The Body Politics

On health-care reform, Democrats have become their own worst enemy.

Peter Suderman | September 25, 2009

As health-care reform struggles to stay afloat, Democrats are desperate to pin the blame on Republicans. But the truth is, no matter how much Democrats gripe, it's their own fault.

With the passing of Ted Kennedy, Democrats have only 59 votes in the Senate, one less than they need to break a filibuster. Until this week, Democrats held out hope that at least one Republican would sign on. But when Senate Finance Committee Chairman Max Baucus finally released his plan on Wednesday, Olympia Snowe, the most likely GOP vote, quickly backed out.

That leaves Democrats with just one option: Go it alone. And that won't be easy. Because a party that not long ago was united behind a leader and a purpose—guaranteeing health insurance to all Americans—has, in just a few short months, descended into disarray.

As the health-reform push enters its final stages, here's who's causing headaches:

Sen. Jay Rockefeller: As a member of the Senate Finance Committee, Rockefeller is a key vote. And he's repeatedly said there's no way he'd vote for the Baucus plan as it stands. He hasn't just knocked the plan, he's knocked the planner, taking aim at Baucus' feints toward bipartisanship. "You don't run a committee that way," he told Politico. The West Virginia senator is so miffed by the failure to include a government-run public plan, a favorite idea among liberals, that he took his complaints all the way to Obama—and still came out shaking his head. Nor is he willing to consider compromises like co-ops or a public option "trigger." For Rockefeller, no public plan means no way.

Sen. Mary Landrieu: Rockefeller, though, faces tough opposition from moderates like Landrieu who have expressed serious reservations about including a public option. At the beginning of last week, Landrieu worried that a public plan might "undermine the private insurance system."

Rep. Nancy Pelosi: Pelosi, the House's top Democrat, also sniffed at the Baucus plan, expressing disappointment in the bill's lack of a public option, saying she wanted "modifications" to make mandatory insurance more affordable.

Sen. Ron Wyden: Like Pelosi, Wyden, another Finance Committee member whose own more radical reform bill has been sidelined, has taken issue with the expenses the plan could impose on the middle class. Shut out, Wyden took his objections straight to the public, putting a stern op-ed in The New York Times detailing the "problem" with the Baucus bill. But increasing middle-class subsidies would also make the bill more expensive—a politically risky move.

Sen. John Kerry: For Kerry, the current Baucus plan is a non-starter. The former presidential candidate has also stated worries about the plan's cost to lower-income Americans—and said it's got to change before passage.

"It's not going to be the bill we're going to vote on," Kerry said when the Baucus plan hit.

Sen. Dianne Feinstein: Any move to make the bill more expensive would risk the wrath of Democrats like Feinstein, who recently told the San Francisco Chronicle, "There is real concern over debt and deficits, and whether this bill will create additional entitlements." Of course, Feinstein doesn't want the bill cut too much: She's also expressed concern that Obama's cost cuts will come out of her home state's public hospitals.

Sen. Bill Nelson: Nelson, a Florida senator answerable to the votes of numerous senior citizens, has expressed tacit support for the measure, but he's also taken issue with the plan's cuts to Medicare. In a strident statement on the Senate floor, Nelson said it would be "intolerable" to ask seniors to give up the "substantial benefits" they now enjoy.

But intraparty bickering isn't the only hurdle for Democrats. They also have to balance the demands of liberal interests like labor unions and major health-care players.

When health-reform efforts started, Democrats opted to buy off industry, which they saw as having killed the Clinton reform drive in the '90s. Every player got a handout—but the handouts may not add up. Insurance companies, for example, were promised comparative-effectiveness research—a government panel that would give them cover to say that treatment options just aren't worth the price. Rather than seem stingy, they can say, "Sorry, the government says this isn't effective."

The pharmaceutical lobby, meanwhile, came on board in hopes of expanding the market for brand-name drugs. But comparative-effectiveness research might slash the sales of some of those same drugs—especially the most profitable ones. The drug companies haven't jumped ship yet but they're fighting hard to nix the insurers' handout.

Comments

MNG|9.25.09 @ 6:21PM|#

I agree the Dems largely have themselves to blame, but for a different reason. This is the second time the Dems have tried to answer the cry for reform with a convulted half-market half-government measure. And for the second time we get this massive complicated thing that nobody knows wtf is in it and what is not. Obama should have picked a simple reform like single payer, one that can be more easily explained, and pushed it as his reform. He was going to get blasted as a socialist either way, as we now know.

Look, personally I don't want to see a single payer plan or whatever the hell Obama care ends up being, as I have great coverage right now and I doubt anything they come up with will be as good.

24AheadDotCom|9.25.09 @ 6:25PM|#

More hilariousness and abject non-seriousness from Reason. One of the ways the Dems majorly hurt themselves was in trying to allow illegal aliens to get into Obama's healthcare plan. Not only were many at townhalls shouting about that (no doubt against the wishes of their corrupt leaders), but I seem to recall a bit of attention being made to "You lie!"

Yet, that's nowhere in Suderman's article. Like I said, Reason is hilarious and non-serious.

Plant Immigration Rights Suppo|9.25.09 @ 6:27PM|#

"Cranky Congress critters. Inter-industry feuding. What's left? Oh right: Voters. As Robert Goldberg of the Center for Medicine in the Public Interest says, Democrats "forgot about the fact that health reform affects people, not just interest groups.""

Congressvermin often forget about the serfs they claim to represent. But the serfs are getting angry and if they try to force this down our throats we will have our pitchforks ready. Remember September 12? You have seen NOTHING YET!

Plant Immigration Rights Suppo|9.25.09 @ 6:32PM|#

"Look, personally I don't want to see a single payer plan or whatever the hell Obama care ends up being, as I have great coverage right now and I doubt anything they come up with will be as good."

Good for you. You are far from alone. Regardless of our personal ideological differences we need to stand shoulder to shoulder on this one and shout in a united voice "NO!" The Congressvermin might actually pay attention if we do this.

Geotpf|9.25.09 @ 6:36PM|#

It's always easier to keep the status quo than to change things. There very well might not be a bill that can get both moderate and liberal Democrats to vote for it. But there's still a chance that something might be worked out. The compromise most likely to pass both groups is something without a public option to start but with a real trigger (as opposed to one that will almost certainly never be activated).

In any case, Obama et al went about this the wrong way. He should have just shot at the moon and extended Medicare to everybody. Medicare polls well, and, in general, it's a lot easier politically to expand an existing program than to create a new one.

Plant Immigration Rights Suppo|9.25.09 @ 6:47PM|#

"but with a real trigger (as opposed to one that will almost certainly never be activated)."

I understand, so you don't want a "trigger" so much as a law that will be in place no matter the actual conditions.

24AheadDotCom|9.25.09 @ 6:51PM|#

Somewhat OT, but it looks like Reason's video about young people choosing supplements and jeans over healthcare wasn't so funny after all.

Paul|9.25.09 @ 6:56PM|#

Obama should have picked a simple reform like single payer, one that can be more easily explained, and pushed it as his reform. He was going to get blasted as a socialist either way, as we now know.

Right, so he might as well have been one because, you know, socialism works so well...

Paul|9.25.09 @ 7:01PM|#

Seriously, there's so much reform to be had in our system (especially in the already existing 'single payer' models such as Medicare) but no one will touch it. No you have to "think big" and have "big ideas". Sucks to just sit down, look at Medicare and say "so why do we provide this kind of coverage?" and start making procedural cuts, while expanding coverage for real medicine.

Heard a story last night on NPR where they spent some time with a relatively wealthy woman who had Medicare and had beaten breast cancer. Part of the medicare coverage was that it provided for 'up to six bras' for women who have had a prosthesis. The woman remarked "Who needs six bras?!!" and then promptly proceeded to get them.

She never thanked me for them at the end of the story. I felt kind of used.

|9.25.09 @ 7:02PM|#

"Somewhat OT, but it looks like Reason's video about young people choosing supplements and jeans over healthcare wasn't so funny after all."

Yeah, I still think it's funny.

Warty|9.25.09 @ 7:07PM|#

She looks like she smelled like hemp shampoo.

Also, shut the fuck up, Lonewacko.

|9.25.09 @ 7:12PM|#

Can we just acronymize this as STFULW, please?

Warty|9.25.09 @ 7:17PM|#

It has more power in its full form, Hazel. Quod erat demonstrandum.

|9.25.09 @ 7:19PM|#

I'm not too keen on this article. Sure, there is intraparty bickering, but so what?

By my observation, the real reason they havn't got a plan is because they really havn't thought through their proposals. The "plan" is a bag of sound bites meant to placate as many interested parties as possible, not a serious attempt to address the underlying reasons for cost escalation in health care.

Just for example, they make no attmpt to address the well-known, well-understood, perverse effects of the employer based system. Instead, they actually reinforce that system by imposing taxes and pentalties on employers that don't offer insurance. Why? Not because they have put any serious thought into it, but because placating voters that want "free" health care through their employers is more important than coming up with workable ideas. They are more interested in passing ANY bill, no matter how hackneyed, for political gain, than in putting an serious intellectual effort into actually addressing the problem.

Daily Kos|9.25.09 @ 7:20PM|#

Nuh uhhh.

Paul|9.25.09 @ 7:22PM|#

What Hazel said.

|9.25.09 @ 7:30PM|#

The pharmaceutical lobby, meanwhile, came on board in hopes of expanding the market for brand-name drugs.

It's worse than that. They made a backroom deal with the feds in exchange for a TV ad campaign supporting Obamacare.

|9.25.09 @ 7:31PM|#

As Robert Goldberg of the Center for Medicine in the Public Interest says, Democrats "forgot about the fact that health reform affects people, not just interest groups."

Okay this line is kind of close to accurate. I mean the insurance mandate was introduced in order to get the insurance industry to agree to the clauses on pre-existing conditions. But they didn't put any serious thought into how to deal with preexisting conditions in the first place. They just decided to force insurance companies to take them. And they aren't even bothering to make an argument for it beyond "insurance companies bad! profits evil!" And consequently, they had to force everyone to buy insurance ... completely forgetting about the millions of ordinary people out there who don't want to be forced to buy insurance or subsidize care for people with preexisting conditions.

Interested groups satisfied: Sick people, check. Insurance companies, check.
Ordinary people? Not satisfied.

Paul|9.25.09 @ 7:43PM|#

Oh yeah, and here's my favorite. If all of this reform effort fails, we'll get some piece of legislation that 'comes out of it all' sort of like HIPAA and the Clinton burn-in of healthcare reform.

HIPAA, a law which turned ordinary network administrators into drooling schizophrenics who are all now utterly convinced they work in a top secret facility with Russian black helicopters and spy vans with electro-magnetic resonance devices, tuning into each copper wire pair to discover what Mrs. Cravitz' urinalysis results were.

I used to work in a top-secret military facility where Russian spies actually were interested in what was going on. When your security people have real, tangible threats, they're afraid of real threats. When your security people don't have any real threats, they're afraid of everything.

MNG|9.25.09 @ 7:59PM|#

Come on Hazel, the arguments I've heard about pre-existing conditions are that 1. it's awful to have someone through no fault of their own be denied care, better to spread the costs over society and 2. markets will have little to no incentive to cover such folks.

|9.25.09 @ 8:00PM|#

Obama should have picked a simple reform like single payer, one that can be more easily explained, and pushed it as his reform. He was going to get blasted as a socialist either way, as we now know.

He would never have gotten the industry lobbies on board with that, and the socialism charge would have resonated even more. While my opinion of Obama as a person ranks him somewhere between the guy who goes through our apartment's dumpster looking for dinner and the crud I just scrubbed up from under the fridge, I do respect his political instincts. He gave this thing the best go he could, and it ain't gonna pan out.

|9.25.09 @ 8:04PM|#

it's awful to have someone through no fault of their own be denied care, better to spread the costs over society

Yeah, no collectivism apparent there. No concern about how it's awful to have someone through no fault of their own being forced to pay for a stranger's care.

|9.25.09 @ 8:05PM|#

Hazel: "They are more interested in passing ANY bill, no matter how hackneyed, for political gain, than in putting an serious intellectual effort into actually addressing the problem."

I think what you are forgetting is that there is a dearth of intellectual power in both the House and Senate. I'm not sure any of them, or their staffers, are actually capable of sustained, difficult thought for any extended period of time. There is a serious lack of intellectual accomplishment among Congress, even in law (which is what most of them are trained in). Everything begins with the fact that we've elected idiots who, for the most part, lack rigorous educations and any real world experience outside of politics.

Of course, you could go to any university in America and find a diversity of well educated professors who come up with a variety of terrible ideas all the time. But they can at least occasionally be reasoned with. These feeble minded, often senile cretins can't be reasoned with (exhibit one, Pelosi).

So there's all sorts of proximate reasons why this latest healthcare clusterfuck is dead on arrival. The ultimate reason is that you have a room filled with profoundly dumb people who have not the slightest clue as to what the hell they are doing since they are under the illusion that they are smarter than everyone else. Moreover, their careers depend on making life more and more of a morass of bureaucratic idiocy--after they pass one piece of legislation that makes all of our lives more difficult, they can then campaign on fixing that problem with a new piece of legislation. That, invariably, makes things even worse, and, well gee, we need yet another piece of legislation.

So long as we allow the chronically stupid and narcissistic to hold office, it's going to be more of the same shit (until they gum up the works so bad it all falls apart, which they're probably close to doing now, actually).

|9.25.09 @ 8:45PM|#

Medicare polls well, and, in general, it's a lot easier politically to expand an existing program than to create a new one.

You can't extend Medicare to everyone. It is a program that takes money from the working, earning majority and gives it to the non-earning, non-working minority. The only reason is "works well" is because there are more people to take from than to give to (for now). Once you "extend it to everyone" who are you going to take from? That is one of the stupidest, most ignorant proposals I've ever heard for health care.

Andrea|9.25.09 @ 8:45PM|#

"They are more interested in passing ANY bill, no matter how hackneyed, for political gain, than in putting an serious intellectual effort into actually addressing the problem."


Because it was never about reform as in "improvement". It was always about how to provide free health care to everyone.

Once they couldn't just tax the rich to pay for it and change the coverage of the majority who were satisfied, things started getting complicated.

How else could the president find himself unable to answer the simple question, "How much will it cost?".

Plant Immigration Rights Suppo|9.25.09 @ 8:48PM|#

"until they gum up the works so bad it all falls apart, which they're probably close to doing now, actually"

Yea, as soon as China gets a clue and realizes that Uncle Sam's credit is sub-prime at best the whole house of cards will fall. Toto will have pulled the curtain down and we will see that the Wizard is not so powerfull after all.

Pollyanna|9.25.09 @ 8:50PM|#

No concern about how it's awful to have someone through no fault of their own being forced to pay for a stranger's care.

There are no strangers, only friends we haven't met.

Plant Immigration Rights Suppo|9.25.09 @ 8:53PM|#

"There are no strangers, only friends we haven't met."

I think I actually heard this on some 1980's era PBS show. This was before the advent of the helicopter parent.

|9.25.09 @ 8:56PM|#

Come on Hazel, the arguments I've heard about pre-existing conditions are that 1. it's awful to have someone through no fault of their own be denied care, better to spread the costs over society and 2. markets will have little to no incentive to cover such folks.

The solution for this is simple. And it doesn't include trying to legislate away reality. You can't make gravity illegal and you can't make it so that insurers can suddenly profit from insuring against a situation that has already occurred.

The only EFFECTIVE approach is to remove the disincentives to buying personal insurance so that people don't lose it when they change jobs. Transitioning away from employer-provided insurance will be one of the biggest ways to reduce the number of folks stuck without insurance with a condition.

Of course, if you choose not to insure against an event, you still CAN get the treatment you just have to pay for it yourself. Also, when uninsured you can always borrow and/or negotiate prices before you get treatment. I know someone who is self-insured and they have called around and got competing bids for a surgery they needed.

Pollyanna\'s Conscience|9.25.09 @ 9:00PM|#

No concern about how it's awful to have someone through no fault of their own being forced to pay for a stranger's care.

There is no forcing, only, only, um, ...

Plant Immigration Rights Suppo|9.25.09 @ 9:07PM|#

"You can't make gravity illegal and you can't make it so that insurers can suddenly profit from insuring against a situation that has already occurred."

Very true. I can't get auto insurance from GEICO and expect the friendly Australian reptile to pay for an auto accident I already have had.

The Libertarian Guy|9.25.09 @ 9:32PM|#

That pic of Pelosi reminds me of why I hate and despise scolds. Finger-wagging, self-important, self-appointed hall monitors/life coaches/people with power and money to waste and abuse just piss me the fuck off.

|9.25.09 @ 9:34PM|#

Come on Hazel, the arguments I've heard about pre-existing conditions are that 1. it's awful to have someone through no fault of their own be denied care, better to spread the costs over society and 2. markets will have little to no incentive to cover such folks.

My arguement is that insurance ought to continue to cover you for an illness, even after you stop paying premiums. You don't continue to pay premiums on a car after a wreck. And they don't refuse to make payment for repairs if you switch insurance companies before the repairs are finished.

Now, that doesn't cover people whose insurance lapses between jobs, but that's their own fault. The problem with the current system, is that having third-parties (such as employers) pay for your insurance has created a situation where customers aren't looking at the details of the plan, and consequently such plans have evolved to revolk payment once you (or rather your employer) stop paying premiums.

IMO, if you pay for insurance for five years, it makes no freaking sense for the insurance company to cut you off because you get sick and then lose your job or can't continue to pay for premiums. Any more than it would make sense for GEICO to refuse to payout on an insurance claim because my car got totalled, so I couldn't work, and so couldn't keep making car insurance payments.

Of course, this doesn't cover the (relatively small) number of people who let their insurance lapse, and then get sick, but that's their own fault.

But if the Democrats actually sat down for thirty seconds and thought through the situation rationally, maybe they would just realize that my approach to thise issue makes a lot more sense than forcing insurance companies to pay for the already sick, and then forcing everyone to buy health insurance so they don't go bankrupt.

Brett|9.25.09 @ 9:39PM|#

The only EFFECTIVE approach is to remove the disincentives to buying personal insurance so that people don't lose it when they change jobs. Transitioning away from employer-provided insurance will be one of the biggest ways to reduce the number of folks stuck without insurance with a condition.

Agree completely.

|9.25.09 @ 9:44PM|#

*** In case this isn't clear enough, my position is that if you get sick on insurance company A's watch, then insurance company A should be responsible for all medical expenses related to that illness, regardless of whether you or your employer keeps paying premiums to them. That would probably eliminate 90% of the complaints about pre-existing conditions, most of which stem from people losing their insurance after they get sick, because they lose their job.

|9.25.09 @ 9:47PM|#

The only EFFECTIVE approach is to remove the disincentives to buying personal insurance so that people don't lose it when they change jobs. Transitioning away from employer-provided insurance will be one of the biggest ways to reduce the number of folks stuck without insurance with a condition.


Well, if you are ALREADY SICK before you change jobs, than your first insurance company should have to keep paying for expenses related to that illness. Even under the employer-based system.

Call it the "post-existing condition" proposal. GEICO doesn't refuse to pay for repairs because you switched to Allstate before they were finished.

Brett|9.25.09 @ 10:17PM|#

Hazel, I understand the analogy you're trying to make. But getting GEICO to pay for the repairs of one wreck is quite different than getting a insurance company to pay for a medical condition that could continue or get worse for years (e.g. diabetes). Also, your scenario would often pit two insurance companies against each other, each refusing payment b/c they disagree on whether some medical issue is related to a pre-existing condition or not, and thus who should pay.

Nipplemancer|9.25.09 @ 10:36PM|#

Hazel - what if you have a twenty-five year old man who has been insured by X Co. for two years, in that time he's diagnosed with something like diabetes and then switches over to Y Co a year later? Is X Co is on the hook for his diabetic care for the rest of his life? That could be another 40-50 years of treatment on their dime.

|9.25.09 @ 10:42PM|#

Maybe I should make 'STFULW' into my new name. That, or LW=MNG.

Back to the topic. Again, it all goes back to Walter Karp.

http://www.amazon.com/exec/obidos/ASIN/1879957132/reasonmagazineA/

Political leaders look after their own interests, not the country's, and not the party's. Too big a majority and they are responsible for the results. Culling out the questionable (Dems in red states) makes for a more obedient party, even if it lessens the chances of that party passing 'reforms'.

BeesInTheBrain|9.25.09 @ 11:05PM|#

Look, personally I don't want to see a single payer plan or whatever the hell Obama care ends up being, as I have great coverage right now and I doubt anything they come up with will be as good.

And you base that conclusion on what? Here in California we have 3 major "Public Plan" types of insurance.

MediCaid - Managed by the state. Fee for service and covers a lot more than my health insurance plan.

MediCaid - Managed by COHS plans, though some take on the trappings of an HMO the coverage is the same as that of the FFS plan offered by the state. Once again better than the vast majority of health insurance plans.

Healthy Kids - The state farmed it out to insurance companies with the requirement that the plan match the "best" insurance that the company offered.

The thing is the government really has no "real" incentive to manage costs, after all they can and do just print money to cover whatever they are short. Besides the government is REALLY bad at telling people no and as much as they talk about costs, it's only the estimated costs that matter. Once anything is passed, the concern about cost goes out the door and the buying votes will come into effect.

24AheadDotCom|9.25.09 @ 11:14PM|#

If I wrote to Hazel Meade (her?) as "Woodrow", do you think she'd respond?

P.S. Here's more about occasional Reason commenter John Thacker, a libertarian. (I found my post about him by Googling his name.)

Chad|9.25.09 @ 11:16PM|#

MNG | September 25, 2009, 6:21pm | #

Look, personally I don't want to see a single payer plan or whatever the hell Obama care ends up being, as I have great coverage right now and I doubt anything they come up with will be as good.

Really? You would get similar care in a number of other advanced nations, with no chance of losing your insurance, for about 2/3 of the cost. Why AREN'T you interested?

There is no upside to our system. We pay far more and bear far more risk, for similar "sick care" and far worse overall health than any other rich nation.

Well, unless you consider all the fat profits that our insurers and doctors make a legitimate "upside".

Hugh Akston|9.25.09 @ 11:23PM|#

There is no upside to our system.

This must be that "intellectual honesty" I've heard so much about finally being applied to the healthcare debate.

j.i.am|9.25.09 @ 11:23PM|#

BeesInTheBrain:

I think the second one there should be MediCal.

Californicators (me one) have a big interest in having the feds takeover. CA tries to provide healthcare to everyone and is going bankrupt partly as a result of this effort. Spreading the mess it made evenly over the other 49 states gets a monkey of its back.

Chad|9.25.09 @ 11:26PM|#

Nipplemancer | September 25, 2009, 10:36pm | #
Hazel - what if you have a twenty-five year old man who has been insured by X Co. for two years, in that time he's diagnosed with something like diabetes and then switches over to Y Co a year later? Is X Co is on the hook for his diabetic care for the rest of his life? That could be another 40-50 years of treatment on their dime.

You have discovered exactly why private health insurance is an epic failure. For health insurance to work like other insurances (auto, home, etc), it would have to work as you described: If a person is diagnosed with a chronic disease while insured by Company X, X would be on the hook for that condition for life, regardless of whether that person continued to be insured by X, or by anyone.

The problem is that particular conditions cannot be isolated from on another. If the person, for example, later has a stroke, was that related to his diabetes or not? What if he goes to the doctor because he is fatigued? Either of these might be related to his diabetes, and might not. There is no reasonable or practical method to sort this out.

The other option is to treat health insurance differently than other insurances, and have X's responsibility for the diabetes drop if the patient decides to part with X, or X finds an excuse to drop him. That is what we have now. The problem this creates is the "pre-existing condition" dilemma. No one in their right mind would insure the patient at a reasonable cost, so he is stuck for life with X (at best), and at worst, is tossed to the wolves until he hits 65.

If there is any way for the market to resolve these issues, no one here has yet come up with it.

|9.25.09 @ 11:30PM|#

You would get similar care in a number of other advanced nations, with no chance of losing your insurance, for about 2/3 of the cost

Nope. If you're a cancer patient in the UK, for instance, your odds of survival are about half of what they are in the USA.

-jcr

Chad|9.25.09 @ 11:30PM|#

Hugh Akston | September 25, 2009, 11:23pm | #
There is no upside to our system.

This must be that "intellectual honesty" I've heard so much about finally being applied to the healthcare debate.

Please, show me the upside. I don't want tiny little things like "The US has the highest cervical cancer survival rate for women of African decent over age 62". I want broad evidence that we have significantly higher survival rates for a broad number of conditions. We damned well better, given the absurd price we pay and finanical risk we suffer.

Please, show me your evidence.

Warty|9.25.09 @ 11:33PM|#

You are a loathsome little toad, Lonewacko. I hope you die soon.

|9.25.09 @ 11:33PM|#

LoneWacko gazed at Hazel's picture again, longingly. Could she ever love him? Tucson was many hours from LA, but he was considering driving out and surprising her. He was pretty sure she wasn't a DirtyMexican. But he was afraid. What if she rejected him? It would be the Kathy Najimy debacle all over again, and he just couldn't handle that.

He took another swig of rye and lit another Chesterfield. Maybe he could provide himself with some liquid courage.

Ah, who was he kidding? He didn't even have a car. He had been stupid even to hope. He washed down a Cymbalta and a Seroquel and turned on the TV. To his delight, reruns of Simon & Simon were on. At least he could salvage the night.

|9.25.09 @ 11:51PM|#

Actually, if you're in a car accident and the other person is at fault, their auto insurance does have to pay for medical treatment stemming from that accident even if the at-fault person stops paying premia, right?

|9.25.09 @ 11:54PM|#

Speaking of Hazel, did anyone else get the vibe that Blackberry and Dandelion were gay lovers in Watership Down? Whenever Bigwig and Hazel are fretting about not having any does, they seem totally aloof and unconcerned.

24AheadDotCom|9.26.09 @ 12:11AM|#

Interesting. I knew his name, but I didn't know that John Batteiger - the person who appears to own the domain "Warty" links his name to - is some sort of reporter. I'll have to compile a list of his "greatest" hits for Google users who want to find out more about him or his book.

|9.26.09 @ 12:15AM|#

RE: nmg

I totally agree with the things you say!

And as far as the argument of self-responsibility goes, why not just use the IRS to go after the people who don't pay their actual medical bills instead of having them go after the people who just don't want to buy insurance? This would enforce real responsibility and it would be a lot easier and cheaper to track only the delinquents instead of having to monitor everyone's individual tax return.

hmm|9.26.09 @ 12:35AM|#

Pelosi was a proctologist in a former life.

Nipplemancer|9.26.09 @ 12:36AM|#

Is your 'date' really a transsexual
Created by lonewacko

20 other people got this result! That's 43%

Take another quiz! Your Result
Most likely, you've already been "fooled" several times.

Nipplemancer|9.26.09 @ 12:37AM|#

oops, forgot the important part:
Shut the Fuck Up L-dub

Art-P.O.G.|9.26.09 @ 12:40AM|#

Hmmmm...I've done some digging, and apparently Chris Kelly is some sort of douchebag.

|9.26.09 @ 12:43AM|#

Hazel, I understand the analogy you're trying to make. But getting GEICO to pay for the repairs of one wreck is quite different than getting a insurance company to pay for a medical condition that could continue or get worse for years (e.g. diabetes). Also, your scenario would often pit two insurance companies against each other, each refusing payment b/c they disagree on whether some medical issue is related to a pre-existing condition or not, and thus who should pay.

It could continue to get worse, yes. That is a risk that should be quantifiable in some way, and hence could be translated into future increases in premiums. Or it could be considered preventive care, and the responsibility of the individual.

However, I'm not proposing that we add a federal regulation requiring them to be on the hook for all expenses permantently. I think if it weren't for the employer-based system, if people were shopping for insurance individually, you could spell out something like that in a policy, which makes it the consumer's risk to take - does he want to pay extra to insure against all downstream effects of diabetes? Or is he willing to pay higher premiums in the future if he gets diabetes? Or is he willing to pay expenses out of pocket to buy his insulin, etc.

Same answer to Nipplemancer. You should be able to either take your chances by paying lower premiums now, and then deal with a premium hike later to insure against future risks after you get diabetes, or (conceivably) you could pay more, and get an insurance policy that will cover the long-term effect. These things could be spelled out.

There's all sorts of ways to deal with the issue.
Say the insurance company is on the hook for future payments. You could, for instance, have insurance companies that would specialize in covering diabetics. And the insurance company (in agreement with the patient), could transfer that responsibility to the specialized diabetics-only insurance company. Say they pay them a lump sum of money to take you off their hands. The specialized company can make a profit that way, because their specialized expertise enables them to more effeciently provide medical care for diabetics. They probably know better what the most cost effective treatments are, and can get access to specialized drugs, etc. So the general insurance company gets rid of you by paying their future obligation to the other company, and the other company gambles that you won't cost them more than that amount.

The problem is that particular conditions cannot be isolated from on another. If the person, for example, later has a stroke, was that related to his diabetes or not? What if he goes to the doctor because he is fatigued? Either of these might be related to his diabetes, and might not. There is no reasonable or practical method to sort this out.


Nonsense. We are not entirely ignorant about the increases in risk factors that one condition can have for another. That's exactly why insurance companies want to charge higher premiums for people with certain pre-existing conditions. (That is, not to cover the illness, but to guard against the higher likelihood that that person will develop another condition.)

But in any case, most of the controversy over pre-existing conditions has nothing to do with these kinds of long-term risk factors. The vast majority of complaints about pre-existing conditions occur in situations where: 1) The person is insured through their employer. 2) The person gets seriously ill and can no longer work, 3) The person's COBRA runs out and they can't afford to pay their insurance. 4) The insurance company dumps them because they aren't paying premiums. 5) No other insurance company will take them because they are already sick.

Now THAT situation I really thinks it's blatantly obvious that the insurance company should be (in a sane universe) legally responsible for paying for immediate treatment, and any complications from surgery, etc. And if individuals were buying their own insurance, they probably would be.

The issue about how to deal with long-term chronic conditions and associated risk factors is an interesting one with many possible market based solutions (as I have outlined above). But it really has no effect on the main problem that we're seeing in the market - which is people getting dumped from their employer-based insurance, because they lose their job after getting ill.

Warty|9.26.09 @ 1:03AM|#

You're barking up an extremely wrong tree, Lonewacko, you colossal idiot. Shut the fuck up before you look even stupider.

Warty|9.26.09 @ 1:11AM|#

Beware, everyone. Lonewacko heard about WHOIS!

|9.26.09 @ 1:17AM|#

I think one of the main mistakes that is made during this debate is that people conflate "Health Care" and "Health Insurance" -- it doesn't make any sense to insure against preventative or routine care, because that is predictable.

Andrew_M_Garland|9.26.09 @ 1:29AM|#

I think politicians know that they can't raise taxes enough to fund their Medicare/Medicaid promises, and want a way to hide their responsibility for the coming denial of services in Medicare, Medicaid, drug benefits, and social security. These plans promises are empty.

The "solution" to this political and economic problem is to put everyone into one medical care pot. We then all get equal amounts of services at whatever high tax rate the government can levy. The young must be coerced into this system, to extract as much money as possible to serve the old.

Medical services will be meager under "health reform", with rationing and slow delivery for everyone. The government has promised $88.6 trillion in unfunded services ($88,600 billion, not a typo), including Medicare, Medicaid, Drug benefits, and Social Security. Politicians now find that just $1 trillion in increased cost during the next 10 years is politically unacceptable. That is the center of the healthcare debate. So, $88 trillion in "needed" services are not going to be delivered in the next 75 years, more than $1 trillion per year. This would also kill any progress in medical care, as we all stew in the rationed system that covers over the fraud of the mostly Democratic politicians.

The government has made promises for 30 years to the now-old that it can't keep, and the now-old did not save enough for their own care or retirement, relying on the wishful-thinking or lies of the government. Without "reform", they will get care corresponding to the minimal amounts that they have saved or that can be raised with current taxation.

Healthcare "reform" by Democrats is really a scheme to raise more money from the younger and healthier population, then ration care for everyone so that people feel equally treated. To paraphrase an old Soviet saying: The government will pretend to pay, and doctors will pretend to treat.

Obamacare Bails Out Medicare

|9.26.09 @ 1:37AM|#

"If I wrote to Hazel Meade (her?) as "Woodrow", do you think she'd respond"

"the person who appears to own the domain "Warty" links his name to"

Fucking stalker

You wanna stalk, come to Tucson asshole

|9.26.09 @ 1:41AM|#

Unfortuantely, I have a boyfriend.

Bwahahahahahahahaha, suckers!!!

|9.26.09 @ 1:48AM|#

Sorry. I normally lurk. The LoneDildo stalking people just set me off.

Carry on... Nothing to see here.

Some Guy|9.26.09 @ 2:17AM|#

Obama should have picked a simple reform like single payer, one that can be more easily explained, and pushed it as his reform. He was going to get blasted as a socialist either way, as we now know.

Well by that rock-solid logic of yours, he should probably just go ahead and round up the Jews as long as the protesters are going to Godwin him, anyway.

Warty|9.26.09 @ 2:17AM|#

I hope Lonewacko doesn't murder the poor bastard who owns the Don Marquis site.

jester|9.26.09 @ 4:47AM|#

She wore a pearl necklace.

penis büyütücü|9.26.09 @ 4:50AM|#

hımmm_

jester|9.26.09 @ 4:59AM|#

Lonewacko,

The vast majority of us here appreciate this site because it is no-holds-barred and when someone insults us we can respond in kind.

It is a truly libertarian site. We don't want big brother finding out who jester is because he doesn't provide his e-mail. That makes you a hypocritical fucktard. So enough already, fucktard!

jester|9.26.09 @ 5:08AM|#

"LoneWacko gazed at Hazel's picture again, longingly. Could she ever love him? Tucson was many hours from LA, but he was considering driving out and surprising her. He was pretty sure she wasn't a DirtyMexican. But he was afraid. What if she rejected him? It would be the Kathy Najimy debacle all over again, and he just couldn't handle that.

He took another swig of rye and lit another Chesterfield. Maybe he could provide himself with some liquid courage.

Ah, who was he kidding? He didn't even have a car. He had been stupid even to hope. He washed down a Cymbalta and a Seroquel and turned on the TV. To his delight, reruns of Simon & Simon were on. At least he could salvage the night."

Nice try, Epi. SugarFree is the master. You fucked up early on Hazel's sex. Boy or girl. Sure you can argue NOW that Lonewacko is a bisexual, but your poor prose did not imply that.

But keep on. I think we all should have a literary contest soon. The results would probably make me laugh for years. You and Sugar and Warty provide plenty of laughs and are one of the reasons I love the comment section.

jester|9.26.09 @ 5:10AM|#

Fucktard, that's a word I learned here at hit & run. Long live hit & run.

Art-P.O.G.|9.26.09 @ 5:50AM|#

jester just got off working the night shift at the obscene novelty factory. Why else would he be posting so early in the morning? He lit up a PCP-laced joint and inhaled deeply from it. He booted his computer and decided to get on Hit & Run to see what that fucktard LoneWacko was up to.
He discovered that LoneWacko's compulsive self-linking and antagonization of the other commenters had finally exploded into a hot, sticky mess all over Lonewacko's fingers. jester leaned back in his seat, a wry smile creasing his face.

|9.26.09 @ 6:19AM|#

Sorry to spoil the fun here but I was doing a bit of research for another thread and found this little fun fact:

he introduced the Comprehensive Health Insurance Act. Nixon's plan would have mandated employers to purchase health insurance for their employees, and in addition provided a federal health plan, similar to Medicaid, that any American could join by paying on a sliding scale based on income.

http://en.wikipedia.org/wiki/Richard_Nixon#First_term

Just thought it might be of interest! :)

jester|9.26.09 @ 6:26AM|#

ART-P.O.G.,

Critique:

jester, a crazed fuck confused as to what is night and what is day due to the tortuous one-day nightshift, one-night dayshift workschedule, gave into drinking high-caliber brews. Even in his most inebriated states he never caved into Lonewacko's paranoia. He was a clerk at an indie record store for God's sake.

Hey, very uncool of you to associate me with lonewacko. Yes I am uncouth, but not in any way in Lonewacko's camp.

I am deeply hurt. We'll have to break up now. Boohoo. I loved you so deeply ART-P.o.G. You're a heartbreaker.

jester|9.26.09 @ 6:30AM|#

'Sorry to spoil the fun'

You di'nt. Tricky Dick was a fag. Fuck fags. Surprise, surprise, Mr. Price Control.

Ebeneezer Scrooge|9.26.09 @ 6:31AM|#

They are more interested in passing ANY bill, no matter how hackneyed, for political gain, than in putting an serious intellectual effort into actually addressing the problem.

If that's what it takes to stop a bill from getting through, then I'm all for it.

Because the one thing you can bet on, is that they won't do anything rational about the real problems. They don't even want to know what the real problems are. They just want Euro-Socialism asap, thank you.

Ebeneezer Scrooge|9.26.09 @ 6:37AM|#

The root of the problem is that somewhere during the last half of the 19th century, Europe's government funded "intellectuals" (read: college professors) decided that Western civilization is no good after all and needs to be done away with.

And US "intellectuals" have never been smart enough to do anything but following the thundering (Euro)herd over the proverbial cliff.


Why is it that most educated, supposedly "smart" people turn into socialists?

Given the socialism's track record, I again say the only available conclusion is that smart people are really stupid.

Ebeneezer Scrooge|9.26.09 @ 6:40AM|#

The ultimate reason is that you have a room filled with profoundly dumb people who have not the slightest clue as to what the hell they are doing since they are under the illusion that they are smarter than everyone else.

Amen.

There comes a point in the management chain where people are no longer conceited, they're convinced.

Art-P.O.G.|9.26.09 @ 7:48AM|#

Hey, very uncool of you to associate me with lonewacko. Yes I am uncouth, but not in any way in Lonewacko's camp.

Should've put that disclaimer on there: Any resemblance to any persons living or dead is purely coincidental. Er, my mistake, I mean, you're far better adjusted than LoneWacko (low bar! low bar!).

Art-P.O.G.|9.26.09 @ 7:50AM|#

Given the socialism's track record, I again say the only available conclusion is that smart people are really stupid.

Serj Tankian said it best: "Stupid people do stupid things/Smart people outsmart eachother/Then themselves..."

Chad|9.26.09 @ 8:18AM|#

Hazel Meade | September 26, 2009, 12:43am | #
The issue about chronic conditions and associated risk factors is an interesting one with many possible market based solutions (as I have outlined above). But it really has no effect on the main problem that we're seeing in the market - which is people getting dumped from their employer-based insurance, because they lose their job after getting ill.

So if I am diagnosed with diabetes while insured by X, but later have a stroke while insured by Y, you are saying that X should pay ~60% and Y ~40%, based on my increased chance of stroke due to diabetes?

Oh, let's double the paperwork! That sure sounds like an efficient system. And I am sure there won't be all sorts of squabbling between X and Y, right? Even if this plan worked, it would be absurdly expensive.

jester|9.26.09 @ 8:36AM|#

low bar! low bar!

Thanks Art P.O.G. My self worth has rebounded.

So why are you such a dick?

|9.26.09 @ 8:37AM|#

Stupid liberals.

Art-P.O.G.|9.26.09 @ 8:41AM|#

So why are you such a dick?

I've spent over a year in a desert.

MNG|9.26.09 @ 8:42AM|#

"No concern about how it's awful to have someone through no fault of their own being forced to pay for a stranger's care."

You're correct there Tulpa, I consider a society with the "horror" of forcing people to pay a little towards the care of hapless strangers to be less awful than a society in which people suffer needlessly because of the luck of the draw. The first is more fair.

If you do the Rawls test you can see why its more fair. Imagine you get to live in one of those two societies, but you don't know ahead of time what kind of person you will be. Maybe you will be the person forced to contribute to another's care, but maybe you will be the hapless stranger in great suffering and need of care. A rational person would pick the society I chose since they could be either and it is less awful to be forced to contribute to a hapless stranger's care than to be the hapless stranger who gets no help.

And even if you end up being the contributor you get the added bonus of knowing that if you ever become the hapless stranger you will be taken care of.

jester|9.26.09 @ 8:49AM|#

in a desert.

On a horse with no name? That would do it to me too. You're forgiven.

jester|9.26.09 @ 8:52AM|#

the "horror"

The horror! The horror!

Fuck you. There's no horror. There is bullshit, but no horror.

MNG|9.26.09 @ 9:00AM|#

"The root of the problem is that somewhere during the last half of the 19th century, Europe's government funded "intellectuals" (read: college professors) decided that Western civilization is no good after all and needs to be done away with."

You know what always gets me about this perennial charge by conservatives? If intellectuals rejected Western Civilization why ask what was wrong with the intellectuals, maybe we should ask what was wrong with Western civilization.

Seems to me there has to be a way between the uncritical slavish fealty to "Western civilization" of conservatives and the wholesale dismissal of the same by many liberals.

Btw-at least one of those "government funded intellectuals," namely Ludwig von Mises (University of Vienna) helped give us body of work critical of Western Civilization (which up until that time had not exactly had a very classical liberal history) that a lot of people on this site are happy was produced...

Plant Immigration RIghts Suppo|9.26.09 @ 9:17AM|#

"Seems to me there has to be a way between the uncritical slavish fealty to "Western civilization" of conservatives and the wholesale dismissal of the same by many liberals."

I never did understand what cardinal directions have to do with culture or civilization. I say this as I eat Sushi and watching Japanese anime on my Sony television.

"Btw-at least one of those "government funded intellectuals," namely Ludwig von Mises (University of Vienna) helped give us body of work critical of Western Civilization (which up until that time had not exactly had a very classical liberal history) that a lot of people on this site are happy was produced..."

To paraphrase Ayn Rand (I do not recall the exact wording) when she responded to a college student who asked her about government grants for college "The only people who can morally accept government funds are those who oppose them." In other words if you do not accept them they will go to someone else. There is no reason to punish yourself. They exist. You may as well be the one to take them.

MNG|9.26.09 @ 9:27AM|#

PIRS
I don't note Mises to argue he was a hypocrite, but to note that the poster in question would probably not object to all of the systems of ideas critical of Western civilization that came out of the university system in Europe.

Chad|9.26.09 @ 10:28AM|#

MNG | September 26, 2009, 8:42am | #

And even if you end up being the contributor you get the added bonus of knowing that if you ever become the hapless stranger you will be taken care of.

You are exactly right, MNG. It is interesting how virtually everyone who is against health care reform has "got theirs" and is trying to protect the status quo....everyone else be damned.

It is all a matter of time, anyway. The younger generations of workers that will eventually take over the political system have been working under a system which is completely broken. Our health insurance is weakening by the day, if it isn't yanked from us entirely, and our job security has gone to hell. Just about everyone I know my age or younger has dealt with being uninsured, and all of us are worried about the possibility even when we do have it. Once our grandparents, who lived under life-long employment by one firm, pass on, things will change fairly quickly.

Art-P.O.G.|9.26.09 @ 10:33AM|#

all of us are worried about the possibility even when we do have it

Hmm...tautologitastic. Apparently, most of the people who are ardent "reformers" are the ones most worried about life in the current "system".

Hate to say it, but I think my contempt for my own generation (and the ones before and after) make me a true mustache-twisting "typical libertarian", therefore rendering my opinion automatically moot due to my isanthropic ways.

Art-P.O.G.|9.26.09 @ 10:35AM|#

And, Chad, it kind of sounds like you're describing the Bolshevik revolution.

Art-P.O.G.|9.26.09 @ 10:36AM|#

misanthropic*, BTW.

anonymous|9.26.09 @ 11:04AM|#

"Hazel - what if you have a twenty-five year old man who has been insured by X Co. for two years, in that time he's diagnosed with something like diabetes and then switches over to Y Co a year later? Is X Co is on the hook for his diabetic care for the rest of his life? That could be another 40-50 years of treatment on their dime."

While I agree with Hazel that any illness/complication of same that occurs under the policy should be covered until the patient is "cured", I don't think that should override any clauses about maximum payment from the policy. Ultimately, provided courts respect the contract, the obligation will be satisfied eventually.

Solanum|9.26.09 @ 11:48AM|#

You're barking up an extremely wrong tree, Lonewacko, you colossal idiot. Shut the fuck up before you look even stupider.

Didn't the ban hammer come down on TAO for doing something similar to Chris Ke.... err, I mean, Lonewacko?

Chad|9.26.09 @ 11:48AM|#

anonymous | September 26, 2009, 11:04am | #

While I agree with Hazel that any illness/complication of same that occurs under the policy should be covered until the patient is "cured", I don't think that should override any clauses about maximum payment from the policy. Ultimately, provided courts respect the contract, the obligation will be satisfied eventually.


The problem is that this system wouldn't work. The patient and his doctors would have to deal with TWO insurance companies every time the patient was treated, and the two companies would be at each other's throats over who owes what portion. About half of the cost difference between our system and that of everyone else is the absurd paperwork required. How is doubling it going to solve the problem? And it only gets worse. What happens when X approves the claim and Y denies it? What if X and Y don't have overlapping networks? God, what a disaster.

Yet for health insurance to function like other insurance, and to eliminate the "pre-existing condition" problem, this is how health insurance would have to function.

Chad|9.26.09 @ 11:54AM|#

Art-P.O.G. | September 26, 2009, 10:33am | #

Hmm...tautologitastic. Apparently, most of the people who are ardent "reformers" are the ones most worried about life in the current "system".

It's not a tautology at all. Indeed, only in America, among rich nations, do citizens have to worry about the loss of their health insurance.

Hate to say it, but I think my contempt for my own generation (and the ones before and after) make me a true mustache-twisting "typical libertarian", therefore rendering my opinion automatically moot due to my isanthropic ways.

If you are approximately a boomer, then yes, I have nothing but contempt for your generation. You have consumed much and given little in return. You have bankrupted the nation and have no inkling of restraining yourselves in the future, and somehow belief that your generation giving 5% of its income to your parents somehow justifies taking 15% of our income.

My cure for FICA reform? We cut SS and Medicare such that it takes no larger a fraction of the GDP than it did when the current recipients were paying. And we should deduct interest on the debt they rang up before we pay out as well. THAT, and only THAT, is what current retirees can honestly claim they are owed.

^-^|9.26.09 @ 12:01PM|#

Hazel Meade | September 25, 2009, 7:12pm | #
"Can we just acronymize this as STFULW, please?"

Warty | September 25, 2009, 7:17pm | #
"It has more power in its full form, Hazel."

If by "power" you mean repetitive stupidity, yeah.
We get it. You disagree with the troll. Ignore him and move on.

Warty|9.26.09 @ 12:11PM|#

Shut the fuck up, Japanese emoticon.

|9.26.09 @ 12:40PM|#

Chad: So if I am diagnosed with diabetes while insured by X, but later have a stroke while insured by Y, you are saying that X should pay ~60% and Y ~40%, based on my increased chance of stroke due to diabetes?

The problem is that this system wouldn't work. The patient and his doctors would have to deal with TWO insurance companies every time the patient was treated, and the two companies would be at each other's throats over who owes what portion. About half of the cost difference between our system and that of everyone else is the absurd paperwork required. How is doubling it going to solve the problem? And it only gets worse. What happens when X approves the claim and Y denies it? What if X and Y don't have overlapping networks? God, what a disaster.


Again displaying a complete lack of imagination.

What I expect would be likely to happen would be that the insurance comopany would make an estimate of the future cost of treating your condition, based on empirical experience with past diabetics and an estimated probability of future complications. Then you switch insurance companies. Rather than deal with the administrative hassle (and cost), the first insurance company pays a lump sum for their obligation to the second company. Company A is happy to pay out a lump sum and be relieved of the duty. Company B is happy to take you, because they are getting paid up front to deal with your pre-existing condition. They take the lump sum and gamble that you won't end up costing them more than what they were paid (plus interest on money in the bank, etc.). Obviously the two companies go through a negotiation process, and you have to sign off on the deal. Now, all parties have basically signed a second contract saying "X has fulfilled his obligations, Y is now responsible", and neither side can sue anyone else.

Problem solved.

JB|9.26.09 @ 12:57PM|#

The latest: buy health insurance or go to jail...
http://www.politico.com/livepulse/0909/Ensign_receives_handwritten_confirmation_.html?showall

Obama thinks we live at the whim of the government. I got some news for that little bitch from Indonesia: we don't.

Fuck him and fuck the government.

The Libertarian Guy|9.26.09 @ 1:06PM|#

"It is interesting how virtually everyone who is against health care reform has "got theirs" and is trying to protect the status quo....everyone else be damned."

Typical.

Well, I'm against it, and I'm poor. I can GET health care; I can't afford insurance for it. I will flat refuse to participate in Obamacare, and I dare those fuckers to fine me for not buying insurance I can't pay for.

So, your big-blanket approach is at least wrong in one instance. I suspect I'm not alone.

I can offer this, though: My brother is mildly retarded, enough that he *could* draw SSDI - but even he, with the mind of a child, refuses to sit on his ass and live off a check from the pockets of strangers. He can work, and would rather work than be dependent on the dole.

Hell, if he can get that, why can't others?

The Liberarian Guy|9.26.09 @ 1:10PM|#

"a society with the "horror" of forcing people to pay a little towards the care of hapless strangers to be less awful than a society in which people suffer needlessly because of the luck of the draw."

Charity isn't charity if it's coerced.

And this "luck of the draw" horseshit is just that... horseshit. I've met more than one person who came from squalor, worked their asses off, and made it big. No luck involved. It's that "winners of lifes' lottery" argument, writ large and often, that has convinced an entire generation that wealth is something one falls ass-backwards into, or is taken only by trickery and deceit.

Typical anti-capitalistic bilge.

Michael Ejercito|9.26.09 @ 1:20PM|#

Obama should have picked a simple reform like single payer, one that can be more easily explained, and pushed it as his reform. He was going to get blasted as a socialist either way, as we now know.

Why shouldn't all insurance (auto, life, fire) be single-payer?

The only EFFECTIVE approach is to remove the disincentives to buying personal insurance so that people don't lose it when they change jobs. Transitioning away from employer-provided insurance will be one of the biggest ways to reduce the number of folks stuck without insurance with a condition.

Employer-based insurance only came about because of wage controls during the 1940's.

Well, if you are ALREADY SICK before you change jobs, than your first insurance company should have to keep paying for expenses related to that illness. Even under the employer-based system.

Call it the "post-existing condition" proposal. GEICO doesn't refuse to pay for repairs because you switched to Allstate before they were finished.

This is true.

Hazel - what if you have a twenty-five year old man who has been insured by X Co. for two years, in that time he's diagnosed with something like diabetes and then switches over to Y Co a year later? Is X Co is on the hook for his diabetic care for the rest of his life?

Yes.

Tony|9.26.09 @ 1:37PM|#

Why shouldn't all insurance (auto, life, fire) be single-payer?

Fire insurance already is. Or at least insurance against not having the fire put out, since fire is a social problem (not likely to be contained to your property). Property insurance is a luxury for people with property; we all have lives and healthcare needs, however. And health problems are as much social problems as fires are, at the very least because of risk pool concerns.

|9.26.09 @ 1:57PM|#

If you do the Rawls test you can see why its more fair. Imagine you get to live in one of those two societies, but you don't know ahead of time what kind of person you will be. Maybe you will be the person forced to contribute to another's care, but maybe you will be the hapless stranger in great suffering and need of care. A rational person would pick the society I chose since they could be either and it is less awful to be forced to contribute to a hapless stranger's care than to be the hapless stranger who gets no help.

The probability of being forced to pay for a stranger's care in your supposedly "fair" society is nearly one, while the probability of being in need of care without insurance in the second society is nearly zero. So it's not as clear what a rational actor would choose as you suppose; if it were, rational actors would stay home 24/7 due to the many dangers to one's life that are present outside your door.

Of course, I personally believe a truly rational actor finding itself existing in this manifestly irrational universe would immediately commit suicide, but that's just me.

The Libertarian Guy|9.26.09 @ 2:33PM|#

"Property insurance is a luxury for people with property"

As a former renter, I forked over renters' insurance. I kind of had to, didn't live in the best of neighborhoods at the time, and if a fire had happened I'd have been shit out of luck.

Should my landlord have been on the hook for that insurance?

But let's look at this "luxury" argument. What is it with wealth envy, anyway? Not everyone with "property" lives in a gated neighborhood.

Then again, what about the Kennedy compound? Isn't that the epitome of "a luxury for people with property"? It's inherited, and the kicker is Papa Joe moved the family fortune offshore decades ago, so they don't pay Their Fair Share in taxes.

Fuck the Kennedys, come to think of it. Not because they're rich, but because they're tax cheats.

Chad|9.26.09 @ 2:35PM|#

Tony | September 26, 2009, 1:37pm | #
Why shouldn't all insurance (auto, life, fire) be single-payer?
Fire insurance already is. Or at least insurance against not having the fire put out, since fire is a social problem (not likely to be contained to your property). Property insurance is a luxury for people with property; we all have lives and healthcare needs, however. And health problems are as much social problems as fires are, at the very least because of risk pool concerns.

Tony, life insurance is also partially socialized through Social Security, and auto insurance is mandated. So in fact, none of our four major insurances are absent heavy government involvement...and things wouldn't work without it.

That being said, health insurance is fundamentally different from the other four. Car crashes, burnt homes, and untimely deaths are one-off events and can be easily insured against. Most health care expenditures are chronic, which leads to the "pre-existing illness" issue that sinks private health care.

I have yet to see one even remotely plausible idea around here as to how a free market system can handle pre-existing conditions. The two prevailing ideas seem to be "well, I guess you are just shit outta luck" and a complex scheme where insurance companies would be liable for the chronic condition for life.

Chad|9.26.09 @ 2:41PM|#

Tulpa | September 26, 2009, 1:57pm | #
If you do the Rawls test you can see why its more fair. Imagine you get to live in one of those two societies, but you don't know ahead of time what kind of person you will be. Maybe you will be the person forced to contribute to another's care, but maybe you will be the hapless stranger in great suffering and need of care. A rational person would pick the society I chose since they could be either and it is less awful to be forced to contribute to a hapless stranger's care than to be the hapless stranger who gets no help.

The probability of being forced to pay for a stranger's care in your supposedly "fair" society is nearly one, while the probability of being in need of care without insurance in the second society is nearly zero. So it's not as clear what a rational actor would choose as you suppose; if it were, rational actors would stay home 24/7 due to the many dangers to one's life that are present outside your door.

Actually, the probability is nowhere near one, as no more than 10% of taxpayers put more into the system than they take out. So you only are really paying for someone else's care if you are lucky enough to get to the top.

|9.26.09 @ 2:42PM|#

It is interesting how virtually everyone who is against health care reform has "got theirs" and is trying to protect the status quo....everyone else be damned.



Who is trying to protect the "status quo"? Almost everyone on this board is proposing radical alterations in the way health insurance is structured. Most libertarians want to to get rid of the employer-based system, and have been loudly pointing out it's many flaws and perverse effect. I just proposed a radical change in the way insurance companies handle long-term conditions ("pre-existing" conditions for the next insurance company down the road).

How exactly is any of the defending the status quo? Everyone here thinks the status quo has lots of inherent problems. We just think most of those problems are caused by government intervention and propose market-based solutions.

If anything the Baucus plan is closer to the "staus quo" than any of our proposals. And both parties want to keep the status quo employer based system combined with various hackneyed government programs.

|9.26.09 @ 2:45PM|#

I have yet to see one even remotely plausible idea around here as to how a free market system can handle pre-existing conditions. The two prevailing ideas seem to be "well, I guess you are just shit outta luck" and a complex scheme where insurance companies would be liable for the chronic condition for life.

Just because you don't understand it, Chad, doesn't mean it's "implausible" or "complex".
You're just to ideological and partisan to actually consider it. You want to dismiss it out of hand because you are just so emotionally commited to your hatred of free markets and your desire for a socialist system.

Chad|9.26.09 @ 2:47PM|#

Hazel Meade | September 26, 2009, 12:40pm | #
Chad: So if I am diagnosed with diabetes while insured by X, but later have a stroke while insured by Y, you are saying that X should pay ~60% and Y ~40%, based on my increased chance of stroke due to diabetes?

The problem is that this system wouldn't work. The patient and his doctors would have to deal with TWO insurance companies every time the patient was treated, and the two companies would be at each other's throats over who owes what portion. About half of the cost difference between our system and that of everyone else is the absurd paperwork required. How is doubling it going to solve the problem? And it only gets worse. What happens when X approves the claim and Y denies it? What if X and Y don't have overlapping networks? God, what a disaster.


Again displaying a complete lack of imagination.

What I expect would be likely to happen would be that the insurance comopany would make an estimate of the future cost of treating your condition, based on empirical experience with past diabetics and an estimated probability of future complications. Then you switch insurance companies. Rather than deal with the administrative hassle (and cost), the first insurance company pays a lump sum for their obligation to the second company. Company A is happy to pay out a lump sum and be relieved of the duty. Company B is happy to take you, because they are getting paid up front to deal with your pre-existing condition. They take the lump sum and gamble that you won't end up costing them more than what they were paid (plus interest on money in the bank, etc.). Obviously the two companies go through a negotiation process, and you have to sign off on the deal. Now, all parties have basically signed a second contract saying "X has fulfilled his obligations, Y is now responsible", and neither side can sue anyone else. Problem solved.

Are you going to shoot all the laywers first? So now every chronic disease is a several hundred thousand dollar lawsuit waiting to happen. What happens if my old company, A, for example, believes my condition only warrants a $300,000 payout while my new insurer B thinks it is $400,000? How will A and I agree on these in advance, given uncertainties about inflation (both regular and medical)?

Your Rube Goldberg schemes are absurd. A national system eliminates this entire problem, saves us a bundle, and in any practical sense gives us more freedom than we currently have.

Chad|9.26.09 @ 2:50PM|#

Oh, and Hazel: Any sort of lump-sum payouts for health insurance greatly increases the asymmetric information market failure.

Hmmm....not feeling well

Buy insurance

Wait minimum time

Get diagnosis

BINGO!

|9.26.09 @ 3:00PM|#

Are you going to shoot all the laywers first? So now every chronic disease is a several hundred thousand dollar lawsuit waiting to happen. What happens if my old company, A, for example, believes my condition only warrants a $300,000 payout while my new insurer B thinks it is $400,000? How will A and I agree on these in advance, given uncertainties about inflation (both regular and medical)?


They fucking negotiate, you moron. How they hell do you think every other business in the history of the planet has done it?

There is such a thing as "math", and "accounting". People actually study these things in "schools". they make these things called "projections" and then they "haggle".

I know these are new words for you, because you obviously grew up in an isolated tribe of lobotomized communists who had no private property or mechanisms for exchanging goods.

|9.26.09 @ 3:03PM|#

Oh, and Hazel: Any sort of lump-sum payouts for health insurance greatly increases the asymmetric information market failure.

Hmmm....not feeling well

Buy insurance

Wait minimum time

Get diagnosis

BINGO!

Wow, Chad, your stupidity appears to have passed through some kind of moment of singulatiry and crashed through the event horizon, as you have just described NOT a reason why insurance companies shouldn't be help responsible for long-term conditions, but exactly WHY they should not be forced to cover pre-existing ones.

Did it not occur to you that if you are already sick BEFORE you buy insurance that that is the literal definiton of a "pre-existing condition"?

Ebeneezer Scrooge|9.26.09 @ 3:14PM|#

You know what always gets me about this perennial charge by conservatives? If intellectuals rejected Western Civilization why ask what was wrong with the intellectuals, maybe we should ask what was wrong with Western civilization.

But you already know the answer: Western civilization is evil and needs to be dismantled/destroyed/stopped, asap.

Not all academics have come to this conclusion. But the vast majority in the liberal arts definitely have.

I'm not "conservative" by any measure that a conservative would recognize. They drummed me out their camp many moons ago.

And I'm not asking what's wrong with the liberal academics (is there any other kind in the liberal arts?). Just observing.


Liberals rail against "religion" louder and more often than any other single group (as long as it's Christianity -- anything else, that comes from outside the Western mainstream, is okay by the standard of cultural relativism). Yet at the same time they've borrowed Christianity's core concepts more thoroughly than any other single group.

Example: the theory of Original Sin, which has been reincarnated more times than I can count. It's most popular current incarnation is in the environmental movement.

Earth: good.
Man: evil.

Liberals get really pissed off when I tell them, it's hard for me to see their basic take on life as anything other than a reincarnated form of Christianity. Complete with all the intolerance (rampant), Grand Inquisitors (Al Gore etc), and devil-inhabited souls (any free market company, or anyone who defends them) who must be burned at the stake for the good of themselves and everyone else. And especially for the good of the Earth, because that's good by definition. You know, along the lines of the Platonic Theory of Forms.

If liberal philosophy wasn't first cousin to some of Christianity's worst vices, I wouldn't have to point it out.


I'm no Christian but it doesn't give me the same case of knee-jerk that I see coming from liberals. Maybe that's because what Darwin said is true: in the game of survival, your worst enemy is that which is most like you.

|9.26.09 @ 3:30PM|#

Ebeneezer: that's exactly what I was going to say. Despite it's atheism, Marxism incorporates fundamental Christian value judgements such as the rich man not being able to get into heaven, a duty to serve, veneration of self-sacrifice, etc.

But I actually would disagree when you say that intellectuals rejected Western civilization. IMO, what was going on was largely a broad effort to try to bring about a socialist transformation. They just instrumentalized issues like imperialism to try to bring about uprisings in the third world, to weaken what they saw as the establishment capitalist class in the devolped world. I.e. take down Western dominance, and a new socialist order can emerge from the "global south" blah blah. Get the gloval "proletariat" to revolt against their capitalist masters, by portraying them as corrupt and decadent (it worked in Russia!).

It was largely a propaganda effort, not a serious intellectual critique of the values of western civilization itself, except to the extent that western civilization was seen as "hyper-individualistic", and hence philosophically incompatible with socialism.
In other words, the rejection of western civ is largely secondary to the infatuation with socialism. Though the infatuation with socialism stems from underlying sublimated Christianity.

Ebeneezer Scrooge|9.26.09 @ 3:52PM|#

Well, you've got some points there. The crush on socialism has never really gone away.

But I still smell a fundamental rejection of Western values somewhere in the mix, too. The environmental movement for example reeks of it.


I'm also not arguing that Western civilization hasn't deserved criticism. My first shot at the Colonial Era, for example, is that the Europeans could never quite figure out what they were really up to. So they oscillated on policy and contributed much (or in other cases created wholesale) to the messes that exist today in third world countries.

OTOH, I have a major beef with the rejection of Western values that I see going on. Not just environmentalism, but look at what's going on with affirmative action.

There's something afoot there that goes beyond an infatuation with socialism.

Chad|9.26.09 @ 4:02PM|#

Hazel Meade | September 26, 2009, 3:03pm | #

...as you have just described NOT a reason why insurance companies shouldn't be help responsible for long-term conditions, but exactly WHY they should not be forced to cover pre-existing ones.

And if insurance doesn't cover pre-existing conditions, you wind up with a whole lot of people who, for a lack of a better word, are *bleeeping bleeped*. This is not only immoral from every point of view but that of a libertarian, but utterly defeats the entire point of insurance in the first place.

Your Rube Goldberg scheme just looks sillier by the minute. Buying insurance would be absurdly complicated, as you would need to have clearly defined payouts for every disease, every severity, for every age group. This would, of course, leave the very real possibility that the payout is insufficient, leaving you *bleeping bleeped*.

Ebeneezer Scrooge|9.26.09 @ 4:14PM|#

Hazel,

What I'm getting at is that here in the West we seem to have moved on to some sort of neo-socialism.

China is communist but they aren't pacifists (a mistaken idea from my reading of history) and they aren't going for environmentalism. But there are significant elements of both mixed in with Western socialism today.

What I sense coming from liberals, is something along the lines of the old Hobbes-Rousseau debate about what man's nature is, in a state of Nature. Is he naturally good or evil, or something in between?

The environmentalists at least are clear in their own minds. We'd be much better off without all this civilization stuff. I believe the big affirmative action believers are of the same opinion.

|9.26.09 @ 5:02PM|#

And if insurance doesn't cover pre-existing conditions, you wind up with a whole lot of people who, for a lack of a better word, are *bleeeping bleeped*. This is not only immoral from every point of view but that of a libertarian, but utterly defeats the entire point of insurance in the first place.


Back to square one. Instead of actually THINKING about where the legal responsibility for someone's condition OUGHT to lie (i.e. they bought insurance from some previous company and developed the condition while they were insured), you just throw up your hands and advocate forcing some random third party, who had nothing to do with it, to pay for their health care. Because otherwise people will be "bleeped".

In other words: You think it makes MORE SENSE to for the NEXT insurance company to pick up the tab for someone's existing illness, than for the ORIGINAL insurance company that they actually PAID MONEY TO to do it? Seriously???

Buying insurance would be absurdly complicated, as you would need to have clearly defined payouts for every disease, every severity, for every age group. This would, of course, leave the very real possibility that the payout is insufficient, leaving you *bleeping bleeped*.

Proving that you've never actually read a health insurance policy, as they actually are really fucking complicated, and include all sorts of fine print. You know, as everyone here has been arguing, if individuals were actually paying for their own insurance, they might actually read those policies, and shop around for ones that clearly explain what is covered and what is not. And no, it wouldn't necessarily have to spell out every detail. It could, for example, spell out a mechanism for estimating costs or negotiating transfer of responsibilities to another insurance company if you switch.

There are lots, and lots of possibilities. Yet you seems unable to fathom how an insurance company could come up with a creative solution for dealing with long-term liabilities. As if nobody has ever encountered this problem in the history of the universe.

Chad|9.26.09 @ 5:35PM|#

Hazel Meade | September 26, 2009, 5:02pm | #

In other words: You think it makes MORE SENSE to for the NEXT insurance company to pick up the tab for someone's existing illness, than for the ORIGINAL insurance company that they actually PAID MONEY TO to do it? Seriously???

No, I am saying that it makes more sense to only have one insurance "company", the government. This solves the issue entirely.
Having a number of essentially identical, heavily regulated, non-profit semi-private insurers, such as the Japanese or Swiss do, would also work. However, I consider this feature of those systems to be mostly an unwanted legacy issue.

Proving that you've never actually read a health insurance policy, as they actually are really fucking complicated, and include all sorts of fine print. You know, as everyone here has been arguing, if individuals were actually paying for their own insurance, they might actually read those policies, and shop around for ones that clearly explain what is covered and what is not. And no, it wouldn't necessarily have to spell out every detail. It could, for example, spell out a mechanism for estimating costs or negotiating transfer of responsibilities to another insurance company if you switch.

I have read plenty. They generally read "X percent co-pay in network, Y percent out. Yearly deductible Z, yearly max A, lifetime max B. 1, 2, 3 are covered, g, h, and i are not". They are bad but not that bad.

Your "spell out the costs later" isn't useful. There is no way I can calculate the value of the insurance NOW unless I know what they are going to pay out then. And who judges the calculation? What if Y disagrees? What if I disagree? It sounds like lawyer central to me.

Tim|9.26.09 @ 5:45PM|#

Chad insurance isn't the same as treatment. So implying that because people who can't get insurance won't get treatment to make your moral argument is incorrect.

Here, though you show your true colors; you are trying to legislate morality against outcomes you don't like, and reasoning backwards from you desired outcome to try and come up with some tortured logic that supports government run health insurance.

As for morality, what you propose is arming men with guns to go out and force people to give the armed men money so that the armed men can give it to the poor. Liberals tend to forget how taxes are collected and what happens to people who don't pay them. Taxes are a necessary evil at times, but to run around and claim that people who don't want to use them for a specific purpose are immoral; that just shows one's misunderstanding of their nature.

John Cochrane at the WSJ has proposed a market based solution to pre existing conditions. http://online.wsj.com/article/SB10001424052970203609204574316172512242220.html

Lots of things we do these days are really complicated, so we'll just turn health insurance over to the people who write the absurdly complex tax code and run the incredibly efficient post office and dmv. Medicare does have less overhead than most private insurance companies, however they get millions of dollars stolen form them via fraud and abuse. The idea that a bunch of government bureaucrats are going to run things more efficiently than private companies with less expensive paperwork is just laughable. In a government system people can't leave and go somewhere else, what incentive do bureaucrats have in such a system to do anything else than play it as safe as possible and just attempt to grow their budget? There is no reason to innovate or to let people take risks they are willing to take, because the bureaucrat has the job regardless; and via the mechanism of diffuse costs and concentrated benefits is perfectly positioned to capture the regulatory structure to his/her own advantage.

Asymmetric information? Ok. So your solution is to force everyone into one system and just ignore how healthy they are? The government doesn't solve the problem of people gaming the system this way, they just force everyone to get gamed.

In theory a mandate for catastrophic coverage could vastly reduce these costs, however in practice the government gets to define what insurance is; and will function like it has in many states of defining coverage levels well above catastrophic to transfer wealth from the healthy to the sick.

One of the reasons health costs are so high is the fact that we have insurance that covers things that should be paid for out of pocket, driving up their prices and making comprehensive insurance more necessary. Liberals then assume these high prices as part of their static world.

Auto insurance coverage for one's own vehicle is not mandated, only for the other driver you might hit. The health analogy would be to require people to get vaccinated/quarantined, because only via infectious diseases can one person's bad health threaten the health of another. Sure we have to pay for people who go to the E.R.; but only because the government says so. This isn't an externality inherent in the market the way the potential for car crashes is inherent in driving. If you assume the externality is inherent, then at most one could do is mandate catastrophic coverage and not coverage for alcoholism, in vitro fertilization, chiropractic treatment etc.

Similarly, fire insurance is not mandated. Firefighters put out fires that might spread to other parts of the community or spread toxins if they strike a chemical plant or something similar; because those are real externalities.

Finally as for the Rawlsian question, it is true that the rich are going to pay the most under that system; however everyone who has below average health costs, and this includes most people since the average is driven up by a relatively few expensive outliers, will also pay more. If one is earning 55-80k one isn't going to get out of the various taxes to pay for health care, and isn't exactly a winner of "life's lotto" anyways. Additionally, Rawls recognized the value that inequality at the top can contribute to higher living standards at the bottom via capitalism in his whole maximize the minimum living standards model; and the level of taxation and regulation required to force only those top 10% to pay for all the health costs is highly likely to deter medical and other innovation which raises all boats. Of course costs aren't only money, waiting lists are as much an expense as dollars; as are deterred economic growth and medical innovation. Behind the "veil of ignorance" the likelihood of being born into a position that has to pay more in these costs is much higher than being born into a less advantageous position.

Of course, one can't just pick out one good and do a Rawlsian analysis of it only. Is everyone with a pre existing condition poor? How much of the costs of treating them are due to the market, and how much to government interventions? Did they have a chance to buy insurance and ignore it? Would tolerating inequality in this field allow us to raise living standards in other fields via incentivizing innovation, medical or otherwise by allowing other to keep their profits? If one wants to bring up Rawls these questions have to be addressed too, the issue isn't a simple as those attempting to portray it as such to support their position would want you to believe.

oaktownadamm|9.26.09 @ 6:08PM|#

RE: Chad @ 4:02pm "Your Rube Goldberg scheme just looks sillier by the minute. Buying insurance would be absurdly complicated, as you would need to have clearly defined payouts for every disease, every severity, for every age group. This would, of course, leave the very real possibility that the payout is insufficient, leaving you *bleeping bleeped*."


Aren't you describing what you're advocating, there? Government-defined payouts for each and every condition, to go along with the government panel-approved treatment regimen?

I've heard liberals make the point again and again that if everyone were on government-paid healthcare, the government could set its own prices....whether or not those prices have anything to do with the reality of what it costs to provide care.

So again, Chad, how is what you just described any different from that which you are advocating?

Art-P.O.G.|9.26.09 @ 6:11PM|#

I'm not a Boomer, BTW. I'm Generation Y or Z or some nonsense like that.

oaktownadamm|9.26.09 @ 6:17PM|#

"Chad | September 26, 2009, 10:28am | #
MNG | September 26, 2009, 8:42am | #

And even if you end up being the contributor you get the added bonus of knowing that if you ever become the hapless stranger you will be taken care of.

You are exactly right, MNG. It is interesting how virtually everyone who is against health care reform has "got theirs" and is trying to protect the status quo....everyone else be damned."

Nice strawman, there. You clearly haven't been paying attention, if you think Reason and libertarians in general have been shilling for the status quo. We just see stupidity calling itself "reform" and call it out as such.

I'm sorry that the Democrats have put together a schizophrenic plan that contradicts itself even in its stated goals, but that's what we're left with. Opposing that idiocy isn't supporting the status quo, it's trying to prevent the situation from getting worse.

Chad|9.26.09 @ 6:48PM|#

Tim | September 26, 2009, 5:45pm | #

John Cochrane at the WSJ has proposed a market based solution to pre existing conditions. http://online.wsj.com/article/SB10001424052970203609204574316172512242220.html

More Rube. So now I don't need just insurance, but insurance for the right to purchase insurance. And more specialied accounts. Yay! This will surely cut costs and make life far more convenient. How could I possibly handle so much freedom?

Or we can do it like Japan. 8% it taxed from your income. You got to the doctor whenever you want. You sign a piece of paper while you are there. The end.

I also love how Cochrane believes that the competition will prevent people from being *bleeped* by their insurer, because unhappy customers will leave and spread the word.

Quick! Tell me who *bleeps* their customers more: Anthem or United Health. Provide solid evidence for your claim.

You will quickly find that this is impossible, and that no mechanism exists to validate their claims or anecdotal customer complaints.

Chad|9.26.09 @ 6:52PM|#

oaktownadamm | September 26, 2009, 6:17pm | #

Nice strawman, there. You clearly haven't been paying attention, if you think Reason and libertarians in general have been shilling for the status quo. We just see stupidity calling itself "reform" and call it out as such.

Agreed. Libertarians are generally shilling for something different, something that will never ever ever be. But in practice, the two choices on the table are more or less the status quo, or move towards universal coverage...and libertarians, in preventing the latter, are implicitely supporting the former. It doesn't matter what you want in theory, it is what you cause in practice.

Chad|9.26.09 @ 6:55PM|#

oaktownadamm | September 26, 2009, 6:08pm |

I've heard liberals make the point again and again that if everyone were on government-paid healthcare, the government could set its own prices....whether or not those prices have anything to do with the reality of what it costs to provide care.

We should have a system like Japan's. Prices are tightly controlled and very transparent. They pay far less than we do despite having more fancy gadgets and a far higher percentage of elderly people.

Their prices may not perfectly reflect reality, but they are not that far off, and are constantly being tuned if over or under supply becomes an issue.

Art-P.O.G.|9.26.09 @ 7:00PM|#

Libertarians are generally shilling for something different, something that will never ever ever be...and libertarians, in preventing the latter, are implicitely supporting the former. It doesn't matter what you want in theory, it is what you cause in practice.

Awesome, just awesome. SugarFree, do you think you can fit this in Typical Libertarian's voice bubble?

oaktownadamm|9.26.09 @ 7:09PM|#

re: Chad @ 6:55pm

"Their prices may not perfectly reflect reality, but they are not that far off, and are constantly being tuned if over or under supply becomes an issue."

Ahh, the centrally-planned economy rears its ugly head again. I will defer to Mises and Hayek in dismissing this fantasy, as they explained it far better than I ever will.

Colonel_Angus|9.26.09 @ 7:20PM|#

What's that rotten tuna smell coming from Chav's direction?

oaktownadamm|9.26.09 @ 7:21PM|#

re: Chad @ 6:52pm

"Agreed. Libertarians are generally shilling for something different, something that will never ever ever be. But in practice, the two choices on the table are more or less the status quo, or move towards universal coverage...and libertarians, in preventing the latter, are implicitely supporting the former. It doesn't matter what you want in theory, it is what you cause in practice."


Funny, because that's one of my main criticisms of progressives....they blindly support feel-good policies without paying any attention whatsoever to the actual consequences. See LBJ's welfare for an example. Sure, handing money out to poor people sounds like a great idea, but the net effect of it was to simultaneously destroy the family structure of those people receiving the government largesse, as well as creating a whole class of dependents (slaves).

Or how about the tax breaks for companies which mix renewable fuels into their petroleum? Sounds great, right? Encourage people to use less oil, and all that jazz....but what happened in reality was that International Paper, which previously used zero petroleum in their manufacturing process, immediately started adding diesel, so they could claim the tax breaks. The result:
"The company recently reported that it received a check from the Internal Revenue System for US$ 71 million as a result of using the tax credit for only one month. "
http://www.globalsubsidies.org/en/subsidy-watch/news/us-renewable-energy-tax-credit-pays-pulp-and-paper-mills-do-business-usual

Chad|9.26.09 @ 7:31PM|#

Ahh, the centrally-planned economy rears its ugly head again. I will defer to Mises and Hayek in dismissing this fantasy, as they explained it far better than I ever will.

Their "centrally-planned" insurance system smokes the hell out of ours by almost all measures. The only way we match them is in quality of care. They pay far less, have no risk of being uninsured, have far less paperwork headaches, have shorter waits, spend more on R&D than we do, have more MRIs, CAT-scanners, etc, and have far better overall health than we do.

But we have richer doctors and insurance salesmen.

Indeed, it almost seems to me that Japan's "centrally-planned" health insurance system serves as a utter refutation of the libertarian belief that centrally-planned systems cannot work well. Their excellent train system (which is profitable, btw) also shows how well a good public-private hybrid can work.

So I guess poor Mises and Hayek will just have to admit that central planning can work sometimes.

|9.26.09 @ 7:49PM|#

Summary of discussion ...

Chad: You libertarians have no idea how to deal with pre-existing conditions.

Hazel: How about we get insurance companies to live up to their contracts?

Chad: Bah, that'll never work! Insurance companies have no idea how to calculate risk!

Hazel: Um, yes they do. It's called "statistics".

Chad: Statistics are a Rube Goldberg device.
You libertarians still have NO IDEA how to deal with pre-existing conditions.
Tim: Hey, here's another market based proposal over at the Wall Street Journal.

Chad: All these proposals are too complicated for me to understand. Therefore they won't work. Libertarians still have NO IDEA how to handle pre-existing conditions. Except for all those fisky proposals I'm ignoring.

Chad|9.26.09 @ 7:54PM|#

oaktownadamm | September 26, 2009, 7:21pm | #

"The company recently reported that it received a check from the Internal Revenue System for US$ 71 million as a result of using the tax credit for only one month. "
http://www.globalsubsidies.org/en/subsidy-watch/news/us-renewable-energy-tax-credit-pays-pulp-and-paper-mills-do-business-usual

You can be assured that the paper-and-pulp lobby got this little boondoggle snuck into the bill....and they surely ain't in bed with liberals. I wonder which Republican is responsible...

|9.26.09 @ 8:01PM|#

What plan? What bill? Baccus' "bill" is a 200-page draft of an outline of a health "care" reform bill. More stealth legislation. Every time they pull a stunt like this, it seems to be nearer the time for tar and feathers.

To those who wonder why academics and intellectuals who not only criticize but undermine and utterly detest - to believe their published and spoken words - their own countries, societies and civilizations ought to be viewed critically; rather than their societies being reflexively thought to have a core of horrible evil, try this: those same bitter critics, those same evaluators, those same would-be destroyers are among the primary beneficiaries of their societies. Academics enjoy work-free and risk-free employment in an environment free of hunger, pain, illness, indeed free of any of the slings and arrows of outrageous fortune that most of the world's people experience as their daily lives. In most cases, this benefice was obtained with little or no serious effort on the part of these benevolent would-be saviours of mankind; their mommies and daddies and grandparents had worked and sweat and killed for the money, their children and grandchildren have the trust fund income and the network of important contacts. Not important, you say? Sure; ask Bill Ayers and Bernie Dohrn how unimportant having wealthy and influential families is. Without the society, without the economic system, without the hard work of all the people which these intellectual and academic stars denigrate and condescend to, these stellar intellects wouldn't have a pot to pee in or a window to throw it out of. That is why such virulent critics of any society are viewed askance: they are in effect urging us and the next generation to commit suicide, based upon their oh, so concerned and loving analysis of the wrongs and evils of the world, by completely reconstructing a social and economic and political system that folks have worked and died for, for the last two hundred plus years. As well they ought to be; in other nations at other times and place they would simply have disappeared or met with sudden accident ... or, perhaps most appropriately, locked up as incureably insane.

Chad|9.26.09 @ 8:06PM|#

Hazel Meade | September 26, 2009, 7:49pm | #

Chad: All these proposals are too complicated for me to understand. Therefore they won't work.

You are right. They are too complicated for anyone but a dedicated actuary to understand. That's precisely why they won't work. They make the system vastly more abstract and bureaucratic. They would make switching from one insurer to another a nightmare, as both of them were squabbling with me over interpretations of contracts which could be worth hundreds of thousands of dollars. Your absurd idea that different agents won't have different interpretations when this much money is at stake is just unfathomable to me. So is your unwillingness to acknowledge that this system would greatly increase the risk of people using their asymmetric information advantage over the insurers (feel sick, buy insurance, wait, get diagnosed, profit). The current system mitigates that somewhat because your "payments" are stretched out over the entire time you are treated. If you make it a lump-sum (at least potentially, when you switch companies), it is much easier for customers to play this game. That alone would wreck your proposal...which is why nothing like it is on the table anywhere.

oaktownadamm|9.26.09 @ 9:01PM|#

re: Chad @ 8:06pm
"That alone would wreck your proposal...which is why nothing like it is on the table anywhere."

Of course! It wouldn't have anything to do with the drafters of the various healthcare bills all working in secret with special interests, would it?

Even Obama, who doesn't even have a plan, has met with and made secret deals with both the AMA and Pharma.

Democrats have said they want "choice"...but they are working to reinforce existing monopolies, and add their own, the so-called "public option". No mention at all of allowing insurance companies to operate across state lines, as the Constitution demands that they do.

They say they want to lower costs, but in the next breath, they want to make sure that everybody's insurance policies cover mammograms and end-of-life planning sessions.

It's schizophrenic and self-contradictory...you cannot simultaneously cover more people *and* give them more covered services *and* lower costs. Pick two.

oaktownadamm|9.26.09 @ 9:14PM|#

re: Chad @ 7:31pm
"Their "centrally-planned" insurance system smokes the hell out of ours by almost all measures. The only way we match them is in quality of care. They pay far less, have no risk of being uninsured, have far less paperwork headaches, have shorter waits, spend more on R&D than we do, have more MRIs, CAT-scanners, etc, and have far better overall health than we do."

Are you nuts? Japan isn't even close to us on government spending on health R&D as a percentage of GDP. We're #1 by a long way, followed by the UK, according to the OECD:
http://tinyurl.com/ydgqtvc

You're also going to have to explain to us how government-paid healthcare will give us "shorter waits". How is cutting costs going to result in more supply?

Also, "far better overall health" cannot be fully explained by any health-insurance system, as it relies quite heavily on factors like demographics and lifestyles.

Michael Ejercito|9.26.09 @ 9:28PM|#

And if insurance doesn't cover pre-existing conditions, you wind up with a whole lot of people who, for a lack of a better word, are *bleeeping bleeped*. This is not only immoral from every point of view but that of a libertarian, but utterly defeats the entire point of insurance in the first place.

So auto insurance should cover pre-existing collision damage?

Fire insurance should cover pre-existing fire damage?

Indeed, it almost seems to me that Japan's "centrally-planned" health insurance system serves as a utter refutation of the libertarian belief that centrally-planned systems cannot work well. Their excellent train system (which is profitable, btw) also shows how well a good public-private hybrid can work.

Why not centrally plan fire, life, and auito insurance- let alone the entire economy?

Of course, one can't just pick out one good and do a Rawlsian analysis of it only. Is everyone with a pre existing condition poor? How much of the costs of treating them are due to the market, and how much to government interventions? Did they have a chance to buy insurance and ignore it? Would tolerating inequality in this field allow us to raise living standards in other fields via incentivizing innovation, medical or otherwise by allowing other to keep their profits? If one wants to bring up Rawls these questions have to be addressed too, the issue isn't a simple as those attempting to portray it as such to support their position would want you to believe.

We should also ask if they are sex offenders.

|9.26.09 @ 9:57PM|#

As Chad insists on repeating his nonsensical argument that THE EXACT PROBLEM with covering pre-existing conditions has something to do with what I'm advocating, I'm going to stop wasting my time on someone this retarded.

The someone as "simple" as Chad, everything beyond "Hammer Smash Rock!" is a Rube Goldberg device.

|9.26.09 @ 10:07PM|#

Any system coming from the government is likely to end up only as a big corporate welfare scheme. Does no one remember the cold war-era defense contractors who charged (and probably still charge) $1000 for a hammer? When it comes to an organization that can make money out of thin air (or so they think) there is no incentive to reduce costs and certainly the manpower couldn't possibly exist to truly verify all the costs involved. It will be a field day for those wanting to screw the government for a few extra bucks.

Chad|9.26.09 @ 10:16PM|#

oaktownadamm | September 26, 2009, 9:14pm |

Are you nuts? Japan isn't even close to us on government spending on health R&D as a percentage of GDP. We're #1 by a long way, followed by the UK, according to the OECD:
http://tinyurl.com/ydgqtvc

Umm, the typical complaint brought up by the right is that if we had some sort of nationalized system, private R&D would be cut. Yet Japan, and many other nations with national systems, spend MORE on private health-care R&D (as a fraction of their GDP) than we do...by the very graphs you show! Japan also spends more on R&D in general (vs GDP).

For various reasons, we spend the most on public R&D through NIH. No one is proposing to cut this, and it is unrelated to a national health care scheme.

You're also going to have to explain to us how government-paid healthcare will give us "shorter waits". How is cutting costs going to result in more supply?

Supply is not determined by the market, but the AMA. That needs to be addressed as part of any national scheme.

Also, "far better overall health" cannot be fully explained by any health-insurance system, as it relies quite heavily on factors like demographics and lifestyles.

Agreed. It can almost certainly be explain in part by their excellent health care systems. Also, much of the "lifestyle" differences that aid good health (such as walkable communities and excellent public transit) in Japan are clearly government-sponsored. I cannot emphasize how valuable the transit system is to the Japanese elderly, as it allows them to waddle down to the station and get around on their own. How many American elderly are essentially trapped in their homes unless someone comes to visit? How quickly do these people wither away as a result of their isolation and loneliness?

Chad|9.26.09 @ 10:19PM|#

Michael Ejercito | September 26, 2009,

Why not centrally plan fire, life, and auto insurance- let alone the entire economy?

Fire: Ever heard of a fire department?

Life: Hello! Social Security, anyone?

Auto: Mandated by the state

oaktownadamm|9.26.09 @ 10:37PM|#

"Supply is not determined by the market, but the AMA. That needs to be addressed as part of any national scheme."

At least we can agree on something. However, basic reforms such as this are off the table, because the AMA has cut deals with all of the power-brokers in government.

But of course, by your argument, our demanding actual reforms such as this, rather than just shuffling around who is going to pay for it, is tantamount to supporting the status quo.

Or something. I would posit that your desire to support the democrats is part of the two-party mentality which simply serves entrenched interests. And thus, all of your arguments are simply a case of projection at best, Orwellian double-think at worst.

|9.27.09 @ 1:56AM|#

Every fucking time! The Democratic Party just caves in on itself and fails! Then, of course, the Republican Party just plain fails, they get into office preaching small government then do the exact fucking opposite. Why do they both suck so much?

FUCK - THE GOVERNMENT - WITH - YOUR FIST!

Art-P.O.G.|9.27.09 @ 7:16AM|#

Life: Hello! Social Security, anyone?

And social security has worked so well. Bravo, progressives, bravo (waitaminute, Social Security's life insurance?).

Chad|9.27.09 @ 8:59AM|#

Art-P.O.G. | September 27, 2009, 7:16am | #
Life: Hello! Social Security, anyone?
And social security has worked so well. Bravo, progressives, bravo (waitaminute, Social Security's life insurance?).

Actually, I am not sure if I have ever heard any serious complaints about the life and disability insurance aspects of SS.

|9.27.09 @ 12:39PM|#

I can't get auto insurance from GEICO and expect the friendly Australian reptile to pay for an auto accident I already have had.

While there are geckos in Australia, they are more plentiful many other places.

And I'm not sure why anyone would identify a lizard that speaks with an English (London Cockney) accent as Australian, either.

|9.27.09 @ 1:28PM|#

Sorry to spoil the fun here...

Not sure you'll find many Nixon fans here. Not even among the few commenters who identify as Republicans.

Chad|9.27.09 @ 2:10PM|#

I can't get auto insurance from GEICO and expect the friendly Australian reptile to pay for an auto accident I already have had.

You also can't expect your auto accident to last years, or the rest of your life. There is a fundamental difference between insuring one-off events and chronic situations.

Michael Ejercito|9.27.09 @ 2:12PM|#

You also can't expect your auto accident to last years, or the rest of your life. There is a fundamental difference between insuring one-off events and chronic situations.

Death is a chronic situation.

As it turns out, there are life insurance settlement options, such as taking a lump sum payment, payments spread out over a period of time, or interest only.

Naga Sadow|9.27.09 @ 2:29PM|#

So has LoneWacko gotten the ban hammer? That crossed a number of lines.

Well, O Mighty Reason Overlords?

|9.27.09 @ 2:57PM|#

As it turns out, there are life insurance settlement options, such as taking a lump sum payment, payments spread out over a period of time, or interest only.

These complicated solutions to the problem are far too complex for Chad's simple mind to comprehend. It's much easier to just have the government hand out money instead. Hammer Smash Rock!

Chad|9.27.09 @ 4:20PM|#

Michael Ejercito | September 27, 2009, 2:12pm | #

Death is a chronic situation.

You are mixing your words up. Being dead is chronic. Dying is one-off. You insure against the latter, not the former.

As it turns out, there are life insurance settlement options, such as taking a lump sum payment, payments spread out over a period of time, or interest only.

And less than 20% of people can even do the calculations on that....and half of those would be irrational and choose the more-money-now option even if it was a bad long-term choice. Now if we were trying to use Hazel's Rube meta-insurances, only 5% could figure it out, and only after great effort....and it still wouldn't work.

|9.27.09 @ 5:25PM|#

Shorter Chad: Compound interest is too hard for the average person to compute. I know because it strains my own demonstrably awesome talents.

Chad|9.27.09 @ 6:44PM|#

Actually, Hazel, less than 10% of people can calculate simple compound interest.

And you think they should be buying credit default swaps on their health insurer as a matter of daily life.

|9.27.09 @ 7:04PM|#

Come on Hazel, the arguments I've heard about pre-existing conditions are that 1. it's awful to have someone through no fault of their own be denied care, better to spread the costs over society and 2. markets will have little to no incentive to cover such folks.

Don't be such a 'tard about health insurance, MNG. If someone has chosen to not get health coverage, and then gets sick, and then wants someone to cover them knowing they will take a loss on the deal, should they be surprised that no one is willing to lose money covering them? And how is that not the person's fault?

Of course insurers have no incentive to offer fire insurance to people who waited to apply for coverage until their house was currently on fire. And why should anyone else be forced via the government to pay for such irresponsibility?

|9.27.09 @ 9:10PM|#

Shorter Chad (again):
Since I'm self-evidently smarter than 99% of the population, anything incomprehensible to me is obviously incompehensibe to everyone else, and hence unworkable.

Chad|9.27.09 @ 9:32PM|#

Hazel Meade | September 27, 2009, 9:10pm | #
Shorter Chad (again):

Since I'm self-evidently smarter than 99% of the population, anything incomprehensible to me is obviously incompehensibe to everyone else, and hence unworkable.

Naah, I have good hard data. I am somewhere in the 99.75+-.1 percentile range.

Your system is only "incomprehensible" to me because you refuse to explain how it will work. That should be really simple if your system is simple.

I am insured by X. I want (or need) to switch to Y. I was diagnosed with diabetes while insured by X. How much money will X have to give Y in order for Y to not charge me a premium? What if X and Y do not agree? What if I don't agree? Who decides? How is this negotiated beforehand between X and I? And how on God's green earth is this going to be cheap, and not involve laywers? And yes, how is this sytem going to be comprehensible to most people?

Michael Ejercito|9.27.09 @ 11:51PM|#

I am insured by X. I want (or need) to switch to Y. I was diagnosed with diabetes while insured by X. How much money will X have to give Y in order for Y to not charge me a premium? What if X and Y do not agree? What if I don't agree? Who decides? How is this negotiated beforehand between X and I? And how on God's green earth is this going to be cheap, and not involve laywers? And yes, how is this sytem going to be comprehensible to most people?

X pays for the treatment of the diabetes since the condition developed under X's policy.

|9.28.09 @ 11:41AM|#

Why do health insurers want to get so involved in care anyway? My auto insurance company just gives me a check based on their estimate, and I can spend it however I want with any provider I want. If I want a little extra it comes out of my pocket.

Similarly, why should an insurance company care what drugs I want to use to treat a condition? Just give me a set check, my doctor and I can decide on the generic, the brand name, or the brand new drug.

The whole system is about central planning, which fails over and over. Why any company thinks it can do it is beyond me. If it doesn't work for governments it won't work for companies either.

Pingback| 10.3.09 @ 5:14PM

Reason Magazine : The Body Politics » words links to this page. Here’s an excerpt:

…the guy who goes through our apartment’s dumpster looking for dinner and the crud I just scrubbed up from under the fridge, I do respect his political instincts. See the original post: Reason Magazine : The Body Politics Previous Entry: HEALTH POLITICS: Mark Me Up Buttercup | New America Blogs Next Entry: How we do politics now – Beyond The Commons, Capital Read … Posted in Politics Tags: apartment…

Pingback| 10.3.09 @ 7:19PM

Reason Magazine : The Body Politics « News links to this page. Here’s an excerpt:

…who goes through our apartment’s dumpster looking for dinner and the crud I just scrubbed up from under the fridge, I do respect his political instincts. … Go here to read the rest: Reason Magazine : The Body Politics Comments (0) No Comments No comments yet. RSS feed for comments on this post. TrackBack URL Sorry, the comment form is closed at this time. Pages: About Blogroll Online Poker Categories: Politics

Pingback| 10.3.09 @ 8:21PM

Reason Magazine : The Body Politics « Noya Khobor links to this page. Here’s an excerpt:

…between the guy who goes through our apartment’s dumpster looking for dinner and the crud I just scrubbed up from under the fridge, I do respect his political instincts. The rest is here:  Reason Magazine : The Body Politics Tags: are-both, arg, between-the, crud, dumpster-looking, for-dinner, fridge, google, opinion, substitute-for This entry was posted on Friday, September 25th, 2009 at 5:00 pm and is filed under…

|10.4.09 @ 11:15AM|#

We'd all be better off creeping across moonie lunarscapes.

|10.6.09 @ 1:40PM|#

~ OUR U.S.CONGRESS AT LEAST DOES NOT DISCRIMINATE ~ THEY AFFORD POORER AMERICANS THE SAME EMERGENCY ONLY HEALTH*CARE THAT ILLEGAL ALIENS RECEIVE ~

AMERICA~LOVE IT OR LEAVE IT~ 45,000 DEAD POOR AMERICANS LEAVE U.S. EVERY*YEAR DUE TO 3rd WORLD HEALTH CONDITIONS ??

** POLITICS IN AMERICA IS VERY SIMPLE TO UNDERSTAND WHEN OUR MIDDLE~CLASS & WORKING POOR CITIZENS ARE ALL BEING FORCED 2 ALLOW BIG $$$ TO CONTROL THE PEOPLES HALLS OF THE U.S.CONGRESS..

~ SADLY, OUR VERY OWN AMERICAN HEALTH*CARE SATANIC VERSES HAS KEPT 45 MILLION POOR AMERICANS IN 3rd WORLD HEALTH CONDITIONS ~

DON'T WORRY BE HAPPY ~ THE WORLDS SELECT BILLIONAIRES AND THEIR FRONT CORPORATIONS WILL ALL GET ON BOARD THE NEW HEALTH~TRAIN OF $$$...**ADDING 45 MILLION MORE AMERICAN CITIZENS TO THE CURRENT GIVEN PROFIT MARGINS + WITH A FUTURE AMNESTY PROGRAM
(6 months) AFTER NEXT U.S.PRESIDENTIAL ELECTION = $$$$$$$$$.........

WEALTH~CARE FOR ALL THE HEAVILY INVESTED INTERNATIONAL AND AMERICAN BILLIONAIRES IN THE CURRENT U.S.HEALTH FOR THE WEALTHY ONLY SYSTEM WILL NOT END ANYTIME SOON... IT WILL ONLY BE RE~ARRANGED TO MAKE SURE ALL THESE MEGA CAPITALISTS PROSPER IN JUST ANOTHER FASHION .

THE FINE ART OF DENYING 45 MILLION AMERICANS HEALTH~CARE IN OUR JUDEO~CHRISTIAN NATION IS NOT RACIST AT ALL... IT'S JUST OUR BEHIND THE SCENE WEALTHY ELITE CITIZENS USING THEIR TREMENDOUS WEALTH TO DIRECTLY INFLUENCE OUR U.S. CONGRESSIONAL REPRESENTATIVES IN KEEPING ALL THE little poor folk down *

AMERICAN RELIGIOUS LEADERS ALL ACROSS THE USA HAVE ALWAYS BEEN ABLE TO COUNT ON THEIR RELIGIOUS FLOCK TO CONTRIBUTE(TITHE)THEIR HARD EARNED MONIES TO THEIR MINISTRIES EVERY WEEK. THE MAJORITY OF AMERICANS ATTENDING RELIGIOUS SERVICES IN THE U.S. ARE MIDDLE~CLASS AND WORKING POOR CITIZENS WHO NOW DESPERATELY NEED THE HELP AND SUPPORT FROM THESE SAME U.S.RELIGIOUS LEADERS IN LOBBYING THE U.S.CONGRESS TO PROVIDE PROPER HEALTH~CARE FOR ALL POORER AMERICANS.

***THERE ARE CURRENTLY AN ESTIMASTED 45 MILLION MEN WOMAN AND CHILDREN WITHOUT HEALTH~CARE IN THE WEALTHIEST COUNTRY IN THE WORLD????

SILENT AMERICAN RELIGIOUS LEADERS WHO ALL HAVE HEALTH~CARE FOR THEMSELVES AND THEIR FAMILIES IS MUCH MORE FRIGHTENING THEN THE POSSIBLE DENIAL OF A FUTURE HEALTH~CARE PLAN FOR ALL...

**45,OOO AMERICANS DIE EACH YEAR IN THE WEALTHIEST COUNTRY IN THE WORLD DIRECTLY RELATED TO THEIR LACK OF PROPER HEALTH*CARE.

LAWYERS FOR POOR AMERICANS
(424-247-2013)