Face the Nation last Sunday had Colin Powell as their guest. He made an interesting point that seemed spot on to me when it comes to the HCR debate. He was asked if President Obama had tried to do too much in his first year and said (emphasis added):
COLIN POWELL: You know, the–if I could use my military experience again, and then I’ll get to my political and diplomatic experience. But we’re taught have a main attack. What you’re really after. What’s most important. Then you could have a secondary attack. And you can have economy of force operations where you keep your eye on it but you don’t jump into it. And the main attack the American people wanted to see him lead, and I hear it everywhere I go–fix the economy; fix the mortgage system; fix the credit problem; get us our jobs back; get trade moving.
Later in the conversation he returned to the point with greater emphasis:
COLIN POWELL: But you have to make it clear what we’re trying to achieve and what the main attack is. You talk about our history. In Philadelphia, when they were writing the Constitution, the great problem they had was what to do with slavery. And, they essentially said the main attack has to be creating a country, not solving the problem of slavery, one of the great compromises in our history. And so, sooner or later, no matter how strongly you feel about issues, you’ve got to find areas of compromise to keep the country moving forward.
I think this makes the progressive case for just passing the damn HCR bill and moving on. It will be compromised legislation–it always is and always has been the case when it comes to legislative progress in America. You start and then you build upon the foundation that you create. No bill: no foundation. The perfect is always the enemy of the good. Some flair-up issues are only distractions–secondary battles that are not worth losing the core goal over. The Public Option is one of those secondary battles. It is worth fighting for but not worth losing or giving up on HCR if you can not get the votes to pass a PO. HRC is too important for such tantrums, we need this change.
Any attempt to get the economy going again can not happen if we do not deal with HCR. It must be done. It is the core strategic goal at the moment, but it is not the main event.
The core struggle is proving that Government can work–this is the main battle. Restoring functionality and the usefulness of government in solving problems is the main battle that President Obama is fighting. Meanwhile, Republicans are focused on perpetuating failure as the only possible legacy of government. They seek to ensure that America is a failed and ungovernable state because that is a better environment for the grifters who control the GOP and the modern conservative movement. This endless Republican embrace of failure as success should be an easy thing to defeat, but way too many Democrats are easily distracted by this or that secondary battle. Minor battles like the fight over a PO distracts attention from the main battle like passing HCR and proving that government can actually work. These minor battles always risk handing the GOP yet another “government can only fail” victory–especially when they are engaged prematurely.
Colin Powell has a lot to answer for due to his misplaced loyalty to Bush the younger. Still it was nice to hear him finally be an honest voice in Washington. Better late than never.
We shall see if the Democrats in Congress have the backbone to pass HCR and get serious about doing the work they were elected to do. It should be easy, but they are always distracted by so many shiny objects. I hope the meeting on Thursday will work. We shall see.
Cheers
dengre
ps: feel free to use this ramble as an open thread
Just Some Fuckhead
Sounds like the General has good health care.
rob!
If Bob Gates ever decides he wants to move on, I think we know who Obama would call.
J. Michael Neal
@Just Some Fuckhead: Maybe he has a pre-existing condition, and wants to be able to get coverage at all.
I read the headline, and thought for a moment that Stuck accidentally hit upon a useful idea.
jcricket
Where’s the part where Colin says, “oops, my bad” about all those WMD labs he totally made up?
But seriously – it’s pretty durn simple. Americans love winners. Americans hate discussing crap. Pass the Damn Bill. Then pass another, then another.
You will eventually break the backs of the GOP and the “vulnerable” moderates (all 4-5 of them) will consistently vote with you – because they will realize saying “no” all the time so they can hang out with racist nutjobs will not get them re-elected.
Or, they obstruct everything, you pass what you can through reconciliation and we still win.
Folderol and Ephemera
We’re doomed.
Hawes
I thought it was Jesus’s General, but I think the point is a good one.
There is not a lot of sound tactical or strategic thinking in Congressional leadership. And there’s not enough steel in the way the WH is dealing with them.
valdivia
I agree with the main points, very much so, PTDB! Don;t make the PO the thing that brings it all down, specially now when it could just crumble so easily at the very end.
But the thing that I don’t get is what exactly people think Obama would have done, instead of HCR, regarding the economy. He got the Stimulus, a lot of other reforms got done, the House passed all the bills they needed everything got jammed up in the Senate. So, anyone think that if they had not done HCR the Senate would have passed financial reform? More jobs stimulus? Yeah with the Party of No?
So while I agree we have to get HCR done and move on, the idea that Obama ignored the economy, or didn’t do enough about it, as if he sat thinking about the economy and doing nothing else things would be better, just seems to me to be saying the exact same thing the DC Village CW has been saying from the beginning: HCR and other stuff should have been put on a back burner,he is doing too much.
jeffreyw
I don’t think the campaign is to prove the country can be governed, the campaign is to govern. Splitting hairs, I know, but the country can be governed-that there is a country is all the proof needed. The real question is not “can it be governed”, it is defining who shall reap the rewards. Is it “We, the People”? It has been a long battle and to paraphrase the last line in Ken Burns’ “The Civil War”–the outcome is still very much in doubt.
ADM
“You start and then you build upon the foundation that you create. No bill: no foundation.”
Agreed – which makes pundit’s blather about obstructionism particularly damning for the democrats. Sure, republicans obstruct to the point that governing becomes basically impossible, but that obstructionism is aided greatly by democrats beginning from a compromised framework.
Joel
When the Republicans start whining again, I’ll just play this loud enough to drown them out.
Just Some Fuckhead
@J. Michael Neal:
That’s rich.
somethingblue
Could we retire this phrase, please? I mean, whatever your views on HIR, just–… enough.
kdaug
@somethingblue:
What, just as we’re settling into our comfortable old catchphrases you want us to get up to do what? Take out the trash?
Next commercial. Promise.
flounder
Very nice dengre.
MaximusNYC
Thanks for this.
I wish everyone would take a deep breath, chillax the F out about the public option (whether you’re screaming in favor of it, or screaming that it’s an impossible pony), and just look at the big picture.
We are very close to making something very big happen here. Let’s try not to tear each other to pieces.
sparky
this is an example of moving forward? are you serious? creating a system with a catastrophe in its center is a good idea? yeah, that’ll be real easy to fix. i could go on (and on) but i hope someone gets the point that it’s generally not a good idea to use a notion that proves the exact opposite of the point it’s put forth to support.
jenniebee
Powell’s point is absolutely unassailable, the application to this particular HCR bill is questionable. I have to ask: what is the main attack that you are hoping is achieved here?
Put another way: for those of us who started from the position that the main attack is (shorter:) Medicare for everyone, tell me how the current HCR bill is furthering that main attack? Because it looks a lot like enshrining a free-market “solution” to health care.
And for anybody who screams “second bite at the apple” – dollars to donuts if what we have on the table now doesn’t pass, the next Republican congress passes essentially this plus extra tort reform. They have no argument with the policy (which is mostly theirs anyway), their only problem is with who gets credit for it.
Cris
But often, so is the “good enough.”
Just Some Fuckhead
I didn’t click on the link but the two grafs you posted Dennis seemed to indicate to me that Colin Powell thinks Health Care Reform should be put aside in favor of economic reform/stimulus/regulation.
Nothing about PTDB.
Not sure about the slavery lesson there either. Just do whatever it takes now and we’ll solve it later with a bloody civil war? Eeek.
angler
Ok, if you all are committed to resurrecting the crappy senate bill, so be it, but if you want to high-five Powell’s analogy here, God help you. Really, God help you.
Quoting “And, they essentially said the main attack has to be creating a country, not solving the problem of slavery, one of the great compromises in our history.”
That’s the analogy you want to stick on? Sure slavery, but, well we made a country?!?!
No biggie, riiiiight.
–1787-1865 (13th amendment and end of slavery) equals 78 years of compromise.
-In the 1787 constitution the international slave trade (forced migration of Africans) was made impossible to abolish until 1808. During those years the US brought 250,000 Africans into the country the highest level in the history of the colonies-country that followed. Another 50,000 brought “illegally” thereafter.
— 1860, 4 million slaves in the US, equal to 15% of the total pop.
— Value of slaves in national economy = 20% of total national wealth. That is the value of owning people was more than banks, factories, railroads combined. Per capita wealth of free people (whites) was highest in the Deep South cotton states.
— Slave laws by state had no penalty for murder of slaves by owners much less rape, beatings, other abuses.
–It was commerce at its cruelest. 1790-1860, 2 million slave sales, 20-25% of them children (under 14) sold without a parent.
— Supreme Court 1857, said the Constitution denied blacks any rights that whites had to respect.
__in 1861 that “main attack,” making a country, what Powell said was worth letting SLAVERY continue, ended in a four year war that cost 600,000 lives.
–Slavery’s legacies range from racism to America’s higher homicide rates (highest today where slavery was strongest) to the anti-majority rule features of federal politics like the Electoral College.
— To argue analogies on this one? Fighting for abolition nationally would have been worth it, without doubt.
Powell is a person of dubious credibility–see comment above on the WMD case–and he’s made a career posing as the “reasonable man” who is willing to contemplate the unreasonable. “Slavery was worth the trade off” was a reflex for him, but is this really where you want to be?
For those in the very odd position of vociferously wanting healthcare reform but vehemently opposing the pubic option, albeit for what you’re calling practical rather than ideological reasons, keep your dignity and back away from this bullshit.
darryl
You’re asking balloon-juice to retire a phrase because it’s worn out? The people who can’t say “Deja vu” without adding “all over again”? The people who would respond to a thread about toaster oven repair with “Good news for John McCain?”
Good luck.
sgrAstar
Fine, thought-provoking diary, dengre.
J. Michael Neal
@jenniebee:
Oh, bullshit. They hate the policy. There are small parts of it that they agree with, but anyone who thinks that they like the idea of mandating community rating, or closing the donut hole, or squeezing Medicare Advantage, or expanding Medicaid, or providing billions of dollars in subsidies, or anything else like this is fucking nuts. Republicans would never pass this bill. Completely and utterly delusional. Honestly, do you really think they’ll pass that stuff?
How does this get us closer to Medicare for everyone? Well, for starters, it enshrines the idea that health care is a right that everyone should have. It sets up the idea that everyone can have it. Where do we go from here? My guess is that we see the continued slow motion demise of the employer based health care system*, putting more and more people on to the exchanges. Once there, you’re going to end up with it becoming more and more obvious that we should finish the job. It won’t be particularly quick, but it will eventually happen.
By the way, did you see the article in the LA Times over the weekend completely shredding your idea that there’s no adverse selection problem without an individual mandate? Did you ever bother to look at the US Census data I pointed you to?
*If you don’t have a solution for the fact that this problem is getting worse right now, when do you plan to come up with one?
Joe Buck
I’d like to see progressives continue to push for a better bill, and if the Democrats were smart (which they aren’t) they’d go for the public option because polls show it’s a lot more popular than the Senate bill, and people hate the insurance companies. But I’d take the Senate bill plus minor fixes over no bill.
I admit it, I’m selfish. I have good corporate insurance right now, but should I be laid off, I have a medical condition that basically means no one will sell me insurance as long as it’s possible to refuse people based on pre-existing conditions.
Mike E
@angler:
Way late here, but fuck Colin Powell. The Doctrine that bears his name was a direct response to our misadventure in Viet Nam, so he put it to the test in Desert Storm–shock, awe, overwhelming force, then a ridiculously premature pull out. Because the ‘optics’ weren’t politically advantagous, he told Poppy to amscray. Fuck him and his supposed ‘wise man’ cred. Stormin’ Norman had Saddam and his inner circle in the proverbial crosshairs, but the thumping of the Republican Guard ‘looked bad’. Whatever. How were the next 12 years for you?
Cut to: the Gen. holding a vial of ‘fuck you’ in front of his face. Gotta love the Bush’s, they’ve got some serious dirt on people locked in the family vault. Must be so persuasive that supposed grown ups like Powell will gladly do their dirty work and sell their souls.
Pam C./femlaw
I think we had this conversation a couple of weeks ago. :-) Yes, I have always thought that the reason health care became such an intense battle was because it represented a fight to reclaim a vision of the government as an affirmative social contract and force for good in people’s lives.
But I am also starting to realize that this is perhaps precisely why the public option fight has gotten so tough and so toxic. What is at stake is how you understand what vision of government we are defending. To me it is supposed to be for making a guarantee of a basic level human decency for all citizens. To others it is supposed to be a safe harbor from a corporatized society. I don’t share that view but I am starting to understand how, if you do, then the stakes of this fight become primary and not secondary.
The problem is this isn’t just a fight among the left between those two visions of the role of the state. It’s a fight that also includes a totally nihilistic view of government’s role and defeating that must be the first priority.
Mark S.
@jenniebee:
Exactly, and I’m extremely dubious that the free market can provide health care. There’s a reason no other industrial country does it this way. They probably have a point, seeing as they get universal coverage at about half the cost we pay.
I don’t know about that; I think they would just pass the tort reform and let insurance companies set up shop in whichever state provides the least regulation. Oh, and tax credits, their solution for everything.
J. Michael Neal
@angler: Do you think that not approving the Constitution would have led to slavery ending any earlier than it did?
PeakVT
@angler: I think you’re misreading what Powell said. He didn’t say that in retrospect the compromise was worthwhile. Instead, he was talking about what the participants in the constitutional convention knew at the time. In the context of that historical moment, compromising on slavery obviously was seen as acceptable. Nobody knew that even non-slave-owning southern whites would sacrifice their lives by the thousands to defend such an evil institution. And if someone had suggested it, mostly likely the proponent would have been regarded as slightly mad. OTOH, the possibility that England would regain control of the colonies if they didn’t unify more was seen as imminent, and quite rational.
burnspbesq
@J. Michael Neal:
Jeez, is there someone out there who actually believes this (I know you don’t, JMN)? Whoever you are, you’ve got it exactly backwards.
Adverse selection is precisely what causes the death spiral that Anthem Blue Cross was trying to rate-hike its way out of. I have no doubt that a rate hike was necessary to keep Anthem on a sound actuarial footing. I am completely skeptical that 39 percent was the right number.
The mandate is the solution – not the problem. In fact, without the mandate, none of the rest of the package will work as intended.
jenniebee
@J. Michael Neal:
Dude, they proposed essentially this bill in ’94. And these are the people who, only a few years ago, created that huge Medicare drug expansion. The only possible way to put together a bigger giveaway from the taxpayers into private insurers’ pockets than that POS was would be to, I don’t know, saddle every single American with a subsidized individual mandate to buy private insurance. The only things they’re more interested in than delivering that kind of gelt are union busting, starving the beast, and denying a victory to a Democratic president.
J. Michael Neal
@Mark S.:
No one here is saying that it is a sensible way to do it. What we are saying is that it is a possible way to do it. There are two ways to get to a sensible system:
1) Wait for the existing system to completely and totally collapse to the point that so many people don’t have health insurance that you finally overcome the deep public hostility to being forced to give up their current health insurance.* In the meantime, live with the millions of people that with exist with crappy health care, no insurance, and bankruptcies.
2) Pass incremental change that shepherds us through the process, leading us in the right direction and cushioning the shock of the transition.
Personally, I think that “Heighten the contradictions” is one of the most disgustingly evil concepts ever used to pave the road to hell, so I think my preference should be clear.
*It never ceases to amaze me that people that scream endlessly about how forcing people to buy health insurance is a complete political death sentence, based upon raw speculation, can completely skip over the death sentence that would be forcing people to give up the coverage that large majorities tell every pollster that asks that they oppose giving up.
burnspbesq
@jenniebee:
Saddle? With all due respect, that’s so wrong-headed I scarcely know where to begin.
As I said before, the mandate is what makes everything else possible. Without all those healthy young people paying into the system, you can’t cover people with pre-existing conditions. You just can’t make the actuarial math work.
And before you use a pejorative term like “saddle,” you might want to ask a family with kids, where both parents work in jobs with no employer-provided coverage, whether they’d like to be “required” to buy affordable insurance. The answer might not be what your ideology wants it to be.
J. Michael Neal
@jenniebee:
Citation? I’d love to see that they proposed the same bill, as well as the reasoning that they’d do it now. However, given your previous argumentation, I’m just really skeptical that this is an accurate representation.
Well, yeah, but this bill doesn’t provide nearly the sort of payout to the insurance industry that Medicare Part D did. That one was pure profit for them, without nasty things like community rating, medical loss ratio restrictions, or exchanges.
J. Michael Neal
@burnspbesq: As you’re about to find out, jenniebee denies the existence of adverse selection as a serious problem, here. See, no one is stupid enough to go without health insurance if they can help it.
jenniebee
@J. Michael Neal: Considering that Great Britain eliminated slavery several decades before the US did, I think it’s fair to say that a failure to successfully separate from them might very well have resulted in an earlier elimination of slavery.
But it’s a ridiculous analogy anyway. The objective in passing the Constitution was to establish a Republic. The objective in passing health care reform is… apparently we’ve backed up to saying that our objective is to get a legislative victory or to make insurance companies work harder to avoid paying claims for sick people, or something.
Bill H
I think Powell should stick his head back up his ass and crawl back in his hole and resume hiding. He lost any moral authority at a desk in the United Nations lying his ass off.
His plan would be wonderful if we only had one fucking problem that needed dealing with. But I voted for Obama because he promised he could walk and chew gum at the same time.
J. Michael Neal
@jenniebee:
We separated from Great Britain five years before anyone even started discussing the Constitution. We’d already crossed that bridge. The question was whether to replace the Articles of Confederation with the Constitution.
No, that’s not what any of us have been saying, but it doesn’t surprise me that you haven’t been listening. The objective of passing health care reform is to improve the health care system, which this bill does.
J. Michael Neal
@Bill H:
I don’t see any evidence that Congress can walk and chew gum at the same time. Getting them just to walk is hard enough.
The Raven
Now explain it to the slaves. Apologize, if you can. Make it right.
If this is an argument for passing the bill, I’d hate to hear one against.
Croak!
MaximusNYC
This.
When people are locked out of the system, they have no one to turn to and nothing to fight for.
When they are inside the system, they have, most importantly, a fighting chance at getting decent care — and staying alive and well.
AND: If their mandated insurance is shafting them, they have someone to complain to, and/or about! The focus then becomes making their health care better.
This is a first step. Note that Obama is currently rolling up the program of public subsidies for private student loans. Sooner or later maybe we can roll up public subsidies for private health insurance. But first let’s grab this low-hanging fruit and GET PEOPLE INSURED.
We are inches from the finish line. Let’s get it done.
J. Michael Neal
By the way, over the last week and a half, has anyone stopped to reconsider the idea that Obama could have threatened Evan Bayh with a primary challenge?
Silver Owl
If there were more Powells in the republican party his plan would work, but instead the republican party is filled to the brim with mind numbing arseholes that do not think. We have an over load of greedy short sighted suicidal assholes.
In fact if there were more Powells in the Republican party I’d say we’d be 500 metric tons lighter of absolute bullshit in both the Senate and the house.
jenniebee
@burnspbesq:
Those healthy young people who are going naked are low-earners, a lot of them are unemployed or employed in small companies that don’t offer insurance. Translation: they can’t afford insurance and their “paying into the system” is going to be heavily subsidized – in other words, it’s going to be taxpayers paying into the system to cover them to pay for the expensive older sick insurees.
The young healthy person who is not offered insurance through his employer but who is still paid so generously he totally could spend $600 a month for insurance is… it’s mind boggling that J. Michael Neal calls me delusional for not believing that they exist. You can talk actuarial numbers all day long, I don’t dispute them, I’m talking about demographics, and when we are talking about 20-30 year olds, we are talking about people who are not secure in the job market, who are making entry level wages, who have not built up any assets to speak of… this is blood out of turnips territory.
I don’t dispute that if a whole bunch of unemployed young healthy people handed over large amounts of money they don’t have to the insurance companies that the insurance companies would make more money without raising rates on everybody. What I’m saying is that you might as well say that the problem is that homeless people aren’t paying into the system.
If the numbers showed that it was a whole bunch of prime earners aged 30-55 who were dropping out of insurance because the numbers worked out better for them that way, I’d say go after them. But when you talk about the 20-30 set, you’re really talking about the 30-55 year olds who are going to pay for them through subsidies paid for by tax revenues, it’s just cosmetically nicer to say that it’s those young healthy greedy meanies who are ruining things.
jenniebee
@J. Michael Neal: Considering that the deadline to enter the primaries was one day after Bayh announced his retirement and only one other candidate was circling petitions and she was a fucking joke of disorganized, unfunded general incompetence, no, it hadn’t really crossed my mind that Bayh’s retirement was because Obama threatened him with a primary challenge.
But then, I’m delusional and my argumentation is unconvincing…
freelancer
@J. Michael Neal:
Jeez, Tom! I was just speculatin’ about a hypothesis!
jenniebee
@J. Michael Neal:
The Articles of Confederation had proved a total failure, and the possibility of being reabsorbed was not exactly farfetched. The Brits were impressing our sailors at the time and they managed to burn our capital a full quarter of a century after the ratification of the Constitution. Thus the “reabsorbed” rather than simply “lost the revolution”
Well shit, with an objective like that, I no longer wonder why you aren’t asking for more. The only mystery now is why you aren’t bitching everybody out for not calling their reps to demand that they take everything but tort reform (and a kleenex subsidy for Repubs to clean up with after passage) off the table so that this can get passed.
Mnemosyne
@jenniebee:
Wait — what? It’s more likely that Great Britain would have not eliminated slavery at all, or not until much later, because the economic reality of slavery was that you could only make huge profits on those huge cotton and tobacco plantations in the South by using slave labor. If said plantations had still been paying taxes to the mother country and making money for Great Britain, you bet slavery would have still been legal in Britain.
ETA: Or they would have “exempted” the American colonies the same way they “exempted” the East India Company from following the law.
J. Michael Neal
@jenniebee:
No, they aren’t. Clearly, when I asked you whether or not you had looked at the Census data I dug up for you, the answer was, “No.”
What that data showed, had you bothered to look at it, is that there are about 21 million people aged 18-30 in households with incomes above $50,000/year, and who report their health status as either Very Good or Excellent. Of those, about 15 million received health insurance through their employers. Of the remaining 6 million, more than half of them have no health insurance.
That’s selecting for people with incomes above the median, who shouldn’t have any trouble getting coverage due to pre-existing conditions. Less than half of them actually buy health insurance. Now extrapolate that into a situation in which the premiums for healthy people like themselves go up, and in which there are fewer and fewer people getting their health insurance through their employers.
This is an enormous problem. As I keep telling you, you simply can’t just assume that everyone calculates risk the same way you do.
Badtux
For the people saying that the proposed bill sets up a system where “nobody else on the planet does it that way” — nonsense. Both the Dutch and Swiss systems are set up that way (where individuals buy coverage on the open market, with a mandate and with a subsidy for those who can’t afford insurance). The only real difference between this bill and the Swiss system is that companies, as well as individuals, have a mandate placed upon them, a mandate to either provide insurance for their employees or pay a percentage of their payroll towards the subsidy fund. That’s pretty much it. There’s details that differ, but the bones are the same, and any issues that come up can be fine-tuned until the system runs as smoothly as the Swiss system.
There’s reasons why I don’t like the Swiss system (and the system set up by this bill) — for example, a larger percentage of working people’s income will go to pay this “health care tax” than for wealthy people, which even the Swiss admit isn’t really fair since a healthy population is good for both workers and their owners — but to say it’s never been done before is just hyperbole.
J. Michael Neal
@jenniebee:
Yes, I understand that you don’t want to see anything improved until you have your pony. In the meantime, I and my pre-existing conditions would like some coverage.
jenniebee
@Mnemosyne: That was pretty much the CSA’s theory – that the Brits wouldn’t allow anything to interfere with the supply of cheap southern cotton – but Lincoln’s step to ensure that Britain absolutely wouldn’t get involved was to frame the war as a war to end slavery. So you’ve got an interesting idea there, but I really don’t see the Southern plantation owners having more pull in a government a couple thousand miles away across an ocean than they did with a US capital sitting on the Virginia border, and without that there’s no reason to think that the Brits would have given southern cotton any more consideration than they non-hypothetically did from 1860-64.
Mnemosyne
@jenniebee:
Really? You see absolutely no way that a group of very rich plantation owners who were subjects of the British empire could possibly influence Parliament to not pass laws that would hurt their business? Parliament would just turn down their filthy money and go with their consciences?
Sorry, but politics has pretty much never worked that way in all of recorded history. The Brits didn’t support the CSA because they weren’t part of the British empire. If that cotton had been British property and not the property of the CSA, you can bet Parliament would have been hanging onto it with both hands even if it meant turning a deaf ear to Wilberforce.
J. Michael Neal
@Mnemosyne:
Of course. You see, the British Parliament of the 19th century was in every way more democratic and less the tool of moneyed interests than the US Senate of the 21st century.
jenniebee
@J. Michael Neal: I’m just using back of the envelope math here, but 6 million is – and this is just a rough sketch here, but I’m pretty sure that it’s – 2% of 300 million. Give or take. Huge problem. Let’s say that those 6 million people each continue to reason the same way and pick up insurance plans with outrageous deductibles that cost $50 a month – just checked with Aetna and they offer a plan at that rate that doesn’t actually cover anything, but they will take your money as long as you don’t make any claims. Again, just rough calculations, but that would be $600 a year times 6 million people is $3.6 billion dollars in lost revenue. Which I’ll admit, is huge. It’s so big that it’s just over 25% of the apparently absolutely irrelevant $12.2 in combined profits that the for-profit insurance companies posted for 2009. And their profits are nothing compared to their bloated administrative costs (read: executive compensation).
Which makes it amazing, simply amazing to me, that this system can work fine with a free market for-profit delivery system, but is going to utterly collapse if we don’t root out those six million ne’er do well twenty-somethings who are ruining the beautiful free market for everybody by being rational actors within it. Because I can do, you know, math.
Daddy-O
Coulda sworn he meant THIS General…
Because Gen. J.C. Patriot is ALWAYS right.
;-)
patrick
“fix the economy”
We can’t fix the economy until we fix health insurance. We essentially charge a 10 percent tariff on business done in our country because our health care is so expensive compared to other countries.
NobodySpecial
@J. Michael Neal:
Instead of a pony, how about a plan a guy like me can actually afford? I mean, I’m a bit over 30, and I make a bit less than 50K, but I always supposed that I was equal to other citizens in the US. I guess in your desire to get your ‘pre-existing’ self covered, you’re perfectly happy no matter how many people you kick in the trenches.
scarshapedstar
I don’t. That’s almost as vague of a “main attack” as “fighting the terrorists”.
mclaren
@Dennis G.:
Absolutely right.
Shorter version:
(Meaningful reform of America’s health care system is impossible for obvious reasons: it’s one of the last few centers of genuine profit in America after we’ve outsourced all our blue-collar manufacturing and, more recently, we’re in the process of outsourcing essentially all our skilled high-paid high-value-added white collar work, whether it be programming or graphic design or accounting or mechanical engineering or biotechnology or robotics or aerospace design work or computer hardware plus software. All those high-skilled high-paid jobs are rapidly leaving America forever for India and China and other parts of the third world, and they’re never coming back to the U.S. That leaves America as a nation of dog groomers and xerox clerks and maids with a few lawyers and doctors on top as the superrich, and a few wildly overpaid insurance agents and wildly-overpaid bedpan-emptying nurses as the only remnants of the middle class. Obviously neither Obama nor the Democrats will willingly dismantle those remnants of the middle class by destroying the American health care system as a sweet sweet river of gold for all those millions of remaining middle class nurses and orderlies and radiological technicians, so meaningful health care reform was never an option. Equally obviously, since FIRE — Finance, Insurance and Real Estate — are the only other real profit centers in American business and since real estate is now gone with the subprime meltdown, that leaves only Insurance and Finance, and it should be self-evident that neither Obama nor the Democrats will dismantle these remaining bastions of middle-class income. Tearing down the current horrendously inefficient U.S. health care system and reforming it would destroy insurance as a profit center in America, leaving only finance. And with real estate gone for at least a generation if not more, and with American finance flat on its back and broke because all American banks are essential in default and illiquid, shutting down insurance would destroy what’s left of American business. That’s not going to happen. Obama and the Democrats reason, correctly, that it’s better to have a grotesquely corrupt inefficient horribly broken health care system that will soon explode and collapse, than to have all current profit centers of American industry in FIRE — finance, insurance and real estate — blown up and destroyed right now and unable to provide jobs for anyone. Hence the obvious and easy-to-predict failure of the HCR effort, as I have in fact long predicted.)
Since meaningful HCR reform was never possible, and since without it the U.S. economy can’t recover, this explains why the overwhelming majority of polls now show a vast Republican landslide, “unprecedented in modern history” to use pollsters’ terms, in which Republican congressional candidates sweep the House this November and get not just the 40 seats required to regain control, but many more — enough to insure a control so substantial that it may last generations.
Shorter version of Dennis G.’s syllogism: (major premise) Without HCR reform the American economy is in an irretrievable death spiral; (minor premise) Meaningful HCR reform is impossible for structural reasons; (conclusion) Therefore the American economy is in an irretrievable death spiral.
The American people know this, since they’re not stupid, and consequently they will blame the Democrats this November. Incidentally, none of this is due to Democratic political ineptitude, or the lack of skilled Democratic politicans. The reasons why healthcare reform was impossible are structural and inherent to the current U.S. economy. Meaningful HCR reform is impossible for the same structural reasons that meaningful decreases in American military spending are impossible — real reform would throw so many highly-paid middle class workers out of work that the U.S. economy would plunge into a depression that would make 1932 look like a buoyant energetic economic boom.
Take a look at the stats and regression model cited here for details, and weep.
When the Republicans sweep the House this November, further meaningful action on any kind of reform of the U.S. health care system or the U.S. financial system or the broken U.S. military or the corrupt American campaign finance system will become impossible.
Instead, after November 2010, we can look forward to an endless round of 24/7/365 Republican investigations into ACORN and the 2008 Presidential vote leading to the appointment of a special prosecutor and eventually a concerted Republican attempt to impeach President Obama sometime between January 2011 and November 2012.
Whether or not the effort of the new Republican House majority to impeach Obama will be successful, and regardless of the fact that no substantive findings will ever be revealed by the various House investigative committees controlled by Republicans looking into Obama’s alleged lack of a birth certificate, the purported role of ACORN in stealing the 2008 election, and other far-right fantasies and delusions, I don’t know. The point remains that it doesn’t matter. Current Republican allegations against ACORN and Obama’s presidential campaign staff are obviously devoid of merit, but so were the Republican allegations against Bill and Hillary Clinton on the basis of the Whitewater land deal, the Clinton “travelgate” nonsense, and the absurd “investigation” into Bill Clinton’s Christmas card list (you might recall that last absurdity).
None of that made any difference. The mainstream media eagerly carried the Republican delusions and fantasies as major headlines around the clock, and the major TV networks regularly scheduled news events about the so-called “Whitewater scandal” (hint: there wasn’t one. After more than 4 years of exhaustive congressional investigation, no criminality or even impropriety was ever found in the Clintons’ Whitewater land deal. See the book “The Hunting of the President” for details.).
Just as with the Clinton investigations, the forthcoming ACORN/birth certificate investigations of Obama will paralyze the White House and shut down Washington, making any Democratic efforts at reform impossible during the remaining window between now and the November 2012 presidential election.
The Republicans will of course use the Democrats’ lack of ability to move forward any substantive reform as a bludgeon, calling the Democrats “ineffectual” and “unable to govern” and “incapable to creating change.” This should clear the way for President Palin to take power in November 2012, at which point any sane person needs to leave America pronto. If you thought Dubya was bad, wait till you see the Palin administration under a Republican-controlled congress.
I said it before, to hoots of derision and snarls of contempt, and now I say it again: the Republicans are unstoppable. They burn with the fierce frenzy of true believers while the Democrats fumble and stumble and bumble ineffectually, divided and unsure of themselves and lacking any real commitment to liberal beliefs. As Yeats put it, “The worst are full of passionate intensity while the best lack all conviction.”
Today America stands poised to repeat the experience of Spain in 1937, with the sociopaths and monsters triumphantly defeating the forces of sanity and common human decency. After 2012, under President Palin, America will become the torture capitol of the world, a war machine bent on invading not just Iran and Syria but applying the kind of psychotic levels of brutal shock-and-awe force we’ve seen in Fallujah against the American people, here at home, with paramilitary assaults unheard-of in American history. As at the end of the 1960 film Spartacus, we can look forward sometime after January 2013 to hearing a Republican president intone on national television:
Never before in American history has one political party exhibited the kind of superhuman discipline we have seen from the Republicans, with not a single defecting vote in block after block of unanimous 40-vote obstructionism. Once the Republicans regain control of the House of Representatives and the White House (the senate remains in doubt, but since it doesn’t have the power of the purse, it’s not very important) , you’ll see a holocaust of repressive legislation that will make General Francisco Franco’s mass arrests in the 1930s look mild by comparison.
If you own a house, sell it and get a passport and get out of America now. If you rent, leave what you own behind and flee before the borders shut down and the Stasi — excuse me, the DHS — come for you with a black hood over your head and Patriot Act powers that allow them to declare you a non-citizen and throw you in a torture chamber forever without charges and without trial.
Run. Flee. Get out of this country while you can. America is finished. Save yourselves.
brantl
I’d feel a whole lot better if the “bill” in the PTDB wasn’t essentially a gift to the insurance industry and did more about actual health care. As far as I know, it’s got no real cap on cost, and doesn’t stop recission. What’s to like?
Yes, they need to pass SOMETHING, to have a marker on the table, to remind everyone that this needs to be fixed, but they should certainly fix all that they can in reconciliation, and stick it down the Republicans’ throats, both for the improvement that it will do the US citizenry, and to knock back the imbecilic conception that government can’t do anything good for people, which idea’s even-remotely-possible validity went out with the middle ages.
Dennis G.
@jeffreyw:
Your edit would have made my point sharper. Thanks
Randy P
@angler:
I see what Powell is saying here, but that was kind of my reaction too. OK, so the secondary goal took only a century to achieve? I hope we’re on a faster time scale here.
And of course we didn’t really fix things even in the 1860s. There was yet another compromise that ended Reconstruction and set the stage for the Jim Crow laws, and it would be ANOTHER 80 years or so to roll back the effects of that compromise.
Dennis G.
@Pam C./femlaw: Yes, it may be that my view of the primary battle is different than others–this is perhaps the nature of politics and why things become battles. I think that in the last 30 years the wingnuts have done a great job of attacking government on all levels. Their point is to always prove that it can not work, can not help and can never be useful. Their point is to drive home their meme that Government is always the source of the problem.
Democrats are fighting about how government should work and overlooking that first they have to win a larger public battle that proves the wingnut meme wrong. I think President Obama is focused on governing and showing that government can and does help. Proving that can can be part of the solution to our problems is the first step, but many are distracted by other things. Once the core battle is won, then secondary questions of better ways that government can be part of the solution can be fought. Getting a HCR Bill passed is part of the core battle. Expanding that legislation in the future with a PO and other needed improvements are next. I can see how some want to bypass the first step, but that can not be done.
Cheers
Cheers
bayville
Why was General war criminal on my TeeVee and not in jail?
Really don’t care what this liar has to say, he should be spending the rest of his life at Gitmo.
Randy P
@darryl:
Hey, I resemble that remark!
And why would you assume this trait is limited to Balloon Juice? You know “assume” makes an “ass” of “U” and “me”.
Besides, it ain’t over till the fat lady sings.
(I tried to work in “there ain’t no I in TEAM” but my creativity wouldn’t stretch that far. Also).
Just Some Fuckhead
@Randy P: My personal fav is “There’s more than one way to skin a cat.” Whenever I hear that, I immediately inform the speaker there is, in fact, only two ways to skin a cat.
Yes, two is more than one but “There’s more than one way to skin a cat” implies many, not just two.
Why can’t we just say “There’s two ways to skin a cat” and be done with it?
Ash Can
Q F the fucking T
Here is someone who truly understands how lawmaking works. Dengre, this was a breath of fresh air, especially coming on the heels of John Cole (and a host of others here), well, having a bad day. Thank you.
Bob (Not B.o.B.)
@rob!:
John Kerry is supposedly a lock.
jenniebee
@Mnemosyne: Dude, they didn’t give that consideration to the rice, indigo, sugar, etc. plantation owners who lived in Britain and (many of them) controlled rotten burroughs, why on earth do you think a bunch of colonials with no Parliamentary representation would have had more sway? And the Brits had no compunction about dumping on colonial industry – or forbidding colonial industry outright, which is why Americans were shipping raw cotton to England rather than producing finished goods here at home.
Besides, the real problem the South had, the reason they rebelled rather than jump at schemes floated before the civil war to do something similar to what Britain did and essentially let taxpayers buy the freedom of all the slaves, was not an economic reason. Economically, it’s possible to get just as much work at lower cost out of a free man than out of a slave. Their real problem with letting slaves become free was pure racism, combined with the fact that generations of slaveowners had literally fucked their way into a situtation where the only way you could tell with some people whether they were free whites or enslaved blacks was the chains. There’s a reason that the South immediately following the war became obsessed with “miscegenation.” And that was not an argument that the Brits were much in sympathy with.
Remember November
@Just Some Fuckhead:
he earned it. next.
Just Some Fuckhead
@Remember November: Well, yeah, if you think the right to live a healthy life is something that is earned. I happen to think that’s immoral.
TJ
Whatever floats your boat. My preference is to make the merely inadequate the enemy of the no chance of working. Especially when it’s becoming obvious that whatever passes is all you’re ever going to get before the health care system implodes.
Chris Johnson
Mclaren: cheerful motherfucker, ain’t you?
I don’t know. Seems to me that as soon as people are willing to float a theory THAT insane and dysfunctional on the back of the idea that people are uniformly insane, toxic and blind, it’s a hint that the theory’s about to implode.
It was much the same with the dotcom boom. “Yes, it’s crazy and really stupid, but it will describe the whole future now, because this!” *implode*
The weird thing is, it’s a nightmare you’re clinging to. Maybe what you think of as a middle class was already gone before you knew it?
I’m not persuaded. I think you’re missing something, somehow. It’s not clear- it never is- but it’s the same mechanism that pops speculative bubbles. In this case the ‘bubble’ is your Gor-like unworkable dystopia.
BC
Once the country was up and running under the Constitution, it was financed by the fruits of slavery, which made it very difficult at that point to even entertain the thought of abolishing slavery. Because the US government had to impose direct taxes, the most-used taxes were the tariff (tax on imports) and export taxes. What US exported the most were cotton and tobacco, which were dependent on slave labor to be an efficient export.
Mark S.
@Badtux:
Fine, I’ll take the Dutch system:
That’s about $1800 a year. That’s a little cheaper than here.
Molly
Curious…I read the number from Jenniebee that $600 per month is what the mandate would cost for the uninsured. Where is that number coming from? I read the “back of the envelope” math, but it doesn’t include subsidies. So, for people who have dug into this, are there any estimates of actual costs per person per month?
And don’t tell me to Google. :) The numbers are so jacked by political agendas you can pick your poison.
ksmiami
Ummm – I also think we haven’t had the talk yet, that basically the elderly consume most of the healthcare at end of life when there is not a lot of hope. My in-laws keep going to Doctors searching for the answer, when the short one is yes, you are old, no, there is nothing we can do and you should just go home and enjoy life that you have. Seniors suck up most care and youth get the shaft. This is the demographic group that now most supports the GOP and we need to break them.
BTW, I love my in-laws and this is all terrible, but at a certain point, you have to accept that life changes.
CalD
Whoa, now. What part of “ME-ME-ME-FIRST!” don’t you get? What do you think this is, Canada?
Go write on the blackboard 100 times:
compromise = “selling out”
compromise = “selling out”
compromise = “selling out”
compromise = “selling out”
compromise = “selling out”…
jenniebee
@TJ: That’s about my take on this. If your main objective is political, then this is about the most essential bill there is and it’s vital that it passes. If your main objective is to establish a foundation, be aware that the “foundation” we’re establishing with this is for a for-profit approach with no cost-capping, and with an individual mandate but not an individual guarantee. This does not build a foundation for public health insurance. This does not make it easier in the future to expand Medicare to everybody because it enshrines a whole system around taxpayer subsidizing of private insurance. I’m still calling my reps asking them to pass it, but let’s cut the BS about this establishing a foundation for future ponies.
jenniebee
@Molly: I got that $600/year figure by going to a site that offers health insurance quotes, telling it that I was a 25 year old non-smoking male in Virginia, 5’11”, 170 pounds, in good health, and checking out the range of plans it offered me. The lowest cost one was about $50 a month for an HMO with a $3500 deductible, and that’s just the good things about it – it’s a worthless POS “no-claims” plan from Aetna, IIRC. And the price goes up if you change any of those factors (you could change VA for some other states without an impact, but not all). But since the “healthy hold-out” who is leaving J. Michael Neal out to dry by not paying for more health care than he consumes is exactly that – a healthy single male who is choosing the lowest cost option – I thought the description and choice of the lowest cost plan were fair.
jenniebee
@scarshapedstar: This. Thank you.
EconWatcher
Maybe I’m predisposed to interpret comments as supporting my own position. But it sounds to me as if the General has the same question I have: Why on earth didn’t Obama go after deep, aggressive financial reform first? He could have forced some Republicans to come along for the ride on that one, he could have built populist cred by going after the universally reviled bankers, and he could have kept the public’s attention on the disasters of the last administration that led to our current predicament, rather than allowing the blame for the 10% unemployment to fall on him.
Financial reform should have been the “main attack,” not HCR. Then he could have taken the addition political capital he would have accumulated to go after HCR. To me, a no-brainer, and maybe that’s what Powell was saying too.
Tim H
@jenniebee:
Yeah. It’s not a foundation, it’s a wall, which will prevent anything that’s long-term workable from being done until the whole thing breaks down. 17% of GDP and rising, and the Senate bill does squat about it.
Pretty much. Which goes to show how desperate they are for any accomplishment that doesn’t involve bank bailouts.
Although my opinion is that the Senate bill, on a purely political level, screws too many Democratic voters to give bennies to non-Democratic voters. And takes three years to do it. Without the public option it’s going to be seen as welfare, corporate and individual. Might not be as potent as they think. YMMV.
Mike in NC
Powell would have probably retired as an obscure three-star general if he hadn’t been deep-selected to be Bush #41’s CJCS and everything that followed. Bush 41 made him rich and famous, and Powell apparently (as a good Republican) places loyalty above all else.
mclaren
“Soaring costs laid to growing power of medical cartels”
(not available online, alas — this is transcribed from the print edition)
Feb. 21 2010, San Francisco Chronicle
by
Carolyn Lochhead and Victoria Colliver
[Comment: Notice that the current health care “reform” bill does nothing to fix these skyrocketing price-fixed double-digit cost increases caused by anti-competitive secretive monopolistic cartels operating among hospitals, doctors, insurers and medical devicemakers.]
The planned spike in health insurance rates by Anthem Blue Cross in California is just the tip of a Titanic-size iceberg of exorbitant price increases, secret pricing and consolidation not only by insurers – but by the hospitals, doctors and medical devicemakers that send the bills to the insurers.
Insurers, who strike deals with providers, pass the bills on to patients, businesses and governments. The nation is fast being bankrupted by a medical money machine that costs $2.5 trillion a year and takes more than $1 of every $6 that Americans earn.
“It’s an insider’s game in health care,” said Jeffrey Lerner, president and chief executive of the ECRI Institute, a nonprofit that researches medical practices.
Anthem, a subsidiary of WellPoint Inc., has come under state and federal scrutiny for its plan to raise rates by as much as 39 percent for many of its 700,000 California members who buy individual coverage. The company blames the increases on healthy individual policyholders who have dropped out of the market, creating a pool of sicker people.
The company said it will delay the rate hikes until May 1 to allow a state review. Hearings are planned in Sacramento and Washington, and Health and Human Services Secretary Kathleen Sebelius issued a report Thursday that found double-digit premium hikes in California and a half-dozen other states.
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
Many industry insiders are afraid to speak on the record for fear of antagonizing the medical groups they rely on for their survival. Contracting practices are draped in secrecy. Prices are almost impossible to obtain because of “confidentiality agreements” among hospitals, physician groups, insurers and devicemakers who do not want their markups exposed to competition or public scrutiny.
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
With doctors and hospitals sprinkled in every congressional district and wielding their clout, a year of health reform in Congress has overlooked some of the biggest cost drivers in American medicine.
“While the talk surrounding health reform has been about problems with the health insurance market, and I don’t want to suggest that’s entirely misplaced, I think market power on the part of providers, doctors and hospitals is a bigger issue,” said Martin Gaynor, an economist at Carnegie Mellon University.
Jerry Flanagan, health care policy director for Consumer Watchdog in Santa Monica, said the heath care system is “in a tug-of-war between warring tribes … over who has market dominance over price.” Flanagan doesn’t think the insurance industry is losing the battle.
Consumers have almost no control over costs, no ability to shop and little incentive to do so because most patients neither buy their own insurance nor pay their medical bills directly. But they foot the bill in skyrocketing premiums, deductibles and co-pays.
Individuals who buy their own insurance instead of getting it through their employer are at an especially steep disadvantage. They do not get the giant tax break Congress grants only to employers. Nor do they get the discounts that providers negotiate, often confidentially, for large insurers.
What has received far less scrutiny is the collusion operating underneath this system. The regional “networks” that hospitals and their allied physicians form to negotiate with insurers often exclude competitors and lock in exorbitant prices that are passed on as premiums.
Keith Smith, an anesthesiologist and co-founder of the Oklahoma Surgery Center in Oklahoma City, posts his surgery center’s prices online, a rarity in the industry. But he points to the “preferred provider organizations,” or PPOs, that he contends have morphed into medical cartels that make deals with insurers to monopolize care in their region.
“My prices at my facility are most of the time 70 percent to 80 percent less than the same procedure across town at a not-for-profit hospital,” Smith said. “Yet Blue Cross and any number of insurance companies are not the least bit interested in contracting with me. And we’re not fly-by-night. We’ve been in business 13 years and have the top physicians in the city. All I know is something smells.”
Don Crane, chief executive of the California Association of Physician Groups, which represents medical groups reimbursed by managed-care policies, blamed much of providers’ high costs on the fee-for-service system, which he says encourages doctors and hospitals to spend more, and on paltry reimbursement rates from government programs.
But a report last month by Massachusetts Attorney General Martha Coakley found extensive evidence of anti-competitive behavior among providers, including huge price disparities that bear no relation to anything except market power. Special pricing pacts and other forms of collusive behavior were “pervasive,” the report said.
The report said large provider networks that dominate local territories exercise leverage over insurers who need to offer their services.
Insurers leap on this argument, blaming rising provider charges, which were up about 6 percent last year, for higher premiums. But they do little to fight them. Exempt from antitrust laws, insurers have been rapidly consolidating and often dominate local regions, giving them power to pass on price increases to consumers and businesses.
Democratic Rep. John Garamendi of Walnut Grove (Sacramento County), a former state insurance commissioner, said provider groups “can dominate the market to the extent of dictating prices” in a local area. “We simply do not have a market system in many parts of the nation and California.”
Critics say even large price increases by providers cannot justify the double-digit increases that Anthem planned.
“It’s hard for me to make the leap from something that’s a few percent over inflation to something that is many multiples over inflation,” said Marian Mulkey, senior program officer for the California HealthCare Foundation, an independent philanthropy group based in Oakland.
mclaren
“Soaring costs laid to growing power of medical cartels”
Feb. 21 2010, San Francisco Chronicle
by
Carolyn Lochhead and Victoria Colliver
(not available online, alas — this was transcribed from the print edition)
The planned spike in health insurance rates by Anthem Blue Cross in California is just the tip of a Titanic-size iceberg of exorbitant price increases, secret pricing and consolidation not only by insurers – but by the hospitals, doctors and medical devicemakers that send the bills to the insurers.
Insurers, who strike deals with providers, pass the bills on to patients, businesses and governments. The nation is fast being bankrupted by a medical money machine that costs $2.5 trillion a year and takes more than $1 of every $6 that Americans earn.
“It’s an insider’s game in health care,” said Jeffrey Lerner, president and chief executive of the ECRI Institute, a nonprofit that researches medical practices.
Anthem, a subsidiary of WellPoint Inc., has come under state and federal scrutiny for its plan to raise rates by as much as 39 percent for many of its 700,000 California members who buy individual coverage. The company blames the increases on healthy individual policyholders who have dropped out of the market, creating a pool of sicker people.
The company said it will delay the rate hikes until May 1 to allow a state review. Hearings are planned in Sacramento and Washington, and Health and Human Services Secretary Kathleen Sebelius issued a report Thursday that found double-digit premium hikes in California and a half-dozen other states.
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
Many industry insiders are afraid to speak on the record for fear of antagonizing the medical groups they rely on for their survival. Contracting practices are draped in secrecy. Prices are almost impossible to obtain because of “confidentiality agreements” among hospitals, physician groups, insurers and devicemakers who do not want their markups exposed to competition or public scrutiny.
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
[Part 1. WordPress won’t let me post the whole article as a block, naturally]
mclaren
If you want a peek into your health care future, take a look at the article “Soaring costs laid to growing power of medical cartels,” San Francisco Chronicle, 21 February, 2010, by Carolyn Lochhead and Victoria Colliver.
Not available online, of course.
mclaren
Here’s the first part of that article. I’ll see how much I can post in small blocks:
“Soaring costs laid to growing power of medical cartels” by
Carolyn Lochhead and Victoria Colliver, 21 Feb. 2010, SF Chronicle
The planned spike in health insurance rates by Anthem Blue Cross in California is just the tip of a Titanic-size iceberg of exorbitant price increases, secret pricing and consolidation not only by insurers – but by the hospitals, doctors and medical devicemakers that send the bills to the insurers.
Insurers, who strike deals with providers, pass the bills on to patients, businesses and governments. The nation is fast being bankrupted by a medical money machine that costs $2.5 trillion a year and takes more than $1 of every $6 that Americans earn.
“It’s an insider’s game in health care,” said Jeffrey Lerner, president and chief executive of the ECRI Institute, a nonprofit that researches medical practices.
Anthem, a subsidiary of WellPoint Inc., has come under state and federal scrutiny for its plan to raise rates by as much as 39 percent for many of its 700,000 California members who buy individual coverage. The company blames the increases on healthy individual policyholders who have dropped out of the market, creating a pool of sicker people.
The company said it will delay the rate hikes until May 1 to allow a state review. Hearings are planned in Sacramento and Washington, and Health and Human Services Secretary Kathleen Sebelius issued a report Thursday that found double-digit premium hikes in California and a half-dozen other states.
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
Many industry insiders are afraid to speak on the record for fear of antagonizing the medical groups they rely on for their survival. Contracting practices are draped in secrecy. Prices are almost impossible to obtain because of “confidentiality agreements” among hospitals, physician groups, insurers and devicemakers who do not want their markups exposed to competition or public scrutiny.
mclaren
Same article, part 2:
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
With doctors and hospitals sprinkled in every congressional district and wielding their clout, a year of health reform in Congress has overlooked some of the biggest cost drivers in American medicine.
“While the talk surrounding health reform has been about problems with the health insurance market, and I don’t want to suggest that’s entirely misplaced, I think market power on the part of providers, doctors and hospitals is a bigger issue,” said Martin Gaynor, an economist at Carnegie Mellon University.
Jerry Flanagan, health care policy director for Consumer Watchdog in Santa Monica, said the heath care system is “in a tug-of-war between warring tribes … over who has market dominance over price.” Flanagan doesn’t think the insurance industry is losing the battle.
Consumers have almost no control over costs, no ability to shop and little incentive to do so because most patients neither buy their own insurance nor pay their medical bills directly. But they foot the bill in skyrocketing premiums, deductibles and co-pays.
Individuals who buy their own insurance instead of getting it through their employer are at an especially steep disadvantage. They do not get the giant tax break Congress grants only to employers. Nor do they get the discounts that providers negotiate, often confidentially, for large insurers.
What has received far less scrutiny is the collusion operating underneath this system. The regional “networks” that hospitals and their allied physicians form to negotiate with insurers often exclude competitors and lock in exorbitant prices that are passed on as premiums.
Keith Smith, an anesthesiologist and co-founder of the Oklahoma Surgery Center in Oklahoma City, posts his surgery center’s prices online, a rarity in the industry. But he points to the “preferred provider organizations,” or PPOs, that he contends have morphed into medical cartels that make deals with insurers to monopolize care in their region.
“My prices at my facility are most of the time 70 percent to 80 percent less than the same procedure across town at a not-for-profit hospital,” Smith said. “Yet Blue Cross and any number of insurance companies are not the least bit interested in contracting with me. And we’re not fly-by-night. We’ve been in business 13 years and have the top physicians in the city. All I know is something smells.”
mclaren
Same article, part 3:
Don Crane, chief executive of the California Association of Physician Groups, which represents medical groups reimbursed by managed-care policies, blamed much of providers’ high costs on the fee-for-service system, which he says encourages doctors and hospitals to spend more, and on paltry reimbursement rates from government programs.
But a report last month by Massachusetts Attorney General Martha Coakley found extensive evidence of anti-competitive behavior among providers, including huge price disparities that bear no relation to anything except market power. Special pricing pacts and other forms of collusive behavior were “pervasive,” the report said.
The report said large provider networks that dominate local territories exercise leverage over insurers who need to offer their services.
Insurers leap on this argument, blaming rising provider charges, which were up about 6 percent last year, for higher premiums. But they do little to fight them. Exempt from antitrust laws, insurers have been rapidly consolidating and often dominate local regions, giving them power to pass on price increases to consumers and businesses.
Democratic Rep. John Garamendi of Walnut Grove (Sacramento County), a former state insurance commissioner, said provider groups “can dominate the market to the extent of dictating prices” in a local area. “We simply do not have a market system in many parts of the nation and California.”
Critics say even large price increases by providers cannot justify the double-digit increases that Anthem planned.
“It’s hard for me to make the leap from something that’s a few percent over inflation to something that is many multiples over inflation,” said Marian Mulkey, senior program officer for the California HealthCare Foundation, an independent philanthropy group based in Oakland.
ThatLeftTurnInABQ
@Pam C./femlaw:
This is very well put.
Since my stock in trade is historical analogies, I’d say that Dems have mismanaged the HCR process about the same way the Allies in WW2 mismanaged the battle of Anzio.
By not being able to decide whether to be bold (we can sieze Rome!) or cautious (let’s go slow putting troops inland until we know what the Germans are going to throw at us) we’ve effectively gotten the worst of both worlds. On the other hand we eventually are going to win this, even if it is a lot uglier than it could have and should have been if our leadership had been better.
mclaren
And here’s the kicker…
Nothing in the so-called health care “reform” bill fixes any of the monopolistic anti-competitive secretive cartel-like features of the way hospitals and doctors and medical devicemakers and insurers currently operate.
It ain’t reform, folks. It’s just more of the same.
Remember November
@Just Some Fuckhead:
No I mean he earned his VA benefits. Despite what you might think about those 16 words uttered on the floor of the UN- or his cheerleading of the WMD’s that did not exist- that does not wipe out the decades of service prior to that he gave to this country.
cyntax
@EconWatcher:
Yeah, I have to say that Powell’s statement isn’t the clearest endorsement of the PTDB position. It really takes some parsing to get it there, and your interpretation seems just as applicable.
I mean Powell was definitely endorsing the idea of going big right out of the gate, but he seemed pretty equivocal about whether HCR was the best target.
justawriter
Whenever I see the cliche “don’t let the perfect be the enemy of the good”, I feel the need for a corollary that goes something like “don’t let the achievable be the enemy of the adequate.” So often compromise guts the effectiveness of good laws to the point they are useless and then those weaknesses are used to attack the bill. I suppose I could go all the way back to the original welfare laws that were compromised to be limited to single parent households in the name of “supporting women and orphans” which were then later attacked for breaking up poor families. Which is the point of needing something better than, in Atrios words, “forcing people to buy crappy, overpriced insurance.”
Mnemosyne
@jenniebee:
Did you miss the part where the East India Company — you know, where a lot of that rice and indigo was grown — was exempt from the anti-slavery laws? The West Indies weren’t producing nearly as much as the East Indies, so it was easy for Parliament to decide to just pay out compensation to those slaveowners.
I’m really astounded by your naivete that you actually think that Britain, a country whose main industry and export was cotton cloth, would voluntarily take a large step that would cause the cost of cotton to rise precipitously out of the kindness of their hearts.
ThatLeftTurnInABQ
@Mnemosyne:
Oh come now. The Brits weren’t that bad. It’s not as if they were the world’s leading narco-terrorists, who invaded another major country (China) not once but twice to prevent them from enforcing their own laws regarding opium. Or that they deliberately starved the Irish to death just to prove an abstract point about political economy. And then did the exact same thing again in India several decades later, causing millions of deaths in the famines of the 1870s. And then did it yet again in India two decades later. Or that they were the people who invented the modern concentration camp during the 2nd Boer War.
Oh, wait..
Alan in SF
Let’s all listen to advice from the most politically ineffective Secretary of State in U.S. history.
mclaren
I particularly love the way the crackpot Mnemosyne has shifted the argument to…the British East India company in the 19th century.
Keep it up, kook. You won’t discuss health care reform because all of your claims are factually and provably false, as Harvard economist Umair Haque and the Congressional Budget Office and National Nurse’s Association have pointed out repeatedly.
“”Those wishful statements ignore the reality that much of the expanded coverage is based on forced purchase of private insurance without effective controls on industry pricing practices or real competition and gaping loopholes in the insurance reforms,” said [National Nurses Union co-president Deborah] Burger.”
Source: Nation’s Largest RN organization says health care bill cedes too much to insurance companies.
“The Senate’s health benefits excise tax would impact 27% of families and 22% of individual plans by 2019 according to the Joint Committee on Taxation,” Courtney said, “and those numbers would just increase.”
Senate Plan To Tax Health Plans Is Bad Policy
Just Some Fuckhead
@Alan in SF:
He endorsed the King of the Obots so he’s the greatest thing evar now.
Sebastian Dangerfield
@angler:
Indeed. That’s some reasoning, huh? It’s better “to create a country” — even one with a massive ticking bomb under it — than to try to work out that pesky little slavery problem. WTF??!! The time-bomb of course went off less than 80 years later, and the country’s been suffering from the poisonous fallout ever since. Doesn’t occur to him that perhaps the “main attack” should be trying to avoid having such a deeply flawed and unstable union that it requires another round of extreme bloodletting to fix, does it?
mclaren
@Chris Johnson:
So the “theory” that all the available polls show massive and virtually unprecedented (since 1946) gains for the Republican party in the House in the next congressional election in November 2010 is “insane and dysfunctional”?
Okay.
Great.
Show me all the polls predicting Democratic gains in the House in November 2010.
Whoops. There are none.
Every single poll I can find shows massive gains for the Republicans in the House this November.
Every. Single. Poll.
I’m willing to change my mind to a more cheerful view. Just show me the evidence for it.
As for your claim that “[as for] the idea that people are uniformly insane, toxic and blind, it’s a hint that the theory’s about to implode,” well…
…You know, now that I think of it, former president Al Gore offers strong support for your view. After all, the American people weren’t so “uniformly insane, toxic, and blind” that they elected a coke-snorting drunk-driving ignorant incompetent sociopath to the presidency instead of Al Gore.
And lord knows, the American people certainly weren’t so “uniformly insane, toxic, and blind” that they elected that sneering jeering coke-snorting drunk-driving ignorant incompetent sociopath to the presidency twice in a row — once in the year 2000, and again in 2004.
And what’s more, John Cole, the guy who runs this site is a highly educated guy, and he’s definitely not so “insane, toxic, and blind” that John would vote for and ferociously defend the crazy destructive policies of that selfsame coke-snorting drunk-driving ignorant incompetent sociopath in the White House from 2001 to 2005.
Right?
Absolutely. I mean, when you’re right, you’re right. Al Gore’s presidency remains a bright spot in recent American history. I concede: you have destroyed my arguments, and I stand disproven.
jenniebee
@Mnemosyne: You keep holding up the East India Company as an example as if it was similar in power to a conglomeration of petty fiefs across the American South, and that’s just not right. In the 19th century, some American companies had “company towns” – the East India Company had a “company subcontinent.” They had a private army. And their headquarters were located in London. If you want to say that the British government wouldn’t want to mess with colonials on the grounds that they didn’t mess with the East India Company, we could play that game counterfactually all day long.
But this “naivete” is borne out by history anyway. Britain did in fact voluntarily emancipate their slaves thirty years before the US did, East India notwithstanding, at a substantial cost (12 million pounds sterling just in compensation to the slaveholders) and for no apparent economic gain. Would they have done so if the cost had included the American South? It’s possible. Was the British reliance on American cotton so complete that they wouldn’t risk it on merely moral grounds? Actual history supports the counter-historical theory that they might just have, because when the Brits’ supply of cotton was entirely cut off during the US Civil War, they didn’t come in on the side of the South and they stopped making noises about the war almost entirely when Lincoln issued the Emancipation Proclamation. And they aren’t the only ones who did – Russia emancipated the serfs in the 1860s, after all. Northern states abolished slavery voluntarily and made out like bandits from it when Irish immigrants raced freed African Americans to the bottom of the wage ladder. If the Brits really thought there would be a labor problem on American plantations after emancipation, they could always dump some more Irish off in Charleston, which from the British point of view would really be something of a two-fer.
I’m not saying that it would definitely have played out one way or the other, just that there’s reason to think that a government a continent away from having to deal directly with a suddenly racially heterogenous free society would see less moral ambiguity in the slavery question than one that was going to be at ground zero with zomg free black people some of whom look really white!eleventy kasquillion! I think your position – which essentially boils down to the idea that the Southern continuation of slavery had more to do with macro-economics than with racism – is less defensible, especially given that the price of cotton after the US Civil War didn’t move much for the rest of the century, and what it did move was down, and that South Carolina did, in fact, have one or two unabashed racists.
jenniebee
@ThatLeftTurnInABQ: Hey, I never said that they weren’t total pricks, just that they were total pricks who emancipated their slaves thirty years before we did. It isn’t saying that they set the bar terribly high to observe that they still set it higher than we did.
Next you’ll be telling me that it would be completely not in the self-interest of enough men to pass a constitutional amendment extending the vote to women, and therefore it never happened. What am I going to believe, your hard-headed realistic reasoning, or my lying eyes?
Mnemosyne
@jenniebee:
And no economic loss, either, considering that they did not produce cotton but had to buy it from foreign countries. You know, foreign countries like the United States. The only economic loss would have come in if they had forced the East India Company to free their slaves as well and you may notice that they didn’t.
I’m sorry, are you claiming that the CSA offered to become part of the British Empire? Or are you just reiterating that the British did not choose one foreign country over another foreign country during a civil war between those two countries?
I realize that you will never, ever understand this, but I will try one last time: there is a difference between supporting an export from someone else’s country and supporting an export from your own country. Talking about Britain not supporting the CSA in this context makes absolutely no sense because the CSA was a foreign country, not part of the British empire.
If you think that there’s no difference between domestic policy and foreign policy so you can draw a conclusion about what the British would have done if the American colonies had still been part of the British empire by looking at their foreign policy, well, then there’s no help for you. Continue living in your fantasy world where countries never take their own self-interest into account when it comes to things like taking a huge economic hit to textiles, their number one industry.
Mnemosyne
@mclaren:
I’m sorry, I didn’t realize this was a private thread where jenniebee and I couldn’t have a side discussion about a point that she made.
Sorry, jenniebee, I guess we have to stop discussing anything that doesn’t personally interest mclaren.
Oh, Jesus, the National Nurse’s Association again? Can you please, please, please find at least one additional source? Just one?
Mnemosyne
@mclaren:
And your links to these polls are … where, exactly? Because the polls I can find say that there’s an even split:
If you have polls showing massive gains by Republicans on a scale not seen since 1946, produce them. Otherwise, STFU.
El Cid
Brazil, where far more African slaves were sent than North America, finally (formally) abolished slavery in 1888. Britain, on the other hand, didn’t have as much invested in slavery as it did conquering and profiting off of Africa directly.
Dennis G.
@CalD:
I look forward to that being in the opening shots of the Simpsons…