Rube Goldberg Already Lives Here

The difference is that when the government takes over health care, no matter how bad a job it may do, it will be there forever.  Does anyone believe Social Security is the best way to handle retirement?  Just try doing it a different way.  You'll never get anywhere.  We should do all we can - assigned risk pools, mandating people buy health insurance, nationwide risk pools instead of state pools, etc, before we go wtih a geovernment plan.  In spite of what Obama says, we have not proven that private industry can't do it.  We need to exhaust that alternative before we go to the govenment.

great analysis, as always, but one small gripe. before i send this on to a friend, can a small spell-check be performed?

They can throw out anything they want, and so far nothing whatsoever from them proposes how to deal with Americans who either have crappy insurance or no insurance. Of course, there are many low-income Republicans who suffer from this, too, and that's why the GOP throws out abortion and anti-gay stuff -- to keep these gullibles in line. I can just imagine a terminally-ill Republican saying on their death bed: "Gee, I'm dying because I don't have insuarance, but, oh well, just as long as those gays can't marry.."

lLrger gripe with McDuffy and ischulz:   If a public health system were offered and run as "poorly" as Social Security, the great majority of Americans would vote for it in a NY minute.  I often suspect that's what Republican ideologues REALLY fear. Any bill that does not include a public option plan is likely to do more harm than good. Churchill once noted that ”You can always count on Americans to do the right thing – after they’ve tried everything else”. We have tried everything else on health care. It hasn’t worked. Now it’s time to do the right thing. Over 20 other first-world countries having heath care plans with universal coverage and a public plan (usually single single-payer systems) have equal or better overall health care statistics at costs of 8-12% of GNP compared to our 16-17% of GNP.  Pick one of the others you like the best (Germany, Japan, Canada, France, Norway, Sweden, Denmark, Netherlands, England, Switzerland, Austria, Australia, New Zealand, whatever) and increase the costs by 20% to cover what you don’t like about that particular system and you’ve got a much better system than ours at 20-40% less cost than our present system. The successful models already exist. Tweaking our existing, unsuccessful, rapidly sinking, model is almost certainly the equivalent of re-arranging the deck chairs on the Titanic. Furthermore, making a basic-coverage public system available to all does not necessarily mean the end of private systems. Many countries with successful, much lower cost, public plans cover basic medical needs for everyone. Additional coverage for other, more elective, medical procedures is handled by optional private plans where the total cost of the two is still 20-40% less than ours. As examples, check out the German, French, or Dutch systems.  What is needed is the political will to vote a version of  systems that have worked well in many other countries.

lLrger gripe with McDuffy and ischulz:   If a public health system were offered and run as "poorly" as Social Security, the great majority of Americans would vote for it in a NY minute.  I often suspect that's what Republican ideologues REALLY fear. Any bill that does not include a public option plan is likely to do more harm than good. Churchill once noted that ”You can always count on Americans to do the right thing – after they’ve tried everything else”. We have tried everything else on health care. It hasn’t worked. Now it’s time to do the right thing. Over 20 other first-world countries having heath care plans with universal coverage and a public plan (usually single single-payer systems) have equal or better overall health care statistics at costs of 8-12% of GNP compared to our 16-17% of GNP.  Pick one of the others you like the best (Germany, Japan, Canada, France, Norway, Sweden, Denmark, Netherlands, England, Switzerland, Austria, Australia, New Zealand, whatever) and increase the costs by 20% to cover what you don’t like about that particular system and you’ve got a much better system than ours at 20-40% less cost than our present system. The successful models already exist. Tweaking our existing, unsuccessful, rapidly sinking, model is almost certainly the equivalent of re-arranging the deck chairs on the Titanic. Furthermore, making a basic-coverage public system available to all does not necessarily mean the end of private systems. Many countries with successful, much lower cost, public plans cover basic medical needs for everyone. Additional coverage for other, more elective, medical procedures is handled by optional private plans where the total cost of the two is still 20-40% less than ours. As examples, check out the German, French, or Dutch systems.  What is needed is the political will to vote a version of  systems that have worked well in many other countries.

It's been a busy day over at The Treatment . House Republicans released a confusing chart this morning

THEY DO LOVE THEIR CHARTS.... Republican opponents of health care reform have a new, colorful talking point. It turns out, if you put reform plans into a chart, fiddle with box sixes, arrow colors, and creative fonts, you discover that...

Probably the most infamous example of the GOP doing this?  When the Bush administration was justifying the creation of the Dept of Homeland Security.

At that time, they released a arrows-and-boxes view of all different groups that the DHS would absorb -- the point was to show how all of the pre-DHS "mess" would be cleaned up through the creation of the DHS.  (If anyone has a link, I would love to see it again -- it looked a lot like the chart above.)  When you looked closely at the boxes, you realize how much of a fraud the DHS chart was.  (The point, of course, was you weren't supposed to look closely -- you were supposed to sit back, eyes unfocued, and stare at the crazy lines, and the point would make itself, without the inconvenience, you know, of acutal thinking.)

Anyway, I think we all know how the DHS has turned out -- no matter what you think of it politically, I think it's pretty accepted that it's a bureaucratic mess. both from a funcational point of view and a cost point of view.

Republicans always call themselves fighters of bureaucracy, but -- time-and-time again -- they've been the originators of many a bureaucratic mess.  Dems shouldn't let Repubs brand them with the "bureaucracy" label -- there's plenty of recent history to fight back with.

Actually I do think social security works well, as do the vast majority of Americans. It was fully funded until 2040 - baby boomers and all that - until Bush gave the surplus to rich people.  Gee, that sure helped the economy and our long term stability. I"m sure it would have worked out OK if we handed it all to Wall Street though.

The lesson is, don't let people who have no interest in policy or governing anywhere near health care.

Arguing for the status quo means unaccountable, price gauging insurance companies draining the economy and emergency rooms as a public options - dumb.  

Good for Obama for ceasing to pander to America's tendency to feel entitled to everything for nothing and to hide behind soothing, utopian ideological platitudes when something is hard or takes personal sacrifice.  

What worries me most of all about the current plans -- and I haven't been studying them in detail, so I may be way off here -- is that not enough attention is being paid to the one crucial reform that would make a massive difference to both the general health of Americans and the health of the labor market:  a portable health care benefit system that isn't tied to the employer.  We are the only advanced country that, broadly speaking, pulls someone's benefits when they lose a job or change a job.

This system was a WW2 exigency, and has no raison d'etre now in 2009 -- except that some employers feel they want an extra edge over their staff which they'd lose if health care was a matter of citizenship and not employment status (to put it crudely).  Indeed, what is startling about some companies is their willingness to keep on shouldering a burden that is damaging them economically, just so their workers won't have health care rights that stay with them.  This peculiar desire to "own" health care does not encourage voluntary job mobility.

The comparative job mobility figures are subject to some disagreement, e.g. between US/EU, but certainly the combination of vulnerability to structural change and relatively less impetus for changing jobs is a nasty convergence that makes Americans cling onto bad jobs with reasonable benefits rather than risk a change to better jobs where the benefits are potentially weaker.

I am in favor or universal health coverage in principle, but I am concerned that what is being cobbled together now just might be a gigantic mess.  While it's true that other countries have made it work, they generally designed a whole unified system, while what we are currently doing is adapting a system that is already stupefyingly complex.  It also seems like it is being done in a big hurry, either to have it passed while Obama is still relatively powerful, or to have something that dems can point to and say, "ta-da!"  

Another point is that while universal health care works well in other countries, there may be cultural differences that make it less effective here.  By and large we Americans tend to be wasteful.  We may also tend to be less realistic about death, and insist much more frequently on expensive  treatments that merely prolong suffering at the end stages of terminal illnesses.  And if our waistlines (on average) are indicative of anything, it is that we don't know how to moderate our consumption at an all-you-can-eat buffet;  when we view all our health care as 'paid for', will we tend to over consume that as well?  

Frankly, Medicare demonstrates a pretty poor record of government health care involvement in our country.  Because Congress repeatedly overrode the mandatory adjustments designed to keep the funding in balance with the expenditures, medicare has spent every last penny of the fund that had been building up to help pay for health care in our advanced years.    That's right.  All the money taken out of your paycheck  for medicare  is already gone.  So if you are fifty, and have already paid into medicare for 30 years, the money that was supposed to have built up to subsidize  your expensive geriatric care is completely gone.  Our Congress has proven itself pretty irresponsible.  

Mostly, I just think we need to take this slower to make sure we get it right.  

"Does anyone believe Social Security is the best way to handle retirement?"

Yes actually, many people do. The difference between them and those who think the question answers itself is the possession of knowledge about the underlying issues. Anathema in this day and age given the time required to inform oneself detracts from that which could be devoted to impassioned divulgence of one's particular brand of ignorance, but there it is.

Speaking of which, Republican opposition to health care has not yet begun to approach sincerity. This is largely because Republicans have managed to convince themselves that the manifestly worst value for money health care system on the planet is not in need of reform. This is among the best ways to boil down the corruptness and intellectual bankruptcy of that once going concern.

How about controlling costs???  diagnostic MRIs and CT scans are a definite improvement obver standard x-ray imaging. But why do they cost thousands of dollars. The answer is there are little or no cost controls anyplace in the the medical business.  How else can you pay the huge salaries of medical administrartors like Michelle Obama. The other large piece that is not addressed is tort reform which Obama says is off the table.I wonder why??  Control these two factors and a large part of the problem would be solved. But because of all the pigs at the trough the system will have to be gutted either incremently or at once from the outside. It is broken.

davidlheber:  What has been the experience in the states that have passed tort reform?  I do not believe that such action has had any effect on costs;  instead it has closed the one avenue through which someone who has been wronged (often in a serious way) can be recompensed.

If you want to control the legal costs of the medical profession, it might make more sense to get serious about disbarring the very small number of practitioners who somehow end up in the majority of cases.  And I'm not meaning certain practices such as obstetrics; I mean the individuals for whom there appears no real way to stop them practicing in a negligent way.  

You are correct on the issue of cost controls.  However I believe that large chunks of the current proposals are dedicated to just that.