The Republican health care plan

They finally offered one. But it seems they did this precisely so they could say they offered one — and not with any intent of actually trying to reduce the ranks of the uninsured. How do I know this? Because the GOP health reform plan doesn’t actually reduce the ranks of the uninsured:

The different goals and effects of the GOP bill are reflected in a preliminary analysis released Wednesday evening by the Congressional Budget Office, which put the bill’s 10-year price tag at $61 billion. That is far less than the $1 trillion estimate for the Democratic bill that House leaders plan to bring to the floor as soon as this weekend.

But the CBO analysis also concluded that under the GOP plan, 52 million nonelderly Americans would have no insurance in 2019 — even more than the 50 million in 2010. By comparison, the House Democratic bill would reduce the number of nonelderly Americans without coverage to around 18 million over the next decade.

So of course it costs less. It doesn’t actually do anything.

Why we need health insurance reform

You hear a lot of talk about “freedom” in opposition to the Democrats’ health reform proposals. But it’s hard to see freedom or any other virtue in the story Nick Kristoff shares today, about a friend of his who had to divorce her ailing husband in order to avoid bankruptcy:

“I was blown away,” M. told me. But, she said, the hospital staff members explained that they had seen it all before, many times. If M.’s husband required long-term care, the costs would be catastrophic even for a middle-class family with savings.

Eventually, after the expenses whittled away their combined assets, her husband could go on Medicaid — but by then their children’s nest egg would be gone, along with her 401(k) plan. She would face a bleak retirement with neither her husband nor her savings.

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

Republicans and conservatives had most of this decade to try to fix these problems through the market-based reforms they talk about now. They didn’t. In fact, they try to repeatedly tell us that American health care is the best in the world, though it plainly isn’t true.

Matt Yglesias comments on the Kristoff column:

In a decent system, everyone would pay a bit more in taxes and nobody would wind up facing that kind of decision. And note that in the end the government winds up picking up the tab for extreme medical scenarios anyway.

Why universal health insurance may, in fact, be doomed

The New York Times today profiles Bob Collier, a town hall attendee who isn’t screaming about Nazis or death panels or anything like that. Nonetheless, he opposes health reform.

The Colliers are committed conservatives who have voted Republican in presidential elections since 1980. They receive much of their information from Fox News, Rush Limbaugh’s radio program and Matt Drudge’s Web site. But they said their direct experience with the health care system had persuaded them of the need for change.

When Ms. Collier’s breast cancer was diagnosed three years ago, Mr. Collier’s employer-provided insurance paid for her office visits, a biopsy and three surgeries. But the insurer covered only a small fraction of her radiation treatments, which it considered experimental, leaving the Colliers with a $63,000 bill. To their great relief, the charge was later written off by Emory Healthcare, whose doctors had recommended the regimen.

Mr. Collier’s employer, Buccaneer Inc., which is based in Atlanta, pays 100 percent of his health premiums but requires $509 a month to cover his wife. That cost has been escalating by at least 15 percent a year, and the couple’s deductibles have quadrupled.

Furthermore, Mr. Collier recognizes that were he to lose the job he has held for 39 years, his wife’s pre-existing condition might well make her uninsurable.

“We’ve got to do something about those people who can’t get insurance,” he said. “There has to be a safety net there. But I don’t want that safety net to catch too many people.”

Right. The Colliers aren’t necessarily bad people. It’s just that — quite rationally — they’ve got theirs. And they want to keep it.

Here’s the dirty secret of the health reform debate: The standard talking point is that 46 million Americans don’t have coverage. When you strip out a few million who simply — by virtue of principle or a belief they won’t get sick or injured — choose not to have insurance, what you have left, essentially, is a bunch of poor people.

And as a rule, poor people don’t vote. The politicians know this. President Obama knows this. So do all the Republicans.

Which means the voting population is largely made up of people who already are covered. Who aren’t necessarily concerned about the folks who aren’t. And who might not be entirely satisfied with their coverage but — like Bob Collier — are worried that major reforms might end up replacing it with something worse.

That’s going to be a tough political battle to win.

Update: I’m going to partially retract this. As other observers have pointed out, a guy who listens to Rush and watches Fox for most of his news might not be your average voter.

But I think my larger point still stands: One of the big obstacles in health reform is asking people with stuff to care about people without stuff. The people with stuff vote; the people without don’t. Bob Collier may not be the best example of this, but the dynamic still exists.

The debate about the health care debate

That’s the topic of my Scripps Howard column with Ben Boychuk this week:

As often happens in American politics, the debate over health reform has become a contest of who can scream louder.

It’s a pretty stupid contest.

This is partly President Obama’s fault. Instead of offering a straightforward proposal, he’s let Congress take the initiative. The result has been a still-evolving series of proposals that, taken as a whole, looks to the average observer like a near-indecipherable morass that might contain a few good ideas — but also might not.

Democrats have thus far been unable to offer a coherent message about why reform is needed and how the proposed reforms solve the problems. That’s created a void into which Republicans have, gleefully, jumped.

Some of the opposition at “town hall” meetings has been based on legitimate philosophical differences. There are conservatives who see a greater government role in providing and regulating health insurance as creeping socialism — and hey, didn’t we wage a Cold War to be free of that kind of thing?

But much of the opposition has come from irresponsible and fact-free fear-mongering: Glenn Beck and his talk about health insurance as “reparations” for slave descendants; Sarah Palin raising the specter of “death panels” that would kill her son; Investor’s Business Daily’s assertion that a British-style health system would’ve killed disabled scientist Stephen Hawking — never mind that A) Hawking has actually lived his entire life in that system; and B) Democrats aren’t trying to copy the UK.

Democrats need to offer a coherent plan and a smart message to back it up, or they deserve to lose the debate. But Republicans don’t deserve to win based on loudness and lies. An estimated 46 million Americans have no health coverage, and millions more are under-covered or unduly burdened by insurance costs. They deserve better than to have the loudest screamer win.

Joe Sestak’s town hall? Not a war.

In fact, it was the very model of civility. You know. As far as these things go.

But hey, while we’re on the topic of health reform, ain’t this very interesting?

INGLEWOOD, Calif. – They came for new teeth mostly, but also for blood pressure checks, mammograms, immunizations and acupuncture for pain. Neighboring South Los Angeles is a place where health care is scarce, and so when it was offered nearby, word got around.

For the second day in a row, thousands of people lined up on Wednesday – starting after midnight and snaking into the early hours – for free dental, medical and vision services, courtesy of a nonprofit group that more typically provides mobile health care for the rural poor.

When Remote Area Medical, the Tennessee-based organization running the event, decided to try its hand at large urban medical services, its principals thought Los Angeles would be a good place to start. But they were far from prepared for the outpouring of need. Set up for eight days of care, the group was already overwhelmed on the first day after allowing 1,500 people through the door, nearly 500 of whom had still not been served by day’s end and had to return in the wee hours Wednesday morning.

The enormous response to the free care was a stark corollary to the hundreds of Americans who have filled town-hall-style meetings throughout the country, angrily expressing their fear of the Obama administration’s proposed changes to the nation’s health care system. The bleachers of patients also reflected the state’s high unemployment, recent reduction in its Medicaid services for the poor and high deductibles and co-payments that have come to define many employer-sponsored insurance programs.

Right. While major, leading mainstream Republicans spread lies that the Obama Administration wants to kill your grandmother, the fact is that the current system really does hurt people. The Republicans offer nothing, really, but a defense of a status quo that’s OK letting less-wealthy people live in pain and die early.

Sen. Specter gets an earful on health reform

I’m confused. Does that mean health reform is a sin that God will punish someday? Seems counterintuitive.

Will Joe Sestak’s town hall turn into a war?

Dan U-A posts over at Young Philly Politics:

Joe Sestak is going to hold a meeting on universal health care this Wednesday. Like every other town hall meeting on healthcare, insurance companies will partner with crazy, racist, nut jobs to try to disrupt any actual meeting from taking place. It is a holy alliance of the fringes of society, spurred on by Glen Beck, Sarah Palin, and a too compliant national media, with the power and money of the insurance companies goading them on. All to stop every American from getting to see a doctor.

For example, word got out that Sestak’s meeting would actually be held in Philly, and so, there was this tweet:

CON SESTAK PA 7TH DISTRICT IS NOT HAVING MEETING IN AREA OF VOTERS THAT ELECTED HIM HE IS MAKING US GO 2 PHILLY WHERE THE BLACK PANTHERS R

Oh, where the black panthers are!?

And, if that was a little to subtle for you, it was followed by this one:

@glennbeck iTS A BLACK CHURCH IN ANOTHER DIS. SESTAK IS GOING TO SAND BAG US

Um, yeah. It is even directed at Glenn Beck. That is too, too, too perfect. That is who will be at the town hall, hoping to drown out any conversation from actually happening.

For what it’s worth, Sestak is running for U.S. Senate now. That’s to represent the whole state. So I don’t see any conspiracy in Sestak holding an event outside his district.

Anyway, Sestak will be speaking at 6:30 Wednesday at Broad Street Ministries, 315 S. Broad. It should be a barn-burner.

The proposed health insurance bill isn’t that radical

Robert Samuelson makes a good point this morning that he doesn’t intend to make, I don’t think. Which is this: The proposed health insurance reforms aren’t actually all that radical:

One of the bewildering ironies of the health-care debate is that President Obama claims to be attacking the status quo when he’s actually embracing it. Ever since Congress created Medicare and Medicaid in 1965, health politics has followed a simple logic: Expand benefits and talk about controlling costs. That’s the status quo, and Obama faithfully adheres to it. While denouncing skyrocketing health spending, he would increase it by extending government health insurance to millions more Americans.

Right. All the reforms that have happened since 1965 have done more or less the same thing: Expand benefits to people who don’t have health coverage while leaving everybody else free to purchase the health insurance or health coverage they desire. And this bill isn’t all that different.

Which makes a lot of the conservative anger about this bill – the stuff that isn’t just completely, wildly off the factual mark — somewhat perplexing. We’re not getting single-payer health care run entirely by the government. So all the talk by supposedly smart conservatives about the horrors of government-run health care in Europe — conservatives would prefer those horrors be delivered more efficiently by the free market — are beside the point: That’s not what this bill would do.

Samuelson is right to be concerned about rising medical costs, and he’s correct to point out that the current bill doesn’t do much to rein them in. But Samuelson, who sneers at the idea that Americans have a “right” to health care, doesn’t seem to realize he’s arguing for a more radical bill.

Robert Samuelson: Paying non-poverty wages is “welfare”

In the Washington Post today, columnist Robert Samuelson talks about America’s “welfare state”:

Broadly speaking, the U.S. welfare system divides into two parts — the private, run by firms; and the public, provided by government. Both are besieged: private companies by competitive pressures; government by rising debt and taxes. GM exemplified the large corporation as private welfare state. In contracts with the United Auto Workers, GM promised high wages, lifetime employment, generous pensions and comprehensive health insurance. All this is ancient history: New workers get skimpier benefits.

This stuff pisses me off. Samuelson basically identifies non-poverty-level compensation for GM’s workers as “welfare.” What crap.

He’s not wrong to say that GM got in over its head with promises to its workers. (As always, it’s worth noting that some of those problems would’ve been alleviated with a national health insurance plan.) (Also worth noting: Nobody forced GM to enter those compensation agreements.) But among some die-hard anti-union capitalists like Samuelson there is a perverse idea that capitalism works best if labor costs are kept to their bare minimum. But the question is: Who would capitalism work best for in that instance? If GM was fabulously successful but its workers couldn’t afford to, say, buy a GM car or send their kids to college or, hell, retire after a lifetime on the assembly line — well, that would suck.

But to be absolutely clear: Compensating your employees who work for you — even compensating them generously — is not “welfare.” Welfare is given to people who can’t or won’t provide for themselves. Wages are paid to people who earn them.

Karl Rove isn’t irritating me quite so much this time

One big reason Bill Clinton’s attempt at providing national health insurance failed in the 1990s is because Republicans didn’t feel like they could afford to give him the victory. Starting a government program that would make health care cheaper and easier to access, folks like Bob Dole realized, would make many Americans grateful to Democrats for years to come. Rather than risk electoral losses, the GOP — not for the last time — decided its best bet was to be the “Party of No.”

So I think it’s telling that Karl Rove is advising Republicans to oppose President Obama’s health-care initiatives … by coming up with some alternatives.

It’s extremely unlikely that Republicans will be able to pass their own health-care plan in this Congress. But in politics you can’t beat something with nothing, so it is critical that the GOP offers an alternative to President Barack Obama’s government-run monstrosity.

Americans will listen more closely to Republicans if they make empirical and specific arguments against Mr. Obama’s attempted government takeover of the nation’s health system. But they must also offer proposals that families, small-businesspeople and health-care providers will applaud.

Well great. I doubt that I’ll like the GOP proposals much — and I’m a bit skeptical that they’re offered in complete sincerity, rather than as a political countermove. (Dole, out of electoral politics, is suddenly enthusiastic.) I think Brendan’s right a single-payer system would probably be best, but Republicans aren’t going to go for it.

But if the politics of the country has shifted enough that cries of “socialism” can’t kill efforts to expand health insurance, if the debate starts with the presumption that Americans have a right to health care outside an emergency room, if the debate starts with an acknowledgement on both sides that too many Americans go without insurance and proper care and if the debate is about the best solutions rather than improvement versus status quo — well then, that’s a debate worth having.