Kevin Drum on the new details in John Edwards’s health plan:
First, do we really want the IRS enforcing healthcare mandates? That’s not what the IRS is for, and Americans are (rightly) suspicious of using the IRS as a quasi-police agency to enforce whatever federal law the current administration feels like using it for. This is probably not a constructive road to go down.
Second, a Rube Goldberg enforcement program like does nothing except highlight the absurdity of individual mandate healthcare plans in the first place. If you’re really this serious about getting every man, woman, and child in the country enrolled, why go through all this? Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically? It amounts to the same thing and it’s cheaper, easier, and less intrusive.
Third, this is a political loser. Do we really want to treat people who don’t sign up for healthcare like deadbeat dads and Chapter 11 refugees by garnishing their wages? Unless I’m way off base, this is just not going to go over well. Republicans will have a field day with it.
Yup, like I observed back in February. Politicians try to propose these public-private mashup plans because (1) incremental change feels like less of a risk, and (2) some genius advisor always convinces them that they can gimmick the incentive structure to avoid outraging every major interest group. It. Can’t. Happen. Adding another layer of bureaucracy without fixing the underlying mess will just increase the opportunities for sick people to die broke.
More than that, it’s hard to believe that the Edwards camp even let that first point out the door. The IRS as a healthcare enforcer? Whichever advisor proposed that gem should be beaten, fired and blackballed.
Look, Medicare works great. So does the VA. Presumably our country have a deep enough field that we can put together a panel of non-morons to figure out what works best with public systems around world and the ones that we already have, and recommend how to make them work here. Instead we get these weaselly plans that are less than useless because they either die in utero from not exciting anybody enough to beat the hysterical opposition, or they fail in execution and sour the country on Democratic health plans.
Grow some balls and propose single payer. The chamber of commerce, which is getting beaten to shit by the crappy private system, will stand behind it and insurers will go apeshit one way or the other. We might as well make it a fight worth winning.
Libby Spencer
Amen Tim. Unfortunately, I think the politicians are still more afraid of the insurance companies than they are of us — at least so far.
My Truth Hurts
The VA does not work great. It does work ok, but not great.
Bob In Pacifica
I worked for a VA hospital from 1974 to 1979 after I got out of the service so admittedly I don’t have any recent experience with them. At the time it accepted all veterans who were honorably discharged. It seemed to do a finejob of providing vets healthcare.
I think that a system, maybe not based on the VA system but certainly with a nod to the VA, would work for everyone.
Go for it, John Edwards.
Jen
I don’t know what the solution to the health care coverage crisis is, but I do think it’s disgraceful that we can’t cover everyone, and I think it’s one of the issues the Republicans are going to lose on because they still think Big Government Health Care is a bogeyman. Guess what, guys, the spectre of “Hillarycare” doesn’t really scare the daylights out of folks without insurance.
But I guess I kind of think the Democrats still think that too, isn’t that why Hillary goes in for this kind of thing? I mean, my understanding of what she learned from the fiasco in, was it ’93, was that people who have private insurance that they’re reasonably satisfied with do not want to be enrolled in a government program. Isn’t all this weird finagling and convoluted stuff an attempt to not mess with those components of the system that might be working for some people and cover those who don’t have coverage? I’m not saying that’s the way to go, because I really don’t know what is, I’m just wondering.
The Other Steve
Our goal should be to simplify the IRS, not make it more complicated.
Davebo
Well, it depends on when you needed help. Unfortunately the VA was in the midst of a much needed downsizing due to older veterans dying. And then along came a new war and new disabled vets streaming in.
It’s tough for an agency that size to be nimble enough to keep up.
grumpy realist
What is crazy is that we spend so much money on health insurance and we get such a crappy system. What is it–an estimated 25% of payments get eaten up in administrative/denial of care management/lawyers fees?
Over the years I’ve become more and more enamoured of single-care. My experience with the Japanese NHS and the U.K. NHS may have been slightly grotty, but at least I wasn’t in a permanent tug-of-war as to whether my supposedly-covered health care was actually covered.
Plus, the cherry-picking attitude of the US health insurance companies basically makes it impossible for a heck of a lot of people to get health insurance coverage at all. This is ridiculous.
gypsy howell
My rightwing-leaning stepdad sent around an email a few weeks ago about HitleryCare (a version of the old “Canadian Health Care Sucks Trust Me I Know Some Canadians” email).
I “replied-all” that considering I’m paying $1200 a month for health insurance and STILL have the pleasure of fighting for months on end with Blue Cross over medical bills, HitleryCare or some socialist variation of it seemed like a damned good idea to me. Funny — I never heard another peep about it, not even a response to my quip that I’d be happy if they’d just give me my step-dad’s Medicare coverage.
Still, I’m disappointed that Edwards would come out with a dumbass proposal like this. Can you think of a better way to sink any chance of getting universal health care than to tell people you’re going get the IR-fucking-S involved in it?
emald
As a disabled veteran I must attest that the VA does not work “great”. As another poster wrote, yes it does work, sort of, in a creaking jerking sort of way. Slowly. With some help the VA system of health care would work for all of us though. It could be done, but since PROFIT would not be involved it won’t happen.
How is it that the once richest country on the earth can’t take care of it’s own? We should all be able to walk into a health center and get the best care we need without cost or hassle. Seems we can spend 12 billion a month on killing and war but it’s a sin to help those who are sick. Strange at the least and ugly beyond belief. Christian indeed. The current state of our country makes me sick each morning anew, the lies and deceit, the phenomenal spending on killing but not on saving.
rambling this morning but it sure steams me up that all americans can’t get the health care of our senators and president. Sooo wrong that we ignore the sick and kick the poor to the curb to die. So wrong.
Dreggas
Can we add shot and beaten again to this list?
Single payer is a great idea and one that should be proposed and even implemented but the idea that I will be penalized by the freaking IRS and forced into signing up for health insurance is Bullshit.
Like I said I am all for single payer, but it’s bad enough dealing with the PC police, let’s not add the HC police into the mix.
Jake
The thing is, it needn’t. Enrollment in Medicare is completely voluntary, it is just that every person is automatically eligible to enroll when he hits 65. If you have a great pension plan that includes healthcare forever, you’re set. Of course, a lot of companies are now backing out of or cutting their pensions, another thing the GOP would like us to ignore.
And correct me if I’m wrong but this is the case in places like the Socialist Republic of Canada and the United People’s State of Britian: People with the money can see doctors outside of the NHS.
But, the point is, no one (with any sense at any rate) is saying you’d have to drop your private insurance and take the public health care and I don’t know why Dems are allowing the debate to be framed as such.
jcricket
What the VA does right includes really great EMR (eletronic medical records) and coordination of care (all patients in the system see caregivers who have access to their records appropriately – no passing the buck back and forth).
The VA’s not the best model for universal coverage only because it serves a very specific population.
“Medicare for all” is a much better stepping stone than the current mish-mash of insurance company protecting programs the Democrats are offering right now. Medicare’s not perfect, but it’s got very low overhead and administrative BS. Plus, since it’s not profit-motivated, it doesn’t spend all its time trying to deny you claims. If it were allowed to negotiate with drug companies, you’d even see cheaper care under Medicare.
It’s pretty simple. Every other industrialized nation has universal/nationalized coverage of some sort. They all spend less than us and achieve better outcomes, across the board. Each system has its own unique problems, but those problems pale in comparisons to the ones we face. We’ve got some smart people here so if we just combine the best of these systems (Canada + Switzerland?) we’d absolutely solve this issue in no time. But the combination of powerful insurance industry lobbying and scare-mongering by the right keeps us from approaching this issue with anything like an open mind.
jcricket
I take that back. You don’t need an open mind. All you need to do is examine the evidence. Any non-biased examination of the evidence will come down overwhelmingly on the side of universal, tax-provided (something like single-payer) healthcare. This is another one of those “solved problems” we insist on debating (like evolution or whether abstinence education works) because our discourse has been fucked up by the Republicans.
Tax Analyst
The IRS has quite enough to do with probably not enough GOOD people to do it. Right now Congress is dicking around with some proposed adjustments to the AMT fiasco that may come down on an additional 23 million Taxpayers this coming Filing season. That will be a jump from about 4 million this past year and it’s because the initial AMT law did not allow for income indexing (an asinine omission). That will be 27 million out of about 88 million expected filers – over 30% of the filers! It’s absurd and guess what Congress’s “fix” is? Index AMT? Well, that would be sensible. No, that’s not it. Eliminate AMT? Extreme, but it would be popular…problem being the revenue lost would require a Tax Increase or a huge slashing of popular programs, many of which serve the American people well. No, that’s not it, either. Give up? OK…Congress’s big move on dealing with the soon to be exploding AMT situation is…(drum roll, please)…to make the Credit for Prior Year AMT (Form 8801) REFUNDABLE in the NEXT FILING YEAR – but probably with some income threshold limitation – which they haven’t figured out yet. Gee, that’s a great idea…we’re gonna keep making you pay this NOW (because we really need the cash to keep this Ponzi scheme of a budget functioning) but we will make the unfair (at the middle-class level. IMHO AMT is an appropriate concept for ultra-high income taxpayer’s) extra tax you pay NOW refundable after they’ve used your money for another year. Of course, maybe you’ll have an additional AMT tax come up on that NEXT year’s return, too…so you will be getting a Refundable Credit that may or may not barely offset the ridiculous additional tax…oh, and be prepared to pay your Tax Preparer anywhere from $25 to $100 or more for those extra Tax Form calculations and review.
Remember, the IRS doesn’t write the Tax Law, they only enforce them. They get handed this crap, often last-minute and then have to develop formulas and create forms that mechanically lead the Taxpayere or Preparer down through a lot of “either/or” steps to get to the end calculation. I can’t say I’m a huge fan of their efficiency, but they have a tough job to do and they actually do SOME of it very competently.
Consider my 2 cents spent.
Damned at Random
I don’t especially want health INSURANCE, I want health CARE. My husband had a cancerous kidney removed 2 years ago. Fortunately he is a retired ferderal employee so his INSURANCE remains in force. If he didn’t have insurance through his (former) employer, though, I doubt he could find private coverage. The greater your need, the lower your access.
INSURANCE is meant to provide coverage for devasstatig, low probabiity events. Everyone eventually needs health care. Universal access is wha is needed, not universal insurance
liberal
Phillip Longman wrote an article in The Washington Monthly about the VA, entitled “The Best Care Anywhere”.
It’s a must read. It shows why, if you’re interested in making the health care industry itself (viz, not insurance, but actual health care delivery) more economically efficient, the market will not work—period.
That’s because the goal of a rational health care industry is to maximize long-term care outcomes, for which it is impossible to construct proper free-market incentives.
Liberals and leftists who go on and on about national health insurance have part of the equation right (viz, national health insurance is economically more efficient than private health insurance), but look to the Medicare model for health care delivery. And that model is one where costs are going to continue to explode, because someone or something has to balance costs and benefits. (And the notion that doctors or patients are either willing or able to do that is laughable.)
liberal
Sorry…above, I meant “maximize long-term health outcomes,” not “care outcomes”.
Damned at Random
Also, with respect to the VA, there was a great article about it in Washington Monthly a year or more ago (I cut it out and gave it to a nurse friend). They have a great electronic record system, the point being that such a system was financially viable for the VA because their patients stay in the system. So in the ’90’s they greatly improved care for the chronic illnesses of old age (diabetes, arthritis and such) that affected their aging population. The system was not geared up for the conditions common to the veterans of a hot war and the Bush administration did not increase funding to make the necessary adjustments to the system.
The author pointed out that HMOs do not invest in electronic record keeping because their goal is to get the chronicly ill (expensive patients)out of their system. Their ads always display healthy young families. If they do a particulary good job managing HIV or diabetes, they don’t advertise the fact because recruiting such patients would have a negative impact on their botttom line.
Our present system is set up to maximize profit, not to provide quality care.
liberal
jcricket wrote, Plus, since it’s not profit-motivated, it doesn’t spend all its time trying to deny you claims.
Medicare’s not profit-motivated on the insurance side, as you point out.
It certainly is profit-motivated on the health care side.
Damned at Random
The Washington Monthly article on the VA hospital system was “The Best Care Anywhere” by Phillip Longman. It isn’t available in the on line archives, but worth a trip to the library. It was in the Jan/Feb 05 edition
Damned at Random
OOps, apologies to liberal, who found the article while I was off on a rant. Also, apologize for my spelling- actually, I can spell, I just can’t type well in angry mode.
MaryS-NJ
I had a conversation about a single payer health care system with my brother in law – an Emergency Room doctor – at Thanksgiving. He’s more conservative than I am but said this:
“If you’d asked me this 10 years ago, I would have said ‘no way’. Now? I would support it.”
He did acknowledge that there are some drawbacks to a Gov’t health care system but said that supplemental insurance could still be available for those who want the security of feeling like they won’t have long waits for voluntary procedures. He thinks that current system is a huge mess for doctors, administrators and patients.
jcricket
My dad, brother-in-law and other doctors in my family are the same way. They all viciously opposed any government-run healthcare program when Hillary first proposed it.
Now, they’re desperate for someone to implement one so they can get out of spending 20% or more of their money/time dealing with the 15 or 20 insurance companies they have to fight with on a daily basis.
Basically, because of the insurance companies, they’re making less money, for more work, with more hassle. Private insurance has no one’s interest at heart but their own (not the doctors not the patients).
Now that Doctors aren’t on the side of insurers anymore, all it’s going to take for the damn to burst is better big business support. Rumblings are starting, but when/if Walmart, Starbucks, Target, Costco, etc. start campaigning for universal healthcare as a way to improve their bottom lines, insurance companies are doomed. If the SBA (small business association) can get it through their heads that it’s in every small business’ interest to be able to say “come work for us, you won’t lose your healthcare” (b/c it’s government-provided), I expect even faster results.