Playing Politics With Health Care In Texas

Conservatives are just grasping at anything that could prove that they have an alternative health care plan and aren't just opposing everything on the Obama agenda due to politics.

http://www.political-buzz.com/

The NYT was right when they guessed that Douthat would bring more attention to their Op-Ed page. They just were wrong about the kind of attention.

OK, so a small number of people acting in their own self-interest are distorting efforts at real reform. Got it.

Now, how about the media repurposing the McCain campaign promise about earmarkers when he said,"You will know their names. I will make them famous."

When individuals become the issue, report the individuals. Something tells me this goes beyond a Texas state representative.

Sullivan has more about Douthat's opinion:

http://andrewsullivan.theatlantic.com/the_daily_dish/2009/08/texas-v-california.html

NPR had a segment on Texas health care, specifically the grassroots efforts by both sides of the issue gearing up for a big showdown. The money quote was from a Republican volunteer. He said there is nothing wrong with our health care system. I try to be even handed, but these people are morons.

pluk accusing you of shilling for the status quo in 5..4..3..2..

KT:

If Ross Douthat is so predictably, ideologically wrong, then why are we (the country) seemingly going to get his health care system reform proposal to Republicans from 2005?

Health Care First

At this point, it's obvious to all but the most delusional that President Bush's Social Security gambit has failed. Having grasped the third rail with his bare hands, Bush deserves our admiration. But he seriously misjudged the public mood. Coming alongside the slow extinction of traditional employer-provided pension plans and the demise of union-supported guaranteed employment, Bush's proposed reforms appealed almost exclusively to people who already have stock portfolios and 401(k) plans--the voters, that is, who already feel most secure about their economic prospects. Everyone else was skeptical--and some of the stiffest resistance came from loyal Republicans.

None of this is to say that Social Security reform should be abandoned--but it shouldn't be the top priority of a party concerned with the interests of working families. In this regard, President Bush repeated an error made by Bill Clinton. In the mid-1990s (as Mickey Kaus especially has argued), Clinton ought to have pushed welfare reform before turning to health care reform. By doing so, Clinton would have demonstrated his commitment to breaking with big-government liberalism, thus gaining political capital for changing the health care system. Instead, Clinton offered a nightmarishly complex "HillaryCare" proposal that convinced many voters that he was a liberal Democrat of the old school.

Similarly, by aggressively pursuing benefit cuts and voluntary personal accounts, Bush only reinforced the view that conservatives are bent on reducing economic security. What Bush missed was an opportunity to demonstrate that conservative solutions can actually increase economic security--an opportunity that could have been seized if the GOP had made a serious effort to extend health insurance to all Americans.

By now, the fact that over 45 million Americans are uninsured is familiar, as is the conservative rejoinder that many of these millions are uninsured by choice. But the 45 million figure is a snapshot--the number who are uninsured at a particular moment in time. The number who are uninsured at some point during a typical year--usually because they lose coverage while switching jobs--ranges from 57 million to 69 million. Over a period of 24 months, that number climbs to over 80 million. This means that at some point every two years, millions of American parents dread seeing their child catch a bad flu for fear of facing long lines at an understaffed, overworked emergency room. Even if this transitional period lasts only a few months, it's a period fraught with anxiety. Nor are health care anxieties confined to voters who lack insurance. Most current plans serve as prepayments for routine medical expenditures. When the unforeseen comes along, millions of families find themselves financially vulnerable.

It's no surprise, then, that Americans consistently rank health care as among the most pressing issues--far ahead of Social Security, and eclipsed only by the threat of terrorism and the war in Iraq. Nevertheless, the Bush administration has failed to offer any comprehensive proposals on this front. The prescription drug benefit was an ostentatious and hugely expensive sop to the elderly, and seems to have left Republicans with a positive aversion to useful reform. Democrats, chastened by their previous failures, have been slow to seize the opportunity, but that's unlikely to last. If conservatives aren't careful, anxieties over health care could yet provide an opening for liberals to impose a system more rigid and stultifying even than HillaryCare.

To forestall such a disaster, Republicans need to deliver a market-friendly health care reform, and simplify the current hodgepodge of command-and-control and laissez-faire. Instead of approaching health care reform as the left does, as a problem for the uninsured--a matter of charity for those less fortunate--conservatives should cast the health care crisis as what it really is: a problem for the insured, for people whose insurance plans will lapse if they lose or shift jobs, whose plans don't cover expensive crises, and who must pay extra, in the form of higher premiums, to cover the medical bills of the permanently uninsured.

And instead of uncritically accepting the liberal insistence that reforming health care would require the government to spend vastly more money, conservatives should realize that the health care system has become so complex and inefficient that a real reform could be crafted that would eventually pay for itself. In 2003, federal, state, and local governments poured out almost $730 billion on health care, and the tax breaks handed out for employer-provided health care came to almost $190 billion. With this level of spending, it ought to be possible to move to a more rational, market-oriented health care system that would provide portable coverage for all families, without spending an extra cent of government money.

For instance, Mitt Romney has proposed in Massachusetts that health insurance be made universal by making it mandatory. Allowing individuals to forgo coverage encourages the young and healthy to live dangerously, giving them a free ride on the public purse when things go awry, and making health care more expensive for everyone else. If you expect government to step in when the going gets tough, you have an obligation to make a contribution.

But if purchasing health insurance is to be mandatory, it needs to be cheaper. To drive down prices, and free up money to subsidize insurance for the poorest Americans, anticompetitive practices in the health care sector would have to be attacked. As professors Michael Porter and Elizabeth Teisberg have argued, the health care industry is designed to reduce costs borne by intermediaries--hospitals, health plans, physician groups--rather than increase value for patients. So there is a relentless drive to shift costs onto individuals, and to minimize competition through network restrictions that prevent consumers from finding the best care. Medical providers collude to suppress information about the quality of care, a practice that would be considered intolerable in any other industry. By negotiating for steep discounts from provider groups, large employers and the government make the individual insurance market intolerably expensive for most Americans. Eliminating these bottlenecks will, over time, go a long way towards reducing costs, while increasing consumer choice.

Driving down costs will also enable Republicans to sever health care coverage from employment. As GM's continuing woes suggest, American industry is being hobbled by health care costs. In 2004, employers spent $443 billion on health care, and even small and midsized corporations are forced to maintain miniature welfare states, with all of the administrative costs and hassles that entails. It's hardly surprising that the Chamber of Commerce is joining liberal groups in seeking some kind of solution, and there's every reason to believe that corporate America will stand behind a smart reform. More important, severing health care coverage from employment will eliminate the gaps in coverage that occur when workers move from one job to the next. Workers will no longer be shackled to jobs they despise, thus offering a tremendous boon to productivity.

Finally, the goal of any health care system ought to be security against catastrophic expenditures. Individuals can choose to pay for comprehensive coverage, but the responsibility of government should extend only to making sure that all Americans purchase a high deductible policy--rather than subsidizing gold-plated plans for upper-income Americans, which the current system often does.

All these reforms would have salutary effects on family life. If your coverage were portable, you'd feel more secure in moving your family to a community with a lower cost of living, or where you're more likely to find remunerative employment. At the same time, making health care more universal and affordable would reduce the costs of child rearing, encouraging family formation and offering a sense of security to parents debating whether to have a second (or third, or fourth) child.

And by passing a reform along these lines, the Republican party would gain the credibility it needs to modernize Social Security, and to reinvent that program so that it works to further conservative goals, rather than undercut them. At present, we have the worst of both worlds: an expensive and inefficient health care system that discourages child rearing and economic risk-taking, and an increasingly expensive pension system that does the same. The latter is popular, but the former isn't--and that should be a clue for conservative reformers.

What's interesting about Ross' Weekly Standard piece is how accurately he describes the problems of our health care system for regular people, and yet cannot wrench himself out of the conservative ideological box long enough to consider that something other than "a market-friendly health care reform" is a requirement. He did everything except say "...and to make this happen, we should obviously reduce taxes on the rich by a significant order of magnitude".

So why does the President sound like Ross Douthat when he talks about reforming the health care system?

Obama: Health reform must not worsen deficits

(07-25) 04:00 PDT Washington - -- President Obama said Friday that he shares the concern of California Sen. Dianne Feinstein and other moderate Democrats that a health care overhaul not compound the nation's deficits, but downplayed worries from governors about being saddled with additional burdens on Medicaid.

"We're not going to set up something that's not fully paid for," Obama said. "I agree with her on that. That's been my criteria from the start."

"None of the plans ... come remotely close to a single-payer plan, none of them," Obama said. "And that's to the consternation of a lot of people who are advocating for single-payer.

"We inherit a tradition of employer-based health care, of a strong private marketplace for health care and the idea that you would scrap that is unworkable," he said. "We need to build on the system we have, which blends government programs with a strong private marketplace to achieve a uniquely American result."

So Ross Douthat is apparently Obama's chief health care policy adviser, and Ross Douthat is apparently writing all of the health care system reform legislation that will make its way into Conference from the Senate.

So if he's so wrong about what the best --or even a good-- model is for our proposed system, then why is Ross Douthat in charge of health insurance reform, KT?

I live in Texas. And I am self-employed. And health insurance in Texas is a total mess. Very fortunately, I am in the Texas High Risk Insurance Pool underwritten by BC/BS. Otherwise, Texas offers nothing for people on their own. This insurance is VERY EXPENSIVE, but I am blessed to be able to afford it. I have the highest deductible of $7500 and pay $650 a month for coverage. So, that conservative NYT columnist is totally off base. I read Ms. Tumulty's article about health care and her bother here in Texas with great interest. I am not asking for free insurance. I just want access. And no denial of coverage due to pre-existing condition. And coverage that I will not lose. I'll pay for it. I want to be able to buy into what Congress has for themselves. I am a subscriber to the dead tree Time. It's one of the few magazines I still enjoy. I also subscribe to Newsweek, but hate their new format and will let my subscription lapse. But I love Time online and Time magazine.

McKinsey just did a study--apparently Texas, without some of the inherent advantages of California, does a much better job of educating its children.

KT, don't forget that the NYorker piece highlights the overuse of medicine in McAllen: too many tests, procedures, etc. I think pirate pointed this out with this article awhile back. I'm guessing you two don't see eye-to-eye on HC. Can I help referee? I'm cheap. The article's photo of a patient dressed as an ATM says it all (1000 words?). That helps explain my previous tomes pleading to stop viewing HC as a thing to buy but as a public safety issue (police, fire), as if that matters or anyone's reading.

KT-- I know you are not a media critic so I applaud your effort to call out Douthat. So while you're on a roll won't you have a word with your colleagues who insist on portraying this corporate thugism (lobbyist employed town hall plants) as grassroots opposition to health care reform. I mean the idea that the citizens of Austin, the intellectual capital of Texas of all places, are as patently ignorant as those rubes who arrived shortly before the meeting by bus, should be offensive to every Texan. Let alone the blatant attempt of corporate lobbyist to thwart Democracy.

Nice work (start?) KT - more li' this please, lassie!

Arrgh!

The real problem here is that health-care has become like Wall-Street like lawyers. What America is finding out is that you can't have professionals who are driven purely by a market-based system or even variably influenced by profit-based motives. It ultimately skews the economy and bankrupts the government and society.

But you say, this is America...everything is for profit and everything can be bought....to that I respond, it is a problem.

Everybody in a capitalist system (read: politicians, doctors, lawyers and bankers) can't be in it just for the money. In order to have winners and losers, you need an impartial dealer someone who is there to call a fair game. When the umpire in baseball or the ref in basketball starts getting a profit incentive- WATCH OUT! The game is about to come crashing down on itself. These guys and gals make plenty of money already (I know I do as an attorney) without gaming the system and being greedy. America worked well in the 50's not because of pure capitalism but because pure capitalism was not allowed to cannibalize American values. Free-market and market-driven philosophies are nowhere to be found in the Constitution. But life, liberty and the pursuit of happiness are the uniquely American values we should value.

Texas should not be a "model" for much of anything. TX has more uninsured than any other state - 25%. They also ranks low on many of the other important issues like quality of life, pollution, education and it ranks high on poverty. Believe me, I live in Houston - TX is not model for anything - if it is to be considered a "model" it should be a model of how things shouldn't be done.

Thanks for this KT (I'd asked you on a dead thread yesterday or the day before to speak to the TX part of his utterly sh!tty piece).
~
As El Vez alludes to, the CA end of his farcical contrast is equally worth a post. How about the Swamp native of that state, MS?

OK. Let me break it down for...most of you. Some things are complicated. Let's take space exploration. It's complex, and there's nothing to be done about it. The insides of your computers are complex. Your nervous system is complex. I like my nervous system to be complex. It's how I think. I couldn't do that with the simple brain of a worm.
There isn't any such thing as simple health care. The days of your grandpappy paying for a doctor's services with livestock are over. What we have for health care now is a labyrinthine enigma wrapped in outright contradiction.
(That means it's complex.)
Nothing is going to change that. A simple solution is a pipedream.

PS: I agree with notfooled. Texas is America's Quebec. Let 'em secede so we don't have any more Texan presidents.

KT, isn't making McAllen emblematic of Texas basically like making Gary emblematic of Indiana? Who are the "Valley politicians"? Are they Dems? GOP?

Obamacare will cost this nation thousands of jobs. In my industry, medical device sales, we have already lost 20,000 medical sales and pharmaceutical sales jobs in anticipation of "reform".

Follow our discussion of this topic at http://www.gorillamedicalsales.com

The trouble that I have with the entire health care debate is how it is being framed. "How will we pay for it all?" seems to be the largest question. The reality is that we ARE ALREADY PAYING for it... and paying far too much.

Instead of discussing this as a tax-and-spend issue--or whatever other fear-cliche is being used today--we need to refocus the discussion on OVERHAUL. True reform needs to not only change the way health care is delivered (including cost-cutting efforts through nationalized systems), but also needs to change the way health care is paid for.

We are already paying the tax. We pay it because goods and services cost more (do you think businesses and employers pay for health care out of their own pocket--or do you think they pass it on to consumers?), we pay for it with more time spent navigating a broken system, we pay for it with lost productivity, we pay for it through traditional taxes, and we pay for it in other indirect ways.

The other thing is this: my health--and your health--should not be decided by politics. Unfortunately, Americans are being suckered into thinking it should be.

[...] Correspondent Karen Tumulty examines the role of politics and money in the health reform debate in “Playing Politics with Health Care in Texas.”  Looking at Texas and specifically at the city of McAllen, which received much national [...]