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Friday, December 18, 2009

Krugman calls for health care reform passage
Posted by Jill | 5:19 AM
What a cynical exercise this entire health care reform debate has been.

Now we have a situation in which Joe Lieberman, who rakes in cash from the insurance industry and whose wife is a lobbyist, and others stuffing their pockets with insurance company cash, are holding hostage real reform on the backs of those who can't afford insurance.

Today Paul Krugman joins the "Pass it, it's better than nothing" side:

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically. That’s an immense change from where we were just a few years ago: remember, not long ago the Bush administration and its allies in Congress successfully blocked even a modest expansion of health care for children.

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail — because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we’re paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.

The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.

Again, history suggests the answer. Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

I respect Paul Krugman, and I do understand his points. But I am cynical enough that the idea of "cutting a deal" holds no weight when you have a bunch of miscreants like today's Republicans, for whom "cutting a deal" means "doing it their way or not at all."

I also question the assumption that just because history shows that social insurance programs improve over time, it will remain that way in the future. This is the first major health care debate that has had not just the 24/7 cable news echo chamber, but the 24/7 internet. This is the first major health care debate that has a cacophony of faux-"grassroots" astroturf group fronts run by major corporations that use falsehoods and half-truths to influence a population too busy working or too frightened about not working to research the veracity of their claims. This is the first time that Dick Cheney's "one percent doctrine" has been applied to mainstream journalism, so that facts and utter horsepuckey have been given equal time, and the very notion of "alternative facts" is even part of public discourse. History may have shown that social insurance programs improve over time, but as the financial giants say about your "investments", "past performance is no indication of future performance."

It may very well be that this is the best we can get (and with so many amendments flurrying around, a simple read of S-1679 doesn't necessarily reflect reality), but my skepticism lies in the reality that just as with the current insurance system, there is absolutely no requirement that I've seen so far that actually requires the for-profit insurance companies to actually pay claims. It's easy to provide "coverage", because "coverage" involves issuance of a policy and the collection of premiums. But with no mandate to actually pay out claims for covered procedures, we have very much the same kind of system we have now, in which in many cases, payment is contingent on just how hard you want to fight with the person in the headset in a cubicle whose job it is to make you beg for actual payment of claims.

And if you want numbers about what the real impact of this gift to the insurance companies is going to be, Marcy Wheeler has 'em.


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Blogger skywind said...
This is such a tough call. As a self-employed person with a genetic condition which will require me to be on medication for the rest of my life, I'm at risk of losing my current insurance, which is pricey and has a lot of exclusions to begin with, but is better than nothing. It would be nice to have some guarantee that my coverage can't be cancelled. Yes, the bill is atrocious. Yes, it is better than nothing. At this point, I'd rather have "better than nothing."

I don't know what kind of health care reform will come out of this session, but I strongly suspect it won't be much. There is, however a silver lining behind this very dark cloud. I am reminded of the Civil Rights Act of 1957. Don't be embarrassed if you've never heard of it, there really isn't a hell of a lot to remember about it; a mere pittance, really - a scrap of leftovers tossed out to "American Negros" (in the parlance of the age) in order to appease them. But it made the passing of the Civil Rights Act of 1964 - the one we remember - all-the-more easier seven years later.

We'll live to fight another day.


Tom Degan

Anonymous Charlie O said...
I'm with Dr. Dean. This whole effort has turned into crap. Scrap insurance. I don't care if every last health insurance company goes out of business. Pass health care for all Americans now. And not tied to employment, in any way, shape or form.

Anonymous tata said...
I gave this a lot of thought, but the bottom line for me is that I'm a woman, and I have a daughter. Anything that interferes with my or my daughter's health care - as opposed to enhancing it - cannot be termed reform. Any bill that does not cap premiums, remove benefit limits and strictly regulate insurers - if we must have them - represents the end of corporate accountability. The answer for me is a firm no.

Blogger Barry said...
The cynical side of me would enjoy watching the perennially apathetic youth, who in 2008 finally put down the bong long enough to go canvas for Obama, be told that they have to buy a $15,000 insurance policy or go to jail.

But the entertainment value of that, while not insignificant, is insufficient for me to support this bill. Kos now has public support at a mere 33%, but does anyone seriously doubt it will pass?

Blogger libhom said...
Krugman always has been out of touch on healthcare. He says mandates are necessary because people are "gaming the system" when they in fact just can't afford the astronomical healthcare premiums.