Karl at the Hot Air Greenroom has put up a typically informative post (“ObamaCare: Burning down the House“) on the current confusing state of play regarding Obamacare. 2 bills? 3 bills? No bill? A new bill? House first? House not there yet? Try just to say you did? Before Easter? After Easter?
If it’s a new bill, what’s going to be in it? What are the Dems going to say is in it? The story keeps changing without any of the major details becoming much clearer.
Questions abound, uncertainty reigns, and no one knows nuthin’.
The simplest explanation for all of the Dem contradictions and maneuvers is that they cannot force a decision, on the current terms of the discussion, without suffering cataclysmic political setback. Everything they’re doing, despite the apparent political harm of keeping HCR alive rather than focusing on other business, could be aimed at waiting around for an unpredictable, unexpected opportune moment that could result from any of a number of factors separately or in combination – favorable drift in the opinion polls, a crack in the opposition, a rally around Plan C (whatever it turns out to be), even a national emergency that re-sets all political calculations and relieves them of the burden of decision.
Taken individually, such alternatives seem to range from uncertain to not very likely to desperate, but what other choices do they have? Temporizing, including through spaghetti-on-the-wall/see-what-sticks hyperactivity, in the hope that something changes is often the best option, if not necessarily a “good” option, when faced with an insoluble dilemma.
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MICHAEL HILTZIK
What do we need health insurers for anyway?
By Michael Hiltzik
February 28, 2010
Angela Braly can’t kid me.
When the chief executive of gargantuan health insurer WellPoint (parent of Blue Cross of California) went before a congressional subcommittee the other day, she displayed all the smile-through-the-tears pluck of Annie looking to a sunny tomorrow or Scarlett swearing to God she’ll never be hungry again.
WellPoint didn’t really want to jack up health premiums on its customers by as much as 39%, she said — it had no choice. “We care deeply about our California customers,” she said.
But what she was really telling the committee members was this: “Please put us out of our misery.”
Braly explained that her company’s premium increases on individual policies were based on several circumstances: One, people are getting older. Two, people are becoming unemployed, and if they’re healthy they’re dropping out of the insurance pool. Three, the cost of diagnostic testing is soaring.
Implicitly, she begged for the government to help — put people back to work so they’re eligible for cheaper group plans, and clamp down on costs. (Not even the government can stop people for growing older.) Without that help, she intimated, premiums are going to keep rising sharply and WellPoint’s already meager profits are going to be hammered worse.
In delivering this appeal, Braly was forced to make an implicit admission that her industry almost never makes explicitly: The nation’s health coverage system is so hopelessly broken that even the health insurance industry can’t handle it anymore.
Her testimony, and other statements she and other WellPoint executives have made, suggests that insurers can’t profitably manage through periods of high unemployment. They can’t price policies in a way that keeps healthy young people in the same pool as older people, producing a mockery of the very point of indemnity insurance. Despite a decade of unobstructed consolidation, which was sold to regulators as a way to control healthcare costs by creating mega-insurers like hers, her industry can’t control healthcare costs.
Braly’s words are a reminder of the most important unasked question in the entire healthcare debate: What do we need insurance companies for, anyway?
http://www.latimes.com/business/la-fi-hiltzik28-2010feb28,0,1011707.column
March 2nd, 2010 at 2:42 pm
Hilzik if you’ve followed Patterico’s site, or that of Hugh Hewitt, for any length of time, well he’s possibly not as bad as Dowd or Rich, but very much in the Krugman vein
March 2nd, 2010 at 2:51 pm
The current confusing state of play regarding Obamacare. “2 bills? 3 bills? No bill? A new bill? House first? House not there yet? Try just to say you did? Before Easter? After Easter?” is entirely intentional. As, if Republicans aren’t sure where the Democrat’s legislative thrust is going to come from, they’ll be less able to defend against it.
“Not even the government can stop people from growing older.”
Death panels are quite effective at keeping people from growing older; dozens of recent articles about the UK’s appalling single-payer system make that undeniable. And, when one of Canada’s provincial Governors recently opted out of his country’s medical system to avail himself of routine but life saving surgery in the US…its case closed!
“In delivering this appeal, Braly was forced to make an implicit admission that her industry almost never makes explicitly: The nation’s health coverage system is so hopelessly broken that even the health insurance industry can’t handle it anymore.”
No, what she was saying is that the nation’s health care system,as presently constructed by Congress is so damaged that the health insurance industry can’t handle it.
Tort reform, allowing insurance across both state lines and changing employers, and instituting the reforms that many doctors are calling for, would greatly enable the health insurance industry to regain its economic footing.
A Government funded, single-payer system is the only alternative to private insurers. That means one giant step forward into the socialist utopia that liberal, useful idiots like Hilzik dream of…
March 2nd, 2010 at 5:37 pm
@ Rex Caruthers:
We don’t have health insurance anymore – we have prepaid healthcare. Her testimony pretty much confirms that. If you have to guarentee payment for every little thing, it only becomes a matter of when the payment comes due.
March 3rd, 2010 at 5:36 am
Geoffrey Britain wrote:
It would? How?
March 3rd, 2010 at 6:27 am
A Government funded, single-payer system is the only alternative to private insurers.
I have no problem keeping the private system IF THEY STOP PRACTICING MEDICINE WITHOUT A LISCENSE. I understand that Government insurance does the same thing,but the Government issues the liscenses.
March 3rd, 2010 at 6:32 am
@ Tortz R Us:
Insurance will regain its footing when they are allowed to actually sell health insurance. Right now, that is pretty difficult.
Tort reform would be helpful in driving out cost and reducing utilization that is driven in part by defensive medicine practices.
March 3rd, 2010 at 6:43 am
Tort reform would be helpful in driving out cost and reducing utilization that is driven in part by defensive medicine practices.
So what’s the downside for being a lousy MD?
March 3rd, 2010 at 7:08 am
@ JEM:
I agree that it would reduce some cost. I don’t understand if it would make much of a difference overall. Would it?
March 3rd, 2010 at 7:12 am
Rex Caruthers wrote:
There isn’t one now. There is limited infomation on quality and outcomes, and tort attorneys are just interested in getting a pay day. State medical associations are terrible about thinning the ranks of bad doctors, more worried about protecting the doctor than portecting patients. And this is in a world of wild, wild west of torts.
If we could get a reasonable reform maybe everyone could stop being so defensive when something odd does happen instead of everyone hiding behind their lawyer. There are some studies which suggest doing tort reform would actually improve quality. I need to see more before I go that far, but I understand the concept behind the assertion.
March 3rd, 2010 at 7:57 am
Tortz R Us wrote:
The two areas it saves are in actual unit cost of medicine, which is marked up with the malpractice insurance rates in mind. I have read that malpractice insurance for delivering babies in Florida adds $2000 to the cost of having a kid.
The other is utilization savings where doctors would not be compelled to order so many additional tests in order to protect them against the potential lawsuit.
Tort savings are not as much as the underpayment providers receive from Medicare, which if corrected could save private insurers up to 15%. Most of what I have seen on tort reform is in the high single digits (%) of savings. Which still is a nice chunk fo savings. It would impact savings in certain procedures more than others. Neuro and OBGYN savings would be huge.
March 3rd, 2010 at 8:03 am
There are some studies which suggest doing tort reform would actually improve quality
LOL,Look I get my Info first hand because my Wife works as a Surgical assistant(RNFA-Registered Nurse First Assistant)and Surgical Malpractice is a daily event,mostly unreported,but Surgical errors cause huge spikes in medical expenses based on readmissions,infection rates etc,Tort Reform won’t weed out the bad apples that are in every OR in the nation.
March 3rd, 2010 at 8:24 am
No it won’t , and the current tort system isn’t doing it today, so if it is ineffective today, and we are paying for a system that doesn’t make a difference, why not change the system and at least save some money in the process. We will be no worse off. And then, keep pushing information transparency, and start refusing to pay for re-admits, and procedures necessary because someone goofed up, etc. I have no argument that more could be done. I am just arguing that tort lawyers are doing nothing to help – just driving up costs.
March 3rd, 2010 at 8:47 am
The comment on tort reform improving quality is because if they knew they weren’t going into a trial attorney lottery we might get better transparency on outcomes information – and what goes on in the operating suite – instead of all the hiding that happens now.
March 3rd, 2010 at 8:51 am
JEM wrote: The comment on tort reform improving quality is because if they knew they weren’t going into a trial attorney lottery we might get better transparency on outcomes information – and what goes on in the operating suite – instead of all the hiding that happens now.
How is it constitutional to legislate a prohibition for damages done to someone? What would be the process about bringing a specific act of malpractice into the light of day? Criminalize it? That might be cheaper.
March 3rd, 2010 at 9:06 am
I remain curious how such a small government strict constructionist as JEM would justify any federal action on tort reform – presuming he does in fact favor it. Why should the federal behemoth be involving itself in such matters? Why should even the states be acting in restraint of the freedom plaintiffs, lawyers, judges, and juries? Not a smartass question, I don’t think. I brought this up on the other thread – why doesn’t this kind of thing stink of cancerous progressivism?
Mitch McConnell was just on TV promising that the elections will be turned into a “national referendum” if the Dems use reconciliation to pass HCR. Is Mitch appealing to mob rule like all those cancers?
March 3rd, 2010 at 11:53 am
CK MacLeod wrote: I remain curious how such a small government strict constructionist as JEM would justify any federal action on tort
My thoughts exactly,
So Welcome JEM to the real world of people carrying around their contradictions.
March 3rd, 2010 at 12:12 pm
@ Rex Caruthers: (And CK)
I see no contradiction. Nice try. I was asked what I thought tort reform would do. I gave an answer.
As to govt intervention – the adjudication of contract disputes is a role of govt. We place all sorts of rules in how that adjudication process shall work and what penalties may be. Your comments suggest I am an anarchist, which I am not. I would expect better from both of you. This isn’t even difficult.
March 3rd, 2010 at 1:03 pm
Tort reform’s easy, NATIONALIZE LAWYERS!
Pay them all public defender salaries!
Simultaneously achieves two objectives; eliminates frivolous lawsuits brought by greedy lawyers working the system and, greatly reduces the number of lawyers in this country.
It’s a win-win!
And if SCOTUS rules it unconstitutional, I guarantee you, we can get a constitutional amendment!
March 3rd, 2010 at 1:57 pm
JEM wrote: @ Rex Caruthers: (And CK)
I see no contradiction.
Somebody has damaged me(at least in my opinion),and Mr. Anti-Statist JEM wants the Government to limit my options to make a fortune on my misfortune,COMMIE
Geoffrey Britain wrote: Tort reform’s easy, NATIONALIZE LAWYERS!
Pay them all public defender salaries!
Nationalize Doctors too,pay them RN salaries.
Nationalize CPAs,pay them Accountant $s
Nationalize MBAs,pay them BS/Administration $s
Now we’re getting somewhere. LOLOL
March 3rd, 2010 at 2:22 pm