Editore"s Note
Tilting at Windmills

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May 30, 2007
By: Kevin Drum

OBAMA'S HEALTHCARE PLAN REVISITED....Ezra Klein has taken a closer look at Barack Obama's new healthcare proposal and finds himself unable to work up much enthusiasm for it:

His is a plan of almosts. It is almost universal, without quite having the mechanisms to ensure nationwide coverage. It almost offers a public insurance option capable of serving as the seed of single-payer, but it is unclear who can enroll in it, and talks with his advisors suggest little enthusiasm or expectation that it will serve as a shining alternative to private insurance. It almost takes on the insurance industry, but asks for, rather than compels, their participation.

....All the ingredients are in place for this to be a great plan — a public insurance component, a commitment to universality, an understanding that coherence is better than fractiousness, a willingness to regulate the insurance industry — but, in each case, at the last second, the policy is hedged before the fulfillment of its purpose. In this, Obama's plan is not dissimilar from Obama himself — filled with obvious talent and undeniable appeal, sold with stunning rhetoric and grand hopes, but never quite delivering on the promises and potential.

Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal. This is not necessarily a bad thing: the time he's spent in the trenches doing community organizing and then as a state legislator seems to have taught him that there are no easy answers; that political coalitions are hard to build; and that real progress often requires a slow but steady approach. He may even be right about that. Certainly I'm no revolutionary myself. Still, sometimes audacity requires audacity. Hope isn't always enough.

Kevin Drum 2:50 PM Permalink | Trackbacks | Comments (55)

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Comments

Caution about healthcare plans usually comes from, and rightly: what do we do with the existing business establishments and arrangements? Maybe if we could just get them to charge off a percent of income instead of a flat fee...it would work like Medicare etc. but not require turning the whole thing upside-down (?)

Posted by: Neil B. on May 30, 2007 at 3:04 PM | PERMALINK

Death to the capitalist parasites that prey upon the lives of the proletari -- excuse me, but Oprah is on now. Catch you later. I hope she has Dr. Phil on again ...

Posted by: Comrade Donald from the People's Republic of Hawaii on May 30, 2007 at 3:10 PM | PERMALINK

I also wonder whether something audacious is really harder to pass. It seems to me that the insurance companies will fight you just as hard if you intend to cut off their leg as if you intend to kill them, so why not go all the way with single-payer? At least that way you won't tick off small businesses, which have a lot of political pull too. And even though the CEOs of big business are probably philosophically uninclined to back single-payer, I suspect with the pounding they've taken on health care costs they might think again.

Perhaps I'm naive, but I don't think a plan that spreads the pain thinly and widely is necessarily a political winner.

Posted by: Wagster on May 30, 2007 at 3:10 PM | PERMALINK

Caution about healthcare plans usually comes from, and rightly: what do we do with the existing business establishments and arrangements?

Why "rightly" when those existing business establishments and arrangements are often at the root causes of the biggest problems? We have no obligation to further the interests of those whose profits depend on keeping the system unfair and inefficient.

Maybe if we could just get them to ...

If you want to work within the existing business establishments and arrangements, then instead of writing "maybe we could just get them to" you should write "maybe we can show them that their profit margins will be higher if ...". And then sure, if you can just explain how giving a deep discount to those who can't pay full price will translate into higher profits, you might be onto something.

Posted by: bob on May 30, 2007 at 3:11 PM | PERMALINK

Maybe it's in contrast to other times I have heard him speak, but the snatch I heard this morning on the radio sounded stilted, uncomfortable, and, worst, unconvincing.

To make health care work it has to jump to, for the US, new ground. It's not like the area hasn't been well reconnoitred by others before us, just that some want to make it seem scary for obvious reasons.

To avoid over-complexity and to get something that works needs a clear, broad jump of audacity.

Haven't seen it yet.

Posted by: notthere on May 30, 2007 at 3:22 PM | PERMALINK

It seems to me that the insurance companies will fight you just as hard if you intend to cut off their leg as if you intend to kill them

On what evidence is this impression based? It's counterintuitive, and there doesn't seem to be any factual basis for it.

Posted by: Mr Clean on May 30, 2007 at 3:24 PM | PERMALINK

"...sometimes audacity requires audacity."

Kevin: That's a great line.

Posted by: Omark on May 30, 2007 at 3:25 PM | PERMALINK

Yes, I'd really like to see some palace revolutionaries running for office please.

Posted by: craigie on May 30, 2007 at 3:51 PM | PERMALINK

Obama is a "cautious liberal".

Is that like a responsible terrorist, or a thinking environmentalist?

Like any liberal, Obama wants to destroy American health care, which is the best in the world. Maybe he wants to do it more incrementally than Hilary, but their goals are the same.

Posted by: Al on May 30, 2007 at 3:57 PM | PERMALINK

"But his record also shows him to be a very cautious liberal."

Compared to whom? Hillary!? Edwards?

Posted by: brewmn on May 30, 2007 at 4:10 PM | PERMALINK

Mr. Clean, seems the impression is quite widespread.

Maybe it is by the absence of any participation by the insurance companies in moving toward universal coverage. That they fund lobbyists so heavily to resist any change and to maintain the status quo in a system that all regular joe users see as failing. That they volunteer absolutely no viable alternative solutions beyond what benefits themselves even more than the present.

Maybe because it is the same with the drug companies. Apparently price negotiation works very well, thank you, on the one proven hand, but couldn't possibly work effectively on the other, to name but one sly lie.

That there are people like you around that seem to suggest it is all hunky dory, and the insurance companies only have our best interests at heart.

Maybe that there is no honesty in the debate.

Maybe because we expected to digest so much BS?

Maybe because you pass around bowls of the same.

Posted by: notthere on May 30, 2007 at 4:11 PM | PERMALINK

I gotta say that Kevin criticizing Obama for being too 'cautious' does exactly fill me with confidence in Obama.

Like someone getting on Al for being too profound.

Posted by: b. on May 30, 2007 at 4:14 PM | PERMALINK

Al -- you mindless turd. You've said it before and been shot to pieces.

If US healthcare is now the "best in the world" you'll obviously be able to supply substantial evidence for your claim. Right?

Right.

Posted by: notthere on May 30, 2007 at 4:15 PM | PERMALINK

The Audacity of Blah...

Posted by: gq on May 30, 2007 at 4:19 PM | PERMALINK

Actually, is Obama really that much more "liberal" than Clinton? I'd like at least some sort of quantification before throwing out such an assertion.

Posted by: gq on May 30, 2007 at 4:21 PM | PERMALINK

OK, it looks like none of the current crop of Democratic Presidential candidates is going to sign onto Medicare for All.

And for the life of me I just don't get why not.

What can these candidates and their advisors possibly know with any real certainty that would make them back off from doing the bold thing here, and adopt single payer?

I understand that health care insurance companies are going to have the biggest fit in their existence if single payer is on the menu -- precisely because it threatens their very existence. I grasp that they will put up all the money and pressure they can to turn public opinion their way.

But public opinion is NOT infinitely malleable by money, however great. Political leaders can be enormously effective pushing in directions toward which the public is inclined for its own reasons. And God above knows that the public has some very, very good reasons to be thoroughly disgusted with the health care insurance as it stands, and very eager to hear about dramatic new approaches. In the end, it is only people who vote.

Medicare for All promises to be the next great social program for Democrats -- perhaps the last great social program. It could easily become tommorrow's third rail in politics, much like Social Security.

Why can't we find a Democratic candidate willing to stand up for it? Where is the Democrat who will dare to be remembered? Have all far thinking Democrats been dashed on the rocks of focus groups and advisors?

Posted by: frankly0 on May 30, 2007 at 4:22 PM | PERMALINK

frankly0,
Wes Clark has said we should take steps toward single payer health care. He probably doesn't think he could get full on single-payer during his tenure (should he run and win), but thinks that we should take appropriate stepts. I think he'll run so I'll wait to see what he proposes.

Posted by: gq on May 30, 2007 at 4:34 PM | PERMALINK

frankly0, because of 30 years of hedging?

And it's almost 20% of the economy. Sort of becoming the second government-military-industrial complex.

See! Even Eisenhower dropped the vital coordinator and guilty supplicant of the triad from his draft.

Posted by: notthere on May 30, 2007 at 4:36 PM | PERMALINK

He probably doesn't think he could get full on single-payer during his tenure (should he run and win), but thinks that we should take appropriate stepts. I think he'll run so I'll wait to see what he proposes.
Posted by: gq on May 30, 2007 at 4:34 PM | PERMALINK

As commander-in-chief, I don't see why not. I mean, according to Cheney's theory of the unitary executive, all President Clark would have to do is say there's a "War On Big Pharma", send in the troops, and boom, we've got single-payer healthcare. (never mind that the single-payer would be the Pentagon).

Posted by: osama_been_forgotten on May 30, 2007 at 4:53 PM | PERMALINK

Call me a literalist, but I think a plan for universal coverage should be a plan for universal coverage. Obama is stuck with this political and policy disaster for the entire campaign.

Obama fans better pry away from Axelrod.

Posted by: david mizner on May 30, 2007 at 5:11 PM | PERMALINK

We are a nation of 300 million people.

Of these 300 million about 43 million are covered by Medicare, a univeral coverage single payor insurance plan for everyone age 65 and over. (Less than 20% of these have MedicareAdvantage, or some other plan,which merely inserts an insurance company between the patient and provider, but they are still essentially Medicare beneficiaries)

And we have another 43 million with no insurance coverage at all but who will be covered on as soon as they hit age 65.

With this in mind I think the best feasable plan would be for a politician to say that on some future date certain, say Jan 1 2010, that all Americans will be covered by Medicare. You no longer have to wait till age 65 to get this coverage, everyone will have it in three years time. That's it.

Everything else is bullshit.

If political opposition makes that goal impossible then compromise by moving the eligibility age to 55 from 65. The ultimate goal is to keep moving it down, as politics allows, till everyone is covered.

Posted by: ken on May 30, 2007 at 5:13 PM | PERMALINK

The expectations for Obama seem bizarrely over-the-top. Ezra seems to be saying that this is a pretty good plan, with some good ideas, but since it's from Obama and not Hillary Clinton, it's not good enough, because he's supposed to be solving world hunger and curing cancer, or something.

Posted by: rashomon on May 30, 2007 at 5:14 PM | PERMALINK

Medicare provides the best medical care in the world and does so at less cost than does private insurance companies. Private companies have to bleed off underwriting, marketing, accounting, tax, and claims denial beauracracy cost before a single dollar is available for medical care.

Posted by: ken on May 30, 2007 at 5:21 PM | PERMALINK

Al: "Obama is a 'cautious liberal', is that like a responsible terrorist, or a thinking environmentalist?"

I'm fascinated, Al -- have you ever had a truly original and substantive thought in your adult life? Or, like the rest of your neo-con brethren, are you just all meringue and no filling?

Even your weatherbeaten GOP talking-points are nothing but recycled cliches from the late '80s -- and they sound just as immature today as they did back then.

Posted by: Donald from Hawaii on May 30, 2007 at 5:40 PM | PERMALINK

Medicare provides the best medical care in the world and does so at less cost than does private insurance companies.

Er, evidence?

Posted by: Anon on May 30, 2007 at 5:51 PM | PERMALINK

notthere,

You're a veritable factory of bowls of BS....

Posted by: Mr Clean on May 30, 2007 at 5:54 PM | PERMALINK

"OK, it looks like none of the current crop of Democratic Presidential candidates is going to sign onto Medicare for All. And for the life of me I just don't get why not."

You mean, apart from the fact that it would be a fiscal and political disaster?

Posted by: Anon on May 30, 2007 at 5:57 PM | PERMALINK

Rashomon, Ezra and others are saying that a plan for universal health care plan should actually be a plan for universal health care.

It fails to deliver what it claims to, so it's not only a mediocre plan, it's a dishonest one as well.

Obama fans should be pissed.

Posted by: david mizner on May 30, 2007 at 6:11 PM | PERMALINK

You're right David Mizner, we're pissed at you Edwards supporters going negative on our candidate.

Posted by: Mike on May 30, 2007 at 6:20 PM | PERMALINK

Is it too much to combine your lack of worry about the details of a plan and the possibility that a more cautious plan won't get him attacked as much into a hope that if elected, he'll try for something more, well, dramatic? Or does that basically go against one of the reasons for electing him?

Posted by: Brian on May 30, 2007 at 6:49 PM | PERMALINK

You know what this

"Still, sometimes audacity requires audacity. Hope isn't always enough"

sounds like?

It sounds like someone afraid to get his hopes up.

No wonder Kevin feels compelled to quote Ezra Klein:
"Obama's plan is not dissimilar from Obama himself — filled with obvious talent and undeniable appeal, sold with stunning rhetoric and grand hopes, but never quite delivering on the promises and potential."

"Never quite delivering" = "I don't have to commit."

You're scared to commit. You fear Hillary, the mighty Wurlitzer, all that shite. We know. Hey, it's early. Vet to your heart's content. But don't hide behind lame criticisms.

Posted by: cazart on May 30, 2007 at 7:05 PM | PERMALINK

"an understanding that coherence is better than fractiousness"

we love the glossy little terms which the Left bestow upon their coercive authoritarian statist schemes.

Posted by: a on May 30, 2007 at 7:08 PM | PERMALINK

Well, you can hope, Brian. But it doesn't seem likely that Obama would try for "something more dramatic" after he's elected. As president, he would have a much larger and broader constituency to please, and his actions are likely to be accordingly modest and restrained. Right now, he's mainly trying to please Democratic primary voters, so he can afford to be more, uh, audacious. The fact that his plan is so modest shows just how politically untenable dramatic health care reform is.

Posted by: Mr Clean on May 30, 2007 at 7:13 PM | PERMALINK

Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal.

I can't help but think that this is a symptom of Obama's lifetime of success. He's gotten as far as he has without stumbling along the way, so he never was faced with the conundrum of whether to take big risks. Rather, he stakes out some safe positions, builds coalitions, makes friends, and succeeds. It's been great for his career, but I'm not sure that is what we need right now. I think we want someone who knows that playing it safe isn't a way to live one's life and is willing to stake out some riskier policy ground.

But this is almost the problem-- Obama can't. He's a frontrunning candidate, and he doesn't have to take risks to get attention. In fact, anything risky is more likely to hurt him than to help him, so he's a captive of his own success, which seems to be the story of his life.

Posted by: Constantine on May 30, 2007 at 7:17 PM | PERMALINK

In this, Obama's plan is not dissimilar from Obama himself — filled with obvious talent and undeniable appeal, sold with stunning rhetoric and grand hopes, but never quite delivering on the promises and potential.

Old Ezra must have a crystal ball, since he already knows Obama's fate. It seems Obama has, in his three years in the spotlight, already demonstrated his "inability to deliver," at least to someone with Klein's piercing insight.

Q: How can anyone read this and not see how foolish it is?

A: Because liberals are always taken in by the silly-cleverness of people who say something like, "This (whatever "this" is), demonstrates this" (some troubling trait they've decided to project onto candidate X). For liberals, and this includes journalists, which is why Gore became a laughinstock and Kerry a stiff, all events are pieces of a jigsaw puzzle that will be fashioned into whatever shape you like, as long as the result is the picture you want. There is nothing Obama can do that won't prove, to someone in love with their own judgment like Klein (or Drum), that he isn't "failing to deliver" on his promise, that he is a light that will fail. Or that Hillary could do that would prove she isn't "calculating and poll driven;" Gore that he isn't "wooden," and so on.

"Obama's record shows him to be...." (Drum)

Another foolish statement, that means absolutely nothing. Translated, this means, "I've decided Obama is cautious, so I'll just take some totally subjective thing like his voting record and use it to support my decision."

Is there any ambitious politician who doesn't vote with their eye on the next election? What the fuck is a "cautious liberal," and why is Obama somehow more "cautious" than anyone else who knows they will be running for president? Drum has been getting sloppy of late, but this is bad even by his recent standards.


Posted by: Martin Gale on May 30, 2007 at 7:26 PM | PERMALINK

Martin hits one deep over the center-field wall. (Probably off that #*$&er Benitez, but that's another rant.)
Nice post.

Posted by: cazart on May 30, 2007 at 7:39 PM | PERMALINK

As pointed out in the comments on the Social Security item, Medicare is rapidly going broke, and nobody is even discussing how to fix it. Fixing it is really hard, because the benefit can't be cut the way a dollar figure for SS can. We could increase the eligibility age -- that is, reduce the number of people covered.

But on this item, people are talking about casually extending this bankrupt system to cover everyone. Since we can't afford the current Medicare covering 43 million Americans, how could we afford to extend it to 300 million Americans?

Posted by: ex-liberal on May 30, 2007 at 8:14 PM | PERMALINK

ex-liberal: Medicare is rapidly going broke ... Since we can't afford the current Medicare covering 43 million Americans, how could we afford to extend it to 300 million Americans?

First, we can afford it. Whether we choose to pay for it is another matter.

Second, Medicare costs per person are rising no faster (in fact slightly slower) than health care costs in general. So if you think that we can't Medicare, that means that we can't afford health care in general (unless of course you think that in the world's wealthiest country health care should be denied to even more millions).

Whether health care is paid for by the government or by companies and individuals, it costs money. Simply getting someone or something other than the government to pay for it does not magically make the costs disappear (what I call the conservative-free-lunch theory).

Talking about a problem with the cost of Medicare is a diversionary tactic at best, since the Medicare cost problem is just a specific case of problems with rising health care costs in general.

Posted by: alex on May 30, 2007 at 8:59 PM | PERMALINK

Second, Medicare costs per person are rising no faster (in fact slightly slower) than health care costs in general. So if you think that we can't Medicare, that means that we can't afford health care in general (unless of course you think that in the world's wealthiest country health care should be denied to even more millions).

Sorry, but that doesn't follow at all. It's not just the rate of increase that matters but the actual cost. Medicare recipients typically consume far more health care dollars than members of the general population, not just because they are older but because oversight of spending is so much weaker than it is in the private system (that's where so much of those private sector "administrative costs" go--into evaluating claims). Moving a person from private insurance to Medicare might dramatically increase his health care costs even if the rate of increase is lower in Medicare than in private insurance.

In any case, you cannot make Medicare's looming fiscal catastrophe disappear by simply waving your hand and declaring that we could pay for it if we wanted to. What matters is not theoretical possibilities, but actual, real-world behavior. And all the evidence we have from actual experience in the real world suggests that "Medicare for all" would produce an even greater fiscal problem than we have now. We have a very, very poor record of funding government entitlement programs. The French are in a huge fiscal mess because their public health insurance fund is chronically in the red, yet the people are unwilling to accept any serious reduction in services or increase in taxes and fees.

Posted by: Mr Clean on May 30, 2007 at 10:39 PM | PERMALINK
Given liberals' obsession with equal pay...meathead republican at 7:42 PM
You could feed a herd of horses with all the straw you use for your straw man.
....we can't afford the current Medicare covering 43 million Americans, how could we afford to extend it...ex-lax at 8:14 PM
Where's the lament about spending a trillion for an illegal, counterproductive war of choice by your Dear Leader? Republicans have money for death but not for life. Posted by: Mike on May 30, 2007 at 10:46 PM | PERMALINK

Frankly, I don't care that much about his or anyone else's views of the issues. After eight years of Bush, I will settle for a smart, well-intentioned, competent person, and I'll trust him to make reasonable decisions. Obama's stance on this issue strikes me as politically smart, and therefore good evidence that he has these qualities.

Posted by: Stargazer on May 30, 2007 at 11:18 PM | PERMALINK

Mr Clean: Medicare recipients typically consume far more health care dollars than members of the general population, not just because they are older but because oversight of spending is so much weaker than it is in the private system ... Moving a person from private insurance to Medicare might dramatically increase his health care costs even if the rate of increase is lower in Medicare than in private insurance.

Well, you're right about the elderly having higher health care expenses, but the rest is faith based nonsense. For example, from the 9/28/04 NYT:

The investigators, from the Government Accountability Office, also said that the private plans had increased out-of-pocket costs for the elderly and had not saved money for the government, contrary to predictions by Medicare officials.

What matters is not theoretical possibilities, but actual, real-world behavior.

Are you trying to be ironic? How else to explain such a comment from someone who extols faith based belief in the vaunted free market (and of course cites no evidence to support it).

And all the evidence we have from actual experience in the real world suggests that "Medicare for all" would produce an even greater fiscal problem than we have now.

Which evidence is that? That gov't administered Medicare has lower costs than private insurance?

The French are in a huge fiscal mess because their public health insurance fund is chronically in the red, yet the people are unwilling to accept any serious reduction in services or increase in taxes and fees.

Oh, those horribly profligate French, who spend 1/3 less of their GDP on health care than we do, despite having universal coverage.

Or how about those irresponsible Japanese, who have both universal coverage and a far older population than the US, yet also spend 1/3 less of their GDP on health care?

BTW, that's "evidence we have from actual experience in the real world". Where's yours?

Posted by: alex on May 30, 2007 at 11:35 PM | PERMALINK

alex,

Well, you're right about the elderly having higher health care expenses, but the rest is faith based nonsense. For example, from the 9/28/04 NYT:

The quote might be remotely relevant if you provided a link or sufficient context to show what kind of "private plans" it's referring to. Private plans for what? Even then, it's hard to see how you think it is related to the statement of mine you're apparently challenging.

Are you trying to be ironic?

No, not at all. I'm pointing out that Medicare is already headed for bankruptcy, that we have a very poor record of balancing government budgets, and that tripling or quadrupling the size of Medicare to provide "Medicare For All!" or somesuch would likely lead to massive, chronic increases in the national deficit and debt. Perhaps you don't care about that, but I do.

Which evidence is that?

The evidence from an $8 trillion national debt, from decades of the government spending more money than it receives in taxes and fees, from the Medicare trustees report projecting insolvency within a decade, from the French health care system, which is closest existing example of "Medicare For All!" and which is chronically in the red. That sort of thing.


Oh, those horribly profligate French,

Yes, those horribly profligate French, whose national debt is now 54% of GDP and growing, one of the highest among the industrialized democracies, and far higher than ours, thanks in large part to its massively underfunded, massively profligate health care system.

Or how about those irresponsible Japanese,

They're even more irresponsible than the French. Their national debt now greatly exceeds 100% of their GDP. You don't seem to know much about the fiscal state of other countries, do you?

Posted by: Mr Clean on May 31, 2007 at 12:25 AM | PERMALINK

Mr Clean: Yes, those horribly profligate French, whose national debt is now 54% of GDP and growing, one of the highest among the industrialized democracies, and far higher than ours, thanks in large part to its massively underfunded, massively profligate health care system.

Wow, 54%/GDP, how irresponsible! Truth be told (perhaps you were trying to spare me) it's even worse. Public debt (from all levels of government) is 64.7%/GDP. Meanwhile, here in the frugal US our public debt is, uh, 64.7%/GDP.

Of course in France no one has to worry about losing their medical coverage, or going bankrupt from medical bills (#1 cause in the US) and the price they pay for this is gov't debt that's no worse than the US.

Thank God we've followed the frugal path of paying 50% more of our GDP for health care than the French, and receiving care that's no better and hardly universal.

How could any country provide UHC and not rack up enormous debt? Must be impossible, well, ok, with a few exceptions:

Austria: 63%/GDP
Switzerland: 51%/GDP
Netherlands: 50.8%/GDP
Poland: 49%/GDP
Sweden: 46.4%/GDP
Norway: 44.8%/GDP
United Kingdom: 42.2%/GDP
Spain: 39.9%/GDP
Finland: 37.7%/GDP
Slovakia: 36.1%/GDP
Taiwan: 34.6%/GDP
Korea, South: 31.9%/GDP
Czech Republic: 29.1%/GDP
Slovenia: 29%/GDP
Denmark: 28.1%/GDP
Iceland: 23.5%/GDP
Ireland: 22.8%/GDP
New Zealand: 19.9%/GDP
Australia: 14.1%/GDP

Posted by: alex on May 31, 2007 at 6:50 PM | PERMALINK

Here's what I'd like to see some candidate propose:

We'll open the Congressional Health Plan to anyone in the United States. If your employer wants to pay some or all of the premium, good for him (and you). But if you are unemployed, self-employed or work for an employer who can't or won't pay for your insurance, you can buy in by yourself, and you'll get an income tax deduction for ANY premium amount YOU pay (just like your employer would get a deduction for any amount they paid). A deduction NOT subject to any damn 7% of AGI floor, either.

Just let me buy into what you give yourself, Congressmen and Senators.

Posted by: Cal Gal on May 31, 2007 at 7:17 PM | PERMALINK

alex,

Wow, 54%/GDP, how irresponsible! Truth be told (perhaps you were trying to spare me) it's even worse. Public debt (from all levels of government) is 64.7%/GDP. Meanwhile, here in the frugal US our public debt is, uh, 64.7%/GDP.

So why are you proposing to make our public debt even worse, much worse, by tripling or quadrupling the amount of money the government spends on an entitlement program that is already headed for bankruptcy within a decade? Extending Medicare to all Americans would be the most fiscally irresponsible act in the history of the nation.

Of course in France no one has to worry about losing their medical coverage, or going bankrupt from medical bills (#1 cause in the US)

Of course they do. The government does not provide unlimited funds for health care in France any more than it does in the U.S. In fact, the amount of money the French government makes available for health care per capita is far lower than the amount spent by the U.S. If the French government denies you health care because it deems it to be too expensive you are obviously at risk of bankruptcy if you choose to purchase the health care yourself. Please cite the source for your claim that "medical bills" are the #1 cause of bankruptcy in the U.S.

Posted by: Mr Clean on May 31, 2007 at 7:58 PM | PERMALINK

alex,

How could any country provide UHC and not rack up enormous debt?

By providing lousy or mediocre care. If you'd really prefer to be treated under the, er, Slovenian health care system than the U.S. one, by all means go there. I don't think many people will be following you. Including the uninsured.

Posted by: Mr Clean on May 31, 2007 at 8:04 PM | PERMALINK

Mr Clean: So why are you proposing to make our public debt even worse, much worse, by tripling or quadrupling the amount of money the government spends on an entitlement program that is already headed for bankruptcy within a decade?

Gee, I dunno, maybe we could raise taxes to cover UHC. Raise taxes, oh no! Of course you could dispense with most employer and employee/private health insurance premiums. Judging by all available evidence you could save 5%/GDP, which is $660,000,000,000. So the bottom line is I want to do it because I'm cheap.

Extending Medicare to all Americans would be the most fiscally irresponsible act in the history of the nation.

Of course, look at those poor Australians, who have a public debt that's almost 1/4 of what Americans have.

the amount of money the French government makes available for health care per capita is far lower than the amount spent by the U.S.

And yet they receive health care that's at least as good, and cover everyone. Damn those insidiously efficient French.

If the French government denies you health care because it deems it to be too expensive you are obviously at risk of bankruptcy if you choose to purchase the health care yourself.

And what are the odds of going bankrupt due to medical bills in France vs. the US? I'll leave that as an exercise to the reader, because all the other facts needed to demolish your faith and conjecture based arguments are just too easy to find.

Please cite the source for your claim that "medical bills" are the #1 cause of bankruptcy in the U.S.

Still having trouble figuring out how to use Google? Ok, here's a link to start you off:

http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html

alex: How could any country provide UHC and not rack up enormous debt?

Mr Clean: By providing lousy or mediocre care.

That must explain all those sickly Australians, what with their lower infant mortality and longer life spans than Americans. And they've had to pay for it with a public debt that's 22% of what Americans have. Thank God we don't have that here!

If you'd really prefer to be treated under the, er, Slovenian health care system than the U.S. one, by all means go there.

Might not be such a bad idea. They do have a lower infant mortality rate than the US (4.35/1000 vs. 6.35/1000).

Posted by: alex on May 31, 2007 at 8:59 PM | PERMALINK

alex,

Gee, I dunno, maybe we could raise taxes to cover UHC.

Yeah, and maybe you'll win the lottery. "Maybes" aren't a very good basis for major changes in public policy, especially in cases where there is substantial evidence that the change is likely to produce massive insolvency. Give me a good reason to believe it is politically plausible that you will be able to fix Medicare financing while at the same time increasing spending by a factor of three or four, and I'll consider your proposition to be serious. Right now, it just seems politically absurd.

And yet they receive health care that's at least as good, and cover everyone.

Yet another unsubstantiated claim. Do please show me how you have determined that the French receive health care that's at least as good as American health care. This means hard evidence, facts and figures. Not wishful thinking asserted as fact without any corroboration.

http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html

That article does not support your claim. It doesn't say whether the study found that medical bills or some other kind of expense was the leading cause of bankruptcy. In fact, it implies that unpaid expenses in general, not primarily medical bills, arising from the loss of income due to illness was primary cause. It mentions unpaid utility bills, for example. It also states that a large majority of those filing for bankruptcy ("more than three quarters") had health insurance when they became sick, and that most of them retained their insurance to the point at which they filed for bankruptcy. So how, exactly, is this problem supposed to be attributable to our lack of "universal health care?" Even if everyone were covered, the problem would still exist. At most, universal coverage might make the problem a bit smaller, but it wouldn't solve it.

And it gets worse, because the study's findings have been challenged in a subsequent study examining the same data. The latter study's authors found that medical bills were a contributing factor in only 17% of bankruptcies, not 55% as reported in the original study. This weakens the claim even further that the absence of universal health care is a significant cause of personal bankruptcy.


Posted by: Mr Clean on May 31, 2007 at 9:42 PM | PERMALINK

alex,

And what are the odds of going bankrupt due to medical bills in France vs. the US?

Yes, what are the odds? If you're claiming they're lower in France, it's up to you to show that. If you're not, then I'm not sure why you even asked the question.

That must explain all those sickly Australians, what with their lower infant mortality and longer life spans than Americans.

Crude aggregate national health indicators like infant mortality rate and average life expectancy tell us precisely nothing about the quality or performance of the nation's health care system. The primary determinants of morbidity and mortality in a population have nothing to do with its health care system. They consist of cultural, social, environmental and political factors like diet, exercise patterns, climate, crime rates, smoking rates, and so on. The rate of death from heart disease, for example, is much lower in Japan than in most western nations. Is this because the Japanese health care system is much better than those of other countries at preventing, diagnosing or treating heart disease? No. It's because the Japanese diet is much healthier than the diets common in western nations, so far fewer Japanese people get heart disease in the first place. You are drawing a conclusion from data that simply does not support it. I see this kind of nonsense ("Country X has a lower infant mortality rate, therefore country X has a better health care system!") all the time from proponents of health care reform. They don't know what they're talking about. You don't know what you're talking about.

Posted by: Mr Clean on May 31, 2007 at 9:54 PM | PERMALINK

Mr Clean: "Maybes" aren't a very good basis for major changes in public policy ... Right now, it just seems politically absurd.

Yeah, that "maybe" of mine was pretty weak. By contrast you rebutted with the earth shattering "it just seems". I humble myself in awe of your grasp of all that's politically possible and your irrefutable arguments (or maybe it just seems that way).

Do please show me how you have determined that the French receive health care that's at least as good as American health care. This means hard evidence, facts and figures. Not wishful thinking asserted as fact without any corroboration.

You mean like the sort of hard evidence, facts and figures that you provided in disparaging Slovenian health care?

With limited time to educate the ideologically blinded, I'll turn it around - show me how you have determined that American health care is superior. Better yet, show me how you have determined that American health care is so superior that it justifies the 50% of GDP more we pay (72% percent more in actual dollars or Euros).

To start you off here are a few simple tidbits of hard evidence, facts and figures:

Infant mortality: France 3.41/1000, US 6.37/1000. Oops, we lose. Sorry junior.

Life span: France 80.6 yrs, US 78.0 yrs. Oops we loose again. Sorry granny.

the study's findings have been challenged in a subsequent study examining the same data

Challenged, oh no! From your link:

Himmelstein and colleagues also say that the new analysis "misrepresent[s] the previous literature on medical bankruptcy," giving as examples one study's conclusion that "medical debts are often buried in credit card balances and second mortgages"

Gee, I wonder how they missed that? Hmmm ...

The reanalysis, which was funded by America's Health Insurance Plans

What do you have next, an Phillip-Morris funded study that claims that smoking doesn't cause lung cancer?

Posted by: alex on May 31, 2007 at 10:38 PM | PERMALINK

alex: How could any country provide UHC and not rack up enormous debt?

Don P. (oops, I mean Mr Clean): By providing lousy or mediocre care.

Do please show me how you have determined that countries which have UHC and do not have enormous debt provide "lousy or mediocre care". This means hard evidence, facts and figures. Not wishful thinking asserted as fact without any corroboration.

If you'd really prefer to be treated under the, er, Slovenian health care system than the U.S. one, by all means go there. I don't think many people will be following you. Including the uninsured.

Do please show me how you have determined that Slovenian health care is of poor quality. This means hard evidence, facts and figures. Not wishful thinking asserted as fact without any corroboration.

Posted by: alex on May 31, 2007 at 10:52 PM | PERMALINK

alex,

Yeah, that "maybe" of mine was pretty weak. By contrast you rebutted with the earth shattering "it just seems".

I guess you didn't read the preceding sentences, then, which explain why your proposal "just seems" to be political fantasy. Let's review: You're going to fix Medicare, raise taxes, and increase government health spending by a factor of three or four. Yes, totally plausible! Completely realistic! It's amazing it hasn't happened already. I'm sure you're lining up the votes in congress right now.

You mean like the sort of hard evidence, facts and figures that you provided in disparaging Slovenian health care?

No, I mean like the sort of hard evidence, facts and figures, that are needed to substantiate your factual claim. Do you have them or don't you? If you do, produce them. If you don't, we need not take your assertion seriously.

show me how you have determined that American health care is superior.

I don't need to support a claim I haven't made. You're the one seeking change, so you're the one who needs to make the case for change by presenting evidence that it is justified. You haven't done that.

Infant mortality: France 3.41/1000, US 6.37/1000. Oops, we lose. Sorry junior.

This nonsense again. Read my last post. Infant mortality rate is meaningless as an indicator of the quality of a nation's health care system, because there are so many other factors that influence the rate than health care interventions. In fact, instead of that, read Phillip Longman's classic article on the subject of the causes and sickness and health in populations. Here's a quote:

In a recent issue of Health Affairs, three researchers from the Robert Wood Johnson Foundation examined scores of studies dating back to the 1970s on what factors cause people to die prematurely. They reported that genetic predispositions account for 30 percent of premature deaths; social circumstances, 15 percent; environmental exposures, 5 percent; behavioral patterns, 40 percent; and shortfalls in medical care, 10 percent.

That's right: shortfalls in medical care are responsible for just a small fraction, around 10%, of premature deaths. Other factors are far more important, swamping any influence from health care services. So stop pretending you can draw any meaningful conclusions about which nation's health care system is "better" than which other nation's by comparing infant mortality rates or average life expectancy. It's meaningless.


Posted by: Mr Clean on May 31, 2007 at 11:21 PM | PERMALINK

alex,

Gee, I wonder how they missed that? Hmmm ...

I don't think they missed anything, but you seem to have missed Dranove and Millensen's reply to Himmelstein's response, which notes that:

Nothing in Himmelstein and colleagues’ response suggests that our criticism of their methodology was incorrect. They continue to offer only one direct causal measure: namely, that medical bills "contribute" to 17 percent of personal bankruptcies.

In any case, the point is: (1) your claim that medical bills are the #1 cause of bankruptcy has not been established in the academic literature. The effect of medical bills on bankruptcy rates is a matter of controversy. And, (2) A large majority of medically-related bankruptcies happen to people who have health insurance so it has little to do with the lack of universal health care. There is no reason to believe that universal health care would be a solution to, or even have much effect on, the problem of bankruptcies caused by illness.

Posted by: Mr Clean on May 31, 2007 at 11:32 PM | PERMALINK

alex,

Do please show me how you have determined that countries which have UHC and do not have enormous debt provide "lousy or mediocre care".

Sure, I'll do that just as soon as you show me how you have determined that the French "receive health care that's at least as good" as that received by Americans.

Then you can explain to me why a health care system that is chronically in deficit, huge unsustainable deficit, should be considered superior to ours even if it provides "health care that's at least as good."

Posted by: Mr Clean on May 31, 2007 at 11:38 PM | PERMALINK




 

 

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