The Heritage Foundation Loves Healthcare Reform! The Heritage Foundation Hates Healthcare Reform!

There's nothing more blissfully entertaining than watching the ongoing contortions of the educated right as they attempt to rationalize why they loved healthcare back when it was Mitt Romney's conservative reform bill, but hate it now that it's Obama's, virtually identical, reform bill.

ThinkProgress has the goods.

– Heritage On Romney’s Individual Mandate: “Not an unreasonable position, and one that is clearly consistent with conservative values.” [Heritage, 1/28/06]

– Heritage On President Obama’s Individual Mandate: “Both unprecedented and unconstitutional.” [Heritage, 12/9/09]

– Heritage On Romney’s Insurance Exchange: An “innovative mechanism to promote real consumer choice.” [Heritage, 4/20/06]

– Heritage On President Obama’s Insurance Exchange: Creates a “de facto public option” by “grow[ing]” government control over healthcare.” [Heritage, 3/30/10]

– Heritage On Romney’s Medicaid Expansion: Reduced “the total cost to taxpayers” by taking people out of the “uncompensated care pool.” [Heritage, 1/28/06]

– Heritage On President Obama’s Medicaid Expansion: Expands a “broken entitlement program,” providing a “low-quality, poorly functioning program.” [Heritage, 3/30/10]

- Lee Fang

Poor Heritage Foundation's a-hurt! An about face like that is liable to give you whiplash.

But then, that's the trouble with this debate. Obama compromised so sharply on this bill that there's really no standing room to his right. You can criticize this bill for not being liberal enough. You could contend that it's not big enough. You could probably argue that it's not necessary, but inasmuch as that involves shackling yourself to the bloated monstrous landfill that is our current healthcare system, conservatives have been understandably reluctant to embrace this form of ritual suicide.

Which pretty much leaves lying like hell. Here's hoping no one notices.

Meager Thoughts On The Constitutionality of Health Reform

In which we use this blog as a notepad to ourselves (now, with added Wikipedia!).
Lately, the web has been all atwitter with questions about the constitutionality of health reform. And why not? Surely the Founders of this great country did not intend for the government to go mucking about with health care delivery. Dammit, they intended America to look much more like this. Or this. Or this.

But all of that aside, it's not entirely clear there was ever a Constitutional problem with health reform until it's opponents woke up one day and declared, "I'd sure like to see some Constitutional problems with health reform." And lo, they did, because the Constitution is a bit unclear on certain points and barely anyone ever bothers to check, and when you look at it facts are actually kinda fungible and confirmation bias is a wonderful thing. And presto! A constitutional problem with health reform.

We blame this on the entirely unclear tenth amendment to the Constitution of the United States¹. Catchy? Of course. Clear as crystal? Hell yes. Point proven? Do not make us laugh.

There are two problems with this tenth-amendment-specifically-mud-wrestles-health-reform-into-submission theory. First, it's pretty clear that the Tenth Amendment was written in much the same spirit as a husband promises to mow the lawn next weekend. It's not meant to do anything. It's just there to reassure people.

Doubt us? You poor fool. The Supreme Court has largely held that the Tenth Amendment is a truism - an amendment that restates powers already granted in the Constitution. In fact, only twice over twenty years or so have laws fallen afoul of Amendment X, in both cases for fairly esoteric reasons involving states enforcing federal mandates.

And that's the problem with the Tenth Amendment - the powers already granted to the federal government are really, really large. They include the powers to regulate interstate commerce and the sweeping clause. They involve powers vast enough to create taxation, treaties, prisons, the FBI, the CIA, the NSA, wars, welfare, the Pentagon, the Army, Navy, and Air Force, Medicare, Medicaid, Social Security, national debt, housing subsidies, farm subsidies, and the Federal Reserve. Yet you think the powers-that-be are going to balk at an incremental, budget reducing reform that affects a measly 4% of U.S. health care spending?

It's pretty fucking doubtful. Social Security and Medicare acquire a hell of a lot more money from your paycheck and the federal government doesn't generally ask for permission.

But then, to paraphrase Brad DeLong, we do have four certifiably crazy judges on the Supreme Court. You never can tell with these things.

¹"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

In Which We Ask A Few Questions

We're the ones in the ring. The ones who floored your pal Heaton . . . and last time I checked, he was still on the canvas.
- Ian Rankin, The Complaints
It’s desperate times here at the SMB. Over the past week, we’ve searched for something – anything – that could be labeled a coherent conservative argument against the healthcare bill. It has not gone well. Instead of vigorous, manly debate, we’ve heard nothing but an empty desolate silence, broken by the faint, fading whisper of “you socialist . . .”

It didn’t used to be like this. Once upon a time, the Strawman Blogger delighted in crossing intellectual sabers with his witty conservative opponents. But those halcyon days are long gone. It appears the crème of intellectual conservatism has died, been excommunicated, or fired in disgrace. And some have just gone plain fucking crazy.

So the Strawman Blogger needs your help. We’re looking for smart, conservative arguments to healthcare reform, and we want you post them below.

But, of course, we have some ground rules.

The Ground Rules

Here’s the deal. It would never do to have you scampering about this blog, shouting “filthy liberal!” until you go hoarse. You can criticize the bill, but with one special caveat: You have to criticize something actually in the bill.

Now, we have a sneaking suspicion that you may not actually be terribly familiar with the innumerable nuances of this legislation. So to make things easy for you, we’ve prepared a list of questions for you to ponder.

We can’t cover everything, but we’ve tried to capture the essence of the new law. So go ahead, my conservative friends! Select your most hated amendment, the foulest part of this legislation, and amaze us with your flawless logic. Post your answers in the comments below. This is your time to shine.

We won’t be holding our breath.

The Questions

1. A Republican Bill – This bill is nearly identical to RomneyCare, the popular conservative reform passed by Republican Governor Mitt Romney in Massachusetts. It is almost exactly like the conservative reforms suggested by Bob Dole. The basic plan was approvingly suggested by the ultra-conservative Heritage Foundation early in the last decade. It is further to the right than the healthcare deal suggested by Richard Nixon. How can a bill be considered a deeply Republican reform in 1974, 1992, 2002, and 2006, but is a socialist takeover in 2010?

2. 4% – A common Republican argument against healthcare reform is limiting the size of government. This bill will amount to around 4% of total healthcare spending. The government will not employ a single doctor. It will not write a single insurance plan on the exchanges. 96% of healthcare spending will continue to be administered by the existing market. If you have health insurance from your current employer, nothing changes. In what way is this a government takeover, and what is a credible Republican alternative?

3. The Exchanges – This bill creates a system of healthcare exchanges. They function as a simple marketplace, where people who are uninsured can purchase a policy from a private insurer. People save money by purchasing insurance as a group, much like we do through employers. Since the exchanges match private insurers with private citizens, how can this be considered an assault on the private market?

4. Public Ratings – This bill allows you to rate your insurance provider based on their performance, and that rating can be seen by the public. When you shop for a new insurer on the exchange, you’ll be able to research how well they’ve served people like you – rather like the product ratings on Amazon.com. How would the market benefit from preventing individuals from speaking their minds about the behavior of their insurer?

5. Pre-existing conditions – Starting today, children can no longer be denied insurance based on pre-existing conditions - and they can no longer cancel your coverage if you get too sick. In 2014, that protection will be extended to adults. People will be able to stay on their parents plan until the age of 26. Would individuals benefit if insurers retained the right to deny coverage to children and adults based on conditions like cancer, AIDS, and hereditable disease?

6. Cost controls – The health care bill reduces the deficit by $1.3 trillion dollars over 20 years – and much more beyond that. It experiments with cost controls like bundling payments to hospitals, so that they’re paid by how quickly you get well, not how many treatments they perform. It researches comparative effectiveness, to see what treatments work better. It creates an independent board to evaluate waste in Medicare. How can a bill that reduces the deficit, cuts costs, and involves less than 4% of total healthcare spending be considered budget busting?

7. Insurance spending – Starting immediately, insurers will have to spend at least 80 cents out of every dollar on medical care. If an insurer spends less than that on care, they’ll have to rebate the difference to its customers. Should less insurance dollars be directed to actual care?

8. Medicare Expansion – This bill leaves our current system of private insurers alone. If you’re currently insured by your employer, nothing changes. If you’re insured as an individual, you’ll still be able to choose your policy – you’ll just be given more information and cheaper premiums. If we went with a liberal option, we would extend the popular Medicare program to all Americans, either directly, or by allowing people under the age of 65 to buy-in. This bill prevents that. How can a bill be credibly considered as advocating big government, when the most likely alternative involves enrolling every single American in a massive government program?

9. Premiums – According to the CBO, premiums on the employer-provided market will become slightly less expensive. Premiums on the individual market, on the other hand, will go down by 7-10%. Why is it bad if existing policies from private insurers become more affordable?

10. Subsidies – Currently, we give the poor insurance through Medicaid. We give the uninsured free emergency care through hospitals, at great expense to responsible adults with insurance coverage. But we had no mechanism to help out middle-class families struggling with insurance premiums that grow at rates in excess of 7% a year. This bill assists middle-class families in affording insurance by providing scalable subsidies to families earning up to $88,000 a year, helping them purchase private insurance for themselves and their children. Why do the poor deserve free care, and the rich the capacity to afford it, but the middle-class has to shoulder the burden on their own?

That should give you something to chew over. We could go on, but ten is a nice round number - and we're getting just a little bit bored. Comments below - do your best.

The Morning After

And that’s it, then. With much fanfare and an acceptable amount of self-congratulation, on Sunday night Congress passed health care reform.

We are relieved.

So what now, you ask? Where, if you’ll pardon the expression, is the beef? What does our future look like in this fresher, newer, health-reformier world?

Beats the hell out of us. We’re a humble blogger, for God’s sake, and while the light of our brilliance may have swept away the cobwebs of your ignorance from time to time, our talents don’t extend to fortune telling. But we’ll promise you this: It’s gonna be a bit of an anticlimax.

See, that’s the trouble with telling the future. Throughout this process, there have been so many lies, so much dishonesty and deliberate misrepresentation, such fear-mongering and obfuscation, that it’s impossible to figure out what the opponents of the bill expect to happen. An immediate tripling of the federal budget? Babies thrown to lions? Stalin’s jackbooted thugs to march through the hallowed halls of Premera Blue-Cross while the ghost of Lenin angrily unplugs grandfather’s ventilator?

Probably not. In spite of the agreeable furor on the Republican right, the Constitution remains relatively intact. The sun will rise tomorrow. And, for the 90% of Americans enrolled on the employer-insurance market, absolutely nothing will change about your health insurance.

Absolutely. Nothing.

. . .

That thought may take some getting used to.

If you’re a part of the majority, the bill isn’t designed to affect you. That’s not how it rolls. It’s been written to alleviate the deep and real suffering of uninsured Americans, slap a bit of sense into our dysfunctional individual market and, maybe, introduce some small steps to taking control of our rising healthcare costs. We could have done more, but quite frankly you lost your shit when we wanted to introduce a fucking research panel, so forgive us if we aren’t tripping over ourselves to fix the rest of your innumerable problems.

Still, as you know, this blog likes to consider itself an armchair expert on health care, the economy, and politics in general. Silence just won’t do. So against our better judgment, we’ll take a quick look into the future and see what changes are wrought from this most unexpected bill.

On Healthcare

First, let’s make a bold claim: This bill is not going to be repealed.

Over the next few weeks, you’ll hear noises on the Republican right that they’ll stake their campaigns on the repeal of this bill. That is not going to happen. The very second a Republican majority advances the repeal of healthcare the Democrats will filibuster the hell out of it, and the Republicans are not going to get near enough seats to ram it through. That would mean weeks of painful political haggling followed by eventual defeat, and the Republicans are not idiots. Even weasels have a certain base cunning.

Secondly, it’s a lot easier to scare people with the unknown. In six months, insurers will no longer be able to deny coverage for pre-existing conditions. 80 cents of every dollar they earn will have to pay for care, or be rebated to individuals. Children up to the age of 26 will be able to ride on their parent’s policy.

After the midterms, in 2014, individuals without insurance will start receiving subsidies to help them purchase it. They’ll have access to insurance exchanges, where private policies can be purchased, and where insurers can’t jack their rates up without giving reasonable cause. And they’ll be able to read community ratings, from people like them, talking about how good or bad an insurer is at doing their job.

People are going to like these things. They’ll become popular. In other words, “Vote GOP: Taking Insurance Away From Children” is not going to gain traction as a campaign slogan.

But for most of us, nothing changes. And that is a pretty big problem. Our system of employer-sponsored insurance is still expensive, dysfunctional, and getting worse. This bill doesn’t fix that. There will be even bigger changes to health care in the years to come.

This bill, though, gives us a structure. First, by requiring people to purchase health insurance, it makes us stakeholders in a system that desperately needs reform. Secondly, employer-sponsored health insurance is going to continue to fail – and as it fails, we’ll have the chance to bring these people into the exchanges. The Strawman Blogger loves a backup plan.

On The Budget

Our budget problem is a health care problem. You could cut every bit of waste, stop every dollar in discretionary spending, fix Social Security and the Pentagon, dismantle welfare, gut the federal prison system, and annihilate the FBI, and healthcare would still bankrupt America. It’s just a matter of timing.

Healthcare continues to grow at rates in excess of 7% a year. Our economy will be lucky to manage half of that. Fixing the budget means controlling rate of growth in healthcare spending.

The healthcare bill starts the messy process of cost-control. Ezra Klein has the dirt here.

It won’t, however, be enough. It’s easy to bend the cost curve in health care. Trouble is, it means reducing payments to doctors or cutting back on unnecessary care.¹Our budget problem is still largely unsolved.²

On Politics

Conventional wisdom says that health care has canonized the culture of “No”. In other words, it’s better for a minority party to block legislation than compromise on it, better to defeat a bill than make it better, better to misinform than to mediate. In other words, make the other guy look bad, and you’ll probably be a winner when the next election rolls around.

It’s a pretty good strategy, politically speaking. Let’s be perfectly clear - Republicans are going to win in the midterm election, and they’re likely to win big. That’s just how these things work.

But it’s not much of a strategy for governing a country. The Republicans will ride back into power, and it will be the Democrats turn to filibuster every bill in sight. And so on and so forth, and the only legislation we’ll be able to pass will go through reconciliation.

So if you oppose the bill, think about this: Over 130 amendments were accepted by Republicans in committee. The public option was dropped and a Medicare buy-in was never truly considered. This is a conservative bill, and not a single conservative voted for it.

Next time around, how willing do you think the Democrats are going to be to compromise? How many days are they going to waste in committee or compromise when they know the minority party is just waiting to stab them in the back?

Fighting legislation in this way makes it more likely you’ll see legislation you hate. The next time a Democratic congress considers health care, they won’t bargain with you. They won’t invite you to sit on a committee or offer an amendment. They’ll craft a liberal bill to suit the rules of reconciliation, and they’ll ram it through. Why not? They know that nothing they do will buy your vote, so they might as well use theirs.

Or maybe not. They’re still Democrats, after all, and they aren’t bright species. But it’s still a crap way to govern a country.

¹In case you have not been paying attention: Neither of these are likely to be popular.
²Tort reform, you say? Don’t make us laugh. $11 billion a year. Come up with something new – and try not to embarrass yourself this time.

Bah!

Today, while driving to work, the Strawman Blogger was able to engage in a time-honoured past-time: family gossip.

Truly, no one can gossip like the SMB family can gossip. Family events are nefarious, shifting affairs, a roiling morass of juicy rumours, traded in an every-shifting series of petty allegiences. The cousins gather to gossip about the aunts, before breaking apart to trade trivialities about the grandparents, only to divide into splinter cells to monger about the nephews. What they say about us, we can only guess.

Wine helps.

Today the subject centered around an ailing British family member. "Good luck to him," someone spat. "He has to survive that awful health service."

We couldn't agree more! Good luck to the poor man! The poor, down-trodden wretch. Not only is he forced to recieve health care at no charge whatsoever, but he suffers the horror, the indignity, of having his care provided by the NHS.

Bloody socialists.

What sane person, after all, would elect to receive free health care from an agency with a 92% approval rating among seniors that assures health outcomes that rank a meager 19 places above America!

Truly, with a table like this, it's amazing anyone bothers to be European at all:

WHO Health Rankings (By Outcomes)

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America

Alternatives

The Setting

Paul Ryan is my hero.

For months, the health care debate has been a pathetic little pantomime of back-and-forth bickering. The Democrats advance a plan; the Republicans rebuke it. The Democrats make changes; the Republicans are unmoved. All of which has prompted the Democratic majority to stamp their tiny feet in frustration. “Show us the money!” they cry, pathetically, “Tell us how you would fix healthcare!”

Rep. Paul Ryan, finally, did just that. He wrote a reasoned, sensible plan that sketches an entirely different plan for healthcare from the Democrats. Then he took it a step further, and had it scored by the Congressional Budget Office. The CBO, staring at the bill from beneath the grey bushy eyebrows of wisdom, declared its opinion: Paul Ryan’s proposal would save money.

Shedloads of it.

“Begorrah!” you cry in shock. “What a turn of events? Could it be that the Strawman Blogger, an inveterate, unapologetic liberal, a nasty little mean intellect who delights in tweaking the nose of all things conservative, has finally changed his stripes? Has he come to support a conservative health care plan?”

You poor idiot. Of course not. Paul Ryan has suggested a shitty plan and, much worse, a shitty plan that is political suicide. Paul Ryan’s conservative brethren are scrambling away from his leprous proposal so quickly they are in danger of smashing through the walls of the Senate, leaving only comical congress person shaped holes behind, Looney Toons-style.

But that’s not Paul Ryan’s fault. The only thing Paul Ryan has done, the thing that is causing all sorts of conservative noses to crinkle, is clearly, intelligently, and lucidly write down a Republican health care alternative.

And just what is this alternative, you ask?

The Alternative

The alternative is pretty simple. Paul Ryan gets rid of Medicare. Instead of Medicare enrollment, seniors are given a voucher to purchase insurance on the existing private market. To save money, the voucher grows much, much more slowly than health care costs.

That’s the power of the proposal. Don’t want seniors spending money on medical care? Just don’t give them any. People will purchase fewer treatments because they won’t be able to afford them.

This is so awesome it has our gonads tingling. Balance the budget on the back of grandma. No wonder the CBO loves it.

Seniors, maybe less so.

The Smackdown

Because if there’s one thing guaranteed to lose you the support of the most powerful voting block in America, it’s asking them to balance the budget by skimping on the chemo. So, much like the Titanic should have done when sailing toward the world’s largest ice cube, Republicans are backing the hell away.

It’s not that seniors shouldn’t sacrifice, they say. But first we might want to try offering consumer protections. Make premiums more affordable. Bring competition to the individual market. All good ideas. Someone should really write a bill like that.

And that’s the lesson of Paul Ryan’s proposal. Sure, you can balance the budget without changing a single atom of our current system. You can leave insurance companies alone, you can ignore our staggering medical unit costs, and you can continue shoveling so much money to doctors that they have to carry their paychecks home in a wheelbarrow.

But that option has costs. It means that we offer less care and we annihilate the single most popular public program in living memory.

Still, Paul Ryan is a hero. He told people the truth. It may be an unpopular truth but, warts and all, we love it. We could use a lot more politicians like him.

Healthcare Redux: In Which We Declare Victory In The Blogosphere

A mere four days after we pointed out the conservative ideas already included in the healthcare bill, venerable blogger Ezra Klein points out the conservative ideas already included in the health care bill.

Of course, this would all hang together better if we hadn't gotten the idea from him in the first place. But we feel that this could be considered points on the board.

Objectively speaking, though, he writes better than we do. Bastard.

In Which We Interact

Over the weekend, someone raised a laudable point in our comment thread: "Why?" they ask. Why healthcare, why the expense? In other word: Why worry?

Life isn't perfect. If 10% of the population lacks health care - well, 10% of the population should try harder. It's America, dammit.

And we can see their point. The Strawman Blogger is no friend of the lower classes. We were born with the silver spoon so far up our mouth that it seriously impaired our gag reflex. Our trust fund is so large it exerts a significant gravitational pull. In our minds, poor people should only be seen at charity events, or when we happen to drive past a bus stop.

But the problem of health care is not a problem of the poor. It is a problem for all of us. And the Strawman Blogger has perfectly selfish reasons to extend health care to the underclass.

Our Perfectly Selfish Reasons

The Strawman Blogger is a man of almost unlimited patience. But even we are beginning to tire of repeating the same, basic refrain: In America, healthcare is broken.

This is a very important point. Let's repeat it:

American healthcare is broken
American healthcare is broken
American healthcare is @$^*% broken

We feel better.

Somewhere Along The Way, Life Happened

But why is it broken? you ask. My healthcare is just fine. I can see any doctor. Get any surgery. All without coughing a single bloody cent.

That's the trouble with American healthcare. It feels free. But it's not. And it's designed in such a way to screw over exactly one person, and screw them so thoroughly and deeply that they may never walk the same again.

You.

Getting Screwed By American Healthcare: A Reference Guide

Part 1 - Costs are Out Of Control

Each year, health care costs rise. Usually, somewhere between 5-12%. By comparison, a vibrant economy grows about 4-6%. Middle-class wages average a terrible 0% - over the past ten years, they haven't grown at all.

Given these rates, health care will consume 50% of government spending by 2082. That's money required for transportation, law enforcement, debt payments and Social Security.

It would be bad enough if health care were pretty cheap already. But it's not. Health care in America is more expensive than any other industrial country in the world:



This is a graph of our health care costs and our health care outcomes. On the left is how much we pay for health insurance - on the right, how long we live. America doesn't just pay more for health care. We pay a LOT more, over 40% more than anyone else. Maybe this would be a good deal if we lived longer, but we don't: our outcomes are rated 37th in the world.

Wondering where that money comes from? The Strawman Blogger is glad you asked.



This graph comes from the eminitable Ezra Klein. Click on it: he has a lot more like it. It's about unit costs - the cost of a procedure in America versus a procedure in other countries. They are not comparable, and they are not cheap. Unit costs are killing us.

Part 2 - You Don't Feel It

Surely you exaggerate, you say. If things were that bad, I would know.

But you wouldn't, you poor simpleton. And here's why: For godawful reasons practically lost in the midst of time, your insurance is provided to you by your employer. Why this should be the case defies all belief. The Strawman Blogger cannot imagine a world were his employer provided his auto, home, or renters insurance.

As long as you're employed, you don't feel health care getting more expensive. Your employer simply soaks up the excess cost behind your back. Whenever health care costs rise, your company absorbs the difference, then hands out any money left over as wages. If costs rise too much, you just get a smaller raise that year.

Skeptical? You probably shouldn't be.

Of course, if you're unlucky enough to be fired, or if you happen to be on the individual market, the pain is very real. Insurance companies don't care how broke you are, or how hard you've worked. They'll simply calculate how much your illness could cost them, and they'll make you pay it. And if it gets too expensive, they'll stop insuring you. You've just been the victim of recission, and it happens every day.


Part 3 - The System Screws You

So that's our situation: We have out-of-control costs, hidden from you by your employer, that you'll rarely see but will be quite the nuisance if you ever lose your job. Perversly, people are quite happy with this situation.

Employers love it because it gives them power. Sure, they're loving it less and less over time, because power is ungodly expensive. But as long as they provide health care, you can't change jobs or quit without risking the individual market. They get to make you unhappy, and you get to take it.

Insurers love it because they don't have to bargain prices down. In a normal world, insurers would have to negotiate with doctors over their fees. The companies that were better at it would be able to offer cheaper policies, and thus would get more customers. The free market in action. But because the costs are hidden by your employer, they don't have to bother. They can pay your doctor whatever he asks for and pass the bill on to you.

Doctors love it because they get paid a lot. Much, much more than doctors in any other industrial country. Remember that unit cost graph? That's what you're paying so your doctor can buy another yacht. It's no coincidence that Medicare, the one insurer who can be ballsed to negotiate with it's doctors, controls costs better than it's private counterparts.


Part 4 - It's About To Get Much Worse

So we've set up a system that doesn't just allow costs to get out-of-control: it encourages it. And if everyone is having second thoughts, if insurers and employees are thinking, "Slow down, we might have underestimated the size of this particular fucking problem," it's too late.

The individual market is already a mess, but it's going to get much worse. The only way insurers can control costs is through recission - they just stop insuring people who are too expensive. As costs rise, more and more people simply won't have access to insurance. It will be too expensive, and insurers aren't a bloody charity.

Employers don't have that option. So healthcare costs will continue to exert downward pressure on American wages. Eventually, they'll stop offering health care all together, or they'll ratchet down the quality of your policy until it makes no difference. Either way, you'll have to get something on the individual market. Good luck.


Final Lesson - There Are Other Options

Let's not kid ourselves. The current system isn't free market. There's nothing free about it. You have no choice - your employer chooses for you. You have no information - if you're an individual, insurance companies are required to tell you $%*# all.

It can be fixed, though. You can have a public option, like Medicare, that uses it's size and market position to bargain aggressively with providers. You can have government owned hospitals, like the VA, that simply sets the wages of their staff. Or you can try reform through a mix of subsidies, regulation, and oversight of the existing private market, and hope that incremental policy changes and public awareness will begin to move prices downward.

That last bit is the administration's plan. And it does a fair job of it: It shaves over 100 billion off the deficit over the next ten years. Of course, you say, that's not near enough to rein in costs - and I agree with you. But given how hard you fought the most conservative piece of healthcare legislation in history, you'll forgive us if we don't sing the praises of the public option quite yet. The Strawman Blogger will take what he can get, thank you very much.


And if all this isn't enough? Well, we can always make a moral argument. Over 45,000 people die a year from underinsurance. That's not 45,000 car accidents, 45,000 random murders, or 45,000 people who died because they were just too fucking lazy to go to the hospital. It's 45,000 preventable, treatable illnesses that went untreated, simply because we chosen an asinine, jackass way of running a health care system. And it's a number that's only going to get larger.

In Which We Consider The Awful, Terrible, No Good Socialist Health Care Proposal

You can’t always get what you want
No you can’t always get what you want
But if you try some time, you might find
You get what you need. -
The Rolling Stones
So several times in the past two weeks, when the topic of health care reform is broached, my conservative family and friends have offered some familiar personal advice:

“You, [Strawman Blogger], are just another socialist.”

Now, I take no offense. If there’s one thing your intrepid blogger enjoys, its being considerately labeled a no-good-red-commie-Mao-loving-Trotskyite. But unlike that time we were caught with the minister’s daughter, these allegations are without a shred of truth. So very shortly, and with damning finality, I shall clear my name.

But before I begin, we need to know what the bill is. And for that, we’ll need a shorter version of the bill in question. If only I had one lying around …

The Awful, Terrible, No Good Socialist Health Care Proposal: A Shorter Version

So this is how the bill works:

Each state sets up an exchange, where individuals who are uninsured (or uninsurable) are allowed to buy insurance from private companies, such as the ever-caring Blue Cross/Blue Shield. The individuals benefit from purchasing insurance at cheap group rates, and the insurers benefit from access to new customers.

In order to be listed on the exchanges, insurers have to meet some minimum qualifications. They have to qualify in price – their policies must be cheap enough. And they have to qualify in quality – they have to provide a basic level of health care service. In return, individuals are allowed to rate their level of satisfaction with their insurance, and these ratings must be made public by the insurers – the community rating system.

But what does the government do? In short, not much. The government provides subsidies to purchase insurance to the mostly poor (people earning up to about 300% the federal poverty line, or around $32,000 for an individual). They also help set up the exchanges.

But, as far as reform goes, that’s it. The government doesn’t employ any doctors, and they don’t tell you what policy to buy. And they don’t insure a single person.

If this all seems terribly conservative, well, it is. It’s so conservative that it’s basically identical to the proposals endorsed by Bob Dole and Tom Daschle. It’s so conservative that some basic elements, like a selling insurance across state lines, were suggested by McCain on the campaign trail. It’s vastly more conservative than the health-care plan advanced by Richard Nixon, and it’s conservative in part because over 160 amendments were accepted from Republicans in the Senate HELP committee.

A Brief, Irritated Aside

Oh. And the end-of-life counseling provision, the late and unlamented father of the death panel rumours? It was included in the GOP’s 2003 Medicare prescription drug bill.

And Back to Our Original Point

So I hope you can understand the uncomfortable position of your Strawman Blogger. Here I stand, accused of all types of nefarious socialism, for the crime of being slightly further to the right than Richard Nixon.

And we’ve sacrificed along the way. We’ve given up on the strong public option on a federal exchange, the federal exchange, the strong public option on a state exchange, the weak public option on a state exchange and, finally, the public option all together. We’ve given up stronger subsidies, on ending the employer-tax exclusion, on Medicare-for-all. We’ve given it all up in a hopeless effort to get a single Republican vote, and now have lost it all, all because a Massachusetts politician doesn’t see the value in shaking hands outside of Fenway Park.

And for this, you accuse me of being a socialist. For shame.

Back to the Future

So where does this leave us? It’s very simple.

Health care is broken. It’s broken enough that we spend 40% more than any other country, but rank 32nd in health outcomes. It’s broken enough that it will bankrupt the country by 2070. It is, in immortal words of Steven Pinkner, well and truly unsu-fucking-stainable.

Of course, if something cannot go on forever, it stops.

Solution #1 – Like Our Sex Life in High-School: We Do Nothing

This, ignorant louts that you are, is the option you’ve chosen. We continue merrily on our present course, while each year health care costs increase, and each year more and more people will be denied, or will be unable to afford, insurance. Eventually this will increase to the point where the system of private insurance will be, for all intents and purposes, broken.

Solution #2 – Like Our Sex Life in College: We Do Something, Anything, At All

There are options for fixing health insurance. Hell, we’re the only country who can’t do it right. We can squeeze insurers and providers with a public option. We can set up a risk-equalization pool. We can nationalize the whole bloody system. But these are all much, much more liberal than the proposal you’ve just rejected.

So this leaves me in a confused position – I am left defending a conservative health care proposal from the conservatives who invented it, when the status quo doesn’t work and all the other options are deeply, terribly more liberal.

Just what is your better idea?