A User's Guide to Bad Faith Health Care Arguments

by publius

One challenge in countering the attacks on the health care bills is that they come in many varieties.  Steve Benen had a good post a while back describing the diversity among the critics (the "Greedy," the "Wonks," etc.).  The attacks themselves, though, are also fairly diverse -- and some of them are more egregiously bad faith than others.

So today, I'm providing a User's Guide to some of the most common critiques that I've seen in conservative circles that I consider "bad faith."  There are, of course, many legitimate criticisms from both the right and the left.  But the ones below all qualify (to me) as bad faith.  Let's start with the absolute worst one:

Death Panels/Euthanize Grandma

This one is the worst.  Anyone who makes this claim -- or some derivative of it -- is acting in 100% bad faith.  There's not a single fact that makes these claims remotely plausible.

Remember that the uproar comes from a provision to allow Medicare to cover end-of-life counseling.  The AARP has pushed for this provision.  Republican Senators have pushed for it too.  

It is, by far, the most absurd allegation.  It's not surprising, then, to see Erick Erickson post stuff like this.

Government Takeover/"Socialized" Medicine

All of the reform bills are constructed around private providers and market competition.  Private coverage is the structural centerpiece of reform (for good or bad).  Accordingly, most people will simply keep what they have (though it will be more stable). 

A much smaller subset of people (e.g., uninsured) will have access to an exchange where they can shop around among private providers -- and, maybe, a public option.  The exchanges are far more important structurally than the public option, and they are premised on private market competition. 

The whole "socialized" medicine business is therefore not remotely true.  The bills go out of their way to protect private providers, or at least to rely on competition among them.

Unlike "death panels," though, this argument has some shred of an intellectual foundation -- though a very flimsy one.  The argument is that the public option will be a "Trojan Horse" that will inevitably overtake private providers.  That's the only plausible justification for saying that the reform bills are government "takeovers."  It's an extremely weak foundation for such sweeping allegations.

In fact, this argument is so flimsy that I consider it bad faith.  First, it's not clear the public option will even be in the bills.  Second, even if it is, it's limited to people on the exchanges.  New legislation would be required to expand it.  And third, it's far from clear it will even succeed even if more people eventually get access to it.  As Paul Starr and others have written, it could wind up as a dumping ground for super-high cost individuals.

In short, the public option is not being structured in a way that promises future success.  To get from here to "government takeover" requires a Rube Goldberg-esque chain of a million different events to happen that just aren't going to.  For that reason, these arguments are being made in bad faith.

"Cutting $500 Billion of Medicare"

There are many variations of this critique.  Some yell that "elderly care" will be cut by $500 billion.  Others simply bemoan the Medicare cuts more generally.  The really creative types combine this attack with other ones listed above to make up an imaginary world where the unfit are allowed to die to save costs. 

For background, the House bill pays for health coverage reform in part by saving $500 billion from Medicare over the next 10 years.  To get some perspective, that's about 7% of projected spending (pdf) (total is roughly $6.7 trillion over 10 years).

Now, if you think that every single dollar of that $6.7 trillion is being spent in the most efficient way possible, then yes, the House is proposing real cuts to Medicare.  But even then, it doesn't follow that the cuts will come from "elderly care" or from the terminally ill, etc.  Indeed, the House has specifically identified (pdf) some of this waste -- one large chunk being the absurd overpayments to private providers under Medicare Advantage. 

In the real world, though, it's silly to think that Medicare doesn't have some waste that can be removed.  The idea that the savings will come from denying critical care is demagoguery.  And it's a particularly hypocritical claim coming from those who simultaneously complain about the high costs.

Anyway, these are three "families" of bad faith critiques that I've seen the most often.

Comments

[StL Pastor]

I think the 'Trojan horse' argument has a little more legitimacy than you are granting it-I mean, basically, that's one of the things Ezra Klein (for example) labels as a big plus to any bill-the public plan can easily be ramped up to a larger level, including more employers and individuals once it has been proven popular and cost effective. When your opponents say 'look at this, it could be a Trojan horse to national health care' it hardly seems unfair to agree with them. Ezra may be wrong, but its in the public discourse in favor of the plan as well.

[allmaya]

The fear of loss is greater than the desire to gain.

[D'd'd'dave]

Camille Paglia wrote an article about Publius today:

But somehow liberals have drifted into a strange servility toward big government, which they revere as a godlike foster father-mother who can dispense all bounty and magically heal all ills.

[Chris Smyr]

This is off-topic, but two general comments:

1) I appreciate the "User's Guides" that you write, Publius. Succinct, easy-to-digest paragraphs with cited evidence help make it a little easier to understand issues like these.

2) Please don't ever write like Camille Paglia. Three pages on every hot news topic in the past couple weeks with much verbosity and few citations doesn't help one understand "Obama's healthcare horror". Maybe that wasn't her goal, but still, keep doing your thing.

[John Spragge]

A wise American friend once put it to me this way: people from other nations have come to terms with their own morality. They know they will die. Americans believe that if they do everything right, they won't die.

I've come to believe he didn't speak of all Americans, or probably even a majority, but he did speak for a definite mind-set within the larger American culture. The notion that if you do everything right, you won't die, or even that if you love your relatives enough, they won't die, has the power to motivate a great many mass departures from reality in American life. Exhibit A: Terry Schiavo. Exhibit B: the current outbreaks of strident irrationality over a system that doesn't work and costs Americans, as a people, enough to put y'all in the poorhouse (or the 救濟院).

[superdestroyer]

If you look at the eight points put out yesterday, it is obvious that the health insurance companies will stop being insurance companies and will function as pre-paid healthcare organizations. The government proposes to eliminate risk management and cost control. The government mandates will cause large price increases.

Also, if you are going to read Ezra Klein, look at what he writes about the spending on the last six months of life. That will be the easiest place to cut and will lead to the government deciding who lives (like Ted Kennedy) and who dies (like the poor elderly).

[russell]

I gotta say, "It's shovel ready" is pretty funny. Erickson is a clown, but at least he's a funny one. I got a laugh out of it, anyway.

We lefties need to reclaim our prankster heritage. Erickson and folks like the teabaggers are having all the fun.

But somehow liberals have drifted into a strange servility toward big government, which they revere as a godlike foster father-mother who can dispense all bounty and magically heal all ills.

For "liberals" substitute "conservatives", and for "big government" substitute "the free market".

Same-same.

And yeah, tu quoque. Everybody gets one per week, that was mine.

Seriously, we all understand that what is on the table is the expansion of the public health insurance offerings, right?

It ain't the Gestapo.

[Hartmut]

You know that Gestapo means Gesundheits-Staats-Politik (government health policy)? ;-)

[cleek]

If you look at the eight points put out yesterday, it is obvious that the health insurance companies will stop being insurance companies and will function as pre-paid healthcare organizations. The government proposes to eliminate risk management and cost control. The government mandates will cause large price increases.

uh huh.

still waiting for that ONE PARTY STATE, btw.

[hilzoy]

The "death panels" part truly angers me. It's so flat-out false: this provision gives more power, not less, to individuals, it does so by funding something that makes it easier for individuals' own preferences to be respected, and it also helps everyone around people who are dying, since the more clarity about what that person wanted, the less room for intra-family arguments about what that person would have wanted, beating yourself up for possibly not making the choice that person would have wanted you to make, etc.

I am now going to say something that Obama can't say, since if the Sarah Palins of the world can make up death panels on the basis of nothing whatsoever, imagine the field day that they'd have with this.

My main reasons for favoring Medicare payment for end-of-life counseling are listed above: greater autonomy for individuals, less risk of people's wishes (whatever they might be) being disregarded, taking away one source of pain and discord from the lives of those who care for someone who is dying. But it would probably also save money, and this is a good thing.

To be clear: I do not -- Not! -- support trying to save money by talking people into declining care. I think that's odious, and I'd much rather not save the money, pay higher taxes, and allow people who are dying to decide their own care. They're losing their lives; they should not lose their autonomy and dignity as well. Period.

That said: the more clarity there is about the kind of care a person wants, the more likely it is that that person's wishes will be respected. If that person wants everything possible to be done to stave off death, clarity about that will increase the odds that everything possible will be done, and that will increase spending on health care. If that person would rather decline extraordinary care at a certain point, then that increases the odds that she will not get that care, and that will diminish spending on health care.

Whether or not you think that making it easier for people to make their wishes known in advance will save money, on balance, depends on whether you think that people are, on balance, more likely to be overtreated or undertreated at the end of life. I think there are serious pressures to overtreat, and thus that this would save money. Specifically:

(a) In general, and obviously with many exceptions, doctors think of themselves as fighting disease, and do not like to do things that feel to them like giving up. I would guess that this would make many of them more likely to go on treating someone given uncertainty about what that person would have wanted.

(b) Also, they might be worried about being sued for not doing enough. A clear directive from the patient saying that she would not like certain kinds of treatment is a powerful defense against such suits (and, of course, a clear directive saying that she would like that kind of treatment is an equally powerful tool for the plaintiffs.)

(c) The patient's loved ones will often feel badly about deciding to terminate care, given uncertainty about what the patient wants. Deciding to terminate care, in the absence of a clear indication of the patient's wishes, often does feel like "pulling the plug on grandma". It also opens you up to a lot of second-guessing: e.g., "sure, I'm telling myself that this is what grandma would have wanted, but am I just telling myself this because I'm tired of being here day in and day out, or because I have some secret unacknowledged resentment towards grandma, etc., etc., etc.?" The psychological factors that might pull one towards undertreatment are generally nothing like this strong.

For such reasons, I think that given uncertainty, both doctors and patients will tend to overtreat: to give patients at the end of life who cannot express their own wishes more medical care than they would actually want. And that makes me think that making it easier for patients to express their own wishes in advance, and more likely that those wishes will be respected, will probably save money.

Those savings ought to be seen as the low-hanging fruit. They are achieved not by making hard choices about whether a given treatment is really worth it, but by not inflicting medical care on people who don't actually want it. Analogy: suppose that doctors were in the habit of doing cosmetic surgery on people who came in for other operations, so that when you had, say, an appendectomy, you might wake up to find yourself with augmented breasts or a perky new nose. And suppose the federal government was billed for this surgery.

Surely one of the easiest cost-saving measures to justify would be to ask people whether they actually wanted cosmetic surgery before they underwent other operations. Because whatever reasons there might be to favor paying for cosmetic surgery for people who actually want it, there's no reason to pay for cosmetic surgery for people who like their bodies the way they are, quirks and all, and who will be deeply annoyed when they wake up all full of unwanted botox, or with the wrinkles they thought were perfectly fine all tucked away. And saving money this way wouldn't be about "denying care" or "double standards" or "ugliness panels"; it would be about enhancing autonomy. When you can save money by identifying people who don't want a certain kind of care and preventing the health care system from inflicting it on them, that's surely where you should start.

Same here. I'm completely in favor of letting people who are dying decide that they want everything to be done, and I'm willing to pay to help them get it. But I'm opposed to inflicting that care on people who don't want it. For that reason, I favor measures that make it as easy as possible for people to make their own wishes known. This would, I think, save money, and it would save it in one of the most justifiable ways imaginable: not by deciding which workable treatments are too expensive, but by cutting out treatments that the patient doesn't even want.

It's a sign of the corruption of our discourse that politicians couldn't make this basic point.

[bob h]

And remember that a lot of that $500 million taken out of Medicare ($170 billion, according to Obama) is removal of the unwarranted Medigap subsidies awarded to the private insurers by the Republicans.

[cleek]

basically, that's one of the things Ezra Klein (for example) labels as a big plus to any bill

the opinions and desires of pundits are really not relevant.

[cleek]

...are really not relevant.

by that i meant to say that most of the pundits i've read who walk this all the way out to nationalization are either wishing for some kind of broad government involvement and hoping this gets us there, or are using the specter of nationalization to stop the current efforts (for reasons which might have nothing at all to do with health care). if they want a European-style system then they will find ways in which this effort is a first step; if they want this effort to fail, they'll do the same. either way, it's got little to do with what's politically possible.

but the idea that anything up for consideration now inexorably leads to actual nationalization is truly absurd. the government will own and control the entire health care sector ? and you get there by setting up a scheme to provide insurance for people who don't have coverage really ? really ?

[publius]

hi hilzoy! :)

[hilzoy]

hi publius! ;)

[Point]

Has hilzoy returned?

[hilzoy]

Either that or I'm having a hell of a hallucination...

[Eric Martin]

Group trip?

[ThirdGorchBro]

This hilzoy person is making a lot of sense. You guys ought to offer her a front-page posting gig.

[Uncle Kvetch]

Camille Paglia wrote an article about Publius today

And the woman who showed up at Arlen Specter's town hall babbling semi-coherently about the US becoming a "socialized country" like "Russia" where people wait in line for toilet paper was interviewed on CNN this morning.

I'd say the two of them are neck-and-neck in the credibility derby.

[skeptonomist]

If you argue that point #2 is false, you are arguing that a "reform" bill is basically useless from a progressive point of view. The critical point of disagreement is not whether or not the bill will introduce socialism, it is whether government or private insurance is better. The facts are quite conclusive on this question, and the argument should be on this basis, not on the false claim that the objective is a reformed private system.

If medicare is cut at all in order to satisfy the phony fiscal conservatives (and they won't be satisfied because their concern about deficits is phony), this is another argument from the left against the bills currently being considered.

[skeptonomist]

By the way, claiming that costs can be saved in general or in certain programs without specifying exactly where and how the savings will be made is arguing in bad faith. Politicians often do this because they know that as soon as they get down do specifics somebody will scream.

[gwangung]

Citing Camille Paglia? I'm not sure that's a good thing for your arguments....

[Marty]

"Same here. I'm completely in favor of letting people who are dying decide that they want everything to be done, and I'm willing to pay to help them get it. But I'm opposed to inflicting that care on people who don't want it. For that reason, I favor measures that make it as easy as possible for people to make their own wishes known. This would, I think, save money, and it would save it in one of the most justifiable ways imaginable: not by deciding which workable treatments are too expensive, but by cutting out treatments that the patient doesn't even want."

I agree with the baseline assessment in all of this. I disagree that it is the end of the story.

While much of the drama around this is clearly overblown, the fact remains that we continue to talk about two different perspectives as if they were the same.

First we talk about what is in the bill, stating that the objections are false (or lies) because the bill doesn't provide for anything that looks like how it is being described.

Then, Democrats (progressives, Liberals?) talk constantly about how the bill doesn't go far enough, that it is a good (or bad) first step. They talk about how it can be modified and enhanced going forward, but "lets get something in place".

They then question why the Republicans(conservatives, Blue Dogs, Right?) question the reality behind their goals.

The general public, despite the focus on the disruptive minority, is justifiably skeptical about the motivation behind the proposals:

Because the proposers constantly tell them it will continue to change over time.

This is a bad thing when trying to convince people to accept a radical change.

[Eric Martin]

Marty,

A couple of thoughts:

1. While many Dems think the bill doesn't go far enough in some areas, NONE, as in ZERO!!!, talk about it not going far enough in terms of killing old people or subjecting them to death panels.

In fact, in every single one of the other western nations that have systems that are farther along - the ones that some Dems want to push toward - there are no death panels or anything closely resembling death panels. They don't exist.

2. Ironically enough, private insurance providers do impose strict end of life measures that are closer to death panels than anything in the Dem universe (see here). The Dems, if you recall, were the party that passed Social Security and Medicare (and the party that has defended each for decades) because it seeks to provide BETTER conditions for older Americans. Not quicker death.

[StL Pastor]

Cleek-
Its clear that the Republicans are lying about nationalization. I was just trying to make Marty's point, less eloquently.

[russell]

The general public, despite the focus on the disruptive minority, is justifiably skeptical about the motivation behind the proposals:

Because the proposers constantly tell them it will continue to change over time.

That's a fair criticism.

That said, to my knowledge the most outlandish, blue-sky, pipe-dream, down-the-road-someday vision that's been put on the table is state-sponsored single-payer health insurance.

I.e., Medicare for everyone.

I understand that not everyone agrees with that as a proposal. But can you explain why it makes people freak out and think the end of the world is upon us?

[D'd'd'dave]

debunking publius re: government option

"In fact, this argument is so flimsy that I consider it bad faith. First, it's not clear the public option will even be in the bills."

The reason that people are expressing their distaste for it now is to influence lawmakers to keep it out of the legislation. Does Publius think we should all be quiet until a final bill has taken shape? Publius certainly hasn't been quiet about his preferences prior to a final bill taking shape.

"Second, even if it is, it's limited to people on the exchanges. New legislation would be required to expand it."

The fee for a company, large or small, to not provide insurance for their employees is 8% of payroll. That is about half of what providing insurance to employees costs. It is an incentive for the company to pay the fee instead of providing insurance. This alone will eventually push everyone over to the exchagnes and make them eligible for the public option. It is a very tiny administrative policy step to undercut insurance companies by underpricing the public option.

" And third, it's far from clear it will even succeed even if more people eventually get access to it. As Paul Starr and others have written, it could wind up as a dumping ground for super-high cost individuals."

It is clear to me. Show me how it is not clear.

[Eric Martin]

Stl Pastor:

I'm not familiar with every one of Ezra's preferences, so could you help me out here. Is he actually in favor of government provided health care, or, rather, government provided health insurance?

There is some merit to someone fearing a trojan horse for universal coverage in terms of government insurances, but health care is beyond a stretch, and I don't even see that much support from left-leaning pundits - and next to ZERO support from actual Dem politicians.

[Marty]

"1. While many Dems think the bill doesn't go far enough in some areas, NONE, as in ZERO!!!, talk about it not going far enough in terms of killing old people or subjecting them to death panels.

In fact, in every single one of the other western nations that have systems that are farther along - the ones that some Dems want to push toward - there are no death panels or anything closely resembling death panels. They don't exist.

2. Ironically enough, private insurance providers do impose strict end of life measures that are closer to death panels than anything in the Dem universe (see here). The Dems, if you recall, were the party that passed Social Security and Medicare (and the party that has defended each for decades) because it seeks to provide BETTER conditions for older Americans. Not quicker death."

Great points, now tell me that once the bill is negotiated and finalized that we will not have to worry about the makeup of the various panels and ongoing recommended changes.

Tell me that the average American can have confidence that, out of the thousand pages of bureaucracy added, none of those would have the ability to substantially change any of the rules going forward.

Don't tell them how it is now, people know what they have now, warts and all. Tell them what they will have going forward, without the caveats and mixed messages, annual reviews, recommendations that Congress can allow into law by doing nothing, etc.

Most important, tell them that the neogtiations are going to create a reasonable long term solution they can evaluate, not a first step.

[(The Original) Francis]

hilzoy: welcome back! Can we have a guest post about your trip, please? With a picture of a bare-faced go-away bird?

[Eric Martin]

Marty,

Tell me why the United States, as opposed to every other nation in the history of the world that has implemented a public option, would suddenly change the rules to kill old people? Why?

When the Dems are in power, and the whole point is to replicate some of the better aspects of other systems?

Even though the Dems fight tooth and nail to preserve Social Security and Medicare in order to preserve the lives and dignity of old people. Suddenly, they do a 180 and push to end their lives? Huh?

Tell me why, having Medicare in place for 60 years already, the Dems have not pushed for death panels through Medicare. But suddenly, now, they're going to push for the death panels that they wanted all along but...didn't ask for?

Doesn't make sense at all.

The onus is on you to tell me how that is even remotely in the universe of possible. Otherwise, I would caution you that there are many things that the government could do after it passes any bill. But we must discard the outlandish, infeasible and bizarre from the conversation in order to have a productive discourse.

[Uncle Kvetch]

An excellent counter to the "slippery slope" argument, from a commenter at Crooked Timber.

If you can't be bothered to click the link: we can draw on the experience of any number of countries where private insurance and a public option complement each other. In none of them has a public option "crowded out" private insurance providers.

[Marty]

"The onus is on you to tell me how that is even remotely in the universe of possible."

Actually the onus is not on me. The onus is on the sponsors of the legislation to convince the American people that the legislation is acceptable to the majority. This includes the reassurance that this is not a bait and switch to accomplish a number of stated goals that get negotiated out.

Just as a note, I would think most people don't actually believe the "death panel" argument. It is a strawman that reinforces their general lack of faith in the motives of the proposers.

[Gromit]

D'd'd'dave: The fee for a company, large or small, to not provide insurance for their employees is 8% of payroll.

And right now, without reform, what is the penalty for not providing health insurance to employees?

[Eric Martin]

The onus is on the sponsors of the legislation to convince the American people that the legislation is acceptable to the majority

Yes, and the onus is on the opposition not to make up blatant lies, not to scaremonger and not to completely distort the debate for ulterior motives.

The American people have been duped by the fear tactics of the insurance/pharma industries before. So, yes, the onus is on the proponents to defeat their misinformation. But, ethically and morally speaking, citizens should also not try to misinform other citizens. So the onus goes both ways.

This includes the reassurance that this is not a bait and switch to accomplish a number of stated goals that get negotiated out.

But those aren't stated goals!!

Not stated goals:

1. Death panels.
2. Government provided health care.
3. Government take over of health care.
4. Cutting $500 billion from Medicare.

Not stated anywhere!

[Uncle Kvetch]

It is a strawman that reinforces their general lack of faith in the motives of the proposers.

In other words, it's a lie, but an effective one.

[Gromit]

Marty: Actually the onus is not on me. The onus is on the sponsors of the legislation to convince the American people that the legislation is acceptable to the majority.

How meta. It's not about persuading the people on the merits of the plan. It's about persuading the people that the people have been persuaded.

[Marty]

"In other words, it's a lie, but an effective one."

Glad we cleared that up.

[Ben Alpers]

If you argue that point #2 is false, you are arguing that a "reform" bill is basically useless from a progressive point of view.

Absolutely.

Indeed, if the public option really ends up structured, as publius puts it, not to succeed, it will have become (in fact, perhaps already is) an aspect of the bill essentially designed to provide a bad faith argument to keep progressives on board this "reform."

And there's my tu quoque for the week!

[tgirsch]

publius:

I believe you missed a prevalent bad faith argument, although it's tangentially related to the "government takeover" argument. Prominent Republicans like Boehner, Cantor, and Pence (among others) keep repeating the lie, err, "talking point" that a study shows that a public option would cause 120 million Americans to lose their current coverage. What that study actually showed was that if a public option were created and were opened up to everyone (something no current proposal allows, by the way), some 120 million Americans would switch to it voluntarily. That's hardly the same thing as "losing" your coverage.

[Catsy]

So clearly I can not choose the health reform bill in front of me!

[cleek]

another bad-faith argument: calling the plan "ObamaCare", when Obama isn't actually involved in writing it. but, that's expected since the GOP's efforts are primary geared toward beating Obama, no matter what.

[Eric Martin]

another bad-faith argument: calling the plan "ObamaCare", when Obama isn't actually involved in writing it.

And it isn't "care" either. It's insurance.

So, other than the fact that Obama's not authoring it, and it's not health care, they nailed it.

[bjrubble]

I think Marty/Pastor are bringing up a legitimate point, which I wish the pro-reform side were addressing more effectively.

I don't think you can credibly claim that the public option isn't at least looking toward scaling up in the future -- if it really is competing with the private options, then by definition it is capable of taking market share, and absent some external controls I don't see how its market share is incapable of reaching 100%.

The critical question is whether the public option will be in fair competition. A public option that succeeds by virtue of scale and lack of profit/shareholder demands would be hard to attack except on purely ideological grounds (which it surely will be, of course). A public option that sits on top of a compulsory tax is basically a fraudulently sold single payer system, and even though this isn't what's on the table I don't think it's a bogus concern.

Basically, I don't see what's wrong with saying that, yes, "we" do think the public option will end up with a substantial portion of the market, because in this particular market a large non-profit can probably deliver a better product. And if it doesn't then it will fail, and it will be allowed to.

[cleek]

This includes the reassurance that this is not a bait and switch to accomplish a number of stated goals that get negotiated out.

i love love love how it's the Dems' job to counter the GOP's lies. the party of personal responsibility and rugged free-thinking, moral, heartland, American individualists is free to spout any insane nonsense that it can think of; but the Dems have to convince people - people who already think the Dems are literally destroying America - that the GOP is lying to them.

in the words of Elliot Smith: what a fncking joke.

[cleek]

if it really is competing with the private options, then by definition it is capable of taking market share, and absent some external controls I don't see how its market share is incapable of reaching 100%.

well, it hasn't worked out that way in countries which have already gone down that road.

take it away, Matthew Steinglass:

What Megan is saying is basically: sure, you’re saying you’re preserving the private health insurance sector now. But really, you want to eliminate it in the next round of reform, and if we let you have your way we’re on a slippery slope to single-payer sooner or later, because we know you all really love Euro-style single-payer systems. But this is just wrong. I’m a liberal who loves Euro-style health insurance systems, but I’ve never been in a single-payer system; they’re in the UK and Canada, and maybe Sweden, I’m not sure. The ones I know are in the Netherlands and France, and they’re not single-payer. And if those systems are supposed to be on a slippery slope to single-payer, well, that’s a strange slippery slope. France instituted universal coverage through private insurers in 1946 I think, and sixty-odd years later over 90% of French people are still buying private health insurance. The Netherlands has had universal care through a mix of public-private plans since the ’40s too, and in 2006 it actually scrapped the public basic insurance plan in favor of putting everyone into the private market, regulated and subsidized to achieve universal coverage. If the health insurance reform bill in the House is a stalking horse for importing the Dutch system wholesale, that’s fine with me. But a Dutch-style system means universal private health insurance, and it’s still just flat-out wrong for Megan to characterize that as a “government-run health system” or “single-payer” or “eliminating the private health insurance market” or whatever.

[tobie]

Gromit's response to D'd'd'dave's comment,

"The fee for a company, large or small, to not provide insurance for their employees is 8% of payroll"

is right on the mark. Gromit said,

"And right now, without reform, what is the penalty for not providing health insurance to employees?"

But let me add another dimension to this now common meme on the right. Group insurance rates are considerably cheaper than individual insurance policies. (My employer, for instance, has a very solid group policy with Blue Cross/Blue Shield, that costs about $1000 per person annually.) HR3200 proposes a national insurance exchange, which includes private plans as well as a public option, only for people who don't get insurance through their employer.

There will be a mandate for employers to provide health coverage for their employees as long as their payroll is more than $750,000/year. This is an extremely important point. It means that a company with a payroll of, say, $1,000,000 a year, would have to pay a penalty of $80,000 (8% of a million) if it didn't provide coverage. In this case, the penalty would indeed be far greater than the cost of group coverage. I'm sick and tired of hearing this argument which doesn't take into account the drastic difference in price for individual vs. group coverage.

[Gary Farber]

"Camille Paglia wrote an article about Publius today"

I'm willing to bet your acceptance of Camile Paglia's opinions, d'd'd'dave, is quite selective. Am I wrong?

Hilzoy at August 12, 2009 at 08:55 AM: this is, as is completely unsuprising, so to the point, and well-stated, that I have to wonder why it couldn't be posted as a front-page post?

I realize that it's far more relaxing to write with the notion that what one is writing doesn't have to come up to a particular standard. This is exactly why I've taken to writing fifty times more comments here than at my own blog, which is really where I should be focusing my efforts, and spending far more of my writing time.

So I understand that part. But in a case such as this, where what you come up with is perfectly useable as a post anyway, why not just allow it to be posted as a post?

Posts do not have to be filled with supporting links; it is not a requirement; there is not a law.

Please don't take this in any way as any kind of attempt to twist your arm!

Obviously you are perfectly and completely and utterly entitled to follow your preferences in this matter, and justify them to no one whatever, least of all me.

I hope, though, that as a friend, I can ask you if you might explain a bit of your thinking on the question. But only if you feel like it!

And it's great to see you comment!

[Marty]

" but the Dems have to convince people -"

1) people who already think the Dems are literally destroying America -

2) that the GOP is lying to them." (numbers added)

Which of these is the bigger problem?

[jonnybutter]

now tell me that once the bill is negotiated and finalized that we will not have to worry about the makeup of the various panels and ongoing recommended changes

It is impossible to prove a negative, as Marty surely knows. His attitude is embedded with a value judgment which pretends to not be there, in that it assumes that there is a will on the part of congress to be malevolent. There is a superficial case for that view - lawmakers do crappy things sometimes. But, unlike in the private insurance industry, this is a relatively open process, and one subject to political pressure. The problem with our legislature is not political malevolence, but the old familiar: corruption. The same political persuasion which eats breakast, lunch and dinner on slandering government, also stands directly in the way of reforming how politics is financed, so of course nothing can be done. Nothing can be done about *any* problem. I've decided that the GOP likes insoluble problems (abortion being exemplary) because they're the gift which keeps on giving, politically. Meanwhile, the political economy is slowly seizing up. Thanks guys!

If I may use an elaborate metaphor, and at the same time slide a toe 'over the line' of the posting rules: the health care situation we're in now reminds me of the tableau (not original to me) in which we see everybody up to their chins in shit; we cut to a close up of one person silently but empahtically mouthing the words, 'DON'T MAKE A WAVE!'.

I would modify that, in this case, to everyone's being up to their *knees* in the stuff this week; last week it was to the ankles - it's rising fast. Those who are crying 'don't make a wave!'*now* are not only foolish, but really exemplify a failure of nerve. Any of the major bills would be better than what we have now. The multi million dollar campaign to spread fear and ridiculous lies ('Good thing Steven Hawking isn't British!') is a kind of proof of that.

[Gary Farber]

"1. While many Dems think the bill doesn't go far enough in some areas, NONE, as in ZERO!!!, talk about it not going far enough in terms of killing old people or subjecting them to death panels."

Except for the part about General Zod.

Russell:

I.e., Medicare for everyone.

I understand that not everyone agrees with that as a proposal. But can you explain why it makes people freak out and think the end of the world is upon us?

It would make us Canadian, eh? We'd have to allow more Tim Hortons and probably make French an official language.

[Ben Alpers]

Basically, I don't see what's wrong with saying that, yes, "we" do think the public option will end up with a substantial portion of the market, because in this particular market a large non-profit can probably deliver a better product. And if it doesn't then it will fail, and it will be allowed to.

The problem with framing this particular issue this way is that whether or not the public option succeeds depends in large measure on how it's set up in the first place. And everyone more or less knows this.

This is not an experiment. There are ways to set up the public option so that it works and ways to set it up so that it doesn't. Those who don't want the public option to succeed want to set it up so that it's crippled from the start.

And one of the problems with this discussion (partially reproduced in publius post above) is that there is, in the real world, no slippery slope from a functioning public option to a Canadian-style single-payer system (let alone a British-style national healthcare system). Most continental European countries have systems in which a baseline, universally available public plan is supplemented by private insurance. And these systems have shown no tendency to jettison their private dimensions. The notion that a system based around a universally available public option will naturally lead (for better or for worse) to single payer is simply false.

The effort to cripple the public option isn't even really an effort to save private insurance. It's something even less exalted: an effort to save the current business model of our private insurance industry.

[Tony P.]

"... fair competition ..."

Fair to whom? I don't own a health insurance company. I am a buyer of health insurance. I don't give a damn whether my health insurance gets cheaper due to "fair" competition between capitalists, or "unfair" competition from the government.

--TP

[Eric Martin]

Basically, I don't see what's wrong with saying that, yes, "we" do think the public option will end up with a substantial portion of the market, because in this particular market a large non-profit can probably deliver a better product. And if it doesn't then it will fail, and it will be allowed to.

The problem is when someone says that because some people secretly want a robust public option they also want...

1. Death panels.
2. Government provided health care.
3. Government take over of health care.
4. Cutting $500 billion from Medicare.

If the conversation stayed on the topic of market share for public and private insurance, I'd be doing backflips with delight.

[Marty]

"It would make us Canadian, eh? We'd have to allow more Tim Hortons and probably make French an official language."

Thats ok, except the Tim Hortons part, might as well get Dunkin.

I know how to say several airline related things in French: tray table, seat upright, seatbelts fastened, and turbulence. I don't really know them except that I can decipher them now if they do the French before the English. They all sound so much better in the French version.

[cleek]

what's French for "sorry, that doctor is not part of our network" ?

[Ben Alpers]

Hilzoy at August 12, 2009 at 08:55 AM: this is, as is completely unsuprising, so to the point, and well-stated, that I have to wonder why it couldn't be posted as a front-page post?

Shhhh, Gary...don't scare her away!

I for one welcome hilzoy's return to blogging commenting and look forward to reading more of her posts comments in the future!

[Gary Farber]

There seems to be nearly universal agreement that Tim Hortons is superior to Dunkin Donuts.

That's in the U.S., not Canada, where one would take that opinion for granted.

"Merovingian: I love French wine, like I love the French language. I have sampled every language, French is my favorite. Fantastic language. Especially to curse with. Nom de dieu de putain de bordel de merde de saloperie de connard d'enculé de ta mère. It's like wiping your arse with silk. I love it."

I can't get much further than La plume de ma tante est sur le bureau de mon oncle," after some very inadequate high school french some 45 years ago, myself.

But I do love me some French cooking. And kissin'. And fries.

Back on d'd'd'dave's high opinon of Camile Paglia's insight, I'm unclear whether he even agrees with her first paragraph of the piece he links to: "Buyer's remorse? Not me. At the North American summit in Guadalajara this week, President Obama resumed the role he is best at -- representing the U.S. with dignity and authority abroad. This is why I, for one, voted for Obama and continue to support him. The damage done to U.S. prestige by the feckless, buffoonish George W. Bush will take years to repair. Obama has barely begun the crucial mission that he was elected to do."

[Marty]

"what's French for "sorry, that doctor is not part of our network" ?"

Something like

Désolé, ce médecin ne fait pas partie de notre réseau

[tgirsch]

Now that we've finally gotten to an important question of actual substance, I feel comfortable weighing in:

Gary is correct. Tim Horton's is far superior to Dunkin Donuts.

[Hogan]

So clearly I can not choose the health reform bill in front of me!

Best laugh I've had all day.

[hilzoy]

I was very, very grateful that I spoke French when I was in Rwanda... While I was gorilla tracking, one of the people in my group seemed on the verge of having a heart attack, and one thing that worried me was that our generally admirable group leader didn't seem to get how serious it was, which I put down partly to the fact that he was walking just ahead of this guy and I was walking just behind, so I saw a lot more, but also to the fact that English was his third language, and while he spoke it a lot better than I speak my third language, he did miss the odd inflection. E.g., when the guy said "I'm going to be sick", and the guide understood this to mean: at some point in the future, I will have an illness.

I was glad I could translate. That was one of the things that convinced the guide that it was, in fact, time to leave that guy to rest with a couple of trackers and a bunch of water, which was, under the circumstances, a very good thing.

So thank you to all my French teachers, and sorry for being such a pest and reading under the desk in class!

[hilzoy]

Plus, without French, I would have missed out on the joys of Congolese television ...

[Slartibartfast]

Mellow greetings, hilzoy!

[D'd'd'dave]

In Publius' post he made the point that we did not have to fear that a public option would evolve into a single-payer type situation because it could only be used by those in the pool and the number in the pool is a small subset of the whole. In other words, it is rare that anyone will use the public option.

When I wrote at 11:21a, I was countering Publius' argument by pointing out that there is a financial incentive for companies that currently provide insurance coverage for their employees (and who aren't therefore eligible for the pool) to terminate their plans and pay the fine. This would push the majority of persons insured now into the pools. Further, all it would take for the public option to attract a majority of the people in the pool is a premium that is slightly lower than the public option. Classic monopolist tactics.

Gromit 11:54a and Tobie 1:54p did not address my point or Publius' point. Instead they essentially said a fee on employers who don't currently have a plan is a good thing because it adds to the ranks of the insured.

They are free to make this point and I'm glad they have but it in no way undermines my rebuttal of Publius.

Finally, I find it highly unlikely that this assertion by Tobie is true;
"(My employer, for instance, has a very solid group policy with Blue Cross/Blue Shield, that costs about $1000 per person annually.)". I would go so far as to say there is no way that a relatively normal full-coverage health plan costs only $1,000 per year. Dental plans cost more than that. I think Tobie means that his/her employer only requires employees to pay $1,000 toward the coverage annually while in the background the employer is paying $4,000 more per employee on the policy.

When Tobie says this " I'm sick and tired of hearing this argument which doesn't take into account the drastic difference in price for individual vs. group coverage." it confirms my belief that he/she doesn't have a clue about a fundamental cost concept in this debate. He/she seems to think that if the employer is paying it then it must not be a cost. He/she will undoubtedly apply the same reasoning to things provided by government - it's a benefit without cost.

Farber at 1:56p and 2:59p that one must agree with a person in order to make reference to their words. I suggested that Paglia had accurately described Publius. I did not make a judgement on her portrayal of Obama's manner of representing the US in foreign relations. He's suggesting htat if I don't agree with her in everything then I can't agree with her in one thing. I'm sure it is a logical fallacy that Farber is using here to try and discredit me but I can't be bothered to look up the proper name for it.

[Marty]

"I understand that not everyone agrees with that as a proposal. But can you explain why it makes people freak out and think the end of the world is upon us?"

Change is threatening. Change Management is a whole real live occupation that focuses on the reality that the greater the change, the more resistance you get. People fear the unknown and hold firmly to the familiar. Couple that with the uncertainty of the shape of the future (multiple proposals, competing agendas) and people will typically reject the change outright.

That isn't a healthcare debate, or whether someone is lying or not. It is basic human response to things they perceive as risk. Forcing them to accept it creates larger and less reasonable resistance. Yelling back at them, telling them they are being unreasonable, mocking them does not create the response one might hope for.

Let's just say it isn't a tool in the Change Management consultants bag of tricks.

What surprises me is how effectively the Obama campaign and early days in the White House managed the even keel response to this problem, only to find, when they are challenged by widespread public concerns, they start shouting back (figuratively).

[Elemenope]

Dunkin Donuts has better bagels.

[Gromit]

D'd'd'dave: Gromit 11:54a and Tobie 1:54p did not address my point or Publius' point. Instead they essentially said a fee on employers who don't currently have a plan is a good thing because it adds to the ranks of the insured.

You said that the penalty would push everyone over to the exchanges. I interpreted this to mean that businesses that currently offer health benefits would opt to drop their health plans, pay the 8%, and pocket the difference, forcing their employees to buy from the exchange instead. Is this not what you were saying?

Because if that is what you were saying, I'm curious why companies that currently face no penalty are somehow less incentivized to dump their employee health plans than they would be if they faced a penalty for doing so.

If not, what were you saying?

[Tony P.]

Opponents of health care reform can't make up their minds: they can't decide whether they oppose "reform" because they're afraid it will fail, or because they're afraid it will work.

And I second Gromit's question to d'd'd'dave.

--TP

[sara]

I've heard it said that those adult children who feel that they need heroic measures to extend their dying parent's life, do so because they feel guilty about not having spent enough time with them in life.

Libertarian family model (kick children out of the house at age 18, only see each other ritually at Thanksgiving/Christmas, not on speaking terms the rest of the year)

[John Thullen]

Camille Paglia is 62 years old.

She will enter Medicare in 5 years, if she chooses to enroll.

Medicare is not boundless in its dispensation nor is it magic.

But she'll be happy to have it, unless by some bounteous magic her ills and infirmities turn out to be few and cheap.

No death panel will be brave enough to snuff out Camille, given all of the kicking, screaming and spitting they would endure.

She won't say so, because Camille makes more money shooting her mouth off about her outrage than she does letting you know things aren't too bad after all.

Kinda like me, except for the money part.

Let me take this opportunity to let Marty know that he should not confuse himself with the "lying scum in the Republican Party" I referred to in a previous comments thread.

Marty is a new, valuable presence here and may his health be vital and paid for mostly by my tax dollars.

My language is not helpful or necessary, but it is a little more direct than Publius' use of the term "bad faith".

When an individual makes up crap about death panels to scare folks, my response is to convene their worst nightmare of a death panel so that demagoguer and demagoguee (who should learn how to spell) can fully enjoy the fruits of their own "bad faith".

I find it funny.

Also, Gary Farber is wrong ;) that I am IN an institution, since I expect to lose my job and my health insurance in December and therefore institutionalization will be out of my financial reach.

(Not looking for sympathy, but I hate it when MY worst nightmares come true)

So, you folks will just have to put up with my madness until you find an affordable, universally insured way of putting a net over me.

Over and out.

[russell]

Which of these is the bigger problem?

That isn't a healthcare debate, or whether someone is lying or not. It is basic human response to things they perceive as risk.

Here is the situation that the Democratic leadership, and folks who favor changes to our health care policies, face.

Instead of having a reasonable, or even heated, or even vituperative, discussion of the actual options that are available for public health policy, we have to talk about whether Obama is planning to create concentration camps. We have to talk about whether the government will set up special review boards that will decide whether your grandmother will be given treatment or whether she will be kicked to the curb. We have to discuss whether private health care will be banned or eliminated as an option.

In short, we have to discuss bullsh*t. Total nonsensical paranoid crap.

We have to discuss this because conservative spokespeople have been poisoning the minds of folks for at least the last generation or two with fantastic paranoid wigged-out loony-tunes nutjobbery.

If it seems like I'm being rude here, I'm not. The stuff that people believe is crazy, unrealistic, paranoid crap.

Remember when fluoride in the water was a Commie plot? Same same. Exactly.

Why is it *my* job to try to walk these people back through the maze of insanity they live in so that we can have a reasonable discussion of the facts?

Why is it *my* job to be Mr. Change Management? Don't these folks bear any responsibility to at least try to get some information?

Why isn't it *their* job to turn off Fox News and freaking Rush Limbaugh, Glenn Beck, and Michael Savage and get a freaking clue?

Why isn't it *their* job to do some simple, basic homework on the issues so they can have a glimmer of comprehension of what is actually on the table?

Why? Why is it *my* job to accommodate their willful, paranoid, stubborn, hateful ignorance?

These folks don't have the sense that god gave a housecat, but they want to stack the house at public meetings and shout down anyone who disagrees with them.

Seriously, concentration camps? Euthenasia?

I'm sick of it, dude. Just saying.

Thanks for humoring the rant.

Thullen, that's crappy news. You got my good wishes FWIW, which probably ain't much. If you come to Boston, there's a bunch of folks here who will at least stand you dinner.

[hilzoy]

russell: don't forget the fun part about how back when we said that our President was proposing to spy on Americans without warrant, supported torture, lied us into war, etc., a lot of the same people who now insist that real bipartisanship means listening to crazy people thought we were not worth listening to.

It's fascinating.

[hilzoy]

And John: that's awful. There are also dinners for you in Baltimore.

[JanieM]

If you come to Boston, there's a bunch of folks here who will at least stand you dinner.

Seconded. What a fun evening that would be! :)

[Gary Farber]

"after some very inadequate high school french some 45 years ago,"

Er, 35 years ago. I'm 50, going on 51 in November, and I was precocious, but not the point of being in high school at the age of 5!

d'd'd'dave: "Farber at 1:56p and 2:59p that one must agree with a person in order to make reference to their words."

This isn't a sentence, but insofar as I can tease what I can from it as to what you may have meant to say, which seems to be something along the lines that I was asserting that to agree with anything anyone says, one must agree with anything or everything they say, which is, of course, not at all what I was implying.

What I was implying was that either one generally has respect for someone's views on politics, or one does not. This doesn't mean, of course, that you can't pick and choose which specific opinions of a person you do and don't agree with: of course you can, and that's commonly what we all do with almost everyone; it's incredibly rare to find someone you agree with absolutely everything they say about every single political issue!

But it does mean that, as I just said, either you respect Camile Paglia's political opinions in general, or you don't. I don't.

More generally, I respect Camile Paglia's opinions on very little. She's kind of a general wacko, rather than a specifically political wacko. She's sui generis.

Unsurprisingly, it turns out I don't agree with her current opinion about "liberals."

D'd'd'dave's free to find quotes he finds apt wherever he likes, of course, and maybe he has lots of respect for Paglia, or maybe he doesn't, or maybe he doesn't have any idea who she is; I have no idea. All I was saying was that I'd find it surprising if d'd'd'dave generally found himself in agreement with Paglia on most of her views, and otherwise I was saying, in short: Paglia, pfui.

"Dunkin Donuts has better bagels."

Do they boil them before baking them? If not, they're not even bagels at all. I mention this because most of America has no idea what a bagel is, and certainly will never find out from any supermarket. A true bagel is fresh for only a few hours before it becomes stale and rock-like.

John, if you just explain to the people at the Suicide Hotline, or any number of relevant such places, that you are having constant thoughts of harming yourself or others, they'll be happy to institutionalize you for a while, and they'll tend to, if not keep you as long as you keep telling them this, let you be a frequent return customer.

You may be sent bills, but you'll be duly locked up, and pumped with powerful drugs, and bored to the point of actually wanting to kill yourself.

I hope this thought will comfort you greatly!

Otherwise, sincere best wishes and sympathies; if the firm of which I am CEO and all other positions were hiring, you'd be at the top of my list for hiring creatively strange people.

[jonnybutter]

[Publius] made the point that we did not have to fear that a public option would evolve into a single-payer type situation because it could only be used by those in the pool and the number in the pool is a small subset of the whole. In other words, it is rare that anyone will use the public option.

FWIW, he actually said 'for good or bad'. I don't understand why a government takeover of health insurance is anything to 'fear' at all, especially compared to what we have now. That would be a feature rather than a bug, IMO.

Pardon me, conservatives, but what, exactly, do insurance companies do? Do they provide health care? No. Do they innovate in medicine? No. What do they *do*? They are middlemen. They take their (large) cut, and that's about it (I know there are some exceptions, but basically, they're middlemen). Why would anyone fear their demise? Well, anyone who doesn't work for one of them? Theirs is not 'a business of caring'....

[Bernard Yomtov]

there is a financial incentive for companies that currently provide insurance coverage for their employees (and who aren't therefore eligible for the pool) to terminate their plans and pay the fine.

No more than there is an incentive right now today to cut all employees' pay by 25%. That is to say, doing what you describe amounts to a serious reduction in workers' pay. That kind of reduction, whether it's in the form of cutting benefits or reducing cash compensation. has consequences.

Employers don't pay what they do out of the goodness of their hearts. They pay at a given level because, in the labor market, that's what it takes to hire the workers they need to make the company go. If they try to pay less, they may save money for a month or so, but longer run they will face disaster, because they will lose their work force. And by the way, they will lose their best workers first.

Any discussion of benefits - insurance, pensions, or other - that fails to recognize that these are just as much a part of workers' pay as the actual paycheck is going to go off the rails pretty quickly.

[Bernard Yomtov]

Almost forgot. Krispy Kreme outdoes Dunkin' Donuts by a mile.

[CaseyL]

Hilzoy's back! Hilzoy's back! Hilzoy's --

er... healthcare reform?

Oh. That.

If it happens at all, I'll be pleasantly surprised (at this point, it's looking like what we're gonna get is "health insurance reform," whatever that is). The GOP is fighting tooth and nail, and even though there is not a single honest argument in the entire GOP/RW/nutbar axis, they're the ones framing the debate. How about that, eh?

If the reform, in whatever name, is actually any good, I'll be amazed. Right now, it looks like what we're likely to get is a timid, nibbling around the edges, let's not piss off the insurance industry gimcrackery that will enable the Dems to say they succeeded in getting something passed, but won't actually reduce costs or increase coverage significantly.

If there is a robust public option, I'll be so amazed I'll go outside and do a Happy Dance.

John Thullen: I am stunned and sorry to hear about your upcoming loss of both job and insurance. Won't you be eligible for unemployment and COBRA extension of your insurance? (Your COBRA premiums might even be reduced.)

[Marty]

"Why is it *my* job to be Mr. Change Management? Don't these folks bear any responsibility to at least try to get some information?

Why isn't it *their* job to turn off Fox News and freaking Rush Limbaugh, Glenn Beck, and Michael Savage and get a freaking clue?"

I appreciate the feeling, I just think there are lots of people who aren't concerned because Rush told them to be.

Most people my age have lived with many of the issues on the list to be addressed for their whole adult life, those older than me are on or approaching Medicare.

The rules were clear, keep a job:keep insurance, pay into Medicare:get minimal coverage in your old age. I would guess this is a huge percentage of Americans (over say, 45). So about 200 million Americans are watching the rules they have lived by all their lives change. They just want to be sure they understand that the new rules don't make them worse off.

It is a really big mistake on both sides to think that right or left wing demagoguery is what is making the majority have concerns about this issue.

Few issues touch the lives of every American, every day, the rest of their lives.

Patience in making the case can win the day.

[CharlesWT]

"I mention this because most of America has no idea what a bagel is, and certainly will never find out from any supermarket."

Supermarket "bagels" are just round loaves of bread with a hole in the middle.

[cleek]

They just want to be sure they understand that the new rules don't make them worse off.

that's just bullshit. the Democratic plan is perfectly clear about what will happen to their current coverage. and the Dem congresspeople are out there trying to pass-along the details. on the other hand, the GOP (which you seemed determined to hold blameless) is deliberately, actively, explicitly, lying to people who want to learn more; and the lies are working.

[Marty]

"that's just bullshit. the Democratic plan is perfectly clear about what will happen to their current coverage. and the Dem congresspeople are out there trying to pass-along the details. on the other hand, the GOP (which you seemed determined to hold blameless) is deliberately, actively, explicitly, lying to people who want to learn more; and the lies are working."

My point has nothing to do with holding the GOP blameless, or blaming anyone. My point is that the way to fight the GOP characterization of the risks is to educate the electorate, without trading tit for tat on every point with the Republicans.

Every time a Democrat says that someone else is lying, it reinforces that there are two views to discuss. Arguing the GOPs points constantly is counterproductive.

I hope we get a reasonable plan by December so John has coverage come Jan 1.

[Turbulence]

My point is that the way to fight the GOP characterization of the risks is to educate the electorate, without trading tit for tat on every point with the Republicans.

Is there any evidence to justify this belief or is it just your opinion?

Arguing the GOPs points constantly is counterproductive.

Why do you believe Democrats are "constantly" arguing GOP points?

[russell]

They just want to be sure they understand that the new rules don't make them worse off.

As stated, that's a very legitimate concern.

Patience in making the case can win the day.

I'm actually skeptical about this. Based on what I'm seeing right now, patience in making the case will just kick the can down the road far enough that nothing really constructive will happen.

I think something stronger than "patience" is needed. By "stronger" I mean clear and directive leadership, which is to say, knocking heads. The heads I have in mind are not those of the folks showing up at town hall meetings, but the (R) and blue dog congressional factions.

It ain't happening.

Arguing the GOPs points constantly is counterproductive.

I wish I could engrave that sentence on the forehead of every Democrat in government.

[joel hanes]

an interesting factoid :

There is at least one state in the Union whose law explicitly enable something like "death panels" -- a law that gives health institutions the right to remove life support from terminal patients who cannot pay.

That state is Texas.

That law is the 1999 Futile Care Law,
signed into law by then-Governor George Walker Bush.

PS: Hilzoy's back! The intertubes are worth reading again.

[Hartmut]

For the record, I am German with no intention to become a US citizen or even put my foot on US soil.
Let's assume that there are indeed evil liebrul plans along the li(n)es spread by Rush Limbaugh (fleas be upon him), Glenn Beck (may he rest in pieces) and GOP congressbeings (may they live in internecine times) but those are not (yet) in the bills currently discussed. How would passing any of these bills inevitably lead to the fruition of these hideous plans? Would it not require additional bills that implement all these abominable things like mandatory sex changes, mandatory abortion quotas for every woman, federally employed granny executioners etc.?

My personal proposal for the townhall events:
Every person presents is given a collar that will measure their level of noise emission. For any dB above a certain level the collar would give the wearer an electric shock proportional in strength to the noise.

[Johnny Canuck]

"How would passing any of these bills inevitably lead to the fruition of these hideous plans?"

I am Canadian, with little desire to visit the land of paranoia, but from what I have been able to deduce, American conservatives are strong believers in "slippery slopes". Once you are started on a path you cannot change direction but must inevitably and mindlessly follow the course. Therefore better not to take the first step (or the next step).

These Americans have woeful stereotypes of the Canadian and English health care systems, but are unaware that anyone east of France has health care.

You might want to explain how well the German system works for the benefit of the more enlightened readers here.

[Hartmut]

Maybe the most important part is that over here there is also a risk pool of health insurers combined with extremly tight regulations. That way a health insurer is at least partially compensated, if he is burdened with the expensive cases. That significnatly decreases the incentives to drop those. The disadvantage is that cost effective companies are not allowed to just lower the premiums (below a certain limit) to attract even more customers.
There are not just a few insurance giants and some companies (e.g. Siemens) even have an insurance subsidiary of their own (originally limited to employees and their families today open to anyone).
If you are employed, the insurance premiums (to be precise: your fraction of it) are deducted from your salary. If you are unemployed and have liquid assets, you pay a basic rate (currently about 140€/month). If you are unemployed without liquid assets, you receive health insurence first as part of unemployemnt benefits and later as part of welfare.
In recent years copayments went up in some areas (esp. in dental care) and visiting a doctor costs 10€ per quarter (you get a receipt, so you only pay once. For specialists you get a referral from the doctor you paid first).
Prescription drugs: some are free of charge (esp. those that have to be taken over long time periods and most antibiotics), the rest have 10% copayment or a fixed limit (whatever is lower) with possible exemptions (e.g. for children or extremly poor people on application). Also medical expenses are limited to a certain percentage of you income. If you keep the receipts and can prove it, you get your money back.
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It's not all gold though. There are people of influence that would love to Americanize the system at least partially and the general costs are rising with the rising average age of the population. The on average younger guest workers and immigrants keep the system running by paying more into it than taking out (that does not hinder our own brand of nativists though to demagogue against them).

[Uncle Kvetch]

from what I have been able to deduce, American conservatives are strong believers in "slippery slopes". Once you are started on a path you cannot change direction but must inevitably and mindlessly follow the course. Therefore better not to take the first step (or the next step).

Yes. And that's why they opposed the invasion of Iraq so vociferously. After all, the road to hell is paved with good intentions.

[russell]

Once you are started on a path you cannot change direction but must inevitably and mindlessly follow the course.

Yeah, cause that *always* happens.

Hartmut, thanks for laying out the German approach.

In case it's useful, I stumbled across this comparative discussion of the common public health care policies found around the world. Germany's is discussed, although not to the level of detail that Hartmut offers here.

[cleek]

My point is that the way to fight the GOP characterization of the risks is to educate the electorate, without trading tit for tat on every point with the Republicans.

how is this supposed to work?

the GOP says "Obama will kill your momma if her productivity falls before 123 widgets per hour," and the Dems are supposed to let that sit there ? go on and talk about something else that the GOP hasn't lied about ?

people don't work that way. not addressing a point is conceding the point. and clearly, people are more than willing to believe anything the GOP tells them.

My point has nothing to do with holding the GOP blameless, or blaming anyone.

maybe that's not your point, but it seems to be your MO.

[Marty]

"how is this supposed to work?"

Good question, it is a reasonable debate tactic to minimally discuss your opponents points while consistently laying out the advantages of your proposaql.

It would be better for the Democrats to list the advantages of what they are proposing every time they talk. Its ok to, somewhere in there, say that the other side is not accurate, but that needs to be wrapped around a set of bullet points on why it is good.

Currently every list of bullet points repeats the worst case accusations, then says it isn't true. Where is the list, in the media every day, of why it is good?

BTW, saying it covers 45 million uninsured is one of those but it is not sufficient for people worried about whether it might be bad for them.

"My point has nothing to do with holding the GOP blameless, or blaming anyone."

All of the responses to this would be to point out that stretching the facts and terrifying people into agreement is a bipartisan sport. No one demagogued fear more than the Democrats during the debate on the stimulus package. So I am unwilling to have this discussion in detail. Both sides want to win the debate, their tactics could well be reversed in the next one.

[Uncle Kvetch]

So about 200 million Americans are watching the rules they have lived by all their lives change. They just want to be sure they understand that the new rules don't make them worse off.

Marty, I know it's not your intention, but this sounds really patronizing. You don't need to explain "them" to "us" as if "they" were some kind of unfamiliar species.

I'm one of those 200 million people. I have skin in this game. This is not an abstraction for me.

Last year I went without health insurance for three months, because I committed the unpardonable offense of leaving a job I didn't like and taking a job I did like. To continue the coverage from my previous job under COBRA would have cost me a whopping $1400 a month...money I simply didn't have. So I went without.

And the rest of the 200 million live with this possibility too. However satisfied they might be with their coverage, they could lose it at any time.

I'm really trying to understand what could possibly be "scary" about a reform that would guarantee that I, or any others out of that 200 million, would never have to face a choice like that again.

[cleek]

It would be better for the Democrats to list the advantages of what they are proposing every time they talk.

they do. that's the reason these town halls are happening. you know, the ones the GOP is turning into live re-enactments of Pam Atlas posts. the Dems are, in fact and in deed, trying to do exactly what you say they should. the GOP is making it impossible for them to get the facts out; and the GOP is doing it exactly for that reason.

and you blame the Dems.

[russell]

Where is the list, in the media every day, of why it is good?

Dear President Obama et al:

Please read and memorize the above.

Why is it good?

It could be a very long list, but pick the top 3, 4, or (maybe) 5 reasons. State them simply and clearly. Lather, rinse, and repeat.

Why is it good?

The reasons why your plan is good is *much* harder to argue against than your list of reasons why what the opposition is saying is wrong.

Plus then you make the opposition argue about *your* talking points, not theirs.

Don't punch the tar baby. Just say why what you're bringing is good for the folks in the audience.

Obama was pretty good at this during the election, I don't know what happened to him.

[Eric Martin]

Question: Why is 200 million the number we're throwing around? That's not the population of the US. Is that the adult population?

Just curious.

[Marty]

"I'm one of those 200 million people. I have skin in this game. This is not an abstraction for me."

I am one of those 200 million people also and there is not a single bill being proposed that doesn't have a negative impact on me.

I have four kids, all grown, two who have no health insurance today (maybe only one, the job for the other might have come through). I would very much like for them to have insurance.

My father is quite old and relies completely on Medicare, I don't want the care he gets to be diminished in anyway. Despite all of the polls etc. here dealing with Medicare is an ongoing challenge for he and my mother, but thank heavens it exists.

My three grandchildren went without insurance for several years early in their lives, with state aid and other programs they managed to get through it.

All of this, including me not having a job, scares the hell out of me. I am not willing to solve all of my fears by doing something that is not the right thing to do. So lets not overreach. Lets just cover the uninsured, impact everyone else as little as possible, and then reform healthcare itself.

The complexity of all of this is unnecessary and scary. There are too many moving parts, new panels, new and undetailed bureaucracies that can't be defined adequately in even a thousand pages. That bureaucracy becomes unresponsive to the voters once it is in place, accountability is not a strong suit of our government.

None of those fears are right or wrong, they are real. In your case the greatest evil is to not be insured. There are other evils that are often unintended consequences in most complex legislation hastily formed. I think it is reasonable to challenge every line and every intent in something of this magnitude.