Obama speaks... does Languish listen?

[The Minsky Moment]

BS. The product is no more complex than air travel. I cannot explain how an airplane flies, or design my own, but I can certainly price shop for the best service and cost for a airplane trip. Can I do that for my health care? Not at all - in fact, I don't even know what a routine test costs.

I don't need to know anyhing to know about how MRIs work to make an informed decision about which one I want to purchase, if in fact I was allowed to make such a decision.

Assume that airplane are prone to crash considerably more frequently than they do today.  Assume further that it is theoretical possibly to determine with some accuracy (but far from total precision) the rough probability of a given plane crashing beforehand, and also that is possible to determine with some (but far less than 100%) accuracy the affect certain interventions on the probability of crash.  But further assume that doing these calculatutions is very complex and requires expertise, and that all the people who have such expertise are employed by airline companies.

What you would get in free competition is competing claims about safety, but with consumers having no way to assess the validity of those claims.  And because of the dire consequences of getting it wrong - there would be a tendency to be safe and get gold-plated service even if not really necessary.

Hell, you don't see anyone saying we can't possibly let people shop for lawyers services, because it is just too complicated for people to possibly understand.

Lawyer advertising is strictly regulated in most states for that reason.  it is definitely a problem in the professsion and some clients get ill-served as a consequence of their inability to accurately assess lawyer skill and honesty ex ante.  Fortunately, this problem rarely results in death or serious bodily injury, just an exorbitant bill and poor case results.

[garbon]

You just have to trust the doctor has your best interests at heart when making recomendations...

That seems like a very foolish thing to do.

[Valmy]

That seems like a very foolish thing to do.

Indeed which is why you need to have alot of expertise yourself in order to know whether or not you are getting good service for your money.

[garbon]

Indeed which is why you need to have alot of expertise yourself in order to know whether or not you are getting good service for your money.

Triple bid.

[crazy canuck]

From the little bits I am picking up about the American health care debate it appears the quality of the discussion has been reduced to the level of saying Obama is worse then hitler. 

Only 1936 Hitler.

Not sure why you are rolling your eyes.  The CBC ran a story yesterday in which they played tape of a person saying she opposed the health care reforms because the "death committees" proposed by Obama are worse then what hitler did.

I thought the level of debate in Canada was low.  At least I have American experience to reassure myself that we are not the worst on the planet when it comes to political discussion.

[Valmy]

Not sure why you are rolling your eyes.  The CBC ran a story yesterday in which they played tape of a person saying she opposed the health care reforms because the "death committees" proposed by Obama are worse then what hitler did.

I thought the level of debate in Canada was low.  At least I have American experience to reassure myself that we are not the worst on the planet when it comes to political discussion.

We once called Presidents Monarchists, Dictators, and Soft on Communism...now we tend to label them all Worse Than Hitler.  It makes me intrigued to see if we come up with something else in the future.

[jimmy olsen]

OBAMA: "The reforms I'm proposing would not apply to those who are here illegally." One congressman, South Carolina Republican Joe Wilson, shouted "You lie!" from his seat in the House chamber when Obama made this assertion. Wilson later apologized.

THE FACTS: The facts back up Obama.

hans did you actually read this stuff before posting.   

As I understand it Illegals are barred from getting covered, however recipients aren't required to offer verification that they are legal residents. So in practice they will be getting covered.

[Valmy]

As I understand it Illegals are barred from getting covered, however recipients aren't required to offer verification that they are legal residents. So in practice they will be getting covered.

How can details like that be available before the final bill is even written?

[Berkut]

BS. The product is no more complex than air travel. I cannot explain how an airplane flies, or design my own, but I can certainly price shop for the best service and cost for a airplane trip. Can I do that for my health care? Not at all - in fact, I don't even know what a routine test costs.

I don't need to know anyhing to know about how MRIs work to make an informed decision about which one I want to purchase, if in fact I was allowed to make such a decision.

Assume that airplane are prone to crash considerably more frequently than they do today.  Assume further that it is theoretical possibly to determine with some accuracy (but far from total precision) the rough probability of a given plane crashing beforehand, and also that is possible to determine with some (but far less than 100%) accuracy the affect certain interventions on the probability of crash.  But further assume that doing these calculatutions is very complex and requires expertise, and that all the people who have such expertise are employed by airline companies.

Why would I make all these assumptions?

Are you saying that the current system solves these problems somehow - that NOT being able to shop for services means that we somehow magically get the best possible service in all cases, from a price/quality ratio? Or even that we get decent service at a decent price? Or that we never get adverse results, like terrible service at a terrible price?

Why would I assume that all the people capable of making these evaluations work for the airline industry - certainly if in fact I was allowed to make decisions on health care based on cost and service, I could employ people to help me make those decisions who are not.

The point is that right now we have a system that hides all these things - not because we don't trust consumers to make good decisions (that is true for everything anyway - and making bad decisions costs people money all the time), but because the system we have is so fucked up when it comes to pricing health services that it is better for people to just be ignorant about what the myriad of tests they get costs, at least from the perspective of the people charging for the services.

What you would get in free competition is competing claims about safety, but with consumers having no way to assess the validity of those claims.  And because of the dire consequences of getting it wrong - there would be a tendency to be safe and get gold-plated service even if not really necessary.

Hell, you don't see anyone saying we can't possibly let people shop for lawyers services, because it is just too complicated for people to possibly understand.

Lawyer advertising is strictly regulated in most states for that reason.  it is definitely a problem in the professsion and some clients get ill-served as a consequence of their inability to accurately assess lawyer skill and honesty ex ante.  Fortunately, this problem rarely results in death or serious bodily injury, just an exorbitant bill and poor case results.

No reason that medical advertising can be regulated as well. Saying that the pricing model used now is broken isn't an argument for some kind of uber libertarian no regulation alternative.

There is no getting around the facts here - health care costs in America have risen at rates that are simply not economically possible under any kind of basic free market system. The pricing is broken, and it is pretty obvious why - there are no pressures on prices to go anywhere but up.

[Kleves]

How can details like that be available before the final bill is even written?

Tim knows things.





You know, anime things. He's probably wrong about the bill.

[Malthus]

We once called Presidents Monarchists, Dictators, and Soft on Communism...now we tend to label them all Worse Than Hitler.  It makes me intrigued to see if we come up with something else in the future.

"Why, politico X is so bad ... he's worse than Obama!"

[Valmy]

"Why, politico X is so bad ... he's worse than Obama!"

Now THAT would just be going too far.

Seriously though I think every President prior to WWI was portrayed as being a Monarchist at some point.

[The Minsky Moment]

As I understand it Illegals are barred from getting covered, however recipients aren't required to offer verification that they are legal residents. So in practice they will be getting covered.

As I understand it, the issue is that the Congressional dems fought back an attempt to impose specific verification systems - including SAVE - whose realiability and accuracy have been repeatedly questioned by the IGs and the GAO.

It is OK for the GOP to argue that even a flawed verification system is better than none (although those adversely affected may beg to differ). 

What is not OK is to argue that a decision to reject a flawed verification system amounts to a positive grant of benefits.  In fact, the proper way to describe that position would be "lie"

[Sheilbh]

The GOP is not some monolithic bloc that will all vote en masse. They have their moderates who are reasonable as well.

The problem politically is that two of the moderates who are negotiating with Blue Dogs, in the gang of six, have actually said that even if they got everything they wanted they wouldn't vote for the Bill if the GOP didn't.  I think that's because the base is very angry and a number of them, such as Grassley, fear a primary challenge.

As an example Bob Bennett of Utah and Rob Wyden of Oregon worked together to produce a bill called the 'Healthy Americans Act'.  Now it's more right-wing but it's the nearest thing to a genuine Republican plan that would achieve what the Democrats want: universal coverage.  It's got a few GOP co-sponsors, though it's been suggested that many of them wouldn't actually vote for it and some left-wing Democrats wouldn't vote for it.

Anyway this is a genuine, moderate, bipartisan bill, albeit one with limited support.  The problem is Bob Bennett's facing a primary challenge and his leading opponent the Attorney General of Utah has attacked it vociferously and has recently picked up support because  the Club for Growth - a very mainstream Republican organisation - is running a campaign against Bennett for advocating a 'government takeover' of healthcare. 

Now that's just untrue but I think it reflects a genuine anger in the base and threatens moderates.  I don't know that most of the Republican party hasn't just decided that killing this bill is safer than being threatened as supporting 'a government takeover'.  Now I think around 45% of Republicans in a recent poll believed in death panels.  If you're facing a primary would you want to have voted for a bill, no matter how much you've actually negotiated and how much you've changed it, that leads to death panels.

Negotiations need two parties operating in good faith.  I think the Gang of Six doesn't seem likely to work because one side has said they may not support a bill, even if they get everything they want.  If you're a GOP Senator with an election coming up and you want to work on healthcare you may decide it's safer to just give it a miss rather than face the sort of attacks and distortions that, for example, Bennett's now facing.

Having said that I do think there are a few GOP Senators who could feel able to negotiate in good faith.  Olympia Snowe is - she's the one who wants a trigger for a public option.  I think the Senators from Maine could do it, maybe Orrin Hatch too, though I'm not sure about that.

This is the rough outline of Bennett-Wyden bill:

The general premise of the Bennett-Wyden bill is that employers would get out of the business of choosing their health insurance plans. Instead, employers would give employees the amount they had previously paid for health insurance so they could choose whatever health insurance plan they wanted.

Insurers would not be allowed to preclude people from buying insurance based on pre-existing coverage. All insurance plans would be required to meet the same standards as the coverage for federal employees.

Employers who don't provide money for health insurance would be required to make payments to the government to help subsidize those who can't afford health insurance plans on their own.

Which a mainstream Republican group considers 'a government takeover'.  There's also a proposal written by the Bipartisan Policy Center (http://www.bipartisanpolicy.org/about) which is basically a draft bill.  Again this isn't something Republicans have taken up as a decent end-result from potential negotiations.




To all that I'd add that I'm not entirely convinced Raz is wrong about the Blue Dog-Civil Rights thing.  My understanding is that bipartisanship in the 20th century was largely a product of parties not actually being that coherent.  They were made up of a number of different groups.  Republicans had conservative Westerners and paternalist North-Easterners, while the Democrats had both Dixiecrats and white ethnic Northerners (this is very much a simplification).  So what happened, most especially in the 60s with Civil Rights and the Great Society, was that votes were more often divided on geographical lines than party lines.  I think with Bill Buckley and his renaissance of conservatism you see the start of the two parties becoming ideologically coherent groups, rather than trans-national coalitions.  Whether that's a good or bad thing, I'm not sure, but I think that's the reason why bipartisanship has generally declined from the 1960s.  There are less North-Eastern Republicans and less Southern Democrats.

It could be the first symptom of America becoming more parliamentary - which was something I worried about a lot in the Bush years.  I hope it's not the case though.

[Ideologue]

More like original Come Dancing but with all genres.

http://en.wikipedia.org/wiki/So_You_Think_You_Can_Dance_(disambiguation)

Now I understand why you shave your armpits

There is nothing wrong with that.