The Fierce Urgency of Not Later

by publius

Here's the basic dilemma on health coverage reform:  We've got an imperfect bill, but we've also got a brief fleeting window of opportunity.  Given this set of choices, I'd much rather have imperfect reform to nothing.

No one is 100% happy with the bills we're seeing.  Personally, if I could wave a magic wand, I'd begin with the Wyden bill and incorporate additional provisions like the public option.  But for contingent historical reasons (e.g., a flawed Senate), that's not the path reform took.

But remember this -- the bills may be imperfect, but they would accomplish many important goals.  It would be a great and historic success to enact reform that ends pre-existing exclusions, limits out-of-pocket pay, creates exchanges, expands Medicaid, ensures a robust baseline of benefits, mandates individual coverage, etc., etc.  Those reforms would have a huge and beneficial impact on millions of Americans' lives.  We should never forget the human costs of the status quo.

But that said, the bills aren't perfect -- we could draw up a better plan.  The problem with waiting, though, is that the political window of opportunity isn't open for long.  I'm over my quota for Wire references for the month, but I'm skeptical that our institutions are capable of passing reform anytime soon once this brief window closes.

It would be different if we were slowing things down to get a better bill.  But the political reality is different.  We have a finite amount of time, and (IMHO) not enough time to start over from scratch.  If reform dies, it will be many many years before there's another serious effort to do it.

So that's the dilemma -- pass the imperfect bill now, or wait and pass nothing for many years.  And because any of the current bills are far superior to the status quo, I say pass reform now.

Also, adopting isolated improvements in the future will be much easier than trying to pass comprehensive reform.  Think about the "new" Wyden Plan -- I could easily imagine adopting this bill a few years down the road to reform the exchanges if costs are out of control.  That's an isolated fix -- you wouldn't be juggling 8 million different chainsaws. 

Same deal with the public option, or even reforming the employee benefits exclusion.  To me, it seems infinitely easier to pass one of these provisions in isolation (maybe even through reconciliation) once the heavy lifting of reform is finished.

So let's keep perspective.  Even enacting the bills we've seen would be a great day for American families.  And though it would be nice to enact everyone's personal fav, the fleeting political window makes that unrealistic.  Let's do the hard stuff now, with the knowledge we can fix other things down the road.

Comments

[ceenik]

Hear! Hear! It's time to go while the going is good!

[CharlesWT]

"Let's do the hard stuff now, with the knowledge we can fix other things down the road."

Problem is that the current bill(s), if passed, will develop constituencies that will fight tooth and nail against them being fixed down the road.

[Warren Terra]

Charles, you are probably correct - but I still think that the hard thing is to get a plan in place. Once that has been accomplished, the calculus changes. There are people who currently are fighting to prevent anything at all from being accomplished (either because they prefer the status quo, or they benefit from the status quo, or they benefit politically from a lack of accomplishment), but once there is a system in place it might be possible to get them to vote on its reform.

We need healthcare reform, because we need some system in place that guarantees everyone has access to insurance. I believe that we should go with a single-payer system, but I also believe that a robust "public option" could in theory achieve some of the benefits of single-payer (wide access, governmental interest in controlling costs) while perhaps retaining more options. We might even see the free market do something constructive in the provision of health care, though I'm not aware of much evidence that there's a precedent for such a phenomenon.

The point is, our current system works for almost no-one: it costs more than anyone else's (50% more than most industrialized countries by GDP, 100% more by dollars), it doesn't achieve better results than other comparable countries get, it leaves a staggering number of people scrounging for charity and miracles and dependent on emergency care, and because our healthcare costs are going up higher than anyone else's these problems will only get worse. And the system doesn't even work for many of the people who are getting good care under it, because more and more jobs are losing their benefits, and the attachment of health care to employment locks workers in those jobs that still have them. The only people who really make out are those with enlightened, insulated employers (i.e. civil servants) and the elderly, who already have Single-Payer. Moreover, no-one can see any way to change any of these problems without major reforms.

So, yes, not great bills. Yes, constituencies will fight against changes that might improve the new system. But even a bad new system will still be better than what we have now, and - unlike our current system - most of the new systems being envisaged contain elements that could be altered to achieve further improvements.

[peggydaly]

i understand the appeal of getting things done now vs later but i don't understand "must be done by the august break or it won't get done for many years". obama has been in office 6 months. why is it such a monumental failure if it takes a few more months? i know the origins of this phenomenon are political, but i'd like to understand it better - rather than have it stated as fact. if someone has a helpful link....great.

[Tony P.]

Well, the status quo has a well-developed constituency that's fighting tooth and nail, now, against it being fixed down the road.

If ANY of the "slow down" crowd were proposing an alternative deadline, I would be willing to consider it. But when Obama proposes August, and the counteroffer is not "October" but "What's the rush?", I get annoyed.

I know, from personal experience, that designing a complex mechanism can ALWAYS be done better. There's ALWAYS a basis for saying "I need more time to get it right"; there's ALWAYS some feature that can be improved. The point of setting a deadline is: you decide WHEN to call the design finished, and settle for the best design you've got by then. A good engineer stands ready to say, "I need X more weeks to get this done." A lousy engineer says, week after week, "I need more time." Lousy engineers never design machines that fail to work, because they never get around to it.

--TP

[logopetria]

peggydaly: I think the concern is that if a several week (month? how long is recess?) gap is inserted into the process, the lobbying machine will take this as an opportunity to get out a barrage of propaganda targeted at wavering votes, and any majority that reform might have today will have withered away by the time they return.

[Kastanj]

The blue cross democrats know they will be struck down in 2010 if they don't vote for the bill when it comes down to it. But if they stall as much as possible then they'll not only lose in 2010, but will also drag their party with them.

Assumed in both scenarios is that their constituents will be the one taking the harshest blow, undeservedly.

However, if they can ruin the bill by the time they have to vote for it, then they'll escape the ire of their voters, their party and their insurance company financiers, while simultaneously disappointing all of them.

That's the only "reasoning" that makes sense for these blue crossers, if only in a despicably instinctive and selfish sort of way.

[peggydaly]

i really appreciate the responses. this is where i'm coming from: i've worked at smallish I.T. companies and understand how long it takes to get a solid release out the door. i know how incredibly important the requirements phase is. the releases i've dealt with directly effect fewer than 10k users for significantly-less-than-life-saving applications. was the august deadline sign-off ok?

this reform is HUGE. i'm not certain that an SDLC analogy totally jives. how significantly can one change the requirements after the "sign-off" (aka "vote")? again, i really want to know. i don't know how hard it will be to tweak it with point releases.

if the major players said "we are IN - we are NOT letting this go away - we are going to keep making this happen" and then they kept their word - wouldn't that be OK? who is to blame if momentum withers away after a month? is it them? is it us? the media? by all accounts health care reform is very important to people in the US. who's fault is it if we can't sustain a push THIS important for that long? and why is that OK? and why don't we have a problem with this pathological legislative A.D.D.?

that's a lot of questions, eh? i swear i'm not just trying to be contrary.

cheers, peg

[Warren Terra]

peggydaly, one issue that I don't think I've seen explicitly mentioned is the electoral calendar: Congress typically gets much more done in odd-numbered years because members need to spend more time at home campaigning and in various places fundraising in the even numbered years - and beyond that they tend to be less willing to back sweeping legislation that might affect the support they (or their opponents) get from constituent groups and less obviously appealing special interests - such as the industries that can fund their campaigns.

Now, September is still 2009, but as unlike August September is within the Fall, and the next election is Fall 2010, the minds will already be refocusing. And if the deadline slips out of 2009 entirely, the effect of the 2010 elections will only increase.

So, while the main point is probably the one mentioned upthread that if the deadline is allowed to slip it will only become easier for it to continue slipping, the time period into which slippage constitutes failure may be sooner than we'd like to think.

[cosanostradamus]

.
"Healthcare" isn't going to fail. It's never going to be given a chance. That will result in the biggest house-cleaning Congress has ever seen.

Americans have made it clear what we want. Corporatists in Congress have made it clear that we're not going to get it. If this is still a democracy, then they're out. If not, an even bigger house-cleaning is overdue.

However it turns out, we're not going to fail.
.

[low-tech cyclist]

One thing that gives me a certain amount of confidence is that anytime after October 15, the Senate can take up health care under budget reconciliation rules.

Which means that they don't need Ben Nelson or Blanche Lincoln or Evan Bayh anymore. If the House can give us a bill before recess, getting the House Blue Dogs out of the post-recess picture, I think we're good.

[Warren Terra]

low-tech cyclist, my understanding is that, other than whatever political significance gets attached to it, using Reconciliation has some drawbacks: measures passed using Reconciliation must be budgetary (which may mean leaving out some non-budgetary aspects of the legislation, according to the Byrd rule), and must expire before a set period of time (which is my recollection but isn't mentioned that I could see in the Wikipedia article I linked, so may be wrong).

Now, I'm ignorant as to the actual status of the Byrd rule - I don't know whether it's really binding, and in particular I don't know who decides what measures can have their eligibility for Reconciliation challenged, a challenged that can only be overcome with 60 votes. But is does appear that bills eligible for Reconciliation may have some unfortunate limitations compared to normal bills.

[DecidedFenceSitter]

Peg,

"and then they kept their word - wouldn't that be OK? who is to blame if momentum withers away after a month? is it them? is it us? the media? by all accounts health care reform is very important to people in the US. who's fault is it if we can't sustain a push THIS important for that long? and why is that OK? and why don't we have a problem with this pathological legislative A.D.D.? "

If we could keep let them keep their word. You say you work for a small IT company. Ever have a CEO who didn't like a plan for reasons that he kept to himself, so he kept throwing committee, after committee to study it at it, until the push to change went away.

We're human, we're designed to hunt animals, not numbers.

So as to your second question? Many of us DO have problems with the pathological ADD of legislation, but there's little to be done, because "many" doesn't make up a large percentage of the population. Activism is hard and intensive, and takes a lot of thought and action behind it. So it is difficult to maintain focus for long periods of time. People get burnt out trying, dejected, and just disappear for a time.

[Brett Bellmore]

Essentially, the only reason you've got a brief, fleeting window of opportunity, is that it's understood that this bill can't pass on it's merits, and after due consideration in the cold light of day. That it's only chance to pass is to be rammed through before anybody knows what's in it, and has a chance to think about it.

When I start reading the fine print, and a salesman tells me that I've got to sign, NOW, or the deal is off, you know what I do?

I walk away. Because that's always an indication that I'd be a damned fool to sign.

Come back when you've got reforms that will still be able to pass after people know what's in them, and have had a chance to think about them.

[GoodOleBoy]

I've been away from SDLC quite but I spent much of my work career right in the middle of it. Usually, in the SDLC interested parties agree on objectives and work requirements to meet those. Most painful parts are frequently costs and delivery schedule. In most cases, disputes don't revolve around lack of agreement on basic technology to be used and even when that is an issue, oftentimes the split in support is so unbalanced that it is quickly resolved. Those occasions when there are major competing technologies and the support is split so that there is no majority because of undecideds is where the analogy might get close. In my time a big one visible to common people in the marketplace was VHS and Betamax. I'm sure there were many headaches and late nights over that one.

In healthcare reform, the competing forces are formed around political philosophies albeit with a lot of noise that interferes with efforts to understand and get clarity. For purposes of this comment assume that the agreed objective is healthcare for all but we are not yet agreed on requirements nor on how to do it. Majorities may exist in pieces of the puzzle but not yet broad enough to put the parts together. DecidedFenceSitter makes a good point that 'many' don't make a majority but can influence matters through activism. This is probably the biggest peacetime political issue of my adult life where the voters have to make a political choice about how to accomplish an objective. Civil Rights was big but that was truly a question of right and wrong and what was already guaranteed in the Constitution, and not one of political choice.

I thinks what frustrates many of us who are actively interested is that what should be only noise influences, like health insurance providers for one, are actually dominating much of the issue.

[Hartmut]

I would go with Sebastian's proposal to not go into recess before the work is not done* .
And for those that say this is a rush:
Senate and House still have to reconciliate their bills and to my knowledge there was no push to do that before the recess. The idea was: let both Senate and House come out with a bill now and do the harmonizing/conciliation/whatever you call it in the fall. If there is nothing now*, then
a) there will be months for the propaganda against any reform more or less unopposed
b) the final bill (that Senate and House can agree on) will not be done in 2009 and therefore likely not at all.
I'd say lock them into the capitol building and leave food for not more than 3 weeks (water for 5) and don't let them out before the work isn't finished and they can send the white smoke (of the paper of refuted amendments) up declaring "Habemus legem".

*I hear from the news that that has failed already

[Brett Bellmore]

"a) there will be months for the propaganda against any reform more or less unopposed"

What, proponents of health care reform have no access to the media? They can't present their side of the matter to the public? What nonsense!

You're not afraid of months of one-sided propaganda, you're afraid of public debate.

[mightygodking]

You're not afraid of months of one-sided propaganda, you're afraid of public debate.

Nobody who seriously wants healthcare reform in the United States is afraid of public debate. The thing is, such a public debate would involve two sides willing to engage in honest argument. The Republican Party (and most of the Blue Dogs) are clearly not willing to do this.

[Nate]

If the current health care/insurance situation were a bill up before Congress, no one would vote for it.

For health care reform, it should be mentioned that the Republican party is SPECIFICALLY trying to delay the bill in attempt to kill it. They're not trying to come up with alternatives, improve the bill, or anything like that. Their simple math is delay = kill the bill = no health care reform = screw Obama = 1994 all over again = PROFIT!

[GoodOleBoy]

I view the push to vote bills out before the August recess as mostly coming from the 'hard left' and the explanation for that is those people know what they want and fear they won't get it if voters become aware of what's in the proposed legislation. Here's why I think this. Most of the problems we have with uninsured and with health costs for the insured have not just surfaced recently, although surely worse with the economic downturn. We undoubtedly have a significant majority of voters who want reforms that will provide healthcare to all at more reasonable costs but that does not mean we have a majority that supports bills as now formulated. Let's see what happens during and after the recess.

[Nate]

GOB: No, they haven't surfaced recently. In fact, they've been with us for years. Of course, so has the idea of health care reform and universal health care, (at least 50 years) which every other industrialized nation has managed to handle.

[GoodOleBoy]

Nate,

Tell me something I don't know. Besides, not all (excepting, of course, the 'hard left') accepts the so-called handling of the healthcare problems in other industrialized nations.

[GoodOleBoy]

accept

[Hartmut]

Well, yes, from the US perspective all other 'civilized' countries (as if there exists any civilization outside the US) are hard left (even if we do not subsume the fascists under 'left'). Even Maggie the Mummy was a commie bitch on that for fear for her neck.
[Drat, another acid hole in the keyboard.]

[GoodOleBoy]

Hartmut,

Exactly which segment of the political spectrum do YOU think is pushing hardest for vote NOW?

[russell]

"excepting, of course, the 'hard left'"

Look, there is no organized political community of any influence in this country that remotely resembles a "hard left".

Maybe d'd'd'dave, with his proposal for a national single-payer solution. But even that is middle of the road by any realistic standard.

My personal opinion is that nothing of use is going to come out of the health care reform effort. We're going to end up with something cumbersome and expensive, that won't actually solve the basic problem.

Dave's single payer idea, and Seb's proposal to simply extend Medicare to uninsured folks, make sense to me as reasonable short-term plans.

Then, circle back and start what will certainly be an arduous and long-term effort to reduce costs. Because the long-term viability of any plan we can come up is going to require cost reduction and containment.

But I'm having a hard time understanding exactly what the proposed legislation consists of.

[Nate]

GoodOleBoy: Funny, 'cause the people who live in those countries pretty much universally like it. And most statistics show they get better results than we do, for a lot less money. But obviously the foolish rest of the world doesn't have any experience with this sort of thing, I guess.

And man, I really wish there WERE a hard left in this country, it'd be a hell of a change.

[GoodOleBoy]

russell,

I didn't say what I meant exactly right. The 'hard left', organized or not, I'm sure accepts socialized medical approaches in industrialized nations. Conservatives in the US, not so much. Others, those between these extremes on this issue, probably are mixed in their views. None of this labeling can be used to adequately encompass those who think our healthcare system needs major work.

[TJ]

No public option, not worth doing. Besides, no public option, you'll lose what passes for the left in the Dem party and most of the young voters and the Dems get massacred in 2010.

[von]

I disagree, Publius. I hope to have a front pager on this one. But, briefly: It's a tactical mistake to entrench an interest with the expectation that, later on, you'll get rid of it. No, you won't: possession is nine tenths of winning.

The fact of the matter is that HR 3200 is a bad bill and moves in the exact opposite direction to where we should be going: we should be severing the link between health care and employment; HR 3200 strengthens it. There are better bills on both sides of the aisle that cost less and do more.

[Woody]

Here's the best you can expect from the current 'compromises' available, imho:

Mandatory coverage paid for by you, including drug coverage. That would be with no caps on cost for the premiums, no caps on co-pays, widening the donut hole in the drug coverage (like now, only after the "reform," they pay 80% of the first $1500.00, you pay the next $7000.00 out of your pocket, and they might pay 20% of your remaining drug costs for the year, but only if they feel like it). But in spite of the mandatory purchase of the insurance, there will be a life-time cap on the benefits you can receive. Once you meet this threshold, you must continue to pay for coverage, even though you will not get any.

[Point]

For me, the two key posts on this thread are peggydaly (4:24) and DecidedFenceSitter (5:44) -- and while Decided raises a good point, I still think Peggy gets it right.

We've come so far already -- the HELP committee has already reported the bill, Pelosi has already said that the House version (HR 3200) will be voted on next week. No other HCR since Medicare got this far.

And how much further do we need to go? If the Senate votes on a health care bill this September, that will leave at minimum one month, and as much as a quarter year, for the a conference committee to report out a bill, and for both houses to vote on it. And if the less the conference committee has to work out, the less time they will need.

Given the progress we have already made, I, for one, am not ready to throw in the towel just because this bill probably won't pass before August recess. As a former activist myself*, I know the people knocking on doors, raising awareness and money, are perfectly willing to keep this up for another month or so. Bring it on!

*FTR, I only left b/c I got a great opportunity on the hill.

[Point]

Also wanted to weigh in on this:

"It would be a great and historic success to enact reform that ends pre-existing exclusions, limits out-of-pocket pay, creates exchanges, expands Medicaid, ensures a robust baseline of benefits, mandates individual coverage, etc., etc."

Aside from limiting out of pocket pay, I agree completely.

[Catsy]

this reform is HUGE. i'm not certain that an SDLC analogy totally jives.

I work with SDLC (and Agile) as well, and I'm fairly positive the analogy is as inapt as could possibly be.

Legislation isn't--and can't be--written in a way that conforms to concrete milestones, or that lends itself to an iterative process. There's all sorts of numbers you can crunch and studies you can dig up, but in the end there's just no way to test the product until you ship it. The making of laws is, so to speak, always tested in production.

I'm not saying that's ideal, just that in most cases I don't see a meaningful way to adapt software design principles to legislating. Hell, they can't even achieve consensus in the concept phase.

[Nate]

von: "here are better bills on both sides of the aisle that cost less and do more."

Such as? The Republican "Waterloo" bill? The Republican "Declaw Obama" bill?

The Republicans have stated, repeatedly, in public, that their only interest is to kill this bill and keep Obama from passing any kind of bill, because it will give them a political victory and keep Obama from fulfilling a major campaign promise. They aren't interested in any kind of reform, and have no alternative bills. Trying to pretend there are "bills on both sides" is willfully ignoring the Republican Party's stated goal of obstruction.

[DecidedFenceSitter]

To follow up to Nate, WashingtonMonthly's Republican's On-Again, Off-Again Plan.

[russell]

"The 'hard left', organized or not, I'm sure accepts socialized medical approaches in industrialized nations."

That would be me.

I guess the point I'm making is that what you're calling the 'hard left' is, by any standards that include the rest of the world, somewhere between middle of the road and mildly conservative.

I recognize that US conservatives generally don't consider an international standard to be particularly relevant, but IMVHO it's a useful thing to consider, simply as a reality check.

The fact is that many peer nations of the US take a frankly socialist approach to health care, and it works for them at least as well as what we do here does for us, and does so at a dramatically lower cost.

If the UK NHS gives you the willies, you might want to consider the French system.

Also IMVHO, the reason we are not making good progress on resolving health care issues in this country -- which is to say, the reason that a decent, basic level of actual health care is not available to a significant minority of the population -- is because of the ideological resistance to having the government operate anything that the private sector is willing to take on.

Regardless of whether the private sector does a good, bad, or indifferent job.

You're quite right, I, and folks with a point of view similar to mine, don't share that resistance.

The government delivers my mail, paves my roads, gets water to my tap, makes sure that the food and medicines I buy are reasonably safe and wholesome, makes sure that my doctor, dentist, carpenter, plumber, and electrician are licensed and do their work according to best practices, etc etc etc.

And it does a damned good job at all of those things.

The way we deliver health care in this country makes expensive, highly technological procedures available to some folks, makes nothing except ER care to others, and insures that no geezer will go without his boner. A huge portion of the population is obese, people contract easily preventible chronic illnesses regularly, and the nation ranks at the poor to middling level in many if not most signficant measures of public health.

I'd be delighted to give the government a crack at it. I doubt they would do any worse.

But that ain't gonna happen, because it will accurately be termed socialist, and that will be the political equivalent of two in the hat.

I mean no criticism of you when I say this, but the fact that an openness to the kind of socialized medicine that is as common as air in the rest of the world qualifies as a 'hard left' view is, in fact, no small part of the problem.

[Steven]

Reform is something that people want. However, I don't believe that a majority of people want the reform currently being offered. If you want to remove pre-conditions or lower co-pays, why not create tax break incentives to insurance companies or tax penalties to those who continue to use them? This would seem to create a better "competition" than some big mess of a government run plan.

Also, to Russell, all of the things you mention that a run by the government, aside from the post office, are run by state governments, which is generally a more palatable idea to most people. Further, the idea that "they do a damn good job," you must have never been to the post office before.

[Nate]

I have almost never had a problem with the Post Office in my entire life, yet people continue to slander them. The closest thing I've had to a real problem is if they had a long line because they can't hire enough clerks for the busy periods. Which is the same basic problem people often have with the DMV. The only notable time I had much problem and a wait with the DMV was right after there'd been budget cuts and they had closed a couple of offices, in a misguided attempt by the legislature to save money.

Which seems to be the Republican's attitude toward government, screw it up and underfund it so it doesn't work well, and then point at your own incompetence as evidence for how government can't do anything right.

[Catsy]

If you want to remove pre-conditions or lower co-pays, why not create tax break incentives to insurance companies or tax penalties to those who continue to use them?

Because in order to have any meaningful effect, they would have to be so steep and draconian as to rival FCC fines. This is their bread and butter.

Further, the idea that "they do a damn good job," you must have never been to the post office before.

"Been to?" Let's skip past silliness like complaining about long lines during peak hours (hardly a unique experience at UPS or FedEx either), and look at the big picture. For under a dollar I can send a letter or small package up to 3.5oz across the state the next day, or across the country in another day or two. For flat rates of ten dollars or less I can send whatever fits in a variety of box sizes--regardless of weight--via Priority Mail, which will be delivered in 2-3 days.

UPS and FedEx have nothing comparable to the reliability, speed and price of First Class USPS mail. And the services they offer which are comparable to Priority Mail are not even remotely in the same price range, even when you add things like delivery confirmation.

Yes, I realize this is because the USPS is government-subsidized (funded, really) and therefore doesn't have to worry about making a profit. But that's my point.

[russell]

"all of the things you mention that a run by the government, aside from the post office, are run by state governments, which is generally a more palatable idea to most people."

Actually, it's a mix of federal, state, and local.

If we want to provide health care through state and local government, I'm fine with that.

"Further, the idea that "they do a damn good job," you must have never been to the post office before."

I was in the PO yesterday to ship some stuff I sold on ebay.

I like using the PO because they're competitive in price with UPS, they're just as reliable, I've had a better experience with them as far as not having stuff damaged, and there's a PO 2 miles from my house.

The nearest UPS dropoff is about 10 miles away. I can use a "UPS store" or arrange a pickup, but both come with a surcharge.

The PO is a bit slower than UPS, usually by about a day, if I'm shipping more than a couple hundred miles. So, if that extra day is critical, I'll use UPS. Generally it's not.

The line at the PO was moderately long, maybe 5 or 6 people in front of me. Most of them were shipping packages, so a little bit of customer service was required. There were two clerks on duty.

I was in and out of there in about 10 minutes, just long enough to catch up with a friend of ours who was also in line and had just got back from traveling.

We did used to have a cranky kinda deaf guy working at our PO but either he retired or they took him off of customer desk duty. Of course, cranky staff never show up in private organizations.

I got no problem whatsoever with PO. UPS is great, too, don't get me wrong, but for the reasons given above I prefer the PO.

[Eric Martin]

This would seem to create a better "competition" than some big mess of a government run plan.

The problem is that private health insurance providers have the wrong incentives, and are generally less efficient than the government at providing health insurance.

Administrative costs are higher for private carriers, they spend much more money on advertising, they are concerned with profit which is itself a block of money that comes off the top, they spend money figuring out who to cover and at what rate, they spend lots of money trying to kick people off the rolls once they get sick, etc.

That last part is pretty big in terms of the incentive argument. Private carriers view payment for health care as "losses" - that's their word, not mine. So like any good profit driven venture, they look to cut losses. Which means deny care to people. It's a question of goals.

[Adam A.]

I disagree that the house bill won't weaken the link between employment and health coverage. Even though the tax exemption on the employer contribution won't be removed, the existence of a public option basically give America the opportunity to get used to the idea of non-employment based coverage. If a person's employer fails to cover them, or that person loses their job, they can get on the public option. Once they move to a new job, if the public option is at all decent, that person will want to stay on it simply for the sake of convenience. Over time, this would weaken the connection between employment and coverage. Later, if the public option experiment has been successful, Congress can take up further reform to take us the rest of the way.

[ral]

There's much more wrong with health care in the U.S. than inadequate insurance coverage. Have you visited an emergency room lately?

[Dissing the Post Office *sheesh*. Remember the scene in Miracle on 34th Street where the New York DA stipulates that the Post Office is efficient and authoritative?]

Eric Martin: The problem is that private health insurance providers have the wrong incentives, and are generally less efficient than the government at providing health insurance.

The perverse incentives are close to the root of the problem, I think. Let me share an anecdote.

I spent a great deal of time in emergency rooms recently during my mother's illness. Not only is the emergency room the provider of care for the uninsured, it is the admitting facility for many insured cases. A patient in acute distress spends hours on a gurney in a cramped space, surrounded by noise and clutter, with limited or no place for family or friends to sit, waiting for a bed.

After admission, despite strong support from a caring family and close friends, with almost continuous company and advocacy, including one son who is a physician, my mother experienced medical errors, incorrectly executed tests and severe pain that could have been avoided.

This was in a hospital renowned for its high level of clinical care, with a staff that seemed uniformly to be dedicated, professional, and caring.

People working in the medical system are acutely aware of the disaster it is currently in and many will share their frustration with the least (or even no) prompting.

Private insurance is one big issue, and may lie at the root of many other symptoms, but it is not the only problem.

[malraux]

Yes, I realize this is because the USPS is government-subsidized (funded, really) and therefore doesn't have to worry about making a profit. But that's my point.
The USPS is self-funding; ie it isn't government funded. It does get money from the government to pay for free and reduced rate mailings, but that is effectively to government paying for the mail that it sends out. The largest benefit it receives from the government is its monopoly power.

[Catsy]

The USPS is self-funding; ie it isn't government funded.

And it's been running at a loss for a long time. Hence why the first word that came to mind was "subsidized".

[D'd'd'dave]

In my experience from making business deals, the best way to achieve a goal is to first align everyones interests. I think that putting everyone in the same boat goes a long way towards aligning their interests.

If everyone has the same insurer and everyone pays the same premium (see the caveat I carved out for youth and the poor) then the interests of all the 'cared for' are aligned. If reform which is ONLY that is sold to the public, it will pass.

Once it is passed, it is an easy step towards cost reduction. Cost reduction is in the interests of all who are 'cared for'. There will be public support for reasonable, incremental cost savings. Much of the cost savings could even be done in a more or less invisible way by ratcheting reimbursements for care down.

Democrats could trumpet that the succeeded in passing real reform. Republicans could say they stopped it (mostly). But in truth, the foot would be firmly in the door and the structure would be in place for continuing improvement.

[russell]

dave is making a lot of sense to me.

[Sebastian]

I think it depends on your definition of 'now'. Do you mean like today? Or within 1 month of proposal? Or by the end of the year? I'd be happy to insist by the end of the year. I'm not going along with "don't look too closely because we have to do something this week".

A couple of arguments about the timing that I don't accept:

That you have to get it done before the August recess.

A) There doesn't have to be an August recess and if there is, it doesn't have to be as long as it usually is. Being a Congressman is their job, they don't HAVE to have months and months off in the beginning middle and end of the year. Unless I'm reading this improperly, it looks like the House is scheduled to get 20 weeks off this NON-ELECTION year. Seriously? 20 weeks? Maybe you can cut that down to 18 weeks off in a year where you have to deal with the economic downturn and the biggest proposed domestic restructuring in the last 30 years. Hell maybe you can cut it down to 16 weeks off!

B) I don't accept that you have to rush "because the election season for November 2010 starts in November 2009". No it doesn't. I don't believe that an incumbent REQUIRES a full year of campaigning so that he only needs to do his real job of governing one year out of every two. I don't accept that as adequate job performance. I don't accept that you can't look closely at one of the most important structural changes in decades for more than 3 weeks because you 'HAVE' to campaign for 52 weeks. That just is not acceptable.

[Point]

Sebastian

JTYWTK, Ezra Klein agrees">http://voices.washingtonpost.com/ezra-klein/2009/07/against_congresss_summer_vacat.html">agrees with you.

[Adam A.]

@Sebastian: I completely agree with you. I don't think that this has to get done this week, but Congress should be prepared to stay over August. That really shouldn't be terribly onerous. Indeed, those people asking for more time should be happy to stay - this gives them another month to read over the proposals and debate. However, I think a lot of the people in Congress asking for delays are disingenuous. They could prove me wrong, but I'm not optimistic.

[jrudkis]

As I understand it, federal law compels Fedex and UPS to charge at least $3 or twice the cost of USPS priority mail (whichever is more) in order to deliver letters (as well as having strict "urgent delivery" times associated with it).

So while the Post office may be primarily self funding, it is doing so by having a government monopoly that restricts private competitors only to certain sectors, and within a given price range.

Which seems to work out fine, but are probably the kinds of restrictions that opponents fear the "public option" will develop to become competitive.

[debt relief]

awesome post, they really need to get this health care program to work so i dont have to keep paying so much for it

[Catsy]

I think the comment from "debt relief" is spam.

[Eric Martin]

yeah, dddave, what's gotten into you lately? You're freakin me out man.

[D'd'd'dave]

I'm not against health reform. I'm against 2% paying for 98%.

[Eric Martin]

The 2% Doctrine?

[The Crafty Trilobite]

Two more points on government's supposed inefficiency compared to business:

1) At least half of all new businesses don't last five years. About a third die in the first year or so. http://smallbiztrends.com/2008/04/startup-failure-rates.html
So, which business? Many are not efficient enough to survive. Others, of course, survive by getting handouts and bailouts from...the government.

2) Governments, unlike businesses, don't get to choose their customers. And governments, unlike businesses, have to constantly justify their choices to a bunch of paranoid "shareholders" -- i.e., the public. Especially the right-wing side of the public, seeking proof that their tax money is being wasted. That's a big overhead cost, most of which is unnecessary and caused by the very people claiming government is inefficient and wasteful.

[D'd'd'dave]

"The 2% Doctrine?"

Whatever that is.

My recent posts on this thread have been to describe what I think would be acceptable to the public and what would be a workable first step toward the overall goal of reducing costs and making affordable healthcare affordable to everyone. It was really not an attempt to describe what I personally would choose to do if I was king.

[russell]

"The 2% Doctrine?"

Whatever that is.

Dave,it's just a joke. Eric is pulling your chain ever so gently.

Your proposal is pretty interesting, thanks for putting it out there.

[Sebastian]

"Two more points on government's supposed inefficiency compared to business"

Again it isn't theoretical. The US government already spends per capita what Canada spends. But for whatever reason the US government can only cover 27% of the population while Canada covers 100%. That sounds like either actual inefficiency, or that something else we aren't addressing well is going on.

[Scott de B.]

And it's been running at a loss for a long time. Hence why the first word that came to mind was "subsidized".

The USPS makes a profit. Has for some time.

As I understand it, federal law compels Fedex and UPS to charge at least $3 or twice the cost of USPS priority mail (whichever is more) in order to deliver letters (as well as having strict "urgent delivery" times associated with it).

So while the Post office may be primarily self funding, it is doing so by having a government monopoly that restricts private competitors only to certain sectors, and within a given price range.

Note that the USPS is mandated by law to deliver mail and packages practically anywhere in the U.S.

What the law does is prevent private shippers from poaching the more profitable routes and leaving the USPS with the unprofitable ones.

UPS and FedEx simply can't or won't ship everywhere the USPS does.

[Eric Martin]

That sounds like either actual inefficiency, or that something else we aren't addressing well is going on.

But private insurers spend more than the government spends to provide same. BTW, Krugman had an interesting bit on some of the contributors to higher costs. Here's one:

Many health care experts believe that one main reason we spend far more on health than any other advanced nation, without better health outcomes, is the fee-for-service system in which hospitals and doctors are paid for procedures, not results. As the president said Wednesday, this creates an incentive for health providers to do more tests, more operations, and so on, whether or not these procedures actually help patients.

http://www.nytimes.com/2009/07/24/opinion/24krugman.html?partner=rssnyt&emc=rss

[Chris]

Don't mean for this to be OT or to hijack the thread, but soooooooo much of our wasted money on healthcare comes from our own laziness (66% of us are overweight - with the problems that come with it: type 2 diabetes, heart disease, wear and tear on joints from carrying around extra weight, costs for cholesterol/blood pressure medication, the list goes on and on) yet none of the reforms on the table will address the user error (fat and lazy) aspect of the problem. Growing costs correlate a heck of a lot better with our growing waistlines than they do corporate profits.

Overweight isn't something you prevent by having insurance and being able to see a doctor. It's as simple as 'eat less and walk more fatty' but most of our country is unwilling to even put in this kind of effort.

How will any of the bills being floated about be able to keep costs down if we as a country aren't willing to take the steps (free I might add - eating less is even better than free) to help ourselves?

[Audrey]

Chris,
Another lurker here - could you provide some sort of cite or other evidence for the statement "Growing costs correlate a heck of a lot better with our growing waistlines than they do corporate profits?"

I see so little clear, fact based analysis of the actual state of health care costs and their drivers that I get really worried/frustrated when I see unsupported this-is-the-problem claims.

Nothing personal

[Nate]

Well, one convenient way to address the obesity problems in the US is to blame "eat less and walk more, fatty."

But let's step back and look at things for a second. First, let's posit that human nature doesn't change THAT dramatically between generations. So people now are not that much lazier than people the generation before, and so on back. So if the people haven't changed, what has?

Well, almost everything else around them has. The nature of work. How people get to work. The nature of food, hell our entire food supply system. The availability of different kinds of food. The explosion of pre-processed foodlike substances. Chain restaurants, and food research designed to make people crave food. The layouts of our cities and neighborhoods.

The entire system of how people get food and get around has changed. And mostly in the directions of more empty calories, more fast food, more pre-processed meals. Which people eat in the car, on their way somewhere, or at their office, where they work at a desk, or at the store where they stand around at a cash register. And the explosion of suburbs and exurbs and cities designed completely around cars means often the only way you can get there is by driving. Many places don't have supermarkets, or ones that carry much in the way of fresh veggies. Which take time to cook, and who has time between working two jobs and having to drive half an hour to each?

Yes, people should eat better and exercise more. But our society is NOT set up to make that a simple task. People are lazy, yes. But not in the sense that you mean, in the sense that people will do what's easiest, and if it's easier to go grab dinner at McDonald's on the way home, or grab that pack of Oreoes from the snack machine, and it's a LOT harder to try and find a healthy meal? Yeah, people are going to pick the worse one, even if they know better, a lot of the time. Because it's easier.

The biggest way to change how people act is to change their incentives, and change how the systems they're in work and affect them. I know it's nice and feels good to lecture how those damn fatties ought to get up and exercise, but lots of the modern world actively discourages that.

You don't get an result like 66% of people being overweight just from individual's failures of willpower to avoid cookies. That's a sign of something MUCH larger, and much more structural.

[Eric Martin]

Dave,it's just a joke. Eric is pulling your chain ever so gently.

Russel is right. I was just riffing off of Cheney's 1% Doctrine. No ill intent. I like your ideas on this subject.

[Sebastian]

"But private insurers spend more than the government spends to provide same."

Sure. I think I've pointed that out repeatedly. One of the saddest things is that the private sphere spends as much as other countries use to cover their whole population and in addition, the US government spends as much as other countries use to cover their whole population.

Which suggests either actual inefficiency, or something else. I'm not particularly convinced by Krugman's suggestion because Germany, France and Japan all operate under fee for pay for large portions of their systems. Unless there is some subtle difference between the systems that I don't understand, which is always possible.

Salaries are of course much higher here. But I wonder if the main difference isn't demand driven. Americans seem to expect something more magical out of their health care system (if it can't fix the problem, someone is thwarting them as opposed to the idea that maybe medicine can't fix it) than my European friends. But that is anecdotal and I have no idea where to look for clear evidence.

[russell]

"What the law does is prevent private shippers from poaching the more profitable routes and leaving the USPS with the unprofitable ones."

Precisely.

UPS sued Canada Post under NAFTA for damages because of their "anti-competitive" practices. Which is to say, that Canada Post offered services UPS wanted a piece of.

They did not want to deliver the mail everywhere in Canada, they only wanted the higher-margin overnight and priority package and letter delivery businesses in the larger urban areas.

The rest of Canada could pound sand, and in fact would have if they had won, because the higher-margin services Canada Post offers help subsidize the less economic delivery services to rural and remote areas.

UPS lost after about 7 years of lawsuits, but it went all the way to NAFTA tribunal arbitration.

[russell]

"It's as simple as 'eat less and walk more fatty' but most of our country is unwilling to even put in this kind of effort."

It would help if corn syrup wasn't an ingredient in everything from iced tea to toothpaste.

It would also help if zoning laws and the transportation infrastructure in this country were not so oriented toward cars.

It would also help if fresh, unprocessed food was more widely available.

It would also help if there was a commitment to keeping some amount of land open, so that there was an interesting and enjoyable place for people to walk.

Those are my great big ideas on the topic. File it under "public health".

[Sebastian]

"It would help if corn syrup wasn't an ingredient in everything from iced tea to toothpaste."

That is only the case because of the corn subsidy and sugar tariffs. Government action at its best.

[russell]

Agreed about the corn subsidy.

[Brett Bellmore]

"What the law does is prevent private shippers from poaching the more profitable routes and leaving the USPS with the unprofitable ones."

which is a remarkably weird way to describe private shippers delivering on ALL routes, and simply charging variable rates based on distance, rather than adopting an insane "one price for across the block or across the nation" pricing scheme.

There's no such thing as profitable and unprofitable routes, if you have a sane pricing scheme. There are routes the USPS loses money on, because they deliberately charge below cost.

Why blame the consequences of that decision on UPS or Fedex? They're not robbing the USPS, they're merely refusing to join it in adopting a stupid policy.

[Scott P.]

which is a remarkably weird way to describe private shippers delivering on ALL routes, and simply charging variable rates based on distance, rather than adopting an insane "one price for across the block or across the nation" pricing scheme.

It's not insane, it's a decision to give all Americans equal access to the postal system. Which is precisely as it should be.

Moreover, private shippers would never deliver on ALL routes. There simply wouldn't be enough profit on the remoter routes to justify serving them -- too few people willing to pay the price.

[Chris]

Happy to oblige Audrey. The Daily Kos had an article just a few days ago on the very subject.

http://www.dailykos.com/story/2009/7/21/755828/-You-Cant-Fix-Healthcare-Without-Fixing-Obesity

You'll see that healthcare costs for normal weight people increased 11 percent from 2001 to 2006 while for the obese it's 31 percent (if my eyes are right). Using CPI inflation rates during that period

http://www.usinflationcalculator.com/site-information/new-inflation-rates-with-chart-graph-and-table/1000137/

gives a cumulative economy-wide inflation of 13.47 percent (assuming we start with 2001 and multiply the annual inflation numbers up through 2005 to get to 2006 data). That means costs to treat normal people is actually DOWN in real dollar terms! It's the overweight people who are ruining the system.

Regards,

[jacksmith]

LEAD, FOLLOW, OR GET OUT OF THE WAY. (Thomas Paine)

We have the 37th worst quality of healthcare in the developed world. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don’t die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.

I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. An insurance bailout is all you really get without a robust government-run public option available on day one.

These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!

Republicans and their traitorous allies have been trying to make it look like it's President Obama's fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.

But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.

But you don't have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.

Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will help you feel better too.

There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.

I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!

You have been AMAZING!!! my people. Don't loose heart. You knew it wasn't going to be easy saving the World. :-)

God Bless You

jacksmith — Working Class

Republican Senators up for re-election in 2010.

* Richard Shelby of Alabama
* Lisa Murkowski of Alaska
* John McCain of Arizona
* Mel Martinez of Florida
* Johnny Isakson of Georgia
* Mike Crapo of Idaho
* Chuck Grassley of Iowa
* Sam Brownback of Kansas
* Jim Bunning of Kentucky
* David Vitter of Louisiana
* Kit Bond of Missouri
* Judd Gregg of New Hampshire
* Richard Burr of North Carolina
* George Voinovich of Ohio
* Tom Coburn of Oklahoma
* Jim DeMint of South Carolina
* John Thune of South Dakota
* Kay Bailey Hutchison of Texas
* Bob Bennett of Utah

[Pithlord]

Gotta agree with Brett on mail delivery. If we really want to subsidize people living in remote areas, we should give them money, not charge them below-cost postal rates, subsidized by creating a bloated monopoly.

[Brett Bellmore]

"Moreover, private shippers would never deliver on ALL routes. There simply wouldn't be enough profit on the remoter routes to justify serving them -- too few people willing to pay the price."

That's an interesting claim. I eagerly await your evidence that there's someplace in the US that UPS and Fedex won't deliver to.

[Pithlord]

I'm puzzled why the blue team would want to transfer money from people who vote for them to people who never will (with a big deadweight loss in the middle). I suppose it's about maximizing government unionized jobs.

[CharlesWT]

In one sense, postage stamps are nothing new to ingenious Alaskans. As I've noted before, the tiny town in Wainwright -- just about as far north in the state as you can go -- once needed a new building. However, the cost to ship each cinderblock by truck or boat to build it was prohibitive. Then, someone came up with a great idea. They weighed the cinderblocks and realized they could be mailed. Stamps were applied to each block along with a mailing label, and all were delivered to Wainwright by the Postal Service.
Alaska celebrates 50 years of statehood

[russell]

"There are routes the USPS loses money on, because they deliberately charge below cost.

I'm puzzled why the blue team would want to transfer money from people who vote for them to people who never will (with a big deadweight loss in the middle). I suppose it's about maximizing government unionized jobs."

In Article I section 8 of the US Constitution, the Congress is specifically authorized to establish post offices.

It's true, there's nothing in the the damned document that requires the same postage to be charged for all first class mail, regardless of where you live or how far you're sending your letter.

It's just enormously useful that that is true. So we do it.

There are a broad range of things for which it is more important that they be done effectively and across the whole population, than that they be done in the most economically efficient way.

UPS has found a nice niche for themselves. They do quite well with it. More power to them.

In point of fact, the services they sued Canada Post over were in the more lucrative big city markets. They were not interested in remote areas. Had they won, it would have cost Canada Post a lot more to make mail delivery available to rural areas.

So screw UPS. They have enough freaking money, they can leave Canada Post the hell alone.

Why should anyone in rural areas of Canada have to pay more for mail delivery so UPS can make more money?

At some point stuff like this comes down to a question of what kind of world you want to live in. I don't want to live in your world, because IMVHO it would suck to do so.

Next time you mail a letter to someone on the other side of the damned country for 44 cents, put five bucks in an envelope and give it to your postman. He'll appreciate it.

[Brett Bellmore]

"Why should anyone in rural areas of Canada have to pay more for mail delivery so UPS can make more money?"

You've got that precisely backwards: Why the hell should anyone in urban areas of Canada have to pay more for mail delivery just so that people in rural areas can get it cheaper?

You always think of the people benefiting, and turn a blind eye to the people you're making pay for the benefits.

[russell]

"Why the hell should anyone in urban areas of Canada have to pay more for mail delivery just so that people in rural areas can get it cheaper?"

Because that way everybody gets to have it.

Not an approach that is really needed for ice cream cones, automobiles, or men's worsted suits.

For mail delivery, highways, utilities, etc etc, yes.

And in the case we're discussing, folks in rural Canada wouldn't have to pay more so that urban folks could pay less, or to help balance the national budget, or because some other budgetary priority trumped mail service.

They'd have to pay more so UPS could gain entree to a market they were interested in.

Seriously, to hell with that.

[Brett Bellmore]

No, that way everybody gets to have it at the same price. Even though some people's service costs more to provide.

Look, I used to live in a rural area, and soon will again. I'm quite familiar with having to pay more for all manner of things because of low population density. Heck, just picking up a gallon of milk involved a 10 mile round trip. Why should postage be this super-critical exception to the rule?

And, since UPS was being denied entry to the market solely so that the rural rates could continue to be subsidized by urban rates, urban folks damn well are paying more just so that rural folks can pay less. Might give YOU some kind of thrill to know that UPS' bottom line was made a little lower by the decision, but most people just want cheap services.

[Warren Terra]

I am pretty sick of people who criticize the USPS as being some sort of hallmark of inefficiency. Maybe I've just been lucky, but I've always gotten good reliable mail service - and the prices, as repeatedly noted upthread, are just incredible. I actually looked up the prices a few months ago, when Andrew Sullivan was indulging in this sort of foolishness and saying "give me Fedex!" (in reference to someone comparing a proposed public option for health care to the post office). Fedex offers five-day delivery at a reduced rate - and about twenty times the price of a stamp, which will get the letter pretty much anyplace FedEx will go in less than five business days. If you compare their overnight rates, Fedex charges four times as much as the post office's highest rate. And that's all for individual packages - anyone reading this blog probably subscribes to some magazines, which get shipped bulk and very cheaply.

Anyone who complains about the post office either isn't considering the incredible value they get for their money or perhaps, having spent too much time in lines at the post office, they value their time much more highly than does the average post office customer.

[Fair Economist]

Were the current flat price to mail changed it would be an unmitigated disaster. It's hard enough finding the stamps on a cluttered desk. With "free-market" pricing you'd have to weigh every single piece of mail on the mail scale (that you'll have to buy and make room for) then look up the pricing rate on the carrier site, then hunt around around for the right stamps in your necessarily large and complicated multi-company stamp collection, no doubt frequently involving extensive hunts through the mail piles where you left them last week. Yuck!

The current system is cheap, reliable, simple, and easy. It would be the height of idiocy to change it.

[Audrey]

Chris,
If you’re still around, thank you. You might also want to read the discussion at Ezra Klein’s (where the diarist linked to for the graph):

http://voices.washingtonpost.com/ezra-klein/2009/07/obesity_and_health_care_costs.html

A few things occurred to me after reading both:

Obesity correlates with other factors for poor health, including poverty. It might be just as accurate to say “It’s the poor who are ruining the system”. Perhaps they should become less poor so they can eat better and move to places where they and their families have better access to safe recreational facilities!

The Kos diarist used this graph to point out that even if we reform the delivery of health care insurance – her desire is for single payer – other policies would be necessary to bring down costs. I agree.

I would consider the issue of tackling America’s obesity problem as an ‘and’ not an ‘or’ in terms of needed health care reform.

Most people get sick at some point in their lives. Many people have priorities that make it difficult to focus on maintaining the perfect, healthy lifestyle. You might even find yourself in either position before your – hopefully long and happy – life comes to its inevitable end.

Anyway, thanks for the follow up link. In return, let me recommend a great book (I received it as a gift in junior high, along with a copy of ‘Elements of Style’) which has helped me to become a better consumer of published material:
http://www.amazon.com/How-Lie-Statistics-Darrell-Huff/dp/0393310728

[D'd'd'dave]

I wonder why people here aren't arguing for postage to be based on the income of the mailer or receiver. What's this new concept you're advocating - same price for everyone? That is very regressive. Shouldn't the people with the top 2% of incomes pay for all mail delivery?

I have the hardest time keeping track of what the meaning of 'fair' is on this site. It seems to migrate. The only consistency that I can see is that the writer (whoever it is) usually thinks 'fair' is when the other person pays.

[Audrey]

Chris,

Sorry, also forgot to ask how you think these stats back up your previous assertion:

"Growing costs correlate a *heck of a lot better* with our growing waistlines than they do corporate profits?"

thanks

[hairshirthedonist]

I have the hardest time keeping track of what the meaning of 'fair' is on this site. It seems to migrate. The only consistency that I can see is that the writer (whoever it is) usually thinks 'fair' is when the other person pays.

Maybe it's because fairness isn't the only thing that people base their policy preferences on, and that other considerations might hold more or less sway depending on the issue under discussion. You know, because different things are, well, different, maybe?

[Lord Sauron]

Yes--welcome to the United States of Emergency. Where everything needs to be done--NOW--or the earth will go spinning off into space or hit the moon if don't pass the Euro-Canadian styled socialized rationed meds of 6 month waiting times for an MRI (I got offered one the other day within the HOUR of the initial dr. visit--top that, Candio-heads).

Not to mention the continued lying about how this will certainly not "crowd out" other health insurance plans or be a "single payer" issue, but will merely compete with private insurance. (LIE).

Or that illegal aliens cannot participate (LIE).

Or that you can keep your health insurance if you like (not if the HR department in your company switches to a "free" plan, you won't)

Or how Medicaid is the supreme example of vast money savings (LIE--it is the government programs that are accumulating both debt and cost hikes, not the private insurers)

Then there is the lie about the 45 million "uninsured" (half truth at best, many of these qualify for medicaid or medicare--about 10 million--and other represent illegal aliens, and those in upper income rangers, or the young who also happen not to have home and car insurance at the ripe old age of 22, and feel immortal and have more plans for keggers than health insurance.)

Yes, how nice.

The new age of the nanny state of Dependency.

Shall we call it the Declaration of Dependence.

[Lord Sauron]

This is just scratching the surface on the problems of what will become single-payer care, after all is said and done.

Notice also that on the abortion issue, we were told this is a decision between a woman and her doctor. Gale force winds of anger meet anyone who denies this.

However, the same crowd of “keep your roseries off my ovaries” apparently has NO problem with government agencies and hacks in DC pouring over your medical records and making life/death decisions about who gets care and who gets the ration.

So there’s no big deal among the Roe crowd of “Let’s have your bureaucratics all over my lymphatics”

[Hartmut]

Don't know about the Mordor health plan but it must have been good or the Dark Lord would have been unable to recruit so large an army (given how bad the food was and how crowded the living quarters).

[Gary Farber]

Bad italics.

"Yes--welcome to the United States of Emergency. Where everything needs to be done--NOW--or the" people without health insurance will go on not being able to treated save what you can get at the ER, and be charged thousands of dollars for that privilege.

"Or that you can keep your health insurance if you like (not if the HR department in your company switches to a 'free' plan, you won't)"

Unlike today, where employees have total control over what sort of health care plan options their corporation offers. Check.

[Brett Bellmore]

You know, I'd buy that you were in a rush to get this thing passed, to deal with the situation right away, if the bill kicked in right away, rather than after the 2012 elections. "Hurry up and do this years from now!" just doesn't carry that sense of urgency you're trying to project.

[Hartmut]

To reuse my rocket model: First we have to get the thing off the ground. We should not ignite the second and third stage at this point. Although it would be clearly preferable to check the systems before lift-off, this does not include actually firing them. If we wait to long we have to call of the launch because all the oxygen has evaporated. And if we take it off the launch pad, we might not get another launch opportunity (especially when the funds run out). Not to forget that there are saboteurs around.
Again, I follow Sebastian's proposal: no recess until the thing is done.

[Brett Bellmore]

Yeah, yeah, I get the analogy: It's much more important to launch Challenger this morning, than to make sure everything is right.

Feh, you're just afraid your rocket will never get launched if the public has a chance to look at the price, and where it's going to crash land.

[Nate]

Yes, Brett, we get it. This is much too important an issue to run into after a mere fifty years of proposal and argument and many decades of experience from other industrialized nations that have made it work! What we need to do is slow down, do some more research, rewrite the bill a few times, kill a few bills, have a couple more elections, transfer some more money to unelected for-profit bureaucrats, have some more people die, let things get worse until Republicans have actually lost their health insurance.

THEN it'll be important enough to deal with. Maybe. If we study it a little more. Eventually. One of these days. Y'know, next week, after we paint the house. And walk the dog, and do the laundry, and hey look, the game's on, and...

You don't want health care reform, we get that. You've made that very clear. And you've also made it very clear your goal isn't delay to produce a better bill, it's delay to make sure no bill happens.

[Hartmut]

And those shuttle boosters were constructed with foreknowledge that exactly that accident could happen but the safe(r) original design was abandoned to safe a few bucks (apart from the idiocy to use solid fuel rockets for manned flight). Doesn't that sound familiar?
This does of course not refute the argument that the whole project should have been scrapped when the huge cost overruns became obvious (i.e. the main argument for the shuttle fell flat).
---
If it crashes, I hope it will be into GOP Headquarters and kill* a visiting Grover Norquist (plus Rush L. and Glenn B.)

*metaphorically/politically, although I would love to see them starve in the streets or die of some nasty disease not covered by their health insurance (after they lost all their money in the next stock market crash).

[Brett Bellmore]

Nate, for fifty years, there's been the vague aspiration of doing something concerning health care. Then there's been a specific proposal on the table for a few days. It's the latter you're asking people to sign onto, not the former.

And, I repeat: If a little bit of delay will ensure that no bill happens, THEN NO BILL SHOULD HAPPEN. This is a democracy, of sorts, and if the only way you can get a particular bill passed in a democracy is to ram it through before the public can get wind of what's in it, and complain to their representatives, (Granted, I've heard some rather pejorative descriptions of that process, but that's what we're talking about here.) THEN IT SHOULD NOT PASS.

Period. Full stop. End of discussion. No exceptions. Not for health care, not for stimulus packages, not for responses to 9-11, not for freaking ANYTHING.

And in this case, we're talking about a bill whose major provisions don't even kick in until after the next Presidential election! Arguing that THIS has to be passed in a hurry is worse than absurd.

The only reason you want to pass it in a hurry is to get it passed before opponents can mobilize. That's not a good reason for hurrying, that's a BAD reason.