Sunday, August 09, 2009

response from comments 

Senator Tankerbell:

What is wrong with an individual mandate, provided lower-income individuals are assisted? How could the system work, how can you try to keep down costs, if you don't require everyone to join? What is the alternative?

More importantly: why assume that modest reform would slam the door to further reform in the future? That's a big assumption.

For one thing, the individual mandate is pretty offensive at the personal liberty level: government coercing you into buying a product, a product you can't live without, from a particular vendor. This essentially amounts to a state-subsidy of the private insurance industry, which isn't incentivized to provide decent healthcare. Using coerced money to pay for public good is one thing. Using it to line the pockets of predatory institutions is another. So there's that.

Beyond the basic insanity of solving a problem created by corporations by further coercing their victims, I'm not sure why you think it reduces costs either. The Massachussetts example does not bear this out. See Trudy Lieberman's work at CJR.

This kind of thing has worked pretty well in the Netherlands, but the insco's there are so tightly regulated they're essentially public utilities, margins are low and the co's are more beholden to the state than shareholders. Obviously that sort of thing isn't on the table here.

The reason I think it will slam the door shut is that it isn't really a reform at all, it's just moving money around the same system being called a reform. Once the dust settles, we will have lot of the same problems, rising costs, underinsurance, reduced bargaining power in the workplace, but this time the line will be that we "reformed" the system.

People who want real reform now will be told to "give it a chance" and marginalized. Insco's, which would now have a captive market, will continue to rake in the cash and will be well positioned to fight any further reform attempts. Not only that, but since the dominant narrative will be that we've reformed things and its time to move on to other problems, reformers will not be able to garner the attention they'd need to resist the insco PR onslaught.

What we have now is a perfect moment of crisis that is being blown because of a lack of Presidential interest and total passivity among his supporters, who are numerous and organized enough to actually change the dynamic if they so choose. But they don't. They'd rather inflate the power of their fake enemies, titillate themselves with the frisson of fear of an imminent fascism, call their opponents racist (see Krugman), and sit at home admiring their Dear Leader and congratulating themselves for having the good sense to like him. More than Obama, who is behaving as promised and as expected, they are utterly execrable and the largest impediment to progress in this country. Much more so than the moribund rump Republican party. People who laughed with bravado at the suggestion that it was "impossible" to elect a black man President, and patted themselves on the back for accomplishing the "impossible", now sit meekly discussing all kinds of impossibilities that they just can't do a thing about, when they're not out pimping the Party's "plan" that is. Pathetic. We won't get this moment again for a while, maybe decades, and it will be they who have blown it. But who cares about substance when you've got a symbol?

(sorry that's bit OT, but I really can't express enough contempt for the Obama movement on this issue. We could have actually passed 676 by now if they weren't so busy trying to redefine "obsequious" for the 21st century. And if you don't believe that, I can guarantee that a good fight for 676 would have gotten us a better compromise than starting the negotiation with your maximal position being "I'd like the Insco broom handle further up my ass, please.")

Lastly, Cohn's Waxman reform expansion example is inapt. Insco's dont' care about expanding Medicaid because they won't give policies to those people anyway. If someone like Waxman tried to expand coverage for people with indiv. mandates the Insco's would freak out and block it. And even if they lost, they'd find ways around it, technicalities, loopholes on the back end. Or they'd wait until the Waxman's of the world have moved on and then get some hired hack to gut the expansion. Their job is to not pay for healthcare. As long as they exist, they will do their job.


Al Schumann puts it well:

Differing realities... with a difference! One of them is real, and appears in the Black Agenda Report. The other is post modern rabbit hole stuff, chasing the ghosts of the shadows of a meliorism that was never seriously considered, and it appears (where else?) in the New York Times.

He also links to this Business Week article which tells you pretty much everything you need to know about the "reform":

The industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business. UnitedHealth has distinguished itself by more deftly and aggressively feeding sophisticated pricing and actuarial data to information-starved congressional staff members. With its rivals, the carrier has also achieved a secondary aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured. That will make the new customers more lucrative to the industry.


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