Free Markets, Free People

Health Care Reform On The Brink

Although I am on the record as predicting that Congress will get some sort of health care bill to the president’s desk, I am hoping that my prediction is wildly inaccurate. Arguably the most important factor in whether I end up being right or not is the decision being made by the Senate and House parliamentarians:

The White House and Democratic Congressional leaders said Tuesday that they were bracing for a key procedural ruling that could complicate their effort to approve major health care legislation, by requiring President Obama to sign the bill into law before Congress could revise it through an expedited budget process.

An official determination on the matter could come within days from the House and Senate parliamentarians, and could present yet another hurdle for Mr. Obama and Democratic leaders as they try to lock in support from skittish lawmakers in the House.

[...]

The most immediate question seemed to be how parliamentarians would rule on the steps that Democrats must follow. The reconciliation instructions require that committees “report changes in laws” that help meet deficit reduction targets.

Democrats are planning to use budget reconciliation to make the final health care revisions because it circumvents a Republican filibuster in the Senate and can be adopted by a simple majority vote rather than 60-vote supermajority normally required.

Something the parliamentarians need to answer is whether or not the Senate bill, currently sitting in Speaker Pelosi’s office, needs to be either passed by the House and/or signed by the President Obama before the “Reconciliation Bill” can even be considered.

No, No

If the answer to the initial question — does the Senate bill have to pass the House? — is “no,” then the House can get to work drafting the “fixes” they want in the Senate bill, and shaping them to fit within the budgetary confines of the reconciliation process. Since any fix that doesn’t have to do with the budget will be cut from the reconciliation bill, how that bill is drafted will be vitally important to keeping the House “yes” voters together. If, for example, provisions relating to Rep. Stupak’s desire to prevent federal funding of abortion are deemed to be non-budget related, then he and his pro-life group of congressmen will not want to vote for the Senate bill. However, because reconciliation apparently requires that the bill being “fixed” be submitted to the CBO for scoring first, then, in the very least the Senate bill must be passed by the House.

Yes, No

Should the parliamentarians decide that the House must pass the Senate bill, but that the president does not have to sign prior to the reconciliation bill being considered, then the House can basically hold the Senate bill hostage while working on the fixes. It’s not entirely clear how long Pelosi could do this (how soon after voting does she have to enroll the bill? What about the ten-day limits re passage/”pocket veto”?). However, it would enable to the House to get a reconciliation bill through the Senate before sending the Senate bill to Obama, thus ensuring that whatever happens during reconciliation doesn’t undermine any Representative’s “yes” vote.

Yes, Yes

If, instead, the House must both pass the Senate Bill and get it signed by the President before the reconciliation bill can be considered, then health care legislation is likely dead. In this scenario, the House would have to trust the Senate to agree to its fixes, that such fixes get through the reconciliation process, and that Obama signs them into law. Meanwhile, a perfectly functional health care law will be on the books which achieves what the Senate Democrats wanted, and what Obama has staked his entire presidency upon. That would require a great deal of faith.

As I understand it, there are numerous variables in play that could decide which of these scenarios is the winner, so nothing is terribly certain at this point. What is known, is that a favorable parliamentarians’ decision is crucial to ObamaCare becoming law.

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67 Responses to Health Care Reform On The Brink

  • But then there is the question of whether it is permissible to “go parliamentarian shopping”.
    If they don’t like the parliamentarian’s answer, can they get another parliamentarian ?

    • I think that the House/Senate Leader can replace the parliamentarian (not sure), but that’s no guarantee to getting a favorable ruling.  And I don’t think any replacement will make a difference after a particular ruling has been issued.  But again, I’m not entirely sure.

    • Ok, I did some sleuthing:

      (1) According to 2 U.S.C. § 287a: “The management, supervision, and administration of the Office shall be vested in the Parliamentarian, who shall be appointed by the Speaker of the House of Representatives without regard to political affiliation and solely on the basis of fitness to perform the duties of the position. Any person so appointed shall serve at the pleasure of the Speaker.”

      (2) According to a C-SPAN primer, the Senate parliamentarian also is appointed by and serves at the pleasure of the Senate Majority Leader.  It goes on to say: “While the Member of Congress presiding is free to take or ignore the advice of the Parliamentarian, most abide by his guidance. Few Members have the independent body of knowledge regarding the chamber’s procedures necessary to preside on their own.”

      I don’t know what that means as far as precedent of parliamentarian rulings, but it does suggest that a parliamentarian could be replaced.  However, the typical replacement of one parliamentarian is by one of his/her underlings: “The complexity of the job requires years of apprenticeship, and the leaders of both chambers have respected the institutional experience necessary to perform the job well. Sitting Parliamentarians hire their own assistants, and for decades, those assistants have advanced to the position of Parliamentarian when a vacancy has occurred.”

      There is also the issue of how “without regard to political affiliation” would play out in this context, should Reid or Pelosi decide to replace a parliamentarian.  A challenge to the impartiality of any new parliamentarian would certainly be made, and may even be upheld depending on political question justiciability, but in any case would definitely slow down the process.

  • The fact that all these questions have to be asked would be a big clue for any prudent man that something is amiss.
     

  • The answer has to be “Yes/Yes” if there is any legitimacy to the process. Currently, there is no actually existing thing that could be “reconciled.” Under normal circumstances, House and Senate leaders would be in a conference committee trying to merge the competing bills and then presenting the result to their individual chambers for an up/down vote. I do not see how any parliamentarian could agree that a document that has no legally binding status could even be considered ‘reconcilable.’

  • Michael-

    You miss a point here:
    Yes, Yes
    If, instead, the House must both pass the Senate Bill and get it signed by the President before the reconciliation bill can be considered, then health care legislation is likely dead.

    >>>>>> If the House passes the Senate Bill and the President signs it, then healthcare legislation HAS BECOME LAW.

    And it wouldn’t shock me if all this reconciliation talk is just that, and this is the real endgame 

    • I am assuming that his point is that if the Senate bill must be signed into law before the reconciliation process begins, then it will not have enough votes in the House to allow it to get to the President’s desk in the first place.

  • And what happens if nothing passes?  Given the skyrocketing cost of insurance premiums, the way businesses are dumping coverage or dramatically increasing the share the employee pays, and the coming demographic challenge of baby boomers retiring, there is no chance the system as it is can be sustained.   If it collapses, you’ll likely get a single payer system out of emergency default.    My wife is a CPA who works at a local hospital, and recently completed an MBA course on the state of the health care industry.    Things are bad, and the imbalances are getting much worse (I can give all sorts of stats on that).   So if this fails, then what?   Wait for total collapse?

    • FEAR! FEAR! FEAR!!!!!

      - Right Scott? Just exactly the same logic as Global Warming.

      FEAR FEAR FEAR!!!!!

    • By the way, you never gave me 3 Obama foreign policy successes, and you never answered if the science was still settled.

    • That was pathetic even for you, Scott.

      “Here’s a big bowl of mush, eat it before the mush factory closes and there won’t be mush for anyone!”

      Or, “Yes, let’s use a bankrupt Medicare system as a reason to bankrupt the entire health care system, the government, and kill lots of people in the process, because we don’t want it all to collapse.”

      I have to say, you’ve outdone yourself.

      And I like the twist: Instead of you offering a course, your wife has taken one.

    • And what happens if nothing passes? Huh? Huh? It will be disaster, awful disaster! Given the skyrocketing cost of insurance premiums, the way businesses are dumping coverage or dramatically increasing the share the employee pays, and the coming demographic challenge of baby boomers retiring, there is no chance the system as it is can be sustained. Because it’s just impossible for people and businesses to figure out on their own what to do without the guidance of wise leftists! You dense righties, with your touching faith in the free market, are just Nazi-like thugs and completely clueless, though of course I don’t insult you the way you insult me. I’ve explained it to you patiently: markets don’t adjust themselves, there’s no reason to believe they do. {eyes rolling} I decree it. If you disagree, you doth protest too much.

      Therefore we must DO SOMETHING! And I don’t have to do any sort of defense of the bill in Congress now at all or try to figure out if it will make things worse. It increases government power and establishes more control over the proles, therefore it’s guaranteed to be better by the holy writ of post-modernism.

      If the system collapses, you’ll likely get a single payer system out of emergency default. Yep, there’s no chance at all that we might end up with a market-based solution, because that’s impossible by post-modern principles. Besides, my wife is a CPA who works at a local hospital, and recently completed an MBA course on the state of the health care industry. Things are bad, and the imbalances are getting much worse (I can give all sorts of stats on that).

      And that has nothing whatsoever to do with the fact that government already controls half of healthcare, nothing at all! I decree it. It’s totally obvious that we need to increase government control to avert TOTAL DISASTER, and you dense righties are just Nazi-like thugs for denying that necessity and focusing on your silly charts and graphs and “evidence” {eyes rolling} as if any of that matters when PEOPLE ARE HURTING AND DON’T HAVE INSURANCE! I can’t believe even you Nazi-like thugs are that callous, but apparently you are. Unlike we compassionate, wise, moderate, pragmatic leftists who want to tell everyone else exactly how their lives should be run, for their own good.

      So if this fails, then what? Wait for total collapse? And don’t start up with any market based things, or even some other kind of bill that might lower malpractice costs by reining in trial lawyers or selling insurance across state lines or any of that other nonsense. Obama thinks like me, so you could you thick righties ever believe you could come up with anything anywhere close to the brilliance and effectiveness of his solution? Huh? Huh? {chuckle}

      Even Sarah Palin used Canadian healthcare, and the fact that it was before their system was nationalized is completely beside the point and I don’t know why you bring it up. But I have a sneaking suspicion that if someone just dug into it more, we would know where she got those full lips and ample bosom. {chuckle} LOL

    •  If it collapses, you’ll likely get a single payer system out of emergency default.

      You stupid jacka$$. You talk as if we won’t get a single payer system out of the monstrosity that you’re pimping for. That means your either ignorant or dishonest, because Obama himself told Democratic congressmen that was the ultimate goal, and Barney Frank gave that whole game away ages ago.

      Classic leftist thuggish behavior: threaten us with something even worse if we don’t buy in to their plans to give them more control. And from a clueless thug at that, someone so damned stupid he doesn’t even realize he’s allied with thugs.

      I tell you again: you have to come here for some sort of bizarre psychological satisfaction. It’s the only reasonable explanation. Your stuff is too clueless, confused, and consistently deluded to be doing it for any honest intellectual reason. You must talk down to us; you can’t help it. And the only one who doesn’t realize the truth of that is you.

      • Well, Billy, I hope your little rant helped make you feel good about yourself, though it was a bit ironic in that style of post for you to be talking about ‘bizarre psychological satisfaction.’  I just asked a question — what if this fails, then what?   And I noted that the current system is unsustainable.   How that can get you into such a hissy fit is beyond me.   It is telling about you guys, not me, how virulent you respond to those who think differently than you.   You (many of you) must demonize effective opponents because to engage in real conversation would lay bare the fact that there are different sides to these issues, and it’s not like good vs. evil.  But that would upset your narrative, right?
        So I ask again, if this fails, then what?

        • Why aren’t you asking your messiah, Obama, this question?  He conjured up this CRISIS!  He put us on this path.  He cut deals with Big Pharma, AARP, and others of their ilk to get us where we are at this legislative juncture.  He, and his willing Democrat cohorts, put this abomination of a bill together.  Why don’t you ask him where we will be going next.

          Hint – the answer is one more end game.  35 more speeches by your Messiah trying to convince an already decided public to change their minds and take one for “The Gipper.”  (Oh how he would love to be remembered like Reagan!)  One more attempt to rescue his fetid legacy.  One more push to get the bill passed.

          Or . .

          Ultimately you will die - just like the rest of us.  What – you were expecting some sort of heavenly excape?  Some sort of rescue?  You of all people, Erb, ought to know better!  You have predicted the end of America time and time again, so what more do you want – your predictions finally came true.  Feel better now?

          Sheesh!

          • Since I don’t have the ultra high opinion of the President that you think I do, the first part of your response was simply misguided.  I do criticize Obama for being too in bed with lobbyists during this process, that’s a weakness of this bill.
            As for the second part — do you mean to say major societal problems should be ignored because we all die?   I mean, huh?

        •  It is telling about you guys, not me, how virulent you respond to those who think differently than you.   You (many of you) must demonize effective opponents because to engage in real conversation would lay bare the fact that there are different sides to these issues, and it’s not like good vs. evil

          >>> Oh, you mean like the way you act here towards those who are sceptical of global warming?

          FEAR FEAR FEAR!

        • “how virulent you respond to those who think differently than you.”
          ” You (many of you) must demonize effective opponents”

          LOL.

          Effective opponents, eh?
          Thanks. This will keep me chuckling for the entire day.
          And, by the way, we don’t respond ‘virulently’ to everyone who thinks differently. It’s only you, baby, only you.

    • “Current system” – there isn’t a current government system – the Health insurance market & industry is the current system.  You keep acting like it’s really IS the problem of the government, and frankly, it’s not.  It’s not  Constitutional in any way, shape, size or form.  There is no guarantee of health insurance, it is not a RIGHT protected under the Constitution of the United States.
       
      But, yeah, Shark is right, you’re a fear monger.  If you aren’t mongering it, you’re cowering before it.  You are clearly fear motivated.  And your logic for this is identical to your logic for alleged Global Warming.  You have no idea what effect the changes these clowns are advocating (and government is causing a good number of these market problems …) but you’re convinced that nearly ANYTHING they do will be good, and will fix the ‘problem!  And …..(panic Chicken Little running around image inserted here….) WE HAVE TO DOOOOOOOOO SOMETHING!!!!!!
      You probably also believe, in a situation analogous to running out of milk at home , one morning the world oil supply will run out, or that one night you’ll go to sleep with the temperature at a decent 65 F and the next morning you’ll wake up to an oven like 120 F.   Your sense of  real world time lines and how long things take to happen are all compressed like some childish movie version of life where Luke Skywalker meets Obi Wan Kenobi, becomes a Jedi, destroys the Death Star and saves the universe….. in 3 days.
      It’s clear, not even they know what they’ve done yet, for heaven sake they’re still arguing over it! you can’t possibly know what effect it’s going to have!  And with all due respect to your wife, it’s unlikely she can tell either.

      • Well you start with a decent point, but the weird charge of ‘fear mongering’ which you go into a little tirade over is odd — the demographic impact of the boomers retiring has been a theme often on this blog, and the reaction wasn’t quite so much over the top.   But I’ll give you some facts to chew on.
        I never said current government system, you’re right that it’s a mixed system.   Obviously the constitution doesn’t guarantee health care, but the voters and representatives have the power to pass it and make available to all if they want — that’s democracy.    If the Supreme Court rules it unconstitutional, then they’ll have to retry.
        From 1999 to 2008 health care premiums increased 119%, and if you talk to people out there you hear stories of businesses dropping coverage, or charging much more.   In 2003 the average cost for a family of 4 was $8,800, it’s projected to rise to $21,000 by 2020.   Coverage can also be easily lost due to layoffs, divorce, employer bankruptcy and other factors — something people are experiencing.  24% of the population is considered under-insured, while 47 million are estimated uninsured.   62.1% of all bankruptcies in the US are due to meddical debt, it has risen 23 fold since 1981 (and that’s data only through 2001, when costs were much lower).
        The US outspends other countries in healthcare, but the profit motive means that the focus is on cutting costs and not giving the highest quality of care — and insurance companies look for reasons to deny coverage, often technical.
        As I believe McQ once pointed out, the Medicare trust fund for Part A will run out by 2017, and with the boomers retiring, what will that do?   That’s just the tip of the ice berg.  No scholar I’ve seen has said the system is sustainable or functions well — perhaps the over the top reaction to my rather bland post is due to the fact that you know I have a point, this is a crisis, it’s not fear mongering to point out the reality of the situation.   Even the GOP was smart enough at the health summit to agree the system needs to be changed.  I simply asked, “when this fails, then what?”

        • Well you start with a decent point, but the weird charge of ‘fear mongering’ which you go into a little tirade over is odd

          >>> If the shoe fits….

        • What I want to know is why almost no one on the left is screaming ‘unsustainable’ over the rate of tuition increases for the last 50 years?  Tuition is doubling at least as fast as health care premiums (tuition is generally inflating 1.5-2x the rate of the CPI and has been for 50! years) but all I hear are crickets?  Care to speculate Dr. Erb? It has to be a hell of a sweet gig to have your industry subsidized endlessly.  Long after we stop subsidizing farming and every other industry, we’ll still be miss-allocating capital into higher ed via numerous distorting government actions.
          As for this:

          In 2003 the average cost for a family of 4 was $8,800, it’s projected to rise to $21,000 by 2020.

          State and federal government plays a large role here by limiting competition, mandating coverages,  providing tax incentives for insurance premiums, underpaying on medicare, burdening the medical community with more and more regulations, and constricting therapies and drugs which might benefit freely choosing patients.  Couple that with a court system that is not designed to make rational decisions on medical liability, an aging population, our desire to make heroic efforts to save all lives (which is a generally good thing, but costly), and the fact that we are the medical technology and research leaders in the world, the cost of the insurance that most people have (but don’t need yet have no choice) is understandable.
          And almost nothing I’ve read in or about the bills up for consideration does anything about these factors.  In some cases it makes them worse.

          • Excellent point. I wonder how many of Erb’s scholars think the current university system is unsustainable. And don’t forget the cost of textbooks and those ridiculous student fees.

          • Well, in my world that issue is talked about more than health care, especially in tough budgetary times.   But the issue doesn’t have the weight on our economy that health care does (over 16% of GDP), and isn’t life or death.   Also poor students have community colleges, often very lucrative financial aid packages, and so it is a problem, but compared to health care, not as important.

          • Nice glossing over Scott.  Not that I expected you to have an unbiased opinion.

          • “but compared to health care, not as important.”

            Not to you, maybe. To those students and their parents it is more important. And I am not surprised that in your world you talk about it. I am even less surprised that you don’t do anything about it.

        • Another thing:
          At least with the rise in insurance premiums there is generally a corresponding rise in improved outcomes over the last 50 years.  I’m sure it’s no where near a perfect relationship, but people are living longer and surviving serious health issues more frequently.
          For the same dramatic increase in tuition over the last 50 years, what increased benefits are students getting for their money?  Have beneficial outcomes of a college education increased proportionally?  I doubt it. One might make the case that for the majority of students a college education is less rigorous than it was 50 years ago and thus worth less.

          • ” Have beneficial outcomes of a college education increased proportionally…”

            Certainly not in areas such as, oh, let’s say Political Science, just off the top of my head.

          • Life expectancy world wide has increased for a variety of reasons, but we are paying a lot more for outcomes that compared to other industrialized states are subpar.   One study ranks us at 37th, but even if one rejects studies that try to get that specific, in life expectancy, infant mortality, and most basic measures we are in the middle.   We have the best system for those with money, but the uninsured and poor bring down our numbers.  That’s why so many people care about this — peoples lives are in the balance.   And no other country has the problem with medical bankruptcies we do — that’s 62% of our bankruptcies.

          • Scott, your superficial citing of statistics is BS.  You need to dig deeper.
            I find it preposterous that the solution to medical bankruptcies is further centralization of the health care machinery.  Only government and it’s supporters thinks the answer is automatically more government.

          •  ”  One study ranks us at 37th,”

            37th in what? ONE study? Pathetic.

          • I see. The solution to individual bankruptcies is national bankruptcy.

            “that’s 62% of our bankruptcies.”

            You are sure it is not 61%, or 63%? Perhaps you have a cite for this number?….

            Didn’t think so.

        • ” Wait for total collapse?”
           
          Ah, you mean like we do with Social Security, the government run plan?  Or Fannie Mae and Freddie Mac?  The government supported mortgage backers?  Or….Amtrack?  Let the government control it so they can play games with it, drive it further towards collapse with their unqualified fingerpoking, patching and favored constituent pandering and then have them tell us every 10 years or so they must make more changes or there will be disaster? (and having hard wired the disaster into the system from the beginning so we’re dependent on them, yes, it probably will be).
           
          And all because you are (here’s the magic word ) AFRAID that we can’t possibly manage anything without their help.   Afraid enough to turn things over to a clown like Joe Biden, who very recently  thought Franklin Roosevelt was President in 1929, Joe Geithner who was seemingly unaware of the tax laws, Charlie Rangel, also unclear of the laws though he’s in charge of them, and Presidents like George W. Bush, the man who, according to you, plunged us into a disaster greater than Vietnam in Iraq, etc, etc etc.  Get the idea here (administrations change…understand?…and you don’t always agree with them, get it?)
           
          And you can’t decide you’re getting bad service from these guys and go somewhere else – if you didn’t like the idea your tax dollars went to support George Bush’s war Scott, you were still paying them.  Not a thing you could do about it.   But you go ahead and eagerly advocate for ‘the government’ to save you from yet another crisis.
           
          And no, I don’t acknowledge it to be a ‘crisis’.

    • Let me try to make a more cogent and less snarky reply.  What will happen? well, for one thing we can (and will) start over with a more bipartisan approach to reform.
      The main problem with all of this is that the costumers for health care have become separated from the costs, and therefore do not exercise the normal price selection which operates in other types of markets.
       
      We have to couple consumers back to the costs of health care in so9me way. There are many different proposals.
      At any rate, contrary to your view, I am convinced that getting government more involved will result in more problems .  In the 1950′s and 1960′s there was little government involvement in health care, and lower middle class people could afford care, and Doctors made house calls.
      So don’t think it is the end of the world, we will do some sort of mixed reform and come out far ahead of the European Nations who opted for socialized medicine and are now bankrupt because of it.
       

      • I think your points make sense.  I have this on going debate with my wife, who is in the financial side of the health care industry.   She likes the idea of a big pool and a national system that doesn’t allow insurance companies to cherry pick the cheapest to cover and spreads risk, etc.  I rather liked Sen. Scott Brown’s idea of states doing it.  The thing I fear the most about a national system is that the bureaucracy will be far too large, and that will breed different problems.   We’ll solve some, but create others.
        The increase in costs since the 1950s comes mainly from technology and pharmaceuticals.  I think one could make an argument that the value of those developments is limited, especially pharmaceuticals.  If this reform fails, and moderates in the House and Senate work hard to quickly develop a “mixed” approach that gets bipartisan support, that would be fine.  I’m not sure it would be better than passing this, but it would be worse than doing nothing.

        •  I have this on going debate with my wife

          >>>> Some hot pillow talk going on at the Erb house…

          • Eeeuw!
            Please! Bad enough to know it has passsed on its genes without going into details.

        • “The increase in costs since the 1950s comes mainly from technology and pharmaceuticals.”

          Amusing. So the system is broken because of progress. 

          ” I think one could make an argument that the value of those developments is limited, especially pharmaceuticals”

          LOL.
          Right. Limited maybe to those of us who use them.

    • And what happens if nothing passes?
      Sorry to tell you, but it will come out of your pension fund

    • The bill has nothing but features to make Premiums increase.

  • I’d hate to be the parliamentarians.  Maybe they should do their showering at home until this thing is over…

  • The “Bush-Gore” Florida election thing went on for what 2-3 months ?   It created scores of conspiracy theories as to how it was stolen away.
    The Health Care Reform thing has been going for over a year.  I can just imagine all the conspiracy theories of how the Republicans bribed the Senate and House parliamentarians into calling it against [pick your aggrieved party].
    I mean ..  hasn’t anybody spotted Diebold or Exxon or Howard Hughes or Halliburton or Richard Mellon Scaife greasing the skids of the Senate and House parliamentarians ?

  • “People have lost faith in government — they had lost faith in government before I ran (for president), and it has been getting worse,” Obama said at a rally in St. Louis.

    A new way to say he inherited it.

    • We’re 14 months in?  He owns about 75% of it now, in my estimation (I give presidents about 18 months before they’re fully on the hook for having impact on the economy).  This has been one of the slowest to rebound downturns as seen in Lance’s earlier post.  And its because of a complete lack of faith or even concern over Obama’s economic policy and his policies that will indirectly impact the economy.

    • People have lost faith in the government…

      You don’t say!!!

      / sarc

      This is a variation on the lefty meme that the country is “ungovernable”.  What Imeme REALLY means is that Americans aren’t shutting up and enthusiastically doing whatever our elected masters (i.e. him) tell us to do, and that’s a bad thing in his book.  It never occurs to him or other statists to ponder that Americans might actually have good reason not to trust the government: the government has demonstrated time and again that it is inefficient, wasteful, and corrupt.  One way or another, this cuts across party lines.  For Republicans / conservatives, do you REALLY trust the government that has mismanaged Social Security and driven us into a fiscal bottomless pit?  For democrats / liberals / morons (BIRM), do you REALLY trust the government that is heavily influenced by corporate lobbyists, went to war in Iraq over a lie, and caused 9-11?

  • “People have lost faith in the government…”

    Why is that a bad thing?
    Perhaps it is time for people to grow up and realize, as the folks who founded this country did, that government is not a panacea but rather a necessary but dangerous tool. A necessary evil.

  • I don’t know what it says that I now instinctively scroll past Scott’s comment looking for Ott’s comment.

  • And what happens if nothing passes?

    I assume that what you are asking is, what happens if we do not address the health care issue, one way or another?  And the reply is that the system may collapse under its own weight, much as is slowly happening with Medicare and SS here, and with nationalized health care in other countries.  The main problem with health insurance is that we call it “health insurance”, but we do not treat it like insurance.
     
    We assume that if we get people to pay less for a service than it is worth and call it “insurance” that it will work just like any other insurance.  Even putting aside the absurdity of restricting competition and then complaining about insurance costs, that formula does not work in the long term.  The idea that we can cover more people and loosen the eligibility rules and lower costs is simply unrealistic.  The idea that government, which shows itself unable to control costs or reduce waste year after year, can suddenly rebuild an industry in a more efficient and cost-effective manner, goes against all logic.
     
    We will only fix health care if we try to deal with it in a realistic manner.  I do not see anyone proposing to deal with it in a realistic manner.  In the end, we will have to deal with it realistically, but by then it will simply come down to rationing, drastic reductions in quality (and quantity) of service, and a system that crumbles anyway because even at its worst, it continues to drain more money than is available.

  • The problem with insurance is also that because there is such a competition for profits, companies deny people for all sorts of reasons, often unexpectedly.   They seek out ways to deny covered people payment, using any technicality they can find.   That hits people who think they are covered.   Moreover, they don’t want to cover those who are higher risk but can’t afford it.
    To me health care is like police protection or education.   It should be available to everyone without regard to income.   A poor person should be able to get treatment without either going broke, or going to an ER — the most expensive place — where they have to be treated, but they don’t pay their bills, creating real problems in hospitals across the nation.
    Now, that doesn’t mean it has to be single payer or the market should be absent.   Insurance companies should be prevented from denying coverage in the way they do, and there needs to be a mechanism for the poor to get insurance.   The wealthy can always pay more and have better plans — just like they can afford private schools.
    My view is common in most of the industrialized world, even conservatives think that it is inhumane to have obstacles preventing basic care from being provided.   I do think there is a problem with life styles becoming exceedingly unhealthy and this will hurt us in the long run — but first I think we need to find away to stop medical bankruptcies (which would help a lot of families), assure a basic level of coverage for all, and then allow choice on top of that.   We can learn from other countries who do that — many European countries have popular and effective health care systems that are not single payer, and can give us hints as to strengths and weaknesses of different plans.    But given the politics of the situation, I suspect that if this fails, your first paragraph will come to pass, it’ll collapse on its own weight.  That might create an opening for hard core left wing populism.   Doing something now can prevent that.

    • Incessantly blabbering Erb: “To me health care is like police protection or education.   It should be available to everyone without regard to income.   A poor person should be able to get treatment without either going broke, or going to an ER — the most expensive place — where they have to be treated, but they don’t pay their bills, creating real problems in hospitals across the nation.”

      So you would prefer a federal bureaucratic control of health care where treatment is rationed, with waiting lists, determinations about who does and does not get treatment, and the inevitable decline in service and quality. In other words, look backwards to the past because we can’t go back there so we’ll get there soon enough because we have to learn to live with what government can dispense to us so stop crying about getting rationed care when you are totally covered!

      You are the very essence of the citizen of the future: walking backward into sustainable grey quasi-poverty for the good of all.

      You’ve become incoherent, but you talk more than ever.

    •  “They seek out ways to deny covered people payment, using any technicality they can find.”

      Oh puhleese!
      That’s it? You can’t even pull some phony statistic out of your a**? Not even one unnamed anonymous study? With such rigorous and logical analysis it is easy to see how you wound up at a top flight university rather than some jumped up community college.

      “To me health care is like police protection or education.”

      Some of us keep trying to make the point that health INSURANCE is not the same as health CARE. Evidently such subtlety is beyond your razor shap intellect.

      “they don’t want to cover those who are higher risk but can’t afford it.”

      Correct. Insurance companies are not welfare agencies. Perhaps instead of teaching online classes you should consider taking a class or two in basic accounting or business. Perhaps even have your wife explain to you just what insurance is and how companies stay in business. 

      “and there needs to be a mechanism for the poor to get insurance.”

      Jeeminy Giblets! Have you ever heard of a thing called ‘Medicaid’? Sometimes your ignorance is truly stunning.

  • Let’s say that the world has many different healthcare systems, and that, as Erb says, life expectancy is rising everywhere. Some systems are single payer. Some are mixed. Some are almost all private. The question to me would not be “why does the USA pay so much while France pays so little for the same results?” but “what is driving life expectancy to climb worldwide despite the differences in healthcare systems?”
    If its just money spent, then why isn’t the USA soaring in life expectancy while France and the UK fall? China also spends little per head,mostly private system yet also has rising expectancy, etc.
    Maybe the rise is life expectancy has little to do with the formal system you have in your country, but more to do with basic sanitation, wealth to pay for basic meds like antibiotics, etc. Well, I doubt those are low-hanging fruit for the US or Europe to reap anymore. So more improvement must come form more advanced medical research and technology. These innovations are now sold in a world market – and as long as the innovators can make money they will continue to do so.
    OK. Let’s say the innovators can’t make much money in France as they will be hit on price and forced to sell close to cost. The innovator doesn’t like that but knows they can charge more in the USA and still make moolah. So that is what they do. And thus our costs go up and up as theirs stay stable. I think the USA should require “global pricing” for healthcare suppliers – this would make the firms price to every market the same, and they would raise their prices to Europe and lower ours. (This is just a theory, don’t know how important it is…)
    I also wonder how much salary affects our costs vs. France.

    • Well, there’s a good way to get better care at the best price for the service: Get the government as far back out of the medical industry as possible. It has its snoot buried in it right now, and that sort of extraction is diffficult, but not unknown.

      Force the medical industry to compete: Don’t regulate its competition, don’t force people to buy insurance within their own state, have a damn free trade zone in the U.S. at least for medical insurance. Let as many possible forms of medical insurance products be offered at as many different price levels at as many different levels of coverage as possible.

      That will increase the number of insured, decrease the number of uninsured, and allow clearer price signals all around.

      Don’t not force insurers to take anyone; do not force them to cover pre-existing conditions. Rather, remove things that they are required to do and allow insurers to offer products to high-risk customers. Do not subsidize anything. Do not subsidize doctors.

      Then, allow non-doctors, i.e., physicians assistants, nurse practitioners, to offer basic medical services — blood tests, examinations, basic prescriptions, etc. That level of medicine is not rocket science. You do not need ten years of expensive education and interning to write a prescription for an antibiotic to treat an infection.

      About Medicare, start to get people out of it. Let it go out of existence. Let people start to buy private retirement insurance at a young age. Or, better, let them pay into their own retirement insurance bank account, which they can later pledge to a particular insurer. Let insurers compete for that business.

      Do not do things that stifle innovation. MRIs will become more efficient and less expensive, or should. Give patients more say over their treatment. And don’t ever put anyone in a position where the government will ration their care.

      Continue to treat people who walk into ERs, but have insurance products there that they can at least learn about.

      Medicaid is a ridiculous problem and I can’t imagine anyone wanting to have to get coverage that way, but if the insurance market is freed up it can develop products for that income range, or at least some of the higher levels in that range.

      Also, try to make insurance purchases something left to the individual.

      But above all: Market forces. Without them, the medical industry will not become more affordable and the government will wind up getting more and more involved and turning it into a sh&thole of astonishing depravity.

    • Life expectancy and all measures certainly do have many variables, not just the health care system.  I think the problem is that in the US the relatively wealthy have access to excellent care, while those not well off are often denied care (unless they use the expensive ER, which adds to the cost of the system) or driven to bankruptcy if they get it.   Also, insurance companies do refuse to cover many things, surprising those with insurance.   All I want is to find a way to decrease costs, assure a basic minimum coverage, and drastically cut or eliminate bankruptcies caused by medical costs.     Other countries have done that.   Salaries do affect costs (doctors earn less in Germany, though prefer the German system to ours).   But some things are just bizarre.   For instance, those who can’t afford insurance and have to go in to get care have to pay much higher costs than insurance companies cover.   So those who afford it the least pay the most.
      As noted, I think the current system is utterly unsustainable.    Salaries may be too high, insurance overhead is quite high (not just the profits), pay back on technology and drug research is increasingly being called into question.   People talk about rationing health care.  It’s always rationed.  When the market rations it, the wealthy get the best, and the poor might not get any.   I don’t want the government to try to ration it equally to everyone, just to make sure everyone has access to a certain level of quality without risking bankruptcy.   The wealthy will always get the best care, I’m not arguing that this should be changed and everything leveled.

      • Erb: “As noted, I think the current system is utterly unsustainable.”

        There is no “system.” There’s a medical industry that consists of thousands of firms. Given more, not less, market freedom and made to compete instead of hiding in state by state fiefdoms, prices points will be established naturally. Get the government as far back out of it as possible, and the industry will sustain itself.

        • Yup – the system that is unsustainable is the government “system”. Ask the Medicare/Medicaid actuaries. The private system is fine, except where it ends up subsidizing the unsustainable government “system. As the government cuts payments to providers, the slack is picked up even more by the private side and premiums go up. As you suggest, back the government out of all of this and the private side will do quite well, thankyouverymuch. But the unsustainability every politician rants about has nothing to do with private care – and this bill does nothing to address the real problem of health care – government.

  • Someday, when cretins like Erb can stop scapegoating insurance companies or people who disagree with them and face reality, we may be able to make some progress .

    “…
    Birds fly  over the rainbow
    Why then oh why can’t I…?

  • Cite for the 62.1% of bankruptcies are for medical reasons: Tamkins, T. (2009).  “Medical Bills prompt more than 60 Percent of US Bankruptcies,” http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/
    I can tell, timactual, by your surprise that the number could be true that you didn’t realize how big of a problem this is.

    • O.K., Scott, so over six years, roughly .4 percent of the U.S. population filed for bankruptcy over their medical bills.

      That’s certainly a good reason to give the federal government full bureaucratic authority over the medical industry in the United States. Who could deny it?