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The people behind health-care reform

Chris Bowers explains his evolving thinking on health-care reform:

In the past, I had previously defined success as increasing the power of the Progressive Block and passing a nationally-available public option tied to Medicare rates. My thinking on the matter started to change when Representative Alan Grayson started talking about the number of people who die each year from a lack of health insurance. Even though I, and other members of my family, had gone through sometimes lengthy periods without health insurance, it was still not an angle I had considered previously. Saving those lives is a very powerful, ethical argument to me.

Granted, it is not entirely clear how many people die each year because they lack health insurance. Different studies have suggested 18,000, 45,000, or an unknowable number anywhere from zero to 36,000. Still, the varying studies make it highly likely that at least several thousand people die each year from a lack of health insurance. With that in mind, the Senate bill reduces the number of people uninsured in this country by roughly two-thirds, which will save two-thirds of those at least several thousand lives. The House bill will reduce the number of uninsured by roughly 75%, thus saving three-fourths of those at least several thousand lives.

Funneling huge amounts of customers and public money to for-profit health insurance companies is offensive to me ideologically. The continued lack of influence Congressional Progressives have over public policy is also extremely frustrating. However, thousands of people dying because they can't afford any health insurance at all is much worse than both of those negative outcomes combined. I don't think I could tell anyone who can't afford any health insurance that I would prefer they not have any insurance at all than have subsidized insurance from a for-profit company. Further, I don't think I could tell anyone who can't afford health insurance that I would prefer they not have any insurance at all than for the Progressive Caucus to remain relatively less-influential than the Blue Dogs. When faced with a choice between the status-quo and providing subsidies to make it easier for low-income people to purchase private health insurance, I choose the subsidies.

I'd add to this that my read of the history is that social policy programs generally get better, rather than worse, over time. Right now, there are a lot of people who worry they'll lose something they have if health-care reform passes. But no one is currently receiving benefits from the plan. If it passes, however, then health-care reform develops its constituency, which has the power to protect its important provisions and expand where necessary. That's how Social Security grew, and Medicare, and Medicaid.

On the other hand, if health-care reform doesn't pass, the issue is probably dead for a decade, and if history is any indication, the next effort will be less ambitious, and less progressive. This bill, when it's finished, is not going to be very good. But it's going to be a lot better than what we have, and almost more importantly, a lot easier to improve in the future.

By Ezra Klein  |  December 3, 2009; 7:37 AM ET
 
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Comments

The political tragedy is that there are plenty of reform alternatives that really would reduce the cost of insurance. According to CBO, the relatively modest House GOP bill would actually reduce premiums by 5% to 8% in the individual market in 2016, and by 7% to 10% for small businesses. The GOP reforms would also do so without imposing huge new taxes.

But Democrats don't care because their bill isn't really about "lowering costs." It's about putting Washington in charge of health insurance, at any cost. -WSJ

Posted by: UncleMikey | December 3, 2009 8:18 AM | Report abuse

This bill, when it's finished, is not going to be very good.
Finally some truth. So why should I support it, for the tax increase?

Posted by: obrier2 | December 3, 2009 8:25 AM | Report abuse

I agree with Chris and Ezra on this point. I can't see how some would kill this bill and leave those uninsurable out in the cold. I don't agree with the bill either (it gives away far too much to insurers, Pharma and it doesn't contain enough cost controls). I guarantee you that anyone currently without insurance with a pre-existing condition is BEGGING for this to pass because their lives depend on it.

Where I do disagree Ezra is a point that I made very early in this debate. If it doesn't happen now it will take a little bit of time to come back (when the Dems come back into significant power after they get hit in 2010 and 2012) but the uninsured will continue to rise and that will grow the voice louder for change. If the special interests are listening they had better take this sweetheart deal because otherwise the next one will be much, much worse for them, IMO. Right now we have 15% of the population uninsured. WHat about when it gets to 20-25% because of cost and no subsidies? The voice will grow louder.

Posted by: visionbrkr | December 3, 2009 8:28 AM | Report abuse

Does Ezra have any argument other than "the perfect is the enemy of the good" on this issue? Or "cheer up, we'll improve things in the (undefined) future?" I know rationalizing our capitulation (again) to the failed private health-care market can be hard work, but a little variety in the lame arguments used to placate us might be helpful.

Posted by: redscott | December 3, 2009 8:29 AM | Report abuse

I'm with redscott on this one. For months Ezra has advocated an ever diminishing loaf as a way to get a bill, even going out of his way to fulsomely praise the quixotic Snowe and Collins and to downplay Lieberman's inflammatory statements. He misread the politics of this, as Digby pointed out in a quietly scathing post yesterday.

And nary a critical word of the administration's tactics or even a real analysis of what Obama "wants" in healthcare reform. What's up with that?

Posted by: scarlota | December 3, 2009 8:41 AM | Report abuse

how is it that some can sit here day in and day out and pontificate for the uninsured and spout out statistics of 45,000 dying annually from a lack of insurance and then when policy isn't good enough for them they then want to conveniently forget those without healthcare until they get something they approve of. i'm guessing they're not uninsured or even close to being uninsured. If they were, I'm thinking their story would change. Just a tad hypocritical, no?

Posted by: visionbrkr | December 3, 2009 8:53 AM | Report abuse

One small point: people do not die from lack of health insurance. They may die from lack of health care. Health care is available without health insurance. And the tax deducitbility of health benefits for employers probably play a largeer role in this phenomenon than any other factor. Yet politics prevents Congress from doind anything meaningful in this area.

Posted by: MBP2 | December 3, 2009 8:54 AM | Report abuse

This analysis just seems wrong to me on a couple of fundamental points.

"I'd add to this that my read of the history is that social policy programs generally get better, rather than worse, over time."

Of course I guess you could argue what "better" means in this sentence, but there's ample evidence that public programs don't necessarily get more GENEROUS over time. Have we already forgotten welfare reform? Moreover, programs with significant state involvement like WIC or even plain Medicaid frequently get less generous as state budgets fluctuate.

Social Security and Medicare have gotten progressively more generous. But I'm not sure it's appropriate to analogize programs that EXCLUSIVELY serve seniors -- the most powerful voting bloc in America -- to all "social policy programs." In fact, the less sympathetic or wealthy the group, the more likely their programs are to be seen as "government waste" that's easy to shed at budget balancing time.

"If it passes, however, then health-care reform develops its constituency, which has the power to protect its important provisions and expand where necessary."

What would a "health-care reform constituency" look like? When has anyone ever identified themselves with a generalized REFORM vs. a PROGRAM? It's Medicare that has a constituency, not the Social Security Act Amendments.

I can see a "subsidy constituency" or maybe a "public option constituency" or a "small business tax exclusion constituency" developing, but that is absolutely not the same thing as a "healthcare reform constituency." In fact, moving forward, it is almost inevitable that this disjointed reform will produce ACTIVELY COMPETING interest groups. Just as strong supporters of Medicare have turned out to be the most opposed to a genuine, government-supported public plan for the rest of us -- once you have a bunch of groups who see themselves fighting over the same pot of money, things get ugly.

The public option might create a constituency you could organize around (although at this point it just seems so limited by law that I don't think it could ever get big enough or financially sustainable enough to be politically meaningful). But the larger reform just reflects our already-existing structure; it will replicate its resource conflicts too.

Posted by: NS12345 | December 3, 2009 9:03 AM | Report abuse

FWIW I still think this bill is worth passing but I think the amount of controversy it's generating is way out of proportion to what it actually does. If the plan was going to be "individual mandate + subsidies and insurance regulation," we never should have pitched it as "comprehensive reform." This isn't a fundamental reform at all; it's a Band-Aid and it deserves to be just as politically uncontroversial as a Band-Aid.

Posted by: NS12345 | December 3, 2009 9:09 AM | Report abuse

"have any argument other than "the perfect is the enemy of the good" on this issue?"

"conveniently forget those without healthcare until they get something they approve of."

redscott and visionbrkr

what other argument could there be?
you could be nothing but a dreamer, to look at the people representing us in congress, the tentacles of lobbyists, special interests and the behemoth health care industry, the inability to reach concensus and think that sweeping change would be possible.


visionbrkr
accepting the reality of a situation, doesnt mean that you are happy with it, or turning a blind eye to the suffering... but it may not be possible to change things the way we would wish, in an imperfect world, with special interests pulling strings that we cant even see, all over the world.


perhaps this sounds foolish to you...but there is a parable of a starfish. many starfish washed on shore. a little boy was throwing them back and a man he was with, said, "why bother doing this. there are so many starfish on the shore...your efforts will hardly make a difference."
the little boy picked up another one and tossed it into the water, and said, "well, it sure made a difference to that one."

because you cant accomplish a perfect solution and solve a problem in its entirety, is not a reason to turn your back on smaller actions.
i have been volunteering in a homeless shelter which is an offshoot of a larger rescue mission. it only houses fifteen women and their children.
someone said to me recently...."there are so many homeless people now, in this county, that a facility caring for fifteen women is hardly anything."
well, the truth is, it would be wonderful if the facility could handle a hundred or more women and their children. but it cant.
but to these fifteen women and their children, it is certainly making a difference.
you can see change as being half empty or half full.
any improvement makes a difference. and small change is also hard won, but nothing to turn your back on.

"do what you can, with what you have, where your are."
(or you will end up doing nothing.)

Posted by: jkaren | December 3, 2009 9:11 AM | Report abuse

The problem, Ezra, is that what you perceive as improvement in social programs is regarded by many people as a slide into socialism and a power grab by an undefined federal elite (I think George Soros and ACORN are supposed to be in there somewhere) that will ruin the lives of Ordinary Americans.

In fact, the "slippery slope" argument is the main one the teabag crowd is using *against* any kind of meaningful health care reform, and it gets a lot of play out here in the hinterlands.

Posted by: roblimo | December 3, 2009 9:17 AM | Report abuse

"This isn't a fundamental reform at all; it's a Band-Aid "

this is what fundamental reform looks like now.
look at the battles, townhalls, demonstrations and reams of paper and attention given to this over the past months.
at the end of the day, this is the reality... the new fundamental reform that our system of government is capable of providing.

Posted by: jkaren | December 3, 2009 9:23 AM | Report abuse

Ten years might be longer than the time needed to do something about the dog's breakfast that is the US system.

Suppose these initiatives fail and the US health insurance system remains as is. What happens then?

Who's addressing the approaching storm-clouds in the health insurance industry? They're getting squeezed from all sides. (Not to excuse their greed -- that's one of the "sides.")

-- Fewer customers, due to unemployment.
-- Poorer customers, due to underemployment and wage and benefit cuts.
-- higher costs, due to sicker customers and greedy medical and pharma providers.
-- pressure to increase their margins by squeezing the remaining customers for all they're worth

Large segments of the US customer base will be and have been collapsing to lower levels. Many can't get insurance, and I assume lots of people who have it, have been looking at their insurance and asking whether it's worth it. Health insurers might not pay out when you need them, and there's no way to know whether they will or not -- but a car payment or heat bill is solid and real.

The insurers are losing their customers, so if the system stays as-is, what will happen over the next few years?

Noni

Posted by: NoniMausa | December 3, 2009 9:25 AM | Report abuse

"This bill, when it's finished, is not going to be very good. But it's going to be a lot better than what we have, and almost more importantly, a lot easier to improve in the future."

Why can't you say the exact same thing about the public option?

Posted by: dday212 | December 3, 2009 9:27 AM | Report abuse

And courtesy of my oldest brother, I urge you all to push the green button...

Posted by: ShermanDorn | December 3, 2009 9:30 AM | Report abuse

And that's why conservaties are adamently opposed to this bill. It's grotesque increases in goverment spending and bureacacy are bad enough but as you say Ezra, big government entitlement programs never shrink after they are written into law, they always grow, and once they are created they never go away. Conservaties should resist even a watered down version of Obamacare with every ounce of their being.

Posted by: RobT1 | December 3, 2009 9:31 AM | Report abuse

I have seen no study that does a good job of separating coverage status from all the other socioeconomic variables that result in poor outcomes. I know that increased financial stress on middle class families causes divorce, domestic violence, and suicide. This bill increases the financial burden on middle class families through a mandate to buy private insurance absent good cost controls and a 40% tax on employer benefits. People will disagree, but I personally can't ever support that.

Posted by: bmull | December 3, 2009 9:31 AM | Report abuse


if you're poor, you can go on Medicaid.

if you're elderly, you can go on Medicare.

if you're disabled, you also can go on gov't programs.

if you're not any of the above, it is highly likely that you can afford even the high deductible plans. As such, you should buy insurance instead of those $200 jeans, $1000 LCD television, gas-guzzling car, overpriced house, $5 daily lattes, restaurant food, or expensive cigarette habit. You are responsible for your own health. This is a free society. Emergency department will be nice enough to stabilize you if you get sick, but it is up to you to buy insurance. One thing - we need to eliminate all of this b.s. community rating stuff that drives up the cost of premiums to lower risk people and basically hampers markets from functioning in places like New York. Check out online insurance quotes to compare how high premiums are in regulated states vs. other states...

Posted by: RandomWalk1 | December 3, 2009 9:33 AM | Report abuse

The 45,000 number rightly gets thrown around as something we should be worried about, and I agree. But if we're not going to reform the health-care system to actually stop the looting by the private market and make it affordable for everyone, then why do the insurance companies' bidding and deliver them a captive mandate market? Let's do the reforms on rescission and non-discrimination, hand out the subsidies so that people can afford (overpriced) insurance, and be done with it. If we're going to hand out money, I'd rather hand it out exclusively to the people who need it and not a huge trillion dollar windfall to the insurance companies.

Posted by: redscott | December 3, 2009 9:39 AM | Report abuse

Just because the public safety net has tended to get better in the past doesn't mean it will do so in the future. The middle class standard of living is stagnant. At the same time the country is becoming more conservative. This bill, as bad as it is now, could actually get worse over time if the penalties and Cadillac tax expand while good healthcare remains out of reach. For all we know, making every living person buy a corporate product is the inflection point on a path back to feudalism. I don't want to go there. Public option or bust.

Posted by: bmull | December 3, 2009 9:59 AM | Report abuse

*Conservaties should resist even a watered down version of Obamacare with every ounce of their being.*

I never knew that a central tenet of conservatism was being against universal health insurance coverage. You need to come up with a plan to cover everyone, universally. If you can't do that, you have no reason being in office. If this is what conservatives are going to "draw a line in the sand" about (not torture? not secret prisons?) then they need to rethink what, precisely, makes their belief system worth having, because it seems like a pretty worthless philosophy to me.

Posted by: constans | December 3, 2009 10:15 AM | Report abuse

*According to CBO, the relatively modest House GOP bill would actually reduce premiums by 5% to 8% in the individual market in 2016, and by 7% to 10% for small businesses.*

The GOP plan would also be, by their own admission, absolutely worthless in getting universal coverage for people's health care bills. Absolutely worthless. The GOP needs to do a little less posturing with for-show publicity stunts that only tinker around the margins and make a little more of an effort to cover the tens of millions of uninsured and the tens of thousands who die every year because of it.

But they obviously don't care, because they wasted 12 years of their lives doing nothing about the issue until the Dems brought it up. I have to ask my conservative colleagues here-- why, exactly, do you think your opinions are worth considering here? This is clearly an issue you have no interest in and in fact seem hostile to considering solving. In fact, it seems like the central, defining issue of your ideology is to prevent any form of universal coverage from being available to the public, which even the most laissez-faire 1st-world countries don't do. What, exactly, is the purpose of holding such a strange belief, and why is it that we should take such irrational ideas seriously?

Posted by: constans | December 3, 2009 10:19 AM | Report abuse

"This bill, when it's finished, is not going to be very good. But it's going to be a lot better than what we have, and almost more importantly, a lot easier to improve in the future."

According to economists, it is going to be much worse, and you did not provide anything to back up your meaningless words.

It is going to rob Medicare from the seniors, require taxpayers to be mandated to pay for pre-birth murder, and increase premiums to $15,200 for a family who makes 30 grand.

Posted by: kwoods2 | December 3, 2009 10:35 AM | Report abuse

I disagree with the premise of this whole article. The problem we have in this country is not that we have [put your own number here] uninsured. The problem is that we do not have an actual national health policy and one of the many consequences of that deficiency is that *care* is beyond the financial reach of a significant number of citizens. While insurance certainly plays a role in good health systems, insurance itself is not equivalent to either care or policy.

As a committed progressive, I strongly object to the way that reform has been characterized by the Democrats and "liberal" analysts as primarily a poverty program. We need reform to construct a system that will ensure that every citizen has access to needed treatment without bankrupting himself, his employer, or government and there is virtually nothing in the current proposed legislation that puts us on a path to achieving that.

Posted by: Athena_news | December 3, 2009 10:37 AM | Report abuse

When, oh when, is it going to dawn on Mr. Klein that "progressives" have created these Rube-Goldberg-on-steroids monstrosities of health plan "reform" which are full of perverse incentives and unintended consequences? Why do progressives who can't balance their own checking account think they can run one-sixth of the national economy?

Only yesterday both Mr. Klein and Sen. Baucus finally admitted the bills are full of budget gimmickries which hide the budget-busitng costs inherent in these bills.

Why can't we try market-based reforms, e.g., tort reform, sale of health insurance policies across state lines, small businesses banding together for group plans?? Interest groups within the Democratic Party have fought tooth and nail against these common-sense reforms for years.

Posted by: dturnerc | December 3, 2009 10:46 AM | Report abuse

bmull, I actually share your concerns and I would be really concerned about a bill that didn't include an alternative. But I'm confused why the sticking point is a "public option," rather than "a working alternative to private insurance."

If the Senate were able to pass something called a "nonprofit" or "co-op" but that was nationally available, empowered to negotiate on its own terms (e.g. w/o regard to prevailing insurance rates), and available to everyone, would it matter that it wasn't called "the public option?"

Posted by: NS12345 | December 3, 2009 10:48 AM | Report abuse

NS12345,

you do realize there is such a "national non-profit".

Its called Blue Cross Blue Shield


although honestly some are moving to for profit status to compete with private insurers with their ability to raise capital through IPO's.

Posted by: visionbrkr | December 3, 2009 11:08 AM | Report abuse

" Why do progressives who can't balance their own checking account"

very nice.

Posted by: jkaren | December 3, 2009 11:08 AM | Report abuse

I'm amazed it took Bowers that long to come around to this argument. Covering more uninsured people so they don't die needlessly is THE main reason I care about this issue in the first place! But, I suppose attitude's like his previous one are common, and that's why so many liberals are now agitating to kill the bill. It doesn't make that attitude any less immoral, though.

Posted by: Chris_O | December 3, 2009 11:15 AM | Report abuse

"Why can't we try market-based reforms, e.g., tort reform, sale of health insurance policies across state lines, small businesses banding together for group plans?? "

Why do we ignore how miserably market forces have worked to date? After all, it was "market forces" that created the perverted, employer-based model we have today. And every time we get some agreement that whatever was tried didn't work, we get proposals for more of the same. How's tort reform working out for Texas; the state with the highest uninsured rate in the country? How are small business group working in states that have tried them?

Why is it so hard for people in the US to accept what every other industrialized country has already discovered: there is no magic bullet that will make "market based" health care financing work. That's why even though most integrate private insurance to implement universal care, none consider healthcare as a market commodity. That's also why they all have substantially lower costs for actual care.

We don't need more insurance here, we need a better financing and delivery model for *care*.

Posted by: Athena_news | December 3, 2009 11:21 AM | Report abuse

"if you're poor, you can go on Medicaid."

That is not true. In most states, Medicaid is available only to women and children. Able-bodied, singles or childless couples are typically not included. It's not clear to me that the currently proposed bills do anything about that either. I have seen the tables that show what the subsidy "eligibility" would be for singles but I've seen nothing that guarantees that the states will actually include them.

"if you're not any of the above, it is highly likely that you can afford even the high deductible plans. "

After which you may well find yourself amonth the 60% of bankrupts who, although insured, listed medical debt as a precipitating factor in their insolvency. Read the transcript from the House hearings last month about underinsurance then tell us why you think those crappy plans are such a good idea?

People do not need insurance; they need medical *care*. Insurance is one way to finance that care, it is not an end in itself.

Posted by: Athena_news | December 3, 2009 11:32 AM | Report abuse

"After all, it was 'market forces' that created the perverted, employer-based model we have today." - Athena_news

No. The federal government caused the employer-based model. In WWII, this benefit became a loophole around price controls. Where "market forces" have supposedly failed, government action is normally the prime reason.

If there are genuine failures in the market place, let's address them. We don't need 2,000 page bills and trillions of dollars in new spending whereby the federal government takes over one-sixth of the economy.

Posted by: dturnerc | December 3, 2009 11:32 AM | Report abuse

Yeah, BCBS is tough. As you say, they're not acting particularly public-oriented of late. But maybe with the tighter charter & regs that would come from being the "official" nonprofit, you could avoid some of those problems.

Of course this is not my favorite position. I think there should be a universal entitlement to at least some services. But if giving up the name can get to a (marginally) better policy, I'd be willing to lose the current "public option."

Posted by: NS12345 | December 3, 2009 11:35 AM | Report abuse

it all depends on what your view of "public oriented" is. THey're trying to control costs for their members so they can continue to be their members, they're trying to keep healthcare affordable for all. That's why they're for reform that controls costs. That's why they're for an individual mandate that makes everyone accountable.

A good comparable for the individual mandate for me is property taxes. Our property taxes go towards public schooling and services like fire, police etc. We can't tell someone that we'll pay property taxes just for the years our kids are in school or when we think we may have a fire or a need for police. Once everyone is covered (or at least 96%) then we can address cost in a fair manner for all (doctors, hospitals, pharma and insurers) and hope and pray that the special interests don't take over.

Posted by: visionbrkr | December 3, 2009 11:50 AM | Report abuse

"No. The federal government caused the employer-based model. In WWII, this benefit became a loophole around price controls."

In other words, it was a *market* response to the situation of moment.

"Where "market forces" have supposedly failed, government action is normally the prime reason"

That's always the claim of free marketers -- even though most economists recognize that health care does not conform to the basic market "laws".

In this case, those who champion Singapore's HSA based health care system as a model for "customer driven care" conveniently ignore that it was not at successful in controlling costs ... which is why they had to go to much greater government control of both supply and prices.

Posted by: Athena_news | December 3, 2009 11:50 AM | Report abuse

According to Ezra, I guess, the only way we can hand out subsidies to people who need them is to give trillion dollar windfalls to the insurance companies via the mandate. So, if you object to that and hope for a system that would actually stop the looting and make health-care affordable for everyone, you're an unrealistic and immoral spoilsport who wants to kill people. Silly me, I thought a system that viewed health care as a privilege and not a right, and that allowed the private market to charge an arm and a leg for it, was the immoral one and ought to be changed. Wevs.

Posted by: redscott | December 3, 2009 12:15 PM | Report abuse

I'm curious what all the Obamacare supporters really envision "universal European style" care really being like? Do they think that everyone will get top of line cadillac union level care? That everyone will have access to the best medical technology, the best medicines, the best medical procedures? Not going to happen. In the U.S. we take it for granted that as soon as a new medicine or a new piece of medical technology comes out all we have to do to get access to it is have our doctor write a perscription for it and off we go. It doesn't work that way in the rest of industrialized world with their wonderful "universal" healthcare. When a new medical device or medicine comes out a medical board in those countries of some type decides after doing a cost, heavy on the cost, benefit analysis on that new medicine or medical device and if they believe it is not cost effective the "universal" healthcare system in that country will not pay for allow that new medicine or medical device to be used in that country. That's why it's ususally years after medicines and medical devices have become available for use in this country that they finally become available in countries with "universal" healthcare.

Also, the U.S. is the medical labatory for the world constantly churning out new medicines, medical devices and procedures that eventually make their way into the rest of the worl. Suppose though that under Obamacare the companies that spend massive amounts of R & D money to create those wondourus advances all of sudden have massive new taxes to pay on their profits to pay for the wonderful new "universal" healthcare? Doesn't cause and affect demand that with less profits due to the massive new taxes that the medical companies will cut back on R & D. So bye bye cutting edge technology and medicine. Of course to save money we'll eventually have to cut back on the new and improved medicine we've grown used to just like they do in every other country in the world that has "universal" healthcare so I guess it won't be an issue. Hopefully America is ready for this unpleasant fact.

Posted by: RobT1 | December 3, 2009 12:34 PM | Report abuse

RobT1:

I think all of the wonderful advances in medecine you talk about are a big part of the cost problem. Many of these "advances" are very costly and have questionable medical benefit. Like everything, medical care is a limited resource.

Posted by: mfreeman3377 | December 3, 2009 2:08 PM | Report abuse

RobT1 --

There is not a single serious supporter of universal healthcare who would want to stop people for paying for additional care. Or even supplemental insurance. No serious observer wants us to go UK/Canada and ration CAPACITY -- even the single payer people mostly say that if you can afford it you should be able to pay for anything.

The problem is that right now you can either have nine top of the line MRI's of questionable value or NOTHING. Either you have to pay for the absolute best (even when you don't need it), or you have to go without. To be frank, that's dumb.

And for what it's worth, Obamacare will absolutely preserve the incentives for pushing tech. It doesn't create any new government-controlled payers, remember? All the insurers are still there (and in fact they get billions of dollars in new premiums), and there are still all the normal incentives to compete.

Posted by: NS12345 | December 3, 2009 3:09 PM | Report abuse

Yes, our amazing advanced technology has helped us so much relative to other indutrialized countries that we pay 2-3 times as much per capita as they do for health-care results that are either (at best) on a par with theirs or (mostly) trail them by every conceivable OECD metric. Try another argument.

Posted by: redscott | December 3, 2009 3:14 PM | Report abuse

I'm trying not to be too closed off to the argument put forward here. Yes, it's better to have all those uninsured people insured, and if it is indeed the case that the coverage they get from that insurance prevents however many thousands of deaths, then I could see the bill being worth it, even with a gutted public option. But those are big 'ifs'. It's also possible that, like in plenty of other cases, insurance companies find some loophole in the legislation that allows them to not pay for expensive patients, or that they just make a business decision that it's easier for them to pay whatever fine the legislation imposes for cutting patients off. Having insurance is not automatically the same thing as having access to decent care.

Also, as for improving the bill later, how many democrats would they need in the senate to do that? 70? 85? Here they are now with their much touted super majority and they can't lean on 3 or 4 senators enough to get a public option through? That's pretty weak, and grounds for skepticism in their ability to improve a lame bill later.

Posted by: andrewbaron78 | December 3, 2009 7:49 PM | Report abuse

1. Nobody (Zero) ever dies or goes bankrupt in other wealthy countries for lack of healthcare.

2. Many medical advances have come from abroad. MRI's were developed in Nottingham, artificial joints in France, even the treatment that Rudy G. boasted he could only get in the US was a Danish invention.

3. Many BC/BS's have been for profit for a long time. Wellpoint owns a bunch of them.

4. My daughter likes the following metaphor: We are debating where to place a million band aids on the TB patient that is our health care system while the rest of the world is using antibiotics.

Posted by: lensch | December 3, 2009 8:41 PM | Report abuse

@lensch: "Nobody (Zero) ever dies or goes bankrupt in other wealthy countries for lack of healthcare."

That is 100% false. People die in every country for lack of healthcare, or lack of being able to pay for healthcare. It is an undeniable fact and in fact necessary that people die due to lack of healthcare. Resources are finite, and we make choices about how much we are willing to spend to save someone. If there is a treatment that costs $100K and has an 85% survival rate and a treatment that costs $2M and has an 86% survival rate, we should choose the first one. But that means some people are going to die that otherwise would not have. When the NHS does not approve a treatment because it does not meet their threshold for QALY they are in fact choosing to let some people die due to lack of healthcare. I'm not saying that is a bad thing, but your claim is a fantasy dream world where everyone gets everything they want, delivered on a rainbow-colored unicorn.

Posted by: ab13 | December 4, 2009 10:48 AM | Report abuse

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