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Tag: "health care"

Lucy Should Probably Wait Until Charlie Starts Running

[ 0 ] August 20, 2009 |

I agree that Kyl and Grassley openly admitting the obvious fact that Republicans will not vote for any Democratic health care proposal seems like a dumb political tactic, which could almost give me a hint of optimism. On the other hand, they may just be thinking that since there aren’t enough votes for a decent bill in the Democtatic caucus either they don’t have much to lose by being honest…


Oh, the Horrors of Socialized Medicine! The Horrors!

[ 1 ] August 19, 2009 |

So horrible it’s nearly Nazi.

I have spent over a month back in my homeland, watching with piqued interest the ongoing travails of the health care debate.  After the 1993-94 debacle (which I give a lecture on in a first year comparative politics class in the UK about how it’s sort of slightly difficult to get anything real accomplished in the American system) my hopes for proper reform are limited.  Cards meet table: I’m well in favor of single-payer, meaning in the current series of watered down proposals, the so called ‘public option’.  
I am getting absolutely pissed off at the ignorance and lies coming from the right about the NHS.  Which is bloody remarkable, seeing as how any of the myriad bills and administration goals working their way through the legislative process don’t come within sight of the suburbs of the NHS.  Of course, I should be calm and expect ignorance and lies from the right — it’s what they’re good at.  I am not at all surprised about the stupid tea-bagging malarky; when the right are not in power they take it as a personal affront and evidence that the USA is heading blindly down some anti-patriotic path of perfidy.  However, this is getting bleeping ridiculous.
This doesn’t surprise me all that much.  In a context where the state assumes responsibility for the health care of its citizenry, anecdotal tales of rationing and bureaucratic malfeasance will abound.  Fortunately, health insurance companies in the United States have no self interest in preventing care for anybody, no self interest in taking into consideration pre-existing conditions, or making it more expensive in terms of percentage of care covered or deductibles, so the status quo as exists in the US is in everybody’s interest.
Yes, the NHS do have to ration care, in a sense.  But then so do private health insurance companies.  The NHS rely on a much-derided (and unfortunately named) quango called N.I.C.E. to determine the cost/benefit analysis of the drugs that they will cover.  But then at least every single prescription in the UK is £7.20, regardless (unless it has gone up in the month I’ve been off the island).  Of course, if you’re under 16, like my daughter, or pregnant, or if you qualify under a number of other conditions, your prescriptions are free.  
There are no bureaucrats between me and my doctor.  I chose my GP, all by my foreign self.  My GP is in private practice — they all are.  She contracts with the NHS for her service.  (This leads to some problems, as with dentistry, as any British subject or resident of that island would immediately understand).  Her office is located in a “surgery” a whole three minute walk from my house.  At least in Plymouth, where I live, this is the norm — GPs are located in residential neighborhoods.
On the two occasions where I or my family have experienced a life-threatening need for the service, it has been provided, immediately and with no questions, no death panels, no profit / loss analysis, no insurance forms, no deductibles, no bureaucracy whatsoever, full stop.  It was just done.  The first instance was when my daughter was born in October 2006.  She was born with a Tracheoesophageal fistula, which was only discovered a few hours after her difficult birth.  Both her and her mother were immediately transported 120 miles north, to Bristol, where the best Children’s hospital in the Westcountry is located.  They stayed there for three months until Imogen was ready to be sent home.  She has to take daily meds for her condition until the age of about five, which (see above) are free.  
The second time was about me, and it was about cancer.  When my GP suspected cancer, there were no waiting lists, no lines, no death panels — again, it was just done, full stop.  I was in the hospital within two weeks for the first of several procedures to work out whether or not it was indeed cancer.  That’s the law, folks, according to my GP with the big C: a two week maximum wait.  (Incidentally, it was, it was very early, and now it’s gone, so it’s no more, but hey, I am the proud owner of a pre-existing condition!  Go me!)
Neither event comes at all close to the characterization of socialized medicine that the wingnuttery are busy producing.  I recognize that as anecdotes, these two stories are of limited value.  Furthermore, the NHS is not perfect.  I understand that had Imogen’s mother received the number of pre-natal scans common in the US, which is a greater number than the three she received in the UK, they may have caught Imogen’s condition between 20 and 25 weeks.  However, I would not trade it for the byzantine US system with its thick layer of corporate looting.  In the last month, I’ve had many discussions here with friends (old and new) and my partner about the logistics of health care and the myriad of plans on offer.  No doubt, as a tenured professor, I’d have a decent plan.  But for a lot / most people, the challenge of sifting through percentage covered / deductibles / etc. is a burden simply to have crappy care.  
And what if we were one of the 50 million uninsured when the daughter was born?
What is remarkable about this is that while the UK spends less per capita on health care than the US (about half I believe, corrections welcome, and while I do give a lecture on this, my notes are in the UK, not Oregon) the outcomes in terms of survival rates etc. are roughly the same (again, IIRC).  Indeed, as Scott points out here the US actually pays a higher % of GDP in public expenditure on health care, and while the UK is underfunded relative to the US, the outcomes are better in the UK on most measures (thanks to the commenter in Scott’s thread who supplied the link to that JAMA article) contra Steyn, but then who are you going to trust, the Journal of the American Medical Association, or Mark Steyn?
Of course, as with the BBC, not all of the British have a stinking clue about what they have in the NHS.  Fortunately, plenty do.  I do pay for this — my taxes are not low in the UK — but if I wanted to augment my care, I could always go private as well.

What’s Worth Voting For

[ 0 ] August 17, 2009 |


Nominally at least that means that health reform is now in a legislative dead zone—there aren’t the votes in the House for a bill without a public option and there aren’t the votes in the Senate for a bill with them. If it comes right down to it and the senate is prepared to pass a bill that:

(a) subjects insurance companies to tough new restrictions,
(b) taxes employers who don’t provide decent health insurance to their employees,
(c) creates a new regulated marketplace in which individuals and small business employees can buy quality health insurance,
(d) expands Medicaid eligibility, and
(e) offers subsidies to ensure the affordability of insurance for middle class families

I have a hard time believing that House liberals will really kill the bill. But maybe they will.

It is certainly possible that a bill without a public option but with these kind of elements could emerge that would be enough of an improvement over the status quo that House progressives probably would and probably should vote for it. But:

  • A lot of the devil is in the details, especially with respect to (a) and (e). A bill with an individual mandate but that doesn’t require companies to supply good insurance and without sufficiently generous subsidies could well make things worse for many middle class working people despite the expense of the program. And the same insurance company lickspittles who are determined to remove the public option are likely to do everything they can to water down the regulatory restrictions on insurance companies too.
  • Consequently, it’s crucial that House progressives maintain the pubic option as a line in the sand, if only for bargaining leverage.
  • I’m not sure what to think about the possibility of adding a public option later on. I wouldn’t say it’s impossible, but I also certainly wouldn’t count on it. If a bill would only be acceptable on balance if a public option was added fairly quickly, I would say it should be rejected.

Points About the Indefensible American Health Care System That Need To Be Made More Often

[ 0 ] August 15, 2009 |


Fun fact the media never tells you: as a % of GDP, the US has greater public expenditures on health care than the UK does. Not total expenditures, we know that. Public expenditures. More big government health care in the US than the UK.

And even the grossly underfunded British system doesn’t seem to produce demonstrably worse results than the American one with it extra-expensive layer of corporate looting.

Palin-LaRouche 2012! Or would that be LaRouche-Palin?

[ 0 ] August 12, 2009 |

Suzy Khimm offers some thoughts on the presence of LaRouchites along the midways of various health care town halls.

The LaRouchies’ logic seems virtually indistinguishable from the current right-wing fear-mongering. “Citizens are receiving Hitler-era ‘reasons’ for why they must accept drastic medical cutbacks, sickness, and death,” LaRouche writes on his site. “For example, you must forego what is called ‘wasteful, excessive treatment,’ during your end-of-life months.” The only difference between their agitations and the far right’s histrionics? Larouchies maintain that Obama and his cronies are in cahoots with HMOs and the insurance industry-and that the real solution to their fascistic agenda is a single-payer plan (which would presumably be rid of its Hitler-inspired leadership, though they don’t go into the details).

I suspect the LaRouchites would argue that once HMOs are abolished and placed on trial for crimes against humanity, their political enablers will join them in the dock — thus turning the American political system over to a new class of leaders who are determined at last to do battle against the English Crown.

Nuance aside, Khimm is obviously correct to point out the crossover between LaRouche and the Soylent Green Right; however, she fails to notice the most obvious (and literal) link in the axis. While Sarah Palin’s views on the Queen of England and her role in the international drug trade are, as yet, undisclosed, LaRouche has been a perennial advocate of a Land Bridge to Nowhere, connecting Asia and the Americas by tunneling under the Bering Strait. LaRouche’s ideas are custom-made for someone like Palin, whose “Drill, Baby, Drill” mantra could be easily adapted to support yet another federally-funded project to benefit a state comprised of independent, freedom-loving people who proudly reject federal funds except when, like, they prefer not to.

Dumber and Dumbest

[ 0 ] August 12, 2009 |

It has to be some sort of landmark in American political discourse when both Lee Siegel and Camille Paglia weigh in on American health care policy. Total combined knowledge of relevant policy area displayed: approaching zero.

Still, tough as the competition is I’d have to say that the Paglia argument is decisively worse. Siegel is at least kind of crazy, making his bad arguments more original, and he does have an actual sensible point about the unwillingness of Dems to raise taxes embedded within the nonsense. Paglia, meanwhile, just re-heats especially stupid talking points (there will be “rationing!” Unlike the current system, where everyone has absolutely unlimited resources!), combined with apparently discovering for the first time that the United States doesn’t have a parliamentary system. I’m reluctant to say that a Paglia argument is embarrassing even by her standards, but…it is.

The Laws of Punditry

[ 0 ] August 5, 2009 |

There’s nothing a winger pundit can do to become discredited. Indeed, if your baldfaced lies help torpedo a major progressive initiative, they’re actually an asset. And, no, the damage can never really be undone.

The Wonders of Free Market Health Insurance

[ 0 ] August 3, 2009 |

Sarah Wildman on the glories of the individual insurance market:

Our six-month-old daughter cost over $22,000.

You’d think, with a number like that, we must have used fertility treatments—but she was conceived naturally. You’d think we went through an adoption agency—but she is a biological child. So surely, we were uninsured.

Nope. Birthing our daughter was so expensive precisely because we were insured, on the individual market. Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy—riddled with holes and exceptions—that the health care reform bills in Congress should try to do away with.


Last fall, the National Women’s Law Center issued a report detailing exactly how women who want to bear children are derailed when searching for out-of-pocket health care. Only 14 states require maternity coverage to be included in insurance sold on the individual market, according to the Kaiser Family Foundation. In contrast, the Pregnancy Discrimination Act of 1978 requires employers with more than 15 employees to include maternity benefits in their health insurance packages. “We looked at 3,500 individual insurance policies and only 12 percent included comprehensive maternity coverage,” said Lisa Codispoti, Senior Advisor at the National Women’s Law Center. Another 20 percent offered a rider that was astronomically expensive or skimpy or both. One charged $1,100 a month; others required a two-year waiting period.

It’s definitely worth clicking through and reading in full. (Or, for those who prefer things in podcast form, she talks about it here.) This is one of the many things that an incremental reform package that keeps the private insurance system in place is going to have to regulate very, very carefully.

The Core

[ 0 ] July 29, 2009 |

Ezra objects to my post arguing that it might be better to reject a bill that sells out too much to the Blue Dogs:

But it’s also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt’s plans, and reformers supported those. It was not in Bill Clinton’s proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured.

I certainly agree with this, as far as it goes. Obviously, the core of the argument for health care reform is universal coverage. And, indeed, there are better ways of achieving this than a public option and employer mandates, although they’re not on the table. My concern is whether or not a compromise bill will, in fact, provide politically sustainable universal coverage, or anything close to it. If Ezra (and Kevin) are right that even compromise legislation will, in fact accomplish a lot, then I agree that it’s worth supporting, and I guess we won’t know until we have actual legislation on the table, and I’m willing to keep an open mind.

Ezra also outlines a criteria we should use to evaluate whether a bill is worth passing:

If reformers cannot pass a strong health-care reform bill now, there is no reason to believe they will be able to do it later. The question is whether the knowledge that the system will not let you solve this problem should prevent you from doing what you can to improve it. Put more sharply, the question should be whether this bill is better or worse than another 19.5 years of the deteriorating status quo.

I agree with this, to a point. Anybody who’s read the many nasty things I’ve had to say about late-period Ralph Nader knows I’m not a heighten-the-contradictions guy. If the proposed bill represents a substantial improvement and is constructed in a way that it will be politically sustainable, I agree that it merits support. However, there also has to be a point in which the two premises start to contradict each other. It’s true that there may not be many more opportunities to pass a good health care reform bill. It is likely, however, that there will be plenty of chances to pass incremental reform that is far too expensive because of the need to buy off vested stakeholders. (The 2003 Medicare expansion, after all, passed with the Democrats holding none of the elected branches, and pretty much fits this description to a T.) If the bill gets bad enough, it’s not clear how much is being risked by trying again, perhaps after mid-term elections likely to be favorable to Senate Dems.

…and, yes, progressives are going to have to use threats if there’s any chance that the bill will be worth supporting. If only conservatives (in both party caucuses) are threatening to torpedo the bill it’s going to be bad.

[X-Posted at TAPPED.]

A Health Care Bill Is Not Necessarily Health Care "Reform"

[ 0 ] July 28, 2009 |

I think it’s pretty obvious that a health care bill with no public option and no employer mandate is worse than no bill at all.

Not the Onion

[ 0 ] July 28, 2009 |

Math is hard!

Health Care Reform Prospects

[ 0 ] July 20, 2009 |

This is certainly right on the merits:

For Gingrich and his allies, the health care debate wasn’t really about health care: it was about destroying the power of a Democratic President.

It’s not surprising that the Republicans have remembered that lesson, but it’s disappointing that the “centrist” Democrats have forgotten it. This bill is make or break for the Democratic Party, and Harry Reid ought to enforce party discipline on the cloture vote. No on cloture should mean no subcommittee chair, no pork, and no money from the DSCC.

Alas, I’m also inclined to think that Benen is right on the politics:

It occurs to me, then, that there’s at least a possibility that “centrist” Democrats — Blue Dogs, New Democrats, Lieberman, et al — might not see failure as such a horrible option here. In other words, they may realize that coming up short on health care, letting this opportunity slip away, and hurting millions of Americans in the process may be devastating for the Democratic majority, but these same “centrist” Democrats may prefer a smaller majority, or perhaps even a GOP majority to “balance” the Democratic president. They may very well disagree with the party’s leadership on most issues, and think the best course of action is taking away their power by undermining the party’s agenda.

It seems odd that these “centrist” Democrats would forget the lessons of 1993 and 1994. But alternatively, are we sure they have forgotten those lessons, or have they learned those lessons all too well?

Alas, I think this is right. It’s not that Blue Dogs don’t know that defeating health care would be a major blow to the Democratic Party, it’s that they don’t care. And while I’d like to think that Reid would apply enough pressure to alter the incentives a little, well, I’d like to think that the Mets could remain competitive while fielding 6 or 7 replacement level players and 1 proven starter, but they’re about equally likely.

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