Wednesday, September 16, 2009

Judo Politics: a way to get all kids insured

Intermission note: Before continuing to give my second part -- this time about some craziness on the left -- I want to say this about Health Care

It appears that President Obama may have to retreat from the "public option" in his effort to achieve some Health Care Reform, this year. It may surprise you to learn that I approve of this jiu jitsu move.

What, you think this is the only battle in this fight? The "only chance?" That kind of impatience ruined Hillary's over-reach in 93 and torpedoed her husband's presidency. Pragmatists prefer incrementalism.

I say, let the insurance companies crow over a "victory" that substantially changes the health insurance marketplace for the better, drives competition, but leaves out a government -run system to take up the slack where people cannot get policies by private means.

Why? Because a man as smart as Obama knows that a multi-step judo move works better than one big sumo charge. Once he has his market reforms in place, he can then do something simple, that would undercut the for-profits and really force them to the negotiating table.

Call for a followup bill that simply puts all american children under Medicare.

The reasoning is simple and implacable -- if old people deserve it, so do their equally vulnerable grandchildren.

Put it just that way, starkly and simply. A bill that could go on one page of paper. One that needs no extensive argument or amending. Vote now: Is this a good idea or not? Yea or nay. Most would not dare oppose it.

Remove forty million Americans, in a shot, from the rolls of the for-profits, and you'll get their attention, all right. Next, threaten to raise the cutoff age from 18 to 21... then 25... and watch how quickly they come to the negotiating table.

Ah, judo.


Yes, some of you have heard this idea, many times before. But its simplicity bears repeating.

Note: poor kids are already getting government health benefits under SCHIP -- though in a far more complex way. Hence, this change would not be a huge new expense. But it would simplify matters greatly.


rewinn said...

"... some of you have heard this idea, many times before. But its simplicity bears repeating....

At the risk of platitudity:

* It's better to risk repeating a good idea, than to let it die away (and it's much better than repeating a bad idea ;-)

* This is a marathon, not a sprint. Quitting is for quitters. Xeno's runner may never cross the line but getting closer is an improvement.

* I do fault the Obama Administration for taking single payer "off the table". While IMO it's not attainable for a long time, it's a great bargaining chip. You should always demand 100, settle for 50. Next, demand 100, settle for 75. Repeat until 99 44/100ths pure.

* I also fault the Obama Administration AND liberals in general (two not-terribly-overlapping sets) for terrible marketing. A better marketing approach is Thom Hartmann's Medicare Part E

* Liberals should criticize liberals for the same reason and in the same way coaches criticize players: to make us better! I do not like criticism but when it is coach-like, it improves my performance.

The last point is perhaps most important and I look forward to the coaching ... even though I will probably complain about it.

WiseLalia said...

We could also work our way down the age scale. From 65 to 60 to 55... Getting insurance for someone age 55-65 is very difficult between the "pre-existing conditions" and the cost.

I also agree with rewinn, the Obama administration has done a terrible marketing job. A lot of the voters make decisions based on feeling good. You either learn to speak their language--like George W. Bush did--or you don't succeed.

steves said...

rewinn, it looks like a good idea, but what will happen to Medicaid? Do you think it is better to just scrap Medicaid and extend Medicare? I have some experience with Medicaid and very little with Medicare, but the latter seems to have better approval ratings by the people that use it.

Why? Because a man as smart as Obama knows that a multi-step judo move works better than one big sumo charge. Once he has his market reforms in place, he can then do something simple, that would undercut the for-profits and really force them to the negotiating table.

Yes, he is smart, but I am not impressed how he handled his part of the bailout, so it is difficult to sit back and just trust him to do the right thing. Dennis Kucinich had this to say about what he thinks will happen. I don't agree with him very often, but I think he is right.

rewinn said...

steve - yours is a good question. However, I don't think it's necessary to change Medicaid at all to implement the Medicare Part E-for-Everybody proposal.

It might be a good idea to fix Medicaid ... and a lot of other things ... but it might be good to focus on one problem at a time.

Carl M. said...

Sometimes I get on my friends' cases for dabbling in conspiracy theories -- and here you are blatantly conspiring. Is it any wonder why those who like their government small resist even reasonable measures? Here you are blatantly stating that the real reason for a "small" step is for a foot in the door towards socialism.

Ilithi Dragon said...

Carl M,

Can you give me any real reason why socialism is bad? Why is socialism wrong, or deserving of opposition? What about socialism doesn't work or should be avoided?

Also, do you know how many programs all through the U.S. that we depend on and take for granted every day, are socialist?

Yeah, it's not the answer to every solution, there's no such thing as a universal solution, but can anyone give me any real reason why socialism, in and of itself, is a bad thing?

David Brin said...

Carl, I oppose secret conspiracies. Do you see me being secret? Fact is, allowing any american child to go without health care is a crime against any decent standards of Morality. Period. Also against any notion of investing in the future.

Notice I said.... "at that point the insurance companies would have to negotiate in good faith."

Um, how does that mean socialism? Right now they are parasites. Surely you would want SOME changes in how it's done?

Finally, there is nobody in America who more deeply regrets that we do not have a sane party to represent free market solutions to problems. Please recall that I once keynoted a Libertarian Party national convention!!

Alas, both the GOP and the LP are completely, verifiably, certifiably insane, at present. No solutions of any form will arise from either group. And hence, BOTH sides of the problem-solving debate must take place inside the demo-party.

Hence the plain fact that there are squabbles AMONG AND BETWEEN democrats, while the goppers march in perfect lockstep, voting utterly according to Rupert Murdoch's detailed orders. Can anyone call THAT "delegated representation and deliberation"?

Withing the dem-party there are plenty of believers in Adam Smith and markets... like me! Note that EVERY DEREGULATION that wasn't a ripoff scam -- trucking, airlines, railroads, telecom, parcel post... and many others that actually OPENED COMPETITION... was done by the dems. (That's socialism?)

In contrast, what the the goppers ever deregulate, even when they had power? S&Ls, investment banking... a few hundred families raked trillions and we got shafted.

STOP FOLLOWING CLICHES! Just because the dems and liberals *include* some socialism in their mix of proposed tools, that does not make them socialists. Nobody ever fought the USSR harder.


Carl M. said...

David, you are not conspiring in secret, but you are advocating a proposal for the purpose of politically intimidating an industry which your team wishes to replace with government programs.

We already have insurance for our children; it's called Medicaid. The purpose of buying health insurance is to insure one's wealth. Should wealth run out, there is Medicaid.

A very large number of the uninsured are that way because they are young and healthy. I know that in my younger days I chafed at the costs of my employer provided insurance; I would have preferred the cash.

HSAs solve part of the problem. There, the young and healthy have some incentive to sign up, as they can see equity building up for use when they get older and less healthy.

Now, let's see: which party pushed HSAs, and which party fought them, and for a time limited them to just a sample of self-insuring employers?


The Republican and Libertarian Parties are insane. That's why the tea parties are so popular. The disenfranchised take to street marching. Glenn Beck may be surfing the wave of discontent, but he sure didn't start it.

Anonymous said...

Carl, why not at least be honest about the tea party groups.

Who conceived of the Tea Party?
Who is backing the Tea party?
Who advocates for the Tea Party?

Until you can address those questions you don't have much to say politically.


matthew said...

HSA's (Health Savings Accounts)do not build equity year after year as Carl claims. The two that I have been able to join both required *ALL* of the account to be used at the end of the fiscal year. "Use it or Loose it."

HSA's are only effective if the user is in a tax bracket where the value of untaxed wages placed in the HSA is larger than the waste inherent in "Use it or Loose it."

HSA's are a present to those making more than 100k a year, or those with fixed medical costs. They are a risky investment if you are young and healthy.

David Brin said...

Carl, Asking parents to go broke and then get medicaid is not the way people do things, if they want to be called a "civilization."

Dig it. Children are the absolute archetype of people whose health care should be socialized. If they have a need, it should be provided, period. It is an investment, like free schooling. And parents could then negotiate their OWN policies from a position of market strength, instead of guilt/worry/panic.

The tea party reds aren't angry about what they surficially think. They are a mob, stoked up by "other-hatred" similar to what Goebbels used... except they hate HALF of their countrymen... anything urban, educated, knowledgable...

Seriously, I HATE that Carter attributed Obama bashing to racism. Bullshit. It is alienation against the way every bright kid these people ever went to high school with WENT AWAY to the big city, instead of staying in rural America.

Murdoch and Limbaugh are terrified that someday the populist ire that they stoke may awaken to how the red populists were used by true enemies of freedom. Not "the rich" but that segment that wants to be our feudal lords.

Rob Perkins said...

HSA's are useless. Their premiums, for the slate I'm offered, are about $20/month less than the "Cadillac" plan the same insurers offer. The deductibles are triple, the catastrophic coverage is less and it's just not worth it.

It *screams* "reform me!"

(I'm a singleton employee in a state where I have to buy individual coverage, and where the risk pool is, by statute, prohibited from combining with the large city only SEVEN MILES from my house, because of a stupid state line!)

Stefan Jones said...

Yeah, charges of racism are ridiculous.

tacitus2 said...

Still groggy, so I have only skimmed the 223 pages of the Baucus proposal. Its not the final word in any case.

But I keep my promises, and in response to suggestions for how to pay for health care reform:

Taxing short term stock market trading-worthy concept, day trading seems to me a negative thing. But effective taxation of it would have the intended effect of driving it off. Coffers remain empty.

Taxing high fructose corn syrup-interesting article today on lack of weight loss switching from full sugar to diet soda! Not what I would have anticipated. But we can put this to rest quickly. Iowa. Corn. First Presidential Primary. A punishing tax will not happen. Any other kind generates chump change. And why damage one of the few industries where the US still rules?

Let the Bush tax cuts expire, or cancel them early.

Worthy fodder.

Estimates of how much revenue the government has "lost" from these tax cuts has a partisan edge to it. I have seen 1.8 to 2.5 trillion dollars mentioned. These at least are amounts that might finance health care reform.

Discussions on what societal good or ill this money has instead been spent on--it was not all squandered on Grey Poupon mustard one imagines--are a bit much for me.

And the wealth of the really rich seems to be quicksilver....hard to pin down and capture.

If Obama is planning on having this be the major kitty for health care reform he should own up to it right off the bat.

I do not personally object to paying more (groan---still more) taxes if it is well spent.

I will wander back in a few days, perhaps this silly Goebbels talk will go away by then.



steves said...

It is alienation against the way every bright kid these people ever went to high school with WENT AWAY to the big city, instead of staying in rural America.

Are you suggesting that rural America is filled with all the stupid people that didn't go off to the big city? I certainly won't deny that there is some resentment by rural people towards urban dwellers, but the opposite is also true.

Acacia H. said...

I am reminded of the old tales of riding a tiger's back, and how you cannot get off once you get on, lest the tiger turn on you. We have seen this with McCain, who upon telling people that Obama was not an evil horrid person had the very people who voted for him in 2008 turn on him with a vengeance.

Limbaugh and his gang of thieves are riding this tiger, and they realize that if they fall from the saddle... they too will be turned on.

Rob H.

David Brin said...

Tacitus... and others... Stefan shared this.

"And the wealth of the really rich seems to be quicksilver....hard to pin down and capture."

Exactly. (UR smart.) The reason I think we'll get nowhere without universal ownership declaration. Simply getting all the rich to declare what it is that they claim they own, eliminating layers of holding companies and trusts, would pay for ALL our deficits, simply with illicit wealth that would be abandoned -- left undeclared. Do you actually doubt this?

Tacitus, supply side was not a theory, it was a mantra, based upon nothing at all, a rationalization that has since proved devastatingly wrong in EVERY one of its predictions. It is now clear that economic activity is best driven by a vibrant and well-off middle class, which is the source of small business startups and most innovation.

Not all wealthy are conniving plutocrats. Most aren't! But the very nature of their economic activity gives their spending very low "velocity" or economic effects multipliers. This low velocvity was called a good thing, during times of inflation, in fact... but today it is a pure killer, stifling the economy, while govt spending tends to have very high velocity rates, getting cash into circulation.

These are important factors, my friend. But they are unneeded. The simple stark fact tells all. Our nation and civilizatiopn thrived under Clinton and plummetted under GOP rule. At ALL levels and in all ways. INCLUDING "how will we pay for it all?"

Hence, the burden of proof is on the lunatic right, to prove they have anything worth listening to, at all.

Stefan Jones said...

I don't think Beck or Limbaugh have anything to worry about.

Not for their physical safety (move to an sunny island; they have more than enough wealth to buy one), their wealth (you think they'd hesitate to use a Swiss bank account?), or their consciences (they have none).

But then, I have no expectation that the working class or lower middle class that have taken it in the neck the last decade to "wake up" or wise up. They're suckers, and barring a massive change in the way we educate people or in the nature of the mass media always will be. Racial resentment, xenophobia, fear of technological change or the need to deal with environmental problems . . . pick your hot button! They'll dance and shout at the slightest touch.

I didn't always think this way. The change came this summer.

Now I'm thinking of ways to take advantage of it, like selling policies that cover co-pays for Death Panels.

learner said...

I have to disagree with you about racism. No other way to explain the move of the South to the GOP! It was just much more subtle in the past. Today it is out in the open. Fear of the other is being stoked. It started with immigration issues. Please note the claims of the birthers which tie to the anti-immigration positions espoused by Limbaugh, Dobbs and Beck etc.

Carl M. said...

@matthew: you are referring to a flexible spending account[sic!], not an HSA. GIGANTIC difference. The former have been around a long time and I think they stink.

My employer just switched from regular Blue Cross plan to an HSA/high deductible Blue Cross plan (after the old plan jumped 29%). New plan plus deductible is about the same price as old plan. Put the difference in the HSA and I break even even if I go over the high deductible each year. Go under the deductible, and money accumulates in the HSA.

As for the middle class kids, simply make the dependent deduction dependent on having at least catastrophic coverage for the dependents in question. Welfare for the poor. Duh.

TwinBeam said...

Perhaps my browser's search is just missing it, but I don't see where DB says:

"at that point the insurance companies would have to negotiate in good faith."

I do see where he says:

"Once he has his market reforms in place, he can then do something simple, that would undercut the for-profits and really force them to the negotiating table."

That sounds a lot more like "cooperate or we'll break your kneecaps" than the previous supposed quote.

TwinBeam said...

Why are US socialists so afraid to admit their true nature? European socialists are proud to announce themselves.

"What? Who, me, a socialist? Is that a joke? Sure, I want to use tax money to pay for children's healthcare - but I'm only doing it in order to put the squeeze on insurance companies. If they don't cave in and take less profit, I'll keep expanding it to more people until they do. How is that socialism?"

I think the appropriate response was coined by Joe Wilson...

Tim H. said...

Children's healthcare is a worthy goal, if it can be gotten past the disciples of Mammon. Persuading them to consider anything beyond one or two quarters away would be an accomplishment. At the risk of digression, I'd like to suggest that this society can no longer afford to waste children. The neo-Dickensian society the olgarchs are building looks to be extremely wasteful of young people, especially those of the working class. Bad enough to lose any child to preventable disease, poor education and violence, but the fact is, genius can happen anywhere and how many have we already squandered?

Jester said...

Odds are, we're getting a bill with a weak Public Option, which will be available to those without insurance as one of several (or several dozen) provider choices on the Exchange.

It's not in four out of five bills for no reason.

The Public Option itself is nothing to freak out about, either way. It's an option. The existence of the Post Office doesn't mean you can't use FedEx, but the USPS does keep package rates down across the board.

It's going to happen, and within 10 years it will have 5-10 million subscribers. We'll see where things go from there. If people like it, businesses will be screaming for access, and will probably get it.

There's still a slim chance we get no bill at all, but that's still more probable than a bill with no Public Option.

70 House Democrats have sworn to block any bill that hasn't got one, and there is no way more than a dozen Republicans in the House will vote for any bill Obama is willing to sign - whether or not to "compromise" it away isn't really Obamas choice.

AMusingFool said...

I think one factor is missing here: timeframe. The current healthcare bills being debated aren't going to have any effect on healthcare until 2013, at the earliest (in some cases, 2018).

Waiting for them, before doing something, is a sure way of getting nothing to happen.

Unknown said...

I can understand your reasoning, and do love to use Judo as a metaphor for good politics.

That said, if you don't get some judo moves done smoothly in one move, you leave yourself vulnerable to be thrown instead.

We need to push things until they start pushing themselves, not simply be incremental for the sake of incrementalism.

If we want to be incremental in a smart way, we start by creating a situation that actually improves things. Without the Public Option, the mandates and other parts of the plan might instead work just to force higher priced bad insurance on everybody. If folks are predictably ungrateful for that, naturally, it becomes harder to sell extension of that program.

Anonymous said...

It's quite possible I don't know or remember something about bills but I don't think you can introduce a bill that can't get riders added to it, Dr. Brin. It's a nice idea to introduce such a bill that has that AND ONLY that on it, but I don't think something like that will EVER happen in this day.