Two Speeches
On Tuesday President Obama addressed the nation's youth in about as apolitical a speech as you'll find. He encouraged students to stay in school, work hard, not let their country down, etc. It was a good speech, but probably more interesting than the speech was peoples' reaction to the fact that he gave it. Aside from the individual extremists fearing their children's indoctrination, some school districts would not allow the speech to be shown, read, or assigned to be watched at home without parental permission (censorship?). Even if it were a politically charged speech, prohibiting our children from listening to our president is disturbing to me.Speech number two addressed a joint session of congress to recharge the health care reform effort. There were no bans on children watching this one, and we even had a British parlament-esque moment with the "You lie!" outburst. As for the content of the speech, I came away less fearful of the president's health care ambitions. Sure the dems want a public option, but they don't want to make the entire system public. On the downside, I'm skeptical of the ability of a government run agency to be self-sustaining and to operate more efficiently than a private business. I also see the new regulations imposed on health care providers as tending to drive up costs, though their abuses (dropping/lowering coverage) do seem too frequent. On the plus side, there's also a chance of tort reform which could lower medical practitioners' costs. So here's to change.
Comments
I'm not as exercised as some about Obama's speech to the children, although, there was something Big Brotherish about it. Reason objects to the speech's collectivism, which does bother me slightly.
http://reason.com/blog/show/135938.html
Also, most of the early criticism was based on a study guide provided to teachers that seemed to hint at the content of the speech, and the contend of that guide and the accountability system do seem objectionable:
http://hotair.com/archives/2009/09/08/e-j-dionne-republicans-pounced-without-evidence/
There's also the double standard angle. Democrats and the media objected when George H. W. Bush gave a similar speech, but when Obama does the same thing is no big deal. (Although I guess that cuts both ways.)
http://hotair.com/archives/2009/09/10/carlson-when-did-the-hopemeister-turn-bitter/
You write: "Sure the dems want a public option, but they don't want to make the entire system public." As far as I can tell, you are absolutely wrong. The public option is a Trojan Horse for "single payer":
http://www.youtube.com/watch?v=f3BS4C9el98
We don't need government "competing" with the private sector to make sure the private sector is acting efficiently. In fact if there is a lack of competition it is probably because of government regulations imposing costs on insurance companies and making it very hard for small start-up insurers to break into the insurance market. For that reason, deregulation, not more government, will help competition.
Furthermore, the evidence suggests that a "public option," (i.e., government program) would not be efficient. The public option will inevitable get a tax payer subsidy (e.g., post office). Furthermore, experience shows that once enacted, government programs never go away, no matter how inefficient. (Think Freddie and Fannie.) This is what Barney Frank had in mind. 1) Create a public option, 2) subsidize it and 3) regulate private insurance so that they cannot compete, and then 4) , voila, you have single payer healthcare system.
Now, there are some things about health insurance law that I do not like, but I'm not sure about "dropping care" or "lowering coverage." What's the evidence of this? Someone has regularly paid their premiums and the insurance company unilaterally decides to change coverage? Don't victims of this capricious change have contract remedies?
Most policies have policy limits, but that seems entirely appropriate to me. Doesn't an insurance company need to know its maximum risk so that it can actually run profitable (e.g. efficiently)
In fact, most of the evidence I'm aware of goes the other way. Health care regulations require insurers to cover all sorts of operations and procedures that most people don't need covered, like sex changes, in vitro fertilization, etc.
Obama's speech had the exact opposite effect on me that it had on you. Except for the fact that it looks like the public plan will fail, I'm more concerned then ever. Some of his ideas are very troubling. Like the idea that we need smaller co-pays. In fact we need larger co-pays and larger deductibles so that people don't visit the doctor unnecesssarily, and so they are sensitive to price. The problem now is that no one comparison shops for medical services because our insurance system makes it so no one is sensitive to price changes.
Similarly, Obama says we should make it illegal for insurers to exclude applicants based on preexisting conditions. Really? So, someone who needs numerous surgeries but is uninsured can just get insurance, pay the same premium as everyone else, and get all the surgeries the person needs? That's going to make everyone's insurance very, very expensive. And isn't that system going to encourage people who believe themselves to be healthy to not buy insurance until they find out they are sick? How can that possibly work?
And that regulation just invites more regulation. The only way to avoid that problem is to mandate everyone buy insurance. Which is simply another invitation for government to enact more regulations and possible a single payer program.
None of these policy proposals make sense unless you believe this endeavor is one big legerdemain to put government in charge of health care.
The idea that the health care system will be fixed by government lessening regulations and not being involved in health care is ridiculous. What country in the world does that work for? Are you against medicare too? How are elderly people going to be able to get insurance then? Why would any private, profit-driven company insure a person who is going to cost them money, if they have a choice in the matter. You're right that less regulation would lower insurance costs, because the only people who could get health insurance would be the ones who are healthy anyway.
Theresa
Is collectivism so heinous an idea that we need to censor it out of our schools? The study guide was likely provided because some teacher suggested that he/she wouldn't show a broadcast without making the students do some related work. The democrats and the media objected to Bush's speech (as they did with everything he did), but was it prohibited from being shown?
2nd Speech:
I see a public option possibly leading to a single-payer plan down the road if there is evidence that it is working well, but the current (proposed) legislation doesn't provide for a single-payer plan.
I agree with most of what you say economically (increased regulation will drive up prices, lower copays are bad idea, etc.), but why be so completely uncompromising that the democrats get fed up and pass a party-line bill? Why not give them their public option in exchange for reforming pricing incentives to make consumers cost conscience and help curb increasing health costs?
I though when I said "some of which I missed" it was pretty clear that I had watched most of the speech. I only probably missed 20% or so.
I don't think lessening regulation fixing the problem is "ridiculous." (Does government regulation never cause and problems in your opinion? Is regulation always better?) In fact, deregulation makes perfect sense in this context, for reasons I've outlined. I'd be more persuaded by your argument if you addressed the merits of what I said or made a case for regulation, instead of just saying "but of course regulation is better! no proof necessary!"
What county does minimizing regulation work for? What county does it not work for that is trying it? I know which counties socialized medicine does not work for. E.g. Canada, where governments conduct loteries to figure out who gets to have a family doctor because there are so few, and where people wait months and months for surgeries. And it doesn't work in the U.K where people wait in Soviet-like lines to get signed up for a dentist. But that's what happens when some bureaucrat thinks he can better decide how to spend your money and can better allocate resources than supply and demand allocate them.
Deregulation also works in the U.S. Surgeries not covered by insurance are considerably cheaper, like lasik eye surgery. As the price of health care on the whole goes up, the cost of lasik continues to fall because consumers are paying for it out of their own pocket and, therefore, sensitive to price. That competition and deal seeking by consumers lowers price.
I'm not against some forms of welfare, but in an ideal world I probably wouldn't be for a medicaid. We've already got a method of helping the poor people in this county who need assistance. Why do we need the government to run the entire show? its like saying, people are going hungry so we need to nationalize the entire food industry, instead of simply giving out more food stamps.
Yes, I'm very much against medicare. Elderly people can get insurance just like any other people--they can buy it. In fact, elderly people are by and far richer than every other group of people in the U.S. Despite that fact, they have a bunch of young workers, with fewer assets, working to provide their health care. How does that make sense. Medicare is welfare for the richest americans from the toil of the poor american and it makes me sick.
The reasons a profit driven insurance company is going to insure a sick person is the law of large numbers and contracts. They don't know which person is going to be sick, but they know that with a large pool, a certain percentage will. They then can charge enough to cover those costs, plus administration and profits. They have a contractual obligation to cover those people if and when they do get sick. We do, in fact have contracts in this country which are usually enforceable (unless Obama abrogates them--think auto bailouts).
You haven't answered my question above: if I can just wait and buy insurance when I'm sick, why would I ever pay for insurance while I'm healthy. I'll just wait until I'm sick right? --rdh
1.
Don't get me wrong. I'm not saying that he shouldn't have given the speech. I mean, I don't feel strongly one way or the other. I just makes me slightly uneasy.
As to your question about 41's speech, I don't know if it was prohibited or not, to be honest. I'm sure it was a school-by-school sort of thing like this speech was.
2.
This is what you wrote that I object to:
"As for the content of the speech, I came away less fearful of the president's health care ambitions. Sure the dems want a public option, but they don't want to make the entire system public."
But THEY DO want to make the entire system public, as shown in the Barney Frank video, they just can't because of the politics of it. That's why this public option is so bad. its a back door to single payer. If you run all the private insurance out because of regulation and subsidies you have single payer.
So, I don't think we give them the public option for this reason. It will be very hard to keep the public option from becoming the only option.
As a political matter, Democrats don't have the votes to pass what they want, and I don't the opposition needs to compromise on the public option. There are too many blue dog democrats to pass the public option, thank goodness.
--rdh
Was just rereading my post from earlier today, and it was kind of rude. It still hold all those views, but I could have expressed them a little kinder. Sorry.
-Theresa
In an ideal world, competition could keep prices low, but now costs of medical services are so high that insurance companies must also charge high rates in order to cover the bills. For instance, last year I had strep throat and accidentally went out-of-network for my throat swab, and the bill was $700. That’s for a common sickness. It was my fault for not being more careful, so I can’t complain about the having to pay, but it shows how necessary it is to have some sort of insurance coverage. (Although in San Francisco I would have been better off without it, since there’s an odd and arguably unfair yet ultimately effective fee charged to restaurants to cover those who are uninsured, which despite worries has not led to restaurant closures or stopped employers from providing insurance).
Lastly on the older people, without a mandate, I still don’t see why an insurance company would sell individual insurance to a recently retired person except at tremendously high rates. Otherwise this person is bound to cost them money, especially as they age. In this case, the company does know the person will cost them money. Why bother with the law of large numbers and contracts? It’s more profitable to just not include them unless they happen to be rich.
-Theresa
The best solution I can see is an affordable public plan that people can fall back on when they’re between jobs, or waiting for employer provided coverage to kick in, or are self-employed and can’t afford family coverage etc. After college I would have loved to have a public plan since my job didn’t provide benefits and extending my husband’s graduate student coverage to me was very expensive, something we could only afford because of money he had won playing poker although it was still cheaper than buying an individual plan. I almost went with accident-only insurance, figuring I was young and healthy, but luckily I didn’t since soon afterwards I found out I had thyroid cancer. Even though it was easily treated and not too serious as far as cancers go, it still would have cost at least $50,000 without coverage. I knew so many other people after college, who reasonable took accident-only insurance, not even having a group plan option, and what if that had been me? I would likely have never gone to the doctor (since I had no symptoms, a nurse just caught it during a routine check-up thing), and the cancer could have turned into something that was much more hard to get rid of. Or if I did have symptoms I would have gone in and then had a “pre-existing condition” and been denied coverage, and in debt for a long time. As it is, I have to be very careful when switching jobs or to school or whatever that I never go without insurance since I have blood tests and medicine to buy for the rest of my life, and I don’t want to lose my “continuous coverage” and turn them into something that can be denied coverage. This has forced me to pay for double coverage at times to have an overlap when switching from work to school or from Elliot’s insurance to mine.
So basically all things considered, if you’re going to deny people based on pre-existing conditions, then you need an affordable insurance option, one that people can pay for even when they don’t have income. And with medical costs as high as they are, the best way to ensure that there’s always one available is have a public plan.
-Theresa
You make a lot of strong points. I agree with much of your diagnosis of the problems. I'm sure, however, we disagree about the cause and the cure.
Let start responding first with a little bit of history about how we got where we are sorry to bore you if you know this already, but maybe someone doesn't. It used to be that no one had health insurance through their employers. (In fact most people didn't have health insurance). As part of economic regulations under FDR, a cap was placed on employee compensation. Now, to skirt the cap, employers started paying employees, not in dollars, but in kind, with health benefits. These benefits were especially nice because they weren't taxed under the tax code at the time. By the time the IRS (or the equivalent agency) realized that there was all this untaxed compensation going to employees, it was too late to do anything about it. Employees were used to getting an untaxed benefit, and the political will was not there to tax the benefits.
So today, as a result, if your employer buys health insurance for you, that income to you is not taxed to you or your employer, but if you buy your own insurance, it is taxed (that is you can't claim a deduction, so you pay with after tax dollars). As a matter of principle this makes no sense, but that's the way it is. The result, however, is to link your health insurance to your job.
Linking health insurance and jobs creates all sort of other problems. First, the tax aspect skews towards over-consumption of health insurance, because one dollar paid to health insurance from your employer is a full dollar of benefit to the employee, whereas a dollar of normal compensation will be taxed. The cost of health insurance is also hidden from the purchaser, where as the benefits are not, such that the employee will tend to over consume health insurance. For example, I don't even know what our insurance premium is at work, although I know it's over $1,000 a month. All I care about is what comes out of my pocket at the doctors office. My incentive is only to get more coverage, not less coverage, because I do not pay the premiums directly.
So, one lesson I take from this history is that regulations that are aimed at one thing (i.e., overcompensation) can have all sorts of unintended consequences which last years after those regulations are long repealed. Another lesson is that many of the problems we have in our health insurance system are caused by linking insurance and employment.
With that background I'm going to defer on the specific responses.
Now about Medicare. I'm not necessarily against any kind of welfare for poor people. But welfare should be for poor people, not rich old people. As a factual matter the elderly are the richest portion of our population. There is no reason that younger, generally poorer workers should pay for health care for all seniors, especially when most of those seniors are comparatively well off. Furthermore, by having someone else pay for their health care, through medicare, we are encourage elderly people to over-consume health care, in turn artificially raising demand and the price of care.
If four younger relatively poor workers can pay for one elderly, relatively rich person's health care (that's how the math works out now), then I'm pretty sure that the senior can usually pay his or her own coverage. We can help out those who can't pay, but there's no reason to pay for those who can pay for themselves.
Decoupling insurance and jobs would again help in this circumstance because employees could bargain for a fixed price over time, or limits on price increases, and have their own care well into retirement.
That is the system we have for paying for doctors. We never ask what routine medical services cost on the whole, only what they cost to us directly. We are incentivised to over consume. Every once in a while, however, we purchase something that's not covered, and then we always get sticker shock. But its because we've got stupid complicated insurance contracts (that usually aren't given to us). We never know what is covered, and so we're just blindly following what the doctor tells us we should get. The point being, insurance shouldn't be covering every single little procedure and we shouldn't have to worry about these contract intricacies. But again, insurance does cover these costs, not because it makes sense, but because our tax structure incentivizes us to have more coverage than we need, and not pay attention to price.
I see this as good for those who run to the hospital with every cough, yet worrisome when it comes to preventive care.
Another sticky issue is getting assistance to those who need it while minimizing the freeloaders. I've known people (ok well a person, but I'm sure there are others) who got injured at home, would go to work and pretend that it happened there, and then draw workers comp. People villanize insurance providers for denying claims, but dishonest customers are a driving force behind some of their tactics. Without some element of individual accountability, the freeloaders drive the costs of welfare programs through the roof.
First, the uninsured problem isn't all it's cracked up to be. (It was interesting how in Obama's last speech the uninsured dropped from 47 million to 30 million.) The uninsured are a combination of people who don't want to buy insurance but can afford it, illegal aliens, young people and people who qualify for medicaid but don't apply.
one final category is people that don't qualify for medicaid, but can't afford insurance. But then what do we mean by "can't afford"? There's no way they can re-arrange their finances, to buy some kind of insurance? I suspect that is rarely the case. For some reason we think people should have insurance, but not have to pay too much for it or make any sort of sacrifice.
The following video is obviously making light of the situation, but it really is true to some extent. Many, many uninsured people can, in fact, make consumption changes and buy insurance, if that is what is important to them.
http://www.youtube.com/watch?v=FikcOmQZgf8&feature=player_embedded
On the one hand I think people should be free to make decisions, like not buying insurance. On the other hand, I understand that we don't want to let people go without certain care, even though it was their own choice not to have insurance covering that care.
http://corner.nationalreview.com/post/?q=Y2YzNjZlOGE3MWNlODlkZTViODI1MGNhZWYxZjU4ZTU
http://corner.nationalreview.com/post/?q=NGM1ZjdkMDkyZjg0MTU4M2U3MmUwYWEwOWM4YzEzYWQ=
One is to say, look you made your choice. We'll let good-hearted people help you out through charity, but we can't go around covering surgeries for everyone that chose to forgo coverage.
Another method is to say, we're going to cover everyone regardless of what decisions they make, so, we'll force everyone to buy coverage. You can do that the Romney way with a health care mandate, or with a tax and government purchase of care.
The problem with the Romney method is that it puts government in control of health care to some extent. In the mandate scenario, the government has to mandate you get certain coverage. Now what care you get is going to be determined to some extent by your coverage, so every specialty is going to lobby to get their profession as part of the mandatory coverage. Democrats in Massachusetts increase the coverage over what Romney wanted, and that, incidentally made it more expensive to buy even basic coverage.
In the tax scenario, the government has a monopoly, and like all government programs, it will be inefficient, and likely subsidized. It is also subject to the same problem as the Romney method.
Another method is to say, you can go without coverage if you want, but if you require expensive surgeries, and the government picks up the tab, you have to pay back the bill in taxes over time. I think that would be a plausibly fair way to say, you can take the risk, but you shouldn't get off scott-free if you actually do need surgery or care.(For reasons I've explained in other comments, I don't see any need for a public plan. We just need to reduce the cost of insurance by reducing which diseases and conditions must be covered)
And finally, on preventative care--preventative care is not necessarily cost reducing. In fact, usually it will increase costs. It sounds like in your case preventative care did reduce costs, and had you detected your disease at a later stage, you would have needed more care. However, the test they did to discover your cancer, was likely performed on many, many other people who did not have the disease, and that increases costs. Also, some medicines for example, lipitor, may prevent disease (strokes), but, you have to pay for the drug/care, and you may be paying to prevent a disease (stoke) that never would have happened anyway. Also, what if you don't take the drug, have a stroke and die? Dying is relatively inexpensive. So it's not at all clear that preventative care reduces costs, although it saves lives.
-Theresa
I did watch the PBS special report and here are a few thoughts:
1. While you have to feel for the family with the little girl with the lung problems, I wonder what in the heck they were thinking letting their coverage lapse. I agree that a the pre-existing condition label is a pretty harsh consequence for a lapse in coverage, yet I see Ryan's point about not getting insurance until you're sick as problematic as well. I see a couple of alternatives. Allow short lapses in coverage (maybe 1 year) before getting slapped with a pre-existing condition label. Or denying coverage for the first year for a person with a pre-existing condition. While the insurance company will still be stuck with an unfavorable situation after that year, the potential of a year of hospital bills for a serious medical problem might be enough to scare people into getting insurance (or a hefty punishment for those who don't).
2. The whole obesity segment seemed rather tangential. And just what are these low-cost unhealthy foods they referred to. They talked about soda, chips, and fast food. These are hardly the cheapest options for a diet. While organic foods and the like are more expensive, things like pasta, flour, and rice seem like an inexpensive and healthy basis for a diet to me.
3. I did find the segment on health care providers in the LA area as telling. With rising costs, continuing the status quo looks like a dangerous road.
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/25/AR2009092502470.html
"And to reduce property insurance costs, especially for Floridians living near the nation's second-longest coastline, Crist expanded, and vetoed reform of, the state's reckless version of a property insurance "public option." It is government-run insurance that, by offering rates lower than rational assessments of risk would dictate, has driven private insurers to limit their business or even stop doing business in the state. When a huge hurricane hits, Florida -- and U.S. -- taxpayers might have to foot the bill, by which time Crist plans to be in Washington."
Regarding the quote by George Will, I can see how statewide public property insurance in Florida could cost tax payers a lot of money if a large part of the state was hit by a hurricane. I'm not sure how this says much about public health insurance. Are you expecting a large majority of US citizens to require emergency care at the same time? I suppose there could be a serious pandemic that sweeps the nation. But without the public option, we'd still be footing the bill for all the uninsured in that case. And private insurance companies can go bankrupt too, if there's an unexpected big surge in claims.
-Theresa