Health Care Reform

[Voronwë the Faithful]

Some elected Republicans are going to have to help. Or it almost undoubtably won't happen.

[anthriel]

I hope they do.

[Primula Baggins]

Anth, I just want to say that I do realize risks are involved in any kind of big change like this. The problem is that many of the legislators, both Republican and Democrat, who are calling for the process to slow down really want it to stop entirely and the status quo to continue. A number of them have said as much. Most if not all of them have received large campaign contributions from the health insurance industry.

Calls for deliberation from people who really want to smother the process entirely are probably the strongest reason for the widespread sense among health care supporters that health care reform has to happen now—with strong Democratic majorities in both houses and with overwhelming support among voters—or it won't happen for years.

[anthriel]

Yes. I understand all that. I do. It's an issue.

I do believe that we will get health care reform legislation, even with the resistance of most Republican and some Democratic leaders. I think you guys are right on target; something will be passed, and we can just hope it is good enough for now. Refinement to a poorly crafted original bill is possible. I hope it works just that way.

I was just laboring to point out that perhaps thoughtful time could be put in to try to make it a good bill, based on the train wrecks I have seen. In both cases where I provided links and documentation, wonderful ideas which were (at least by some) well-intentioned were catastrophically destroyed by a flawed original bill. No one benefited in the long run, the costs were unsustainable, and the original goal was not met. In at least one case, the speed at which the law was passed was a huge reason for its failure.

As I kept getting feedback as though I was saying "let's not get any bill out there at all", I realized I was not making my point particularly well. My apologies.

[Primula Baggins]

It's not you, Anthy. You're making an honest and entirely valid point, and making it clearly.

It's just the same point is being made dishonestly by some others including Blue Dog Democrats. I don't at all mean to say that that invalidates what you're saying. It just limits the ability of the people trying to pass health care reform to respond to calls for prudence without risking complete failure.

[anthriel]

Isn't it too bad when politicians hijack perfectly good ideas and massage them for their own political gain?

I'm certain health insurers are panicking and running in circles right now, and I am certain they are pressuring every politician they can get to in order to block this idea.

Too bad. Health care reform is coming. They need to deal with that fact.

[Griffon64]

I haven't had time to research the post that I want to write yet, and it isn't looking like I'll get around to it today, either.

But.

I feel like Treebeard.

I'm not convinced that even a faulty bill with would be worse than not doing anything at this point.

What would ramming through a half-baked bill accomplish, though? Surely the sausage factory crammed some special interest language into that bill to water it down here and leave open a loophole there. That's how they all get made. There is some political capital to spend here - why spend it on something that isn't well-crafted? Once it is spent, it is spent. I don't want it spent on something that health insurance companies can point at forever and say: "See? Single payer doesn't work. You need us, and we will fleece you harder and harder."

And I also don't want such a thing near my tax money. Sorry, but I don't. This bill has the potential to be heinously expensive. With the deficit ballooning and the economy stuttering, I'm sorry, but no. I know Obama has said the bill won't increase the deficit, but last I heard the projected cost wasn't covered yet. And I wouldn't trust the projected cost until I know more about how that particular product was made. The cost sounds low to me, actually.

I can't say more until I actually find the text of this bill online, and I don't have time at work to do that, nor do I want to. But I want to know how this bill proposes to control costs. What incentives are given to the various parties - doctors and patients - to control costs? What mechanisms are in place to prevent abuse? How about preventative care? Will the coverage given by this put an emphasis on preventative care, or did the pharmaceutical companies sneak in language that would help ensure hundreds of thousands of people will need to take a handful of their products each day to control preventable diseases?

I also notice that poor Anth had to fight an uphill battle to make a very basic and sound point: How do we guard against the danger of urgency being over-emphasized for political gain? Wall Street is still licking the dripping fat from its chops thanks to political urgency - that enormous bailout bill being slopped through because it was urgent. And heck, it was urgent enough. But the money also flew away without very sound control, and its been a scramble to keep 'em honest with it, plus the results haven't been that good, what with banks not yet feeling like lending too much, last I heard.

I heard the urgent drum call to action very recently, and I'm surveying the results, a little unsure that those drums should have been beaten quite that urgently, and a little less willing to heed this new drum beat without making sure I know what we're called on to jump into know.

Getting it wrong would not only be wasteful, it could end up with the very people who need the help the most getting absolutely none.

That is true. Still, at this point, I do think that it is better to get an imperfect bill through than none at all. Once we've taken the plunge, as a society, we can perfect the way we swim.

Swimming is a dangerous business, though. Once you're in, there's no turning back. And if the waters is choppy and your technique no match for it, you're in big trouble.

There are tons of special interest groups, and also just people adept at milking a system for more than their share, out there. Unless this bill is specifically designed to stop that kind of thing, I don't think all the good intentions in the world will keep the taxes of hard-working Americans from lining the nests of the lazy. In this economy where lots of people hardly have two pennies to spare once the bills are paid, I don't know how much of that kind of fat the economy can afford.

Anth had a couple of good examples of well-intentioned bills that folded under the weight of poor language. This bill is much larger, and I haven't noticed anybody urging swift action give any reassurance that this bill won't suffer the same fate.

Delay is a powerful political tool, like Tosh said, but so is urgency. I think one is just as bad as the other, personally.

I have to cut it short here to start my work day. I'll try and be back with a more helpful post later.

[Voronwë the Faithful]

That one was pretty helpful in and of itself, Griffy.

[Primula Baggins]

Yes, it was.

I really would like to see a CBO breakdown of the cost over the next ten years of doing nothing, to lay in beside the various estimates of the cost of the various plans. It might be startling.

And Anth's uphill battle was of course my fault. I have a bad habit of arguing with people who aren't right here talking to me, because I happen to think the one who is talking to me has a good point but maybe it segués into something else in my distractible mind, and I start posting about that without first saying "Good point". . . .

You should see me around shiny objects.

Anyway, my apologies. I will try to keep from doing that again.

[Voronwë the Faithful]

I haven't had time to research the post that I want to write yet, and it isn't looking like I'll get around to it today, either.

But.

I feel like Treebeard.

I'm not convinced that even a faulty bill with would be worse than not doing anything at this point.

What would ramming through a half-baked bill accomplish, though?

I'm not sure that "faulty" and "half-baked" are necessarily synonyms. I don't want a half-baked bill either. I want one that succeeds in meeting Obama's three basic requirements: (1) provides health insurance to the vast majority of those who don't have it; (2) cuts costs to those of us who are being driven under by the cost of health insurance; and (3) doesn't increase the deficit and in fact decreases it in the long-term. I think even a faulty bill cold achieve those goals. I don't think a half-baked one could.

And I also don't want such a thing near my tax money. Sorry, but I don't. This bill has the potential to be heinously expensive. With the deficit ballooning and the economy stuttering, I'm sorry, but no. I know Obama has said the bill won't increase the deficit, but last I heard the projected cost wasn't covered yet. And I wouldn't trust the projected cost until I know more about how that particular product was made. The cost sounds low to me, actually.

This is the key paragraph, right here, I think. As much as I appreciate Obama, I don't know whether I can trust that a bill that he and his allies claim is deficit-neutral in the short-term and will cut the deficit in the long-term really will. And that is the one thing that I think can be a deal-breaker.

I do appreciate both you and Anthy raising the points that you have. It has transformed this thread from mostly like-minded people largely going in circles to a real discussion with valid points on both sides. I know it has to have been frustrating for both of you at points, but I'm really pleased to see it (not the frustration, obviously, but the genuine discussion).

[axordil]

Griff-

You may be excused for not knowing, since you were elsewhere (and pretty young) at the time, but this isn't a new debate. The debate we're having now is essentially the same debate that existed sixteen years ago, the last time a Democratic administration tried reforming health care coverage. It's arguably the same debate they had back in the 60s when Medicare was started, and that was the tail end of a struggle stretching back to WWII at least.

That's the flaw in the "we can't afford to get it wrong" argument. We've been fiddling with this for generations, which pretty much means we HAVE been getting it wrong, to one extent or another, for decades. If we got it RIGHT, we wouldn't still be arguing so loudly. This is another step in the political and cultural process, that's all. It happens to be a very important step for a lot of folks, but it's not the be-all and end-all. So long as health technology changes, it can't be: after all, 100 years ago, the whole argument we're having would have seemed lunacy, since the vast majority of health expenditures we have now are for things that simply killed people then (and in a lot of the world, still do).

So my priority: fix what you can knowing what you know, and see what happens. What works now may break later, or become irrelevant, or be subject to a hundred other possible outcomes. When that happens, you have to assume the people in power then have the tools to deal with it, because there is no foreseeing all outcomes.

[Griffon64]

Ax - since it was mentioned by other posters earlier in this thread, I am vaguely aware of it - though, I may not be manifesting this knowledge behaviorally like some might want me to. In that case, I can only hope that I may be forgiven.

As for using the same methodology as years ago to bring in new legislation - arguably the methodology might be due for a change, too. If we haven't been getting it right, maybe it is time to look a little harder before leaping, to try and have less iterations of applying a fix and then seeing what happens. [ But not be an obstructionist, either. ] Each do something, then wait and see burns through time and tax money until the waste and loopholes are plugged. Of course, a needlessly long deadlock would, too. So maybe do and wait and see and correct is the only way to do this. But maybe there's a different way that could have better results.

Probably my small personal experiences do not extrapolate, but I know when I tackle a project without having my ducks in a row, my mistakes are almost always costly to me. Maybe I have a bunch of coding to do over, if it was a programming project. Maybe I put in a fence and bought the poles or boards too short, and had to buy them all over again. To me, personally, these leap before looking mistakes are costly. I'm behind on a project and working extra time and stressing myself out. Or I have extra expenditure to get proper materials.

Perhaps when it is only tax payer's money that is being wasted, we just fling it freely at our ideals or our thoughts and see what sticks. There's always more, right? We usually don't feel it like we feel our personal mistakes.

Except that maybe now we have less "more" than usual. The deficit is huge, the economy is down, the dollar is weakening. Maybe we're coming close to maxing out that "always more" source.

[ The "there's always more" group should maybe also take a quick peek at California's budget right about now to see how there isn't always more. ]

Prim - I would like to see the breakdown of cost over the net 10 years of doing nothing, too. Nothing is also an option, and the cost of it may also be extreme. ( How exactly would one measure the cost of doing nothing? To the tax payers as a collective, or to the tax payers who will be paying for the new plan, or to all Americans, including those who do not pay a lot of taxes? Numbers are wicked, you can make them say what you want to. I'd like to see the costs measured by the same measure - and by a few different measures each, perhaps - for the options. )

As much as I appreciate Obama, I don't know whether I can trust that a bill that he and his allies claim is deficit-neutral in the short-term and will cut the deficit in the long-term really will. And that is the one thing that I think can be a deal-breaker.

I do not trust the claim at present - in fact, I do not think that they can make that claim at this point. Until the remaining lacking funding is sorted out, I can't really say a lot more about it. But to me this looks like it could be a mechanism to get the bill in and let the funding hammer fall later. How do you sign up to spend this much money and be sure that economically it will come up roses? There are powerful lobbies working against utilization of some of the proposed funding sources.




PS: Prim, you made me laugh out loud with

You should see me around shiny objects.

[Voronwë the Faithful]

As for using the same methodology as years ago to bring in new legislation - arguably the methodology might be due for a change, too.

Actually, the Obama administration has taken almost the diametrically opposite approach to making this happen than the Clinton administration did, almost to a fault. The Clintons came in with a fully formed plan, presented it to Congress, and basically said "our way, or the highway." They basically refused to work with anyone in Congress of either party to compromise or adjust their plan at all. As a result, a great deal of resentment was created, that greatly contributed to the failure of that effort.

This time, Obama only presented a few very broad general principles, and basically said to Congress "I'm giving you the responsibility to figure out to get this done." The result is that we have all of these different, competing plans. I think the only way that this is going to get done is if Obama backs a particular plan that is likely to be able to attract the support of conservative Democrats and some moderate Republicans (which of course would mean that it would have to be a plan that is fiscally responsible) and then push it through. Otherwise, I don't see it happening.

[vison]

I do understand the fear of rising taxes - taxes used to fund a health-care system that will spiral out of control if it isn't done properly in the first place.

But the same nation that shakes in its boots (collectively speaking) is the nation that threw trillions of dollars into a pointless war and then trillions more into an equally pointless "bailout" of the banking system. I guess I'm going against the flow here, but as a fiscal conservative I was and am aghast at the insanity of that bailout.

The war is "so yesterday" and there is no point of beating that particular dead horse, but the bills have not really begun to come in yet and they will be coming in for at least 50 years. Health care? The American taxpayer is on the hook for thousands and thousands and thousands of veterans and their families from now until they are all dead. That is a drop in the bucket of the huge cost of the war, but it is a significant cost nonetheless.

The bailout has not fixed anything. I am going to go out on a limb and make a prediction that I sincerely hope is wrong: it is going to get worse. This little bit of recovery is only an illusion and the worst is yet to come and there will be no bailing out then. The money will be gone. I sincerely (another sincere wish) hope that I am dead before the stuff really hits the fan.

All of that is beside the point of a health care system. If only the bullet could be bitten NOW and bitten HARD to bring in a plan similar to Canada's, which is really quite simple and effective. The Canadian medical system fought tooth and nail, screamed "communism" and "dictatorship" when it was brought in, but as time has gone by, it has worked out quite well.

The issue is of far more importance than the "war on terrorism" or "the war on drugs", and yet money is found (or printed) to fund those two activities. What is more important to the average American? Being able to get cancer treatment, or feeling "safer" because American bombs are killing people in Afghanistan?

[axordil]

Griff--

When the goal is a marketable product, having the ducks in a row is crucial if it's going to happen on time and on budget, yes. I think that's not the best analogy, though, because it assumes a discrete thing to be sold.

I think a better model is the service model (IBM's influence has nothing to do with this conclusion ). The most important thing about a service is that it does what the customer needs at the moment. A year from now the situation, the terms, the customer may all change, and the service must evolve with it.

I worry about the cost too. Even though it would negatively impact my job, I would prefer a single-payer system for exactly that reason: it removes an entire layer of profit-seeking from the operation. But then, I would also pay doctors salaries instead of piece work rates that encourage doing things more than helping people, subsidize medical education instead of starting new practices off insanely deep in debt, and ban advertising for medical services and prescription drugs again.

Of course I'm pretty much a socialist, so you should expect no better from me.

Still, I remain hopeful. I think there are enough people interested in improving the overall situation this time to make it happen, and enough people watching their wallets to keep it from breaking the metaphorical bank. It's not what I want, but it might do what needs to be done and what can be done, for now.

[vison]

Canadian doctors do not work on a state-provided salary. They are in private practice and work in publicly funded hospitals. There ARE fee schedules that are negotiated by the government and the CMA. Just like, in the USA, the AMA sets fees.

I guess there could be any number of doctors who "game the system", but it doesn't seem to be a problem. Not that I know of, anyway.

Our doctors - and to a large extent American doctors as well - are largely educated at public expense. The fees for medical school, at least in Canada, do not go anywhere NEAR the actual cost of educating doctors and I have read that is also true in the US. So why should every doctor think he should therefore have a license to do what he chooses? Do American doctors pay for hospital privileges? They don't here, as far as I know.

Still, I don't advocate for state-paid doctors. A government insurance scheme is what you need. Anyone wants private insurance, let them have private insurance.

[anthriel]

This is a perhaps very honest, and yet deeply disturbing, comment from John Conyers today.

http://www.cnsnews.com/public/content/a ... rcID=51610

During his speech at a National Press Club luncheon, House Judiciary Chairman John Conyers (D-Mich.), questioned the point of lawmakers reading the health care bill.

“I love these members, they get up and say, ‘Read the bill,’” said Conyers.

“What good is reading the bill if it’s a thousand pages and you don’t have two days and two lawyers to find out what it means after you read the bill?”

So now we've got lawmakers who are not even going to READ this bill? Too much work, Mr. Conyers, to understand what you are voting on?

Perhaps these comments were taken out of context, and he's lobbying for less complicated bills. Maybe he's complaining about not having enough time to understand what he is reading, which is what I have been talking about. I would like to see the rest of the speech, but I can only find that one snippet. (Never a good sign, btw)

I think he's being honest, just like my state representative when I asked her how in the Sam Hill she voted for the alt-fuel mess. She (very honestly, I thought) said she didn't have time to read it, and it was so complicated that what she did read was misleading.

This is EXACTLY what I was fearful of. Wow.

[Primula Baggins]

Yikes.

[anthriel]

(I did edit it a bit, and cross posted with you, Prim. I still think "Yikes" is an appropriate reaction!)

[Dave_LF]

Complexity kills. Microsoft woke up to that fact; maybe it's time Washington did the same.

Of course, that assumes the complexity isn't being introduced for the express purpose of killing the idea.