The liberal Jacob Weisberg makes the case for Paul Ryan:
Ryan’s proposal to turn Medicare into a voucher provides an easy political target. But it’s hard to make a principled liberal case for the program in its current form. To do so, you have to argue that government-paid health care should be a right only for people over the age of 65, and for no one else. Medicare covers doctor and hospital bills at 100 percent, regardless of income. This gives doctors and patients an incentive to maximize their use of the system and waste public resources.
This would all make sense…if private insurance functioned effectively in this country. But it doesn’t. We pay nearly twice as much as countries with single payer models and receive worse care by almost any measure. Why does some wankerly rhapsodizing about the hypothetical inefficiencies of single payer systems enter into the discussion?
One possible answer is that Weisberg enjoys playing the contrarian. Why work at trying to understand a proposal when you can just put a catchy, thought-experimentesque contrarian spin on the whole issue and call it a day? The composure class members who read Slate don’t want to get into the weeds either. They’re titillated by “is genocide good for your 401k” type edginess, and the fact that Weisberg spent Michaelmas term as All Souls with Niall Ferguson proves that he is credible on this and all other issues.
I promised myself I wouldn’t let this devolve into another discussion of how we’re facing another example of the shock doctrine here, so I’ll close on a happier note with what reader E sent me about this:
thank god the american people don’t give a fuck what jacob weisberg thinks and would rather not see grandma die because she can’t afford a dialysis treatment in paul ryan’s galtian paradise
Martin
Great. You said ‘titillated’ and now the page is full of ads for breastfeeding supplies. When is Google supposed to become sentient again?
Turgidson
Wanker sez:
…and when Democrats try to reduce such waste in the ACA, the GOP campaigns on bravely protecting Medicare from the Demon-rat party trying to destroy it. Then they turn around and propose to destroy..er, privatize it.
and that’s just the tip of the “idiot iceberg” you could get into with that quote. What a dolt.
Stillwater
Reminds me of Fight Club:
Narrator: Tyler, you are by far the most interesting single-serving friend I’ve ever met… see I have this thing: everything on a plane is single-serving…
Tyler Durden: Oh I get it, it’s very clever.
Narrator: Thank you.
Tyler Durden: How’s that working out for you?
Narrator: What?
Tyler Durden: Being clever.
Narrator: Great.
Tyler Durden: Keep it up then…
Butler
So I guess Medicaid doesn’t exist anymore. That was quick work by Mr. Ryan.
Corner Stone
OT:
Libyan rebel leader says NATO isn’t doing enough
“He said bureaucracy means that NATO strikes sometimes come eight hours after rebels’ have communicated targets.”
“”When the revolutionaries were here, more than 50 percent of people supported them. People thought things would change and improve,” he said. “Then the revolutionaries were defeated and they ran away to the west. … Now I think Gadhafi should stay because I want stability and I want to keep my shop.”
Hoocoodanode that we don’t node nothing about what’s going on incountry?
WaterGirl
i have been away all day. Do we know anything about the outcome of the election for judge in Wisconsin? Exit polls, anything?
Steaming Pile
There’s a major problem with this, namely that people who are currently 65 or older will be “grandfathered” into the existing system, so I understand. This is to keep the people who so dutifully carried those signs saying “govmint hands off my medicare” just a year and a half ago from waking up and realizing that they’ve been had.
No, it will be you and I getting the shaft, and rightly so, according to the Ryanites. We’re such slackers, after all.
If I’m mistaken, and Rep. Ryan does indeed intend to push my parents onto a private system with inadequate vouchers, please be nice to me while pointing this out. Thank you.
Butler
@ Watergirl
Polls close at 9PM ET. I doubt there were any exit polls, and if there were I doubt they’ll be released before the actual poll results. Just have to wait it out I’m afraid.
Martin
Well, if this is the House budget proposal then I don’t expect the government to ever reopen. I don’t think there’s a single thing in there that the Senate or WH is going to approve of.
Apparently the lesson from 1993 was that Gingrich simply wasn’t stubborn enough.
Roger Moore
He’s right that it’s unfair that old people get medical care just because they’re old. Everyone should access to top quality medical care at government expense, not just people older than a magic number.
Riggsveda
Gives patients an excuse to waste public resources?? Yes, I don’t know about you, but I sit around for days on end planning my excessive visits to specialists and MRI theme parks, and cackle into my sleeve as I lay waste to the public weal.
Who pays these assholes for this dreck?
zach
Subsidized Rascal scooters aside, Medicare ought not to pay 100% of what patients and doctors want, but instead 100% of what doctors recommend, patients consent to, and medical research proves effective. Attempts to move Medicare and Medicaid towards this ideal have consistently been opposed; almost uniformly by Republicans. Of course, the reality is closer to this ideal than to Weisberg’s impression of what’s going on.
JPL
@WaterGirl: I did read that turnout was good. Some polling stations said it was like a presidential election but that was earlier today.
JGabriel
@Martin:
I’m not getting them.
Sigh. I miss all the fun.
.
Steve
Why do we need to make a principled case for the system in its current form? Raise your hand, fellow liberals, if you aren’t in favor of Medicare-for-all, as opposed to just for people over 65. Okay, basically everyone’s hand is up, as I thought.
Let’s see, we have a problem in that our country spends far more money than every other country in order to achieve health care outcomes that are the same or worse in virtually every case. We also have a system that is far more market-based than every other country. So instead of coming to the logical conclusion – gosh, markets may work great for some things, but we don’t really seem to be seeing a payoff when it comes to health care – the answer is to become even more radically unlike all the countries who are succeeding in cutting costs. Yes, empowering individuals to make market-based health care systems will surely drive our costs way, way down, even though that’s not the solution that has worked for anyone else at all!
Stillwater
@Corner Stone: Now I think Gadhafi should stay because I want stability and I want to keep my shop.
Hmmm. I wonder what the hell is going on here. Maybe Joe fro Lol can clear up why this guy is wrong and to reconfirm that the rebels are fully capable and willing to set up a new Qaddafi free shop all on their own.
Comrade DougJ
@WaterGirl:
Polls close at 9, we’ll know stuff then.
cathyx
This whole idea that if people have unlimited access to healthcare that they would abuse it and go all of the time for every little thing is absurd. Does that happen in those countries that have medical care like that? Most people would still hate to go to the doctors and only go when absolutely necessary, just like now if they happen to have health care that is provided for them.
Corner Stone
@Stillwater: Air strikes 8 hours later aren’t going to get it done.
And rebels relying on air strikes aren’t going to get it done.
Boots Onna Ground(tm) !!
Zifnab
We rich people gave all those poor people this charity out of the goodness of our hearts. And now they’re wasting it!
In other news the AiG bailout and the Iraq War reconstruction funds (particularly the $9 billion in case that literally just vanished) was money well spent.
JGabriel
Jacob Weisberg:
Funny how arguing for single-payer isn’t even considered.
And by funny I mean predictably fucking tragic.
.
arguingwithsignposts
@Comrade DougJ: and @WaterGirl – technically, the polls close at 8 p.m. local (central) time. It’s 9 for all those east coast liberal elitists.
Fucen Pneumatic Fuck Wrench Tarmal
the intent of ryan’s plan, has worked to perfection.
liberals, left wingers, democrats, people who still pay some what attention and slightly give a shit, et al, are going to, and have begun wasting limited resources knocking this junk, however far fetched, down.
all of that effort is a win.
because republicans experience no ill-effects money and fundraising wise, by proposing stupid shit, there is no capital cost, no barrier of entrry to them throwing out all manner of heinous shit at the wall….
if they happen to get consessions, ie tax cuts or whatnot,then its a big win. everytime the gop throws shit like this, we need 5 proposals that they have to knock down.
put something out there sizing our military budget at the costs the french english chinese and russians budget, watch them scramble their asses off to explain why the great and mighty U S OF A, can’t do it as well, for the cost of four countries that otherwise would be top spenders..
seems to me, reagan’s big push, once upon a time, was that the soviets were way ahead of us, and were threatening to outspend us into oblivion.
maybe we need to complete the circle and talk about how much we spend on our military, in terms of what other countries are spending.
and maybe i will win the lotto, bang the victoria’s secret catalog, and use my winnings as venture capital to start a business that does for the world’s richest 20% what facebook, twitter, and online porn did for the social media generation.
Cacti
So the “liberal” solution is to make healthcare for seniors worse rather than healthcare for non-seniors better.
God bless the ‘Murrican crab bucket.
sven
More nonsense from the same piece:
If government doesn’t pay for healthcare we might get more parks, Yay!
What universe is Weisberg living in? If the government is unable to provide something Americans REALLY, REALLY, REALLY, want and need (like healthcare in old age) how in the world are we going to enact this wonderful new liberal agenda?
WaterGirl
Thanks for all the answers about the election in Wisconsin. I am on pins and needles about this.
Is anybody going to listen in on the call with Obama that starts at 8:30 ET tonight?
http://www.barackobama.com/livestream/campaign-2012-kickoff-call
Corner Stone
Quarrels among rebel leadership threaten to split anti-Qaddafi opposition
“Nevertheless, strains are showing. There are disagreements over who is in charge of the insurgents’ military operations, Abdel Fatah Younes, a former interior minister, or Khalefa Haftar, a former army colonel who recently returned from exile. The differences pose a new challenge to a political leadership that is under great pressure to show western countries they are in control of their forces.
The lack of organisation and poor co-ordination with Nato forces, as well as the reliance on untrained youth to carry the fight to Colonel Qaddafi, came to a head last week, when 13 rebels were killed in an air strike by allied warplanes.”
Comrade Luke
@Fucen Pneumatic Fuck Wrench Tarmal:
And bonus! Simpson-Bowles all of a sudden becomes a “reasonable compromise”.
Corner Stone
I guess we’ll see what’s left of ACA in 2014.
Corner Stone
@Comrade Luke:
It’s fucking shocking how that worked!!
jl
The link in the post is the horrifying result when smart hip contrarianism decays into stupid dopey contrarianism.
Three (Edit: four) things that jump out:
implicit false dichotomy combined with non sequitur: current Medicare and Medicaid is not perfect so the Ryan plan must be good.
dog in the manger bitterness disguised as reasonable plea for equity: it stinks for non elderly so why shouldn’t it stink for the elderly
self contradiction encapsulated in one screen: the elderly should enter the non elderly health insurance and health care hellhole, but at current average reimbursement rates will be able to afford care just fine and nothing will change
self contradiction encapsulated in one screen: at current average reimbursement rates will be able to afford care just fine and nothing will change, but the government can eventually control costs through rationing and (fewer resources devoted to?) end of life care (note: what is the lever for cost control here? Reducing the value of vouchers is all that’s left. Stricter regulation (as in Netherlands or Switzerland, those known communist hellholes) is off the table.
Man, I cannot believe people get paid money for scribbling such lazy thoughtless rubbish.
Cacti
@sven:
One where old people dying is the price we have to pay for Headstart programs.
Not that Weisberg is abusing the false dilemma fallacy or anything.
Calouste
@sven:
Father a well known lawyer and judge. Yale and Rhodes scholar. Journalist at Slate and Newsweek, wife’s the editor of WSJ magazine.
Need I go on?
Comrade DougJ
@Calouste:
Bingo.
Duncan Dönitz (formerly Otto Graf von Pfmidtnöchtler-Pízsmőgy, Mumphrey, et al.)
Ahh, fuck. This shit is so depressing. I feel like going out looking for Republicans and beating the first one I find into the ground with my old 34″ P-72. (That’s a baseball bat, by the way, not some phallic code name or anything like that.)
I was waiting at the doctor’s office today. I took my wife’s 84 year old grandmother in to get looked at for what turns out to be mild pneumonia. Anyway, while they were looking her over, I was sitting in the waiting room where they had a t.v. set to CNN, which is depressing enough right off the bat, but they had this story on about how Jan Brewer wants to charge Medicare or Medicaid recipients (I forget which) $50 a year if they smoke, another $50 if they’re overweight and another $50 if they have any “chronic” diseases.
Now, I’m not the smartest guy, but the first thing I thought was, “Poor people are often fat because the cheapest food is the most likely to make them fat and sickly. And besides that, poor people don’t have a lot of time to cook, since they’re often working long hours just to scrape by, and the food that takes the least time to make is also the food most likely to make you fat and sickly.”
That’s the first thing that popped into my head, but neither person who came on to “debate” the bill or order or whatever it was said anything about that, not even the Democratic state senator who came on to argue against it. And, needless to say, the zombie newsreader who was asking the questions never brought that up, either.
I hate living in this country where we seem so hellbent as a society on stripping away every last shred of dignity from poor people. Poor people don’t want to be moochers. But they sometimes need a hand to climb out of the mire of poverty this country has let them stay stuck in. We could do so much fairly cheaply, but all the assholes who write influential columns or spout off on the worthless Sunday “news” shows–well, most of them–don’t give a shit about anybody but the poor, put-upon millionaires in America. Social Security, Medicare, Medicaid, all this “wasteful” spending, well, hey, we can’t afford those frivolous expenditures now, we need sacrifice!
Well, that’s until somebody wants to raise taxes for Messrs. Koch. Or the sorry opinionators themselves. Hey, they are important. They work hard. They have kids to put through college. After all, Their vacation houses aren’t going to pay for themselves.
I just feel so depressed and angry. These assholes fuck everything up, they beat people down, they lie and cheat and steal, and there doesn’t seem to be any justice. I could deal with it better if it seemed like they were going to get held to account somehow, but I fear aren’t a country where that can happen any longer.
Sorry for the long, rambling, bad tempered screed. I’m just pissed off. Maybe I should get drunk…
Ailuridae
I wonder what percentage of Jacob Weisberg’s social circle and friends are comprised of people be they Doctors or Hospital Administrators or health care executives would benefit from this massive transfer of wealth (and make no mistake that is exactly) from Americans to the medical cartel. 40%? 70%?
This was the problem with trying to do health care reform without accurately telling the American people the reason for the outrageous costs of health care in the first place: doctors and hospitals have organized themselves into a cartel that is enriching them while bankrupting the country. Medicare controls that by telling doctors that they get less from each procedure. Breaking up medicare would just empower Doctors and hospitals to do what they do to individual insurers: tell them to fuck off when they ask for reasonable prices.
Elizabelle
@JGabriel:
It always amazes me that we have a program that provides generous health treatment for those over 65, but barely any coherent program for those under.
Allowing people with a lifetime of terrible health conditions (untreated or not, some of them preventable) and poor habits to consume beaucoups public dollars once they hit the age trifecta.
What socialist said something about an ounce of prevention?
maya
Really? Then what are all those Medicare suppliment insurance brochures about? They gotta be spam mail. Right?
Elizabelle
@JGabriel:
It always amazes me that we have a program that provides generous health treatment for those over 65, but barely any coherent program for those under.
Allowing people with a lifetime of terrible health conditions (untreated or not, some of them preventable) and poor habits to consume beaucoups public dollars once they hit the age trifecta.
What radical said something about an ounce of prevention?
(took out the socXXX word that brings on moderation)
jl
@maya: Thanks. I missed that boneheaded mistake in my critique.
OK, add that to the total of, now, five things that should jump out:
Obvious complete ignorance of subject matter that should be common knowledge of all adults, like the side of the road we drive on here in the USA, and willingness to do absolutely zero research before publishing.
Stillwater
@Ailuridae: Breaking up medicare would just empower Doctors and hospitals to do what they do to individual insurers: tell them to fuck off when they ask for reasonable prices.
We need another mandate!
MikeJ
@Stillwater: My mother used to say to me, ‘Elwood’ — she always called me Elwood — ‘Elwood, in this world you must be oh-so clever, or oh-so pleasant.’ For years I was clever. I’d recommend pleasant — and you may quote me.
sven
@Cacti: I just can’t understand how he believes this formulation. People who see their own benefits being cut simply won’t feel generous about new spending on other programs.
@Calouste: Wow. No wonder he isn’t worried about Medicare!
Ailuridae
@Stillwater:
What we really need is either to remove the supply constraints on the number of doctors or start telling doctors what they can charge.. Because as it stands in nearly every state in America except maybe Maryland doctors and providers are bankrupting the country.
Stillwater
@Ailuridae: {{Snark failure}}
I agree with you. The Ryan plan compounds problems instead of fixing anything. I just thought a mandate on Doctors to see patients at a pre-determined price would be something Ryan – who’s very courageous, btw – might consider implementing to get health care costs under control. I mean, the dude’s a visionary. And he’s fearless.
Zelma
I am one of those elderly Americans who is on Medicare and I have a pretty good sense of the realities of the program. One fact that someone who takes a good look at the “Explanation of Benefits” recognizes immediately is that Medicare payments are usually much more reasonable than those paid by private insurers or those charged to “uninsured” patients. The differences are striking. Yet providers seem quite willing to accept the Medicare payments. If all medical costs were the same as Medicare costs, we would solve at least part of the cost problem.
Another issue that is fudged by the current discussion is that elderly consumers like me and my husband would be “wiser” consumers of medical services. How in the world does anyone think this is true? I am a reputedly very bright woman who is also a cancer survivor. How in the world can I decide whether my oncologist’s advice is right or wrong? She tells me I should take a drug that costs over $350 per month. I am going to say, well I don’t need that drug; it’s too expensive? I don’t think so.
My husband just had two major cervical surgeries. Lord knows how much they cost; we haven’t gotten the EIBs yet. (Although I can say for certain that there will be a huge difference between what Medicare will pay and what the doctors and hospitals “charged.”) When three doctors tell us the surgery is imperative, are we going to say, well, maybe it’s not really necessary? How the hell do we know?
The idea that “consumers” can make “rational” decisions about the health care they consume is fallacious. I can “comparison-shop” about TVs or cars or phones or groceries or a whole raft of things. Neither I nor anyone else can intelligently make those kind of decisions when it comes to medical care. We are at the mercy of the “experts,” the doctors who, we can only hope, are providing the best care possible.
Frankly, I am deeply grateful for the existence of Medicare. There is no way that any insurance company is going to insure either me or my husband at any reasonable cost. (BTW, including Medicare and supplemental insurance, we pay close to $10,000 per year) And this is true of the vast majority of senior citizens. And since I paid into the system for over forty years, I don’t feel much guilt about enjoying its benefits. I would be happy if there were “Medicare for All.” I am grateful that thanks to the health care bill drug costs during the dreaded “donut hole” will be half as much as last year since our “out-of-pocket” expenses were nearly $8000.
But the current “debate” about Medicare is at base dishonest, as is every part of the discussion of Ryan’s purported scheme. As Americans, we ought to be ashamed that we would consider making the weakest and the most powerless the ones who bear the greatest burdens.
Comrade DougJ
@Zelma:
Thank you for this comment!
Maude
@Zelma:
THIS
Fallsroad
So Jacob Weisberg is not only a moron for endorsing the loony plan put forth by Ayn Ryan, but is also either terribly uninformed or a lying propagandist.
I am under 65, disabled, and on Medicare. It does not cover 100% of everything. Not even close.
For most regular medical things, it covers 80%. There is an annual $100 deductible, plus I pay a premium each month that runs close to $100. For things that are not covered at 80%, there is simply no coverage at all. Quite a number of things (including long term and catastrophic care) are not covered. Eye care, unless it is a medical problem with the eye itself, is not covered at all. There is no dental, and no option for it.
Medications are not covered at all, unless you buy one of those incredibly fraudulent Part D plans where the list of drugs your plan covers changes literally daily, and the deductible goes up a large percentage year over year, as does the premium. Drugs are covered by most of those plans in three categories, one of which is “no payment” and you can readily guess which list is the longest.
Sure, there are the “Medicare Advantage” plans available, which is another way of saying there are over priced private plans that can be purchased for additional coverage that are very expensive, have high deductibles, and are susceptible to the same vagaries of random profit making denial of service as any other privately run plan.
I am a medically intractable epileptic. This means pharmacology cannot help me in my lifetime. I am exploring surgical options, but cannot guess how we would come up with our 20%. After all, it may not be rocket science, but last time I checked brain surgery was still an expensive proposition. So what’s 20% of say, 100 grand? And from whom can I steal that kind of cash?
So Medicare will not pay the full cost of surgery, if I even meet the neurological requirements to be a candidate. It does not cover in home physical therapy for my destroyed back, the result of an injury sustained on the job 14 years ago and aggravated daily by seizures. With my additional drug plan some of my daily meds are covered, none fully, and some not at all. My out of pocket last year for my health care, including deductibles for Medicare and my Part D drug coverage and the monthly premiums for both, ran somewhere around $9500, all told.
OTOH, Medicare never fuxors my paperwork, the way my private insurance did those years I could afford to have coverage at all. It doesn’t deny claims out of hand for no good reason. It pays my doctors on time, and on a pay schedule so they know in advance what they will make from each of my visits. If I have a problem with my benefits there is one place to call, and so far, they have never failed to promptly answer my questions or concerns.
In other words, Medicare kinda rocks for what it is, but it isn’t even close to a full service single payer health insurance system, not in the way that it ought to be, and yes, it ought to be made available to everyone on that basis. How the fact it currently is not prompts an alleged liberal to declare Paul Rand a fucking genius is something I cannot fathom nor stomach.
ETA: What Zelma said.
Corner Stone
God. Old people.
Fallsroad
@Corner Stone:
Which ones?
opie jeanne, formerly known as Jeanne Ringland
@Fallsroad: Probably all of us.
Fallsroad
@opie jeanne, formerly known as Jeanne Ringland:
Great. 45, and I’m officially old.
Someone bring me my tattered slippers and an old, ill-fitting bathrobe.
And get off my lawn while you’re at it.
opie jeanne, formerly known as Jeanne Ringland
@Fallsroad: I meant all of us old people, but if you want to join me on the porch I’ll give you a glass of lemonade and you can set a spell in the best rocker. ;-)
bob h
“To do so, you have to argue that government-paid health care should be a right only for people over the age of 65, and for no one else.”
And why not? These people are shunned by private healthcare, which was the reason Medicare was set up in the first place.
kerFuFFler
@Zelma:
Unfortunately this is the attitude that keeps seniors from being willing to countenance any (needed?) changes in Medicare. Since on average Medicare patients have about three times as much spent on them than they paid in all over their working lives it seems like a great deal. It is for them. But their children and grandchildren will be paying off that extra couple hundred thousand dollars (per grandparent).
There is abuse of Medicare. Some doctors who own imaging equipment and other expensive technology order excessive testing and screening. And yes, some patients do go to the doctor at the drop of a hat—–I know some of these people.
Frankly I wish we had a single payer system for people regardless of age. Perhaps reigning in the current Medicare spending and making people see how little we are getting considering how much we are spending would create more support for ditching this hopelessly inefficient system.