Oct 31, 2009

Response to "Obamacare 2"

JRB,

Good to hear from you again, as always!  Don't worry -- I totally forgive you for the incendiary nature of your polemics.  (Okay, so maybe I slide into polemics too, every now and then, haha).  You are right, opinions can change as life unfolds.  (It's never too late, you know!)  I would be quite religious and conservative today if I couldn't change my mind.  Let me know when you start trying to persuade me.

By the way, may I make a suggestion?  Your post title needs a subtitle.  I was thinking along the lines of "Obamacare 2:  Blood Harvest".  Or maybe "Obamacare 2:  Rise of the Machines".

Okay ... seriously now, kidding aside ... I do have to ask:  are the irrelevant insults about the sexual orientation and gender of Barney Frank and Nancy Pelosi really necessary?  Why do you keep bringing it up in your first post?  I don't get it.  Anyway, on to the points:
  • You are right, the public option is in the House bill and now the Senate bill.  Excuse me a moment . . . . *celebratory dance* . . . . ahem, okay then.
  • The argument of Frank and people who want single-payer someday is that people will flock to public insurance because it will be much cheaper, secure, efficient, etc.  If public insurance is better than private insurance, that's competition for you, don't hate the player hate the game.
  • You say low profit margins derive from competition.  Of course.  But we have Aetna, B.C.B.S., WellPoint, Cigna, WellCare, United, Humana just to name the biggest insurers....they aren't competing with each other?  There's no competition?  The primary competition that is lacking is competition between private and public insurance.  And at some point, isn't too much competition a bad thing when it comes to insurance (i.e. more insurers, and therefore smaller pools of shared risk)?
  • The Commerce Clause:  but interstate insurance companies like Blue Cross Blue Shield are interstate commerce.  No?
  • "If you don't like their prohibitions/exclusions, don't engage them ... they'll soon be out of business".  Not sure what that means.  If you have a preexisting condition or if you can't afford to pay, they probably don't want your business anyway.
  • Amendment IX:  See my response to Fred under the comments to "Obamacare (Guest Post)" Oct. 24, 2009.

  • Please be specific on how the bill excludes Congress, unions, etc.  If you're in a union you won't have a public option?
  • Death Panels:  For goodness' sake, I was being facetious!  There are no government-run death panels in Britain which would deny needed care to a person with muscular dystrophy, as our privately-owned death panels do.  The quote from Stephen Hawking is an actual quote.
    • My health insurance: comes from an employer-sponsored insurance program.
    Finally:  my perspective has changed a lot.  I voted for Bush in 2004 and believed America would never torture captured enemy combatants.  Then my youthful idealism confronted reality.  Of COURSE I'm open to changing my mind.  And I'm sure you are as well ... right? : )

    6 comments:

    1. FREYGUY,
      If the government says that we need more competition to lower health care costs....why don't they pass legistlation to allow private companies to compete across state lines? Competition seems to regulate price/value in many indistries (as JRB mentions). Government regulation in the health care industries IMPEDES competition. The Federal Government (David Axelrod) says that States rights make it very difficult to allow competition across state lines...but they are about to pass laws to let the Federal Government health care compete across state lines.....no problem there?
      Also, Barney Frank and others argument is that the Government will be the ONLY insurance comapany. SINGLE PAYER means ONE. One only- NOT competition!
      MOM

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    2. Mom,

      I don't understand. Private insurance companies do compete across state lines. For example, Blue Cross Blue Shield, CIGNA, and Aetna seem to offer plans in all 50 states, according to their websites. So how are they not competing with each other?

      Can you give me an example of some federal regulation that is impeding competition?

      Finally: we have an entirely private system. We have the most private system, with the most competition of all developed countries. If private companies competing at the state level doesn't work why would it work at the national level? (But then again, there IS competition at the national level . . . no?)

      Freyguy

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    3. At the end of the day, unless you’re a politician, healthcare is not about who has the cleverest arguments, the best talking points or most feigned compassion. It’s about the system we wind up with, what it accomplishes (good and bad), what it costs, and what improvements implementing this ‘reform’ now might PREEMPT in the future. So it is interesting and informative to see what the dean of the Harvard Medical School thinks about the Congressional health care plan(s). For anyone interested, a link follows. However, a word of caution. Reading this might be hazardous to your health care. http://online.wsj.com/article/SB20001424052748704431804574539581994054014.html

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    4. Let's not let those pesky 'facts' and 'common sense' ideas get in the way Fred!

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    5. It is indeed very interesting to read Dr. Flier's editorial in the WSJ. About the closest Dr. Flier comes to putting an actual number on anything is when he mentions the unnamed "dozens of health-care leaders and economists" who agree with him. At first I thought perhaps he had dumbed things down for the benefit of the average WSJ opinion page audience, but then I noticed the same sparsity of factual evidence in Dr. Flier's editorial in the Journal of Clinical Investigation (Oct. 2009).

      The centerpiece of Dr. Flier's argument is Massachusetts. Massachusetts did the exact opposite of creating free, universal, non-profit public insurance. Massachusetts made it a crime, punishable by a large fine, not to buy from the for-profit insurance companies. If you can't afford private insurance, Massachusetts doesn't give you insurance. Instead, the state gives the insurance companies a subsidy--even beyond what the federal government doles out.

      When we get past the standard hymns sung to innovation and investment, the ritual condemnation of regulation, and unspecified "deep flaws" in Medicare and Medicaid, not much remains. But the little that does remain is quite interesting: Dr. Flier's assertion that our system needs "major reform", that it must be different from the reform in Massachusetts, and that politicians should be honest about the fact that "this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America".

      The following harsh criticism of the current legislation arrives at a similar conclusion, but it delves into a level of detail, and communicates in a tone of frankness, and reaches conclusions not suitable for the Wall Street Journal opinion pages. The author is not the dean of the Harvard Medical School. She is merely an MD and professor at the Harvard Medical School.

      http://www.pnhp.org/news/2009/june/testimony_of_steffie.php

      -Freyguy

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    6. Freyguy,

      You really want to use Dr. Woolhandler’s comments as an argument for or against something? Seriously? Well, okay then, it looks like I agree with her opening. I agree that a single payer system, which this legislation almost certainly insures (no pun intended), is better then trying to create something which is going to be an unmitigated mess before it morphs into a single payer. But wait, she has further insights.

      No discussion of healthcare could be complete without mention of dangerous cars, tainted dog food and lead paint in toys so I congratulate her for covering the bases. And with the toys there is a surprisingly teachable moment which she omits. Because of the way the legislation limiting lead in toys was crafted, virtually the entire industry of small manufacturers that do not have the money to test or volume to justify that their toys are lead free will disappear. But that’s okay. I like only being able to buy Chinese made toys at Walmart anyway. And too bad if you have an inventory of newly worthless bicycles because they have has brass parts which probably contains lead - damn the physics of it. You never know when a child will suck hard on a bicycle, motorized or otherwise. If you sell second hand children’s stuff just kiss your entire business goodbye (as long as your lips don’t touch anything not certified as lead free) since testing makes no commercial sense and nothing is grandfathered in. Or you could continue your criminal enterprise selling second hand stuff and hope you don’t get caught. And while you’re at it you can kiss many old library books goodbye too (again, with caution). Let’s all repeat in unison, “Beware the law of unintended consequence.” But no, how foolish of me! With 2,000 pages of exquisite detail and just oodles of amendments on the way, I’m sure Congress has thought of (or will think of) everything.

      Dr. Woolhandler also discusses fines for wife beating, communicating with terrorists and not carrying insurance. She is truly the embodiment of a Renaissance Woman and knows how to stay on message. I was only disappointed that she omitted the wars in Afghanistan and Iraq as well as any mention of Sarah Palin’s new book, although she testified(?) in June so I guess that last omission is understandable.

      Oh, and one more thing I agree with the good doctor on. Health insurance should be less expensive. Whether she thinks legislative directives add to the cost is less clear. And whether there is anything that can be done short of recreating healthcare is also left unsaid. Well, at least her testimony was short. But man-oh-man she sure did pack in a lot of really neat important stuff into a one page narrative.

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