Time for Obama to Get Serious
Half measures are boring.
That political reality derailed Bill Clinton’s 1993 healthcare reform plan. And it will likely unravel that of Barack Obama.
The non-partisan Congressional Budget Office finds that Obama’s plan, sponsored by Senators Chris Dodd and Ted Kennedy, “would reduce the number of uninsured only by a net 16 million people. Even if the bill became law, the budget office said, 36 million people would remain uninsured in 2017,” reported The New York Times. Yet it would cost at least $1 trillion over ten years.
Americans like Obama’s basic idea: “Seventy-two percent of those questioned [in the latest Times/CBS News poll] supported a government-administered insurance plan–something like Medicare for those under 65–that would compete for customers with private insurers. Twenty percent said they were opposed.” The support is broad. But it isn’t deep.
“Pay higher taxes for a healthcare plan that probably won’t help you personally, even if you’re uninsured” isn’t much of a sales pitch. No one is going to call their Congressman, much less march in the streets, to demand action for a half-measure–or, in this case, a quarter-measure. Without public pressure to push back against drug and insurance company lobbyists, nothing will change.
Like every mainstream Democrat since Jimmy Carter, Obama is a militant moderate, elevating triangulation and compromise-for-its-own-sake to the status of Holy Writ. But radical problems–and the state of healthcare in America surely qualifies–require radical solutions.
More than that, simplicity sells. French- or U.K.-style socialized medicine–everyone covered, every doctor’s visit free, every pill free, every doctor a government employee–might indeed cost three times more than Obama’s incomprehensibly vague, vaguely incomprehensible proposal. But it’s easy to understand. Moreover, as James D. Miller notes in his book “Game Theory at Work,” people crave certainty:
“What would you rather have: 1) $100,000 or 2) a 50 percent chance of getting $200,000 and a 50 percent chance of getting nothing? Both choices give you on average $100,000. The majority…would prefer the first choice: the sure thing. Most people dislike risk, which is why so many of us buy insurance.”
When we can afford it.
When citizens evaluate a political proposal, the first thing they ask themselves is: what’s in it for me? Thus the appeal of a gimmick like George W. Bush’s $300 tax rebate checks. No one seriously believed they would stimulate the economy. But hey, three hundred bucks is three hundred bucks.
Right out of the gate, Obama’s “public option” plan tells the public that there’s probably only one thing in it for them: higher taxes. Most Americans do have insurance. They don’t like their deny-deny-deny insurance companies, but there’s nothing for them in the Obama-Dodd-Kennedy proposal. Some Democrats have even floated the idea of taxing health benefits!
At least 47 million Americans have no insurance. And that number is going up fast. But the CBO says only one of out of four of people without insurance would be helped by Obama’s “public option.” The rest would pay higher taxes–and still remain uninsured. Why should they get excited about The Return of Hillarycare?
As president-elect, Obama said he planned to “keep [his] finger on the pulse” of the American people. “One of the worst things I think that could happen to a president is losing touch with what people are going through day to day,” he said. But it is painfully clear that “the bubble that exists around the president” has already enveloped him.
There is no true middle ground on healthcare. The most civilized and efficient approach, tried and tested by the rest of the industrialized world, is fully socialized medicine. Put the insurance vampires out of business. Cutting out the health profiteers and encouraging preventative care will save hundreds of billions of dollars a year.
Failing a comprehensive solution, let the free market reign. True, 20,000 Americans will continue to die each year due to lack of insurance. But private healthcare corporations will continue to invest in innovative treatments and medications. The city of Hartford will keep adding shiny new skyscrapers to its skyline–and our taxes won’t go even higher over this issue.
Obamacare offers the worst of both worlds–it would be expensive and inadequate.
COPYRIGHT 2009 TED RALL
21 Comments.
The CBS News/NYT poll you reference is highly skewed. Of the 73% of respondents who said they voted in 2008 only 34% voted for McCain and 66% for Obama. The actual vote was 48% McCain. 40% of Americans consider themselves conservative, vs 21% who consider themselves liberal.
Let the free market reign? I'm tapping out. Rall has lost his mind.
Your system does make we europeans shake our heads with bewilderment,the cruelty of denying your own citizens health care is typically American,but your country is built on making money so you are being consistent.We do pay for pills by the way,unless you are unemployed, over 60 or a child.Stay healthy.Regards.
That was one of the most lucid, well-written opinions on healthcare I've ever read. Yet I fully expect you to return to frothing at the mouth and shouting incoherently in the near future. Hopefully I'm wrong.
Obama's plan is doomed, even if he somehow pushes it through. A compromise always leaves everyone unhappy. If the democrats can't propose a REAL healthcare plan now, then I doubt they ever will.
I recently returned from living in Japan, where I experienced first-hand the horrors of socialized medicine:
*Limited choices – When I got sick, my coverage was limited to all the doctors in Japan.
*Stacks of paperwork – The first time I went to the doctor, I had to fill out a whole one-page form.
*Skyrocketing healthcare costs – When my mother was visiting and had to stay a night in the hospital without insurance, we had to self-pay. The stay, the food, the drugs, the nursing, the doctors exams… it all adds up, and just about broke us at $340 total.
so what am i missing on the math here? you keep saying the obama plan will cover 1 in 4, calling it a "quarter-measure," etc. but the numbers you give– 47 million uninsured, 16 million potentially covered by obushma's plan– indicate a one in THREE ratio. that still sucks, obviously, but one in three is quite a bit different from one in four, and i know you were a physics major, so you must be good at math, right..? so that's why i ask, what am i missing? i don't get the 1 in 4 thing, at least not based on the numbers you've quoted.
There are other things about health care that are not being dealt with, which make healthcare more expensive:
1) Medication is grotesquely overpriced. Break the monopoly of the pharmaceutical companies.
2) Medical supplies are also overpriced. They should only cost the money it takes to put the items together and ship them to the hospital.
That should lower the cost of healthcare just by itself, if these two measures where taken.
Lucid, pithy, amusing — a great column! Thanks!
Contributions through PAC's or just contributions have to go. These legal bribes are killing us (20,000 each year, apparently).
Like the current banking crisis brought on by repealing Glass-Steagall. Remember the 100,000's protesting in D.C. to end that? Me neither.
If we were to have a million demonstrators in D.C. asking for the health care of a poorer country like Finland, they would still say "we" can't afford it–"we" have other priorities.
One word: Guillotines!
Much ado about nothing.
Gotta agree with Mr Rall 100% on this one, there's definitely no sure thing – no single payer, no public option, no plan, period.
Capitalism can't allow it, won't allow it, and is currently tossing millions at stunting another of Obama's grand illusions, not that he was ever on the right track to begin with.
Universal coverage was not only an unachievable first choice, it wasn't even a close second. No matter how they fashion the language, they still get the same duck.
This administration's course continues down its winding, circuitous path along the path of least resistance – a milk toast excuse for governance, let alone a radical 'change' in governing. The healthcare package is just another bag of magical rocks headed for the bottom next to human rights, the environment and an end to war.
I love the guy, enjoy listening to him talk, and he can talk, but I've come to realize there ain't gonna be no 'change', not any significant change, just the fair to middling repackaging of the status quo, new covers on the Bush comics, and a whole lot more of that seductive BamaSpeak we'll be hearing for the next few years.
Still do love to hear him talk.
I am always curious about the overpriced pharma questions especially regarding generics vs new medicines. I am actually VP of R&D for a Drug company (small one, not a massive multinational). Our team for our one single drug consists of 23 PhD's, 11 lab techs, 12 outside MD consultants runnign a phase 2 clinical study at four centers each patient costing us 14,000 dollars out of a required 115 patient enrollment for just this phase of the clinical study. We don't want to do this but have to for FDA approval which has cost us about 540,000 dollars in filing fees to date. We still have another four to five years to complete the phase 2 and then phase 3 study which is even more expansive. All total our drug which is a cheap development process is going to come to about 80 million give or take for something that treats psoriasis. How exactly does this get paid for since all of that money had to be put up front only on the chance that it will gain approval and safety. It's a monopoly but GMP manufacturing, good clinical practice and regulatory approval are an unbelievable expense for a tube of cream to treat a skin disorder but there is no way to skip this or the public suffers. I look every day at how to do this cheaper because it would help me and my investors greatly but costs are costs. One model could be government sponsored R&D but we technically have that with the NIH which does a spectacular job with the basics but a terrible one with the commercialization. I guess the system is broken in the same way the arizona desert is broken with a big canyon but how do you fill in the hole without losing the landmark?
Tort reform is needed. The big bucks game of suing for malpractice is driving up costs, especially in the areas of obstetrics and gynecology. Doctors have been closing up office since around '01-'02.
As far as socialized medicine, whoever above mentioned the routine visits, those are not the dire concern. Routine visits would be… routine. It's the serious illnesses, the ongoing or costly procedures, the rationing of preventative care. It's BUREAUCRATS and office workers deciding who is worthy of treatment.
If you're 55, 70 or 80 and need chemo, radiation or CT scans, that's where you hear the complaints to this very faux coverage-for-all description, which is both deceptive and misleading.
Also, Dianne Feinstein (of all people) just said that she doesn't want HC reform to become a state burden, as planned, within 5 years' time. That's the plan: Federal funding will eventually dovetail into state-funded support. Seeing how our states are not that healthy revenue-wise, outside of Alaska and Texas… well. It's rare when Feinstein makes a comment that all political persuasions can agree with.
I ask for tort reform at the very least and definitely before any office worker with no medical training decides my family's health needs. Rationing will become part of the solution. Couldn't keep costs down without it.
There's a lot of misinformation about what's wrong with our healthcare system.
Pharmaceutical companies aren't making profits that are out of line with other commercial ventures. It costs a billion dollars to bring a drug to market, and these companies must make money for the investors who make it possible. It sucks that some people cannot afford to benefit from these innovations, but treatments wouldn't exist at all if not for the profit motive. The mail-order prescription houses that Medicare Pt. D and private prescription plans deal with are much more blameworthy. They charge an outrageous markup, add no value, and the Government cannot negotiate with them by law. As far as I can remember, these companies didn't even exist before Great Leader instituted Medicare Pt. D.
Also, no one asks why are hospitals are overpriced? Simple answer, because they can be. A market system relies on actors having bargaining power. You're not going to drive a shrewd bargain when you are dizzy and have chest pain. In fact, you'd pay your life savings to someone who can help you out of that situation. Happy coincidence that that is exactly what hospitals charge. They may say that they're taking care the insured with that money, but that's just a tiny fraction. Non-profit just means that executives and board members don't have to split the excess with stock holders. We have some of the richest people in our society robbing us blind and blaming the theft on the poorest. That's truly disgusting.
Finally, we have insurance companies effectively making medical decisions by withholding payment. Why aren't the CEO's arrested and they're employers shut down? Why aren't they at least sued for millions when someone suffers unnecessarily from their actions? Because there is a law that protects insurance companies from such lawsuits. You can only sue a health insurance company to recoup the cost of a procedure that has already been performed. Good luck getting that done without a pre-cert.
Socialized medicine scares me. I wouldn't particularly mind a Canadian or European system, but an American system will be a frightening prospect. The issue is not that people are being overcharged for healthcare and going without. They have been for years. We're only getting serious about "socializing" the system now that honest people can no longer afford the rates to which hospitals and insurance companies feel entitled. We need to give them tax money now, or God forbid, market forces may start to contain costs.
I think we can live with 2009 era medicines for a little while.
R&D should be frozen until everyone is covered.
At that point, we will get cures for common illnesses the same way we got to the moon. Tons and tons of government money and academic research.
This stuff about how a government plan allows bureaucrats to decide what coverage we get drives me nuts. Who do you think decides it now?
My brother-in-law's cancer treatment was delayed (probably fatally) by the insurance company denying his treatment (the one the doctors ordered). After a lengthy appeals process, the insurance company relented.
My eldest son was born with a protein intolerance. He needed an amino-acid based formula to survive while his digestive system matured (otherwise he would slowly starve to death). It cost about $200/week. The doctor showed us the arbitration agreement whereby the insurance company had said they would cover this formula for this condition (when someone had sued them earlier for coverage). They didn't cover it for us. We fought for months to get them to. They claimed they never received our claim forms (we sent them certified mail and had signed receipts proving they were lying). They delayed, they fought. We called literally every business day for months. Finally, they paid us partial reimbursement. We contacted the insurance commission in Maine, where we live. The people there told us the most the insurance company could be penalized was to pay what they should have paid in the first place. No punitive damages at all could be levied.
So don't tell me that bureaucrats don't currently ration our health care. And these bureaucrats have a profit motive to deny us the coverage we and our employers have paid for.
1. How do we address those who are hyperactive in using the system for very silly or highly cosmetic treatments?
2. Who will question the food industries who are in the first place causing all sorts of miseries by their highly processed edible junks?
We human being are considered as recycling machines by eating junk – burning them out (if one can) – get sick and pay life.
Universal Health care or not, we have to stop ourselves being pushed around by the evil food industries.
Even after all the miserable health care options we have, we have not revolted against the politics of science and food industries' capitalism, who will save us?
Stay healthy or die
Anon 6/25/09 11:10 AM,
Who are you going to call or sue when the government is screwing up your healthcare?
When we went to the moon, they were afraid the whole surface might be quicksand.
We still went.
I say "we" because we are still paying for it.
If only Michael Jackson could've had Obamacare.
"What would you rather have: 1) $100,000 or 2) a 50 percent chance of getting $200,000 and a 50 percent chance of getting nothing? Both choices give you on average $100,000. The majority…would prefer the first choice: the sure thing. Most people dislike risk, which is why so many of us buy insurance."
This is a perfectly rational decision for anybody who doesn't already have millions of dollars lying around. The first $5000 solves immediate problems you already have. The next $50,000 solves all your problems for the next year or two. The $45,000 after that is just gravy. Throwing it all away and getting your original problems back for a hypothetical shot at more gravy would be stupid.
How do we address those who are hyperactive in using the system for very silly or highly cosmetic treatments?
Same way we do now. We state what we will and will not pay for. How do we address those asking distracting questions that obscure the issue?
Who are you going to call or sue when the government is screwing up your healthcare?
The government. Seriously, wtf? People sue the government all the damn time.
And “disliking” risk isn’t the issue. Not all risk is acceptable. If I gave you a garaunteed chance at $1k, or a 50% chance to get $5k and a 50% chance of death, you’d be an idiot to take the risky option. When large sums of money are concernend, bankruptcy or failure can mean complete devastation of one’s life or actual death, so the idea that people are “risk adverse” is simply pure stupidity. People understand that losing big costs more than mere money. Further, garaunteed income can be built upon, borrowed agains, and relied upon when planning. You can’t move and take a new job with the expectation that the transition costs are “50%” covered by some gamble. It is perfectly rational and often wise to pay a premium for certainty and reliability. That’s the whole reason why we have the FDA in the first place: we pay a tax for reliability in food and drug products. (We don’t get it, but it’s not because the idea doesn’t work, but because our leaders don’t work.)