Thursday, October 22, 2009

My Email to Keith Olberman

Subj: Another selling point of Medicare Part E that no one is mentioning... and Keith should

I've been a fan of this idea for a while (since Josh Marshall at talkingpointsmemo mentioned it), but I think many who are promoting this as "Medicare for everyone" are missing a massively powerful selling point that could push the debate and get us over the finish line.

It's this: it could save medicare.

Everyone loves medicare, or has to pretend to (if they are on the right). The only negative with medicare is that it's running out of money. Why?

Basically because it only allows those over 65 to participate. This is actually a bad idea; ask any private insurance company if they'd like to limit their customers only to those most likely to get sick. As an actuarial issue, it's pretty bad business.

By allowing younger people to "buy in" to medicare, we would fund the program via people who, statistically, are less likely to have expensive medical issues.

Save medicare! There's a selling point for ya. Why aren't Pelosi and her caucus promoting this aspect of medicare part e?

I guess because Keith has not mentioned it on Countdown yet. :) I think he should.
Scott L. Bain
skype: slbain9000

Friday, October 9, 2009

The Dividing Line

How big should the goverment be, and how deeply should it reach into our lives?

The extremes are, on the one hand, a goverment "so small you could drown it in a bathtub" (Grover Norquist) which is, was, and will likely be the goal of the neo-cons that dominated the Bush era.  In Thomas Franks' recent book The Wrecking Crew, he took this notion to the nth degree, and makes a fairly decent argument along these lines:  The Bush administration was not a failure, it was a success in that its real goal was to destroy the federal government.

On the other hand, we are told, the progressives believe that the answer to every problem is more taxation and centralized spending, and that this will inexorably lead to the socialist state with an enormous central government controlling the economy, health, commerce, travel, education and basically everything else.

It's been suggested by many (Thomas Jefferson among them) that the goverment should do for the people exactly those things (and only those things) that the people cannot do for themselves.  Whereas I agree that this is a seemingly reasonable dividing line between public and private concerns, what is often left out of the equation is that this measurement must be re-evaluated in the light of modern life.

For example, the widespread access to sophisitcated digital technology has certainly made people able to do certain things for themselves that they could never have done in the past.  On the other hand, there are problems now that individuals can do little to ameliorate on their own, which in the past didn't even exist: Global Warming comes to mind.

Also, we can share the burden on a problem without placing it in the hands of the government.  Fraternal organizations, mutual insurance, and organized religion are but a few examples.

I think the real question is separate from the government itself.  The government, after all, is a creation, not a natural force.  So, I'd say the evaluation we need to make, and remake as each age changes the forces in our lives, is what things we think we can do alone, and what things we must come together to accomplish.

To place this in the context of the current debate, where do we think Health Care fits?

Monday, October 5, 2009

The Right to Health

There is much to be said for "the public option" in healthcare reform, though I suppose nobody has said it better or more convincingly than Paul Krugman recently did in the New York Times.

Still, I wonder if the real argument is not being made openly here.  Perhaps the real question is... should corporations be making a profit on people's health in the first place?

The notion of a mandated system, where you have to buy in whether you like it or not, is analagous to the system of car insurance.  Want to drive?  Be responsible and insure yourself and your car.  Don't want insurance?  Take public transportation.

If we take note that this really only works because there *is* public transportation, we get the point.  You can opt out because there is an option here.

You cannot decide not to "have health" or heath problems.  Well, I guess you can, but suicide is still illegal.  Since you have to deal with your health, then one cannot treat this like a personal choice (like, say, smoking).  The need for a "public transportation" option in order to mandate car insurance is even more sharply needed for health care if we're going to mandate health insurance.

"...and that among these rights are life, liberty, and the pursuit of happiness"... includes life.  Nobody is able to hold me up to their profit motive to ensure my liberty, why should they be able to in order for me to keep my life?

If life is a right, then health is a right.  Let's get the profit motive out of it entirely.  Let doctors and nurses and medical techs make a good living, certainly, but no market participation in this, the most basic human need.

People will say that the public option is just a step toward single payer.  Maybe.  Maybe a needed step.

Sunday, September 6, 2009

Healthcare: Two Birds With One Speech

On, Josh Marshall made a very good point: Obama needs to attach "the public option" to medicare, because no politician in his or her right mind would attack medicare.

The easiest way to do that?  Make medicare the public option.

It's a deceptively simple idea.  Tell those who are under 65 that they can, if they wish (no mandate here), buy into the medicare system.  Once they reach 65 they would be covered as seniors are now.  They can buy private insurance if they want, but entering medicare early would be an option too.

Why is this a good idea?
  1. It's easy to sell.  Everyone loves medicare, or at least is unwilling to admit that they don't.
  2. It's not "creating a new program", it is extending an existing one.
  3. Medicare is a great success with one exception: it is in real financial danger.  Could this also save medicare?
Ask any public insurance executive what one does when there are money problems.  He'll tell you, you must raise rates, or cut benefits, or expand the number of people insured (spread the risk more broadly). 

Medicare, as currently configured, only admits those over 65.  I think it is safe to assume that older folks are more prone to illness.  Allowing younger people in would increase the pool, bring in funds (remember, the young have to pay for medicare), and change the actuarial balance to include those who are less likely to become ill.  That's how you run an insurance company.

There are some moving parts and details to deal with, such as letting the poor in for a a reduced cost (or even free), reforming aspects of insurance that are a problem in and of themselves (pre-existing conditions, portability, etc...) but these reforms would simply apply to medicare exactly as they apply to private insurance.

The right will argue that employers will move their employees to medicare due to the cost saving, and this will drive private insurance out of business.  True, unless private insurers provide a better service for less.  Are we saying they cannot, that private enterprise cannot compete with a government-run program?  Hm.  That does not sound very capitalist at all, does it?

Extended medicare by making it a volutary buy-in for those who want it would seem to be easier to explain, defend, and implement than either a separate public option, or the establishing of "co-ops".  I think Marshall may be right; that this is what Obama should propose.

Friday, September 4, 2009

The Filibuster

I remember when I was a child, and "Mr. Smith Goes to Washington" was on T.V. one evening. I liked Jimmy Stewart (because I liked "Harvey") and so I watched it. They got to the scene where he conducts a filibuster, and I didn't understand what was going on. He just talked and talked for hours on end, losing his voice, getting tired... it was dramatic, but weird.

My mother explained it. Senators can, if they want to, simply keep talking forever and keep other people from voting on things. They do this when they would otherwise lose the vote.

I remember how amazed I was. It seemed like something schoolkids would do... "I'm gonna hold my breath 'til I turn blue" sort of thing. I could not believe adults did this, especially adults in the government.

I recently read that, in 1975, the Senate decided to allow for filibusters without anyone actually doing the continuous-talking thing. A senator just says he wants to filibuster, and the issue is set aside so the senate can get to other things. It's a filibuster without a filibuster.

It feels like the schoolyard again. "Hey gang, let's pretend that I talked forever. You be the other guys..." How in the world did this ever get started?

Looking around the internet, the argument seems to be threefold: 
  1. The Senate is meant to be a collegial, deliberative body, where everyone acts in the best interest of the body overall.
  2. The process is meant to be open-ended, to ensure that legislation is adequately thought-out before it is presented to the president.
  3. The filibuster is one tool to prevent "the tyranny of the majority", to ensure that minority points of view are represented and not steam-rolled by the majority.
I think point #1 has been essentially destroyed by our polarized political system, and also by the fact that political campaigns are so expensive now (courting big money into the process). Senators now represent monied interests, or they don't get reelected very often.

Point #2 was always meant to be "within reasonable limits" which is why the rest of the senate can vote to end debate (called a "cloture motion") with a 60-vote supermajority. I really do not believe that "open-ended" was ever meant to be used as "forever, until you submit to my point".

Point #3 makes me wonder where the judicial branch fits in. If the minority feels that the majority is forcing their will in an inappropriate way, they have the courts to argue this. If they simply feel they've been outvoted, well... welcome to democracy and sit down.

Can the filibuster be destroyed? Yes, it turns out. With a procedural vote of 51, the senate can vote to make it illegal. Why don't they do this?

First, the party in power is afraid they won't be able to do it when they are out of power. That seems obvious. What's less obvious is that the party in power wants to be able to continue to use the "we need 60 votes, really" idea as a fund-raising tool, even after they have achieved a majority.

This is absurd. We need to pressure our senators to get rid of the filibuster.

Also, senators should not be allowed to cut in line, put gum under their desks, or draw comics in the margins of their legislature. Those who do should have to wear the pointy hat and sit in the corner, or write "I will conduct myself as an actual statesman" 100 times on the blackboard.


"Socialized Medicine"

Part of the health care debate we're embroiled in right now centers around whether and to what degree we should have the government involved in our health care. There are many who would (and do) connect the notion of government involvement with "socialized medicine", which, of course, is a bad word in our country.

Let's redefine the term a bit. I think the term "socialized medicine" should mean any form of medical care that is paid for and furnished by the society one is a member of. Government is one form of this, but insurance is another.

The notion of insurance comes from the concept of shared risk. I may or may not get sick, you may or may not get sick, let's create a pool of money to cover whichever one of us gets sick. I agree that I'll help you, you agree that you'll help me. The money will go to the one that needs it. This seems inherently socialistic to me.

From those that have, to those that need. Kind of the definition of the thing.

The main concern that conservatives have about the notion of a socialistic approach (to anything) is the inherent tyranny of the bureaucracy that social systems depend upon. The government, they say, will muck it up, create inefficiency, waste money, cause rationing, create arbitrary restrictions, etc...

Seems likely. Unfortunately, we have all those problems already. Insurance companies can deny coverage for whatever reasons they decide, and you have no voice (and in most markets, very little option to go to another provider). The insurance companies spend vast amounts of money on advertising, lobbying, etc... which does not help me, as the insured, to be more healthy... this is waste, from my POV.

Rationing? Any time you have a limited resource and an uncontrollable need (there are only so many health resources, we cannot control how many people get sick), the resource will be rationed, in some way. Right now it is rationed by the fact that some people cannot afford health insurance.

So... I think the "socialized medicine" boogeyman is bogus (or, I guess Boogus) because we have socialized medicine now. It's just a question of who controls it.

So, now we get to the notion of "the public option". The right wing says two things about it:

1) The government is terrible at running things. It will mess up any public program.
2) It will create competition that will drive private insurance out of business.

You cannot have it both ways. Either the public option will be terrible (in which case people will not take it) or it will be good (in which case it will provide competition for the private options). Are we saying competition is a bad thing? That seems rather un-American to me.

The truth is, the private insurance companies don't want competition, and they have paid for many a senator to fight this fight for them. It has nothing to do with socialized medicine, it has to do with money. Lots and lots and lots of money.