Thursday, February 25, 2010

Sum It

I watched the first hour or so of the "health care summit." I stopped, partly, because I early came to the conclusion that it'd be a battle of talking points, and, partly, because I went to see "Avatar" in IMAX 3-D. A much cooler experience.

But, sticking to reality, and having read summaries and watched clips, I have a couple of thoughts on that summit thing. First and foremost, as I've said before, I think that we won't get any really significant reform until the system totally collapses; at which point the main question will be whether it's simply too late. Second, and fivemost, since both parties are wedded (one more than the other, but it really doesn't matter) to maintaining the centrality of private insurers, who do nothing much more than suck money out of the system, I don't think it matters what they do, in terms of making the changes that are needed.

Underlying the discussion are a couple of obvious questions that no one asks Republicans: do you think our citizens deserve health care or not? Do you think that it's okay that people routinely face bankruptcy over health care bills? If you say yes to the one and no to the other (and, of course, they may say it but they really don't believe it), then how do you propose to accomplish it, and how do you pay for it? The answers we heard today were 1) "market forces" and 2) malpractice reform.

Market forces are what got us here. Market forces are what are keeping millions from having insurance, and they are what's behind the steadily increasing premiums. Market forces, if they work in other areas (like banking?) have failed in health care. There simply is no argument to the contrary. Many times today the empty talking point was raised from the right: "Washington" shouldn't be telling consumers what they need in health care. So who should? Insurance companies? Where has that gotten us? And what's so wrong about federal regulations, when needed? Should we leave it up to "market forces" to decide workplace saftety standards? Food safety? Is there a problem with the government setting standards for pharmaceutical efficacy and research? Have we been damaged by regulations that assure us, for the most part, that buying food won't kill us? [added later: I hadn't seen this clip but it seems our President has thoughts similar to mine. Which is nice.]

What does seem clear from the meeting is that there simply is no middle ground. Despite having dropped the "public option," which would have been a real fix, despite incorporating (with a couple of intelligent restrictions) cross-state purchasing, despite the many ways in which the Senate bill is nearly exactly like one proposed by Republicans several years ago (when "moderate" and "Republican" weren't mutually exclusive terms), it's apparent the Rs will not accept anything other than their way forward.

As a surgeon, I don't have a problem with malpractice reform. I think it's needed. But, as I've written, I don't think it's a huge part of the economic equation. Far as I'm concerned, put it in the bill. It's an area in which the Ds are dishonorable. (I do buy the argument, however, that malpractice law has had positive effects on quality of care.)

On the way home from the movie, I listened to some R congressman dodge the question: Do you think the Senate bill is a "government takeover" of health care? He said that because there are regulations imposed on insurers, it's government-centered. He refused to answer specifically, but he would NOT agree that "takeover" is not part of the plan. If there are regulations, by definition, it's bad. Non-negotiable, it seems. It makes no sense, but the cry of "government takeover" has been a most effective rallying cry for the uniformed. Tea baggers, in other words.

Many were the references to polls saying "the public" doesn't like "this bill." Absent were references to polls that show that if people are told the truth about what's in it (meaning, of course, when they get their info from someplace other than Fox "news" and the rest of the RWS™), they actually like it.

Be that as it may, I have no idea what the politically right thing to do is. Start over? I sincerely doubt that unless the solution were 100% written by Rs they'd support anything. Push it through as is? Using reconciliation? I don't know. But, given the disastrous future if nothing is done, it seems we need to start somewhere, get something in place. Legislation often needs fixing when it's made into flesh and blood.

I do know that today we learned again what has been clear for at least a year: if anything will be done to improve our health care situation, it will have to be done by Ds. Rs had the whole place to themselves for most of the last forty years, and they didn't do a damn thing; the reason, it should now be obvious, is because they really don't want to (and I'm not the only one who thinks so). They have theirs. As to the rest, quoting that estimable Senator from Kentucky, who said it about people suffering in related ways, "Tough shit."

The Ds, as is their wont, will screw it up, make it overly complex, won't go far enough, will pander to too many interersts. But at least they're serious about trying. I don't see evidence of that on the other side. Can anyone really argue with that? Other than "market forces" (which has failed), no regulation (which has failed), and malpractice reform (the economic importance of which they overstate), did they produce any serious proposals?


  1. Well I watched the WHOLE thing Sid, it was like a horrible traffic accident or someone with a hideous congenital deformity, I just couldn't look away.
    And one thing that's not better on a 70 inch Pioneer 1080p Plasma...
    Henry Waxman's TEETH, Jesus, go to a Dentist Man! And watching Charley Rangles Hair shimmer in the late afternoon sun was something I'll never forget, unfortunaely,


  2. "Market forces, if they work in other areas (like banking?) have failed in health care. There simply is no argument to the contrary." - Dr. Sid

    Wow. That's quite a non-sequitur. There hasn't been a "free market" in health insurance since FDR's wage freeze during WW2 tied purchase of health insurance to employers (how's that for an unintended consequence of government interventionism?). Even today, the government regulates what insurance must cover (accupuncture? massage? really?) & tells us we can only buy insurance in our home state. There's not much freedom in the insurance marketplpace these days.

    As a side note, when the govt. gives insurance companies a de facto state-by-state virtual monopoly, the lack of competition allows the insurance companies to behave badly b/c their customers can't switch to other companies.


  3. Frank, I'm going to be frank- I've read quite a few of your blog posting throughout the net. I apologize in advance if you take offense, but I have to say that, in general, you come across with an attitude. You sound as if you might be a mean spirited person. I really don't intend to be malicious, but the remarks on this page just don't hold any constructive value, and do make you sound mean. The majority of your comments I've read on other blogs, generally do follow suit. Just an observation, I hope everything is OK.

  4. Sounds like we agree, PT. First, let's get rid of the anti-trust exemption. And, since the Senate bill does include cross state purchasing, you'd be for that, too.

    As to non sequiturs: having a certain amount of regulation does not an unfree market make. Seat belts. Asbestos-free buildings. The fact is insurance companies have been free to exclude people, place limits on coverage, raise prices, control markets with minimal regulation. Inarguable.

    We do agree, however, on acupuncture. And you left out aroma therapy.


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