12 September 2009

Health care debate!

Moved, I guess, by how the lack of ideas being reported as coming from the conservative side of government, during the current attempt at health care overhaul, resembles the lack of conservative ideas reported way back in the financial bail out days, I got back on my high horse, and decided to prod Dad, again, with assorted liberal rhetoric on the topic, in lieu of any evident "debate". I sent him a link to a Krugman column, asserting that the "public option" was a necessary gambit for reducing costs, and a recent Matt Taibbi piece, from Rolling Stone, wherein he explains why the entire process has been completely bungled by corporate interests, and is doomed, as a result, not to save anyone any money.

Dad responded in kind, sending me a list of 14 conservative talking points, that I don't suppose he wrote himself, since they display a wit that's a bit snarkier than I'd characterize his as being; but he didn't say who wrote them. I imagine these are the points that are just hit on, repeatedly, on conservative talk radio--some of the points themselves are repeated--and, as a result, don't do much to explain anything, only to incite indignation in their target audience.

So I responded, perhaps a little too graciously, "This is the first time any republican thinker has managed to squeeze a cogent argument for some completely different idea to the way health care works in the entire rest of the developed world outside the U.S., into the San Franciscan airspace!", before getting down into the dirty work of actually trying to read the stuff, and then debunk all the poppycock therein. I don't think it's likely I got any sound counterpoints across, but at least I was able to highlight some paradoxes in the conservative grab-bag of horror stories. At the same time, I have to admit that, on both ends of the political spectrum, we share a lot of pessimism over what's likely to come out of the process.

[UPDATE: 24 Sep 2009--it recently occurred to me that, if these aren't Dad's words, and I'm publishing them here, unattributed--he hasn't yet responded--I'm infringing on someone's copyright. So, a search of some choice quotes online, has turned up a series of "Liberal Lies about National Health Care", from which the following 14 points are drawn, being published on a variety of sites, written by that paragon of reasoned debate and conceptual performance art, Ann Coulter. I can fully understand if you're unable to continue reading. If, however, you'd like to see the sorts of responses she engenders in other corners of the web, here are parts 1, 2, 3, 4, and--beyond the scope of this particular blog post--an increasingly unhinged part 5. As you were...]

(1) National health care will punish the insurance companies.

You want to punish insurance companies? Make them compete.

As Adam Smith observed, whenever two businessmen meet, "the conversation ends in a conspiracy against the public, or in some contrivance to raise prices." That's why we need a third, fourth and 45th competing insurance company that will undercut them by offering better service at a lower price.

Tiny little France and Germany have more competition among health insurers than the U.S. does right now. Amazingly, both of these socialist countries have less state regulation of health insurance than we do, and you can buy health insurance across regional lines -- unlike in the U.S., where a federal law allows states to ban interstate commerce in health insurance.
U.S. health insurance companies are often imperious, unresponsive consumer hellholes because they're a partial monopoly, protected from competition by government regulation. In some states, one big insurer will control 80 percent of the market. (Guess which party these big insurance companies favor? Big companies love big government.)

Liberals think they can improve the problem of a partial monopoly by turning it into a total monopoly. That's what single-payer health care is: "Single payer" means "single provider."

It's the famous liberal two-step: First screw something up, then claim that it's screwed up because there's not enough government oversight (it's the free market run wild!), and then step in and really screw it up in the name of "reform."

You could fix 90 percent of the problems with health insurance by ending the federal law allowing states to ban health insurance sales across state lines. But when John McCain called for ending the ban during the 2008 presidential campaign, he was attacked by Joe Biden -- another illustration of the rule that the worst Republicans are still better than allegedly "conservative" Democrats.

I'll certainly grant that the "conservative" democrats are a bane to this whole process.

In France and Germany, the government picks up 75-80% of the health care tab. Individuals in France pay roughly two-thirds per capita, of what we pay here in the U.S. for health care. Each of those "tiny little" countries (and I find that peculiarly American diminution of some of the planet's largest economic engines just charming!) pays about 11% of their GDP toward health care, while in the U.S., we're up above 15%, second only to East Timor, apparently, among all United Nations member states. These are all World Health Organization statistics, which, I would guess, makes them terribly liberally slanted (?). Here are some pro-business (if not demonstrably conservative) perspectives:
So, my question becomes: do they pay less per capita for health care in France and Germany because of the three-quarters of the business that the government handles, or because of the supposedly "greater competition" and presumably "less governmental regulation" on the quarter of the business handled by private insurance companies? Personally, I doubt that the descriptors in quotation marks in that question are very accurate, given the common American understanding of western European government structures. In any case, Germany, for one, has been experimenting with and utilizing universal health care since the 19th century. If they haven't perfected it, well, I guess they've thrown a couple wars into the mix; but anyway, they have nearly a century and a half head start on us. You can read more about their systems in wikis, here: French and German health care.

If conservatives really believe that 90% of all health insurance gripes can be solved by interstate commerce, I don't really think they'll have much trouble insisting on getting that into a reform bill. They should really make more soundbites focusing on that idea. We shouldn't hear republicans talking a bunch of smack about liberal big government this-and-that, "abortion this", and "illegal immigrant that", if "90% of the problems with health insurance" are rooted in this one issue! And if, at the same time, conservatives really believe we can have a more robustly competitive insurance industry, while the government handles three-quarters of the overall tab, I have to say, I'm completely behind them. Go, conservatives! Let's be French! Really! Let's go! For God's sake, will some republican member of congress stand up and advocate for this?!

While we're waiting, maybe you could send me some evidence, perhaps from the recently past era of republican congressional majorities, of republican congressmen standing up, in some way, in any way, against the wishes of large health insurance and/or pharmaceutical industry, or who, for instance, wants to "punish insurance companies" by making them compete. I'm not saying it hasn't happened--I'm honestly not aware, and if it's happened, I'd be curious about the details. Seriously: I hold Max Baucus in every bit as high regard as does Matt Taibbi, and wish there was some passel, somewhere, of republican congressmen who could give voice to something other than big business interests. I'm encouraged to read a conservative pundit villainizing big business, but to suggest that it's somehow more aligned with democrats than republicans is blatant malarkey: they're both forever battling for the bigger corporate teat.

The picture you're painting here, of some kind of cottage industry health insurance, arising from the grass roots, to keep the big guys honest, has about the same plausibility for me, as "government cutting costs" has for you. Interstate commerce for health insurance is something that will happen between Blue Cross, and Kaiser, and Aetna, and their ilk; and you know what? They're in a bunch of states already. And they've already figured out how to lower their costs: don't insure sick people. Will deregulation take care of that?
(2) National health care will "increase competition and keep insurance companies honest" -- as President Barack Obama has said.

Government-provided health care isn't a competitor; it's a monopoly product paid for by the taxpayer. Consumers may be able to "choose" whether they take the service -- at least at first -- but every single one of us will be forced to buy it, under penalty of prison for tax evasion. It's like a new cable plan with a "yes" box, but no "no" box.

Obama himself compared national health care to the post office -- immediately conjuring images of a highly efficient and consumer-friendly work force -- which, like so many consumer-friendly shops, is closed by 2 p.m. on Saturdays, all Sundays and every conceivable holiday.

But what most people don't know -- including the president, apparently -- with certain narrow exceptions, competing with the post office is prohibited by law.

Expect the same with national health care. Liberals won't stop until they have total control. How else will they get you to pay for their sex-change operations?
Yes, let's look at a few of those certain narrow exceptions: umm... Fed Ex... UPS... DHL... and, surprisingly, a handful of smaller vans I see around town, somehow making a go of it, somehow competing in the shipping industry. I think of that summer out of high school, when I worked for--shudder!--the government, scheduling shipments for army families being deployed from Aberdeen to Korea and Okinawa and beyond: there were maybe a dozen or so shipping companies we helped contract with, and I still see their big rigs up and down the highways today.

Now, let's look again at the French and German health care systems, wherein most of the business is under government aegis, and there's supposedly more competition among the private insurers for what's left of the pie. Do you think those private insurers are in anything like the situation FedEx and UPS are in, here? Do you think FedEx and UPS are able to turn any kind of profit at all under this oppressive system? Do you think we should abolish the postal service, because it's demonstrated that it's doing such a crappy job of... business management? I heard they wanted to close on Saturdays, or something, recently. Obviously, the government has completely bungled the whole parcel shipment game. And it's so pricey, too! What are stamps up to now? I don't doubt for a second that FedEx and UPS would dearly love to prevent the government from exercising their monopolistic control all over small-box Priority and Express Mail packages, but I, for one, thank God that such an affordable alternative has been created! And I marvel that it hasn't prevented those other businesses from thriving, too!

I would posit that, in the U.S., as in France and Germany, things like sex change operations would fall under the purview of the FedExes and UPSes of the health insurance industry, and would remain the sort of thing someone has to pay a premium for--but I don't doubt for a second that whatever extremely tiny percentage of our GDP is expected to be allocated for sex change operations will be the focus of much consternation and debate, in effort to derail the whole reform train. Get a good hard look at those offensive saplings, please, while the forest withers, uninsured.
(3) Insurance companies are denying legitimate claims because they are "villains."

Obama denounced the insurance companies in last Sunday's New York Times, saying: "A man lost his health coverage in the middle of chemotherapy because the insurance company discovered that he had gallstones, which he hadn't known about when he applied for his policy. Because his treatment was delayed, he died."

Well, yeah. That and the cancer.

Assuming this is true -- which would distinguish it from every other story told by Democrats pushing national health care -- in a free market, such an insurance company couldn't stay in business. Other insurance companies would scream from the rooftops about their competitor's shoddy business practices, and customers would leave in droves.

If only customers had a choice! But we don't because of government regulation of health insurance.

Speaking of which, maybe if Mr. Gallstone's insurance company weren't required by law to cover early childhood development programs and sex-change operations, it wouldn't be forced to cut corners in the few areas not regulated by the government, such as cancer treatments for patients with gallstones.
I will not argue that the government has done anything other than an utterly abominable job of health insurance regulation to date. I might argue (and you might even agree), that from an actuarial standpoint, it would make more sense to insure more healthy, young people, to offset the cost of covering the ill and destitute--and that the premiums paid by legions of healthy twenty-somethings would go a lot farther to bolster the insurance companies' bottom lines than striking some fictional requirement to bankroll sex change operations. I think this is what they're calling the "individual mandate", that would put us all "under penalty of prison for tax evasion", should we choose the tax evasion route. Maybe, once we're all on the lam from the tax cops, we'd be harder to find if we all got gov't subsidized sex changes.

What is all this hoo-ha about sex change operations?

(4) National health care will give Americans "basic consumer protections that will finally hold insurance companies accountable" -- as Barack Obama claimed in his op/ed in the Times.

You want to protect consumers? Do it the same way we protect consumers of dry cleaning, hamburgers and electricians: Give them the power to tell their insurance companies, "I'm taking my business elsewhere."
This kinda overlaps with talking point 3. If insurance companies don't "scream from the rooftops about their competitors' shoddy business practices", I get the impression that it's because they all uphold the same shoddy business practices.

But, ultimately, yes, I agree: government regulation, as I understand it, has historically promoted competition, breaking up trusts and the like. If it isn't doing so in this case, it must be because the few winners in the health insurance game, the same players who are doing all they can to twist this reform process to their own best ends, have previously twisted the regulation process to improve their own situation at everyone else's expense. I would argue that this is not so much government's fault, except that it indicates an endemic weakness in the face of corporate will--the perfidious tendency to promote corporate rights above human rights, due to the corporations' financial wherewithal to call attention to themselves.

I can think of at least four different corporate options available to me for the purchase of health insurance for myself, and none, save the one I get through my wife's job, are affordable for me as an individual, at any kind of decent coverage level. I used to have Kaiser, years ago, and had nothing but good experiences in their care, but they're not an option for the self-employed, as near as I can see. The bare bones coverage I had, subsequently, paid Blue Cross for, turned out to be useless, as they chose not to pay a red cent for any kind of x-ray, or diagnostic stuff, or a brace, or anything whatsoever, really, last time I broke an arm, out of town. I've been told I could have "fought", somehow, for compensation, but I didn't even know where to begin. Why should I have to fight? What is/was unclear about the need for medical care for a broken arm? I need to argue that? Now, I'm on Deb's Blue Shield plan, through her work, and because it's employer subsidized, the plan is much more thorough, for the price. I'd be unpleasantly surprised if they left me dangling with a broken arm in Tahoe, but I'm really not looking forward to testing them. Last time I broke bones in town, the city of San Francisco picked up nearly the entire tab for 10 days of hospital care, assorted braces, prescriptions, and some months of physical therapy. I had to fill out a form about my income, and there were some minor bureaucratic hoops to jump, but not much. And it all happened at the hospital. I didn't need to know who to call to sort any of it out. Of course, this only happened because I did not report that I had a Blue Cross policy, which itself (as later experience confirmed) would have refused to cover any of my care anyway, but which would have prevented my eligibility for city subsidized care. Is that dishonest? Is that "gaming the system"? I was paying some $50 or 60 a month for an emergency care plan from Blue Cross, with a high deductible, and a minimum of coverage, and they wouldn't even bother to meet that much--yet, by virtue of living in San Francisco, I'm just... taken care of. That strikes me as... decent. Honorable. Civilized. Sane. Humane. The kind of gift I'd share with loved ones. Even others besides loved ones. Neighbors.

San Francisco: it's like living in France, or something. And that was even before the whole Healthy San Francisco plan got under way! If Deb gets laid off now, and we lose her Blue Shield coverage, we have little to worry about on that front.

(5) Government intervention is the only way to provide coverage for pre-existing conditions.

The only reason most "pre-existing" conditions aren't already covered is because of government regulations that shrink the insurance market to a microscopic size, which leads to fewer options in health insurance and a lot more uninsured people than would exist in a free market.

The free market has produced a dizzying array of insurance products in areas other than health. (Ironically, array-associated dizziness is not covered by most health plans.) Even insurance companies have "reinsurance" policies to cover catastrophic events occurring on the properties they insure, such as nuclear accidents, earthquakes and Michael Moore dropping in for a visit and breaking the couch.

If we had a free market in health insurance, it would be inexpensive and easy to buy insurance for "pre-existing" conditions before they exist, for example, insurance on unborn -- unconceived -- children and health insurance even when you don't have a job. The vast majority of "pre-existing" conditions that currently exist in a cramped, limited, heavily regulated insurance market would be "covered" conditions under a free market in health insurance.
Well, at least you've got some funny zingers in this one. Michael Moore is fat! I can't say as I quite get the logic behind how a less regulated health insurance industry would foment some kind of bidding war for coverage of the chronically ill... And I really don't get what "microscopic" has to do with health insurance industry profits. I do hope, however, that one day, we get, here, something like the French or German system--but if not that, then something like you describe here, wherein people who don't feel the government covers their health needs sufficiently, can purchase additional insurance for their yet-to-be-conceived offspring.

(6) There will be no rationing under national health care.

Anyone who says that is a liar. And all Democrats are saying it. (Hey, look -- I have two-thirds of a syllogism!)

Apparently, promising to cut costs by having a panel of Washington bureaucrats (for short, "The Death Panel") deny medical treatment wasn't a popular idea with most Americans. So liberals started claiming that they are going to cover an additional 47 million uninsured Americans and cut costs ... without ever denying a single medical treatment!

Also on the agenda is a delicious all-you-can-eat chocolate cake that will actually help you lose weight! But first, let's go over the specs for my perpetual motion machine -- and it uses no energy, so it's totally green!

For you newcomers to planet Earth, everything that does not exist in infinite supply is rationed. In a free society, people are allowed to make their own rationing choices.

Some people get new computers every year; some every five years. Some White House employees get new computers and then vandalize them on the way out the door when their candidate loses. (These are the same people who will be making decisions about your health care.)

Similarly, one person might say, "I want to live it up and spend freely now! No one lives forever." (That person is a Democrat.) And another might say, "I don't go to restaurants, I don't go to the theater, and I don't buy expensive designer clothes because I've decided to pour all my money into my health."

Under national health care, you'll have no choice about how to ration your own health care. If your neighbor isn't entitled to a hip replacement, then neither are you. At least that's how the plan was explained to me by our next surgeon general, Dr. Conrad Murray.
So, let me just make this clear: you had better not go giving health care, willy-nilly, to those 47 million uninsured Americans, not to mention the countless floods of confounded illegals, unless you're also going to cover my sex change operation! Look: unless the perfect health care plan springs, fully formed, from the womb, at the end of this session, I think I'm content to just keep with the status quo!

Yep, whoopsie, everyone: I don't know how to tell you that whatever health care system we end up with, it's not going to do everything, for free, for everyone. I guess our current one doesn't either. I also guess most of the other health care systems in the modern world do a helluva lot better than we're doing here, and for less money, too.

If you think, somehow, that a free, unregulated health insurance market, is going to undercut the costs of all those other nationalized systems in the world, well, I'm afraid that here, in 2009, staring down the vast economic fallout from a free, unregulated mortgage-backed securities market, you've simply shown up to the dance with a rather trampy looking partner. Get 'er cleaned up a bit. I hear she's fun at parties. A li'l wild!

(7) National health care will reduce costs.

This claim comes from the same government that gave us the $500 hammer, the $1,200 toilet seat and postage stamps that increase in price every three weeks.

The last time liberals decided an industry was so important that the government needed to step in and contain costs was when they set their sights on the oil industry. Liberals in both the U.S. and Canada -- presidents Richard Nixon and Jimmy Carter and Canadian P.M. Pierre Trudeau -- imposed price controls on oil.

As night leads to day, price controls led to reduced oil production, which led to oil shortages, skyrocketing prices for gasoline, rationing schemes and long angry lines at gas stations.

You may recall this era as "the Carter years."

Then, the white knight Ronald Reagan became president and immediately deregulated oil prices. The magic of the free market -- aka the "profit motive" -- produced surges in oil exploration and development, causing prices to plummet. Prices collapsed and remained low for the next 20 years, helping to fuel the greatest economic expansion in our nation's history.

You may recall this era as "the Reagan years."

Freedom not only allows you to make your own rationing choices, but also produces vastly more products and services at cheap prices, so less rationing is necessary.
Go check figures anywhere you can find them, comparing percentage of GDP spent on health care, comparing individual health care costs, comparing quality of care received, comparing satisfaction with care, etc., between our nation and any and all nations with some variety of "nationalized" health care. And quit babbling about Reagan. And really--the price of postage stamps?!? In the parlance of our day, "ZOMG!" How cheap do you need it to be to mail a letter?!

(8) National health care won't cover abortions.

There are three certainties in life: (a) death, (b) taxes, and (C) no health care bill supported by Nita Lowey and Rosa DeLauro and signed by Barack Obama could possibly fail to cover abortions.

I don't think that requires elaboration, but here it is:

Despite being a thousand pages long, the health care bills passing through Congress are strikingly nonspecific. (Also, in a thousand pages, Democrats weren't able to squeeze in one paragraph on tort reform. Perhaps they were trying to save paper.)

These are Trojan Horse bills. Of course, they don't include the words "abortion," "death panels" or "three-year waits for hip-replacement surgery."

That proves nothing -- the bills set up unaccountable, unelected federal commissions to fill in the horrible details. Notably, the Democrats rejected an amendment to the bill that would specifically deny coverage for abortions.

After the bill is passed, the Federal Health Commission will find that abortion is covered, pro-lifers will sue, and a court will say it's within the regulatory authority of the health commission to require coverage for abortions.

Then we'll watch a parade of senators and congressmen indignantly announcing, "Well, I'm pro-life, and if I had had any idea this bill would cover abortions, I never would have voted for it!"

No wonder Democrats want to remind us that they can't be trusted with foreign policy. They want us to forget that they can't be trusted with domestic policy.
I don't know what the last couple of paragraphs are on about, but as for the rest, yeah, probably so. Conceded.

(9) If you like Medicare, you'll love national health care, which will just extend Medicare's benefits to everyone.

Hey -- I have an idea: How about we make everyone in America a multimillionaire by pulling Bernie Madoff out of prison and asking him to invest all our money! Both Medicare and Bernie Madoff's investment portfolio are bankrupt because they operate on a similar financial model known as a "Ponzi scheme." These always seem to run fabulously well -- until the money runs out.

Not only is Medicare bankrupt, but it is extremely limited in whom and what it covers. If Medicare were a private insurer, it would be illegal in many states for failing to cover hearing aids, podiatry, acupuncture, chiropractic care, marriage counseling, aromatherapy and gender reassignment surgery.

Moreover, Medicare payments aren't enough to pay the true cost of those medical services it does cover. With Medicare undercutting payments to hospitals and doctors for patients 65 and older, what keeps the American medical system afloat are private individuals who are not covered by Medicare paying full freight (and then some). That's why you end up with a $10 aspirin on your hospital bill.

National health care will eliminate everything outside of Medicare, which is the only thing that allows Medicare to exist.

Obviously, therefore, it's preposterous for Democrats to say national health care will merely extend Medicare to the entire population. This would be like claiming you're designing an apartment building in which every apartment will be a penthouse. Everyone likes the penthouses, so why not have a building in which every apartment is a penthouse?

It doesn't work: What makes the penthouse the penthouse is all the other floors below. An "all-penthouse" building is a blueprint that could make sense only to someone who has never run a business and has zero common sense, i.e., a Democrat.
Ba-da-BUM! You're full of zingers today!

I don't doubt that Medicare has some hand in the reason hospital aspirins cost $10, although I have a hunch there are a number of factors involved in hiking that price--factors which this whole thing is aimed at addressing. I doubt the answer is to "keep the gubmint outta my Medicare"; but in the end, yeah, I don't rightly know how to make health care affordable for everyone, and apparently not France, nor anyone else knows quite how either. I think the idea of handing it all over to unregulated profit-driven corporations is a daring, bold vision, the wisdom of which is perhaps too advanced for my simple liberal think-hole.

I am curious: Medicare doesn't cover sex change operations? You mean, like, there's a government-run health care plan that doesn't cover sex change operations? That's legal?!? Well, that's it: I'm moving to Canada. Do they cover sex change operations up there? Would I have to wait as long as if I was getting a hip replacement?

But beyond that: Medicare also doesn't cover hearing aids? I know some of those Medicare folk have hearing troubles. What do they do? Just... go out and... buy them? Criminal. It's just criminal. That people can just go out and buy things they need, like health insurance that covers hearing aids. Or no wait: is being old a pre-existing condition that would prevent you from getting hearing aid coverage by a private insurer? Granted, I imagine there's some rule that prevents Medicare subscribers from having any other kind of insurance. It's not something I'm very familiar with. Nor am I very familiar with the French or German health care system, but I get the impression, from the wikis linked to above, that their versions of national health care do not "eliminate everything outside of Medicare", so to speak. At any rate, whatever kind of national health care we cobble together here, will be so influenced by private health insurance company money, that you can rest assured, they will not be eliminated. Rest now. You do not need to be afraid of this.
(10) National health care won't cover illegal aliens -- as the president has twice claimed in recent radio appearances.

Technically, what Obama said is that the bill isn't "designed" to give health insurance to illegal aliens. (That bill, the "Health Insurance for Illegal Aliens Act of 2009," was still being drafted by Ted Kennedy at the time of his death, may he rest in peace.)

But unless the various government bureaucracies dispensing health care are specifically required by law to ask about citizenship status, illegals will be covered. We can't even get employers and police to inquire about citizenship status, but liberals assure us that doctors will?

And by the way -- as with the abortion exclusion -- the Democrats expressly rejected amendments that would have required proof of residency status to receive national health care.

Still not convinced? Day after day, The New York Times has been neurotically asserting that national health care won't cover illegal aliens (without ever explaining how precisely it will exclude illegal aliens).

So far, just this week, these Kim Jong Il-style pronouncements have appeared in the Treason Times:

-- "Illegal immigrants will be covered. (Myth)" -- Katharine Q. Seelye, "Myth vs. Fact vs. Other," The New York Times, Sept. 2, 2009

-- "(Sen. Jim DeMint) fueled speculation that a health care overhaul would cover illegal immigrants, although specific language says it would not." -- Katharine Q. Seelye, "Fighting Health Care Overhaul, and Proud of It," The New York Times, Aug. 31, 2009

-- "'Page 50: All non-U.S. citizens, illegal or not, will be provided with free health care services.' ... The falsehoods include (that italic statement)." -- Michael Mason, "Vetting Claims in a Memo," The New York Times, Aug. 30, 2009

-- "But that would not help illegal immigrants. Contrary to some reports, they would not be eligible for any new health coverage under any of the health overhaul plans circulating in Congress." -- Duff Wilson, "Race, Ethnicity and Care," The New York Times, Aug. 30, 2009

The last time the Times engaged in such frantic perseveration about a subject was when the paper was repeatedly insisting that Durham prosecutor Mike Nifong had a solid case against the Duke lacrosse players.

By August 2006, every single person in the United States, including the stripper, knew the stripper's claim of "gang rape" was a lie. That was when Duff Wilson -- quoted above -- co-wrote the Times' infamous cover story on the Duke case, titled: "Files From Duke Rape Case Give Details but No Answers." No answers!

I don't really even understand this rhetoric, but big whoop. This is obviously a sticking point for some segment of the population, which probably doesn't overlap much with the uninsured segment, or any of the poor, huddled mass segments.

I remember an old acquaintance, who was on tour with his band in England, back in the 90s sometime, and threw his shoulder out, in a way that happened to him from time to time, severely enough to need medical attention. And, uh, he got it. He wasn't an illegal immigrant, or anything. Just passing through. Mind you, he wasn't paying any U.K. income taxes on his way through (I hear they're brutal!), but the doctors fixed him up just the same, for free. Like the sane, humane, caring, Hippocratic sort of folk they're reputed to be, all 'round the world.

Yeah, immigration: something needs to be "reformed", or something, there. But can we get some decent universal health care, first?

(11) Obama has dropped his demand for the ironically titled "public option" (i.e., government-run health care), which taxpayers will not have an "option" to pay for or not.

Liberals never, ever drop a heinous idea; they just change the name. "Abortion" becomes "choice," "communist" becomes "progressive," "communist dictatorship" becomes "people's democratic republic" and "Nikita Khrushchev" becomes "Barack Obama."

It doesn't matter if liberals start calling national health care a "chocolate chip puppy" or "ice cream sunset" -- if the government is subsidizing it, then the government calls the shots. And the moment the government gets its hands on the controls, it will be establishing death panels, forcing taxpayers to pay for abortions and illegal aliens, rationing care and then demanding yet more government control when partial government control creates a mess.

Which happens to be exactly what liberals are doing right now.
Certainly, the democrats, however liberal they are, or not, are creating quite a mess. You're almost in agreement with Taibbi on that score. They could certainly clean it up quite a bit, if they would just drop whatever weird road blocks they're putting up against government-run health care, in apparent effort to appease their corporate overlords.

Speaking of "chocolate chip puppy", it sounds like you're foaming at the mouth a little in point eleven.

(12) Only national health care can provide "coverage that will stay with you whether you move, change your job or lose your job" -- as Obama said in a New York Times op-ed.

This is obviously a matter of great importance to all Americans, because, with Obama's economic policies, none of us may have jobs by year's end.

The only reason you can't keep -- or often obtain -- health insurance if you move or lose your job now is because of ... government intrusion into the free market.

You will notice that if you move or lose your job, you can obtain car and home insurance, hairdressers, baby sitters, dog walkers, computer technicians, cars, houses, food and every other product and service not heavily regulated by the government. (Although it does become a bit harder to obtain free office supplies.)

Federal tax incentives have created a world in which the vast majority of people get health insurance through their employers. Then to really screw ordinary Americans, the tax code actually punishes people who don't get their health insurance through an employer by denying individuals the tax deduction for health insurance that their employers get.

Meanwhile, state governments must approve the insurers allowed to operate in their states, while mandating a list of services -- i.e. every "medical" service with a powerful lobby -- which is why Joe and Ruth Zelinsky, both 88, of Paterson, N.J., are both covered in case either one of them ever needs a boob job.

If Democrats really wanted people to be able to purchase health insurance when they move or lose a job as easily as they purchase car insurance and home insurance (or haircuts, dog walkers, cars, food, computers), they could do it in a one-page bill lifting the government controls and allowing interstate commerce in health insurance. This is known as "allowing the free market to operate."

Plus, think of all the paper a one-page bill would save! Don't Democrats care about saving the planet anymore? Go green!
I think you'll be happy with what we end up with: it seems increasingly unlikely that there'll be any sort of "public option", and you can be relatively certain that whatever options we end up with, will not be tied to our employment.

It's so quaint, to blame current job shortages on Obama's economic policies, even before Fall 2009! Keep pumping those blather muscles, and before Fall 2010 we'll have forgotten all about Fall 2008! Believe me--you and I both hope! (albeit, toward quite different ends, I imagine)
(13) The "public option" trigger is something other than a national takeover of health care.

Why does the government get to decide when the "trigger" has been met, allowing it to do something terrible to us? Either the government is better at providing goods and services or the free market is -- and I believe the historical record is clear on that. Why do liberals get to avoid having that argument simply by invoking "triggers"?

Why not have a "trigger" allowing people to buy medical insurance on the free market when a trigger is met, such as consumers deciding their health insurance is too expensive? Or how about a trigger allowing us to buy health insurance from Utah-based insurers -- but only when triggered by our own states requiring all insurance companies to cover marriage counseling, drug rehab and shrinks?

Thinking more broadly, how about triggers for paying taxes? Under my "public option" plan, citizens would not have to pay taxes until a trigger kicks in. For example, 95 percent of the Department of Education's output is useful, or -- in the spirit of compromise -- at least not actively pernicious.

Also, I think we need triggers for taking over our neighbors' houses. If they don't keep up 95 percent of their lawn -- on the basis of our lawn commission's calculations -- we get to move in. As with Obama's public option trigger, we (in the role of "government") pay nothing. All expenses with the house would continue to be paid by the neighbor (playing "taxpayer").

To make our housing "public option" even more analogous to Obama's health care "public option," we'll have surly government employees bossing around the neighbors after we evict them and a Web site for people to report any negative comments the neighbors make about us.

Another great trigger idea: We get to pull Keith Olbermann's hair to see if it's a toupee -- but only when triggered by his laughably claiming to have gone to an Ivy League university, rather than the bovine management school he actually attended.
You're foaming at the mouth again. I agree: the trigger is a ridiculous ploy. I think it's there just to assuage people who want a government-secured universal health care plan, but aren't likely to ever get it, to think that one day, one day, just maybe... But it's a ruse. The trigger won't ever get pulled, and the same forces that reduced the "public option" to a "trigger" for same, will make sure of that.
(14) National health care will not cover abortions or illegal immigrants.

This appeared earlier, but I keep seeing Democrats like Howard Dean and Rep. Jan Schakowsky on TV angrily shouting that these are despicable lies -- which, in itself, constitutes proof that it's all true.

Then why did Democrats vote down amendments that would prohibit coverage for illegals and abortion? (Also, why is Planned Parenthood collecting petition signatures in Manhattan -- where they think they have no reason to be sneaky -- in support of national health care?)

On July 30 of this year, a House committee voted against a Republican amendment offered by Rep. Nathan Deal that would have required health care providers to use the Systematic Alien Verification for Entitlements (SAVE) Program to prevent illegal aliens from receiving government health care services. All Republicans and five Democrats voted for it, but 29 Democrats voted against it, killing the amendment.

On the same day, the committee voted 30-29 against an amendment offered by Republican Joe Pitts explicitly stating that government health care would not cover abortions. Zealous abortion supporter Henry Waxman -- a walking, breathing argument for abortion if ever there was one -- originally voted in favor of the Pitts amendment because that allowed him, in a sleazy parliamentary trick, to bring the amendment up for reconsideration later. Which he did -- as soon as he had enough Democrats in the hearing room to safely reject it.

If any liberal sincerely believes that national health care will not cover illegals and abortion, how do they explain the Democrats frantically opposing amendments that would make this explicit?
We don't.


Boof! Okay. Let me see if I can summarize here:
  • You and yours are steadfastly resolved not to contribute any of your hard-earned dollars into casting a net to provide care for however many millions of uninsured people are already born in America; and particularly not, if that net might also provide care for any unwanted person already born outside America, or might in any way contribute to preventing the birth of any unwanted embryo in America.
  • You are convinced that the private health insurance industry, left to its own devices, will provide more universal health care at lower costs than the government could ever hope to achieve; while paradoxically suggesting that the private health insurance industry, left to its own devices, supports the "big government" ideas of the democrats.
  • The paradox extends, in an interesting twist, to wanting to "end" a federal law that "allows" states to ban interstate health insurance commerce--flying, surprisingly, in the face of the typical conservative plea to "let the states decide!"
  • Any evidence of successful, broader, less-expensive care provision in more heavily nationalized health care systems than we have in America, is falsified or misinterpreted, and anyway, impossible to emulate here.
  • Free market good, governance bad: deregulate, deregulate, deregulate!
  • Republicans want hip replacements. Democrats want sex change operations. Whatever it is, we all want new stuff in our midsections. Seriously: you're a bit wigged out about sex change operations. It's okay: I guess we all are.
Well... I dunno. I may have spoken a little too quickly when I wrote "cogent argument" up top. I can understand why to be concerned about the abortion issue. It's a little harder for me to understand why to be so upset about illegal immigrants, but, yeah, I think I can see why people are concerned. I just think that conservative pundits, and congressmen, would be doing themselves, and us, and everyone, a much greater service by harping on that interstate commerce point. Any aspect of this debate that puts personal needs above those of the corporation is something I can see a way to get behind, and sounds to me like exactly why we elect representatives to begin with. I see the democrat side of the aisle giving up just about any truly liberal, populist ideal, in order to get in bed with industry. It would be great--beyond belief--to see the republican side give up any conservative moralizing and xenophobia, in order to temper the power of giant health insurers with measures aimed at increasing competition! I mean... I simply can't imagine it! Again: please, point out to me, where, since 1994 (or ever, really), the republican party has taken an interest in diminishing corporate power, to effect health care savings. That just sounds like a fantastic idea! Like the sort of thing I would bring to the table--and there are, in fact, republicans at the table, alongside Max Baucus! I think Taibbi listed them (and the amount of health insurance industry contributions to their campaigns) in his article.

Yeah, well, anyway: the subject line here ("health care debate!"), was kind of a joke, since there didn't--and still doesn't--appear to be much of one.

None of my friends have gotten back to me yet, in my shout-out for help in understanding these points, but I think I made fair enough hay of them. I, for one, am going to keep an ear out for mention of the interstate commerce solution, and am going to inject it into every conversation I can, to see what arises.

I anticipate being every bit as disappointed with the outcome of this reform effort as you, and, miraculously, for almost completely opposite reasons.


UPDATE: I sent that email draft around to friends with whom I'd recently discussed the debates and had the following exchange:

On Sun, Sep 13, 2009 at 9:50 AM, Jeff wrote:
We were just tweens when there were basically two beer options available to the general public – Bud and Miller. Competition certainly helped the beer industry, leading to today’s plethora of microbrews and Snood Brew [a.k.a Malenbrau, for which I've designed a label]. Must be the same with health insurance, right?
To which I replied:

Yeah, that makes sense to me. Then, I just read this excerpt from the transcript of a documentary, Money-Driven Medicine, talked about on Bill Moyers' show:

COMMERCIAL: Intensive care requires a finely orchestrated team led by physicians and nurses passionate about patient care.

COMMERCIAL 2: Some of the world's finest…

MAGGIE MAHAR: It's interesting how hospitals advertise. Who would make a decision about where to have their baby or where to be treated for cancer based on an ad they saw on TV?

COMMERCIAL 3: Number one for heart surgery in New York State.

COMMERCIAL 4: A magnet hospital for nursing excellence.

MAGGIE MAHAR: Hospitals are not advertising to the patient. Hospitals are advertising to doctors. Hospitals don't have patients, doctors have patients. And hospitals want doctors to bring their well-healed, well-insured patients to that hospital.

COMMERCIAL 5: Our award winning full service cardiology department has been nationally recognized as the best in the region. And in the…

MAGGIE MAHAR: Hospitals have engaged in, what many call, a "medical arms race".

COMMERCIAL 6: Using advanced micro technology physicians determine…

MAGGIE MAHAR: Typically, 4 or 5 hospitals within a 5 mile, 10 mile, 15 mile radius will all buy the same technology because they're competing with each other.

COMMERCIAL 7: When you need us, rest assured, we will deliver an exceptional performance.

MAGGIE MAHAR: One time Dr. Donald Berwick called a hospital in Texas and said, "We've heard you have a very good procedure for treating a particular disease. We'd like to learn more about your protocol so other hospitals can use it." And the hospital said, "We can't tell you that. It's a competitive advantage in our market that we're better at treating this disease and it is very lucrative. So this is proprietary information."

DR. DONALD BERWICK: We believe in markets, right? Isn't that the American way? Well, markets mean competition. Isn't that the American way? Competition makes things come out right. Well, what does that mean in health care? More hospitals so they compete with each other. More doctors compete with each other. More pharmaceutical companies. We set up war. Wait a minute, let's talk about the patient. The patient doesn't need a war.

MAGGIE MAHAR: The patient isn't the center of a collaboration. The patient is the victim of a competition. There's a saying in Swahili, "When…" I can't remember this one… "When the elephants fight the grass is trampled." The patient is essentially the grass.

Unfortunately, they're no longer streaming the video of the show, because I think it was mostly just excerpts from the documentary, and they want you to buy copies of the documentary. So, to get more clearly the context in which they're speaking, there, I'd have to do a lot more reading than my patience endures... I just skim. The Moyers' show segment ends with him saying:

[R]emember that television ad Barack Obama made as a candidate for president?

BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.

BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…

Each of these stories illuminates the scarlet thread that runs through Maggie Mahar's book - the story of how today's market-driven medical system gives Wall Street investors life and death control over our health care, turning medicine into a profit machine instead of a social service to meet human need. That's the conflict at the heart of next month's showdown in Washington.

I'm Bill Moyers. See you next time.

This is kinda why I can feel Matt Taibbi's pessimism about this whole reform process. I mean, all we're looking for (I think) is (1) reduce costs, and (2) cover everyone. Are we seriously gonna weather this storm, and come out the other side without having achieved either of those goals? If I were a republican, damn straight I'd be pissed. If I were a democrat, I should sure as fuck be pissed, too! I'm afraid they're gonna jumble words and end up with (1) reduced coverage that (2) costs everyone.

I found out about that documentary, above, in the comments to a blog post, connected to a Canadian public-affairs podcast episode, hoping to explain the Canadian health care system to Americans frightened of it. The blog post took its title from a 1964 Harper's article, "The Paranoid Style in American Politics", which makes it sound like the far right tactic in debates such as these hasn't changed in at least 50 years.

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