Ezra Klein has a great piece comparing Clintoncare with what is being proposed now. I had no idea that most people were on something other than managed care before the 90s.
I really recommend reading Ezra’s piece.
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Incertus
Now that you mention it, when my daughter was born in 1990, we thought ourselves lucky because we’d just gotten into this newfangled thing called an HMO which meant that even though we had to drive 30 miles for a doctor’s visit and 65 miles to Oschner Hospital for anything major, we got it done for a shitload less money. Our daughter was born C-Section and it cost us $190 bucks for 3 days in a private room–that was it. So the Clinton health plan to me at the time wouldn’t have seemed like such a deal. But I was 20 and naive and listening to Rush Limbaugh. My how times change.
AhabTRuler
God damn, we suck.
amk
Shorter Klein – Americans are too lazy to move their assess. So, their pols screw them.
Janet Strange
@Incertus: Yep – I had just signed up for an HMO at the time too. It was a choice among several other options offered by my employer at the time.
I didn’t like the traditional indemnity plans b/c unless you needed something major like surgery, the dr didn’t bill the ins co directly. You paid up front – for routine dr’s visits, lab work, etc. Then you had to fill out all of this paperwork and mail to the ins co. They totaled it all up for a while until you met your deductible (usually $500-$1000) and then after that, they’d send you a check for some percentage (80%?) of what they thought your dr should have charged. Which was never as much as what he actually did charge.
So even young Ezra doesn’t describe it quite the way it was.
But the whole Harry and Louise thing was, “OMG! Clinton’s gonna force us all into HMO’s” (it was a little coded in the H&L ads themselves, but the op-ed’s etc at the time made it explicit). And I kept thinking, “You morons, you really think the ins co’s aren’t going to make HMO’s the only option if we don’t do this reform now?”
And of course, now I have only one “choice.” A BCBS HMO.
I remember – and I always wonder if I’m remembering it correctly – that the Clinton plan was for every employer (who had over a certain number of employees) to contribute an amount equal to 1/2 of the premium for what we’d now recognize as a PPO. But there would also be an indemnity option (if the employee was willing to pay extra for it) and an HMO option (if the employee wanted to save some money).
Anyone else remember this? Am I imagining it?
simonee
“Private insurance is a bit like a fire department that turns a profit by letting buildings burn down.”
We should repeat that everyday.
Ezra Klein FTW.
KG
interesting read. once again, like the banks and auto makers, the thing that jumps out at me, we let monopolies form in this industry. Did they repeal the Sherman Anti-Trust Act while we weren’t looking?
Comrade Kevin
When government agencies that are charged with enforcing parts of the law are deliberately starved of funds and manpower, it doesn’t matter if the laws under their jurisdiction are still on the books or not.
Yutsano
When government agencies that are charged with enforcing parts of the law are deliberately starved of funds and manpower, it doesn’t matter if the laws under their jurisdiction are still on the books or not.
AKA the governing philosophy of St Ronnie culminated in eight years of the Bush disaster. I have a friend who just left her job with the EPA last year. Had such a small budget all she could really do was sit in her office and make phone calls with occasional visits to the site she was supposed to be regulating. She found the exercise absurd but she rode it out just for the joke of getting to regulate my father.
Linkmeister
@KG: “Did they repeal the Sherman Anti-Trust Act while we weren’t looking?”
No, but insurance has traditionally been regulated by each individual state, not by the Feds. Thus the Anti-Trust Act hasn’t been tried against the Blues, Kaiser, Humana, etc. (AFAIK).
Yutsano
No, but insurance has traditionally been regulated by each individual state, not by the Feds. Thus the Anti-Trust Act hasn’t been tried against the Blues, Kaiser, Humana, etc. (AFAIK).
I think you’re right, although a LexisNexis search would be a good tool for that (wish I had a subscription but I don’t!). However acting within an individual state doesn’t necessarily exempt a business from anti-trust law if it can be proven that the business is monopolistic in the state (again, hasn’t been used against health insurers, I think the state has to be the acting party or something like that).
Micky
Off topic: I never heard of IPA or Dogfish Head until I saw it posted on this site. After a nice evening and hours later, a bitter taste still resonating in my mouth, I’m a strung out hophead. Damn you all.
KG
Ah, yeah, Link, I forgot about that (side note: how ’bout them Dodgers?). Although, I’m pretty sure that most States have some sort of anti-trust laws of their own. Of course, I also hear that most state insurance commissioners are the most corrupt government autocrats in the American system.
Edit: just looked up California’s law, and yup, looks like there is a state equivalent, though I don’t know how vigorously it is enforced (I’m guessing not at all)
Martin
Well, California actually has the most diverse insurance market in the country. There are 2 Kaiser franchises, BC (Wellpoint) and BS are separate entitites, and there are a lot of other players. I doubt that any company covers more than 25% of the market.
And it’s not that the commissioners are corrupt (though they may be) but the commissioners aren’t tasked with ensuring a competitive market – just a well regulated one. It’s very easy to regulate a single player, so the commissioners really don’t have a vested interest in going to the AG with a case to break up the industry.
(I always feel I should remind that I have an immediate family member who is a C-level at a major insurer – one that covers about 75% of the market in at least one state. I have these conversations all the time.)
Mike D.
The difference between Hillarycare politics and Barackcare politics is that Barack is POTUS. He actually should have taken the bull by the horns, but that’s in retrospect. I thought giving control to Congress was the right move a couple months ago too.
What I’m not cool with is that his sensible opposition to an individual mandate in the campaign turned out to be bullshit.
El Cid
Often people forget that the type of health care managed competition proposed by the Clinton White House put the interests of a very small numbers of HMO’s and large insurers against the interests of many more ‘small to medium’ insurers — and those are the ones who ran the HIAA and the “Harry and Louise” ads and funded Newt Gingrich and the Republican ‘Revolution’.
The dispute on the side of health insurance interests were not just for or against the plan, but within the industry over who would get all the dough.
For a look back at a crazy ultra-liberal fringe left view from a 1993 article in the Nation by Sam Husseini:
———————–
…As Patrick Woodall of Public Citizen says, “The managed competition-style plan the Clintons have chosen virtually guarantees that the five largest health insurance companies — Aetna, Prudential, Met Life, Cigna and The Travelers — will run the show in the health care system.”
These big companies helped develop Clinton’s plan of managed competition, and all but The Tavelers paid for much of the research that was done by the Jackson Hole Group, an organization that drew up the original blueprint for managed competition…
———————–
…Indeed, the H.I.A.A. is made up mostly of small and medium-sized insurers. The five biggest insurers have formed their own organization, the Alliance for Managed Competition, which basically backs the Clinton approach. These big insurers stand to gain from the Clinton plan’s increased corporatization of health care since they have been rapidly buying H.M.O.s, 45 percent of which are now owned by the eight largest insurance companies. The outlays for advertisements by the big insurers and the H.M.0.s dwarf the moneys being spent on advocacy ads by the H.I.A.A. and either the Democratic or Republican Party.
El Cid
And just in case there’s still that hoary myth about how Bill Clinton made America cry in 1993 by being too left and that this killed health care reform, another look back in time by the insane fringe-y liberalefty Norman Solomon:
———————
…the new president fought like hell for the corporate-beloved trade agreement known as NAFTA. And he spread his wings as a deficit hawk, while his campaign’s pledges of “public investment” fell to earth with paltry line items. Less than five months into his presidency, Newsweek lauded Clinton’s “shift to the right” and urged him to show “the backbone” to stay there.
But none of that has stopped the media’s clucking about the Clinton administration’s early “lurch to the left.” The myth never died, though it was quickly ripe for debunking.
In real time, one of the most astute debunkers was Barbara Ehrenreich. As the only writer from the left with a regular column in a major U.S. newsmagazine (she later got the boot), Ehrenreich wrote a Time piece in mid-June 1993 that directly addressed the nascent mythology. The incoming president’s leftward lurch was “a neat parable,” she noted, “but it never happened.”
Ehrenreich added: “The lurch to the left is like the ‘stab in the back’ invented by right-wing Germans after World War One: an instant myth designed to discredit all one’s political enemies in one fell swoop.
“… Maybe it’s been so long that we’ve forgotten what ‘left’ is and how to tell it from right. At the simplest, most ecumenical level, to be on the left means to take the side of the underdog, whoever that may be: the meek, the poor and, generally speaking, the ‘least among us,’ as a well-known representative of the left position put it a couple of millenniums ago.”
wobbly
I read it, and laughed, when I should have wept.
OMG, Hillary Clinton actually had her s**t together back in the day…
OMG, she was like Cassandra looking into the future, told it like it was going to be, and nobody listened.
“I had no idea that most people were not on managed care in the ’90’s….”
Shows your ignorance about the Secretary of State and Rochester, New York.
jayackroyd
The pre managed care environment was fee for service for normal, outpatient care. You paid cash to your GP, for both visits and stuff like inoculations. Blue Cross/Blue Shield, non profit at the time, covered only inpatient encounters, including ER visits.
As always happens, this created perverse incentives. Unnecessary inpatient operations were common, as with hysterectomies of asymptomatic post menopausal women, and tonsil removal for young kids.
Managed care was intended to remove these perverse incentives by having the HMO benefit from effective preventative care, and from minimizing inpatient encounters. Because you get paid a monthly fee per patient, regardless of treatment provided, the idea was to make it more profitable to provide low cost, effective treatment.
As always happens, this created perverse incentives. First, there was an implicit assumption that your HMO would be stable over time, as most people’s GPs are. That is, because the HMO was gonna be covering you for decades, there would be strong incentives for docs to work with patients on lifestyle choices that would eventually lead to inpatient treatment. In fact, the strong incentive was to find a way to get those people off your roster. It also created (profits!) an incentive for plans to get bought out be private providers. The margin opportunities were irresistible.
Only a strong regulatory regime can succeed. It will work better with an accompanying public option, imitating the better cheaper care we see in the rest of the OECD.
asiangrrlMN
Yeah. What Ezra Klein said. I wish I had been that well-written when I was his age.
Oh, and fuck the insurers. They need a big helping of STFU.
bago
@asiangrrlMN: Not so much STFU, but more along the lines of “Stand and Deliver”. If the private market is indeed better at delivering innovation, they should welcome the competition of a slow and bloated government plan.
It’s all about recision. Seriously, what good is insurance if you are subject to recision? It undercuts the entire premise of insurance. Having a competitor that does not engage in recision will really whip things into shape.
low-tech cyclist
The funny thing was, the effect of the switch to managed-care did make it into news stories in the mid-1990s. I remember thinking, “Hey, we’re getting all the bad stuff they told us would happen under ClintonCare – only we still don’t have universal health care.”
Would have been nice if some of the major pundits – a Richard Cohen, or a Robert J. Samuelson, or someone like that – had noticed this too. But our commentariat sucks.
geg6
OT but also about excellent punditry…check out Frank Rich’s column today for what might be the most excellent writing about Cronkite’s real importance and the hackery that is today’s MSM. Calling them out by name, especially Stretch. Awesome. Oh, and yes, Ezra is amazing on the reality of health policy. How a guy that young has such skills with such wonky subject matter never ceases to amaze me.
amk
America must be the only country that puts so much weight on their useless pundits’ useless “analysis”. Teh pundits, either on cable, msm or print, sound too stoopid, uninformed and partisan to me to be taken seriously.
Comrade Jake
Classic Ezra. Sharp as a razor.
gypsy howell
I believe we will get a health insurance bill of some sort. And I also believe it won’t change much of anything for most people who have some kind of coverage now. They’ll still be stuck with whatever plan they have now. Costs will not go down appreciably, if at all. There may be changes around the margins, but most people won’t feel any sense of relief, and whatever relief there is won’t kick in for so many years that by the time it happens, we’ll all have forgotten why.
The end result, for most of us, will be a whole lot of brouhaha over nothing. It’s clear at this point that it’s not going to be the kind of landmark legislation that brings about widespread relief and improvement in quality of life like Social Security or Medicare did. From that standpoint, the democrats aren’t going to get much political benefit out of it either.
I do expect that the insurance companies will continue to increase their profits, however.
Svensker
I think the move to managed care was one of the biggest components of the huge rise in health costs. When the patient paid and then sent the bills to the insurer, there was always a first hand witness — you’d look at your bill and say “hey, I didn’t have that!” or “why the heck are you charging me $400 to look at my toe?” Now, everything is 3rd hand and there is no direct feedback. The game is: medical providers see how much they can submit for, and insurers see how little they can pay. The person who had the procedure done is out of the loop.
MikeJ
If he’s so smart why does he hang out with Mcmegan?
arie
another article with a lack of real information. not sure why i needed to read it. it didn’t explain how the current plans congress offers will lower costs, or how the current problems in the system can be fixed without heavy federalisation.
but then, those of us getting ok or even great care without insurance are magical fairies who don’t exist. can’t possibly talk to us and try to get that experience for everyone.
geg6
OT again, but sure hope John’s watching CBS Sunday Morning. It’s all about the animals today. First segment on animal communication was great.
Cervantes
Private insurance is a bit like a fire department that turns a profit by letting buildings burn down.
Dear Ezra, please do not give our fire departments any ideas.
Riggsveda
When I got a job with a state agency in ’94, the default health insurance for all new hires was Blue Cross/Blue Shield, the same insurance I had had, on and off, since childhood. But they offered an HMO that looked like a good way to save money on day-to-day out of pocket costs, so when Open Enrollment came around, I took it. It has undergone a serious negative change since then, and if I had another option now I would grab it. Unfortunately, the Blue Cross traditional option was eliminated some years ago, leaving us with only an HMO, PPO, or “consumer-driven” option to choose from. I don’t even know if the old plan is still available in my state. No doubt in my mind that the elimination of options and reduction of benefits in those remaining was always in the game plan for the health insurance industry, going all the way back to when they pitched it to Nixon.
SiubhanDuinne
@geg6/21
@geg6/28
I read the Frank Rich column at midnight and posted about it over on the Saturday Night Open Thread (#88). I also loved that he named names, and had no fear about criticising the NYT which does, after all, sign his cheque each week.
And I join you in hoping that John and many others are watching CBS Sunday Morning. Always one of the few bright spots on the T & V, with today’s forcus on animals a real joy.
JenJen
Anyone catch ABC’s deliberate GOP water-carrying, via on-screen graphics on Stephanopolous’ show a short while ago?
They labeled health care reform “ObamaCare.” I’m pretty sure that’s what Michelle Malkin calls it.
DougJ
“I had no idea that most people were not on managed care in the ‘90’s….”
I said *before* the 90s, dickhead. At least quote me correctly when you start in with your one-sentence-per-paragraph attacks, okay?
JenJen
@wobbly: Rise, Hillary, Rise!!
Ugh.
geg60
Siubhan Duinne: OMG, and Sarah Silverman, too. That was like the cherry on top of the ice cream sundae.
geg60
“Awaiting moderation”?? Seriously? Now what the hell did I say? Sorry, Doug.
geg6
Ah, I think somehow my screen name got screwed up. That’s what’s causing my mod problems. Again, sorry Doug.
amk
@geg6: We have moderation here ??? What gets you thrown out on your ass here ?
Comrade Jake
OT, but anyone watching Hillary on MTP? She’s very, very good.
geg6
amk: I dunno. You could ask BOB. He certainly knows, though it seems he just can’t help himself sometimes.
geg6
Comrade Jake: I refuse to watch Stretch on ANYTHING even if I like his guests. Even better is watching Krugman, Arianna, and Donna Brazille taking George Will apart on his white privilege and stupid wankery.
SiubhanDuinne
@ geg6 / 10:09 am
Silverman was great! I just wish they’d had someone other than Katie Couric doing the piece.
And even the segment on rats was pretty interesting. I find it quite charming that they like to be flipped over and have their tummies tickled :-)
Comrade Jake
@geg6:
The best part about Will to me is that he’s apparently not bright enough to know he should avoid the roundtable when Krugman’s on.
HRA
Hilary could not get her plan approved. First of all the talk among almost everyone I knew or had contact with was what is a first lady doing promoting policy. It was not the standard first lady role and people resented the change along with not trusting her. Her reputation had taken many hits in the media.
If you were fortunate enough to be employed by someone who offered Blue Cross and Blue Shield before the HMOs, you did not pay for anything. In some jobs, you did not even contribute towards the payments.
After I had my last child, I was sent a bill for the delivery. I had walked into the hospital at 8:50 am and had her at 9:00 am. It was a quick natural painless birth. The bill for the doctor who was not there was $3,000+. When I went for my first checkup, his finance secretary flashed the bill in my face rudely. I brought it in to the doctor and asked him about it. He ripped it up and tossed it into the trash with a “you don’t have to pay it”.
Is this the example of what happened to the best coverage I ever had for health insurance?
Leelee for Obama
Ezra is so good at this, because it’s what he’s chosen to be an expert on. This health care debacle we are in has caused unknowable as well as knowable damage. Trudi Lieberman and Marcia Angell said what needs to be said on Moyers show this past Friday. Bill Maher was correct as well, saying that some things shouldn’t be profit centers. Single Payer is the only sane alternative, and eventually, it will become the way we do health care in the good, old US of A. But just like the truism that without GWB there is no Barack Obama, we will work our way toward SP in the most half-assed ways possible. Winston Churchill knew us well. He said, “You can always count on the Americans to do the right thing, after they’ve tried everything else.” Or words very close to that.
kay
I think most people have no earthly idea that health insurers have effective monopolies within states. That alone is a huge contribution to understanding why costs keep going up.
The problem with federalizing insurance regulation, which Republicans have been pushing, by the way, is we could do a race to the bottom on regulation (and would have, I believe, had Republicans been able to federalize it when they were in power in Congress, and they tried).
In other words, we could end up with a situation where insurance oversight and regulation is standardized across the country at the least regulatory level, trumping good state law that disallows an insurer from operating in a particular state unless that insurer agrees to cover a pool with pre-existing conditions, for example.
When Republicans say that the way to bring down costs is to standardize regulation across state lines, I think it’s safe to assume, given the dogma, they’re talking about less regulation, not more.
That’s a race to the bottom, and it’s part of what happened with mortgage lenders, who were traditionally regulated at the state level, until they weren’t.
geg6
Saw some bad news on the In Memoriam segment. Young man named Josh Rimer was killed in Afghanistan this week. He’s from the town next door to mine and I know his dad. I’m heartbroken for the family. Very nice people. So sad.
Leelee for Obama
geg-please extend my condolences and gratitude for the service of this young man. There are times when the losses come home more than others. This is one of those times.
Martin
Originally, Blue Cross *only* covered hospital visits and Blue Shield *only* medical care (routine doctor visits, etc.) Later they joined and provided a more comprehensive formula. California’s BC/BS split doesn’t reflect this division any longer – they’re just two franchise that provide similar services, but I’m pretty sure outpatient care was always part of the BC/BS operation.
amk
@geg6:
Sad. Condolences to that family.
HuffPo has a FP piece quoting an US commander that afghans are tougher nuts to crack than iraqis. Duh.. Those guys have been guerilla fighters for centuries and they have the home ground advantage. I think Afghanisthan will be Obama’s real waterloo rather than this health care.
BC
I just want to remind everyone why Kathleen Sebelius was elected governor of Kansas – she was insurance commissioner and denied Blue Cross/Blue Shield going from nonprofit to for profit. Every old fart in Kansas (including my dyed-in-the-wool Republican father-in-law) voted for her for governor. (Most Medicare recipients had BC/BS for the medigap) So even in the very conservative states, there is awareness of the health insurance reform that is needed. The problem is to marshall this awareness so that a good package can be passed. It’s really tough to get over that tribal affiliation the GOPers have, where they support congressional action or inaction that is opposed to their needs.
geg6
Leelee for Obama: You are right and I will pass along your condolences. You know, it’s weird. Many more people served in Vietnam and, young as I was at the time, I knew many who did. Two cousins and many friends of my older brothers and sisters for instance (one brother served but spent the entire time stateside). But I didn’t personally know anyone who died. Whereas so many fewer have actually gone to Iraq and Afghanistan, but I have personal connections with at least five people who have died in those conflicts. And it hits me so hard with every single one. I still haven’t gotten over my anger at the one who was killed by the KBR shower electrocution. I may never stop being angry over that.
Leelee for Obama
geg-you shouldn’t ever stop being mad about that. It’s one of the many deaths-by-spread-sheet. Some things shouldn’t be profit centers. If the old system was in effect, it may still have happened, but someone would have been accountable for it, in some way. Now, it’s just the cost of doing business. My hobby horse is the MWRP hold-up that cost so many lives, limbs, eyes, brains. And still, I wonder why I don’t sleep well anymore. Some of it is my personal situation, but some of it is wondering how we ever deserve these service members.
kay
@BC:
It’s just tough for me because I can’t think of any other sector like this, where we’re trying to go from a (very lucrative) for-profit model to a less profit oriented model.
Would we have had universal K-12 education in this country had states not mandated it in their constitutions? We set up the universal public schools and have a private system alongside, and that’s true for colleges too. Setting up universal public education after a for-profit system was in place would probably be easier than overlaying universal health care over the for-profit system, because private school administrators aren’t CEO’s and they don’t make 40 million a year, and the only “shareholders” they answer to are parents.
I have trouble imaging us getting around the profit motive. This system works really well for a large group of people making a lot of money.
Uloborus
Hmmm. I worked for Kaiser for a long time. This left me with strange and conflicted feelings on this topic. Practically everyone I knew was proud to work for Kaiser. It was non-profit, it treated its employees very well, and the insurance arm was, largely, subservient to the doctor arm. And by and large doctors really care about health care. There was a huge preventative focus.
At the same time they, especially the doctors, were horribly troubled by health care as a whole. They were forced to charge outrageously, because costs were unreal in the industry. Pharmaceutical costs are through the roof and just getting higher. They were deeply concerned by some new health plans Kaiser was releasing that they felt cheated customers, offering worse service for more money. The irony being that Kaiser had no choice but to release these plans. They’re *popular*, and other insurance agencies were using them to skim off the most profitable patients and dump the sick people on whichever company would take them. That’s actually a major thing in insurance today. Pitch plans that sound good to the young and healthy, reap the rewards of a customer base that rarely gets sick, screw them over if they do get sick because these plans aren’t actually any good, and ditch the customers who aren’t profitable.
And if an insurance company is reluctant to play? All your profitable customers get drained away, and you’re left with patients who you’ll go under if you give them the care they need, because YOUR costs are skyrocketing.
It’s all very complicated. There are definite problems, but exactly who’s at fault or how to fix them, I’m not sure. One of them is that medical costs themselves, especially pharmaceuticals, are constantly rising. Another is that some people are abandoning the basic principle of insurance, that the people who are lucky pay for the people who are unlucky. And that’s throwing the system itself into chaos.
KG
@47: well, yes and no. It depends on the form that the regulation takes. There are many areas of federal law where they allow the States to go further, particularly in areas of consumer protection. A couple of examples, the federal franchise laws allow the States to provide stronger protections to franchisees; the Truth in Lending Act allows States to provide stronger protections to consumer/borrowers; same goes with the fair debt collection act, I believe. It really depends on how the law is written.
I share your concern though, mainly because I don’t trust either party to tell the oligarchs they work for to fuck off.
The Other Steve
Two lessons learned from The New Deal and The Great Society
Democrats ought to pass something, just to get it out there. Once it is out there there is no going back.
Once it is out there, they need to put a lot of effort into monitoring it and evaluating it, and if it’s not working change it.
It needs to cover everyone. Everyone is a part of it.
FDR understood this… Johnson Democrats did not, and defended a lot of bad programs instead of fixing them. This is what brought Ronald Reagan to power.
Yet despite Reagan and all that, the programs that did work and covered everyone like Medicare are still here and the GOP won’t touch them.
KG
Ok, since I’ve been thinking about this quite a bit the last few days (and I must admit, from the beginning, health care reform has not been very high on my agenda), I have a couple of ideas that may help…
1. Require that all insurance companies (and I really do mean all, not just health insurance companies) be non-profits;
2. Make insurance companies (and not just insurance agents), as a matter of law, fiduciary agents of the insured;
3. Do not allow insurance companies to issue stock for public trading (this sort of goes with point 1, though I have to double check the law on it, been a while since I dealt with that area of corporate law);
4. Bring back indemnity-style insurance policies – at least require insurers to offer such a policy (I tend to believe one of the problems, as Svensker says @26, is that by removing the patient from the payment discussion, you drastically distort the market)
5. At the State level, I’d also suggest drastically strengthening insurance bad faith laws (though much of that would be accomplished by the fiduciary duty point above) and include one sided attorney’s fees provisions for successful plaintiffs.
I think there is still an issue of how we deal with the pharmaceutical companies, who seem to be a central player in the rising cost of health care.
sparky
@Uloborus: somewhere along the way, i think with the Reagan years, people realized that you could decouple the public good aspect of insurance and just treat it as a profit center, much the way banking was unleashed. as in so many areas, the poison flowers the GOP cultivated are now in full bloom, but for some reason we are still in thrall to them. and the reason we are still in thrall is because we refuse to grow up. as an example, klein pulled his punch in that article: he could have said that americans still want something for nothing, but he was unwilling to say it in a fashion that would be well and truly seen.
incidentally, i don’t agree with the notion that any program should be passed. a bill that is really just a buy-off of the insurers, the AMA and big pharma is not going to solve the problem, and will actually make things worse by instituting government benefits to the private sector. you think it’s hard to get change now? wait till the US agrees to guarantee big health profits. you’d need a constitutional amendment to fix that.
Leelee for Obama
sparky-I would love to wait, but waiting has left us in this mess since TR proposed a UHC system in 1912! Pass something, let it work a bit, show the pros and the many cons of free-market principles in a common-good arena, and wait for the PEOPLE to demand Single Payer. It will come, because, as the Dutch said after the massive floods of 1953, “Now, we all live on the polder.” (The polder is the Dutch word for flood plain. That’s why the Netherlands has the best flood control system on the planet.
sparky
@Leelee for Obama: i didn’t say wait, i said a bad bill will create a new, larger set of problems. so long as the profit motive remains, someone will have to pay the insurance companies to profit, the doctors to profit (including useless procedures and equipment) and everyone else in the food chain. do you really want an equivalent of the farm lobby where the insurance companies get a guaranteed return? cuz that’s what it looks like at the moment, and with no subsidy for poor people to pay for it.
and as far as your 1953 example goes, we are not there yet. europe ain’t america, and here slavery ended with the Civil War. and the excesses of free-market capitalism ended with the great depression. when mainstream america loses its corporate health care, then we’ll have a similar situation. this isn’t it.
Davis X. Machina
KG is describing the insurance landscape a generation ago.
“Mutual” as in Mutual of Omaha once meant something, and the overarching design of many, many insurance companies was originally more akin to that of a credit union than to that of an investment bank. John Hancock, MetLife and Prudential, inter alia, were mutual insurance companies.
The insurance companies in the compulsory-insurance health provision regimes in e.g. Switzerland and Germany are much closer to the old mutual model — I don’t think many of them would be considered ‘insurance companies’ in the presently accepted American sense of the term at all.
Leelee for Obama
sparky-the mainstreamers will lose their health care soon-it’s inevitable. Even the rich will balk at no care for usurious premiums. It takes them longer, but it arrives. In the meantime, even a bad bill may help 35-40 million un-and under-insured Americans.
Ailuridae
@The Other Steve:
An interesting point re: the differences between the New Deal and the Great Society. America did an unapologetically great job addressing poverty in the 60s under Kennedy and especially LBJ. What Reagan, Atwater and the Southern Strategy did effectively was to overemphasize the otherness of those being helped by these programs. Its a uniquely American trait that in the developed world our citizenry doesn’t realize that helping the poor arise out of poverty is, in an of itself, both a morally and economically good decision.
Lisa
I had no idea that most people were on something other than managed care before the 90s.
Ummm…how old are you?
kay
HRC said today that when she tried to sell health care reform in the 90’s 61% of small businesses offered health insurance to employees.
Now it’s 38%.
I’m so glad the media, lobbyists, Republicans and cowardly Democrats saved us from the horror known as Hillarycare, and we retained our cherished non-system, because it’s working out wonderfully.
Corner Stone
@Leelee for Obama:
But how? How will an insurance mandate help anyone but the private insurers? That’s where this current bill is headed, with the end result being guaranteed rent for the private insurers.
ISTM that even if some could afford the premium – they most likely will not be able to afford the deductible threshold. And so they will put off all the small, nagging issues until they become large unavoidable issues. At that point they will go to the ER, get their treatment (hopefully) and go home to file bankruptcy. The tax payer will be left to subsidize their care yet the private insurer will have their profit all the way through.
Corner Stone
As someone said upthread – wait until the private insurers have a govt mandated profit center off a large population. Good luck getting change at that point.
They’re spending something like $1.4 million dollars a day right now on just lobbying – what do you think they’ll do when they get an extra $300B annually to share between about 8 companies?
Corner Stone
@arie:
And more to the point – Ezra seems to miss the entire lesson of the HillaryCare debacle of the 90’s.
If Clinton had pushed actual *Healthcare* as the issue it may have turned out differently. The Clinton admin did not – they pushed a revamp of *Health Insurance* and how it was to be administered.
IMO, the same mistake is playing out in the here and now.
kay
@Corner Stone:
The House bill caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses. It also forces insurers to do what they should have been doing all along, which is waive deductibles for routine preventative care.
That’s where Orzag says some of the savings will come in, and that can’t be scored by the CBO. Preventative care for everyone. It’s cheaper than the emergency room, and certainly more humane.
Ailuridae
@kay:
I am astonished when I read others on the left demonize private insurance companies qua profit-seeking enterprises for the American health care crisis. American health insurance countriess are nearly universally awful but that ignores the success companies like Switzerland have had providing universal coverage with a system that is more private than even America’s current one.
Before I get pilloried, I should point out I favor an expansion of Medicare at 105% of market costs to anyone willing with 100% exemption below the (actual) poverty line and a slligding scale to 400% of the poverty line.
kay
@Ailuridae:
I just think no one knows what’s in the House bill, because our zany media stars have decided not to talk about the actual proposal. They seemed as if they might, for a second there, and instead they decided to talk about how the proposal they haven’t read costs too much.
I think it’s a solid piece of work, actually. I’d put it in tomorrow.
sparky
it doesn’t matter what is in the house bill at the moment. what matters is what happens in the conference, and that is the province of the lobbyists.
kay
@sparky:
I think it matters a lot where negotiations begin, in terms of where they end up.
Yutsano
it doesn’t matter what is in the house bill at the moment. what matters is what happens in the conference, and that is the province of the lobbyists.
Just out of curiosity do you have any evidence to support this assertion? Conference, from what I understand, is to reconcile bills not to add things in or change legislation substantially. Either something has to be passed by one legislative body in order to make it into conference or it doesn’t get in period. And everything I’ve been hearing about the House bill suggests that it’s a lot more muscular than what’s currently going on in the Senate. I predicted the House was going to take the lead on all this, now it’s just a matter of getting it to Obama’s desk.
Paula
A query:
During the primaries, were mainstream progressive blog people concerned about the lack of Single Payer discussion in Democratic Health Care Policy? Because from what I remember, while people were trying to decide between Obama, Clinton and Edwards, the debate was all about Mandates and how cruel Obama was for not having them and how the other two were great because it was real reform. Meanwhile, the candidates who actually supported Single Payer languished in the shadows.
WTF is up with the concern over single payer NOW? Absent real advocacy during the election, why are people surprised and/or upset over its absence NOW? Was I reading the wrong blogs? or reading them at the wrong time? Was there a big concerted effort to promote single payer that I missed during the primaries?