by publius
One challenge in countering the attacks on the health care bills is that they come in many varieties. Steve Benen had a good post a while back describing the diversity among the critics (the "Greedy," the "Wonks," etc.). The attacks themselves, though, are also fairly diverse — and some of them are more egregiously bad faith than others.
So today, I'm providing a User's Guide to some of the most common critiques that I've seen in conservative circles that I consider "bad faith." There are, of course, many legitimate criticisms from both the right and the left. But the ones below all qualify (to me) as bad faith. Let's start with the absolute worst one:
Death Panels/Euthanize Grandma
This one is the worst. Anyone who makes this claim — or some derivative of it — is acting in 100% bad faith. There's not a single fact that makes these claims remotely plausible.
Remember that the uproar comes from a provision to allow Medicare to cover end-of-life counseling. The AARP has pushed for this provision. Republican Senators have pushed for it too.
It is, by far, the most absurd allegation. It's not surprising, then, to see Erick Erickson post stuff like this.
Government Takeover/"Socialized" Medicine
All of the reform bills are constructed around private providers and market competition. Private coverage is the structural centerpiece of reform (for good or bad). Accordingly, most people will simply keep what they have (though it will be more stable).
A much smaller subset of people (e.g., uninsured) will have access to an exchange where they can shop around among private providers — and, maybe, a public option. The exchanges are far more important structurally than the public option, and they are premised on private market competition.
The whole "socialized" medicine business is therefore not remotely true. The bills go out of their way to protect private providers, or at least to rely on competition among them.
Unlike "death panels," though, this argument has some shred of an intellectual foundation — though a very flimsy one. The argument is that the public option will be a "Trojan Horse" that will inevitably overtake private providers. That's the only plausible justification for saying that the reform bills are government "takeovers." It's an extremely weak foundation for such sweeping allegations.
In fact, this argument is so flimsy that I consider it bad faith. First, it's not clear the public option will even be in the bills. Second, even if it is, it's limited to people on the exchanges. New legislation would be required to expand it. And third, it's far from clear it will even succeed even if more people eventually get access to it. As Paul Starr and others have written, it could wind up as a dumping ground for super-high cost individuals.
In short, the public option is not being structured in a way that promises future success. To get from here to "government takeover" requires a Rube Goldberg-esque chain of a million different events to happen that just aren't going to. For that reason, these arguments are being made in bad faith.
"Cutting $500 Billion of Medicare"
There are many variations of this critique. Some yell that "elderly care" will be cut by $500 billion. Others simply bemoan the Medicare cuts more generally. The really creative types combine this attack with other ones listed above to make up an imaginary world where the unfit are allowed to die to save costs.
For background, the House bill pays for health coverage reform in part by saving $500 billion from Medicare over the next 10 years. To get some perspective, that's about 7% of projected spending (pdf) (total is roughly $6.7 trillion over 10 years).
Now, if you think that every single dollar of that $6.7 trillion is being spent in the most efficient way possible, then yes, the House is proposing real cuts to Medicare. But even then, it doesn't follow that the cuts will come from "elderly care" or from the terminally ill, etc. Indeed, the House has specifically identified (pdf) some of this waste — one large chunk being the absurd overpayments to private providers under Medicare Advantage.
In the real world, though, it's silly to think that Medicare doesn't have some waste that can be removed. The idea that the savings will come from denying critical care is demagoguery. And it's a particularly hypocritical claim coming from those who simultaneously complain about the high costs.
Anyway, these are three "families" of bad faith critiques that I've seen the most often.
I think the ‘Trojan horse’ argument has a little more legitimacy than you are granting it-I mean, basically, that’s one of the things Ezra Klein (for example) labels as a big plus to any bill-the public plan can easily be ramped up to a larger level, including more employers and individuals once it has been proven popular and cost effective. When your opponents say ‘look at this, it could be a Trojan horse to national health care’ it hardly seems unfair to agree with them. Ezra may be wrong, but its in the public discourse in favor of the plan as well.
The fear of loss is greater than the desire to gain.
Camille Paglia wrote an article about Publius today:
But somehow liberals have drifted into a strange servility toward big government, which they revere as a godlike foster father-mother who can dispense all bounty and magically heal all ills.
This is off-topic, but two general comments:
1) I appreciate the “User’s Guides” that you write, Publius. Succinct, easy-to-digest paragraphs with cited evidence help make it a little easier to understand issues like these.
2) Please don’t ever write like Camille Paglia. Three pages on every hot news topic in the past couple weeks with much verbosity and few citations doesn’t help one understand “Obama’s healthcare horror”. Maybe that wasn’t her goal, but still, keep doing your thing.
A wise American friend once put it to me this way: people from other nations have come to terms with their own morality. They know they will die. Americans believe that if they do everything right, they won’t die.
I’ve come to believe he didn’t speak of all Americans, or probably even a majority, but he did speak for a definite mind-set within the larger American culture. The notion that if you do everything right, you won’t die, or even that if you love your relatives enough, they won’t die, has the power to motivate a great many mass departures from reality in American life. Exhibit A: Terry Schiavo. Exhibit B: the current outbreaks of strident irrationality over a system that doesn’t work and costs Americans, as a people, enough to put y’all in the poorhouse (or the 救濟院).
If you look at the eight points put out yesterday, it is obvious that the health insurance companies will stop being insurance companies and will function as pre-paid healthcare organizations. The government proposes to eliminate risk management and cost control. The government mandates will cause large price increases.
Also, if you are going to read Ezra Klein, look at what he writes about the spending on the last six months of life. That will be the easiest place to cut and will lead to the government deciding who lives (like Ted Kennedy) and who dies (like the poor elderly).
I gotta say, “It’s shovel ready” is pretty funny. Erickson is a clown, but at least he’s a funny one. I got a laugh out of it, anyway.
We lefties need to reclaim our prankster heritage. Erickson and folks like the teabaggers are having all the fun.
For “liberals” substitute “conservatives”, and for “big government” substitute “the free market”.
Same-same.
And yeah, tu quoque. Everybody gets one per week, that was mine.
Seriously, we all understand that what is on the table is the expansion of the public health insurance offerings, right?
It ain’t the Gestapo.
You know that Gestapo means Gesundheits-Staats-Politik (government health policy)? 😉
If you look at the eight points put out yesterday, it is obvious that the health insurance companies will stop being insurance companies and will function as pre-paid healthcare organizations. The government proposes to eliminate risk management and cost control. The government mandates will cause large price increases.
uh huh.
still waiting for that ONE PARTY STATE, btw.
The “death panels” part truly angers me. It’s so flat-out false: this provision gives more power, not less, to individuals, it does so by funding something that makes it easier for individuals’ own preferences to be respected, and it also helps everyone around people who are dying, since the more clarity about what that person wanted, the less room for intra-family arguments about what that person would have wanted, beating yourself up for possibly not making the choice that person would have wanted you to make, etc.
I am now going to say something that Obama can’t say, since if the Sarah Palins of the world can make up death panels on the basis of nothing whatsoever, imagine the field day that they’d have with this.
My main reasons for favoring Medicare payment for end-of-life counseling are listed above: greater autonomy for individuals, less risk of people’s wishes (whatever they might be) being disregarded, taking away one source of pain and discord from the lives of those who care for someone who is dying. But it would probably also save money, and this is a good thing.
To be clear: I do not — Not! — support trying to save money by talking people into declining care. I think that’s odious, and I’d much rather not save the money, pay higher taxes, and allow people who are dying to decide their own care. They’re losing their lives; they should not lose their autonomy and dignity as well. Period.
That said: the more clarity there is about the kind of care a person wants, the more likely it is that that person’s wishes will be respected. If that person wants everything possible to be done to stave off death, clarity about that will increase the odds that everything possible will be done, and that will increase spending on health care. If that person would rather decline extraordinary care at a certain point, then that increases the odds that she will not get that care, and that will diminish spending on health care.
Whether or not you think that making it easier for people to make their wishes known in advance will save money, on balance, depends on whether you think that people are, on balance, more likely to be overtreated or undertreated at the end of life. I think there are serious pressures to overtreat, and thus that this would save money. Specifically:
(a) In general, and obviously with many exceptions, doctors think of themselves as fighting disease, and do not like to do things that feel to them like giving up. I would guess that this would make many of them more likely to go on treating someone given uncertainty about what that person would have wanted.
(b) Also, they might be worried about being sued for not doing enough. A clear directive from the patient saying that she would not like certain kinds of treatment is a powerful defense against such suits (and, of course, a clear directive saying that she would like that kind of treatment is an equally powerful tool for the plaintiffs.)
(c) The patient’s loved ones will often feel badly about deciding to terminate care, given uncertainty about what the patient wants. Deciding to terminate care, in the absence of a clear indication of the patient’s wishes, often does feel like “pulling the plug on grandma”. It also opens you up to a lot of second-guessing: e.g., “sure, I’m telling myself that this is what grandma would have wanted, but am I just telling myself this because I’m tired of being here day in and day out, or because I have some secret unacknowledged resentment towards grandma, etc., etc., etc.?” The psychological factors that might pull one towards undertreatment are generally nothing like this strong.
For such reasons, I think that given uncertainty, both doctors and patients will tend to overtreat: to give patients at the end of life who cannot express their own wishes more medical care than they would actually want. And that makes me think that making it easier for patients to express their own wishes in advance, and more likely that those wishes will be respected, will probably save money.
Those savings ought to be seen as the low-hanging fruit. They are achieved not by making hard choices about whether a given treatment is really worth it, but by not inflicting medical care on people who don’t actually want it. Analogy: suppose that doctors were in the habit of doing cosmetic surgery on people who came in for other operations, so that when you had, say, an appendectomy, you might wake up to find yourself with augmented breasts or a perky new nose. And suppose the federal government was billed for this surgery.
Surely one of the easiest cost-saving measures to justify would be to ask people whether they actually wanted cosmetic surgery before they underwent other operations. Because whatever reasons there might be to favor paying for cosmetic surgery for people who actually want it, there’s no reason to pay for cosmetic surgery for people who like their bodies the way they are, quirks and all, and who will be deeply annoyed when they wake up all full of unwanted botox, or with the wrinkles they thought were perfectly fine all tucked away. And saving money this way wouldn’t be about “denying care” or “double standards” or “ugliness panels”; it would be about enhancing autonomy. When you can save money by identifying people who don’t want a certain kind of care and preventing the health care system from inflicting it on them, that’s surely where you should start.
Same here. I’m completely in favor of letting people who are dying decide that they want everything to be done, and I’m willing to pay to help them get it. But I’m opposed to inflicting that care on people who don’t want it. For that reason, I favor measures that make it as easy as possible for people to make their own wishes known. This would, I think, save money, and it would save it in one of the most justifiable ways imaginable: not by deciding which workable treatments are too expensive, but by cutting out treatments that the patient doesn’t even want.
It’s a sign of the corruption of our discourse that politicians couldn’t make this basic point.
And remember that a lot of that $500 million taken out of Medicare ($170 billion, according to Obama) is removal of the unwarranted Medigap subsidies awarded to the private insurers by the Republicans.
basically, that’s one of the things Ezra Klein (for example) labels as a big plus to any bill
the opinions and desires of pundits are really not relevant.
…are really not relevant.
by that i meant to say that most of the pundits i’ve read who walk this all the way out to nationalization are either wishing for some kind of broad government involvement and hoping this gets us there, or are using the specter of nationalization to stop the current efforts (for reasons which might have nothing at all to do with health care). if they want a European-style system then they will find ways in which this effort is a first step; if they want this effort to fail, they’ll do the same. either way, it’s got little to do with what’s politically possible.
but the idea that anything up for consideration now inexorably leads to actual nationalization is truly absurd. the government will own and control the entire health care sector ? and you get there by setting up a scheme to provide insurance for people who don’t have coverage really ? really ?
hi hilzoy! 🙂
hi publius! 😉
Has hilzoy returned?
Either that or I’m having a hell of a hallucination…
Group trip?
This hilzoy person is making a lot of sense. You guys ought to offer her a front-page posting gig.
Camille Paglia wrote an article about Publius today
And the woman who showed up at Arlen Specter’s town hall babbling semi-coherently about the US becoming a “socialized country” like “Russia” where people wait in line for toilet paper was interviewed on CNN this morning.
I’d say the two of them are neck-and-neck in the credibility derby.
If you argue that point #2 is false, you are arguing that a “reform” bill is basically useless from a progressive point of view. The critical point of disagreement is not whether or not the bill will introduce socialism, it is whether government or private insurance is better. The facts are quite conclusive on this question, and the argument should be on this basis, not on the false claim that the objective is a reformed private system.
If medicare is cut at all in order to satisfy the phony fiscal conservatives (and they won’t be satisfied because their concern about deficits is phony), this is another argument from the left against the bills currently being considered.
By the way, claiming that costs can be saved in general or in certain programs without specifying exactly where and how the savings will be made is arguing in bad faith. Politicians often do this because they know that as soon as they get down do specifics somebody will scream.
Citing Camille Paglia? I’m not sure that’s a good thing for your arguments….
“Same here. I’m completely in favor of letting people who are dying decide that they want everything to be done, and I’m willing to pay to help them get it. But I’m opposed to inflicting that care on people who don’t want it. For that reason, I favor measures that make it as easy as possible for people to make their own wishes known. This would, I think, save money, and it would save it in one of the most justifiable ways imaginable: not by deciding which workable treatments are too expensive, but by cutting out treatments that the patient doesn’t even want.”
I agree with the baseline assessment in all of this. I disagree that it is the end of the story.
While much of the drama around this is clearly overblown, the fact remains that we continue to talk about two different perspectives as if they were the same.
First we talk about what is in the bill, stating that the objections are false (or lies) because the bill doesn’t provide for anything that looks like how it is being described.
Then, Democrats (progressives, Liberals?) talk constantly about how the bill doesn’t go far enough, that it is a good (or bad) first step. They talk about how it can be modified and enhanced going forward, but “lets get something in place”.
They then question why the Republicans(conservatives, Blue Dogs, Right?) question the reality behind their goals.
The general public, despite the focus on the disruptive minority, is justifiably skeptical about the motivation behind the proposals:
Because the proposers constantly tell them it will continue to change over time.
This is a bad thing when trying to convince people to accept a radical change.
Marty,
A couple of thoughts:
1. While many Dems think the bill doesn’t go far enough in some areas, NONE, as in ZERO!!!, talk about it not going far enough in terms of killing old people or subjecting them to death panels.
In fact, in every single one of the other western nations that have systems that are farther along – the ones that some Dems want to push toward – there are no death panels or anything closely resembling death panels. They don’t exist.
2. Ironically enough, private insurance providers do impose strict end of life measures that are closer to death panels than anything in the Dem universe (see here). The Dems, if you recall, were the party that passed Social Security and Medicare (and the party that has defended each for decades) because it seeks to provide BETTER conditions for older Americans. Not quicker death.
Cleek-
Its clear that the Republicans are lying about nationalization. I was just trying to make Marty’s point, less eloquently.
The general public, despite the focus on the disruptive minority, is justifiably skeptical about the motivation behind the proposals:
Because the proposers constantly tell them it will continue to change over time.
That’s a fair criticism.
That said, to my knowledge the most outlandish, blue-sky, pipe-dream, down-the-road-someday vision that’s been put on the table is state-sponsored single-payer health insurance.
I.e., Medicare for everyone.
I understand that not everyone agrees with that as a proposal. But can you explain why it makes people freak out and think the end of the world is upon us?
debunking publius re: government option
“In fact, this argument is so flimsy that I consider it bad faith. First, it’s not clear the public option will even be in the bills.”
The reason that people are expressing their distaste for it now is to influence lawmakers to keep it out of the legislation. Does Publius think we should all be quiet until a final bill has taken shape? Publius certainly hasn’t been quiet about his preferences prior to a final bill taking shape.
“Second, even if it is, it’s limited to people on the exchanges. New legislation would be required to expand it.”
The fee for a company, large or small, to not provide insurance for their employees is 8% of payroll. That is about half of what providing insurance to employees costs. It is an incentive for the company to pay the fee instead of providing insurance. This alone will eventually push everyone over to the exchagnes and make them eligible for the public option. It is a very tiny administrative policy step to undercut insurance companies by underpricing the public option.
” And third, it’s far from clear it will even succeed even if more people eventually get access to it. As Paul Starr and others have written, it could wind up as a dumping ground for super-high cost individuals.”
It is clear to me. Show me how it is not clear.
Stl Pastor:
I’m not familiar with every one of Ezra’s preferences, so could you help me out here. Is he actually in favor of government provided health care, or, rather, government provided health insurance?
There is some merit to someone fearing a trojan horse for universal coverage in terms of government insurances, but health care is beyond a stretch, and I don’t even see that much support from left-leaning pundits – and next to ZERO support from actual Dem politicians.
“1. While many Dems think the bill doesn’t go far enough in some areas, NONE, as in ZERO!!!, talk about it not going far enough in terms of killing old people or subjecting them to death panels.
In fact, in every single one of the other western nations that have systems that are farther along – the ones that some Dems want to push toward – there are no death panels or anything closely resembling death panels. They don’t exist.
2. Ironically enough, private insurance providers do impose strict end of life measures that are closer to death panels than anything in the Dem universe (see here). The Dems, if you recall, were the party that passed Social Security and Medicare (and the party that has defended each for decades) because it seeks to provide BETTER conditions for older Americans. Not quicker death.”
Great points, now tell me that once the bill is negotiated and finalized that we will not have to worry about the makeup of the various panels and ongoing recommended changes.
Tell me that the average American can have confidence that, out of the thousand pages of bureaucracy added, none of those would have the ability to substantially change any of the rules going forward.
Don’t tell them how it is now, people know what they have now, warts and all. Tell them what they will have going forward, without the caveats and mixed messages, annual reviews, recommendations that Congress can allow into law by doing nothing, etc.
Most important, tell them that the neogtiations are going to create a reasonable long term solution they can evaluate, not a first step.
hilzoy: welcome back! Can we have a guest post about your trip, please? With a picture of a bare-faced go-away bird?
Marty,
Tell me why the United States, as opposed to every other nation in the history of the world that has implemented a public option, would suddenly change the rules to kill old people? Why?
When the Dems are in power, and the whole point is to replicate some of the better aspects of other systems?
Even though the Dems fight tooth and nail to preserve Social Security and Medicare in order to preserve the lives and dignity of old people. Suddenly, they do a 180 and push to end their lives? Huh?
Tell me why, having Medicare in place for 60 years already, the Dems have not pushed for death panels through Medicare. But suddenly, now, they’re going to push for the death panels that they wanted all along but…didn’t ask for?
Doesn’t make sense at all.
The onus is on you to tell me how that is even remotely in the universe of possible. Otherwise, I would caution you that there are many things that the government could do after it passes any bill. But we must discard the outlandish, infeasible and bizarre from the conversation in order to have a productive discourse.
An excellent counter to the “slippery slope” argument, from a commenter at Crooked Timber.
If you can’t be bothered to click the link: we can draw on the experience of any number of countries where private insurance and a public option complement each other. In none of them has a public option “crowded out” private insurance providers.
“The onus is on you to tell me how that is even remotely in the universe of possible.”
Actually the onus is not on me. The onus is on the sponsors of the legislation to convince the American people that the legislation is acceptable to the majority. This includes the reassurance that this is not a bait and switch to accomplish a number of stated goals that get negotiated out.
Just as a note, I would think most people don’t actually believe the “death panel” argument. It is a strawman that reinforces their general lack of faith in the motives of the proposers.
D’d’d’dave: The fee for a company, large or small, to not provide insurance for their employees is 8% of payroll.
And right now, without reform, what is the penalty for not providing health insurance to employees?
The onus is on the sponsors of the legislation to convince the American people that the legislation is acceptable to the majority
Yes, and the onus is on the opposition not to make up blatant lies, not to scaremonger and not to completely distort the debate for ulterior motives.
The American people have been duped by the fear tactics of the insurance/pharma industries before. So, yes, the onus is on the proponents to defeat their misinformation. But, ethically and morally speaking, citizens should also not try to misinform other citizens. So the onus goes both ways.
This includes the reassurance that this is not a bait and switch to accomplish a number of stated goals that get negotiated out.
But those aren’t stated goals!!
Not stated goals:
1. Death panels.
2. Government provided health care.
3. Government take over of health care.
4. Cutting $500 billion from Medicare.
Not stated anywhere!
It is a strawman that reinforces their general lack of faith in the motives of the proposers.
In other words, it’s a lie, but an effective one.
Marty: Actually the onus is not on me. The onus is on the sponsors of the legislation to convince the American people that the legislation is acceptable to the majority.
How meta. It’s not about persuading the people on the merits of the plan. It’s about persuading the people that the people have been persuaded.
“In other words, it’s a lie, but an effective one.”
Glad we cleared that up.
If you argue that point #2 is false, you are arguing that a “reform” bill is basically useless from a progressive point of view.
Absolutely.
Indeed, if the public option really ends up structured, as publius puts it, not to succeed, it will have become (in fact, perhaps already is) an aspect of the bill essentially designed to provide a bad faith argument to keep progressives on board this “reform.”
And there’s my tu quoque for the week!
publius:
I believe you missed a prevalent bad faith argument, although it’s tangentially related to the “government takeover” argument. Prominent Republicans like Boehner, Cantor, and Pence (among others) keep repeating the lie, err, “talking point” that a study shows that a public option would cause 120 million Americans to lose their current coverage. What that study actually showed was that if a public option were created and were opened up to everyone (something no current proposal allows, by the way), some 120 million Americans would switch to it voluntarily. That’s hardly the same thing as “losing” your coverage.
So clearly I can not choose the health reform bill in front of me!
another bad-faith argument: calling the plan “ObamaCare”, when Obama isn’t actually involved in writing it. but, that’s expected since the GOP’s efforts are primary geared toward beating Obama, no matter what.
another bad-faith argument: calling the plan “ObamaCare”, when Obama isn’t actually involved in writing it.
And it isn’t “care” either. It’s insurance.
So, other than the fact that Obama’s not authoring it, and it’s not health care, they nailed it.
I think Marty/Pastor are bringing up a legitimate point, which I wish the pro-reform side were addressing more effectively.
I don’t think you can credibly claim that the public option isn’t at least looking toward scaling up in the future — if it really is competing with the private options, then by definition it is capable of taking market share, and absent some external controls I don’t see how its market share is incapable of reaching 100%.
The critical question is whether the public option will be in fair competition. A public option that succeeds by virtue of scale and lack of profit/shareholder demands would be hard to attack except on purely ideological grounds (which it surely will be, of course). A public option that sits on top of a compulsory tax is basically a fraudulently sold single payer system, and even though this isn’t what’s on the table I don’t think it’s a bogus concern.
Basically, I don’t see what’s wrong with saying that, yes, “we” do think the public option will end up with a substantial portion of the market, because in this particular market a large non-profit can probably deliver a better product. And if it doesn’t then it will fail, and it will be allowed to.
This includes the reassurance that this is not a bait and switch to accomplish a number of stated goals that get negotiated out.
i love love love how it’s the Dems’ job to counter the GOP’s lies. the party of personal responsibility and rugged free-thinking, moral, heartland, American individualists is free to spout any insane nonsense that it can think of; but the Dems have to convince people – people who already think the Dems are literally destroying America – that the GOP is lying to them.
in the words of Elliot Smith: what a fncking joke.
if it really is competing with the private options, then by definition it is capable of taking market share, and absent some external controls I don’t see how its market share is incapable of reaching 100%.
well, it hasn’t worked out that way in countries which have already gone down that road.
take it away, Matthew Steinglass:
What Megan is saying is basically: sure, you’re saying you’re preserving the private health insurance sector now. But really, you want to eliminate it in the next round of reform, and if we let you have your way we’re on a slippery slope to single-payer sooner or later, because we know you all really love Euro-style single-payer systems. But this is just wrong. I’m a liberal who loves Euro-style health insurance systems, but I’ve never been in a single-payer system; they’re in the UK and Canada, and maybe Sweden, I’m not sure. The ones I know are in the Netherlands and France, and they’re not single-payer. And if those systems are supposed to be on a slippery slope to single-payer, well, that’s a strange slippery slope. France instituted universal coverage through private insurers in 1946 I think, and sixty-odd years later over 90% of French people are still buying private health insurance. The Netherlands has had universal care through a mix of public-private plans since the ’40s too, and in 2006 it actually scrapped the public basic insurance plan in favor of putting everyone into the private market, regulated and subsidized to achieve universal coverage. If the health insurance reform bill in the House is a stalking horse for importing the Dutch system wholesale, that’s fine with me. But a Dutch-style system means universal private health insurance, and it’s still just flat-out wrong for Megan to characterize that as a “government-run health system” or “single-payer” or “eliminating the private health insurance market” or whatever.
Gromit’s response to D’d’d’dave’s comment,
“The fee for a company, large or small, to not provide insurance for their employees is 8% of payroll”
is right on the mark. Gromit said,
“And right now, without reform, what is the penalty for not providing health insurance to employees?”
But let me add another dimension to this now common meme on the right. Group insurance rates are considerably cheaper than individual insurance policies. (My employer, for instance, has a very solid group policy with Blue Cross/Blue Shield, that costs about $1000 per person annually.) HR3200 proposes a national insurance exchange, which includes private plans as well as a public option, only for people who don’t get insurance through their employer.
There will be a mandate for employers to provide health coverage for their employees as long as their payroll is more than $750,000/year. This is an extremely important point. It means that a company with a payroll of, say, $1,000,000 a year, would have to pay a penalty of $80,000 (8% of a million) if it didn’t provide coverage. In this case, the penalty would indeed be far greater than the cost of group coverage. I’m sick and tired of hearing this argument which doesn’t take into account the drastic difference in price for individual vs. group coverage.
“Camille Paglia wrote an article about Publius today”
I’m willing to bet your acceptance of Camile Paglia’s opinions, d’d’d’dave, is quite selective. Am I wrong?
Hilzoy at August 12, 2009 at 08:55 AM: this is, as is completely unsuprising, so to the point, and well-stated, that I have to wonder why it couldn’t be posted as a front-page post?
I realize that it’s far more relaxing to write with the notion that what one is writing doesn’t have to come up to a particular standard. This is exactly why I’ve taken to writing fifty times more comments here than at my own blog, which is really where I should be focusing my efforts, and spending far more of my writing time.
So I understand that part. But in a case such as this, where what you come up with is perfectly useable as a post anyway, why not just allow it to be posted as a post?
Posts do not have to be filled with supporting links; it is not a requirement; there is not a law.
Please don’t take this in any way as any kind of attempt to twist your arm!
Obviously you are perfectly and completely and utterly entitled to follow your preferences in this matter, and justify them to no one whatever, least of all me.
I hope, though, that as a friend, I can ask you if you might explain a bit of your thinking on the question. But only if you feel like it!
And it’s great to see you comment!
” but the Dems have to convince people -”
1) people who already think the Dems are literally destroying America –
2) that the GOP is lying to them.” (numbers added)
Which of these is the bigger problem?
now tell me that once the bill is negotiated and finalized that we will not have to worry about the makeup of the various panels and ongoing recommended changes
It is impossible to prove a negative, as Marty surely knows. His attitude is embedded with a value judgment which pretends to not be there, in that it assumes that there is a will on the part of congress to be malevolent. There is a superficial case for that view – lawmakers do crappy things sometimes. But, unlike in the private insurance industry, this is a relatively open process, and one subject to political pressure. The problem with our legislature is not political malevolence, but the old familiar: corruption. The same political persuasion which eats breakast, lunch and dinner on slandering government, also stands directly in the way of reforming how politics is financed, so of course nothing can be done. Nothing can be done about *any* problem. I’ve decided that the GOP likes insoluble problems (abortion being exemplary) because they’re the gift which keeps on giving, politically. Meanwhile, the political economy is slowly seizing up. Thanks guys!
If I may use an elaborate metaphor, and at the same time slide a toe ‘over the line’ of the posting rules: the health care situation we’re in now reminds me of the tableau (not original to me) in which we see everybody up to their chins in shit; we cut to a close up of one person silently but empahtically mouthing the words, ‘DON’T MAKE A WAVE!’.
I would modify that, in this case, to everyone’s being up to their *knees* in the stuff this week; last week it was to the ankles – it’s rising fast. Those who are crying ‘don’t make a wave!’*now* are not only foolish, but really exemplify a failure of nerve. Any of the major bills would be better than what we have now. The multi million dollar campaign to spread fear and ridiculous lies (‘Good thing Steven Hawking isn’t British!’) is a kind of proof of that.
“1. While many Dems think the bill doesn’t go far enough in some areas, NONE, as in ZERO!!!, talk about it not going far enough in terms of killing old people or subjecting them to death panels.”
Except for the part about General Zod.
Russell:
It would make us Canadian, eh? We’d have to allow more Tim Hortons and probably make French an official language.
Basically, I don’t see what’s wrong with saying that, yes, “we” do think the public option will end up with a substantial portion of the market, because in this particular market a large non-profit can probably deliver a better product. And if it doesn’t then it will fail, and it will be allowed to.
The problem with framing this particular issue this way is that whether or not the public option succeeds depends in large measure on how it’s set up in the first place. And everyone more or less knows this.
This is not an experiment. There are ways to set up the public option so that it works and ways to set it up so that it doesn’t. Those who don’t want the public option to succeed want to set it up so that it’s crippled from the start.
And one of the problems with this discussion (partially reproduced in publius post above) is that there is, in the real world, no slippery slope from a functioning public option to a Canadian-style single-payer system (let alone a British-style national healthcare system). Most continental European countries have systems in which a baseline, universally available public plan is supplemented by private insurance. And these systems have shown no tendency to jettison their private dimensions. The notion that a system based around a universally available public option will naturally lead (for better or for worse) to single payer is simply false.
The effort to cripple the public option isn’t even really an effort to save private insurance. It’s something even less exalted: an effort to save the current business model of our private insurance industry.
“… fair competition …”
Fair to whom? I don’t own a health insurance company. I am a buyer of health insurance. I don’t give a damn whether my health insurance gets cheaper due to “fair” competition between capitalists, or “unfair” competition from the government.
–TP
Basically, I don’t see what’s wrong with saying that, yes, “we” do think the public option will end up with a substantial portion of the market, because in this particular market a large non-profit can probably deliver a better product. And if it doesn’t then it will fail, and it will be allowed to.
The problem is when someone says that because some people secretly want a robust public option they also want…
1. Death panels.
2. Government provided health care.
3. Government take over of health care.
4. Cutting $500 billion from Medicare.
If the conversation stayed on the topic of market share for public and private insurance, I’d be doing backflips with delight.
“It would make us Canadian, eh? We’d have to allow more Tim Hortons and probably make French an official language.”
Thats ok, except the Tim Hortons part, might as well get Dunkin.
I know how to say several airline related things in French: tray table, seat upright, seatbelts fastened, and turbulence. I don’t really know them except that I can decipher them now if they do the French before the English. They all sound so much better in the French version.
what’s French for “sorry, that doctor is not part of our network” ?
Hilzoy at August 12, 2009 at 08:55 AM: this is, as is completely unsuprising, so to the point, and well-stated, that I have to wonder why it couldn’t be posted as a front-page post?
Shhhh, Gary…don’t scare her away!
I for one welcome hilzoy’s return to
bloggingcommenting and look forward to reading more of herpostscomments in the future!There seems to be nearly universal agreement that Tim Hortons is superior to Dunkin Donuts.
That’s in the U.S., not Canada, where one would take that opinion for granted.
“Merovingian: I love French wine, like I love the French language. I have sampled every language, French is my favorite. Fantastic language. Especially to curse with. Nom de dieu de putain de bordel de merde de saloperie de connard d’enculé de ta mère. It’s like wiping your arse with silk. I love it.”
I can’t get much further than La plume de ma tante est sur le bureau de mon oncle,” after some very inadequate high school french some 45 years ago, myself.
But I do love me some French cooking. And kissin’. And fries.
Back on d’d’d’dave’s high opinon of Camile Paglia’s insight, I’m unclear whether he even agrees with her first paragraph of the piece he links to: “Buyer’s remorse? Not me. At the North American summit in Guadalajara this week, President Obama resumed the role he is best at — representing the U.S. with dignity and authority abroad. This is why I, for one, voted for Obama and continue to support him. The damage done to U.S. prestige by the feckless, buffoonish George W. Bush will take years to repair. Obama has barely begun the crucial mission that he was elected to do.”
“what’s French for “sorry, that doctor is not part of our network” ?”
Something like
Désolé, ce médecin ne fait pas partie de notre réseau
Now that we’ve finally gotten to an important question of actual substance, I feel comfortable weighing in:
Gary is correct. Tim Horton’s is far superior to Dunkin Donuts.
So clearly I can not choose the health reform bill in front of me!
Best laugh I’ve had all day.
I was very, very grateful that I spoke French when I was in Rwanda… While I was gorilla tracking, one of the people in my group seemed on the verge of having a heart attack, and one thing that worried me was that our generally admirable group leader didn’t seem to get how serious it was, which I put down partly to the fact that he was walking just ahead of this guy and I was walking just behind, so I saw a lot more, but also to the fact that English was his third language, and while he spoke it a lot better than I speak my third language, he did miss the odd inflection. E.g., when the guy said “I’m going to be sick”, and the guide understood this to mean: at some point in the future, I will have an illness.
I was glad I could translate. That was one of the things that convinced the guide that it was, in fact, time to leave that guy to rest with a couple of trackers and a bunch of water, which was, under the circumstances, a very good thing.
So thank you to all my French teachers, and sorry for being such a pest and reading under the desk in class!
Plus, without French, I would have missed out on the joys of Congolese television …
Mellow greetings, hilzoy!
In Publius’ post he made the point that we did not have to fear that a public option would evolve into a single-payer type situation because it could only be used by those in the pool and the number in the pool is a small subset of the whole. In other words, it is rare that anyone will use the public option.
When I wrote at 11:21a, I was countering Publius’ argument by pointing out that there is a financial incentive for companies that currently provide insurance coverage for their employees (and who aren’t therefore eligible for the pool) to terminate their plans and pay the fine. This would push the majority of persons insured now into the pools. Further, all it would take for the public option to attract a majority of the people in the pool is a premium that is slightly lower than the public option. Classic monopolist tactics.
Gromit 11:54a and Tobie 1:54p did not address my point or Publius’ point. Instead they essentially said a fee on employers who don’t currently have a plan is a good thing because it adds to the ranks of the insured.
They are free to make this point and I’m glad they have but it in no way undermines my rebuttal of Publius.
Finally, I find it highly unlikely that this assertion by Tobie is true;
“(My employer, for instance, has a very solid group policy with Blue Cross/Blue Shield, that costs about $1000 per person annually.)”. I would go so far as to say there is no way that a relatively normal full-coverage health plan costs only $1,000 per year. Dental plans cost more than that. I think Tobie means that his/her employer only requires employees to pay $1,000 toward the coverage annually while in the background the employer is paying $4,000 more per employee on the policy.
When Tobie says this ” I’m sick and tired of hearing this argument which doesn’t take into account the drastic difference in price for individual vs. group coverage.” it confirms my belief that he/she doesn’t have a clue about a fundamental cost concept in this debate. He/she seems to think that if the employer is paying it then it must not be a cost. He/she will undoubtedly apply the same reasoning to things provided by government – it’s a benefit without cost.
Farber at 1:56p and 2:59p that one must agree with a person in order to make reference to their words. I suggested that Paglia had accurately described Publius. I did not make a judgement on her portrayal of Obama’s manner of representing the US in foreign relations. He’s suggesting htat if I don’t agree with her in everything then I can’t agree with her in one thing. I’m sure it is a logical fallacy that Farber is using here to try and discredit me but I can’t be bothered to look up the proper name for it.
“I understand that not everyone agrees with that as a proposal. But can you explain why it makes people freak out and think the end of the world is upon us?”
Change is threatening. Change Management is a whole real live occupation that focuses on the reality that the greater the change, the more resistance you get. People fear the unknown and hold firmly to the familiar. Couple that with the uncertainty of the shape of the future (multiple proposals, competing agendas) and people will typically reject the change outright.
That isn’t a healthcare debate, or whether someone is lying or not. It is basic human response to things they perceive as risk. Forcing them to accept it creates larger and less reasonable resistance. Yelling back at them, telling them they are being unreasonable, mocking them does not create the response one might hope for.
Let’s just say it isn’t a tool in the Change Management consultants bag of tricks.
What surprises me is how effectively the Obama campaign and early days in the White House managed the even keel response to this problem, only to find, when they are challenged by widespread public concerns, they start shouting back (figuratively).
Dunkin Donuts has better bagels.
D’d’d’dave: Gromit 11:54a and Tobie 1:54p did not address my point or Publius’ point. Instead they essentially said a fee on employers who don’t currently have a plan is a good thing because it adds to the ranks of the insured.
You said that the penalty would push everyone over to the exchanges. I interpreted this to mean that businesses that currently offer health benefits would opt to drop their health plans, pay the 8%, and pocket the difference, forcing their employees to buy from the exchange instead. Is this not what you were saying?
Because if that is what you were saying, I’m curious why companies that currently face no penalty are somehow less incentivized to dump their employee health plans than they would be if they faced a penalty for doing so.
If not, what were you saying?
Opponents of health care reform can’t make up their minds: they can’t decide whether they oppose “reform” because they’re afraid it will fail, or because they’re afraid it will work.
And I second Gromit’s question to d’d’d’dave.
–TP
I’ve heard it said that those adult children who feel that they need heroic measures to extend their dying parent’s life, do so because they feel guilty about not having spent enough time with them in life.
Libertarian family model (kick children out of the house at age 18, only see each other ritually at Thanksgiving/Christmas, not on speaking terms the rest of the year)
Camille Paglia is 62 years old.
She will enter Medicare in 5 years, if she chooses to enroll.
Medicare is not boundless in its dispensation nor is it magic.
But she’ll be happy to have it, unless by some bounteous magic her ills and infirmities turn out to be few and cheap.
No death panel will be brave enough to snuff out Camille, given all of the kicking, screaming and spitting they would endure.
She won’t say so, because Camille makes more money shooting her mouth off about her outrage than she does letting you know things aren’t too bad after all.
Kinda like me, except for the money part.
Let me take this opportunity to let Marty know that he should not confuse himself with the “lying scum in the Republican Party” I referred to in a previous comments thread.
Marty is a new, valuable presence here and may his health be vital and paid for mostly by my tax dollars.
My language is not helpful or necessary, but it is a little more direct than Publius’ use of the term “bad faith”.
When an individual makes up crap about death panels to scare folks, my response is to convene their worst nightmare of a death panel so that demagoguer and demagoguee (who should learn how to spell) can fully enjoy the fruits of their own “bad faith”.
I find it funny.
Also, Gary Farber is wrong 😉 that I am IN an institution, since I expect to lose my job and my health insurance in December and therefore institutionalization will be out of my financial reach.
(Not looking for sympathy, but I hate it when MY worst nightmares come true)
So, you folks will just have to put up with my madness until you find an affordable, universally insured way of putting a net over me.
Over and out.
Which of these is the bigger problem?
That isn’t a healthcare debate, or whether someone is lying or not. It is basic human response to things they perceive as risk.
Here is the situation that the Democratic leadership, and folks who favor changes to our health care policies, face.
Instead of having a reasonable, or even heated, or even vituperative, discussion of the actual options that are available for public health policy, we have to talk about whether Obama is planning to create concentration camps. We have to talk about whether the government will set up special review boards that will decide whether your grandmother will be given treatment or whether she will be kicked to the curb. We have to discuss whether private health care will be banned or eliminated as an option.
In short, we have to discuss bullsh*t. Total nonsensical paranoid crap.
We have to discuss this because conservative spokespeople have been poisoning the minds of folks for at least the last generation or two with fantastic paranoid wigged-out loony-tunes nutjobbery.
If it seems like I’m being rude here, I’m not. The stuff that people believe is crazy, unrealistic, paranoid crap.
Remember when fluoride in the water was a Commie plot? Same same. Exactly.
Why is it *my* job to try to walk these people back through the maze of insanity they live in so that we can have a reasonable discussion of the facts?
Why is it *my* job to be Mr. Change Management? Don’t these folks bear any responsibility to at least try to get some information?
Why isn’t it *their* job to turn off Fox News and freaking Rush Limbaugh, Glenn Beck, and Michael Savage and get a freaking clue?
Why isn’t it *their* job to do some simple, basic homework on the issues so they can have a glimmer of comprehension of what is actually on the table?
Why? Why is it *my* job to accommodate their willful, paranoid, stubborn, hateful ignorance?
These folks don’t have the sense that god gave a housecat, but they want to stack the house at public meetings and shout down anyone who disagrees with them.
Seriously, concentration camps? Euthenasia?
I’m sick of it, dude. Just saying.
Thanks for humoring the rant.
Thullen, that’s crappy news. You got my good wishes FWIW, which probably ain’t much. If you come to Boston, there’s a bunch of folks here who will at least stand you dinner.
russell: don’t forget the fun part about how back when we said that our President was proposing to spy on Americans without warrant, supported torture, lied us into war, etc., a lot of the same people who now insist that real bipartisanship means listening to crazy people thought we were not worth listening to.
It’s fascinating.
And John: that’s awful. There are also dinners for you in Baltimore.
If you come to Boston, there’s a bunch of folks here who will at least stand you dinner.
Seconded. What a fun evening that would be! 🙂
“after some very inadequate high school french some 45 years ago,”
Er, 35 years ago. I’m 50, going on 51 in November, and I was precocious, but not the point of being in high school at the age of 5!
d’d’d’dave: “Farber at 1:56p and 2:59p that one must agree with a person in order to make reference to their words.”
This isn’t a sentence, but insofar as I can tease what I can from it as to what you may have meant to say, which seems to be something along the lines that I was asserting that to agree with anything anyone says, one must agree with anything or everything they say, which is, of course, not at all what I was implying.
What I was implying was that either one generally has respect for someone’s views on politics, or one does not. This doesn’t mean, of course, that you can’t pick and choose which specific opinions of a person you do and don’t agree with: of course you can, and that’s commonly what we all do with almost everyone; it’s incredibly rare to find someone you agree with absolutely everything they say about every single political issue!
But it does mean that, as I just said, either you respect Camile Paglia’s political opinions in general, or you don’t. I don’t.
More generally, I respect Camile Paglia’s opinions on very little. She’s kind of a general wacko, rather than a specifically political wacko. She’s sui generis.
Unsurprisingly, it turns out I don’t agree with her current opinion about “liberals.”
D’d’d’dave’s free to find quotes he finds apt wherever he likes, of course, and maybe he has lots of respect for Paglia, or maybe he doesn’t, or maybe he doesn’t have any idea who she is; I have no idea. All I was saying was that I’d find it surprising if d’d’d’dave generally found himself in agreement with Paglia on most of her views, and otherwise I was saying, in short: Paglia, pfui.
“Dunkin Donuts has better bagels.”
Do they boil them before baking them? If not, they’re not even bagels at all. I mention this because most of America has no idea what a bagel is, and certainly will never find out from any supermarket. A true bagel is fresh for only a few hours before it becomes stale and rock-like.
John, if you just explain to the people at the Suicide Hotline, or any number of relevant such places, that you are having constant thoughts of harming yourself or others, they’ll be happy to institutionalize you for a while, and they’ll tend to, if not keep you as long as you keep telling them this, let you be a frequent return customer.
You may be sent bills, but you’ll be duly locked up, and pumped with powerful drugs, and bored to the point of actually wanting to kill yourself.
I hope this thought will comfort you greatly!
Otherwise, sincere best wishes and sympathies; if the firm of which I am CEO and all other positions were hiring, you’d be at the top of my list for hiring creatively strange people.
[Publius] made the point that we did not have to fear that a public option would evolve into a single-payer type situation because it could only be used by those in the pool and the number in the pool is a small subset of the whole. In other words, it is rare that anyone will use the public option.
FWIW, he actually said ‘for good or bad’. I don’t understand why a government takeover of health insurance is anything to ‘fear’ at all, especially compared to what we have now. That would be a feature rather than a bug, IMO.
Pardon me, conservatives, but what, exactly, do insurance companies do? Do they provide health care? No. Do they innovate in medicine? No. What do they *do*? They are middlemen. They take their (large) cut, and that’s about it (I know there are some exceptions, but basically, they’re middlemen). Why would anyone fear their demise? Well, anyone who doesn’t work for one of them? Theirs is not ‘a business of caring’….
there is a financial incentive for companies that currently provide insurance coverage for their employees (and who aren’t therefore eligible for the pool) to terminate their plans and pay the fine.
No more than there is an incentive right now today to cut all employees’ pay by 25%. That is to say, doing what you describe amounts to a serious reduction in workers’ pay. That kind of reduction, whether it’s in the form of cutting benefits or reducing cash compensation. has consequences.
Employers don’t pay what they do out of the goodness of their hearts. They pay at a given level because, in the labor market, that’s what it takes to hire the workers they need to make the company go. If they try to pay less, they may save money for a month or so, but longer run they will face disaster, because they will lose their work force. And by the way, they will lose their best workers first.
Any discussion of benefits – insurance, pensions, or other – that fails to recognize that these are just as much a part of workers’ pay as the actual paycheck is going to go off the rails pretty quickly.
Almost forgot. Krispy Kreme outdoes Dunkin’ Donuts by a mile.
Hilzoy’s back! Hilzoy’s back! Hilzoy’s —
er… healthcare reform?
Oh. That.
If it happens at all, I’ll be pleasantly surprised (at this point, it’s looking like what we’re gonna get is “health insurance reform,” whatever that is). The GOP is fighting tooth and nail, and even though there is not a single honest argument in the entire GOP/RW/nutbar axis, they’re the ones framing the debate. How about that, eh?
If the reform, in whatever name, is actually any good, I’ll be amazed. Right now, it looks like what we’re likely to get is a timid, nibbling around the edges, let’s not piss off the insurance industry gimcrackery that will enable the Dems to say they succeeded in getting something passed, but won’t actually reduce costs or increase coverage significantly.
If there is a robust public option, I’ll be so amazed I’ll go outside and do a Happy Dance.
John Thullen: I am stunned and sorry to hear about your upcoming loss of both job and insurance. Won’t you be eligible for unemployment and COBRA extension of your insurance? (Your COBRA premiums might even be reduced.)
“Why is it *my* job to be Mr. Change Management? Don’t these folks bear any responsibility to at least try to get some information?
Why isn’t it *their* job to turn off Fox News and freaking Rush Limbaugh, Glenn Beck, and Michael Savage and get a freaking clue?”
I appreciate the feeling, I just think there are lots of people who aren’t concerned because Rush told them to be.
Most people my age have lived with many of the issues on the list to be addressed for their whole adult life, those older than me are on or approaching Medicare.
The rules were clear, keep a job:keep insurance, pay into Medicare:get minimal coverage in your old age. I would guess this is a huge percentage of Americans (over say, 45). So about 200 million Americans are watching the rules they have lived by all their lives change. They just want to be sure they understand that the new rules don’t make them worse off.
It is a really big mistake on both sides to think that right or left wing demagoguery is what is making the majority have concerns about this issue.
Few issues touch the lives of every American, every day, the rest of their lives.
Patience in making the case can win the day.
Supermarket “bagels” are just round loaves of bread with a hole in the middle.
They just want to be sure they understand that the new rules don’t make them worse off.
that’s just bullshit. the Democratic plan is perfectly clear about what will happen to their current coverage. and the Dem congresspeople are out there trying to pass-along the details. on the other hand, the GOP (which you seemed determined to hold blameless) is deliberately, actively, explicitly, lying to people who want to learn more; and the lies are working.
“that’s just bullshit. the Democratic plan is perfectly clear about what will happen to their current coverage. and the Dem congresspeople are out there trying to pass-along the details. on the other hand, the GOP (which you seemed determined to hold blameless) is deliberately, actively, explicitly, lying to people who want to learn more; and the lies are working.”
My point has nothing to do with holding the GOP blameless, or blaming anyone. My point is that the way to fight the GOP characterization of the risks is to educate the electorate, without trading tit for tat on every point with the Republicans.
Every time a Democrat says that someone else is lying, it reinforces that there are two views to discuss. Arguing the GOPs points constantly is counterproductive.
I hope we get a reasonable plan by December so John has coverage come Jan 1.
My point is that the way to fight the GOP characterization of the risks is to educate the electorate, without trading tit for tat on every point with the Republicans.
Is there any evidence to justify this belief or is it just your opinion?
Arguing the GOPs points constantly is counterproductive.
Why do you believe Democrats are “constantly” arguing GOP points?
They just want to be sure they understand that the new rules don’t make them worse off.
As stated, that’s a very legitimate concern.
Patience in making the case can win the day.
I’m actually skeptical about this. Based on what I’m seeing right now, patience in making the case will just kick the can down the road far enough that nothing really constructive will happen.
I think something stronger than “patience” is needed. By “stronger” I mean clear and directive leadership, which is to say, knocking heads. The heads I have in mind are not those of the folks showing up at town hall meetings, but the (R) and blue dog congressional factions.
It ain’t happening.
Arguing the GOPs points constantly is counterproductive.
I wish I could engrave that sentence on the forehead of every Democrat in government.
an interesting factoid :
There is at least one state in the Union whose law explicitly enable something like “death panels” — a law that gives health institutions the right to remove life support from terminal patients who cannot pay.
That state is Texas.
That law is the 1999 Futile Care Law,
signed into law by then-Governor George Walker Bush.
PS: Hilzoy’s back! The intertubes are worth reading again.
For the record, I am German with no intention to become a US citizen or even put my foot on US soil.
Let’s assume that there are indeed evil liebrul plans along the li(n)es spread by Rush Limbaugh (fleas be upon him), Glenn Beck (may he rest in pieces) and GOP congressbeings (may they live in internecine times) but those are not (yet) in the bills currently discussed. How would passing any of these bills inevitably lead to the fruition of these hideous plans? Would it not require additional bills that implement all these abominable things like mandatory sex changes, mandatory abortion quotas for every woman, federally employed granny executioners etc.?
My personal proposal for the townhall events:
Every person presents is given a collar that will measure their level of noise emission. For any dB above a certain level the collar would give the wearer an electric shock proportional in strength to the noise.
“How would passing any of these bills inevitably lead to the fruition of these hideous plans?”
I am Canadian, with little desire to visit the land of paranoia, but from what I have been able to deduce, American conservatives are strong believers in “slippery slopes”. Once you are started on a path you cannot change direction but must inevitably and mindlessly follow the course. Therefore better not to take the first step (or the next step).
These Americans have woeful stereotypes of the Canadian and English health care systems, but are unaware that anyone east of France has health care.
You might want to explain how well the German system works for the benefit of the more enlightened readers here.
Maybe the most important part is that over here there is also a risk pool of health insurers combined with extremly tight regulations. That way a health insurer is at least partially compensated, if he is burdened with the expensive cases. That significnatly decreases the incentives to drop those. The disadvantage is that cost effective companies are not allowed to just lower the premiums (below a certain limit) to attract even more customers.
There are not just a few insurance giants and some companies (e.g. Siemens) even have an insurance subsidiary of their own (originally limited to employees and their families today open to anyone).
If you are employed, the insurance premiums (to be precise: your fraction of it) are deducted from your salary. If you are unemployed and have liquid assets, you pay a basic rate (currently about 140€/month). If you are unemployed without liquid assets, you receive health insurence first as part of unemployemnt benefits and later as part of welfare.
In recent years copayments went up in some areas (esp. in dental care) and visiting a doctor costs 10€ per quarter (you get a receipt, so you only pay once. For specialists you get a referral from the doctor you paid first).
Prescription drugs: some are free of charge (esp. those that have to be taken over long time periods and most antibiotics), the rest have 10% copayment or a fixed limit (whatever is lower) with possible exemptions (e.g. for children or extremly poor people on application). Also medical expenses are limited to a certain percentage of you income. If you keep the receipts and can prove it, you get your money back.
—
It’s not all gold though. There are people of influence that would love to Americanize the system at least partially and the general costs are rising with the rising average age of the population. The on average younger guest workers and immigrants keep the system running by paying more into it than taking out (that does not hinder our own brand of nativists though to demagogue against them).
from what I have been able to deduce, American conservatives are strong believers in “slippery slopes”. Once you are started on a path you cannot change direction but must inevitably and mindlessly follow the course. Therefore better not to take the first step (or the next step).
Yes. And that’s why they opposed the invasion of Iraq so vociferously. After all, the road to hell is paved with good intentions.
Once you are started on a path you cannot change direction but must inevitably and mindlessly follow the course.
Yeah, cause that *always* happens.
Hartmut, thanks for laying out the German approach.
In case it’s useful, I stumbled across this comparative discussion of the common public health care policies found around the world. Germany’s is discussed, although not to the level of detail that Hartmut offers here.
My point is that the way to fight the GOP characterization of the risks is to educate the electorate, without trading tit for tat on every point with the Republicans.
how is this supposed to work?
the GOP says “Obama will kill your momma if her productivity falls before 123 widgets per hour,” and the Dems are supposed to let that sit there ? go on and talk about something else that the GOP hasn’t lied about ?
people don’t work that way. not addressing a point is conceding the point. and clearly, people are more than willing to believe anything the GOP tells them.
My point has nothing to do with holding the GOP blameless, or blaming anyone.
maybe that’s not your point, but it seems to be your MO.
“how is this supposed to work?”
Good question, it is a reasonable debate tactic to minimally discuss your opponents points while consistently laying out the advantages of your proposaql.
It would be better for the Democrats to list the advantages of what they are proposing every time they talk. Its ok to, somewhere in there, say that the other side is not accurate, but that needs to be wrapped around a set of bullet points on why it is good.
Currently every list of bullet points repeats the worst case accusations, then says it isn’t true. Where is the list, in the media every day, of why it is good?
BTW, saying it covers 45 million uninsured is one of those but it is not sufficient for people worried about whether it might be bad for them.
“My point has nothing to do with holding the GOP blameless, or blaming anyone.”
All of the responses to this would be to point out that stretching the facts and terrifying people into agreement is a bipartisan sport. No one demagogued fear more than the Democrats during the debate on the stimulus package. So I am unwilling to have this discussion in detail. Both sides want to win the debate, their tactics could well be reversed in the next one.
So about 200 million Americans are watching the rules they have lived by all their lives change. They just want to be sure they understand that the new rules don’t make them worse off.
Marty, I know it’s not your intention, but this sounds really patronizing. You don’t need to explain “them” to “us” as if “they” were some kind of unfamiliar species.
I’m one of those 200 million people. I have skin in this game. This is not an abstraction for me.
Last year I went without health insurance for three months, because I committed the unpardonable offense of leaving a job I didn’t like and taking a job I did like. To continue the coverage from my previous job under COBRA would have cost me a whopping $1400 a month…money I simply didn’t have. So I went without.
And the rest of the 200 million live with this possibility too. However satisfied they might be with their coverage, they could lose it at any time.
I’m really trying to understand what could possibly be “scary” about a reform that would guarantee that I, or any others out of that 200 million, would never have to face a choice like that again.
It would be better for the Democrats to list the advantages of what they are proposing every time they talk.
they do. that’s the reason these town halls are happening. you know, the ones the GOP is turning into live re-enactments of Pam Atlas posts. the Dems are, in fact and in deed, trying to do exactly what you say they should. the GOP is making it impossible for them to get the facts out; and the GOP is doing it exactly for that reason.
and you blame the Dems.
Where is the list, in the media every day, of why it is good?
Dear President Obama et al:
Please read and memorize the above.
Why is it good?
It could be a very long list, but pick the top 3, 4, or (maybe) 5 reasons. State them simply and clearly. Lather, rinse, and repeat.
Why is it good?
The reasons why your plan is good is *much* harder to argue against than your list of reasons why what the opposition is saying is wrong.
Plus then you make the opposition argue about *your* talking points, not theirs.
Don’t punch the tar baby. Just say why what you’re bringing is good for the folks in the audience.
Obama was pretty good at this during the election, I don’t know what happened to him.
Question: Why is 200 million the number we’re throwing around? That’s not the population of the US. Is that the adult population?
Just curious.
“I’m one of those 200 million people. I have skin in this game. This is not an abstraction for me.”
I am one of those 200 million people also and there is not a single bill being proposed that doesn’t have a negative impact on me.
I have four kids, all grown, two who have no health insurance today (maybe only one, the job for the other might have come through). I would very much like for them to have insurance.
My father is quite old and relies completely on Medicare, I don’t want the care he gets to be diminished in anyway. Despite all of the polls etc. here dealing with Medicare is an ongoing challenge for he and my mother, but thank heavens it exists.
My three grandchildren went without insurance for several years early in their lives, with state aid and other programs they managed to get through it.
All of this, including me not having a job, scares the hell out of me. I am not willing to solve all of my fears by doing something that is not the right thing to do. So lets not overreach. Lets just cover the uninsured, impact everyone else as little as possible, and then reform healthcare itself.
The complexity of all of this is unnecessary and scary. There are too many moving parts, new panels, new and undetailed bureaucracies that can’t be defined adequately in even a thousand pages. That bureaucracy becomes unresponsive to the voters once it is in place, accountability is not a strong suit of our government.
None of those fears are right or wrong, they are real. In your case the greatest evil is to not be insured. There are other evils that are often unintended consequences in most complex legislation hastily formed. I think it is reasonable to challenge every line and every intent in something of this magnitude.
“Question: Why is 200 million the number we’re throwing around? That’s not the population of the US. Is that the adult population?”
Eric, its just a round number I used. the thought was 300 million minus the uninsured minus those on Medicare. Not meant to be statistically accurate. Sorry.
russell:
Your rant @08:13 PM last night made my front page. It’s perfect.
If you don’t look at a thread for 24 hours all sorts of things happen.
Yes it is great to read hilzoy’s “voice”
JT, I wish you the best. I may also be losing my job, but am under my wife’s insurance so that is not one of my worries.
And I agree that Marty is a new and valuable voice.
There are a lot of comments above thsi one that have inspired responses form me, btu I will focus on only a couple right now.
Marty wrote: “The rules were clear, keep a job:keep insurance, pay into Medicare:get minimal coverage in your old age. I would guess this is a huge percentage of Americans (over say, 45). So about 200 million Americans are watching the rules they have lived by all their lives change. They just want to be sure they understand that the new rules don’t make them worse off.”
Two problems with this. The first is the rules have already changed. “keeping a job” is not really under a person’s control so much any more, and therefore neither is keeping insurance. The “new rules” being proposed are actually beneficial to the very people you are talking about, and this has been hammered on time and again by the Dems. Unfortunately, we have a media that is more interested in covering the yellers than the explication of the positives.
Secondly, most people on Medicare actually have better coverage than people have under regular insurance. They have more independence in picking providers of care and less restrictions on what care they get.
Regarding russell’s last comment. I tend to agree with you that Obama has not been as good as he could be in finding the catch phrases necessary. He doesn’t talk in sound bites anymore, and he needs to. At the same time, he and the other Dems can’t just ignore the idiocies coming from what passes as the Republican Party. When a Republican denounces the “death panel” talk, is mentioned by Obama in a positive way, and suddenly starts backtracking on everything he said previously, the country really has a problem.
But again, even if Obama started doing what you suggest, it means nothing if the media doesn’t push it. The largest cable network Fox, cut away form his town hall early on. And since it is mainly the Fox viewing audience that is most misinformed, how does that help the discourse.
ABC has actually done a fairly good job, other than having Carville and Coulter on to debate the issue,on pointing out some of the lies and trying to do some fact checking. But that is the only one outlet.
The largest suburban paper in the Chicago area had its top story today about Rep Biggert (R) making claims that were patently false. But instead of actually pointing out they were false (except for one sentence buried in the article) it basically did the he said/she said approach.
The media no longer informs.
Not directly related, but there is a new Gawande article that may be of interest.
That bureaucracy becomes unresponsive to the voters once it is in place, accountability is not a strong suit of our government.
Right. I feel so much more comfortable knowing that the unaccountable, unresponsive bureaucracy controlling my health care is motivated by profits.
Marty:
Lets just cover the uninsured, impact everyone else as little as possible, and then reform healthcare itself.
But if you “just cover the uninsured” without doing anything else, it’s going to cost a LOT more than the $1 trillion over 10 years that the CBO, the Blue Dogs, and the GOP collectively lost their sh-t over. How, pray tell, do you intend to pay for THAT?
Marty:
I find nothing to disagree with in your comment.
I hope you find a job.
“But again, even if Obama started doing what you suggest, it means nothing if the media doesn’t push it. The largest cable network Fox, cut away form his town hall early on. And since it is mainly the Fox viewing audience that is most misinformed, how does that help the discourse.”
Intersting article on the actual numbers of Fox News audience here
Reaching less than 2mil people on a regular basis.
“But if you “just cover the uninsured” without doing anything else, it’s going to cost a LOT more than the $1 trillion over 10 years that the CBO, the Blue Dogs, and the GOP collectively lost their sh-t over. How, pray tell, do you intend to pay for THAT?”
So what is different in the bill, from a cost standpoint, than just extending Medicare type coverage to the uninsured and paying for that? They have to get paid for somehow. Requiring them to buy it? Ok we can do that. Supporting it with tax breaks, check. Taxing high income individuals, we can still do that. Requiring businesses to pay the fine or insure their employees? Still can(shouldn’t).
All that is a 200 page bill.
Dear President Obama et al: Please read and memorize the above. Why is it good? It could be a very long list, but pick the top 3, 4, or (maybe) 5 reasons. State them simply and clearly.
It’s already been done. Eight points, to be exact.
I understand CNN was going to cover them in detail, but they decided instead to interview the woman who cried to Arlen Specter that if health insurance reform passes, one day we’ll all have to wait in line for toilet paper.
“Marty:
I find nothing to disagree with in your comment.
I hope you find a job”
Thanks John, I don’t want to be misleading, I do currently have a job. There have been times I didn’t and the possibility of not having one scares the hell out of me. Hope you can find one soon, and I am hoping we can pass a bill that bridges that gap if you don’t.
Hope you can find one soon, and I am hoping we can pass a bill that bridges that gap if you don’t.
Something we can all agree on, indeed.
Eric, its just a round number I used. the thought was 300 million minus the uninsured minus those on Medicare. Not meant to be statistically accurate. Sorry.
No need to apologize!
I was sincerely just wondering if there was some signifance that I wasn’t hip to. It’s a decent enough number. Just scratching my itch.
I’ve seen the discussion that health insurance should get deregulated and thus the market would open up like auto or home owners insurance. I could never find the right words, but I came across this commentary as to Why Health Insurance is Not Car Insurance on LiveJournal.
I believe the author does a good job of delineating the “why” it isn’t, and to summarize:
He makes some other points, but those are the key ones for me.
tgirsch – thanks for the link. thanks also for linking to my fabulous, sophisticated Web 2.0 home page!! 🙂
Uncle K, thanks for the link to Obama’s 8 points.
I note that they basically amount to some simple moves in the direction of the German/Bismarck model — both care and insurance provided by the private sector, with the private insurance companies subject to tight regulation to insure broad and useful coverage.
Unless I’m missing something, there isn’t a single word in the eight points about a public option for either insurance or care.
Services via tightly regulated private providers has historically been a common model in the US, at least until the deregulation mania of the 80’s. I’d be interested to know what anyone here found objectionable about any of the 8 points.
I beg to differ. Have you met my grandfather?
Hey russell, for web 2.0 you should add some animation — perhaps a butterfly flying around or the sounds of birds in the background. 🙂
Great rant, by the way.
There are other evils that are often unintended consequences in most complex legislation hastily formed.
what is the proper length of time for crafting a bill like this ?
and how long has this one been in the works ?
LOL. Let me rephrase.
They do not get less expensive to replace. 🙂
“Lets just cover the uninsured, impact everyone else as little as possible, and then reform healthcare itself.”
But I *want* to be impacted! Healthcare is a mess–expensive, difficult to access–even for many of the insured.
“an interesting factoid”
That’s not a factoid (a “spurious—unverified, incorrect, or fabricated—statement formed and asserted as a fact, but with no veracity”), but an actual fact.
“Two problems with this. The first is the rules have already changed. ‘keeping a job’ is not really under a person’s control so much any more, and therefore neither is keeping insurance.”
Also, though I am unemployed, I observe that people keep telling me about their company announcing changes in the health care plans that the company is offering, and the changes always involve either paying more, or offering less coverage, or both.
Someone with more expertise in this area might be able to offer or dig out actual figures on these trends. But keeping one’s job seems to offer no guarantee of one’s health insurance not changing for the worse, either.
“But I *want* to be impacted!”
You’ll definitely need health care, then. How much force do you desire to be struck with?
(Gary sighs nostalgically for the days when people still used the word “affected,” rather than get caught up in worrying about whether they meant “effected,” and took to choosing to go with the rather different meaning of “impacted,” instead.)
The complexity of all of this is unnecessary and scary. There are too many moving parts, new panels, new and undetailed bureaucracies that can’t be defined adequately in even a thousand pages. That bureaucracy becomes unresponsive to the voters once it is in place, accountability is not a strong suit of our government.
I’m very sorry that the world is complex. I’m sorry that the nature of our crappy health care system and the nature of our crummy third rate constitution means that any substantiative improvement in our health care system is going to be complicated and is going to have lots of moving parts. I wish it were otherwise. Uwe Reinhardt explains why you need so many moving parts here.
But I really don’t care about a lot of the fear that you’re describing. All policy design and legislation is scary and way too complex if you’ve never bothered to look into the process before. Just like driving a car is the scariest thing in the world if you’ve never done it and have never rode in a car. It seems that a lot of the people most terrified have enjoyed a life of blissful ignorance where they never bothered to learn about what real policy making consists of. This is it. It is complex. There are lots of moving parts. It is not risk free. But then again, the status quo is certainly not risk free either.
I understand that people on Medicare are particularly scared. But let’s be clear: these people are feeling a small bit of the fear that younger people live with every day. Every day, I worry that I might become incapacitated and lose my job and not be able to provide for family. And by provide, I mean: not able to get them medical and dental coverage. People on Medicare don’t have to worry about that. I do. If they’re starting to get an inkling of what that fear is like, then good. Welcome to my world.
He makes some other points, but those are the key ones for me.
Some other points that may or may not be key:
1. While there is some coverage for personal injury, these insurances primarily cover things, not people. (This underlies some of the points made in the linked post.)
2. People often don’t own homes or cars outright, and have no choice but to carry insurance on those things as mandated by the requirements of the loans used to purchase them. (This somewhat underlies a segment of “pure profit” insureds and, thereby, the overall risk pool.)
3. There is a liability component involved with home and auto insurance that isn’t involved in health insurance. Your health insurance doesn’t cover other people whom you might injure or infect. If you crash into someone or someone slips on your icy steps, you have to pay for them, usually through your insurance. In my home state, car insurance is mandatory for liability coverage if you have a car, even if your car is paid off, since what you’re really covering are the other cars you might potentially damage. This might be taken as increased risk for the insurer, which it is. But it’s really the sort of risk that makes people more likely to buy insurance for low-probability occurrences for fear of losing too much in the case of a bad accident. The portion of the premiums paid for liability coverage are mostly gravy for the insurance companies.
So, no, the business models are not the same.
From the same link, the same paragraph in fact: “However, the word can sometimes mean, instead, an insignificant but true piece of information” — i.e., a fact.
Which is the more common usage, in my experience.
For Marty, and everyone else who is complaining about how the current 1000 page bills are too complex: did you complain about how Medicare Part D legislation was too complex as well? If not, why not?
Medicare Part D was over 416 pages. It seems to me that adding a prescription drug benefit to Medicare should be much simpler than a bill that (1) adds an individual mandate, (2) impose new fairness regulations on private insurers, (3) sets up health insurance exchanges, (4) reduces costs in government plans, (5) raises taxes to fund (6) subsidies for poor people to purchase insurance and (maybe) (7) adds a public plan available on the exchanges. Does anyone disagree with that?
“(1) adds an individual mandate,
(2) impose new fairness regulations on private insurers,
(3) sets up health insurance exchanges,
(4) reduces costs in government plans,
(5) raises taxes to fund
(6) subsidies for poor people to purchase insurance and (maybe)
(7) adds a public plan available on the exchanges.
Does anyone disagree with that?”
No, it should probably be 3000 pages to define all of that adequately.
Marty:
So what is different in the bill, from a cost standpoint, than just extending Medicare type coverage to the uninsured and paying for that?
A lot, actually. For starters, THAT would be a lot closer to the “government takeover of health care” that’s currently being demagogued than anything that’s actually being proposed.
What’s in the current proposals that your proposals lack is an effort to bring costs down, rather than “just” expand coverage. The public option helps bring costs down by providing downward price pressure. The introduction of evidence-based medicine to what Medicare pays for also helps trim costs. As does some of the more obvious stuff, like cutting or eliminating Medicare Advantage.
Otherwise, what Turbulence said (and linked).
All that is a 200 page bill.
I’m guessing you pulled that figure out of a secure, undisclosed orifice. 🙂
JanieM:
I’m with Gary on this one, as I, too, am constantly pushing that boulder of preserving clear meanings up the hill. Yes, as words become commonly misused, dictionaries and other reference guides will acknowledge the common misuse, but that doesn’t make it a correct usage.
My giant pet peeve along these lines is “unique,” which people frequently misuse to mean “unusual” or “interesting,” when in fact the word is supposed to mean “one of a kind, like no other.” It’s a binary word — something either is or is not unique; it can’t be modified, i.e. you can’t correctly say that something is “very unique” or “somewhat unique.”
“Epicenter” is another word that’s commonly misused, and whose misuse makes me cringe.
[/pedantic threadjack]
” understand that people on Medicare are particularly scared. But let’s be clear: these people are feeling a small bit of the fear that younger people live with every day. Every day, I worry that I might become incapacitated and lose my job and not be able to provide for family. And by provide, I mean: not able to get them medical and dental coverage. People on Medicare don’t have to worry about that. I do. If they’re starting to get an inkling of what that fear is like, then good. Welcome to my world.”
And it was their world right up until they turned 67. Do you think they were born 67 years old?
“(Gary sighs nostalgically for the days when people still used the word “affected,” rather than get caught up in worrying about whether they meant “effected,” and took to choosing to go with the rather different meaning of “impacted,” instead.)”
Agreed. I only used “impacted” to create the nice parallel with the quote I was responding to.
“All that is a 200 page bill.
I’m guessing you pulled that figure out of a secure, undisclosed orifice. :)”
Hopefully secure yes.
I bid “penultimate”.
“What’s in the current proposals that your proposals lack is an effort to bring costs down, rather than “just” expand coverage. The public option helps bring costs down by providing downward price pressure. The introduction of evidence-based medicine to what Medicare pays for also helps trim costs. As does some of the more obvious stuff, like cutting or eliminating Medicare Advantage.”
So here is a real difference. I don’t believe anyone’s numbers that say this bill will in anyway reduce costs. Reducing costs will be the result of changing healthcare delivery, not tinkering with how insurance pays for it. Most of the key proposals will certainly raise the cost of insurance not provided by the government.
As for it being closer to “government takeover of health care” I see it as doing what government should do, fill the gaps.
“I bid “penultimate””
I can still hear Howard Cosell intoning the “penultimate moment”. Odd memory.
No, it should probably be 3000 pages to define all of that adequately.
Ah, I see. So, when Congress puts out a bill that is 1000 pages long, conservatives at town halls scream about how the bill is too long. When I point out an actual comparison, you complain the bill is too short. Question: if the bill was 3000 pages, as you think it should be, do you think that would increase or decrease support amongst conservatives?
And it was their world right up until they turned 67. Do you think they were born 67 years old?
As John Miller explained to you, it was not their world because the world has changed. My mother, my father, my wife and myself all have roughly the same profession and same educational background. My parent both worked for their respective companies for over 25 years. My wife and I have worked for companies that have literally disappeared. Even just looking at data from our professional associations, average job tenure is much shorter. Economic changes have greatly reduced job security and volatility.
tgirsch — I’m as pedantic as the next person. One of my current pet peeves is “belie” — which I have been seeing lately in sentences that make it clear that people think it means exactly the opposite of what it does (currently) mean.
You wrote, “Yes, as words become commonly misused, dictionaries and other reference guides will acknowledge the common misuse, but that doesn’t make it a correct usage.”
But the process goes on, and often what was once an “incorrect” usage may become the correct usage. “Silly” once meant happy or innocent. A hundred years ago George Bernard Shaw was b*tching about the use of “contact” in much the same way Gary is now b*tching about the use of “impact.” We could spend ages listing such words.
The first time I saw “belie” misused — on this very blog — I wrote a comment pleading for its “correct” meaning. I’ve seen it “misused” so often since then that I’m convinced that in another few decades, its correct and accepted meaning will have flipped 180 degrees. So now when I see that usage, I just shrug and go back to work.
I first heard the word “factoid” in the early 80’s; on that occasion it was used to mean “a tiny fact” — and that’s what I’ve always heard people use it to mean, except when Gary “corrects” someone. If you and Gary want to try to stem that tide, good luck. 😉
/pedantic answer to pedantic threadjack
“Ah, I see. So, when Congress puts out a bill that is 1000 pages long, conservatives at town halls scream about how the bill is too long. When I point out an actual comparison, you complain the bill is too short. Question: if the bill was 3000 pages, as you think it should be, do you think that would increase or decrease support amongst conservatives?”
No, I said it should be that long to try to do all the things you listed (plus all the things it does you didn’t list), I did not agree that it should be that long. The length will not get more or less support from conservatives.
I doubt anything will get more support from “conservatives”, even what I would want.
I bid “penultimate”
I was listening to the morning news summary from France Culture (Radio France’s most highbrow outlet, along the lines of BBC Radio 4) when I was gobsmacked to hear that the budget deficits of France and Germany had “literally exploded” this year.
(Granted, he didn’t actually say that, since he was speaking French–he said “ont littéralement explosé.” But it’s the same error in French as in English.)
Standards are slipping everywhere, I tell you.
Standards are slipping everywhere, I tell you.
Despite the best efforts of the Academie Francaise, too. 😉
JanieM:
One of my current pet peeves is “belie” — which I have been seeing lately in sentences that make it clear that people think it means exactly the opposite of what it does (currently) mean
Ooh, that’s a good (bad) one! It’s the worst kind, where people actually mean the opposite of what they’re actually saying. Like the expression, “I could care less.” Umm, you mean you couldn’t care less.
Speaking of less, “less” vs. “fewer” is another of my pet peeves.
But the process goes on, and often what was once an “incorrect” usage may become the correct usage.
And it’s my sworn duty to try to prevent that from happening. Especially in such cases when there are already other words that mean what the misuse means, or when the shift in meaning leaves us without a word that means what the hijacked word used to mean (as with “unique”).
Yes, I realize I’m tilting at windmills here. Now if you’ll excuse me, I have some kids I have to go kick off of my lawn….
Marty:
I don’t believe anyone’s numbers that say this bill will in anyway reduce costs.
I’m partially inclined to agree with you, except that I really do think that the medicare expert panels on evidence-based medicine can make a difference, and that the public option would create some downward pressure.
You are correct, though, that a more fundamental reform of the delivery system is needed. I’m not sure it’s politically feasible at this time, however. I mean, look at how badly people are freaking out at imaginary changes to how they’ll receive health care. Just think how they’d react to actual changes!
Marty, I do believe that the bill, particularly with a public option (because there is no other way to significantly increase covergae, will lower costs by changing health care delivery.
Health care delivery for what is now the uninsured will no longer be through the ER (yes it will still be used) but through the provision of both preventive care and early care that resolves health issues prior to their becoming major, far more expensive issues.
That will be a major change in health care delivery which will have a major impact on costs.
Some of the changes, including electronic record keeping, after an initial increase in costs, will reduce costs both at the hospital/doctor’s offcie level, as well as for traveling or moving patient’s or patient’s that change their healthcare provider (usually at the insistence of their private insurer.
There are several other minor tweaks that are in the bill, and several more that could be in the bill, that would all reduce costs. Unfortunately, no one is talking about them. The encoragement of end-of-life counseling itself can reduce costs, simply by putting more power into the hands of the patient.
Of course, probably the best way to reduce overall costs would be to go to a single payor system, but the right and much of the center would not go for that at this point. That is too bad, but fear works wonders. Look at Iraq.
We should have a thread for grammar and usage pet peeves.
Another of mine is use of the accusative case for a pronoun that’s the subject of a clause that’s the object of a preposition. Instead of, let’s say, The prize goes to whoever calls first, people say “whomever” … even here! At ObWi!
Okay, I’ll stop. But if ever I notice that a thread wants jacking, I’ll remember this topic…….
“I could care less.” Umm, you mean you couldn’t care less.
Unless the former is used sarcastically, which depends on inflection. Although my favorite version is my dad’s “I suppose I could care less” (implying that he found it hard to imagine the circumstances under which he would, in fact, care less).
I also have insurance through my employer, but hope that I’m affected by reform.
I’ve taught at the University of Oklahoma since 1998. OU has struggled repeatedly with the problem of rising insurance costs. Although some of their fixes have been better than others (and they deserve some credit for learning from some of their more egregious mistakes), the long-term trend is clear: costs will go up, out of pocket expenses will go up, and benefits will slowly go down. And if health benefits aren’t reduced, others will be to compensate for the growing costs of health insurance to the university.
While I am reasonably satisfied (if not remotely delighted) with my current coverage, I understand that even for me–a fully employed academic with the protection of tenure–the status quo is entirely untenable.
On the topic of misusage, let me add my personal pet peeve: people who use “beg the question” when they mean “raise the question.” As often happens with these creeping misuses, the cost is that a very discrete (NB: not “discreet”) and useful concept essentially gets eliminated from the language when “beg the question” loses its particular meaning.
Meanwhile, everyone should know that this is the sort of thing the non-insured and even the low-insured turn to, if they’re extremely lucky enough to be in one of the very few places that has such a thing even once.
“Amazed” once meant something more like “bewildered”. But who are we to stand in the way of progress?
Gary sighs nostalgically for the days when people still used the word “affected,” rather than get caught up in worrying about whether they meant “effected,” and took to choosing to go with the rather different meaning of “impacted,” instead.
“impacted” now means affected, thanks to manager-speak. and even worse, “impactful”: its adjective version.
i also hate using “going forward” to mean “in the future”. if you’re talking about time, there’s no other way to go but forward! just use “in the future”.
i also hate “on a daily basis”. 4/6 of those syllables are superfluous. if it happens every day, it’s daily.
tgirsch wants to stand athwart the flow of lingusitic change and yell “Stop!”
Marty wants to stand athwart the flow of change in health insurance and yell “Stop!”
Each of us is conservative in his own way. In that respect, each of us is “unique” — just like everybody else:)
There’s an important difference between the Martian and tgirschian flavors of conservatism: one opposes planned change, the other opposes random change. Which of those is the One True Conservatism is unclear.
–TP
I nominate ‘decimate’, which actually means ‘to reduce by a tenth’. I know it’s a completely lost cause, but I find it grating because it’s so obvious what ‘deci’ means. Probably people are thinking ‘devastate’ but say ‘decimate’ because it sounds more edumacated.
“We should have a thread for grammar and usage pet peeves.”
May I sign up for it too? especially re:
” “less” vs. “fewer” is another of my pet peeves.”
It grates every time i hear “less” used in cases where I was taught to use “fewer”.
But I fear it is a losing battle.
I believe there was a few years when it was fashionable to believe that grammar could be acquired by osmosis and didn’t need to be taught. The “educated” products of those years cause the pain unwittingly.
“Yes, as words become commonly misused, dictionaries and other reference guides will acknowledge the common misuse, but that doesn’t make it a correct usage.”
I was told that after Webster’s Second International was published dictionaries stopped seeing their role as prescriptive, and became merely recorders of usage.
back to the subject
“But if ever I notice that a thread wants jacking, I’ll remember this topic…….”
Then there’s the topic of ellipses. 🙂
“But who are we to stand in the way of progress?”
I am awful in my regard for evolution in usage, even if at times I am abashed, and at other times I find it tremendous.
A useful site, by the way, mayhaps even to understand the above as I intended, rather than see it misdone. Pray let it be so.
“comprise” anyone? “and I” always, no matter what? (Not that I’m close to being perfect grammatical-wise-speaking.)
I don’t really have grammar pet peeves and I must admit — I find the notion somewhat baffling. People are not computers. The shape and structure of our languages depends a great deal on innate features of the human brain. Languages evolve because languages are a creation of human brains; they are always fluid no matter how much we like to pretend that they are static.
I can see how people might find linguistic evolution grating when they encounter a usage that differs from what they grew up with. But these battles are beyond futile.
I have an easy way to loop my pedantic threadjack back onto the topic at hand: by pointing out how much it bugs me when people say “insure” when what they really mean is “ensure.” 🙂
JanieM:
Instead of, let’s say, The prize goes to whoever calls first, people say “whomever” … even here! At ObWi!
I’d have gotten* this wrong. I had to look up the rule.
* – Bonus points to me for annoying the Brits. 🙂
Ben Alpers:
people who use “beg the question” when they mean “raise the question.”
That’s a good one, too.
Tony P.:
tgirsch wants to stand athwart the flow of lingusitic change and yell “Stop!”
Nah, I just want to restrict those changes to what makes sense.
I’m not opposed to building new highways. I’m just opposed to building new highways where they’re not needed, or where they do more harm than good.
Thus, I’m a liberal, not a conservative. 😉
Johnny Canuck:
But I fear [less vs. fewer] is a losing battle.
I agree. I was thrilled, however, to see that the express lane at the local Whole Foods Market here is labeled “15 Items or Fewer.” Huzzah!
For less vs. fewer, the confusion I think stems from the fact that the opposite of both words is “more,” combined with the fact that “fewer” is used less frequently. I tell people to subject words to the “much” test. If you wouldn’t use “much” to modify the word, you shouldn’t be using “less” to modify it, either. “Much” ties to “less,” and “many” ties to “fewer.”
” I nominate ‘decimate’, which actually means ‘to reduce by a tenth’.
I fear, Jonnybutter, your sentence must be amended to: I nominate ‘decimate’, which used to mean ‘to reduce by a tenth’.
” My Canadian Oxford reports your losing battle this way: 1. destroy a large proportion of. *Now the usual sense although some still consider this an inappropriate use. 2 kill or remove one in every ten of”
I’m having difficulty in thinking when, except in a 1918-like flu epidemic, we would think the original meaning appropriate, and in that case we would probably think 10% a “large proportion”.
But “<" means "less than," so if I have, say, 14.3715 items, that's <15. (I should probably be more discrete with my comments.)
Turbulence: “I don’t really have grammar pet peeves”
Did you go through school during the period when grammar was not emphasized?
‘As often happens with these creeping misuses, the cost is that a very discrete (NB: not ‘discreet’) and useful concept essentially gets eliminated from the language when ‘beg the question’ loses its particular meaning.”
Thus, as I frequently state, I am most definitely not a strict prescriptivist — one reason being that most people get that sort of thing wrong, given that all sorts of odd and ahistoric, and ungrammatical, prescriptivism crept into American education in the 20th and 19th century (particularly odd notions that English should be used according to the rules of Latin) — but neither am I pure descriptivist.
I simply aim for the target of that which improves clarity, and decreases confusion.
Neologisms are ofttimes useful, as are elements of evolution in English. Recognition of this is merely realism, rather than a mere. (Or is it merely realism? Ha!)
Whilst I retain the right to fuss on occasion in antiquarian fashion, simply because I find the nonce fusty fun, and sporadically enjoy the pleasures of the contrarian. I am large, I contain multitudes, and sometimes some of the multitude even, dare I say it, wax prolix. From hell’s heart, I stab at thee, Strunk!
At one point, though, I did contemplate writing — again in contrarian spirit — an article on Stan Lee’s Guide To English Usage.
But I said thee nay, by the hoary hosts of Hoggoth!
Rawls hadf the best example of departed usage I’ve ever heard of: one of the King Charleses, on first seeing St. Paul’s Cathedral, supposedly said: It is awful and artificial! — And both words were compliments.
(But not complements! Another sore point.)
For those who perceive the proposed bills won’t control costs, is it that you have no faith in the CBO? My impression was that the CBO had been rather conservative in scoring proposals, and that the administration believed that a number of the reforms that might cut future overall health care costs were being scored at zero.
“I believe there was a few years when it was fashionable to believe that grammar could be acquired by osmosis and didn’t need to be taught. The “educated” products of those years cause the pain unwittingly.”
Yes we do. But I am told the new health care bill won’t kill grammar….
I was told that after Webster’s Second International was published dictionaries stopped seeing their role as prescriptive, and became merely recorders of usage.
Funny bit of personification, there.
Between Webster’s second unabridged (1934) and their third unabridged (1961), the editors at Merriam Webster decided to remove labels like “vulgar” and “erroneous” and “regional” from the definitions. They didn’t think it was their job to tell people whether to use “ain’t”; they thought it was their job to describe the lexical items that English speakers use.
Wackiness ensued.
That’s still, I believe, the attitude of Merriam Webster, but the market has moved on. The first edition of the American Heritage Dictionary (1969) was an effort to save whatever baby remained in the old prescriptivist bathwater: the editors assembled a Usage Panel of professional writers and editors and asked them to weigh in on controversial questions. There are usage notes at the end of some definitions explaining what the panel was polled on, and what the results were (e.g., 98% of the panel thinks that using “beg the question” to mean “raise the question” is the abomination of desolation.) Of course, that means the editors get to prejudge the question of what counts as “controversial” (the use of “ain’t,” yes; the use of “he” to mean “he or she,” no).
(particularly odd notions that English should be used according to the rules of Latin)
So you’re okay with splitting your infinitives, Gary, as most fans of Star Trek should be?
“… one of the King Charleses, on first seeing St. Paul’s Cathedral, supposedly said: It is awful and artificial!”
Thus my use of “awful” in my 03:08 PM.
I also enjoy the illusions of allusion, and the allures of alliteration, though both bring me hairy palms.
“But I am told the new health care bill won’t kill grammar….”
No, it was beauty killed the beast.
“Languages […] are always fluid….”
But over time, and within limits. Otherwise we couldn’t communicate. Some of us prefer a form of punctuated evolution, and beware the Jabberwock, my son: the jaws that bite, the claws that catch!
In uffish thought we stand, and consider that perhaps not everyone should be licensed to attempt to be a James Joyce, a Neal Stephenson, an Irvine Welsh, a Samuel R. Delany, a Roddy Doyle, a John Barth, an R. A. Lafferty, a Brian O’Nolan, a Jack Vance, a William Faulkner, a Cormac McCarthy, an Iain Banks, or an Iain M. Banks; many should not try to play the home game; there could be smashups, crashes, and eyes put out.
“So you’re okay with splitting your infinitives, Gary, as most fans of Star Trek should be?”
There’s what I’m okay with, and what I personally lean towards.
I’m fine with boldly going with splitting infinitives, but I lean towards avoiding it.
And you didn’t ask, but ending a sentence with a preposition is something up with which I will put. When it doesn’t lead to lack of clarity.
I’m also not wholly against sentence fragments, but apply the same principle.
In short, I’m utilitarian, if not Unitarian. And I am short, even when my sentences are sentenced to be long.
I’m also not the most consistent person in the world.
My favorite linguistic shift is that of “nirmod,” which went from meaning “mighty hunter” to “idiot” courtesy of one Bugs Bunny.
lolz!
“My favorite linguistic shift is that of ‘nirmod’….”
D’oh!
And I’m fond of anagrams, though palindromes are even better!
I believe health care reform should lead towards more use of palindromes: has anyone read the bill to see whether that’s a tenet among the many stats?; at minim, it should be on the radar. Then we shall say, ladies excluded, rise to vote, sir!
Elsewise, dammit, I’m mad!
Did you go through school during the period when grammar was not emphasized?
I don’t know…which periods are those? I went to a school at a time when the ability to communicate clearly using the written word was emphasized; that does not seem to require intensive instruction in particular forms of grammar.
But over time, and within limits.
And who sets those limits? Can you give me an example of linguistic evolution that exceeds acceptable “limits”?
I agree there are limits, but those limits are things humans observe in practice rather than legislating. They are limits in the sense that human height and weight has limits.
“Elsewise, dammit, I’m mad!”
Of all things in this thread, this went without saying.
“Can you give me an example of linguistic evolution that exceeds acceptable ‘limits’?”
Sure.
The principle (not the principal!) is to draw the line where ambiguity is such that — outside of fiction where it can be a joy — reasonable people come to different conclusions as to what the writer meant.
If expression reaches such a level of ambiguity and lack of clarity that readers are left at sea, communication is not actually taking place. We call this “bad writing.”
Evolution leads towards survival of the fittest. It doesn’t lead towards endorsing all mutations as equally dandy and praiseworthy and useful.
“I agree there are limits, but those limits are things humans observe in practice rather than legislating.”
Has someone proposed legislating an Academy of English to Make Rules?
Meanwhile, for more examples, I suggest checking what goes into your spam filter.
Gary:
You knew what I meant. Still, it bugs me that I made such an awful typo. I meant “nimrod,” of course.
I had a great-uncle named Nimrod, I imagine he was less than pleased about that shift. But there were a lot of strange names in that family – Uncle Eusibius, Aunt EllaBass, etc… Must be something in the water out in Missou. Or maybe it’s just that when you have 14 kids you just run out of the common names pretty quickly.
I had a great-uncle named Nimrod
So you weren’t quite Nimrod’s son…
Sure.
That’s not linguistic evolution. Linguistic evolution involves lots of people adopting a particular linguistic change, not some random crazy individual speaking incomprehensible gibberish. Just like a freakishly deformed individual’s deformities do not constitute an example of biological evolution: at least, not unless those deformities occur in many other individuals and those individuals are fertile. Do you know of many people who have adopted TimeCube man’s crazy talk? For your own sake, I hope not.
Do you have any examples of linguistic evolution that exceed acceptable “limits”?
The principle (not the principal!) is to draw the line where ambiguity is such that — outside of fiction where it can be a joy — reasonable people come to different conclusions as to what the writer meant.
This is a good principle for individuals to adhere to. But it is not a principle that guides linguistic evolution. That means when languages evolve in ways that make some utterances more ambiguous, I see no reason to get worked up.
Moreover, it seems that in many (all?) of the specific changes people are complaining about here, there is no (or very little) ambiguity in most cases because context makes the meaning clear. There might be ambiguity if you rip a few words out of context, but that’s not how humans communicate.
If expression reaches such a level of ambiguity and lack of clarity that readers are left at sea, communication is not actually taking place. We call this “bad writing.”
Bad writing abounds even in the absence of linguistic evolution. I daresay that linguistic evolution is one of the least significant causes of bad writing. Certainly, the quantity of bad writing that finds its way past copy editors in published books and newspapers is simply astounding.
Evolution leads towards survival of the fittest. It doesn’t lead towards endorsing all mutations as equally dandy and praiseworthy and useful.
True, but the metric by which languages are most fit has to do with how they map to human brain structures, not how effective they are at facilitating clear communication. I mean, if you’re focused on clarity and simplicity, english is a complete disaster.
Has someone proposed legislating an Academy of English to Make Rules?
Not that I know of. I don’t understand your comment about limits though if you were not implying that some forms of linguistic evolution must not be permitted. Perhaps I was expecting too much relevance from that portion of your comment.
RE: Yomtov 10:02p 12th. (I think this addresses Gromit and Tony P’s questions too).
D’d’d’dave: “there is a financial incentive for companies that currently provide insurance coverage for their employees (and who aren’t therefore eligible for the pool) to terminate their plans and pay the fine.”
Yomtov: “No more than there is an incentive right now today to cut all employees’ pay by 25%. That is to say, doing what you describe amounts to a serious reduction in workers’ pay.”
I believe it does not have the affect of reducing their pay. Allow me to demonstrate.
Assume an employer is currently paying George $50,740 annually (the median income) and paying for health insurance coverage for George and his 1.67 dependents (median household size is 2.67). The health insurance coverage costs $11,300 (the average for a 2.67 member household). Ignoring other payroll taxes, George costs the employer $62,040 (50,740+11,300) and George takes home $50,740 of it.
Assume that HR 3200 becomes law in its current form. How can the $62,040 go furthest?
Case A – Status Quo
Employer puts 65% towards employee’s premium (HR 3200 sec 312): $11,300 x 65% = $7,345.
Employer pays the $54,695 (62,040-7,345) remainder to George.
George pays the $3,955 (11,300-7345) balance of premium.
George receives no affordable premium credit from IRS because the premium he paid is less than 9% of his income. (HR 3200 sec 243) The bottom line is that George has net pay, after insurance premiums of $50,740 (54,695-3,955).
Case B – Employer terminates plan and pays 8% penalty.
Employer pays $4,963 (8% of $62,040) as penalty.
Employer pays the $57,077 (62,040-4,963) remainder to George.
George pays the $11,300 premium.
George receives $6,163 (11,300-(57,077*.09)) as an affordable premium credit from the IRS because the premium he paid was more than 9% of his income. The bottom line is that George now has $51,940.
Case B has the better result:
George has $1,200 more in net pay.
It cost the employer no more and he now doesn’t have to bother with health insurance administrative issues.
Voila. People migrate to the pools.
I assert that once people are in the pools they will migrate to the govt option because it will be priced lower (in a predatory way).
Footnotes
HR 3200 sections 243, 312, 313.
Median income and household size are from census bureau.
Federal poverty lines are from HHS.
True, but the metric by which languages are most fit has to do with how they map to human brain structures, not how effective they are at facilitating clear communication.
There are thousands of extant human languages being spoken right now. Some have no grammatical gender for nouns, some have two (masculine and feminine), some have three (masculine, feminine and neuter), some distinguish only between animate and inanimate nouns, some engage in some combination of masculine/feminine/neuter and animate/inanimate. Given those differences in how each of these languages — all of them being spoken by human beings with grossly identical brains — perceives and describes something so elementary as those things we categorize in English as “nouns,” please explain how their continued existence is a factor of “how they map to human brain structures,” rather than how clearly then communicate meaning within the cultures in which they’re spoken.
From there, you can provide the same answer for why some languages have words for only two numbers, some for three, and some for an infinite number. Then we’ll move on to colors, and why some languages have only two colors, some three, etc., despite the fact that the vision centers of human brains are the same around the world.
So you weren’t quite Nimrod’s son
but i hear he comes from the land of plenty, land of fun.
where beer does flow and men chunder.
“Do you have any examples of linguistic evolution that exceed acceptable ‘limits’?”
I like to think that every time this subject has ever come up I’ve been entirely specific that the “limits” I’ve spoken of are those below which “we couldn’t communicate.”
Beyond that, there’s personal preference. Within personal preference, some people like appeals to authority, and some don’t, and within those who like such appeals, some like appeals to certain authorities, and others prefer others.
Whatever your personal preference is, is yours. And on any serious level, YKIOK.
Ditto, in turn, my personal preference.
It’s entirely possible I’m highly unclear in the innumerable times when I vary between quite joking statements about usage, and statements about my personal preference, and occasionally stronger forms of my opinion.
But at worst, given that I’m not in an hierarchical relationship with anyone here over their writing, however strongly I might on rare occasion actually put forward a serious opinion, you remain utterly free to ignore my opinion, which is another reason I am completely uninterested in any further attempts to continue this line of questioning, if you don’t mind.
I recommend finding someone to argue with about prescriptivism, if that’s your interest, because, honestly, I’m not, myself, interested in drawing precise lines about limits on prescriptivism/descriptivism preferences.
“I don’t understand your comment about limits though if you were not implying that some forms of linguistic evolution must not be permitted.”
I wasn’t implying any such thing, no matter what you believe you inferred.
Really, if I believed such a thing, what do you think my Sekrit Plan Of Enforcement would be? Invisible killer robots? Poisoned ASCII via packet transmission? Voodoo? Harsh words on a blog thread? Ascension to godhood?
The possibilities open to me, given your assumption, seem quite limited.
I wish people would quit migrating to the Census Bureau and the HHS for statistics.
We can’t have public options in statistics like the Census Bureau and HHS …. it’ll lead to death panels for all of the private facts, like “12 billion burgers consumed” and “4 out of 5 dentists recommend” and “if your erection lasts for more than 4 hours”, which are really the only facts and stats a free people require.
I believe it does not have the affect of reducing their pay. Allow me to demonstrate.
Assume an employer is currently paying George $50,740 annually (the median income)
N.B.: the median HOUSEHOLD income. But let’s agree George is the breadwinner for the household.
and paying for health insurance coverage for George and his 1.67 dependents (median household size is 2.67). The health insurance coverage costs $11,300 (the average for a 2.67 member household). Ignoring other payroll taxes, George costs the employer $62,040 (50,740+11,300) and George takes home $50,740 of it.
Okay, so the employer is currently paying 100% of George’s family premium. N.B.: the employer pays that with PRE-TAX dollars.
Assume that HR 3200 becomes law in its current form. How can the $62,040 go furthest?
Case A – Status Quo
Employer puts 65% towards employee’s premium (HR 3200 sec 312): $11,300 x 65% = $7,345.
Why does the employer switch from paying 100% of the premium to 65%? Especially since …
Employer pays the $54,695 (62,040-7,345) remainder to George.
… he’s not planning to pocket the savings?
George pays the $3,955 (11,300-7345) balance of premium.
So George just takes his raise and pays his now-35% share of the premium with it. Uh-huh.
George receives no affordable premium credit from IRS because the premium he paid is less than 9% of his income. (HR 3200 sec 243) The bottom line is that George has net pay, after insurance premiums of $50,740 (54,695-3,955).
So after all that rigmarole, the employer comes out even and George comes out even. What’s the point of the whole thing?
And anyway, George does NOT break even. He pays income tax on his raise. AFTER TAX, his raise does NOT cover his now-35% of the premium. It’s the IRS that wins here, at George’s expense. Unless the employer is actively looking to screw George, the employer will just keep paying 100% of the premium.
Case B – Employer terminates plan and pays 8% penalty.
Employer pays $4,963 (8% of $62,040) as penalty.
Why 8% on $62,040? The payroll number is …
Employer pays the $57,077 (62,040-4,963) remainder to George.
… really the $57K or so. It’s a minor point; I only raise it because if you’re going to do arithmetic down to the dollar, you might as well do it right.
George pays the $11,300 premium.
N.B.: the assumption here is that George’s premium will be the same, now that he’s shopping for insurance on his own, as it was in the employer’s now-dropped group plan. Not a safe assumption, in my experience.
George receives $6,163 (11,300-(57,077*.09)) as an affordable premium credit from the IRS because the premium he paid was more than 9% of his income. The bottom line is that George now has $51,940.
Again, this ignores George’s income tax hit. We don’t know what his AGI is now, when he’s grossing $50,740 — but we can be fairly sure it will be bigger when he gets his raise to $57K or so. Worst case, he pays something like 25% on his roughly $6K raise. That’s about $1500.
Case B has the better result:
George has $1,200 more in net pay.
You really mean GROSS pay. After tax, which is what “net” usually means, he might be down $300.
It cost the employer no more and he now doesn’t have to bother with health insurance administrative issues.
Right: now it’s George himself that has to deal with health insurance administrative issues. ANOTHER hit to poor George.
If we are really to believe that this employer is a paragon of enlightened self-interest, determined to spend the same total money on George, then we have to believe he won’t bother with THIS rigmarole either. He will keep the company plan, keep paying George’s whole premium in it, NOT give George a raise, and spare George the aggravation of administering his own health insurance so that George can spare more time and energy for work.
Of course, the employer might just say, “Screw George! I’m dropping the plan, paying the 8%, and pocketing the difference.” That’s a realistic possibility, but it’s contrary to the whole premise of d’d’d’dave’s exercise in arithmetic.
Voila. People migrate to the pools.
I assert that once people are in the pools they will migrate to the govt option because it will be priced lower (in a predatory way).
So, after all that down-to-the-dollar arithmetic, we come down to “I assert”.
Oh well.
Incidentally, d’d’d’dave ought to ponder how the IRS makes out in his Case B. By his (slightly wrong) numbers, it pays out $6,163 as a credit to George. But it collects $4,963 from the employer. And it collects as much as $1,500 or so extra from George. The IRS comes out a couple of hundred bucks ahead. Allowing for error and uncertainty, it probably breaks even. Maybe the policy wonks who crunch these numbers for a living got the 8% about right, eh?
–TP
ða ic wide gefrægn weorc gebannan manigre mægþe geond þisne middangeard, folcstede frætwan. That’s proper English!
I recommend
The Unfolding of Language: The Evolution of Mankind`s greatest Invention by Guy Deutscher
He has some interesting things to say about how abuse/misuse of language drives the development. It took centuries (for example) for ‘going to’ to turn from a spatial moevement to an intention and an element of grammar not related to movement anymore (‘I am going to stay’).
But as far as (Latin) grammar goes, ‘to stay’ is a verb of moevement 😉
That should of course be ‘movement’ not moevement. Curse! Coarsely off course there.
“Incidentally, d’d’d’dave ought to ponder how the IRS makes out in his Case B. By his (slightly wrong) numbers, it pays out $6,163 as a credit to George. But it collects $4,963 from the employer. And it collects as much as $1,500 or so extra from George. The IRS comes out a couple of hundred bucks ahead. Allowing for error and uncertainty, it probably breaks even. Maybe the policy wonks who crunch these numbers for a living got the 8% about right, eh?”
This is about right, I am sure the math was done to create a revenue neutral situation for the government.
The obvious part of this, the elephant in the room, is that the maximum cost of healthcare coverage under this plan, for the employer, becomes fixed at 8%. (The only assumption I make here is that the government doesn’t adjust it up annually based on actual costs etc., I haven’t heard a proposal that would build in those adjustments) So one of two things happen, insurance companies set rates at no greater than 8%, or the employers pay the 8%. There isn’t really a third option.
Today almost every employer would love to fix that cost percentage. It is one of a few variable costs of employing people that they don’t control. After the bill is passed there is an immediate increase in private insurance rates based on these key parts of the bill:
* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.
Each of these will make insurance companies raise rates to maintain profit levels. So any competition created will be created over time as insurance companies try to become even more efficient, finding ways to cut the risk to their business, which impacts coverage in other ways not contemplated by these 8 points.
I would restate the point here that costs are really out of hand on the provider side. None of this addresses that.
During all of this smart companies migrate to the tax to fix their costs. As the employers make the change there will be initial angst (as there was when cost sharing of insurance costs by employees was first introduced), some changing of jobs, but after a few years the smart companies all fix their cost percentage because it is just good business. It then becomes a non issue for hiring and retention and the public pool likely becomes single payer.
This consequence is not an unreasonable outcome to expect of this proposal based on sound business practice.
“No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.”
Oh, great: So, they’re outlawing the “high deductible/HSA” approach? That’s brilliant, and I mean that sarcastically.
Meanwhile, for more examples, I suggest checking what goes into your spam filter.
What I really miss are those dadaist word salad emails that spammers used to send to get around Baysean spam filters. You, know stuff like:
“sasquatch travel under lime tree grenades”
or
“underwear marks true dolphin pose”
Sublime machine poetry, it was. And now, sadly, gone.
On the topic of pet peeves, sign me up for “the question becomes”. It scans perfectly well grammatically, it’s just a very weird concept.
Ooh, I’ve got one. “With au jus sauce.”
So, they’re outlawing the “high deductible/HSA” approach?
please don’t take away my right to experience first-hand the full cost of medical services! what will i do without that $8,000 deductible?!
Or even just “with au jus,” which I see a lot. 🙂
you can buy little bottles of “au jus” in supermarkets, too.
Marty thinks that insurance premiums will go up if insurance companies are forbidden to reject people for pre-existing conditions or drop them after they get sick.
The obvious implication, though Marty might deny it, is that insurance companies keep premiums “low”, now, by rejecting people for pre-existing conditions and dropping them when they get sick. That’s a lousy thing to say about our beloved insurance companies.
And anyway it’s not really true. Insurance companies selling group plans to large employers are already forbidden to do those things to individuals within the group. I have not heard that big insurers are looking for ways to drop big employers as customers because of these onerous restrictions.
Now maybe Marty thinks that insurance premiums could be reduced (for healthy people) if big insurers could in fact cherry pick within employer groups. I cannot dispute that possibility. I can merely decry it.
–TP
“Ooh, I’ve got one. ‘With au jus sauce.'”
Now we’re talking Department of Redundancy Department: ATM machines. Audible gasp. Honest truth. Free gift. Equal halves. Past experience. Mental telepathy. ISBN number. Enclosed herein.
Next chapter: oxymorons!
Average and median net compensation from the Social Security Admin. Note for 2007 Average was 38,760.95 and Median was 25,737.20.
Next chapter: oxymorons!
Yeah, that stupid O2 cracks me up.
Meanwhile, over at the Atlantic, Megan Mcardle is making another bad faith argument on health care-that if there is health insurance reform, pharmaceutical company profits will decline and innovation in the pharmaceutical industry will cease.
http://meganmcardle.theatlantic.com/archives/2009/08/what_does_it_mean_to_have_a_pr.php
Check her out. Her libertarian chorus are chiming in to sing that that any involvement by the gumint MUST stifle innovation while a few of us in the reality based community are querying her claims.
Check her out.
what a fool.
McArdle: My objection is primarily, as I’ve said numerous times, that the government will destroy innovation. It will do this by deciding what constitutes an acceptable standard of care, and refusing to fund treatment above that
spoken like someone who has never opened a letter from an insurance company and found that they won’t pay the full bill because they think your doctor charges too much.
Megan Mcardle is making another bad faith argument on health care-that if there is health insurance reform, pharmaceutical company profits will decline and innovation in the pharmaceutical industry will cease.
There’s the crude Game (birthers, deathers) and the more genteel version, represented by what McArdle regularly flogs these days. This argument is just as easily debunked as the cruder stuff, but it’s still effective just for being repeated.
what the hll is wrong with me?!
‘..effective for *having been* repeated’
I’d feel better about the pharmaceutical company research issue if the majority of the profits weren’t made in the US, and if the misconception that one of the easier places to save money would be by cutting pharma prices weren’t crawling all over the place.
I guess it is time to recycle one of my old pharma posts.
“Past experience”
Oh, and past history!
Maybe that’s to disambiguate it from the other sort, though.
I’m talking health care. Fun for all!
Especially the stories from ER residents and med students.
“That’s proper English!”
I have to call it middling.
“Marty: “People call others lots of bad names, my least favorite, by far, is liar.”
Marty, two sentences earlier: “I just think he said it and everyone trying to say he didn’t, or he didn’t mean it, is intellectually dishonest.” ”
I recognized this when I wrote it, intellectual dishonesty is typically not being honest with ones self. I suspect no one here of lying to me.
We have the Birthers and the Deathers. We simply lack the middle ground. Would that be the Pubertists or the Middleagers*?
*alternatively the Midevilists
Publius wrote (in part):
And, as Amy Sullivan reports in Time, they supported a very similar provision in the 2003 Medicare prescription drug bill.
http://swampland.blogs.time.com/2009/08/13/oh-those-death-panels/
The GOP says that Obama
Has a plan to kill your grandmama.
This lie of a claim
Will further defame
Their “us-versus-them” campaign drama.