So I’m reading that new majority link DougJ provided earlier, and needless to say, I am less than impressed with these pearls of wisdom:
Republicans should rally vocally for universal healthcare coverage – and then work hard to remove the tax and regulatory barriers that impinge on the market for private health insurance.
***Before anyone starts suggesting universal coverage, the American people want to see waste and inefficiency wrung from the current system.
And on and on. It doesn’t matter what the issue, it is the same old nonsense. This is governing by magic 8-ball:
Is there seriously any issue regarding domestic affairs that they won’t apply the same talking points? How can anyone in their right mind think all we need to do to fix health care is to deregulate the industry like we did with credit cards?
DougJ
Is there seriously any issue regarding domestic affairs that they won’t apply the same talking points?
No.
Janus Daniels
Republican magic eight ball only has 2 answers; an American eight ball has at least 4.
They outsourced the manufacture.
ChrisS
You forgot the “invade third world country.”
Warren Terra
I thought the whole point of advocating single-payer was to wring the inefficiency of paying insurance companies’ profit margins out of the system?
Also, anyone who thinks the problem with insurance companies is too much regulation is a moron or has been living in a cave. They clearly know nothing about “pre-existing conditions”, “rescission”, or lifetime caps.
Complimentary Airsickness Bag
These people are clowns, and are mostly beyond parody. But, I’m willing to try.
I’m trying to get through to a local right wing station here in Los Angeles. I want to express my outrage at a provision in the eleventy-something-pound health care bill tentatively called “End of Life Care Cost Savings Family Participation Incentive.” Or, in other words “Cash for Granny.”
In the House version, the “Cash for Granny” program will offer participating family members a one-time cash incentive of 20% of the estimated cost savings if they “pull the plug” on eligible elderly relatives. Senate Democrats prefer the “flat fee” option.
Obama and the Democrats want to pay you to kill Granny just like they wanted to kill Terry Schiavo!! I am practically sputtering with outrage (or a reasonable facsimile thereof). I will deem my effort successful if the host and/or any single caller believe that “Cash for Granny” is a real provision in the bill. Maybe I’ll set up a Free Republic account, too. Wish me luck.
Roger Moore
That depends. Do you include social issues, like abortion and gay marriage? Because they have a whole different set of talking points for those.
Janus Daniels
Oooops… first time the page loaded, only top two answers showed up.
Parenthetically, I’ve only heard Democrats recommend cutting waste.
When did Republicans do that?
The Grand Panjandrum
@DougJ: Wrong!
One of the fearmongering talking point right now is that not only does Obama want to euthanize granny, he wants to CUT her Medicare! (He doesn’t.) They don’t explain that the reduction in Medicare funding won’t cut bennies for recipients, because its removing inefficiencies and redundant testing from the system. They ARE NOT reducing services to granny. So yeah, the talking points only apply when its to their advantage to sound all responsible and thrifty and shit.
Why do you think we have all these ignorant people carrying signs and crying out at the townhall meetings, “Keep the gummint outta my Medicare!” It’s in the mass emailings and letters coming out of the astroturf groups.
Karmakin
Best way to eliminate waste and inefficiency?
Single-payer.
Of course, waste and inefficiency in the economy as a whole is a large part of increasing the amount of employment available for the population, and as waste and inefficiency are reined in, that’s when jobs are eliminated. Which is why nobody is really talking about single-payer. Single-payer can’t happen until labor reform is done, and labor reform won’t be done until the neo-calvinistic tribal thought is a social and cultural pariah.
It’s really a nasty knot to untangle.
ChrisS
Or wait, they can also blame George Alinsky, or Saul Soros
General Winfield Stuck
Those big black balls skeer meh!!
ChrisS
@Janus Daniels:
When did Republicans do that?
Well they always promised it and finally achieved that noble goal in 2005:
David Hunt
@General Winfield Stuck:
You must have some Republican in you. They’ve been afraid of big black balls for at least two hundred years.
JR
Hey, you might not always agree with ’em, but at least you can guess within 5 seconds of hearing the most basic description of a complex and nuanced issue where the GOP stands.
ellaesther
I’ve consulted my own Magic 8-Ball regarding this post, and will you just look at that! “It is decidedly so“!
/shake shake/
ellaesther: “Magic 8-Ball, is John Cole stinkin’ funny and his analysis of his political party of origin generally awesome?”
/shake shake/
Magic 8-Ball: “You may rely on it.”
I knew it!
ThatLeftTurnInABQ
@General Winfield Stuck:
You are posting in the wrong thread. For fear of big black balls, try this one.
J. Michael Neal
I disagree with this. At a minimum, that is the secondary concern premised upon something else. In general, I don’t think that companies’ profits constitute an inefficiency. They are, in fact, the incentive for providing the product or service more cheaply or better. For the vast majority of products and services, this is the way it works.
The problem is that this model is premised upon well-functioning markets. If the incentives of participants don’t align with the interests of society, you have a problem. Health care is a monumentally fucked up market, so this model doesn’t work.
At its most basic, this is because we are not willing to allow the most basic functioning of the market to work: you get what you pay for, and if you can’t pay, you get nothing. For reasons I entirely agree with, we have decided that health care should not be distributed on this basis. Once you take this step, the free market in health care breaks down. The question becomes what you are going to do to deal with the inefficiencies involved.
I’m of the opinion that the best way to deal with them is to go to a single payer system, for reasons I won’t go into here. One of the consequences of that view is that the profit motive is not the best way to provide incentives in this market. With that premise, the profits of the health insurance industry are an inefficiency to be gotten rid of. They are not, though, the direct issue to be dealt with, merely a secondary consequence of the other goals.
General Winfield Stuck
@David Hunt:
Your snark detector needs adjustment.
ellaesther
@ChrisS: “or threaten same.”
Also: “Raise terror alert.”
Also.
scarshapedstar
What about “the terrorists win” and “nobody could have anticipated”?
Trollhattan
And in yet more healthcare reform news, McMegan is still att it-this time dispensing her unique wisdom to The Economist. Matt Steinglass provides the necessary smackdown.
http://trueslant.com/matthewsteinglass/2009/08/24/yet-another-round-on-health-insurance-reform/
Why won’t she just STFU? She certainly can’t learn as she earns.
jibeaux
@General Winfield Stuck:
I’m thinking he counter-snarked you.
General Winfield Stuck
@jibeaux:
Momma never told me blogging would be so mysterious. Now I’ve been counter-snarked. The Humility. Oh The Humility of it all!
ImJohnGalt
I thought the Repulican Eight-Ball only had one answer:
“All signs point to ‘No’. NO! NO! NO! NO!”
Keith
DEATH TAX!
ImJohnGalt
I thought the Republican Eight-Ball only had one answer:
“All signs point to ‘No’. NO! NO! NO! NO!”
Zifnab
@J. Michael Neal: Single Payer and Public Option aren’t very far apart in a marketplace that refuses to get competitive. If the private companies refuse to lower their rates to reasonable levels, everybody will hop on board the public option bandwagon. If the private companies continue to try and hedge people out, public option will become increasingly more attractive as the default “no hassle” insurance of choice. If the private companies keep trying to cheat the customer, the public option remains the only honest broker and the best form of coverage.
Either the private companies become desirable or the public option becomes de facto single payer as individuals gravitate to it.
Imagine it like the postal service. When was the last time you saw someone send a post card via UPS or FedEx? How many people rely on USPS because the post office is the only mail carrier in their area? What kind of business do you think FedEx would be doing if didn’t have to worry about losing you as a customer even if they regularly lost your mail?
A solid public option will quickly become entrenched and vital for large swaths of the public. And there’s nothing magic about the United States such that if we don’t cover all 300 million uninsured, the program will fail. Just take the 47 million uninsured. Get them paying into the program and you’ve got the largest insurance company in the world. If you can’t run a business on the backs of 16% of the population, why would Single Payer work any better?
ellaesther
@jibeaux: “Snark – Counter-Snark”! It’s the teevee show for our age!
But who would be the hosts…? I’m thinking Joel McHale would have to be one, and maybe, ooh, Kathy Griffen?
Alan
You highlight why I don’t read Frum’s site or any other Right leaning site much anymore. I can’t handle the cognitive dissonance the Right bathes in. Frum, like other supposed moderate conservatives, still pull out the same solutions from the same old stale bag of tricks–and even after the fallout from the banking crisis. Even though Frum and others decry popular RW pundits like Limbaugh or Levin for taking the Right down the wrong road, they still regurgitate the same garbage those pundits peddle. It makes one wonder just how stupid the Right actually is?
scav
never metasnark we couldn’t jump? ohh and we’re off…..
chuck
The Republican 8-ball also has “Because SHUT UP That’s Why”
Also “USA! USA! USA! USA!”
robertdsc
Now we know where the Republicans got their ideas for the infamous “Road To Recovery” plan offered during the stimulus fight.
Meyer
@J. Michael Neal:
@Zifnab:
I agree with both of those comments, but I think we should go about this in a much more phased approach. I think the market incentives are completely skewed and I agree that once we’ve bitten of the apple that affordable healthcare is akin to a right, we’re only fighting over how much regulation we will have, not whether we’ll have it.
What I’d like to see is considerably simpler to pass (IMO) than either single payer or a public option. I’d call it simply insurance reform, and it would consist of ending rescission, pre-existing condition and lifetime coverage caps and enforcing a minimum basic package. This would, in essence, force the insurance companies to cover everyone. Fairly.
It should be relatively easy to pass (who wants to defend these practices? I dare you to do so, republicans. Have at it) and it has NO budget implications whatsoever.
Now we have a cost problem. To handle that, I would simply index the minimum package cost to medicare. Medicare should logically be the upper bound – it is a “bloated public program” (sic) , and it covers the most expensive segment of the population. Surely the insurance companies can beat that?
Then you work like hell to drop medicare costs, giving private company’s access to your cost savings, if negotiated (make them part of the negotiation, really.) Here’s your competition. No need for a new public program to get it.
This part is budget positive.
Take those savings and roll them back into rebates for the uninsured or pass that portion separately. Your choice.
Not as good as a public option, certainly not as good as single payer, but should be very easy to pass and can achieve the same goal.
Leaves profits for the insurance companies (but limits them) which will infuriate various people, but I like leaving a profit motive in there – once we get it properly aligned.
C Nelson Reilly
Obamacare will mandate removing your flag pin before having an MRI.
Roger Moore
@J. Michael Neal:
Another major problem is that there can be a long delay between payment and receiving what you paid for. Unregulated markets are terrible at dealing with that kind of asymmetry, since it’s so easy to collect big money now and fail to deliver care in the future. Solving that problem demands that insurance companies be heavily regulated, to make sure that they remain both willing and able to meet their obligations when called on.
ThatLeftTurnInABQ
@chuck:
Let us not leave out the timeless classic: IOKIYAR
Meyer
@C Nelson Reilly:
Obamacare will mandate removing your flag pin before having an MRI.
Not so. Removing metallic jewellery is before undergoing a scanning procedure involving heavy duty magnets will remain optional – but will be filmed for eventual youtube posting.
EnderWiggin
OT: My idiot home state of NJ, which is run by the mob and has show repeatedly that it can protect or aid in foster care of children with any degree of competency seems to this that Atheists are the problem
http://www.time.com/time/magazine/article/0,9171,877155,00.html
geg6
@ThatLeftTurnInABQ:
And don’t forget the immortal “Drill, baby, drill!”
Loved that one.
Jay in Oregon
@C Nelson Reilly: I saw what you did there.
David Hunt
@General Winfield Stuck:
It’s pretty much as jibeaux said. I simply could not let straight-line like that go by. I rarely come up with anything like a good joke-line that’s still timely when I get around to reading thatit was simply irresistible. Note how long it took me to get back to responding to your comment. It was meant to a yanking your chain in a friendly manner.
As a consolation, I left in all the opportunities for dick jokes that even I can see in the above paragraph unedited. Have at it.
Lee from NC
“Before anyone starts suggesting universal coverage, the American people want to see waste and inefficiency wrung from the current system.”
Yes. When my mother was being treated for lung cancer and the bills were being mostly paid by Medicare, that was my number one concern. I really hated that saving my mother’s life was contributing to waste and inefficiency.
If only there had been some kind of “death panel” to review her case and determine whether or not her value as a human being outweighed the cost of treating her. That would really have put my mind to rest that we weren’t being inefficient.
God, the level of discourse in this country is absurd. I don’t even know which side my snark is hitting anymore.
General Winfield Stuck
@David Hunt:
No sir. As a oft time chain yanker, sometimes me own chain needs yanked. And you yanked mine with skill. My hat is teh off:)
jl
This link is to a bunch of stupid wingnut soundbites. So, I guess they really are offering magic 8-balls.
The current health care mess IS the result of 30 years of attempted magic eight ball market magic. Back in the late 1970s it was called ‘managed competition’. The move to for-profit health care started around that time too. Courtesy of an ideologically driven and unscientific US market fundamentalist US economics and policy establishment.
You see, the non-profit health care system run by clinicians that dominated the market until the late 1970s just had to be inefficient. The magic X demand and supply diagram, marks on a piece of paper that summarize the intellectual heritage of US economic policy wisdom, said so. Change the laws so ruthless corporate money grabbers could control it and run it, and things would look up, everyone would be very happy and healthy, and we all would get rich.
It hasn’t worked out that way. Usually, if you can only make an X on a piece of paper, it is considered a sing of illiteracy, and considered a problem. Among our wise overlords in the US, it is the philosopher’s stone.
Health care reform is heading towards high deductable high copay policies. The new line to further extract money from ordinary people’s wallets for substandard care is a government enforced policy of a 35% copay. Yep, the insurance companies are trying to push the policy that the average out-of-pocket cost share should increase by 10% to 15% , from 20% to 25% to 35%.
With that policy set, the insurance companies will love a mandate that everyone must have coverage. Nothing will be done about their adminstrative waste, nothing done about cartelized industrial and AMA and other professional organizations’ rent seeking from the public.
JGabriel
John Cole @ Top:
This is one of those logic puzzles, isn’t it? Ok, let me think for a minute …
Got it! It’s an Am Ex heiress!
Did I get it right?
.
Zifnab
@Meyer: The problem is two-fold. One, insurance companies cheat. They break the rules and engage in cover-ups. They dupe their customers into buying into bad plans. They drag everything they can into court and generally abuse the system in any way they can find to turn a profit. This isn’t simply a problem of cost or of coverage, but a fundamental problem with the people managing the industry.
Two, regulation doesn’t do much to cover the uninsured. Even if you pass the trifecta – no coverage limits, no rescission, and no pre-existing condition denials – you can’t give a person making poverty-level wages a premium he or she can reasonably afford.
The public option does what regulation can’t. It sets up a baseline plan that guarantees everyone certain minimum standards simply by buying into it. I would argue that all the extra regulation is unnecessary – hell, I’d even embrace the “let’s deregulate the whole god damn market” idea – if I could get a strong public option. Because a government sponsored public choice of health insurance would engage companies at the bottom line.
With the shadow of rescission and the default denial of coverage and the upper limits that don’t rise with inflation, you’re looking at a very unappealing product that people generally don’t want to buy if they think they can afford it. You don’t need to make a bunch of rules regulating the industry when you can just offer a better product.
Demo Woman
This is ot and I have a question, am I being overly sensitive about this line on the Washington Post web site..
The Washington Post which covered Clinton’s penis in dozens of articles and the paper that uncovered Nixon’s crimes is concerned about prolong debates? WTF
geg6
@Meyer:
That’s all fine and dandy as long as you already have health care. But all of it, IMHO, is irrelevant if there is no public option. None of it solves the major problem of health care–45 million people without it who end up costing all of us a large chunk of what we and/or our employers pay for our health care. Only a public option can provide them with quality health care services at an affordable price. You’re crazy if you think any private insurance company will do what a public option can. Your solution of indexing to Medicare is not realistic. The packages they’d come up with would possibly have the same cost as Medicare, but the coverage it would provide would be undoubtedly crappy as nothing else would make a profit.
The public option is the only solution. No half measures. Who cares if the PO is hard to pass? No one said it would be easy. And I didn’t get into this for halfway bullshit legislation that will be tinkered with every year until it is no different than what we have now. If single payer isn’t on the table, then the only way to go is the PO.
Makewi
Which is completely different from the 8 ball used by the other side of the equation of which there are also only 2 responses:
1) Government program
2) Tax the rich (or the richish).
wasabi gasp
A GOP Magic 8-Ball type thing wouldn’t have an eight on it, just a fuse stickin’ out the top.
Sloth
@geg6:
I do agree that a public option is better. I tend to think that we are going to have a hell of a time passing a public option with an individual mandate, and without both haven’t achieved anything. One or the other is a sure loser.
As I said, you setup the minimum plan with a required set of coverage and you eliminate the abuses that exist today. That gets you basic coverage.
You index to medicare to establish a minimum reasonable cost – same thing you have to do with a PO. Nothing new there, you have to establish a basic package and what it will cost to provide. You have to do this with a PO, too – or else a PO will simply turn into the dumping ground for everyone that the insurance companies do not want to cover, at which point you have simply managed to increase their profit margins by assuming all of their trouble cases.
Then you drive down cost. The cost side is handled by driving down medicare, to which everything is indexed.
That leaves getting more people insured. Handle that with subsidies – pass whenever you choose to whatever level you choose, and can be augmented by the medicare savings.
There is nothing in “my” plan which you don’t have to do with a PO.
The benefit of a PO is that it is -possibly- more efficient.
But it is damn near impossible to pass. In my opinion. And the budget effects may be so toxic that it gets repealed and that the dems end up ejected from power for some time to come. That’s my real worry.
Ash Can
@Makewi: Brilliant analysis, Makewi. You clearly have an excellent grasp of the dynamics of the American political system.
And you’re different from the simplistic hair-on-fire left-wingers exactly how? Because you’re smarter than they are, you say? Yes, of course. That must be it.
Tonal Crow
@Meyer:
This doesn’t work without also including premium cost controls. Otherwise the insurers will simply jack up rates to preserve and enhance their profit margins. And even then it won’t work, because insurers will multiply the bureaucratic obstacles to reduce the amount they pay for clients who really need the coverage. If the rescission brutality teaches us anything, it’s that many health insurers have no objections to destroying their clients.
General Winfield Stuck
@Ash Can:
Makewi is just sad that the GOP is currently behind the 8 ball.
I coudnt hep meself.
Sloth
This doesn’t work without also including premium cost controls. Otherwise the insurers will simply jack up rates to preserve and enhance their profit margins. And even then it won’t work, because insurers will multiply the bureaucratic obstacles to reduce the amount they pay for clients who really need the coverage. If the rescission brutality teaches us anything, it’s that many health insurers have no objections to destroying their clients.
You will note that I included those. Twice.
Zifnab
@Makewi: Ok, Makewi, you do make an excellent point. The GOP isn’t nearly so one-dimensional. For instance, in my home state of Texas, Governor Rick Perry is a strong proponent of toll roads (also known as tax-the-poor roads). And if we can all remember back to the Terri Shavio affair, I’m pretty sure the “One Woman, One Law” program didn’t have anything to do with socialization, tax cuts, cutting waste, or deregulation.
Republicans have lots of bad ideas to bring to the table that can be included in the 1) Government Program and 2) Raise Taxes categories. I guess that makes them just like liberals.
Tonal Crow
@C Nelson Reilly:
Not only that, but section 1516887(b)(21)(i) revokes your family’s coverage if you’re raptured. Why does Obama hate Christians?
CalD
What do they call it again when people keep doing the same thing over and over expecting different results?
Tonal Crow
@Sloth:
On second reading, I do see something about limiting the subscriber’s cost for the basic package, but it doesn’t seem to go beyond that. Also, you didn’t address the problem of getting rid of costly and troublesome clients by forcing them into Bureaucratic Hell.
Tonal Crow
@CalD:
Um, “Democratic Party strategy”?
Makewi
@Ash Can:
Who said I’m different. I’m merely filling out the other half of the equation. Which is, in fact, what I said.
I didn’t mention the analysis of the GOP position, although some here seem to be under the mistaken impression that I did.
Sloth
On second reading, I do see something about limiting the subscriber’s cost for the basic package, but it doesn’t seem to go beyond that. Also, you didn’t address the problem of getting rid of costly and troublesome clients by forcing them into Bureaucratic Hell.
Frankly, that’s a detail and a pretty easy one to solve. The simplest way would be to simply reverse liability on any medical charge to be the insurance company first. Another reform which I dare anyone to fight.
Makewi
@C Nelson Reilly:
Not a problem really, since the closest MRI machine is in Cleveland. Unless you live in Ohio, in which case it’s in Boise.
The good news is that if you want a taxpayer funded abortion you have the choice of 32 different locations, and if you wish to quit smoking you can have your very own compassionate government worker follow you around telling you no and smacking you on the nose with a rolled up newspaper when the circumstances call for it.
gizmo
In the end, we are going to get healthcare “reform” that enjoys the enthusiastic support of the corporate health insurers. The gummint will pick up the tab for the most high-risk and expensive segment of the population (senior citizens and veterans and the poor) while the most profitable portion of the market will be conceded to the private insurance industry– people in the prime of life who don’t get sick very often.
Change, my ass…..
Zifnab
@Makewi: You must hang out in a lot of hospitals to know where an entire state keeps its MRI machines.
And, once they get around to repealing the Hyde Amendment, you can actual get one of those abortions. I’ve heard some women have been in line for their government funded abortion for the full 33 years. Almost as long as you’d have to wait in Canada! Amirite? ZING!
Demo Woman
@Makewi: lol My family used to have the gold plated health insurance and the only call I ever received questioning a dr who happened to be Tom Price.
It seemed that he wanted an unwarranted MRI and they just wanted to know if he told me that he owned it. Of course this was before they changed the law preventing these types of things and where is Tom now, of course he is in Washington fighting against regulation. LOL
Ash Can
@Makewi: Sorry. After the GOP budget announcement of last April, I just assumed that’s what you were doing.
Makewi
@Zifnab:
Not a problem, we can get around the Hyde Amendment in the same way welfare reform was repealed, by bundling it into an extremely important and highly successful emergency spending package.
Tonal Crow
@Sloth:
It’s a very important issue, and will become more so if insurers lose other means of dropping expensive clients. Your solution does not account for the insurance “pre-approval” process, under which the company determines whether it will cover a treatment before the patient obtains it. When the proposed treatment is expensive, the company has every incentive to string along the patient until she gives up or dies. It happens often, e.g., http://www.nytimes.com/2008/07/09/nyregion/09about.html?_r=1 , and will take serious effort to stamp out.
someguy
Got to admit, it’s good seeing John shill for higher taxes, greater regulation, ignoring government waste, less competition and more socialism. These are all things we need desparately, just in case nobody has looked out at the wreck that used to be our country – pre-deregulation, tax cuts, and unrestrained capitalism.
Thank God you’ve finally seen the light, Cole.
Now if you could pimp a little bit for people trying to thwart the U.S.’s imperialist ambitions, I might find myself having a Strange New Respect for you.
Demo Woman
@Demo Woman: Oh Makewi let me make one more point, this fine repub that is held in esteem for his views on health care, did ask me what type of insurance I had first before he ordered the bogus test. Cuz I’m a good mom and the phone call from the company made me nervous, I switched to Scottish Rite.
rec
@J. Michael Neal:
I have little empirical data to support this, and I realize that my socialist tendencies are showing, but something Matt Yglesias wrote a while back resonated with me (emphasis mine):
I just don’t see how you typically make huge profits in the ‘well functioning market’ when you have fair competition (of course this is a generalization and I’m sure there are exceptions). If your margins are low and there’s fierce competition you can make a living, you can even do well, but you’re not ‘oil company’ rich, or ‘pharmaceutical’ rich, or ‘financial services’ rich or even ‘medical insurance’ rich.
For that kind or profit you need to game the system. You either have some kind of price collusion, or favorable legislation or resource monopoly or arm twisting. Not that there’s anything wrong with competition, but it seems to me the market hardly ever works like that. If the playing field is level and fair, the profit margins are low, or someone else would enter it and charge less. If you innovate, it’ll give you a bump, but over the longer haul your competitors would come up with something similar. Not that I have any personal knowledge of it, but my instinct tells me you don’t get rich by being fair and playing by the rules.
Makewi
@Demo Woman:
Doctors are greedy. If you don’t watch them all the time they try to steal your tonsils and chop off your feet. It seems fitting that this doctor, which I am sure is a good example of ALL doctors, decided to go into politics.
Zifnab
@Makewi: And the moment we do, I’m getting some chick pregnant and rushing down to stab the baby back out of her.
But until then, your tax dollars are safe.
cbear
Is it really a good idea for us to be talking about “magic 8-balls” where the goopers might hear us?
Do we really want 25% of the population running around all jacked-up on weasel dust—paranoid as a motherfucker, reaching for guns at every strange noise, strung out on booze and hookers, indulging every weird sexual fantasy they ever had, stealing every cent they can find to get more……
Oh wait, looks like they already heard us. Damn.
Brachiator
@Zifnab:
I’m not sure that this is a good example. Was snark intended?
Congress granted the USPS a monopoly over first class mail. You can’t send a postcard via UPS or FedEx unless you send it as a parcel at a much higher cost than buying a stamp.
As an aside, this also indirectly touches on other issues related to any public option vs private health care.
A public option might work if it is innovative enough and flexible enough to offer good service and spur competition. Otherwise the public option will fade away as it becomes ponderously out-of-date. The analogy here again is with the USPS. For example:
The answer here of course is that the USPS has been a victim of social and technological change, gradually dying as a mail delivery service as people stopped writing personal letters and cards, shifting this first to the telephone and later email, and even more so as people shift bill paying and other correspondence to the InterTubes.
So, the USPS monopoly business has evaporated, and the postal service is woefully inefficient, technologically out-of-date and outclassed when it comes to parcel and express delivery service (and Kinkos stole another piece of USPS business). The competitive advantage is all on the side of FedEx and UPS.
Much depends here on how the public option is developed. If it is simply a funding mechanism, but funds a mediocre level of service, then it vulnerable to being picked off by private plans.
Makewi
@Demo Woman:
Well, between you and me, Republicans are the devil and should probably be rounded up and put into camps. The world would be a better place if we all shared the same diverse viewpoints.
rec
Looks like my blockquotes and my emphasis were sacrificed to the HTML gods. I hope my previous comment is still legible. What happened to that little edit button?
General Winfield Stuck
@rec:
Dead as Michael Jackson.
cbear
@General Winfield Stuck: Deader than Novak’s dick.
Sloth
It’s a very important issue, and will become more so if insurers lose other means of dropping expensive clients. Your solution does not account for the insurance “pre-approval” process, under which the company determines whether it will cover a treatment before the patient obtains it. When the proposed treatment is expensive, the company has every incentive to string along the patient until she gives up or dies. It happens often, e.g., http://www.nytimes.com/2008/07……html?_r=1 , and will take serious effort to stamp out.
Well, as it happens, I’ve had that happen to me, so I’m pretty clear on the issue. And I still think this is pretty easy to solve.
We have a broken market. You can fix it in a few ways (republican assertions aside – we’re already breaking the market by assuming that affordable healthcare is a Societal Good.) We can inject competition or we can regulate the players.
There are tons of examples of regulated markets. They work…OK. Ever heard anyone complain about their auto insurance? I haven’t – and that’s a regulated insurance market with an individual mandate.
At the end of the day, though, I do think that the public option is a better plan. I also think that single payer is better still.
I just think that wither one, with the required individual mandate, is dead on the vine. And bears SIGNIFICANT political risk, political risk that is not necessary.
Health care reform is a hell of an important issue. But I think we can get it to good enough without sinking every other progressive goal.
Zifnab
@Sloth:
Then you live under a fucking rock.
Sloth
Then you live under a fucking rock.
It is kinda dark, now that you mention it.
But I’m still not seeing anyone complaining about their auto insurance.
And if a public option is so necessary to regulate an insurance market, where’s my public auto insurance option?
MikeJ
What’s wrong with the Post Office? For less than half a buck send a physical object anywhere in the country in a couple of days, next day in the same city. Honestly, I can’t think of anything that cost as little as a stamp.
Old people really hate the post office for some reason. I doubt you could build a ground up replacement that works half as well unless you were willing to charge FedEx type rates. And of course the federal regulations about mailboxes help a lot.
Demo Woman
@Makewi: Democracy succeeds because we regulate greed. Just remember my story when you see the fine dr. on tv talking about the problem with health cost is to much regulation.
slippytoad
@Brachiator:
Somehow they managed to ship a package for me at 1/2 the price I was quoted by UPS, and they got it there in 3 days exactly like I wanted.
Rumors of the death of the USPS have been greatly exaggerated.
Sloth
Rumors of the death of the USPS have been greatly exaggerated.
I’ve been puzzling about this one myself. Seems to work pretty damn well and be surprisingly cheap.
slippytoad
@Sloth:
Memo: Apples != Oranges.
Addendum: Health insurance != Auto insurance.
El Cid
The problem with all the Savings & Loans is that they’s got too many regulations. If we deregulate them and let them do more risky investment, then they’ll do better.
cbear
Tweety leads off his program with a tease about Holder authorizing torture investigations—and then goes immediately to the big news of the day–“SOMEBODY KILT MICHAEL JACKSON!!!
Oh noes.
El Cid
@cbear: Good. I’d rather Chris Matthews be chattering mindless Beltwayspeak about Michael Jackson than attempting to talk about an important investigation.
Calouste
@Brachiator:
Not really a good analogy is it?
In the messaging realm the options are send a letter, make a phone call or send an e-mail.
In the health care realm the options are live, or die.
Ok, I’ll be generous, there is also the option live in discomfort and pain.
Tonal Crow
@Sloth:
Regulated markets (e.g., like those in retail electricity) can work pretty well. I have real doubts, though, about whether there are enough lawyers at the bottom of the sea to craft the regulations necessary to provide universal healthcare while containing costs and stymieing bureaucratic dodges. I think it’s going to be anything but simple to do, and that, without at least a robust public option, we’ll be right back here in 5 years discussing the insurance industry’s latest tactics for unloading unprofitable patients.
On auto insurance, the product is so much simpler than health insurance, and the stakes are so much lower, that it’s just not comparable.
MikeJ
If your auto insurance company rips you off and refuses to pay, you’re still alive to sue them.
jl
@Tonal Crow: Countries that base their health care finance on regulated private industry have very intrusive regulations, by US standards. For example, if we adopted the Swiss system, that would mean rate regulation, with federal audits of the companies records (all their records, and data, and analysis, in addition to financial statements and supporting documents). It would be a public process too.
That is why I support a public option, I do not think we can get such strong regulation in the US.
Saying something works for the Swiss will make no dent in the US debate. The GOP and our sundry organizational and individual corporate lackies would just start calling the Swiss inefficient, communists with a bad health care system who kill their old people. All evidence contradicts those statements, but that means nothing in the stupified USA.
jl
@MikeJ: And, in the US, even if you were still alive, you could not sue the insurance companies or health plans in state courts, since they are protected from lawsuits for many types of coverage. You could only sue in federal courts, under damage limits that are intentionally designed to protect the insurers. ERISA. Look it up in Wikipedia.
Tonal Crow
@jl: Bingo. We are so GOPed up I’m surprised that we haven’t gone the way of the dodo yet.
Warren Terra
This.
Also, if your car has a known replacement value, and can be written off. I don’t know about your family members, but mine differ in these important respects. Diagnosis and treatment are also easier with cars.
tc125231
@J. Michael Neal: You realize this post is religious –e.g. without empirical support.
There is lots of evidence –and some mathematical modeling to support it, to suggest that markets cannot work efficiently when the seller intrinsically has better information than the buyer. I believe that used cars has been written up as an example several times.
It is pretty obvious that health care fits this model.
So believe in the Free Market Jesus if you want to –but all the evidence from other countues’ experienc e, is that is really the Antichrist you are worshipping.
“I don’t care of it rains or freezes,
long as I got Free Market Jesus
glued to the dashboard of my car….”
Makewi
I still think a shared risk pool is the way to go. Every state has the uninsured covered jointly by all the insurance companies that want to do business in their states. This still leaves open the problem of denied claims, but this could perhaps be handled by some sort of subsidy as a means to defray cost.
Makewi
@MikeJ:
I don’t hate the post office, in fact most times I love them. I had them hold my mail for a week a couple of months ago and they managed to lose all my mail for that period. Well, I don’t know it’s lost, nor do they, they just have no idea what happened to it.
I guess I should be glad it wasn’t my kidney.
JGabriel
Sloth:
Visit New Jersey during a political campaign. Turn on the TV. Wait 10 minutes.
Every NJ election features tons of ads and complaints about auto insurance. Makes me so glad I don’t drive.
.
Sloth
I have real doubts, though, about whether there are enough lawyers at the bottom of the sea to craft the regulations necessary to provide universal healthcare while containing costs and stymieing bureaucratic dodges. I think it’s going to be anything but simple to do, and that, without at least a robust public option, we’ll be right back here in 5 years discussing the insurance industry’s latest tactics for unloading unprofitable patients.
My issue is that you are going to have the same set of issues with a PO, really. You are going to have denied coverage and will need a resolution mechanism for that (yah, call them death panels, call them what you want – they exist today, they will exist tomorrow, we need to control costs and nail fraudulent and/or unecessary treatment.),. payment and billing issues need to be resolved, etc. Probably the best model here is just to extend medicare down, but that doesn’t seem to be seriously on the table.
My primary worries around a PO are about getting one passed and implemented without shooting the progressive platform in the head. Like it or not, the “tax and spend” crap is starting to stick and the deficit is wildly large, even by Krugman standards (even his defense of it is kinda weak.)
A PO will ultimately be cheaper, but the startup drag is going to be large, will involve touching medicare (even if the touch is not harmful) and is easy to turn into boogeymen like “government controlled healthcare! Socialized medicine! Killing granny!”. And if you mess this one up, the potential downside is seriously bad, even in a non-political way.
I think you can craft a proposal that achieves the same goals without all the risk.
Point taken that we’ll need regulation more stifling than we are used to seeing (although we have some pretty serious regs on other industries.)
As for the comparison to the auto industry, obviously it is a simplification, but you have a very similar structure there – required insurance, an individual mandate, etc, and a regulation model which basically works. So I think it’s possible to extend a similar model to HC.
Tonal Crow
@tc125231:
Yes. The inequality of the parties’ bargaining positions, the differences in the amount of information each party has, and the urgency issue all make the health-insurance market a deadly-poor candidate for “free market” nostrums. We long ago recognized that similar issues required extensive regulation of public utilities. Alas, the GOP is doing its best to prevent us from recognizing the need for extensive regulation of health insurers — or, even better, for single payer.
rec
@slippytoad: The frightening thing is that someone could take the same approach and say that the USPS should be closed because it’s losing money, and therefore inefficient.
It doesn’t matter that they provide cheap service that otherwise would not be available. If you want socialized communication you should move to Russia. I’m sure UPS and FedEx would rush to deliver letters to rural bumblefuck. And for 44 cents a piece.
If people can be denied access to basic healthcare, what’s a little postal denial? You may not know it, but government run postal service is nothing but a secret plan to steal your kidneys. Glenn Back told me so.
Makewi
@rec:
Sweetness, you aren’t smart enough to understand my comment. Let’s pretend that they didn’t lose a weeks worth of mail, and instead my fear is that someone will steal my kidney. Because that’s totally awesome. That’s what awesome people would do. Rock on captain awesome.
rec
@Makewi: Makewi, I am humbled by your superior intellect. Yo post office is so dumb, they don’t even keep track of mail. Therefore, having a normal healthcare system means you’d wake up in a bathtub full of ice.
And there I was thinking you actually thought the post office would sell your kidneys. Boy, do I feel stupid.
Brachiator
@Calouste:
@Sloth:
Actually, these are not the only options at all, but I appreciate the drama.
Still, this is irrelevant to my larger point, that a public option does not necessarily insure competition or the delivery of good health care.
By the way, how many people do you know who regularly write letters and use the postal service to deliver them? Just askin’
Sloth — But I’m still not seeing anyone complaining about their auto insurance.
What? WTF? In California, which has, you know, a lot of cars and a heck of a car culture, we had to go through a couple of insurance commissioners before we found one who would not just roll over and do the insurance industry’s bidding. Ultimately, rates were lowered and reasonable regulation imposed again. Until this happened, the public was howling for reform.
slippytoad — Rumors of the death of the USPS have been greatly exaggerated.
You might want to check the pulse again. The postal service is talking about raising rates again, cutting back on deliveries, closing offices and have already started removing post office boxes to reduce the total number.
And my larger point stands. The USPS may survive in one form or another (sorta like AMTRAK), but their primary mission, delivery of first class mail, is becoming as obsolete as newspapers or Reader’s Digest magazine.
I think a public option for health care is a good idea. I just think it has to be carefully crafted. Too many people mumble “public option” or “single payer” as though the incantation alone is the answer to every prayer.
Brachiator
@Brachiator:
Crap! This board definitely needs a public option with respect to editing.
John S.
Wow, and here I thought one could only turn the stupid up to eleven…
And Makewi turned it up to twelve.
CelticTide
There are only so many inalienable rights, rights that one is born with. When you start adding truly alien “rights” to the mix they inevitably trample on subsequent and truly inalienable rights. Read this:
http://www.adamsmith.org/think-piece/welfare/a-short-history-of-the-social-rights-myth-200903253173/