Is a Bad Health Care Reform Bill Better Than None?
This is what some supporters of health care reform are starting to ask:
The normal justification for passing a compromise bill is that once a new system is entrenched it can be tweaked later. But I don’t think it applies in this case. The public option is the core of the reform; a Blue Dog bill isn’t so much half a loaf as a few meaningless crumbs. And far from making a public option more viable in the future, if anything, passing something that could be called health-care reform will reduce the impetus to pass actual reform. And, worse, a bill with no public option will further entrench the insurance industry and make it easier for them to block actual reform in the future.
There’s no inherent value to passing a health care bill, per se. If it doesn’t contain the elements that make it worthwhile, progressives shouldn’t let it out of Congress, and Obama should make clear that a Blue Dog bill would be vetoed. A bad bill would be worse than no bill.
Ezra Klein thinks that we may never get health care reform that both addresses the enormity of the human problem, and is cost-effective:
Something might get done. And if that something that gets done extends health-care coverage to 40 million people who don’t now have it, that will be a big deal, and a big improvement in the lives of many, many Americans. It’s important for people who get good health care and have the luxury of seeing this as an intellectual and political project to keep that in mind.
But whatever gets done will be much too expensive because the political system is very afraid of harming any of the relevant industries. Taibbi is right that this, like climate change, is a litmus test for our government. Both are serious, foreseeable and solvable threats to our society. One threatens to bankrupt the country. The other threatens irreversible damage to the planet we live on. Responding to such threats is the test of a political system. And our system will fail it. We will not avert catastrophic climate change. We will not protect ourselves from health-care inflation.
In another post, Ezra again argues forcefully for keeping the focus on 47 million uninsured Americans:
The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt’s plans, and reformers supported those. It was not in Bill Clinton’s proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.
Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. That an unemployed machinist gets screwed by fly-by-night insurance schemes while a comfortably employed banker need never worry. That the working class ends up in emergency rooms with crushing chest pains because they didn’t have health insurance and didn’t get prescribed cheap blood pressure medications five years before.
[...]
Opportunities at health-care reform do not happen frequently. The average between major attempts is 19.5 years. That’s 19.5 years in which the uninsured stay uninsured and their ranks grow. Where a situation that is already bad gets a lot worse. This year, Barack Obama is popular, and there are 60 Democrats in the Senate and huge majorities in the House. There is no reason to believe that Democrats will be in a stronger position anytime soon. It is not like when a weakened Nixon, or a fading Bush, offered a compromise.
If reformers cannot pass a strong health-care reform bill now, there is no reason to believe they will be able to do it later. The question is whether the knowledge that the system will not let you solve this problem should prevent you from doing what you can to improve it. Put more sharply, the question should be whether this bill is better or worse than another 19.5 years of the deteriorating status quo.
35 Responses to “Is a Bad Health Care Reform Bill Better Than None?”
Looks as though there are many among us who do not see 47 milllion uninsured Americans as anything to be particularly concerned about. Frankly I'm not sure just what those people would see as a moral outrage, unless maybe it had something to do with Obama's birth certificate, increased taxes on millionaires, or maybe the government taking AGW seriously. The American moral compass is cracked.
What is it with the need to continually trot out the completely discredited '47 – 48 million' number?
For those who do think health care reform of the type under discussion is a good idea, what is wrong with the really big numbers that are accurate – 15 – 30 million?
Constantly needing to use an acknowledged inflated number only makes your cause seem more suspect.
That and the lying about it saving money (it doesn't), keeping your existing plan (you will be forced to change within 5 years), that everyone will receive better care (only the chronically uninsured will – the rest will see reduced care over time, except, as always, the very wealthy).
JSpencer's analysis and Ezra Klein's are both accurate and depressing. I am afraid the Blue Dogs will not let coverage be extended due to the perceived cost. Americans are very bad at thinking ahead and only respond to real, tangible crises. Things may have to get worse before anything happens in healthcare, climate control or even taxes. That may happen much faster than 19.5 years – it may come to crunch time in just 2 to 4 years as this economy is heading off the cliff. Again, another great blog Kathy. I hope it sparks the same huge debate your prior one did. Best wishes from MP in PHX.
As to global warming, real scientific skeptism and review may be making a comeback on this issue, finally:
Correcting Their Stance?
This is certainly an aside, but I followed Austin's link. The letter the skeptics have written seems rather odd. Some of the claims there make sense, they just don't match much of the research. But then there are logical oddities, such as: there have been warmer periods in the past. True, but so? The earth was half molten 4 billion years ago as well, but that doesn't mean I want to live in a volcano. Or to put a closer analogy out there: Some guy slams the door of a freezer on me and I'm locked inside. I yell for him to let me out and I hear the reply from the other side, “mankind survived in the ice age, so what's the big deal?” Or to put a third analogy to it, the continents were all once together in Pangaea. That doesn't mean it would be a good idea to try to push the plates around and re-form it ourselves.
When simple logical points like this are in a letter, I wonder about how much actual thought went into the science they are hoping to present?
Then there's this bit about “the APS has decided to review their statement on climate change” (which is currently very strongly worded that it's happening). What's the evidence for this review? Very hard to find actually, as your link then links to the Watts blog as evidence for this review, which links to another skeptic blog (http://motls.blogspot.com/2009/07/aps-is-review…), which finally has a link to a letter on Nature (actual journal, not a blog) with a letter saying that we must act on climate change.
Now, there's definitely a letter from some member or former members of APS asking for a change, and so the strong implication on Watts and all is that these brave skeptical scientists wrote in with words of wisdom and so the APS is reviewing the statement. But the data I have found so far just don't match up. Indeed, the letter from 6 scientists (see link above) seems to be after the decision of the APS to make a review. The letter is from 6 days ago on July 23, while the review may have started on May 1. In short, this letter appears to have nothing to do with the APS's climate review, which is just coming after about a 2 year period. Instead, what we have is the majority of the APS consistently supporting climate change research, doing a review (possibly) but we do not know to what end, and at the same time some number of people have written a letter of disagreement after the review started.
The letter is honest disagreement, but the “APS is reviewing their stance” is phantom disagreement. What I mean is the APS may actually be reviewing their statement, but there's no reason to suspect that it has anything to do with the skeptical letter. They simply paste their own ideas under this announcement to act as if there is a causal relationship, thereby giving an unwarranted impression that the APS is becoming skeptical about climate change.
It would be like me taking a headline “Obama takes revolutionary and universally lauded path on health care” and then I copy my random healthcare plan below the headline as if my plan had something to do with Obama's decision, when it's in fact entirely unrelated (more accurately, I've seen no evidence yet that there is a connection.)
We will decide by what the media tells us! We don't even have a complete bill yet and already the Nay Sayers are out number the Yay Sayers in the polls. How is this so when President Obama was elected largely on healthcare reform?
I don’t know. I’m steadily losing faith in our political system. Its almost as if somebody is telling the media “spread this crap or spread that crap and get this popular opinion or that popular opinion and then we can dump or pass this reform”….
Please somebody tell me, what is freedom anyway?
It's really good to know that global warming is beyond scientific skepticism and the public health option is disastrous.
I mean really, established scientific theories have never been over turned, and the universal health insurance provided to Congress and the armed forces has never been medically effective.
Scientific theories should be validated by the Catholic church and only the private health industry should validate the public option. I mean really, it's only fair.
pacatrue–
Very good point (s).
@@Please somebody tell me, what is freedom anyway?@@
You get to make your choices and I get to make mine. But, as liberals cannot seem to comprehend, your range of choices obviously can't involve making mine for me.
You stop affecting me with YOUR idea of good government and I'll stop blocking your legislation.
Austin Roth–
I'm interested in your sources for the lower, though still large number.
Here is one quick one. It is actually the normally quotes source of 47 million that admits that number is too high, as it counts anyone who is uninsured for even one day during the year, illegal immigrants, etc.
It is easy to search the web and find that number doesn't hold water. But to be fair, as the link will point out, the 8 M number tossed around by some is assuradlt too low, as well.
46 million and 8.2 million uninsured myths busted/
“You get to make your choices and I get to make mine.” – casualobserver
Ah yes… except when it comes to abortion. Then the rules somehow change. So much for grand, sweeping statements about “freedome”…
Back to the topic for a moment: If caving occurs on the public option, I think we all lose, including the folks who think they don't want it. It will be hard for the D's to dress a loss up like that and make it look pretty.
Forget “47 million”, it's an inflated, not entirely accurate figure. That's not the worst number, and it wouldn't be even if it was completely “true”. What is truly unpleasant is the 20000 who perish every year because of the systematic flaws in the status quo. When 3000 people died on 9/11, America saw it fit to invade two countries (one with no due cause) and spend tons of money just to react.
“and the universal health insurance provided to Congress and the armed forces has never been medically effective.”
Yes it is. The veterans may be mistreated horribly in some cases, but the actual medical care for the soldiers is excellent.
“As to global warming, real scientific skeptism and review may be making a comeback on this issue, finally:”
What an arrogant and bombastic way to express yourself. Skepticism and review was always a part of the work of the climate scientists. Science itself is nothing but criticism taken to the human empirical limit. Trying to portray the skeptics as some sort of “real” scientists who have been oppressed by some mysterious force is just pathetic. The skeptics are taken to task and found wanting, regularly, by people who examine the data. Stop trying to act as if the case against global warming is underrepresented among scientists for any other reason other than its lack of comporting with reality.
Austin Roth–
That PDF from the Census Bureau keeps crashing my computer, so I can't see the underlying data. But The American Spectator seems kind of iffy.
JSpencer–you undoubtedly confuse me with others (not that I know of any regular posters here who are anti-abortion)………….I offer no interference, by threat or in actuality, to any woman pursuing an abortion.
I simply refuse to pay my money for her to implement her choices in life.
Global warming——knock your socks off in whatever direction you wish to go. Do I deny the possibility, no. Is it high on my priority list, no.
It seems to me the question asked in the title is framed to lead you to the answer Kathy wants you to give. It looks like many people are now defining any bill without a public option as “bad” which is certainly debatable. If the title of the post were “Is a bill that improves the health care system somewhat better than none at all?” the responses would be different.
Austin Roth–
I found this from CNS, which briefly makes the case against the 47 million number. Though it certainly qualifies as anti-Obama spin (headline: “Obama Falsely Claims There Are 47 Million Uninsured Americans”), it also lays out the numbers clearly.
Uninsured in America = 45.65 million, according to 2007 Census Bureau report. That number alone is lower than the 47 million Obama claimed. (I believe Obama is using more recent estimates to arrive at 47 million, so this complaint based on a different source is kind of shady.)
Of that 45.65 million, 9.73 million are foreigners, so they don't count. (While I see a distinction here, the distinction doesn't make much difference. Since, if they needed health care, they'd go to an American emergency room or other American provider, rather than going back to their native country, they depend on the American health care system. If they can't afford to pay for this treatment, the hospital will have to recover its costs from other patients.)
CNS also goes on to say that 9.1 million of the uninsured Americans earn over $75,000 a year and are just choosing to go without insurance. (They'd still have to go to an American emergency room or other provider and without insurance, they'd be subject to the highest prices charged. I recall an argument that people who make $250,000 a year aren't rich, so $75,000 would be too poor to afford top-dollar health expenses. You can say they'd be getting what they deserve, but if they go bankrupt without paying, the hospital would still have recover those costs from other patients.)
That number Obama uses is basically the same as the number (46 million) used by reputable sources like the Kaiser Family Foundation.
All that checks out, GS, but the point isn't that there aren't '46 million uninsured people in America', it's that this number is falsely used to represent the people that need to be targeted with healthcare reform plans.
No plan is going to be available to illegal immigrants, so if everyone is honest about it right off the bat that reduces the correct figure by about 20%.
Then there are poor people who currently qualify for Medicaid or SCHIP but aren't enrolled. Surely we're not going to create a new program and expect that people who haven't enrolled in the old programs will suddenly find a way to the new program? Can we agree that those people aren't the target of healthcare reform either, except perhaps to put a bit of money into the plan to expand outreach efforts to help people find the resources they need?
And then there are the people who are only temporarily uninsured. The only real way to deal with people who are between jobs would be to reform or subsidize COBRA (the subsidy is already in place in the ARRA bill) and/or to address economic recovery so that we get into a cycle of positive job creation.
And finally there are the voluntarily uninsured- people who will not qualify via means testing but are generally young and healthy and would rather have disposable income for other uses than to insure against health problems. I guess one could either include this group in the target number or not, depending on whether one supports mandates, because that would be the only way to get those people paying into the system.
CS
If it's 47 million or 30 million, isn't the strain on our health system and financial burden basically the same? Illegals still show up at the Emergency rooms along with those that could have Medicare/Medicaid, so uninsured costs still impact all of us.
I'm all for truth in making an argument, but isn't the problem of cost and service effected by the 47 million regardless of their eligibility? It seems to me that the medical and financial demands remain the same.
CStanley–
I was going to say what HemmD said about the cost demands on our system.
In fact I attempted to preempt you complaint by describing those demands in the comment you're responding to.
That 46 million number is accurate and honest. That's why it is generally accepted by reputable organizations.
Well, yes and no, Hemm.
First off, it's not entirely clear that having uninsured people access routine care is a cost saving- it may be more effective for the health of the individual, but not necessarily economically better. It's true that on a per event basis, a visit to the ER is a lot more expensive than a visit to a family physician, but how often does the former happen compared to the number of times the latter would happen if it was free for the individual?
So that part really is more of a moral question than an economic one because as far as I've seen, the claim that preventative care saves money has been debunked.
On the moral issue- personally I'd love for everyone to be covered, but do we actually think we can afford to pay for healthcare for everyone who finds their way across the border? That would leave an open ended promise to the entire population of Mexico (and Guatemala). I mean, I'd like to buy the world a Coke, and free healthcare- but we live in the real world where things cost money and there's not an unlimited supply of money or other resources involved in providing healthcare.
So I think we have to draw the line at citizenship- not to mention that it would be political suicide for anyone to suggest otherwise.
Now, if you want to talk about real immigration reform which makes some current illegal aliens citizens and deports others, and enforces border crossings- there would be a certain number of those illegals who would fall under the current plans. But that was tried and failed in the last administration, and the Dems don't even have it on their radar screen.
So, GS and Hemm- you don't think it's dishonest to use the number as the basis for the need for reform but then craft reform proposals that don't address a large portion of that number at all? Seriously?
CStanley–
It's possible you missed the fact that reputable sources use the 46 million number?
cs- likely the better argument is that illegals use ER's mainly for gunshots and other serious injury………
@@Illegal Aliens perpetrate much violent crime whose physical results arrive in ERs. [15],[16] “Dump and Run” patients dropped on the hospital sidewalk or at the emergency room entrance before the car speeds away usually are connected to drugs and gangs. Patients requiring tracheotomies and thoracotomies for stab or gunshot wounds are dumped at hospitals whether or not exclusively dedicated to trauma care and EMTALA governs their treatment.[17],[18]
While nationally most people coming to emergency units are not poor and have medical insurance,[19] cities such as Los Angeles with large Illegal Alien populations, high crime, and powerful immigrant gangs are losing their hospitals to the ravages of unreimbursed care under EMTALA. In Los Angeles, 95% of outstanding homicide warrants are for Illegal Aliens, likewise for 66% of fugitive felony warrants.@@
To the extent the hospital has a service population of non-criminal, insured persons, the costs of treating illegals is currently absorbed by the former. Therefore, there will be no cost savings just because the gangbanger presents his Obamacare card in the future.
What George has to show support for is his notion that the Obamacare HMO will reduce the incidence of ER usage by illegals to claim it will produce a cost savings.
CS
My point was that you and I pay for these uninsured now through higher medical insurance and higher costs charged by physicians and hospitals.
Health reform is not about money, it's about coverage. Currently, you and I pay for any services supplied to uninsured people. Health care reform is a matter of getting all receiving services to have some kind of reciprocal contribution. You seem to want to take the 20% illegal figure and make it about immigration. Real health care reform must address that as well. The problem is a lot bigger than the rise of premiums.
If you don't mind paying for uninsured services through higher insurance premiums and procedural costs, we can divide the 46 million into any subgroups you wish. The payer remains the same.
Health reform is not about money, it's about coverage.
Well, we've been told that it's about both, but obviously since the current plans bend the cost curve in the wrong direction, you're right that no one currently is addressing the cost. I suppose what I'm asking is that the proponents of those plans start debating it honestly.
And honest debate is impossible as long as both sides are taking millions from priate health PACs and lobbyists. That's one of the reasons why the public plan is not even in the picture.
Ah yes… except when it comes to abortion.
JSpencer, you read my mind.
@ Hemm, private citizens can certainly still debate the relative merits of various proposals. Saying that this one isn't good based only on which lobby supports it doesn't really cut it because there's always an opposing interest group that funds the other guy's proposal.
The answer to your question, Kathy, is that intelligent adults say no (and have opposed the current idiocy from the beginning), while the childish and otherwised “challenge” say yes, strongly.
* * *
“As to global warming, real scientific skeptism and review may be making a comeback on this issue, finally”
… politically incorrect (and subject to savage treatment) as that will be, though many of us have seen through the hype for ages as well as the destructiveness of what would be attempted in the name of “solving” “problems.” (Sadly, though the public widely opposed it, the nonsense associated with global warming and related idiotic extremism and activism was favored by the Dems in their earlier stupid rush on “climate” legislation that is not only silly but destructive legislation.)
In this case, the rushed stupid health care initiative, the more the public learns, the more the public realizes is wrong with it, and that's aside from the fundamental flaw that costs were deliberately neglected from the beginning, which killed its support immediately among the intelligent.
What's sick (an approprate word) with this current health care initiative in particular is what you have identified, the lying, that comes with those continued Obama campaign-style staged “town hall” attempts to manipulate public opinion, as if the Dems believe everyone is as silly and easily led as their core voters.
It's as bad as the current pathetic AFSCME ad trying to get support for the initiative (which itself is real-world evidence the initiative should be rejected!) that features appeals to emotion including someone who is pretending to wipe a tear from one of her _dry_ eyes. That's the nature of the support for the initiative!
“Constantly needing to use an acknowledged inflated number only makes your cause seem more suspect.”
I have observed that most people now don't even respond to the “N insured” argument; they were quickly made sick of it during the Clinton health care fiasco and yawn at the higher numbers used today; such an appeal to emotion (the bigger the number, the greater the appeal, the users must reason) doesn't work because everyone has seen people who have problems with the insurance they have, in addition to those who don't have insurance at all.
“That and the lying about it saving money (it doesn't), keeping your existing plan (you will be forced to change within 5 years), that everyone will receive better care (only the chronically uninsured will – the rest will see reduced care over time, except, as always, the very wealthy).”
The lies are indeed annoying, though one of the additional things that this lying does that contributes no doubt to the increasing public concern about the health care initiative is that the Dems have lied before about other things (not running General Motors, that the climate legislation is good and we “need” to act quickly on global warming) and we're just seeing more such lies now. (This is a general problem the Dems have developed in addition to specific additional concerns they have created with their health care initiative by their lying about _that_.)
* * *
“So I think we have to draw the line at citizenship”
That will cost the Democrats support, and even _votes_, so it is a non-starter, C. Stanley.
* * *
“Global warming——knock your socks off in whatever direction you wish to go. Do I deny the possibility, no. Is it high on my priority list, no.”
And what do we see with the Dems this year, pushing bad legislation on all issues? TOP PRIORITY, RUSH, RUSH, RUSH.
The _real_ question remains (more than the poor quality of the legislation, which is obvious) is _why_ the Dems are _rushing_ to enact all the bad legislation as quickly as they can. (Only the most childish have supported this vigorously.)
I mis-conveyed my point. Private citizens of course MUST debate these issues, but I was alluding to the fact that those laws being propagated in Washington hold little resemblance to the real issues. The current proposals leave out basic questions and current realities:
1. All the talk about cost for reform, but no discussion of the current rise in costs that will kill us sure as strychnine.
2. The Mayo clinic now provides health services at 20% less cost than most every other hospital in the country. Haven't heard a word about using their techniques as a model for true cost reduction.
3. Single payer? What PAC supports single payer?
4. Government run health care is a disaster. Except that it's not that way for congress or the armed forces. Too expensive? The armed forces don't pay anything except their service to the country. Active service families are covered free of charge. No wonder
I ramble, but I hope you can see what I'm driving at. The Washington debate talks about co-ops and limitation of services. They don't discuss efficiency or cost savings within the existing system.
All Washington proposals are written to maintain the status quo, the same status quo that is killing us now and in the future.
Being a Utah health insurance underwriter for http://www.BenefitsManager.net and http://www.DentalInsuranceUtah.net I have the opportunity to consult within many state insurance committee meetings. Some interesting changes took place in Utah with the passage of House Bill 188 that other states should pay attention to and perhaps the federal legislation. The bill created a state insurance pool requiring private health insurance carriers to come together and underwrite risk. Through governmental guidelines (which I have traditionally opposed in the past) they created a arena of underwriting rules that essentially guarantees the participating insurance carriers a ?no loss? or ?no gain? over each other. What this essentially means is that they pool the underwriting medical risk and spread it evenly among each carrier. All the sudden, we see guaranteed issued policies. We see rates drop by as much as 13% In Utah, our average monthly family rate is $867 for a $500 deductible plan. Some of the family rates within the ?Utah Insurance Exchange Portal? are approaching $700.00 now. To see more of HB 188 and see how Utah wrangled change without increasing taxes or rationing go to: http://www.prweb.com/releases/utah_health_insur…
The private insurance sector can be corralled into cooperation where they can meet their goals. You have to understand that health insurance carriers are only looking for a 4-5% administration fee. That is it and they are more efficient as compared to a governmental portal that will cost more money. Take a look at Utah folks!
Nothing associated with S. Fred Singer has any credibility.
The Denial Machine
One of Singer's great accomplishments
Hemm- Obama has praised Mayo repeatedly. Unfortunately they didn't return the favor regarding his reform plan, so somewhere along the line he must have missed the ball in incorporating whatever costsaving measures they've employed.
I don't think Obama is to blame for Congress' lobby laden proposals. If he starts writing these bills, your criticism is fair. Congress has produced bills that demonstrate look first to maintain the status quo and maintain profit levels for private interests. These bills are no more Obama's than they yours or mine.