Seconded
I would just like to associate myself with every word of Von’s discussion of the necessary elements of any meaningful health care reform, the elements that are neither necessary nor fatal to health care reform, and why HR 3200 is a horrible, terrible, no good, very bad bill that will accomplish little-to-nothing other than to exacerbate some of the existing problems.
Last week, Michael Drew peppered me with some tough, but fair questions about why I think a flawed bill will do more harm than good even without respect to my general pro-free market bias, in essence suggesting that he thought I was making the perfect the enemy of the good. Von’s post does a better job explaining why HR 3200 is not only imperfect, but actively worse than the status quo than I ever could.
Von is certainly a thoughtful conservative voice. One of the purely political problems with reforming health care is that many people don’t want significant changes to their coverage even if they acknowledge the problems with the system. So health reform in 2009 means trying to do a major overhaul without changing to much. Talk about threading a needle. This is sort of like fixing a car while still driving while giving several cranky mechanics complete veto power over success.
Yes strengthening the tie of employment to health care is bad. But the hope is , and the pants wetting fear in the Repub party, once we have universal coverage that will never be taken away. That is a positive.
Bending the cost curve that means less money for people who presently make a lot of money. Well now, coming out and saying that is …um…bad for a health plan. So concessions have been made to get support from the various stakeholders. Is that bad? Mostly, but what is the choice. No health plan will pass if the various corporate interests fight to much. Is that bad? Yes. People have already played the tens of thousands will die from some unmeasurable, theoretical lack of pharma innovation if big pharma loses any of its vast profits. Critics who want to push another plan need to realistically judge if their plan could pass with no repub support, since that is the reality.
Any reform we get now will be a work in progress.Report
I totally agree with you that this is “threading a needle.” And the political problem of overcoming resistance to change in existing coverage is, methinks, a near-absolute bar to the passage of Wyden-Bennett in the current political climate.
I also understand the justification of creating an irreversible step towards universal and/or single payer coverage. I’m kind of ambivalent at this point about the value of a single payer system, and I think universality is an important and worthwhile goal on its own, but it’s increasingly clear to me that HR 3200 won’t get us even to universality (and if it does, it will do so at an unacceptably high cost), and once we get some kind of “reform,” I think the public is going to have very little stomach for more reform down the road. So I tend to think that if there is going to be meaningful reform of our health care system within my lifetime, it is going to have to be done all (or at least mostly) at once rather than incrementally.Report
I just wanted to hear the explicit case that it was worse than doing nothing. It’s not that I ever thought I could persuade you that this is good legislation given your outlook, which is entirely legitimate. I assumed there were good arguments to be made for that view, but I thought what you were offering was somewhat circular. It was all about the importance of decoupling last week, and when asked why what was on the table was worse than nothing if one assumed decoupling was off the table, the answer still came back around to the bill not decoupling. But I always assumed the arguments were there — and Von gives good ones.
And in fact in the intervening week my view of the legislation has taken a fairly steep dive itself, and not even just because it seems to be getting worse by the minute.Report
I assumed there were good argument for the negative view of the legislation, is what I meant above. In point of fact I have also been assuming there are good arguments for the view that it is better than nothing, but am beginning to get discouraged of that.Report
Yeah- I didn’t do the best job explaining my position on that, which is why you were right to challenge me (I tried to acknowledge this, but I’m not sure that I was clear on that either). Von’s explanation is 1000 times better than mine, which is why I thought it important to link.Report
You were more than solicitous of my prodding, and I thought so the whole time, even though it definitely didn’t really come through. Because even if you do define any reform that does not decouple insurance and empoyment as worse than the status quo, that would be an entirely legitimate if debatable view. I was just trying to get a fix on the argument — if that was it or not. I actually wasn’t meaning to challenge your view, because I you’re pretty much compelled to it by your broader viewpoint, but rather I simply wanted to be familiar with a good version of the argument. And Von has nicely provided me (us) with that.Report
Oh, I thought your questions were great and your persistence was totally warranted. In fact, I’d go so far as to thank you for keeping up with the questions, because they helped me think things through a lot more.
But I was not happy with the quality of the answers I was able to provide. I knew you wanted a good version of the argument; I just felt like I wasn’t doing an altogether great job of giving that version.Report
I would still say some mediocre reform is better then none. If absolutely nothing passes this year, which I rather unlikely, next year is an election year. Election years are traditionally harder to pass major bills. And the anti-reform crowd will feel even more powerful and energized to keep killing reform.
That said, this is a down lull in the process, but there will be a few more innings and we still have a chance for a last second field goal, or something like that. Whatever the senate finance oozes out will get worked over. The way this is working it appears until we get to conference committee it will be all up in the air. It appears the Big O is going threaten to turn the Kenyan mafia on the conference committees to get a better result then we are seeing.Report
I suppose it depends on how you weigh the costs and benefits of the mediocre reform. For me, I think the mediocre reform will do more harm than good, but then again, I probably have a slightly different set of priorities on healthcare reform.Report
There is no doubt that at the end of the day, we reformers are going to have a tough time justifying the final product. Fresh Air today today is I think highly recommended listening. Terry Gross talks simultaneously with Krugman and a more libertarian-minded economist about all this. I caught the end; I’m going to check out the rest. In the part I heard, Krugman is reduced to essentially just flat-out saying that any expansion of coverage (the implication being at almost any price and in the absence of any other necessary reform) at this time is better than nothing. It’s about the weakest defense possible (and the bill doesn’t yet even suck as much yet as it’s going to), even if ultimately I’m just barely inclined to agree with it.
Btw, Mark — perhaps E.D. has mentioned that I’ve been discussing with him the possibility of at some point finding a knowledgeable writer/analyst (an example of my own non-qualification for the job: I just late last week realized that for all Obama’s bluster in the campaign, there in fact is an individual mandate in the House bill) that would provide a nominal defense of the final legislation to be posted for consideration (read: dismantlement) here at the League, if only just to have it on record as a reference. Of course any thoughts you might have about that idea would be very valuable, even if at this point my own motivation to find that writer/piece is flagging considerably.Report
Hmmm….well we are the League of Ordinary Gentlemen, not Expert Gentlemen! That said, I’ll look around to see if I can find some others that may be interested.Report
Actually, that was the substance of my proposal to E.D. (and I ought to have dialed you in — it’s just that E.D. and I had corresponded once before). That is, if you guys are interested in such a thing appearing on the site, then I’d be quite interested in doing some legwork to see if I could find someone to pen something that would provide a provisional answer to the inevitable question, “What in the HE*L were they thinking???” — maybe even something that would respond to some of the main criticisms, so that it’s not a completely pointless exercise. The reason I thought it might be good to get something original for the League is that you guys and the commenters can post links all day long — that’s kind of old hat and doesn’t really add any extra value IMHO.
But if you like the idea and want to do some digging yourself, that’s great. My rolodex is probably not going to be up to the job in any case.Report
…the main criticisms voiced here at the League to be precise — which parenthetically was a reason I was so interested in the the full breadth of the specifics of the case you personally would make or endorse against the pending legislation last week. (“Ah-ha, it all becomes clear…” says Mark, seeing the sheepish grin on Mike’s face.)Report
There is nothing good about the healthcare bill as it is written now. The costs alone will finish bankrupting our once great nation. The fact that Nancy Pelosi can announce that she has enough votes to pass a healthcare bill, when the bill is not even complete just goes to show that it is more about passing a Socialist Democrat law than to actually pass something that will help instead of bankrupting the country.
Bill
http://theconservativenation.comReport
How much of health care, like any kind of wealth, is measured (measured by the individual, I mean) relationally?
That is to say, Treatment X is seen in light of Treatment Y, Treatment Z, Treatment Aleph, and so on. When Joe Patient gets Treatment X for his ailment and he knows that Treatment X is the cutting edge of treatments, he feels pretty good about stuff… but let him find out that there’s a Treatment Z that Dean Martin can afford but he can’t (but he can afford Treatment X) and it becomes an issue of wickedness, and society not caring, and people being “denied treatments” and what have you.
A friend of mine was reading the James Bond books and he told me about a scene that gave him a wry grin: Fleming was describing Bond’s apartment and specifically mentioned the 27″ television.
Back at the time the book was published, this was intended to make the reader know that Bond was ballin’ hard like a baller would. Reading it now, without context, you think about how that’s the television that gramma has… no, wait… she has a 29″ television.
Let me bring this back to health care: I wonder if much of the calls for “health care” could be met, like, *TODAY* with something like “Grade B Health Care”. Stuff that was really good, Project X stuff, back in the 80’s and 90’s.
If we wanted to give everyone in America a 50″ plasma television set (remember, a few years ago, when those were the biggest and the best?) we wouldn’t be able to. We couldn’t come close… but if we wanted to make sure that everybody who didn’t have a better television would get a 27″ crt… that’s something we might be able to pull off.
If we did, though, would the fact that there would be people out there with 65″ LCDs (or 73″ DLPs!) make a mockery of making sure that everyone had a television?
Do you see what I mean?Report
Totally. But doesn’t that kind of give the lie (or at least tend toward doing so) to those who warn that in a system where the government exerts some pressure to limit treatment of the very cutting-edge variety that you’re questioning here, we’ll be living in a country that provides less than the best care, when before such as system, at least a person could get the cutting edge for himself if he was able to pay for it (or had a plan that would)? In other words, doesn’t your very excellent point cut in a direction that you don’t want it to (or at least such was my impression of your leanings)?Report
If the government exerts some pressure to limit treatment of the cutting edge (bleeding edge!) tech, it’ll probably create a black market. That’s what usually happens when the government tells enough people that they can’t buy something that is out there.
I also suspect that the bleeding edge stuff is not something that the government can legislate into existence… but it’s certainly something that they can legislate out of existence. We’ll see if “universal health care” does the latter.
Which comes back to the question of whether the US is responsible for a disproportionate amount of the bleeding edge stuff in the world. If it is, and I suspect it is, then we will see a great levelling. I suspect that this will result in people being happier as there won’t be anything that Stephen Stills can afford that isn’t available to schlubs like you. I don’t see “happiness” as an end in itself, however. For everyone in America to be able to afford an iPhone (we’re getting there!), we had to go through a period where only doctors and lawyers had carphones. It was certainly unfair that only the rich, like Harrison Ford in The Fugitive, could afford a phone in their car… in 1992. Now, everyone who wants a phone in their pocket can have one (Safeway is selling them out of a cardboard display for a pittance).
MRI tech seems to have followed a similar trajectory.
I worry that new legislation will strangle the offshoots of tomorrow’s bleeding edge stuff in the proverbial cradle.Report
I don’t think anything much is going to change on the front you are concerned about: the rich are the ones who can get that stuff now, and they will be under most scenarios. I don’t see the government planning on legislating out of existence rich people’s right to the very best medicine. But eventually that stuff will be denied to the moderately well-off, whether by the government or by private insurance. (It seems to me.)Report
They can get that stuff because it’s available.
Legislation won’t prevent them from buying it. It’ll just prevent it from being discovered/created and thus from becoming available for them to buy.Report
It will? Tell me more.Report
What percentage of cutting edge/bleeding edge medical treatment is discovered/created by countries that are not the US?
That percentage will go up considerably once the US installs Universal Health Care.Report
Why?Report
I’m extrapolating here:
The US is responsible for a larger chunk of R&D than its relative size would indicate. This is due, in part, to the form of health care that we have. If we moved to a more Swiss/Finnish model of Health Care, we would be responsible for a more Swiss/Finnish percentage of cutting/bleeding edge new technology.
Since our percentage of what we discover would go down (I suspect considerably), everyone else’s percentages would go up.
Without, of course, any increase of output.Report
I assume you mean “Swedish,” not “Swiss,” since the Swiss model is generally viewed as approximately as market-based as our existing system.Report
All you white people look alike to me.Report
I don’t think this is the point you want to make but there is an element of truth. Many of us see other countries that are similar to us in wealth, tech., and many aspects of lifestyle. They have something really cool and shiny that we would like to get here: Universal health care.Report
It seems to me that “universal health care”, as it works in practice, gives everybody (in that other country) a 27″ television… and if someone needs a bigger one, they come to the US to buy one.
They have a two-tiered system. We’re the second tier.Report
great, everybody having a basic level of tv is far more human than some people not being able to watch Big Brother.Report
And we can now jump into the whole “stuff white people like” issue of people who have the option of having a television but don’t anyway (even Obama himself said that a huge chunk of the uninsured were young folk who were taking a risk but would be otherwise easy to insure).
There is the unpleasant question of the percentage of folks (my research says 20%) who might not exactly be able to produce their citizenship papers to the right and proper authorities when asked and what effect they may have on health care costs (and, thus, insurance costs). How many televisions should they get? Are they entitled to satellite so they can also get Univision?
Wow, I also just read this: “Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more.1 A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.”
When a household making 50k a year can’t afford health care insurance, I’m beginning to wonder if regulatory capture isn’t the culprit (barriers to entry, etc) rather than the solution.
We’ll find out, I guess.Report
This is an absolutely unloaded question with no agenda open to all comers: How much should health insurance cost. Answer in any terms you feel are appropriate.Report
I’d compare to auto warranties. The Platinum Level covers absolutely anything and everything and even pays for oil changes for the first 3 years. The Gold Level covers everything except wires and windshields. The Bronze Level covers the engine and transmission. The Lead Level covers only catastrophic failure (the engine falling off).
The Platinum Level is expensive to the point where you’d be better off buying the Gold and paying for your own oil changes, however.Report
Well its not exactly news that health care costs have been rising far faster then inflation for a while. I think almost 11%. So it has been obvious something had to be done about health care for years.
Wow health care is really expensive. who woulda thunk it. wow people can’t afford it?????huh???? gee I wonder why insurance companies don’t want to insure people? That just can’t be.
Yes it is accepted that a chunk of the uninsured are young people who are taking a risk. So? And another chunk are people with preexisting conditions who can’t get insurance because they might use their insurance.Report
I’m one of those people who point out the increased government meddling, the increased cartelization, the increased regulation, then point to the increased costs and say “it’s an iatrogenic disease”.
Of course the costs keep going up.
Of course they will. But, you know what? Universal Health Care will not result in costs going down.
And it won’t be because the Republicans screwed everything up.Report
http://meganmcardle.theatlantic.com/archives/2009/07/a_long_long_post_about_my_reas.php
This post of Megan McArdle’s is worth exploring.
Freddie commented already… I think other gents will find meat in there.Report