Nate Silver on Health Care Reform

[Vekseid]

I found this to be particularly insightful and found it deserving of spreading.

...

There's more than way for democracy to become dysfunctional. One way is if the Congress consistently adopts policies that the American people don't support. Another is if one of the major political parties routinely misleads the public to manipulate public opinion, and the other party aids and abets them by behaving like a bunch of gutless wonders who can't see farther than the next midterm. Neither outcome is desirable -- but Iraq ought to be a reminder that the latter is every bit as much a threat to our democracy as the former.

We could always start with something hardline conservatives and progressives both want, but keeps getting swept under the rug by everyone from NPR to Fox.

Transparency.

[MercyfulFate]

This version of the health care bill was a disaster. It didn't do enough for some, and it did too much for others. I personally hate the idea of mandatory health insurance, and of course that's included.

[consortium11]

I don't quite know what to make of the article. A lot of it is true... those against this reform (and at times it seems any reform) put out a whole load of lies and misinformation about it to try to twist the debate. It's the sad state of politics in the US today where (from what I've picked up) a decent amount of people on both sides seem to gain their political insights from the infotainment type shows.

(I do have to repeat one thing though. Death Panels (although not in the "send granny to see the doctor who decides whether it's worth treating her if she has a stroke in the next 5 years" sense) do exist... they exist in the NHS under the title of NICE (National Institute for Clinical Excellence) which decides which treatments are cost effective... but they also exist in the US system where an insurance company worker does the same. The question isn't to death panel or not to death panel, it's about who you want sitting in such a group)

But yes, the article seemed ok... and then it came to this bit that scared me;

Well, you know what, what Massachusetts tells us is that we haven't done a very good job of explaining our values to them. Maybe we need to take a step back and have that conversation with them. And some of our opponents have been made that job more difficult by telling them things that just aren't true. But we believe that, when people learn what's really in the health care bill, they're going to realize how much good it does for our country. And that's what we were elected to do -- to get our country back on track after eight years of a government that misled the American people and produced the worst crises since the Second World War. We understand that people are scared and upset about the tumultuous times that we face and they have every right to be. But we have to continue pressing forward.

This seems to me to come scarily close to saying "Listen, you poor guys just didn't understand what was going on. Don't worry though, we'll keep telling you until finally you give us the right answer."

Now, that's not entirely fair. Massachusetts wasn't just a referendum on this health bill... Coakley was almost uniquely inept as a candidate, making gaff after gaff and never getting any real momentum while also appearing to insult many of the voters. Despite that she only lost by 5 points... if it had been a simple vote on healthcare or the Democrats had got an even vaguely capable candidate the entire result could have been much different even with a massive drop in Dem support. That said, both sides made healthcare a major issue... and the quote above is still troubling.

A similar situation happened in Ireland with the Lisbon treaty/EU consitution. Ireland voted no to the Consitution necessitating some backroom dealing which resulted in the Lisbon treaty... which is pretty much identical, at least according to nearly everyone involved with it (unless you're a UK Labour Politician in which case it's completely different apparently). So a few months after voting No, Ireland were made to vote again on roughly the same thing, the entire time the EU higher ups not thinking that perhaps the Irish (and others) genuinely disagreed about the direction of Europe but instead that they simply hadn't spelt out the case strongly enough. Of course, they were vindicated when the Irish voted Yes the second time, but it is perhaps telling that it was after the Yes side outspent the No side int he region of 10-1 and a large plank of the Yes campaign was that "Look, these idiots who are in power at the moment in Ireland screwed everything up... the EU can't be any worse."

Are people misinformed about the US healthcare plan? Yes, of course... the GOP spin machine has been working at its best/worst on the issue. Does the fact that some people are misinformed mean that those supporting this healthcare bill should act as if nearly all disagreement is simply due to that misinformation and that you should just keep going until people realise that it's the right answer? No.

Perhaps the author didn't mean that, but it sounds awfully close.

[Trieste]

I don't know how much of the country (and anyone watching internationally) realizes that Massachusetts has mandatory healthcare laws. We have no public option. Instead, we shop around for whatever insurance, sign up for it, and the state pays a certain percentage of the premium dependent on your taxable income. Sounds simple, fair, and reasonable, right?

My parents' insurance rate was just raised to about two thousand dollars a month plus copays and deductibles. They are two reasonably healthy (eat well, don't smoke, exercise regularly, regular checkups, etc) adults. Their income bracket, while I don't know the precise numbers, is about lower middle class. They are your average people who got hit hard by the recession but managed to keep the house.

The kicker? 2k a month is the part they pay. "We haven't explained it well enough to Massachusetts"? Not so much. More, MA has been there, done that, and we would like to see genuine reform and contained costs. Nobody should have to pay 24k (12k a person) a year for insurance that's only marginally better than catastrophic care.

[consortium11]

I knew about it but I've seen it spun both ways:

1) Mas has mandetory healthcare, hate it, and that's why it was shot down.

2) Mas has mandetory healthcare, love it, and thus don't give a toss about reform.

I still think a style similar to the Swiss one would have been a good option... and practical to both implement and get voted through... in the US as opposed to the mess this bill has become. Government mandates health insurance for everyone and sets a basic insurance package  which the private insurance companies have to offer to everyone and can't make a profit on. How they make their money is on more comprehensive packages. The system offers universal healthcare on the cheap while keeping the free marketeers happy.

[Trieste]

2) Mas has mandetory healthcare, love it, and thus don't give a toss about reform.

This is the part I don't understand. If MA doesn't give a flip about healthcare reform, why would both of the major candidates have made it such a central platform? Both sides of an election do not usually miss the mark so much regarding what's important to people.

I would be extremely amenable to the plan you noted, Consortium, so long as the basic plan was essentially funded by taxes, or otherwise affordable for people who have no wiggle room in their budgets.

[Caliban]

This version of the health care bill was a disaster. It didn't do enough for some, and it did too much for others. I personally hate the idea of mandatory health insurance, and of course that's included.

I dislike mandatory anything, but what I hate the most about the health care bill is that it would actually make things worse for consumers *and* it would also give unfair advantages to insurance companies.  Ironically, left-wing populist Dennis Kucinich points this out as well.

As I've said elsewhere, even those who think it's possible to improve health care with more government involvement should understand that *this* bill would actually make things worse.

[consortium11]

This is the part I don't understand. If MA doesn't give a flip about healthcare reform, why would both of the major candidates have made it such a central platform? Both sides of an election do not usually miss the mark so much regarding what's important to people.

I would be extremely amenable to the plan you noted, Consortium, so long as the basic plan was essentially funded by taxes, or otherwise affordable for people who have no wiggle room in their budgets.

Competition and the restrictions on profit lowers the costs already and beyond that the Swiss government transfers funds directly to those unable to pay (I believe contributions are made for those whose health insurance costs more than 8% of their household spending)

There are issues with the Swiss set-up... it squeezes doctors fairly hard and out of pocket expenses can be high, but I generally like it as a system. Singapore has some statistically amazing results, but I'm never sure how much of that is due to factors outside healthcare directly.

[Vekseid]

I don't know how much of the country (and anyone watching internationally) realizes that Massachusetts has mandatory healthcare laws. We have no public option. Instead, we shop around for whatever insurance, sign up for it, and the state pays a certain percentage of the premium dependent on your taxable income. Sounds simple, fair, and reasonable, right?

My parents' insurance rate was just raised to about two thousand dollars a month plus copays and deductibles. They are two reasonably healthy (eat well, don't smoke, exercise regularly, regular checkups, etc) adults. Their income bracket, while I don't know the precise numbers, is about lower middle class. They are your average people who got hit hard by the recession but managed to keep the house.

The kicker? 2k a month is the part they pay. "We haven't explained it well enough to Massachusetts"? Not so much. More, MA has been there, done that, and we would like to see genuine reform and contained costs. Nobody should have to pay 24k (12k a person) a year for insurance that's only marginally better than catastrophic care.

The current HCR bill wouldn't require them to spend that unless they were making $300k a year, and even then there would only be a $2k/year fine if they didn't.

What I want from the HCR bill is the cost control pilot programs, though. That would make a lot of the insurance BS a moot point.

[Trieste]

I know that the current bill is already better than what we have in MA - however, I think that the current experience makes MA voters pretty leery.

[RubySlippers]

Competition and the restrictions on profit lowers the costs already and beyond that the Swiss government transfers funds directly to those unable to pay (I believe contributions are made for those whose health insurance costs more than 8% of their household spending)

There are issues with the Swiss set-up... it squeezes doctors fairly hard and out of pocket expenses can be high, but I generally like it as a system. Singapore has some statistically amazing results, but I'm never sure how much of that is due to factors outside healthcare directly.

Doctors should treat this as a calling and not expect to be over middle middle class being one even if a specialist. The Hippocratic Oath demands they do no no harm refusing care due to the patiants ability to pay is harming patiants so such healers are being immoral.

As for the system why not take what works from other countries like we did when we stole the autobahn from Germany, thanks to Ike. I would love to see the government run the system like in the UK who I will note started their plan right after WWII. And Germany under Bismark ,who hated taxes and government control, set-up national health care first in the 19th century because it made them more competative economically. AND it used the free market system with government oversight hardly a "socialized" system. If they can do this why can't we?

[Trieste]

On rate hikes.

I'm sure I'm not the only one who's noticed the rate hikes. Even in Massachusetts, we're feeling them. I found this part especially interesting.

"Our decision to agree to postpone the rate adjustment does not change the underlying issue. All health plans are in the same situation in trying to deal with the steadily increasing medical costs in the delivery system, which are not sustainable," said Brian A. Sassi, president and chief executive officer of the Consumer Business Unit of WellPoint, Anthem's parent company. "We need to refocus the health care reform debate toward steps that will improve quality and control the underlying medical costs, which is driving the high cost of coverage."

But Sebelius said WellPoint recorded more than $2.7 billion in profits last quarter -- one week before the announced rate increase.

In fact, she said, the five largest health insurance companies -- WellPoint, Cigna, Aetna, UnitedHealth group and Humana -- took in combined profits of more than $12 billion in 2009, up 56 percent from 2008. She called those profits "wildly excessive."

12 billion in profit isn't the number that caught my eye. It was the 56%. A 56% increase in profit across two of the worst economic years for most of the families they have been covering. 56%. Half again as much as they made before. More than half.

How could a government option and a raise in taxes possibly suck us drier? Really? I mean, really? 12 billion dollars - and that's just the excess as opposed to the gross - made off the backs of a populace already dealing with an economic depression.

Argh.

[RubySlippers]

They have the right to charge what they want as companies barring some laws that would restrict that. I would favor treating health and other insurance like we do basic utilities with the states having control over price increases, the companies having to justify them.