Jul 18th, 2009 at 2:26 pm
Health Reform in Massachusetts Gets More Fierce
Massachusetts passed a major health care reform bill back when Mitt Romney was governor, that effectively created a universal health care system which was paired with some fairly hand-wavy promises of cost controls. The expanded coverage has worked great, but the cost controls haven’t. That said, with the state now explicitly on the hook for coverage, they’re not just responding to cost increases by letting things slowly unravel. Instead, an ambitious recommendation has been made to move away from fee-for-service medicine, which would be a truly revolutionary change if it happens.
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Check out analysis from Alex MacGuiness and Ezra Klein. This could be the future.
40 Responses to “Health Reform in Massachusetts Gets More Fierce”
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July 18th, 2009 at 2:47 pm
I seem to remember concerns about state universal health care systems being unable to weather difficult economic times (because of less tax revenue) due to the inability of states to deficit-spend (I think it was in reference to Hawaii).
That was in turn used as an argument for federal universal health care. Would this fee-for-service reform negate this issue?
July 18th, 2009 at 2:57 pm
That’s a pretty good summary of the issue. Massachusetts’ health care reform has (due to its dramatic increase in subsidy funds for low-wage earners) significantly increased the health coverage for poor and low-income families, at the cost of basically kicking middle-income people who for whatever reason didn’t have health care (because they’re self-employed, their job didn’t offer it, or they pieced their income together from several part-time sources) while they’re down by fining them without really making cheaper alternatives available.
I’ll certainly be very interested to see where they go with this idea.
July 18th, 2009 at 3:24 pm
We’ll see. It sounds good in theory, but it could also turn out to be the Democrats’ version of “Starve the Beast.”
July 18th, 2009 at 3:42 pm
So, Matt, are you saying that the Democrats of Massachusetts foisted a health care plan upon the unknowing public without a proven ability to control costs? That is simply shocking to my ears. That Massachusetts has had the highest rate of increase in health insurance costs in the whole country since 2006? (How many times must I link this damning assessment of the Commonwealth Plan before leftists take this plank of criticism seriously?)
But of course, as with much of the Left’s ideology, the plan will surely work this time, if we can only but look in our hearts to give in and trust. Cast off your fears and intransigence! Lo, I have looked upon the face of Love and Caring, and I fully embrace Big Brother.
July 18th, 2009 at 3:50 pm
Joe:
Capitation plus outcomes bonus works pretty well in the U.K.
Whatever things people complain about re: the NHS, the primary physicians aren’t it.
July 18th, 2009 at 4:02 pm
But of course, as with much of the Left’s ideology, the plan will surely work this time, if we can only but look in our hearts to give in and trust.
Wow — serious question: what is it about gov-run health care that makes the right totally bonkers? The government runs a whole lot of other big government programs — and they work! Yes, some don’t work so well – but we can look at other countries and, whoa!-their universal health care plans are far better than what we got. The rhetoric just seems totally disproportionate to the potential negatives of changing the awful status quo.
I wish the right would critique the policy at hand on the merits or come up with policies of their own. Equating “wasteful big government” with “anything the government does” is obviously false and doesn’t really help voters concerned about health care. It’s honestly unproductive if there’s one side discussing solutions and one side bringing the crazy.
July 18th, 2009 at 4:34 pm
what is it about gov-run health care that makes the right totally bonkers?
I don’t know if you want a serious answer or not, but I will give it a shot. Govt run healthcare will create more, and I mean much more, dependency on the govt. We on the right think that is a bad thing. The less the govt. is in your life the better. That is the big picture problem for the right. There are many smaller picture arguments like rationing, choice, free-market ideals, efficiency. But, bottom line, I don’t trust the govt. enough to give them this power. And neither should you.
July 18th, 2009 at 4:35 pm
I wish the right would critique the policy at hand on the merits or come up with policies of their own
That’s done on a daily basis, you need to expand your news gathering sources.
July 18th, 2009 at 4:43 pm
The less the govt. is in your life the better.
That’s nice as a middle school axiom, but I can think of tons of areas where I wouldn’t want less government. Police and fire departments, road building, the FDA, etc. I really can’t understand the mindset that anything the government does is inherently evil just because the government’s doing it. And if I didn’t have health insurance (as my government being involved in our national defense generally gives me as part of my employment), I’d definitely want the government stepping in to make sure I didn’t go bankrupt over medical bills, because the free market has shown that it has absolutely no interest (nor should it) in doing so.
That’s done on a daily basis, you need to expand your news gathering sources.
Oh, I’ve seen plenty of critiques, though most of them just seem to be Frank Luntz’s talking points. But as for policies of their own? I haven’t seen a single one. Seriously, link me to the Republican health care plan, I’d love to see how they propose to fix the problem. The last thing I heard was Steele: “Just get the insurance companies in a room, and fix it! If someone doesn’t have coverage, just get them coverage! Why get the government involved?” And that’s about the level of intellectual sophistication I hear from most conservatives on it.
July 18th, 2009 at 4:52 pm
I really can’t understand the mindset that anything the government does is inherently evil just because the government’s doing it.
Strawman. Less is not none.
But as for policies of their own? I haven’t seen a single one.
http://online.wsj.com/article/SB124277551107536875.html
I’d definitely want the government stepping in to make sure I didn’t go bankrupt over medical bills,
Why don’t YOU make sure you don’t go bankrupt over medical bills. It is possible, people do it everyday.
July 18th, 2009 at 4:56 pm
I’d definitely want the government stepping in to make sure I didn’t go bankrupt over medical bills,
Dependency on parade. That is my exact point.
July 18th, 2009 at 5:00 pm
Pretty much the only purpose of a government is to protect your property. Therefore, the more you have the more you need government.
July 18th, 2009 at 5:04 pm
If they’re moving away from FFS, what are they moving toward? The link makes it sound like they’re just looking at a capitated-payment managed care system or something.
That does change the incentive for providers, but the problem is, it pegs payment to managing your caseload rather than providing any service. That is, the way you make money is to keep a panel of healthy people and not accept too many sickly people, so that you are typically using less treatment than your capitation rate for that person. You get paid based on who you see, not what you do. That’s actually more perverse in many ways than a FFS system if you’re concerned about health disparities at all.
This approach is hardly the future. It’s been well tried and found wanting. But maybe I’m missing something? Anyone have more details on what they’re looking at doing?
July 18th, 2009 at 5:11 pm
Strawman. Less is not none.
Let’s go over this again. You claimed the less government, the better, with no exceptions. That means that that you think everything the government’s doing is bad. Otherwise, you would say that you want less government in some areas, but in some areas it’s at the appropriate level. Do you think that? Or do you actually believe that any reduction in any government function whatsoever would be a good thing? My guess is that you don’t actually think that, but you pretend to as it allows you to oppose anything Democrats propose regardless of its merits and benefits on the sole basis that it involves the government.
WSJ link
Sweet, thanks. I hadn’t seen that specific plan but it looks a lot like what McCain proposed. I’m not sure what they plan to do about the millions of families can’t get coverage for $5700 a year (or anywhere close to that), and I don’t see any details on how they plan to guarantee insurance for people with pre-existing conditions that currently can’t get it. They just kind of threw that in as a one-liner, but as it’s an op-ed and not a proposed bill I’ll be generous and assume they do actually have some plan. I’d like to see how they do that though without the government interference with the free market they hate so much. And I’m not seeing a single thing in there that deals with the rapidly expanding costs involved, just a different way of buying the insurance that gets more expensive every year. But hey, it’s better than the bubble graph from before.
Why don’t YOU make sure you don’t go bankrupt over medical bills. It is possible, people do it everyday.
See, this is why you’re never going to get people to vote for you. If I had a pre-existing condition or just had my COBRA run out and was still unemployed and I got diagnosed with cancer or some other really bad thing tomorrow, do you have any idea how much that would cost? Often times it’s 500k if you’re lucky. Very few middle class people have that kind of savings. If you’re living paycheck to paycheck (which tens of millions of people are), even a one-day trip to the emergency room costs thousands of dollars and can put you over the edge. A pregnancy can be tens of thousands.
And what’s your answer? “Don’t let that happen.” I know it’s very hard for you to believe, but sometimes there are circumstances beyond one’s control. No, not in Ayn Rand novels, but in the real world, it happens. And the party that says “screw you” when people have problems beyond their control is, well, only going to get the votes of people who never have problems and don’t care about those that do. That’s not very many people.
July 18th, 2009 at 5:12 pm
Dependency on parade. That is my exact point.
Yes, if the options are going bankrupt or having the government step in and say “no, that’s not acceptable in a civilized country”, I’ll take the second. And so would the overwhelming majority of the population, if I’m reading the polls right. That’s how it works in every other civilized country, you know. It’s that whole “empathy” thing you guys hate so much.
July 18th, 2009 at 5:39 pm
You know, rereading the Republican plan Judd linked, I’m a little upset. Judd can’t possibly be in favor of it. I really have to doubt Republicans’ ideological convictions (well, I already did, but this is more blatant than usual).
Low-income Americans would get a supplemental debit card of up to $5,000 to help them purchase insurance and pay out-of-pocket costs.
They’re literally just giving money to poor people. This is the very definition of redistributing the wealth. Can you imagine what the Republican reaction would be if Obama proposed this plan? Socialism! Let the rich keep their money! They would howl on every pundit show. This is just completely disingenuous.
And let’s not forget this gem:
It also provides a new safety net that guarantees access to insurance for those with pre-existing conditions.
A safety net! From the party that furiously opposes every safety net in existence and fought to keep every one of them from passing. But hey, I’m sure their safety net will be entirely free market and not redistribute any wealth, right? That would just be unamerican.
I guess this explains why I haven’t heard of this plan before now. They don’t actually want to advocate for it because someone might point out that it involves the same principles they say they hate. And that might make it clear that there is no free market solution to the health care problem.
July 18th, 2009 at 6:04 pm
I don’t want to abolish a system that works for a high percentage of the population (polls say 75% are happy with their insurance) for a small few who are having issues. Let’s tweak the current system, like the repubs in that article have proposed, not completely tear down a system and turn it over to the govt for a 1% problem.
Oh, and I have plenty of empathy, that’s why I give a portion of my income to charity. I just don’t define empathy as spending other peoples money.
July 18th, 2009 at 6:38 pm
I don’t want to abolish a system
So you don’t want single-payer. OK. That’s not what’s being debated in Congress. Although it is clearly demonstratively better in both costs and results than every option being discussed, it’s off the table in this political climate.
polls say 75% are happy with their insurance
Yeah, of course they are. Most people don’t have too many major medical problems that cost tens or hundreds of thousands of dollars. If you never see the failings of the product you’re paying for, you’re going to be fine with it. And of course, the 75% number conveniently leaves out the 47 million people that don’t have any insurance to be happy with.
Take a poll of people who’ve been seriously sick and ask them if they were happy with their insurance. And take a poll to find out how many people want to switch jobs or start their own company but can’t because they’re tied to their insurance.
Let’s tweak the current system, like the repubs in that article have proposed
Perhaps you missed the poll numbers that say 30% think health care needs to be rebuilt from scratch and another 45% think it needs major overhauls. The public doesn’t think tweaking the system is acceptable, and they didn’t elect Obama and 60 Democrats to tweak the system.
I’ve already pointed out the numerous issues with the Republican proposal, none of which you responded to. Nor did you address any of the numerous the ways in which it completely violates the espoused philosophies of both you and the people proposing it.
for a 1% problem.
The problem is people dying far earlier than they would with the proper treatment they can’t afford, not to mention the massive numbers of bankruptcies. This would be a problem even if it affected far less than 1%. And of course, the uninsured rate is something like 15%. None of this happens in any other advanced country.
Oh, and I have plenty of empathy, that’s why I give a portion of my income to charity. I just don’t define empathy as spending other peoples money.
When I pointed out that tons of people go bankrupt because of insurance companies either refusing to pay for medical care or refusing to insure them in the first place, your response indicated that you didn’t really care about them and that they should have been smarter. That is the very definition of a lack of empathy.
But good job on the charity. If enough people donated to charity, there would be enough money for them to handle the problems they’re trying to deal with. While it’s a nice thing to do, in terms of this issue charity and the free market have completely failed.
July 18th, 2009 at 6:42 pm
judd Says:
July 18th, 2009 at 6:04 pm
I don’t want to abolish a system that works for a high percentage of the population (polls say 75% are happy with their insurance) for a small few who are having issues. Let’s tweak the current system, like the repubs in that article have proposed, not completely tear down a system and turn it over to the govt for a 1% problem.
Oh, and I have plenty of empathy, that’s why I give a portion of my income to charity. I just don’t define empathy as spending other peoples money.
Are you kidding me? 25% is a HUGE portion of the population. Especially considering that is the percentage of people WITH insurance who are happy with it. Add in the people who have no insurance and you are talking about just a huge, huge number of people.
How you can admit in one breath that 25% of those with insurance are unhappy with it, and in the next breath call it a 1% problem really demonstrates something about you. I’ll leave it to you to think about what that is.
July 18th, 2009 at 6:57 pm
I also read this editorial and read the “long summary” on Paul Ryan’s website. I do not see how people with pre-existing conditions will be covered. The plan seems to specify that “health insurance exchanges” will be created and will apparently be required to take all comers, including people with pre-existing conditions. But I don’t see anything about making it affordable. Take my friend Andy with non-hodgkins lymphoma. He survived, is still paying off his bills, but can’t get any insurance. He doesn’t have the cash to pay > $5000/year, but he isn’t so poor that he’s likely to get a debit card (the cut-off for which is also unspecified). So wtf is he going to be doing?
July 18th, 2009 at 6:58 pm
I don’t know if you want a serious answer or not, but I will give it a shot. Govt run healthcare will create more, and I mean much more, dependency on the govt.
Sounds nice in theory. The problem is there’s no way to get everybody covered without boosting the government’s role from 50% (status quo) to, say, 70%, when it comes to paying medical bills. Now, what most conservatives and virtually no conservative politicians will admit is that they don’t think having millions of people without access to robust preventative care matters. To paraphrase an argument I read Ezra make the other day, apparently it’s fine to mandate universal access to emergency care, but it’s verboten to mandate access to the preventative care that would make the former less necessary.
Anyway, one of the arguments conservatives always employ is that the 47 million number is inflated, because most of the uncovered are only temporarily so (or else are illegal, or else are young and healthy and would rather do something else with their money). Fair enough. How about we limit reform to allowing those people who can’t otherwise find affordable coverage to buy into Medicare, with a premium cap based on a percentage of income? Would you take that, deal, conservatives? I mean, surely you don’t deny that some people genuinely can’t afford coverage, or can’t get a policy issued at any price.
July 18th, 2009 at 7:02 pm
Now, what most conservatives and virtually no conservative politicians will admit is that they don’t think having millions of people without access to robust preventative care matters.
Exactly. If you got them to say what they really thought, they’d say those millions should have worked harder in school and gotten a better job that has insurance. It’s a fundamental lack of caring about others that I think is indicative of psychological issues.
July 18th, 2009 at 7:13 pm
Would you take that, deal, conservatives?
Yes, but the “public option” is a trojan horse to eventually get to single payer, which is not acceptable.
Now, what most conservatives and virtually no conservative politicians will admit is that they don’t think having millions of people without access to robust preventative care matters.
It does not matter as much as you seem to think.
It’s a fundamental lack of caring about others that I think is indicative of psychological issues.
Fuck you. We can’t just have a policy difference? You’re a fucking idiot.
July 18th, 2009 at 7:28 pm
Fuck you. We can’t just have a policy difference? You’re a fucking idiot.
We could have a policy difference if you were advocating some conservative solution to getting 47 million people health insurance. But you and other conservatives generally have the same attitude on every issue: “we got ours, screw you”. It sums up the whole philosophy. Again let me quote you from upthread:
Why don’t YOU make sure you don’t go bankrupt over medical bills. It is possible, people do it everyday.
That’s not a policy difference. It’s the statement of someone with sociopathic tendencies. There’s a reason no Republican politician would ever dare say that even if they’re thinking it: because it would reveal them for the completely heartless bastards they are and would end their career.
July 18th, 2009 at 7:54 pm
Yes, but the “public option” is a trojan horse to eventually get to single payer, which is not acceptable.
What you’re admitting here is the impossibility of guaranteeing universal access to robust preventative care without a dominant role for the government. If you took the deal I described, the percentage of people buying their (heavily subsidized) care directly from the taxpayers would grow inexorably, as more and more people found that their private health insurance premiums were bumping up against affordability caps. Also, while I personally wouldn’t mind it if we eschewed an individual mandate (Obama’s position during the primaries), it really wouldn’t be tenable to allow people to go without coverage even after they’d received critical care from the system. I mean, if you’re an uninsured, healthy 27 year-old living in a country where people can voluntarily buy coverage directly from the taxpayer, and then you get in a car accident, it simply wouldn’t be feasible to allow you to remain uninsured once you’d been discharged from the hospital. At that point we’d have to say: hey buddy, you just got $130,000 worth of healthcare from your fellow citizens; now you’ve got to get health insurance coverage.
Anyway, there is no universal coverage without increasing government’s role. I suppose that’s an intellectually defensible position, if libertarianism is your thing (though to be consistent you should calling for the abolition of Medicare and Medicaid) — just don’t expect to win many more elections espousing such views.
July 18th, 2009 at 9:22 pm
When you continue to be intellectually dishonest by quoting that “47 million American” figure Adam, when it has been endlessly debunked, and go about speculating on civil opponents’ “psychological issues”, well then I’m perfectly content to remain an evil Rethuglican as a long as you remain an evil and mendaciously ignorant Democrat. It’s why I hate modern leftism, by the way, not because of its ostensibly noble principles I disagree with, but because I’m positive history should surely harshly judge a movement that has so readily disregarded the knowable in favor of the comfortable to detriment of at least 30 million people in the past century alone and still counting.
Preventative care doesn’t lower health care costs. Megan McCardle has gone on and on about this. The only thing that has been rigorously proven to reduce health-care costs is denial of treatment. You hope to make that “cost-effective” somehow, and yet are unwilling to fully argue to the American public how that requires giving some unaccountable medical board some real teeth. I do pity your position; indeed, the American public has become deeply immature from decades of coddling.
By the way, if these leftists were more introspective, this infruriating debate would neatly demonstrate to them the essence of the Hayekian Socialist Calculation Problem. Note how invested the egos of those like Adam, Matt Yglesias, and Ezra Klein are in the notion that they are engaging in policy “wonkery”. (See Hilzoy of Obsidian Wings get mocked by one of her commentariat for “inappropriate” use of the word here in this post). It’s a word that is deeply pleasing to them, and thus they get enraged when such rubes as us dare to disregard their arguments with such simple aphorisms like “government involvement in the private sector always fails”. And then they later act so, so, surprised when some latent variable they have not considered comes and bites them in the ass turning all those well-laid plans to dust.
You don’t have cogitating power enough to accurately weigh the different inputs and studies we’re discussing. Suppose this was a purely academic debate, with no real people with real lives encumbering our positions, and we professors could accurately display our utility functions to the inspection of the opposing side before the fact. Even if that was so the default position should still be to the implacability of health care costs, as long as we are still “human” and not Gods! No human on Earth, with their limited biological wetware, has such computing power, no Democrat, no Republican. If anything, few people are qualified to opine on even a small portion of the health care debate, and that takes investment of thousands of man-hours in the attainment of a Ph.D and tenureship and many publications to be able to do that. (On a lark, I picked up on sale a cheap book called “Health Economics” at my local bookstore – daunting once opened, to say the least!) How laughable it is to believe that Congress or the CBO or blogger “policy wonks” can aggregate all that information and turn it into good public policy, even if we Republicans don’t quite agree with them on the appropriate distributional inequalities of the American health care system.
July 18th, 2009 at 9:45 pm
Why don’t YOU make sure you don’t go bankrupt over medical bills. It is possible, people do it everyday.
…and if you can’t – tough shit.
July 18th, 2009 at 10:33 pm
That Donkey Benjamin Says:
July 18th, 2009 at 9:22 pm
When you continue to be intellectually dishonest by quoting that “47 million American” figure Adam, when it has been endlessly debunked, and go about speculating on civil opponents’ “psychological issues”, well then I’m perfectly content to remain an evil Rethuglican as a long as you remain an evil and mendaciously ignorant Democrat. It’s why I hate modern leftism, by the way, not because of its ostensibly noble principles I disagree with, but because I’m positive history should surely harshly judge a movement that has so readily disregarded the knowable in favor of the comfortable to detriment of at least 30 million people in the past century alone and still counting.
I know! If only for those damn liberals, we wouldn’t have done something as idiotic as invade Iraq! And why did they fight so hard against the Civil Rights movement, just because it was easy to keep things the same? Wusses! If there is anything we know, it is that conservatives will NEVER take the easy, comfortable path that is maintaining the status quo despite its obvious flaws! Gosh, and those damn liberals who fought to keep the US isolationist and out of World War II! Bastards! Certainly well known liberal economists such as Paul Krugman were WRONG WRONG WRONG about everything! MORE DEREGULATION AND TAX CUTS!!!!! REAGAN!!!!!!!!!!!!!!!!!!!
The truth is, as you say, that we can never know the exact outcomes of anything! I agree! Therefore, we must all sit at home on our hands instead of doing anything, ever! I MIGHT GET HIT BY A CAR IF I GO OUTSIDE!!!!!!!!!!!!!!!
UNTIL MR. YGLESIAS OR ANYONE ELSE CAN PERFECTLY PREDICT ALL POTENTIAL OUTCOMES OF ANY POLICY, HE MIGHT AS WELL STFU!
July 18th, 2009 at 11:10 pm
By the way, if these leftists were more introspective, this infruriating debate would neatly demonstrate to them the essence of the Hayekian Socialist Calculation Problem.
That’s the awesome thing about the health care debate. Conservative theory predicts that government regulated or adminstered health care fails. In reality, across the world, it works better than the American system. So we don’t just get to be right about one thing, we get to falsify their theories across the board. This is awesome!
July 18th, 2009 at 11:29 pm
First of all, I must applaud your ardent application of Alinsky’s Rule #5. Second of all, you are entirely correct, this isn’t far from my rule at all, except that I would change “all potential outcomes” to “all critical potential outcomes“. It is not asking too much to be cautious in changing a system that millions of Americans depend upon.
False. I completely dispute this assertion. As the honorable deleter-of-comments Brad DeLong writes, “you are entitled to your opinions, but not to your own facts”.
July 19th, 2009 at 12:04 am
That’s not a policy difference. It’s the statement of someone with sociopathic tendencies
Oh, now I see the problem. You are stupid. I gave you far to much credit.
July 19th, 2009 at 12:14 am
Adam, I’m going to help you out a little here. If you think everybody who disagrees with you is insane, it’s more than likely you who is insane. Good luck.
July 19th, 2009 at 1:10 am
Truly revolutionary change? More like back to the future.
Global payment is capitation. Accountable care organizations are managed care.
http://stateofthedivision.blogspot.com/2009/07/capitation-and-managed-care-return-as.html
July 19th, 2009 at 12:59 pm
Note the complete absence of consideration of the quality and availability of heath care in this analysis. It is purely political, purely ideological. There is nothing whatsoever in this thought process that deals with the best way to make sure people get the health care they need.
July 19th, 2009 at 1:03 pm
I’m sure Adam’s response to someone who supported a British-style NHS, or a purely private managed care system, or a program of radical deregulation combined with vouchers, to solve the problem of people who are unable to get decent health care would have been polite disagreement over efficacy and cost.
But there is a meaningful distinction between those who want to solve problem in a different way, and those who look at those people and say “Fuck ‘em.”
July 19th, 2009 at 2:40 pm
There is nothing whatsoever in this thought process that deals with the best way to make sure people get the health care they need.
I guess you didn’t read the whole comment you quoted. Here.
There are many smaller picture arguments like rationing, choice, free-market ideals, efficiency.
But there is a meaningful distinction between those who want to solve problem in a different way, and those who look at those people and say “Fuck ‘em.”
I linked a proposal by Congressional Repubs that exactly deals with the issues as we both see them. Far from a “fuck ‘em” attitude. You don’t think they will work, fine. I don’t think govt. run health care will work. But to deem your political opponents as insane is lazy at best and intellectual cowardice at worst. But I will look on the bright side Joe, at least you didn’t call me a racist.
July 19th, 2009 at 3:46 pm
The less the govt. is in your life the better.
choad would sooner be reamed by a private health insurer, which is responsible primarily to stockholders who complain when 80% of its premium money is spent on healthcare instead of 78%, than to a government that is responsible to the voting population.
Or, to put it more precisely, choad doesn’t mind if other people are reamed, because as a member of the Wingnut Elect, that would never happen to him.
I have plenty of empathy, that’s why I give a portion of my income to charity.
Shorter choad: look at my virtue. The resort-to-charity is almost always the response of those who pride showy contingent acts over structural reform — where they can impose their shitty moral superiority complexes on other people.
July 19th, 2009 at 8:42 pm
See, there’s your problem; had you not assumed from the outset I was illiterate, you could have thought for a second and been able to figure out what I was saying.
In fact, that is precisely the line of your comment I was discussing. You raise many issues that should be considered. Not a single one of them has to do with the problem of people who don’t have health care coverage. “Rationing” is an issue of how much health care people who have coverage can get. “Choice” is an issue of how many options people who have health care coverage get to select from among. “Free-market ideals” is a vague, platitudinous term that means something different in the mouth of everyone who uses it, but is wholly unconcerned with those who cannot afford the goods and services supplied by the market, and in fact, postulates that it is good for those who cannot afford something to go without it rather than being helped to acquire it. “”Efficiency” is a measurement of the amount of health care available for a given price, and once again, is wholly unconcerned with the question of those who cannot afford the health care coverage they need.
We don’t both see the issues the same. The Republicans’ proposal, and your comment, are both wholly unconcerned with universality, with assuring that everyone gets the health care that they need. This issue is, as I wrote, of so little concern to you that you don’t even notice when it is not being addressed. For me, on the other hand, its absence in the Republicans’ proposal and in your comment is so glaring that it is the first point I notice.
Not only will they not work to address the problem you are so unconcerned about – universality, making sure that everyone can get the health care they need – they don’t even attempt to accomplish that end. You didn’t even notice that, because that issue is of so little importance to you.
Under a universal system of health care, you would not have to worry about whether your plan covers visits by the Waaaaaaaaaaambulance.
July 19th, 2009 at 9:54 pm
…and if you can’t – tough shit.
You do realize that for a large part of human history people were jailed, sold to slavery, or even killed for unpaid debts?
Bankruptcy is a social safety net, and America has more generous bankruptcy laws than most European nations you so love.
July 21st, 2009 at 6:24 am
Re: Bankruptcy is a social safety net, and America has more generous bankruptcy laws than most European nations you so love.
This is absolutely true, but the implication that the bankruptcy courts are an efficient means of providing universal healthcare is a howling absudity,