Saturday, December 19, 2009

Astonishingly Inept

Leaving aside the byzantine details of the policy, notwithstanding the president's attempts to polish the turd, I am absolutely baffled by the sheer politics of the health care "reform" the Democrats are about to pass into law.

When Democrats force people to buy private insurance without putting adequate rules on the nature and pricing of the insurance, it comes across as a straightforward and substantial tax increase, one that goes directly to companies that are already loathed across the political spectrum.

Moreover, it means that the line between "what those asshole insurance companies did to me" and "what those asshole Democrats did to me" becomes impossible to find. It dissolves that line.

Democrats had a chance to stand up here. Sixty-vote Senate majorities don't come along often. The Democrats are about to stand up and reveal what they truly stand for on one of the most significant public policy disputes of the last half-century. I wish I didn't have to see it.

Dylan Ratigan is cranky at what looks it like -- to him, to me, to people who trade stocks, to anyone with eyes -- namely, a massive redistribution of wealth from people to health insurers:


Laura said...

Hmm, interesting. I'm not sure how to respond to the video.

He definitely has a valid point, but I don't think his being an asshole is really helping the situation. He actually DIDN'T let her speak and basically had her on the show just to lecture her. I'm not suggesting she would have been able to say anything redeeming, but stuff like this doesn't really do much to improve public discourse to the point where we might be able to actually address and resolve the issues he's railing against.

MandyinTX said...

Haven't watched the vid, but here's my $.02 on what's wrong with this "reform" - there's never been talk about containing the actual cost of healthcare, not by anyone who can make a change (i.e. Democrats in power). I've heard about the problems with "fee for service" on NPR but that's all. Anyway, no one wanted to figure out how to make the product more affordable. They just wanted to "help" people buy insurance. INSURANCE!! Geez...
By the way, if people weren't so afraid of single payer, they'd realize that the current "fee for service" would HAVE to be addressed, because it'd be tax money we're trying to save.
Does that make me a socialist?

Dale said...

Laura, you're right that Dylan Ratigan is being an asshole here, and not helpful. But I see it as an illustration of the anger progressives are feeling right now. If I had a member of Congress sitting across from me right now telling me that shit is gold, I'd be in a shouting and/or throttling mood too.

Mandy, as I see it, insurance has to be covered with insurance one way or another because, sooner or later -- and usually sooner -- the services and technologies you'll need are inherently, inescapably expensive. It takes many years to educate a qualified, competent, dedicated doctor. It takes zillions of dollars and tons of time to produce a workable, beneficial new technology or treatment -- advanced drugs are expensive, advanced scanning thingies are expensive, developing less invasive forms of surgery is expensive. R&D conducted by highly-educated, qualified people is expensive. And sometimes, probably more often than not, a given hypothesis exhausts tons of resources only to produce ... nothing. Yet it must be done for the sake of the times it works.

In an important way we WANT that because that's where the innovations and improvements come from. There is no $8/hour brain surgeon or cancer researcher, nor should there be.

There's no getting around this: medical care worth having costs a lot. The prospect of facing a calamitous medical situation is a lot like the prospect of facing a calamitous flood or fire -- it could happen any time to anyone, and when it does, the person affected does NOT have bargaining power. You have to finance it via the mechanism of insurance (whether that insurance is private, public, or both is a different question).

There are libertarian types who wish away this reality, and effectively expect us to haggle with health care providers as a way to control costs, as though we're purchasing a car or choosing which of the big box stores from which to purchase duct tape. This is bullshit, and an illustration of the child-like simplicity of libertarian thinking.

We *can* in the USA roll back much of the costs by taking steps to reduce the amount of duplication (me-too drugs, e.g., "Proyzok is just like Prozac!"), marketing, advertising, excessive administrative overhead, and so on. We *can,* but apparently we will not.

MandyinTX said...

All good points, which I hadn't fully considered. Also your last paragraph hits home for me...I believe the overhead of the marketing, advertising and administration needs to be addressed and is flatly not. This is the problem that makes me throw my hands in the air. I'm sure you've heard from Wendell Potter, an insider who has a lot to say on this subject.
It seems we agree that tax money should not be going to the bloated insurance companies. What avenue would you take in health reform, given the chance? (Point me to a previous post if I've missed it. I'm new here!)

Dale said...

Mandy, what I'd like to see in health care is a single payer system they have in Canada and other places. Under this scheme, the practice of medicine is private, and the funding (insurance) mechanism is run by government.

Or in other words, Medicare for all. Medicare exists; it works. No wheels need to be reinvented.

This could be strengthened and enhanced in assorted ways. It is *not* rocket science. We have numerous real-world models on which to draw and from which to learn. None are perfect. There is no perfect. But there is better -- getting better than the routine abuse and deprivation in the USA is, despite rumors to the contrary, achievable. Better is sitting out on the table, in numerous forms, ready to be grabbed and put to effect.

Bpaul said...

Just grabbed the video and reposted to my blog. Great catch, and I think I will allow it to speak for me entirely on the issue over there.

I'm basically speechless, as I watched this thing get whittled down nearly to death, then magically converted into yet another corporate handout somehow.