by Eric Martin
He's got a point:
As a columnist who regularly dishes out sharp criticism, I try not to question the motives of people with whom I don't agree. Today, I'm going to step over that line.
The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.
There are lots of valid criticisms that can be made against the health reform plans moving through Congress — I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.
Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.
…While the government will take a more active role in regulating the insurance market and increase its spending for health care, that hardly amounts to the kind of government-run system that critics conjure up when they trot out that oh-so-clever line about the Department of Motor Vehicles being in charge of your colonoscopy. […]
By now, you've probably also heard that health reform will cost taxpayers at least a trillion dollars. Another lie.
First of all, that's not a trillion every year, as most people assume — it's a trillion over 10 years, which is the silly way that people in Washington talk about federal budgets. On an annual basis, that translates to about $140 billion, when things are up and running.
Even that, however, grossly overstates the net cost to the government of providing universal coverage. Other parts of the reform plan would result in offsetting savings for Medicare: reductions in unnecessary subsidies to private insurers, in annual increases in payments rates for doctors and in payments to hospitals for providing free care to the uninsured. The net increase in government spending for health care would likely be about $100 billion a year, a one-time increase equal to less than 1 percent of a national income that grows at an average rate of 2.5 percent every year.
The Republican lies about the economics of health reform are also heavily laced with hypocrisy.
While holding themselves out as paragons of fiscal rectitude, Republicans grandstand against just about every idea to reduce the amount of health care people consume or the prices paid to health-care providers — the only two ways I can think of to credibly bring health spending under control. […]
Health reform is a test of whether this country can function once again as a civil society — whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off. Republican leaders are eager to see us fail that test. We need to show them that no matter how many lies they tell or how many scare tactics they concoct, Americans will come together and get this done.
If health reform is to be anyone's Waterloo, let it be theirs.
But then, this is the same old story. Powerful, monied interests fighting to keep their piece of the pie, even if the pie-making process is dragging the country down. And to win that fight they're employing scare tactics, misinformation, the Republican Party and a gaggle of sell-out Democrats. See, also, Wall Street deregulation/bailouts.
Given this vicious dynamic, I'd be wary of throwing around words like "Waterloo" because by my measure, we're all going down together.
(h/t to p-diddy)
[UPDATE: I agree with Matt that "political terrorists" was a bad choice of words, unncessarily inflammatory and distracting from the overall point.]
ah, but you forgot to admit that a Democrat did something bad in 1973. therefore, your whole point is moot.
IBTL!
Yep. Brownshirts backed by money are quite likely to win.
Or, more accurately, brownshirts created and exploited by moneyed interests.
If there is a political “Waterloo” moment coming up, when did the whole exile to Elba, subsequent escape and 100 days phases happen? I must have been on vacation that week. Also, where is Blücher and what does he intend to do? And did we sell off the Louisiana Territory, and if so how much did we get for it?
Sometimes US politics is so confusing.
Waterloo Sunset v. Moneygoround.
“Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.”
I believe this is reasonably disingenuous. The debate on healthcare reform is not about the compromise bills that can be passed today. The debate is over the long term goals of the Democrats. A favorite topic of this blog is that the current bill is only a first step.
Perhaps we should give the Republicans credit for expanding the debate to include ALL of the issues and their assessment of what the end game might be, rather than calling them liars.
A good view of these issues is here.
Notably two parts, first this quote:
“House Majority Leader Steny Hoyer, D-Md., says Republicans are distorting the facts on a complex issue. “Medicare is going to be available for seniors — at the levels they need,” he said. (italics added)
The seniors and Democrats hear this statement very differently. Perhaps a bad choice of words, or subtle recognition that the benefits will change.
Second, and more important this observation:
“Despite the cuts, the seniors’ lobby is supporting the House legislation. But AARP says that’s as far as the cost-cutting should go. The group says it’s troubled by a proposal recently embraced by Obama to create a special advisory panel that would regularly recommend more savings, with authority to force Congress to act on them. AARP says the costs board should also have to take into account effects on quality of care and access before making any recommendations.” (bold added)
Seniors, in particular, recognize the law of unintended consequence, which creates uncertainty that is exacerbated by this kind of proposal.
The debate is over the long term goals of the Democrats.
um. no, it isn’t.
Perhaps we should give the Republicans credit for expanding the debate to include ALL of the issues and their assessment of what the end game might be, rather than calling them liars.
oh yes. let us honor the great Republicans for expanding the debate. why, just think of how small and narrow the debate would be if it didn’t include such important concepts as “Obama wants to send bureaucrats to kill your grandmother” and “The government will choose your doctor” ! thank you, wise Republicans, for expanding the debate to include every vile lie you’ve been able to come up with !
Political terrorists?
Really?
I mean seriiiouuuusly?
Eric Martin should mention when he’s cross posting from the democratic underground.
“The debate is over the long term goals of the Democrats.
um. no, it isn’t”
Um, whether you want it to be or not, it is now
What long term goals of the Democrats interfere with this:
Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.
Eric Martin should mention when he’s cross posting from the democratic underground.
So should Fred Hiatt. That’s an op-ed from the Washington Post.
“Despite the cuts, the seniors’ lobby is supporting the House legislation. But AARP says that’s as far as the cost-cutting should go. The group says it’s troubled by a proposal recently embraced by Obama to create a special advisory panel that would regularly recommend more savings, with authority to force Congress to act on them.
This is a lie. Congress would not be forced to act on the panel’s recommendations; it could easily override them in fact.
AARP says the costs board should also have to take into account effects on quality of care and access before making any recommendations.” Seniors, in particular, recognize the law of unintended consequence, which creates uncertainty that is exacerbated by this kind of proposal.
I don’t think seniors recognize the law of unintended consequences better than other citizens. I think the real issue here is that seniors get the benefit of government health care while most of the cost is borne by non-seniors. Since they’re not paying for most of the cost, they’re less concerned by the fact that costs are growing faster than inflation; after all, that’s a problem for younger people.
One way or another though, cost growth has to come down, in both medicare and private insurance. This is going to happen sooner or later, even though it makes seniors uncomfortable. We can either do it now in a controlled fashion that allows us to cut waste and unnecessary treatments or we can do it later in a crisis when we’ll have to cut everything without thinking. But sooner or later, we’re going to have to do it.
Um, whether you want it to be or not, it is now
sorry Marty, it just ain’t. the rantings of ignorant rubes and professional liars do not qualify as “the discussion”.
“… On an annual basis, that translates to about $140 billion, when things are up and running.
Even that, however, grossly overstates the net cost to the government of providing universal coverage.”
So he’s saying that the government’s estimate for the cost of this program is way too HIGH? That they are seriously overestimating the costs?
I can’t recall ANYTHING the government spends money on that costs LESS than the original estimate. It ALWAYS costs way MORE than estimated yet he thinks that for Obamacare this will be reversed?
Reality-based? I think not.
tomaig: the 140 estimate does not factor in the savings captured elsewhere. that’s the point.
And it’s not Obamacare. It’s Obamainsurance.
I’m not on board with the AP’s batshit crazy plans to sue everyone who links to them and what, but is it really kosher to excerpt an entire column, and surround it with two paragraphs worth of commentary?
It’s not the entire column. But I did hesitate based on the amount excerpted. Still, it was so good I couldn’t bring myself to cut more.
“Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals.”
Isn’t that only because of the serious resistance you’re getting though? Wouldn’t quite a few here like to get a much more comprehensive public plan or even complete single government pay plan through if you thought it could get through Congress? Much as I detest the Republicans right now, it is precisely the strong resistance that such plans are getting right now that are keeping the bolded part of the sentence true.
Cleek: “The debate is over the long term goals of the Democrats.
um. no, it isn’t.”
I’m torn on this. First, we should admit that almost none of the Democratic Congressmen see this as anything like an endpoint on health care reform. So on some level the ultimate goals are part of the issue. But if this bill ends up being good, that shouldn’t be a major point against it. Second, in furtherance of that, part of what makes the bill good or bad will be whether or not the government cheats in favor of pushing other players out of the market by subsidizing itself. For example if it claims to be setting up a competing insurance plan but subsidizes it so that the true cost is not actually reflected in the premium, the ultimate goals become more relevant because it would be trying to kill off the competing plans *even if the government is not really doing any better. If the premium reflects the actual costs, but ends up lower because of wonderful government efficiencies and thus crowds out the rest of the market, I am not nearly as concerned. (When I say that the government should not cheat on the premium, I mean in subsidies for the people who currently already have insurance. If we want to potentially subsidize the poor and/or uninsured with an EITC-like subsidy, I’m fine with that because it would be covering a need not currently covered.)
But the idea that ultimate goals are not part of the issue really depends on how much the current law forces the next step. And we don’t know yet, because even among the proponents there isn’t settled agreement about some of the most important parts.
Isn’t that only because of the serious resistance you’re getting though? Wouldn’t quite a few here like to get a much more comprehensive public plan or even complete single government pay plan through if you thought it could get through Congress?
No. The people “here” are not in Congress. And Congress has not shown any inclination to want single payer. Few want it, regardless of the opposition. Too many Dems are coopted by the insurance industry. So the GOP raising arguments against a British style government provided health care – let alone single payer! – is entirely off the mark.
First, we should admit that almost none of the Democratic Congressmen see this as anything like an endpoint on health care reform.
Um, there are plenty of Dems that don’t even see this as a STARTING point, let alone endpoint. Have you met the Blue Dogs?
If the premium reflects the actual costs, but ends up lower because of wonderful government efficiencies and thus crowds out the rest of the market, I am not nearly as concerned.
Not “wonderful government efficiencies” but basic math. Government does not need to generate profit for shareholders (the insurance industry ciphons tens of billions), the government doesn’t have to advertise in any way near the same level and the government doesn’t pay huge salaries to people whose only job is to try to find loopholes to boot sick patients from the rolls. Medicare, for example, provides insurance cheaper than the private sector.
“Health reform is a test of whether this country can function once again as a civil society — whether we can trust ourselves to embrace the big, important changes that require everyone to give up something in order to make everyone better off.”
I’m wondering what the 95% who earn less are being required to give up since the plan calls for the 5% who earn more to subsidize everyone else.
In my book this democrat statement: “require everyone to give up something in order to make everyone better off” is a lie.
Someone will now say: ‘But that is different.’ and that I am using it to justify republican lies. But go back and read carefully and you’ll see that I do not justify ANY lies. I merely point to A lie and A LIAR.
First, we should admit that almost none of the Democratic Congressmen see this as anything like an endpoint on health care reform. So on some level the ultimate goals are part of the issue.
and yet…
And we don’t know yet, because even among the proponents there isn’t settled agreement about some of the most important parts.
so they aren’t unified now, but they will be in the future.
tweet! double-Carnac: mass mind-reading from a distance and an attempt to read the same minds in the future.
tomaig:
“I cannot recall ANYTHING the government spends money that costs LESS than the original estimate. It ALWAYS costs way more than estimated yet he thinks that for Obamacare this will be reversed.”
Please provide an estimate to the government for the cost of all of your future healthcare needs, in the interests of full disclosure. Surely, you’ve done this for whomever in the private sector insures your healthcare. I have a feeling, since you’re an optimist, that you’ve underestimated the number.
While we’re at it, how much will all future space travel by NASA and the private sector cost?
Are the final estimates for World War II in yet?
I’m still waiting for the final and precisely accurate estimate for all of the stop signs that will be required for the tri-State area.
Cripes.
The people “here” are not in Congress. And Congress has not shown any inclination to want single payer. Few want it, regardless of the opposition. Too many Dems are coopted by the insurance industry. So the GOP raising arguments against a British style government provided health care – let alone single payer! – is entirely off the mark.
Thanks, Eric. I was about to write the same thing.
However, what you don’t quite acknowledge is the extent to which Congressional Democrats have successfully convinced some progressive supporters of actual national healthcare that whatever they pass can be a first step in that direction.
Now that rhetoric is either: a) abject b.s. designed by Democrats to shut progressives up; or b) a reflection of Democratic intentions, in which case Marty and Sebastian have a point.
It seems pretty clear to me that it’s “a” not “b,” but while I disagree with Marty and Sebastian, I think it’s worth admitting that the Democrats are playing a bait-and-switch game with progressives on this issue that leads them to make noises about this reform being the first step to something more significant.
Isn’t that only because of the serious resistance you’re getting though?
“Resistance” is a funny way of putting it.
“This is a lie. Congress would not be forced to act on the panel’s recommendations; it could easily override them in fact.”
It has become way too easy to just say that any objection is a lie. Certainly it makes the argument easier, huh? Since it is a proposal, described in what I thought was a reasonably balanced report (media doing it’s job?) maybe it says that.
By the way, my question was whether forcing Congress to act on it translated to approving it or just voting on it. So I don’t know that I disagree that Congress could override it, I haven’t seen any actual language around the proposal.
“sorry Marty, it just ain’t. the rantings of ignorant rubes and professional liars do not qualify as “the discussion”.”
I will assume my rantings don’t fall into these categories?
It seems pretty clear to me that it’s “a” not “b,” but while I disagree with Marty and Sebastian, I think it’s worth admitting that the Democrats are playing a bait-and-switch game with progressives on this issue that leads them to make noises about this reform being the first step to something more significant.
Good points Ben.
But even then, the “bait” isn’t government run health care. The most exotic bait is a massive government insurance option with the option to buy supplemental insurance. Ala France and Canada.
I will assume my rantings don’t fall into these categories?
Not in my book.
“I will assume my rantings don’t fall into these categories?
Not in my book.”
Thanks Eric, I tend to think of myself as a reasonably informed rube and an amateur liar.. 🙂
My sentiments exact!
First, we should admit that almost none of the Democratic Congressmen see this as anything like an endpoint on health care reform.
Since no one really knows how well any particular plan will work, it’s not really possible for anyone to see any particular plan as an ednpoint. I think the Democrats’ hope is that the plan they end up with will be so successful that people will want more of it–wider eligibility for the public option, further restrictions on abusive insurance practices, etc. In that sense you could call that plan a Trojan horse for some future expansion; but you could say that about Social Security as well, or the F-35, or (dare I say it) cash for clunkers.
It’s worth distinguishing between (a) opponents of Democrat-style reform who oppose it because they think it won’t work (which includes single-payer supporters), and (b) opponents of Democrat-style reform who oppose it because they think it will work, which will redound to the credit of the Democrats, and it’s more important to create transitory electoral advantages for the Republicans than it is to have a rational and humane health care system (e.g., Bill Kristol).
By the way, my question was whether forcing Congress to act on it translated to approving it or just voting on it. So I don’t know that I disagree that Congress could override it, I haven’t seen any actual language around the proposal.
You can look at Orzag’s letter here and see for yourself:
This draft bill would establish an Independent Medicare Advisory Council (IMAC), which would have the authority to make recommendations to the President on annual Medicare payment rates as well as other reforms. Both the annual payment updates and the broader reforms would be prohibited from increasing the aggregate level of net Medicare expenditures. This proposed legislation would require the President to approve or disapprove each set of the IMAC’s recommendations as a package. If the President accepts the IMAC’s recommendations, Congress would then have 30 days to intervene with a joint resolution before the Secretary of Health and Human Services is authorized to implement them. If either the President disapproves the recommendations of the IMAC or Congress passes such a joint resolution, the recommendations would be null and void, and current law would remain in effect. The review process would permit intervention if the IMAC’s reforms are not in keeping with the goals of Congress or the President, while retaining autonomy for implementing annual payment updates and other Medicare reforms for the IMAC.
I think that when a group says IMAC could force Congress to act, that is a lie because Congress can easily pass a resolution rejecting IMAC’s proposal. What Congress cannot do is dither and delay and refuse to make decisions: they have to take a stand.
Thanks, Turb.
“I think that when a group says IMAC could force Congress to act, that is a lie because Congress can easily pass a resolution rejecting IMAC’s proposal.”
I would characterize it as imprecise, not a lie. That word implies an intent to deceive that would be unnecessary here.
The requirement of a proactive step by Congress to stop it would create more objection in the people concerned. IMHO
I would characterize it as imprecise, not a lie. That word implies an intent to deceive that would be unnecessary here.
I agree with you it is imprecise. However, it is also carefully crafted to be correct in a very narrow technical sense while also being deceptive to the average reader. In my experience (and yours might differ), those two factors rarely combine unless someone is lying.
The requirement of a proactive step by Congress to stop it would create more objection in the people concerned. IMHO.
I’d buy that if those same people objected strenuously to the existence of the Federal Reserve Open Markets Committee. I mean, we entrust a huge chunk of the management of our economy to an unaccountable unelected group, and no one seems to mind. At least Congress and the President have a clear and explicit way to nullify IMAC decisions, which is something they don’t have when it comes to the Fed’s decisions.
“Not “wonderful government efficiencies” but basic math. Government does not need to generate profit for shareholders (the insurance industry ciphons tens of billions), the government doesn’t have to advertise in any way near the same level and the government doesn’t pay huge salaries to people whose only job is to try to find loopholes to boot sick patients from the rolls. Medicare, for example, provides insurance cheaper than the private sector.”
Great, and if it can provide better overall quality for lower prices, it will win out legitimately. I have no problem with that. I don’t believe it will actually happen (see the pays 100% per capita what Canada does and only covers 27% of the population) but if it does, I’m ok with that.
Cleek: “First, we should admit that almost none of the Democratic Congressmen see this as anything like an endpoint on health care reform. So on some level the ultimate goals are part of the issue.
and yet…
And we don’t know yet, because even among the proponents there isn’t settled agreement about some of the most important parts.
so they aren’t unified now, but they will be in the future.”
I don’t see the contradiction. They don’t agree at exactly what the endpoint is but agree that this won’t be it.
(see the pays 100% per capita what Canada does and only covers 27% of the population) but if it does, I’m ok with that.
But private insurance pays even more than that!!!!
Health care costs are higher in America for private insurers and government insurers alike (part of this is the cost of drugs, overmedication/treating, administrative costs, etc).
But in America, the government provides insurance for less than the private sector provides insurance.
“I’d buy that if those same people objected strenuously to the existence of the Federal Reserve Open Markets Committee. I mean, we entrust a huge chunk of the management of our economy to an unaccountable unelected group, and no one seems to mind. At least Congress and the President have a clear and explicit way to nullify IMAC decisions, which is something they don’t have when it comes to the Fed’s decisions.”
Not sure I agree that this analogy is pertinent to the discussion. The seniors concerned about Medicare changes on an annual basis would be more inclined to want a better check on recommended changes.
The Fed Reserve is an “independent” part of the regulation of the financial management system that most people don’t spend anytime understanding and, in fact, most of what they do is trying to manage long etrm eceononic stability.
“I’m not on board with the AP’s batshit crazy plans to sue everyone who links to them and what, but is it really kosher to excerpt an entire column, and surround it with two paragraphs worth of commentary? ”
I don’t know why you ask this, since Eric made many cuts, clearly indicated. It’s 100% bog-standard blogging, and not at all the entire column.
Not sure I agree that this analogy is pertinent to the discussion.
People who have a principled objection to Congress delegating important areas of governance to independent panels of subject matter experts are very few in number. If the AARP is raising this principled objection, then they need to explain why they haven’t complained about the Fed. Of course, it is extremely unlikely that the AARP is objecting based on this principle; rather, they’re probably objecting because of status quo bias. And I’ve got no problem with that. But if that’s the reason, they need to say that explicitly and stop pretending that there is some larger principle at work here. Saying “there must be no changes because I got mine and I don’t give a frack about anyone else” is at least honest.
The seniors concerned about Medicare changes on an annual basis would be more inclined to want a better check on recommended changes.
Better how? Congress is subject to interest group capture in ways that an independent panel is not. Congress frankly lacks the expertise to deal with many of these issues. And the Congressional solution to many problems is often ‘do nothing and hope the problem goes away’. Congress is still free to do that with IMAC: the only difference is that Congress has to actually go on record and say ‘we refuse to cut costs in this way’. Surely that makes for a more accountable government, right?
The Fed Reserve is an “independent” part of the regulation of the financial management system that most people don’t spend anytime understanding and, in fact, most of what they do is trying to manage long etrm eceononic stability.
The Fed’s decisions have a much larger impact on a much larger number of people than IMAC decisions would. Now, if there are people who are completely ignorant of the Fed but insist on having a loud voice on the most intricate details about how Medicare governance should be structured, my answer to them is “you’re too ignorant to participate in this conversation.” Governing is complicated. And if you’ve managed to make it through life without learning what the Fed does, then I don’t think you have the knowledge necessary to meaningfully discuss this subject. Call me an elitist if you like.
“But private insurance pays even more than that!!!!” and covers more than twice as many people. There might be an argument that the comparison isn’t directly fair because the people are younger but unvarnished like that you’re just misleading yourself.
And remember that you are the one who believes the government is so much more efficient–yet it is clearly much less efficient than any other Western government when it comes to healthcare.
“But in America, the government provides insurance for less than the private sector provides insurance.”
Do you have information backing up this contention?
“Health care costs are higher in America for private insurers and government insurers alike (part of this is the cost of drugs, overmedication/treating, administrative costs, etc).”
First I really wish you would quit mentioning the cost of drugs in these discussions (especially as the first reason). It is like Republicans who keep mentioning how cutting earmarks would help the budget deficit. You’re wrong, and in ways that make it seem like you are trying to make political points rather than actually worry about how the budget is spent. The higher cost of drugs is not an important contributing factor. As I’ve shown you repeatedly the entire cost of drugs (not even worrying about what is the ‘higher’ cost) is about 10%. Hospital costs and doctors visits make a much larger portion of the difference in cost of care.
And administrative costs are specifically one of the things you where you say the government is significantly better than the private sphere? How can you then say that administrative costs is one of the things that makes costs so much higher for both? (I think much of it is just pushed onto other government accounts–collection from the IRS, fraud investigation from Justice, etc.) And if overtreatment is the problem, government hasn’t shown any ability to rein that in.
Again IF the government can actually provide a better option for the currently insured, I’m happy to let it win. I’m not however an advocate of assuming it is better, especially when it has proven to be not-so-amazing with Medicare, and on the basis of the mere assumption structuring it to take over before you prove it.
And remember that you are the one who believes the government is so much more efficient–yet it is clearly much less efficient than any other Western government when it comes to healthcare.
No, it’s not inefficient. Health care costs are higher here. Higher for private insurance and the government alike.
and covers more than twice as many people.
It is cheaper per capita for the government to provide health insurance than private insurers in America.
http://institute.ourfuture.org/files/Jacob_Hacker_Public_Plan_Choice.pdf
But seb, it’s only logical: the government does not have to spend money on executive salaries, high volume advertising, recission, calculating risk pools/determining who to cover, profits for shareholders, lawsuits for recission, etc.
How could it cost more for the government to administer an insurance program? I mean, what inefficiencies could amount for the amount of money that goes to the above list?
How can you then say that administrative costs is one of the things that makes costs so much higher for both?
The myriad of insurance providers creates a data entry/clerical mess that adds costs to the entire system.
And if overtreatment is the problem, government hasn’t shown any ability to rein that in.
The VA does a fine job of it.
http://www.time.com/time/magazine/article/0,9171,1376238,00.html
The higher cost of drugs is not an important contributing factor. As I’ve shown you repeatedly the entire cost of drugs (not even worrying about what is the ‘higher’ cost) is about 10%.
But Seb, 10% of the costs is still significant!! Wipe that out, and you’re taking a big step. Not alone sufficient, but necessary and helpful.
I should have said, reduce the costs within that 10%…
“But Seb, 10% of the costs is still significant!! Wipe that out, and you’re taking a big step. Not alone sufficient, but necessary and helpful.”
It is a little agressive to think that the higher costs of drugs is actually the total costs of drugs don’t you think? Surely you don’t think that pharma companies should provide drugs literally for free, do you? So until you show that a large portion of the 10% is higher than expected costs (which you are unlikely to do, since the European models spend similar percentages on drugs) you haven’t identified a significant area of savings.
“The VA does a fine job of it.”
And Medicare does not. Which one is the larger, more representative government program? Why hasn’t Medicare been fixed yet?
“But seb, it’s only logical: the government does not have to spend money on executive salaries, high volume advertising, recission, calculating risk pools/determining who to cover, profits for shareholders, lawsuits for recission, etc.
How could it cost more for the government to administer an insurance program? I mean, what inefficiencies could amount for the amount of money that goes to the above list?”
Same things that make military R&D so expensive despite its ability to avoid all that–the fact that decisions are much more likely to be made on the basis of politics rather than logic or efficiency.
If you really believe all this, why my proposal should sound great to you, extend to all the uninsured, and charge a revnue-nuetral premium. If it is really so much better it will win everyone over and no big deal.
I don’t understand why we can’t just have Medicare for the uninsured and then let the market play out. If the government is so great at it, it will charge less money to do a better job.
(This is the flip side of the silly Republicans who say they believe that insurance companies are better but also say that a public option will put them out of business.)
It is a little agressive to think that the higher costs of drugs is actually the total costs of drugs don’t you think?
Yes, that’s why I corrected myself in a follow up.
And Medicare does not. Which one is the larger, more representative government program? Why hasn’t Medicare been fixed yet?
Neither does the private insurance sector. Why hasn’t that been fixed yet? Medicare does do it cheaper than the private sector at least.
I don’t understand why we can’t just have Medicare for the uninsured and then let the market play out. If the government is so great at it, it will charge less money to do a better job.
Medicare can be improved upon. But basically, I want a robust public option. The reason we can’t have one is the influence and clout of the insurance companies and drug companies.
“And Congress has not shown any inclination to want single payer. Few want it, regardless of the opposition.”
http://www.johnconyers.com/hr676endorse
Except for those who do. Not that they matter as much as those Blue Dogs.
Then we have those like Sen. Franken who would gladly support it, but since “few want it,” why even mention it?
//”But in America, the government provides insurance for less than the private sector provides insurance.”
Do you have information backing up this contention?//
I agree with Sebastien on this. I’d really like to see what the medicare apparatus overhead is in comparison to the number of people it services. I am skeptical that an apparatus that has no need to keep an eye on whether it is profitable or not could over time keep from getting very bloated in terms of staffing and payroll per unit of output. We’ve all heard of public employees retirement benefits kicking in at absurdly low ages and high payouts as a percentage of final pay. We’ve all heard of how difficult it is to lay off an underperforming government worker. (As a child, my father used to tell stories around the dinner table of how the nurses and techs at the VA hospital where he worked would do the absolute minimum and less for years without getting fired.
This is all anecdotal, I know. But, I’d really like to see the overhead numbers so I can compare the efficiency of public vs private.
I keep reading here how private insurance is obviously more expense because there are profits. The presumption is that an entity without profits would be less costly in the amount of the profits that were foregone. This relies on the assumption that workers who need not take regards to profits continue to work at the same level efficiency.
It is contrary to my experience that people chase no reward as hard as they chase some reward (ie they don’t work as hard). Further, comfort seekers (ie slow workers) gravitate to jobs that do not measure output as closely. Over time, a work environment staffed with a majority of comfort seekers succeeds in progressively lowering the standards of what work effort is expected.
“I keep reading here how private insurance is obviously more expense because there are profits.”
You don’t have to read that here. This was one of the first points that those objecting to the govt. plan stated – that the private companies couldn’t ‘compete’ specifically because the govt plan doesn’t have to make a profit.
That pretty much puts to rest their thirty year argument that the free market is more efficient every time it’s time to privitize some public project. It has always been bullcrap and they just admitted it up front.
rdidiot
A deep pocket entity (the govt) can price it’s product below cost and run private insurers out of business. Such a deep pocket entity could do so whether it is inherently more efficient in it’s cost structure or not.
So, to say, as you have, that being run out of business by a govt using monopolist practices “puts to rest their thirty year argument that the free market is more efficient every time it’s time to privitize some public project. It has always been bullcrap and they just admitted it up front.’ is false.
Being driven out of business by a deep pocketed monopolist is not the same as being less efficient than the deep pocketed monopolist.
This relies on the assumption that workers who need not take regards to profits continue to work at the same level efficiency.
It is contrary to my experience that people chase no reward as hard as they chase some reward (ie they don’t work as hard). Further, comfort seekers (ie slow workers) gravitate to jobs that do not measure output as closely.
You must know a lot of lazy, stupid people. During the decade my wife and I lived in the DC area, I knew a lot of people with life-long careers in the nonprofit arena, and most of them worked harder than pretty much anyone I’ve ever met. My wife managed, created and edited all the content for the national website of the American Red Cross, so she wasn’t even directly involved in disaster relief, but regularly worked 15 hour days during major disasters. During the tsunami, she worked 18 days in a row without a day off.
And then there’s my father, who was worked his entire adult life in the nonprofit sector, first with a 26-year career as a military NCO, then at Yale and Stanford managing their physical plants, and finally as the director of facilities management, telecommunications and IT for the Red Cross’s Holland Laboratory for Biomedical Sciences. I can’t wait to tell him that he doesn’t work as hard as other people.
I’m really sorry to hear that you’re surround by such slackers and layabouts, dave, but don’t project your crappy experience out to government and nonprofit workers generally.
Phil
Do you have a time and motion study to support your subjective judgment about your parents work output? Spending alot of hours is not the same as producing alot of output – it may only be indicative that the person is on an hourly pay rate. Do you have data to support your suggestion that they are representative of all gov and nonprofit workers?
I specifically said my notions are based on anecdotal evidence, that I was skeptical, and would like to see numerical evidence. Skeptical does not mean certain.
You have presented further anecdotal evidence to me. I will continue to refer to my experience until such time as I am presented with numerical evidence.
It is contrary to my experience that people chase no reward as hard as they chase some reward (ie they don’t work as hard).
This is so true. I can’t help but think of the laziest comfort seekers of them all, the fire fighters. And of course, the laziest fire fighters in the country are the cushy union members in the NY FD; they’re extra lazy because they suck the blood from real hard working Americans: the brave heroes who trade mortgage debt on Wall Street. Come to think of it, that’s probably why so many NYFD members died on 9/11. They get up to the top of the towers and then, because of their laziness and lack of profit motive, didn’t feel like doing anything else.
Palin speaks:
This is totally unlike: a) insurance companies and HMOs rationing care, denying claims, and denying applicants, or:
b) being unable to afford or obtain health insurance at all, both of which are facts of the current health care system Palin prefers.
In today’s system, the sick, the elderly, and the disabled, of course, are all totally taken care of.
These are pretty unpatriotic claims to make about the U.S. military, aren’t they, d’d’d’dave?
Or has it started to function on the basis of profit-making now, and ceased being made up of “government employees”? Do members of the military “take regards to profits” or is it that you’re saying they’re generally inefficient, unreliable, and lazy?
Or is it possible that, in fact, there are other motivations towards doing a good job, beyond monetary profit, such as patriotism, a sense of duty, and a desire to accomplish good, which can and might apply to a wide variety of people who seek jobs in government, both military and in all sorts of government jobs?
But why consider these questions, when we can use ancecdotal stereotypes as substitutes for facts?
“The reason we can’t have one is the influence and clout of the insurance companies and drug companies.”
Who was it here who previously posted the link to this article? I’m at least contemplating a blog post on it, and have lost track of who pointed it out, and would like to give credit if I do get around to posting.
It’s worth reminding people here of, in any case.
Eric: my bad. It seems that we use different conventions concerning ‘…’ and ‘….’.
I’m not Phil, but I bet he’ll supply one if you first supply one about your dad’s anecotes.
People who don’t use the serial comma (aka the “Oxford comma”) are Just Wrong.
I thank my parents, Ayn Rand and God, for this conviction.
Gary and Turbulence
You seem to think that if you just double down with more anecdotes you’ll win the debate. The subject was ‘efficiency: work output per money spent’. It was not ‘can you find someone who was willing to die in service of one’s country/city.’
If you want to have a contest of whether more died in service to their country/state/county/city v chasing a buck in 2008 then we can do that. I’m sure there are plenty of overwork heart attacks in private enterprise every year. But that is a separate question. We can try to find numbers on that if you want.
But anecdotes won’t win the debate on either question.
I see Seb trotted out his favorite statistic again, so I will do the same.
Health care is provided by physicians. Whether physicians get paid a lot or a little; whether they get paid by a random collection of private insurance companies, or by the single payer called Medicare; whether they get paid fees for service or a straight salary; none of these considerations change the fact that to get more health care you need more physicians.
Per capita, the US employs 10% more physicians than Canada, while US “healthcare spending” per capita is about twice Canada’s. Anybody who wants to talk efficiency has to face the fact that our “healthcare system” is inefficient in a very precisely-defined way: the ratio of dollars spent per physician-hour purchased is much higher in the US than in Canada.
How does Canada’s system manage to be way more efficient than the US “system”? Could it be that Canada’s system employs fewer NON-physicians than the US “system” does? Very possibly. Could the extra non-physicians the US “system” employs be vital to better health outcomes? Not likely: our outcomes are no better than Canada’s. So what are all those extra employees of the US “system” doing to earn their living?
Well, some of them lobby Congress. Some of them produce, direct, or act in boner pill commercials. Some of them pore over insurance applications looking for plausible reasons to cancel sick people’s coverage. All sorts of useful, free-market, competition-enhancing things. In theory, this competition leads to “efficiency”, the Holy Grail and the raison d’etre of The Market.
But the ugly, nasty little fact challenging this theory of “efficiency” is that health care is provided by physicians, and our so-called system manages to spend twice the money for just 10% more physicians.
And STILL some people think it works too well to change. Such people must have a different definition of “efficiency” than those of us who go to doctors when we get sick.
–TP
“Health care is provided by physicians.”
and nurses, physical therapists, respiratory therapists, occupational therapists, radiation technicians, flebotomists, lab technicians, pharmacists, psychologists, councilors, and probably more.
But Tony wants to attribute all of the extra costs only to physicians.
“But Tony wants to attribute all of the extra costs only to physicians.”
Posted by: D’d’d’dave
I think D’dave you read his comment too quickly. That isn’t what he is saying. He is saying US is spending twice Canada with only 10% more doctors. Intuitively, one would expect, twice the cost, twice the doctors. He is assuming Canada probably has comparable numbers of the other categories you list (don’t know that is true) and the additional cost is insurance company caused administrative costs. i.e if you would adopt Canada’s single payer systems you could reduce your total cost to Canadian levels while maintaining US level of care- all you presumably eliminate is administrative costs and insurance company profits.
I think D’dave you read his comment too quickly.
If I were a cynical person I’d think that Stutterin’ Dave understood Tony’s point perfectly well and chose to deliberately misrepresent it out of ideological douchbaggery. However, I am a stranger to cynicism, so I’ll just assume that Stutterin’ Dave
is stupidhas reading comprehension issues.dddave: I provided a link in response to Seb showing the lower admin costs of Medicare.
Start there if you really want the evidence.
And it’s not just profits. Again, to repeat myself, it is also the very large executive salaries (many earning tens of millions a year), the costs of advertising (quite large), the costs of calculating risk pools and which patients to insure, the costs of maintaining a large staff tasked with the job of finding loopholes with which to kick sick and costly customers off the rolls.
I also provided a link to an article on the VA which shows that government run healt care, and not just insurance, is cheaper.
You can read that too.
Spending alot of hours is not the same as producing alot of output – it may only be indicative that the person is on an hourly pay rate.
Neither service members in the US Armed Forces, nor people in large corporations with the title “director,” are paid hourly, and you know that, dave.
Nor, for that matter, are most people at nonprofits, aside from perhaps clerical staff or temps; for the simple and obvious reason that nonprofits work on very tight budgets, and thus hire people at set pay rates so that they are not put in a position to be paying overtime.
If the American Red Cross had to pay overtime during the course of a major disaster response, they’d be bankrupt within about six months.
I specifically said my notions are based on anecdotal evidence, that I was skeptical, and would like to see numerical evidence.
And I suggested that you, who live on the west coast, are surrounded by categorically lazy people; whereas I, who lived and worked in the literal capital of the US nonprofit sector, have direct experience with the people you suggest are lazy and unmotivated, and know for a fact that you are incorrect.
(I can tell you this: My father turned the Holland Lab from a relative afterthought into one of the premier Level 4 Biohazard research labs in the region, one that began renting lab space to academics and startup biotech corps and became a profit center for the Red Cross. So suck on that.)
But you know what? You’ve made the claim about productivity by nonprofit workers, so you do the research, and you find the numbers, and you support your own claim. I don’t do other people’s homework for them, and certainly not for free. (I am willing to discuss a reasonable fee for doing the research, although it’s going to be pretty high, because I’m going to contract the work out to Gary and just collect a middleman fee.)
Until you put up the numbers that support your claim, I’m going to assume it’s just another of the stink bombs you throw when you find yourself reacting ideologically to something that bothers you and you stick up your quills like a threatened porcupine.
Oh, and it should be pointed out, although it’s probably pretty obvious to everyone but dave, that an annual salary of $XX,XXX is the same to the person receiving it whether the party paying it is a for-profit or non-profit organization.
Workers at, for example, GE, don’t — except in a very abstract sense — work at whatever productivity rate they do because they want to increase GE’s share price or make the company itself more profitable. They do it to maximize their own personal pay. Thus it is with workers everywhere.
This is interesting. d’d’d’dave’s claim, which he agrees he supports with nothing more than anecdote from what his dad told him as a child, is that:
My counter-claim was to ask, as regards the government-employed, non-profit-sharing, U.S. military:
This, in fact, brought up no “anecdotes” whatever, but simply a concept. Now, either d’d’dave agrees with my point, or he disagrees. It’s not a matter of who has the better anecdote at all, as d’d’d’dave would now — understandablely — have us switch arguments to.
It’s instead, very simple, given d’d’d’dave’s claim, and my query about it: does d’d’d’dave, in fact, believe that members of the U.S. military — and, as Turbulence with great relevancy also pointed out, firefighters — are “comfort seekers (ie slow workers) [who] gravitate to jobs that do not measure output as closely,” or does d’d’d’dave not believe this?
I’d like to know d’d’d’dave’s answer to the question, if he’d be so kind. I can understand that he’d prefer not to answer, and instead deflect the conversation away from having to answer, to be sure, if he can.
But either d’d’d’dave’s basic thesis, that if you’re not motivated in your job by a greater share of money, you’re going to be less motivated than you otherwise would be, period, end of claim, is correct, or it isn’t. There are more ways to answer this question than either statistics or anecdotes, and that’s to look to the simple sense of it, and thus I’d like to know d’d’d’dave’s answer to my question: do you believe that members of the U.S. military and firefighters are “comfort seekers (ie slow workers) [who] gravitate to jobs that do not measure output as closely,” or do you not believe this?
Thanks in advance for responding, d’d’d’dave.
Phil: “Workers at, for example, GE, don’t — except in a very abstract sense — work at whatever productivity rate they do because they want to increase GE’s share price or make the company itself more profitable. They do it to maximize their own personal pay. Thus it is with workers everywhere.”
Say, wouldn’t it be a good idea if all for-profit companies had profit-sharing for all their employees, down to the lowliest secretaries, temps, and janitorial staff?
I’ll field that question: The answer is, yes, yes it would be.
The use of the word “terrorist” is entirely correct if one accepts the definition as someone who attempts to achieve political goals through disruptive actions, which is exactly what we have here. The GOP have no vision other than negating Obama and are resorting to any distortion necessary to achieve that goal.
“The use of the word ‘terrorist’ is entirely correct if one accepts the definition as someone who attempts to achieve political goals through disruptive actions,”
I wouldn’t accept that definition. I’d assert that you have to at least use serious violence, if not outright be trying to kill people, to be a “terrorist.”
The Weather Underground might have arguably been terrorists; the Yippies were not. Etc.
No matter how “disruptive,” lying and shouting aren’t terrorism. Shouting down someone, no matter that I entirely disapprove of it, is not terrorism.