Thursday, September 17, 2009

Reforming Healthcare - and smashing some idols

A few remarks on zona healthcare

1. The teabaggers, like anti-war demonstrators, are discovering that numbers aren’t headlines. The rush of the street, the vast numbers one imagines oneself to be part of, are dispatched the next day on page A-2 if you are lucky. There’s nothing like the power of not seeing what is in front of your nose – and that is the power of the metro newspaper. Condolences.

2. I’d have more sympathy with this group if, in fact, they had turned out in the street in large numbers long, long ago. Turned out to protest the Bush tax cuts that destroyed the surplus. Turned out to protest the literal trillions spent on a fraudulent global war against terror. The behemoth of those trillions did not even give birth to the little mouselet of destroying al qaeda, which would have been childishly easy to do in late 2001. Turned out to protest the largest hike in medicare spending ever passed, which happened, of course, in 2003 with the passage of Bush’s gift to BigPharma, the pill bill. One should recall that the enormous expenditures were added to government spending on top of enormous tax decreases.

3. So, in general, the teabag crowd is hypocritical and blindly selfish. But the liberal meme that these are ignorant bigots won’t wash. Instead, these are people who feel, rightly, that they have lost symbolic power in this country. Their habit of bashing the government and enjoying the benefits of government spending lends their message its special ductus: spend the money on me.

4. The message, in other words, is all about the Soviet-like decay of the system. The teabaggers, past beneficiaries of a system that is broke, can’t believe the system broke. This is an utterly predictable response.

5. However, the liberal response to the Obama administration’s continuation of Bush policies is more puzzling. The Pentagon gravy train is chugging away at 750-850 billion per, with no handwringing on my side. That is easily 650 to 750 billion dollars too much.

More importantly, liberals, looking at the absolute horror of the Wellpoint-Baucus bill, should be asking, how did we get here.

The old answer was that the single payer was politically untenable. The new answer is that the public option is politically untenable. And the sum total of the answers is: Dems have no intention of “reforming” the health care system. From Obama’s astonishing willingness to keep the old Bush rule of paying ransom prices for pharmaceuticals to BigPharma to the dropping of the public option by Baucus to rigging the public option with the deadweight of provisions to make sure it doesn’t compete with private insurance providers, I’m not sure what is more delusional: the belief Obama is a radical Marxist, or the belief that Obama is a progressive.

6. So, we are given another solution that isn’t a solution. By the team that took over and made its own Paulson’s TARP.

7. The problem needs to be stated over and over again. The U.S. health system is the most costly in the world, and – for all that spending – has the least social scope of any of the major developed economies. It is absurdly expensive and absurdly insufficient. To spend hundreds of billions of dollars more than other countries, and to cover less, could only be accomplished by a very special beast.

8. The reform doesn’t slay the beast. It puts a collar on it.

9. When Obama said, in the presidential debates, that healthcare was a right, not a privilege, he lifted the doubts from my heart. At the moment, he has been piling them back on. The NYT obit of the public option cited a Republican sponsored study that showed that the public option could garner up to 100 million clients. For the Republicans, this showed how bad the public option is. For those whose heads are not up their assholes, this showed that the public option would be, like the post office, one of the most popular government programs ever.

10. Designing a government program that does not compete with – and kick the ass of – private insurers is the sure route to inefficiency and failure. As for the mandate hatched by Wellpoint and Baucus, what can one say? The vileness of the scheme, which exists to shuttle even more money into the hands of private insurers, is in competition with the laughability of the scheme, which essentially raises the taxes (which is what an enforced enrollment in a private insurance program would be) on the middle class to a level not seen since, well, the level on the rich in the pre-Reagan days. This is happening as we have the new reports showing zippo income growth over the last nine years in the median household, and astonishing Golcondas going to the upper 1 percent.
11. A Fanny Healthcare – a government backed entity to which anybody could transfer their current insurance for a cheaper one - is the necessary first step towards shrinking the amount the U.S. pays on a per capita basis for healthcare.
12. The right has made the point, over and over again, that socialized healthcare leads to longer waiting times. And, in one respect, they are right. Waiting times as they are measured now, say by Merrit Hawkins, extend from the time one contacts the healthcare provider to the appointment. The Merrit Hawkins survey showed that when Massachussetts put in place a universal healthcare scheme, waiting times shot up. Why? This is where the right falls silent. The why is because waiting times as measured by MH are a subset of all waiting times. Those who don’t have insurance or who have coverage with a heavy deductible simply don’t call up doctors to make appointments, unless they have to. They try to tough it out. But in a system in which they have coverage, they will make those appointments. In other words, demand shoots up. And given that the supply is stable, what gives is the wait time.
13. This is pretty obvious. Or it should be. On the one hand, the right is actually defending one of the feature of the system that doesn’t extend to everybody – your middle class patient actually benefits from this. That defense could be called, I’ve got mine, Jack, and you can bleed to death. On the other hand, liberals have shut their eyes to the fact that reforming the system will dramatically increase demand. A good healthcare reform would aim at increasing healthcare supply – one way being increasing the number of healthcare providers. We should cut a nice fifty billion per year from the Pentagon budget and devote it to scholarships for medical and nursing students. And we should have a major discussion about what primary care providers do that can be done by trained nurses.
14. We won’t have that discussion. It is easy to see that Dem legislators are influenced by the greedymen of K street – but their actions are partly motivated by the fact that covering the uninsured is not necessarily a votecatcher. Not only are there more overlaps between the uninsured and the non-voting, but the voters are going to be shocked by the increase in waiting times. This is why it is crucial that those voters are given a good, public option, as a tradeoff for universal coverage. Otherwise, universal coverage will fade - it will be successfully subject too vilification and become a welfare-like entity, ringing the neck of liberals.

15. Bus we won’t have this discussion, as I say. Politics at the moment is not only full of hate, but the hate has crowded out reality. The hatred exists for itself. Opinions are adopted not on their own merits, but to “get” the other side. This is the kind of factionalism that happens in old, decaying empires. The American Imperium is dying.


Anonymous said...


followed your link here
should have done so long ago
but i'm
a narrow if zig zag path type


ps you and i oughta exchange views on clintonomics

Roger Gathmann said...

Well, Mr. P., my view is that clintonomics is dead, so the argument is between dissectors of the beast. But my view of the state of the nation between 92 to 2000 changed as I had this decade to compare it to.

Looking at Clinton doing two things - whacking down war expenditures and patiently applying measures that make sense from the point of view that governance always has to be prepared for business cycles - I am more impressed. Anne has driven home some good points.

Anonymous said...

"whacking down war expenditures"

not really all that impressively
what was the expenditure ratio between us and say russia plus china plus iran in 93 vs 00 ??

i suspect you are NOT a human rights interventionist no ???

so why laud a simple benign neglect of the weapons sector ??
better ttoppling a rogue state
then to constrict it ???

of course with two parties
we can get both !!!!

"patiently applying measures that make sense from the point of view that governance always has to be prepared for business cycles "

not sure i follow this

but my macro in 93 would have looked like bill vickrey's

i guess if one
chronic deficit dread syndrome
i can understand the parlor trick of budget surplusing
might look slick

after all
99% of thinking americans
are sure we're eating our seed corn every dollar uncle borrows for transfer from closed wallets
to open mouths

following her fallen icon
bondage bobby rubin
suggests the low interest rate helps to account for the tech investment boom

i don't
and i submit that rates were far lower under bush II
and investment sucked
in fact i suggest interest rates have no relationship to investment decisions about plant and equipment

or even sky scrapers

the safe rate of interest and the ground rent buried in mortgages and property taxes
are operating system neutral

the steady demand accomodating
flow of real bank and security market credit however ...
now that's serious bidnezz
as the effect of recent heavy run of hiccups on the global production system and trade shows

clintonomics was well obamanomics
in boom years
the diff from bushite policy ???

i don't think if folks could transfer from one universe to the other
too many folks would dance
in the streets over the difference it would make in their own lives
the top 1%
and the bottom 13%

share this affliction

Roger Gathmann said...

Well, I'm comparing Clinton to the other American pres's as far as war expenditures are concerned. This is, of course, one of the ways the gov. touches the economy, and it certainly worked in the Eisenhower to Nixon era. And it had a second coming in the Reagan era. So a decade of growth without a decade of military spending growth is definitely not the American norm.

I didn't think I was being mysterious about the counter-cyclical thing. By raising taxes at the beginning of the boom, which is what Clinton did, the government, among other things, gave itself an edge for the downturn in the business cycle. That edge was, of course screwed up by Bush. Bush style governance was also out of the norm - abnormally bad - but in essence, the policymakers acted as though there was no such thing as a business cycle.

Now, I'm not one to say, well, x held down interest rates over this period, and y held them down over this period, and you had two different outcomes, thus it couldn't make that much difference. You have to look at the composition of economic activity in each period, surely, Mr. P. And yes, I think the tech boom was structurally distinct from the housing boom, because I think the tech boom directly raised median incomes, where the housing boom did not. Both benefited from low interest rates, but it seems to me that you want some things to benefit from low interest rates, and you don't want other things to. I'd have to find my copy of Jamie Galbraith's The Predator State to find the more complex analysis of this point, but it is one J.G. makes.
This isn't to say I think we couldn't have done much better than we did with Clinton. In 1998, Clinton should have regrouped and taken up the proposals he lost in 1993, especially health care, and crammed them down the Republican congress' throat. They would have rejected Clinton's plan, no doubt, but I believe they would have been trapped in that rejection.

Etc. I could come up with a whole alternative history, but it would be peopled by fictions. If you accept the neo-liberal economic order, as Clinton did, than he certain did an excellent job of carving out the liberal niche within it. If you reject it, as I do, then you'd like to see, in the ruins of that order, liberalism return to the projects it once had.

You know, I voted against Clinton once and Gore once. I don't regret the 1996 vote. I wish I had voted for someone besides Nader in 2000 - I think of that man as a wrecker, now. But I lived in Texas, and could vote for Tinkerbell if I wanted, since Bush was going to carry the state even if Jehovah appeared in the Panhandle and threatened the shitkickers with plague. And we live in a semi-democracy where we continue to drag an electoral college behind us. But I expect that one now can look at the nieties with some objectivity - not for what might have been if Jesus had been president, but in light of the opportunities that were offered.

Anonymous said...

"If you accept the neo-liberal economic order, as Clinton did, than he certain did an excellent job of carving out the liberal niche within it."

i agree but then the neoglibs ought not be the core of dembot political economy

as to interest rates
maybe i wasn't clear enough

low or high interest rates had nothing to do with the tech boom
in real investments

the credit constraint on households ..income to debt service ratios
made the lower rate important
in the lot boom of the bush years
that rates in the 90's ..never so low by the way

i'll get pedantic on this

ike lite clintonomics was just lucky timeing
and a hideously missed opportunity
like obama may be into also

though one can hope for a ground level wake up fire wave across the nation

we'll see
he seems capable of stuff
like lincoln he has a soul

billary ???

pure rubber made