Health Care Reform - the morning after

[Cordelia]

SDBG--I always like seeing when you've posted, one reason being because I love your user name. It tells me you have a sense of humor about yourself.

Jeez, we all need a reminder to lighten up sometimes.

(I'd like to suggest using an old picture of the governor of your state pumping iron as your avatar.)

[jam.fuse]

I don't want no stiinkin health insurance.

I want to pay a fair price for health care, if and when I need it.

In the Bundesrepublik Deutschland I visited a health clinic to have my liver checked out, I was worried I might have the hep.

Walked in, made an appointment for later in the day, came back, was interviewed by a patient, competent doctor for about ten minutes, had a blood sample taken by a couple of friendly nurses.

The doctor called me personally a few days later, told me everything looked fine (knock wood, thank you jesus).

Cost was under a hundred dollars.

[JackRiddler]

jam.fuse - do you live in Germany? Because residents are required to pay into the system.

[jam.fuse]

jam.fuse - do you live in Germany? Because residents are required to pay into the system.

I have lived there, and you are correct, at least with respect to us citizens; so the shitstem is in effect over there.

On a us passport, one has three months of impunity, however, until one is granted residency.

[ninakat]

SDBG--I always like seeing when you've posted, one reason being because I love your user name. It tells me you have a sense of humor about yourself.

Jeez, we all need a reminder to lighten up sometimes.

(I'd like to suggest using an old picture of the governor of your state pumping iron as your avatar.)

Agreed. Well, all except the avatar suggestion.

[ninakat]

Right on, Jeremy Scahill. But check out this article by Kevin Drum at Mother Jones. Unbelievably delusional (see my emphasis in bold near the end).

Scahill on Healthcare
By Kevin Drum | Thu Mar. 25, 2010 1:45 PM PDT

Glenn Greenwald commends to us Jeremy Scahill's take on healthcare reform:

BD: Given the political divisiveness of issues like health care, there's a lot of pressure for progressive publications to fall into what you have called a "blue state" mentality. What are the hazards of this?

....Health care is a perfect example of this. Obviously, we want to have pre-existing conditions covered. Obviously, we want young people to be able to continue on their parents' health care plans. There are many things that are going to be improvements.

But let's be clear here: This is a complete and total sellout to the interests of the insurance lobby by the Obama administration. This is, as Michael Moore has said, a complete victory for the ultra-capitalists. Yet, if you look on the liberal blogosphere, people like Jane Hamsher are attacked mercilessly for having the audacity to stand up and say "this is a Democratic sellout."

So you have this blind allegiance to ... what? To Obama as a man? To the Democrats as a party? To me, it's very dangerous when you start going down the road of unquestioning support for any powerful individual or any politician. The moment you cede your conscience to a politician is the moment you stop struggling for a better society.

I've got nothing but props for Scahill's work, but this is just wrong. There are, obviously, plenty of partisan hacks on both sides of the aisle, but most of us who supported the current healthcare bill — warts and all — did so because it was, plainly, not only an enormous first step1 forward, but the only way to make that first step. A government-run single-payer solution was never even remotely politically plausible, and anyone who insisted on jettisoning our current framework of private insurers as a condition of reforming healthcare would never get any serious reform passed. End of story.

Supporting the legislation we got doesn't make anyone a sellout, and it doesn't make anyone a blind supporter of St. Barack. It makes us people who actually want to create a better society, not just struggle for it.

As for the private insurance industry, I'll make a prediction: within 20 years it will be gone in all but name. Either the federal government will fund the vast majority of health insurance, or else private insurers will essentially be regulated utilities, as they are in Germany or the Netherlands. This bill is the beginning of the end for all of them, and this week's reform bill is what set that train in motion.

1OK, technically it was the second step. Medicare was the first. But you know what I mean.

[Cordelia]

SDBG--I always like seeing when you've posted, one reason being because I love your user name. It tells me you have a sense of humor about yourself.

Jeez, we all need a reminder to lighten up sometimes.

(I'd like to suggest using an old picture of the governor of your state pumping iron as your avatar.)

Agreed. Well, all except the avatar suggestion.

Yea, but Arnold's Austrian too. (I get a kick out of some of his old footage.)

http://www.youtube.com/watch?v=imJrle6zypM

Sorry.

[SanDiegoBuffGuy]

jam.fuse, that's the ideal world that I would like to live in. Just like the 1970s here in the States.

Don't worry, I won't use the Arnold avatar, and thanks for the comments, Cordelia and others.

[compared2what?]

Right on, Jeremy Scahill. But check out this article by Kevin Drum at Mother Jones. Unbelievably delusional (see my emphasis in bold near the end).

You're right. I mean: It's delusional and unbelievable and unbelievably delusional, all three. Amazing.

Supporting the legislation we got doesn't make anyone a sellout, and it doesn't make anyone a blind supporter of St. Barack. It makes us people who actually want to create a better society, not just struggle for it.

Uh-huh. Because if you're not a useful idiot, you're a beautiful loser. Those are the only two choices. Actually creating a better society, rather than just wanting to create one? Why, that's just crazy talk!

As for the private insurance industry, I'll make a prediction: within 20 years it will be gone in all but name. Either the federal government will fund the vast majority of health insurance, or else private insurers will essentially be regulated utilities, as they are in Germany or the Netherlands. This bill is the beginning of the end for all of them, and this week's reform bill is what set that train in motion.

Unbelievably delusional. There are no cost controls to speak of. What precedent is there, in all of marketplace history, for viewing the moment when an unregulated industry that supplied something for which there used to be a very high natural demand became an unregulated industry that supplied something for which demand was creeping toward being universally mandated by law as the moment that marked the beginning of the end?

It wouldn't be too late to pull it out if they stopped patting themselves on the back and started tacking some corrective legislation onto the end of other bills that were guaranteed to pass, the good old-fashioned way. But why should they bother doing that when they're getting wet, sloppy kisses from Kevin Drum et al?

It's just inexcusable to be that wrong when lives are at stake. Same as Iraq.

[compared2what?]

Ahab, you are not reading what I am writing. I said: "talk to all of the people who drain the healthcare system by making poor lifestyle choices and making the decision to be unhealthy."

Obviously, a baby has no choice in the matter. As you can see I'm talking ONLY about people who drain the healthcare system by making poor lifestyle choices and no one else. That's pretty plain English. How is that unclear at all?

In no way is it unclear, except in the way that it doesn't say who the people draining the healthcare system by making poor lifestyle choices are. Who are they? How numerous are they? What part of the healthcare system are they draining? And of what? And also of how much of [what]? As a consequence of which, the healthcare costs of people who make good lifestyle choices are increased by how much?

In short: Facts and figures, please. Because if you're talking about smokers, for example, they already pay much higher rates than non-smokers.

In fact, anyone who self-insures and tells the truth on the application about, let's say, having a close relative with diabetes (or any number of other conditions for which some people have a higher statistical genetic risk than others, including but not limited to lots of kinds of cancer) pays much higher rates than people who aren't related to any diabetics do. And not telling the truth is a non-option, since it provides just cause for unilateral cancellation of the policy.

That's one of the main things that makes self-insuring prohibitively expensive for most people. No matter how good their lifestyle choices are, the odds are that there's something in their medical history that puts them at risk for an expensive-to-treat illness. And preventative medical procedures (ie -- the whole battery of annual lab tests and what-have-you-grams that every adult who's making wise lifestyle choices should probably take at least one or two of in youth, and more than one or two of if they're above the age of forty-five or so) being unaffordable to most people who don't have health-insurance, those people are kind of bound to end up making any number of what I think it would be accurate to describe as poor lifestyle choices.

So define your terms, please.

What about a hypothetical observant married Catholic woman who has one of the one thousand and one autoimmune diseases that manifest after pregnancy and get worse after each subsequent pregnancy who does nothing to avoid getting pregnant for religious reasons?

Her neo-natal care would definitely be more expensive than if she didn't have the autoimmune disease, and there would also be an increase in the costs of treating her autoimmune disease proportional to its pregnancy-accelerated progression with each live birth. Plus, she'd probably be at a higher risk for staph infections and other assorted bugs someone with a weakened immune system might pick up in a hospital. And thus, theoretically, for all the complications that might flow therefrom.

Would she be making poor lifestyle choices? And whether she would or wouldn't, whom else do you have in mind when you use that phrase?

[compared2what?]

In fact, anyone who self-insures and tells the truth on the application about, let's say, having a close relative with diabetes (or any number of other conditions for which some people have a higher statistical genetic risk than others, including but not limited to lots of kinds of cancer) pays much higher rates than people who aren't related to any diabetics do. And not telling the truth is a non-option, since it provides just cause for unilateral cancellation of the policy.

That's one of the main things that makes self-insuring prohibitively expensive for most people. No matter how good their lifestyle choices are, the odds are that there's something in their medical history that puts them at risk for an expensive-to-treat illness. And preventative medical procedures (ie -- the whole battery of annual lab tests and what-have-you-grams that every adult who's making wise lifestyle choices should probably take at least one or two of in youth, and more than one or two of if they're above the age of forty-five or so) being unaffordable to most people who don't have health-insurance, those people are kind of bound to end up making any number of what I think it would be accurate to describe as poor lifestyle choices.

Of course, all of those uninsured people could save up their pennies in order to make responsible medical choices affordable, and also make impeccable lifestyle choices for the whole of their lives, right up to the moment that they got hit by a car whose driver was entirely at fault for causing the accident that put the uninsured person he or she hit in a wheelchair with no bladder.

The driver's auto insurance might or might not cover some of the costs of care for that person, assuming that the car was insured. But even in a best-case scenario, it wouldn't cover them all.

Expensively bad health happens to people for lots and lots of reasons, many of which have little if anything to do with lifestyle. Frequently. To lots of people who can't afford to have expensively bad health. And I guess I can try to find some figures for that, if you want to factor them into your draining equations, SDBG.

Should I do that? Let me know.

Edited for typo.

[compared2what?]

Seriously, if this health care reform legislation offered no help to American citizens and workers,

then

the Republicans and fascists would not have fought it so contentiously and passionately.

AND

If this were such a boon to insurance firms,

then

the insurance firms would not have invested so many millions of dollars to defeat it.

Sometimes

you can identify your friends by marking their enemies.

Clear your heads and think vertically.

Sorry, I'm just catching up on this thread. They invested millions fighting over trivia, that's what they do.

The pharmaceutical companies made the deal that leaves them free to carry on as wrecklessly and predatorily as usual with our president before any legislation had even been written.

The insurance companies didn't, so they were more visible. And they didn't get everything they were asking for. But that's how hard-ball negotiations go. You put in demands you're willing to give up so that you can give the appearance of compromising later.

As far as I can tell, there is absolutely nothing in that bill that even slightly impedes their ability to set rates wherever they want to. Which is the A-#1 priority for them. The common-sense market-based consequence of that (for people who are insured through their employers) is that all insurance companies will start charging more to provide group plans that cover less. And wherever that ends up will be more or less the standard for people who can afford to self-insure through one of the high-end gimmicks they included, as well.

The really scary implications are all in the how-they-plan-to-pay-for-it part, but they're not getting any play in the media. But essentially, at least as I read it, the fiscal viability of the whole shebang is predicated on starving Medicare into a state of near-non-existence, thereby creating pressures that will push large numbers of uninsured/unemployed people of all ages into an expanded Medicaid system. Medicaid is the one and only public program they're spending a dime on. And they're not spending a dime on improving it, although it sucks. They're spending a dime on expanding it.

AARP are total suckers for endorsing it. The main game isn't the one they're pointing at. It's about slashing the Medicare program in the name of "reducing fraud and abuse," and also by starting to enforce the fee-caps that they've been waiving for years, which (unless they changed something at the last minute) they've now made permanently obligatory (enforcement, not waiving enforcement, in case that's not clear) absent a super-majority override vote in the senate.

The only reason almost all doctors accept Medicare now is that those restrictions have always been waived. So people who are insured through Medicare will also probably be getting less and lower quality coverage through Parts A and B. Which -- good though it is -- isn't really good enough by itself to begin with, unless you get a supplemental policy from a private insurer at Medicare-determined rates, which I believe vary from state to state. Although I could be wrong about that. But in all events, they're pro-rated to the market-rate, which will almost certainly go up, since there's nothing stopping the insurance companies from raising them.

Basically, the way they're funding it looks to me like it's designed covertly to create an institutionalized two-tier system predicated on income, with the expectation that the second tier will keep growing and the first-tier will keep shrinking. There's a nominal middle-tier for the nominal middle-class, but the economy being what it is, I can't imagine that one will include very many people. In practice, it will be Medicaid or slightly enhanced Medicaid for most, good health insurance for the happy few.

But that's just as I understand it. So put a big fat IMO on all of it. And I do wish it were otherwise, I'm not bashing just for bashing's sake. That's really how it looks to me.

I reiterate my earlier comment then: it's all about control, under the guise of the trojan horse of healthcare.

I don't know about "all." But you may be right. So let's say that you are. Granting that it's all about control entails acknowledging that it's also all about money, since money is the the controlling mechanism in this instance.

That being the case, I think that after a certain point, it's self-defeating to define and consider it exclusively as a controllers/controlled equation. Because in that paradigm, the controlled really only have one way out, and that's refusal. Which is an excellent tactic in some circumstances, but it really can't hurt to supplement it with a few more proactive tactical maneuvers, so that you can save the refusal for the situations in which it will pack the most punch.

Again, that's just what I think, though. So I'm not really disagreeing with your opinion, per se. I'm just stating mine.

[SanDiegoBuffGuy]

c2w said (among other things):

Expensively bad health happens to people for lots and lots of reasons, many of which have little if anything to do with lifestyle. Frequently. To lots of people who can't afford to have expensively bad health. And I guess I can try to find some figures for that, if you want to factor them into your draining equations, SDBG.

Should I do that? Let me know.

Find some figures if you want but it all has nothing to do with what I said originally, which was taken out of context by several of you now. I won't provide statistics on an argument that I am not making.

I'm not going to explain myself for a third time here or tell you people again to go back and read what I wrote. Enough already.

And c2w, that was a lot of typing, really, for nothing.

[§ê¢rꆧ]

§

It seems to me this is the old class war strategy, a small win for the middle-middle class, and a big fat zero for those below them. Only in America could they force us to buy private health insurance and spin it as progress! You can argue about the upper classes, those who create the insurance schemes and even the medical industry as well, but I suspect they are making out like bandits.

The thing is, I'm poor. I can't afford health insurance. Now, when I get sick I can relish that fact that I am sick and a criminal, because I didn't buy the mandated insurance. Great! It will create the perception that it's all my fault because I didn't go along and buy the insurance.

This seems to strike at the heart of the false left-right dichotomy debate, doesn't it? I tend to agree with that position; I think we've got a center right democratic party and a far right republican party. Sometimes I think the republicans are just there for that Overton Window effect. I find some of their ideas and values so alien I often just can't process that a real human being could hold them, but I suspect that is more about my own lack of understanding. It's ignorant to reduce your foes to non-human status. But still, it might not be so ignorant to suspect the top of the far-right foodchain is pushing bullshit and they know it, and that they are likely mostly drawn from that 1 in a 100 sociopathic pool of humans.

It's particularly galling to see progressive friends cheering this on like their favorite wrestler just won, or something, and then you go and point out the many, many problems with this insurance industry reform law and they equate you with the nutty right wingers, who are threatening congress now (I caught a second of some talk of this flipping thru channels yesterday). It seems the right-wing resistance to this democratic 'victory' could be engineered from the top, just to make any valid criticism seem crazy, to distract from it, to, ahem, hijack it. And so people can say, "how can you say this isn't a win for us jackasses, the elephants are so maaaad about it!"

Crazy idea, huh?

If I sound bitter it is because I am. I had the crazy notion that, gee, the US will finally catch up to the rest of the western democracies and give a fuck for it's peoples health and wellbeing, there really could be a public option. Maybe I should have done more to make that happen, I'm sure. But I can't escape the feeling this whole fucking thing was engineered from the moment Obama was (s)elected.

[julie doceanie]

§
But I can't escape the feeling this whole fucking thing was engineered from the moment Obama was (s)elected.

I know what you mean, S.

And, given the 21st century congressional tendency to name legislation in a way that gives us a sick Orwellian tummy-ache, I think that the title of the health care thing says it all: the Patient Protection and Affordable Care Act.

The title tells us that we're screwed and it's going to be expensive.