Wednesday, December 23, 2009

Watching Sausage Being Made - Health Care "Reform"

There is an old saying that there are two things one should not look too closely at: the making of sausages and the passing of laws. In the case of what is left of health care "reform" after all the purging and paying off, which may be passed tomorrow by the Senate, this is the case more than usual. It is not a change of system, but at best an extension of the existing system, even though Obama said he would change it, and many among the Dems in Congress have pushed for more serious systemic change. As it is, I see six different possible systems broadly:

1) pure laissez faire, done in the US in the past, but no longer in place in any high income country, 2) the US system of for-profit private insurance with some state provision (medicare, medicaid), 3) a universal system of non-profit private insurance, what is in place in the Netherlands and Switzerland, 4) a universal coverage system of private-non-profit coverage through employment and a public option for rest, found in Germany and France (whose system has been rated the world's best by the WHO), 5) a single payer public system, with healthcare workers self-employed, Canada an example, and 6) a fully socialized system with healthcare workers state employees as in the UK and the former Soviet Union. I think that Obama was pushing for something like the French system, although keeping our useless for-profit insurance companies, but, well, not only sausage in the making, but pretty smelly sausage coming out the other end...


Jack said...

That's a good way to sum things up. I'd only differ with your assumption regarding what Obama may or may not have been aiming at. The results speak volumes, though changes may still occur. There are few to look up to in our Congress within the debate over health care finance reform. To suggest that Obama was aiming at a French style system, as you've described it, is to also suggest that he has failed miserably. I tend to think that he got what he wanted, change that can't be identified as such. The Republicans were in total disarray with nothing to offer but obstructionism. That could have been over come if there hadn't been so much cow towing to the three or four disreputable Democratic Senators who made their representation of the private insurance companies so obvious. But Obama is a conciliator, not a leader. He'd have made an excellent CEO for an auto company in the '80s and '90s. Which is to say a near total failure with no personal vision other than what sounds pleasing to his followers. Hopefully those people have seen the disappearance of the zebra's stripes and recognized it for an ass. said...

Well, I happen to have believed him when he said he wanted a public option, which he did say many times. However, given the lockstep of the Republicans and the unbudgeability of Lieberman (I-Insurance Companies), that simply became impossible.

Funny thing is that if there had been some reasonable faction of Republicans, I think something better might have been done. Thus, I happen to think some sort of tort reform is not at all unreasonable and would help keep down costs. The GOPsters could have had that if some had been willing to deal on public option. But with no Republicans giving at all, except for some shuffing of feet by Olympia Snowe (but in the end no support for a public option to offset Lieberman), the Dems had no incentive to overthrow the trial lawyers on tort reform.

Of course to get to the French system would take much more than even such a bill. Some years ago we spent a semester in France, visitors, although officially registered with the municipal Mairie. When our daughter fell ill, not only did we not have to pay anything, but we actually got a house call from a physician. My family got house calls from our family doctor back in the 1950s when I was a kid, but nobody seems to think anything of the fact that today, all these pathetically sick people have to drag their sorry asses to a doctor's office for the privilege of him/her seeing them in their illness. After all, being paid so much, the physician's time is clearly worth so much more than the health or time of the patients. That is what the market tells us, right?

BTW, last data I have seen does not show that the for-profit hospital in this country are any better than the non-profits, if anything, it is the other way around.

TheTrucker said...

There is no such thing in this republic as permanent legislation. Every legislature can repeal, alter, or embellish the current body of law as it chooses. The fact that there is no public option in the Senate passed health care bill is actually irrelevant in my own opinion and can be a blessing if handled by an intelligent and capable Democratic party.

There is absolutely nothing that will prevent the House of Representatives from acceding to the Senate version and Obama signing it into law before the end of the year.

At that point it will be time for a NEW bill called the Public Option bill which will be a SINGLE PROPOSITION bill that will be brought to the floor of the House as an addendum to current health care law. As there is 60% support in the public for this particular program the politicians cannot vote it down or they end up in the street. That will include Joe LIEberman.

Anonymous said...

US is inhabited by a feudal society, run for the benefit of a minute portion of the society, the ownership class, who buy a police state, a warrior complex, and a phony social CONtract inside the beltway.

The serfs live in cottages characterized by jobs which allow them to keep the cottage and not become "outlaw".

Health insurance is integral in defining the cottage and the hold the ownership class has on its share cropper serfs.

Take the employment (health care) feature from the insecurity of the serf and the system is threatened.

Perpetual war anyone?

ilsm said...


Won't happen before end of year as Congress has adjourned and will not readjourn until after the first of the year. Latest I am reading is that it is 50/50 whether it will be ready for Obama to sign by 1/26 when he is to deliver the State of the Union message. There are a lot of technicalities still to go through between now and then, although as long as Sen. Byrd's health holds, it should probably get through.

That 60% is national average. Not sure what it is in CT, major home to many insurance companies, who will certainly support Lieberman in his position.


Somehow on Christmas Eve I am not up for a call to "perpetual war." Pass me some well-lubricated eggnog, please, and make it snappy!

Peter H said...

although keeping our useless for-profit insurance companies

So, Barkley, I take it you're not a fan of Alain Ethnoven & "managed competition", then?