Heartland Paper to Dems, Obama on Health Care: "Tear it Up, Folks. Just Tear it Up and Start Over."

The Cincinnati Enquirer calls for a time-out on the Dem plan for health care overhaul:

President Barack Obama should call a time-out on health care reform, go back to the drawing board, and actually listen to what all Americans are saying instead of dismissing those who object as simply uninformed stooges. Polls show that Americans increasingly agree with Sen. Joe Lieberman, I-Conn., who argues for a more incremental approach and says it's "a real mistake to try to jam through" the proposed Democratic overhaul.

Even some of Obama's supporters seem unsettled by the botched message and bumbled strategy on health care reform. They wonder why he ceded the job of crafting a plan to the likes of House Speaker Nancy Pelosi and her left-leaning allies who have yearned for a government-run, universal single-payer plan - an overhaul far more radical than Americans were ready to accept.

The editors at the Enquirer list the basic issues they think reform should address, such as "first, do no harm" and "cover everybody." Their specific ideas are less interesting that the fact of their opposition, which reflects a large and growing lack of cofidence that this president and this Congress are the ones to unilaterally overhaul and expensify (yes, a useful neologism to describe the last decade of federal politics) a massively complicated part of our lives. The Enquirer editorial board leans right but they are centrist in the best-worst sense of that term, meaning they do live the big government when it's about "helping" people, especially people in depressed areas such as southwestern Ohio. If you've lost them, you're in real trouble, buddy.

Whole thing here.

And it's good advice for other mega-legislation waiting in the wings, such as cap-and-trade and "consumer protection" stuff. Ruling be decree may be more fun, but ruling by a consensus borne of actual conversation, debate, and suasion is longer-lasting and better overall. Over a broad set of hugely important issues, ranging from foreign policy to health care to entitlement spending, we've had nary a peep of real talk in well over a decade. That's one of the reasons why things are so godawful on those fronts.

Comments

[ed]

Serious question: how much real influence do newspaper editors have these days?
Who are they speaking for?

[KingShamus]

Boiling the frog slowly is the better strategy. You can get the American voter to go along with nearly anything if you have an incremental gameplan.

[Kyle Jordan]

I agree with KingShamus. The dems saw the election as being handed the keys to the kingdom and got carried away. Hopefully, they'll continue to "stay the course" because it seems as though that would result in the dems getting kicked right the hell out of office.

One can hope...

[Tricky Prickears]

Your argument would be valid if the general population actually knew how to think for themselves and had a real grasp on the issues. Unfortunately, most people look to the left or the right to do their thinking for them. Add to that the relative ease of throwing a blanket label on someone who actually can think.

Case and point: Medicare recipients are now beginning to turn to "conservatives" to save their entitlement to free healthcare. Similar to the way that same demographic relied on conservatives to "save" their Social Security. I guess they forgot that it was conservatives who originally opposed both of those programs.

[ondigo]

Nick: spell-checker is your friend. Use it.

[Cabeza de Vaca]

"Medicare recipients are now beginning to turn to "conservatives" to save their entitlement to free healthcare. Similar to the way that same demographic relied on conservatives to "save" their Social Security. I guess they forgot that it was conservatives who originally opposed both of those programs."

Tricky,

You must not know what being a conservative means. Conservatives are for whatever the status quo is. Don't ever change anything, because change is scary. Once the change has been made though, then they support it & don't what it altered. Because that is the new status quo.

[Tulpa]

CBV, that's not what conservative means in this context. Meanings of words diverge over time.

If we're to be insistent on using the original definitions of the words, then conservatives aren't conservative and liberals definitely aren't liberal.

[zack]

"I agree with KingShamus. The dems saw the election as being handed the keys to the kingdom and got carried away. Hopefully, they'll continue to "stay the course" because it seems as though that would result in the dems getting kicked right the hell out of office.

One can hope..."

Kicked out for what? Republicans? Great... the cycle of stagnation continues. Dem, Repub, Dem, Repub....... lets oust all those who don't make this country a better place and put in people who will.

Oh wait.... we are a bunch of sheep and have no thoughts of our own. Better to identify with the mobs that are the 2 major political parties and let the lowest IQ in each beat the drum for the rest of us..............

[Tulpa]

zack,

No one we put in is going to make this country a better place. The best we can hope for is to keep the power-hungry maniacs at each other's throats and out of the American people's way long enough for them to solve this mess themselves (as we always have in the end).

[James Ard]

TP, I'd say the fogies are pressuring Republican politicians that want to get reelected. "Conservatives" still hate SS and Medicare. Considering their hopeless financing mechanisms, what's not to hate?

[Cabeza de Vaca]

Tulpa,

I understand what you're saying, but I don't agree. I think the original meaning still applies to conservatives. I know lots of conservatives & they are generally in favor of big government programs that have been in place a long time like SS & Medicare. When we end up with government run healthcare & we will eventually. Wait ten years & the conservatives will love it & defend it.

[James Ard]

CdV, anyone who supports a scheme that steals the wealth from future generations shouldn't be called a conservative. And when century old institutional racism came up for a vote, you will see many conservatives were for stopping it. Saying they are only for status quo is total crap.

[zack]

Tulpa-

I disagree. There are people out there who want to do good things for other people. The problem is that they get stuck on the "fringe" because they aren't part of the major 2 party system. This goes for most elected offices besides presidency. Money drives the Dems and Repubs alike and with that kind of money, they can buy advertising (or taxable brainwashing).

[nmg]

The health care bill suffered from two typical flaws. 1. it was legislation so already we can assume it's a terrible idea. 2. It was a bill that worked backward from the premise of needing a health care bill. Instead of the RIGHT way to consider legislation which is to ask "what problem are we trying to solve?"

Every single congressperson should be harassed in their town halls with this very logical question: "What problem are you trying to solve?"

The only two that are at all pertinent are usually: 1. Insurance companies drop people illegally and 2. Those with pre-existing conditions can't find insurance.

Neither of those problems require the behemoth that was the health care bill.

[Cabeza de Vaca]

James Ard,

I would have to say that by your definition there isn't alot of conservatives out there then. You make a good point about civil rights. Although, most of those conservatives were from northern states. Where a large percentage of the population was always in favor of treating blacks with equal status dating back to post civil war days.

[R C Dean]

nmg, you overlook the mantra that "There are 49 million Americans without health insurance."

Even though this number has been thoroughly and utterly debunked, I still hear it from supporters of "universal coverage" all the time.

[P Brooks]

Pay those Cincinnati hicks no heed.

They're just bitter.

[creech]

I've yet to hear a good, free market solution to how an insurer can provide insurance, at a reasonable price, to people with pre-existing conditions. Who is going to insure someone with, say, a failing kidney? [Who is going to insure your jewelry when your house has already been burglarized?] Someone has to come up with a catastrophic policy that one may buy upon birth and carry it with them throughout life. Those born with existing conditions, or too poor to buy a plan, are going to have to depend on the very generous American public. And those who had the bucks, but rolled the dice and lost, well you can see if the generosity of Americans stretches far enough to enable your irresponsible ways.

[Alice Bowie]

I've yet to hear a good, free market solution to how an insurer can provide insurance, at a reasonable price, to people with pre-existing conditions.

Creech,

That is IMPOSSIBLE. Insurance is a Pyramid Scheme that requires healthy people to contribute to pay for the few sick people.

You can't have a 'pre-existing condition insurance policy'. It would be cost prohibitive.

You don't want to pollute a private policy with people with pre-existing conditions because that will bring the rates up.

The ONLY solution for people with pre-existing catastrophic diseases is that the Government (us the USA taxpayer) covers their medical needs. AKA Medicaid. I see no way around it.

That said, the PUBLIC PLAN would be useless for these people. You can't have a policy that is void of a pre-existing condition clause...no matter what the president says. Universal Healthcare can work...but nobody in America wants it. The only thing that will make everyone happy is probably eliminating ALL GOVERNMENT Mandates and any laws applied to insurance companies. Let the Insurance Companies do what they want...and let them face the consequences of the free market. And once you get kidney failure and your insurance drops you, you can go on MEDICAID.

[Alice Bowie]

The ONLY solution for people with pre-existing catastrophic diseases is that the Government (us the USA taxpayer) covers their medical needs. AKA Medicaid. I see no way around it.

Let me correct this point. These people should NOT be helped by the Government (us the USA Taxpayer) until they have exhausted all of their financial resources.

[PapayaSF]

Alice Bowie: True, if the goal is to get affordable health insurance for pre-existing conditions. But if the goal is to get affordable health treatment for pre-existing conditions, there's an awful lot of things that could be done to make the practice of medicine cheaper: tort reform, more doctors, allowing pharmacists to prescribe drugs (the way they used to), reforming the FDA, etc.

[Michael Ejercito]

Price controls can make medical care cheaper.

[Cincinnatian]

Even though Cincinnati leans to the right, The Enquirer editorial board (what remains of it) leans to the left.
Also, southwestern Ohio is not like the rest of the state. While not a booming economy it is not depressed.

[Craig]

Ruling be decree may be more fun, but ruling by a consensus borne of actual conversation, debate, and suasion is longer-lasting and better overall.

Not being ruled at all beats them both.

[JB]

And there really are some small things that could have a big effect on the health care front.

Someone should propose a bill letting people purchase health insurance across state lines. Nothing else in the bill. That would be one small step in the right direction.

[PapayaSF]

JB: Exactly. But that would undercut all those state mandates that liberals have been passing for decades: health insurance must cover mental illness, drug addiction, birth control, pregnancy, acupuncture, etc. etc.

Which highlights, of course, a standard pattern in politics: the left passes laws and regulations which make something (medicine, housing, etc.) more expensive, and eventually it becomes so expensive that Something Must Be Done, which in their minds is . . . more government!

[Nick]

Price controls can make medical care cheaper.

Cheaper and much suckier and eventually non-existent.

[Hazel Meade]

I've yet to hear a good, free market solution to how an insurer can provide insurance, at a reasonable price, to people with pre-existing conditions. Who is going to insure someone with, say, a failing kidney? [Who is going to insure your jewelry when your house has already been burglarized?] Someone has to come up with a catastrophic policy that one may buy upon birth and carry it with them throughout life. Those born with existing conditions, or too poor to buy a plan, are going to have to depend on the very generous American public. And those who had the bucks, but rolled the dice and lost, well you can see if the generosity of Americans stretches far enough to enable your irresponsible ways.

You are right that nobody will insure someone with a bad kidney (nor should they be required to). But you are mixing together several wildly different conditions under the term "pre-existing". That can mean anything from "has a genetic predisposition for cancer" to "actually has terminal cancer at the moment".

This is one of my frustrations with the debate over this. It is thoroughly unclear whether the people being turned down for "pre-existing conditions" are people with a bad kidney, or people who merely have some sort of genetic factor that makes them more likely to develop kidney disease.

It is utterly insane to expect insurance companies to "insure" people who are already sick - that would be like buying one month worth of car insurance on an already totaled car, and expecting the car insurance company to pay for a replacement.

However, it DOES make sense that insurance companies shouldn't be allowed to boot someone after they get sick. In fact, they shouldn't even require people to keep paying premiums until after they get better. That's like rescinding car insurance after a crash and demanding premiums on an aready-totaled car. You get sick - the insurance should pay out for the complete cure, not just a couple of months of the initial bills.

Partially this is the fault of the employer-based system, because nobody actually reads their health insurance policies to see what the terms are. If consumers shopped for their own insurance, they wouldn't voluntarily choose policies that would boot them when they got ill.

But as for genetic predispositions as "pre-existing conditions", I am (first of all) skeptical that many insurance companies actually would turn anyone down for this. (Again, someone needs to clarify WHAT KIND of pre-existing condition they are talking about). Secondly, yeah, people ought to be able to buy some kind of life-long insurance from birth to cover this kind of thing. But the definitely need to make insurance transportable to do that kind of thing. Either make it possible for another company to "buy" your policy, or else allow insurance companies to compete across state lines.

[Alice Bowie]

Price controls can make medical care cheaper.

How un-libertarian of u.

[R C Dean]

However, it DOES make sense that insurance companies shouldn't be allowed to boot someone after they get sick.

Agree, provided the policy wasn't fraudulently obtained by someone who failed to disclose a pre-existing condition. Just because rescission has been abused doesn't mean it has no place at all.

In fact, they shouldn't even require people to keep paying premiums until after they get better.

You lose me here. Why not? Most episodes of care are pretty short (typically, about fifteen minutes, the time it takes your GP to write a prescription). Some trauma/catastrophic care can take weeks/months to play out, but you'd have a hell of a time writing a policy that identified which kinds of care led to a suspension of your premiums, and which didn't.

That's like rescinding car insurance after a crash and demanding premiums on an aready-totaled car.

This is where the car analogy breaks down. A totaled car is more like a dead person - there's no repair work/health care being done, and nobody is paying any premiums on the dead car/person.

[Alice Bowie]

Hi Hazel Meade,

There is NOTHING that can be done for people with pre-existing conditions, people with history of disease, and (as time keeps ticking and we let insurance companies do whatever they want) people related to people with diseases and pre-existing conditions. Insurance simply doesn't work that way.

These people will have to use their insurance until they are dropped. Then, they must use their own savings, sell their houses, run up the credit cards, and spend junior's college fund. And, once all of their money is gone, they will be eligible for Medicaid. Yea, they may loose their current doctors if they don't accept Medicaid...but they will at least get medical care...which is all the charity America is willing to offer.

The libertarians of America will NOT let You pass a law forbidding insurance companies from dropping you when you are sick. What libertarians want is a PURE FREE MARKET with NO REGULATIONS and NO LAWS.

[Alice Bowie]

Hey R C Dean,

U work 4 Aetna...don't u ??? ;>

[Alice Bowie]

Insurance companies have to be allowed to drop people if they get sick and are going to cost a lot of money. It's a fundamental part of their business model.

Besides, don't you want a FREE Market without any restrictions and laws? Won't the FREE Market weed out those bad-insurance companies anyway without government intervention??

[MikeP]

There is NOTHING that can be done for people with pre-existing conditions, people with history of disease, and (as time keeps ticking and we let insurance companies do whatever they want) people related to people with diseases and pre-existing conditions. Insurance simply doesn't work that way.

You know, the first fourteen times you said this, it wasn't worth responding too because it was a small point in the argument you were making. But now it's getting annoying.

Nothing has infinite cost. For every single individual, and every present health condition he has, and every future health condition he might have, there is a price at which it is profitable to insure him.

If insurance companies are allowed to individually charge those individual prices, from top to bottom, then both the supply and efficiency of insurance are maximized. And many more people than you think would be able to afford insurance even with pre-existing conditions.

Also this...

You can't have a 'pre-existing condition insurance policy'. It would be cost prohibitive.

...is mistaken. See Reason's own discussion of John Cochrane's proposed health-status insurance.

[Alice Bowie]

I like that Article MikeP.

That health-status insurance almost sounds like a good idea. But I really would have to think about it. It sounds like the health-status premium is not right in any of those examples. I can't imagine that the insurance company offering this policy would last too long without charging a pretty high premium.

Nothing has infinite cost.

I'm not saying that there are infinite costs. I'm saying that any single individual may not be able to afford the costs. It may not be infinite, but it can still be unaffordable.
For every single individual, and every present health condition he has, and every future health condition he might have, there is a price at which it is profitable to insure him.

I don't believe this to be true...unless you're insuring Warren Buffet or Donald Trump.

[MikeP]

I don't believe this to be true...unless you're insuring Warren Buffet or Donald Trump.

I may not have been clear.

Just because there is a price at which is profitable to insure him, that does not mean that he can afford that price.

But that is not market failure, nor does it require that the beneficiary be dropped for the insurer's business model to work.

Simply put, more people can afford insurance than you think. Free up insurance companies to offer policies at prices that are profitable but with terms that are desirable, and more people will be insured with policies more of them prefer.

[Isaac Bartram]

It seems that there is an awful lot of confusion about what a preexisting condition actually is in all of theses discussions.

There seems an awful lot of confusion between a chronic or incurable diseases and preexisting conditions.

A preexisting condition is merely a condition that existed before the policy went into effect. It does have to be chronic or incurable. Once the occurence of the disease in question has been successfully treated subsequent recurrences (after a certain interval - spelled out in the policy - to insure that it is not a relapse from the old one) will be covered.

I won't name names but I get a pretty good impression from the comments which of you already understand this and those that don't. In case I have not made this clear perhaps someone else can explain this better.

In fact, they shouldn't even require people to keep paying premiums until after they get better.

I'm with R C Dean here. If your car is repairable you still pay premiums while it is in the shop, no matter how long. And totalled car=dead patient is a good analogy. Then the premiums stop.

[anonymous]

"Hi Hazel Meade,

There is NOTHING that can be done for people with pre-existing conditions, people with history of disease, and (as time keeps ticking and we let insurance companies do whatever they want) people related to people with diseases and pre-existing conditions. Insurance simply doesn't work that way."

Then why do people bother paying for insurance? They can't possibly win by having insurance companies pay for expected care, it would be easier to pay out of pocket once you consider the cost of the bureaucracy. The only financially sound reason to have insurance is in case of incredibly expensive, but unlikely, problems -- if insurance companies almost always weasel out of paying for that, there's no point to having it at all.

Either it isn't as bad as you make it out to be, people are complete idiots, or it's just that they have no choice. If the latter is the problem, then why not make the first priority of reform giving people a choice?

Yes, in theory the public option does that -- but A) it gets to cheat by hiding part of what its customers pay in their taxes instead of premiums, and B) they still only get at most one additional choice. A duopoly is better than a monopoly, but not by much. And if their employer dumps everyone onto the public plan, they have same number of options as before.

If people bought their insurance directly, they'd be better off. Employers have different incentives with regard to insurance -- wouldn't you be a little worried if your employer took out a life insurance policy on you? Right now your insurance company doesn't work for you, they work for your boss.

"These people will have to use their insurance until they are dropped. Then, they must use their own savings, sell their houses, run up the credit cards, and spend junior's college fund. And, once all of their money is gone, they will be eligible for Medicaid. Yea, they may loose their current doctors if they don't accept Medicaid...but they will at least get medical care...which is all the charity America is willing to offer."

Wait, keeping middle class people in a middle class lifestyle is charity now? Should we also bail out wealthy bankers because their precious companies aren't doing so -- oh, wait..

"The libertarians of America will NOT let You pass a law forbidding insurance companies from dropping you when you are sick. What libertarians want is a PURE FREE MARKET with NO REGULATIONS and NO LAWS."

Libertarians still want insurance companies to abide by their contracts. Besides, what libertarians want is irrelevant. As a fringe group, they can only provide some slight influence on the direction of policy.

Moreover, many libertarians are practical enough to support reforms that are imperfect, provided that they're superior to the status quo from the libertarian perspective. For instance, a plan that completely decoupled insurance from employment, and gradually led to middle and upper class patients paying out of pocket for all non-catastrophic care would be a massive improvement, especially given that we predict it would drive down costs of care in the long run. Concessions to regulation or expanding medicare would be acceptable to make that happen.

[anonymous]

"However, it DOES make sense that insurance companies shouldn't be allowed to boot someone after they get sick. In fact, they shouldn't even require people to keep paying premiums until after they get better."

I halfway agree -- any health problem that manifests while the policy is in effect should be paid for under the terms of the contract, up to the maximum payable, even if the policy itself terminates, whether it's the insurer dropping you or you deciding to stop paying premiums. That includes any and all treatments necessary until you are restored to your experienced health when you signed the contract. Health problems that arise as a complication of the original problem, or iatrogenic problems related to a covered problem should also be covered.

However, if you stop paying premiums, you should not be covered for any unrelated health problems incurred -after- you stop paying. That is, if you get messed up in a car accident and then stop paying for your insurance, and then three months later you get cancer, you're not covered (also, God obviously wants you dead).

Of course, the sort of catastrophic health issues that would take months to cure are also likely to put you out of work. I imagine that if they had choices, insurance customers would probably demand some sort of grace period without premiums anyway, at least for cases where they're too sick to work.

[alice bowie]

Then why do people bother paying for insurance? They can't possibly win by having insurance companies pay for expected care, it would be easier to pay out of pocket once you consider the cost of the bureaucracy. The only financially sound reason to have insurance is in case of incredibly expensive, but unlikely, problems -- if insurance companies almost always weasel out of paying for that, there's no point to having it at all.

Either it isn't as bad as you make it out to be, people are complete idiots, or it's just that they have no choice. If the latter is the problem, then why not make the first priority of reform giving people a choice?

The fact is the vast majority of today's personal bankruptcies is due to financial ruin after sickness/injury. There's a chain of events that occur once something bad happens to you. It doesn't happen to about 98% of the people. Don't hold me to that statistic. That's why 80% of the population is happy with their health insurance.

Insurance is great when you are healthy...and the vast majority of people are healthy.

Insurance is not weaselling out of paying every claim...just the extremely expensive ones...and for some people. And that may be bad for the poor slob that becomes catastrophically sick...but it's great for the rest of the policy holders.

U wanna solution...here's one

Deregulate everything, banking, insurance, ...everything. Pass an amendment to the constitution that bars the government from ever passing any regulations/laws for any commercial reason...And let's see how that goes.

Hey, didn't everything work just darling once the FED eliminated Uptick rule?

[alice bowie]

A preexisting condition is merely a condition that existed before the policy went into effect. It does have to be chronic or incurable. Once the occurence of the disease in question has been successfully treated subsequent recurrences (after a certain interval - spelled out in the policy - to insure that it is not a relapse from the old one) will be covered.

Isaac,

Once you get cancer, you'll never be insurable AGAIN. Ask anyone.

[MikeP]

Once you get cancer, you'll never be insurable AGAIN. Ask anyone.

Egad.

Okay, let's ask R. Gene Ramsay and Michael Higgens, two insurance agents who showed up high in my search answering the same question.

The former said you would need to be free of cancer for 5 years for an individual policy and 12 months (6 before insurance starts and 6 after) for a group policy.

The latter said that in Arizona an individual policy would need 10 cancer-free years and that the cancer would not be covered. Group policies saw the same 6 months plus 6 months and did cover cancer.

I saw lots and lots of other evidence that people who have had cancer can get insurance.

Pray tell, what research did you do to prove your negative?

[MikeP]

The fact is the vast majority of today's personal bankruptcies is due to financial ruin after sickness/injury.

Oh? Got a cite?

Even by the wildly biased recent study from Elizabeth Warren et two doctors who campaign for single payer insurance, the number is 62.1% -- not a "vast majority".

Then when you read through that study and see that only 29% of the poll respondents actually volunteered that medical bills were the reason for their bankruptcy, you get well below a "vast majority".

[alice bowie]

The former said you would need to be free of cancer for 5 years for an individual policy and 12 months (6 before insurance starts and 6 after) for a group policy.

A mere 5 years.

Perhaps we should really not worry about these isolated incidents and not worry about the uninsurable

[MikeP]

Perhaps we shouldn't use the word "never" to describe less than 8% of the average person's life.

[Isaac Bartram]

I'm fairly sure that the vast majority of preexisting conditions are not cancer. As scary as it is cancer is actually rare especially in young people.

Could be wrong.

[alice bowie]

Isaac you are right. Young people have nothing to worry about. However, us old people depend on them for the Health Insurance Pyramid Scheme.