I am a firm believer in the Heritage Uncertainty Principle of True Conservative Healthcare Reform Plans:
Conservative health-care-policy ideas reside in an uncertain state of quasi-existence. You can describe the policies in the abstract, sometimes even in detail, but any attempt to reproduce them in physical form will cause such proposals to disappear instantly. It’s not so much an issue of “hypocrisy,” as Klein frames it, as a deeper metaphysical question of whether conservative health-care policies actually exist.
The question should be posed to better-trained philosophical minds than my own. I would posit that conservative health-care policies do not exist in any real form. Call it the “Heritage Uncertainty Principle.”
P-Care was a recent iteration of such a principle as the primary financing mechanism was immediately clawed back as soon as liberal wonks started asking obvious questions (why yes, it would be a massive tax hike on middle class Americans AND massively disruptive to the market).
The most recent iteration of conservative “health insurance reform” proposals is from Always Wrong Kristol et al. The diagnosis of the problem is simple — Americans, or at least non-rich Americans, have it too easy and risk is too insulated. We must suffer more. And TAX CREDITS:
We propose providing a refundable health insurance tax credit of $1,200 for those under 35 years of age, $2,100 for those between 35 and 50 years of age, and $3,000 for those over 50, in addition to $900 per child. These tax credits would be made available to those, and only to those, who purchase health insurance through the individual market.
An 18 year old male can get half decent coverage for $100 a month. A 35 year old male can’t. Not unless you define decent coverage as a $15,000 or $20,000 deductible, exclusion of mental health coverage, exclusion of pre-exisiting conditions for at least a year and no preventative care benefits. An 18 year old woman for $100 a month will see a $10,000 deductible, no birth control, and no maternity care coverage. A 35 year old woman with no problems will be lucky to get a $25,000 deductible and significant exclusions.
And god help you if you can’t maintain continuous coverage and have a pre-exisiting condition. Any insurance company that can underwrite will laugh at $1,200 a year.
There is plenty of evidence that very high deductible plans will reduce health care expenditures. There is also a lot of evidence that people aren’t perfect consumers and the high deductible plans increase health risk. People can die because of this plan design.
But hey, it at least looks like an apparition of a plan
Roger Moore
It’s not just an attempt to manifest in real form that causes conservative health care reform to dissipate. It’s also the absence of a liberal attempt at their own version of reform; conservative plans can only exist when there’s a liberal plan to shoot down. That’s why after a near absence for over a decade, they started to appear again in 2009. It’s the need to have something for the “replace” part of “repeal and replace” that’s causing them to crop up now.
Omnes Omnibus
They have no plan. They have no interest in having a plan. The only things they have are gimmicks and douchebaggery.
Yatsuno
The Republicans have a health plan: don’t get sick. And if you do, die quickly. Alan Grayson had this pegged years ago.
Omnes Omnibus
@Yatsuno: Ah yes, I had forgotten about that one. It is, however, covered under my douchebaggery category.
jharp
“And god help you if you can’t maintain continuous coverage and have a pre-exisiting condition. Any insurance company that can underwrite will laugh at $1,200 a year.”
$12,000 a year is far more accurate.
jl
The results of the Rand Health Insurance Experiment suggested substantial increase in death rate from high deductible plans included in the experiment, which were designed to be much more forgiving and flexible than anything that would be found in the market place.
Here is what the principal investigator of the Rand HIE says:
“…for those who were both poor and sick—people who might be found among those covered by Medicaid or lacking insurance-the reduction in use was harmful, on average.4 In particular, hypertension was less well controlled among that group, sufficiently so that the annual likelihood of death in that group rose approximately 10 percent. This adverse effect occurred in spite of the reduced cost sharing for low-income families, a feature not generally found in today’s plans. “
Joseph Newhouse, Consumer-Directed Health Plans And The RAND Health Insurance Experiment Health Affairs, 23, no.6 (2004):107-113
you can access Health Affairs articles at
http://www.healthaffairs.org
The horrible behavior of the GOP on this issue is mind boggling. It is a matter of life and death for many people. Seems like the GOP wants to protect interests profiting off the status quo, even though the status quo means death for many people.
Yatsuno
Gotta go OT right away but Holee Shitballs. Nevada is about to become number 19. Or 21 if you count Utah and Oklahoma. The Mormons are gonna shit themselves.
@jl: Mammon must always have his pound of flesh. All must be subservient to his whims and those lucky few who are blessed to have his wealth.
jl
I am not as concerned about the PR effect of GOP propaganda and pretended interest in health care reform than reports of real problems in the news.
I’ve heard some reports from Washington that there is some confusion about which providers are in the narrow networks and which not. Apparently some sick kids ended up in Seattle Children’s Hospital under the assumption that it was in most networks, but it was not. So, for now, the hospital is paying the kids’ way.
WA: Seattle Children’s Sues the OIC
http://stateofreform.com/news/states/washington/2013/10/wa-seattle-childrens-sues-oic
Has RM heard about widespread narrow network disillusionment?
mai naem
@Yatsuno: I have not been following this closely but I understand Arizona’s law is supposed to be very similar to Utah’s so I figure if Utah’s law falls so does Arizona’s.
Roger Moore
@Yatsuno:
I think you’re giving the Republicans too little credit for their health plan. They also want the Federal government to deny states the right to regulate their own insurance industries with inter-state sales, and to subsidize their sale of snake-oil policies. It’s not enough that they deny people useful insurance; they want us to subsidize their sales of worthless insurance.
RepubAnon
@Yatsuno: I think Alan Grayson was being overly generous. My theory is that the Republicans are trying to kill off as much of the middle class as they can before the under-7-figure-income Republican voting blocks wise up.
Omnes Omnibus
@Yatsuno: It looks like everyone in the 9th Circuit is going to be forcibly gay-married. This is why the Right HATES the 9th Circuit.
Roger Moore
@Yatsuno:
There won’t be true marriage equality until gays have an equal right to be married in a tasteless Las Vegas ceremony presided over by an Elvis impersonator at a drive-through chapel.
jl
@jl: To put my cards on the table, I tend to follow the Uwe Reinhardt line that the biggest single problem with health care is that the prices for health care resources (doctors, tests, hospital services) are just too dang high, and mostly the high price of resources is due to market organization and pricing mechanisms in the U.S., not the real cost of the resrouces. So, a lot of health care expenditure is really a kind of tax on the population, just a transfer of resources from patients to ownersship of health care resources. I think Reindhardt gets some of the details wrong but is right on the basic issue.
One question in my mind about the chances of success of the current reform is whether the price of access to providers can come down fast enough to satisfy people on the lower tier silver and bronze plans. Maybe that is exaggerating the importance of the individual market. Any reduction in price for group plans should make the vast majority of people covered by those happy, along with increased portability. But seems to me that if the people on the individual market are unhappy enough, and it is not fixed quickly, they will have an outsize influence on perception of the reform. And the GOP will be ready to publicise and distort any honest problems in the reform.
Mandalay
From your link:
Bill Maher was pushing this same massive lie the other day on his show.
Why do “massive taxpayer-funded subsidies to older Americans” automatically impact younger Americans, and why are older Americans the problem? Why aren’t low taxes for the rich the problem? Why isn’t corporate welfare the problem? Why aren’t corporate tax loopholes the problem? Why isn’t massive defense spending the problem?
Why do shitbags like Maher and “Real Healthcare Reform” insist on making “older Americans” the villain of the piece?
jl
@Mandalay: The younger subsidizing older line is due, IMHO to the myth that young people are the ones that are bailing out all the sick old. The line forgets that the premiums are age adjusted, and that a higher proportion of young will qualify for a subsidy. What is most important is that both healthy and sick of all ages sign up, and healthy middle age people (apparently there ARE quite a few left in the country) are just as important as young.
Dean Baker at his blog Beat the Press at the Center for Economic and Policy Research (CEPR) has been pushing against this myth hard in a series of recent posts and has some links to accurate research on the question.
Violet
@Omnes Omnibus: I think that deserves its own category: evil.
Suffern ACE
@Mandalay: But Bill, older people also pay more in taxes because they tend to have higher incomes until that point where they retire. In reality, the older people are reallocating money to themselves.
Cervantes
Chait is on a roll. This is a good article. I was especially amused by the section on Gingrich (my quintessential Republican idea man).
Thanks, Richard.
jharp
@Mandalay:
Agree. Maher is either a dick or ill informed or a corporate shill.
Believe me or not but I think it’s about a 1/3, 1/3, 1/3.
Omnes Omnibus
@jharp: Maher is a left leaning libertarian. He is not a liberal. He is not a not a center left guy. He is not a Democrat. He can be an ally on some things and is more on (what I perceive to be) our side than the other.
jl
@Cervantes: And if I recall correctly, Gingrich was the genius who decided to put the AMA in its place during the late 1990s when they were presumptuous enough to presume that they would have some say in GOP proposals. I read that Gingrich told them in no uncertain terms, that they were not among the big players and to get out. He said that they were a mere industry interest group and that the big money boys would be making the big decisions.
I am not a big fan of the AMA’s history in influencing health policy, where they have often acted as though they were more interested in maximizing specialist MD income more than anything else. But to the extent the AMA has been more cooperative in reform, Gingrich’s clumsy and overly honest approach might be one of the reasons.
Edit: I do think that a big chunk of the AMA is a mere industry special interest group, and in the past has sometimes been a corrupt one. But they are more than that. And it is silly to insult what could be a big GOP institutional ally (and has been at times in the past).
Cervantes
@jl:
The unification of quantum mechanics and general relativity is mind-boggling.
Whereas two-bit hoodlums are utterly, completely transparent.
Gex
@Yatsuno: Ah, the Keller plan.
Omnes Omnibus
@Cervantes:
Does that we can neither know where they are nor how fast they are moving? Or is it the other way around and we know exactly what they are and we know what exactly what they are doing?
MomSense
@Yatsuno:
Wowie Zowie!
Regarding the Republican “plan”, I think the reason the Republicans talk in abstractions is because what they want is so immoral it is disgusting. I’m lucky that I am a healthy person with healthy children but I do have a pre existing condition that could cause problems and of course one of us could have an emergency health problem. Under their plan I could go bankrupt or not get adequate care. It could destroy my family. And again, I am lucky. I don’t have a chronic condition like diabetes or high blood pressure. I’m not missing work because a child has uncontrolled asthma because of lack of regular medical care.
I have experienced something unexpected and significant now that I have had health insurance for two months. I am a lot less stressed out. I’m not getting as many colds. I sleep better at night. I feel better. I’ve had some new ideas at work that I think will turn out well. Before, I was living with a baseline of worry that is just not sustainable. It is draining and makes everything tougher. Having health insurance is a BFD.
Omnes Omnibus
LUGE!
ETA: Skeleton is cooler.
MoeLarryAndJesus
I once heard a rumor that there was a modern Republican who lived deep in the woods somewhere who wasn’t a complete asshole, but the guy turned out to be a goat.
Every other last Republican in the country is a worthless motherfucker.
Sorry to burst that bubble.
Omnes Omnibus
@MoeLarryAndJesus:
I look at it differently. I say that any Republican have surrendered any benefit of a doubt. If there is more than one way to interpret someone’s statement, I assume that the Republican means the very worst interpretation. They have earned that.
Mandalay
@jharp:
I certainly go for the first two choices. I’ve been slow to realize that Maher has an unusual set of views that do not compartmentalize well, and he is much more of a wingnut than a progressive on some issues. He appeared to be missing the good old days when a neighbor could get away with hitting your kid on his last show, and he is sometimes downright scary on issues such as tax rates, national security and foreign policy.
Yatsuno
@MoeLarryAndJesus:
Nobody tell Mickey Kaus.
@Omnes Omnibus: Too bad Utah and Oklahoma have different circuits to go through. That might be good as it will hit the Supremes and Fat Tony can stroke out sticking it to the kweerz. If he could figure out a way to overturn the existing laws anyway.
? Martin
@Mandalay: He’s just lazy. He wants easy, postcard policies. Some of those policies favor us (religion, civil rights), others don’t (taxes).
Actually, I’d go for a simple tax scheme. Flat tax can be awesome, but it requires flat wages. I won’t hold my breath.
Omnes Omnibus
@Yatsuno: It is happening. I know that justice delayed is justice denied, but a lot of people are weirded out by you. They shouldn’t be, but we might need to wait until a shit-load of them to die off.
SatanicPanic
@Yatsuno: That one never gets old. You couldn’t put more perfectly than that.
Omnes Omnibus
@? Martin: No flat tax will ever be fair. Don’t accept the premise.
Big R
@Omnes Omnibus: In another forum or from someone else I’d call that concern trolling.
Mandalay
@? Martin:
Not quite sure what you suggesting there, but a truly flat tax rate is regressive and inherently unfair.
Big R
@Mandalay: Sounds pretty straightforward to me. For a flat tax rate for all taxpayers to work, every taxpayer has to have the same wages.
There are other adjectives for this plan that some BJ commenters might like.
Cervantes
@jl:
Here’s an October 1995 document (from the Clinton OMB, primarily) that describes, from the Administration’s perspective, a deal that Gingrich and the AMA were discussing, or reaching, or threatening.
And here’s a NYT report by Robert Pear a few weeks later describing the chaos that was now consuming the Gingrich-AMA deal:
Wheels within wheels.
Mandalay
@Big R: Ah, gotcha. So obvious I missed it. Bedtime for bozo.
J.Ty
@Big R: A flat tax only works if it’s inherently redistributive, like the “Fair Tax” BS proposal that gives poor people tax subsidies to subsidize… the flat tax. I really don’t understand why libertarians love the Fair Tax. I mean, I do understand (it hates poor people and glorifies capital gains and nonetheless appears to be ‘fair’), but still.
Suffern ACE
My taxes, they be done and waiting for the ability to file them. No flat tax right now please; it will disorganize what is currently organized.
West of the Cascades
@Yatsuno: Holy shitballs, indeed — Governor Sandoval, a Republican, who agrees with the decision to not fight it, is also a former federal judge … evidently actually knowing something about the law will make even a Republican think twice about defending the indefensible. Now if we could only get that to happen on the US Supreme Court …
J.Ty
@Suffern ACE:
Best get used to that if you haven’t already, it’s kind of a fundamental law of nature =D
Omnes Omnibus
@Big R: In another forum and responding to another person, I would say fuck off. You have no idea what concern trolling is. Learn what the fuck concern trolling is before you suggest that I was doing it. I am talking about a real world where real equal rights will take time. I have seen how long it is taking for black people to be fully accepted (Hint: for a disturbingly large portion of the population it has not yet happened – I am horrified and embarrassed by this, but it does not make it less factual). Why should one expect it to be ever so much faster for sexual orientation?
J.Ty
@Omnes Omnibus: Going to have to side with Omnes on this one. There is a very, very good reason that us gays tend to stick to the coasts. Trying to change the minds of voters on such a (strangely) fundamental issue just won’t work well enough–waiting until they die is a much better strategy.
That said, we should definitely focus on places like Uganda and Russia and actually most other countries where LGBT issues are much more urgent, especially after last summer’s SCOTUS wins.
Big R
@Omnes Omnibus: Relax, chief. The point was that you weren’t concern trolling because you’re a known quantity here, but that the message of “I don’t have a problem with you, but others do”, stripped of the context of it being you saying it here, is kinda concern-trollish.
I promise, we’re both engaged in the art of the possible, and in pushing against those limits. So you can drop the territorial display and we can engage in some social grooming. I’ll grant your superiority in the pack social structure.
Cervantes
@J.Ty: Uganda, and Russia, and India, and Nigeria …
Big R
@J.Ty: If only Martin had suggested that a flat tax can only work with heavy redistribution, we might have won the lists on that one! Alas that he did no –
Oh, he said that flat taxes only work with flat wages? Oh, so that means that if everyone is being taxed the same, they have to be getting the same income? Oh, so he said in a brief, punchy, and rhetorically catching way that the flat tax requires redistribution as a condition precedent to avoid horrific regressiveness and policy failure (unless your preferred policy is “make my country into Somalia”)?
Whoda thunk?
Omnes Omnibus
@J.Ty: FWIW my view is that you have every right to marry or not marry and be happy or not happy as any straight person on earth. I, however do not run the legal system in this country and getting the right result will take time. I have ful confidence that we will get there. I also understand that people will suffer as a rsult of the fact that it will take time. From my privileged white, straight, male etc. position, I offer what support I can and my vote in favor of any equality issues.
J.Ty
@Big R: Sure, but if I’d responded as if I read it that way, I would’ve missed my opportunity for libertarian-punching.
@Cervantes: Hell, I’d even put France on the list. Not law-wise, but results-wise.
@Omnes Omnibus: I didn’t mean to suggest anything else… Apologies if I missed some context or something. And there’s no reason to apologize etc. I hit all of those adjectives myself except for ‘straight’.
Ruckus
@Omnes Omnibus:
I hate to say I agree.
It shouldn’t be like this. It’s just wrong that people can’t see that humans don’t have to be the same color or have the same religious bent or like people that have the same physical equipment as they do, or…… But there are people who hate for no reason, way too many people like this. There are many that are overt about it and many more that think this way and mostly keep it to themselves. I don’t see any way to get them to change their minds because they are not logical nor rational about their hate.
Omnes Omnibus
@J.Ty: I am a little pissy after the veiled concern troll accusation from someone else. No apologies necessary.
@Big R: You are just kind of an asshole, aren’t you?
Big R
@J.Ty: I will grant you that libertarian-punching is my favorite Olympic sport. But not all of us can be the fine practitioners of the high art of Dudgeon Trolling that DougJ is. I really try to be sincere in my internet dealings, since sarcasm and whimsy come through very poorly.
But combine a very positive hearing today with the fact that reading comprehension seems a little low tonight, and maybe I’m being just a mite manic.
Churchlady320
Let’s see – for people over 50 individual market plans run around $900 per month. That’s $10,800 per year. But they’ll give me a tax credit of $3000. Be still my heart! Average plan for younger people is about $200 per month. They’re offering $100 per month. In all cases, the ‘tax credit’ is SO AWFUL that it’s not even worth discussion. This is right up there with Mitt’s original plan that doled out $235 per month even when your premium was $900-1000 or more. THEN he added a deductible of $15,000 per person per year, and nothing you got other than children’s immunizations was covered by the policy BEFORE the deductible kicked in. Yup – great GOP plan. I know I’d feel patriotic doling out to insurance companies and getting help at this level – about the level of my ankles – from the GOP.
? Martin
@Mandalay: If everyone is supposed to pay the same tax rate, then its fair if everyone is paid at the same wage rate. Let’s say a minimum wage of $20/hr and a maximum of $60/hr. And that’s maximum – including unearned income. If we’re supposed to reward working, then you can take a maximum $2 unearned for every $1 earned, to a total combined $60/hr ($120K). Every dollar above that gets taxed at 100%.
J.Ty
@Big R: Apologies for excessive assumptions of sarcasm/trolling.
Omnes Omnibus
@Churchlady320: You forgot the various shih-tzus that they will send biting at your ankles to make sure that it is as unpleasant as possible.
Big R
@Omnes Omnibus: Hardly the worst name I’ve been called. Let me start over, because I think I stepped in something a while back:
Hi, I’m , and I use the nym Big R from a name an ex-girlfriend gave me (no speculation, please). I really respect your opinions and thoughts here, and you always strike me as a contributor to the discussion whose comments I value. Earlier, I tried to tease you a little, and I think I made you think that I was trying to admonish you. I’m sorry that I gave you that impression. I should not have let my predilection this evening toward being silly derail a comment that is true, and sad.
You’re right: they won’t ever change their minds. And it’s tragic that people have to suffer so that my neighbors can get their hate on. And I’m sorry for my part, however small, in continuing that tonight.
Omnes Omnibus
@Big R: Fair enough. The suggestion of concern trolling – for all my internet vices, I do not confess to that one – set my teeth on edge. Bygones can be bygones.
J.Ty
Yay, we’re all friends now!
(Actually glad and stuff, to be clear)
Omnes Omnibus
@J.Ty: Fuck you.*
*One had to. You know that.
GregB
Sandoval seems far to un-insane to remain a Republican.
Big R
@Omnes Omnibus: A man wishes he could drop that particular dime.
J.Ty
@Omnes Omnibus: I offer you a combination of extended fingers that mean the same thing, based on the traditions of whatever country you hail from!
=D
Omnes Omnibus
@Big R: @J.Ty: Okay then.
Years ago, I was at a party with one of my best friends and he had brought with him another friend. The friend of a friend and I clashed every time we met. Being in our early 20s we decided to go outside and deal with it. As we were walking outside, I explained that I thought he was an obnoxious asshole. He told me that he thought I was superior and condescending. We both agreed that these accusation were true and we have remained friends to this day. Cheers.
AnonPhenom
Betsy
@MomSense: that makes sense. It is a BFD!
Matt McIrvin
@J.Ty:
Right now, with opinions on LGBT rights, things are actually changing way faster than death alone can explain. Compare it to progress on, say, support for interracial marriage and it’s going at warp speed.
(Though, in that case, it was the legal situation that changed first. Loving v. Virginia was in 1967. According to Gallup, nationwide approval of interracial marriage was around 20% then. It rose above 50% in the 1990s.)
http://www.gallup.com/poll/149390/record-high-approve-black-white-marriages.aspx
boatboy_srq
@Yatsuno: I love how “risk” is portrayed as a bad thing by Kristol et al. Healthcare, apparently, wouldn’t be a problem if people just didn’t take risks with their health – as if if eating, drinking, working, breathing, crossing the street, climbing stairs, mowing lawns, or being a member of [insert gender or ethnic group prone to specific health risk] are things that can somehow be avoided or selected while still carrying on with daily life.
Nutella
@MomSense:
Son of a gun! Useful health insurance makes for better, more confident workers! Who’d a thunk it?
Repubs hate to hear these things because they don’t actually want better workers and more efficient businesses.
Nutella
@boatboy_srq:
I’ve been having some health problems lately that are largely specific to white people. I wonder if the Repubs would think health care for those kind of things should be subsidized?
slippytoad
@boatboy_srq:
These are cowardly, insecure people, I have realized. The more one craves wealth, it seems, the less willing they are to actually live, and they apparently find the entire affair terrifying. I really am starting to think that the personality type that selects for wealth and power also selects for timidity and cowardice, and some kind of pathetic need to control everything around them. We put up with this as a society because we think wealth is a reward, and it is for normal people. The Kristols and Kochs of the world use it as a shield, a security blanket . . .and more often than not the ones who fear “risk” the most are the ones who never had to risk a thing to get their own.
different-church-lady
One of the only parts of Daily Kos still worth the time is when Ruben Bolling does his “Lucky Ducky” strip, which nails what you’re describing to a wall.
slippytoad
@different-church-lady:
I’m apparently too foul-mouthed for the right-wing concern trolls at Kos. Cartoon is spot-on. Really, it’s amazing that someone has to spell this out, because all you need to do to learn it is try yourself. Doing hard work is like an invitation for the wealthy to kick you in the face.
different-church-lady
@slippytoad: “I’m not asking if you kiss your mother with that free health care. I’m just saying someone else might.”
different-church-lady
@Big R:
Radish?