Sep
30
Yesterday in the Senate Finance Committee, the public option was rejected not once but twice with some significant no votes from Democrats. The first of the amendments (the Obama option) had five of thirteen Democrats voting against it.
David Frum in response makes an interesting suggestion. Now might be the time for Republicans to jump aboard:
Until now, the threat of a government-run healthcare plan has deterred Republicans from negotiations with the administration. They were (reasonably) afraid of being mousetrapped into a philosophically unacceptable deal. But if the single most threatening element of such a deal has been voted down by Democrats, the field looks different. Instead of worrying about worst-case scenarios, Republicans now can begin to think: are there things we want? Might we successfully wedge centrist Democrats away from the Chuck Schumers?
Obama, Pelosi and the Democrats have too much political capital invested in healthcare reform, they have to pass something no matter how watered down, especially with their majorities. But at the same time, the Democrats, in particular the moderates and blue-dogs, will want some Republican cover on the bill. Wholly owning the reform could be potentially disastrous for the Democrats in 2010.
But it poses problems for the GOP too. If they oppose healthcare reform en masse, but it proves to be popular in the long run, they will always painted as the party of “no”. But there is an opportunity here to turn what is most likely inevitable healthcare reform into something much more palatable. For example, they could temper the mandated coverage into “catastrophic” rather than general coverage. They could get some form of tort reform and they could explore ways to make reform less costly for the country in the long run. And Frum’s suggestion of using engagement by the GOP to create a wedge between moderate and progressive Democrats has benefits too. The more GOP-ised healthcare reform becomes, the less the liberal Democrats will like it. Negotiated successfully, it may well happen that the progressives will find any bill unpalatable and they may well become the ones viewed as being obstructionist.
Comments
49 Responses to “Is It Time For Republicans To Jump On Board Healthcare Reform?”
Leave a Reply
Well the Republicans are increasingly out of step with public opinion inc the public option
According to a CBS Poll
http://www.cbsnews.com/stories/2009/06/19/opinion/polls/main5098517.shtml
“A clear majority of Americans — 72 percent — support a government-sponsored health care plan to compete with private insurers, a new CBS News/New York Times poll finds. Most also think the government would do a better job than private industry at keeping down costs and believe that the government should guarantee health care for all Americans. “
THX
Did you check the date on that poll? June 20th. A lot of water under the bridge since then.
Cabbie
Okay he is a CBS poll from last week”
65% Support A ‘Public Option As Part Of Health Care Reform
http://www.cbsnews.com/stories/2009/09/24/opinion/polls/main5337843.shtml?tag=cbsnewsSectionsArea;cbsnewsSectionsArea.2
“A lot of water under the bridge since then.”
No that much water but certainly a lot of shit has been thrown at the wall since than and looks like it isn’t sticking.
THX
More dodgy polls. It lists the percentage of Republicans as 22%, pollster.com has Republican support at 32% amongst registered voters. Very undersampled.
The government would do a better job of keeping expenses down? Based on their success with…the USPS? Oh. how about the existing government healthcare programs, remind me how they are going, cost-reduction-wise.
I should know better than to step in to anything to do with US health. Such rubbish talked by both sides. Right now this is a prime example of how not to reform a system.
Cabbie
More dodgy polls.
As Mike Smithson at PoliticalBetting is fond of quoting – a rogue poll is one you don’t agree with.
Rhoda
Who said that?
I agree, that government is a license to spend money badly. I’m arguing that the GOP getting involved might be a way to make some of the reforms less costly. For example by taking financial support for abortion out of the mix, by stopping Democrats tacking on lots of extra money for their supporters like ACORN and the Unions.
But something needs to be done. Obama’s reforms are wrong,but the current system is hardly a major success either. Personally, if I would want one reform, it would be to have insurance available across state lines.
If I were reforming it, I’d start with this sort of analysis..
What do we want to achieve?
How does this compare with what we’ve got now?
How much can we afford?
How do other people do it?
What sacred cows must we keep?
What nice-to-haves can we ditch?
..then formulate a plan, submit it to criticism, have someone in charge who can push the project, admit no pork, kill no golden-egg laying geese, present modified plan to Congress.
All the debate we’ve seen, and we can’t answer even question one with any degree of agreement. And agreement we must have. We don’t want to have to come back to this for decades.
Rhoda
That’s great in a political vacuum, but the partisan nature of american politics precludes that analysis. I agree that bth sides have handled this poorly. I’m really annoyed that the Republicans have vowed not too touch Medicare in terms of reform. The bloody thing is going bankrupt! How can people trust the GOP to be the party of fiscal responsibility when they’re prepared to prop up a fiscally irresponsible program for short term political gain?
This is my problem with the right in America at the moment. It’s all about political tactics with no vision for a better conservative tomorrow. There is a moment, right now, in which someone can step up, articulate a vision, and take a huge swathe of the American people with them. And no-one is stepping up.
Bobby Jindal talks sense on this issue:
http://www.politico.com/news/stories/0909/27729.html
Did he say it in a squeaky voice?
This is what commie healthcare did to a man in Ontario, Canada, the very same system Obama wants to duplicate:
http://www.freemarketcure.com:80/brainsurgery.php
Surely people realise that without competition things just fall to bits?
OT
“Surely people realise that without competition things just fall to bits?”
Everything falls to bits it’s called Entropy
So you will be in favour of the Public Option to compete with the insurance Co’s then?
THX
But that isn’t competition. It’s effectively a priviliged monopoly.
Cabbie
No the insurance Co’s have a monopoly now that’s why premiums keep sky rocketing and they can behave so badly to their customers.
I have an iphone I can only get it from O2 the tarrifs are crap and the customer service non existent, from next year Orange & Vodafone will be able to sell the phone too. Any money says that the O2 tarrifs will come down and they will start answering the customer services calls.
Businesses hate competition that’s why the insurance Co’s are bitching about the public option .
Is it your contention that the public option (whatever that turns out to be) will be in competition, level playing field, with the insurance companies? If so, it might work. Problem is, we don’t get told any detail, we are expected to judge undefined sound bites. This is the worst debate everrrrr.
THX
How can a number of different companies have a monopoly? However, in one way you are right, by restricting competition to only within a state, the free market is being diminished. Which is why it makes sense to follow Republican proposals and have cross state border competition. A public option cannot be competitive because they don’t have to be responsible to shareholders, can be propped up with governmnent money and don’t have to show a profit. And as a bureaucracy, are likely to be wildly inefficient, without the punitive element that would befall an inefficient private company.
..and they compete for investment money with aircraft carriers and govt subsidy to arts to produce propaganda, and so on.
Rhoda
Which is why they are a disruptive influence in the market. At all levels there conditions are out of sync with the conditions that private companies have to face. As a further example from The corner:
Make the competition in the private sector stronger, don’t throw government into the mix.
cabbie
So in this utopian free market with all the Co’s competing with each other why do premiums keep going up & cover going down?
Because it’s not a free market- An Economist David Kendall speaks
“With millions unemployed, and health care costs rising through the roof, and the only answer ever given to unemployment is ‘go back to school’, why are there still so few medical schools that 1/3 of our doctors are imported and Americans who want to be doctors frequently have to resort to joining the military in order to be trained? We should have a doctor on every corner, competing with each other.” [1]
The above quotation is an excerpt from a recent article regarding the economics of health care reform. My aim here is not to dispute those views but to expand upon them. The article cited above makes some key points regarding what economists call “perfect competition”, specifically “many buyers and sellers” and “freedom of entry and exit”. In addition to all the screaming and yelling about moral and ethical issues, if the American people would approach the health care debate from a truly “free-market” economic perspective, there probably wouldn’t be anything left to “debate”. According to the Office of Health Economics in London:
“An efficient free market requires producers to be operating under conditions of perfect competition. This requires a stringent set of conditions – perfect information, many buyers and sellers, a uniform product and freedom of entry and exit – which ensure that firms are price takers, producing for the lowest possible cost in the long run and only earning normal profits.” [2]
In health care, not only is the number of sellers deliberately and artificially restricted (manipulated), but the number of buyers is uncontrolled and virtually infinite. Moreover, the ever-increasing number of buyers have no “freedom of exit” from health care, as everyone is forced to engage at some point in their lives: “You can check out anytime you like, but you can never leave”, (Hotel California, The Eagles). These factors along with extreme asymmetry of information, the monopoly power of hospitals, and the inherently non-uniform (customized, personalized) nature of health care are clear violations of the “perfect competition” requirements of any “free market”.
In a free market economy, price is supposedly established through daily interactions between buyers and sellers. That is, neither buyers nor sellers have absolute control of price. But the market forces of supply and demand fail to establish either price or quantity for health care because demand is price-inelastic. In other words, sellers control the price absolutely and buyers have little or no choice but to engage.
Thus, health care professionals draw greater incomes by forcing more and more consumers out of the market while charging higher prices to those who are able and willing to pay. This is what economists refer to as “market failure”, because the market itself fails to establish price and quantity. Health care providers become price-makers, not price-takers, and health care consumers have little or no choice or voice in the matter.
These conditions characterize the inherently non-market nature of health care, and cannot be corrected through any sort of “market” reform. In fact, ‘market failure’ is the ‘pre-existing condition’ of the health care industry before insurance companies ever get involved. The inherent function of insurance corporations is merely to exploit the market failure of health care and to exacerbate it as much as possible in order to maximize shareholder value. By direct contrast, the function of government intervention could (and should) be to regulate price and to provide a guaranteed quantity of supply — primarily by flooding the health care industry with increased competition, i.e. a continuous supply of new doctors and other health care professionals.
However, since the Demand curve for health care is essentially vertical, it can never intersect with the Price axis at Quantity demanded = zero. Therefore, I think it’s a serious mistake to assume the measures outlined above could ever possibly convert health care to a free market commodity. Rather than implementing a mere “reform” agenda, it seems government intervention must eventually “replace” the existing dysfunction by 1) regulating the price of US health care 2) providing the greatest possible access to US health care education, and 3) providing guaranteed health care services to every US citizen. While single-payer doesn’t address all of these issues, it would certainly be the most genuine start in the right direction, especially in terms of removing the corruptive influence of insurance corporations.
In the meantime, the current health care reform debate doesn’t address any of these issues — and as usual, most of the American people are passive spectators, not active participants, in their own democratic system. More and more viable solutions keep getting swept “off the table” of discussion, as general interests and “special interests” are directly opposed. The American geniuses who understand this general principle find themselves at odds with the American boneheads who don’t. So instead of engaging in adult-level discussions about health care, we, the people, find ourselves standing in the streets with picket signs and automatic weapons, shouting obscenities at each other, like a bunch of developmentally disabled social rejects, trying to drown out any possibility of reason.
I certainly feel your pain, “America”. Thanks for calling. I do apologize for the inconvenience. May I place you on hold for a couple of centuries while I review your file?
Or as I said there nothing that big business hates more than competition
Or as I said there nothing that big business hates more than competition and there really isn’t any in the American healthcare insurance market or with my iphone
That’s why they are both expensive and the service crap.
THX
Interesting, but it doesn’t address some key variables. The reason why sellers are able to control the price, is because government regulates in-state insurance conditions. Insurance companies
have to provide coverage for certain conditions mandated by state government. That might be important things like breast cancer, but it is often less important matters supported by proffesional lobby groups like the anti-smoking lobby. There is no chance for a cheap and cheerful insurance company to enter the market, undercut prices and therefore drive prices down. Think what easyjet did to air travel. And as I keep saying (and which you keep ignoring), it is the cross state border reform which is key. If there is a good efficient and price-conscious provider of insurance in Montana which Montanans can benefit from, no one else in the country can, which is therefore no pressure on crappy inefficient and expensive insurance companies to improve their services and prices to compete with the successful Montanan upstart.
Rhoda
“..and they compete for investment money with aircraft carriers and govt subsidy to arts to produce propaganda, and so on”
True enough but the private sector in the USA has delivered a system that costs twice as much as ours but doesn’t provide twice as much benefit and manages to leave a significant minority out in the cold.
That can’t make sense either?
Cabbie
I agree with that but what is wrong with allowing a Government run scheme to compete too, if people don’t like they don’t have to use it.
THX
Because there is no way it can compete fairly. A large number of democrats, including Obama, have said that the public option is a trojan horse to a single payer system. For that very reason it should be opposed.
Cabbie
“Because there is no way it can compete fairly.”
Of course it can, and as the article from economist shows the present insurance system is inherently unfair.
“For that very reason it should be opposed.”
So you would rather see consumers ripped off and denied coverage for purity of ideology?
The GOP fought tooth and nail to stop formation of Medicare and then it’s extension and they are worried that once the general public got a taste of what a lower cost more consumer driven system looked like there would be no going back.
Cabbie
“Because there is no way it can compete fairly.”
for who Big insurance or the little guy?
THX
It is the Democrats propping up big insurance by over-regulating the market, preventing the little guys from bringing competition into the market. Regulation favours the big companies who can afford to accomodate the costs.
As for Medicare and medicaid. The reasons the GOP opposed them is that they are programs that are now bankrupting America becausev they aren’t self sufficient. Which is why I dislike the fact that the GOP have taken the position that Medicare is now untouchable.
Big government programs are too easily weighted down by special interest pork, by ever increasing responsibilities, by inefficient bureaucracies and endless government subsidies. Government just doesn’t run things well.
cabbie
“It is the Democrats propping up big insurance by over-regulating the market, preventing the little guys from bringing competition into the market.”
Now your having a laugh follow the campaign contribution money and you don’t understand the market it is structurally unfair to the consumer only Governments can tilt it back in favour of the consumer
Government just doesn’t run things well.
Well it put a man on the moon and say that to the troops in Iraq & Afghanistan or the FBI agents who just foiled a major AQ plot.
But the NHS took two years of tests to tell me I had terminal cancer, and then they were mistaken. In all that time I never saw an oncologist, still haven’t. So the government option isn’t perfect automatically, it requires constant work and a little competition. But the competition the NHS gets is from aircraft carriers, an unbelievable nuclear deterrent and tyranising native people in faraway lands.
Rhoda,
Ye Gad…
The NHS sounds like a complete horror show…they tell you you have terminal cancer, their prognosis is wrong and you never saw an oncologist? Well, if you were in the US, it would have taken less than 2-3 weeks to see 2-3 specialists and have surgery if needed…that’s the God’s truth.
I don’t want socialized medicine and your story is why. God help all of us.
My government is so completely fucked up now…I have lost all hope…in the meantime Obama is flying to Denmark to buy his Chicago cronies their Olympic pie in the sky…
thx
there are many big reasons why premiums are so high and excessive profits are not among them:
-mandates. you cannot buy insurance for basic medical care and a supplemental catastrophic policy in the U.S. states have imposed mandates the require that your policy (and everyone else’s) pay for a variety of things like personal trainers, hair replacement, in vitro fertilization and so on, ad infinitum.
http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2009.pdf
so the price is high for everyone.
– insurance companies cannot compete across state lines. the republicans tried to amend the present legislation to remove these barriers and it was voted down on a party line vote.
– tort law. there is an enormous amount of defensive medicine that drives up costs and therefore premiums.
if these things were fixed, prices would drop like a rock.
blaming excessive profits for this situation is just repeating mindless talking points.
do you notice that the government is responsible for all of these? the government breaks things and then says it must rescue people from a situation that they created by taking it over. and the sheeple follow.
THX
I do understand the market. I see a system in which businesses aren’t able to behave as they would do in other markets, and that market therefore being inaccurate. Loosen the regulation and the relationship between consumer and supplier can flow more freely.
Think about car insurance. You are able to choose any insurance company you want, any level of service you want and choose different price levels depending on what service you want. And because of this, anyone in the UK is able to buy car insurance (with possible exception of the yoof). Don’t have much money, then choose third party and don’t load your insurance up with courtesy cars, windscreen cover and choose a higher excess. If you’ve got plenty of money, then you can choose to load up your insurance with the services that make life easier. That’s how an insurance market should work. No-one really claims that the car insurance market systemically doesn’t work or that what we need to make it better is a government option. If you’re scottish, you’re not restricted to only buying insurance from scottish insurance companies, government doesn’t say that windscreen coverage is mandated which would drive up the price for all insurance buyers, and new companies like Churchill, Hastings Direct can challenge the big traditional insurance companies.
CC
You make a good point.
The Car Insurance example is exactly what the US healthcare insurer are trying to avoid.
The insurance Co’s hate car insurance because of the level of competition and transparency provided by the internet and price comparison sites, now 95P in £1 taken in premiums is paid out in claims. I would imagine that is not a ratio that US health insurance Co’s would relish
Also I’m not sure that your right people not wanting a Government option for car insurance, plenty of people suggest that basic third party insurance should be provided by the state from additional tax on RFL or fuel to cover all drivers because so many “yoof drivers forgo even the most basic cover due to cost.
AA
“Well, if you were in the US, it would have taken less than 2-3 weeks to see 2-3 specialists and have surgery if needed…that’s the God’s truth.”
Yes but without insurance which effects significant minorities you could bankrupt or have to sell your house to pay the bills.
We could of course have a better NHS in the UK, of course we could but the public has basically decided that we don’t want to pay more tax to pay for it .
We pay about 8% of GDP on health you pay 16% and yet you don’t twice as good outcomes as us & you manage to not cover significant numbers of your citizens.
Who is getting the better deal?
Rhoda
I hope you’re okay now!
thx
profit margins for healthcare insurers are the lowest of 86 industries studied at 3.3%.
http://seekingalpha.com/article/155858-health-insurance-industry-s-profit-margins-rank-86
what is the profit margin in the film industry?
http://www.lockergnome.com/swordofdestiny/2009/08/13/are-these-evil-for-profit-health-insurance-companies-really-so-evil/
claims of excessive profits are just part of the untrue demonization of a capitalistic industry, made up to hide the real reason for wanting government run health care—social justice.
shockwaver
Well It’s “net profit” which hides a multitude of sins and is that after the huge amounts pays in bribes to elected representatives ?
As for the film industry how would you feel about investing $200 million in a film with no idea if you were going to get your money back? Worried I imagine.
if you want a real example of abuse in our health care system, read this article by a breast cancer surgeon from california.
we have created an entitlement attitude nightmare in this country and the left wants to fix it by expanding entitlements.
http://www.americanthinker.com/2009/10/subsidized_health_care_a_view_1.html
thx
i would not invest 50 cents in the film industry.
THX, sure I’m OK. Never was very sick. Remember a couple of years ago the NHS told some guy he had pancreatic cancer, which kills in a year without exception, and he sold up his house and gear and effectively gave up, only to find they were wrong?
http://www.thisislondon.co.uk/news/article-23395267-patient-given-wrong-diagnosis-of-year-to-live-now-faces-bankruptcy.do%3Bjsessionid=B2C0B39CFB021C750EA4E56C4BDE6FB6
Well, the same thing happened to me, except I didn’t believe it and asked for more tests. The problem with my treatment wasn’t related to the NHS funding method, but just to poor methodology. Every test or scan or whatever was conducted serially. Wait for the results of A before deciding on B. When one hospital lost the results, the process stopped, until I went chasing up the delay. What I’d get out of it as a criticism is not that it was socialized, but the way it’s structured the patient doesn’t matter very much. What we need is the system used in France and other countries where the money goes with the patient. As I understand it the US current system doesn’t do that, nor does it provide a clear market because there are links between the insurance companies and the treatment providers which mean the patient does not get free choice. I suggest that would get worse under a public option, govt is going to tell you where to get the treatment, and you are stuck with it. If anybody actually laid out how it’s going to work, that would be a start. But right now there’s a debate going on where neither side knows the facts of what the option means. The debate is already lost, because it is now in the shouting but not listening phase. And America is the loser.
shockwaver
“i would not invest 50 cents in the film industry.”
How do you know you aren’t?
I bet your pension and insurance Co’s are investing in film Co’s especially as they are owned by the biggest Co’s in America, for instance Universal is owned by GE and Fox by News Corp who also own your beloved Faux news
have you never been to the movies, don’t you watch TeeVee?
Shockwaver
You had better not buy the Palin book as it’s published by Harper Collins who are owned by News Corp so who know’s 50 cents of your money might be invested in the evil Hollyweird film industry.
THX
Not true…we have a state sponsored hospital here…one of the biggest in the state where you can get some of the best of care…FREE. And believe me when I say many of the people who use their services would rather have a new car than pay for health insurance…Now who is smarter? Me…who pays for health insurance or the people who get their healthcare FREE.
What is it about the Economic illiterates such as THX that swarm into all discussions relating to market forces and economics with these long bloviating postings that demonstrate so much ignorance, failure to acknowledge any reality and offer solutions that have demonstratively failed in multiple realtime implementations. I think these lefty minds have turned into mush! I don’t know how or why but the evidence is everywhere.
westright
right on. they “feel” more than they “think”.
WestWright
Welcome.
I’m a total believer in free markets and have run small businesses competing in those markets foe most of my working life.
What do you do?
PS I wish I could write a post like that I cut n pasted from an economics website & I think it explains very well why the US healthcare insurance system does not run on free market principles
THX:
A very gracious response to a rather crude posting.
My compliments.
WestWright.
You have a point?