Senator Feinstein's Unsatisfactory and Confusing Statement on Health Reform

My analysis from TPM (0.00 / 0)

Good on you Jason.  I commented on this last night at TPM:

Feinstein's statement deserves to get deconstructed up the ying-yang. Mostly, it's deceptive, shallow mush.

Except for the following, which is the worse kind of corporate whoredom:

Clearly, the individual mandate - and how it is funded - is the critical, and as yet unanswered, question.

Without a strong public option that any American can choose, a mandate to buy insurance is a pure increase for the demand for health care without any commensurate increase in supply: in effect the price of insurance rises, and the insurance rackets will simply pocket the profits. It turns what is currently a protected oligopoly in to an even better protected, even more profitable oligopoly. It's why the "reform" in Massachusetts has turned out to be such a clusterfuck.

The only way to prevent the insurance companies from doing exactly the same paper-pushing, health care denying shenanigans they currently do now is to build real competition into the system, where the competitor competes by giving better care, rather than competing on how effectively you can fuck the public. That doesn't mean warmed-over HMOs, which is what Conrad's "health care co-ops" really are. It means a plan that anyone can choose over a private plan, that will actually pay for health care people need, when they need it.

A private plan can compete, by actually giving real health care coverage, and by actually reimbursing doctors for needed care, rather than forcing doctors to hire two or three clerical people to try to ungame what the insurance companies currently game on physicians. It won't be as profitable as the current racket. But that's exactly the reason real competition is essential: competitive markets are just profitable enough to cover costs and a reasonable return. Any "health care" insurer that needs more than reasonable market returns should be forced out of the business, for the good of the public and for the good of health providers like doctors and hospitals.

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by: mbayrob @ Wed Jun 24, 2009 at 18:25:46 PM UTC

Agreed with that comment (0.00 / 0)

A functioning market is key, and we don't have that, not nearly close.

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by: Jason Rosenbaum @ Wed Jun 24, 2009 at 19:05:00 PM UTC

[ Parent ]

There is no possible functioning market for health care (0.00 / 0)

One does not exist around the world. European models all have a primary state provider, or have so heavily regulated it as to be following more a "concessionaire" model that is largely divorced from market forces.

A "functioning market" isn´t the goal here. Guaranteed, affordable care is the goal.

You can check out any time you like but you can never leave

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by: Robert Cruickshank @ Wed Jun 24, 2009 at 21:21:06 PM UTC

[ Parent ]

Indeed.... (0.00 / 0)

................this is exactly right. And thus 'for-profit' has to go away as the State will be the payer.

Lots of better practices come from this as the EU shows the rest of the world, including China, the way to go on toxics in the environment and preventative care.

Are we going to join with the undeveloped nations or follow the EU that is the real question.

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by: A.Citizen @ Wed Jun 24, 2009 at 21:30:25 PM UTC

[ Parent ]

Markets are structured by law (0.00 / 0)

There is no possible functioning market for health care

Not so.  There is no possible functioning market that is based solely on private ownership without regulation.  There's a world of difference.

Economists have come up with a variety of ways to structure the way markets work.  For example, a totally "free" labor market would allow us to sell people into slavery.  So we regulate: we make slavery illegal.  We created regulations back in the 1930s to encourage banks and S&Ls to create mortgages where there was only a small amount of money down, rather than half or more of the cost up front.  And we have a variety of rules and regulations that push for better disclosure of information about many kinds of transactions.

Many health care systems across the world have universal access, but much of their day-to-day functioning are handled via regulated markets.  Germany's system is mostly private.  Single payer systems handle payment socially, but provision via competitive markets.  These systems all work better than ours.

On the whole, markets do a better job allocating scarce resources than government bureaucracies, because price signals do a good job of revealing where scarcity is in a system.

Markets generally speaking do a fairly poor job of allocating wealth over time, however, and private wealth is very corrupting of government and other regulatory institutions.  This is a limitation.

On the whole, markets are simply a tool, and should not be an end in and of themselves.  But as a tool, they are a very useful one.  

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by: mbayrob @ Thu Jun 25, 2009 at 00:35:40 AM UTC

[ Parent ]

This makes perfect sense (0.00 / 0)

It´s Feinstein´s M.O. She will undermine anything left of center-right as a matter of principle. Her opposition to genuine reform is unsurprising and typical.

Her list of conditions does show our need to continue to reframe the terms of debate. Containing costs and expanding coverage is most assuredly NOT what this is about. The goals of reform are instead to ensure every American has a guarantee of health care coverage that is affordable to them. It´s not just Feinstein who isn´t using that language, but the reform movement as a whole.

The only "critical question" involving an individual mandate is how we will kill it - firing squad? lethal injection? the gallows? a guillotine?

You can check out any time you like but you can never leave

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by: Robert Cruickshank @ Wed Jun 24, 2009 at 21:24:22 PM UTC

The idea of Medicare running out of money in 2017 (0.00 / 0)

is scary, but so abstract.

I like to compare it to my concrete example: given my current health care premium and the trends for cost increases, my family health care premium will be over $40,000 a year in 2017.

Medicare isn't the problem. The whole health system is the problem.

Fry, don't be a hero! It's not covered by our health plan!

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by: elfling @ Wed Jun 24, 2009 at 23:11:41 PM UTC