By Lambert Strether of Corrente.
Tonight I want to focus on only two topics: First, ObamaCare apologists, Democratic operatives, and career “progressives” have been peddling the Big Lie that ObamaCare is universal. WaPo’s Sarah Kliff has a story today: Left behind: Stories from Obamacare’s 31 million uninsured; I’ve been saying 30 million, but heck, who’s counting? Enough with the “universal,” already! At least for these United States. Because anybody who’s been paying attention to the heath care reform debates knows that there’s already a truly universal, proven system, on this very continent, in a country with a culture and a political system very much like our own, and called, amazingly enough, Medicare:
The Canadian single payer system.
We also know that although Obama did verbally support single payer in 2003, he was already backing off by 2006. We know that In the 2008 campaign, Obama ran “Harry & Louise”-style ads attacking Clinton for supporting the individual mandate, which Krugman called him out on. (This matters because if you accept the premise that people should be forced to buy a health insurance, even though it’s a defective product, then the mandate is the only way to achieve universal coverage; universality, therefore, has never been Obama’s priority.) We know that once elected, Obama and his administration dissed single payer at every opportunity, including mocking its advocates, censoring Town Hall coverage, and cancelling his own family doctor’s appearance at a forum after it became known that he was going to advocate single payer. Kathleen Sebelius says Obama’s goal is to block single payer permanently. So when you hear ObamaCare apologists, Democratic operatives, and career “progressives” say they want ObamaCare to evolve in the direction of universal coverage, take that with a dose of salts, because they will not advocate, and hate to even mention, a proven system that achieves that goal. Based on their track record — and I know this will come as a surprise to you — they’re lying.
But there’s an even simpler way to tell that universal coverage is not a priority for Obama, or the Democrats:
You know how the Democratic nomenklatura is always whining that the Republicans keep introducing bills to repeal ObamaCare (40 at last count), even though they don’t have a hope of passing them in the Senate? How they’re grandstanding and throwing red meat to the base? Well, how come turnabout isn’t fair play on this? How come Nancy Pelosi hasn’t thrown her own base some red meat by putting John Conyers’ single payer bill, HR676, on the floor 40 times? And so what if the Republicans suppress it, or vote it down? And how about the Senate? Bernie Sanders had a single payer bill, S703, in 2009; so why not at least do a little grandstanding for the base and introduce that bill on the Senate floor? And if 40 times is too much for the stately processes of The World’s Greatest Deliberative Body, then how about once? Or if Harry Reid wants to take some luster from the Kennedy name, how about he re-introduces Kennedy’s bill to reform Medicare by progressively lowering the eligibility by five years, every year, ’til all are covered? Just once? Or if the Democrats just have to have a poorly architected, complex, and Rube Goldberg-esque health care proposal, why not write another 2000 pages of bug fixes for a bill that really does guarantee universal coverage, and put that on the floor 40 times?
The simple answer: Priorities. The Congressional Democrats — or at least Obama’s rump faction of that party — don’t introduce any bills to guarantee universal coverage because that’s not their priority; once they’ve serviced their constituents and handed out the walking around money, their interest is at an end. And the Congressional Democrats don’t introduce single payer bills because that’s not their priority: Like Obama, they hate it. That’s because they’re owned by the health insurance companies, and their priority is to preserve the health insurance industry by guaranteeing them a market. If you get coverage from that effort, that’s a happy side effect and not the goal.
Second, I’d like to focus on the idea of ObamaCare as an experiment. From an article by Henry J. Aaron and Kevin W. Lucia (credentials omitted) in this month’s New England Journal of Medicine:
[T]he ACA has set in motion a large number of pilot programs, experiments, and demonstration projects involving new methods of paying for care and organizing providers. These innovations include bundled payments and accountable care organizations. Not all these innovations will succeed. But if some do, the exchanges will be in a position to encourage or require their adoption. And if exchanges cover a sizable fraction of the insured population, they will have the clout to change the delivery system.
The authors say “experiment” and “innovation” like those are good things. And I suppose, if you are funded to do them, they must be good. However, if we’re designing an entire health care system, we don’t need to experiment, because the Canadians already did that for us. Take a look at this chart (originally from Ian Welsh):
Notice how US and Canadian costs are similar until 1970, and then diverge? That’s when the Canadians adopted their single payer system. Looking at the same data, Yglesias writes:
This is the chart that I think ought to dominate the conversation about public-sector health care spending in the United States, and yet it is curiously [BWA-HA-HA-HA!!!] ignored. The data show government health care spending per capita in the United States and Canada. The United States spends more. And that’s not more per person who gets government health insurance, it’s more per resident. And yet Canada covers all its citizens, and we don’t. That should be considered shocking stuff, and yet I rarely hear it mentioned.
Even odder [BWA-HA-HA-HA!!!] is that the most recent time I heard it mentioned was Valerie Ramey talking at the American Economics Association conference in San Diego and her conclusion was that this showed U.S. health care needs free-market reforms. The more straightforward interpretation, I would think, is that the U.S. needs to make its system more like Canada’s. It’s important to note that the example here is Canada. Not some radically different society. Not some far-off distant land. And the gap is actually growing. …
Canada’s public-sector health care system—conveniently called “Medicare”—is available to people of all ages, and thus has even more bulk purchasing power than its American analogue. That allows it to obtain services at a much lower price, which reduces spending.
Again, we don’t need to experiment. (I don’t want to say that Aaron and Lucia are running a scam, but feel free to think it.) The Canadians have run the experiment, and we have the results. Unfortunately, the political class suppressed them, at the behest of the health insurance companies.
Now, the medical profession is very well aware of the word for experiments that are performed on people without their informed consent. That word is unethical. And ObamaCare is an experiment; Aaron and Lucia admit as much (and give several other reasons in their article besides the passage I quoted). Have the American people given their informed consent to this experiment, which will affect not only their personal economies, but their health and even their lives? No. Obama and the Democrats mock, censor, and suppress single payer advocates (see paragraph three, above), and refuse to seriously legislate for it, or even grandstand for it, exactly in order to deny Americans informed consent. That makes them, in medical terms, unethical. “First, do no harm.” How does advocating for experimental solutions while keeping silent on proven solutions comport with the words of Hippocrates?
Summing up, I’ve been trying to work up an ethical critique of ObamaCare (and, necessarily, of its advocates). Here goes:
1. ObamaCare purports to be universal, but is not. This is unfair.*
2. ObamaCare coverage depends on “the luck of the draw.” This is unfair. People are equal in their suffering, and should have access to care that eases their suffering equally.
3. ObamaCare is an experiment performed on the health of the American people without their informed consent. This is unethical.
NOTE * Also too, lying is bad, and Big Lies are worse.
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Ezra Klein, during the last presidential campaign, was puzzled that Michele Bachmann and other Republicans didn’t support ObamaCare. After all, ObamaCare is setup to “break the two largest single-payer health-care systems in America”.
“[T]he president has a realistic plan to privatize Medicare…”. As Klein says earlier in his post, “Wouldn’t this make Obama essentially the greatest Republican ever?”
Among liberal bloggers who supported the ACA, I think Digby was the only person who even noted Klein’s comments. All the liberals who claimed to support Medicare – and yet backed a scheme devised by the Heritage Foundation – should have been outraged that they were tricked into supporting a Trojan Horse. Their silence demonstrates their complicity.
No one took note of Klein’s essay because it is bullshit through and through. It is an example of Little Ezra Klein trying extra hard to find clever ways to “prove” the opponents of Obamacare are stupid for acting against their own self-interests.
Ezra Klein is a huge advocate of the ACA. He was one of the most steadfast supporters of the legislation and was frequently cited by liberal bloggers in order to sell it to their readers. He is also one of the “progressive media stars” that met with Obama, prior to the last presidential election, to discuss economic messaging and campaign strategy. When it comes to health care, he gets his talking points from the White House.
It is well known that the Canadian system is not without flaws. It therefore must not be adopted in the USA where only the flawless is good enough.
Probably the same objections obtain against adopting the system of France, or Singapore, or Iceland, or NZ, or Australia, or indeed anywhere else at all.
Mind you, anyone who says “Whatever you do don’t copy the NHS” is spot on.
I can tell you from personal experience:
Medicare is not free. I pay out of my SS every month and every yr what I pay per month increases.
Those of us on small SS cannot afford the co-pays for many procedures, so the 80 percent coverage seems good until you look at actual costs and realize what 20 percent is in dollars: more than I can afford. Many SS recipients are shut out of medical care for lack of the money to co-pay. If you’re counting the total number of people who lack coverage, many of us on Medicare are in that total because we’re only partially covered and partial coverage isn’t good coverage.
This is true and has become true over the last 5-6 years.
I’m feeling grouchy this morning, so suspect this is part of the plan–to make Medicare increasingly less functional and more expensive until dumping it into Obamacare will not mean all that much.
Yes, they run the “Degrade public services then privatize” play rather a lot, don’t they?
Maybe I’m just paranoid and cynical, but I can see the current and very belated handwringing over the 401(k) disaster culminating in a “Marketplace” for retirement funds, with Social Security as “the public option,” gradually gutting it.
Yep, I get tired of hearing how US medicare is such a terrific program.
Compared to everything else–particularly to what would be available to seniors as an alternative–it’s good.
But as you know, the “free” part of medicare is hospitalization coverage (less copays, deducts, etc). The other parts, like drug coverage or physician services, cost money paid in monthly premiums.
My wife and I are 62. We’ve figured up that to get full coverage under medicare and separate supplemental policies with its 20% copays paid, etc., it will cost my wife and I a total of about $850/month in premiums.
The federal government, being Monetarily Sovereign, can and should implement a fully paid “Medicare for Everyone” program — for every man, woman and child in America.
There is no reason to extract taxes or to impose limitations. The government can afford it, because the government is Monetarily Sovereign.
See: http://mythfighter.com/2013/07/27/i-just-thought-you-should-know-lunch-really-can-be-free/
So, how is Obamacare better?
Did I say it was? I can’t see where I said that, please cite.
all of these trends converge, in my mind if nowhere else, into this:
they want the lower classes to die, and get out of their way.
making sure that they get substandard or no medical care, stealing their homes for petty tax bills, allowing the landgrab known as the subprime mortgate fiasco, constantly putting social programs on the ax.
they want us to pay out all of our wealth on this shit, and then expire from illness that would have been taken care of if we’d only been a few brackets higher in the tax code.
sounds like conspiracy, but it sure does look like all of the actions trend in the same way. when the suicide rate increases, from the despair of having few or no hopes for the future or having fought in wars of empire or whatever, increases and lifespans decrease, when the gun murders stay higher than anywhere else in the world and the incarceration rate as well, and all of the other things that have happened over the past few decades comes into view, I think the overall “plan” (world view does not have to be conscious) is to let the unnecessary limbs die to preserve the core of the body.
beware to those of us who are a part of those limbs.
Exactly. Dropping life expectancy isn’t a bug. It’s a feature.
Nice work, as usual. Except please stop with the “Also too”. What are you, Atrios?
Sarah Palin.
Yes, it’s an Atrios tribute. I was one of the first summer fill-ins at Eschaton back IIRC in 2003? Or was it 2004….
Adding, 2003, because 2004 was Bush v. Kerry — and what an exciting campaign that was, what with Kerry rolling over on the Ohio results — and by then I was well into the blogosphere. Sheesh, a decade. Shit is fucked up and bullshit.
I have written it before, and I will probably write it again in the future- Democrats picked Obamacare because it was basically a way to hide the cost of extending care to the uninsured. Sure, they could have (and, in my opinion, should have) made Medicare universal. However, that would have required explicit tax financing (or deficit increases) to cover the costs. They weren’t, and probably won’t ever be, willing to take that position as a party. So, you get mandated insurance and cost shifting between private insurance purchasers which is going to collapse due to the perverse incentives contained within.
I agree with the fact that Dems went with the PPACA, in order to cost shift to the individual (if that’s what you’re saying, YW–I’m not totally certain that is what you mean).
MFA would have much greater initial outlays, due to the degree of subsidization.
But as Lambert constantly points out–it would save beaucoup taxpayer money in the end.
BTW, it appears to me that the PPACA “type” of plan is the same that all the major Dem candidates have endorsed for several election cycles now. (Apparently, our Dem Leadership decided a number of years ago to “fold,” and go with the Heritage Foundation’s conservative plan.)
(Probably since the “wonderful success” of the MassHealth–which is not to say that “some” didn’t benefit. I’ve read more than one newspaper article and blog post (FDL) that has pointed out that many lower income residents there can’t afford to buy, or to use, health insurance under this plan.)
Obama is a shameless liar. But the real question is Why do we allow the “health” insurance companies to exist at all. There should be enough outrage by now to demand that they be made illegal, like any other RICO enterprise. We should be attacking them with all our focus and energy.
See the HMO Act of 1973. We can thank Saint Ted Kennedy for ending the cruel and anti-American ban on for-profit healthcare. Its the hospital cartels as opposed to the insurance companies which are the problem. I suppose they are both problems, but I could live with insurance companies. The hospital cartels and Big Pharma are the real problem.
The whole idea of 20 – 40% personal contribution just as you are likely to find it more difficult to work, lose your job and find it more difficult to get a new one is stupid. It reeks of a rationing system or a parts but not labour guarantee where you find the labour is double or triple the going rate.
The UK NHS is not perfect and around the world such systems are often subsidised with trained foreign labour. McKinsey regularly claimed the US system subsidised all others through R & D and other innovation costs. My view was this was specious rot, along with other ‘privatisation is wonderful’ notions on medicine. This said, room is needed to boot nationalised systems from complacency. All Western health services have taken skilled specialists from the third world and failed to train their own people. The senior professions involved have used their scarcity (often engineered) in ways much worse than any trade union activity.
doctoring, at least here, is the ultimate Made Man profession.
yes, you go through an arduous trial-by-fire training process, but after that it is rather smooth sailing, some of the best working hours and conditions on offer, and a six-figure salary.
also, the training process itself is meant to make you feel that you are part of a special class, somehow more than human (sociological papers have been written on the mentality instilled by the training process).
of course, we all love doctors when we need them and appreciate their knowledge and skill. but over my lifespan, I could count on less than 3 fingers the times I’ve come into contact with one who actually seemed like what they “cared about” was helping people. and one of those was an RN.
MINIMUM WAGE FACT CHECK
BELIEVE————REALITY
teenagers————-average 38
work part time—— 88% are not teens
lives with parents—36% are over age 40
Extra spending $$—Spend on essentials
Women—————-56%
Have children———28%
Work full time——– 55%
On average earn half family income——-
from the nation.com
So here’s a lovely datapoint: average costs of each the five silver plans approved by Nevada’s insurance exchange. Of course the costs vary by county, so I assume more urbbanized Clark County (ie., Vegas) would be above the statewide average– assumng these averages are unweighted, for all counties. In any event, the overall average premia across the 5 plans are $311/ month for a 30 year old, and that scales up to $722 for a 60 year old. To emphasize the obvious, these price quotes are per person, not per family.
I’d assume that Nevada is a lower cost jurisdiction than many… and remember, this is for a silver plan, which requires 30% co-insurance plus deductible. MEH!!!
http://www.zanebenefits.com/blog/bid/314521/Nevada-Health-Insurance-Exchange-Update-Approved-Health-Plan-Rates
Thanks, sellem.
You’ve made my point–repeal and replace (the ACA).
;-)
Great $$-fact report on the ACA silver junk!
The more these facts come out front and slam into people’s faces as they begin (or not) their engagement with FrankenCare, the more it will be revealed that ACA is the AMERICAN UNAFFORDABLE INSURANCE ACT (by design via the collaboration of Obama and Insurance Companies).
so, what’s the plan here, guys? should this been seen as advocacy of a general boycott, by all of those who would not be substantially helped (chronic health conditions, those with children who probably shouldn’t risk it?) by such a program?
granted, you never know what emergency will happen. but if bankruptcy is to occur anyway, then you might as well roll on that and save your premiums.
What would you suggest?
sometimes, really….
didn’t I just say it, above?
if you don’t like certain posters, just ignore them.
Personally, I think the Republicans are nuts on this; some people will do the math, figure out they’ll benefit, and the Republicans (1) want them to not sign up and (2) want to abolish the benefits. That’s nuts; the benefits will certainly appeal to at least some of their constituents. If I were a Repubublican, I’d be thinking of a campaign of tax resistance, which is their forte anyhow, especially since there’s no penalty or lein for not paying your fine if you don’t have coverage.
Since I’m not a Republican, I think the thing to do is replace the ObamaCare with single payer Medicare for all. Hence the focus on making people aware of all the problems in advance, and presenting the better alternative. The other thing to do is support state efforts like VT or OR, in the hope that they turn out to be the Saskatchewans of the United States. So my answer is push for legislation (on this issue at least).
Adding… There are also excellent organizations like PNHP and the national Nurses Union to support.
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In general, the “assignment” of work to others is not well-regarded here; “So, what’s the plan here, guys?” struck me as being very much like an assignment. It’s a thread management thing, not a personal thing.
So I asked because I didn’t see a plan “above”; I just reviewed the thread and I still don’t see a plan. Better to throw out a proposal than to ask others to do the work, no? What am I missing?
if people who won’t clearly benefit boycott the program, the failure to sign up the desired percentage would be a start, no?
I don’t assign work to anyone. but if every time someone makes a comment, and you come with a “well, what is YOUR plan to fix this problem, then? hmmmm?” then it strongly suggests that puzzling over stuff and idea-gathering in comments is not welcome. it shuts down discussion before it can even take place.
from now on, the peanut gallery (me) will be silent.
As for failing to sign up the desired percentage, I’m betting its lowballed anyhow, so that effort will fail. In addition, we have a table where some of the starving can eat, but not all. I can’t bear to tell those who will eat not to. If things were much much more polarized than they are, perhaps, but as things are, the few who denied themselves would suffer for no good purpose. CCCH advocates this and I think their passion has led them over the line. Better to eat and then overwhelm Yelp with lousy reviews.
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underpants gnomes riff still rankling? It should, because there’s a lot of that going around. So, “every time”? A hard thing to prove.
anon y’mouse, I don’t presume to tell anyone what is best for them, okay? And you do make a good point that “if bankruptcy is to occur anyway, then you might as well roll on that and save your premiums.”
And as I see it, aside from lowering the cost of health insurance plans for small business owners, and fulfilling the desire of conservatives to shift the burden and cost of health insurance unto the general populace (thru the “individual mandate”), and away from state and federal government, there are few “positive” outcomes as a result of the implementation of the PPACA.
Frankly, I believe that we haven’t seen anything yet. Eventually, the millions and millions of Americans who’ve participated in group health plans for years will “wake-up” to what the PPACA is all about.
(And BTW, Former Governor Howard Dean has actually acknowledged that he would like to see employer-sponsored health insurance dismantled. IMHO, this was one of the “intended consequences” of the PPACA.)
When millions of American employees realize that they (and in some instances, their family members) will either be completely thrown out of their employer-provided health insurance plans into a state or federal exchange, resulting in an increase in their health care premiums, or, that their employer-sponsored plans will become increasingly expensive, even though many of the group plan benefits will be greatly diminished, there will be a “backlash” like we haven’t seen in many years.
[Bear in mind, the Administration’s IRS ruled that the stringent requirements which applied to small businesses, do not apply equally to large corporations.
That is why the “skinny plans” have received the blessing of the IRS, when they finalized the rules.]
As far as whether or not to participate in the ACA–that’s a very personal decision. One that each individual and family should make in consideration of their own particular set of circumstances.
Good luck!
well, no. I would never presume to tell someone “don’t get health coverage. it’s just a scam blahblahblah” i’m not them. they need to take stock of their own situation and do what they deem best. I don’t see “advocacy” as telling people WHAT to do. just putting forward things for consideration.
which, your post did in great detail. so, thank you for that.
anon y’mouse, did not intend to imply that “you” are attempting to tell anyone, anything, LOL!
I was actually trying to state that although “I” have VERY strong opinions on this issue, I don’t presume to tell anyone what there course of action (regarding the ACA) should be.
Sorry for the confusing syntax (on my part). ;-)
I’m sick of free market so-called solutions. A market is not a social program. Obamacare is a market that’s supposed to fix a social problem through some sort of magic market forces. The only magic will be how more wealth gets transfered to corporations from the dwindling middle class.
Here’s how “free market solutions” will end up applying vis-a-vis Obamacare: If all you can afford is a Bronze plan premium, you probably can’t afford the 40% out-of-pocket cost, either. You’ll effectively have no more access to healthcare than you did before you paid the premium, only now, instead of just being sick and poor, you can be sick and even poorer. If you’re lucky, maybe AIG’ll be on your exchange and you can give them premiums in addition to tax-funded bail-outs. If you can’t afford the Bronze plan at all, consider yourself “free” to eat all the Freedom Fries you want since you’ll be dying early, anyway.
We’re already paying for a national health care program. How come we’re not just using that? Oh, yeah – it’s a real social program and not a free market solution. Where’s the guaranteed profit in that?
O-bot care = that new fangled funeral insurance scam (look into it).
Skippy… Firstly the system makes you sick and then charges you for that pleasure… new definition for sickness in order methinks.
laff thingy…
Al Murray vs. Americans
http://www.youtube.com/watch?v=xUdaPNXC_68
Skippy, para 2… Hou might enjoy these metaphors…
http://www.cracked.com/article_19384_the-5-creepiest-ways-animals-have-mastered-mind-control.html
Several points need to be made about health care:
1. The cost issue is directly linked to quality of care-when physicians misdiagnose, when hospitals fail to rely on practical clincal procedures that build safe and reliable methods into there procedures, when consumers fail to report quality of care issues to their insurance carrier-all of these contribute to the huge cost over-runs in the health care system. We know more about the performance skills of classical muscians and basketball players that we know about the skills of our physcians and the quality of care given under specific conditions at critical care units (say a high risk cardiac patient entering the ER for the third time in three years; this is so wrong that it is a wonder we tolerate such a situation.
2. Cost over-runs are also caused by patients and physicians over-utilizing expensive procedures such as MRI’s and CAT scans. These procedures should only be used under specified circumstances; often there is a simpler procedure that will suffice to treat the patient. Over-utilization by individuals is a complex subject and depends a lot on what folks expect from their medical care providers. Suffice to say that we often expect too much from medical professionals and staff at care facilities-such as walk in clinics, ER attatched to critical care facilities and then once admitted from the staff at the observation unit where a patient is often place after the initial care in the ER unit.
A comment about Medicare-it is not the panacea for health care that is seemingly presented in this posting. Medicare, as has been pointed out, is expensive; the 20% cost for the individual has no stop loss placed on it. A patient entering the health care system could expect to pay say 20% of $250,000. When the cost of the professiional (part B) enrollment (say $100/month) and deductable is added in, we can see that Medicare is very costly to the individual. Thus individual Medicare supplemental policies enter the scene; these typically run about $240/month. This will take care of the %20 and the deductable leaving usually a low copay of about $10-$20 per visit to the professional’s office An individual could thus, for complete coverage pay several thousand dollars ($1200 for part B and about $2800 for the supplemental. I think people who extol the wonders of Medicare should talk about this, sadly the author of this post chose not to.
Also, Medicare repeats all of the faults of failing to address quality of care of over-utilization cited in my comment above. Medicare,like the private health insurance carriers also is flawed by other failing to consider other issues. I’ll save that for a web page I will author so I can just pull that out when ever this issue comes up as it so often does. Praise for a single payer system without correcting the flaws of the system is hypocritical and cruel.
your posts make some good arguments.
what do you think drives “overutilization”?
I still have yet to meet anyone who wants more doctoring than they think they need. meaning, they want it to solve their problems and then they don’t want it anymore.
if they go to a doctor, some indeed do want to see evidence of what their problem is (hence scans, tests, etc.), and don’t want to think that the doctor is just guessing about their problem, prescribing a drug and telling them to come back in a month and “we’ll see how you feel”. they think that all of these medical developments we’ve made should allow a more targeted approach.
another reason I can point to might be the flipside–doctors don’t want to have to justify any treatment they suggest unless they have real “proof”, and try to run the approval gauntlet for reimbursement (or even worse, malpractice liability) with “it seemed right at the time”.
you kind of see this going on with the current discussion about how often, and at what age, women are supposed to endure mammograms.
http://www.salon.com/2013/09/09/new_study_may_reignite_debate_on_mammograms_for_younger_women/
We have comments so near but off-topic material can be added to supplement the post. Thanks for the information.
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Personally, I don’t understand the “over-utilization” theory at all; granted, this is anecdotal and I’m not familiar with the literature. It seems as if it’s an economist’s homo economicus perspective where people always purchase what they regard as underpriced. (“Hmm, going golfing? I’d have to pay full freight. Kidney operation? What a bargain!”) Purely from my own experience, I’d just as soon get involved with our horrible medical system as I would with our horrible financial system; I’m certainly not going to be going bargain hunting at the local clinic.