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You are here: Home / Anderson On Health Insurance / Scope and hope

Scope and hope

by David Anderson|  February 11, 20158:27 am| 30 Comments

This post is in: Anderson On Health Insurance, IOKIYAR, Blatant Liars and the Lies They Tell, Bring On The Meteor, Just Shut the Fuck Up

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Brad Delong is puzzled about the state of healthcare discourse in this country and he looks at a former Heritage bigwig for his puzzlement:

Can someone point me to something Stuart Butler has written in the past three years that has turned out to be correct?

I mean, it seems to be blinkered, partisan, wrong–and obviously wrong at the time, both in its analysis of the political forces and of the policy substance…..when I look at what Stuart Butler is writing today, I see no talk about how his root-and-branch opposition to Medicaid expansion, unwarranted budgetary and health-care spending-growth pessimism, and belief that the politics were still favorable for ACA repeal were all misjudgments. I see no talk about how the fact that the world has turned out to be a different place from what he claimed it was back in 2012 and 2013 has led him to rethink.

As a historical note, 2001 to 2015 contains an interesting case study of policy implementation and formulation by reactionaries and liberals in the United States.  The liberal policy project was to greatly expand health insurance coverage while reducing total societal cost growth of health care spending.  The conservative goal was to break and remake Iraq.  One is succeeding, the other is a Hydra headed cluster-fuck.

The project that is successful in its stated goals was built from an effective pilot case (Massachusetts) in a shared cultural and political mileau.  It took elements of a known society activity (private health insurance) and tweaked it a bit but not too much.  The policy makers saw that subsidized private insurance worked in the S-CHIP program, it worked in Medicare Advantage, it worked in Massachusetts, it was just brought to scale.  The other major component of coverage expansion was Medicaid expansion where the greatest barrier to expansion would literally be ordering sufficient ID card stock in some states.  Other elements of the plan have significant structural impacts (guarantee issue, community rating etc) but those elements have a history of both policy examples and judicious study by experts who were listened to.

Have there been problems… yes, but the basic analytical insight that this is a fairly straightforward build out of tested programs and things can be muddled through as problems emerge.  And that is basically what has happened.

The conservative big policy project was the invasion of Iraq with the goal of making it a Heritage Foundation designed paradise.  Experts who knew better were shunted aside, evidence was ignored, interns who were ideologically reliable were given tasks of rebuilding foreign institutions where the local stakeholders were ignored, and the project was managed for television and not reality.  Purple fingers were far more important than actual governance and institution building.

Basically any one who cheerleaded for the invasion of Iraq and believed that there was exclusively Good News ™ and painted schools in Iraq for the first decade of this century and then argues that a fairly straightforward health care coverage expansion is impossible should be ignored as they’ve proven that they have anti-judgement.

 

 

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30Comments

  1. 1.

    Baud

    February 11, 2015 at 8:32 am

    So the jury is still out?

  2. 2.

    Betty Cracker

    February 11, 2015 at 8:33 am

    As a historical note, 2001 to 2015 contains an interesting case study of policy implementation and formulation by reactionaries and liberals in the United States. The liberal policy project was to greatly expand health insurance coverage while reducing total societal cost growth of health care spending. The conservative goal was to break and remake Iraq. One is succeeding, the other is a Hydra headed cluster-fuck.

    How true. And if average voters were capable of taking in demonstrably true facts and drawing obvious conclusions from them, the reactionaries would spend the next 50 years howling in the political wilderness. But sadly, that’s not how it works. Le sigh.

  3. 3.

    Belafon

    February 11, 2015 at 8:34 am

    This is an interesting explanation of why parents don’t vaccinate their children:

    Why would parents choose not to vaccinate themselves or their children, in spite of the overwhelming evidence that the measles vaccine is safe and effective?
    There is no rational answer, experts in public health and psychology say. The scientific evidence supporting the vaccine’s safety is strong. An infamous report published in a British health journal linking the vaccine to autism was retracted long ago and its author lost his medical license.

    There is, however, a very human explanation, one that illustrates the power of the connection between the head and the heart, they said.

    People feel much more responsible for a decision they make actively than if they choose to do nothing, said Daniel Kahneman, a Nobel Prize winner and professor emeritus of psychology and public affairs at Princeton University.

    “People are much more afraid of their children dying from a vaccine than they are from a child dying of an illness that spreads naturally,” said Kahneman. “If something would happen to their child after being vaccinated, their decision becomes a focus of enormous regret.”

    Maybe physicians can give parents a choice: “The needle contains the vaccine, the swab contains the virus. You choose.”

  4. 4.

    Baud

    February 11, 2015 at 8:38 am

    @Belafon:

    People are made to feel much more responsible by their self-appointed social betters for a decision they make actively than if they choose to do nothing,

    Fixed.

  5. 5.

    Belafon

    February 11, 2015 at 8:45 am

    @Baud: Don’t know that that fixes it. People own guns because they’d rather take the chance that someone might get hurt with it than to have someone break into their house and they not be able to defend themselves, even though the former is far more likely.

  6. 6.

    Matt McIrvin

    February 11, 2015 at 8:46 am

    @Belafon: The people who hold “measles parties” would choose the swab.

  7. 7.

    gene108

    February 11, 2015 at 8:47 am

    The conservative goal was to break and remake Iraq.

    What’s dangerous is all the flunkies responsible for the Iraq mess are still in positions of foreign policy influence in the Republican Party, and more than likely will advise any potential Republican Presidential candidate on foreign policy matters and assume positions of power in a Republican Presidential Administration.

    And the media will never point out Mr. Republican Candidate, why do you have a flunkie responsible for the clusterfuck in Iraq leading your foreign policy team?

    Romney was staffed to the gills with neo-con flunkies with no adverse consequences for having them around.

  8. 8.

    I'mNotSureWhoIWantToBeYet

    February 11, 2015 at 8:47 am

    Epic. Thank you.

    Of course, if modern American politics were governed by logic and evidence then things would be very, very different. Here’s hoping we can slowly turn the ship that way.

    Since Obama is on the path to be the best private sector job creator ever, I hope that doesn’t mean that we’re getting ready for a replay of the 2000 election (where we (with some help from the SCOTUS) handed a decent, fairly peaceful, economy – on a reasonable path – off to the NoNothings…)

    Cheers,
    Scott.
    (Who needs more parentheticals…)

  9. 9.

    Baud

    February 11, 2015 at 8:52 am

    @Belafon:

    I don’t know. If you’re in a gun culture and you don’t have a gun, I think your social network would make you feel guilty.

  10. 10.

    Betty Cracker

    February 11, 2015 at 9:03 am

    @Baud: They certainly will, as I found out this week. Not guilty so much as stupid for not having a gun with which to plug an unarmed teen trespasser.

  11. 11.

    JimV

    February 11, 2015 at 9:04 am

    Amen – but I’m in the choir, and it needs more strong singers. Thanks for leading the bass line.

  12. 12.

    Enhanced Voting Techniques

    February 11, 2015 at 9:08 am

    @I’mNotSureWhoIWantToBeYet:

    I hope that doesn’t mean that we’re getting ready for a replay of the 2000 election (where we (with some help from the SCOTUS) handed a decent, fairly peaceful, economy – on a reasonable path – off to the NoNothings…)

    It doesn’t seem likely any of the GOP candidates can repeat Bush II’s mix of white resentment combined with Hispanic appeal on the down low.

  13. 13.

    p.a.

    February 11, 2015 at 9:20 am

    Mr. Mayhew you are still not clapping hard enough. If you have not reached the bone-on-bone clapping stage, you are not even trying. Why do you hate America?

  14. 14.

    Marc

    February 11, 2015 at 9:33 am

    Sadly, too many people in the media blew the call on Iraq for them to ever hold anyone else accountable for it. The rot runs too deep.

    But god help you if you misremember a chopper crash…

  15. 15.

    boatboy_srq

    February 11, 2015 at 10:13 am

    @gene108: I’m still not convinced that Iraq was the goal. There’s too much that happened in the US that Iraq drew attention from (the first Jobless Recovery, DOMA, “Faith-based initiatives”, trade agreements, Medicare Part D, rampant outsourcing, gutting of oversight, etc) that deserved attention in its own right that didn’t get the scrutiny it deserved because war (and then occupation) coverage took the spotlight. Also, Iraq was very effective at silencing opposition: remember “with us or with the terrorists” was boilerplate response to anyone raising any question whatever. Iraq was distraction from domestic policy (or the failures thereof) at least as much as it was Conservatist agenda item by itself.

  16. 16.

    boatboy_srq

    February 11, 2015 at 10:24 am

    @Betty Cracker: I still don’t understand how the same people who can elevate LEOs to demigodhood can insist that nobody can protect them but themselves nor with anything less than an automatic, and that cops are only there to take notes and file the reports.

  17. 17.

    Starfish

    February 11, 2015 at 10:24 am

    @Belafon: Here’s the deal. Insurance allows doctors to spend about 15 to 30 minutes per patient. If patients are generally healthy, they only see their doctor once a year or so where he/she administers shots.

    Patients are not building relationships with their doctors, and they see their hairdressers more than they see their doctors. This is why a lot of social health programs may be implemented by getting hairdressers to talk to people.

    Having medical care professionals call patients and make sure they are sticking to their regimen is a low-cost way of getting people to stick to whatever it is they need to do to stay healthy especially when it comes to things like diabetes.

  18. 18.

    drkrick

    February 11, 2015 at 10:40 am

    @Baud:

    People are made to feel much more responsible by their self-appointed social betters for a decision they make actively than if they choose to do nothing,

    Fixed.

    Actually, that’s the opposite of fixed. A lot of research into how the human mind assesses risk backs the original version. It’s not a social construct.

    The bad information that’s been promoted by certain people is one thing, but it’s interacting with human nature.

  19. 19.

    drkrick

    February 11, 2015 at 10:44 am

    @Matt McIrvin: Turns out the measles parties are as phony as the rainbow parties were.

  20. 20.

    Fair Economist

    February 11, 2015 at 10:55 am

    I’m boggled that even in my liberal California social circles, there are still people unaware of the Obamacare subsidies. One guy was talking to me about how unfair it was to require the working poor to have insurance without helping them pay for it. Seriously.

  21. 21.

    Chris

    February 11, 2015 at 11:21 am

    @Betty Cracker:

    The 2000s also gave us an interesting example of two major crises, one handled by a Republican president (9/11) and one a Democratic one (the financial crisis), and how the opposition parties react. Faced with a national crisis while someone else was in the White House, Democrats rallied around the flag. Republicans said “I hope he fails” and acted accordingly.

  22. 22.

    Chris

    February 11, 2015 at 11:38 am

    @boatboy_srq:

    Yep. I continue to think that the primary goal of Iraq was to 1) make a bunch of defense contractors rich, and 2) perpetuate the war hysteria, allowing them to keep pushing for more powers and use the war as a hammer against their political enemies in 2002 and 2004.

    I also think the fact that the war was so blatantly unjustifiable was in some sense the point; they knew it would be hugely controversial in a way that Afghanistan, right after 9/11 and directed against Bin Laden’s protectors, wasn’t, and that they’d get a lot more opposition if not from Democrats then from activists, foreign nations, the UN, whatever. This allowed them to reframe the “us versus them” mentality of 9/11, so that “them” now included not just terrorists, but our traitorous allies stabbing us in the back, our traitorous fifth columns marching against the war, and those weak-kneed appeasers at the League Of Nations UN. Ultimately, they’re far more interested in the war on terror as a tool against all these people – their political enemies – than against actual terrorists.

  23. 23.

    Jacel

    February 11, 2015 at 11:46 am

    There’s no good reason for “measles parties” now, but over fifty years ago that would have been a grim name for something parents actually did. I was a child in years surrounding 1960 (which was before any of the MMR vaccine components were available) that those childhood diseases were pretty inescapable, and carried the risk of severe consequences. The best parents could do was to hope or arrange for their kids to get these diseases at an age when they and their siblings (who would of course catch it as well) were at the lowest risk for complications. I recall concern that mumps would have stronger risks if caught during adolescence. So sometimes kids would be deliberately exposed to other kids with a disease to get suffering from it out of the way. But the vaccines are a much, much better way to reduce the risks. I wish they existed in time for me.

  24. 24.

    Splitting Image

    February 11, 2015 at 11:53 am

    @Belafon:

    People feel much more responsible for a decision they make actively than if they choose to do nothing, said Daniel Kahneman, a Nobel Prize winner and professor emeritus of psychology and public affairs at Princeton University.

    I don’t know about this. A lot of the same people who are refusing to vaccinate their children are the same people who were throwing that fake Edmund Burke quote in your face (“All that is required for evil to triumph is that good men do nothing.”) when they wanted the bombs to start falling now, now, now. To date, none of them appear to have accepted the slightest bit of responsibility.

  25. 25.

    Whammer

    February 11, 2015 at 12:49 pm

    I think that whenever anyone mentions Iraq, they should also mention “now an ally of Iran, thanks to us.” Just to, you know, help folks remember what a true cluster this whole thing has been.

  26. 26.

    bemused

    February 11, 2015 at 1:09 pm

    @Fair Economist:

    Did he believe you when you said there was help?

  27. 27.

    Tree With Water

    February 11, 2015 at 1:46 pm

    I don’t know how she felt about freshly painted schools, and she does support Obamacare (which is not called Hillarycare for good reason). But Hillary Clinton supported the Bush-Cheney war full throttle. She is not ashamed of that support. And yet she is by all accounts the odds on favorite to win the democratic nomination for the presidency. WTF? The democratic rank and file should take a hard look at themselves and their own candidates before cursing the foreign policy imbroglios of the republican party.

  28. 28.

    What Have the Romans Ever Done for Us?

    February 11, 2015 at 2:44 pm

    Well I’m not sure that Iraq was the only or even the primary attempt to implement a big conservative policy project, but all the other examples were failures too (financial deregulation, tax cuts for the rich to promote middle class prosperity, etc.)

  29. 29.

    Tree With Water

    February 11, 2015 at 3:28 pm

    Criticism of anyone with the first name of Stuart always brings to mind Al Franken talking to himself in a mirror.

  30. 30.

    Zinsky

    February 11, 2015 at 3:41 pm

    Hey, lets give credit where credit is due – Romneycare = Obamacare. The differences are insignificant. Democrats need to remind Republicans of this over and over again, until everyone down to the dumbest, knuckle-dragging teabagger understands their pettiness and hypocrisy.

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