The "Reform" In The Health Bill: If Only It Were So

I like that Ezra Klein wrote the post he just did. Because I think it illustrates precisely what is wrong with the analysis provided by the Village Wonks. Ezra writes:

Insurers seem evil because of the marketplace in which they operate. The healthy don't buy as much insurance as the sick. The sick aren't as profitable as the healthy. Insurers, like all private firms, are very simple: They pursue profit like a pig sniffing after truffles. It is up to society to train them, and we do that by setting rules.

Health-care reform will establish many, if not all, of those rules. The individual mandate will mean the healthy cannot hang back until they become the sick. Insurers, for their part, will not be able to discard the sick in favor of the healthy. Perhaps more importantly, risk adjustment -- which compensates insurers with sicker customers by taxing insurers who have cherrypicked healthier people -- will end the days when it is profitable to do so. As the exchanges open up -- if they open up, more to the point -- all of this will work better and more smoothly. This is how the Netherlands' health-care system looks, and few would accuse their insurers of being evil.

(Emphasis supplied.) We do not live in the Netherlands. If what Ezra prescribed actually worked, it would have worked in even one state in the US. Regulation would work. It has not. The Exchange has not worked in any state the way Ezra describes. The individual mandate has not worked in any state the way Ezra describes. The excise tax has not worked in any state the way that Ezra describes. Only one thing has worked to contain health care costs in the United States - government run insurance plans. Those are the facts. In ivory towers, you can build any Rube Goldberg contraption you want and claim it will work. In the real world, one program HAS worked. Only one. Medicare. Therein lies the problem with the Village Wonk. He lives in the Ivory Tower. The rest of us have to live in the real world. Right here in the good ole USA - where regulators do not effectively regulate health insurance; where exchanges do not work; where excise taxes will result in less health care for workers, not lower health care costs and increased wages.

Speaking for me only

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    Will the Medicare Buy In follow the (5.00 / 1) (#2)
    by MO Blue on Fri Dec 11, 2009 at 10:46:16 AM EST
    path as the public option?

    Snowe said the Medicare expansion exacerbates an "already-serious problem," with the low government reimbursement rates for doctors and hospitals that serve Medicare patients. It could force her to vote no, she said.
    And Nelson said allowing people ages 55 to 64 to purchase Medicare coverage could simply be an intermediate step on the way to an entirely government-run health care system -- "which I do not like."
    "I am increasingly troubled about the proposal," Lieberman said. "I am worried about what impact it will have on the Medicare program's fiscal viability and also what effect it will have on the premiums paid by people benefiting from Medicare now." link

    Look for the Senate to "fix" the Medicare Buy In in much the same way as they fixed the public option. Medicare rates to negotiated rates - to opt in - to only being triggered if there is suddenly world peace.

    there is a problem though (none / 0) (#24)
    by Socraticsilence on Fri Dec 11, 2009 at 08:39:23 PM EST
    How can anyone think that's not a problem-- I don't know the solution but its clearly an issue- I had hoped a public option would bridge the gap and pay "true rates" you know between those and that Medicare/Medicaid pays and those paid by Insurance companies and out-of-pocket patients (artificially high in order to cover the problem) but since that's not the case lets not pretend this isn't a problem.

    Whole lot of people up in D.C. (none / 0) (#31)
    by MO Blue on Sat Dec 12, 2009 at 09:15:41 AM EST
    screaming about "the problem." Seems to me that this would be the perfect opportunity to "fix" the problem. But no they would rather spend their time screaming and going around the problem.

    I may have to start referring to (5.00 / 5) (#3)
    by Anne on Fri Dec 11, 2009 at 11:02:14 AM EST
    Ezra as "Rumpelstiltskin," for his valiant efforts to spin straw into gold; or maybe we should nickname the legislation the "Pegasus and Icarus Act," to honor the efforts of so many to staple wings on a horse, and then persist in the  belief that it will actually fly.

    Here's some food for thought on the Medicare buy-in that I found enlightening (my emphasis):

    The Senate proposal to allow uninsured people over age 55 an opportunity to buy into Medicare constitutes yet another government subsidy to the private health insurance industry, a leading health policy analyst and single-payer advocate says.

    Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and professor of medicine at Harvard Medical School, told a radio host Wednesday morning, "One of the better provisions of the reform legislation was that it prohibited charging older people more than twice (or thrice in the some versions) as much as you charge younger people in the individual market. But by saying everyone over 55 in the individual market can be picked up by Medicare, you've really let the insurance industry off the hook."

    Woolhandler continued: "That is, the highest-cost patients in the individual market will be taken off their hands and paid for by the taxpayers; and private insurance will remain the only option for people under the age of 55 and for anyone who gets their insurance through their employer. Another way of saying that is: if you now have private health insurance and you don't like it, you're forced to keep it.

    "The buy-in to Medicare is only for those 55 to 64 and it's only for people who are not offered private health insurance through an employer. So it turns into just a subsidy to private health insurance: the taxpayers will pay for the high-cost patients and the health insurance industry can take the lower-cost patients."


    "I want to remind people that at its core, this bill takes $450 billion in new taxes from the taxpayers, and hands it over to the private health insurance as subsidies. So, the core of the bill is a financial strengthening of the private health insurance industry. Now, one of the small things that was good about the plan, that is, forcing the insurance industry to lower the prices for older enrollees, has been taken out of the bill, essentially."

    This might be an even sweeter deal than the one the banksters got.  And that's saying something.

    Klein is wrong (5.00 / 2) (#6)
    by TheRealFrank on Fri Dec 11, 2009 at 11:42:32 AM EST
    First of all, the Dutch system has much stricter regulation then any Senate bill will ever have. The government defines a base insurance package, that all insurance companies have to accept everyone for, and it is illegal to change the premium for it based on the health of the client. The base package alone is better than any private insurance I've seen here. It covers all the common procedures. It covers all medication. It covers it 100%.

    Secondly, the Dutch system grew out of a situation that was completely different from the US. Premiums weren't high. Coverage had always been good. Half of the insurers were non-profit coops (originally the German model, brought in by the Nazis, heh). It was easy for the system to evolve like that.

    Lastly, there are worries that the system is on a slipperly slope because it's all based on private insurance now. The influence of private insurers is growing, sadly. So far, the effects have been minor, but I have some concerns about it, seeing how insurance companies here run the whole show.

    That's you letting the actual facts (none / 0) (#8)
    by Big Tent Democrat on Fri Dec 11, 2009 at 11:49:48 AM EST
    get in the way of the ivory tower.

    Its actually kind of sad (none / 0) (#25)
    by Socraticsilence on Fri Dec 11, 2009 at 08:41:37 PM EST
    Klein if he wanted to look at an example of a nation that has private insurers and decent coverage should have looked at the Swiss- they changed from for-profit insurance to nont-for-profit pretty quickly despite having shareholders, etc. to worry about.

    Klein is an Obamabot (none / 0) (#33)
    by norris morris on Sat Dec 12, 2009 at 08:59:01 PM EST
    He's also wrong on almost all of his "facts" and interpretations.

    He first was passionate about the Public Option and knows damn well that without a meaningful option no reformed healthcare is possible and is a supreme snow job aided and abetted by conservative dems and progressive faux cave-ins alike.

    The Insurance and Drug lobby wrote this piece of dreck and it will seriously hurt millions. It's contradictory and ill conceived with no real cost containment and no manageable access for insurees to shop for less costly insurance that delivers real relief.

    This should be known as The Big Insurance Giveaway
    that a weak and timid President who promised real change reneged on. We are governable. The fact of the matter is that Obama has not governed or led, and he threw this into the lions den for political cover in a cowardly political maneuver
    that has produced disastrous results.


    Here's some non-Ivory Tower realism. (5.00 / 2) (#11)
    by Dr Molly on Fri Dec 11, 2009 at 12:14:04 PM EST
    The Democrats are turning 'healthcare reform' into a giant corporate hand-out. Period.

    There is no real regulation or cost control proposed. There is no government competition. At best, only partially expanded access with some extra benefits for insurance company profit increases.

    Can we stop pretending now that being a democrat corresponds to any form of liberalism? We have one big corporate-controlled party in this country.

    Its not like thats a sudden revelation (none / 0) (#26)
    by Socraticsilence on Fri Dec 11, 2009 at 08:42:58 PM EST
    we've been that way since at least 1994, maybe even earlier.

    Here, Here. (none / 0) (#34)
    by norris morris on Sat Dec 12, 2009 at 09:00:24 PM EST
    Thanks for your post. You are right on.

    Misuse-of-metaphor alert (5.00 / 1) (#14)
    by Cream City on Fri Dec 11, 2009 at 12:29:57 PM EST
    Klein is not an occupant of the Ivory Tower, nor does he have the c.v. to even be considered.  The Repubs have muddled the metaphor enough, in their anti-intellectualism.  This only confuses again as to who is not performing their roles in society.

    Klein is a journalist.  The metaphor for that, if metaphorize we must, is the Fourth Estate.

    let's not be elitist he's 25 (none / 0) (#27)
    by Socraticsilence on Fri Dec 11, 2009 at 08:47:17 PM EST
    has a Bachelors, and rose fast without apparent family connections- he's obviously very bright and at 25 isn't to old to go back to school now if he's 35 I'd say you're right, but even then you have to consider that within his specialty one of the leaders didn't go back for a PHD until 50.

    Journalist???? (none / 0) (#35)
    by norris morris on Sat Dec 12, 2009 at 09:01:35 PM EST
    In what universe could this idiot be called a journalist? He can't reason, write, report, or speak.

    I don't think this is strictly true, BTD (5.00 / 1) (#15)
    by goldberry on Fri Dec 11, 2009 at 12:43:13 PM EST
    There are other programs in the US that have worked.  For example, Tricare.  That's the military insurance program.  It's a bit like socialized medicine.  My mom is on Tricare.  She loves it.  Then there is the Hawaii model.  Everyone in Hawaii is required to purchase insurance.  There are a few low cost insurance programs to choose from. My daughter who lives in Maui has one of these provided by her employer.  Is it perfect?  Heck no but I don't worry about her getting into an accident or seriously ill and ending up in the poorhouse.  
    I am very concerned with the left's penchant for latching onto one particular concept and not considering other alternatives. Like the public option or single payer. It isn't necessarily the case that a single bullet is going to fix the health care problem nor would we necessarily be content with the results of one.  TR Reid did a study of healthcare around the world and there are various models that could conceivably work for us if only the politicians were serious about reform, which they are not apparently.  The most successful models have certain things in common:
    1.) they control hospital and care giver costs.  Doctors' prices are controlled by a committee.  Hospitals can't charge $40000 for a four hour stay in their ambulatory surgical unit for a hernia operation (true story).
    2.) They limit the profits of the insurance industry.  Al Franken introduced an amendment that would do this.  Also, they encourage competition.  The most successful models make insurance companies compete for customers.  
    3.) The health care industry is heavily regulated and participation is universal.  The exception was Germany where the richest 10% were able to opt out.  Taiwan copied the German model pretty closely but required everyone to join because Germany's model has the flaw of insufficient funding with the opt out.  
    Taiwan is a good example of what we SHOULD have done.  They studied all of the options and, using best practices as their guide, they crafted a plan that would work for them.  
    We did exactly the opposite.  We put all of the cost cutting on the consumer and didn't follow any best practices for putting together a plan.  This was a complete waste of time and an unconscionable waste of opportunity on the part of Congress and the President.  Obama will try to make this a failure of the legislative branch but it was a failure of leadership on his part that brought us to this point.  
    Media Darlings do not necessarily good leaders make, especially if they haven't been in the upper echelons of government long enough to know what the hell they're doing.  

    Thank You (none / 0) (#36)
    by norris morris on Sat Dec 12, 2009 at 09:06:48 PM EST
     A really insructive post, and you have it all down.

    Obama cannot be allowed to get off the hook. This was his to lead on, and he's obviously backed off and capitulated.

    It is highly conceivable that a well crafted healthcare program can be worked out. It just takes leadership and hard work.

    Obama does not like confrontation and accountability which has now become obvious.

    He has used none of the powers of his office, and has done nothing to pursuade either the public or congress. Timidity, narcissism, and broken promises.


    Bravo BTD (none / 0) (#1)
    by Ga6thDem on Fri Dec 11, 2009 at 10:32:15 AM EST
    on your last paragraph!!

    All I have to say is that all these peolpe must have always had good insurance that was largely paid for by their employer. Surely they've never been in the market for insurance and had to pay the entire premium themselves.

    Remember . . . . (none / 0) (#7)
    by nycstray on Fri Dec 11, 2009 at 11:45:30 AM EST
    Ezra didn't even know he wasn't signed up for insurance . . . .

    Ezra is an idiot (none / 0) (#37)
    by norris morris on Sat Dec 12, 2009 at 09:08:12 PM EST
    Why are we paying any attention to a third rater?

    He is carrying water. That's all it is.


    If you mean people in the Ivory Tower (none / 0) (#16)
    by Cream City on Fri Dec 11, 2009 at 01:35:34 PM EST
    -- that is, the real Ivory Tower -- many are among the increasingly large group of Americans who are underemployed (as well as underpaid) and without benefits, such as group health insurance at all, in part because so many of them do work for institutions that are government-run.  

    And thus, we the taxpayers are complicit in funding some of the worst employment practices in this country, if because we underfund them and thus the increasingly permanent class of academic wage slaves.

    As noted elsewhere, though, none of this applies to Klein -- although we certainly have a growing group of unemployed and/or underemployed journalists these days.  But in his case, he is part of a corporation.  So he may have access to a group plan via his employer, his magazine.  


    I thought you would object (none / 0) (#17)
    by Big Tent Democrat on Fri Dec 11, 2009 at 01:40:12 PM EST
    I thought you would (none / 0) (#20)
    by Cream City on Fri Dec 11, 2009 at 03:37:31 PM EST
    use more precision -- as in your newest post, which correctly brings attention to how often legislation is screwed up by inattention to detail in the difference in verb tenses and forms, for example.

    Can't see how it helps to confuse the issues by mixing up metaphors.  But then, if the purpose was not to clarify but to take some potshots at specific other targets, have your fun.  Just wait 'til law school faculties start to suffer, too, and see what it does to the future of your field. . . .


    Although the state of CA is broke, (none / 0) (#18)
    by oculus on Fri Dec 11, 2009 at 01:43:25 PM EST
    state employees continue to have decent health care coverage options--not entirely pd. for by the state, of course.  Though we are substantially raising college tuition.

    Unionized state employees, yes (none / 0) (#21)
    by Cream City on Fri Dec 11, 2009 at 03:40:23 PM EST
    at least until the next contract negotiations.  You do have more unionized campus employees there than in many states.

    The rest of us, not so good -- and of course, the huge group of which I was speaking, the permanent temps and just-less-than-fulltimers and the like, rarely are unionized.  Not even in California, as I recall.  (We all are following the insanity out there, getting info from colleagues and former classmates and the like -- including, in my case, a sibling on faculty there.  What a mess the state has made of a formerly great system, but at least there is enough left in it to rebuild, if the state settles down and the taxpayers see the need.)


    The city of St. Louis is requiring (none / 0) (#22)
    by MO Blue on Fri Dec 11, 2009 at 04:14:46 PM EST
    employees take a one week unpaid furlough. Management staff must take a two week unpaid furlough.

    Regarding the SEIU visiting the WH (none / 0) (#38)
    by norris morris on Sat Dec 12, 2009 at 09:10:47 PM EST
    The SEIU heads have visited the WHouse more than any other group. They donated over $600,000 to Obama's election campaign.

    We'll see what this Union gets.


    Surely (none / 0) (#4)
    by Salo on Fri Dec 11, 2009 at 11:15:46 AM EST
    Lieberman ought to be metaphorically shot. He's like Alberich the dwarf and is sabotaging everything the voters supported in 2008.  He's got to have a skeleton in the closet we can blackmail him with?

    Free associating on Versailles Pool Boy Ezra Klein (none / 0) (#5)
    by lambert on Fri Dec 11, 2009 at 11:20:06 AM EST
    The Netherlands makes me think of tulips. And tulips make me think of an old Sophie Tucker joke. Just saying.

    what's better than roses on my piano? (none / 0) (#9)
    by Dadler on Fri Dec 11, 2009 at 12:00:14 PM EST
    Tulips on my upright? (none / 0) (#10)
    by desertswine on Fri Dec 11, 2009 at 12:08:35 PM EST
    in the sophomoric version i know (none / 0) (#12)
    by Dadler on Fri Dec 11, 2009 at 12:19:16 PM EST
    it's an organ.

    Oh Nooooooooo... (none / 0) (#13)
    by desertswine on Fri Dec 11, 2009 at 12:23:18 PM EST
    Yes, and this being Versailles... (none / 0) (#23)
    by lambert on Fri Dec 11, 2009 at 05:45:22 PM EST
    ... whose?

    Of course, to people like ... (none / 0) (#19)
    by Robot Porter on Fri Dec 11, 2009 at 02:54:53 PM EST
    Klein the US probably does feel like the Netherlands.

    I'm frankly shocked that anyone takes someone of his age and experience seriously.

    He's still a child intellectually.  And he shows it every day.

    There's much more of the Nursery than the Ivory Tower in his clueless maundering.

    god you're such an arrogant person (none / 0) (#29)
    by Socraticsilence on Fri Dec 11, 2009 at 08:52:55 PM EST
    oh yeah no one young should be taken seriously- hey maybe we should just raise the voting age to 30.

    I don't know how old you are, (none / 0) (#30)
    by Anne on Fri Dec 11, 2009 at 09:39:05 PM EST
    but I have children - daughters - who are 23 and 26.

    Their life experience is such that while they have definite opinions about a lot of things, it's mostly an academic exercise; they aren't going to know how they really feel until they've lived more - not necessarily longer, just more.

    I didn't have kids until I was almost 30, so my opinions about parenthood and motherhood and all that stuff were not informed by actually having kids.  Heck, I didn't understand my own parents, really, until I was a parent myself.

    No one's saying Ezra isn't smart, or passionate about what he does; he just hasn't lived enough, experienced enough first-hand, to have more than an academic perspective on a lot of what he writes about.

    As for the voting age, if it were only young voters who weren't informed, raising the voting age might make sense, but you and I both know that being well-informed is not a function of age.


    When I was a kid, I asked ... (none / 0) (#32)
    by Robot Porter on Sat Dec 12, 2009 at 04:08:34 PM EST
    my Dad why kids can't vote.

    He said:  "Because they might elect someone like Nixon."



    in other words... (none / 0) (#28)
    by beowulf on Fri Dec 11, 2009 at 08:50:45 PM EST
    Insurers seem evil because of the marketplace in which they operate.

    "You see, a pimp's love is very different from that of a square."