Dept. of Humanitarianism

[tim]

I am *so* *fucking* *tired* of what passes for health care debate that assumes the problem is any or all of:
1. rich people (i.e. people like you, the person reading this, and me, the person posting this on a taxpayer-sponsored computer) have to pay too much for health care
2. rich people spend too much on health care
3. other organizations spend too much on health care on behalf of rich people
4. rich people sometimes spend 3 months not having health care when they change jobs

The problem actually is:
5. poor people die of asthma attacks because they can't afford preventive care,

you idiots.

And no, (5) is not a direct consequence of (1) through (4), because the problem isn't that the pie isn't big enough for everybody, or that some people are bigger eaters than others; the problem is that most people find it convenient to throw extra pie in the trash rather than giving it to people who don't have any.

Comments

[etb]

0.5. the US is a unique flower that is absolutely and totally unlike all the other flowers

Statistics

[anemone.livejournal.com]

If we had the infant mortality rate of Sweden, there'd be 30 more children a day that would live. That adds up to about 10,000 children a year dying because we are doing a crummy job of giving health care to the poor.

But that's just a count of the dead babies. For every one of those children, there are certainly many more with non-lethal health conditions that would be significantly healthier if our country had more even access to care.

[asrabkin]

"The" problem? Certainly, 5 is "a" problem, but it is not the problem the president is telling the country he wants to solve, and it's not the problem the congress is attempting to solve. You can disagree with their priorities, but if you're worried about 5, you're having a health debate mostly with yourself.

[tim]

You can disagree with their priorities, but if you're worried about 5, you're having a health debate mostly with yourself.

Yes. Hence my characterization of people who aren't worried about 5.

[adularia]

I for one would be delighted to share my pie with those who don't have any (shut up, Beavis) but that is because I am what the industry refers to as a "consumer", or perhaps a "commie pinko socialist."

[asrabkin]

Yes, and your characterization -- "you idiots" -- is misleading. They're not idiots. They might be callous, or evil, but they're not stupid. Mostly, the country doesn't care that poor people have crummy health care. We have polling data on this. So the problems we're trying to solve are 1-4, not 5. This isn't an "assumption" -- it's a conscious decision.

[tim]

To stretch this painfully distended analogy even further, part of the problem is that even if most of us were theoretically willing to give up some of our pie, the cafeteria monitors would stop us from giving it to someone else who doesn't have any. So individuals giving up some pie won't fix the problem.

[tim]

Sufficient levels of evil are indistinguishable from stupidity, or maybe the other way around.

[asrabkin]

Mmm. I disagree with this, but I'm not sure there's a useful way to discuss it. I think this is fundamentally a question about definitions.

[etb]

If polling data actually determined the course of public policy, then—IIRC—the US would have no troops in Iraq and a full investigation of the Bush administration's torture system. Oh, and single-payer health insurance.

If it's a conscious decision, it's one that was made without debate.

And I don't see much point in arguing over Tim's choice of "idiots" vs. "assholes".

[asrabkin]

The poll you cite is from January. I believe the polls have shifted, sharply, since January. Famously, there's been a 20% rise in the fraction of adults who think their healthcare is "good" or "excellent" in the last six months. Plus, the deficit is now spooking people, and that makes people much more skittish about drastic increases in government obligation.

I was thinking of this poll: http://www.gallup.com/poll/121997/Americans-Healthcare-Reform-Top-Takeaways.aspx

You're saying "without debate." I'm sure this was debated inside the White House and in Congressional offices. I think they very consciously decided that "tax the many to benefit the poor" was a loser, politically.

[asrabkin]

Speaking of polls, one just came out today: http://firstread.msnbc.msn.com/archive/2009/08/18/2033674.aspx . Note that "adults" are about evenly divided, and that voters tend to be significantly to the right of "adults" -- particularly in midterm elections.

As to your observation about the public wanting a pullout from Iraq and investigations of the Bush administration: I don't think I said "the public always gets its way." I said "The Obama people don't want to have a debate about health care assistance for the poor, because they think it's a loser, politically." Politicians don't always cater to public opinion, but they sometimes do.

[rjmccall.livejournal.com]

To probe your painfully distended analogy, I'd like to point out that you can, in fact, pay other people's health care bills. The proper analogy here (and I believe I've stated this in unloaded terms) would be cafeteria monitors trying to ensure that everyone gets a slice of pie if they want it.

Also, I know you like hyperbole, but even people who are primarily focused on poverty issues should care about #4. Being unable to switch jobs out of fear of a coverage lapse is a major problem for a lot of people under or near the poverty line.

[etb]

Speaking of polls, one just came out today: ... . Note that "adults" are about evenly divided (on the "public option")

That poll also found 48% who thought that "a public option would reduce access to their choice of doctors, and would lower costs by limiting medical treatment options". They should also have asked "Does the public option include death panels?" (and/or "was President Obama born in the United States?") so we could discount the utterly gullible and clueless and be left with the merely seriously confused.

Do you really think a poll about a specific policy proposal, taken during a shameless disinformation campaign directed at that proposal, outweighs a vague one taken before the disinformation campaign began?

[tim]

Famously, there's been a 20% rise in the fraction of adults who think their healthcare is "good" or "excellent" in the last six months.

Yeah, like etb said, I don't see any evidence for attributing this to anything other than the disinformation campaign.

[tgies]

Frage: Welche Blume ist wie die USA?
Antwort: Ein Mondfische.

[asrabkin]

Oh, the former by far outweighs the latter. Politics is about specifics, and it's about specifics that you can defend in the face of opposition. You get no credit for having people agree with you, before they're paying attention, and before they've seen the arguments pro and con.

If a popular president, famed for his rhetorical skill, is unable to sell a program, that's a very bad sign. Given how unpopular the Republicans were at the start of the debate, it's a terrible reflection on both Obama and his program.

[asrabkin]

Why is the disinformation opposed to the program so much more effective than the disinformation in favor of it?

[tim]

If a popular president, famed for his rhetorical skill, is unable to sell a program, that's a very bad sign. Given how unpopular the Republicans were at the start of the debate, it's a terrible reflection on both Obama and his program.

Is this really all that surprising? People who are interested in keeping health care the way it is have a lot of money to spend on lying to people. I'm not sure how even Jesus Christ, having risen from the dead and been seated as president, could out-rhetoricize that kind of smear campaign.

[tim]

People under or near the poverty line generally have employers who are doing everything possible not to provide them with health care (working three "part-time" jobs is pretty typical; employers know how to hire part-timers for just few enough hours not to have to provide insurance). So really, people who already have health insurance are pretty low on my priority list.

[tim]

I don't know what "disinformation in favor of it" you're talking about, but in any case, the health insurance lobby has a hell of a lot higher ratio of (money to spend on disinformation)/(money to lose if the disinformation fails) than any group in favor of health care reform has.

[anemone.livejournal.com]

The disinformation in favor of it is predictable exaggeration. (It won't cost anything!) The disinformation opposed is outright lies that play on deep-seated fear-o-government shared by many Americans.

I don't think it's right to judge what people really want based on their reaction to recent ads.

[etb]

What disinformation in favor of Obama's program? Who's said anything remotely approaching the mendacious absurdity of the Republicans' screaming about "death panels" and "pulling the plug on Grandma" and "government takeover of health care"? (On the last one: sounds intriguing, but Obama's program bears no resemblance to it.)

[asrabkin]

Interestingly, huge volumes of corporate money are being spent in favor of the plan. And more has been spent supporting than opposing. Source: http://online.wsj.com/article/SB124865057962382365.html

[etb]

Let's say you proposed that Americans be able to buy insurance across state lines without restriction.

I (and my deep-pocketed socialist sugar daddies, or something like that) "explained" that you're going to force everyone to buy insurance from a state they don't live in, and that if they get sick, they'll have to go to the state where they bought the insurance to get treatment. I also "explained" that you want to kill everyone's grandmother. With rusty forks. Twice. So now people think you're a cad and a bounder, etc. But since you aren't completely unethical, you haven't responded in kind with your own Big Lies. What a terrible, awful reflection on you and your proposal!

[asrabkin]

The president famously said "this won't add to the deficit" -- and the nonpartisan CBO analysis showed that this wasn't remotely true. Likewise, the president has wildly exaggerated the cost savings from preventative medicine.

[asrabkin]

Let me see if I follow. "It'll cost a trillion dollars more than we claimed" is merely "predictable exaggeration", but "government price controls will reduce the supply of health care" is an "outright lie." Well then.

Likewise, I don't quite understand why "deep-seated fears" aren't an important part of people's real desires and opinions. If it's deep-seated, it's a genuine opinion.

[asrabkin]

See above -- the president has wildly underestimated how much this will cost.

[asrabkin]

The president has 60%+ approval ratings when this debate started, has a vast donor base and the support of large, well-heeled unions and advocacy groups. If he can't make this case in the face of opposition, that's a bad sign.

But in fact, one of the things that hurt him a lot is that the nonpartisan Congressional Budget Office reported that several of his claims just weren't true. Is the CBO part of the health insurance disinformation machine?

[anemone.livejournal.com]

Politicians always say "It won't cost much" when talking about programs. I'm not claiming it's honest, but it's hardly a surprise that a politician takes an incredibly rosy view of the cost. Bush played all sorts of games with this.

If the deep-seated fears were actually about real aspects of the health-care plan, the Republican ads would be totally valid. But they took the fear of the govt saying "no health care for you", and then falsely claim that the plan will do that. For example, claiming that it's single-payer-like when that's not on the table, or saying that a voluntary provision meant to help people make living wills is an attempt to euthanize the old and the sick is just wacky.

If the Republicans were arguing that this would drive us deeply in debt, placing an incredibly burden on future generations, be unsustainable expensive, etc, that's a fair debate point.

[etb]

one of the things that hurt him a lot is that the nonpartisan Congressional Budget Office reported that several of his claims just weren't true.

Which report(s) are you referring to?

[etb]

If you're talking about this report, I don't see how it supports your claims. That report says the net impact on the deficit over 10 years (i.e. added debt load) would be $239B. I'm very skeptical that some CBO report I haven't yet heard of has been a major part of the debate, but since only I know how much or how little I've been paying attention, there's no point in arguing about that. I'll just ask, again, for a direct citation of the CBO report(s) that support your claim.

[asrabkin]

http://cboblog.cbo.gov/?p=345 and http://cboblog.cbo.gov/?p=332 Both contradict claims made by the Administration.

[luinied]

There are still some poor people out there who've managed to hold on to a job with health insurance. And, from what I've seen, this does make switching jobs a pretty scary prospect, not just because of coverage lapses but because they know that they're lucky and that they probably won't be able to get any coverage at all if they leave their current job. (Of course, if it's a time like now, plenty of them end up losing those jobs and having to adapt to life without insurance anyway.)

[asrabkin]

See above for citations.

I think this does support my claims. I said "it'll cost a trillion dollars" -- which is what the CBO says. The $200B is what's paid for with borrowing; the rest is covered by a half-trillion dollars in increased taxes, plus price controls in Medicare spending.

[etb]

I said "it'll cost a trillion dollars"

Nope. You said "Let me see if I follow. 'It'll cost a trillion dollars more than we claimed' is merely 'predictable exaggeration'..." You were thus claiming that the proponents were saying that it would cost nothing (i.e. $0B instead of the CBO's $1,042B). Who has said that?

[etb]

For people who don't want to read the CBO report, I want to make several things clear:

1) the CBO numbers are over the 10 year period 2010-2019;
2) the CBO is not saying that the proposal would increase the deficit by $1,042B, but that the insurance coverage provisions alone will cost $1,042B over 10 years;
3) the cumulative increase in the deficit would be $239B, again, over 10 years, for an average of $23.9B.

I don't see fudging $80 per capita per year as remotely comparable to pull-the-plug-on-grandma shit-flinging. But you're free to explain how it is.

[asrabkin]

The president has said, many times, that his plan will not increase the deficit at all. $200B is rather significantly greater than zero.

Note that averaging the expense per year is misleading -- If I understand correctly, the plan has negligible expenses in the first few years, before the public option comes online. The average yearly cost, starting from year 11 and going forwards, will be much more than $20B per year.

[asrabkin]

The president has said that "health care reform is not going to add to that deficit; it's designed to lower it" (http://www.boston.com/news/politics/politicalintelligence/2009/07/obama_on_health.html)

[etb]

That doesn't back up your claim, which was, again, that the proponents claimed it would cost $0 instead of $1T.

[asrabkin]

You got me there -- I believe I've heard administration surrogates saying "this will save money, net". But I can't dig up a good reference in a few minutes of googling, so I'm falling back to "administration claimed this will reduce deficit, when it will actually increase it by 0.2T". Which is still an instance of disinformation by advocates of the plan.

The promotional material on whitehouse.gov is full of ambiguous references to "reducing costs", where it isn't quite clear if they mean "net costs to individuals", or "to society" or "to the government" or what. Which, again, isn't quite on point.

[etb]

The average yearly cost, starting from year 11 and going forwards, will be much more than $20B per year.

"Estimating the effects of major changes to the health care and health insurance systems over the next 10 years is very difficult and involves substantial uncertainty; generating longer-term estimates is even more challenging and is fraught with even greater uncertainty." —CBO

[etb]

The promotional material on whitehouse.gov is full of ambiguous references to "reducing costs"

You're accusing a politician of ambiguity? You'll have to step outside.

[asrabkin]

I don't dispute that -- there's a reason I'm not being quantitative. But it's still misleading to treat this program as having constant per-year costs, given that the most expensive parts only kick in late in the 10-year period.

[asrabkin]

Bah. I'm not phrasing myself clearly. That wasn't meant as a criticism of the white house. I was explaining why that's a non-example of "the president claiming the cost is $0".

[etb]

it's still misleading to treat this program as having constant per-year costs, given that the most expensive parts only kick in late in the 10-year period.

It also doesn't have constant per-year savings. In the CBO's projections, the program increases expenses by $187B for 2018, and by $202B for 2019—up $15B in one year! oh noes! But it reduces other outlays in 2019 by $50B, vs. $42B in 2019, and increases revenue by $86B in 2019 vs. $82B in 2018. So the yearly deficit only increases* by (202 - 50 - 86) - (187 - 42 - 82) = $3B. If we look at 2015 through 2019, it's not quite as low; the average deficit increase is $8.3B a year. [ETA: *I mean the deficit would be $62B higher in 2018 and $65B higher in 2019.]

I really don't understand how you can both accept that

"Estimating the effects of major changes to the health care and health insurance systems over the next 10 years is very difficult and involves substantial uncertainty..."

and also act like anyone with a deficit estimate that's more optimistic than the CBO's is peddling disinformation.

[asrabkin]

I don't believe the white house has released estimates; they've just released assertions, without any sign of a serious and dispassionate analysis.

[naath]

Oh, evil can *disguise* itself as stupidity; but successful evil people aren't stupid, if they were stupid their evil plans would always be foiled. These people know and *don't care*, which is much worse than not knowing (because that can be cured by wielding simple facts).

However I think there *are* many stupid people in the US health care debate, not the people running the show, but all the ordinary people who appear to be under the misapprehension that *they* will never be in the position of not being able to afford health care, they appear to have deluded themselves into thinking they are all mega-rich when actually many of them are not even close to well-off.