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May 30, 2007

A Lack of Audacity

My full-sized wrap-up of the Obama health care plan, and how it's an almost perfect representation of Obama himself, is over at TAP. A taste:

His is a plan of almosts. It is almost universal, without quite having the mechanisms to ensure nationwide coverage. It almost offers a public insurance option capable of serving as the seed of single-payer, but it is unclear who can enroll in it, and talks with his advisors suggest little enthusiasm or expectation that it will serve as a shining alternative to private insurance. It almost takes on the insurance industry, but asks for, rather than compels, their participation.

Read the rest.

May 30, 2007 | Permalink

Comments

"My full-sized wrap-up of the Obama health care plan, and how it's an almost perfect representation of Obama himself"

Indeed.

Posted by: Petey | May 30, 2007 12:07:44 PM

Read the rest.

I would very much like to, but I get a signin prompt and then a message:

Page Not Found!

The American Prospect has redesigned its website and is experiencing difficulties in redirecting urls from articles on the old site to the new one. For now, please consult our archives or run a search for the title to find the article. We apologize for the inconvenience.

I get the same message when clicking on the title of the article on the TAP home page.

If this is a "wrong password" message, its a fairly obscure one.

Posted by: BruceMcF | May 30, 2007 12:12:21 PM

^^ I got the same problem.

Posted by: Korha | May 30, 2007 12:28:06 PM

ditto, site seems to be malfunctioning.

Posted by: cms | May 30, 2007 12:43:31 PM

I got the article, but I'm registered (no payment). You may have to register to see the article.

Posted by: JimPortlandOR | May 30, 2007 1:51:39 PM

The article's working for me. Can some more folks give this a shot and tell me the results?

Posted by: Ezra | May 30, 2007 1:56:56 PM

I came late to the last thread on Obama's plan, so I am going to repost my comment from there:
What I think people are skipping over is there can be benefits to have private policies, but efficiency is not going to be one of them. I remember reading an article about the differences in medical systems between the US and the other industrialized nations and one point brought up was that in the Netherlands, the standard is four patients to a hospital room. The article quoted someone saying that middle class Americans complain loudly about even sharing a room. So, I could see having a public health care policy that provides good health care, but in a bare bones, cost effective way - 4 patients to a room, waiting lists for many procedures, mail order prescriptions for maintenance meds, etc. Then private health care policies would provide more user friendly services at a premium price. Companies would probably be willing to pay more than the public policy as a recruiting tool.

To me, that's the only way having public and private medical insurance in competition will work. If the government provides the same coverage as a private insurer, it will be at a lower price because the private company has to make a profit and the government doesn't. Private companies know this and will fight any plan with a public medical insurance component tooth and nail.

Posted by: Dennis_D | May 30, 2007 1:59:32 PM

Ezra: But as he told Morgan Miller back in March, there is time yet. And he is so very close.

Ah, the reassuring words of an optimist (heheh). This isn't horseshoes.

IMO, the chance of Obama making the 'almosts' into real hard plans is very very low. More likely, he will take even further right when the blowback begins.

It is the old story of Dems starting with a proposal that they think middle-right Repubs might accept, finding out no one speaks for them, and being rolled by the 'no-never' elements of both parties - but mostly those who like things as they are. Profitable.

He blew his chance at a plan that the nation needs, and marked clearly his position that there's less there there than his rhetoric suggests.

Posted by: JimPortlandOR | May 30, 2007 2:01:27 PM

Well, put me down for 'page not found'.

Whatever Obama may have said one day, his support for 'coal liquefaction' the next pretty much negates.

I imagine that to eat at the rich person's table, you must display appropriate table manners.

Posted by: serial catowner | May 30, 2007 2:17:31 PM

If the government provides the same coverage as a private insurer, it will be at a lower price because the private company has to make a profit and the government doesn't.

Right. And if the government provided cars and computers and houses, it'd put private companies out of business in those sectors too. Because it wouldn't have to make a profit or "waste" all that money private companies spend on advertising and promotion. We'd get better products and services at lower prices, if only the government controlled it all. Just like it was in the consumer paradise of the Soviet Union or North Korea.

Posted by: JasonR | May 30, 2007 2:34:15 PM

Or like it is in France, Germany, Japan, Sweden, Denmark...

Posted by: Ezra | May 30, 2007 3:00:44 PM

The government doesn't control it all in any of those countries, either for health care funding or for any other major sector of the economy. And the public health insurance fund in France, which you seem to especially admire, is in a chronic state of deficit.

Posted by: JasonR | May 30, 2007 3:43:57 PM

I got the "page not found" thing for a while, but then I remembered to check the "subscriber" box, and it put me through.

As far as the article itself, I certainly agree with it. The question for Obama is whether this sense that he lacks substance will move outside the realm of politically obsessed bloggers or not.

And if the government provided cars and computers and houses, it'd put private companies out of business in those sectors too. Because it wouldn't have to make a profit or "waste" all that money private companies spend on advertising and promotion. We'd get better products and services at lower prices, if only the government controlled it all. Just like it was in the consumer paradise of the Soviet Union or North Korea.

In the Soviet Union, resources were hoarded by the politically powerful instead of being redistributed to the population. The same thing is currently happening in North Korea. I'm not arguing for the validity of communism. However, the systems you mention only have a rhetorical relationship with communism or socialism.

The countries that Ezra mentions, however, actually have set up a truly socialized healthcare system. It is limited in scope, so there isn't really a worry that Finland's government is going to put Nokia out of business, for example.

The problem we have is that we have guaranteed a minimum level of care for every person in this country. What we obviously haven't done is set up a way to pay for it all. So we're already headed down the path of socialized healthcare, indeed the biggest and most important step. If people want to argue against socialized healthcare, then instead of trying to defend the status quo, they should try to do away with all obligatory treatment - Bush, of course, has made efforts in this area.

And that's what makes this industry fundamentally different than all others. No carmaker is required to give cars away to those who cannot pay. Computers are likewise not considered a fundamental right. But to be provided a minimum level of care in an emergency room generally is considered a right, with most urban areas at least in possession of a hospital that will provide many more services to those who cannot pay.

Posted by: Stephen | May 30, 2007 3:45:42 PM

> Right. And if the government provided cars and
> computers and houses, it'd put private companies
> out of business in those sectors too. Because it
> wouldn't have to make a profit or "waste" all that
> money private companies spend on advertising and
> promotion.

People can live without cars and computers, and they can control their expenditures on housing both in size and timing. They can also take their time in purchasing cars and computers and bring to bear information and bargaining. As I say to my kids, effort and shoeleather can substitute for money.

People cannot live without health care - literally. They have very little control over the timing ("oops - broke my leg. Have to wait until next month to get it looked at"). And they have essentially zero ability to obtain or make use of information, and exactly zero ability to bargain over prices.

Back in business school days we had a whole semester class on how economic structure affects markets and the characteristics of the firms that serve them. You have conflated two realms with utterly different economic structures and assumed that they can have the same market. Pretty naive.

Cranky

Posted by: Cranky Observer | May 30, 2007 4:41:50 PM

I am a paid subscriber AND a registered user. And I can't get the article.

Posted by: Danfreedmn | May 30, 2007 4:57:34 PM

cranky,

Food, housing and clothing are all necessities of life. Even more necessary than health care. Yet we don't have "single payer" funding of them. So the idea that single-payer government funding of health care is appropriate because it's a necessity doesn't make sense. We don't have single-payer home insurance, or life insurance, or car insurance either. We don't have single-payer insurance of any kind. These are all private, market-based services. So it doesn't make sense to have single-payer health insurance either. The claim that people can "bargain" over other kinds of insurance but not health insurance is nonsense on its face.

You claim health care is different in some essential way from other goods and services that we fund through multiple payers, a way that makes single-payer government funding approrpiate for health care but not any of those other things, and yet you cannot identify what this difference is. That's because it doesn't exist.

Posted by: JasonR | May 30, 2007 5:05:46 PM

The problem we have is that we have guaranteed a minimum level of care for every person in this country. What we obviously haven't done is set up a way to pay for it all.

Huh? If a private insurer pays more in claims than he collects in premiums and other revenues, he'll go out of business. That's how we ensure that we pay for what we provide in the private sector. If the government pays more in claims than it collects in revenues, it creates a deficit and has to borry money to cover it, imposing a debt burden on future generations. That's where we're headed with Medicare. On current projections, Medicare is going to run out of money in about a decade. Quadrupling the size of the program ("Medicare for all!") will put the country even more in debt (like in France), or force rationing (like in Britain and Canada). No thanks.

Posted by: JasonR | May 30, 2007 5:15:53 PM

JasonR, you reply to my post was pretty weak.
> Right. And if the government provided cars and
> computers and houses, it'd put private companies
> out of business in those sectors too. Because it
> wouldn't have to make a profit or "waste" all that
> money private companies spend on advertising and
> promotion.

First off, the evidence is overwhelming that government provided health care is cheaper than what we have private medical insurance in the US. Every country that I know of that has government provided health care gets better results with less per person cost than the US. Also, insurance companies can't compete economical with Medicare and have to be paid more per person than Medicare costs in order to provide comparable coverage.

Secondly, medical insurance is very different animal than the car, computer and housing industries. I take medicine to keep my cholesterol under control. As this is much cheaper than my having a heart attack, you would think my medical insurance company would just give it to me. However, that heart attack is only a future possibility and I may be insured by another insurance company when my heart attack happens, so my medical insurance company does everything they can to make my pay all of the cost of my cholesterol medicine now. What is good for them is bad for me and bad for the country as a whole.

Posted by: Dennis_D | May 30, 2007 5:21:21 PM

Once I signed in, I got it with no problem.

Great article, Ezra.

Posted by: Jumada | May 30, 2007 5:23:08 PM

Notes from someone who is a bootscraper (myself) to Jason (someone who is not). If you don't know what a bootscraper is, let me explain. It's someone who has actually had to go from the bottom rungs of this society - as in Katrina type of poverty to the relative middle class. One thing you learn a long the way is that there is a hierarchy of needs. What most people think they need, they really only want, etc. Sometimes what they think they only want, they need. Etc.

We are dealing with a hierarchy of need here when discussing healthcare (life sustaining surgery versus the ability to skip a meal versus not being able to skip all meals versus a house in summer versus a house in bitter cold winter and on and on) versus want (I want a car). If your argument depends on treating all needs the same as all wants, then there is a problem with your argument. Indeed, your argument seems worse- it treats all needs as equals. Not even all needs are the same as all other needs. A house in winter versus one in summer. Much less all needs being the same as all wants. And society clearly doesn't treat them as equals- so why then are we suppose to do so economically? We don't treat home ownership the same as car ownership or eatting. No matter how people set up interest rates and other type of economic structures, the value attributed to it beyond economics is different. Why? Because the need for housing is greater than the need for a car.

So long as your argument denies all this- it will remain a false argument.

Posted by: akaison | May 30, 2007 5:26:22 PM

JasonR, let me add something else. With most industries, companies can set their prices such that virtually all customers are profitable. With medical insurance, the 1% most unhealthy are incredibly expensive and cost way more than they pay in premiums. Consequently, insurance companies spend huge sums of money to try to predict which customers will be in that 1% in order to avoid them. Such predictions are expensive to make because they involve reviewing medical records and cannot be done off of something simple like your mailing address. If you are in that 1%, it is very difficult to get any medical insurance. If the government provides universal medical coverage, then all of that expense goes away. Yes another reason why government provided universal medical coverage is less expensive that private medical insurance.

Posted by: Dennis_D | May 30, 2007 5:54:42 PM

Dennis D,

I'd love to see your "overwhelming evidence" that "government provided health care is cheaper than what we have private medical insurance in the US." Other countries certainly spend less per capita on health care, but they also get less.

Posted by: JasonR | May 30, 2007 6:08:07 PM

akaison,

If there is an actual answer to my question about why you think it is appropriate or necessary to have single-payer health care, but not single-payer housing, food, clothing, computers, cars, home insurance, life insurance, etc., etc., then I cannot extract it from your rambling statements. Can you explain, clearly and concisely, exactly what it is about health care that you think justifies single-payer funding?

Dennis D,

Your argument doesn't make any sense, either. Yes, some customers pose much greater risks to insurers of making a claim than others, and insurance companies incur substantial costs in evaluating risks and calculating appropriate premiums. But that's true of all types of insurance, not just health insurance. How is it an argument for single-payer health insurance, or single-payer insurance of any kind? You say, "If the government provides universal medical coverage, then all of that expense goes away." But that would also be true if the government provided universal life insurance, universal home insurance, car insurance, renters' insurance, mortgage insurance, credit card insurance, disability insurance, flood insurance, etc., etc. and yet we don't have any of those things. In fact, actuarial costs are minimized through the use of large pools and could be virtually eliminated by regulations like mandated coverage and community rating. So again, how is this an argument for single-payer health insurance?

Posted by: JasonR | May 30, 2007 6:55:59 PM

In fact, actuarial costs are minimized through the use of large pools and could be virtually eliminated by regulations like mandated coverage and community rating.

Heck, once you have those two regulations you're 90% of the way to having socialized medicine, so I'm not sure what you're so emotionally invested in.

Posted by: Consumatopia | May 30, 2007 7:42:48 PM

JasonR,

One of these things (insurances) is not like the other. I can live in a cheap apartment, use public transportation, avoid accumulating expensive possessions, and pretty much eliminate my need for any other kind of insurance. But a health crisis could cost more than my gross income for a decade. Clean living might modestly improve my odds of avoiding such a fate, but it hardly eliminates it.

Posted by: idlemind | May 30, 2007 7:45:25 PM

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