September 1, 2009

Looking for good-faith opponents to healthcare

And not finding them among the elected Republicans or those who speak for them.
But I can't find them. Instead, we see Tom Davis, a famously moderate former GOP member of Congress, tell a 62-year-old woman who can't get insurance because of her diabetes that she should just go get a job with a big employer (good luck with that, dear). We see Tom Coburn, a Republican senator and a doctor himself for heaven's sake, tell a sobbing woman who can't get coverage for her husband with a traumatic brain injury that government can't help her. Instead, he suggests, "The other thing that's missing in this debate is us as neighbors, helping people that need our help," as though the answer for her and the other millions of people without insurance is to start knocking on doors to see if the folks on her block can come up with a couple of hundred thousand dollars for her husband's care. Again and again, we see people who have been given the power to make laws labor mightily to convince citizens that their most ridiculous fears about health care are true and that they've never had it so good. I try to believe that these critics are moral people whose outlook on the world simply differs from mine and that they are not actually pathologically indifferent to the suffering of others. But the longer this debate goes on, the harder it is to detect any light of human feeling in those working feverishly to destroy the hope of reform for another generation.

17 comments:

Nancy said...

And your solution is what? Let the government do it? And how would that be paid for?

Monk-in-Training said...

Yes,
Let the Government be part of the solution.

Just like it is the only solution for firefighting. We socialized that a century ago, and it works great.

How to pay for it? Raise some taxes, cut some spending (particularly the defense budget that is as large as the rest of the planet combined).

It can be done, Republican Ron Paul explained it in his campaign. Mostly by as he put it, let go of the Empire!

Charles W. said...

Improving medical coverage and lowering costs is a nice idea, but it may be a waste of time. It assumes we have a future in which there is a sound economy and social order; neither of which, I think, are likely.

Streak said...

Nancy, like Monk says, we have a lot of examples where government does things quite well. Those with medicare and VA healthcare are generally pretty pleased with it, and they don't end up getting kicked off their plan.

The argument that it is expensive is another way of saying that we aren't willing to help those with no or poor insurance, and are willing to let them go. Is that really our argument?

charles, we could have an assurance of both, if we could get back to two real parties. With one coddling the racist, secessionist, and violent populism of the uninformed right, that is hard to see.

LB said...

Streak/Monk,

Regarding the cost of healthcare, I think it is something that those on the left have truly failed to appreciate.

First, regarding the true cost of healthcare. We have all seen the CBO reports that estimate healthcare costs at $1-1.6 trillion over 10 years. Monk may be right that you could cut defense spending and raise some taxes and that would pay for the proposed bill. However, what is often forgotten is that no one has ever successfully estimted the cost of a government run healthcare program for more than a few years. For instance, when MEdicare was first started CBO estimated it would cost $9 billion by 1990. It cost $66 billion by then. Granted, making a predicting of more than 30 years is tough, so it may be hard to fault CBO for such a bad job, but the point is, healthcare cost grew astronomically faster than anyone predicted.

Take a more recent example. Mitt Romney's plan in Massachusetts costs twice as much as estimated already. And that plan is a few years old.

Compound these examples with the fact that last year for the first time that budgeted healthcare expenditures were the large budget item (and not defense) in US history, and with the fact that the population of the US is getting disproportionately old (old age is when more than 50% of all lifetime health expenditures occur) and you have a the very real likelihood that health care costs are going to drastically exceed those estimated by CBO.

This still does not take into account that if you raise taxes and cut defense spending to create a deficit neutral health care bill that there will still be $9 trillion worth of deficit spending over the next year, pushing the national debt to over $20 trillion!! How do you balance the budget at this point if you have already raised taxes and cut defense spending?

This brings me to the ethical component of my argument which you (both Monk and Streak) right bring up. The $20 trillion debt ten years from now is not imaginary, it is a real number that has volumes of interest associated with it that simply sucks money away from the US economy every day with not return to the US people. Eventually debts have to be paid. It doesn't take an economist to realize that a sum as astronomical as $20 trillion threatens the long term health of the US economy.

This poses the ethical question: should we pay for health care now and sacrifice people's future jobs? This means people's ability to provide for their families above the poverty line and an individual's sense of satisfaction and accomplishment.

Health care now or jobs later? It seems like a trite comparison, but its not. A middle aged person 25 years from now ought to have just as much a right to a healthy economy where he or she can do something so they are not dependent on government as a 70 year old has a right to a kidney transplant.

Perhaps that makes me cold-hearted comparing health-care to the economy. But as much as the Bible speaks to caring for the sick, the Bible also challenges us to fiscal responsbility and warns us that there are consequences for today's actions.

I say these things not to be trite, but because I think the various aspects of health care reform have barely begun to be talked about and that no one, Republican or Democrat is willing to admit to how complex the issue really is.

Streak said...

Lb, this is some good stuff, and as I have noted, these are the conversations we should be having. I am still a little unsure that the conclusion of "let them not have healthcare" is a solution, but understand your concerns.

Let me suggest rather briefly that you are looking at these costs only as a cost. My friend UBUB made this point about another conservative, and I think it is a good one. It isn't that those numbers aren't real, because they are, and they are frightening numbers. But they are not just an outlay of money--they are an investment in something, just as when we increase our personal debt to purchase something of substance. I am thinking of those people who have had to divorce because of the threat of financial ruin, or those who have gone into bankruptcy because of healthcare bills. Those are productivity losses. As are those people who stay in the job they hate because they can't get health insurance without it.

Those rising healthcare costs are part of the reason that liberals want a "public option" to serve as some competition with private healthcare plans, and to help push down prices. This reform also includes some recommendations for looking at those very expensive services that are over-used or used inefficiently. And I was trying to find this, but I think I read that the prescription drug plan passed under Bush precluded Medicare from negotiating prices on those drugs? Or precluded using generics? I am not sure what the problem was, and am relatively sure that the political failure was on both sides, but think there are a lot of reasons that our healthcare bills are skyrocketing, and they don't have to. A report I read recently noted how Japanese use some similar technology, but are able to use it far more efficiently and cost to the system is less.

What is more, I think the debate should include the fact that if we do nothing, we will watch as healthcare costs continue to soar. And despite the rhetoric of "socialism" (thankfully, not used by you, and thank you for that), we have to acknowledge that we already pay the costs of these healthcare deficiencies. We pay them in the least possible efficient manner possible, by having millions of people do their primary care through emergency rooms and absent basic checkups or care. We pay when people lose their entire wealth and end up on medicaid or medicare. We are already paying. Let's figure out a way to make those payments more efficient and direct.

I appreciate your thoughts here, and look forward to more dialogue on this. As this post suggests, I see very little genuine debate from elected Republicans right now.

LB said...

Streak,

Thanks for your kind words.

You are quite correct that health care reform is necessary. The problems with the current system are undeniable. You are also right that Bush and that Republican controlled congress really screwed up the prescription drug plan. I have few details as well on it, but basically from what I have seen, it has done nothing but increase costs.

That is a very good example of why I am for healthcare reform, but opposed to every proposal the Democrats have come up with thus far. As I have shown above and in my previous post, government involvement in health care tends to increase costs, not decrease costs.

The Republicans are completely blowing it here. They've done a good job of showing the problems with Obamacare, but what have they offered? Nothing. The Republicans need to come up with a healthcare reform bill of their own.

What I think is pathetic is that I and many conservative commentators in the media have pointed out some easy obvious solutions the Republicans could present, like buying health insurance across state lines and allowing people to purchase health insurance with pre-tax money just like their employers can, thus giving them more job mobility.

But the Republicans are undeniably the party of "no" right now. An appropriate "no" I think. But they must offer more than that.

Streak said...

LB,

More good points. Obviously the cost issues are bad, but I am not completely convinced that, as you say, government involvement has to result in higher costs, simply because it has in several instances. If we look at other countries with some kind of universal care, we see that government cost controls have effectively managed costs. Ours are the worst in the developed world, or awfully close. The prescription drug is a good example, and I agree with you that politicians dropped the ball on that, but it does not follow that they are incapable of doing something that is more useful.

I guess that is my issue with your take right now. I understand your point, but couldn't we say just as easily, and with just as much validity, that the past experience with private for-profit healthcare has only increased costs and limited coverage--why would we continue with that at all?

Beyond the cost issue, btw, and I think that is a valid concern, what other problems do you see with the Obama approach? Especially if, as we often hear, the public option is not likely to happen. What I hear from Republican politicians are dire threats about rationing and panels, but most of those other reform issues seem pretty straightforward. Stopping insurance companies from arbitrarily discontinuing coverage, closing gaps in coverage so that those with major illnesses don't run out of coverage, and stopping the exclusion of those with pre-existing conditions. What is wrong with those reforms?

Monk-in-Training said...

LB,
I really do appreciate your comments. You are a person I can dialog with and listen to.

You are right about no one can tell the future cost, but Streak has a good point that we have lots of those costs now.

I would like to propose that providing health care could be as I stated before, like firefighting, a "cost of doing civilization".

I personally would love to change jobs, but I have insurance lock. I wonder how much innovation is stifled and jobs not created because entrepreneurs could not leave there old jobs, nor provide insurance for a few employees?

During FY 2008 the US Dept of Defense and Homeland Security spent 793 billion or so. That is heading toward a trillion a year, Medicare and Medicaid spent about 595 billion or so. (these numbers are from Wikipedia, so take with a grain of salt)


The trillion dollar price tag over ten years (yes I agree it will be more) means 100 billion per year. Ron Paul said (though he is not a supporter of Gov't funded health care) "I would cut from these trillions of dollars we have spent over the years and bring our troops home so we can finance it.”

It is my belief that civilization flourishes in Europe, Taiwan, Canada, Australia, etc. and would here as well with universal health care. Defense budget would get less, but then we don't need an Empire anyway. Ando of course, I am a pacifist type monk person. :)

LB said...

Streak,

Regarding the rest of the health care plan, I honestly haven't paid much attention to it as the public option has been the central issue in the debate thus far.

I think some necessary reforms include:
1. Not punishing people for lapses in coverage.
2. Allowing people with preexisting conditions to get coverage (though I think they should pay higher rates, just like a smoker does).
3. Not letting insurance companies drop persons from coverage.
4. Not allowing "spikes" in cost once someone gets sick. (After illness, I think its acceptable for the insurance company to increase premiums somewhat, but what those increases would be, must be made explicit to the consumer before the policy begins.
5. As stated before, allow people to buy health insurance with pre-tax dollars.
6. As stated before, allow people to buy insurance across state lines, thereby creating real competition in the insurance industry combined with point 5.

Monk:

Regarding the firefighter comparison, I see your point. However, firefighters are controlled by local government, which has the ability to be far more responsive to the needs of the individual than the federal government.

If the firefighters screw up in your area, you have a far better chance of making a case for fixing things or making the department work better by presenting it to your local county/city councilman than you do of getting your congressman to fix problems or failings with a large national healthcare system. Also, if you really hate the firefighters and its that crucial to you, you have the option of escaping the bad firefighters by moving.

I'll admit that those countries that have some varying degree of socialized medicine (I think using the term socialized is appropriate of countries like the UK or Canada), have some advantages over the US.

That said, I do not think it is a Utopian as is often made out to be. The hard and fast government rules and procedures prevent proper treatment at times.

Monk-in-Training said...

Hey LB,

You are right when you say firefighters are controlled by local government, which has the ability to be far more responsive to the needs of the individual than the federal government.
However one could just as easily say it is more susceptible to corruption and local baronial influence. I have seen that personally at the local level as I grew up.

And your well taken point The hard and fast government rules and procedures prevent proper treatment at times. Goes just as well as the implacable rules that insurance companies (cartels in my opinion) and their accounting dept. puts on people seeking treatment.

This whole system is a double edged sword ,and certainly no human solution will be perfect. I just hope we can work some sort of compromise to engender the best possible solution to serve our citizenry.

Streak said...

LB,

I think we have a lot of agreement here on some of the needed reform. A couple of points of difference. Monk notes the fundamental (seeming) disagreement between conservatives and liberals on which form of government is more responsive. My own observation--anecdotal as it is--is that local government, as Monk says, can be more corrupted by business interests than even the national level. The amount of pressure you can bring to bear is also much less, as is the amount of media scrutiny (and this is assuming that our national media acts as a watchdog part of the time).

Second, I am a little concerned that you equate all pre-existing conditions with choices such as smoking. I understand charging smokers more, just as younger drivers pay more for car insurance, or those with bad driving records. But many of the pre-existing conditions came out of living, not because of bad behaviors. I am not sure why a kid born with diabetes should be penalized any more than he already has.

Third, as Monk notes, I am not sure why bureaucratic nightmare is only attached to government. I have been incredibly lucky in not having to deal with insurance people that much, but even when we have the bureaucracy has been daunting. The miscommunication and red-tape, etc.

LB said...

Monk,

It is my opinion that all government is equally susceptible to corruption regards of size or level. There is no way I can prove this other than to say that all levels of government are made up of equally fallibly humans, sometimes moral, and sometimes not.

Insurance companies undeniably are difficult to deal with. However, and I should have been more clear on this, I think if insurance companies really had to compete for people, they wold be easier to deal with, though not necessarily easy.

Streak,

Regarding costs of preexisting conditions. I think that those who are born with say, diabetes, are in an undeniably tough boat. However, if we see insurance companies for what they are, groups of people pooling money so that a few may take that money out at a time to pay large expenses, it is equally unfair to ask a young athletic male (basically the stereotypically healthiest and least in need of a doctor individual I can think of right now) to pay extra for the person born with diabetes (because simply put, someone has to pay for the diabetes treatment, it will either be by raising rates on the collective whole, or on the individual).

I would certainly want those who chose to be unhealthy (smokers) to pay more than those who were born with health problems.

I would assume that each individual preexisting condition would have its own cost associated with it and that there would not simply be two rates, the preexisting condition rate and the non-preexisting condition rate. Instead I would assume there would be hundreds of rates based on physicals and medical history, of an individual when he or she tried to purchase health insurance (in my vision of a competitive environment).

And if Congress passed a reform that prevented persons who have pre-existing conditions through no fault of their own from paying higher premiums,, that wold be fine by me as well.

leighton said...

Just a quick comment before I head back home to an internet connection killed by a damaged coax cable--

I wouldn't say that government is subject to corruption, but rather that people who hold power are subject to corruption. Government workers and officials are subject, sure, but they're far from the only ones. And further, that people in large corporations have every reason to be corrupt that people in government offices do (the thrill of power, real or imagined, plus exploiting their positions for personal and financial gain), plus an additional direct financial incentive to screw people over. And they're also subject to less oversight. Looking only at job descriptions, maybe a county DA would have as much power to make people's lives miserable for his own enjoyment as the officer of a large insurance corporation would. But corporate executives don't usually have US attorneys staring at them with their mouths watering. The regulatory environment for corporations is barely noticeable unless you're just stupid, or really overextend yourself.

Sure, if we had a fair market, people could pick and choose which insurance company gave the best deal. But we don't. It's more profitable for companies to all agree to screw chronically ill people over than for any one company to play nice.

I think the failure of even the best forms of contemporary political conservatism is the inability to realize that threats to liberty and individual rights are capable of taking more forms than the traditional bogeymen of government corruption and individual criminal behavior. Corporations often engineer situations of de facto tyranny over the people whose living necessities and health they hold in their hands. And going back to checks and balances, the only entity that can check the domestic behavior of national and multinational corporations is the federal government. Whatever direction we go, public option or no, if we are to have any kind of improvement in our health care coverage system, we need the federal government to be much more involved than it is.

I think to solve the health care problem, we would need to solve at least a dozen other related problems--involving the disproportionate corporate influence in legislation, and worse-than-useless media coverage of everything, just for starters.

Sorry that I don't have time to expand more. I have 19 minutes to run to the library before it closes. I'll try to hop on tomorrow if my home connection is back up.

Monk-in-Training said...

LB,
You are right, it is unfair for that young, healthy male to pay for those who are sick, but then it was unfair for farmers in the Hebrew Scriptures to leave gleanings in the corners of their fields.

In fact the Lord commands us in Deuteronomy 15:10, 11 Give liberally and be ungrudging when you do so, for on this account the Lord your God will bless you in all your work and in all that you undertake. Since there will never cease to be some in need on the earth, I therefore command you, "Open your hand to the poor and needy neighbor in your land."

My point is, that as a Christian, I believe that God commands us to take care of each other, and there simply isn't any getting around it.

And in case any one says that those commands were to individuals not governments, we individual citizens are the government here, and even if we weren't, God's commands are for individuals, governments, all humanity.

All throughout the scriptures, God takes extra care of the poor, and helpless. In my tradition we are taught to serve Christ Himself in the face of the poor.

LB said...

Monk,

I have only a few moments to write this, so apologies for not developing my argument fully.

I would say that your argument from Deuteronomy logically leads to toal socialism. From a Christian perspective, that is not necessarily a bad thing.

However, I do not believe Jesus called us to force others to take care of the poor. Jesus wants us to take care of the poor out of our own excess however large or small it may be.

Jesus said if you have two cloaks give one away. He did not say if you have one cloak, go and get the state to pass laws that force those with two cloaks to give those away.

I do not think God calls us to cause government to pass laws that will force others to conform to a Christian worldview. Instead I think God wants us to individually take care of each other through the Church.

This is a very terse argument, and I acknowledge that, but I wanted to say something briefly, as I will be away for the next several days.

leighton said...

LB, I think a better analogy than the government forcing people with two cloaks to give one away is the government compelling people who have amassed millions of cloaks for no better reason than that they happen to like cloaks to surrender a few hundred thousand of them to those who have none. Not at gunpoint for no reason, but as a fair exchange for the government safeguarding a system in which they are allowed to amass the cloaks they have without being molested by their neighbors who have a few thousand more cloaks than they do. They still would have more cloaks than they would ever possibly use, and those who would otherwise be exposed to the elements would be protected. Given that the choice is between (a) lots of people suffering and dying and (b) a few people living in slightly more luxury than they otherwise would, I have trouble seeing any way in which this idea is inherently unjust. We would want to be extremely careful with the implementation, as with everything government offices do. But I believe the principle is sound.

For reasons I really don't have time to go into at work, I have no sympathy for the idea that churches (or The Church, pretending such a thing ever existed) ought to bear the sole burden of guaranteeing social welfare either in the U.S. specifically, or throughout the world. Besides having no persuasive power among non-Christians, I believe it is a profoundly bad idea that cuts off far too many Christians from meaningful engagement with social reality; it seems to channel many people's passion for justice down channels that spend more energy trying to deregulate corporations and hamstringing government's sometimes legitimate efforts toward equality than in actually helping people.

I have every sympathy for churches that do everything in their power and more to help the most vulnerable parts of the population, and there are a lot of them, and most of them are too busy doing good work to bother with the PR to make themselves more widely known. But I also believe that the idea of churches being the best source of help to the needy has become a propaganda tool of the corporate right to trick people into speaking out for big corporations and voting Republican--easy tasks--rather than assuming the almost impossibly hard and sometimes soul-crushing work of engaging with the real emotional and financial needs of real people in trouble.

I further believe based on my limited experience that people and churches who have been engaged in the work of trying to provide for the most vulnerable among us eventually realize that their biggest human enemy isn't the government trying to horn in on their turf; it's the immense national and multinational corporations who by their actions show that they don't believe that human beings have value. If Niger had used Nigeria's rural population for drug experiments the way Pfizer did in the 90s, there would be well-meaning US conservatives clamoring for war; but because it was a company instead of a government, there was a little handwaving about "free markets" and it largely went unnoticed.