Tag Archives: Reform

Down With Earmarks!

Well, the Republicans and Tea Party Activists have laid down their marker for the next session, and it appears to be the abolishment of the much-balleyhooed earmarks from Federal legislation. Mitch McConnell, after first requesting a billion dollars in pork for his state, then opposing the “earmark reform” efforts, now seems to be bowing to the pressure and supporting it.

Only problem is: earmarks only define the way in which money gets spent when a budget gets passed. They don’t actually spend money nor create the expenditures. Its just a way of allowing Congressmen to accept a bill by assuring them that a little bit of that pork barrel spending – if such is the term your most comfortable using – gets “earmarked” for them and their district.

Oh, and the earmarks only represent about 11 billion dollars. Which sounds like a lot, unless you consider the fact that that 11 billion dollars represents less than ten percent of discretionary spending in the federal budget, which itself is about 38% of the total budget. Don’t get out your calculator, I’ll save you the trouble. They’re going to change Washington by adjusting the way 3 percent of the budget gets spent – without actually cutting it.

Supporters of the ban will say that three percent is a good chunk of money. And I agree. But Democrats learned a hard lesson in the last two years, which is that in a bad economy, the American people have very little patience or good-will for the incumbent party. Mitch McConnell may indeed have opposed the earmark reform on the basis of his own personal pork barrel spending. But as a veteran of Washington, he just as likely opposed it for what it is: a complete waste of time.

Jon Greenbaum Compares Sicko and the Senate Bill

So, how well or poorly do the House and Senate bills on health care reform match up to the clarion call of this decade, Sicko? Jon Greenbaum does an excellent job of sizing it up for you by comparing each case study from the movie to what the bill has to offer:

Would the House and Senate proposals address the problems raised in SiCKO? | Chant Down Babylon.

By and large, while the bill is no peach for us Progressives, the fact is that it does address a lot of the endemic problems associated with the insurance-based system we have. My concern is that, if we lose the public option as a means to control costs, forcing insurers to insure those they previously dumped from their roles will only serve to add an excelerant to the already escalating costs of health care.

The D&C Sez: Brutus is an Honerable Man

The D&C opinion page has decided to go Pollyanna with its descriptions of town hall meetings happening here and across the country. While insisting how important it is that politicians do more of these types of meetings, they describe the Eric Massa town hall as follows:

More than 500 people questioned Massa for two hours outside the Mendon Community Center last Thursday night. The meeting felt Lincoln-esque in its nature, with citizens gathered in a circle around Massa. Most behaved with respect, although a few people shouted now and then.

Wow. Sounds like a splendid ice cream social. But the story I’ve gotten from those who are there is that, to start, the crowd was at least three to four times the size of a normal crowd. The people running the meeting went the extra mile to accommodate those who showed up by holding the event outside. And then, the stories about euthanasia and forced abortions came spilling out of the crowd’s email in-boxes and into what normally would be considered rational company.

It is convenient for those who oppose health care reform – among whose numbers the D&C appears to be – to insist that politicians subject themselves to the attacks of the crazies. But until someone learns how to deal with astroturf uprisings and converse directly with their constituencies, these meetings are doing more harm than good for everybody involved. Which is a shame, because the town hall meetings are what politicians like Eric Massa have built their careers on.

Simple Economics and Health Insurance: a Perversion of the Free Market

Setting aside all the nitty-gritty specifics of the various bills running through Congress, it seems to me that reestablishing some baseline facts on health insurance is in order. In writing this post, I am setting out to prove that there is not, in fact, any such thing as a free market economy where insurance is applied to a given industry. To demonstrate this, I’ll build on a few Economics 101 concepts that we all know and love. The point of this exercise is to establish that any economic structure which employs for-profit insurance is endemically doomed to fail.

Economics 101: Supply and Demand

In the capitalist marketplace – in its purest form, what we call “Free Market Economics” – there are two fundamental building blocks of the system: supply and demand. There are those who produce goods and services and there are those who require or want those services. It is the interplay between those two building blocks that determines price, quality and availability.

More specifically, the Marketplace requires an Educated Consumer and an Honest Producer. The educated consumer is not necessarily a college graduate; the education I’m referring to in this case is the knowledge of the product or service that the consumer is buying. In the Free Market, if I require an appendectomy, I check with local hospitals and doctors, patients and consumer groups to determine which doctor or medical facility performs this procedure with the greatest success rate, greatest customer satisfaction and lowest price. Basically, I bargain shop for the best deal. This process, multiplied over all the people in my area seeking appendectomies and other procedures, forces producers to keep honest about what it costs to perform their duties to the best of their abilities. Hence the price and quality of medical services is kept at a balanced level, relative to the ability of consumers to pay.

This is a concept upon which every economist agrees, as do the rest of us who took seventh grade business math. There is no doubt that this concept, like Bernoulli Principle in physics, is a quantifiable, predictable force on our economy. But what happens when, rather than paying for services directly, we pay insurance companies to provide that service?

Enter the Insurance Company

In our current health care market, things work a bit differently. As consumers, those of us fortunate enough to have insurance pay insurance companies a monthly fee, in conjunction with our employers, to have constant coverage for our medical needs. When we require medical services, we go to a doctor, get the work done, get a prescription for whatever pain or antibiotic medication they deem necessary, pay a copay for the service and be on our merry way. But the important point is this: we do not pay our health care provider and we do not consider cost when choosing that provider.

Right off the bat, without much thinking or digging, we find that one of the fundamental pillars of the Free Market is eliminated from the equation. There is no Educated Consumer in this scenario, because we as consumers have no idea whatsoever what a given service costs, what a prescription costs, what the total of the bill will be. What’s more, we really don’t care because as consumers of insurance products, there is an expectation that we will get what we paid for.

With no educated consumer, only unrestrained need, there is nothing to control medical costs. As medical costs rise, so too do insurance premiums. Of course, this is what happens in a supply and demand economy when the cost of supplies goes up without a correlating change in demand. There will be no change in demand, because we all need medical attention from time to time, no one can afford it on their own and thus we all actively pursue jobs with health benefits. The inevitable result is that insurance companies – who have a profit motive and will not simply go bankrupt on moral grounds – need to lower demand the only way possible: cutting off services.

Let’s Stop There

We could go farther with our example, citing case after case where the above scenario is currently in effect and speculating where it heads next. We could continue to expand on how the imbalance of insurance surrogating the Demand side of the equation is continuing to erode our medical security in this country. We could discuss the effects of the uninsured and the Hippocratic Oath that compels doctors to treat them. But while in doing so, we could come up with much that is demonstrably wrong with our current system, we would stray further from the central point and in my opinion, the most critical for a serious discussion of health care reform in this country. That point is to say that there is no scenario in which the unfettered health insurance industry – free of government reform or a public option – will arrive at any other result than the one we find ourselves with now.

It is an important concept which cannot be ignored: we are not in a health care crisis because of a few bad apples; we are not where we are because we need some new laws passed. We are in our current dire straits because our current system is fundamentally, systemically flawed at its core. The solution is to introduce a new player to the field; one which can arbitrarily change the rules of the game to fit the best interests of the American people.

Thank You, Blew Dogs….

Jon Greenbaum checks in with the current status of the health care reform bill moving though the House. Not looking good, thanks to Blue Dog efforts:

via OK, Now H.R. 3200 Really Does Suck | Chant Down Babylon.

And worst of all, the Blue Dogs cut my family out of the deal. Whereas the old bill would help median income folks with our premiums, the Blue Dog version says you are on your own after you jump over 400% of poverty. So if your family earns the median income in Monroe County in the low mid 50 grand per year for a family of four, or even quite a bit less, you are on your own buddy.

Thank you Blue Dogs.

On a positive note, the bill does manage to go a long way towards reforming private health insurance policies, eliminating lifetime service caps and denial of service because of pre-existing conditions. But clearly, the Blue Dogs are actively working against the interests of the working poor in this country. Perhaps those who negotiated this bill aught to be called out on it by name?

Give Them Enough Rope…

Jeffery Feldman comments on the status of the town hall meetings being held across the country and the Teabaggers that are arriving to shout them down:

FRAMESHOP: Anodyne Town Halls are the Problem, Not Teabaggers.

Feldman’s solution sounds to me like a fairly typical overreaction, not sage advice of any kind. It’s classic Sean Connery, The Untouchables type of stuff, “What are you prepared to do?”

I actually think that, inside of a week, the Teabaggers will have overplayed their hand, badly. We’ve seen this kind of unhinged behavior before from their ilk: from the shouts of “kill him” at McCain/Palin rallies to the insane ramblings of Orly Taitz to the Hitler/Obama signs at Teabagger rallies. At this point, I very much doubt if anyone paying cursory attention to any of this can possibly tell one nut apart from the other, where indeed the difference is quantifiable.

Just because people are worried about what health care reform might mean for them is no reason to believe that Middle America – in whose hands, to repeat the obvious, the fate of our nation lies – is suddenly in support of the same nuts that they voted against in the 2008 election. Teabaggers are not offering a solution and in fact are actively hurting the cause of whatever “reform” Republicans want.

Once it becomes obvious that the same type of “outrage” present in Texas is present in Iowa, people will figure this out. And they’ve got all month – with no other distracting news – to do it. I actually see the Teabagger/THM Nexus as manna from heaven, if only because it so dilutes the Republican message.

Oh, and About that Cars for Clunkers Program..

I debated a Conservative friend of mine for a few hours via Twitter about this. Once again, Democrats need to step back on this one and let the Republicans hang themselves.

Because of course, giving the American people their money back and letting them stimulate the economy is precisely what Republicans have always advocated. And in this one case at least, that policy seems to be a rollicking success. Yet the Republicans on the hill and on TV are actively against this program as “wasteful.”

This kind of thing doesn’t just write itself. Kick back and enjoy the show.

The Dignity of Work

At the risk of breaking up the national dialogue on how to reform health care to best benefit employers and health insurance executives, I thought I’d share with you a thought that comes from my evening’s meal.

My wife and I were discussing the fact that the service at our restaurant of choice for the evening was so good. We talked about our love of food and how much more vibrant it’s become since becoming adoring fans of the Food Network and Bravo shows. We considered how the food shows on those networks have increased the profile of the chef and the line cook alike – that we have an entirely new and different appreciation for the job they do – and we both thought how great it would be if only they started showing programming aimed at the front of the house as well. Professional service does not just happen, and we agreed that it would be great if people got to see just how much work went into it.

And I was reminded of a conversation we had with a couple of guys at our table on a cruise ship. They noted that there were next to no Americans working on the boat and said, “that’s because Americans don’t take jobs like that seriously. We don’t really respect service jobs.”

And they were right, of course. It occurred to me that providing health care for people in jobs such as these would go a long way towards redressing this lack of respect. Providing health care options for cooks and waiters, gas station attendents and cafeteria workers alike might go a long way towards making those jobs a viable option for more people.

I don’t know. Maybe just something to think about. Tip your waitress.

On Health Care, Small Business is Every Politician’s Favourite Whore

“Small Business! We have to protect Small Business!!! They’re the Engine That Drives Our Economy! Won’t someone please think of the children Small Businesses?”

Ok, /snark. But to listen to politicians talk for the last six years or so, you’d think we all bunked in the same bed as our employers. And I don’t want to discount the value of small businesses, either. Heavens, no! But the fact is that the “Small Business” thing is a proxy for “how do we as politicians give ourselves the biggest benefit from this bill?” Because many small businesses are owned by investors who don’t even know what they are.. like rich politicians. Does anyone remember the “you want some wood?” comment?

An interesting aside came while Kerry was rebutting Bush’s assertion that the Kerry tax plan would put a tax burden on small businesses. To drive home his point that there were too many loopholes in tax law, Kerry said that both Bush and his vice president, Dick Cheney, qualified as small businesses. ‘President Bush owns a timber business,’ Kerry said.

Bush blew it. “I own a timber business? You want some wood, Charlie?” he chuckled.

…”President Bush himself would have qualified as a “small business owner” under the Republican definition, based on his 2001 federal income tax returns. He reported $ 84 of business income from his part ownership of a timber-growing enterprise. However, 99.99% of Bush’s total income came from other sources that year…

This is not a Republican issue. Dems do it too, I’m sure. And Independents and Anti-Masonic Party members, if any still exist. This is about rich investors, not political parties.

But once again, this discussion of small businesses is a red herring – however legitimate an authentic discussion of the issue might be. Once again, we are removing the discussion from its epicenter: the issue of what is best for patients and consumers in our country. It’s not about health insurance companies and it’s not about your employer. Its about your health. Whatever your position on the issue, let’s at least agree on that.

Forcing Out Private Insurance

I think that it’s interesting in the current debate over health care that Republicans keep insisting that a government-run health care system would force private insurers out of business. Jon Greenbaum chimes in with a hugely salient point which is being lost in this whole conversation: if a government-run health insurance program would force private insurers out of business, what is different about the government-run pension system known as Social Security which makes it unable to force out it’s own private competition?

The difference, I might suggest, is none. And a public option for health insurance would likely have the same effect on that marketplace as Social Security has had on pensions: covering the uncovered, driving down costs and improving the quality of life for Americans across the board. After all, imagine how much more expensive life would be if your retired parents were dirt-poor with no means of income like 80% of pre-SS seniors.

The fact is, wherever there is a service provide, there is a Cadillac version rich people pay for. The same will be true of health insurance in a public option world. What will be different then and now is that insurers will need to provide services at prices which are reasonable, unless they want to confine themselves to being the over-priced, exclusive and much smaller solution to the very rich.