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.
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