Monday, June 29, 2009

Debunking Arguments Against the Necessity and Efficacy of the Government Health Plan

Before we get to the actual substantive arguments, I'd like to call attention to an often-used tactic, in this case by the shameless Diane Feinstein, who opined today that criticism from the left on healthcare "doesn't move me one whit" and who also has taken campaign contributions from the healthcare industry (though in fairness not nearly as much as some of her democratic colleagues in Congress. Feinstein said on CNN, “I don’t know that [Obama] has the votes right now. I think there’s a lot of concern in the Democratic caucus.” And that controlling costs of the new system is a “difficult subject.”

The idea is to convince us that the ship has already sailed, that though a a majority of Americans support the option of a public plan (and an even larger majority of her democratic constituents), the effort has already failed. You see this tactic used all the time. In the primaries, the Clintons tried to convince people that Obama would never win enough white male votes to get elected, so Hillary was the only option. Yes, we know you want Obama, but he's already lost. No use pining for what you can't have... So, here's Feinstein trying to portray the situation as something that's already failed because then there's nothing she could or should do about it. Ordinarily I'd do my job, but the task before me is impossible, or in any case, highly improbable, so you see, there's no point in getting upset about it. Of course, the left (and not merely the left), are upset about it. So Feinstein has a choice - either acknowledge the clearly-expressed will of her constituents, or like Ayatollah Khameni, declare the protesters insignificant. One wonders how disconnected a public servant is from her central mission when the public will is something to be dismissed.

But I digress - as the point of this post was to debunk bad arguments against the public health option. So above - we can't have a government option because it's too hard to pass is false. That's a determination to be made after the fact, not as an excuse for inaction beforehand. Everyone has challenges at work. This is your job, Senator Feinstein. Shut up and do it. Or as a friend of mine likes to say: "I don't want to hear about the pain - just show me the baby."

Second, the argument that the government can't run anything as competently as private for-profit industry. This is also patently false. Medicare's administrative costs amount to three percent of its budget - private insurance's more than 27 percent. Moreover, private insurers need to make a profit, the government just needs to break even. Our system of for profit insurance has resulted in the 37th best care in the world at the highest cost. Almost every country ahead of us, including the very top ones on the list, have some form of socialized care that costs less than ours and has far better outcomes.

Third, if we socialize healthcare, we'll become socialist. False. Our police and fire departments are socialized; so is our criminal justice system and our water supply. That doesn't mean you can't hire a security guard or buy bottled water. It does mean that many of our essential services are run by the government. Health care is an essential service.

Fourth, the free market is more efficient at setting prices for care than the government. This is false for two reasons (1) because one who needs an essential medical treatment isn't in a good position to bargain for a good price; and (2) because in many cases one lacks the expertise to determine whether a particular medical procedure is necessary. If the buyer has no choice but to buy no matter the cost, the market cannot possibly be efficient. And if the buyer lacks a proper basis to make an informed purchase, he's put in the position of trusting the seller to decide whether and how much he should buy. How anyone could possibly think such a system would be anything but disastrous to the American consumer is mind boggling. Health care is not like the latest electronic device where you are perfectly free to buy it or not buy it based on your financial situation and your personal priorities. You can also pretty easily grasp the pros and cons of owning that device on your own. In cases like that, the free market works perfectly well. Not so with healthcare.

Fifth, if the government's running health care, it'll put private health insurers out business. Might be true, might be false. Who cares? If it puts them out of business, then it proves the point that the government plan was a better deal. If it doesn't put them out of business, then it's false. Either way, it's not a serious objection. In fact, it's actually the point of the public plan - either to demonstrate the raw deal we're getting or to force the private insurers to come up with a fair one.

Sixth, turning insurance over to government and cutting costs will stifle innovation, e.g,, life-saving medical devices and drugs. Maybe, maybe not. Some of the biggest "innovations," e.g,, cholesterol lowering drugs, make a ton of money for the pharmaceutical companies, but do not significantly reduce the risk of heart disease. When profit is the chief motive for medical researchers, then they will do what most reliably yields a profit. Marketing drugs as life saving based on what they can do (lower cholesterol) is easier than to make drugs that actually save lives. Real innovation in any field is difficult. You can't just throw a billion dollars at Jerry Bruckheimer and expect him to make art with it. What you usually get is product, commerce. Something that can be marketed and sold. While it's not impossible for creative breakthroughs to happen while chasing the money (Fyodor Dostoevsky wrote many of his novels to pay off his gambling debts), it's the exception rather than the rule, and it's unclear that researchers motivated by smaller profits and something as pathetic as the good of mankind would fare worse.

Seventh, we can't afford it. This is the stupidest argument of all. First off, the current for profit system is what no one can seem to afford, least of all the federal government for which it's the biggest long-term liability. Second, if people don't get care, and remain sick, they'll continue to fill emergency rooms, costing more money than if they received timely treatment. Third, chronically sick people are unproductive in the workforce and drain otherwise productive family members who need to speed time caring for them. The cost in GDP of having substandard care for a substantial number of American workers must also be taken into account.

Never mind that treating the sick - rather than squeezing every last penny out of them and their families - is also the right thing to do.

Thursday, June 25, 2009

Who Socialized the Water Supply?

How are Arrowhead and Poland Spring expected to compete?

Obama is a Conservative

When you get past the social issues that go in and out of favor with different parties (abortion being legal is actually an example of limited government and was not always anathema to conservatives) and consider conservatism as a posture toward governing, Obama is more conservative than his predecessor.

For starters, Obama believes in incremental rather than radical change. Even though he believes that single payer government run healthcare is how we'd do it if we started from scratch, he's going to work within our current system because he's sensitive to the impact dismantling the healthcare industry, however corrupt and incompetent, would have on the economy.

Even though the banks and the car companies were inept and reckless, he opted to bail them out because he did not want radical disturbances to ripple through the economy. On Iran, he showed restraint in not siding with one presidential candidate over another, but merely condemned the violence against peaceful protesters. In other words, he didn't not meddle or involve the United States in a conflict that on this occasion had nothing to do with us.

It would seem that being conservative (in its most positive sense) is to be humble and restrained. You are rightfully wary of radical change because you can't possibly know the outcome (unlike the neocons who arrogantly and wrongly assumed things would go smoothly after they invaded Iraq and dismantled its army). You act only out of necessity (as when the financial system nearly collapsed), but not out of choice. You regulate financial markets to ensure they serve their function - to grease the wheels of commerce, and so they don't devolve into casinos that produce short-term revenue but ultimately destroy long-term wealth creation.

Changing the health care system is also a move of necessity with long-term costs threatening to destroy our fiscal outlook and already bankrupting millions of citizens. Moreover, our outcomes are among the worst in the civilized world and our costs are the highest. To do so without starting from scratch is the conservative way to go about it.

There are times I wish he were far more radical and willing to take the hammer to the crooks in health insurance, banking and other corrupt industries that have stolen from the public for decades. I'd like to see him prosecute the Bush administration for torture and take on the corn lobby that helps poison our food supply. But if Obama were that guy, he would probably not have been elected president. And even though a more radical approach that emphasized instant justice would be more satisfying, its side effects and potential backlash are impossible to know.

Monday, June 8, 2009

If You Kill the Government Health Care Option I Will Make it My Mission in Life to Run You Out of Government

Let me start by saying my health care plan sucks. It's a joke. For example, I need to have ankle surgery, but it doesn't cover rehab. Of course, anyone who has surgery needs rehab, but it's not covered. Moreover, the surgeon recommended trying rehab first, which I did, but stopped when I found out it wasn't covered.

The reason I have such a terrible plan is twofold: (1) It's cheap, and (2) I didn't have a better choice. Let me explain. For five years, I saw a doctor in his late 70s as my primary care physician. He was a decent man who genuinely cared about his patients, but in retrospect, I believe he was getting slightly senile. (He retired a couple years ago). I believe this doctor (in retrospect) was a bit panicky about certain harmless symptoms I had and wanted to put me on statins and other harmful medications I didn't need, which I refused. Except that when I went to change to a more comprehensive plan, they downgraded my status to Tier 4, based largely on that doctor's diagnoses. I appealed and lost, and so I had the choice of paying $500 a month for myself (I was 36 at the time with no known health problems other than torn ligaments in my ankle), or $79 dollars for a terrible plan (Tier 1 price). I chose the former, as I didn't want to give up my tier 1 status.

Now that I have a few other health problems, thyroid, adrenal glands, pre-diabetes, and still the chronically sprained ankle for which I am going to shell out $6000 in out of pocket costs for the surgery, I realize how meager the scope of my coverage is.

While there are many factors as to why health insurance is a joke in this country (from drug company lobbyists, to our poisonous food supply to the lack of preventative care), there's little doubt that the bloated infrastructure and big CEO paychecks of health insurance companies are a major one. If one is sick, one needs someone with knowledge (a doctor or nurse) and the best materials/medicine/technology for treatment. The costs of those two things are unavoidable. Throw in the rent for the doctor's office, the salary of the receptionists - that's all fine.

But why the fuck are we paying the salaries of the incompetent health care customer service, their office overhead, their marketing and advertising costs, their adjusters, their lawyers, their lobbyists, their management, including their wealthy CEOs? How did this slippery middleman weasel and connive his way into a huge piece of our paychecks in an area we have but no choice in?

It is quite easy to find doctors online. One does not need Blue Shield of California to provide a directory of doctors these days - one merely needs a bank of sorts, a pooler of risk that charges a very small vig for administration and processing.

That is why we need a government option - one that simply costs some taxpayer money and the only function of which is to pool risk, so that those with financially catastrophic problems are covered.

And if one wants still to keep his piece of shit private insurance, that's fine - keep it and continue as you were. Being foolish in your financial choices should always remain legal. But let's see how well these useless and outdated middlemen fare when they are no longer the only choice we really have. We will see the costs of insurance go down dramatically.

But the spineless "Blue Dog" democrats are now opposing the government option saying they will only support it if and after insurers fail to meet a particular set of goals. In other words, they will delay any real reform until after the insurance companies - the same ones under whom health costs have skyrocketed - get another chance to meet some benchmarks, which no doubt they are currently lobbying to set low. Only then should we consider giving people another option these "Blue Dog" dems argue.

Sorry, the time for those companies to provide a solution for us was in the last 15 years, and they have not. They had their chance, and the state and cost of health care have gotten substantially more expensive, more complex and arcane and flat-out worse. No one fucking likes our health care system. Not the patients, not the doctors and certainly not anyone with an eye on our long-term fiscal situation. It's over.

So you cowardly, unprincipled piece of shit representatives who have taken so much money from the health care industry

Jason Altmire: $405,279

Michael Arcuri: $103,547

Joe Baca: $159,250

Marion Berry: $536,917

Sanford Bishop: $356,496

Leonard Boswell: $304,680

Chris Carney: $167,664

Ben Chandler: $223,300

Jim Cooper: $894,414

Jane Harman: $292,694

Stephanie Herseth Sandlin: $323,924

Tim Holden: $386,278

Frank Kratovil: $86,556

Mike Ross: $833,670

Loretta Sanchez: $183,162

Adam Schiff: $380,708

Zach Space: $144,125

Charlie Wilson: $138,724

Mike Thompson: $631, 532 (His take from the health care industry, was second only to beer/wine/liquor business, which gave him $1,009,370)

if you stand in the way of an alternative to the status quo, I will make it my fucking mission in life to be absolutely sure you are removed from office and never work anywhere ever again until you repent and do something useful rather than destroy the well being of the very people whom you purport to represent.

And by the way, the next phase of health care reform will be to go after the drug company-funded studies that skew the results and help them sell billions of dollars worth of useless and often harmful drugs. There needs to be a truly independent board that puts the kibosh on that deeply corrupt and harmful practice. And finally, it needs to be made illegal - to the point of sanctions and the threat of losing one's medical license - for doctors to accept lunches and paid trips by these drug companies. Every doctor should take the time at least a few times a year to read up independently on new developments in his or her field (just like everyone does at every other job) and not rely on for profit salespeople to tell them what the latest and greatest medicines they're selling are while bribing them with gifts, meals and travel. It's a fucking disgrace that a person whose job it is to help other people heal from illnesses would ever be involved in that kind of transparently obvious corruption. But far from being the exception this is now the norm - as even doctors on the Harvard Medical School faculty are being paid to turn their students into pushers of product.

The bottom line, our current medical establishment is by and large as morally bankrupt and grossly incompetent as we recently discovered our financial one to be. The reason for the corruption is the same - that greed and short-term profit have caused systemic blindness to the facts and a callous indifference to the damage it does to the citizen that lives with it. While the financial sector, with a massive assist from the banking lobby which corrupted government, first created a great disparity in wealth between the rich and poor, then destroyed the pensions, home equity and the job security of millions while saddling everyone with a massive debt, the health care lobby is destroying what little we have left while giving us inferior and unaffordable treatment, resulting in avoidable illness and death. It, too, is our greatest long-term fiscal liability.

So getting a government option is mandatory now. And if you people on this list - you who purport to represent us - stand in the way, I will personally see to it that you're finished in government and that your reputation is permanently and irrevocably destroyed