The Fat Lady Clears Her Throat

Sometimes in a restaurant, when I am hungry and waiting for a meal to arrive, I get up a go to the bathroom. Not because I really need to go, but because I think that the food will be there when I get back. Sometimes I go on vacation with a similar expectation: things will be better when I get back. A year ago I got back from several days of hiking in Theodore Roosevelt National Park to discover that John McCain had chosen Sarah Palin as his running mate. It doesn't always work.

This time may be different. Yellowstone is almost a news-free zone. When I did get some information, I learned that the Obama Administration was saying that "the public option" might not be part of the healthcare package, and that it would be part of the package. And then I read this, at The Politico:

A day after House Speaker Nancy Pelosi said that health reform won't get through the House without a public option, House Majority Leader Steny Hoyer said Friday that the public option may have to go in order to get a bill passed.

Well, as my Irish ancestors liked to say, "it tis' and it tisn't." When they say that sort of thing, you can be pretty sure that it tisn't. When I left for the last outpost of civilization (the last place one can buy whiskey) I had no confidence in the Democrat's reform project so coming back to signs of deepening disarray among Democrats is comforting.

The problem for the Democrats seems to be this: a substantial portion of the House coalition won't support any healthcare plan that doesn't include the public option, and another substantial portion (the Blue Dogs) won't support any proposal that involves big increases in deficit spending. So far no one has figured out how to square that circle, so that means no plan can pass.

Meanwhile, the President's approval ratings continue to decline, especially when it comes to confidence about his handling of the healthcare issue. Americans are increasingly convinced that healthcare reform will mean higher prices and fewer choices for them. Oh, and the Rasmussen poll has the generic Congressional vote favoring Republicans by five points. That is huuuuge. Republicans always do better in actual elections than the generic polls predict. They rarely lead Democrats. Right now that means the Republicans have recovered in a big way. Only a few weeks ago the outlook for next year's election favored Democrats. Now The Hill reports that 2010 looks like an uphill battle for the Donkeys.

Of course a lot of things may change before next year's November. The Press may declare that the recovery is under way (it will). That can't hurt their beloved. But it might not be enough. President Obama has focused all the public attention on the healthcare issue. He has made a mess of it. He has promised that all Americans can be covered with health insurance, that this will help balance the budget and be revenue neutral (a contradiction involving an implausible claim), that no one will have to give up their present coverage (another implausible claim) or face reduced options, and that no one will have to pay more in taxes (except the very rich). Any idiot can see that this doesn't add up. And when you figure out that there is something he isn't telling you, you can be sure it's bad.

As my friend and frequent interlocutor A.I. says, the fat lady hasn't sung yet for health care reform. But she is certainly clearing her throat.

Comments

[caheidelberger]

Paging Dr. Goldblum: "Forget the fat lady. You're obsessed with the fat lady." ;-)

(This comment would be more fun with links:
Goldblum: http://www.uselessmoviequotes.com/umq_i002.htm
obsessed: http://southdakotapolitics.blogs.com/south_dakota_politics/2008/week6/index.html#entry-45299974
fat lady: http://southdakotapolitics.blogs.com/south_dakota_politics/2008/week7/index.html#entry-45485958)

[Grink]

After spending two hours yesterday morning in a crowded waiting room of the provider selected for me by my PPO for a routine blood test; dealing with a surly receptionis; and watching the comings and goings of an indifferent staff, I ask myself, "How bad could a public option be?" I've already got my private insurer telling me where I can go, who I can see, what will be paid, and what won't. And on top of it, I have to deal with medical personnel who make the USPS look like the model of motivation and efficiency.

[KB]

Cory: your zen koan leaves me speechless. Maybe you could provide a few clues as to its meaning.

Grink: Sorry your provider is so bad. Fortunately, a lot of Americans seem to find their own healthcare service acceptable. The question is how to improve the system without making it worse.

[A.I.]

You perhaps inadvertently point out a problem health care reformers have in pursuing their/my goals: rhetoric. Being a bit liberal, I tried to be PC (and a little funny) by referring to the stereotypical opera diva as a woman with a body mass index of 35 or more. A lot of people might be a bit confused by my reference but you, being conservative, got right to the point and called her the "fat lady", a reference understood by all.

A similar situation exists as advocates try to explain elements of health care reform. Bill Maher pointed out that "public option" might as appropriately refer to a toilet as a health insurance plan. In fact, it is difficult to find terminology that resonates when discussing issues as complex as those involved in the change side of the health care debate and reformers arguably have not met the challenge. They try to express concepts using arcane langrage and peoples eyes glaze over. Meanwhile those opposed to reform say something like "government can't do anything right" and people nod in agreement with the familiar assertion--or clap and cheer.

[A.I.]

By the way, I did not mean to imply conservatives are so crude as to never be PC, just that they often have the good sense to use familiar language to get to the point while a liberal will use a bunch of "wonkese" and thus fail to communicate. That is not true of liberal Bill in Portland Maine however. Say hello to BarackWOW insurance reform: http://www.dailykos.com/storyonly/2009/8/24/771216/-Cheers-and-Jeers:-Monday

Take that Obamacare!

[KB]

A.I.: You raise an interesting question here. Is healthcare reform in trouble because the Democrats have been less skillful in their language than Republicans? The LA Times article that I mention elsewhere does point out that the rationales for reform that Obama has presented are vague and shifting, whereas the Republican message has been tight and focused. To some degree this is simply a consequence of the fact that it is easier to attack a proposal than to build a case for it. And it may be, as you say, that the Democrats are more wonkish by nature.

But, to use a now famous metaphor, make the problem is the lipstick and maybe it's the pig. I think the healthcare reform effort is a vast project based on half-vast ideas. Maybe the way to get real reform is to rethink it. The Democrats haven't done that for decades.

[A.I.]

Granting that current proposals are, as you note, vague and shifting; I believe there are vast differences in approach from earlier ideas Democrats have offered. We are not discussing "single payer" and this is not universal coverage under a system of HMO's as was the Clinton plan of 94.

What reform should be is a series of measures that will curtail cost increases while eliminating the most egregious practices of insurers such as discontinuing coverage if someone becomes chronically ill. The so-called public option is central to these goals and arguably the least anti-capitalistic approach that has any chance of reaching them. But, it needs a name.

Maybe we could call it "Fedicare". Or maybe it could have a long name that makes a catchy acronym. Comprehensive Health Insurance Made Possible may not be the best choice, however.

[A.I.]

Comprehensive Health Underwriting Made Possible would be even worse. But Comprehensive Health for America Made Possible would be just fine! Sorry, couldn't help myself.

[KB]

A.I.: Why is "the public option" central to the goals of cutting costs and curtailing abuses? As for the latter, why not simply eliminate the abuses by legislation? Make it illegal to revoke coverage when someone becomes sick. As for cutting costs, on what planet are public corporations more cost effective than private ones? It isn't Planet Earth. You can argue that public institutions are fairer, more compassionate, etc. But when the people who wash the linens in the hospitals get a public workers union ...

I continue to think that the problems with "the public option" are the problems with the public option, and just the problems with what we call it.

[A.I.]

In terms of curtailing abuse KB, it's arguably more free-market to establish standards for all insurers and then spend money on administrators of a public plan rather than on regulators of private plans. Granted, that leaves the privates with a greater option to cheat, but it also leaves consumers with choice. They will know the public plan meets an established set of standards at a given price. The privates will be free to convince consumers they are reputable and offer a product that is better, cheaper or both. And if a private fails to live up to standards, there is the threat of free-market regulation in the form of lawsuits, which is a system I would think a true capitalist should find preferable to outright government regulation.

I don't know that "public corporations" is quite the term I would choose, but health care systems supported by total or some degree of public financing and administration are more cost effective than ours in many countries that happen to also be on this planet. There are countries (I'm betting many with unionized health care workers) spending far less of their GDP on health care and far less per capita while insuring virtually all of their people. If they can do it, then damn it America can do it too. And if our ability is at all in line with our collective ego, we can do it better.

This is the point where the "all those 'socialized' systems offer inferior care" argument comes up. In fact, a given country's care may be inferior by some standards and superior by others. From what I've seen, the inferior/superior argument seems to be a wash. So it comes down to, we are paying far more to get at best, comparable care for a smaller percentage of our population.

A final argument for a public option is simply this: without one, establishing universal coverage hands the privates 45 million new customers on a silver platter; their premium's underwritten by the full faith and credit of the U.S. Treasury. There would be no competing entity to curtail price increases like the 100% plus jump we've seen over the past ten years. Coops are offered by some as an alternative, but studies and experience show they are ineffective at cost containment.

[Matheus]

The question is a leindag question and assumes that the health reform bill will, in some way, cause positive change. First, they have not defined a "public option" you think it will be a government run plan, but "public" can mean exchanges, etc. Second the last time I heard anything on the public option, they were going to use the medical reimbursement of Medicare or Medicare + 5%. As Medicare only reimburses about 80% of the actual cost of care and most private insurers pay Medicare + 20% or M + 30%, there is an immediate disconnect. If this is the case, then all insurance companies should drop their networks and pay exactly the same reimbusement as the public option. That way it is a more level playing field. Remember, the elephant in the room is the cost of health care, not cost of health insurance (as insurance is only the financing of the cost). If we don't tame the cost, then the system implodes in 5 years.A couple of thoughts to include in the reform. 1. pay doctors a salary. Most would love this. Then they can focus on medicine.2. Use Nurse Practitioners as the first line for most people. 80% of all issues can be treated by a NP.3. Have the American Medical Association come up with best practices for those issues that they have enough information to do this with. Doctors should not be able to be sued if they follow those best practices. One would be ALWAYS prescribe a generic medication first unless there is a good reason (which needs to be written into the medical record) to use a brand name drug. It still gives the doctor discretion.Next, federally tax all punitive damages at 100% above $1 million dollars. Punitive damages are NOT designed to enrich the plantiff or the attorneys and compensatory damages are designed to compensate the plaintiff. This would fundamentally alter the whole legal industry.I'd also like to see a tax on fatty/sugary foods.Just some thougths.

[Nicky]

kbot: I am going to assume you are asknig, why help people who can not help themselves and were born with disabilities, not of their own choosing .*If you have to ask, then there is really no hope for you. I can only hope you are personally adversely impacted by one of these diseases and have to rely on others. Only then will you understand their lives and know why they need our help.*Normally I would not wish that on anyone, but someone like you needs to know what it is like.

[Nake]

Thanks, Dan, for making it pesonral to your family. I do believe that narratives about real people are most effective in helping the public understand public policy and the effects of policy change. My two sons are in college and I had already been afraid of what they would do if they didn't get a job with benefits. I have preexisting conditions which would preclude me from getting insurance on my own. I have always said that were it not for my husband's job as an academic at a state college,our family's trajectory would have been very different. Some people have not been so lucky.When middle class people who have health insurance finally grasp what's in it for me and my family they will see that this is not another poor people's entitlement . Unfortunately a lot of people don't see life in terms of the common good and don't link how supporting what is good for the greater good will benefit them as well. Your link about how health care will free people with regards to employment opportunities is most apt. When workers begin to see how many more employment and educational opportunities are available to them when they are not tied to one job or locked into one profession, they will ultimately be living the American Dream! Can't imagine any Republican taking issue with individual freedom and the free market!