Bipartisanship on Health Care Makes No Sense
Whenever I hear someone call for a "bipartisan solution" to the health care crisis in America, I just want to pull my hair out. It makes absolutely no sense whatsoever. It's like calling for a bipartisan solution to the next presidential election.
Health care policy is a definitional issue in American politics. For as long as I can remember, the Democratic party has fought to increase the government's role in providing health care coverage for Americans while the Republican party has fought to reduce the government's role. The Democrats are responsible for Medicare, Medicaid, and S-CHIP; the Republicans fought all of those initiatives. On a policy level, the Democrats believe that the best health and cost outcomes can be achieved by increasing access and encouraging widespread use of routine and preventative medical care. Republicans, on the other hand, have routinely identified the problem as over-consumption of care. Their proposals to fix the system inevitably involve significant deregulation with the goal of encouraging the use of high-deductible policies to try to discourage personal consumption of health care. Nearly every Democrat (including the blue dogs and "centrists") believes this to be bad policy.
In other words, there is virtually no common ground between the parties. The parties don't even see eye-to-eye regarding basic goals and policy assumptions. So why on earth would anyone believe that there is a bipartisan solution to health care? If one side believes the answer is behind door #1 and the other believes it is behind door #2, the correct answer is never to walk into the wall between the doors. Yet any conceivable "bipartisan solution" to health care would amount to exactly that.
Furthermore, as a simple political matter, it makes no sense to seek Republican support. First, it's a quixotic quest. Putting aside the fact that the Republicans are determined to uniformly oppose any significant Obama initiative, on this particular issue, there are actual principles and core beliefs underlying that opposition. Yes, there is a lot of standard Republican propaganda and demagoguery as well, but beneath all that disinformation is an actual philosophical disagreement. I happen to think that Republicans are dead wrong about health care, but I don't question that their beliefs are genuinely-held.
At the end of the day, no matter how willing the Democrats are to water down their proposal, they are unlikely to get any Republican support. And even if they were able to woo a few Republicans, it would not provide any meaningful political cover. The Democrats would still own the final bill.
Which is fine, because there is virtually no political downside here. The Democratic party is already identified with the issue of health care. It's one of its chief strengths. Despite their reluctance to support anything progressive, the reason red state Democrats like Ben Nelson get elected at all is because of issues like health care, where most people side with the Democrats. And it's not like what's on the table now is particularly radical. We're talking about providing people with a choice, giving them a public health insurance option if they want it. Not only is that idea already wildly popular, but it has virtually no political downside. Republicans and the insurance industry will do their best to demonize such a policy, but at the end of the day, no one is going to be upset that they are being presented with more options, and many people will be immensely thankful for it. Once the dust clears and the bill is passed, there is almost no political risk.
So the goal here should not be bipartisanship. The goal should be come up with the policy that is most likely to be effective and then browbeat every last Democrat in the Senate until they're on board. I don't say that about every issue, but on this one, there is no other sensible option.
Health care policy is a definitional issue in American politics. For as long as I can remember, the Democratic party has fought to increase the government's role in providing health care coverage for Americans while the Republican party has fought to reduce the government's role. The Democrats are responsible for Medicare, Medicaid, and S-CHIP; the Republicans fought all of those initiatives. On a policy level, the Democrats believe that the best health and cost outcomes can be achieved by increasing access and encouraging widespread use of routine and preventative medical care. Republicans, on the other hand, have routinely identified the problem as over-consumption of care. Their proposals to fix the system inevitably involve significant deregulation with the goal of encouraging the use of high-deductible policies to try to discourage personal consumption of health care. Nearly every Democrat (including the blue dogs and "centrists") believes this to be bad policy.
In other words, there is virtually no common ground between the parties. The parties don't even see eye-to-eye regarding basic goals and policy assumptions. So why on earth would anyone believe that there is a bipartisan solution to health care? If one side believes the answer is behind door #1 and the other believes it is behind door #2, the correct answer is never to walk into the wall between the doors. Yet any conceivable "bipartisan solution" to health care would amount to exactly that.
Furthermore, as a simple political matter, it makes no sense to seek Republican support. First, it's a quixotic quest. Putting aside the fact that the Republicans are determined to uniformly oppose any significant Obama initiative, on this particular issue, there are actual principles and core beliefs underlying that opposition. Yes, there is a lot of standard Republican propaganda and demagoguery as well, but beneath all that disinformation is an actual philosophical disagreement. I happen to think that Republicans are dead wrong about health care, but I don't question that their beliefs are genuinely-held.
At the end of the day, no matter how willing the Democrats are to water down their proposal, they are unlikely to get any Republican support. And even if they were able to woo a few Republicans, it would not provide any meaningful political cover. The Democrats would still own the final bill.
Which is fine, because there is virtually no political downside here. The Democratic party is already identified with the issue of health care. It's one of its chief strengths. Despite their reluctance to support anything progressive, the reason red state Democrats like Ben Nelson get elected at all is because of issues like health care, where most people side with the Democrats. And it's not like what's on the table now is particularly radical. We're talking about providing people with a choice, giving them a public health insurance option if they want it. Not only is that idea already wildly popular, but it has virtually no political downside. Republicans and the insurance industry will do their best to demonize such a policy, but at the end of the day, no one is going to be upset that they are being presented with more options, and many people will be immensely thankful for it. Once the dust clears and the bill is passed, there is almost no political risk.
So the goal here should not be bipartisanship. The goal should be come up with the policy that is most likely to be effective and then browbeat every last Democrat in the Senate until they're on board. I don't say that about every issue, but on this one, there is no other sensible option.
posted by A.L. at 10:30 PM
45 Comments:
E.J. Dionne just wrote a column expressing a similar frustration.
The whole "bipatrisan" gambit is all about avoiding blowback in the next election. Democrats, who are still running scared of business interests but desparately need their campaign donations, don't want to loose in the next election because they "imposed" reform. They are doing this in a cynical version of CYA.
Oh, stop. The free market will adjust to and fix the horrible state of healthcare in this country. You just have to give it time. Like, another couple of centuries. Or something.
Conservatives always want change... just not now.
Nothing works better than the Free Market. Nothing. "Freeeeeeeedom!" (spoken in your best Braveheart voice.)
I'm now taking 'bipartisan' as a code word for 'pro-business'.
The Dems don't need bipartisanship on healthcare or cap-and-trade; they just need to get their own house in order.
Obama should threaten to withhold the Obama For America voter file from any Dem who doesn't have a very good reason for voting against whatever bill makes it out of committee on both fronts (say, someone in Kaiser's home district, or someone whose district is on top of a coal mine). Make a threat like that, with teeth, and he'll get Congress in line.
I realize this will burn bridges, but frankly health reform and cap and trade are probably the two hardest hills to climb (in terms of getting a *good* bill and not just any bill) that Obama will face in his first term.
A.L.,
Are you going to switch to the public plan if it passes and becomes available?
Are you going to switch to the public plan if it passes and becomes available?
Since I get my health insurance through my employer for free, probably not. But if I left my current job and became self-employed, I certainly would. And if my employer offered it as an option, I would certainly consider it. I'd compare it to my the private options and see which provides the most coverage at the least cost to me.
And that's kind of the point isn't it? If the public option sucks, the private insurance companies have nothing to worry about. No one will choose it.
Moreover, the notion that "government insurance" will necessarily be an inferior product to private insurance is kind of silly. The private sector almost surely produces better consumer goods than the government ever could, but insurance is insurance. It's just a promise to pay a bill. What do I care who is paying that bill as long as it gets paid? Indeed, I'd trust the government not to screw me over much more than I would a private insurer. The government isn't going to rescind my coverage once I actually need it because they discovered some minor defect in my application. Private insurers do that all the time.
I'm self-employed, and I'll seriously consider a public option, if they have a cost-effective option that provides what I need (catastrophic coverage).
My current insurance (high-deductible) has nearly doubled in the five years I've had it, although I've never had a serious illness and am a non-smoker, minimal alcohol imbiber in perfect health.
Right now I'm paying 10 percent of my before-tax income for just my health insurance.
A.L.:
Since I get my health insurance through my employer for free, probably not. But if I left my current job and became self-employed, I certainly would. And if my employer offered it as an option, I would certainly consider it. I'd compare it to my the private options and see which provides the most coverage at the least cost to me.
And that's kind of the point isn't it?
No, it isn't. Your employer provides the insurance; therefore they pay for your insurance. With the public option, not only do they pay for your health insurance, they get the "benefit" of paying an extra tax for the public option, and you'll get to pay some of it too. It stands to reason that since the companies we work for wouldn't have an option to pay the new tax, and they will want to control costs, they will probably dump their health plan benefits which will force employees to sign up for another option. Since individual plans have huge costs associated with them, it also stands to reason that people will pick the public option. So instead of creating a competitor, the government creates a monopoly, closing hundreds and hundreds of health insurance companies, and putting thousands of people out of work.
The government isn't going to rescind my coverage once I actually need it because they discovered some minor defect in my application.
That's true. But based on what I've seen, you'll be covered as long as you don't get sick and need treatment.
The problem isn't that the government doesn't have enough involvement in health insurance; it's that they have too much already at the federal and state levels. Government allows insurance companies to negotiate rates with doctors and hospitals, but we as individuals don't. For the vast majority of things people go to the doctor for, those items should be paid out of pocket, but not at a rate that puts the individual at a disadvantage. Reforming that is health care reform, not putting health care in the hands of useless government bureaucrats and elected officials.
As a foreigner, the number one thing that amazes me and most other non-Americans is the state of your healthcare system.
With the possible exception of education, healthcare is the MOST IMPORTANT SERVICE a government can offer. I don't care about the trains running on time or being able to launch space shuttles if it means people have to go without health coverage. Slice a few percentage points off that bloated defence budget and stick them in the medical system.
Grubstreethack--- But you're not putting this in perspective. Remember, we have to think of those poor, helpless, noble, beloved insurance companies...
grubstreethack:
As a foreigner, the number one thing that amazes me and most other non-Americans is the state of your healthcare system.
With the possible exception of education, healthcare is the MOST IMPORTANT SERVICE a government can offer....Slice a few percentage points off that bloated defence budget and stick them in the medical system.
I'll bet the "bloated" U.S. defense budget protects you and your country's butt, just so your country doesn't have to have a "bloated" defense budget.
I got an idea; in any country where the U.S. military is serving as the de facto defense force for a foreign power, the people of that country should pay a tax into Medicare and Medicaid.
Oh please. We're long overdue for decent health care coverage for everybody.
Republicans want to have it both ways. They crow to the moon about how great America is & how it leads the world and so forth and so on. Well. Exactly how does it lead the world these days? Military spending, certainly. (And by any rational measure, our military spending is indeed bloated. Halliburton, anyone? No-bid contracts? Outrageous over-charging? No Republican-leaning company would ever behave in such a way.)
In what other ways do we "lead the world"? Our health-care is ranked 37th by the WHO. Hmmm. And, you know, some 40-million plus Americans have no coverage whatever. Are they all lazy bums who simply can't be bothered to rustle up a decent standard of living? My yes, that makes a lot of sense.
Republicans -- and many modern Dems (who are Dem-lite at best, worse luck) -- fail to understand that in order to lead, you have to move forward. Republicans have no interest whatever in doing so.
Our health-care is ranked 37th by the WHO. Hmmm.
Just because I see this argument trotted out so often:
http://www.denverpost.com/opinion/ci_12667987
You are absolutely correct about the pointlessness of seeking a bipartisan solution. Health care reform needs to be rammed through in the most progressive form possible. Republicans have held the country back long enough.
I'll bet the "bloated" U.S. defense budget protects you and your country's butt, just so your country doesn't have to have a "bloated" defense budget.
Then why aren't conservatives going ape-sh*t over the defense budget? Big (American) government for the Swiss, Spanish and Austrians, but not for Americans?
I'll tell ya why. Conservatives live vicariously through the military - similar to the nerdy sports fan who doesn't have an athletic bone in his body but talks smack when his team is better than the other guy's team. As if his team being better makes him better than the other guy.
Colin, I read your article. Best line, of course, was this:
The American health care system is in need of reform. It's inefficient,
its costs are rising at unsustainable rates and it leaves too many people
uninsured. But for all of that, most Americans do get something for the fortune
they pour into healthcare — pretty good treatment, at least compared to the rest
of the world.
Shorter Colin Article: "Sure, our U.S. system sucks and will get even worse. But ignore that and instead be thankful we have good doctors here."
And Michael bravely knocks down a strawman.
This is a false dichotomy. You only seem to see a division between radical socialists and libertarians while democrats and rebublicans are mostly in between.
Example#1:Bush's huge medicare prescription drug benifit.
Example #2: Republicans did support SCHIP, just at a 50% lower increase in the level than democrats wanted in the last bill Bush vetoed.
They also support many other programs, just not at the 100% Ministry of Medicine level most door #1'ers would like.
I say this as a radical door #2 libertarian, not a republican.
Colin apparently doesn't even understand what a strawman argument is.
The general principle exploited by those like Carrol (of the Denver Post) is that, in any sufficiently complex situation, it is possible to produce any desired conclusion by the selective inclusion or exclusion of data.
Or, in simpler terms, if you squint just right, you can see what you want to see.
Hey, who are you going to believe? The WHO, who openly described their metrics and the statistics they used, or a guy with an axe to grind, who uses anecdotal evidence and cherry-picked data to reach the conclusion he likes?
C2H50H, I don't see how you get that at all. The main point in Carroll's article is not a number crunching disparity but that the "WHO based its list on five factors, three of which involve political value judgments."
Do you dispute this?
Dave,
What factors associated with a nation by nation comparison of health care would not have political judgments associated with them?
You could use infant mortality (in which the USA performs very poorly) and overall life expectancy (in which the USA performs not all that well), I suppose -- but that would hardly reach the conclusion Carrol wishes, and so he waves his hands.
Even the per capita cost of health care (in which the USA performs terribly) could be considered tainted with political issues.
So, no, I don't dispute the statement that three of the factors involve political judgments. I do wonder why it's only three of five -- but I don't see that it really matters. Any attempt to correct for political bias will, inevitably, be politically biased.
Carroll was more specific than that. Quoting again the article:
"For example, one of the criteria is "financial fairness," related to the percentage of household income spent on health. The use of this measurement, Whitman notes, "necessarily makes countries that rely on market incentives look inferior."
Clearly including this as a ranking measure would make two countries, whose health outcomes are identical, rank differently if the govenment picks up a higher percentage of the tab.
This alone makes the WHO comparison useless as a meaningful measure.
Unless of course this is not true and Carrol is just making it up. Is this your contention?
Dave,
I see. On the basis of one measure, and without regard to what percentage of the overall score that measure represents, you assert the whole comparison is useless.
For myself, I don't think that the whole comparison is useless. I doubt that the study is unbiased -- that would, as I said earlier, be beyond the bounds of reason -- but I wouldn't dismiss it totally.
The truth is probably that the USA doesn't rank below Columbia or Costa Rica, and probably compares with Chile, although, having been to Chile, I wouldn't go so far as to assert that outright without more analysis.
It's possible that the USA might even be up there with Morocco. Reason for pride, there.
C2H50H,
Yes it is useless unless you are going to give a reasonable rational on how to weigh X number of cancer deaths to Y number units of "financial fairness".
These are incomparable quantities, apples and oranges.
Perhaps the ranking within each of the five categories would be meaningful, but subjectively mixing them together makes a poor and unconvincing case for anyone not sharing your own political prejudices.
.
Dave,
Since monetary policy is wildly different, country to country, there can be no metric for the effectiveness of health care which would pass your criterion.
It's as simple as that.
The WHO report breaks all the statistics and measures down and you can find out how much what counts, so your contention that the report is worthless is based on ignorance.
Just take out all the stuff that involves money and you'll be safely non-political. It'll be worthless, of course, but non-political.
C2H50H,
I didn't say the report was worthless, only the comparison that placed the U.S, as 37th in the world.
The variance in monetary policy between countries is just further evidence that the ranking has far more to do with political ideology than real health outcomes.
And I suspect you would be making the same criticism if it had ranked the U.S. as #1 if part of that ranking calculation had to do with a bonus for a less percentage of government payments (as I would prefer).
Dave,
Either you didn't understand that we were speaking of the ranking or you are feigning not to understand. Either way, it's unimpressive.
I see that you don't object to politically subjective metrics, just ones you don't agree with. How objective.
Your suspicions of what I would do in some hypothetical situation are worthless unless you have actual evidence to back them up.
Actually Steve, I'm from Australia, which is perfectly capable of defending itself and faces no external threats anyway. I'm sorry if that doesn't fit into your pre-conceived notion of the US being the burly protector of all the world's people.
I understood rather clearly when you said in your previous post “your contention that the report is worthless is based on ignorance.” If you meant differently I suggest the problem is yours, not mine.
I have been consistently critical of only the ranking. The statistics and data that make up the report may be perfectly fine. It is the apples and oranges subjective mixing into an overall ranking that is worthless.
“I see that you don't object to politically subjective metrics, just ones you don't agree with. How objective.”
I see you do object to providing examples, perhaps because you don’t have any?
“Your suspicions of what I would do in some hypothetical situation are worthless unless you have actual evidence to back them up.”
Fine, then I concede the point and that you in fact would have no problem with a report that ranked the U.S. as #1 with part of that ranking calculation having to do with a bonus for a less percentage of government payments (as I still would prefer).
I would think such a ranking would be as disingenuous and the 37th ranking of the WHO study so perhaps we will just have to agree to disagree of standards of evidence.
C2H50H,
Apparently you do not know what a strawman is. A strawman is a deliberate misrepresentation of an opposing argument.
Here's the strawman:
"Sure, our U.S. system sucks and will get even worse. But ignore that and instead be thankful we have good doctors here."
No one is saying that.
Colin,
To quote from conclusion of the article in question: "The American health care system is in need of reform. It's inefficient, its costs are rising at unsustainable rates and it leaves too many people uninsured. But for all of that, most Americans do get something for the fortune they pour into health care — pretty good treatment, at least compared to the rest of the world. "
Michael's paraphrase is perfectly acceptable, and your claim of a strawman is ridiculous.
Dave,
How did this discussion turn into something where I was expected to provide examples? Of what?
But, if you wish, I'm happy to agree to disagree with you. Well, at least I'm happy to disagree with what I regard as nitpicking and sophist contentions.
From the BBC, "Many UK cancer deaths 'premature'":
Up to 15,000 people aged over 75 may be dying unnecessarily from cancer each year in the UK, according to research.
[snip]
Possible reasons include the UK being more susceptible to certain cancers related to the way we live, but many experts think it unlikely given the similarities in Western lifestyle and diet.
The other possibilities include later diagnosis, and poorer treatment once that diagnosis has been reached.
"The circumstantial evidence does suggest later diagnosis," said Dr Moran. "But there are many stages where these delays may occur - the patient, the GP or the hospital."
This is what health care in the U.S. will become under the public option. In fact, it will probably be worse.
SteveAR：
To stereotype; English older people are pretty curmudgeonly about visiting the doctor and less able to get about. They probably don't want to create a "fuss" until it's too late. Americans are much more activist consumers who insist on their service. The British culture is not to complain at all, to their detriment.
Daro,
I believe the article already stated that. Apparently, it isn't the only reason however.
SteveAR,
According to the article, it may not be the only reason. Then, again, it may be the major reason.
Anyway, it's useless in the present debate unless there's comparable information about other countries, especially the USA.
C2H50H:
Anyway, it's useless in the present debate unless there's comparable information about other countries, especially the USA.
Here you go:
He calculated that if the UK was performing as well as Western Europe in the age group 75-84, and as well as the US in the 85 and over age group, there would be 15,000 fewer cancer deaths among the elderly every year.
C2H50H:
According to the article, it may not be the only reason. Then, again, it may be the major reason.
This is addressed as well:
"The point is we don't know why this is happening," said Dr [Tony] Moran [lead researcher from the North West Cancer Intelligence Service]. "Elderly cancer survival is an area which has been grossly neglected. It is crying out for research."
I can believe that one of the reasons why this has been neglected is because the government doesn't want to pay for it.
SteveAR,
That you "can believe" something is hardly evidence. In light of my experience, I'd say it calls for suspicion that the opposite is true.
C2H50H:
That you "can believe" something is hardly evidence.
Duh. It wasn't supposed to be evidence. But by observation and deduction, I can believe the government will screw up a public health care option like they've screwed up countless other domestic programs over the last 40 years.
In light of my experience, I'd say it calls for suspicion that the opposite is true.
What experience is that, getting handouts from the government for doing nothing?
C2H50H,
You can't be serious. The section you quoted says that the system needs reform.
Michael's paraphrase says "But ignore that" when clearly the author says we shouldn't ignore the problems and even calls for reform.
Strawman.
SteveAR,
Ah, but it was evidence -- of your out-of-control paranoia.
Colin,
Dishonest argumentative methodology number 3: impose pedantic requirements on all arguments other than your own.
I'm "pedantic" for calling a strawman a strawman.
My bad.
Steve, call me guilty for not clicking on your link and reading the whole thing, but please humor me with a couple questions. 1) Since it seems to refer to people over 75 in the UK, does it mention how many covered under the US Government healthcare system, you know, the one called Medicare, die prematurely from cancer? That might be a better gauge as to what our system might look like. And 2)Does the article mention how many people don't die each year because they have government funded healthcare as opposed to no healthcare?
Frankie:
Steve, call me guilty for not clicking on your link and reading the whole thing, but please humor me with a couple questions.
It's a BBC, the British Broadcasting Corporation, article discussing health care in Britain, and compares a small aspect of U.S. health care (along with that of Germany) as it relates to the subject in question, and doesn't go into a dissertation on all the differences between the U.S. and UK health systems. It isn't all that long. I would suggest you read the whole thing.
Thanks for the advice - i went and read the whole thing. Not sure the totality of the piece does much to buttress the argument that a public option would be bad as it doesn't seem to really make any such attempt. All it does is throw around a few stats that compares one small subset of each respective society, with respect to solely one ailment. And then attempts to hypothesize as to the cause. Pretty much a non starter.
Post a Comment
Links to this post:
Create a Link
<< Home