The health care mess

So many thoughts on so much and so little time to write the past couple days.  But I feel a need to get at least some of it down, so excuse in any semi-coherence.

1) I hate tonight’s headlines from the Post, Times, etc., e.g, “House approves Bill that allows policy renewals” or “House approves bill to let some keep their health plans.”  No, no, no!   Maybe not quite dishonest, but hugely misleading.  “House passes bill to fundamentally undermine Obamacare would be a way more accurate headline. The Republican Bill, which nearly 40 Democrats shamefully signed onto, does not just let people on crappy plans keep their crappy plans.  It lets insurance companies keep offering crappy plans to anybody who wants them.  Of course, all the stories just give us a pathetic, “he said, she said” but the simple fact is that letting the insurance company keep offering crappy plans wholly undermines the individual health care market reforms of Obamacare.

2) Both Drum and Chait have written great posts on the absurdity of Republican ideas for health care “reform.”  Drum:

The whole point of insurance is to pool risk because you don’t know what kind of problems you might have in the future…. When we sign up for employer coverage—by far the most popular kind of health coverage outside of Medicare—we all understand that we’re joining a risk pool. I’m paying for someone else’s maternity coverage. They’re paying for my blood pressure meds. We’re all paying for the possibility of some kind of catastrophic bout of cancer that we all dearly hope will be someone else’s problem. What’s more, we all understand that the benefits of employer health care are immensely unequal. A 50-year-old head of household receives benefits that are probably worth about $20,000 or so. A healthy 25-year-old single worker receives benefits worth about $4,000. Is that unfair? I wouldn’t say so, and Americans have voted with their feet for years in favor of this kind of system.

In any case, as Chait says, the most bizarre part of the current Republican screamfest is their objection to men being forced to pay for maternity coverage. Seriously? They think that the societal cost of carrying on the species should be borne solely by women aged 18-40? Young women should pay the full freight and the rest of us should give them a vote of thanks but otherwise tell them they’re on their own? That’s morally contemptuous, and I’m pretty sure that most of us understand that.

The aforementioned Chait:

Here is the basic ideological division. Obama wants the health-care system to do more to pool risk — which is to say, to shift the burden of covering the sick onto the healthy. Republicans want it to do less to pool risk, so that healthy people can be free of the burden of subsidizing the costs of those less medically fortunate…

The right’s dilemma grows more acute when you move from the general to the particular. Their argument is that Obama forces healthy people to pay higher premiums to pay for a bunch of crap they don’t want or need. Karl Rove argues in his Wall Street Journal column that Obamacare forces people to pay for “expensive and often unnecessary provisions.” And what provisions are these? Where is the medical equivalent of Bridge to Nowhere or scientific research on animals that Republicans love to mock? The problem turns out to be a requirement that “every policy offer a wide range of benefits including mental health and addiction treatment, and maternity care (even for single men or women past childbearing age), and cover 100% of the cost of an array of preventive services.”

This is a morally bizarre conception of what health insurance means. Most of us don’t need mental-health or addiction treatment. Some of us do. Some of us who don’t currently need mental-health treatment might potentially need it one day. You could have a system in which only people who need mental-health treatment pay for mental-health insurance, but then it wouldn’t be insurance anymore. It would be a system in which you pay for a doctor out of pocket.

3) The panic of Congressional Democrats is just pathetic.  You own this.  Voting for a Republican plan that totally undermines Obamacare will not save your skin.  What will save your skin is Obamacare working (which it surely will eventually if politics does not completely sabotage it).  As John Dickerson keeps saying– and he’s largely right– all that matters now is getting the exchanges working in time for people to sign up. Chait takes the panicky Democrats to task:

And here’s Representative Steve Cohen:

“They’re telling us all about actuarial tables and all about how the process would work and all of this is fine and great and it would be great in a classroom and you would get an A on your test, but this isn’t about getting an A on your test, this is about ads.”

Actuarial thisadministrative that … put a sock in it, professor! They want ACTION and they want it NOW!

Do these sound like people about to enact sensible policy changes that will leave the system more workable a year from now? Do they even sound like people able to sensibly assess their own political self-interest? Republican strategist Carl Forti, a former top National Republican Congressional Committee official, tells Politico he’s surprised even more Democrats haven’t already fled: “If I’m in Arkansas or Louisiana or North Carolina or Alaska, I’m running for the hills.” It’s possible, just possible, that the National Republican Congressional Committee does not have the best interests of the Democratic Party at heart.

Tomasky also says Democrats need to stop panicking and get serious:

Democrats—especially Obama, but all Democrats—have to take charge of the situation right now. In danger of losing the country’s trust, they must say in essence: “All right, we did screw up Round 1. We’re going to admit it, and we’re going to apologize, and we’re going to fix it, and we’re not going to bullshit you. But we’re also not going to panic. We’re going to make this thing work.”

If they do all those things, they will still come out looking a hell of a lot better than the radical obstructionists.

4) I’ve been wondering how in the world Obama could have thought this promise of “keeping your plan” wouldn’t backfire.  The answer is that if the exchanges were actually functioning the people having their plans canceled would be a much smaller story.  In many ways, this all hinges on the totally bungled roll-out of  At some level, that really is Obama’s fault.  I do think is is fair to question Obama’s management skills as president.  But that is another post.

Photo of the day

Amazing and depressing set of In Focus photos of the Philippines.

Ships lie next to destroyed houses after being swept ashore at the height of Typhoon Haiyan in Tacloban city, on November 14, 2013.(Ted Aljibe/AFP/Getty Images)

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