But the flip side of that doesn’t work: things that help people will also help corporations.

    Let’s take another example: the stimulus. Made a lot of money for corporations, but should we have done nothing, lest corporations profit?

  224. Bruce Baugh:

    All of the above. Not to mention things like “X is cheaper at A because they do it often, and have a higher success rate and the advantages of routine”, as opposed to “X is cheaper at A because they don’t do it carefully or often”. Some factors are easy to evaluate. Others just aren’t.

  225. Ed:

    If ACA was/is such a good deal for them, then the health insurance companies would have been for it, right?

    They were behind it publicly.

    http://www.nytimes.com/2009/09/12/health/policy/12lobby.html?_r=0

    Some no doubt would have preferred no deal at all, but if there had to be a deal one that involved delivering a bunch of new customers to the industry was obviously desirable. The opposition was nothing like what the Clinton plan faced.

    http://www.nytimes.com/2012/09/30/opinion/sunday/why-obamacare-is-a-conservatives-dream.html?pagewanted=all

    “This explains why the health insurance industry has been quietly supporting the plan all along. It levels the playing field and expands the potential market by tens of millions of new customers.

    The rationalization and extension of the current market is financed by the other linchpin of the law: the mandate that we all carry health insurance, an idea forged not by liberal social engineers at the Brookings Institution but by conservative economists at the Heritage Foundation…”

  226. los gringos son locos:

    Watch Frontline: Obama’s Deal please. Available on Netflix and pbs.com. Summary: There were two bills, and after Obama realized that the first one was unpopular and at the very least perceived to be by the public to have health insurance lobbyist’s fingerprints all over it (thank you Max Baucus!). So the WH worked with the Dem leadership to write a new one and the industry went to war against them.

    This isn’t exactly ancient history.

  227. joe from Lowell:

    The VA is a pretty darn good medical system. No?

    Is the problem scaling up?

  228. Richard:

    One problem is scaling up. The other is forcing all docs to become federal employees in order to make a living. NHS here would be a disaster as it would be opposed by 95 per ent of all doctors. Under the V A system now, the choice to be a VA doctor is voluntary. Big difference

  229. STH:

    Too many lawyers, not enough doctors, and it takes time to get law schools retooled as med schools, so . . . retraining grants? Paid internships in phlebotomy?

  230. Anonymous:

    I’m sure you can find a lot of silly liberal argmuments to use as strawmen, how about working more then one neuron at a time and taking on some tougher liberal arguments:

    1
    At the end of your post, you compare MA and MS; the problem is, a) we here in MA havn’t figured out how to pay for it, althought it is clear radical changes are needed, and b) BEFORE romney care, ~90% of people (ive seen 88-93%) ALREADY had healthcare, so the cost of universal care wasn’t a lot in MA – no more then 10% of the pop (and we are a wealthy state)
    In other states, such as MS and TX, the % of the pop that currnetly (pre obamacare) has healthcare is <<80%, to the cost to these states is going to be very high.
    if insuring 10% in MA is hard, how are we going to insure 25 -50% in MS and

    2) Obama care keeps the2 main flaws of our current system: access is not established as right, and we have this insane, please cheat system where private firms send bills ot the gov't.If you tried, you couldn't invent a system that was worse.
    maybe better wasn't attainable, but we shouldn't delude ourselves into thinking that obama care is a great soluiton.

    3) how do we know gov't care will be good ? A model is the right to a lawyer, enshrined as all good liberal High School students learn, thru Gideon. but we know in the real world that the lawyers provided to indigent defendants are barely better then no lawyer; perhaps obama care will evolve into a similar system – v poor quality care for the poor (like the old soviet joke, they pretend to pay us, we pretend to work)

  231. joe from Lowell:

    phlebotomy

    Lol.

  232. Incontinentia Buttocks:

    I obviously thought you did. I’m more than happy to be corrected. I apologize for the error!

    As for the other mistake: as a resident of one of the states with such a GOP governor, you were, unfortunately, wrong (as you now say).

  233. joe from Lowell:

    We know government care will be good, because all of the government-run systems health care system (the military, the VA) and health care coverage systems (Medicare, Medicaid, SCHIP) have very high levels of patient satisfaction.

  234. Thers:

    I’m sure you can find a lot of silly liberal argmuments to use as strawmen, how about working more then one neuron at a time and taking on some tougher liberal arguments

    That’s a comma splice. Independent clauses cannot be linked with a comma, motherfucker.

  235. Sherm:

    Sarcasm. I agree with Bruce Baugh.

  236. A better liberal conspiracy is...:

    A better liberal conspiracy is that Roberts is laying the ground work for reversing much of commerce clause jurisprudence that serves as the legal foundation of most federal programs

  237. laura:

    I don’t. The best health care systems in the world are not single payer. The ACA distinctly moves the US in the direction of European mixed health care systems which are, on pretty much every metric, better than single payer.

  238. SN:

    Blaming the constitution for why the US can’t possibly do single-payer is a reification.

    It is harder to get an abortion today than in 1988 because the right bothers to fight. Even when it loses battles, by fighting the right is able to set the ideological agenda which does impact which bills become laws and which do not. If the Democrats had been beating the single payer drum since Clinton failed to get health care reform in the early 1990s the debate by the time Obama entered the White House could have been very different. Opposition to single-payer healthcare isn’t genetic, isn’t geological, and isn’t an inevitable feature of nature or some ur feature of the US constitution. Rather, it is an accomplished fact of politics in the US.

    The green lantern meme is an alibi for per-emptive surrender.

    Scott is a cop for the Wall Street wing of the Democrats. He seeks to demarcate anything to the left of himself as hopelessly utopian. In contrast he is the font of hard nosed pragmatism. But the measure of pragmatism is efficacy in getting concrete results, not just opportunistically tacking right and policing the left.

    Accommodate, Accommodate, Accommodate.
    That is Moses and the Prophets.

  239. Scott Lemieux:

    The documentary is excellent, and Paul Starr’s book confirms this as well. They did cut deals with the pharmaceutical industry and the providers, but they didn’t with the insurance interests, and the insurance interests went all-out to kill the bill.

  240. Scott Lemieux:

    Right, I don’t mean to say that I favor only single payer per se; the French system would also be fine.

  241. Scott Lemieux:

    If you ignore the fact they contributed $80 million to kill the bill, then they were totally behind it!

  242. Scott Lemieux:

    Except that it didn’t actually do that in any meaningful way.

  243. Scott Lemieux:

    So your counterexample if institutions not mattering is the decades-long conservative war on reproductive freedom, which (in large part because of the advise and consent power) has resulted in abortion being legal in all 50 states, albeit with some really bad abortion regulations in the most favorable state legislative contexts? I guess you’ve conceded my point.

    Also, single payer isn’t to the left of me, but anyway.

  244. MikeJake:

    I want a discount NOW!

    *BANGS FISTS ON TABLE*

    ….Ow.

  245. jeer9:

    Scott is a cop for the Wall Street wing of the Democrats. No, because he’d be a very bad cop. It’s more of a lack of interest in financial corruption.

    He seeks to demarcate anything to the left of himself as hopelessly utopian. Given the current nature of the Democratic party, it often sadly is.

    But the measure of pragmatism is efficacy in getting concrete results PPACA fits that description, even if one has a number of reservations about its eventual effectiveness.

    However, conspiratorial minds want to know. If the Dems are now willing to tinker with (reform?) the filibuster, why wasn’t this possible in January 2009 when there were large majorities in both houses?

  246. (the other) Davis:

    Dude, your argument fell apart. Accept it, stop digging, and move on.

  247. Cartman:

    lol: ARITHMETIC

    30 million new customers X [average payments] X [15% - 20%* profit taking] = MASSIVE ‘corporate welfare’.

    Check my math:

    Assuming only 30 million new customers x $1,000 average annual payment, that’s 30 BILLION a year in new corporate revenue. Taking the lower percentage of a 15% profit margin, Obama signed into law a corporate welfare gift of $4.5 BILLION in annual (ahem) leaching.

    That’s a baseline. There’s likely to be more than 30 million new corporate customers, those average payments are currently multiple times the $1,000 used as an example, and that 15% rate assumes that everyone is in group plans as individual plans are allowed to skim 20% as profit.

    Medicare has a less than 5% overhead rate by comparison (as low as 3% overhead by some ‘liberal’ estimations).

    To reiterate: Honest, informed people knows that Obamacare was the right-wing Heritage Foundation / Republican Dole / Romneycare health care plan wet dream.

    The revisionist history that has made this Republican healthcare plan Obama signed into law as the new ‘progressive victory’ is ‘through the looking glass’ lunacy.

  248. IM:

    Time and tide wait for no man, whatever illusions about healthy living they have.

  249. IM:

    There’s likely to be more than 30 million new corporate customers

    You have heard of a thing called Medicaid?

  250. Manju:

    I think there’s a lot to what Joe’s saying. Basically, “Kennedy’s greatest regret.” (A quick google shows some Daily Kos folks doubting this*, and I’m not up on the detail, so they may be right, but here is the CV).

    Nixon offered defacto Universal Health Care. His idea: give money to the poor so they could buy some. Kennedy saw this as a giveaway to Health Insurance Companies. So he rejected it. Plus he figured he could get Single Payer once Dems reclaimed the WH.

    Needless to say, single payer never came to pass. He regretted his rejection as his greatest regret ever since.

    *The revisionists appear to believe that Nixon wouldn’t have gone thru with his proposal anyway, even if Kennedy had accepted.

  251. Chatham:

    “For all intents and purposes, there’s a “mandate” to spend it at private corporations unless you don’t use the benefit.”

    Which is completely different from the healthcare “mandate.”

  252. Matt McIrvin:

    We already use them as a ready source of organs.

  253. Scott Lemieux:

    But which is not meaningfully different from the health care mandate if you think that any public money that will end up in corporate hands is a bad thing.

  254. Scott Lemieux:

    Republican healthcare plan

    Yeah, the “Republican plan” that not a single Republican in Congress supported, and the “Heritage Foundation plan” the Heritage Foundation bitterly opposed the second it had any chance of becoming law.

  255. Sherm:

    Yeah, a huge corporate giveaway, if you conveniently ignore all the new regulations which offset the added revenue from the mandate. Look, a large majority of the people here would have preferred singer payer, but Scott said it best and most succinctly when he commented about an unwillingness to hold the uninsured hostage while demanding a system which had no chance of passing congress. Obamacare is far from ideal, but it’s a huge improvement and the alternative sought by progressives would have never passed. So get over it, or at least deal with reality and present your arguments in a more honest fashion.

  256. FlipYrWhig:

    Also, isn’t there a bureaucratic process involved in approving which foods can and can’t be bought with food stamps, WIC, etc.? That’s in addition to which stores take them: which products in the store can be bought with them. Right? I defer to experts.

  257. joe from Lowell:

    This is not the first divide-and-conquer strategy Obama has used with corporate interests.

    Look at how his administration has gone after coal while being relatively favorable towards oil and gas.

  258. joe from Lowell:

    …before they came out against it.

  259. joe from Lowell:

    Which is completely different from the healthcare “mandate.”

    Indeed. If you violate the “health care mandate,” you are assessed higher federal taxes.

    If you violate the “eat food mandate,” you die an agonizing death.

    This argument is bad enough coming from libertarians.

  260. joe from Lowell:

    Opposition to single-payer healthcare isn’t genetic, isn’t geological, and isn’t an inevitable feature of nature or some ur feature of the US constitution. Rather, it is an accomplished fact of politics in the US.

    Just so everyone is clear, this wicked awesome leftier-than-thou leftist thanks that there are no unique structural challenges to the creation of universal public benefit programs in American politics – no “those people” problem – but rather, the difference between the American and, say, French experience with health care reform is a matter of tactics.

  261. joe from Lowell:

    But the measure of pragmatism is efficacy in getting concrete results

    Indeed it is. So, how is the Great Progressive Victory Train going?

  262. joe from Lowell:

    If the Dems are now willing to tinker with (reform?) the filibuster, why wasn’t this possible in January 2009 when there were large majorities in both houses?

    Because the Republican filibuster-abuse of 2009-2010 hadn’t yet happened. That experience changed a lot of minds.

  263. joe from Lowell:

    Assuming only 30 million new customers

    Your very first premise is wrong. There is no such thing as “30 million new customers” for the health insurers.

    Honest, informed people knows that Obamacare was the right-wing Heritage Foundation / Republican Dole / Romneycare health care plan wet dream.

    You can tell, because they all opposed it.

  264. joe from Lowell:

    Honest, informed people know that Republicans are never dishonest when they bring up an alternate proposal.

  265. Anonymous:

    you know, it my personal experience, calling people names like “motherfucker” is a good way to pursuade them that they are in error, and a good way to get them to change their views.
    I mean, motherfucker for a debatable grammar error ??
    What would you call me if I said i was a dues paying member of the KKK ?

  266. jeer9:

    According to research by UCLA political scientist Barbara Sinclair, there was an average of one filibuster per Congress during the 1950s. That number has grown steadily since and spiked in 2007 and 2008 (the 110th Congress), when there were 52 filibusters.

    Try harder.

  267. joe from Lowell:

    OK: there were 136 filibusters in 2009-2010. How good are you at math, asshole? Because the rest of us can look at the number 52, asshole, and at the number 136, asshole, and see a difference, asshole.

  268. jeer9:

    spiked in 2007 and 2008 (the 110th Congress)

    It was almost unpredictable, Joebot. More impossible knowledge.

  269. joe from Lowell:

    Thanks, asshole, now that you repeated the word “spiked,” I completely understand why the difference between 52 and 136 is utterly meaningless to anyone’s opinion about whether the filibuster was being abused.

  270. Dilan Esper:

    You shouldn’t assume that just because Obamacare makes some bad insurance company practices illegal that it will actually be enforced. One very plausible scenario is insurers capture the regulators, violate the rules, and let their customers die while pocketing the premiums from healthy people now required to buy the product.

  271. Dilan Esper:

    Scott, if something makes actual reform more difficult, it may not improve the status quo. By your logic, legislators should never oppose a bill due to a poison pill provision.

    You seem to have a very binary mind. The leftists you despise think several moves ahead in the chess game. You are constantly criticizing things you don’t understand.

  272. Dilan Esper:

    Medicaid sucks. VA or Medicare expansion would have been fine.

  273. Dilan Esper:

    Actually Medicaid sucks. Poor people express satisfaction wirh it compared to dying, but it sucks.

  274. jeer9:

    Cloture was rarely invoked in the early 1900s and mid-1900s. The rule was used only four times, in fact, between 1917 and 1960. Cloture became more common only in the late 1970s, according to records kept by the Senate.

    The procedure was used a record 61 and 63 times, respectively, in the 110th Congress, which deliberated in 2007 and 2008, and the 111th Congress, which met in 2009 and 2010, Senate records show.

    Try harder. Maybe if you take your meds, the statistics won’t baffle you.

  275. Davis X. Machina:

    Yeah, but is that 5% figure also good for prominent lefty bloggers?

  276. genedebien:

    Here are two anecdotes from the other side of the Atlantic for comparison.

    My wife and I live in Belgium and had a child here almost four years ago. It was a normal pregnancy and delivery, with the mandatory 5 day post-delivery stay for mother and child. Total cost to us for the delivery and stay? 700 Euro.

    We had 4 or 6 follow-up (home) visits from a pediatric nurse in the first two months after delivery. Free. Wellness visits for the baby and first year vaccinations? Free, as long as we went to the community health center. We could also go to our own pediatrician (who charges us 45 euro per visit) for the wellness checks and to have the vaccinations; the only catch was that we would have to pick up the vaccination itself from the health center and take it to the doctor, who would administer it.

    About five months after his second birthday, our son injured his leg. The initial visit to our GP was 25 euro. He sent us to the ER, where, after showing nothing but the boy’s national ID, he was admitted and treated. X-rays showed a small radial fracture of the tibia and his leg was set in a splint. The total bill from this visit? 38 euro.

    Five days later, there was another visit to the hospital with an examination and more x-rays. The doctor found a small pressure sore on the boy’s heel. They put his leg in a cast, but asked us to come back in two days so that they could open the heel of the cast and look at the sore. I don’t recall ever getting a separate bill for this visit.

    On our return visit, the doctor opened the heel of the cast and didn’t like the look of the sore. He had us come back the next day for a consultation with the head of the gerontology department (I understand, they often deal with pressure sores.) At this visit, the doctors agreed to set up a series of visits – every two to three days – where the sore would be cleaned and examined. For the first few visits, they also applied an antibiotic cream. There were at least two – but maybe three – visits where the leg and sore were so tender that they administered gas to calm the boy down. I don’t recall getting a bill for any of these visits either.

    We continued returning to the hospital to have our son’s leg and the sore examined basically every other day for two weeks. No bill for any visit. In the end, once the cast was removed and following two follow-on visits with the doctor, we received a bill for 142 euro. This was the only bill we received after after our initial visit.

    The doctor also prescribed a short course of physical therapy (4 visits) which cost us 13 euro per visit.

    So, our son’s broken leg – including a visit to the ER and some complications – cost us a total of 357 euro.

  277. StevenAttewell:

    Medicaid expansion was also paired with equalization of reimbursement between Medicaid and Medicare.

  278. Chatham:

    Right. But to argue that food stamps are a mandate only confuses the issue, since mandate has a particular meaning in the healthcare debate (as a shorthand for the individual mandate). Plus there’s no reason to argue that food stamps are a mandate, since you didn’t write that in the original post. It just seems to needlessly confuse the discussion.

  279. Chatham:

    That’s…pretty silly. Food stamps are comparable to the healthcare subsidies. You can say that there’s a mandate for the subsidies, or, hell, you can say that there’s a mandate for anything the government…mandates. That doesn’t change the fact that mandate has a particular meaning in the healthcare debate.

  280. SN:

    You aren’t doing institutional analysis, you are doing reification – treating institutions as if they are forces of nature instead of patterns of social life that are shaped and constrained by political struggles. Those pesky little “some really bad abortion regulations” and federal firewalls on funding are exactly the consequence of the Republicans willingness to fight battles that shape campaigns even as individual battles aren’t always won. As a consequence of the Dems not fighting and the Republicans willingness to fight, it is harder to get an abortion today than in 1988. Your smug obfuscation does not hide this simple point.

    In contrast to the Republicans willingness to actually fight, the Democrats, with help from left-cops like yourself insure that policy change from the putative left is a matter of micro reforms (like Obamacare, where costs will continue to rise and outcomes will only marginally improve), instead of actually fighting for something substantial that has been show to achieve better results (like single-payer).

    Your problem isn’t taking institutions seriously. You fundamentally misunderstand how institutional arrangements are arrived out and are reproduced across time. You treat the mechanisms of the constitution as an immutable force of nature that makes fighting for single-payer impossible. Instead of being fixed and unchangeable, the political views of the people who hold positions within the constitutional framework are the consequences of concrete and accomplished political struggles. The Democrats haven’t fought for single-payer since Bill Clinton in 1993. The constitution didn’t keep this from happening. Not fighting for single payer since 1993 is a political choice, and one you have embraced.

  281. SN:

    No, strategy, and operations come to play as well. But what doesn’t work is pre-emptive surrender under the guise of pretending the institional arrangements of the US are pre-given by nature. Scott and yourself are clearly keen to wish away any space for actually fighting for real reform. You are content to simply see things get worse more slowly under the Democrats than under the Republicans.

  282. SN:

    Er, Scott is the one who is claiming the mantle of pragmatism with the great victory of Obamacare. And thanks to left-cops like yourself, things can only get worse more quickly or more slowly. The fact of the matter is that real waves of reform have come about at times when those pesky social movements and labor movements have been most radical and not at times when people like yourself and Scott set the agenda (and lower the horizons) for the left. You do the Right’s job for them.

  283. SN:

    “Scott said it best and most succinctly when he commented about an unwillingness to hold the uninsured hostage while demanding a system which had no chance of passing congress.”

    This is a consequence of the Democratic party consciously choosing to *not* beat the drum of single-payer from 1993-2009. If you can see past the end of your nose, you will see that the Democrats have no interest in single-payer. The Republicans fight rabidly for guns, and god, and abortion. The Democrats don’t fight. Instead of seeing this as helplessness in the face of forces of nature, recognize it as the political choice that it is.

  284. Scott Lemieux:

    Yeah, hell, let’s just repeal the Clean Air Act and disband the EPA, we’ll never enforce any of the rules anyway.

  285. Scott Lemieux:

    Scott, if something makes actual reform more difficult, it may not improve the status quo

    1)An improvement in the status quo is an improvement in the status quo. 2)The ACA won’t make reform more difficult. 3)The ACA was “real reform.” 4)Anybody who thinks that the ACA failing would make reform more likely in any foreseeable future must have started paying attention to American politics about 3 minutes ago.

    The leftists you despise think several moves ahead in the chess game. You are constantly criticizing things you don’t understand.

    This is just comedy gold. First of all, teleological assumptions that policy outcomes in American politics will just naturally gravitate towards optimal outcomes irrespective of power relations are both pathetically unsophisticated and not remotely left-wing. And telling the uninsured to go fuck themselves because you fantasize about policy outcomes whose implementation would be essentially without precedent in American history are both staggeringly unsophisticated and grotesquely immoral.

    Several moves ahead, Jesus. This is based on theories of politics and American political institutions that wouldn’t pass muster in a civics textbook written for kindergartners. The idea that the crudest heighten-the-contradictions horseshit represents some extraordinarily complex political theory we’re not capable of grasping…wow. Just wow.

  286. Scott Lemieux:

    Raise the green lantern!

  287. Brien Jackson:

    Shorter SN: WHHHHAAAAAAAA!

  288. Dilan Esper:

    Obamacare relies a lot more on states for enforcement, and the statutes you mention don’t impose anything like the individual mandate on ordinary people.

    At any rate, the record of enforcement of those laws in Republican administrations is very bad. Not enforcing laws against insurance companies would be much worse, because the individual mandate tax penalty will still be in place.

    You really fail to understand very basic concepts like counterproductivity and that Republicans will sometimes win elections. This is bad enough but what makes it worse is how you feel superior to the people to your left who actually get these things. The worst combination is to be both smug AND uninformed.

  289. Dilan Esper:

    Scott, there are many examples in history of contradictions being successfully heightened, and many other examples of actual reforms being stalled by elite endorsement of half measures. What you like to assert through sarcasm and name calling (not actual argument) to never happen actually happens all the time.

    Note how you didn’t even respond to the poison pill point.

    You combine being a simpleton with a contentless dismissal of everyone who thinks about more than the next election or the yes or no vote on one bill. That serves the interests of corporate elites and constantly moves the Overton window to the right.

  290. Dilan Esper:

    That wasn’t the main problem with Medicaid. The main problem is that states control it and many of them will always make sure it is a crappy program.

  291. Brien Jackson:

    “Scott, there are many examples in history of contradictions being successfully heightened”

    A fact so obvious that you name…zero.

  292. djangermats:

    Probably ‘a Klansman’

  293. John:

    Are you suggesting that prior to Romneycare, insurance companies and their management were not very wealthy?

  294. John:

    PPACA does a hell of a lot more than the Civil Rights Act of 1957.

  295. John:

    Filibusters in the 110th Congress didn’t matter because Bush was president and none of that stuff was going to become law anyway.

  296. Does Conservative Opposition To Immgration Reform Make Sense? - Lawyers, Guns & Money : Lawyers, Guns & Money:

    [...] can instantly recognize this form of argument, of course, from attacks on the ACA from the left. Arguments against it almost always involved baselines that were (in the context of deciding [...]

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    [...] I’ll grant that the left version of this argument is just as silly and made by people who should know better. The health insurance industry [...]

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