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Matt Taibbi on health care reform

Matt Taibbi has written what to me looks like the definitive account of the health care reform process thus far. I can’t find a thing in it to argue with. The most frustrating thing about it is that I have a hard time seeing how it could have gone any differently. It’s not as though anyone can point to any one bad decision that would have made things go more easily — this is how our government works.

The one thing that really does disappoint me is that when campaigning for President, Barack Obama said he would break through the gridlock in Washington by going directly to the people and getting them to put pressure on Congress to enact important reforms. I’m not sure whether he’s to blame for not harnessing the public effectively, or the public is responsible for not answering when he called. But we’re now stuck with the same dysfunctional lawmaking process that we’ve had for as long as I can remember.

Not only are we stuck with a government that is incapable of effectiveness, but we are stuck with a populace that is unwilling to demand effectiveness. The most energized portion of the electorate is operating in a fever dream of paranoia and stupidity so deep that they are indistinguishable from followers of Lyndon LaRouche.

5 Comments

  1. Woah to the image accompanying that article. It took me a sec to realize that wasn’t blood spurting out of Kennedy’s brain. Looking forward to reading; thanks for the link.

  2. I don’t buy Taibbi’s conclusion (really more of an unsupported assertion), that single payer would save money because of eliminating profit as a motive. There are plenty of government agencies that pay out bonuses as part of compensation packages, sometimes followed by credible allegations of waste, fraud, and abuse (http://bit.ly/3aK2b). Similarly, a government monopoly (really, monopsony in this case) doesn’t necessarily eliminate spending on marketing. It just changes the nature of it (I would expect a lot of ad spending on programs to encourage healthy behavior for instance, a la the ONDCP).

    Without profit as a meaningful indicator of performance, you get Amtrak or the post office. Even good people in those systems are limited in the impact they can have because some of the information needed for rational decision making is missing, and political pressures keep inefficiencies in the system (for another illustration of that principle in play, observe how every round of BRAC in the DoD has had congressmen trying to keep bases open in their district that the DoD itself wanted to eliminate).

    One of the reasons there are so many inefficiencies in the system currently is that there already is a lack of real competition in most states. Every state has 2-3 large insurers and a high barrier to entry for anyone else attempting to offer a competing product.

    I think there are a number of other problems with Taibbi’s article, but that was the most glaring. Thanks for posting, though. It was worth the read.

  3. I think there’s plenty of room for disagreement about the ideology behind the article (not everybody is going to think single payer is the optimal health care system, although I’m surprised that anyone argues it wouldn’t be better than the status quo). But I think he nails it when it comes to analyzing why the reform process has fallen so far short of the goals espoused by the people promoting it — expanding health care coverage to everyone and lowering the rate at which health care costs are increasing.

  4. I too have been disappointed with Barack Obama’s lack of direct appeal to the public regarding health care (and few other issues)

    When he was running for office this was a man who toured the country non stop, speaking before record crowds to get people motivated.

    If health care is such an important issue (and I believe it is)he should be out doing stadium tours to get people fired up about this. Dodger stadium at 11:00 am. Qualcom Stadium at 2:00. Candlestick Park at 5:00. It seems like a no brainer to me.

    Matt Haughey wrote a terrific piece ( http://a.wholelottanothing.org/2009/08/the-entrepreneurial-case-for-national-healthcare.html )on the stifling impact health care is having on the economy. Many might leave their current job to start their own company if they could be certain they would be covered on some kind of health insurance.

    How is that one of the best speech makers does not seem to be able to articulate how important this really is? The republicans have succeeded in dumbing down the argument to a grade school level and the only the thing the democrats seem to be able to do is respond to silly allegations like death panels.

  5. I think the public would help Obama if Obama the President were acting anything like Obama the candidate. I hardly even recognize the man. Of course, maybe that’s what happens when you move from feel good ideas with little detail to actual implementation.

    While I agree that health insurance companies are a huge problem with health care, I don’t see more government as the solution. In fact, I will stand up and say that a single payer system WILL be far worse than our current system. My father-in-law has to deal with the VA health system, mother-in-law deals with Tricare. Neither of those give me warm fuzzies about the government’s ability to provide quality or timely health care. Medicare is and has always been over budget and unsustainable. It’s a pain to find doctors to take Medicaid patients in many parts of the country.

    The projected debt in 10 years is $23+ trillion! And yet, somehow the government is magically going to be able to take over 20% of the economy and run it efficiently and fairly. I doubt it.

    I agree the status quo is unacceptable, but that’s about it. What’s really lost in this discussion is the difference between when insurance pays for treatment and what an uninsured patient pays. Why don’t we start with requiring all doctors accept the same payment for the same services? I don’t know about you, but I could swing $75 for getting a mole removed and another $25 for the lab to analyze it (which is what the copay+insurance equals). I can’t swing $600 that the doc and the lab would charge me as a private paying patient.

    Let’s talk about tort reform and medical malpractice which is driving many specialty docs (namely OBs) out of rural areas where volume isn’t enough to support costly malpractice insurance, or the amount wasted on defensive medicine that are only there to CYA in case of a lawsuit.

    Let’s talk about Certificate of Need laws in 36 states which only serve to restrict supply and prevent new competitors from entering geographic markets.

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