Thursday, December 17, 2009

Health Care. Again... Insure the kids first!

 What does it take to see the obvious?

 First, in today's weirdly reshaped political process we should not be wringing our hands over details in the Senate's version of Health Care legislation.  The current bill is warped by the need for perfect unanimity among members of the Democratic Party coalition. The Republicans’ strangely awe-worthy trait of utter party discipline, threatening filibusters instead of negotiating and deliberating as individuals, has put the independent senator from Hartford (capital of the insurance industry) in a powerful position to make certain that his industry gets what it wants.

In the current Senate version, that is.

But remember, all the Democrats need is to get some kind of bill out of the Senate.  It will then go into a reconciliation process with the version passed by the House.  The final bill that results from that blending will then be offered up for a straight vote in both chambers with no filibuster allowed.  This means that:

 1- liberals who are crying now about President Obama's "cave-in" concessions to Joe Lieberman ought to learn something about the process. And about patience.

 2- Since the final bill will only need 50 Senate votes to pass, Senators Lieberman, Lincoln, Landrieu, Nelson, Baucus and several other Democrats from more conservative states, will be able to posture and vote against it, for the sake of those at home, and still see it pass.

3- If the final version looks a lot more like the House Bill, and thus more liberal than anything the Senate might have passed, that will only be the Republicans' fault.  They could have negotiated and participated in a real process of deliberation, and hence had a real voice on the reconciliation committee.  (Democratic majorities have traditionally given the GOP Congressional leadership substantial voice in the reconciliation process -- that is, until the Republicans chose all-or-nothing political war. Total political war has its consequences)

 But I want to focus, briefly, on another matter-- one that I've raised many times before... that the Democrats have waged this struggle with the wrong emphasis, all along, in ways that are tone-deaf to both justice and the inclinations of the voters.

On several occasions I've pointed out the obvious, that Americans are inherently more "socialistic" toward children than toward adults.

When it comes to grownups, we retain, from Wild West Frontierland days, an attitude that people ought to stand on their own two feet.  Hence, our public still expresses relative puritanism over issues like welfare and insurance etc, compared to other industrial nations. (For all the FoxNews screeching about "Socialist Obama," the most radical version of health care reform that he ever proposed -- including the "public option"-- was positively right-wing by European standards.) 

But that puritan-cowboy-individualist reflex tends only to apply when the topic is adults.  The point I have been pushing is that we feel differently toward kids.

Just Go Ahead and Take Care of All Kids First!

It goes all the way back to Adam Smith, the so-called "father of capitalism" who nevertheless pushed for free public education.  The logic is simple.  Free enterprise works best from a level playing field, so that a maximum number of  individuals can participate in the competitive  process, delivering ever-improving goods and services  (Um, duh?  This is why any trend toward monopoly or oligarchy is the enemy of enterprise, whether that oligarchy is governmental or "private.")

Now, one can level the field by bringing the aristocracy down a notch. (Smith actually favored this, to a cautious and limited degree, at least by eliminating the secretive, collusive power of oligarchs to warp markets.) But a better way is to lift the bottom up. Again, carefully.  In the right ways.

If helping the poor has real capitalist-pragmatist justifications, certain types of help benefit long-range competition better than others. Conservatives are right to be suspicious toward lefty endeavors to "equalize outcomes."

On the other hand, certainly, the most justifiable kind of aid to the poor is also the most moral -- lifting up children.  Even rough-n-ready Americans know that.  And even George W. Bush felt compelled to push the State Children's Health Insurance Program (SCHIP), which - inefficiently and haphazardly - helped states with matching funds, to reduce the number of uninsured children.

My point is that Obama and the Democrats have been foolish to ignore this inherent double standard -- a willingness on the part of Americans to apply socialist methods to help kids.  Instead of trying to expand Medicare downward to include people between the ages of 55 and 65, they should have gone to the other end and presented a provision to simply cover all American children.   

I've been proposing this for a long time. First, it would - in a shot - take care of the most vulnerable citizens and those whose long range futures merit the greatest investment... offering the most profound return, on a simple cash-actuarial basis!

Second, a lot of the health care needs of kids offer great bang for the buck.  These include effective preventive care, or the rapid attending to brief-acute problems... exactly the areas where even Republicans admit that Canadian-style single payer systems work best.

Third, even if that left a lot of parents uncovered, at least those parents would get their worst fears lifted off their shoulders.  They could then negotiate their own policies with private insurers from a position of strength.  In fact, the insurance industry would know it had to play nice, or else "children" could be re-defined upward, from ages 21 to, say, 25... and so on.

Finally, this approach is politically powerful.  Because many who rage at "socialism" for lazy adults would not dare object to making sure that children get seen by a doctor and have their basic needs met. Putting opponents in a position of refusing care for babies... now that's political hardball.

Frankly, it worries me that this blatantly obvious option seems not to have occurred to Obama or the Democrats.  It reveals a tone-deaf lack of political savvy, as well as any clear-eyed notion of how to get the most accomplished, in a long and grinding process of incrementalism.


Final note... go to GOODREADS.COM and look up your favorite author! But you can help by writing "reviews" of some or all of his books! It would be much appreciated and help a lot! Come on, do this for the guy! ;-)


Greg Sanders said...

I'd say it is worth noting that the current bill does raise the age in which dependent children are covered by insurance to 27.

Now admittedly, that doesn't help parents without insurance, but I think it partially explains why people weren't thinking that much of the children despite the political logic. That said, I think that might have proved a better gambit.

Acacia H. said...

Your suggestion is an excellent one, Dr. Brin, but unfortunately you are forgetting about insurance of children at that most key and vital part of their growth: prenatal health insurance. In short, the government should also have a Single Payer Insurance Plan for pregnant women, covering all aspects of this care including abortions if the pregnancy endangers the life of the mother. This last point will be a sticking point, but the anti-abortion activists will be playing with a live landmine here. Are they stating that it is better to let a woman die along with her unborn child, than to allow an abortion that saves the mother's life so she can perhaps try to have another child later?

Health insurance for children is one of the biggest drains for people. Paying for a spouse and for children can quadruple the amount of money a person pays for health insurance. By having the government take on the "burden" of providing insurance for children, this "burden" is removed from people and from the insurance companies. Further, it ensures that children will have medical care (and we need to add Dental to that, because far too many children don't have dental insurance and have rotting teeth as a result!) and a chance at a healthy happy life.

Adding expectant mothers to the mix not only is icing to the cake... but can even be claimed as a means of saving the insurance companies money and allowing men and women to be balanced in treatment by private insurers now that insurance companies need not worry about paying for pregnancies.

Robert A. Howard, Tangents Webcomic Reviews

Doug S. said...

It's amusing that has Twilight on both the "Best books" and "Worst books" list.

Acacia H. said...

"It was the best of books, it was the worse of books..."

Tim H. said...

I liked the idea the first time I heard it, still sounds good. With public option covering the beginning and the end of life, preserving a market for insurance companies will look more like "Welfare for MBAs". Yes, I know you covered these angles before, just wanted to add a "Good idea!".

David Brin said...

I know, youse guys have all heard it before. But I have a new venue on another site, with some important readers. And given the dems' missteps on health care, I figured I better give the notion a remise.

David Brin said...

Recommended unusual gift:
see the companion web site of Cyberian Khatru, a CD of music by members of the Usenet discussion group It really is an amazing album and completely off the charts...

David Brin said...

While I'm at it. Give a copy of Paul Williams's cult classic rock opera film PHANTOM OF THE PARADISE.

Especially to anyone you know who actually likes that dreadful-stupid and horrifically BORING piece of load... The Rocky Horror Picture Show... with its insipidly banal music (except for Meat Loaf's song!) and tedious attempts to shock us ("Oh! Look at me! I'm wearing hose and a garter belt! Oh! Did I mention that I'm wearing hose and a garter belt?" Yawn! Morons.)

PHANTOM OF THE PARADISE does everything Rocky Horror failed at, delivering variety, surprise, panache, the hilarious sendup of TWO DOZEN classic cliche tropes... plus a whole lot of really good songs.

Oh, but I did (and do) like Meat Loaf.

rr8004 said...
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Tim H. said...

Meatloaf again? "Time Warp" was great.

LarryHart said...

Oh, but I did (and do) like Meat Loaf.

A major point of agreement between me and the "honest conservative" I've been (unsuccessfully) arguing with is a shared love of Jim Steinman, who wrote much of Meat Loaf's repertoire.

Nate said...

Dr Brin: Two things.

First, according to Wikipedia, the conference reports can be filibustered, but the motion to proceed on them can't be, which seems to be a rather arcane difference that I'm not sure what it would mean in practice. But I wouldn't put it past Joe Lieberman or some of the other Very Serious Moderates to join the Republicans in that, especially if it has any sort of public option, Medicare expansion, or similar.

And second, applying it to the children probably wouldn't have helped. The Republicans repeatedly opposed S-CHIP over the past few years. The "Teabaggers" and other screaming crazies would have opposed it just as much as they have the "socialism" of the current bill. So I doubt limiting it to children would have made much difference. When it started out, the public option polled with 70%+ support, before the screaming and the dwadling for months in Congress. Expanding health care for children would most likely have been just as demonized, and compromised so much it lost support from liberals, which was one of the major reasons the public option lost support, because it kept getting weaker and suckier.

Really, since the Republicans were going to oppose ANYTHING as "socialism", and the Very Serious Moderates were going to demand to kill parts of it to piss off liberals and get invites to the best DC parties as "moderate", we should have started out with something GOOD, not the pre-compromised place we did. Then what came out of the meat grinder might have been a little better.

Robert: Something like that would be great, and frankly, a vote on something like that would help put the anti-abortion congresscritters in a tough place, since they claim to be worried about saving babies, but oppose contraception, pre-natal care, infant health care, etc. I don't think they'd vote for it, but it'd help reveal their real concerns, which sure don't seem to be protecting children.

Ilithi Dragon said...

Speaking of Healthcare, apparently the GOP is now willing to block the war-time spending bill in order to stop the healthcare bill. Yup, that's right, the GOP attempted to filibuster the spending bill for the wars in Afghanistan and Iraq, and leave Dems scrambling to find some provision to pay for those wars when the temporary funding extension expires tonight, just to try and block the healthcare bill from passing. All 40 GOP senators voted in partisan lockstep in a surprise, 13th-hour move that would have screwed our troops, and the Dems had to get even Sen. Feingold, who has been firmly opposed to the war, to vote to let the bill continue and stop the GOP filibuster. Fortunately, the Dems defeated the filibuster attempt. But this is an outrageous and blatant demonstration of the GOP hypocrisy and refusal to behave like adults and do their jobs as representatives in our national congress. I hope the DNC takes full advantage of this public relations windfall, and burns the GOP in the fires of public wrath over this. I want to see commercials and political columns declaring, "GOP Commits Treason! Attempts to Deny War Funds to Troops!" You know that's not even half as far as they would go if the shoe were on the other foot. As much as I disagree with the war and how it's been handled, filibustering this is an outrageous betrayal of our troops. I've got friends and family over there. Even if I didn't, I'd be pissed. Bastards.

Stefan Jones said...

I have to agree with Nate.

No matter how common-sense a suggestion, in the current political climate the Republicans will declare it the end of America as we know it if Obama proposes it.


I wish the president would stop being so polite and bipartisan. Eight years of the Bush administration should have been enough to confirm that the Republicans don't give a fig about anything but retaining or getting back into power. You can't appease them. You can't make friends with them. They're out for blood, incensed at having the K Street Project taken away from them.

LarryHart said...

Somewhat off-topic, but since I felt it necessary to inflict my depressive state on this blog earlier in the week (after spending Sunday and Monday listening to/about Joe Lieberman), I just wanted to bring the good feelings as well. Because hearing Senator Al Franken metaphorically slap Lieberman across the face was so darn cathartic that I actually find myself in a good mood.

Leave it to a professional comedian manage that when the regular politicians are clueless.

I'm even starting to think Obama may yet pull a rabbit out of his hat on HealthCare. Ok, I recognize my own irrational exuberance, but still.

Tacitus2 said...

Perhaps a reality check, as I perceive reality anyway, would be in order.

The bill currently under consideration by the Senate is is not a very good one. It uses a variety of accounting legerdemain to try and look "budget neutral". It in fact increases the cost of health care substantially, while still leaving quite a few uncovered. It is an obvious outcome of a process that was flawed from its inception, as its goal was never affordable healthcare but entitled healthcare.

From the initial backroom deal with the pharmaceutical industry, to neutering the tax on Cadillac plans, to the first introduced amendment, guaranteeing mammograms despite the fairly good science regarding mammogram screening's limitations. It got worse and worse.

Its one big slab 'o Leg. that has in its favor only that the original Baccus plan was an honest progenitor, and that it is still better than what the House came up with.

Notice that Howard Dean, that screaming right wing nut, has called to kill it and start over.
(actually, Dean does scream a bit).

When you can take a break from conspiracy land, consider that the GOP may actually, sincerely feel that this is a whoppin' cowflop of poor public policy, and be opposing it on that basis? Not that they mind getting in a dig at the Dems.

The best thing for all concerned would be to pull the plug, go on vacation and come back next month. Park the half dozen or so senators from both sides of the aisle that actually have some integrity in them in a locked room. And bring the country something better, shorter, more incremental.

Just my thoughts. Its a free country after all.


Ilithi Dragon said...

Tacitus 2:

If that were so, that the Republicans are just acting against problems what they honestly perceive as serious problems/fatal flaws in the bill, wouldn't the logical, honest thing to do have been to work with the Democrats in deliberation to get those problems changed, reworked, or removed? How many Republicans did that? Three? And got hammered for being "RINOs" before falling back into lockstep with the party. What has the GOP done, besides voting in lockstep "NO!" formation to everything proposed by a Democrat, to fix the problems with this bill? If the intent of the GOP was to create an honest, functional healthcare reform bill, why haven't they tried to change and modify the bill through honest, open deliberation?

David Brin said...

I keep forgetting Jim Steinman's name. His lyrics - and Meat Loaf's passionate conveyance - offer among the only places in American life - other than the military and the boy sprouts - where the word "honor" is obsessed upon. Much to our net loss.

"The best thing for all concerned would be to pull the plug, go on vacation and come back next month. Park the half dozen or so senators from both sides of the aisle that actually have some integrity in them in a locked room. And bring the country something better, shorter, more incremental."

Tacitus, I would grasp at any straw, to NOT see this as a conspiracy. But puh-lease, will you try to consider the possibility you are in denial?

GOP discipline is PERFECT. The party line both perfect and utterly simplistic. It is clear that nothing offered to them will ever, ever be accepted.


You complain about a bill that has flaws. Do you think those flaws would be there, if six or seven sincere republicans had joined in the negotiations? At all? At any level, in any way?

If the bill is flawed, it is entirely and 100% the fault of the manic, insane thing that conservatism has become.

Unknown said...

A friend of mine once waitressed at a Waffle House where Meatloaf stopped while on tour. The exchange between them went like this:

Meatloaf: Do you know who I am?

Friend: Yes! You're from the Rocky Horror Picture Show!!

Meatloaf: Ugh. Don't ever mention that movie.

Friend: But why!? It was the best thing you've ever done!!

...and he became surly from that point on.

I'm not a big fan of RHPS - okay, not a fan at all - but I think most people like it because it's flamboyantly and unselfconsciously campy while not being ironic, clever, dark or introspective. It's just really stupid fun, like dancing on a table while singing about dancing on a table.

Apropos, I had another friend whose parents burned all her Rocky Horror fan paraphernalia for religious reasons. Maybe Paul Williams could achieve the same fame if he brought his film to the attention of TV evangelists.

JuhnDonn said...

Bill Gates Sr. on the Estate Tax:

A common, and misguided, criticism of the estate tax is that individuals who work hard and save their money should be entitled to pass on the fruits of that labor to their family. I am not against working hard, saving money, or taking care of your family.

However we must acknowledge that the person who accumulates wealth in this country was not able to do that independently. The simple fact of living in America, a country with stable markets and unparalleled opportunity fueled in part by government investment in technology and research (something my family has plenty of firsthand experience of), provide an irreplaceable foundation for success and have created a society which makes it possible for some men, women and their children to live an elegant life.

I attended the University of Washington under the G.I. Bill, and then became a lawyer enjoying a successful career that allowed me to provide well for my family so that they in turn were able to create their own wealth. So I believe that those of us who have benefited so greatly from our country's investment in our lives should be asked to give a portion of our wealth back to invest in opportunities for the future.

Society has a just claim on our fortunes and that claim goes by the name estate tax.

As for Rocky Horror, I worked at a mom-n-pop art theater that showed Rocky on the weekends. What a mess! The crowd (not the regular performing cast) ended up ruining a $40k screen. And since I was the one searching folks and someone got past me with the wrong stuff, yeah, I was out and the theater closed down shortly after.

But yeah, Meatloaf! Bright spot of the 80's what that he and Warren Zevon were both on the outs with popular music at the time and were playing small bars and such in St. Pete, FL. Really cool being able to share a beer with these guys after a set.

Tacitus2 said...


I would never ask that you do a reality check without undertaking the same regularly. But the process by which this thing has lurched to the finish line should offend you on several levels.
Anti-transparency? Check, back room deal with big pharma to buy their support.
Anti-science? Emotionally charged as issues like mammography can be, to dish up amendment numero uno to lock in a scientifically dubious screening schedule is not a good sign.
Dig it! (sorry, couldn't resist), we have not even seen an honest price tag yet. And this was the priority that was supposed to be rushed through before August break!
The Republican minority has limited tools to work with. If they introduce a bill that says puppies are cute the committe chair can append a funding earmark for ACORN. They are using their tools exceedingly well. Its a shame that a residue of efficient governance is being used in a negative fashion.
While we are at it, did you not actively invite a fillibuster last summer? I say, bring it on. The reason the Dems are skittish is not a desire for serenity, but a fear that a week or so of public airing of this steaming accretion will kill it dead.
I am being harsh, but remember, I actually want health care reform. But again, I want competence. Et tu, Brinus?


LarryHart said...

Tacitus2 said:

From the initial backroom deal with the pharmaceutical industry, to neutering the tax on Cadillac plans, to the first introduced amendment, guaranteeing mammograms despite the fairly good science regarding mammogram screening's limitations. It got worse and worse.

Tacitus, I'm more in agreement with you than you'd think on what you say. The bill under consideration is a horrible one. I think a government mandate to purchase a private for-profit product is a horrible way to go. But the bill had two good things going for it that I could hold my nose and wish for: the Medicare Buy-In and the ammendment that would have allowed Medicare to negotiate price on drugs.

It's the good parts of the bill that are being evicerated. And the latest was by someone who advocated the Medicare Buy-In himself as recently as three months ago, and who is presumably still in the Democratic Caucus (with committee chairmanships) because he agrees NOT to do things like filibuster Democratic initiatives.

Lieberman didn't infuriate me by making the bill harder to pass. He infuriated me by making the bill even less worthy of passing.

Look, I'm a social liberal but at least used to be a fiscal conservative. I'm not in favor of a "government takeover of health care". I'm in favor of the government stepping in to provide essential services that (for whatever reason) the free market doesn't lend itself to providing. There is really only one thing I want from health care reform--an end to the practice of denying coverage once a condition makes itself known. "Everybody's covered; everybody pays.", just the way we are all "covered" by police and fire protection and we all pay through taxes.

A caller to Thom Hartmann's radio program had a good point when he said that the first thing you hear when you're arrested is "You have the right to an attorney. If you cannot afford one, an attorney will be provided for you free of charge." According to the tea-baggers' arguments, this consitutes a government takeover of the law industry and makes it impossible for private attorneys to compete. Do you see anything like that actually happening to the private law business? Why not simply substitute "emergency health care" for "an attorney" in the above statement?

David Brin said...

Doesn't work, Tacitus. You keep trying to make it sound that the people who have been negotiating with each other are the bad guys, while the people who refuse to step up and negotiate are somehow reasonable.

ALL of the things you are complaining about could have been laid out in the open, debated and horsetraded away. That is what a loyal opposition is for.

Goppers have made it so that evry single democratic congressman and senator is absolutely essential, and so each one can demand his pound of flesh, in exchange for supporting an overall bill. It is a recipe for corruption... and it is almost entirely the fault of the GOP.

BTW... the pharmaceuticals law under Bush Jr was a half-trillion dollar GIFT to Big Pharma. Gimme a break.

Tacitus2 said...

Democratic corruption is the fault of the GOP. This makes my brain hurt.

"Bad guys"? Hardly. Both parties are willing to take money from entities with a vested interest to keep the current ridiculous, unfair system shambling along.

The problems at hand are:
1. entrenched and enriched interests. Pharma, AMA, Trial Lawyers. All with money to hand out lavishly.
2. Extraordinary unrealistic expectations on what the health care system can/should/must do. (they blur together rather rapidly).
3. a craven political class.

I can't defend the GW Bush present to the pharmaceutical industry, (I assume you mean Medicare part D). I also recall him taking flak from the Dems for not making it sweet enough.

Enough, enough. My intent is only to offer a counter point of view from time to time, not to argue.

And when the law passes I will do my best with it, as shall we all.


Rob Perkins said...

At the time, I seem to recall GWB taking flak for merely breathing in and out. And having the wrong religion. And coming from the wrong part of the country. Therefore nothing he did could have been good or right.

Critics of Obama have been no different, and it didn't start with GWB, it started with critics of Clinton. At least this round.

Medicare Part D could be fixed by simply removing the bargaining prohibitions from the law. It was a good idea in the first place: Medical treatments with pills are far less invasive than surgeries.

We still need tort reform, and insurance reform. I think the Senate bill does neither, but the idea of "must-buy" insurance has appeal; we do it for cars, after all, and that hasn't bankrupted the nation.

Acacia H. said...

Tacticus, the GOP made a lot of noise about how the Democrat health care reforms were flawed and that their system was so much superior, and yet they never showed anything. The few glimpses we had of a "Republican health care reform" was a rehash of old ideas which everyone already knew was a bit wet sloppy kiss to the insurance companies and medical fields.

No. What the GOP want is VICTORY. At any cost. They have not offered negotiation. They have instead said "it's my way or the highway." And then screamed bloody murder when Democrats said "fuck you" and took them out of the loop.

The GOP is in a position of WEAKNESS. They should not be trying to negotiate from a position of dictatorship, which they are. And they use their ability to negate any and all progress in Congress through filibusters as a weapon of mass destruction.

Meanwhile, the GOP has been proven to be the Party of No. There is little doubt of that. Even as they cry foul over being painted by a wide brush, they march in perfect unison, and refuse to show individuality or initiative. They are literally becoming the party of decay and inaction. And I truly look forward to the day that the Republicans die their final death, the Democrats split between Blue Dogs and Liberals, and we can get some actual honest negotiation in Congress for a change.

Rob H.

Ian Gould said...

"At the time, I seem to recall GWB taking flak for merely breathing in and out. And having the wrong religion. And coming from the wrong part of the country."

Yes and it was so unfair because his presidency was so successful on all the substantive issues.

Poor poor white southern born-agains, when will their suffering ever end?

Ian Gould said...

I'm at a loss to understand the sudden reversal of the American left and independents like David on the Health care Bill.

Even as it stands, the Bill will extend coverage to 20-30 million more Americans.

It will provide tens of millions more Americans with financial assistance to maintain coverage.

It represents a major step forward and if the problems claimed do emerge they can be fixed later.

I've commented here previously on the absolutist, ideologically-driven, winner-takes-all nature of American politics and the lack of pragmatism.

The response to this draft bill appears to be a prime example of that, especially since the reconciliation process is likely to result in major changes to what is currently being discussed.

David Brin said...

LarryHart said...

Tacitus2 said:

The problems at hand are:
1. entrenched and enriched interests. Pharma, AMA, Trial Lawyers. All with money to hand out lavishly.
2. Extraordinary unrealistic expectations on what the health care system can/should/must do. (they blur together rather rapidly).
3. a craven political class.

You forgot one more that overshadows everything else.

4. "Corporate personhood".

As long as the Supreme Court perversely considers corporations to be "persons" with constitutional rights such as freedom of speech and privacy rights, then the rest of us have no hope competing in the political arena with entites that can treat billions as "throwing around money".

Tim H. said...

You do realize, the democrats only look responsible in contrast to what the GOP has allowed theirselves to become. Trying to out-Reagan Reagan. Expletive.

David Brin said...

Fried just saw Avatar:

"I kept thinking the trees came from Garth, the flyers from Pern,
and the unification attack from Deathworld.

Never mind Dances with Wolves and The Word for the World is Forest.

A fair enough movie, but again I think little will be remembered of it as
disposable excellence defines the mundane epic."

Unknown said...

The problem is that children as a group are the healthiest people out there (at least once you get past the one year or so point). This is of course a product of good nutrition and antibiotics, and other tools of modern medical care, but as a population they have an extremely low death rate.

I'm far more concerned with the hacking off of the forty years of remaining life from a meaningful fraction of the population of people in their forties, than I am of less than 1 in 10,000 additional kids losing their 70 years. And anyways there always will be more donations to children's health care. So basically the reason we shouldn't be focusing on kids is because they just don't matter that much in the context of people who actually need health care and aren't getting it.

Also most of the states also already have programs for covering children. They already are much better covered, again because of our socialism for kids is okay attitude.

Nate said...

Timothy: I'm not sure about that. Yeah, kids are durable and all, but lack of health care and more nutrition as a kid can have life-long negative consequences. So can nutrition, which is an easier fix, but not a direct part of the current discussion.

As for the current bill, I'm split. If you look at it as a complete health insurance overhaul, which it was supposed to be, well, it's crap. It's, at best, an incremental improvement, which requires everybody to buy for-profit insurance, and doesn't regulate them heavily enough OR expose them to more competition, so that's a fail.

On the other hand, it DOES have subsidies to help pay for these, though funneling subsidies to for-profit companies is not such a great idea. And it would be a small step toward establishing health care as something that everyone should have, not as something only for the rich. Plus, if this bill dies, there will be no "come back next month", or any kind of "serious bipartisan commission", the "serious bipartisan commission" that Max Baucus ran kept out any real liberals, and involved a bunch of Republicans who publicly said, while still in discussions, that they wouldn't support anything that came out of it.

So if this reform effort dies, the lesson won't be "this bill turned into crap because the Very Serious Moderates made it something nobody could support", the "message" the media will give, and the politicians will take, is "OMG HEALTH CARE IS UNTOUCHABLE DON'T DO ANYTHING, AMERICA HAS THE BESTEST HEALTH CARE IN THE WORLD EVAR!!!!eleven" which is total crap, and would lead to lots of extra suffering over the next ten-fifteen years as the current shitty status quo falls apart even more until enough people are pissed for politicians to try something again. Probably something crappier, unfortunately. And it would justify the Republican's Party of No status, even further demoralize the Democratic base, and give the whack-job Republicans a victory going into the next elections, which would be Very Bad for the country.

But passing it increases the power of the Very Serious Moderates, especially King Joe, makes the actual liberals who fought for this for years look weak since they gave up almost everything, and gives the Republicans a crappy bill to campaign against.

So do I support the current bill? ...Probably. Not happily at all, as I said, it's crap, but it's better than the current status quo, which is unbelievably crappy, which I know from personal experience.

Which is the trap we liberals are in on this bill. We have actual moral reasons to pass a bill, and the status quo really is that bad for people who aren't professionals or politicians. The Republicans have no desire to fix it, or ideas to, they'd rather try and stick it to Democrats. And enough Democrats are addicted to being Very Serious Moderates (or petty @$!holes) that they will happily make the bill worse and worse to burnish their Moderate credentials or stick it to hippies, or whatever. The hundreds of thousands of people without health insurance, or with health insurance that vaporizes when they don't need it don't matter to them.

So we're negotiating with people who argue in bad faith and don't care about the results of their actions. So yeah. Does the good in this bill outweigh the bad? Right now, probably. If only barely. I expect Ben Nelson and King Joe to continue to try and hack at it until they don't, though.

Unknown said...

Well over half of bankruptcies in the US are from healthcare issues. 70% of those bankruptcies occurred from insured folk.

Al Franken had a very nice STFU response when pushed on this point:

We need to push public Health Care (as does just about every other developed nation) as a matter of National Security and preserving our economy as well as being the right thing to do.

Yeah, insure the kids first. It is a great idea.

When I ran for office in HI this was a big part of my campaign. It's hugely unpopular politically since Pharma and insurance industry heavily finances BOTH SIDES of political contests. Both the Dems and Repubs are totally beholden at the federal level. It is easy to see on this issue - more so than others that seem more "divisive" .

Unknown said...



That we are talking "insurance reform" is absurd. It does not substantively relate to health care on its own. See the first paragraph in the previous post.

Will passing INSURANCE reform help? Maybe a little. But it will not bring us much closer to having a healthier, stronger population until we drop the insurance debate (yes, putting the three or so mega- insurance companies on the rail. Don't worry: they're smaller than the banks we had to bail out) and focus on actually getting health care to people.

It is being done around the world at a fraction of the cost we spend for our broken "system"

Stefan Jones said...

I agree about health care reform and health insurance reform.

The system we have isn't deeply dysfunctional, but it is far from perfect, and its problems -- cost and poor outcomes -- will continue to get worse and worse.

Then there's the problem of unhealthy habits that the current system does little to discourage.

And the current system seems toothless when it comes to dealing with environmental problems.

Ian Gould said...

Living in Australia, I'm very strongly in favor of single-payer government-run health insurance.

However, I will point out that there are a number of countries that have universal healthcare based on private health insurance with government subsidies for the premiums of the poor - Germany is an example.

The American debate on this issue has seemingly become polarised between opponents and supporters of single payer.

I'd just point out that Germany shows it is possible for a system based on private for-profit insurance funds to deliver the key goals of the American reforms - cost containment and universal coverage.

Dwight Williams said...

Except that the private insurers of the USA presently seem to see little or no value in enduring the oversight/enforcement mechanisms that such a scheme as Deutschland/Germany likely has in place.

Emily said...

As to the remark: I did pop over & noticed you're currently reading The Moral Animal. Do let us know what you think, yes?

Stefan Jones said...

@Ian: There was a great PBS (public television) documentary that surveyed health care programs around the world.

Germany's system sounded like a quite acceptable model to shoot for.

Ilithi Dragon said...

Saw Avatar in 3D IMAX today, and very much enjoyed the show. 3D IMAX was just awesome, of course, and the movie delivered on the special effects, as expected. The story was also surprisingly good - it's basically Pocahontas and Dances with Wolves injected with 10 million CCs of Michael Bay, but it actually turned out pretty well. 11 out of 10 for VFX (they're really that good, and of course the IMAX experience makes a difference - see it in IMAX 3D if you get the chance, it's definitely worth it), and an 8 out of 10 for the story. Some of the stuff that happens to the secondary characters is pretty predictable by the end, but I was guessing the whole way through about how everything would ultimately turn out. There are some rough spots, and the "evil, money-grubbing corporation from the environmentally-devastated Earth" cliche is, well, rather cliche, but overall I found the story rather good and enjoyable, jokes about Pocahontas and Dances with Wolves aside. Characters get a 9 out of 10, and dialogue a 9 out of 10. I give them an 8 out of 10 for science stuff - most of the tech and science they employed wasn't stretched that far beyond what we have now. Now, it's Hollywood, so it wasn't perfect, but most of the issues I saw were largely a matter of engineering and practicality/effectiveness, with few "that doesn't/can't work that way!" (and they neatly avoided explaining how almost everything actually worked). The biology stuff with the native fauna might be iffy, but I don't know enough in that field to say. The Unobtanium was also rather amusing.

Anyway, I personally enjoyed it very much, and think it's a very good movie. It's also VERY much worth it to see it in IMAX or 3D IMAX if you can. The movie was made for it.

Marino said...

Utterly Out Of Topic (re: Uplift), but just a strange coincidence...
the Streaker's fin physician is called Makanee, and the name triggered something (memory is an odd thing)..- Ma-kanee is also the name of one of the two moons of Teff-Hell, the planet of the bad guys in Campbell's The Mightiest Machine. In-joke or subconscious echo?

beowulfS said...

I wasn't going to mention it, but as long as we're off topic: the BBC seems to have accepted the noughties. It's not quite what Brin suggested but its close. I've seen it used in several articals and this talking point

David Brin said...

Amazing... I never get any cred for the suggestions I make, that are ignored for years, then suddenly "discovered." I started calling the decade the "noughty oughts" back in 2002!

In fairness, a guy on SLATE found that someone in the 1910s gave that name to the 1900s.

We're plowing our way through Inglorious of the most tedious, boring, SLOW and dumb films I have ever seen.

Tarantino used to channel Segio Lenoe, inspired by the great spaghetti western director to deliver great confrontation scenes between good and evil... now he's like some kind of shambling ZOMBIE version of Leone. Forgetting for ten minutes at a stretch to do anything but go "u.u.u.u.h"

Perhaps the second half will be better... if we can drag ourselves back to the dvd player.

Stefan Jones said...

I heard "noughts" on NPR. Good contraction for both noughty oughts or noughties.

* * *

If you want a brain-whomp film, try "A Serious Man."

Kind of like the "Book of Job" meets Schroedinger's Cat.

Some rather painful humor at the expense of the poor shlub of the title.

rewinn said...

@Stefan Jones
"... there's the problem of unhealthy habits that the current system does little to discourage. .."

Indeed, the current system has positive incentives to avoid dealing with some unhealthy habits.

If your current insurer can put off dealing with something long enough, you'll be out of the system entirely and Medicare's problem. Why would an economically rational insurer sink $X into you today to prevent a problem costings $Y is 10 years ... when that $Y will come out of someone else's pocket?

Now, there may be some marketing advantages to providing some of the more obvious forms of preventative medicine; smoking cessation comes to mind. These may be popular because many smokers really do want to quit their addiction, so the marketing advantages may outweigh the costs of relatively inexpensive antismoking programs. Alcoholism and drug addiction OTOH may have less marketing value (...who wants to admit they have an alky working for them?????) so "the system" may calculate that, although they will be far more expensive to treat later than earlier, insurers may rationally choose not to provide earlier, more effective and less expensive intervention... since by the time the need for treatment is acute, the patient has a different insurer entirely ... or perhaps no insurer at all.

By "rational" I am of course speaking of "economic rationality" as taught in ECON 101, not any sort of actual human value.

David Brin said...

I recommend Russ Daggatt's latest:

Here's an excerpt:

"As we seem to be approaching the end game for the current effort at health care reform in Congress, it is worth reviewing what the debate is all about. As I outlined in a blog post back in August (“common ground on health care”) the basic objectives of reform are two-fold: 1/ expand coverage to more of the 45 million or so Americans who currently lack health care coverage and 2/ control costs in the system (if you can call our current mess a “system”).

I quoted Paul Krugman’s good short summary of the basic elements of the approach being taken in Congress (“Health reform made simple”):

The essence is really quite simple: regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance.

Everything else is about making that core work. Individual mandates are a way to prevent gaming of the system by people who don’t sign up until they’re sick; employer mandates a way to hold down the on-budget costs by preventing a rush by employers to drop insurance; the public option a way to create effective competition and hold costs down further.

But what it means for the individual will be that insurers can’t reject you, and if your income is relatively low, the government will help pay your premiums.

That’s it. Any commentator who whines that he just doesn’t understand it is basically saying that he doesn’t want to understand it."

Jester said...

Dr Brin -

We already have covered virtually all the uncovered children.

Between medicaid and SCHIP, nearly all children who aren't covered by their parents employer are covered by uncle sam.

This "ominbus bill" approach has always been a mistake. It is now under Obama, it was 16 year ago under Clinton.

They ought to just open up the Medicare buy-in for 55-65 and open up Medicaid to everyone below FPL, including those who are 21-65 and not officially disabled.

Jester said...

Russ Dagget is a wealthy idiot.

There is no effort underway to reform health care. Only to reform Insurance. They're not the same thing.

Anyone who has ever been well enough off not to qualify for public assistance, but too poor to even think about buying a car with less than 100,000 on the odometer would understand that the uninsured don't share Daggets goals.

Most of us know what it is to live check to check with junk insurance...and avoid getting that mole checked out because of the deductible.

We know what it is to choose between a co-pay on a chest x-ray and a birthday present for our kid.

Russ? This idiot think "insurance coverage" and Access to Health Care are synonymous.

The junk 'bronze plan' with 40% co-pays the Senate is pushing is literally worse than nothing. A single person at 300% of FPL could be required to shell out 3,400 a year and would still face 40% co-pays.

In any urban area outside of the rust belt, those kind of numbers mean losing an apartment or getting the heat turned off.

I guess we can solve that problem, though, by mandating people by homes.

Oh, that analogy isn't mine. It belongs to some skinny big-eared guy to whose election campaign I devoted hundreds of hours and more money than I had.
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Ilithi Dragon said...

Jester, I don't agree with the mandates, and I definitely know of the situations you're talking about because I'm in that now (I need new glasses and some dental work, but can't afford to right now because I just don't have the extra money for the deductibles and co-pay).

That said, I'm still hoping the bill passes, because despite it's flaws, if it does pass then it is a step forward, a step town the road to reform, and if it doesn't pass, the GOP will drag it through the campaign trail and take it on another decade+ detour.

The bill is imperfect, and there are plenty of flaws that will need to be fixed and revised, but we should never have gone into this expecting a perfect bill. Sure, we could have hoped for, and could have had a better one, but we could have had no bill at all and the political death of any hope for reform for the next decade, as well. What we got is somewhere in between. It's not what we want, not yet, and it will probably exacerbate some existing problems and create new problems of it's own, but it IS something that we can work with, something that it looks like we may just well have. The final bill that is reconciled between both houses of Congress may be better or worse than either of the independent bills, but even if it is worse, it is still something that we can work with, a platform for reform from which to start. More importantly, it will carry the momentum of reform. If the bill is killed now, then we probably won't see another one until after the next election, at least, if not longer.

Personally, I think it is better to have an imperfect bill, that at the very least sets us down the path of addressing and fixing our problems, than to not have any bill at all, and have our hopes for reform pushed back another year, or four, or ten or more.

And, besides, this is democracy. Rigid, clean perfection isn't what we do. What we do is messy, imperfect, often slow, and rough to start, but ultimately, over the long run, it usually (not always, but usually) tends to work out much better, with much more success. It's a rough-and-tumble process, frustrating and aggravating, that often makes you want to rip your hair or horns out (as applicable
} ; = 8 ) ), but that is better than any other process we've tried before, as Dr. Brin has reiterated time and again.

Tim H. said...

The current bill should be considered a "First pancake" (Pre-teflon), not that good, but a harbinger of tastier things on the way.

Mark said...

What do you mean, "Democrats had never thought of insuring kids first?" Ted Kennedy proposed that a while ago: