Friday, September 11, 2009

About Obama and Health Care

President Obama's speech on health care (full text here) was not a big surprise - lots of smoke and mirrors on costs, a perfunctory attempt to bring a couple of Republicans on board with a vague promise on tort reform, some posturing, and (pardon the profanity, and expect more) a big hearty fuck-you to young people.

"Now, even if we provide these affordable options, there may be those -- especially the young and the healthy -- who still want to take the risk and go without coverage... The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for these people's expensive emergency room visits."


The young and the healthy cost us money? This is patent fucking bullshit of jaw-dropping proportions. Obama is demonstrably ignorant about basic economics ("profits and earnings ratios"?!), but even he does not believe such tripe. Here's a neat chart of health care costs broken out by age in several countries - and in the US those 75 and older use well over half of the spending. On average, the young and healthy uninsured simply do not pay for the unhealthy old. The government needs the cash and good actuarials of the young to push guaranteed issue and community rating on the insurance companies without bankrupting them promptly. Obama, of course, cannot say that, so he has to resort to a blatant lie, hoping enough of hoi polloi are economically challenged enough not only to not catch it, but also to tune out when the experts call him on it. Puke break.

"Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. And without competition, the price of insurance goes up and quality goes down. And it makes it easier for insurance companies to treat their customers badly -- by cherry-picking the healthiest individuals and trying to drop the sickest, by overcharging small businesses who have no leverage, and by jacking up rates.
Insurance executives don't do this because they're bad people; they do it because it's profitable."


In Alabama, that would be Blue Cross Blue Shield Alabama, which is a non-profit. Thus, they do not do it because it's profitable. They probably control the market because they do a good job and offer the best rates, and because regulation at the state level prevents others from selling insurance there. Care to try again? Puke break.

"...we've estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse."


As Arnold Kling noted: "And if we don't pass this plan, does he intend to keep the waste and inefficiency, out of spite?" How about first eliminate the abuse and waste, show us the bundle of money saved, and then propose ways to spend it? To propose to pay for a new health care program by making a fucked-up older one run as it should does not exactly inspire high trust in your ability to run health care programs... or any other programs. Departments of Energy and Education... Social Security... Medicare... For Christ's sake, "cash-for-clunkers" has pushed some dealers to the brink of insolvency as they wait for reimbursements. And these people want to run health care. Puke break.

"Now, much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers."


Customers, eh? I suppose you can call us (I am one of those young, healthy uninsured - the irresponsible prick, you know, who has used $0.00 of health care in the last 10 years) that, much like someone arrested for public intoxication is a "customer" of the county jail. Puke break.

"Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. (Applause.) So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. (Applause.) I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today. (Applause.)"


Oh, my, what a staunch commitment! It's already a couple of days past, and I have not heard Sebelius' plans to test the blindingly obvious - that $200K/year malpractice insurance premiums increase the cost of care (through defensive medicine) and drive physicians out of business. Puke break.

"For some of Ted Kennedy's critics, his brand of liberalism represented an affront to American liberty. In their minds, his passion for universal health care was nothing more than a passion for big government. "


Damn right it was. Extended puke break.

"But those of us who knew Teddy and worked with him here -- people of both parties -- know that what drove him was something more. His friend Orrin Hatch -- he knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient's Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities."


Sheesh, those right there might be a good part of any thinking person's reason to despise the Republicans too. The cream of the douchebag cream. Major puke break.

"That large-heartedness -- that concern and regard for the plight of others -- is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise."


And, if the helping hand is not extended, we will have the government twist it, and, if necessary, rip it off? It's not easy to puke and curse at the same time.

"You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom."


This almost makes sense, but is, of course, unadulterated bullshit. Our predecessors understood more than that. They understood that the government could not, and should not solve MOST problems. Puke break badly needed, but postponed in expectation of the coup de grace.

"But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter -- that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves."


Those same predecessors also crafted a Constitution, which enumerates what the government MAY do, not what it MAY NOT do. It has no exceptions for carefully crafted and beneficial measures or for people in need. The government has no monopoly on facts or reason; moreover, most of the time it has neither. Reagan put it best: "The best minds are not in government, if any were, business would hire them away." And civil conversation necessitates the right of all parties to turn around and walk away without being robbed. Nothing left to puke... just a mixture of disbelief, bitter anger, and sadness.

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