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.