In a move that made conservative heads explode and liberals more celebratory than the occasion maybe deserved, the U.S. House of Representatives passed a health care reform bill. This leaves a long road ahead requiring a bill to get past Joe Lieberman in the Senate and then requiring a conference vote when the House and Senate versions are merged. But, still, it’s a solid first step.
The final roll call is here. The bill passed 220 – 215. All five Hoosier Democrats voted in favor of passage. Visclosky and Carson were never really in question. Nor were the four Hoosier Republicans: Burton, Buyer, Pence, and Souder – all of them are consistent in marching to the tune set for them by party leadership. But Donnelly, Ellsworth, and Hill were more open questions. Ultimately, they voted with their party as well. The most radical departure from party discipline was actually Joseph Cao (R-LA), a Republican from a very Democratic district who took the seat be virtue of its being vacated by its prior, criminal occupant, William Jefferson. Thirty-nine Democrats broke ranks and voted against the bill.
The line I’m getting from the conservative blogosphere is that <em>this</em> is what will cause the Republic to fall. (Quoting Star Wars, no less, “So this is how liberty dies . . . with thunderous applause.”) It wasn’t false calls to war, warrantless wiretaps, torture, attempts to suspend habeas corpus, or even expansion of Medicaid that posed such an ominous threat to life, liberty, and the American way. No, it’s the attempt to use government as a tool to rationalize an obviously broken health care system that is the step too far.
I’ve covered this ground before, but briefly, this is why I support government efforts to reform health care:
1. Our system is broken. This is not (as we see perhaps too often) legislation in search of a problem. We spend twice as much as other countries on health care and don’t get more for our money, certainly not twice as much, and possibly less. Current estimates are that something like $700 billion of our current health care expenditures are wasted. And, no, there is no convincing evidence that these expenditures are malpractice related.
2. The market is not well suited to pricing and efficiently distributing health care services. Proponents of free market solutions argue that the current system is not a free market. That’s probably true, but it has more free market elements than other countries that seem to manage to do more with less. And, there don’t seem to be other countries that have had much success with a free market health care system. (Singapore has been suggested as a model with good results and greater than average free market elements. But, from the Wikipedia entry anyway, it sounds like they have a great deal of government intervention with price controls and compulsory savings.) Some problems with market solutions to health care delivery here are that: a) it’s frequently like negotiating with a gun to your head; b) lack of information as to pricing – comparison shopping is all but impossible currently (this one could probably be fixed); and c) lack of information as to what is actually necessary – medicine is complicated and you generally have to rely on the expertise of those who are selling you the product.
3. Costs need to be controlled. Opponents of health care reform say that increased government involvement in health care will bankrupt the country. I suppose it’s possible, but along our current path it seems almost certain. And, the experience in other countries suggests that greater government involvement leads to less, not more, spending on health care. The knock on government financing of health care seems to be more of a matter of faith than evidence. The dogma is that private industry can do everything more efficiently than government and that government screws up everything it touches. (Never mind that we entrust such things as administration of the death penalty and military defense of the nation to this organization that is supposedly hopelessly and inevitably incompetent.) Again, I can point to other countries for examples where health care gets delivered at considerably less cost. Opponents will tell me that other countries’ experiences are not transferable to our own or that the numbers are cooked — but the disparity in spending is so enormous that I cannot believe that the numbers are cooked at that level of magnitude. The International Federation of Health Plans put together a comparison of prices (pdf) for various health care services internationally. The U.S. price bar for a given service consistently and significantly dwarfs those for other countries. (Start at page 5, two examples: a) well-child visits, $88 – $148 in the U.S. compared to $15 – $38 in Canada, France, Germany, & Spain; b) normal delivery, $2,348 – $4,847 in the U.S. compared to $498 – $1,041 in Canada, France, Germany & Spain and $1,601 Medicare.) By contrast, free marketeers seem unable to point to a place where the market is successful in delivering health care more efficiently, mostly citing to theory. (“In theory, it should work in practice. In practice, it doesn’t.”)
4. My theory is that, unless we are willing to follow the market through to its logical conclusion and simply let people die when they can’t pay for health care, we’re going to get the worst of both worlds with half a loaf of free market health care. People can’t and don’t get preventative care or care early on in their illness when treatment is less expensive. Instead, they wait until things are life threatening and go to the emergency room and get the most expensive treatment at a time when their health condition has progressed to a point where treatment doesn’t do as much to help their quality of life as would have been possible with early treatment.
5. Criticism of lifestyle choices is popular among the opposition. I do not disagree that people should eat better, exercise more, and reduce or eliminate things like smoking and alcohol consumption. However, most what I see in these critiques is not a true effort to figure out how to solve these problems, but an excuse for doing nothing. If we can cast the sick person as morally blameworthy as fat and lazy, we can sit back and cast judgment rather than work to fix the problems. If you want to get at sloth and gluttony, we need to do things like reform the agricultural subsidies, impose urban planning requirements that encourage walking, running, and cycling and perhaps even discouraging use of the automobile. Additionally, we probably need to consider limits on marketing that encourages people to make unhealthy choices over healthy ones. And, probably, we need higher wages so there is more leisure time in which to exercise. I’m uncomfortable with the level of intervention necessary for some of these steps. Certainly you’ll not see too many proposals along these lines from the folks citing sloth and gluttony as the cause of our high health care costs.
Probably there are some more points I should raise, but I guess this is sufficient for a Sunday morning blog post. I think I’ll go eat some more bacon so I can develop heart problems and enjoy some of that sweet, sweet, communist health care.
According to crazy Gary at AI, this bill will cost $1.2 trillion to be paid for by borrowing from the Chinese!!! When I pointed out that the CBO says it’ll actually reduce the debt by $129 billion, Welsh replied that’s it’s just shows how incredibly misdirected I am to believe that “rhetoric”.
It’s hard to have a serious discussion of policy when opponents just fabricate facts willy-nilly.
I had forgotten to mention the CBO scoring. I think the trend is that, the closer we get to a single payer system, the less the overall expenditure on health care.
You also forgot to mention that the CBO scoring is required to assume that congress is telling the truth about what they’ll do to pay for this.
When do you expect to see the $500 billion in Medicare savings?
Do you think those savings, if in fact they happen, will have no impact on anyone’s health care?
Do you think this is going to be the shining exception to the fed’s dismal record of predicting the costs of benefit programs?
“unless we are willing to follow the market through to its logical conclusion and simply let people die when they can’t pay for health care”
Yes, we’ll be spared some of those anecdotes. And the people who are poorer from this, and those who die untimely from this, will go unremarked.
We’ll be spared those anecdotes just as we’re already being spared a fair bit of medical innovation – but things that don’t happen because of ham-handed government are not obvious things that one can point to, so obviously they don’t matter.
Will we be be better off in a decade? I’d be ecstatic to be wrong about this – get in touch with me in 2019 with a tale of even modest success and I’ll buy the drinks till neither of us can stand.
I am curious as to how much we have borrowed from the Chinese in order to conquer foreign countries over the past few years. Nobody on the right seems to have a problem with that.
I also notice that abortions are forbidden under the Government Plan. I assume this is so that the military can be assured of a constant supply of warm bodies from poor women who have no other choice than to pump ’em out.
Nobody on the right has a problem with borrow and spend? If you believe this, you have no idea about the right.
I vividly recall the tea party protesting on the right when we went into Iraq without figuring out how to pay for it as well as the vehement condemnation of the Bush tax cuts with no corresponding spending cuts.
The balanced budget fervor is blind to party.
“Donnelly, Ellsworth, and Hill were more open questions. Ultimately, they voted with their party as well.”
They didn’t vote with their party; they voted for the Stupak-Ellsworth-Pitts et al amendment. http://www.tribstar.com/opinion/local_story_311232753.html/resources_printstory
How ironic that 64 Blue Dogs who c/wouldn’t support health insurance reform for millions of living Americans became willing to support reform if allowed to support the un-alive!
I’m one millions trying to survive without health insurance; still, I’d rather see this bill die than see it pass at this cost.
Issue by isue is the very definition of pragmatism and staying true to an ideology is what the conservative ideologues preach. Katies point above is well-taken. Getting to choose to support anti-abortion within the cover of health care reform turns out to be a good pragmatic way to keep with party ideology and still support the independant voters who elected them ,who want health care reform.It makes us wonder what is ideology and what is pragmatism. But it would take a woman to point this out.
Mayeb thereinlies R
Sorry guys, I wasn’t referring to REAL Republicans who actually believe the original ideology, more those who support Big Business at any cost — plenty of those on the left, as well.
Budget balancing seems to be a fallacy that is used to smite down the other side’s ideas. The question is, do we continue to expand the Empire or try to clean up at home with our borrowed loot?
Doug –
Does your vivid memory also include the full panoply of Democrat inspired spending cuts? And how BOTH parties have lived up so well to spending cut promises?
There’s are reason that a majority of Americans would vote to replace the entire Congress as a group, if that were on offer – bad policy knows no party.
BTW, I checked, and it looks like we STILL have the damned mohair subsidy – although it seems to have been interrupted a couple of times, it rises again like the monster in a bad zombie flick. As far as I can tell, both parties share blame on this one – not a huge deal in its own right, but symptomatic of the problems attendant upon the ability to spend other people’s money.
I think we are reaching the point where we are running out of ‘other people’s money’…
I don’t have any real beef with the people who have been yelling about deficits through a series of administrations; criticizing increased spending as well as tax cuts without corresponding spending cuts. But, these folks seem to be pretty thin on the ground.
We seemed to be doing pretty well, relatively speaking, through the latter half of the Clinton administration. At the time, I wasn’t a huge Gore supporter, but thought he was the better choice because I thought Bush’s tax cuts were insane, given that we still had a national debt to pay down. I was assured by my Republican friends, however, that paying down the debt too quickly would be bad for the country. But, not to worry, it would get paid.
Bush came along with his tax cuts and wars and at least the first part of the bailout. He also carried enormous deficits. Libertarians and some small number of Republicans may have been sounding the alarm, but it certainly wasn’t very loud. It galls me, however, that Democratic policy initiatives should be abandoned because of the fiscal mismanagement of the Republicans. This would seem to be rewarding bad behavior.
But, aside from the partisan food fight, I believe that health care reform done properly saves us money in the long term. I understand “done properly” is an enormous assumption and, in my mind, it involves significant government participation. The current health care system is untenable. We spend gobs more money on health care than our more socialist brethren. When Republicans had power, they did nothing. So, they present no real options. Libertarians won’t get power and, if they did, I’m not sure they have a real plan either. So, that’s not an option.
The realistic options are either do nothing or roll the dice on one of these Democratic plans.
Is the Republican plan so far beyond the pale, then? Yes, there is one – it just never seems to get covered.
Me, I’d like to be able to buy a major medical policy from a company in Ohio (or Kentucky, or New York, or Oregon). I’d like to be able to specify what it covers and doesn’t cover.
I’d like to see some real tort reform replace ‘legal liability lotto’.
I’d like to see medical insurance separated from employment – possibly the most unfortunate legacy of WWII, compounded by bad policy decisions ever after.
I’d like to see policy that realizes that when you price something below its value, it disappears.
I’d like our policy makers realize that not everyone can have all the medical care they want, whenever they want. (Sorry – if someone can make this happen cost-effectively, they’ve got my vote. Just convince me that this will make us better off a decade down the line.)
[While I’m ranting, on a related note, I’d like a thank-you card from somebody who got in on the cash-for-clunkers deal or the first-time-home-buyer deal. After all, the government isn’t paying for those – I am. Hey, enjoy your car/house – but offer me a ride or supper at your place, if you want to be gracious about it.]
I’ve pretty much given up commenting on topic of health care reform, because for some reason, it brings out the unfounded opinions like almost no other. Nevertheless, Parker, your comments made me chuckle and prompted a response.
Why do you think you would ever be able to get private insurance, yet get to choose what that insurance will or won’t cover? Why would an insurance company give up the ability to dictate and deny coverage? Even if the insurance companies let you pick and choose coverage, would you be able to magically predict all of your future health needs, just so that you make the right choices? Would you be allowed to make changes whenever some condition or circumstance occurred that you could not predict? Even if you could do that, would your choices be cost effective? Chronic disease management often costs a lot of money. In your fantasy world, would you be able to pay a reasonable premium to cover any and all chronic conditions that may arise for you? If you’re a smoker, all of the insurance companies may choose to penalize you with higher premiums, whether you think that is fair or not. Same thing could happen if you are overweight or obese. Do you honestly think you would have much choice in those circumstances?
As for real tort reform, what do you mean exactly? Are you an attorney? Are you a physician? Can you point to any specific negative effects of medical malpractice litigation on your life? Are you aware that Indiana has limits on recovery of attorney’s fees and fairly low damage caps for medical malpractice? There has already been tort reform for medical malpractice in Indiana, and it has been on the books for years. What alternative system would you propose to replace torts? Do you want to “reform” all areas of tort liability, or only that in the area of medical malpractice?
I don’t know anyone who gets all the medical care they want, whenever they want it. Maybe our senators and congressmen have that, but most Americans don’t, even those with supposedly good insurance coverage.
I’m not a fan of the current bill that was passed in the house. I don’t think it addresses some of the major issues.
That said, I’m sick of the statement I keep hearing about “If they would just have tort reform and allow sales across state lines, everything would be fine!”. I have seen no evidence to support this, but it just won’t die.
Right now, my personal plan is to vote out every incumbent. (Time to run again please, Mike Kole!) I feel the Democrats are being completely corrupt in their health care reform, and the Republicans are completely impotent to come up with a compelling alternative.
Pila –
You may want to re-read both my comment and yours, perhaps without reasoning from your pre-existing conclusions. Just a thought.
Your combination of condescension and seemingly willful obtuseness make a curious blend. Not anything useful, of course, but curious. Perhaps your policy of not commenting on health care reform should be more strictly observed.
You might want to investigate what is meant by ‘major medical’, for one thing – you may be of an age never to have encountered it, though it was once common.
Also, your assumption that I would expect to be able to pick both my coverage AND the price for it is truly breathtaking, although it shows a rather unkind assumption regarding my logical faculties.
I have in mind being able to negotiate for a high-deductible medical care policy, more on the lines of automobile insurance than the current medical mess. [The lack of clairvoyance on my part that you so cleverly detect extends to not knowing in advance whether I will have any fender benders in the coming year, as well – and yet, I can rationally insure against car-related risk anyway! Imagine!]
Jason –
I don’t know what would make it so that “everything would be fine” – if I did, I would share! – but I think there are things that could make our situation better that aren’t being looked at.
Also, per both your and Pila’s commentary on the topic – Indiana is not the entire country, although it’s nice that we, at least, have some of the benefits that tort reform might bring to others.
I’m with you on dumping the incumbents – we need a ‘three strikes’ law for national office, I think. Or perhaps jail – Guantanamo may be empty soon, so there’s that possibility…