Strong opinions, weakly held

This week in health care reform

I really want health care reform to be enacted, so I’m going to keep talking about it.

Last week Whole Foods CEO John Mackey wrote an inflammatory op-ed about health care reform for the Wall Street Journal. He’s posted the unedited version on his own blog, and notes that he didn’t come up with the headline that appeared in the paper. Starting out with a quote warning of the dangers of socialism from Margaret Thatcher, who never tried to dismantle Britain’s completely socialized health care system, was his own choice. Radley Balko says it’s dumb to boycott Whole Foods even if you’re irritated by Mackey’s op-ed.

Speaking of op-eds, Barack Obama laid out his case for reform in the New York Times. It’s a written version of the opening comments he’s been making at town halls for the past week.

Nate Silver says the public option is probably dead. For people who aren’t obsessed with the health care debate, the public option is the proposed government-run insurance company that individuals would be able to use if they prefer it to any of the options offered by private insurance companies. Silver explains why the public option is probably dead and what it means — it’s a must-read piece.

Republicans keep making the point that what we really need is easing of regulations that prohibit health insurance companies from operating across state lines. For example, here’s what John Mackey says:

Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that health insurance wherever we live. Health insurance should be portable everywhere.

Anyone seen any data driven analysis that predicts what the effects of this would be? I’ve seen a lot of reference to it, and it seems to make sense, but I’ve only seen the assertion that this would be good and that it would make a significant difference, not any arguments that bear it out. I still haven’t seen any arguments from the anti-reform camp that deal with the adverse selection issue.

Tyler Cowen says that our health care debate in the US is going to make it more difficult for the UK to improve its health care system.

Update: Here’s a very simple flow chart that lays out how the reform plan is intended to work. Pass it around.


  1. If we repealed all laws prohibiting health insurance companies from competing across state lines, I wonder if that would really lead to more competition? Or would it just lead to further consolidation and even more lessening of consumer choice? The consumer in this case being the employer, of course, since employees don’t often get to choose unless you count “super-expensive unpredictable private insurance” as a choice.

  2. One thing I’d love to see happen is to remove the Certificate of Need process that 36 states still use. As a Wake county resident, it’s very easy to see that CoN is just used to reward the establishment and prevent new entries into the market. It’s really a joke to watch providers fight over 40 hospital beds in a county that has grown by 250,000 people over the past 8 years.

    I’d also love to know why Obama never proposed cutting the $136 million/day waste that exists in Medicare/aid when he was a Senator. If it exists today, why not cut it today? I doubt there would be any opposition to that bill.

  3. I read something the other day that really illustrated how much better Obama understands the health care issue than he did when he started campaigning for President. (It was about an SEIU forum that focused solely on health care and how badly Obama did.) Obama was not a health care expert when he started out, but seems to have become one in service to getting elected President.

  4. A large portion of the waste in Medicare is Medicare Advantage, which pays a 17% subsidy to private insurers to provide the same services that Medicare itself provides. That amounts to perhaps $10 or $20 billion a year in itself.

    Given that Bush passed the damn thing in the first place, a bill to repeal it would have been useless while he was still President. On top of which the same group of industry-aligned Senators that are currently standing in the way of reform now would’ve definitely opposed it. So yes, there would’ve been opposition to that bill.

  5. Look, I do not mind paying for health insurance. In fact, I feel that those who can afford to pay, should. The problem I have is that it is just too freaking expensive. Health care costs for self-employed, unemployed and small business are freaking expensive. It’s very very difficult to pay a mortgage and health insurance or pay for rent and health insurance.

    For instance, I was recently laid off and I chose to participate in my company’s COBRA plan, which is a shockingly high amount of $2100/month. This is ridiculous! Even with the Federal COBRA subsidy of 65% I am paying $721/mo for my family of three. This is still too much! Sadly, this is a better deal than buying private insurance.

    This is what needs to be fixed. I don’t care who gets my money, I just want it to be more affordable and not some stripped-down, no-prescriptions, high deductible, bullshit piece-of-shit plan that many people are being forced to buy because they have no other choice.

    And don’t even get me started on the pre-existing conditions bullshit. That’s just fucking evilness from the profit-maximizing insurance companies who can’t get their heads out of their asses long enough to realize that “health insurance provider does not equal health care provider”.

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