In defense of quality not quantity: the case for better safety nets, not more entitlements

Avatar

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.

Related Post Roulette

69 Responses

  1. Avatar North
    Ignored
    says:

    Great stuff E.D. Here’re my initial thoughts:

    1- Works great for young and middle aged people but what do you do with the elderly? The bothersome thing about healthcare (from a market/insurance perspective) is that you’re not actually insuring against something that might not happen. With your health as your age increases your probability of needing significant medical intervention rapidly goes to 100%. It’s a question of when, not if.
    2- What about preventative care? People unfortunately have turned out to be ridiculously disinclined to spend a few bucks regularly in the near present in order to prevent spending a thousand bucks in the future. With government picking up the tab for catastrophic coverage wouldn’t there be no incentive for insurance companies to provide this? Why pay for insulin when you can not and save a buck and if Johhny develops type II diabetes you can just heave him into the safety net and cancel his coverage.
    3- This of course does nothing at all for people with anything that insurance companies can call pre-existing conditions (and they seem to be merrily expanding that definition all the time) and especially the abomination of retroactive pre-existing conditions (you get cancer, they discover that you were treated for something small before you hired on with them and cut you loose for pre-existing conditions). The badly ill will bounce on the safety net for a bit until their money runs out and… then what?
    4- It’d be awsome if there was a party in the country that was pushing or talking or considering this angle of things. Especially if it was a party that was constantly calling itself conservative. Goodness, think of how useful the political conversation would be if there was a party doing something like that? Or should we be expecting the Democrats to argue both sides of it? (Actually considering how they’re really an amalgam of two parties already maybe they actually could pull that off but what does that say about the Republicans?)Report

    • Avatar Kyle in reply to North
      Ignored
      says:

      Your first point is an interesting one and I speaks to the cultural component of what E.D. is saying. Which matters (indeed, I’ve been trying to formulate a post of my own on the subject for a few days) more than I think people think it does.

      I mean all these points are pretty good but I think to me it seems like a of culture entitlement is an anti-budgeting culture. If I am entitled to X, I’m not thinking about whether I should have X or whether it X should continue to be provided to me in a given set of circumstances. While I think that’s good for something like say free speech or the freedom to petition government, when it comes to goods and services, I become enormously skeptical.

      On one hand, medical costs become more certain as we age, and cognizant of that fact, it might be a good thing if we had to pay for them because then we’d budget – we’d be more discerning. On the other, we as a society are uncomfortable with grandma choosing between pills and food this week.

      I’m in the camp that says means test for phase 1, if you can afford pills and food, then by all your means you should pay for them. I don’t see why America should rack up more debt because the money grandma would’ve spent on a nice dinner out is instead used for her pills.

      This is where I see this as a cultural issue, if we as a people (not a government) see medical expenses as an expected cost of old age, then we should be encouraged to save for them alongside retirement, the same way parents are told to save for their kids’ college expenses. I’m with E.D. there should be – perhaps a specially designed safety net for old age – a safety net for those who can’t save for old age. However, if you could save and simply didn’t because those steak dinners were tasty and you had to live in 10024 instead of 11430, it’s not worth diverting resources and debt to cover your medical expenses.

      Clearly medicare shouldn’t be pulled from people counting on it but if more people see it as potentially not there it only creates incentives for preventative care and savings. Of course, that’s my mentality already because Medicare and Social Security are effectively not safety nets for my generation.Report

      • Avatar Art Deco in reply to Kyle
        Ignored
        says:

        Clearly medicare shouldn’t be pulled from people counting on it but if more people see it as potentially not there it only creates incentives for preventative care and savings.

        That is an appropriate rule for any old-age benefit – that reductions be phased in cohort by cohort.

        One might conceive of a public insurance program with a three-tier deductible: one for families consisting of the elderly and disabled, one for families without elderly or disabled, and one for mixed families. Although it might lead one into a minefield of interest group pressure, one might conceive of special dispensations for families with a member suffering from one of a schedule of chronic illnesses, much as kidney dialysis is currently covered by Medicare.Report

    • Avatar E.D. Kain in reply to North
      Ignored
      says:

      North these are good points and I wish I could address all of them but I’m short on time. First, preventative care is something that people really just have to choose to do. Even having insurance doesn’t make people do this, and indeed often creates an incentive not to. I have insurance but I’m lousy at the preventative stuff. So that’s just another story altogether.

      Also, with old age, I think you run into complications. I do think, however, that many people could pay a great deal more in their old age than Medicare recipients pay – especially if they were to put money into some sort of investment vehicle/health savings account. There are so many other ways to think about these things, we just never do because we’ve become reliant on the idea of Medicare. But what happens when it’s no longer sustainable? Massive tax increases and the resulting economic slide simply to pay for old people’s insurance? All old people too, not just the poor?

      Re: pre-existing conditions, I recommend looking into health status insurance, something that Michael Cannon has written on extensively.Report

  2. Avatar Sam M
    Ignored
    says:

    “the delivery was fraught with complications that I’m sure would have bankrupt us had we not had any insurance.”

    I am less sure. In most cases, hospitals and doctors will allow you to enroll in a very low-interest payment plan. Even if the bills were on the order of $50,000, people certainly finance car loans of that magnitude, and educational loans far greater than that.

    And at the risk of using anecdotes as evidence, I know of several uninsured people who got very costly medical procedures done and never saw a bill for them. Never saw a mark on their credit. because the hospital waived the fee. One was a sort of indigent guy I worked with over a summer, but the other was a gainfully employed young man who simply chose to risk being uninsired. He got gravely ill, and the risk still paid off for him.

    But let’s say that he had received a bill, had failed to arrange an affordable payment plan, and had been forced into bankruptcy. That’s bad.

    Is it as bad as paying $5,000 a year for insurance in the five years leading up to the plan, then $5,000 a year for the seven years of bankruptcy? Maybe it is that bad. But it’s close enough to a wash that I can imagine making a case for it.

    This is not to say that people without insurance don’t face real challenges. They do. But as per Cowen and McArdle and all the rest, I think it’s worth really examining some of the basic claims. What really are the health risks associated with being uninsured? Clearly, there are impacts, but I think claims of 45,000 deaths a year are absurd. And what are the real financial risks? Yes, bankruptcies are serious business. But we could amend the bankruptcy process, too.Report

  3. Avatar zic
    Ignored
    says:

    In most people’s minds, the safety net that helped you and entitlements are one and the same thing since that safety net comes in the form of Welfare.

    In the ongoing debates on McArdle’s blog, I told the story of a friend’s family — on the verge of losing their home because of a medical emergency that’s left one spouse unable to work for an extended time, and said they’d applied for disability and been turned down.

    Many of the slams the post received were the family’s stupidity for not have disability insurance — though according to the insurance industry, only 20% of people have such insurance.

    So remember you safety net is someone else’s entitlement program and the insurance industries potential rent capture.Report

    • Avatar E.D. Kain in reply to zic
      Ignored
      says:

      There is a significant difference between a safety net and an entitlement. Indeed, the answer is in the question. Whether people think of them as the same is not the issue. In fact, I think my post was actually asking that people stop thinking of them as the same…Report

  4. Avatar Sam M
    Ignored
    says:

    “That they never saw a bill means it drove the cost of care up for others. The bills didn’t go away.”

    But that is always going to be the case for any plan that offers medical care to people who can’t pay for it.Report

    • Avatar Jaybird in reply to Sam M
      Ignored
      says:

      If it’s not sustainable, it’s going to eventually go away.

      I very much like the whole trickle-down effect that constantly pushing for new and better medical advances has. When I was a kid, the only people who got MRIs were baseball players and the like. Schlubs like me were stuck getting X-rays or CAT scans. Now? MRIs are available to pretty much everybody.

      Schlubs like me have to get MRIs now. What will schlubs like me have to get in 20 years?

      I’m hoping it won’t still be an MRI.Report

  5. ED – Great post. Just spitballing here but I am increasingly more convinced that the key is to disconnect health insurance from employment. For folks that are between jobs and having trouble making their premiums, I am okay with a government subsidy program as a safety net. The caveat of course is that there needs to be some ways of weeding out abuse.Report

    • Avatar North in reply to Mike at The Big Stick
      Ignored
      says:

      I agree on the employment part Mike. Problem is it’s pure political poison and it’s never going to get anywhere near being enacted with the R’s in their current mood.
      As for the safety net, I wouldn’t be in support of the safety net paying insurance premiums, it’d be a pure giveaway to the insurance industry. Pay a % of the actual medical costs instead.Report

      • Avatar Mike at The Big Stick in reply to North
        Ignored
        says:

        The problem is, if you don’t pay the premiums and they lose coverage, what if a pre-existing condition crops up while they are between plans? I still don’t like forcing insurance companies to cover patients that are a guaranteed net loss…unless the government wants to subsidize that as well.Report

        • Avatar North in reply to Mike at The Big Stick
          Ignored
          says:

          Well that’s a pointless. You can’t force insurance companies to take on people regardless of pre-existing conditions because then you have to mandate that everyone buy insurance and that leads, well, to the current HCR bill plus or minus some pork.

          What I meant is I don’t think government should be paying insurance companies anything. I’d like ED’s position better, pay all of their medical costs above say 20% of their yearly income. Paying insurance premiums instead would be pure corporate wellfare.Report

          • Avatar Art Deco in reply to North
            Ignored
            says:

            Not necessarily. One could assess each household 7% of personal income, randomly assign housholds to cohorts, and then auction off rights to the assessment of each cohort (i.e. the collective premium) in return for fulfilling an insurance contract specified by the legislature. The bids of the competing insurance companies would take the form of stating the deductible over which they would cover costs, with the low bidder getting the contract. If one were concerned to enact a grandfather clause to protect the eldery, one might specify that the deductible be x for a family composed of the elderly and disabled, 6x for a family with none such and 3x for a mixed family (say, a married couple with a retired spouse and a working spouse). The bids would then take the form of the deductible for a family of the first type. Households could then purchase insurance to cover the distance between a minimum deductible and whatever their cohort insurer has bid; the clientele of credit unions might make passable actuarial pools for this last. Is this corporate welfare?Report

            • Avatar North in reply to Art Deco
              Ignored
              says:

              It would be once the insurance companies colluded to fix prices or bought themselves some senators, bureaucrats or lobbyists. Better to just directly pay the medical expenses over a set % of income and let the insurance companies, which are in essence parasites on the patient/provider exchange, try and do business selling premiums to cover the difference.Report

              • Avatar Mike at The Big Stick in reply to North
                Ignored
                says:

                If you’re moving in the direction of paying a certain % of medical expenses – I think we’re better off just going to a retail model for medical services. Let consumers pay the doctors directly.Report

              • Avatar Art Deco in reply to Mike at The Big Stick
                Ignored
                says:

                Yes, for sums below the deductible. The foregoing presumes a body of commercial law, insurance law, debtor-and-creditor law, and guild law which govern certain practices. Transparency of pricing is a necessity, separation of medical practices on the one hand and laboratories and imagining centers on the other is a necessity, a regularized means of contracting and servicing medical debts is a necessity, definition of circumstances under which medical debts may be foregiven is a necessity, a definition by law of the sort of services which may be paid for with drafts from medical savings accounts is a necessity, regularized procedures by which providers may verify that the contents of a medical savings account are exhausted is a necessity, specification of what sort of procedures require pre-clearance by the cohort insurer are a necessity, a corps of arbitrators to resolve disputes between insurers and providers is a necessity….Report

              • Avatar Art Deco in reply to North
                Ignored
                says:

                There is such a thing as anti-trust enforcement.Report

              • Avatar Art Deco in reply to North
                Ignored
                says:

                I think the utility of my idea is that it fixes the public committment to provision of medical services at a particular level of domestic product and allows the remainder to fluctuate according to the preference of consumers and producers.Report

          • Avatar Mike at The Big Stick in reply to North
            Ignored
            says:

            I don’t follow how it’s corporate welfare to cover people’s premiums. The citizens would have to prove need. The health insurance companies would still have to compete for their dollars by offering the best value, etc.Report

            • Avatar North in reply to Mike at The Big Stick
              Ignored
              says:

              If we’re going with E.D.’s plan why not simply pay the portion of the actual medical bills when they exceed 20% of the individuals yearly income. That cuts out the insurance corporation middle man and the price incentives and shopping etc that Art is talking about above would still be done by the customers trying to get the lowest price.Report

              • Avatar Mike at The Big Stick in reply to North
                Ignored
                says:

                Would there be an associated medical tax placed on yearly income to cover those over-20% payouts?Report

              • Avatar North in reply to Mike at The Big Stick
                Ignored
                says:

                I don’t know; I suppose we could finance it out of general revenue like the Bush Minor’s era republican Medicare expansion but personally I’d want to see it paid for either by removing the programs that it’d be purporting to replace or levying a tax for it.

                Art, maybe I’m misreading you but aren’t you essentially saying that a bureaucracy is needed to arbitrate between the consumers and providers of medical care and you’d prefer it be a private for profit bureaucracy rather than a government one?Report

              • Avatar Art Deco in reply to North
                Ignored
                says:

                No. An aspect of an insurance contract composed by the legislature and let out by competitive bidding is going to be whether pre-clearance is required ‘ere billing the insurer and under what circumstances, a corrollary of that would be appellate review for the objecting physician, whether via administrative law judges or some other means of arbitration.Report

              • Avatar Art Deco in reply to North
                Ignored
                says:

                I do not think that would contain public committments. Public committments have been an important driver in cost inflation.Report

  6. Avatar Todd
    Ignored
    says:

    The idea of having the government step in as a last resort to prevent medical expenses from ruining an individual is less absurd than many of the current proposals being bandied about, but I would make sure that we not restrict the discussion of someone’s ability to pay to their income. Were such a system to be implemented, it would be very important to also consider accumulated wealth in that calculation. I’m sure you would include this aspect were the idea to be more considered more seriously, but just thought I’d throw it out there even if it is premature.Report

    • Avatar North in reply to Todd
      Ignored
      says:

      So you’d be in favor of some kind of means-testing?Report

    • Avatar zic in reply to Todd
      Ignored
      says:

      when it comes to receiving welfare, accumulated wealth is already considered. (Believe me, I know, I wrote to prototype computer systems to help detect fraud being committed by folks with accumulated wealth.)

      Currently, more of a concern might be loosening the system so that ‘accumulated wealth’ means you don’t have to sell your home or go into foreclosure before you can receive any sort of assistance.Report

      • Avatar Mike at The Big Stick in reply to zic
        Ignored
        says:

        I don’t follow why we would protect people’s homes in that case. We don’t protect their home if they can’t feed themselves. Home ownership is a privelage, not a Right.Report

        • Avatar zic in reply to Mike at The Big Stick
          Ignored
          says:

          Because the massive wave of foreclosures yet to come will have serious consequences — from the value of homes in general to the stability of banks are two good examples. Someone without insurance through loss of a job or medical problem isn’t necessarily guilty of the same sins as many who over-borrowed. In the long run, spending a little to help a family that’s down on their luck could end up being much cheaper.Report

    • Avatar Sam M in reply to Todd
      Ignored
      says:

      Interesting pojnt, Todd. But for many, protecting accumulated wealth (like a house) is often part of the reason for protecting people from the bills.

      Then all of a sudden, in an effort to protect us from people who might game the system, you have all these considerations. What if someone has a ridiculously expensive house that they have been knocking themselves out to afford for 20 years? Should I really be expected to pitch in for a guy’s kidney-stone operation so he can protect his jacuzzi and three-stall garage?

      So we count the accumulated wealth. But then we see a bunch of people… lose their house to pay for health care. Which is what we wanted to avoid, right?

      I might add that protecting people from bills more than 20 percent of their income would induce a lot of people to go without insurance. My insurance currently costs me about that much. Why would I pay for it if my losses are capped at 20 percent anyway? Especially if, barring any major medical bills, I would be free to spend the money on other stuff? Finally, what impact would all these incentives have on the consumption of preventative care? Would the 20 percent rule apply to lifestyle problems, like smoking-realted illnesses? Etc. Etc. Etc.

      Suddenly, this simplified bill starts to look a lot like the bloated thing we are all complaining about already.Report

  7. Avatar mike farmer
    Ignored
    says:

    I’ve talked about for a long time an idea for creative, private insurance plans starting at birth that I think would begin solving the problem for the great majority of citizens — I don’t have room here, so I will write a blog post today at http://www.bonzai.squarespace.com to spell it all out.Report

  8. Avatar zic
    Ignored
    says:

    E.D., have you seen this?

    It might be another answer to your question. I know right now we pay more for a high deductible policy for four in ME than this chart shows for comprehensive most place. And our premiums are slated to go up another 15 to 25%.Report

  9. Avatar Bo
    Ignored
    says:

    I have to admit I got a chuckle out of the line, “This would also eliminate the need for Medicare/Medicaid.”Report

  10. Avatar RTod
    Ignored
    says:

    A good and thoughtful post, E.D. – unsurprising as I’ve come to expect them from you as a matter of course, even when I disagree. However, as someone in insurance & risk management, I think you stumbled upon part of the issue at hand without noticing it:

    “My wife and I had, prior to having children, gone quite a long time with no insurance at all. We were “young invincibles” without a real pressing need for insurance, and we consumed very little healthcare.”

    I think this is the reason healthcare baffles so many people: because it is identified as “insurance” they think of it in the same way they think of, say, their car insurance, or their homeowner’s policy. But the structure and cost of it are wildly different, for three reasons. The first, which I won’t get into here, is that healthcare doesn’t work with supply and demand forces the way everything else seems to. The second is that unlike your home burning down, which will almost never happen to most people, just about everyone who isn’t hit by a proverbial bus in their youth will have catastrophic medical bills at some point in their life.

    But the third is what you have edged up next to, but then not explored. It’s that the young and healthy often don’t choose to have insurance, even when their employer picks up 50% of the cost. This is part of what drives costs up so much – it’s as if only the people who were having accidents were pooling their money to pay for car insurance.

    My point as it is connects to your central thesis is this: I fear the safety net without the entitlement can’t work economically – or rather, it can only work for a certain period of time. As healthcare costs continue to rise, less and less people can afford it, which means more young and healthy people who subsidize the costs will opt out, and a greater percentage of the cost will be shouldered by the sick and infirm, which will drive up individual premiums, which will mean less people can afford it, which will drive out more young healthy folks, and so on and so on. Eventually in order to keep the system from crashing the safety net is forced to become so large that it is, in fact, an entitlement. I do not believe that this method is sustainable, and in fact the very existence of medicare seems to me to be the result of a safety net only system.Report

    • Avatar JosephFM in reply to RTod
      Ignored
      says:

      As a liberal I am inclined to agree with this view, though I don’t really object to most of the alternate proposals bandied about here, aside the fact that they are possibly even more fanciful than a UK-style fully socialized system from where we are now.

      I consumed about $500 worth of insured healthcare (ie not including OTC drugs, which cost me about $15-$20 a month due to persistent allergies).Report

    • Avatar E.D. Kain in reply to RTod
      Ignored
      says:

      RTod – really excellent points. I think the trick is to make healthcare more affordable in general. There’s no reason that more competition, more supply, larger pools, etc. couldn’t start to reverse the trend. Similarly, less regulation, better options for catastrophic coverage – these things can make younger people more likely to buy in to the larger pool while giving them time to accrue wealth so that they can afford better coverage later in life. Health status insurance is one way to purchase insurance very cheaply when you are young to insure against the problem of pre-existing conditions (like age!) later in life.Report

  11. Avatar Jaybird
    Ignored
    says:

    There will always be an outlier *SOMEWHERE*, however. Someone (inevitably a child, inevitably poor) who gets misdiagnosed or gets a bad staph infection or something and (rich guy) was able to get it treated at Mayo but (poor kid) was not and now we have a situation where (rich guy) had this exact same thing and he was saved but we, as a society, have decided that (poor kid) wasn’t worth the trouble.

    Do we want to live in a society where children like (poor kid) are expendable? Would you save the life of (poor kid) if it was an option?

    It’s an option, you know.Report

  12. Just wanted to mention that Megan McArdle has a new post up covering a lot of the ground we’re discussing in this conversation.

    http://meganmcardle.theatlantic.com/archives/2010/02/the_limited_benefits_of_first.phpReport

  13. Avatar Francis
    Ignored
    says:

    1. A safety net is an “entitlement”. That’s what entitlement means — every last one of us, if we fall off our high wire, is entitled to get saved by the net. But because Medicaid is a joint federal-state program, low-tax states do their best to keep people from claiming what they’re entitled to receive.

    2. I just love blog posts by quasi-libertarian quasi-conservatives which wish desperately that other Americans were more like them. It’s a very common style, and one that’s always worth a laugh or two. This is a classic of the genre.

    a. The government should offer catastrophic coverage only. Great idea, if you can persuade everybody to have a nice fat chunk of cash lying around to cover the deductible. But most people don’t. In fact, most people want first-dollar coverage. Even small co-pays lead to a dramatic cut-off in the usage of doctors.

    b. Make health care insurance into an actual insurance product. Fair enough; health insurance is, of course, not insurance at all in economic sense. It is instead cost pooling. But once again, the market has already spoken — no one actually wants insurance.

    c. Means testing — a perennial favorite. You think the IRS is intrusive? Try a government agency charged with determining that you have neither income nor wealth. One of the reasons that the number of actual enrollees in Medicaid is substantially lower than the number of qualifying persons is the level of intrusiveness in the application process. Just how many poor kids are you willing to shaft?

    Healthy kids and adults represent a huge positive externality in schools and the workforce. We should be making it as easy as possible to get good care, not raising the bar (which is what means-testing does).

    Conservatives would be far better off claiming that the current health care bill is a vindication of conservative ideas.Report

    • Avatar Jaybird in reply to Francis
      Ignored
      says:

      “In fact, most people want first-dollar coverage.”

      Indeed they do. Most people also want someone else to pay for it. If asked to pay for it themselves, most people would want the insurance company to not be allowed to use actuarial tables when making decisions.

      Most people in hell want ice water.

      If something is not sustainable, it’ll eventually stop. Most people don’t like this fact. I’d even say that most people are hoping that they can ride the wave before it crashes.

      Eventually, we’re going to reach a situation where most people realize that they are part of the most people who got screwed rather than part of the most people who got taken care of.Report

    • Avatar Kyle in reply to Francis
      Ignored
      says:

      Could you have packed in anymore disdain, Francis?Report

    • Avatar Art Deco in reply to Francis
      Ignored
      says:

      I am interested. Do you have a source for your contention that most people want ‘first-dollar’ coverage, or that people are sensitive to co-pays at their current common level? (Generally, public opinion polls are poor predictors of economic behavior when people are making actual choice with actual material consequences for them).Report

      • Avatar Koz in reply to Art Deco
        Ignored
        says:

        Megan McArdle just wrote about that today (linked in a comment by Mike here).

        Whatever the problems with health care, the solution is going to require unwinding the third-party payer system for a larger part of the medical services economy. That is the zeroth order solution. Of course, the liberals are on the other side of this, which is why all their proposed policies are horrible.Report

        • Avatar JosephFM in reply to Koz
          Ignored
          says:

          You agree to stringent enforcement of anti-trust and disclosure regulations regarding medical pricing and I’d be on board with that. I agree – we need to break the cartels.Report

    • Avatar Art Deco in reply to Francis
      Ignored
      says:

      Healthy kids and adults represent a huge positive externality in schools and the workforce. We should be making it as easy as possible to get good care, not raising the bar (which is what means-testing does).

      One’s state of health is as a rule fairly insensitive to the application of the techonology of medicine.Report

    • Avatar Koz in reply to Francis
      Ignored
      says:

      “2. I just love blog posts by quasi-libertarian quasi-conservatives which wish desperately that other Americans were more like them. It’s a very common style, and one that’s always worth a laugh or two. This is a classic of the genre.”

      Right. IMO, most of the motivation for posts like this have to do with the unwillingness to be associated with the “divisiveness” of the Evangelical Right. I wish we could do a better job of operating without labels if we have to and think about issues like health care from first principles, whatever our labels.

      Among other things, we need more appreciation of the limits of what can be done wrt subsidized public health care. Most of the time we talk about what various pressure groups want instead.Report

    • Avatar E.D. Kain in reply to Francis
      Ignored
      says:

      Francis – the whole smug, holier-than-thou condescension is precariously wearisome at this point. Go do it somewhere else. I’m done listening to you.Report

  14. Avatar Kyle
    Ignored
    says:

    No offense, Erik, but these days are you ever not thinking about health insurance?

    I think Michael Cannon raised a few good points, not the least of which was that people who are skeptical of progressive politics aren’t all right wingers. To make one of my own, the collective inability of HCR proponents to learn how to distinguish the unconvinced from the downright hostile – and their concordant inability to speak to the former persuasively has a fair amount to do with why health care reform is in jeopardy.

    I also think he’s right to question whether the intuitive is, in fact, correct. The obsessive focus on expanding access to health care and the indignant insistence that increasing access will save lives, ignores whether access equals quality. It also ignores burden shifting, it doesn’t seem far-fetched at all to think that after HCR, instead of hearing stories about how people die from lack of insurance, we’ll hear more stories about how people die from waiting for care, in understaffed hospitals.

    If education is any indicator, though by no means is it the only one, the idea that one can improve access then come back and improve quality doesn’t pass the laugh test. If compulsory education was meant to insure educational (and job) opportunity “for all,” it’s quite established that our various of public education systems fail spectacularly at doing so and in some areas, Chicago and DC come to mind, children are directly exposed to life-threatening violence, that the government insufficiently protects against.

    This shouldn’t be taken to be an argument against the provision of health care or compulsory education broadly, but I don’t think it’s particularly ideological to question whether the same old approach will work this time and not turn out to be an expensive program of less than stellar success, the main accomplishment of which will not be improved outcomes but the halting of worsening outcomes.Report

    • Avatar Jaybird in reply to Kyle
      Ignored
      says:

      Word.Report

    • Avatar Koz in reply to Kyle
      Ignored
      says:

      “To make one of my own, the collective inability of HCR proponents to learn how to distinguish the unconvinced from the downright hostile – and their concordant inability to speak to the former persuasively has a fair amount to do with why health care reform is in jeopardy.”

      Ditto (apologies to Rush)

      That, plus the refusal of progressive health care reform proponents to accept the advocacy of HRC to the general public as an affirmative burden. They’ve had their head buried, ostrich-style, with the rationalization that they won the 2008 election so they can do whatever they want, “never comprehending the race had long gone by”.Report

    • Avatar E.D. Kain in reply to Kyle
      Ignored
      says:

      What Jaybird said.

      Might I add that you have been on fire in the comments lately, Kyle. Good stuff all around.Report

  15. Avatar mike farmer
    Ignored
    says:

    Scrap the healthcare plan, let congress take a six month vacation, then while they’re gone, let’s solve the problems.Report

Leave a Reply

Your email address will not be published. Required fields are marked *