Health care– free market or cheap, not both

Terrific post from Ezra this week.  You know, I first discovered Ezra when I got into health care wonkery.  I do love how the current health care controversy is bringing so much good stuff out of him.  Anyway, another excellent piece on the inherent contradictions in Republican health care policy desires:

Republicans in particular, but Americans in general, are confounded by an unusual dynamic in health policy: The health care systems that spend the least rely on government the most. This is difficult for Americans to grok because anti-government rhetoric takes as a given that government services cost more — we’ve all heard the stories of Pentagon procurement gone awry, or some agency somewhere spending absurd sums on pencil trays.

But in health care, the cheapest, highest-performing systems all do the same thing — they let government set prices centrally. That’s true in the UK’s absurdly inexpensive, and fully socialized, health care system; but it’s also true in the Singaporean system, which conservatives often hold up as a model.

Hell, it’s even true in the American system! Medicare and Medicaid pay much less for health services than private insurers…

The other argument you hear is that setting prices means rationing care. In the most stringent systems, like the UK’s, there are worthwhile treatments the government simply refuses to cover, and so patients have to pay for them out-of-pocket. This is an unacceptable abrogation of freedom — we don’t need government telling us what treatments we can and can’t but.

This is true, but it’s less of a difference with our system than people realize. We ration care, too — we just do so by letting individuals who can’t afford it go without it. This rationing by price is a particularly brutal form of rationing, and it’s one reason there’s such persistent political pressure to have the US government ensure access to medical care. It turns out that being free to not be able to afford lifesaving treatments is not a freedom Americans value very highly…

Republicans have failed to resolve these tensions in their own health care ideas. They say they want to build a generous health care system around private insurance — the most expensive form of insurance — but they also don’t want to spend much money on it. So far, they have tended to try to resolve that dispute by cutting back on the “generous” and “insurance” parts.

This is more or less what the American Health Care Act attempted. But as Republicans learned, Americans don’t want a health care system where 50 million people go uninsured and the remainder struggle with higher deductibles and sparer coverage.

I’ve said it before, I’ll say it again.  Free markets are great where they work.  Creating universal, affordable health care is one place they definitely do not work.

Photo of the day

Recent National Geographic photo of the day:


Icelandic horses have a distinctive look and Your Shot photographer Peter Izzard fell for the creatures saying, “they are the most gentle, inquisitive and approachable horses I’d met, and they looked super cool with their fantastic hairdos.”


HB2 Compromise– I’ll take it

So, presumably this should be happening sometime this morning.  Some basic details:

According to a statement from Berger and Moore, the bill would:

▪ Repeal HB2.

▪ Leave bathroom regulation to the state, essentially returning to the status quo before Charlotte passed a 2016 ordinance allowing transgender people to use the restroom of their gender identity.

▪ Enact a moratorium on similar ordinances until Dec. 1, 2020.

Not great.  You know what, though?  Better than the status quo.  Better than anything else we seem likely to get from this bunch of bigots running our state government.  Thus, I’ll take it.  I’m so not a believer in both sides are mad, so this must be a good compromise.  Maybe it just means it’s not good.  I get why the discriminators are mad– they are giving in to some modest degree in the face of pressure.  Not a big fan of the absolutist position of the LGBT advocates, but I get it:

Advocates for the gay community are calling the compromise “a sell out,” while conservatives are equally critical of any move that would negate what they see as a “common sense privacy law.” The latter refers to a highly-debated belief that giving transgender people rights to use the restroom of their choice would allow male sexual predators into women’s restrooms.

NC Values Coalition, which has been a major backer of House Bill 2, is urging state officials to “stand strong” on the widely criticized law. On Thursday, the group was promising to “target” any state official who voted for the compromise “as we did with Governor Pat McCrory.” McCrory lost his bid for re-election last last year, in part due to the HB2 controversy…

The group [Values Coalition] says lawmakers are “scurrying to make concessions just to appease the NCAA,” which has threatened to overlook North Carolina for championship games unless HB2 is repealed by Thursday.

“If the State succumbs to this new form of economic and corporate extortion, North Carolina will be establishing a precedent and illustrating a template for future corporate extortion efforts on any number of legislative issues,” says the coalition.

The Human Rights Campaign and Equality North Carolina, both advocates for the gay community, is urging state lawmakers to reject a backroom “deal” because it offers nothing to improve the life of the state’s LGBT community. In fact, it would specifically prohibit cities from passing policies that give rights to transgender people.

“The rumored HB2 ‘deal’ does nothing more than double-down on discrimination and would ensure North Carolina remains the worst state in the nation for LGBTQ people,” said HRC President Chad Griffin. “The consequences of this hateful law will only continue without full repeal of HB2. Sellouts cave under pressure. Leaders fight for what’s right.”

Chris Sgro, of Equality NC, referred to the proposal as a “train wreck that would double down on anti-LGBTQ discrimination.”

But here’s the thing.  Is there evidence that any amount of pressure will lead to a full, unqualified repeal?  Nope.  None at all.  You know what will?  Voting these rubes out of office.  Okay, work on that.  But the reality is that with this set of Republican “leaders” and this Republican majority, this is almost assuredly the best we’ll get.  I’m all for having good goals and fighting for rights, but I’m also for pragmatism, and that’s what this compromise is.  If it get stop, or at least mitigate, the ongoing damage HB2 is doing to our state, I’ll take it.

A basketball-loving liberal friend, recently posted, “Human Rights > Basketball‬ #HB2.”  Maybe.  But we simply are not going to get full, unqualified repeal.  I’ll take my basketball and economic benefits to the state and a return to the (essentially) 13 months ago status quo when nobody was arguing that NC was a discriminatory hellhole for LGBT people.

What do right-wing populists want?

Love this from Conor Friedersdorf:

Do populist Republicans want a federal government where politicians stand on principle and refuse to compromise? Or do they want a pragmatist to make fabulous deals?

The intra-Republican conflict highlighted by last week’s failure to repeal or replace Obamacare is usefully understood as a consequence of confusion on those questions. Elected officials associated with the Tea Party, or the House Freedom Caucus, believe that they were sent to Washington, D.C., to replace sell-outs who compromised themselves by seeking earmarks for their constituents, buckling to establishment whips, or horse-trading with the Democrats.

Yet many populist entertainers, like Rush Limbaugh and Sean Hannity, who fancied themselves champions of the Tea Party’s no-compromise ethos, morphed, during Election 2016, into cheerleaders for a different kind of populist—Donald Trump—who pointedly declared that he was seeking the nomination of the Republican Party, not the conservative party, and regularly boasted during the campaign that he should be elected in large part because of his prowess as a dealmaker. Forget principle—the art of the deal was the way to make America great again.

The contradiction was lost on many populist Republicans, who’ve been trained for years to use antagonism to President Obama and the media as a heuristic for judging loyalty––having “the right enemies” became a substitute for a positive agenda. Now that Obama is gone, and Republicans are totally in charge of governing, the party is discovering the inevitable tension that ensues when the populist wing of a political coalition elevates legislators chosen for their aversion to compromise, and then a president who intends to succeed via successful negotiating. [emphasis mine]

Even shorter version: A political party held together by hating Obama/Democrats and not much else finds there’s not a lot to hold it together when you can’t rely on hating Obama/Democrats as your main focus.

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