Should Democrats pass the healthcare reform bill?


Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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89 Responses

  1. Avatar Jaybird says:

    That’s sort of like

    Don’t leave me hanging, bro.Report

  2. Avatar Scott says:


    I thought reconciliation was a procedure for budget bills, which the HCR is not. Clearly now the ends justify the means if the Dems don’t have the party discipline or can’t buy the votes?Report

    • Avatar North says:

      Scott, you are misinformed informed about the Senate rules. The HCR bill, in case you missed it, has already been passed by the senate by a party line vote. If the House were to pass the same bill then HCR would be on the Presidents desk faster than you can say “legacy”.
      Reconciliation is being brought up only as an option to modify the budgetary portions of the Senate bill to make it more palatable to the House so they will pass it. Modifying bills by reconciliation is not uncommon and has been done extensively in the past decade or so as the filibuster has gone from the exception to the rule.
      Using reconciliation to amend the bill would be neither shady nor unscrupulous no matter how much the republicans may howl. Brown’s election definitely knocked the wind out of HCR politically and visually but in terms of substantive law he was elected roughly a month too late to actually ~block~ the HCR bill.Report

      • Avatar Scott says:

        You failed to mention that the House apparently lacks the votes to pass the Senate version of the bill as it is not liberal enough for them. Even Sen Byrd didn’t believe that reconciliation was appropriate for a HCR bill when it was suggested for Clinton’s HCR so I doubt things have changed that much in terms of its applicability.Report

        • Avatar North says:

          The liberal canard is nonsense. The liberal defections can likely be whipped back into voting yea and may well fall into line on their own if they realized that it’s pretty much this or nothing. I would suggest checking out Nate Silvers’ analysis of the House layout for moving HRC forward. It is on the right side of the Dem causus that the opposition, either the principled (mostly abortion based) or unprincipled (idiotic re-election jitters and cowardice based) lies.Report

          • Avatar Scott says:

            I suggest you contact Nancy and offer your services to crack the whip on those liberal members. She has publicly stated that the votes are not there for the current Senate plan but I guess you know better.Report

            • Avatar North says:

              I suggest you read my post again. The votes aren’t there at the moment but the dissident democrats are primarily on the right, not the left of their caucus. Characterizing the house opposition as being due to the Senate bill being insufficiently liberal is facile. The lion’s shares of naysayers are either objecting to the Senates less stringent wording on abortion or are running scared because they’re blue dogs in endangered runnings.Report

          • Avatar Koz says:

            ….either the principled (mostly abortion based) or unprincipled (idiotic re-election jitters and cowardice based)….

            What part of the reelection jitters are idiotic? Or did you just mean that rhetorically?Report

            • Avatar North says:

              No not rhetorically. As a practical matter the people who are worrying about this are too late. They are already on the record for voting for HCR in either the Senate or the House form. That the HCR fails would merely make them “Supporters of HCR that was so bad even the Dems ran away from it.” instead of “Supporters of the historic HCR legislation that does this and this and this and it turns out doesn’t do this and this that the republicans said it would do”. Killing HCR will not make the Republicans go easy on them so running away from it now would be idiotic. It would be an essential acquiescence to the republican mischaracterizations. From a purely political and electoral perspective voting HCR in makes far more sense.Report

              • Avatar Koz says:

                “Killing HCR will not make the Republicans go easy on them so running away from it now would be idiotic.”

                Of course not but I think you’re giving us credit for power we don’t have. The D’s in Congress have a lot more to fear from their constituents than from us. And the message from their constituents is unambiguous and has been heard. If the D’s push this through anyway, that crosses the Rubicon of (lower-case) republican accountability that won’t be good for the country.Report

              • Avatar North says:

                If the Dems bought the Republican line that the bill is genuinely a bad piece of legislation then of course passing it would be crazy. Why bother? But since they don’t and believe that the bill is a constructive piece of legislation that will eventually be valued by their constituent’s then yes, passing it is a fine idea. Since the bill is quite centrist (though admittedly porky and unattractive) and could have doubled for the Republican one in 1994 for instance I don’t think that they’re incorrect in thinking that it would be a good idea to pass it. Failing to pass it would be a tacit admission that all the Republican mongering was true.

                Nor are the Dems obligated to govern with their finger to the polls every week or two. They’re elected for specific terms. Last I checked Clinton was roundly criticized from the right for such triangulating during his term and Bush minor certainly paid the polls no mind during his reign and for that matter the polls are not as uniformly opposed to HCR as the right likes to pretend.Report

  3. Avatar North says:

    I’m glad you picked up on this post E.D. but I think you have missed or left off the most important point that Bernstein makes:
    “Really, it comes down to this: if Democrats truly believe that their plan will be deservedly unpopular if passed — that people will hate the individual mandate more than they like the benefits it brings — then they should back off. Not because of how it will be portrayed, but because of what the program actually does. If, however, Democrats believe that once passed health care reform will rapidly become part of the scenery, the way that Social Security and Medicare have become, then it’s not even a close case; the best political course for them is to pass the bill. ”

    I don’t think I’m quite as pessimistic as you though I would agree that this lies almost entirely in Obama’s hands. If he jumps on this with both feet he has all the resources he needs to work HCR through; he has a Senate leader willing to try and add some sweeteners (improvements) to the Senate bill via reconciliation; he has a House leader who has been working the trenches ever since Brown to keep the bill alive and who is clearly ready to whip her votes if she thinks that her colleagues have her back; he has (in theory at least) a bill that should be a lot more popular once it’s enacted than it is now. The President is wearing it either way. Either it’s a good bill that’s been unfairly maligned in which case he’ll be a pure idiot for scrapping it at this stage or it’s a bad bill and the public will hate it in which case he’s an absolute fool for allowing it to turn out like it did in the first place. Obama needs to man up and decide what he’s going to do.Report

  4. Avatar zic says:


    A few weeks of hammering home what’s in a bill — not multiple bills — first.

    There’s been so much misinformation, some real information that lines up with reality after the bill becomes law would be nice.

    I think most folks are going to like being able to keep their insurance even if they get sick. That’s not a guaranteed thing now — that you insurance will actually do what it’s supposed to do.

    And for the many who haven’t been able to get insurance or have been stuck in a crappy job for insurance, it will be a relief.

    So Yes. It’s been a Democratic goal for many dozens of years. Generations of political life.Report

    • Avatar North says:

      Well the goal is within reach, you’d think the party would behave like it was.Report

    • Avatar Koz says:

      “There’s been so much misinformation, some real information that lines up with reality after the bill becomes law would be nice.”

      If so that’s your own fault. Your team has been running misdirection plays and other hide-the-ball games for the better part of a year.Report

      • Avatar zic says:

        Yup. Couldn’t agree more. While Dems have waited for some indication of what a Republican, any Republican, might get behind, they’ve sat on their hands when they should be communicating.

        ‘Course outright lies from your side haven’t helped, either. It’s not like this is serious business, important to people’s lives or anything, is it?

        And there’s that ohh-so-liberal media, that’s handicapped this like a horse race instead of done their homework to help inform people; making a game out of politics.

        Have you ever tried to go out and buy insurance on your own? To shop for the best price on a medical procedure? I have, as both a consumer and as a reporter (reformed, I might add). It’s easier to figure out what’s in this bill, believe it or not.

        But I’m sure tort reform and selling insurance across state lines will take care of all of that, won’t it?Report

        • Avatar North says:

          Bitterness isn’t going to change things alas. President Hope’n Change pretty much offered his ass for the kick. The Republicans sure gave him a thumping there but honestly, he did kindof ask for it. Politics really ain’t beanbag. The question is whether he’s going to learn his lesson or whether it’ll take another kick.Report

  5. Avatar Jaybird says:

    In my yute, I would have been a big fan of “the worse, the better!” and hoped for a statist takeover of the health care industry and then when everything collapsed, we could have a glorious revolution rise from the ashes of the old order.

    Now… well. I just ask “will this create more supply?”

    Since I’ve come to the conclusion that it will not create more supply, I’m of the opinion that, at best, it won’t change anything. The best case scenario isn’t even remotely likely, however… which means that it’s most likely going to make things worse.

    Without even getting into the underlying principles.

    But I repeat myself.Report

    • Avatar North says:

      Well sure Jay, but if the Dems thought as you did the thing wouldn’t have been proposed in the first place.

      Goodness knows they could use more libertarians in the party though.Report

      • Avatar Jaybird says:

        I’m not even asking people to believe as I do. I’m not as into that as when I was younger.

        I’m just asking them if they agree with the following:

        1) Price is a function of supply and demand
        2) If the rate of supply grows more quickly than the rate of demand, prices will tend to go down
        3) If the rate of demand grows more quickly than the rate of supply, prices will tend to go up

        I just want them to agree with that. If I can get them to agree with those (I think that they’re pretty uncontroversial!!!) premises, then we can argue about what the government ought to be doing.

        But they aren’t doing even that. They’re just waving around pieces of paper and screaming “HEALTH CARE IN OUR TIME!” as if good intentions and prayers are the equal of health care providers.

        They’re Christian Scientists only with better press.Report

        • Avatar greginak says:

          Some of think the health care market is a bit more complex then the simple supply and demand scenario you present. In fact ECON 101 tends not to describe the intricacies of complex situations all that well.Report

        • Avatar Koz says:

          “I just want them to agree with that. If I can get them to agree with those (I think that they’re pretty uncontroversial!!!) premises, then we can argue about what the government ought to be doing.”

          It should be uncontroversial, but I can promise you it’s not.Report

        • Avatar 62across says:

          Can I agree with all 3 of these premises and still not think they are terribly relevant to the health care debate?

          I don’t argue with the need to increase supply or that increased supply can lead to a decrease in price. But, we should be clear what supply we are talking about here. I’m fairly certain you are not arguing there is a lack of supply of health insurance. The supply shortfall is in the number of healthcare providers and medicines. I’d applaud any efforts to increase the number of healthcare providers or the inventory of medicine and this bill doesn’t do anything for that.

          On the other hand, I would contend demand does not work anything like Econ 101 for healthcare. One doesn’t see a shiny new artificial heart in the showroom and just have to have one. The Plavix commercials on TV don’t make me want to induce a heart attack so I can get in on that great product. Instead, healthcare demand comes from when healthcare is needed. And since when healthcare will be needed is not foreseeable that is where the insurance comes back in. There is amply supply, but the insurance companies’ current business model is built on creating barriers to coverage to control for risk. The mandates combined with the recision regulations will go a great way toward mitigating the problems on the demand side.

          That is no small thing.Report

          • Avatar zic says:

            I’d argue there are a number of problems, starting with price obscurity, and that’s a national problem. And price obscurity has two components; first, most folks with employer-provided insurance don’t have a clue, beyond their part of the premium, how much the insurance costs (and how much untaxed income they’re getting, by the way.) Then there’s the obscurity for the price of a procedure or test; typically not determined until the provider figures out who’s paying. And the uninsured get the highest rate.

            Other problems are regional.

            In some areas, it’s a lack of providers. (How can you tell the tooth brush was invented in Maine? Otherwise, they’d call it a teethbrush. And yes, Maine has a shortage of dentists.)

            In some places, it’s too many specialized providers.

            Some places have uncompetitive insurance markets. Others have unregulated insurance, and take your premiums right up to the time you get sick, then dump you like last week’s boyfriend.

            And in some places, the insurance market isn’t open, but controlled by brokers. Everything about the market depends on finding a broker who take the time to search out what insurers will offer you.

            But perhaps the biggest issue is state’s rights. Currently, health insurance regulation is a patchwork of 50+ regulatory environments, and we’re trying to cut a one-size-fits-all piece of legislation that encompasses all those different programs.Report

          • Avatar Jaybird says:

            62across, this has been bugging me and I think I’ve finally figured out why.

            My assumption about the whole price relationship to supply/demand is that it’s akin to a law of physics. So when you say that you don’t consider it relevant, it strikes me as the fundamental problem that will poison everything else that follows if it is not addressed first.

            Since we agree on those three (pretty uncontroversial!!!) premises, I’d then move on to the issue of how people can no longer afford health care… and say that this is a price signal.

            The signal is that the rate of demand is increasing at a rate much faster than the rate of supply is increasing.

            Now to the meat of your post:

            Yes, I don’t mean “coverage”. Coverage is a piece of paper. It’s a social construct. It’s a “positive right”. It is not, however, the thing that one receives from a doctor… which is health care.

            I’d applaud any efforts to increase the number of healthcare providers or the inventory of medicine and this bill doesn’t do anything for that.

            As such, I’d say that this bill does not do anything to address the “supply” issue… so I’m hoping it does something when it comes to “demand”.

            When you say that demand for health care doesn’t work the way it works in textbooks, I’d say that even if it isn’t like demand for an Alpha Black Lotus, it’s still close enough to be able to have a relationship with supply that will affect price.

            Which, as has been pointed out, is going up.

            Here’s where I’m going to say something controversial: Health Care Coverage is “demand”.

            By increasing “Health Care Coverage” without increasing supply (something we’ve already defined as “Doctors” and “Medication”), this will cause the price to go up even more.

            This will make the problem worse. You say “There is amply supply, but the insurance companies’ current business model is built on creating barriers to coverage to control for risk.”

            I don’t see the supply as ample. We are not dealing with doctors who are sitting around twiddling their thumbs due to being tied down by insurance companies (would that we were!). Everything that I’ve seen tells me that doctors are run ragged, nurses are run ragged, all the way up to specialists are being run ragged. They don’t have enough free time to be tied down by insurance companies.

            What we have is a supply/demand problem and the government, in response to the price going up, is doing the only thing that governments ever tend to do in this situation: they’re increasing demand even more.Report

            • Avatar greginak says:

              Jay- I noticed this tendency to view ECON 101/supply and demand as immutable laws of physics a while ago. It made it much easier to see why there is a failure of communication. I just don’t see ECON as physics. Frankly I doubt many economists do, they usually know better then that.

              Not to re-re-re-hash this debate, but what isn’t mentioned in the way you present the health care market is that many people are money losers for insurance companies. They don’t want to insure people with significant health care problems because it costs to much. One major surgery or illness will cost the insurance company far more they will get back from the client in 10 years or in some cases they never will make that money back. The only way most people with big money conditions get health care it that they are in pools with other people. Talk about supply and demand all you want, but a solution to pre-existing conditions clauses/recission/ the uninsured has to address how to make it work for insurance companies to cover people who are expensive.Report

              • Avatar Kyle says:

                “only way…” surely not.

                It would be more accurate to describe it as one method there’s a fair consensus around that would work.

                That said, I find this a bit unfair greg. Jay was talking about where the costs come from and how a solution, which implicitly includes all you accuse him of not addressing, will make those costs go up and not down.

                You said he wasn’t addressing the idea that a solution needed to address people who aren’t covered by the market because they’re money-losing patients. (a concept well-addressed in economics, so I don’t see how it fails in this case) But he totally does when he talks about expanding coverage is tantamount to expanding demand.

                Which then opens a new set of problems that are ill-addressed by either your response or the legislation at hand. Namely, that we can’t expand coverage, without expanding demand for medical services and medicine.

                The system is already overtaxed so expanding demand will raise prices, which would act as a signal that more people should enter the field and more suppliers should produce more medicine, which will then lower the costs somewhat and form an equilibrium. So if we do nothing, prices will go up.

                However, if we cap payments to lower costs or slow the growth rate of costs, fewer people will choose to be medical professionals and suppliers will have less incentive to produce medicines, thereby limiting increases in supply. Then we get the medical equivalent of 1970’s gas rationing.

                62across is saying that because health doesn’t operate like market goods with price elasticity it’s somehow immune to economics. Which isn’t true, plumbers aren’t immune to economics because you only call them when you have a plumbing issue. It’s the same with lawyers, it’s not like discounted legal fees create an upsurge in demand for legal services. In both professions, costs are useful signals for increasing the labor supply. That’s what Jay was addressing.Report

              • Avatar Jaybird says:

                Greg, there are important things in here that need to be addressed.

                many people are money losers for insurance companies.

                Would you agree that “insurance” may be the wrong word for these people? It’s like saying “lunch insurance” when you know that you are going to be eating lunch every day. At some point it might be addressed that what “insurance” is giving you is the same thing that you might buy on your own plus the cost of overhead.

                The people who are “money losers” are people who need more health care than they can afford to buy and thus need a subsidy from everybody else.

                If we stop calling it “insurance” and start calling it a “subsidy”, does that change things?

                Another (admittedly heartless) question is this: Is there an upper limit to how much I (and you, and that guy over there) are obliged to pay to subsidize someone else? Is there a limit at all?

                Is the answer “there is no limit, the only limit is given by the death of the person who needs health care, anything else is something that we are obliged to give him”? (Which is, of course, a different kind of heartless answer.)

                If we agree that, no, of course… there is an upper limit of what we are obliged to pay for… that’s yet another kind of heartless answer. (A joke that won me no friends a few years back during the Schiavo incident: “Republicans have finally found someone they are willing to provide universal healthcare to no matter the cost”)

                Talk about supply and demand all you want, but a solution to pre-existing conditions clauses/recission/ the uninsured has to address how to make it work for insurance companies to cover people who are expensive.

                Show me a problem for which any insurance company that covers it will go bankrupt, I’ll show you a problem that no insurance company will cover (maybe I’ll even show you a handful of insurance companies that went out of business along the way).

                How much is a human life worth, Greg?Report

              • Avatar greginak says:

                How much is a human life worth? Depends yours or mine.
                Well of course there should be limits to how much we or anybody will have to pay. So what. There are always limits to what can be done, but that doesn’t mean you don’t do anything.

                Insurance or subsidy. Tomato or tamatoe. The usage of the words is a distraction. We call it health insurance when we really mean more then insurance so what. The word is used imprecisely but I don’t see how it changes the debate.

                Many of us see it as a problem that a large group people can’t get insurance in our current system. Some form of subsidy or national care plan is the way to solve that. The point of a mandate in the current version of HCR is to keep the insurance companies viable since they have to cover money loser type of people. Of course then people on the right and left scream about how the insurance companies are making out. Of course if there was a plan that hurt the insurance companies then people would scream about putting the companies out of business or people who have insurance don’t want theirs changed. If the insurance companies are doing fine then that is a problem and if they aren’t fine then that is a problem. It seems like the goal is to just argue for not doing anything.Report

              • Avatar Jaybird says:

                It seems like the goal is to just argue for not doing anything.

                I’m pretty sure that you didn’t mean to but this is one of the things that drives me absolutely screechy. You are attributing intent to me, bad moral intent, despite things that I have said.

                It’s the equivalent of me saying “it seems like the goal is for your chosen overlords to make me a slave.”

                Please don’t do that.

                I can provide yet another link to my theory of stuff that will make the level of health care in America better. Here we go. Why not?


                There. I have offered a solution. I believe that this solution will make things better.

                I can appreciate that you want to make things better.

                From my premises, you are only going to make things worse.

                For what it’s worth, I don’t think that this is a goal of yours.Report

              • Avatar greginak says:

                FWIW I don’t think I am attributing moral intent in what I said.

                I have been in a lot of these discussions with various people that start off as discussing one issue. Lets say its how much can be learned from looking at other countries health systems. The other party says something very reasonable like “we can’t just scale up the Netherlands health plan.” Very true. So then I say something about how we can try this or that. Then I hear “ well the cultures are different”. Yes very true. But then I say something like we can tell that other countries have some measurable good outcomes so we can certainly learn something and they say something like “ well I don’t believe that “ or “I haven’t seen that “ or “no America has the best health care in the world.” Then I quote stats on something like infant mortality and then I’m told “ well no America has the best health care” or some non sequitur. By this time I’m wondering, as you put in often, what are we really talking about? After a while I just started to ask people, well what do you think we should do? What problems do you see? And I started to find that a lot of people were just against HCR in general or at least any plan that was likely to get more then a handful of votes. And then there were the OMG death panel, or this or that concern.

                So what I started to see after a while, was that many of the objections I was told were more like bullet points from a “why HCR is bad” list , then part of a dialogue about where we should go. If people don’t want HCR then fine. There are a set of “moral” and fiscal issues that go along with not doing anything. Well own them.

                I thought I was involved in a process of debate aiming at understanding something better. That’s my own bias. It seems like a lot of people I’ve talked to were just ripping off reasons why they don’t like HCR and we not interested in an exchange of ideas. They are completely entitled to their style of debate/thought , just like I am. If somebody else just want to repeat what Rush told them that’s their deal. I may not think much of the thought process, but that’s my business. But that is not a moral judgment.

                But I do not think I, in any way, that I know your morality. I assume people are moral as they understand it. I don’t think most people who are against HCR are immoral. I’m guessing there is certainly a strong sub-set who really truly don’t give a crap about anybody but themselves. They are free to have that thought and advocate it and I am free to think that is less then moral. But I think most people against HCR don’t think it will work or make things worse but still don’t want uninsured people to die.Report

              • Avatar Jaybird says:

                Well, please understand me when I say that not only do I believe that there are things that the government might do to increase the amount of health care available to everyone (including The Children) and, not only that, will increase the quality of health care in rural areas and create doctors with roots in any given community.

                I, too, have spoken to people who, whenever you suggest something, explain why it’s not possible and when you ask them to suggest something that *IS* possible shrug and say it’s not their problem.

                I have also met people who, in response to a plan, explain how, when they talk to other people, these other people have, whenever you suggest something, explained why it’s not possible and when they asked them to suggest something that *IS* possible they shrugged and said it’s not their problem.

                Now, if we want to get into particulars, we can discuss the bill we’re likely to get from the government…

                Does the bill we’re likely to get make us more like Denmark?

                Does the bill we’re likely to get make health care more available to people who need it? (I’m not talking about “coverage”. Something that is “covered” but the person ailing cannot get to see a doctor is *NOT* covered no matter how many people are crowing that, finally, everyone has health care in our time.)

                Will the bill create more doctors, nurses, candystripers?

                It seems to me that the answer to all of the above is “no”.

                Much like pretty much everything, the argument is that if one opposes the bill we’re likely to get from the government then one opposes the idea of children like Deamonte Driver being eligible for Medicaid in the first place.

                My problem is not that Medicaid doesn’t exist. It’s that people shouldn’t think that the creation of Medicaid would save Deamonte’s life.

                And people who hammer on how we need to create another Medicaid despite the failure of the last Medicaid to save his life need, at some point, to seriously question their methods of how, exactly, they’re helping.Report

              • I have to mention this whenever the topic of preexisting conditions comes up: preexisting conditions are a problem only because we’ve tied employment to health insurance, a feature of our system that has literally nothing to do with free markets and everything to do with government interventions in free markets. The preexisting conditions problem is no different from the problems that arise when someone without homeowners’ insurance has their house burn down – at that point, we don’t expect any insurance company to cover the cost of rebuilding and restoring their home. But that’s exactly what we expect of health insurers. I would submit that this is because in the former case, lack of insurance is almost certainly a function of irresponsibility by the homeowner, while in the latter case, lack of insurance is quite likely a result of being laid off or changing jobs, etc.Report

            • Avatar Bo says:

              If supply and demand were an immutable law of physics, then toothbrushes would be more expensive than cars, since everyone needs a toothbrush but only 70% of people need cars.

              Functioning markets generally work on the principle of aggregate demand, in which suppliers, faced with a semi-predictable level of demand in the aggregate, compete to fulfill that demand in the ‘best’ (i.e most popular) way possible. In this model, the dollars you spend on things don’t inevitably ‘increase demand’, and thus prices; rather, they pay the salaries of the various suppliers, and the price is based on how much work is required to fulfill it. These suppliers, as demand increases, get to take advantage of economies of scale, organizational efficiencies and manufacturing breakthroughs in order to decrease the cost. This is why almost everything that has gotten vastly more ‘in demand’ has simultaneously come down in price, be it cars in the 30s, or plane tickets in the 80s, or computers in the present era.

              As for why healthcare has been resistant to this trend, the classic work on this subject is Kenneth Arrow’s Uncertainty and the welfare economics of health care (warning: Scanned PDF link) published way back in 1963. It’s short and mostly avoids the worst of economics jargon.Report

              • Avatar Kyle says:

                “If supply and demand were an immutable law of physics, then toothbrushes would be more expensive than cars, since everyone needs a toothbrush but only 70% of people need cars.”


              • Avatar Bo says:

                Yes, you really need a toothbrush.Report

              • Avatar Jaybird says:

                For instance: Deamonte Driver.Report

              • Avatar Bo says:

                I hadn’t heard of that case, but that same thing happened to a friend-of-a-friend of mine. He had gotten laid off, lost his health insurance, ignored a toothache, and ended up in the hospital with a massive infection. He didn’t die, but he was in a doctor-induced coma for a week. Last I heard, he’s doing fine now, no brain damage or anything.Report

              • Avatar Jaybird says:

                I did not say that “supply and demand were an immutable law of physics”.

                I said that “the whole price relationship to supply/demand is that it’s akin to a law of physics.”

                If we are in a situation where the price keeps going up (I presume that that is the situation we are in… what with people saying that they can’t afford it and all) then I know that we are in a situation where the rate of growth of demand is outstripping the rate of growth of supply… and the best way to address the price issue is either to retard the rate of growth of demand or seriously buff up the rate of growth of supply.

                Given that this bill does neither, I know that it will make things worse.

                Toothbrushes notwithstanding.Report

              • Avatar Bo says:

                I know that we are in a situation where the rate of growth of demand is outstripping the rate of growth of supply

                Or we could have an inefficient market for all the reasons listed in the paper I helpfully linked. Economics is like physics in that there is not (yet!) any Grand Unified Theory; however, we do already know that supply and demand isn’t it.Report

              • Avatar Jaybird says:

                I’ve no doubt that we have an inefficient market… but it’s one in which the price keeps going up. A good question might be “is the government making the market more efficient or less efficient overall?”

                Then we can address fun questions like “is this bill going to result in the price going up or in the price going down?” and “is this bill going to result in more market efficiency or less?”

                The conclusions I’ve reached is that the price will go up and the bill will make the market less efficient.

                Coverage is a lot closer to demand than supply.
                Doctors are a lot closer to supply than demand.

                This bill creates coverage, not doctors.

                (Additionally, the fact that most was written by insurance lobbyists ought to set off klaxons.)

                But if the bill passes and things get worse… please remember what I’ve said before talking about either how no one could predicted this or how the wreckers got in the way of making sure that prices would get downward pressure.Report

              • Avatar Bob Cheeks says:

                JB, dude, thanks for this…I’m having lights go off!!!! A regular illumination. Now what is the proper methodology for addressing the problems of gummint, supply, demand, coverage, etc. given the political component? ;Looking forward to yous guys continuing remarks…youns should have your own talking heads show!Report

              • Avatar Jaybird says:

                Periodically, the talmudic discussions that libertarians have in the libertarium is over the pros and cons of arguing from a moral standpoint vs arguing from a pragmatic standpoint.

                Sometimes (usually) I argue from morality but it usually results in me getting screechier and screechier (which can be funny, sometimes). February is my own personal rainy day/monday and it’s really kicked in so I only have the energy to argue pragmatics.

                March can’t get here fast enough, if you ask me.Report

              • Avatar Jaybird says:

                Oh, to answer your question:

                Now what is the proper methodology for addressing the problems of gummint, supply, demand, coverage, etc. given the political component?

                I have no idea. Universal open carry, maybe?Report

              • Avatar Kyle says:

                Did you even read Arrow’s work? He’s quite clear when saying, “it is frequently observed that widespread medical insurance increases the demand for health care” (This was Jay’s point about…demand)

                What’s frustrating here is that the economics involved are more complex than simple supply and demand curves but that doesn’t mean they don’t matter.

                The Arrow paper is interesting not because it’s proof that supply and demand don’t matter, and with respect to medical care supply he addresses the issue briefly, it’s that the price system and the logic of competitive markets are an insufficient explanation for what we see in the medical care provision market. Indeed Arrow’s paper only strengthens Jaybird’s point that the likely result is higher costs, not lower costs.

                I think it’s important to realize that market efficiency is different from social optimization. We don’t have a well-functioning market now and I’m not defending it but you can’t build a network of provision without factoring pricing structures and economic principles. Incentives have consequences, even (one might say especially) when they’re inconvenient.Report

              • Avatar Bo says:

                To understand my point, Kyle, it’s important to separate the two sections of Jay’s argument here: 1) that insuring more people will increase demand. 2) That increased demand will cause prices to rise. Number 1 has been amply demonstrated; number 2 has not. In fact, as I pointed out earlier w/r/t cars and plane tickets and computers, in most markets where demand has increased substantially, the market became more competitive and prices actually decreased.

                While it might be tempting to think that someone whose entire knowledge of economics is two words (three if you include the ‘and’) found some secret weakness in the bill that all the economists and forecasters forgot, that’s not so. The CBO, in its estimates, specifically decided not to include the sort of spillover effects Jay cites because 1) The bills in question raise demand only modestly, about 4% for the Finance Committee version IIRC, and 2) health care pricing has been shown to not be highly sensitive to increased demand (either upward or downward), and that other factors are paramount in driving the increased prices (cf. Newhouse’s ‘Medical Care Costs: How Much Welfare Loss?’).

                So, is it important? Well, it depends what you mean. Obviously, this effect is very important emotionally to some people, but in terms of health care costs, it’s a small fraction of a small fraction of the story.Report

              • Avatar Kyle says:

                But your second point isn’t some big mysterious “who knows what will happen” point. There are important factors to consider. Cars expanded in the first part of the twentieth century because mass production made them cheaper to produce, thus stimulating demand.

                I’m glad you chose airlines because it quite aptly proves Jay’s point. Airline prices came down in the 1980’s not because demand substantially increased but because of de-regulation. Prior to that airfare rose at the discretion of the CAB, which created enormous barriers to entry in the market protecting suppliers and profit at the expense of convenience. Capacity was high before deregulation and declined afterwards. (Which goes back to my earlier point that capped prices could solve the cost issue but would force rationing.)

                Deregulation didn’t create demand, it made it easier for suppliers to compete which had the effect of lowering prices thus stimulating demand increases. Again, prices were effective signallers here. I can’t speak to computers but for at least two of your three examples they got cheaper because of supply side effects, not demand.

                As Arrow mentioned in his article, the problem with the supply side of medical care is licensing which acts as a guarantor of quality but also a barrier to entry. We have a shortage of doctors and nurses currently. Increasing the number of people who will call upon their services will do one of two things, potentially both. Increase costs or increase wait times.

                This goes back to another point, just because one has health care coverage does not mean one has access to medical care, unless the system has sufficient supply, very little suggests that we do now or would have more under the Senate bill.

                As to your second paragraph, nobody here suggests that increased demand for medical service has been the primary engine driving cost increases, in fact we’ve said quite specifically that it will cause more increases, which is prospective. I don’t think I’ve found some hidden flaw, people have said as much, including the CBO which – to my knowledge – has always said that costs will go up, which prompted the bill’s backers to shift from “lowering costs” to “lowering the rate of rising costs.”

                There’s also a rather obvious point you didn’t address. “health care pricing has been shown to not be highly sensitive to increased demand”
                It doesn’t have to be highly sensitive to still respond to increased demand. Talk about shifting goal posts. Picking up from Jay’s point, I don’t believe either us were saying costs would go up by X amount, just that costs would go up because of this bill.Report

              • Avatar Bo says:

                Picking up from Jay’s point, I don’t believe either us were saying costs would go up by X amount, just that costs would go up because of this bill.

                This is precisely what I mean by this issue being emotionally rather than fiscally important. The CBO has scored the excise tax, to pick an example in the Senate bill, as lowering the rate of health care growth significantly, while it has analyzed that the increased costs associated with demand increases (i.e. Jay’s argument) will be negligible. Which is where that X comes in; for the bill to actually make costs rise, the X has to be bigger than the negative Ys.

                I’m not quite sure how any of this is “shifting goal posts”: For those who haven’t noticed, health care costs have been growing just spectacularly without passing this bill, and slowing that rate of growth rather than cutting absolute costs has always, AFAIK, been the goal here.Report

              • Avatar Jaybird says:

                My point is a different one.

                We are in a situation where price keeps going up. We are, in fact, in a “crisis” because the price keeps going up.

                My point is that the government solution is to increase demand.

                I’m not even talking about paying for it. I’m talking about how the government solution creates demand instead of supply in a situation where price is signaling that demand is growing at a rate faster than the rate of supply is growing.

                The government is going to make things worse. Whether or not the CBO said, no, we’re going to raise taxes to pay for it is *IRRELEVANT*. The tax rate could hit the levels they have in Denmark and it would still be *IRRELEVANT*.

                The government is responding (yet again) to a price signal by increasing demand.Report

              • Avatar Jaybird says:

                Let me rephrase:

                Which is where that X comes in; for the bill to actually make costs rise, the X has to be bigger than the negative Ys.

                We are *NOW* in a situation where the rate of growth of demand is growing at a much, much faster rate than the rate of growth of supply.

                And even the CBO says “well, this bill won’t make that any worse, probably. Negligible.”

                We will *STILL* be in a situation where the rate of growth of demand will continue to grow at a much faster rate than the rate of growth of supply.

                And the bill’s defenders point to the government CBO saying “we will affect this dynamic negligibly” proudly and are upset at the Health Care Deniers who flail and say that the underlying dynamic isn’t being addressed.Report

              • Avatar North says:

                I don’t know if I disagree Jaybird, I’m not certain on this, there is a lot of just musing here but let me throw this thought out there. I wouldn’t characterize this bill as necessarily raising demand and leaving supply untouched. I think it would raise demand for some kinds of supply but lower demand for others. For instance we as a country often like talking about making people pay for what they consume but we also as a country are completely unwilling to let broke people die on the streets. This means that the sick, even the uninsured or the underinsured or the poor, are ending up with hospital and medical care when their health issues compound to the point of threatening their life. The cost of their care is then added onto the cost of care being given to paying customers (with whatever they can squeeze out of the initial patient being subtracted and the initial patient thus being medically bankrupt).
                So plugging that into your equation wouldn’t this mean that the demand for emergency care nurses and doctors will likely significantly decrease and the demand for non emergency care nurses and doctors increase?

                Also your equation doesn’t seem to account for the fact that in the states there’s a third entity in between the demanders and the suppliers of medical care; ie the gatekeepers, mostly private insurance and some government. Are you certain that this bill doesn’t diminish the friction that these third parties cause on the flow between demand and supply? It seems more complicated than you’re portraying.

                Again just thinking about it. Personally on HCR I’m young and healthy so it’s not immediate for me. So I tend to view the issue politically rather than principally.Report

              • Avatar Jaybird says:

                So plugging that into your equation wouldn’t this mean that the demand for emergency care nurses and doctors will likely significantly decrease and the demand for non emergency care nurses and doctors increase?

                It might… but we do not have an issue where we have a surplus of doctors here but a dearth of them there. We have a dearth of them everywhere. To decrease demand (yay!) for emergency room services with a commensurate increase of demand for non-emergency room services (boo!) seems to me to be exchanging an acute problem for a chronic problem (or is it the other way around?)… now perhaps we’d rather deal with chronic than acute. That’s a fair argument.

                But… at the end of the day, we’ll still have a rate of increase of demand that grows faster than the rate of increase of supply. Saying that we can shift some of the tops of the peaks to help fill in the worst of the troughs might be a good trade-off… in the short run. (To repeat myself, I am pleased that this decision was not made for me in the 70’s, 80’s, or 90’s.)

                Are you certain that this bill doesn’t diminish the friction that these third parties cause on the flow between demand and supply?

                Who wrote the bill? I’m under the impression that it was written under the influence of (if downright intoxicated by) insurance company lobbyists.

                I assume that they’re rent-seeking and engaging in regulatory capture.

                Should I not make that assumption?

                It seems more complicated than you’re portraying.

                If I said that PATRIOT was a giveaway to local law enforcement to give them better tools to fight against the “war on drugs” and the creation of Homeland Security and the TSA was a blatant attempt to create more government employees rather than actually make The Children safer… would a casual observer be able to say that it is more complicated than that?


                But we see what PATRIOT became. We see what the TSA is.

                I don’t think it’s particularly outlandish to wonder if Health Care won’t have more than a little in common with the last two government boondoggles.Report

              • Avatar North says:

                Fair enough Jay, I’m just saying it’s not just as simple as declaring that the bill will increase demand and not help supply. No doubt the bill was influenced by insurance companies and pork obsessed legislators, though we’ll set aside the irony that you’re essentially saying that it’s been pulled too far to the right, a lot of health care experts do assert that it’ll improve on the situation that we have now which you’ve gotta admit is a pretty crummy state of affairs.

                Now lord knows I’m no fan of bureaucracy for bureaucracies sake so I’m far from a fan of the HCR bill. Personally I think it’s kind of funny how centrist the sodding thing is considering that the Republicans pretty much declined to participate. The bluedogs do good work I suppose.Report

            • Avatar Jaybird says:

              I just don’t see ECON as physics.

              Many don’t… but then they don’t understand why the price for stuff keeps going up and why there are shortages despite price caps and why black markets keep being created and why rich people consistently have higher standards of living than poor people despite all attempts to ensure that poor people have better standards of living.

              When I started seeing the whole “price is a function of supply and demand” as something akin to a law of physics, it started explaining why the price for stuff keeps going up and why there are shortages despite price caps and why black markets keep being created and why rich people consistently have higher standards of living than poor people despite all attempts to ensure that poor people have better standards of living.

              There were a handful of countries that tried to will the whole “price supply demand” thing away in the 20th century and they failed magnificently. Most of the greatest economic failures in the US from the last 100+ years have all been based on not understanding the whole “price supply demand” thing.

              If this Health Care Reform bill passes, and it might, and it doesn’t work (which it wouldn’t), the above is why.

              It has nothing to do with wreckers or Republican intransigence or the wrong people implementing the policy.

              It’s that.Report

              • Avatar greginak says:

                Which explains why all those countries with universal health care have such staggeringly higher costs then we do. Maybe all those countries with far higher costs and universal health care, have different schemes of regulation or more simplified systems or some players make less money or a variety of other issues that relate to how much health care costs.

                Oh yeah I forgot all those countries with universal health care spend less per person then we do, but the rest of it still stands.Report

              • Avatar Kyle says:

                Snark aside, if the bill were building a universal health care system like some other countries, it might cost less. It’s not. If other countries had a system like we’re attempting to build there’s a fair chance that they would be more expensive.

                Different countries = different cultures = differences that matter. It’s not enough to say they have something therefore if we do something somewhat similar we will have the same outcomes…without factoring differences in culture, differences in scope, and most importantly differences in plan.

                Also, health care doesn’t exist in a vacuum – those countries’ systems are affected by how ours works in drug development and medical products innovation among others. I don’t know but I wouldn’t rule out the possibility that the results of our problematic system account for some of the outcomes produced in foreign countries.Report

              • Avatar greginak says:

                I completely agree that culture matters, however that does not mean we cannot or should not be learning what we can from other countries. Obviously whatever we do will be our own, but there is valuable experience out there. Learning how other people have succeeded or failed seems a pretty basic part of figuring out how to do something.

                One of the frustrations of those of who support HCR is that no matter what is suggested there are always seemingly insurmountable obstacles. Most of us wanted a more radical or progressive change. Something like Wyden-Bennet would have been a far more radical change although it may have been better then the current bill. However what has been clear is that many people are afraid of change. So radical change is limited by peoples fears and the fight it would get from insurance companies, docs, etc. But change that is more moderate then isn’t enough change so then that is supposed to be a no go.

                Re: the drug development issue. That has never impressed me that much. I seriously doubt all the lower costs and good outcomes of other countries are due to US drug companies.Report

              • Avatar Kyle says:

                On the first paragraph I rather obviously agree. If the Senate bill were something that took successful lessons from other countries, it’d be a better bill. Instead, it’s taking Massachusetts, ignoring that state’s inability to control costs, and suggesting that we nationalize it and hope that somewhere down the road things will become less expensive or that the baby boomers will suddenly decide to tax their children at an obscenely high rate.

                As for the drugs issue, I don’t assert that, but – mr. multi-causal – I suspect they do contribute and think it’s equal parts folly to assume they are either wholly responsible or have nothing to do with lower costs. So that makes me hesitant to hear someone say let’s just do what the others are doing and simply take it at face value that it’s “cost-free.”

                In complete honesty, I think there are bigger issues than HCR and care about those far more. However, what strikes me as the problem is that the voice on the left for HCR have a very clear idea of what they want, some kind of American NHS, and want to push (incrementally or boldly) to get us there. The right is opposed and the reformers there want to make the market more competitive and less public.

                It seems to me that were this discussion devoid of ideological attachment to preferred solutions and more rooted in doing what works. We would tack right then left, push through interstate competition (with national regulation), decouple insurance from employment, and push through tort reform. Then tack left, offer catastrophic insurance coverage based on medical expenses as a percentage of income and allow Medicare buy-in. The right wants options beyond the government, the left wants coverage, and everyone wants affordability.

                Not that I’m perfectly reflective of America, but I think most people are fine with mailing options. An accessible, affordable public option in robust competition with private operators, particularly in premium areas. Arguably, FedEx and UPS have made the USPS stronger and the USPS ensures both affordability and access.

                Of course, between the people who can’t consider that their options don’t satisfy everyone who deserves to be satisfied and people generally concerned about change the result is…blech.Report

              • Avatar Koz says:

                “It seems to me that were this discussion devoid of ideological attachment to preferred solutions and more rooted in doing what works.”

                I agree with almost everything you wrote here, except let’s note that your sentence above is at some level a non sequitur because what the judgment of what constitutes working is itself a very important ideologically contested point. Specifically, the other team wants coverage, therefore anything that doesn’t provide quasi-universal coverage isn’t “working” by definition.

                If we could get the other team to agree to push that aside and pursue other, supposedly secondary benefits then, like you suggest, we could find some compromises. But they’ve never said or even hinted that they’re willing to do that.Report

              • Avatar Jaybird says:

                They don’t have staggeringly higher costs. They have much lower costs… universally. And the really rich come here to get better care than the care everybody else has available.

                It’s a two-tier system in those countries.

                We’re the second tier.Report

              • Avatar North says:

                We are the second tier for them. And their lower tiers have to wait in line, sometimes for unpleasantly long times, to get access to some kinds of treatment. Meanwhile our lower tiers get medical bankruptcy. I suppose it’s what one could expect; higher highs and lower lows.Report

    • Avatar zic says:

      You’re repeating yourself a lot today today today.

      Liked the link to the Greenwall piece, lest you feel the need to repeat yourself again.Report

  6. Avatar Scott says:

    Regarding your P.S. that, “health care is the budget” is an excuse for those that would use reconciliation when and where ever it becomes hard to engage in real legislative work. I guess every law in some way effects the budget so everything is subject to reconciliation? Just as the gov’t saying that everything is interstate commerce so as to let them regulate everything.Report

    • Avatar North says:

      Uh, Scott, do you even know what reconciliation is or what it does or how it’s done?Report

      • Avatar Scott says:

        Well since you seem to know so much, why don’t you explain it to the rest of us? Perhaps you can also tell us why Sen. Byrd didn’t think it was an appropriate process for health care?Report

        • Avatar North says:

          I’ll take that as a no.

          As for my educating you, I’ve described reconciliation in detail in previous posts and unlike dear Jaybird I only like repeating myself when the subject is nuclear power. Just google it up yourself man. It’d do your cause good for you to be able to know what you’re arguing about.Report

  7. Avatar Bob Cheeks says:

    Should the commie-dems ram this exercise in statist hubris through, one hopes cars are burning in the capitol by nightfall, with millions moving toward Washington.Report

    • Avatar North says:

      Well if the Vaux-populi feel that strongly then good for them. Heck it’d be nice to have proof that they were even paying attention. Considering, though, the things that the populace has endured (or even applauded) being done in their name in the very recent past I somewhat doubt that health care reform would excite their passions to that degree.Report

      • Avatar Bob Cheeks says:

        Well, my acute political observer friend, I fear you’re right. Not until they mostly all loose their jobs, or they’re hungry, or being driven from their homes, or required to sacrifice their children to Moloch will the unwashed rise up!
        I was just hoping and then you gotta watch out the commies don’t take over…oh well! A shame really the lamp posts in Washington and on Wall Street ought to be decorated with the rotting corpses of scoundrels, scalawags, and outlaws.Report

      • Avatar Koz says:

        “Well if the Vaux-populi feel that strongly then good for them. Heck it’d be nice to have proof that they were even paying attention.”

        I don’t know where you’re from but here on planet earth they are paying attention and they want no part of that bill.Report

        • Avatar North says:

          Really? They sacked congress and strung Reid and Pelosi up on lamp posts Koz? Fascinating, I knew I should have turned on the news this morning. You’d think I’d have heard Pelosi screaming even in Minnesota. I’m told she has a very piercing tone when she gets upset.Report

          • Avatar Koz says:

            “They sacked congress and strung Reid and Pelosi up on lamp posts Koz? “

            Have you not been paying any attention to Sen. Reid’s reelection chances? It’s one the top, oh, dozen or so political stories over the last few months.Report

            • Avatar North says:

              So since it looks like he’s going to not get re-elected he should just curl up in a ball under his desk and whimper? Not advice I’d extend to the Dems’ blue dogs but hey that’s just my opinion.

              Can’t wait for him to go though. I never forgave him for scuttling the nuclear waste repository.Report

          • Avatar zic says:

            This problem is regional, too. But instead of location on earth, it’s location on the cable news channels.Report

  8. Avatar Bob Cheeks says:

    “Can’t wait for him to go though. I never forgave him for scuttling the nuclear waste repository.”

    Please tell me you’re being facetious!
    Can we talk about Dear Leader’s use of the word “corpsman?”Report

  9. Avatar historystudent says:

    Short answer: No, they should not.

    Longer answer: Congress is not the place for defining health care to the degree Congress wishes. The hubris of legislators: to think they can legislate everything. The foolishness of citizens: abdicating their own responsibilities for their own lives by buying into the idea that the government can run all our lives well. 535 people who engage in behind-closed-doors politicking, who allow themselves to be bought with money that isn’t even theirs, who obfuscate regarding the contents of bills, who are too often beholden to lobby money, who think regular voters are idiots, are not a group which I want passing a comprehensive health care bill. Health care is a matter of a network of many interested people to work out various systems that will work for different people. We are not all the same. We need different things from our health care. We need a system that is flexible, adaptable, cost-conscious but also committed to timely preventative and curative medical care. That kind of system won’t come from “comprehensive legislation” cobbled together hurriedly by a partisan Congress. That kind of system requires input and exertion at the local, state, and, to the least degree, the federal levels. It requires a system open to experimentation, revision, and constant improvement. The federal government isn’t known for its ability to set up (or run) such a system. It requires a system that is more distributive than integrative. It requires respect for doctors and for health care insurance systems (provided those systems also respect the patients and doctors). Many in Congress and the president have, by their statements and actions, shown they are more interested in passing a health care bill for reasons of power flexing than in actually improving the health care system. So, I certainly hope whatever the Democrats want to do, neither health care bill passed in the houses of Congress, nor any possible negotiated compromise will actually become law.

    It doesn’t take such massive, messy pieces of legislation to do something about pre-existing condition clauses. I totally disagree that voters are such a bunch of dummy forgetters that if the Democrats pass the huge morass they have before them they (voters) will just be glad some kind of health care bill has been passed and that something has been done about pre-existing conditions. I wouldn’t expect any huge demonstrations in the street, but I would expect them to have plenty to say in the voting booths in November. The voters have been too docile for too long, but they are waking up. They realize how badly Congress has handled all kinds of things, and they are sick of the professional politicians who disregard them and blithely spend away their children’s futures and play around with their lives and their health.Report

  10. Avatar Michael Drew says:

    I agree with pretty much everything E.D. says here, except that the bill’s dead. It’s definitely on hold for a while. And it might be dead. But I agree with North it’s too early to say that because the votes aren’t there right now that means they won’t be. I also agree the problem is on the right of the House caucus. The question is whether Obama or Pelosi can instill the desire in them to go big risk big reward (on the assumption an achievement is better than a failure). In that context, improving jobs numbers may actually be a detriment to passage this year. That’s not a tradeoff Obama is probably willing to make (declining to emphasize economic improvement in favor of pushing House members on health care), so I think that may explain some of his retreatReport

  11. Avatar Kyle says:

    I take it you guys missed this gem of an article in The Hill on the reconciliation loophole the GOP plans to exploit.Report