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The politics of healthcare reform
July 25, 2009 11:36 PM   Subscribe

Bill Moyers' discussion with two expert analysts of health care, Trudy Lieberman, director of the health and medical reporting program at the CUNY Graduate School of Journalism, and Marcia Angell, senior lecturer in social medicine at Harvard Medical School and former editor in chief of the New England Journal of Medicine.
posted by semmi (100 comments total) 9 users marked this as a favorite

 
That was slightly depressing, but I've been kind of depressed lately about the whole health care thing anyway.

Also, this is the second week in a row someone has posted the latest `Moyers on the blue a few hours after I've watched it. It's... kind of scary.
posted by palidor at 11:58 PM on July 25, 2009


Actually that last post was a couple weeks ago. But still, mere hours after I watch it, here it is! Maybe that means MeFi is failing me.
posted by palidor at 12:02 AM on July 26, 2009


BILL MOYERS: The Republicans have more than health care reform in their bomb sights -- they want a loss for Obama so crushing it will bring the administration to its knees and restore Republican control of Congress after next year's elections. In the words of Republican Senator Jim DeMint, "If we're able to stop Obama on this, it will be his Waterloo. It will break him."
posted by semmi at 12:15 AM on July 26, 2009 [4 favorites]


God forbid that proposals be judged on anything other than their potential as political leverage. Asshats.
posted by flippant at 12:18 AM on July 26, 2009 [5 favorites]


The Republicans have more than health care reform in their bomb sights -- they want a loss for Obama so crushing it will bring the administration to its knees and restore Republican control of Congress after next year's elections

The bizarre right-wing objection is that, as written, it will cost the public $230 billion over ten years — ignoring the tax revenue and productivity benefit that is accrued from a healthier, working populace.

We just finished eight years of Republicans putting this country $11 trillion in debt.

And this bullshit is working, too, according to the lastest Economist. These fucking crooks have no shame at all.
posted by Blazecock Pileon at 12:31 AM on July 26, 2009 [25 favorites]


God forbid that proposals be judged on anything other than their potential as political leverage. Asshats.

Oh let's be fair. They also see it as an opportunity show obama as a witch doctor.
posted by delmoi at 12:41 AM on July 26, 2009


And if 18 thousand Americans die each year because they can't go to a doctor, or because they fear going will mean being deined coverage or bankruptcy, that's entirely acceptable "collateral damage" as far as Bill Kristol and Jim DeMint and Eric Cantor are concerned.

Eighteen thousand preventable deaths -- six 9/11s -- per year is, for the Republican Party, an acceptable cost, just to damage Obama, just to get another chance to plunge this counyry into more debt to pay off the already rich and the well connected.

Eventually, we will get single payer in this country, one way or another -- just as, eventually we got Social Security. It may not be soon enough for me, or for you, but the day will come, and it's coming fast. And the Republicans who spent so many years blocking it will be seen just like the racist buffoons who delayed Social Security and the Voting Rights Act.

But this time, instead of just blacks and liberals who will remember, every American who had to delay getting care for himself or for her kids will remember. And very time Americans go into a clinic or a hospital after we get single payer, their amazement that it can be so simple and easy and right to get the care they need regardless of their pocketbooks will remind them to damn the Republicans again for all the wasted lost years of fear and suffering. And the Republican Party (and its Blue Dog Democrat enablers too) will be damned and abandoned.

It's not a question of if, it's a question of when, and of how many people will die or be permanently disabled or be bankrupted before we get there. It's a question of how much the Republican Party wants to make itself irrelevant and despised.

We shall overcome. And those who seek to delay that day will be damned.
posted by orthogonality at 12:53 AM on July 26, 2009 [36 favorites]


This is depressing. It has nothing to do with productivity or a healthy populace, or poor people having insurance. This is pure, unbridled captalisim. 'Health' is nothing but the product, and the companies that trade in 'Health' are fighting tooth and nail to get a favorable bill passed or keep the status quo.
I don't know, I have no proof, but I believe that something is looming regarding health care costs. Something that is making this a very urgent issue for Obama. Possibly that without reform, he believes that a full economic recovery (whatever that may be) won't be possible, because of the enormous costs. Just like with the banking system taking such a toll on the economy. I believe that if a plan favorable to the insurance companies passes, the best option is probably to buy stock in health care and insurance related companies, and then move to Canada (and I don't say that flippantly).
I'm with the two experts, that basically the system as it is needs to be replaced, but I don't think that will happen. I only hope the stop-gap measure that might actually get passed now isn't just round after round of Chemo, when a new wonderdrug (that isn't FDA approved, mind you) would be a one-pill cure.
posted by FireballForever at 1:08 AM on July 26, 2009


I don't know, I have no proof, but I believe that something is looming regarding health care costs. Possibly that without reform, he believes that a full economic recovery (whatever that may be) won't be possible, because of the enormous costs.

It's a clear problem once you separate out the pieces:

- A failing economy affects everyone, including people with good jobs that provide health insurance.
- People with insurance lose that insurance once they lose their jobs.
- People with jobs that don't provide insurance can't go to the doctor and can't afford the medication anyway. They mostly just hope they don't break a leg or get ill, because the doctor and the hospital are out of the question. When you're jobless or simply insuranceless, your priorities become, in this order: housing, food, transportation, everything else.
- If you have insurance but it won't cover you properly when you need it, you effectively have no insurance.
- People who get sick, or become disabled, and cannot do anything about it are less effective, less stable workers.
- Sick and disabled people can't look for work effectively.
- A lack of workers in a population served by an economy weakens that economy.
- A weak, dying economy causes companies to shut down or cut jobs.
- A dead economy affects everyone, including people with good jobs that provide health insurance.

We all need to be well for the country and its economy to work. The only way this is possible is if none of us has to worry about what happens when we're not well. Not a single one. If someone says otherwise, and protests that the for-profit health care industry in the United States works so well that it's an unrivaled, functional health care model, that person is ignorant or a goddamned liar. There's no argument, no debate—that person is full of shit to the point of overflow.
posted by Mikey-San at 2:16 AM on July 26, 2009 [10 favorites]


that the for-profit health care industry in the United States works so well that it's an unrivaled, functional health care model, that person is ignorant or a goddamned liar

oh, I don't know. The argument can be made that there are simply too many people taking up valuable space in this country. People with no wealth or wealth-producing skills are a form of surplus, no? Half this country can't find their ass with both hands. Why should the productive members of society be forced at gunpoint to help them? That's not freedom, and not what this great country was founded for.

Reagan's recorded speech in 1961 for the AMA's Operation Coffee Cup lays it out best.
posted by @troy at 2:59 AM on July 26, 2009


I saw this and completely agreed with Marcia Angell. I've been following her writing on health care reform for years and I admire her (and, clearly, agree with her perspective).

Whether or not this reform passes (I'm agnostic as to its chances), sooner or later it will have to be redone in favor of a single payer system; the ever increasing costs, the cumbersome nature of the current (or reformed) system, etc will necessitate it. Perhaps the current reforms will grease the skids and the cost pressures will squeeze the government in the right direction, but I doubt it. And, when I say sooner or later, I'm betting on later. I think cost savings will come on the backs of the poorest and least politically connected (both as health providers and recipients).

I think our political system - resistant to change, supportive of the established power/money relations - has become a serious obstacle to the social changes which are required to have a decent society. (California's problems are a good model of the dysfunction playing out at the national level). And I think, increasingly, that structurally, systemically, our government simply doesn't work and isn't up to making the changes necessary to sustain and enable this country and promote the well being of its citizenry.
posted by Auden at 3:00 AM on July 26, 2009 [2 favorites]


Obama said it in so many words, the very first thing out of his mouth at his presser: The only way to cover everyone is single payer. I pray to whatever god covers this that they go for reconciliation and 51-vote passage, give the cowardly Blue Dogs their "political cover" (jesus my health is at stake because some asshole with no balls doesn't want to lose his/her job? wtf) and stop writing a Health Insurance/Healthcare Industry bill, giving us instead the healthcare system that every other goddamned wealthy industrialized country has had, on OUR dime (cough Marshall Plan cough) since 1948.

Who am I kidding.
posted by nax at 4:04 AM on July 26, 2009


nax: single payer isn't even on the table right now.

At this point we just need to hope for a public option; we're not supposed to say so but the Republicans are correct that a robust public option is a stalking horse for single payer. Yeah, yeah the Democrats will deny that until their last breath. They have to for political reasons. We know it is. The Republicans know it is. They know that we know. It's a necessary bit of kabuki theater.

But Baucus is going to gut the public option and replace it with some bullshit "co-op" system which won't do squat. And the Democrats will declare victory and pass it with a bunch of fanfare. And Obama will declare victory and sign it with a bunch of fanfare.

Did I mention it will include an individual mandate to buy insurance?

So the Democrats and Obama will screw us all over just so they can pass something and declare victory even if it makes everything even worse. Which it will. An individual mandate with no public option is a complete and total betrayal of the people that voted the administration into office. Don't let them fool you into believing otherwise.

But the truth is that health care reform has been doomed from the start given that Max Baucus is chairman of the Finance Committee. No decent legislation of any sort (and I'm not limiting this to health care reform) will ever pass the Senate as long as we have that tin pot bastard in charge. Baucus is bought and paid for.
posted by Justinian at 4:19 AM on July 26, 2009 [1 favorite]


If we're dumb enough to fall for this again, then we deserve what we get.
posted by 1adam12 at 4:21 AM on July 26, 2009


If we're dumb enough to fall for this again, then we deserve what we get.

Whadda ya mean we, paleface? I don't think anyone deserves to suffer because of the avarice of a few old white cranks. As auden said upthread, the arteries of our political system are clogged with kickbacks and self-interest, and any attempt to resurrect the mental dead (to borrow a phrase from the Nation of Islam) and have tax payers DEMAND change is being shouted down by a blustery minority that make up our nation's talking heads. Before the country can make any significant progress politically, there need to be sweeping reforms within the system.
posted by orville sash at 4:31 AM on July 26, 2009


Pharma spent $40 million in the last quarter on lobbying: Money spent for drug lobbying bought some resolution. Government regulation of drug pricing is already off the table, as is importation of drugs from Canada.

What's that old saying about money talks?
posted by SteveInMaine at 4:47 AM on July 26, 2009


Once again, the Obama administration, instead of delivering change, comes up with more of the same. I am surprised, really. And deeply disappointed.

Cue the "but he's only been in office six months" apologists.
posted by Kirth Gerson at 5:06 AM on July 26, 2009 [1 favorite]


Cue the "but he's only been in office six months" apologists.

I prefer to be a "he's not the legislative branch, and respects separation of powers more than his predecessor" apologist.
posted by oaf at 5:24 AM on July 26, 2009 [4 favorites]


MARCIA ANGELL: Well, he says, let Congress do it. In their wisdom, they'll come out with something, and I will give you a few feel-good principles. And then we'll wait and see what happens. Because he doesn't want his fingerprints on it if it fails.
So - oddly enough - in response to our courageous respectful President's leadership, our courageous fully-owned-subsidiary-of-the-healthcare-industry Congress delivers legislation that further enriches said industry, at the expense of people who already cannot afford their product. People are dying, and this is how they all deal with it?
posted by Kirth Gerson at 5:42 AM on July 26, 2009


The House approach to the health care bill is a fabulous piece of fail.

* Does not actually cover everyone (assuming that is a proper objective).

* Does not do anything serious to control costs (which is regarded as a proper objective, in general, by most).

* Not only does not create, but in fact reduces, systemic incentives for healthy behavior.

* Re-engineers >10% of the GDP by reference to the policies and practices of economies which are fading in competitive consequence (Europe, Canada) and not by reference to the true competition of the 21st century in Asia -- soft of like it would be if Microsoft benchmarked itself to GM and not to Google.

* Funds itself in the most disastrous way imaginable: tax-attacks upon high income professionals (who provide the creative and analytical services which are the only thing in which America enjoys comparative advantage) and tax- and regulation-attacks on small business proprietors (who create virtually all the economic growth which isn't attributable to high income professionals). A great strategy if we want to transform the whole country into Detroit, but dubious otherwise.

A serious and fair bill would provide for basic health care services to be paid out of pocket and the government to pay for care above that, and fund itself from a VAT or payroll tax that retained a cap at a level such that no one's individual tax burden was more than some reasonable multiple (3x or so) over the average payroll tax burden. A serious bill would not treat the entrenched interests (pharma, health care systems, or health care workers unions) as in any way sacred, but on the most capitalist of grounds: if they want the tax payers' dollars, they need to accept the tax payers' conditions.
posted by MattD at 5:47 AM on July 26, 2009 [1 favorite]


Why should the productive members of society be forced at gunpoint to help them?

frankly, the people you believe are productive members of society aren't that productive - many of them are rent-seekers, con men, advertisers, paper-shuffling idiots and know-nothing managers who, among other things, created the housing bubble and the bank crisis

their economy is built on lies, their politics are built on lies and their relationships are built on lies

keep lying for them - maybe they'll throw you a crumb
posted by pyramid termite at 6:07 AM on July 26, 2009 [20 favorites]


Why should the productive members of society be forced at gunpoint to help them?

There are millions and millions of productive members of society who don't have health insurance. I worked in new home construction for seven years and didn't have insurance the whole time because I was working for small contractors who couldn't afford it.
posted by octothorpe at 6:43 AM on July 26, 2009 [1 favorite]


The argument can be made that there are simply too many people taking up valuable space in this country. People with no wealth or wealth-producing skills are a form of surplus

I'd like to hear more. Do you maybe have some sort of solution that would finally address this issue?
posted by Justinian at 6:47 AM on July 26, 2009 [4 favorites]


concluding remarks from shields & brooks friday:
JIM LEHRER: It doesn't really change the system itself that much?

DAVID BROOKS: Right, that's the essential critique.

JIM LEHRER: Yes, what about the Republican reaction here, particularly that of Senator Jim DeMint, who said what's really important for the Republicans to do is to win the health care battle against Obama and "we'll break him"? What's that all about?

DAVID BROOKS: Well, this is how politicians talk in private. It's incredibly stupid to talk about it in public, because it makes it seem cheap and political, and this actually is an issue that touches everybody. This actually is a crisis.

And it makes it seem like you're opposing it simply for political reasons so you can break this guy the way you did Clinton in 1994. And they're actually doing well on the argument.

JIM LEHRER: The Republicans?

DAVID BROOKS: The Republicans. As I said, people are skeptical of the government health care plan, and then to distract with this narrow political Waterloo talk, it does a tremendous disservice to the criticism.

JIM LEHRER: I noticed, Mark, that Senator Lamar Alexander of Tennessee, part of the leadership, has distanced himself from that, "Jim DeMint doesn't talk for me," or whatever, but I haven't heard any other Republicans do that.

MARK SHIELDS: They will in private.

JIM LEHRER: They will in private?

MARK SHIELDS: They know that Jim DeMint is a disaster. Jim DeMint, the kind of politics he's talking about, the knee-capping and this kind of crazy tough, you know, "We'll take him down, and this is Waterloo, and we'll kill him," that kind of language, Jim, that is why, in large part, Barack Obama won the presidency. People were so disgusted. They were furious with that politics.

This has nothing to do with people's lives. It all comes down to gamesmanship and who's going to get the edge up. He's indifferent to the issue involved, the fact that 14,000 people are losing their insurance today and 14,000 will lose their insurance tomorrow. That's just irrelevant to DeMint's equation.

And he made it on a conference call, talking to interest group politics. We talk about interest group politics. Who could most feed the raw meat to the true believers on his side?
also btw, fwiw, nate silver sez the timeout is fine, while von & publius have been discussing the wyden plan...
posted by kliuless at 6:54 AM on July 26, 2009 [4 favorites]


Oh but Peggy Noonan says that "emergency rooms that provide excellent service for the uninsured", so we shouldn't worry about those poor unfortunates.
posted by octothorpe at 6:55 AM on July 26, 2009



oh, I don't know. The argument can be made that there are simply too many people taking up valuable space in this country. People with no wealth or wealth-producing skills are a form of surplus, no?

You're right. They're called children. How do you feel about abortion?
posted by dortmunder at 7:08 AM on July 26, 2009 [3 favorites]


This seems appropriate:
"Americans can always be counted on to do the right thing...after they have exhausted all other possibilities." -- Winston Churchill
posted by sety at 7:23 AM on July 26, 2009 [2 favorites]


It doesn't take a genius to realize any public option will be a dumping ground for the pre-existing illness folks who won't be profitable for the private sector insurance industry. As has been pointed out above, a big part of the problem is that anyone who seeks office requires suitcases full of filthy lucre to have any hope of paying for an election campaign.
posted by Daddy-O at 7:52 AM on July 26, 2009


As a Canadian, it stuns me that your last president can take your country into a war without any effective resistance whatsoever, but you current president can't get your citizens proper health care because you have a means by which he can be stopped. Where was this system 8 years ago?
posted by You Should See the Other Guy at 7:56 AM on July 26, 2009 [22 favorites]


Why should the productive members of society be forced at gunpoint to help them?

Being wealthy and highly paid because you come from a rich family and have lots of powerful buddies--which describes not only most CEOs but much of Congress and our last president-- does not equal "productivity". And Wall Street's "productivity" has brought this nation to its knees. Or did you just forget that one little part?

I would vouch for the productivity of any single mom working two jobs to feed her kids, without any access to healthcare or vacation pay, than I would for any lazy goddamn CEO bankrupting his/her company then sailing out on golden parachute.
posted by emjaybee at 8:06 AM on July 26, 2009 [8 favorites]


There was no effective resistance to the US invasion of Iraq because many Americans were behind him due to the fabrication of evidence that Sadam was constructing WMD's and cavorting with terrorists. America was out for blood and revenge after 9/11.
posted by Daddy-O at 8:08 AM on July 26, 2009


It's astounding to me that Republican foot-dragging on this issue is tolerated at all. Truly, all the questions have been asked and answered. This has been a topic of discussion for SIX DECADES. Ted Kennedy alone has championed health care reform for forty years ; he fell out with, and ran against, Jimmy Carter over this very issue.

It's obvious that for one side this is all about the (personal) Benjamins. What's it gonna take? Do we need to start legally looking at correlations between contributions and voting records? Would RICO cover that?
posted by Benny Andajetz at 8:11 AM on July 26, 2009 [1 favorite]


Why Markets Can't Cure Healthcare
posted by Benny Andajetz at 8:19 AM on July 26, 2009 [1 favorite]


Half this country can't find their ass with both hands.


@troy, I have to tell you that with ever increasing frequency, you are framing your arguments in multiple threads as obvious trolling. Sometimes you have some things to say that are interesting to me, but your house style is wearing so thin that it's almost not worth it anymore.
posted by lazaruslong at 8:25 AM on July 26, 2009 [3 favorites]


Why should the productive members of society be forced at gunpoint to help them?

Nice troll, but there you have it, America. You're only worth your paycheque. Work two jobs at minimum wage and you're worthless compared to an old-monied trust-fund hipster. So we're saying to all the Hairnet McNametags out there, YOU'RE NOT WORTHY, DIE ALREADY.

Anyone saying "It's not about principal, it's about principle" is full of shit.

Half this country can't find their ass with both hands.

"... and they're voting Republican!"
posted by hangashore at 8:34 AM on July 26, 2009 [3 favorites]


Marcia Angell is right on about all of this. It angers me that the typical American believes that the AMA represents physicians' views on health care reform. For years, The New England Journal of Medicine's editorial staff has been much more informative and in line with how most doctors see this issue (both in my experience and if you look statistically). It's wonderful to hear her come out and say flat out: "We need a single payer system." Dr. Angell isn't a far left wingnut -- this is mainstream medicine right here. I don't understand why there hasn't been more of an organized lobbying effort in favor of single payer on the part of health care providers -- I suspect is has something to do with lacking the financial clout and being overworked just trying to survive.

The comparison between health care reform and the civil rights movement in the 60s is apt. If we are really going to see some of the change we need, it's going to take massive, direct action on the part of the citizenry. Marches on Washington, people refusing to go to work, boycotts, etc. I've been discouraged but somewhat amused to see the insurance industry's television advertising over the last few weeks, mostly because it so manifestly laughable. In 2009, arguments about rationing and government bureaucracy fall flat on the average working Joe's ears because by now *everyone* has been a victim of an insurance company's denial of care or forced hoop-jumping. Public opinion is firmly in favor of the heavy hand of government creating a more just system. The problem is that our legislators live in a bubble where they mostly just hear the insurance industry's propaganda. I don't wont to let the perfect be the enemy of the good vis a vis single payer (a robust public option might be a necessary first step), but I think if ordinary people don't speak out loudly and in a way that is very disruptive to the system, it's true that we're just going to get a watered down plan that hands truckloads of money to the same system that got us into this mess.
posted by Slarty Bartfast at 8:35 AM on July 26, 2009 [3 favorites]


I'm Canadian. Part of the right-wing campaign to scare Americans into opposing any change in their system has been the recruitment of one Shona Holmes, a Canadian with a tale of a life threatening wait that was only resolved by a trip to the Mayo clinic in Arizona. Her story has been running in TV ads and she has been making the talk show circuit. (There seem to be some factual problems with her tale).

I started a Facebook group (self-link) to allow Canadians to stand up and say that Ms. Holmes does not speak for them. There's been good response after just a few days. We've had some pretty amazing personal stories posted, too.
posted by bowline at 8:45 AM on July 26, 2009 [4 favorites]


There's another motivator in all this that I don't hear mentioned very often. I'm an employer, and one of the hardest parts of my job is finding and keeping good people. (Less so right now, but usually). If I was the source of their main health insurance, that would give me a lot more power to keep them working for me, especially if they had a pre-existing condition that would make it hard for them to get coverage somewhere else. (I can live without this.)

As a result one of the biggest changes that a American government health insurance plan would bring is the transfer power from employers to employees.
posted by bowline at 8:57 AM on July 26, 2009 [3 favorites]



It's a clear problem once you separate out the pieces:


You left something else out: the healthcare situation now is even killing huge companies. Do you think Ford and GM would have been in near as much trouble if they hadn't had to provide health insurance for their employees and retirees? And small businesses never have a chance. If what's good for GM is good for America, this has to get fixed.
posted by dilettante at 9:12 AM on July 26, 2009


one Shona Holmes

Let's see here.

She had to pay huge sums out of pocket for surgery, faces financial ruin due to the cost, and is fighting her insurer in order to recoup those costs.

How, exactly, is this different from the American system? (Other than the fact that a private U.S. insurer would have already dropped her like a hot potato, and OHIP will do no such thing.)
posted by oaf at 9:20 AM on July 26, 2009 [3 favorites]


As a result one of the biggest changes that a American government health insurance plan would bring is the transfer power from employers to employees.

Without getting all Karl Marx about it, I see this as a feature and not a bug.
posted by hippybear at 9:29 AM on July 26, 2009 [4 favorites]


Their spokeperson is Shona Holmes, a Canadian, who claims the Canadian system was going to make her wait six months to see a specialist for her brain tumor, but she only had around that amount of time to live. So she went to the Mayo Clinic in Arizona and got her problem taken care of for $97,000 dollars. Wait times are a problem in the Canadian health care system, but when you hear a story like that it makes you feel some outrage.

What amazes me about this episode: whether Shona Homles' story is true or not, it is being used to assert that, essentially, there are no "wait times" for anything in the American health care "system," which is just about as false as it gets.

And notice that Holmes' problem got "taken care of" at the Mayo Clinic in Scottsdale because she had money to pony up front. What if she'd had no money?
posted by blucevalo at 9:31 AM on July 26, 2009


I'm an employer, and one of the hardest parts of my job is finding and keeping good people. (Less so right now, but usually). If I was the source of their main health insurance, that would give me a lot more power to keep them working for me

Is the business in your website your business?

Because if it is, you almost certainly wouldn't be able to afford meaningful health care benefits for your employees in the US and your retention problems would, if anything, magnify as people leave for bigger corporate fish whose risk pool is big enough to be affordable, or for the public sector.
posted by ROU_Xenophobe at 9:32 AM on July 26, 2009


Health care companies are in the business of denying, not providing, health care, and most of their overhead comes from the back office needed to deny coverage and claims. Worse yet, from an aggregate social-cost perspective, each of those operations is duplicative. It's as if every state had 10 privately-owned DMVs, each dependent for profit on registering only late-model cars owned by people with great driving records, and passing the cost of figuring out who's a good bet to every driver. The health-insurance industry is a parasite in the most literal sense of the word. Correction: it's actually several dozen parasites, all feeding on the same host.

And here's the best part, and one I've been dealing with for ten years: in many states, insurers can refuse to sell you an individual policy for any reason at all or for no reason. If you have Type II diabetes in Ohio and want an individual policy, you're screwed. Uninsurable. Most doctors in Ohio don't know this, but the insurance agents all do. Simply changing the law to mandate some kind of reasonably-priced coverage would make a huge difference to millions of people, but they won't do it. That's how greedy these bastards are.
posted by words1 at 9:46 AM on July 26, 2009 [7 favorites]


If you have Type II diabetes in Ohio and want an individual policy, you're screwed. Uninsurable. Most doctors in Ohio don't know this, but the insurance agents all do.

Truth.

I have Type 1 diabetes, so medical care is an absolute necessity for me. And I'm pushing 50. I had to buy a policy for myself and family during a spell of unemployment - I was essentially laughed at by more than ten carriers. One finally consented to cover us with a super-high-deductible policy that was worse than a major-medical policy (remember those?), for the bargain price of $1600/month.

Fuck them and their horse. Fuck the congresspeople who support them. And fuck the system that allows them.
posted by Benny Andajetz at 9:58 AM on July 26, 2009 [11 favorites]


Why should the productive members of society be forced at gunpoint to help them?


They are already being forced, in that taxpayers and the actually insured foot the cost for emergency visits by uninsured people. Emergency visits that tend to cost more than regular, preventive health care.

It's amazing to me that people who have insurance can convince themselves that they are not already subsidizing the uninsured .
posted by oneirodynia at 10:29 AM on July 26, 2009 [2 favorites]


If you have Type II diabetes in Ohio and want an individual policy, you're screwed. Uninsurable

I'm in my 40s, self-insured with Blue X, don't know if this is true or not but decided not to take any chances and went to Walmart to get a glucose meter to do my own tolerance tests just in case.
posted by @troy at 10:31 AM on July 26, 2009


Me:
"Why should the productive members of society be forced at gunpoint to help them?"

They are already being forced, in that taxpayers and the actually insured foot the cost for emergency visits by uninsured people. Emergency visits that tend to cost more than regular, preventive health care.

Actually, reading this essay I think my original jape above wasn't quite right.

If that is true, and it resonates with me, conservatives are truly afraid of the loss of choice and the overbearing involvement of Gummint into the free market wonder that is modern medicine.

There's nothing wrong with medicine in this country if you are independently wealthy.

Conservatives don't want to see this system destroyed by a Democrat patronage system on the order of the Postal Service or DMV. They believe in their bones that the competition of the free market is more reliable than a centralized planning.

So conservatives aren't necessarily opposed to government charity, they just want these government services to be limited, decentralized, inferior, under-funded, so as to not interfere with the existing private system for regular people. Same thing with Medicare in the 1960s, and the sam thing Bush II tried with Social Security in early 2005, when he thought he had some political capital.
posted by @troy at 10:40 AM on July 26, 2009


Exactly - the Republicans are out to prove that government can't work, and they actively work to break governement systems, just to prove they're right.

There's nothing wrong with medicine in this country if you are independently wealthy.

Nailed it there.
posted by yesster at 10:46 AM on July 26, 2009 [4 favorites]


Quoting myself : As a result one of the biggest changes that a American government health insurance plan would bring is the transfer power from employers to employees.

Quoting Hippybear: Without getting all Karl Marx about it, I see this as a feature and not a bug.

Hippybear: Just to be perfectly clear -- I agree with you 100%.
posted by bowline at 11:06 AM on July 26, 2009


Is the business in your website your business?

Because if it is, you almost certainly wouldn't be able to afford meaningful health care benefits for your employees in the US and your retention problems would, if anything, magnify as people leave for bigger corporate fish whose risk pool is big enough to be affordable, or for the public sector.


ROU_Xenophobe: That is my business, and I am sure you are right. I am very grateful for the system I have.
posted by bowline at 11:08 AM on July 26, 2009


Conservatives don't want to see this system destroyed by a Democrat patronage system on the order of the Postal Service or DMV.

do you even know anyone who works for either? have you ever taken the test to get in the postal service? are you aware that in some states the dmv is ran by republicans?

do you realize that this system is well on its way to destroying itself without a democrat patronage system? that's why millions of people aren't in it, the premiums keep going up and the benefits keep going down?

talking points don't get it anymore - lose the propaganda and the cant and take a look at what's going on

you're not a troll - you just don't have clue one as to what you're talking about
posted by pyramid termite at 11:18 AM on July 26, 2009 [4 favorites]


I'm in my 40s, self-insured with Blue X, don't know if this is true or not but decided not to take any chances and went to Walmart to get a glucose meter to do my own tolerance tests just in case.

just think - with a real health system you could afford to go to a doctor to do that
posted by pyramid termite at 11:19 AM on July 26, 2009 [1 favorite]


Either way, I'd hate to get sick in America
posted by A189Nut at 11:33 AM on July 26, 2009


I'm in my 40s, self-insured with Blue X, don't know if this is true or not but decided not to take any chances and went to Walmart to get a glucose meter to do my own tolerance tests just in case.

Oh, it's true. And you're smart to do that. My wife was diagnosed purely by accident in the course of dealing with something else. She controls it with diet and exercise. But that one notation on her records makes her uninsurable in OH.
posted by words1 at 11:36 AM on July 26, 2009


so as to not interfere with the existing private system for regular people

@troy, these "regular people" constitute a very small portion of the population: people who are independently wealthy and can pay to make any health care problem -- including six-figure hospital billes -- go away. They are not "regular." They are a tiny minority, and yet they have had a disproportionately large influence on tax and social policy because of the privilege that comes with their wealth. Their elected minions in the GOP make pseudo-populist arguments, but they are really acting on the behalf of a tiny minority, to the detriment of the life prospects of tens of millions of Americans.
posted by foxy_hedgehog at 11:58 AM on July 26, 2009 [2 favorites]


just think - with a real health system you could afford to go to a doctor to do that

Sorry if my first post above muddied the discussion. I'm all for single-payer, mandatory-enrollment, subsidized-for-all government health system, even at the cost of levelling the tops of the trees who enjoy premier access and the professionals who profit thereby (Canada's exclusive private system appears to be the right model for that).

Health care -- to keep people productive members of society -- should be a core social service like lifelong education, local transportation, criminal justice, the legal system, disaster prevention & recovery services, and affordable access to land.

But 30% or so of this country is most certainly not in this camp; these people agree with Reagan's view on personal liberty of profit-seeking and distrust of gummint (eg here and here).

Me, I go with Alan Kay's "Point of view is worth 80 IQ points" observation and thereby think of the limited-government contingent as morons.
posted by @troy at 12:00 PM on July 26, 2009 [1 favorite]


Here's a thought. I don't know if this would be effective, but hear me out.

The Republicans in Congress are doing there best to block health care reform, and calling or writing them -- though we should -- isn't going to do much good.

But for every Republican Congressman "representing" you, you have a state senator, a state assemblyman/delegate/representative, county commisioners, members of the school board, etc.

What if you called up any Republican office holder who represents you, and let him know this: "if my Republican Congressman/Senator doesn't work to support real health care reform, I'll vote against you, I'll work to defeat you. Because he's only representing the monied interests that profit from denying me care, I'm going to vote against anyone in his Party -- and that includes you. You can win back my support -- but only if you publicly call for health care reform and repudiate your Party and its representatives in Congress."

Call up your Republican school board members, your county commissioners, your state delegates, and let them you that if health care reform doesn't pass, you'll hold it against them and their Republican Party for years to come. Maybe with that we can shake loose a few votes.
posted by orthogonality at 12:04 PM on July 26, 2009 [9 favorites]


I'm all for single-payer, mandatory-enrollment, subsidized-for-all government health system, even at the cost of levelling the tops of the trees who enjoy premier access and the professionals who profit thereby (Canada's exclusive private system appears to be the right model for that).

Thank you for the clarification. I think your estimate of 30% of the country being against "gummint" (defined as any government interference or even marginal government growth) probably understates the number.

Referring to one of your links, that anyone would even attempt to use a Ronald Reagan speech from 19 effing 61 (let alone posting a photograph from the same period, as though extremely proud of how antediluvian the thinking behind it is) as a basis for any kind of argument or discussion strikes me as about the imbecilic thing imaginable.
posted by blucevalo at 12:09 PM on July 26, 2009


But 30% or so of this country is most certainly not in this camp


orly
posted by lazaruslong at 12:09 PM on July 26, 2009


Conservatives don't want to see this system destroyed by a Democrat patronage system on the order of the Postal Service or DMV. They believe in their bones that the competition of the free market is more reliable than a centralized planning.

Funny how this logic doesn't seem to apply to the military, as if having weapons involved means everything is done by the government very well. Although, somehow under Bush even the military was privatized to a large degree, though this isn't exactly popular with most conservatives.
posted by krinklyfig at 12:10 PM on July 26, 2009


Oh wait. I get it. You are using the classic Republican strategy.

You reconcile this:

oh, I don't know. The argument can be made that there are simply too many people taking up valuable space in this country. People with no wealth or wealth-producing skills are a form of surplus, no? Half this country can't find their ass with both hands. Why should the productive members of society be forced at gunpoint to help them? That's not freedom, and not what this great country was founded for.

Reagan's recorded speech in 1961 for the AMA's Operation Coffee Cup lays it out best.



With this:

I'm all for single-payer, mandatory-enrollment, subsidized-for-all government health system

by saying "The argument could be made".

Like "mistakes were made".

Or "to the best of my knowledge".

If you are going to derail with trollish comments, at least stick to your guns.
posted by lazaruslong at 12:12 PM on July 26, 2009 [1 favorite]


I think I'm finally starting to understand the mindset behind opposing single-payer healthcare. "There are too many poor and sick people that are too expensive to keep alive! Fuck them! What about my money?" Thanks, @troy,
posted by tehloki at 12:28 PM on July 26, 2009 [2 favorites]


These people don't think about what happens if poor people who serve their food, clean their bathrooms and kitchens at work, ring up the groceries when they shop, provide sex services they don't admit to using, etc., get sick with hepatitis/flu/TB/syphilis/CMRSA and can't get it diagnosed or treated properly. They don't think it can really spread to them or to their kids. Let's see if the swine flu really takes off this fall.
posted by dilettante at 12:55 PM on July 26, 2009 [3 favorites]


understand the mindset

there's the dislike of the forced-charity thing, yes, but note that in 1961, and later in 1980 in the debate with Carter, Reagan was willing to pay lip service to the limited, optional, de-centralized Kerr-Mills subsidized cost-sharing plan.

So there's also the conservative fear of being locked into a nationalized, anti-competitive system you don't like or is otherwise inferior to what you had before.

At least with a private system you theoretically have a choice to change service providers. If you have enough theoretical money, or happen to fall under welfare program, of course.

I mock free-market fundamentalists when able, but it probably is true that to really screw things up requires a government. But I also think Mencken in his darkness was right: "Democracy is the theory that the common people know what they want, and deserve to get it good and hard".
posted by @troy at 1:06 PM on July 26, 2009


From Bill Maher's final New Rule this past weekend:

If the conservatives can call universal health care "socialized medicine", I get to call private for-profit health care "soulless vampire bastards making money off human pain."
posted by hippybear at 1:11 PM on July 26, 2009 [6 favorites]


Not that Reagan didn't create forced charity with his tax policies, giving money to those who need it the least while trying to support the finances of running the nation on the backs of those with less money...

Robbing the poor to feed the rich. It's charity no matter which direction it goes. It's just less sustainable when you do it that way than the other.
posted by hippybear at 1:14 PM on July 26, 2009


I brought up this topic at lunch with some family members who are very religious (Catholic). Their main concern was that the government would introduce de facto euthanasia through strict rationing of care for the elderly. None of them remembered where they first heard it, but they all had. So, that meme is apparently out there.
posted by the jam at 1:36 PM on July 26, 2009


So there's also the conservative fear of being locked into a nationalized, anti-competitive system you don't like or is otherwise inferior to what you had before.

What in the world could possibly be inferior to what we have now? And I don't mean some conservative boogabooga fantasy construct, either.
posted by blucevalo at 1:37 PM on July 26, 2009 [2 favorites]


How difficult is to understand that private companies do save a lot of money when they don't pay insurance claims as can afford an army of lawyers and lobbying, while you can't?

The alternative may be a slightly croocked and corrupted public healthcare, but something you can dive your nose into as they have to produce PUBLIC records, as opposed to private company records which are mostly secret for the masses, except for balance sheets which are often meaningless anyhow?

Of course if you sit tight and wait for your politician or insurer to help your ass out of trouble you will get nothing.
posted by elpapacito at 2:22 PM on July 26, 2009


At least with a private system you theoretically have a choice to change service providers. If you have enough theoretical money, or happen to fall under welfare program, of course.

I'm having trouble parsing this sentence. Are you actually saying that welfare recipients have a choice of healthcare providers, from which to receive the best quality heathcare?
posted by Blazecock Pileon at 2:29 PM on July 26, 2009 [1 favorite]


[My apologies to @troy for referring to him as a troll, since I'd confused his comment as being his own opinion, and not a speculative representation of that of some health-reform opponents.]
posted by hangashore at 2:41 PM on July 26, 2009


Are you actually saying that welfare recipients have a choice of healthcare providers, from which to receive the best quality heathcare?

It doesn't have to be hypothetical, my Mom is on Medicare in California (which goes by the google-proof "MediCal"). Her doctors in the private sector when she was under Dad's insurance don't take MediCal patients, since MediCal doesn't pay them enough, and the supply/demand is apparently such that they don't need to.

But she DOES have access to a simulacrum of socialized medicine within the MediCal system, with access to 3 or 4 doctors in the fifth largest city in California. They key thing for conservatives is that the MediCal people do get some access to services, without impacting the really-for-profit mainstream. She's got an XXXogist appointment scheduled next month and I think this was the specialist being a nice guy and making an exception for her.

Conservatives are fine with that. What they don't want to see happen is that everyone, ie. them, have to join the MediCal system and wait for service with the campesinos and other undesirables.

They also know doctors don't want that.
posted by @troy at 2:51 PM on July 26, 2009


What in the world could possibly be inferior to what we have now?

Conservatives are of the mindset that free competition lowers prices, increases innovation, and money talks and bullshit walks. It's great to be a conservative with money in this country.

They fear government will add inefficiencies, "shovel-leaners" will increase makework that the private sector with its ruthless drive for profit does not tolerate, and that something other than how much money you are willing to spend will determine how much service you get.
posted by @troy at 3:01 PM on July 26, 2009 [1 favorite]


They fear government will add inefficiencies, "shovel-leaners" will increase makework that the private sector with its ruthless drive for profit does not tolerate

The problem being that from the point of view of a health insurance company, physicians are shovel-leaners or active saboteurs.
posted by ROU_Xenophobe at 3:08 PM on July 26, 2009 [3 favorites]


She's got an XXXogist appointment scheduled next month and I think this was the specialist being a nice guy and making an exception for her.

I'm not sure how you equate a doctor making exceptions to grant your mother treatment, with the concept of legitimate choice.

Can you please clarify what the word "choice" means to you for welfare recipients, when doctors are turning away welfare recipients? That doesn't sound like any kind of "choice" at all.
posted by Blazecock Pileon at 3:23 PM on July 26, 2009


They fear government will add inefficiencies

what

30% of U.S. medical costs are overhead (compared to, what, 4% in Canada?). If they're making that argument, they're either cerebrally lacking or profiting from the inefficiencies they decry.
posted by oaf at 3:27 PM on July 26, 2009 [1 favorite]


@troy, if you intend to Argue On The Internet some point of view other than your own, it's wise to flag that clearly and even then, expect some people to skim-read it and assume that you are putting forward the argument you outline as your own, even though you say otherwise. FWIW, AFAIK MetaFilter is the forum where this is least of a problem. On that point though, while contra-debate is a perfectly respectable rhetorical style, you should consider what it achieves to put forward those arguments at all other than to immediately refute them. The minions of Mammon are doing a sterling job already preaching evil with their own lungs and do not need yours added to the chorus.

It's important to distinguish the type of activity that the "ruthless drive for profit" promotes, which is to extract profit rather than to provide healthcare. The greatest profit, as American insurers are well aware, is made from charging the highest premiums and providing the least services. You already have healthcare rationing. The elderly, newborn, and all between are already effectively euthanized by healthcare rationing on the basis of money; to ration on the basis of need may or may not reduce the numbers of persons euthanized, but the process has a relative moral cleanliness to it, and the practical benefit of not causing providers to look over the crowd of potential customers waving money at them and pick the ones who are willing to pay the most.

Mikey-san made the point above that if you have insurance that will not cover you you effectively have no insurance, but the reality is that a person whose insurance is denied is far worse off than one with no insurance at all. Firstly, you're out by whatever it cost you, or your employer on your behalf (remember that this is money they could and should be paying to you directly) to buy the worthless insurance, the "fairy gold" as someone put it in another thread, and this is hundreds to thousands of dollars. Anything else you could have done with that money would have been better: had you gotten drunk with it, at least you would have actually gotten drunk. Had you set fire to the money, you would at least have been aware that you had a pile of ash now, and acted accordingly.

Secondly, in order to have a claim denied, because of the mindbogglingly vicious way that American insurers operate their scam-businesses, you had to have incurred upfront whatever costs you're claiming for, ie had your operation or whatever that you medically needed, under the impression that your insurer would pay for it. So you're now out for that, to your surprise.

Thirdly, you're out the time and effort and cost and psychological damage involved in arguing with the insurer, dealing with your employer as owner of the policy (even if they're completely on your side and helpful to you, this still takes time), and pursuing legal remedies if these are available to you at all.
posted by aeschenkarnos at 3:29 PM on July 26, 2009 [3 favorites]


when doctors are turning away welfare recipients?

By welfare I meant Medicare/Medicaid means-tested style welfare that Reagan and his AMA backers grudgingly allow, not welfare for the able-bodied.

Those that pass the means test, ie the poor, have fuck-all power in this country, of course, so having some half-assed welfare assistance for medical services is not threatening to the Conservative Agenda of keeping gummint out of their private [economical] affairs. Plus of course if the indigent have a life-threatening condition they can get treated in the ER.

I tried to make sense of Ron Paul's recent interview and couldn't find any traction, other than gummint spending bad, freedom good.

To clarify all that, I think Conservatives don't mind mainstreaming SOME charity cases into the private system, but they don't want to see the entire system turn into a "government program" on the model of the NHS of the UK, or the halfway-house that is single-payer up in Canada. Or France, Norway, Sweden, Denmark, Germany, Holland, Finland, or Japan's system. We 'mericans value our freedoms more than they. <--- conservative viewpoint attempt
posted by @troy at 4:02 PM on July 26, 2009


What they don't want to see happen is that everyone, ie. them, have to join the MediCal system and wait for service with the campesinos and other undesirables.

The "campesinos and other undesirables"? Wow, you certainly do not live in California. Speaking as the grandson of a "campesino" myself.

Your language is truly approaching offensive and I've completely lost any interest in anything that you might be arguing.
posted by blucevalo at 4:21 PM on July 26, 2009 [1 favorite]


The "campesinos and other undesirables"? Wow, you certainly do not live in California. Speaking as the grandson of a "campesino" myself.

I think troy was using language that approximates the viewpoint of many conservatives Republicans, not advocating that viewpoint himself. In other words, Republicans don't care about the health of people they see as, and marginalize as, "campesinos and other undesirables".
posted by orthogonality at 4:42 PM on July 26, 2009


If you ever worked in any private company, you know exactly how inefficient it can be. Private being always better than public is just a myth used in propaganda.
posted by elpapacito at 4:55 PM on July 26, 2009 [3 favorites]


I think troy was using language that approximates the viewpoint of many conservatives Republicans, not advocating that viewpoint himself.

Yeah that shits pretty fucking tiresome.

He's not saying it. He's, you know, just sayin'.
posted by lazaruslong at 5:26 PM on July 26, 2009


I don't honestly care whether he was using it himself or approximating others' use of it (and I'm not the only one finding it difficult to discern which situation is the case in his comments). The terminology contributes absolutely nothing to the discussion. There are other ways of saying the same thing. Many other ways.
posted by blucevalo at 5:35 PM on July 26, 2009


He's not saying it. He's, you know, just sayin'.

No, I value the ability to argue the other side. Not that I value the other side's argument, but I think it's important to understand where they're coming from.

Not doing so is how we get blindsided by Prop 8s.
posted by @troy at 6:07 PM on July 26, 2009


The bizarre right-wing objection is that, as written, it will cost the public $230 billion over ten years — ignoring the tax revenue and productivity benefit that is accrued from a healthier, working populace.

We just finished eight years of Republicans putting this country $11 trillion in debt.

And this bullshit is working, too, according to the lastest Economist.


The thing is, see, ours was eleven trillion, sure, but Obama's is two hundred and thirty billion.
posted by flabdablet at 6:38 PM on July 26, 2009 [3 favorites]


I'm certain flabdablet is meaning to make this point...

but isn't the more fair way to say this: "ours was eleven thousand billion, but Obama's is two hundred and thirty billion"?
posted by hippybear at 8:02 AM on July 27, 2009


25 Million Have Insurance, But Not Enough: On Top of 47 Million Americans with No Health Coverage, Underinsured Present a Strong Case for Reform
posted by homunculus at 4:38 PM on July 27, 2009


An Incoherent Truth: On health care, the Blue Dogs aren’t making sense. The conservative Democrats can’t extract major concessions on the shape of health care reform without dooming the whole project.
posted by homunculus at 5:08 PM on July 27, 2009


But the truth is that health care reform has been doomed from the start given that Max Baucus is chairman of the Finance Committee.

Yes, I'm quoting myself. Because if you read the leaked details of Max Baucus' "bipartisan" plan that will be coming out of the Finance Committee you will see that I actually understated things. The plan, if accurately reported, is actually significantly worse than what we have right now! Yes, the Baucus idea of health care is a giant giveaway to insurance companies. Bend over, America! MAX IS BACK!

I assume it is a coincidence that he is such a large recipient of health care dollars.
posted by Justinian at 5:19 PM on July 27, 2009


Actually, hippybear, the point I was trying to make is that political discourse is all about perception; that to most voters, billions and trillions are just Big Numbers and therefore indistinguishable; that it's a hell of a lot easier to inject a completely bogus talking point into circulation than it is to give its perfectly reasonable rebuttal any traction; and that all the party spin machines are perfectly aware of these facts and use them on a daily basis.
posted by flabdablet at 5:43 PM on July 27, 2009


I assume it is a coincidence that he is such a large recipient of health care dollars.

Allow me to be pedantic for a moment and point out that he's a large recipient of dollars that should be going to health care but aren't.
posted by oaf at 10:14 AM on July 28, 2009


So glad I don't have to worry about this. Quick question though, if as Krugman asserts in the piece linked to by Benny Andajetz, Arrow shows that a free market for health care is a classic recipe for market failure. Why are Democrats not more gung-ho about calling Republicans on their bullshit?
posted by munchbunch at 9:00 AM on July 29, 2009


fwiw, here're some articles i've come across recently that i thought were interesting re: The politics of healthcare reform...also btw von linked to a handy health care comparison tool from the Kaiser Family Foundation :P

cheers!
posted by kliuless at 7:34 AM on July 30, 2009


Baucus Could Lose Chairmanship Over Stalled Health Care Negotiat
posted by homunculus at 6:20 PM on July 30, 2009


Blood Money: Blue Dogs and the Medical-Industrial Complex.
posted by homunculus at 3:12 PM on August 2, 2009


Why I Oppose National Health Care

Megan McArdle's Case Against National Health Insurance. Sort of.
posted by homunculus at 3:17 PM on August 2, 2009


Health reform made simple
George F. Will Admits Public Option Will Cut Costs
posted by kliuless at 9:36 AM on August 3, 2009


Countdown: Calling BS on Health Care disrupters.
posted by homunculus at 5:57 PM on August 3, 2009


Attack of the Zombie Plumbers
posted by homunculus at 11:53 AM on August 4, 2009


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