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[politics] My initial thoughts on HCR, and some related links - Lakeshore
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Jay Lake
Date: 2010-03-22 05:44
Subject: [politics] My initial thoughts on HCR, and some related links
Security: Public
Tags:cancer, health, healthcare, politics
I thought I'd put the healthcare reform links in their own post, rather than link salad. A special link salad, as it were. Basically, as flawed and difficult as this bill is, I'm glad it passed. I'm even more glad Representative Stupak and his merry band of forced pregnancy enthusiasts weren't able to derail it. How can you call yourself "pro-life" and oppose something that will reverse mortality outcomes for tens of thousands of Americans every year simply by ensuring they have access to healthcare? Not to mention if abortion reduction is your goal, why ignore the documented link between increased access to healthcare and decreased abortion rates?

Everyone benefited last night. Even all the screaming, spitting Tea Partiers. Because now their coverage won't be cancelled if they fall seriously ill, or run against a lifetime coverage limitation if that illness becomes extended. My lifelong experience of observing politics is that liberal-progressives want to help even people who don't want their help, even at a cost to themselves, while conservatives want to put limits on both rights and opportunity for everyone they disagree with in the name of preserving their own rights and opportunities. Healthcare reform has been an amazing illustration of this principle in point.

As conservative commentator David Frum notes in one the articles linked below, this HCR initiative is rather similar to Republican plans from decades past. Yet to hear our Republican friends tell it, this is a Socialist millstone that will sink the Republic. The politics of this have been beastly, funded and driven by an effort to unseat Obama, as much as any actuality of healthcare. The people protesting this will benefit as much as the rest of us, for all the bill's flaws.

The left, such as it is, tries to talk policy, the right talks politics. And politics makes for better soundbites, angrier voters, and ultimately stronger electoral returns.

We lost a lot here. Single payer would have solved so much of the healthcare spending issues. (Quick quiz, what percentage of private healthcare spending goes to processing costs and profit margin? What percentage of Medicare healthcare spending goes to processing costs and profit margin?) The public option would have been a decent compromise, if nothing else through a Medicare buy-in. But those things can come into play over time, once people see this bill isn't a 'poison pill', but something that benefits them and their families personally, regardless of their political views.

We may still lose ground here. I imagine there will be hundreds of court challenges, some from politically ambitious Red State attorneys general, others from the Orly Taitz wing of the conservative nuthouse. Some challenges might even have substance on the merits, though I'll be surprised. And much of the long-term success of HCR depends on not having a massive string of bills overturning it pieces in the next few years.

Still, today, I woke up in a world where my healthcare funding won't be terminated because of lifetime coverage limitations, or because I am too sick. I woke up in a world where I can change jobs without sentencing myself to death from the disqualifying pre-existing condition of metastatic colon cancer. I woke up in a world where a major liberal-progressive idea has gained a significant foothold.

And that idea will benefit every American, even those who willfully misunderstand it, and hate it with a screaming passion. That's what good political ideas are all about. Benefiting everyone.

Meanwhile, some linkage:

Health Vote Caps a Journey Back From the Brink — How Speaker Pelosi brought HCR back from the dead.

Tea Party Protesters Shout The N-Word At, Spit On Passing Legislators — More on this. The Sarah Palin cite in this piece is especially trenchant. Ah, the classness of conservatives.

Waterloo — Conservative David Frum on HCR. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994. Definitely sounds like screaming socialism, doesn't it? In other news, Republican lawmaker says of this same plan, "We believe that this is the beginning of the end of America." Hyperbole much?

In Case You Missed Obama's Health Speech Saturday Afternoon — Political capital, and the expending thereof. I do significantly disagree with one of Fallows' closing statements, "I support it, because it is a step toward the principle that for society's benefit and for individual protection, everyone should be insured." Actually, everyone should have access to healthcare. Insurance is just a mechanism. Healthcare is the issue. There are other ways to deliver and fund it.

A look at the healthcare overhaul bill — Might have been nice if the media had spent more time on this and less on people screaming about death panels and socialism. For my part, I note "Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick." That removes two of the several death sentences I've been living under. The market-based solution thought it was fine to cut me off to die once I'd received too much healthcare. Any wonder I favor government intervention? I wasn't willing to die for conservative beliefs about the free market, thank you.

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Cairsten
User: kuangning
Date: 2010-03-22 14:35 (UTC)
Subject: (no subject)
Oh, that link about Teabagger behaviour just isn't complete without the followup: http://gawker.com/5498448/right+wing-bloggers-demand-apology-from-lawmakers-called-nigger-by-tea-partyers

Yes, you read that right.

"DOES CLYBURN OWE TEA PARTY PROTESTERS AN APOLOGY? The bogus racism card has been played so often that I no longer find such charges very credible." -- Glenn Reynolds.
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Elf M. Sternberg
User: elfs
Date: 2010-03-22 15:20 (UTC)
Subject: (no subject)
Don't you know? In their reality, the only people who would say such a thing out loud must have been plants from the commie left, inserted into the crowd to make the tea partiers look bad.
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fledgist
User: fledgist
Date: 2010-03-23 11:25 (UTC)
Subject: (no subject)
Glenn Reynolds can kiss my café-au-lait ass.
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Autopope
User: autopope
Date: 2010-03-22 14:51 (UTC)
Subject: (no subject)
Still, today, I woke up in a world where my healthcare funding won't be terminated because of lifetime coverage limitations, or because I am too sick. I woke up in a world where I can change jobs without sentencing myself to death from the disqualifying pre-existing condition of metastatic colon cancer. I woke up in a world where a major liberal-progressive idea has gained a significant foothold.

<nit>
No, you woke up in a Unite States of America that has just managed to catch up to where the rest of the developed world was, half a century ago.
</nit>

This is still a good thing, mind. But it's not one giant leap for the world; it's just one small corner of the world -- 5% by population -- running to catch up.
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Jay Lake
User: jaylake
Date: 2010-03-22 14:57 (UTC)
Subject: (no subject)
Understood. As as you know, I am not world-blind like so many of my compatriots. It was, erm, a figure of speech.
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Autopope
User: autopope
Date: 2010-03-22 15:08 (UTC)
Subject: (no subject)
There's a long way to go ... but (if you're willing to take an outsider's opinion) I think the next targets ought to be (a) to ride Stupak and his executive order out of town on a rail, preferably tarred and feathered, and (b) to legislate for a federal-sized single payer scheme: possibly along the lines of "pay 5% more federal income tax, get Medicare, no ifs, no buts."

Then let the insurance-industry rent-seekers try to compete on efficiency or service, rather than a legislative monopoly.
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cathshaffer
User: cathshaffer
Date: 2010-03-22 17:16 (UTC)
Subject: (no subject)
Just FYI, via Medicaid and Medicare, the US government is already the largest payer by far in the insurance market, and quite likely larger already than than the entire health service of many smaller countries with single payer health insurance. I agree that if we move toward single payer in the future, that will be the way to go. The current HCR expands Medicaid by quite a lot as it is.
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Twilight
User: twilight2000
Date: 2010-03-22 17:25 (UTC)
Subject: (no subject)
That sort of opinion is welcome at least to me - regardless of whether it's from inside or outside ;>. It's what a lot of us were hoping for from the beginning...
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threeoutside
User: threeoutside
Date: 2010-03-22 22:43 (UTC)
Subject: (no subject)
But...does there not yet have to be a vote in the Senate? They being the proverbial Fat Lady, and who knows what song she'll be singing...?
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Kevin Standlee: Not Sensible
User: kevin_standlee
Date: 2010-03-22 15:13 (UTC)
Subject: (no subject)
Keyword:Not Sensible
I am concerned, however, that the "Cadillac tax" -- taxes on so-called premium coverage -- will mean that any employer offering coverage better than the maximum allowed before the tax cuts in will simply reduce their coverage to that level to avoid the tax. I know that the CEO of my company distributed a letter to all employees last week warning that my company's insurance plan is a "Cadillac" plan. So in a few years, I expect that my health insurance coverage will decrease as employers adjust their behavior to the new taxes.
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cathshaffer
User: cathshaffer
Date: 2010-03-22 17:20 (UTC)
Subject: (no subject)
I'm very annoyed with the whole concept of "Cadillac" health insurance plans. Health care is not a luxury. When I'm bored and in need of entertainment, I don't go to my doctor and get a knee replacement. And if I need a knee replacement, there are not various grades of knees I can get based on my income. There are really two choices--good standard of care, and below standard of care. Health insurance plans tend to cost a lot not because people are getting luxury care that they don't deserve, but because the members of the group have higher health care needs--maybe the average age is higher or some people have had serious medical problems increasing costs for the whole group, etc. Now we have high cost health insurance being redefined as "luxury." Whereas once we could expect employer-provided health insurance to cover almost everything with minimal copayments, now we can expect increasing copayments and deductibles so that the employer can keep premiums below the "Cadillac" limit. Tax credits may or may not cancel out the added expense, depending on your income bracket.
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Jay Lake
User: jaylake
Date: 2010-03-22 18:04 (UTC)
Subject: (no subject)
I'm not defending the 'Cadillac tax' (in fact, my plan may be vulnerable to it), but I believe part of the thinking was that there's a layer of health insurance that most of us never see, the sort that senior execs and Wall Street types get in their high end benefits packages, where there are no copays or deductibles or out-of-pocket maxima or treatment limits or drug formularies, that still function essentially like the indemnity plans did back in the 1970s and 1980s. I believe the number I saw quoted in a story about this a while back in WaPo or WJS was employer paid premiums at the $40,000+ per year level.

Unfortunately, like the AMT, this tax will catch a lot of unintended people in its net.

Edited at 2010-03-22 06:04 pm (UTC)
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They Didn't Ask Me
User: dr_phil_physics
Date: 2010-03-22 15:24 (UTC)
Subject: (no subject)
Still, I have to get some points to Stupak. One of the best moments of the debate last night was when he angrily rose and called shenanigans on the Republican's call to "restore" the Stupak amendment and table the Health Care Bill. He said not only was it only about killing the bill, but how could one be pro life and work to deny health care to children, the poor, the elderly, etc.? I spent 7-1/2 years in Michigan's U.P., so I know the kind of people who support Stupak. This was one small moment where I could at least understand why he's a Democrat.

Dr. Phil
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Jay Lake
User: jaylake
Date: 2010-03-22 15:35 (UTC)
Subject: (no subject)
how could one be pro life and work to deny health care to children, the poor, the elderly, etc.

A question I've been wanting to ask Representative Stupak for months, actually.

Edited at 2010-03-22 03:36 pm (UTC)
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They Didn't Ask Me
User: dr_phil_physics
Date: 2010-03-22 17:49 (UTC)
Subject: (no subject)
Apparently he found a compromise he could live with and treat the whole thing as "pro life" and he was ticked that his name was being used by the Republicans for wanting to derail the whole thing at the 11th hour. Like I said, I give him some credit for being consistent.

Dr. Phil
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Jay Lake
User: jaylake
Date: 2010-03-22 18:05 (UTC)
Subject: (no subject)
Point taken. And consistency is one of those things I despair of most in politics.

Unfortunately, Stupak is consistently wrong to the point of evil. Sigh.
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User: nicosian
Date: 2010-03-22 16:17 (UTC)
Subject: (no subject)
I'm new to your LJ, but I'm happy over the vote yesterday.

I'm grateful that the canadian system had given both my grandfathers care that kept them around for an extra 15-20 years.

And saved the life of my mom, my grandmother this year, and family in the past.

Without bankrupting them.

It's a big step for the US, and I'm excited, and relieved that you and the many people I know in the US, most without insurance not by choice but by the hand of old insurance tricks, are now going to access care. They work hard. This is the least the country can do for them.
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cathshaffer
User: cathshaffer
Date: 2010-03-22 16:25 (UTC)
Subject: (no subject)
small correction. HIPAA already protects you from being denied due to preexisting condition if you changr jobs, from one group plan to another. I wouldn't want your readers to think they have to wait until 2014 for that benefit. It's consumers in the individual health insurance market that have been shut out due to preexisting conditions.

I am relieved that we have some HCR at last. It may not be perfect, but it's better.
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Jay Lake
User: jaylake
Date: 2010-03-22 16:36 (UTC)
Subject: (no subject)
Right. I'm familiar with HIPAA corrections. One of my terrors has been the possibility of being forced onto the private market...
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cathshaffer
User: cathshaffer
Date: 2010-03-22 16:53 (UTC)
Subject: (no subject)
Oh, yeah, mine too. Strange to think, but my family is no more insurable than you are on the private market. I have heard that asthma is a total dealbreaker for private insurance, and we all have asthma. It's mild, we are all extremely healthy and rarely even get colds, but we couldn't buy insurance for any price on the private market. Of course we could eke by without insurance, and you could not...
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Jay Lake
User: jaylake
Date: 2010-03-22 17:59 (UTC)
Subject: (no subject)
My daughter has a chronic disease which is ordinarily acute, but she has a narrow spectrum immune deficiency with respect to it. In effect, she simply never develops antigens to a virus that's present in her blood stream and organ systems at very high loads. (This particular pathology is not uncommon in persons of East Asian descent.)

The virus itself is asymptomatic for her, and her added lifetime mortality risks fall nearly into statistical noise. The only costs of treating this, ever in her life, are occasional blood tests and discussions at her annual physical — that because there simply is no cure for her unless/until somebody develops a direct antiviral treatment for this particular disease.

She is and always has been utterly insurable outside of nonqualifying groups. The only reason she has life insurance is that quite coincidentally I took out a nominal policy on her prior to her diagnosis. At this point she will never qualify for life insurance except potentially as an expansion to current coverage. She will probably be barred from military service and most public safety professions because of this. She was nearly barred from her school in first grade for this, as there are a high number of vaccination protestors in the parent population (and you know how I feel about that crap), some of whom protested their children's potential exposure to a carrier. (It's transmissible by blood contact or sexual contact.) My response to that was a not very polite, very public "Fuck you, you can vaccinate your child any day you come to your senses, I cannot cure mine." The school wound up backing me on this, but it was an issue.

So far as the insurance companies are concerned, she might as well have a terminal illness. The disease is invisible, it's asymptomatic, and the nightmare of pre-existing conditions has been mine since 1998, long before cancer came into my life.

So, yeah.

Edited at 2010-03-22 06:00 pm (UTC)
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cathshaffer
User: cathshaffer
Date: 2010-03-22 18:28 (UTC)
Subject: (no subject)
Gah! Well, it looks like protection from child pre-existing conditions will kick in this year.
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Chris McKitterick: smiling Chris 2008
User: mckitterick
Date: 2010-03-22 19:02 (UTC)
Subject: (no subject)
Keyword:smiling Chris 2008
Thank you for the lucid response, Jay. I heard the news just before I headed back to bed (sleep issues) and didn't get the chance to respond in such a thoughtful way. Linking to this.
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zachariahskylab
User: zachariahskylab
Date: 2010-03-23 02:05 (UTC)
Subject: (no subject)
When discussing the deficit, neither party ever seems to bring up defense spending... we can pay for all of this if we just cancel construction of a couple nuclear subs.

Sadly, defense spending has accelerated since the collapse of the Soviet Union... seriously, during the Cold War our ridiculous defense spending could still be reasonably defended, but why haven't we scaled back? At all? Even just a tiny bit since the Soviet Union collapsed?
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jwjohnson
User: jwjohnson
Date: 2010-03-23 04:17 (UTC)
Subject: (no subject)
Thanks Jay. Why don't more people get it? Linking.
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