socialized medicine

If the public option passes in some form, thank the liberal blogosphere who put pressure on Democratic members of Congress to publicly threaten to derail health care reform if it wasn't included in the final bill.

The specter of Democrats reverse-filibustering their own President's plan is what has kept the public option alive, even if one could argue that "alive" is akin to a persistent vegetative state.

Contrast this to yes-man approach of the Congressional GOP in the early Bush years, and I personally find a lot to like about the Democratic model of the Congressional party serving as a sort of whip against the political expediency that will be the norm in any White House.

In 2005, I thought it would have been a good idea for conservative Republican members to publicly threaten to oppose any Social Security bill that did not include private accounts. There were multiple problems with this, not the least of which that the Congressional leadership was too spineless to bring a bill out of committee. But another was that conservatives in the House and Senate, with no strategic prodding or muscle in the blogosphere and the activist groups, never made the threat that would have rendered a "compromise" bill dead on arrival.

How groups like Open Left and the Progressive Change Campaign Committee are taking on the role of legislative strategy is very smart, and something we can learn from. How the right has fueled the tea party movement to feed into a sense of backlash in the country about the left's total control of government is also very smart, and may have the last laugh in 2010, but will it be enough to deal with the immediate task at hand, derailing a government takeover of health care? I'm not so sure.

Of course, this could all blow up in their faces. Having destroyed any possiblity of compromise, or at least defined "compromise" as something very, very close to an absolutist-left position on health care, the left-blogosphere has ensured that the only alternative to doing nothing at all is a very leftist final bill. And if that's the choice, doing nothing becomes a much, much more palatable option for the Blue Dogs. I'm personally unsure as to how they thread the needle of getting a public option passed with 60 votes.  

Still, it's valuable to understand what the left is doing and how it differs from the Congressional GOP "roll over" strategy on White House initiatives in the Bush years, in which we either actively collaborated on bad bills (Medicare Part D) or didn't make a serious push to make the good bills (tax cuts, Social Security) even stronger.

I know there's a lot of competition in what is the worst reason to eliminate competition from the health care sector, but I think we have a winner.

Megan McArdle's piece on why she opposes national health care got deservedly wide coverage, and provoked some generally limp objections, such as this offering from Ezra Klein:

For all its waste, elevating the U.S. government to sole purchaser seems to ensure a much-higher rate of military technology innovation than if we left it to the private sector.

How does this remotely make any sense? The reason the government is the sole purchaser of laser-guided 500 lbs bombs and Tomahawk cruise missiles is that we don't allow civilians to lob them around at each other. There is no private market for such military technology, unlike for Lipitor or Viagra. Utterly ridiculous

Is the argument the Left is now making is that we need to make civilian health care as cost-effective as Pentagon weapon procurement?  Hello, let's let the folks who gave us $700 hammers get into the bandage business.

 Indeed, one of the shills for socialized medicine once used the Pentagon as a poster child for waste.  And the Center for American Progress, one of Klein's soulmates,decried the program we've used to buy weapons.  So the same system that was utterly broken for the Pentagon prior to Obama is the way to reform health care under Obama? 

Hello? I'm a mick lawyer from deepest suburbia, not someone like Klein who is kingpin of Jornolist and part of the Beltway Brain Trust, but Talking Heads described this whole concept about the time Klein was born.    

Even if you thought these folks made sense before, they sure aren't now that they are in charge.

And Ezra, you know, most of the stuff in this movie happened about the time you were in utero or slurping down formula, and the Pentagon had nothing to do with it.   Innovation? No government bureaucracy to be found here.

Maybe in Klein's future the NEA will be distributing posters "Wouldn't be great if the schools got all the money they needed and they had a bake sale to buy an MRI machine"

Am I the only one out there who seems troubled the President of the United States seems better informed about a disorderly conduct arrest in MA than the details of the most important policy initiative of his administration?

Who needs to be familiar with the details of something that affects our family's lives every day. Hurry up, just pass a bill. Now, What does it say? Who cares.  So what if one of the top guys wants our loved ones to be cut off if they aren;t "participating citizens". It's all a matter of taking the red pill instead of the blue pill. We'll figure it all out for you later.

For his next act is the President going to say he can see Walter  Reed Hospital from the White House window?...therefore just trust him. ,,,,he stayed in a Holiday Inn Express last night. That means he's qualified to decide when your kid needs his tonsils out.

C'mon trolls, Defend this. 

The Right is floundering in the healthcare “reform” debate. It’s complicated, but it need not be. How do you make the water cooler case? Tell ‘em “before we let them do anything stupid, we could fix healthcare in 5 easy steps”:

1. Let people buy health insurance across state lines. I live in North Carolina. If folks in my state could buy insurance in Idaho, we would cut our premium almost in half. New Yorkers could reduce premiums by about 2/3 buying in other states. Everyone would have access to the lowest rates in the country. Competition would bring costs way down. Why won’t the government let us?

2. Give poor and working class people tax credits (vouchers) to buy insurance. It’s not hard. Help the poor. Keep the competitive market, too. But for goodness sake, don’t make us pay for rich people’s healthcare and bankrupt private insurance all at once. (A high-risk pool can help people with pre-existing conditions, btw.)

3. De-couple health insurance from our jobs. (Change the tax code.) This coupling is an artifact of WWII wage controls. When your company chooses your insurance, it limits competition and choices. It's very costly, but you don't see the cost. And under the current system, you lose your insurance if you lose your job. Wealthier, employed people get subsidized to get insurance. Unemployed or independent contractors get nothing. 

4. Give greater access to health savings accounts for use on the small stuff. They can save money for old age, or purchase out-of-pocket healthcare. They’ll be more careful with their spending. We’ll eliminate much of the “split-the-check” effect where people over-consume and cost-shift. (For example: Prilosec OTC costs $15 at the store. Prescription Nexium costs a $15 copay (but $150 in reality). These drugs are almost identical. Yet people choose Nexium without a second thought. Why shouldn’t they? Still, $135 unseen gets dinged to the risk pool, so premiums go up.)

5. Stop driving up costs with regs and mandates. In some states, the government forces insurance companies to charge everyone the same rate whether they’re young and healthy, or sick and old. This is terribly costly. High rates mean young people go uninsured. Also, forcing companies to insure people after the fact is not “insurance” and drive up costs even more. Again, carrots for consumers to get insurance are far better than sticks against insurance companies and employers. Of course, consumers pay for those sticks, anyway.

On No 5, the Left has consciously been using these kinds of regulations to drive up costs. This limits people’s “access.” They don’t care. They want medical socialism no matter the cost. The plan is, and always has been, either to hasten the destruction of the insurance market and/or to drive up costs so we’ll cry uncle. Once we cry uncle, they’ll usher in the age of bureaucare. Functionaries will make our healthcare decisions. Bureaucrats will decide if and when you need a drug. You will wait in medical bread-lines for care. Innovation will dry up. Just go to a Cleveland hospital. Find Canadians getting MRIs because Canada has made them wait. 

It will be a few weeks yet before we see the final details, but the broad outlines of the democratic proposals to take over the American health care system are becoming apparent. And from what we can see so far, it looks like bad news for American taxpayers, health-care providers, and, most important, patients. The plan would not initially create a government-run, single-payer system such as those in Canada and Britain. Private insurance would still exist, at least for a time. But it would be reduced to little more than a public utility, operating much like the electric company, with the government regulating every aspect of its operation.

• At a time of rising unemployment, the government would raise the cost of hiring workers by requiring employers to provide health insurance to their workers or pay a fee (tax) to subsidize government coverage.

• Every American would be required to buy an insurance policy that meets certain government requirements. Even individuals who are currently insured — and happy with their insurance — will have to switch to insurance that meets the government's definition of "acceptable insurance."

• A government-run plan similar to Medicare would be set up in competition with private insurance, with people able to choose either private insurance or the taxpayer-subsidized public plan. Subsidies and cost-shifting would encourage Americans to shift to the government plan.

• The government would undertake comparative-effectiveness research and cost-effectiveness research, and use the results of that research to impose practice guidelines on providers.

• Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk.

• Subsidies would be available to help middle-income people purchase insurance, while government programs such as Medicare and Medicaid would be expanded.

• Finally, the government would subsidize and manage the development of a national system of electronic medical records.

Taken individually, each of these proposals would be a bad idea. Taken collectively, they would dramatically transform the American health care system in a way that would harm taxpayers, health care providers, and — most importantly — the quality and range of care given to patients.

In the face of this assault on one sixth of the US economy and some of the most important, personal, and private areas of our lives, one would think that the Republican response would be a resounding “No!”  One would be wrong.

Instead, the Republican response has been a plan of their own to increase regulation, mandates, and government control over the health care system. 

Sens. Tom Coburn (R-OK) and Richard Burr (R-NC) and Reps. Paul Ryan (R-WI) and Devin Nunez (R-CA) have proposed a plan based on the failed Romneycare experiment in Massachusetts.  

It is not all bad. 

In fact, it contains some very good proposals, such as changing the tax treatment of health insurance and expanding HSAs. However, it would also preempt many state insurance regulations, establishing new federal insurance rules, including a requirement that insurers accept all applicants regardless of their health or age.   There would also be a federal “risk adjustment” board that would tax some insurers and subsidize others based on whether the people they insure are healthy or sick. These policies will mean higher insurance premiums for the young and healthy.

The plan falls just short of an individual mandate, setting up automatic enrollment in exchange plans at “places of employment, emergency rooms, the DMV, etc.” — essentially, trying to achieve universal coverage by nagging Americans to death.

Notably, Coburn-Burr-Ryan-Nunez abandons one of the best recent Republican ideas for health reform, Rep. John Shadegg’s proposal to allow Americans to buy insurance across state lines, in favor of a requirement that states establish Massachusetts-style connectors. But the Massachusetts Connector has been one of the worst aspects of that state’s reform, acting as a super-regulatory body, adding new mandated benefits, restricting consumer’s choice of plans, and adding both regulatory and administrative costs to insurance. (In fact, the Connector adds its own administrative costs, estimated at 4 percent of premium costs, for plans that are sold through it.) What the Connector has not done is live up to its promise of breaking the link between employment and insurance, giving workers personal, portable insurance that they could take with them from job to job, and which they would not lose when they lost their jobs. Unfortunately, the Connector has not lived up to its promise in the latter regard. In fact, as of May 2008, only 18,122 people had purchased insurance through the Connector. That’s very little gain for so much pain.

Since there is virtually no chance that the Coburn-Burr-Ryan-Nunez will actually be enacted, perhaps one shouldn’t get too excised about its failings. It is clearly far superior to Obamacare. But one can’t escape the feeling that the best way to show the American voters that Republicans have regained their commitment to limited government—and to defeat Obamacare—is not with Obamacare Lite.

Upon reading this comment, remarking on Specter's treachery, my interest was piqued.  Now that the Dems have the magic 60, one of our local liberal "skeptics" now wants "real universal health care".  I am assuming that by "real" he means something along the lines of state-run health care.  And I have to ask:

WHY?  Why on EARTH would you want such a thing?

I understand that for many on the left, health care isn't an issue of finances or even of medicine, but of morals.  They see it as a moral crime that each and every single person in this country doesn't have blue-chip health insurance.  I don't understand this argument either - what if a person doesn't want health insurance? what if a person would rather make do with lower-quality health insurance and use the difference in insurance premiums for some other priority? - but let's just concede the point for now.  Still, questions remain:

1. Why would you want the state to run it all?  If you believe the liberals, the state that they want to run everybody's health care is the same one that, under George Bush, tortured people, spied on innocent Americans, started a pre-emptive war for no good reason, and bungled the response to Hurricane Katrina so badly that lives were lost needlessly.  And this is the state to which you want to transfer immense amounts of power over your personal medical decisions?

2. Which medical procedures would and would not be run by the state?  How about abortion?  Of course, the liberals now in charge would have no qualms in demanding that taxpayers subsidize abortions (even though they should have some qualms).  But suppose the next Republican president and Republican Congress reverses that decision - no more taxpayer subsidized abortions.  NOW you pro-choicers are in a pinch - no tax money for abortions AND the state runs the entire health care industry!  What would women do for abortions then?  Would there even be private clinics left after the nationalization of the health care industry imagined by many liberals?  Electing Republicans, in this case, would be effectively equivalent to the outlawing of abortion.  Do you really want availability of abortions to be subject to the result of the next election?  Are you that confident that you will always be able to elect pro-choice Democrats forever?  And the same argument can be made for any controversial procedure - fertility treatments, etc.

3. Now, admit it - you have bad habits.  We all do.  For my part, I drink too much beer and eat too much red meat.  Whatever your bad habits happen to be, they undoubtedly have some adverse health consequences.  (That's why the habit is a bad one.)  Should taxpayers bail you out of your poor choices?  We have seen the aftermath of Bailout Nation and it is not a pretty one.  When the state bailed out banks, what did they do?  Did they use the money to correct their problems?  No they used the money buy up other banks, thereby exascerbating their problems.  And when the state bailed out the car industry, what did they do?  Did they reform their practices?  No, instead the state got even more deeply involved in the operation of the car industry, going so far as to fire the CEO of GM and to guarantee car warranties (I guess I missed the 'car warranty clause' of the Constitution, but it's apparently in there somewhere right next to the 'abortion clause').  We should learn from these experiences, not repeat the mistakes.  Based on these cautionary tales, what will happen when the state tries to bail out individuals from their poor health care choices?

(a) The individuals will be allowed to go right on engaging in the bad habits (like the banks), which will lead to public outrage that 'less deserving' individuals are receiving scarce tax dollars for expensive medical procedures; or

(b) The individuals will be scrutinized to within an inch of their lives (like the car makers), leading to an incredible loss of personal autonomy and freedom over one's decision-making power.

There really isn't another alternative here.  What will happen when I, after years of beer drinking and cheeseburger eating, demand to get a 'free' heart transplant and 'free' liver transplant?  Do you think I'll get them, no questions asked, no repercussions, and without controversy?  If so you are living in fantasy land.  And the same can happen to anyone with bad habits, and that would be everyone.

So I am truly at a loss to explain why so many liberals are so enthusiastic about state-run health care.  It would seem to me that such a proposition leads to so many illiberal results.

Here is a better, if naive, suggestion: The state can simply hand out $3,000 each year to each man, woman and child in the nation for the purpose of buying health insurance.  A rough cost estimate, based on 300 million people, would be $900 billion annually.  For a family of four that corresponds to a health insurance premium of $12,000 per year, which is close to average in this country.  Sure that's a lot of money but it would undoubtedly be cheaper, both in dollars and in liberty, than state-run health care:

• It satisfies objection number 1: no bungling or oppressive government will be running health care.  It will remain private.
• It satisfies objection number 2: no need for the state to get into the business of deciding which procedures are subsidized or not, that would be entirely up to the individual when they decide which health insurance policy that they get.
• And it could be structured to satisfy objection number 3 as well, as long as the state didn't nannify the subsidy.

It's not perfect but it's a great deal better than letting the state run it all.