Democracy in America

By July 20^th, the Washington Post had reported that the approval rating of Obama’s healthcare plan had dropped below 50%. In spite of this, the Democrats pressed on. Arlen Specter and Kathleen Sebelius continued to preach the benefits of the plan, even after being loudly booed and screamed at by their constituents.

 Those who argued against the plan were accused of being fearmongers, Nazis or anti-patriots by Obama’s supporters, including congressional Democrats like Nancy Pelosi and Blanche Lincoln. To me the situation was beginning to look a little hopeless.  What did protests matter? The Democrats controlled both houses of congress (with a 60-vote majority) and the presidency. I supposed they could  and would pass any bill they wanted to, whether or not they had the support of the people.

But  today, the Democrats surprised me by doing the last thing I would have expected them to do. They listened to the people.  The headline I woke up to today read “White House Appears Ready to drop `public option.’” Here is its first line:

Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.

If the Democrats truly mean to follow the will of the public, then they will deserve credit for listening when doing so is optional. They will have proven themselves, at least this instance, to be true democrats. 

If, however, Obama and his supporters are giving up, not because they care about the will of the people, but because they cannot get enough support from their own party, then Obama and his supporters have much to be ashamed of. Meanwhile, the Democrats who have stood up for their constituents in spite of political pressure ought to be applauded.

Comments

[A.I.]

The woman with a body mass index of 35 or greater has not sung yet regarding the so-called public option, but the signals yesterday do make it appear she is clearing her throat. That leaves the private insurers salivating at prospects for passage of other reform elements. Here's a little of what might happen.

Congressional Democrats will take a victory lap for establishishing some hinky dink coops to control health care costs. The coops will suck a few billion from the treasury, will offer no true competition, and then will be crushed by the big private insurers.

Forty-five million new customers will be delivered to the privates on a silver platter, their premiums underwritten by the full faith and credit of the U.S. treasury. While most of us lose, Cessna and Gulfstream stock goes up on insurance industry orders for private, luxury jets.

Health care costs will continue to rise at triple the rate of inflation and salary increases thus sucking the life out of other sectors of the economy. More and more companies will be driven out of business or overseas thus reducing tax revenues as more unemployed seek government subsidies to afford health insurance. Eventually, the the whole system collapses under its own weight.

As with the economic meltdown, a few Republicans will finally acknowledge a crisis while the majority continue spewing right-wing ideology that runs totally counter to solutions needed for problems at hand. How wonderful that Democrats are "Bowing to Republican pressure and an uneasy public."

[Doug Jensen]

One of the biggest problems with health care costs in the United States is the out of control insurance industry. The insurance industry is driving up the costs of health care. John Thune the republican senator for South Dakota gave a statement representing the republican position regarding health care reform on August 1, 2009. His statement didn't even come close to addressing the issue of the out of control insurance industry, which isn't unlike the out of control financial industry. Under republican guidance during the Bush administration, big business had a free pass to ravage the consumers and the country. The idea was to allow competition to limit big business not government. However, in the United States big business has no competition and when there are two or more businesses that could compete they form a coalition to insure that they don't do anything that would create a true competitive environment. The insurance industry isn't made up of competing businesses, it is a coalition that acts to maximize the profits of that coalition and they couldn't care less what that does to the consumers health or well being.

In the United States, consumers must pay for whatever the cost of health care is PLUS the cost of maintaining an out of control insurance industry, along with the cost of providing emergency care to the uninsured (which is rolled back into the amount paid for health care and is minimal compared to the costs of maintaining the insurance industry coalition.)

The democrats are correct on the health care issue, government must step in and provide competition to an industry run wild with greed. Republicans need to step back away from the plate and help with the reform or get out of the way.

[A.I.]

But Doug, aren't you concerned government will take away our sling shots as we Davids try to deal insurance company giants?

[P. Chirry]

I'm not sure I want the coops either.
What's the matter with just opening health insurance across state lines like Senator Thune suggests? That way, each individual state can decide the sort of health-care reform it wants and the market can pick the winner. Why do we need the Federal government to do it?

[Miranda]

I think you're fearmongering, A.I. But I agree with you that the co-ops are a bad idea. The Democrats can still choose not to implement them. I am not against healthcare reform, but I think reform should be done openly and honestly. I do not think it requires a thousand-paged bill, with hidden surprises in it. And I don't think congressmen and senators who haven't even read the bill should be in charge of voting on it. I also don't think reform requires what amounts to a governmental take over. I also think that a lot of Americans agree with me. Sometimes the solution is worse than the problem. This is one of those times.

[FascistSocialist]

Holy Jesus Hitler Christ! A thousand pages? That's almost as long as a Harry Potter novel! No one could possibly be expected to read that!

Miranda, what you're advocating is the status quo. You have no ideas. You're just saying no to everything that you don't understand. Your general apprehension toward government is not a legitimate reason to knock a proposed government program. If there is some flaw in the program itself, that would be a reason to criticize.

To Chirry: The reason why you can't open up insurance companies to operate across state lines is because SOME states have responsible insurance laws, like Minnesota where for profit insurance companies CAN NOT OPERATE. Minnesota only allows not for profit insurance providers in the state. Minnesotans should not be obligated to allow predatory practices into the state circumventing the consumer protections that Minnesota's legislature has passed.

In general regarding health insurance: as long as 100% of people are covered, there is an affordable option (subsidized in some cases) for everyone, the coverage is adequate, and we eliminate certain phrases from the insurance lexicon like "pre-existing condition" I don't see major obstacles as to why there can't be a single payer system, public option alternative, non-profit health care co-ops, for profit health care systems, or whatever other means you want of paying for health care. It doesn't matter too much who pays for the health care as long as we meet those above conditions. There's virtually no difference between a corporate insurance company and the government run insurance company except that the government one has infinitely more transparency. I think we need to legislate some transparency along with consumer protection for for-profit insurance companies. However, insurance companies are not where major waste is in the health care system. So, substantial reform can be passed with out necessitating a public option, which could come later if coverage issues persist without it.

Miranda, you don't think congresspeople and senators (WHOSE JOB IT IS TO UNDERSTAND THIS LEGISLATION) should vote on it? If I let this sigh out it might evacuate my lungs.

You have no basis for making any claim about this legislation being worse or better than the current situation because you don't know a god damn thing about it.

[A.I.]

What don't get read Amanda are the insurance plans most of us think give us coverage. Perhaps you have read all the fine print (legalese and medical terminology including the exclusions and caps) in yours, or maybe you just read the summary info as most of us do. P. Chirry apparently believes we all are capable of reading that fine print and choosing between legitimate plans and a plethora of garbage plans that would be marketed if states could not regulate standards and whose policies are sold within their borders.

There's a lot of "individuals must retain control" crap emanating from the right. That is a load of dung. Whether I'm dealing with the insurance industry or a government agency, I'm overpowered, outgunned and at their mercy. So my choice is this: Do I stay with the status quo leaving me with only the choice of dealing with the insurance industry, or do I opt for change that ads the ability to choose a government sponsored program that sets minimum standards for insurance--standards that exceed those now offered by many if not most policies? I will opt for the latter.

You both complain that reform is complicated, that the bill--as though there were one bill--is not being read. One reason, likely the primary reason, this process is so complicated is we're trying to accommodate the private insurance industry. You want to simplify, go with single payer. And yes I know, your rejoinder is: or do nothing at all.

[P. Chirry]

Hey, it makes sense to trust the invisible hand. If an insurance company is engaging in too many predatory practices, word should get around and consumers should switch to one that does. The invisible hand should reward honesty. The problem right now (if there is a problem which, compared to Europe and Canada, there really isn't) is that consumers don't have enough choice. Opening up health insurance across state lines would empower consumers more. Consumers would no longer be outgunned.

Another reform I think would work would be to set up a system where individuals choose their own insurance plans, rather than their employers. Employers, profit-driven businesses, don't have an incentive to choose honest insurance companies that don't drive their premiums down with predatory practices, but individuals do.

If we arm the individual with choice, he will no longer be outgunned.

These solutions make way more sense to me than single-payer, a public option, or coops.

[FascistSocialist]

Chirry, wrong. It's been explained in ample detail in other threads and even Ken Blanchard's posts on this very site why there's no such thing as competition between health plans, it's a myth that such a thing could exist. It's also insane to think that consumers could possibly have the information at their fingertips to make informed decisions about various insurance corporations and the fine print of the available plans vis-a-vis their own unforeseen health care circumstances.

[Miranda]

FascistSocialist: I was referring to the comments of Democrat Representative John Conyers who said:

I love these members that get up and say, Read the bill! Well, what good is reading the bill if it's
a thousand pages and you don't have two days and two lawyers to find out what it means after you've read the bill?

(Sources: http://www.foxnews.com/story/0,2933,535244,00.html)

You're exactly right. They should be able to understand the bills they pass. It's their job. But they're not doing
their job. Maybe because with this bill they can't.

So I'll stick to my comments above.

Thank you for your participation.

[Miranda]

A.I.: I do agree with you that there is a problem with the current healthcare system. And you're right that individuals in the current system don't have as much control as they ought to. But the solution to that problem is not to make us dependent on the government. Nor should the solution be more complicated than the current system. It should simplify things. It should give us more freedom. If the problem is that insurance premiums are rising too quickly, one solution would be a cap on premiums. If the problem is unclear or overly complex wording, then the solution should involve simplification. It does not need to involve the government taking over what it has no business interfering with.

Our choices are not "all or nothing." We can let our senators and congressmen know what we'd like to see in the way of reform, rather than letting them decide alone.

Or we can follow P. Chirry's plan, which might turn out to be the best option.

Of course, that's my opinion. Amanda may feel differently.

[A.I.]

Sorry Miranda, I've been speaking a bit with a woman named Amanda lately and her name just came out. And since you mention it, she absolutely would feel differently.

So I take it you have not read the fine print in your health insurance policy. If you do try, my bet is you'll find you do not understand much of what is there and that is not a problem that can be remedied by simplifying the language. Medicine and law employ specific terms to describe complex things. You would end up with a tome explaining what is meant by all the terms used in a typical policy.

Now lets apply that to actual comparison shopping for a policy. First you may read the summary stuff for a bunch of policies to see which appear to offer what you want. You narrow the list down to 3, 4 or maybe five policies. Then you read the tomes and find each has some pluses and minuses, but you finally make a choice and buy the plan.

One year later, you're up for renewal. Whether you filed a claim or not, you're rates have increased because of inflation and your increased age increasing your risk to the company. Not only that, the company has changed some clauses in the policy you had and those changes are unacceptable to you. So now you get to start the whole shopping process over again. Are we having fun yet?

Of course you agree P. Chirry's "invisible hand" theory will fix all this. Basically, if a company screws enough people, word will get around and you will know not to buy their policies. Of course that does nothing for the people who were screwed and there is no guarantee that the reputable company you have won't be purchased by a "predator" company. So a year down the road, you end up with a crappy policy. But, you don't realize that because the unregulated market you envision does not demand notification of change. No problem though, because the invisible hand will do its magic and word will get around that what once was a good company has now gone bad. Just don't get sick in the meantime.

[lexrex]

a.i., your complaint about the invisible hand runs across all industries. it's not a problem wholly-owned by health insurance. but that's how freedom works. freedom is not perfect. sometimes it even works against us.

but i'd rather have that than a government-run plan. besides, there are no guarantees that people won't get screwed by their government. in fact, the government has a pretty long track record of doing that, already.

injecting politics into health care -- and that's exactly what obamacare does -- would be a horrible mistake, and would only make things worse.

[William]

This is probably the best analysis I've read concerning the problems in our current system and how to make REAL reforms.

"A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing."

"The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system."

The full article is well worth reading!

After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.
by David Goldhill
http://www.theatlantic.com/doc/print/200909/health-care

[FascistSocialist]

Wow, that article is really good... A well explained argument against our current system of private and government insurance. It explains well the absurd and sluggish response of health care providers to improving quality and reducing cost of care.

I read the article twice just now, I'm going to pass it along to some colleagues for double checking, there were a few places I had some grievances with but it is the best formed argument against insurance and for consumer health savings accounts I've ever read. Of course he doesn't lay out all the various consumer protections that would have to be implemented along side such accounts and government funded watchdog groups that should also be funded along side the creation of such accounts, etc. but... it makes a hell of a lot of sense.

Anyway... thanks for the link.