So, kiddies. It’s a still, slightly damp morning down here at the other end of the world – the light is yellowed and odd through the haze. The air is redolent of burning eucalypti and, sadly, a couple of hundred houses that went the same way, with more to come it seems. Spare a thought for those poor people, and the brave boys and girls of the volunteer Rural Fire Service.
But for the smoke, which is playing silly buggers with my asthma, I could be as far from the fires as you. My neighbour is pottering in her garden. A kookaburra is eying off the goldfish pond from his perch in the jacaranda. The kids next door are playing a bit too much hip hop for my taste, but it’s not too loud so I haven’t called down the wrath of the local constabulary upon them. (Ask for Constable Reilly – he’s the one with buttocks like a ripe, if slightly bruised, peach.)
I am reading, as I am wont, a scholarly work about healthcare reform, and the politics of healthcare reform. This one was linked to by Backwoods_Sleuth over at LGF. It’s a ripper.
I like to read all political books as if I knew nothing about the author (and let me tell you, with the amount I drink, I’m often not pretending). It’s wonderful. I read a book the other day by a young woman called Ann Coulter that was the funniest thing I had read in years. Who knew Americans could write satire that dark? Or Germans? Mein Kampf. Fucking. Hilarious.
Anyway, let’s see. A National Health System for America. Edited by Stuart M. Butler and Edmund F. Haislmaier. Good solid names, I thought. I imagined them as avuncular, charming types. Maybe a bit fusty, but a good night out if you got a few drinks into them early enough.
Published by the Heritage Foundation. Who doesn’t like heritage? I have a Louis Quinze armchair I’d sell my nephew to match, and that’s heritage. Heritage made me think that Stu and Ed are possibly a little more conservative than me and you, but so’s many of my friends. I imagined that the Heritage Foundation has a nice library, with lovely armchairs, where Ed and I could get happily shickered together on some of his undoubtedly fine scotch while we bantered about inpatient deductibles. It was all quite reassuring.
Now, being your dedicated blog-servant, I have read all 127 pages of Ed and Stu’s little book, and I am pleased to say that you pretty much only need to read the introduction, in which Ed and Stu quite helpfully summarise the whole thing.
Let’s see. Are you sitting comfortably?
Sounds familiar. Not many laughs in there though. Well, if you’re not a Republican, anyway. Then it might raise a few guffaws. A good start though – Our health system is fucked. And has been since at least 1988, apparently. More amazingly, people expected Congress to do something about it. Who would have thought?
And why, pray, is it fucked up?
Yep, that sounds about right. Ed’s actual chapter 1 is helpfully titled, “Why America’s Healthcare System is fucked”, so you get the basic idea of it. It takes 33 pages to say, “It was politics and greed what done it”.
50 years or so of political dysfunction and corporate avarice has left us with a medical system that is second to none, a medical insurance system that operates like a dickensian cheese dream, and a lot of people who can’t afford to access either one of them. This is considered quite odd in countries where people have guaranteed access to good healthcare at a reasonable price.
Now, Stu and Ed, it must be said, seem to have a thing about Big Government which, almost inevitably, means they don’t think much of socialised medicine.
And let’s be frank – they have a point. Big Government always leads to socialism, which leads to Communism, which eventually leads to all of us living in yurts and surviving on potato peelings and all the hooch we can drink. You start out planning a stable, vibrant, free, democratic, capitalist society with universal welfare and instead you end up living in the three feet of space between the yaks and the fish drying racks, and only having parades to watch on the telly.
Moreover, it is clear that socialised medicine doesn’t work, given the many studies which demonstrate that universal healthcare always results in private doctors and insurers being driven into penury, and medical care being reduced to the level of leeches and opening holes in people’s skulls to let the bad thoughts out. Not to mention the seven month waiting list for a good leeching.
We’ll put aside such silly (nay, un-American) thoughts and move on.
“This not only gives conservatives a reputation of insensitivity…”. That’s gold, right there. It’s another of those irregular verbs, Minister – I know my own mind; you are a grumpy old git who hates poors and blacks; they have a reputation of insensitivity.
Thankfully, dear Haislmaier and dear Butler have a strategy that will keep us all healthy and, almost as importantly, our society free of the socialist taint, which they intend to outline in exhaustive detail.
The remainder of the book looks at reform of Medicare and Medicaid, with a focus on state governments forming public-private partnerships to provide healthcare for the elderly, the poor and the chronically ill, before good ol’ Ed finishes us off with a rousing call to arms.
Works for me. A health insurance system where people (or their employers) are assisted to freely choose between a large number of competing providers to buy mandatory cover, backed up with price subsidies for some and guaranteed basic care for all.
I’m trying to remember where I read about something just like that over the last three years or so.
I am, of course exaggerating. Stu and Ed’s proposed system was different to the Affordable Care Act in many details. Despite the sweeping terms used in their introduction, the system they proposed was clearly aimed at protecting people from the costs of catastrophic injuries, based upon the primacy of the (almost) unregulated market, and enforced through tax breaks and vouchers.
Still, throw a few pre-existing condition protections, some minimum standards and a couple of bundled payments arrangements into Stu and Ed’s plan, and you’ve got … well, Obamacare. Even if it whiffs a bit of the gunpowder tang of socialism, it might, at worst and with a little bit of tinkering, form the basis of a future system more to their liking.
You would think, if you were as naive as I’m pretending to be, that while Ed and Stu might have concerns about the mechanics of the Affordable Care Act, they would would be broadly in favour of it.
I don’t think the ACA is perfect. I do think it’s a great stepping stone to an even better system. Something like this one. Or this. Or this. But that’s not going to happen for what, twenty years, the way we are going? In the meantime I will take what I can get.
Only dimwits, weasels or madmen would advocate digging our new system out, root and branch, returning us to the old one (which everyone one of us knows is helplessly broken), in the vain hope of then passing comprehensive health legislation through a fundamentally divided congress jammed full of dimwits, weasels and madmen.
Sadly, Ed and Stu have spent the last few years fulminating at length about how Obamacare will eat the souls of your little babies. Stu seems positively exercised that anyone might think that all this government mandate stuff might be his fault because that wasn’t what he meant, and even if it was he’s changed his mind and besides, he only came up with it in the first place to piss Hillary off.
Don’t Blame Heritage for ObamaCare Mandate
…
The confusion arises from the fact that 20 years ago, I held the view that as a technical matter, some form of requirement to purchase insurance was needed in a near-universal insurance market to avoid massive instability through “adverse selection” (insurers avoiding bad risks and healthy people declining coverage). At that time, President Clinton was proposing a universal health care plan, and Heritage and I devised a viable alternative.
…
Moreover, I agree with my legal colleagues at Heritage that today’s version of a mandate exceeds the constitutional powers granted to the federal government. Forcing those Americans not in the insurance market to purchase comprehensive insurance for themselves goes beyond even the most expansive precedents of the courts.
And there’s another thing. Changing one’s mind about the best policy to pursue — but not one’s principles — is part of being a researcher at a major think tank such as Heritage or the Brookings Institution. Serious professional analysts actually take part in a continuous bipartisan and collegial discussion about major policy questions. We read each other’s research. We look at the facts. We talk through ideas with those who agree or disagree with us. And we change our policy views over time based on new facts, new research or good counterarguments.
Thanks to this good process, I’ve altered my views on many things. The individual mandate in health care is one of them.
Meanwhile, dear old Ed really does have his knickers in a twist, telling everyone who he can make listen that Omamacare is a vile distortion of his beautiful words. Including Neil Cavuto, who I swear thought was fictional, like Damocles or William of Ockham.
No Way Out: How Conscience Gets Trapped in Obamacare’s Little Box of Horrors
Thus, however this particular issue is eventually resolved, the root problem will still very much exist. Given the enormous amount of discretion the law grants to unelected bureaucrats in numerous places, there are likely many other ways that Obamacare can conflict with religious freedom. We have yet to see, for example, how the essential benefits package rules will affect issues related to reproduction, end of life, and parental authority over medical care and testing for minor children.
Indeed, when it comes to religious freedom, the most fundamental problem with Obamacare is that it empowers an overweening federal government—often through a vast regulatory system administered by unelected bureaucrats—to micro-manage every corner of the health care system and everyone who participates in it. Furthermore, from the perspective of the legislation’s authors, this result is, in the parlance of software developers, not a bug but a feature.
When a building is so badly designed and built that no amount of renovation can fix it, the only solution is to call in the bulldozers and start over—preferably with different architects and engineers. The same is true of Obamacare.
Dimwits, weasels and madmen – it’s all the Republican party has left.
All picture quotes:
Starlit
When a building is so badly designed and built that no amount of renovation can fix it, the only solution is to call in the bulldozers and start over—preferably with different architects and engineers. The same is true of
Obamacarethe Republican Party.Warren Terra
Once I realized this was a conjugation, I saw that it was pure gold.
raven
What is this????
Baud
Ed and Stu never said nothing about a black Democratic president.
Baud
@raven:
Monday Night Football thread.
Sarah, Proud and Tall
@Warren Terra:
Stolen shamelessly from the best television show ever written (hence the slightly odd wording). The original was:
Betty Cracker
Genius!
Ash Can
Neil Cavuto has a TV network to sell.
gnomedad
Conservatives are never wrong; it’s just a question of clarifying why they are actually right.
gnomedad
@Betty Cracker:
I hate it when that happens.
schrodinger's cat
@Sarah, Proud and Tall: I loved that show. Too funny, the escapades of Jim Hacker and company.
Ash Can
Here, Stu, let me help you with that…
You’re welcome.
Ash Can
@Baud: Considering the fact that the two teams in question have a grand total of one win between them, I’d say we’re better off without one.
Chris
I love the obsession with “unelected” bureaucrats.
Who elects the bureaucrats making the decisions in private insurance companies, exactly? Who elects their bosses? When you finally decide you’ve had enough of these meddlesome bureaucrats, what’re you going to do – run up the Gadsen flag and elect new CEOs on a “take back our corporations” platform? Whoops, sorry, Wall Street doesn’t work that way.
And ah yes, “religious freedom” – after “states’ rights” and “free markets,” the latest variation of “the rights of amorphous institutions run by unelected elites to trample the rights of anyone they see fit trumps the rights of actual human beings not to have their rights trampled.” It’s so nice to know nothing ever changes.
stickler
Haislmaier? Obviously an Austrian name; probably from Upper Austria, common name construction from the region north of Linz.
And you know who else was from that part of the world and established “death panels?” (No, not Hayek, that’s more of a Slovak-sounding name.) We should have been paying closer attention all these years.
(OBAMACARE IS DEATH PANELS!)
Violet
Good to see you, Sarah! Hope things improve with the fires soon.
Thanks for the post. I don’t have time to read it at the moment, but seems like things never change.
boatboy_srq
Interesting, isn’t it, that both authors of the original text were happy as pigs in mud with what they had written – until that Blah President came along and agreed with them.
Yatsuno
@Sarah, Proud and Tall: I find myself smiling whenever I hear something that reminds me of that show. It was fecking brilliant even if the politics seemed a bit obscure to me. And Nigel was, as always, awesomeness.
Hi dear. I’m suddenly missing the forced vacation. New job, I needs it.
Yatsuno
@Betty Cracker: Florida basketball might just be awesome.
raven
@Yatsuno: It really sucks but the SEC schedule does not have Florida, Kentucky or Tennessee playing in Athens this year. The Dawgs will be terrible but to not have those three teams, all of whom bring a decent number of fans, is really dumb.
Suffern ACE
@Chris: based on the performance of our congress, would we really rather elect our bureaucrats? I don’t think so.
Mike in NC
@Chris:
To the wingnuts these people are also known as “czars” and there apparently are thousands of them working on stuff like confiscating the hard-earned guns of Real Americans and others who’ll force the pregnant teenaged daughters of Real Americans to have abortions unless they convert to Islamofascism.
geg6
@Mike in NC:
I had a guy on my FB page just today clueing me into that very thing. I stupidly engaged him. Won’t be doing that again.
KG
@Mike in NC: and yet, they want to repeal the 17th Amendment, so that Senators are not directly elected by the people… of course, they also ignore that when the 17th passed, most States had already decided that direct elections were the way to go because State Legislatures were 17 kinds of fucked up.
Yatsuno
@KG: They really want to repeal everything past the 12th, and even that one is looking a little funny to them. If you get them really drunk and honest, the wingnuts will tell you all the REALLY need are the 2nd and the 10th. The rest are crushing their freedumbs.
some guy
a bit of good news from this weekend, the Fee Syrian Army, not having received the appropriate fees from the families of the kidnapped, have released their hostages once the ransom money was paid by Qatar and cleared into their Swiss accounts. The Fee Syrian Army, along with their sponsor, Qatar, able to secure the release of Turkish pilots the families of the hostages had kidnapped. On Saturday. the hostages received a heroes greeting in Beirut. hooray.
http://www.dailystar.com.lb/News/Lebanon-News/2013/Oct-20/235127-released-lebanese-pilgrims-get-heroes-welcome.ashx#axzz2iPYSe7e6
Steeplejack
Ha-ha-ha-ha-ha-ha-gasp-ha-ha-ha-ha-ha!
Stop, you’re killing me.
some guy
@raven:
The Gators and the Dawgs never play in Athens. ever. that game is always in Jacksonville, and has been since the 1933.
Villago Delenda Est
I’m not seeing a downside to this, other than what they actually deserve is to be tied to a stake in Death Valley on a July afternoon after being liberally coated with honey next to a fire ant colony.
Drunken hausfrau
Brilliant post. I salute you, in good hard bourbon!
We need a dimwits, weasels, and madmen hash tag.
Yatsuno
@Steeplejack: Hey you can’t say she didn’t warn you…
KG
@Yatsuno: ninth and tenth, though they probably couldn’t tell you what either of them mean… having been in the Federalist Society, and having heard some of the more crazy and/or extreme views, I’ve pretty much come to the conclusion that they’re basically anti-federalists and really want to dismantle the whole system. I mean hell, there’s a movement to bring back the Lochner Era .
Villago Delenda Est
@KG:
They want to repeal the Enlightenment, basically.
Mind you, the US Constitution is a fruit of aforesaid Enlightenment.
Redshift
@Steeplejack: Yeah, do they really think they’re fooling anyone?
Does that include the precedent established in National Federation of Independent Business et al. v. Sebelius, Secretary of Health and Human Services, et al., Stu?
KG
@Villago Delenda Est: not sure they want to repeal the Enlightenment, but definitely the Industrial Revolution and modernity.
Redshift
@KG: Rove talked about wanting to go back to the McKinley era, when corporations pretty much openly owned government at all levels. And yet he’d be upset if we called him a fascist…
KG
@Redshift: well that’s because fascists are liberals, and we all know that liberals are bad…
piratedan
@Redshift: well it’s a pretty sweet set up…. education could be privatized, through the church where there never seems to be a lack of people in the clergy who relish telling their congregations how to think, jobs are controlled by those who own the businesses and there wasn’t much in the way of national interest while there was still frontier to exploit. All rather idyllic for those at the top of the gilded age. Yet they’re attempting to reintroduce that by the usual methods of distraction via culture war and telling folks that they’ll never know Jesus until they march in lockstep with the theologians…
Sometimes I do think that the gulag option sounds appealing but we’re going to have to take a LOT more abuse before we get there.
Spike
@some guy:
Talking basketball here. The SEC effed up their round robin when A&M and Mizzou joined.
pseudonymous in nc
One of the interesting things about being in a country with universal healthcare is that the specifics of healthcare policy are election issues, and voters collectively get to decide the healthcare policy direction they want. Where do you vote to change the people deciding things in backrooms at private insurance companies? By changing insurer? Good luck with that if you’re getting your health insurance through work.
KG
@efgoldman: actually, there’s a contingent that buys into the whole “yeoman farmer” bullshit and wouldn’t necessarily be opposed to going back to that era…
jenn
@KG: Yeah, until they find out just how much work being a “yeoman farmer” actually is.
Steeplejack
@Yatsuno:
I was talking about the Heritage weasels. That was some comedy gold.
James E. Powell
@pseudonymous in nc:
One of the interesting things about being in a country with universal healthcare is that the specifics of healthcare policy are election issues, and voters collectively get to decide the healthcare policy direction they want.
Exactly. I don’t know why people don’t get this.
If a government health care system adopts a policy that does shitty things to people, elected officials lose their phony-baloney jobs, parties lose their majorities.
In corporate world, insurance companies all adopt a policy (no anti-trust protection) that does shitty things to people, there are two or three news reports about it, a couple of speeches, rich big shots pocket the money, insurance companies run lots of TV ads about how much they care about people, puppies, and Our Brave Troops.
RSA
As late as the summer of 2008, Stuart Butler was writing about federalized health care, with mandates, and without mentioning that mandates are a horrible, horrible idea. I wonder what could have happened to change his mind? (Heritage was also pretty big on Romneycare, back in the day.)
Betty Cracker
@some guy: Except when the stadium in Jax was being rebuilt. There was a game in Athens and a game in G’ville.
Paul in KY
@some guy: He is talking about basketball
Paul in KY
@jenn: Your standard yeoman usually yeodied at about yeoforty.
Sad_Dem
Sarah, your entire post is as beautiful as those 80s fonts, as beautiful as big hair and shoulder pads, as beautiful as Pat Banatar.