Flying Pink Unicorns

Health Care reform passed the House. 220-215, only 2 votes to spare! Nancy must have done yeoman's work arm twisting "moderate" dems. One Republican voted for it, which is one more than I expected. Although the House did pass it, the margin was SO narrow that it gives a lot of cover to wavering moderate dems in the Senate.


Just a short time ago, the House passed one of the 2 or 3 most important pieces of legislation in the last 50 years. Yet another step in the never-ending journey towards a just and more sensible country was passed. The Senate is taking its sweet time, and then there will be a conference committee, and the House passage was a nearly foregone conclusion for months, but it is still one of the most dramatic bills ever to pass the House. This is a truly historic day, a key step on the road to a more sane health care system. That less-than ringing endorsement STILL means that this is a Monster Important Bill. Health care is THAT important.

This post is going to be on the rambling side, because I have a few different threads going through my head, and don't want to do two separate posts, so please bear with me. Health care is crucial and I have some interesting things to say, I think, so bear with me.

In general, I'm of two minds on health care reform. The health care reform I REALLY prefer is frightfully simple. The House bill is 2,000 pages long. My health care bill is literally a paragraph: "All Americans shall have the right, and be required, to purchase access to Medicare at prices to be set by a Panel of 5 members appointed by the President and Confirmed by the Senate. This Committee, called the Medicare Committee, shall have the power to promulgate rules and regulations it deems appropriate, with Congress having the right to veto said regulations within 30 days of their promulgation; otherwise they have the force of law."

That's it. Basically, Medicare access for all. The idea is for private insurance to whither on the vine and end up with a single payer system. But Obama and many others deemed that FAR too radical, and they are surely correct. The democrats just wouldn't go for it.

So we end up with reform designed to make the current system work less dysfunctionally, less badly, rather than, as I much prefer, ripping it up, stomping all over it, burning it to a crisp and forcefully throwing it in a landfill, to die a well-deserved death.

But if you're going to make the health care system work less badly, the House Bill seems to me to be a very good start. I haven't followed the health care debate closely, for some reason, but this bill does restrict the more odious health insurance company practices. We appear to be stuck with the private system, but it will be less awful. The success or failure of this great reform effort, assuming it passes, will be in whether health care costs stop soaring far beyond inflation, and instead go up at around the rate of inflation. That change may not sound like much, but over a 10-20 year period, its HUGELY HUGELY important. We spend circa 2.2 TRILLION dollars a year on health care. Call it 2 trillion for simplicity. A difference of 5% in the rate of growth of health care spending is $100 BILLION a year in growth in spending avoided. That's well over a trillion ANNUALLY in avoided growth in health care costs in 10 years time, and far more than double that in 20 years time. I know I sound a bit hysterical when I say this, but slowing the growth in health care costs is, literally, crucial for the survival of this nation. Without exaggerating one iota. Every other problem America faces absolutely pales in comparison to the inexorable growth in health care costs, and the hugely dysfunctional health care system. And even though the lack of insurance by 50 million people is HUGELY significant, costing by most estimates more than 30,000 lives per year (that's nearly a 9-11 EVERY MONTH) self inflicted by our insane health care system, even that enormous problem pales in comparison to the ridiculous costs in our system. If we spent per person what France (a rich complex economy and a healthy country) spends each year, we would spend about $800 BILLION less each and every year on health care. $800 billion!!! That amount of money just dwarfs everything else in our national discussion. That's the total cost of the Iraq war-- EVERY YEAR, above and beyond what France spends, if only we spent what France spends per person! This is, beyond a shadow of a doubt, the most significant domestic issue facing America. Its fiscally critical, its the civil rights issue of our times, its so very important!

Civil Rights? Huh? Has Flyingpinkunicorns flown into a brick wall and suffered a concussion? Not at all. I think that health care should be a right, like the right to equal justice, the right to a free to the student public education through high school, the right to freedom of speech. If we don't provide AS A RIGHT health care to every single American (and not merely access to an emergency room) I think we should e-mail Gordon Brown, the PM of Britain, CC the Queen, and tell them we screwed up in 1776 and we want back into the British Empire! I really do-- I don't think we are a worthy nation right now because health care is not a right. It should be. That's a civil rights issue if ever I saw one; we discriminate on health care access based on ability to pay. If anyone proposed instituting charges for public schools such that poor parents couldn't afford to send their kids to school, in an attempt to secure a better life, there's be million person marches and riots! If we had previously enshrined health care as a right, and tried to take it away, the same would result. We should move towards making access to health care a right. Now you don't have a right to the very best private schools, and I'm actually 100% ok with having more expensive and less expensive plans. But access to a basic "Ford" plan should be, must be, a right. The democratic health care reform bills do NOT do this, but they do move several steps in that direction, which is why I support the effort on civil rights grounds.

I watched a lot of the house speeches today. They were not illuminating. There are a great many things I could say about the STUPID things the Republican members said, but I want to focus on just one. The GOP fancies itself the party of freedom. And at least 5-7 members mentioned the loss of FREEDOM in the House bill. You know, those who would sacrifice liberty for security deserve neither, blah blah blah. That's one of many sayings that if you think about it for a nanosecond you'll realize just how silly it is. Now government can EASILY go too far, and restrict liberty without increasing security correspondingly. See airport security. But having regulations decreases freedom? Want the freedom to drive without the restriction of traffic lights? Let the market decide? How about preventing insurance companies from discriminating based on pre-existing conditions. This decreases freedom for insurance companies, but as for individuals, not so much. Oh, the horror of government bureaucrats getting between you and your doctor. What do you think the private insurance sector does, every hour of every day in every state? This is just silly. Think most seniors think they've lost freedom by being on Medicare? Go ask them, Medicare is hugely popular. Veterans care, despite some problems, also works fairly well. The idea that millions of uninsured, myself included, who will soon enjoy vastly cheaper access to the health care system somehow are losing freedom is, of course, insane. Even those who have insurance will, if this bill works, pay less/their employers will pay less in coming years. Not much of a loss of freedom! The only persons losing "freedom" are health insurance companies, which have had far too much freedom and have done a huge degree of harm with it.

Anyway, there are some anti "freedom" provisions, to be sure. But overall, I'm with FDR who spoke of freedom from want and freedom from fear. Its easy to take that way too far, but this legislation doesn't even come close. By and large, this bill rationalizes to an extent a partially irrational health care system. It puts sensible regulations on insurance companies, protects individuals from arbitrary practices, and so on.


Now don't mistake for a second what I've said to indicate that I buy what the democrats are saying. What the democrats are saying is in many cases nearly as silly as what the GOP says, which is impressively silly indeed! Here's my favorite: several female legislators said that they rise to support this bill because it prohibits insurance companies from charging women more than men. Now let's assume that they insurance companies do so not out of animus, but because women's health care costs more. I don't know this to be the case, but I'm assuming it, as its overwhelmingly likely to be true.


So why on earth shouldn't insurance companies be allowed to charge more to those who cost more to service? GEICO charges more for bad drivers than good drivers, because paying out claims for bad drivers cost more. This makes all the sense in the world. Now if government thinks for social policy reasons that women shouldn't be charged more for health care (a somewhat reasonable position) then it should be government that pays for this preference somehow, either for a credit to the private sector or, better yet, by being the insurer (I support a single-payer system, strongly, for all of its flaws). But why on earth should this preference be imposed on the private sector? Similarly, why should an insurance company be forced to cover a pre-existing condition, presumably without being allowed to charge an appropriate rate? If someone has diabetes or the like, and is likely to cost a lot, and is getting new insurance, why should the insurance company be forced to insure at less than a market rate? This forces a private, for profit business to subsidize someone it does not have a business relationship with. That's INSANE! INSANE! It really is. Should American Airlines pay if I get cancer next week? No? Then why should a new insurance company? Because its in the insurance business? But I thought the private sector should be allowed (in the bounds of other laws) to act as it pleases. You are taking away what the private sector can do usefully; set prices. Using the private sector in this way is crazy; you get all of the downsides of the private sector (incentives to deny care, huge marketing costs, incentives to delay payment, etc) with few or none of the upsides (a market based pricing mechanism). The design of the democrats' health care reform is so far from optimal it isn't even funny. Of course, its still far, far better than our crazy, insane health care system, but it sure as heck isn't the way I would design it.


If you want to see a democrat saying what I'd like to say about the GOP and health care, look up on c-span.org the speech by George Miller on Saturday night the 7th at 8:40 p.m. eastern. HOO BOY! Tell em what you really think George! And he's 100% right. The GOP has no answers for the huge problems in our health care system. Zippo. Well, they have a few good ideas. We do need to reform the medical malpractice system. Its not nearly as big a deal as you've heard, but it is a problem, a meaningful one, and it should be addressed. The government should be the primary watchdog over bad doctors, either state or federal. But that doesn't really happen overmuch now; so the tort system takes on this role. And it does so hugely inefficiently. So reform is needed.



And the GOP is going on and on and on about allowing insurance companies to sell across state lines. Now this creates huge new marketing costs, so I'm not wild about it. Still, if we're stuck with this insane system, we may as well have the competition that selling across state lines will bring. Would you prefer that only 2 or 3 car companies be allowed to sell in your state? I didn't think so.



But these "ideas" do literally nothing to deal with the uninsured, and little to nothing to deal with runaway health care costs. The GOP is out of ideas. Completely out. If you're in any way surprised by this, you haven't been reading my blog! Or paying close attention. Well, that's what we have bloggers for!