Is the Obama Honeymoon Over?

[ulmont]

Tort Reform is a red herring. In the states that have enacted tort reform, it has made no difference to costs.

Interesting.  If you have a link I'd love to take a look.

For starters, McAllen, Texas, the second most expensive health-care market in the country, is in a state with a non-economic damage cap, the doctors admit that cap dropped lawsuits practically to zero, and yet their health care costs keep growing faster than anywhere else...
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

For second, unfortunately I can't get to the actual article:

In the 1980s and 1990s many states adopted tort reforms. It has been argued that these reforms have reduced the practice of defensive medicine arising from excess tort liability. We find that this does not appear to be true for a large and important class of cases–childbirth in the United States.

http://www.mitpressjournals.org/doi/abs/10.1162/qjec.2008.123.2.795

I concede that they say eliminating joint and several liability lowers costs, but note that they say non-economic damage caps increase them.

To shift a bit towards the anecdotal side, about 20 states have adopted non-economic damage caps, over 30 have abolished joint and several liability, and medical costs keep going up anyway (including here in Georgia, which has both).

[Admiral Yi]

Good read.  Thanks.

[crazy canuck]

Yeah it is pretty ridiculous.  We managed to create a system even more inefficient and expensive than socialized medicine.  We should get a medal or something.

"Socialized Medicine" is a bit of a misnomer.  Really the difference is that we have a single payor system rather then multiple payors.  This creates a lot of efficiencies as Doctors dont have to worry about who will be paying the bill and what restrictions may or may not apply to that.  It also allows the payor to have the bargaining power to keep costs down when negotiating the rate it will pay to the service providers.

Socialized Medicine makes it sound like the government controls other aspects of medical treatment such as who I can see, what treatment I can obtain etc.  In reality, from what I know of the US insurance system, there are far more restrictions placed on policy holders then anyone in Canada might have.

I can understand why there would be a big lobby against a single payor system.  It would create a lot of efficiencies that would put a large number of people out of work and it would restrain the fees that doctors could charge individual patients.  But I dont see any downside to the patients themselves.

[Hansmeister]

Yeah it is pretty ridiculous.  We managed to create a system even more inefficient and expensive than socialized medicine.  We should get a medal or something.

"Socialized Medicine" is a bit of a misnomer.  Really the difference is that we have a single payor system rather then multiple payors.  This creates a lot of efficiencies as Doctors dont have to worry about who will be paying the bill and what restrictions may or may not apply to that.  It also allows the payor to have the bargaining power to keep costs down when negotiating the rate it will pay to the service providers.

Socialized Medicine makes it sound like the government controls other aspects of medical treatment such as who I can see, what treatment I can obtain etc.  In reality, from what I know of the US insurance system, there are far more restrictions placed on policy holders then anyone in Canada might have.

I can understand why there would be a big lobby against a single payor system.  It would create a lot of efficiencies that would put a large number of people out of work and it would restrain the fees that doctors could charge individual patients.  But I dont see any downside to the patients themselves.

Yes, efficient like Medicare.   

Of course it is complete nonsense.  We know how single payer systems save money: they simply ration health care.  Expensive treatments are rationed by limiting supply, relusting in waiting lists several months long.  This is why prostate cancer has a 98 percent survival rate in the US but only a 49 percent rate in the UK.

50 percent of health care costs are consumed by 5 percent of the patients.  You simply fuck over the minority to cut costs and volia, you have your precious savings.  You also cut doctor's pay since the state then has a monopsony, creating a shortage of doctors.  You then just have to import your doctors from third world countries, fucking them over in the progress.  All medical innovation ceases as well, since the state monopoly prvents the development of new medicines and treatments.  These cost money to develop, and given the high rate of failure will only be undertaken if there is a chance of high profit margins.  So if you want to have all medical decision making capacity transferred to the gov't, want to cease all medical research, and want to create a health rationing systen that is predicated on the hope that enough people die while waiting to get treated to save money then the single payer system is for you, otherwise it is nonsense.

[Savonarola]

Back on the original topic; I found this political analysis piece in the Detroit Free Press:

Obama's attorneys sound like Bush's
In courtroom battles, administration adopts familiar rationales
BY MICHAEL DOYLE • MCCLATCHY NEWSPAPERS • June 21, 2009

WASHINGTON -- President Barack Obama is morphing into George W. Bush, as administration attorneys repeatedly adopt the executive-authority and national-security rationales that their Republican predecessors preferred.

In courtroom battles and freedom-of-information fights from Washington, D.C., to California, Obama's legal arguments repeatedly mirror Bush's:

• White House turf is to be protected.

• Secrets must be retained.

• Dire warnings are wielded as weapons.

"It's putting up a veritable wall around the White House, and it's so at odds with Obama's campaign commitment to more open government," said Anne Weismann, chief counsel for Citizens for Responsibility and Ethics in Washington, a legal watchdog group.

Some differences exist
The Obama administration released documents from the Council on Environmental Quality that the Bush administration sought to suppress. Some questions, such as access to White House visitor logs, remain a work in progress.

On policies that are at the heart of presidential power and prerogatives, however, this administration's legal arguments have blended into the other administration's.

"There is no question that there are cultures and mind-sets in agencies," Weismann acknowledged.

A courtroom clash Thursday illustrated how Obama has come to emulate Bush.

Weismann's organization sued last year to obtain the notes from an interview that the FBI conducted with then-Vice President Dick Cheney. The interview was part of an investigation into leaks concerning undercover CIA officer Valerie Plame, and the Bush administration fought the release of the notes.

"The records contain descriptions of confidential deliberations among top White House officials which are protected by the deliberative process and presidential communications privileges," Bush's Justice Department argued in an Oct. 10, 2008, legal brief.

Obama's Justice Department held the same line Thursday.

"The new leadership of the department supports those arguments," Justice Department attorney Jeffrey Smith told U.S. District Judge Emmet Sullivan during the oral argument. "The Department of Justice is an ongoing entity, and it is not normal for us to update cases simply because we have a new attorney general."

Perspectives change
Perspectives, of course, often change once candidates assume responsibility upon taking office.



As a candidate, for instance, Obama opposed the Defense of Marriage Act, which defines marriage as between a man and a woman. As president, however, he's following Bush's lead in defending in court the federal marriage law, which a California same-sex couple is challenging.

The law "reflects a cautiously limited response to society's still-evolving understanding of the institution of marriage," Assistant Attorney General Tony West declared in a legal filing June 11.

Legally speaking, every administration inherits lawsuits filed against its predecessor. The Solicitor General's Office, which represents the government in appeals, traditionally tries to hold a steady course.

Personnel, too, stick around. John Brennan, the CIA director's chief of staff during the Bush administration, is closely advising Obama as a senior National Security Council staffer.

Policy persists
Whatever the reasons, policy persists. The Bush White House sought to keep e-mails secret. The Obama White House has followed suit.

The Bush White House sought to keep visitor logs secret. The Obama White House, so far, takes the same view.

Similarly, the Bush administration objected to an American Civil Liberties Union request for access to documents that include photographs that reportedly show the abuse of foreign prisoners held by the U.S. military in Iraq and Afghanistan.

The Obama administration declared in April that it would release the photographs. Three weeks later, Obama reversed course.

The Free Press editorial board usually endorses Democrat candidates.  Judging by their well thought out editorial diatribes from the past 8 years saying that Obama's attorney's sound like Bush's is the equivalent of accusing them of slander, libel, gross abuse of power, treason and witchcraft.     

[Phillip V]

Good.

[crazy canuck]

Of course it is complete nonsense.  We know how single payer systems save money: they simply ration health care.

ignorance is bliss I suppose.

I have never once had my health care rationed.  It is this kind of idiotic rhetoric that makes your system so messed up.

[ulmont]

I have never once had my health care rationed.  It is this kind of idiotic rhetoric that makes your system so messed up.

I have.  First, you have to go to the primary care physician to get a referral to the specialist, then choose medicines from a particular list if you want them to be paid for, etc., etc.  HMOs suck; the public plan can't be any worse.

[grumbler]

I have never once had my health care rationed.  It is this kind of idiotic rhetoric that makes your system so messed up.

All health care is "rationed."  The question is whether or not to ration based on income.

No health care system can afford to simply hand out unlimited health care on demand.  Some health care systems have such a generous ration, though, that few even see the rationing.

[Ed Anger]

I can get all the prostrate exams I want.

[The Brain]

I can get all the prostrate exams I want.

What do those look for?

[Ed Anger]

I can get all the prostrate exams I want.

What do those look for?

The chick doctor just wants to stick her fingers in my ass.

[The Brain]

I can get all the prostrate exams I want.

What do those look for?

The chick doctor just wants to stick her fingers in my ass.

Does she do a prostate exam as well while she's down there?

[crazy canuck]

All health care is "rationed."  The question is whether or not to ration based on income.

No health care system can afford to simply hand out unlimited health care on demand.  Some health care systems have such a generous ration, though, that few even see the rationing.

You are correct but in systems like the one we have in Canada where the rationing process is not noticeable then comments like the one Hans made are at best misleading - which is really what I responding to.

[Berkut]

It isn't noticeable?

I've heard plenty of anecdotes at least about long wait times for health care - that is certainly "noticeable", isn't it?