Democrats & Liberals Archives

Primary Obligations

We’ve been having a little trouble out of this current Congress. My suggestion? Don’t ignore the primary. It’s our most basic opportunity to scare the pants off of wayward party politicians, or to eliminate them entirely if they see fit to get stubborn on matters. It’s also the opportunity, for those so inclined, to get into the game. The American people have shifted, for the most part, in our direction. Whether they remain there depends on who we choose to lead.

Democracy is the kind of ballgame where there's always a next inning. Play the game sloppy now, and you won't be winning for long. The Republicans got sloppy. Real Sloppy. Complacent. REAL complacent. They gerrymandered their way into a permanent majority, and then forgot to do what was required to keep on the good side of folks in those districts.

It is said that all politics is local. The reality is that all politics is individual. It's important to keep that in mind because political parties are very dependent on what could properly be described as a metastable political climate. People think it's all divided up neatly into parties and left/right designations, but those are really just there for the convenience of reference, to make generalized statements that might be statistically true at the moment.

Oh, before I move on, let's define that word metastable, because it's fairly important:

Metastability is the ability of a non-equilibrium state to persist for some period of time.

Also wrapped up in this is what we could call critical states, that is states prone to self-sustaining change when disturbed.

People want stability, dependability from government. One of the major sins of the Republican Party has been their failure to produce dependability and stability in America's affairs. Also, though, they have failed to recognize that American culture and politics both fall under the definition of the word above: metastability. They can remain in a seemingly stable state for some time, during which you might get the impression that your status quo is self sustaining.

Under the surface, though, change is always at work. Sometimes it gets in its own way, what scientists would call negative feedback. Other times, though, the changes reinforce themselves. Democrats learned that the hard way over the last generation, and in the 1994 election. Dissatisfaction arose against the corruption of the politicians, and the seemingly permanent majority fell with almost no warning.

It can happen again, if we force it to. Let's not have the years in the wilderness be a lesson in vain. American politics is metastable, and if we push things far enough, one spark could cause a runaway reaction.

Primaries are the most crucial element to our system. If we look at this like a political tournament, we want our best player put forward. We want a person who most voters can agree on, in the district in question. At the same time, we want somebody who represents and puts the best face forward for the party. Compromise is good, but how we make that compromise is an open question. The best compromise is the candidate who can eloquently sell our policy.

Let's not forget, though: Results matter, especially for incumbents. People want real change, real improvements. Campaign promises take second place to the duties and responsiblities of good governance, which is something else the Republicans forgot, in their eagerness to sell the party line.

And if the non-ideal candidate should tend to win the primary anyways? It's not the end of the world, especially if the primary challenge is fierce and consistent enough. Even a longtime Washington incumbent can get the message, if we make primary campaigns bruising enough (and I don't mean merely rhetorically heated. I mean the incumbent feels the breath of the challenger on his or her neck.)

Politicians are often survivors, and survivors adapt to the environment. If we are lax in our approach, complacent and apathetic, they will adapt to an environment where people like us are not applying any pressure. If, however, we keep the pressure up, and keep the environment appropriately, Congress will adapt to us as well. We'll never get an ideal assembly out of this, but we certainly can do much to remind our representatives and senators that the ground can very quickly move beneath their feat, if stress builds up within the faults of the party.

Posted by Stephen Daugherty at November 21, 2007 6:41 AM
Comments
Comment #238916

SD
Wasn’t it Churchill that called politicsa blood sport?

“Compromise is good.” Not necessarily. Although it lends itself to expediency and sometimes to political actualization, compromise is not and should not be an end in itself. It can be profoundly dangerious. For example,the “Great Compromise” in the Constitution led directly and inevitably to the Civil War. The Munich compromise with Hitler speaks for itself. There are principles that should never be compromised.
Currently one of those principles is universal healthcare. Its past time we joined with every other civilized country in accepting it as a resposibility of modern government. Anything short of that is a profound mistake and will condemn many to untimely deaths not to mention the severe economic strains on all of us.
John Edwards has offered the best plan so far and by doing so has pushed the issue front and center. His plan does offer a compromise of sorts. Those that choose to can enroll with a private insurer if they wish but that insurer may not” cherry pick” and must offer a minimum package of benefits. He has also realeased an 80 page policy book with specific goals. This is a challenge to every other candidate to actually get specific as to their intentions instead of wishy-washy general platitudes of the moment. For doing this he deserves the gratitude of us all and at least a good look when considering a favorite candidate.

Posted by: BillS at November 21, 2007 12:47 PM
Comment #238924

I agree Edwards is the best candidate out there I doin’t know why he is not doing better in the polls but is still early.

Posted by: Jeff at November 21, 2007 1:11 PM
Comment #238926

“Those that choose to can enroll with a private insurer if they wish but that insurer may not” cherry pick” and must offer a minimum package of benefits.” Posted by: BillS at November 21, 2007 12:47 PM

Bills, insurance is all about risk assessment. Take away the insurance companies ability to assess the risk and it is no longer insurance, it’s a social program run by government. Risk assessment is the primary tool of private insurance to control expenses and guarantee reserves to pay claims. Most insurance companies do this very well, and those who don’t go out of business. The insurance industry in the U.S. is very healthy and effective because it is private and practices risk assessment thru dilligent underwriting. Underwriters assess risk using the statistical averages of large numbers and structure premium accordingly. Those who present the least risk pay lower premiums than those who present greater risk. Very straight-forward and fair. Our government is not healthy and not effective in health care (Medicare and Medicaid) as it bypasses this fundamental risk tool. Universal healthcare is not insurance any more than social security is an investment plan. Does anyone on this blog not believe they would have a much better retirement plan had they invested their SS in a private plan under their control. Social welfare, whether disguised as healthcare or retirement benefits always requires someone to pay more to provide benefits to someone who can pay less. It’s the old Robin Hood fable without the happy ending. When Robin gets old and can’t efficiently rob the rich anymore the poor are left in even a more dire circumstance. The liberal left stands for more government, less freedom, and forced redistribution of wealth. Liberals or so-called Progressives always wish to take someone’s money away to make them feel good and give others a reason to keep them in power. Hardly a formula for success.

Posted by: Jim at November 21, 2007 1:34 PM
Comment #238931

You take my money for a war I do not support. And you need to get your mind around univeral healthcare it is coming one way or another we are the only country with out it. To do other wise is to let people die for lack money in the wealthist country in the world.

Posted by: Jeff at November 21, 2007 1:57 PM
Comment #238936

“You take my money for a war I do not support.”

The Constitution covers that. Where does it cover “free healthcare?”

“And you need to get your mind around univeral healthcare it is coming one way or another we are the only country with out it.”

What a weird coincidence. We are also the only country who has a Constitution of the United States!

“To do other wise is to let people die for lack money in the wealthist country in the world”

Really? If the 50+ million Dems who “say” they care about healthcare so much, actually helped those people who “lack money,” you all wouldn’t have to use govt to force the rest of us to believe as you.
Do you give those people every spare dime you have to help them? If you don’t, aren’t you “letting people die for lack of money?”

Emotions based on guilt trips are no way to run a country.

Posted by: kctim at November 21, 2007 2:09 PM
Comment #238938

Stephen
Which of your candidates could best “eloquently sell your policy” to the moderates?

Is it important for your candidate to try and be a “uniter and not a divider” in the next election?
Or do you believe we are past the point of that happening so don’t worry about it?

Posted by: kctim at November 21, 2007 2:21 PM
Comment #238940

Jim-
Your definition of the purpose of insurance neatly cuts out the purpose of it for consumers: spreading the costs of events over time and other underwritten clients. You can’t have insurance do what it’s supposed to do without accepting a certain level of risk, and modern business wish to externalize all they can.

Without proper regulations, the inevitable result is expensive insurance with spotty coverage. more on this later.

Posted by: Stephen Daugherty at November 21, 2007 2:45 PM
Comment #238941

Jeff
One reason Edwards is not getting good MSM coverage is the major players are owned by large corporations. We need a TR or an FDR right now. So long as as corporations call the shots we will not get universal healthcare,energy independance etc.

Jim
Personally I would forbid for profit healthcare insurance unless they wanted to offer coverage for things not on a reasonable public formulary and cover things like braces and liposuction. That is what Canada does and most Canadians love their program dispite propaganda to the contrary.
Oh yeah,Few could afford an annuity that provided all the protections offered by SS. Disability,widows and orphans coverage and lifetime beneifits. Try priceing one if you can find one.

KCTM
blah….blah….blah…try promote the general welfare clause. BTW you are paying for healthcare for the uninsured already and getting reamed while at it. Price controls are only possible with universal care. Single payer,like Edwards plan promotes, still leaves the bulk of actual healthcare providers private.

Posted by: BillS at November 21, 2007 2:46 PM
Comment #238943

blah…blah…blah? Really Bill? About what the Constitution says? Pretty crappy attitude there.

I know I pay more for healthcare to cover the uninsured. Everybody has been doing that ever since govt started dictating how private was run and people found out they did not have to save or pay for it, somebody else would do it for them.
Thats not my gripe with un-Constitutional healthcare though.

And, btw, promote does not mean provide by force.
As in, govt can promote those who “say” they care about those without, actually help them out themselves instead of complaining and waiting for somebody else to do it for them.

Posted by: kctim at November 21, 2007 3:13 PM
Comment #238944

Bills, if “for profit healthcare” is so bad, why not forbid “for profit energy, lawyers, autos, food, housing, etc.” Oh wait, there’s a name for that, socialism, and the world has been there and done that. Liberals just don’t get it. Capitalism works, and is threatened when nasty, greedy, vote centered politicians get elected and re-elected. Hillary has advocated government taking from private companies in a grab for more power. Many libs pretend to be constitutional advocates but espouse very different ideas. Whatever happened to private ownership free from government confiscation enshrined in this great document? She has baby bonds, free IRA’s and, in her own words, “a million other ideas that we can’t afford”.

Stephen, your statement, “Without proper regulations, the inevitable result is expensive insurance with spotty coverage. more on this later.” makes no sense. Insurance is well regulated, insurance companies are required to establish sufficient reserves to pay claims, and, one can shop in the free market to find the best coverage for the least amount of premium. A much better system than Medicare, Medicaid or Social Security. Can you imagine the impact on Americans if the concept of private life insurance didn’t exist. Well, I guess not, perhaps you would just expect a government handout when the family breadwinner died. More folks with their hand out and their brain scrambled by the craddle to grave concept of freedom expressed by liberals. Government handouts and dependency is what gives libs power and just as that concept destroyed ancient Rome, it will destroy America.

Posted by: Jim at November 21, 2007 3:30 PM
Comment #238946

Kctim… How about this for emotion My best friend was 46 years old and had no insurance he died three weeks ago because he could not pay the 400 dollars a month for his heart meds.

Posted by: Jeff at November 21, 2007 4:06 PM
Comment #238949

Sorry to hear that Jeff, but does your grief make it right to have govt force others to do what you think is the right thing to do? Or should you do all that you can do to prevent it from happening to another, yourself?

My father died at the end of a gun, but I am a huge 2nd Amendment supporter. I do not want others to lose their individual right to bear arms, no matter how sad I was.
Why should others be forced to pay for how I feel?

If we allow govt to continue to govern on emotions, we will will continue to lose our rights. And I am not willing to do that.

Posted by: kctim at November 21, 2007 4:45 PM
Comment #238950

I to support the right to bear arms. I own lots of guns of all types don’t hunt anymore can’t seem to find the time. These are not emotions these are real people. And the cost will go down if everybody has coverage the risk will be spread out. We are forced everyday to do things that we may not like its the price you pay to live in a civil society.

Posted by: Jeff at November 21, 2007 5:08 PM
Comment #238951

BillS-
Compromise is a practical necessity. Nobody gets everything they want, or agrees on all things. Moreover, if we’re unwilling to budge on how we make laws within and outside of the party, we might end up forcefully ignoring an objection that could come back to haunt us later.

Munich itself was a product of earlier hardline attitudes towards defeated Germany that the people of Europe couldn’t maintain, and didn’t have the heart to repeat WWI to prevent. We could have made Germany grovel at our feet again, but instead, we firmly went for a productive middle ground with them, blending mercy with justice.

The real question might come, as much bad as the slavery compromises created, of whether we could have had a United States of America, if we had not made that compromise.

We have to consider how to get there from here. Now, I’m not an advocate of compromises made to avoid criticism from the other side- say, many of the capitulations the Democrats have made with the Republicans in Congress. But we should learn the lessons of the Republican Congress and not be so quick to keep power to ourselves, hording it.

Jim-
Healthcare itself is about risk as well. Insurance companies have become infamous lately for their policies of denial, their red tape, and their hyper-stringent risk sensibilities. We have to ask ourselves: is healthcare an option? No, it really isn’t.

I haven’t felt particularly free under the current system. The current system buries people who need to be hospitalized under mountains of debt. Medical expenses happen to be one of the most common reasons for people to go bankrupt.

Meanwhile, fewer people go to a doctor, which means fewer epidemics are stop short or noticed in due time. It means problems that could have been nipped in the bud bloom to full healthcare crisises for people.

All these elements conspire to become a hidden tax on people, weighing most heavily on the people least able to handle the burden.

I don’t understand why people should be made to feel as if they are some kind of moocher for wanting decent healthcare. A healthy population is cheaper to employ and more financially stable than an unhealthy one. The good of the patient should be more important than the risk of the insurer, and if the insurer cannot or will not cover them, then maybe they shouldn’t be involved.

This is about Americans coming together to act for their common good.

Oh, and before you badmouth government healthcare, do yourself a favor and research the VA’s healthcare, which is rated the best in the country, above and beyond even private healthcare firms. If the private healthcare firms are such success, how is government beating them?

kctim-
It use to be not much of a questions for most people whether we would help others. Gradually, though, we’ve been shown the error of our ways by conservatives, leading to a utopian society which we now live in.

Or maybe everybody’s miserable, in no small part because of a system that seems rigged to beat them down a few rungs, even while the people in charge get all the more richer. Is it envy? Not really. People would rather get rich than drag the rich down. The rich themselves are calling for better healthcare, better government services, greater tax burdens on themselves.

A generation worth of tax revolts has only managed to sink America much deeper in debt than they were thirty or forty years ago, drastically dropping the value of the dollar, stagnating wages and earning power, raising the national debt insanely, with none of the promised revenues coming to the rescue as predicted.

Maybe Bush’s election should have been your first clue, but the conservative agenda is not that appealing to people anymore. He got elected on a platform of “compassionate conservatism”, which essentially tried to make Republicans look more liberal. He passed a new Medicare Benefit, for crying out loud.

And yet he did not pay for it with higher taxes. No, he repeated LBJ’s mistakes and tried to have both guns and butter, an expansion of the Vietnam War and an expansion of social programs at the same time.

Even with monstrous spending, it’s no new taxes for the Club for Growth befuddled conservatives. The old Republican call for fiscal responsibility has become a faux-populist notion of keeping your own money, even if you have borrow from China and Japan and pay them back for it.

And yes, what does the constitution say? Thou shalt not create entitlement programs?

At the end of the day, Americans are not seeing the benefits they were told would trickle down to them. They are not as happy as they once were. They work harder, longer, for less, and are forced to accept indignities that would have been unheard of in more liberal times.

Well, those times are coming back, in no small part due to people’s experiences with a generation worth of conservative policy. We were once the country that could go to the moon. Now we’re paying the Chinese to take our jobs, pay for our debt, and go to the moon themselves. What a glorious outcome.

Posted by: Stephen Daugherty at November 21, 2007 5:28 PM
Comment #238952

Jeff, the risk will be spread out by using govt to force people to comply with what others believe.
Is the right for you to live how you want and believe how you want, worth giving up so that you can, arguably, save a few bucks? Its not to me.

Contrary to what the media tells us or leftist talking points, big govt is not the only answer to a civil society. It is very possible to respect the rights and beliefs of others and still have a civil society.
I do not and would not, want govt to force you to not help those you believe need help. Why would you want govt to force me to help and believe as you?

Lastly, I was not questioning or assuming where you stand on the 2nd Amendment, just merely giving a personal experience which related to yours.

Posted by: kctim at November 21, 2007 5:36 PM
Comment #238957

Stephen Daugherty…Very well said I wish I was as worded Kctm…My point was that all dems are not anti-gun too many times people on both sides try to assume things about both partys.

Posted by: Jeff at November 21, 2007 6:31 PM
Comment #238959

kctim-
Screw big or small, how about government at the size it needs to be to do the jobs we ask of it? If Americans are not going to get rid of these institutions, we might as well have them be effective and get our money’s worth out of them.

That’s the focus of most Democrats. We don’t want lead in our children’s toys, the laws are on the books, so why is our enforcement so crappy? The Republicans never matched their radical sensibilities about government with the kind of radical rewrite of the laws necessary to make big government a thing of the past.

And for good reason. Most people wouldn’t have stood for it. America isn’t about big government or small government, but agreed-upon government. That might leave some critics like you out in the cold, but that’s Democracy. Nobody wins all the time on everything.

Americans agree, for the most part, with Social Security. They’re fine with having the money taken out for that purpose. They want these safety nets there, especially with trust in the corporate willingness to look to their interests at such a low.

Now, social security could go the way of the dodo, but your folks are going to have to be the ones to persuade people to that, and you’ll have to give them a workable alternative.

This focus on the constitution seems to me a way to justify arguments against strong federal powers on the basis of an overriding political mandate. however some may feel, my experience that the courts don’t take this interpretation. Because of that, it is only opinion to say that it’s unconstitutional, at least for the moment.

It’s time for the conservatives to stop forcing and start persuading. It’s time for them to recognize that they’ve lost the argument with most of the population, and need to rethink their approach, if not reconsider their position altogether.

Posted by: Stephen Daugherty at November 21, 2007 6:43 PM
Comment #238963

“Jim-
Healthcare itself is about risk as well. Insurance companies have become infamous lately for their policies of denial, their red tape, and their hyper-stringent risk sensibilities. We have to ask ourselves: is healthcare an option? No, it really isn’t.” Posted by: Stephen Daugherty at November 21, 2007 05:28 PM

Stephen, I read your blog twice and both times my eyes glazed over from the hyperbole, confusion, half-truths, generalizations and just outright propaganda. I have owned my own independent insurance agency for many years and the statement you made above is obviously based upon Michael Moore’s idiotic movie or some other useless pap you read in a liberal newspaper or blog. Accusing insurance companies of a policy of denial, red-tape and “hyper-stringent” underwriting reveals a total ignorance of the industry. A few stories blown out of porportion by the national press and a few TV networks is hardly proof of anything you have charged. You would be amazed at how hard most insurance companies work to find a reason to insure an applicant. They only make a profit when they issue an insurance policy. Based upon your contention, they should all be out of business by now. In reality, the opposite is true, insurance companies are thriving and paying decent dividends to policyholders and stockholders. Do you really want the government to insure your house, life and auto as well as your health? You cite the VA as providing better health care than private insurance. Apparently you have not read some of the latest reports indicating that all is not as rosy as you indicate. Stephen, it is difficult for you to understand that many millions of people choose not to pay for health insurance, opting instead to take the risk themselves and when they loose come crying to government to bail them out. Every state I have lived in requires proof of auto insurance to obtain a license. Have you ever wondered why? Simple answer, without the requirement many would not purchase auto insurance choosing instead to spend their money on something else. I talk to prospects every day who have become so jaded that they tell me that they don’t worry about needing long-term care insurance because Medicaid will pay their bills. These aren’t folks who lack the income to pay their own way, but rather, folks who have been brainwashed into thinking government will pay at the expense of the truly needy who suffer in understaffed nursing home funded by government. Conservative Americans understand that relying on the government tit all their lives is not living, but merely existing. I have compassion for the truly needy, legal Americans. And, should someone address them, and them only, I would listen to their plan. Our private healthcare insurance system is healthy, effective and better than any government social program I have heard proposed. When is the last time someone you personally know been turned away by a hospital? I don’t want the usual ancedotal stories but actual experience. My county and state (Texas) have more health care assistance programs than you can count on your fingers and toes, and if you take a minute and visit your state website you will find hundreds of government and private programs for the needy.

Posted by: Jim at November 21, 2007 7:05 PM
Comment #238974

Jim said: “You would be amazed at how hard most insurance companies work to find a reason to insure an applicant.”

Jim, everyone knows insurance companies compete to get people insured, which translates DIRECTLY to capturing their money for the insurance company. That’s not the problem.

Getting some insurance companies to part with the money they collected, is the problem. I am very close to a case in Texas where a woman has been treated and on meds for six months due to an auto accident caused by another carrier’s insured. To date they refuse to pay anything more than a couple hundred dollars for pain and suffering.

Lawyers want 40% to take her case. Which means what pain and suffering increase they might get for her would be paid directly to the lawyers, and she is back to suffering without compensation for it. It’s a rigged system, highly unfair, and in most states the insurance commissioner is on the side of the insurance companies via the lobbying of politicians.

Not all insurance companies are outright crooked, but, they have all lobbied directly or via associations for maximization of profitability att the expense of customers, and been very successful in their efforts.

Having worked as an adjuster for 5 years, I am modestly familiar with the industry. There is adversarial role between many insurance companies and claimants who are not their premium payers. There is also in the medical insurance industry, and adversarial role between the company and their own premium payers, via successful endeavors to raise premiums while reducing scope of coverage, in increments over many years as to make the changes appear to be small. Cumulatively however, they have been huge.

The medical delivery system and medical education systems are also responsible for the history of medical care costs increasing 2% more than real wage increases each year for the last couple decades.

The companies have been making out fine, and therefore have not been motivated to become part of the solution, thanks to their associations and lobbying power. But, for consumers, the industry has become an enormous problem for 10’s of millions of Americans.

Posted by: David R. Remer at November 21, 2007 8:35 PM
Comment #238978

Jim-
Give me a break. I’ve lived through this crap. My mother worked in the healthcare industry, and dealt with insurance companies. I’ve seen the result of healthcare problems in my own family.

But of course, since I’m a liberal, nothing of that counts, right? Or because the media’s reporting it, it’s got to be biased nonsense.

Like the VA thing. Despite the Walter Reed problems, The VA does provide some of the best healthcare in the country.

These three paragraphs, I think, indicate exactly why Republicans have been getting dropkicked out of office:

As the reforms produced results, veterans began “voting with their feet,” says Dr. Jonathan Perlin, who just resigned as the VA’s health under secretary. Hundreds of thousands abandoned private physicians and enrolled in the lower-cost and higher-quality VA care. But that created a new problem. The VA’s budget from Congress (currently about $30 billion annually) couldn’t cover the influx. By January 2003, with hundreds of thousands waiting six months or more for their first appointment, the VA began limiting access to only vets with service-related injuries or illness or those with low income.

Veterans’ groups understandably want the health-care system expanded to accommodate vets with higher incomes and no service-related ailments. Tom Bock, commander of the American Legion, has another idea: allow elderly vets not in the system who are drawing Medicare payments to spend those benefits at a VA facility instead of going to a private doctor, as is now required by Medicare. “It’s a win-win-win situation,” he argues. Medicare, which pays more than $6,500 per patient annually for care by private doctors, could save with the VA’s less expensive care, which costs about $5,000 per patient. The vets would receive better service at the VA’s facilities, which could treat millions more patients with Medicare’s cash infusion.

But conservatives fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector. Congress has no plans to enlarge the scope of veterans’ health care—much less consider it a model for, say, a government-run system serving nonvets. But it’s becoming more and more “ideologically inconvenient for some to have such a stellar health-delivery system being run by the government,” says Margaret O’Kane, president of the National Committee for Quality Assurance, which rates health plans for businesses and individuals. If VA health care continues to be the industry leader, it may become more difficult to argue that the market can do better.

Nope. That just will not do. We’re just going to have to stick with substandard healthcare, even if it kills us. You hear me?

Posted by: Stephen Daugherty at November 21, 2007 9:46 PM
Comment #238994

Walter Reed isn’t a VA hospital and its problems had nothing to do with the VA healthcare system.

Stephen, do you think it’s a coincidence that the VA system and hospitals have improved to become (as you accurately point out) among the best in the world at the very same time that’s it’s become harder and harder to be accepted as a patient into that system?

These are not unrelated phenomenon. The VA system made a conscious decision to use their resources to do an absolutely first-class job of serving a smaller pool of patients, and it’s now very difficult to participate in it if you have the means to get care healthcare elsewhere and/or don’t have service-related health problems.

With a lot of money and a smaller group of those being served, it’s not difficult at all to deliver top-flight healthcare. Nobody disputes that. But the success of the VA system is not, therefore, a workable model for delivering health care to 300 million people.

People who look at the success of the VA system and say that it should therefore expand to include more people or become the model for a nationalized system are ignoring the very reasons WHY the system is a success.


Posted by: Loyal Opposition at November 22, 2007 12:34 AM
Comment #239007

LO
I believe you will find most progressives favor a “single payer” system as opposed to a VA type socialized system. With single payer the facilities and providers stay in private hands and compete on the basis of customer service. Its really the only way to check the enormous cost increases we have been burdened with and IS the compromise position.

Jim
45-47 million Americans without healthcare insurance is prima facia evidence the free market delivery system is not working. Yeah,sometimes they can get crappy care at some clinic if they are lucky. How about preventive care? Spend a weeks wages for a checkup? How about follow up test? Forget it.
This might be a good time to branch out into some other ares of insurance provision.

Posted by: BillS at November 22, 2007 3:41 AM
Comment #239023

Okay, let me just toss out an idea. The whole reason it is so much more expensive to buy private insurance than to get it through an employer is because spreading out the pool of payers drives down the individual cost. So if we spread out the pool to, oh I dunno, 330 million people, wouldn’t that make it far less costly to the average person than any corporation could touch? And this is bad for the American public….. how exactly? Except for the whole “more government is bad” line, I can’t find a single coherent arguement from the Right against universal health care. I just don’t get how anyone can object to it.

And to all who say our current system is fine, explain our drop in life expectancy and increase in infant mortality

L

Posted by: leatherankh at November 22, 2007 11:32 AM
Comment #239034

LO-
That’s only a funding issue. If we were to fund it sufficiently, it would work for all veterans, and given enough spread, everybody else. The real advances?

The roots of the VA’s reformation go back to 1994, when Bill Clinton appointed Kenneth Kizer, a hard-charging doctor and former Navy diver, as the VA’s under secretary for health. Kizer decentralized the VA’s cumbersome health bureaucracy and held regional managers more accountable. Patient records were transferred to a system-wide computer network, which has made its way into only 3% of private hospitals. When a veteran is treated, the doctor has the vet’s complete medical history on a laptop. In the private sector, 20% of all lab tests are needlessly repeated because the doctor doesn’t have handy the results of the same test performed earlier, according to a 2004 report by the President’s information technology advisory committee.

Another innovation at the VA was a bar-code system, as in the supermarket, for prescriptions—a system used in fewer than 5% of private hospitals. With a hand-held laser reader, a nurse scans the bar code on a patient’s wristband, then the one on the bottle of pills. If the pills don’t match the prescription the doctor typed into the computer, the laptop alerts the nurse. The Institute of Medicine estimates that 1.5 million patients are harmed each year by medication errors, but computer records and bar-code scanners have virtually eliminated those problems in VA hospitals.

Private hospitals, which make their money treating people who come to them sick, don’t profit from heavy investments in preventive care, which keeps patients healthy. But the VA, which is funded by tax dollars, “has its patients for life,” notes Kizer, who served in his post until 1999. So to keep government spending down, “it makes economic sense to keep them healthy and out of the hospital.” Kizer eliminated more than half the system’s 52,000 hospital beds and plowed the money saved into opening 300 new community clinics so vets could have easier access to family-practice-style doctors. He set strict performance standards that graded physicians on health promotion.

So what do we have here? Centralization of information, decentralization of bureaucracy, immediate access to patient medical records, elimination of needlessly repeated tests, strong reduction of mistakes with drugs, and a heavy investment in preventative care, none of which has been broadly adopted in private healthcare.

It’s not that private companies couldn’t do that, it’s that they won’t do that. The management of those companies is too lazy and cheap to really take advantage of these advances and approaches.

The real problem is that this costs society at nearly every level. It reduces productivity, increases stresses, allows non-fatal problems to become deadly, and contributes to the spirally rise in debt. Healthcare in particular, for children is one of the leading contributers to bankruptcy.

Healthcare can be important for improving childhood development, and by improving that, improving the adult’s mental faculties and healthiness. When regular check ups and testing become affordable, and people are not scared to show up at the local clinic to get themselves looked at when they have a problem, progressive diseases can be caught and treated early. It’s not for nothing that the American Cancer Society has made universal healthcare a high priority. Many cancers are treatable, caught early, but not so easy when caught later.

The real question is, how much are you willing to pay not to have healthcare?

Posted by: Stephen Daugherty at November 22, 2007 1:09 PM
Comment #239045

A universal single payer system relieves corporations and employers of the health care burden, freeing up capital for both better wages and competitive advantage in the global market for American products and services.

That is a pretty big plus for conservatives who champion free enterprise and competition.

Posted by: David R. Remer at November 22, 2007 8:36 PM
Comment #239054
LO- That’s only a funding issue. If we were to fund it sufficiently, it would work for all veterans, and given enough spread, everybody else.

Only a funding issue. Right. As if that’s just a minor and insignificant detail. Kind of how the fact that I don’t live on my own private tropical island is “only a funding issue.” When money grows on trees, all of these problems will just evaporate. But until then, they’ll still be problems.

The VA system’s innovations that you mention work very nicely for using a relatively large amount of money to serve a relatively small group of people.
The same thing simply won’t work for 300 million Americans, and the VA is under no illusion about this either, as is evidenced by how many people they turn down who want to be covered by their system.

You’re not going to get more decentralization of bureaucracy, in any case, by giving healthcare over to a centralized bureaucracy. It’s a total logical contradiction to believe otherwise. Nobody believes that our healthcare system is not deeply flawed, but making it worse is no solution.

Posted by: Loyal Opposition at November 23, 2007 1:47 AM
Comment #239063

LO
A good chunk of our healthcare dollar goes to pay for private bureacracy.Much involves claims adjustments and disoutes. The insurers try to get out of paying and the providers dispute it. This is routine. It forces the providers to spend huge sums on lawyers. If you have ever had to fill out a claim form then you know how ridiculiously complicated they can be.Someone on the recieving end has to process them also. There are estimates that single payer would save enough on paperwork to fund healthcare for the uninsured.I know it is conter-intuitive but the red tape generated by the PRIVATE payment system is in large part of why we pay much more for healthcare in this country than any other country . An example is SS. It has about a %2 overhead. Private annuities carry about a %20 overhead.

Posted by: BillS at November 23, 2007 10:30 AM
Comment #239075

LO-
What are you talking about? It’s cheaper than Medicare! If they scale it up properly, it’ll save money for Americans. The question is, why aren’t we at the very least applying these lessons to Medicare?

The reforms worked. Even you have to admit it. You claim that it can’t be applied on a broader basis, but why, besides your general dislike of government, would that be the case? Are you just going to make the standard Republican point that it can’t be done, despite the fact that the prediction was wrong in the first place?

Government may not be 100% of the answer, but what kind of answer is private healthcare at this point?

Posted by: Stephen Daugherty at November 23, 2007 3:48 PM
Comment #239077

Someone answer this, please: what pot does malpractice insurance get fed from? I know that Dr.s and hospitals pay into it, which partly can take responsibility for driving costs and fees up.
If anyone has ever considered, or has been involved in a wrongful death case, you’ll know the depth of protection around an errant Dr. or facility.

Posted by: Jane Doe at November 23, 2007 4:36 PM
Comment #239078

Stephen, I agree that the reforms worked. No doubt.

But one of the reforms was radically limiting the number of people who can participate in the system. When you talk about extending the system, you’re actually talking about abolishing it by rolling back a key component of its success.

I’m not saying that other healthcare systems can’t learn anything from the VA because they can (including private healthcare) but there are many basic facts about the VA that can’t simply be swept under the rug.

Another feature of the VA system that makes it inapplicable elsewhere is that not only do they limit the number of people they treat, they also have the luxury of limiting what kinds of treatments, medications, and services they offer.

Requiring that patients have “service-related” medical conditions before they can even get through the door allows the VA to efficiently focus on a much smaller set of health problems and do an excellent job of treating them.

But how is this applicable to serving the population at large? Any broadened health care system can’t just pick and choose who they serve like the VA does. If your neighborhood hospital announced that they’d only treat spinal injuries and gunshot wounds from now on, they’d probably start doing a MUCH better job of treating those kinds of injuries. But would you then say that that hospital was doing an excellent job and everyone else should follow their lead? Even though they were pushing the majority of patients who show up at their door for treatment onto the street?

Posted by: Loyal Opposition at November 23, 2007 4:56 PM
Comment #239084

LO-
The real reforms took place before then, and the quality of the care brought veterans to “vote with their feet.” Your explanation is typical of some people’s confusion of penny-pinching with efficiency.

Your idea of what makes the system effecient is not unlike the idea that the private hospitals have, where they limit treatments, limit what doctors you can choose, limit what diseases they will cover… in essence, they are already taking your suggestions.

The real reforms were not such limitations. The real reforms related to information technology, reducing redundancies and mistakes, and to preventing disease rather than waiting until it became serious to treat it. The real improvements in efficiency were practical, not the result of financial trickery or limitations on treatment.

The real issue of why most patients are being pushed on the street is that the Bush administration is not willing to sufficiently fund a working program. The Bush administration is being cheap all around about dealing with the health of our Veterans, despite all it says about supporting them.

Would you support funding the VA sufficiently to fulfill it’s promise to all veterans, or do you measure efficiency by how little a system can do for people for the money used to fund it?

Posted by: Stephen Daugherty at November 23, 2007 7:19 PM
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