Saturday, February 27, 2010

Healthcare "summit", part I

OK, I went over the outlines and quotes from the healthcare "summit" on Thursday. It took me a while to catch up because we lost internet and TV connections for quite a while due to damage from the latest storm. Here is some commentary on the issues raised by both sides.

1. A big part of the PTR strategy was to use a full printout -- about 2400 pages -- of the Senate-passed bill as a prop to emphasize their silly point that the bill is somehow ponderous and incomprehensible. This of course plays on the fact that reading and understanding difficult and complicated issues is somehow "elitist". The idea of emphasizing this is just what you'd expect from a party that is beneath contempt. The simplest counter is to point out that a complete working description of of the specs of a complicated but functioning system such as, say, a Boing 747, would likewise take thousands of pages. Should we then assume that such a compendium of specs -- each one necessary to describe functionality and specify safety issues -- should be scoffed at solely because it is long, complete and takes up space? This is so absurd as to be ... well, beneath contempt. To bad Obama couldn't have been prepared enough to point this out. Furthermore, the PTR wants the Feds to go into the business of rooting out "waste, fraud and abuse." Interestingly, the bill does address these issues in many pages; increasing the emphasis would make the document even longer -- not that the PTR has had a long and impressive
history of tackling corporate fraud. How many pages of documentation did they produce on KBR and other contractors in Iraq? The PTR loves big government interference -- see the Patriot Act e.g. -- when it agrees with their ideology. The Reagan-era OBRA, a major rewrite of tax policy among other things, amounted also to thousands of pages; furthermore, the "R" in its title reminds us all of how it was passed: rammed through Congress by reconciliation -- as were the Bush tax cuts that primarily benefitted the wealthy.

2. The PTR, no friend historically of either Social Security or Medicare, has decided to use scare tactics regarding the latter. Yes, the Senate bill would cut -- even eliminate -- the Medicare Advantage plans. But these are exactly the kind of inefficient items that they usually inveigh against. In this case, the Advantage plans are subsidized plans run by insurance companies that provide an extra layer of bureaucracy and spending between the actual government
Medicare and the consumer of healthcare. They are an example of an idea that simply did not work -- see my blog on Advantage plans. Only about 20% of Medicare recipients have such plans and there is no evidence that these plans are more "healthful" than regular Medicare. Furthermore, they cost about 15% more than the regular Medicare plans;
this extra cost is paid as a subsidy by the remaining 80% who don't have Advantage plans.
The PTR is also shedding crocodile tears over Medicare/Medicaid doctors whose payments are always being cut -- then restored -- under various Medicare saving plans. Oddly, tort reform which cuts lawyers incomes is a "big idea" for the PTR. However, tort reform is only a very small part of the possible savings related to healthcare. Of course tort reform within reason is a good idea but not so simple. The Texas version of tort reform is basically to screw consumers by limiting the liability of large corporations to the extent that it is cheaper for them to do unsafe
things and pay small penalties than to make pro-safety changes in their products. (Some time I'll relate the story of our dealings with the Texas-based Dell Computer after their laptop set fire to our house.)

In spite of what conservative "experts" such as Paul Ryan say about the terrible condition of Medicare and Social Security, both systems can be made solvent for at least half a century by changing the "tax" structures that pay for them. That is a long story that real economists such as Paul Krugman have related much more authoritatively than I can.

3. In a related attack on a federal program, Lamar Alexander says of the Senate bill: "It dumps 15 million Americans into a Medicaid program" which is being shunned by more and more doctors. That's rather odd coming from a spokesman for the party that thinks anyone can get good medical care by simply going to an emergency room. Emergency rooms are the most expensive possible ways of obtaining medical care, and the least efficient. There are no vaccinations, prenatal care, or preventative medicine that can generally be obtained via that route, and, of course, as any conservative should know, it is by no means a free lunch. Hospitals simple transfer the cost of unpaid emergency room visits to other payers, including cities and states, who must collect it in taxes or other fees paid by the rest of us. Paul Ryan, a big advocate of eliminating Medicare and Medicaid, frankly states that the rationing of healthcare is a reasonable idea, not much different from the rationing of cable TV for those who can't
afford it. So there you have the PTR's love of the "common man." If you can't afford it tough -- that's life.

4. While I'm mentioning Rep. Paul Ryan, some of his analyses of the Democratic plan are a bit misleading. It is important to understand that the savings are "back-loaded" -- in other words, more is saved in the second decade than in the first -- so looking at the numbers for just the first 10 years doesn't tell the whole story. The PRT is making a big deal about Ryan, who at least had something substantive to say. I am not enough of an expert to evaluate his other claims, but I will let you know how they fare when real economists and experts on the Congressional Budget Office evaluation report in.

5. I agree that the Democratic plan as now constituted will not save a lot of money; it has many other virtues, however, like bringing insurance to about 10 times as many uninsured people as anything the Republicans have come up with, while regulating the rapacious and much-hated insurance industry.

6. The PTR has been trotting out its favorite polls, as if to show that the "American People" support their position. Well, of course, one of the American People's most favored ideas is SINGLE PAYER -- an idea so radical that neither party will mention it. In fact, poll after poll has shown that any sort of "public option" enjoys more popularity than either party. (Polls uniformly show that, in terms of trust, Obama comes out way on top, with the Dems a weak second, and the Republicans a very dismal last.)These polls the PTR didn't mention. In no poll does any idea or party get as much as 60% -- the magical number that Republicans think is what's needed to pass any kind of legislation these days. As for popular "disapproval" of the Senate-passed plan, or what the PTR has managed to label "Obamacare", it is doubtful that most people polled could name a single provision in it, or explain in any coherent way why they did or didn't like it. These polls are simply asking people which talking points or propaganda has been most effective. Certainly outright lies, like the "Death Panels" and "losing your doctor" have been very effective, as outright lies often are. Interestingly enough, when people are asked about individual items from the plan, such as regulating insurance company rates, disallowing cancellations for pre-existing conditions etc., the public, as the President correctly pointed out, is quite supportive. And, finally, the polls may show the plan is unpopular, but nowhere as unpopular as the Republican

7. I would like to see a poll which asks the question: "Should the government be allowed to take over Social Security?"

Anyway, it's getting late. I'll write more tomorrow, and add some links to this blog.

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