The horizon is not so far as we can see, but as far as we can imagine

Tag: health care

Priorities

Actions tell you what politicians really care about.  For example the Senate Health, Education,  Labor & Pensions (HELP) Committee hasn’t put out a public option on health care, because two Democratic members won’t vote for it.

“Not even at Rahm’s level has anyone specifically called members of the HELP committee and said ‘we want this public option,’ said the source. “No one from the White House has called and put pressure on any of them.”

Obama says that a robust public option is important to him.  But it’s all about priorities.    The war and IMF money to bail out Eastern European banks was a White House priority, you could tell because Obama himself whipped for it when it was in trouble, just as he did for the TARP bailout funds..  A real public option?  It’d be nice to have, says Obama, just like he said he’d like to repeal the Defense of Marriage Act and Don’t Ask Don’t Tell.

He’d like to.  But he won’t expend any effort or capital for either.

I wonder how much capital he’ll expend for real health care reform.  Is something that can be called “health care reform” enough, or does he really want the real thing?

We’ll see.

Bankruptcies Due to Healthcare Costs up to 60%

And even more damningly, 75% of those had health insurance. This is up from 50% of bankruptcies just a few years ago.

Meanwhile, in Washington, Single Payor healthcare, which would end this, is “off the table” and a public insurance “option” is under attack, and even if it gets into the final plan, will probably be so crippled by restrictions that it is no better than private insurance.

Current proposals seem to center around the “car inssurance model”, which is to say, you will be forced to buy insurance.  Yes, there will be some subsidies, but do you trust them to be sufficient?  I don’t, and if you do, well, I have a bridge to nowhere you should consider buying.

Health insurance costs are crippling America.  GM and Chrysler probably wouldn’t have gone bankrupt if there had been single payor universal healthcare, for example.  People are forced to stay in jobs they hate, and not move into jobs they would prefer to do (and thus be better at) because they need to keep their insurance.  This directly reduces productivity, decreases the number of new businesses created (since creating a business will leave you uninsured) and reduces innovation.   Countries with universal healthcare pay, on average, 1/3rd less per capita than Americans.  That additional money can be used for other purposes: like good internet, or high speed trains, drug benefits or an industrial policy.  Americans, instead, spend more and get worse health care on virtually every metric.  You don’t live as long, you’re not as healthy, and when you get sick it destroys your finances, often for life.

Here’s my prediction: whatever health care “reform” you get from Obama and this Congress is going to be a half-hearted piece of suck, because it won’t sufficiently (or at all) cut out the private insurance companies.  The public option, if it exists, will be a crippled piece of crap, won’t work well, and will be used to discredit the idea that the government can provide health care cheaper than the private sector.

If the goal was to make a system which worked, the US would simply either copy a system which does work (Germany’s or France’s, say) or it would just extend Medicare to everyone, and allow private insurers to do top-up insurance.  Oh, and it would allow Medicare to negotiate with drug companies, and to choose its own formulary.

Instead, what will happen, is a program which amounts to a massive forced subsidy of the private insurance industry.

None of this should be a surprise.  Obama never promised anything better during the campaign, and since he has a record of not even living up to his campaign promises, why would you expect this to be any better?

[h/t Americablog]

Good Policy Rule #1: Don’t Reinvent the Wheel

Good policy is pretty easy to create, and it’s also easy to recognize, but very few people know how to do either, because we so rarely see good policy in the real world. Almost every policy which comes out of Washington, and most other capitals, is sold as doing one thing, but is actually written and designed to serve the interests of those players which have bought various politicians. So, as a result you wind up with “stimulus” bills which don’t include food stamps and unemployment benefits or you wind up with tax “reform” which makes the tax code more complicated and gives most of the tax cuts to the rich. In fact, it’s very rare that any major bill either does what it’s supposed to (No Child Left Behind, for example, has almost certainly done more harm to American education than good) or if it does, that it does it in a way that is efficient and effective. Medicare drug benefits, which were designed to make drug and insurance companies money, not to deliver cheap drugs to Americans, are an excellent example.

Each post in this series will discuss one rule for judging or creating policy. We’ll start with the simplest rule of all:

Don’t Reinvent the Wheel

Sometimes another country, or a state or city, has already solved the problem, or has solved a large chunk of it. The prototypical example of this is health care. Every other modern (and some 3rd world) country in the world has universal, usually single payor, healthcare. Most of those systems produce as good or better results than the US on almost all metrics.

And these countries pay, total, about two-thirds of what Americans pay per person, for health care that covers everyone. A side effect is that GM and Ford price in $1,500 of insurance costs into every car, while Toyota avoids that expense, and continues to eat Detroit’s lunch. Meanwhile, 50% of all bankruptcies in America are caused by health care costs. There is virtually no downside to universal healthcare, even for the very rich (the very rich will always have private clinics. They did even in the USSR.) Every health expert who isn’t paid not to know this, knows that universal care is cheaper, and better.

We know it works, because it has worked in every 1st world nation which has tried it. The reason the US does not have universal healthcare, ironically, is the huge amount of money that could be saved—5.3% of the US’s total GDP. That’s a heck of a lot of money, and a lot of people are getting very rich off of it. And those who make a killing use the money to buy lobbyists and politicians and make sure that 50 million Americans don’t have insurance, another 20 million or so are underinsured, that 50% of all bankruptcies are caused by health expenses, and that US healthcare metrics continue to lag other first world countries. They stop real reform because the pain and suffering and financial devastation of all those millions of Americans is earning them a lot of money. Making a “killing” isn’t exactly a metaphor when it comes to US healthcare.

So we know one big, simple way to fix US healthcare and it doesn’t require reinventing the wheel, but simply learning from what others have done.

But healthcare isn’t the only place where this works—one could, for example, look to how other countries handle, say, drug use, and learn some lessons. Or look to their prisons. Or figure out how much smaller countries than the US are able to have effective militaries without spending 50% of the world’s military budget.

This is simple stuff, the basic rule is familiar to anyone who’s ever wanted to learn how to do something and gone to find out how other people do it, looking in particular at the people who are best, then copying what they do and making minor adaptations to your own situation. When I want to learn how to cook something I’ve never cooked, I look it up. When I want to buy a new car, I look up reviews. When I want to build something, I find out how others who have built something similar did it.

So the first rule of making, and recognizing, good policy is just common sense. Learn from others.

Don’t reinvent the wheel.

(Originally published June 17, 2008, at FDL.  Never did write the others in the series, may take it up.)

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