Not rammed, crammed, jammed and thrust down America’s throat in the dark of night! Nosir!
There are actually 3 approaches to a problem from that view
- We prefer pragmatic government solutions.
- We prefer pragmatic private solutions.
- We’re not interested in pragmatic solutions, we are interested in ideological purity.
The GOP for the most part seems to subscribe to option 3 whereas in the past they were more option 2.
The GOP wants to allow interstate competition and bring about tort reform. My understanding is the research into these 2 programs show they will not reduce medical costs or increase quality of health care to a meaningful degree. Therefore they are not really solutions. What they are is attempts at ideological purity under the guise of solutions. A real solution is one that increases coverage, lowers cost and makes insurance more reliable. The GOP solutions, while ideologically pure, do not do those things as well as the democratic plan. In fact they can make them worse. Interstate competition can make insurance less reliable.
Ending the anti-trust exemption might be an example of 2). And despite the CBO finding their plan inferior to the democratic plan, it does cut the deficit over the next 10 years.
The 1993 health debate had both sides generally wanting health reform. There was agreement on a list of goals that both sides had from what I can tell:
Universal coverage
Reliable insurance
Bending the cost curve to slow medical inflation
Keeping the system solvent
Lowering the long term deficit
The GOP doesn’t seem as interested in most of those things anymore. Interstate competition will attack reliable insurance. Their reforms don’t cut the deficit as much. We will still have 17% not covered in 2019 under the GOP plan. I also don’t know if they ever explained how they’d pay for their plan which again, shows a lack of pragmatism.
According to the CBO this health reform will keep medicare solvent for another 9 years and will reduce the deficit by 1.2 trillion in 20 years. Even if you disagree with the methods, most people should/do agree that keeping medicare solvent and cutting the deficit are laudable goals. However the current GOP seems to lack interest in those things.
Some of their ideas that were pragmatic and good, like sending people undercover to expose waste and fraud in medicare and medicaid, were incorporated into the bill. That is how it should be. You take the best ideas from all sides and work out a compromise since everyone fundamentally has the same goals. However that doesn’t seem to be the case as much. The dems seem interested in pragmatic solutions (both public and private) to serious problems, the GOP seems more interested in using problems as a shock doctrine to pass Friedman economic policy irrelevant of whether it helps or hurts solve problems and in blindly obstructing anything that doesn’t do this.
If the GOP had a list of goals it agreed with the democrats on (reliable insurance, bending the cost curve, lowering the long term deficits, possibly universal coverage) then they would likely support the Obama bill, which has a lot in common with the Lincoln Chafee (R-RI) bill from 1993.
Democrats can and are concerned with ideological purity over pragmatic solutions too. However in the GOP It seems to have risen from a fringe attitude to the official attitude.
Anyway, this is why I like posting here because differences of opinion show me I did overstep and say things that aren’t totally true. It is not true to say the GOP has no interest in pragmatic solutions. However it doesn’t seem to be of primary importance to them. Their health bill covers fewer people, saves less money and they don’t explain how they were going to pay for it. And the biggest aspects of their reform really aren’t shown to work to make health care more reliable or more universal (tort reform and interstate competition). And they don’t seem to really have any concern for the benefits of this health bill that just passed (cutting the deficit, helping to bend the cost curve).
Is this what you were thinking about? It is a piece by Kaiser Health News with more detail here.
The first article says :
- “A mandate that individuals buy insurance, subsidies for the poor to buy insurance and the requirement that insurers offer a standard benefits package and refrain from discriminating based on pre-existing conditions were all in the 1993 GOP bill.”*
Tell that to Bob Packwood.
I am miffed for three reasons.
First, I want universal health care. This plan is crap. It will take ten years to fully implement and still leave about 15 million Americans uninsured. So what’s the point?
Second by passing this and not a decent UHC plan you have no motive to get it right. We will be left with a mess, that needs cleaning up.
Lastly this is simply yet another attempt by Mr Obama to be famous. He doesn’t care about anyone or doing anything right. He wants to be famous. The rock star president. If Mr Obama could’ve been a movie start, and famous that would’ve been fine with him. He only wants to be able so say "I was the first black president. “I was the first president to give health care.”
Social reforms is not a place to try and achieve fame and boost your own ego.
Lastly this victory for Mr Obama, can and most likely will be undone by four years time. Look at the credit card reform. Banks found out and simply lowered everyone’s credit limit or dropped them all together, even if you paid all your bills.
Insurance now has four years to figure out ways around this
How are you gonna feel, when we had a chance to pass a real bill and give health care to all Americans, quickly and cleanly and you realize we didn’t. How are you gonna feel in four years when 15 millions are uninsured and you are paying hire rates for insurance and higher taxes and not getting coverage, 'cause some slick insurance company figured out a creative way of accounting to not pay out.
Politicians have four years to change this law. Everyone says “they can’t repeal it.” They don’t NEED to repeal it, just pass enough laws and have enough judicial rulings to take out any teeth to it.
Listen, I’m not in love with the new law either. I wanted the Public Option. Hell, I wanted Single Payer, but it was never on the table. Late last year, I’d even reconciled that we probably weren’t going to get the Public Option either. Yeah, I was unhappy about it…still am. However, the law that was passed last weekend is a step in the right direction, and one that needed to be taken so, warts and all, I’ll take it and remain optimistic that this is simply a slice of more and larger reforms to be made to the healthcare pie in the coming years/admnistrations.
I believe, because of the ultimately unsustainable nature of even the new healthcare law as relates to costs to the industry and individual insureds, the US will eventually be dragged, probably kicking and screaming, into embracing and enacting full UHC. I am, in fact, convinced of it.
On the bright side, now only 22% of Republicans think Obama wants the terrorists to win.
Its always like that, pretty much. Any progressive action is fought tooth and nail, hammer and tong. We fight like hell, demand everything, settle for less than we want, swear never to ask for anything more, and start committees to ask for more.
Its far too slow, agonizingly slow, but we don’t have to shoot anybody to get our way. That’s a good thing.
A strict constructionist would note that there’s nothing in the Constitution that allows political parties. Therefore, the Democrats are illegal.
Then let these principled opponents make that argument. But if they’re going to insist on spouting off about death panels and communism and “targeting” then we have every reason to view them as unprincipled idiots.
Please, at least quote my name when you address me. When you use the ubiquitous ‘they’ you shift part of the hysterical blame on yourself. Radio talk show hosts and political pundits (from both sides) apparently feel no shame in spouting diarrhea, but every adult in this country should.
For me, it’s pretty basic.
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I would like the government to have as little say in my life as possible because I can manage my life far better than an impersonal bureaucracy. I believe this to be true for the vast majority of people.
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My interactions with big government tend to be negative. They are categorized by massive waste, arbitrariness, and dehumanization.
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I believe that laws and government should be kept to the minimum necessary to maximize freedom.
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I don’t think health care or insurance is a right. I think you have the responsibility to take of yourself without expecting other people to do it for you. I don’t think you can remove that responsibility without decreasing freedom.
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I think this bill attempts to solve the wrong problem. The problem this bill is trying to make inroads against is “Healthcare is very expensive. We need to make a program to make it available to all.” The problem I see is “Why is healthcare so expensive? What can we do to make it less so?” For example, when we take our dogs to the vets we manage to provide a pretty high level of healthcare for our pets at an affordable price. Why do the same goods and services cost so more when applied to people? I think it’s largely because we’ve attached a lot of external costs to those goods and services when we use them for people. First, we use insurance companies. When the person using the goods and services is not paying for them he has no incentive to seek value for the health care dollar (since he’s not spending it.) In fact, he is incented to maximize costs at the point of care as this gives him the most value for his insurance dollar. Add to this all the bells and whistles associated with the healthcare insurance company, it’s costs, it’s profits, its bureaucracy. The provider also needs staff to deal with the insurer. All these extra steps, extra entities, absorb time and money.
Think of healthcare as a blackbox. For your dog, you take him to the vet, the vet provides services and bills you. Your pay for those services goes into the blackbox. The blackbox contains the vets time, his overhead, his need for a profit, and the cost of goods used.
With a human the blackbox contains all that, and all the overhead, need for a profit and cost of the insurance company as well. Because we like to sue, we have the cost of the doctor’s malpractice insurance and a whole other insurance company in there as well. I could go on, but the blackbox of human healthcare contains and supports a lot more items than the blackbox for a dog. A lot of those things aren’t related to your care. Ultimately, it seems to me that this bill increases the size of that blackbox, which necessarily means that our healthcare dollars will be buying less.
Good reform needs to decrease the size of the box, not increase it.
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In few years I will be fined if I don’t have healthcare insurance. At the same time, insurance companies will be forbidden to exclude based on preexisting conditions. The whole reason that I have healthcare insurance now is so that in the event that I come down with something major and catastrophic, I can pay for it. As far as I can tell it seems to be in my best interests to drop my healthcare and pay the small fine. In the event that I come down with cancer or something down the road, I just sign up then. This concept is well-known in the insurance industry as adverse selection. Insurance is impossible if adverse selection is not guarded against. If everybody waits to buy life insurance until they think they are going to die then two things happen: A. A lot of people die unexpectedly without life insurance that they needed and… B. A lot of people buy life insurance right before they die and the insurance company doesn’t take in enough money to pay out the benefits unless it raises rates to an extreme.
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I think the government plays poorly with the private sector and vice versa, creating massive inefficiencies in the marketplace. We need look no further than the recent housing debacle for an example.
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I think the primary motivation for this legislation is not better care, but a government takeover of 20% or so of our economy, and I’m not a socialist.
That’s enough.
This sums up why TRUE universal health insurance works well in countries that have tried it; it eliminates the problem of adverse selection and perverse incentives. And of course, this is not what Obama has signed into law.
For all the blather and nonsense about how Canada’s health care system is wonderful/awful (depends who’s talking) its basic function is to eliminate the problem of adverse selection; everyone pays into one insurance plan. (Okay, it varies from province to province a bit, but you see what I mean.) To an economist, it makes perfect sense. Health insurance is fraught with market failure, so fundamental health insurance is a logical place for government to step in. The way most Western countries do it is a sensible balance between eliminating adverse selection and allowing freedom of choice - when I get health care, I never deal with a government employee.
Obama’s plan doesn’t solve this problem. In fact, I’d argue it misses the point entirely. There’s too much emphasis on “we have to get everyone covered.” Well, yes, but patching existing holes doesn’t address the central problem of adverse selection. In fact, I suspect this legislation is going to be largely unsuccessful.
You and Markxxx both dislike the bill for essentially the same central reason, even though you’re approaching that conclusion from different directions.
[better said, so better not said]
I’m crossing my fingers! But something tells me it will be decades before true UHC is enacted in the US and it will be followed by small steps (like the one just passed) that were taken after an awful fight (again, like this time).
Speaking as someone that isn’t working in the government, but is trying desperately to do the right things and help big issues along and some day get noticed by my compatriots in DC and to be able to use my talents to help more people, I also disagree with that previous statement.
For what reason would Obama, and/or the Democrats as a whole, want a government takeover 20% of our economy? Just to consolidate power?
And if that really is their motivation, wouldn’t there be easier ways of doing it? Seems like it would be much simpler just to ramp up military spending a bit and change the way government contracts are awarded. Much less messy than changing health care.
Exactly. The ultimate goal of Democrats is to expand the power of a government they may have to hand over to their opponents in as little as 2-4 years. Brilliant in its sinister simplicity!
There will be no handover.
Reacharound?