What’s Wrong With Obamacare.

March 3, 2010 at 12:09 pm (By Amba) (, )

I don’t have to tell you, because this says it all.

Now don’t get marooned in politics, go read Donna’s wonderful post below.

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24 Comments

  1. Donna B. said,

    A 14 page bill? We need to send all our legislators to Canada immediately.

  2. wj said,

    Donna, what offense did the Canadians ever do to you??? ;-)

  3. Maxwell said,

    Careful, Donna – they might come back with a 14-page bill for single payer.

    In all seriousness, that article told me nothing about what’s wrong with Obamacare – just what’s wrong with the US legislative system.

  4. Donna B. said,

    True Maxwell, but then they’d actually to have to admit that’s what they are voting for.

  5. amba12 said,

    Maxwell — to know what’s wrong with Obamacare, you’d have to read the bill. Very few people have the time or fortitude to wade through the bill or the bureaucratese descrambler to make sense of it. And that’s what’s wrong with Obamacare. It’s hidden in plain sight — in obfuscating language, in self-contradiction, in verbal and bureaucratic overkill. The medium is the message, in this case.

  6. Peter Hoh said,

    Single payer is only okay if it’s for veterans and seniors.

  7. Peter Hoh said,

    Gratzner’s suggestion that Congress be allowed to vote on each provision, thus ensuring that the popular bits get passed while the unpopular bits languish, is disingenuous. The popular bits — like getting rid of exclusions for pre-existing conditions — require the unpopular bits — like the individual mandate — in order to work.

    At issue are the millions of uninsured Americans who lack primary care but can access expensive emergency room care, paid for by some combination of taxes and higher insurance premiums paid by those with health insurance.

    If there were a simple, 30 page bill that could solve this problem, it would have been done already. When the GOP had control of Congress, they pushed through Medicare, Part D, but did nothing to address the problem of the uninsured. This, unfortunately, is the result.

  8. amba12 said,

    Single payer is okay for veterans because the country owes them for their service. So it provides education and health care. That seems a fair exchange.

    As for seniors, society has taken that burden on because otherwise it is just too big. While health care costs generally are big, they are randomly big. Apart from smoking, which is voluntary, even other lifestyle factors affect people in a rather randomly inconsistent way, depending on complex genetic and other factors. Age is a consistent, monolithic actuarial risk.

    I’m not saying you can’t make arguments for single payer for everybody. I’m saying why I think the above arguments have prevailed even in a society where there is a strong fear of further enlarging and empowering government, stronger than the fear of being exposed to life’s risks. I think my one criticism of that fear is that it perhaps should be more of an across-the-board fear of bigness generally. As in “too big to fail.”

  9. amba12 said,

    The Republicans pushed through Medicare, Part D. Someone more knowledgeable please tell me to what extent that is an out-of-control government entitlement and to what extent it is a sweetheart deal for big pharma.

    The Big tend to go hand in hand like Brad and Angelina — the way celebrities marry other celebrities. Who else understands?

  10. Maxwell said,

    And that’s what’s wrong with Obamacare. It’s hidden in plain sight — in obfuscating language, in self-contradiction, in verbal and bureaucratic overkill. The medium is the message, in this case.

    Sure. But there’s nothing particularly unusual about that – as the list I linked to shows, major (and even not-so-major) legislative acts are often very long. Our healthcare system, like our education, transportation, and energy systems, is very complex and has a lot of moving parts on both the federal and state levels. Any major bill affecting any of those systems is going to be proportionately big and ungainly.

    As for Medicare Part D – here’s that rarest of birds, a thoughtful argument in favor of it. Since on paper it looked to be even more of a boondoggle than the current healthcare bill, I think that’s evidence that you never know where good outcomes are going to come from.

  11. Icepick said,

    At issue are the millions of uninsured Americans who lack primary care but can access expensive emergency room care, paid for by some combination of taxes and higher insurance premiums paid by those with health insurance.

    So, the problem isn’t that these people can’t get health care, it’s that they’re free-loaders! This is becoming like global warming – it explains everything, including things that seemingly contradict each other.

  12. amba12 said,

    major (and even not-so-major) legislative acts are often very long.

    How’s Canada get a 14-pager then??

    So you — Maxwell and Peter — think the bill might turn out to be OK and the fear of big government is hysterical? Whipped up by cunning corporate-funded propaganda? Sort of like the fear of big corporations on the other side? I really don’t mean to be snarky. That fear may indeed be irrational — and it certainly does leave us at the mercy of big organizations whose sole priority is profit — but it is also so bone-deep American.

  13. amba12 said,

    I feel as if I should take a long look at the Canadian system. It is pretty much single-payer, right? (Though other options can be opted for.) But not single-provider; most providers are private. Therefore it gets better billing than the British NHS.

  14. Peter Hoh said,

    I don’t think that corporate-funded propaganda is fueling the opposition to the current health care reform. I think the current HCR is pretty corporate-friendly.

    I think those who are bitching about the cost and scope of this bill — and the methods being used in the attempt to pass it — ought to be honest about the recent history of Medicare, Part-D, which was a huge entitlement expansion, rammed through congress with much chicanery. The key vote in the House was secured by promising a retiring congressman that his son would receive generous help with his campaign. And the chief architects of the bill left for cushy jobs with big pharma.

    Icepick, do you want hospitals turning away people based on ability to pay? As a society, we’ve decided not to do that.

  15. karen said,

    What a freaking mess- and we’ll end up w/it, too- JUST WATCH AND SEE. oooops, caps got locked.

    It’s the pork- ain’t it always(heh- no red line under ~ain’t~, my little Maeve would like that.) It has major consequences. So many things could be swallowed if the right size and w/a little spit, as opposed to this wanker of a Bill that’s to be rammed down our throats.

    Why can’t the states do it?? Why can’t each state tailor health care for their population? I mean, VT subsidizes my care, i pay a stipend, i guess you’d call it. A co-pay. According to NPR, this goes way back when some committee(look at that word, weird spelling, eh?) put price tags on care so that it was itemized and charged equally- or so i understand. Yeah, it’s complicated– so’s sex. We figure that out ok– i think we could get the gist of this, too- if the gov’t actually let us. A 300million$ Louisiana Purchase shouldn’t be part of our solution, though. Etcetc to the additional pig parts, as well.

  16. Icepick said,

    I think those who are bitching about the cost and scope of this bill — and the methods being used in the attempt to pass it — ought to be honest about the recent history of Medicare, Part-D, which was a huge entitlement expansion, rammed through congress with much chicanery.

    If you’re talking about the pols in Washington currently objecting to the HCR bill, then you’ve got a point. But a lot of the people complaining about this across the nation are none to happy with the Republicans, precisely because of things like Medicare Part D.

    Further, the problem for the small government types is that there’s nowhere to turn. The Democratic Party opposition to Medicare Part D was that it wasn’t big enough and that the wrong groups were being rewarded.

    Our choiuces don’t seem likely to improve anytime soon. This fall I will have the option of voting for that piece of shit Alan Grayson, or his Republican challenger. That challenger may well be one of the Tea Party types. That’s great. Except that if that person wins, and enough like them across the countrry win, I will get John Boehner as Speaker of the House. yipee. Given my choices, I’m not likely to bother voting this fall.

  17. Icepick said,

    Icepick, do you want hospitals turning away people based on ability to pay? As a society, we’ve decided not to do that.

    Were you playing a violin when you wrote this?

  18. Icepick said,

    Icepick, do you want hospitals turning away people based on ability to pay? As a society, we’ve decided not to do that.

    But since you asked – what I want is largely irrelevant. (Actually it’s totally irrelevant.) The current system of half-assed governmental involvement can’t be sustained. Nor could the current proposals in Congress be sustained. Eventually these systems WILL collapse. One way or another that will lead to a system in which people only get as much as they can pay for.

    You can’t get something for nothing, but the current system is designed so that a great many people seemingly get exactly that. That means someone else is having to bear the costs, either directly or indirectly, and either immediately or in the future. But eventually someone’s got to pay the bill. The longer we put that off, that larger the bill will be.

    So my questions are, Who has to pay? When? How? And for what? The current proposals pretend to answer some of these questions, but they really don’t. MANDATING a cost cut is merely a guarantee of shortages, nothing else. The nation is ill-governed, and we’re to blame for that. We’re getting what we voted for.

  19. Maxwell said,

    I go back and forth on the bill. As I’ve said before, I see Obamacare as the epitome of mushy-headed centrism. It panders to a multitude of interest groups (including, as Peter said, plenty of corporate interests), locks in a system that should probably be blown up, and does little to seriously address costs. It’s a deeply problematic piece of legislation.

    That said, I think there is ethical value in broadening coverage, and dollar value in chipping away at the employer-paid tax deduction through the so-called “Cadillac” tax. That’s one of the core problems with our healthcare systems (& correctly identified as such by John McCain). The bill does not go nearly as far as it should in this regard, but any bill that does (such as Wyden-Bennett) would be unacceptable to the public. It takes the first step, and that’s worth supporting.

    As for the fear of big government, it’s a basic and essential part of our republic. I see it as kind of like our immune system – anything that can get by it is either beneficial, or will kill us.

  20. Donna B. said,

    “As for the fear of big government, it’s a basic and essential part of our republic. I see it as kind of like our immune system – anything that can get by it is either beneficial, or will kill us.”

    And the fear factor is likely increased in those who have been “vaccinated”, though regular booster shots seem to be required. We got a major booster shot with TARP and the stimulus package. Heh… stimulus.

  21. Peter Hoh said,

    I’d like a system that put people in charge of their own health care spending, as I think that’s the best way to control costs. I have a lot of trust in open markets. The problem is that health care is not currently an open market. Hospitals don’t tell you costs up front, and when it comes to emergency or trauma care, most of us don’t care what it costs.

    Further complicating things are really expensive treatments. Take herceptin, which, according to wikipedia, can cost $70,000 for a course of treatment. Neonatal care can be tremendously expensive. Are couples supposed to wait until they have several hundred thousand in the bank in the event that their offspring need such care?

    I’ll be back with more thoughts in a bit.

  22. Peter Hoh said,

    I’ve been stuck trying to make my next point. Something about the sense that health care is an entitlement without reference to the cost, at a time when the cost of health care is taking off.

    I’m reminded of the analogy someone used comparing health care to transportation. (Wish I could give credit where it’s due.) While we accept the idea of government running some sort of transit service, we would never imagine that the government should be in the business of making sure that everyone had the same car. But with health care, we are approaching the point that we are looking towards government to make sure that everyone gets a brand new Mercedes.

    I just started reading this article.

    I won’t pretend that I know how to make the system work, but the system we’ve got is going to continue to eat up a larger slice of GDP until . . . . Until something breaks.

  23. Peter Hoh said,

    From the article cited above: Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

    Read more: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=3#ixzz0hehKx1Uc

  24. amba12 said,

    And that, Gawande says, is because the local medical culture has developed in the direction of regarding patients as profit centers and doctors as entrepreneurs. Gawande says that “who pays” is not the main issue. The main issues are whether medicine is quantitative or qualitative, and fragmented or collaborative. In some cultures, kickbacks for referrals and racking up numbers of procedures have come to predominate. In others (like the Mayo Clinic and the surrounding area in Rochester, MN), cross-specialty collaboration makes the patient the center and substitutes thinking for many tests and procedures.

    A fascinating, must-read article. Gawande recommends creating incentives, penalties, or both that will shape the practice of medicine in the direction that is both lower in cost and higher in quality!

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