The Importance of Being Insured

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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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71 Responses

  1. Avatar Jaybird says:

    but the ACA is certainly a step up from the status quo. Anyone with a pre-existing condition could tell you that.

    This seems premature.
    The quickest analogy seems to me to be people cheering when the 18th Amendment was ratified because crime was going to go down now.

    There are a lot of unintended consequences yet to kick in. Let’s let them do so before we start talking about how much better off we are.Report

  2. E.D., I’m a little confused here. On the one hand you are talking about the dangers of centralization and yet you talk about support for something like single-payer which is…centralized.

    So, which is it? Is health care reform something that should be handled by Washington, left to states or what?Report

    • Avatar E.D. Kain in reply to Dennis Sanders says:

      Dennis –
       
      Subsidiarity calls for each task being undertaken at the lowest level of society possible. My support for a federally run military does not come into conflict with my support for subsidiarity. Similarly, I don’t think the states are sufficient to handle healthcare (though, to be fair, I do mention my support for Wyden’s opt-out plan and his earlier bill which was more state-based, so there is room for wiggling here.) I see no conflict in supporting decentralized education and centralized health insurance like single-payer.Report

  3. Avatar BSK says:

    One idea I had was to make a health care system that mirrors the school systems, though at a federal/national level.

    Everyone would have immediate and unfettered access to a basic public insurance option. It would be free and would offer comprehensive coverage but with the obvious limitations that come from a public system (limited doctor network, potential wait times, etc.). Beyond this, those with the means or desire would have every right to contract with private insurers, which would offer (presumably) better coverage and better options or to work individually with whatever doctors they so choose.

    We’d end up with a two-tiered system, which many people (particularly on the left, potentially) would rail against. But we already have a two-tier system…. only one tier is the insured and one tier is the uninsured. Wouldn’t we rather have a tiered system in which at least everyone is insured?

    To appease folks who’d argue that their tax dollars are paying for insurance they aren’t using, offer some sort of deduction for what they pay out of pocket for private insurance. It probably wouldn’t entirely offset the tax they are paying as a whole, but it seems a reasonable concession to make.

    I know this is far from an ideal solution and analogizing it to the school systems will bring groans because of the struggles but, warts and all, the fact is we have just about every kid getting a least a minimum level of education. Why can’t we do the same with health insurance?Report

    • Avatar ThatPirateGuy in reply to BSK says:

      Because old people watch Glenn Beck and go crazy.Report

    • Avatar trumwill in reply to BSK says:

      I’ve had a number of thoughts along these lines. I think that a tiered solution is likely what is going to need to result. Giving everybody something, but also giving those that have the resources greater choice among doctors, better accommodations, and so on.

      I also have a slightly more market-based variation. Have the government kick in the portion of insurance currently fronted by insurers except spread more widely. A voucher, more or less. I suspect that a number of insurance companies would find some plan that comes in below that (maybe you have to see a MLP before you can see an MD or you have to go to who the insco says you have to go to). And people that want to spend more in order to have more flexibility would be able to do that, too.l

      Or, if the market doesn’t step up, then the government itself has its own clinics and makes its own arrangements. Which I think is more of what you have in mind. And I’m not really opposed to if the first option doesn’t work.

      I doubt that any of these solutions are politically possible, though.Report

      • Avatar E.D. Kain in reply to trumwill says:

        Trumwill –

        How about we set up a system of exchanges and give people vouchers based on their income to help pay for private insurance. We could also expand Medicaid for the poorest Americans. This would lead to a three-tiered system instead of a two-tiered system (and maybe four-tiered if you count Medicare).Report

        • Avatar BSK in reply to E.D. Kain says:

          ED-

          I like this idea as well. As I just said to Trumwell, so long as everyone has access to reasonable insurance and no one is limited (except by their own finances) in how much they have beyond that, I think the solution would be a huge step forward from where we are now.Report

        • Avatar trumwill in reply to E.D. Kain says:

          The exchanges are possibly the bright spot in a law I am otherwise pretty unsure about. We’ll see how they work. I am trying to think of a more comprehensive solution rather than simply trying to plug in the holes created by a health care system tied to employment.Report

      • Avatar BSK in reply to trumwill says:

        trumwill-

        Mine is hardly the most fleshed out idea, so there are definitely variations on it which may be better, yours included. The overall goal of my system is to have the government insure insurance (ha!) to everyone with those who want/need more being given unfettered access to more. While more research would need to be done to see whether this saves taxpayer money over the current system or the proposed reforms (answering the legitimate question of how this is paid for and how much those not in the public system pay for others), it definitely addresses the fears that many have expressed that they’ll be at the mercy of the public system. They would have every right and opportunity to opt out and do it there own way.

        As I think more about it, I think the “voucher” system might be preferred for a variety of reasons. Again, I don’t know how the finances of such a system would work, but it seems like a nice solution. And it would avoid many of the pitfalls that education vouchers fall into, namely that you deciding to leave the doctor we previously shared and another, sicker person becoming a patient has little to no bearing on my health and care (which isn’t necessarily the case in the school voucher system).Report

    • Avatar Jaybird in reply to BSK says:

      I argue for a two tiered system as well. Heck, I even make mine time-dependent. If you want a level of health care using techniques and knowledge from (sometimes I say seven, sometimes I say ten) years ago, it’s covered by the government.

      I mean, most of the stuff that happens to folks is stuff that has been happening for thousands of years. A broken arm. Getting cut. Broken nose. Heart attack. Stroke. Cancer. We have centuries of experience with most, decades with some.

      If you want socialized health care, you have access to the stuff that is vintage. (Additionally, once doctors tire of keeping up with the latest bleeding edge stuff, they can slip from the one tier down to the other.)

      If you want the bleeding edge care, you pay for it (or have special insurance for it). If you want a semi-private room with a tv, you pay for it (or have special insurance for it). If you want a drug that was finally approved by the FDA two months ago, you pay for it (or have special insurance for it).

      (The problem with saying such things is that it always gets the response of “what, so you’re saying that a poor child doesn’t deserve a television???” or similar.)Report

  4. Erik,

    I think that you missing the fact that your own ideas or thoughts are shaded by ideology. You think that the government and more specifically, the federal government, should have some control in the area. Ok, fine. But that is an ideological argument. It isn’t somehow free and pure of some ideological thought. What I am reading in this post is that people like you and Freddie are mad that Republicans didn’t just adhere to ideas put forth by the Democrats. Republicans should give up their ideology, but the other doesn’t have to.

    The Republican alternatives to the Health Care Bill were more market-based and yes, based on their ideology. (I compiled a list of the offerings put forth in the last Congress.) We can argue if these were good ideas, but we can’t say that the GOP had no ideas.

    As for Wyden/Bennett, I think it was a great idea, but I do wonder why no one who supported it was out there writing letters to Congress or putting feet on the ground to make it viable. The plan never seemed to garner much attention beyond the punditocracy, when what it needed was citizen involvement.

    The health care issue is going to involve a clash of ideologies. That’s part of democracy. I do think there needs to be something out there in the area of health reform. But I think it means finding a solution agreeable to all sides instead of asking one side to just capitulate.Report

    • Avatar Michael Drew in reply to Dennis Sanders says:

      I don’t see where E.D. denied there is ideology in the desire for federal treatment of health coverage. He merely said that when an ideology you tend to hold prevents from supporting solutions to problems you would otherwise favor, it might be time to adjust or suspend your adherence to said ideology for the sake of the workable solution, or indeed simply recognize a real limit to the application of the ideology itself. That’s what separates using ideology as a rough guide for relating our specific views to our overall values from simply being a rigid ideologue.Report

    • Avatar E.D. Kain in reply to Dennis Sanders says:

      Dennis,

      I think that you missing the fact that your own ideas or thoughts are shaded by ideology.  You think that the government and more specifically, the federal government, should have some control in the area.  Ok, fine.  But that is an ideological argument.  It isn’t somehow free and pure of some ideological thought.  What I am reading in this post is that people like you and Freddie are mad that Republicans didn’t just adhere to ideas put forth by the Democrats.  Republicans should give up their ideology, but the other doesn’t have to.

       
      You are delusional if you think Democrats put forward a purely ideological, uncompromising bill. Oh for sure it’s no free market bill, but it’s very, very similar to earlier Republican ideas from people like Bob Dole during his doomed campaign. Nor am I saying ideology doesn’t come into play; my one critique of ideology is when it is take so far it becomes uncompromising and nothing gets done at all.
       

      The Republican alternatives to the Health Care Bill were more market-based and yes, based on their ideology.  (I compiled a list of the offerings put forth in the last Congress.) We can argue if these were good ideas, but we can’t say that the GOP had no ideas.

       
      The GOP was in power for years and came up with no ideas. The fact that they proposed alternatives was essentially meaningless, done more to provide contrast and cover than to offer meaningful solutions. If they wanted to pass healthcare reform they would have done it ten years ago.
       

      As for Wyden/Bennett, I think it was a great idea, but I do wonder why no one who supported it was out there writing letters to Congress or putting feet on the ground to make it viable. The plan never seemed to garner much attention beyond the punditocracy, when what it needed was citizen involvement.

       
      How do you know this? Do you know that people weren’t contacting their congress critters? I mean, there was a good deal of blog/news coverage of the plan. Lots of attention for it. I suppose there were as many people writing their congress critters and putting their feet on the ground (not sure how you do this for a specific bill but okay) as there were for the ACA. How would citizen involvement have changed the outcome? The outcome was determined much more by special interests and lobbyists, and I don’t think you could have gotten the sort of grassroots levels you would need for any one particular bill.
       

      The health care issue is going to involve a clash of ideologies.  That’s part of democracy.  I do think there needs to be something out there in the area of health reform.  But I think it means finding a solution agreeable to all sides instead of asking one side to just capitulate.

       
      I’m not sure this is possible. Agreeable to all sides? Not gonna happen. I mean, that’s a very noble idea but it’s not very realistic. Sometimes one side has to capitulate. Sometimes compromise is just one long train-wreck of capitulations.Report

      • Avatar Mad Rocket Scientist in reply to E.D. Kain says:

        I know that I, for one, wrote all of my federal critters and asked them to support the Wyden/Bennett bill.Report

        • Avatar TycheSD in reply to Mad Rocket Scientist says:

          I did as well. To me, it was the best of the more fully formulated solutions.

          I constantly wrote in favor of it on Marc Ambinder’s old blog at The Atlantic and elsewhere.

          There were tons of pundits and health care experts who were in favor of Wyden-Bennett – even White House favorite, David Brooks, but the plan still didn’t get any attention!! It was maddening! Even the Heritage Foundation wrote somewhat favorably about it.

          And, Bob Bennett losing his seat for coming up with this plan with Wyden is a crime. This just signals to me that the Republicans are not serious about health care reform.

          And, for Ron Wyden to be invited to Obama’s health care summit as an afterthought was utterly ridiculous!!! I thought he was the go-to guy in the Senate for health reform!Report

      • You are delusional if you think Democrats put forward a purely ideological, uncompromising bill. Oh for sure it’s no free market bill, but it’s very, very similar to earlier Republican ideas from people like Bob Dole during his doomed campaign. Nor am I saying ideology doesn’t come into play; my one critique of ideology is when it is take so far it becomes uncompromising and nothing gets done at all.

        Erik, I would appreciate that you not engage in calling me delusional. You can say you disagree with me and say that, but I don’t enjoy being called crazy.

        As to why the Dems plan not being ideological, you have a point. And yes, the Republicans did propose something similar in the 90s. But just because they supported it 15 years ago, doesn’t mean that they would support it now. I’m not saying I like that, I’m just saying things change.

        The GOP was in power for years and came up with no ideas. The fact that they proposed alternatives was essentially meaningless, done more to provide contrast and cover than to offer meaningful solutions. If they wanted to pass healthcare reform they would have done it ten years ago.

        But isn’t your argument moving the goal posts a bit? People say the GOP has no ideas, so when they do come up with ideas, people then say there are meaningless. Opposition parties usually put up alternative plans to provide an alternative. They usually go nowhere. It is meaningless? I don’t think so. Could you do better. Yes.

        I do remember during the Bush 43 years there was talk of Health Care Savings Accounts and rolling those out as an alternative. I’d have to do some searching as to what if anything came up in Congress during those years. Was that a good idea? I don’t know.

        I do agree that health care is not a big issue among the GOP. It’s not that Republicans are simply meanies, but the people that support the party these days are folks who don’t see this as an issue. I think there are Republicans who do have real ideas, but there isn’t a constituency for them.Report

        • Avatar Aaron W in reply to Dennis Sanders says:

          I think he (perhaps unfairly) called you delusional because it’s just frustrating to see the Republicans constantly moving the goal posts in terms of different healthcare plans over the years. In my more pissy moments, I think the same as well. I feel like that if the whole thing is declared unconstitutional, if the Democrats then offered catastrophic coverage + HSAs upon regaining power, the Republicans would oppose that as well.Report

          • Avatar stillwater in reply to Aaron W says:

            EDK, I’m glad to see getting beat up on your home turf, means that at least you aren’t cowing to the party line at either place! But really, I agree with you: the Democratic bill was as far from ideological as a meaningful piece of legislation ever could be. The purpose was two-fold: to expand medical coverage (to new recipients but also to ensure that private providers couldn’t jigger the system by recision or outright denials of coverage), and to preserve Medicare by shoring up care costs (it is of course not so effective in this regard since provider costs weren’t directly affected by the Act.) Now, someone may say that Medicare is an ideological issue, but it seems like conservative voters are pretty set on retaining it as an entitlement.Report

        • Avatar E.D. Kain in reply to Dennis Sanders says:

          Dennis I said “if”. I dont’t think you’re delusional. I’m just not sure you can actually believe that the ACA is an uncompromising ideological bill. And what Aaron said. I didn’t mean to come across as pissy as I did.Report

    • Avatar Robert Cheeks in reply to Dennis Sanders says:

      Dennis, I enjoyed reading the above. Thank you for the common sense and reason, it’s much appreciated here at the League where socialists dominate the discussion while ignoring decades of failed, centralized policies that have pretty much morally and financially wrecked the old republic.Report

    • Avatar Simon K in reply to Dennis Sanders says:

      Dennis, I don’t think there was a clash of ideologies. This is the thing where there is a disconnect. I see the Republicans constantly doubling down on a baldly political decision to try to screw the administration, in the probably correct belief that when they finally fold it won’t be them paying the bill.

      Large parts of Obamacare – the mandate, the reforms to Medicare, the various cost saving initiatives – are straight out of the Republican playbook from 1994, and were proposed by Republican think-tanks as recently as 2008. Given this, I expected, and I think the Democrats expected, the Republicans to say “okay, but …” to the other bits – the taxes, the price controls, the Medicaid extension – and add in some of the things they previously said they wanted. For example, they could have added better support for HSAs, tort reform, and changing the employer based above-the-line deduction into a fixed credit.

      But they didn’t do that. Instead they decided to see if they could defeat the President, and since they were in the position of having almost no legislative power, they did so by going after the public. So be it – that’s politics. Unfortunately a lot of the public and a disturbing number of Republican officials has gotten the idea that there’s some giant ideological gulf between the President and the Republican congressional delegation that just doesn’t exist. If you think Wyden Bennett was a brilliant plan, there’s not a lot of ground for saying the ACA isn’t at least a step in vaguely the right direction.Report

  5. Avatar Mad Rocket Scientist says:

    Why are we still focused on the idea that health insurance is a pre-paid medical care plan, instead of, well, insurance against catastrophe?

    My auto & home insurance policies protect me against catastrophic damage or loss of my car or house, but they do nothing for my regular upkeep & minor repairs. I have to pay to have my plumbing fixed, or roof repaired, or oil changed, or tires replaced. A big issue I have with ObamaCare is that (from what I know) the only insurance it considers acceptable is the pre-paid medical type plan. It considers Major Medical type plans to be unacceptable.

    It also does nothing to fix the MediCare/MediCaid compensation shortfall. MediCare/MediCaid are great, but fewer & fewer doctors are accepting patients in those programs (more MediCare than MediCaid, but still). Insurance != access, and the ObamaCare plan does little to nothing to address this issue.Report

    • I agree with you. There was a great article in the Atlantic a few years ago about the American health system and how the solution should be something maybe more along the lines of Singapore: a catastrophic insurance system with Health Care Savings Accounts for other medical issues.Report

    • Avatar DensityDuck in reply to Mad Rocket Scientist says:

      “Why are we still focused on the idea that health insurance is a pre-paid medical care plan, instead of, well, insurance against catastrophe?”

      As well as the notion that it’s absolutely impossible to pay for health care without some kind of shared-cost plan. To return to the car analogy, I don’t expect State Farm to cut me a check in reimbursement for my oil change and brake inspection.Report

  6. Avatar Freddie says:

    It’s bizarre for me to see people saying that I’m mad that Republicans didn’t jump on board with a Democratic bill. I am asking for something very obvious and very specific: the counter proposal that conservatives and Republicans say they will support but haven’t come up with. We are getting this from just about everybody; “oh, I support universal coverage, but…” Well it is high past time people ante up and show us. But they probably won’t, because their claim that they want a health care regime where everyone gets coverage is empty sophistry. As has been revealed for months and months.

    By the way, the Democrats bent over backwards to involve Republicans in the health care bill. It was one of the showiest acts of conciliation and outreach I can remember. It was utterly rebuffed, because the GOP has switched into a 100% pure obstructionist mode, as is clear to anyone who isn’t profiting by denying it.Report

    • Avatar DensityDuck in reply to Freddie says:

      See, I hear this a lot. “Oh, well you can’t denigrate something unless you propose something better!” Really? That kind of blows away the entire art-analysis industry, then, because you’re denying the validity of value judgements made by laymen.

      “By the way, the Democrats bent over backwards to involve Republicans in the health care bill.”

      “Here’s what we’re going to pass, you can vote on it if you want” is hardly bending over backwards.Report

      • Avatar Jaybird in reply to DensityDuck says:

        What makes it worse is when many folks have, in fact, proposed different health care “fixes” to be told that such fixes are politically untenable.

        So we are not only left with Hobson’s Choice but then derided for opting to take no horse at all.Report

      • Avatar Boonton in reply to DensityDuck says:

        Single payer – off the table
        Abortion coverage, even if it was choosen by the patient – off the table
        Public option – off the table
        Public option with trigger as Bush’s Medicare D has – off the table.

        Ohhh, illegal immigrants getting covered, that’s off the table too but that didn’t stop the yahoo from yelling ‘you lie’ a the State of the Union.

        The Democrats compromised quite a bit, the Republicans took each concession and demanded more without offering even token votes. Yes at a certain point you’re done, you vote and either the yes’s or no’s win and that’s that. That’s not some horrible victimization of Congressional Republicans.Report

  7. Avatar TycheSD says:

    At the risk of sounding uncompassionate, I don’t see how the cost of health care can be lowered without people/consumers having more of a stake in their own health care. Isn’t the cost of health care high because there is too much demand for health care?

    And, about that guy on Medicaid in Arizona who needed a transplant – should the state be responsible for paying for extremely expensive and complex medical procedures for poor people? Does everyone have a right to the most sophisticated and expensive medical technology?Report

    • Avatar Jaybird in reply to TycheSD says:

      Does everyone have a right to the most sophisticated and expensive medical technology?

      I’ve always looked at the situation through this hypothetical:

      Imagine a wonderdrug. It will lower your bad cholesterol, raise your good cholesterol, reduce your risk of heart attack, raise your metabolism to help you lose weight, and give you a full head of hair.

      This drug will not be ready to be evaluated by the FDA until 2050. Let alone released after clinical trials! As such, it’s not even on the drawing board now. The precursor won’t even be stumbled across by a particularly happy accident until 2022.

      Here is my question: are you entitled to this drug?

      It seems to me that the obvious answer is “no”. It doesn’t exist! It won’t even go on sale until 2060!

      Fair enough. I agree.

      Now, here’s my intuition: once it exists the status of whether you (or anyone) is entitled to this drug will not change one iota.

      And, from there, I extrapolate out to other drugs, and other medical technologies.Report

    • Avatar ThatPirateGuy in reply to TycheSD says:

      Yeah, they do.

      The whole point of having a society is to increase human welfare. More years of productive healthy life cleary outwieghs most other possible uses of those resources. If the point of distributing resources via things like capitalism, etc. is to increase human welfare and the system isn’t working well you patch the system.

      Otherwise why don’t we call this whole society thing off and eat the delicious goo inside each others skulls.Report

      • Mr. Pirate, the Founders said the purpose of gummint is to protect our rights. You could look it up. Here, I’ll save you the trouble:

        “…That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed…”

        You posit;

        The whole point of having a society is to increase human welfare.

        Now, you perhaps unintentionally make what is or should be a necessary distinction between “gummint” and “society.”

        The modern scheme, of course, contemplates “gummint” and “society” as synonymous. Hence its fatal error. Hence—may I say it–oh, what word to pick? Socialism? Communism?

        Ah, “communitarianism?” Does that sound nice enough?

        Feh. Fascism. The sticks bundled together so as to be unbreakable. You could look it up, and it would cheat you of a necessary discovery to save you the trouble.Report

      • Avatar TycheSD in reply to ThatPirateGuy says:

        “The whole point of having a society is to increase human welfare.”

        I agree with Tom that this may be the purpose of society but not the purpose of government, which was established to protect rights.Report

        • Avatar ThatPirateGuy in reply to TycheSD says:

          “promote the general Welfare”

          Unlike some crazy trolls I am assuming that you are worth talking to. I am also assuming that you have heard of the income tax. Given that the income tax is definately constitutional and that part of the reason government was established was to promote the general welfare government can do more than run courts and hire people with guns to shoot people we feel need killing.

          It can for instance hire scientists to perform basic research, provide for the eductation of our children, protect us from infectious disease and natural disasters, provide healthcare(Medicare have you heard of it?), and many other-things. In addition since the ratification of the 16th it can use income taxes to raise the funds to do these things. It can even give tax breaks to promote things it likes such as people having health insurance or raising children.

          You might think this is wrong or a violation of your rights but it ain’t unconstituitional. It also ain’t a garunteed slide to totalitarian dictatorship. I know that because I know how to read about europe.Report

        • Avatar E.D. Kain in reply to TycheSD says:

          TycheSD – I dunno. Most governments were (and are) certainly not established either to protect rights or at least not just to protect rights. As Pirate says, they do a lot of other things and were established with the intention of doing a lot of other things. Whether that’s right or wrong is another question, but saying they should do nothing but protect rights isn’t saying much at all. I mean, the expensive transplant – well our core rights are the pursuit of Life, Liberty, and Happiness right? Doesn’t the state – at least in this day and age – have some obligation to not simply let someone die who could otherwise be saved?

          So “society” should step in instead? Isn’t a democratic government an expression and a vehicle of society? Isn’t it merely a method of organizing society to achieve certain outcomes – like saving lives?Report

          • Gentlemen, from James Madison’s 1813 veto of a public works bill:

            “To refer the power in question to the clause “to provide for common defense and general welfare” would be contrary to the established and consistent rules of interpretation, as rendering the special and careful enumeration of powers which follow the clause nugatory and improper. Such a view of the Constitution would have the effect of giving to Congress a general power of legislation instead of the defined and limited one hitherto understood to belong to them, the terms “common defense and general welfare” embracing every object and act within the purview of a legislative trust.”

            Enumerated powers. If you disagree, pls take it up with Mr. Madison.

            http://www.constitution.org/jm/18170303_veto.htmReport

          • Avatar TycheSD in reply to E.D. Kain says:

            The rights to life, liberty and the pursuit of happiness are basic principles of our government. In fact, our government was founded in order to create an environment highly conducive to people living in those conditions. That doesn’t mean that the government is charged with saving the life of each individual.

            I don’t think the people who wrote and contributed to creating our Constitution envisioned anything like Medicare or Medicaid, so the state guaranteeing medical care for individuals is something we made up pretty far into our existence as a nation. And, it wasn’t planned very well.

            There are differences in interpretation of the general welfare clause in the Constitution. Providing for the general welfare of the nation as a whole, which is my interpretation, doesn’t mean providing for the general welfare of each individual.

            For example, I believe in very stringent environmental laws and regulations because I think the government is responsible for ensuring that our air and water are safe and healthy and that our land and resoures aren’t squandered or ruined. But, I don’t think the government is responsible for making sure that I eat broccoli so that I personally am healthy.Report

  8. Avatar TycheSD says:

    As an aside, Ron Wyden warned that health care reform would need to be bipartisan or it would be vulnerable to repeal. The ACA plan has no legitimacy with a whole segment of the American public.Report

    • Avatar tom van dyke in reply to TycheSD says:

      TyscheSD hits it on the head. There was no consensus on health care. The bill was passed with political maneuvering and brute majoritarian force.

      Yes, we’re a democracy, but we’re also a republic. The latter is structured to assure consensus, as our Founders in their wisdom did. One party plus a significant minority of the other.

      That’s not how this healthcare thing went down, which is why it lacks legitimacy in the consent-of-the-governed sense and is bad governance. We are not a parliamentary democracy, thank God.Report

    • Avatar Michael Drew in reply to TycheSD says:

      It has no legitimacy because it was fearmongered to within an inch of its life in terms relating it to Stalin and Hitler. Twenty years ago, the problem with making this bill bipartisan would have been getting Comie-Dems to sign on, so corporatist is it. The Democratic presidential candidates ran on making ideas like this law as a centerpiece of their campaigns. It was passed by, yes, legitimate legislative procedures. It may not be popular and it may be vulnerable to appeal, but that is a political fact about it, not a fact about its legitimacy.

      What would a bipartisan health care reform have looked like. Republicans openly admitted they’d have opposed anthing Obama would have been willing to be for, so what you are really saying (not intentionally but this is the effect) is that health care reform could only have been legitimate if done by a leader (ideally Republican) whom the Republicans did not try to delegitimate. Is that really how you want to determine what laws you think should be passed? If you think health care reform should hve been undertaken in 2009 and 2010 but it should have been bioartisan, then what reform ideas do you assert would have been passable? What is your evidence that Republicans would have given their imorimatur to it if it had been proposed by Obama that outweighs their explicit statements that they chose not to go along with anything specifically in order to render all attempts to gevern partisan and not bipartisan?

      If you think that health care reform didn’t need to be pursued in the last two years, but needed to be pursued at some time soon, and needs to be bipartisan, what reform ideas do you think a) are desirable to you b) are sufficiently extensive so as to provide real reform that address the scope of the problems that make it a priority issue to begin with, and c) we can reasonably expect would have been met with extensive Republican approval while Barack Obama was president? If you do not think that health care reform needed to be addressed while Obama was in office, then I don’t think you can say that you think that health care reform is a priority for you at all, in which case you simply have a fundamental disagreement with them about what priorities are important for the country. But they were entirely clear that this was their priority as a matter of substance, and no where did they say that it was subject to achieving bipartisan support for a reform, as much as they wanted and tried to do just that.

      As long as our present era of constitutionalist and hysterically allusive argumentation about public policy persists, we can assure ourselves that a segment of the population will regard many acts of our government as illegitimate. That does not make them in fact illegitimate. If you think this is bad legislation, that is perfectly defensible. If you think that health care reform needed to wait for an elusive moment of bipartisan consensus, then you simply don’t place health care reform on a level of priority that a working majority of Congress as well as all the Democratic presidential contenders explicitly did. That too is perfectly fine, but that difference in priorities is enough to justify their taking action despite your preference about achieving a bipartisanship whose arrival date was entirely uncertain.Report

      • Avatar greginak in reply to Michael Drew says:

        All true and of course the mandate was as Repub idea that had considerable support and was actively proposed for a couple decades up until 2009 . Over on Ezra Klein’s site he interviewed the guy who developed the idea of the mandate: it was developed by a R during Bush 1.

        Bipartisan is to often just another word for BOHICA.Report

        • Avatar Jaybird in reply to greginak says:

          So it’s a Republican Bill passed by Democrats.

          And the Republicans opposed it for that reason and the Democrats supported it for that reason.Report

          • Avatar greginak in reply to Jaybird says:

            Its more about how much the screaming and wailing about the D’s not being bipartisan enough and mean to the poor ol R’s is poo. The D’s have moved steadily towards the R position and people still whine about the D’s not being bipartisan enough or willing to compromise, or being socialist, blah blah blah.

            And plenty of D’s dislike the ACA because they/we feel it went in the wrong direction. Remember all the fuss about D’s and Lib’s wanting a public option at least.Report

      • Avatar Robert Cheeks in reply to Michael Drew says:

        Mike,
        Good points!
        I think once the political truth of who Barry is was made public a ground swell of ‘push-back’ began. The dude believes in the efficacy of big gummint given all the empircal data that negates such nonsense and many of us out here in fly-over country, people who wet their pants at the opportunity to prove they weren’t prejudiced, really don’t like or TRUST him, personally!
        I think any legislation emanating from the White House, especially the now moribund Obamacare, is going to be met with Republicans elected by these people. And, it sure looks like “the people” aren’t done replacing commie-Dems, but we’ll see.Report

      • Avatar TycheSD in reply to Michael Drew says:

        Michael, I guess you were responding to me. It’s hard to tell.

        Health care reform was not a priority of mine when I voted for Obama. I wanted an end to the wars, entitlement reform and a carbon tax – with an offsetting redution in payroll or income taxes (as Al Gore proposed some time ago, and Tom Friedman also supported). I disagreed with cap-and-trade too because it’s too bureaucratic and complicated.

        The Center For American Progress were backers of cap-and-trade also. I don’t think that center has the best ideas, despite what a nice guy John Podesta seems to be and how connected he is.

        I don’t think the Republicans were acting in good faith in opposing health reform, but I think it may have been harder for them to explain their opposition if Obama had proposed something like Wyden-Bennett that actually had very recent Republican support.Report

  9. Avatar Jaybird says:

    And didn’t we just have a discussion about abortion being equated with slavery?

    Now health care reform is Jim Crow?

    I swear, next week someone is going to compare Citizens United to Reconstruction.Report

    • Avatar Koz in reply to Jaybird says:

      Yeah, it’s amazing that we’re supposed to take this sttt seriously. In fact, it’s amazing that Freddie does.

      As near as I can see, no one has called him out on the basic structure of his argument: that he wants the Republicans to figure out how to give him what he, ie, Freddie wants. And of course the Republicans have failed to do this. But that’s not the GOP’s problem, it’s Freddie’s. If Freddie wants universal health care, let him figure out what form it should take and how to get it through the sausage factory.

      Put it this way, if someone were to ask which prominent figure on the Right is most committed to universal health care coverage, I wouldn’t even have a guess.Report

    • Avatar Sam M in reply to Jaybird says:

      Agreed.

      The basic structure of the argument is interesting, insofar as a failure to provide healthcare in some way equates to Jim Crow.

      One of the defining problems of the healthcare debate is that some people, for whatever reason, CHOOSE not to buy healthcare. That’s what the mandate is all about. Forcing those people to choose in a way that we want them to.

      Was one of the problems of the Jim Crow era that black people were simply choosing to be oppressed? Or that they didn’t view themselves as oppressed at all?

      I guess you can make the case that the people who need health insurance but cannot afford it are being oppressed in the same way as black people were in 1954. I think that’s a stretch, but OK. An analogy doesn’t have to be perfect to be effective.

      But those people are only part of the problem. The other problem is that a lot of people, for the moment, see health insurance as a bad deal, and going without it as a solid gamble. And writ large, they are right. If you are 24 and in good health and your employer is charging you $200 a month for coverage… you might be better off refusing it and socking it away. Or spending it on beer. And these incorrigible people are gumming up the works something fierce.

      Where do they fit into the analogy?Report

      • Avatar Boonton in reply to Sam M says:

        One of the defining problems of the healthcare debate is that some people, for whatever reason, CHOOSE not to buy healthcare. That’s what the mandate is all about. Forcing those people to choose in a way that we want them to.

        No it’s not. If tomorrow someone ‘discovers’ some Constitutional theory that limits the number of commas that a bill can have by next Monday trust me they will be a newly formed advocacy group demanding that the Health Bill must be stopped because of its surplus commas. When the case goes to court a collection of people will appear screaming that excessive comma use is exactly how Hitler and Stalin came to power and they honestly have no problem with health care reform but please just get rid of this bill and pass one with fewer commas.

        Anyone who really wants to not have health coverage for whatever reason will find it quite easy to do with the current bill.Report

        • Avatar Jaybird in reply to Boonton says:

          When the case goes to court a collection of people will appear screaming that excessive comma use is exactly how Hitler and Stalin came to power and they honestly have no problem with health care reform but please just get rid of this bill and pass one with fewer commas.

          You’ve no technique.Report

  10. Avatar Jaybird says:

    Another thing that I’ve been wondering is how much of the “denial” of health care is logistical?

    That is to say, if you live in a place where you have to travel X hours to get to the doctor (where X is large enough to constitute “a pain in the ass”), is really, really, really awesome insurance coverage enough to get you to go to the doctor for your annual checkup when, otherwise, you “feel just fine”?

    It seems to me that having to travel X hours to get to the doctor is a recipe to only going when you think you’re going to die otherwise *OR* when you say “well, it’s been Y years, I probably should go so she can tell me that I need to quit smoking, exercise more, and quit eating fast food (again).”

    It doesn’t strike me that this particular solution will fix this particular problem.Report

    • Avatar DensityDuck in reply to Jaybird says:

      Sort of the healthcare version of “food deserts”.

      And there’s some validity to that. Right now, I’m lucky enough to work for an employer who’s happy to let me take an unscheduled, unplanned half-day as “sick time” so I can go to the endocrinologist. If I worked a minimum-wage fast-food service job, I doubt I’d have that kind of freedom; if the doctor weren’t open outside of my work hours then I’d never have a chance to go.Report

    • Avatar Michael Drew in reply to Jaybird says:

      You’re totally right about that; there’s been a lot of reporting about this.

      Nevertheless, if people living far from care centers get hurt badly enough, they will seek care, and if they are not covered and not of means their costs in that scenario would be just as much a burden on the system as any others’.

      But this does seem like a good argument that the mandate for maintaining minimum coverage can only be just if it mandates at most kinds of care that would be unavoidable for people who are more inconvenienced than served by partaking of care that they are forced to be covered for.Report

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