ObamaCare IS Working – That’s WHY It’s a Problem
There’s a reason for this.
After the (wholly justified, understated) bitterness of my last post, a moment of cheer: An old friend of mine is in the process of losing his job.
Now, normally I wouldn’t celebrate anyone—let alone a friend—losing a job, but, you see, he sells medical insurance in Texas and Indiana. And he’s been told that over the next three years, his income will be reduced, and basically eliminated entirely ca. 2015.
Translation on a macro level: insurance companies—far from acting as if they are “uncertain”—are cutting the commissions they are paying to agents in preparation for greater competition as the phases of the PPACA come into effect.
We have already seen variations on this: insurance companies that will no longer write policies for only parents, because their children have other options. Insurance companies complaining about the “cost” of having to cover basic services—you know, the preventive care that would seem to be implied when you call your plan a “Health Maintenance Organization” and which is covered by State Medicaid plans such as NJ FamilyCares.
The English translation of “the market won’t support it” is “we can’t compete with our current structure.” It is a tale told by a capitalist since the beginning of double-entry accounting, with the steel industry being a recent example of American Rebirth.) Economists us the phrase “creative destruction” to explain it, even though there is very little creative and a lot of destruction (or, in significant cases, structural shifting) that goes on at the time.
“Bending the cost curve” means producing more consumer surplus. This is what competition does in economic models, primarily by cutting margins (“excess rent”) and thereby making firms allocate capital and labor more efficiently. When your margins are large—through monopoly power, including “monopolist competition”—consumer surplus is low. Since Steve Jobs is the sexiest human being in the world, Apple products sell for higher margins than other communication/computing devices do. This may always be so—or maybe the world will shift to Android phones, a and the Apple of five years from now will look like the Apple of 15 years ago, taking cash from Microsoft in order to survive.
Health insurance is an area hasn’t had true competition—search costs are too high for most people. (Indeed, the evil of employer-provided health insurance deductibility isn’t that it is a suboptimal allocation of resources so much as it is that that pre-tax money allows insurance companies to maintain higher margins without the consumer feeling the full cost of their loss. It is a system that perpetuates excess rent being paid, effectively as a transfer from the government to the insurer.) One of the first things health economists noted about Medicare Part D is that, while one had to “shop” to find an insurer, the effort required meant that very few people would then switch, even if the insurer later reaped excess rent. When switching costs (consumer) are higher than menu costs (supplier), excess rent is virtually an inevitability. (In this case, again, the American taxpayer is footing a large portion of the bill for a transfer to insurance companies. It is impossible to believe, given the bill’s enactment process, that this was not considered a feature.)
So there are multiple areas where consumer surplus is low in the health insurance industry. Which means that many people—including my friend—have been “earning” more than they are “producing”—some of the excess rent is distributed, after all. And, for the next few years, they will be seeing their incomes decline while people believe (as Jon Stewart said to Barack Obama last night) that PPACA will not take effect until 2014.
And Obama’s reply (starting around 7:30) was spot-on:
| The Daily Show With Jon Stewart | Mon – Thurs 11p / 10c | |||
| Barack Obama Pt. 2 | ||||
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So for the next few years, people such as my friend will see that the squeeze is hitting them, while the benefits haven’t reached all of the general populace. (They have already reached many children—including adult children who can’t find a job and can at least be insured by their parents—and helped many senior citizens who were being affected by the “donut hole.”)
We saw this same sequence in the mid-1980s and early 1990s in the travel field—slowly at first, and then quickly as internet bookings and purchases determined solely by price became the rule. The survivors were the agencies with large corporate accounts and the ones that provided specialty (“niche”) services you couldn’t get from Travelocity and its competitors.
The travel agency market existed for one reason: in the old days, it cost an airline about 16 cents of every dollar to get a seat booked. An agent who could be paid 8-11% per ticket—with incentives for volume—was a bargain. It was, to use the economist’s favorite cliché, a win-win situation. And the benefits of tour and hotel bookings could truly be treated as marginal cost increases, with their own revenue stream generally more than enough to justify for even a small office.
But true competition—the decline in the incremental Search Costs presented to consumers by Travelocity and its competitors, followed quickly by direct booking availability directly with a specific airline—meant the end of that model, leading to industry consolidation, downsizings, and closings—just as the insurance agents are feeling the pressure now of the impending “exchanges.”
And, as then, my friend noted that there are still areas that will continue to be profitable for insurance agents in 2015. For insurance, policy service for the elderly. (Showers of gratitude from the insurance agents to the unfunded, deficit-exploding Medicare Part D shall continue.) Everything else will see the agents’s livelihood affected as the insurance companies try to protect their own share of the turf.
He has four years to prepare, and a roadmap for change that remains valuable. And for those interested in “bending the cost curve,” the first fruits of that effort are being realized. And people are realizing they will have to change their lifestyle and practices to deal with the new world.
Good call Ken. Changing the US system will be steadily expansive. Certainly the masters of the MA system have not found a way.
Mission Accomplished?
A little premature perhaps.
Yeah and they hate us for our freedoms.
I wonder if e-textbook publishing will do the Travelocity thing for the excess rents earned by publishers of $130 econ textbooks. At least one company is trying to break the oligopoly of the major publishers, although with limited success so far
Hi Ken:
Bull Shit,
The total healthcare bill was never written in entirety, the bill was a skeleton of what was to come. What will happem in 2011 is:
– Coverage for children until age 26
– no cap
– etc.
The healthcare bill needs to be fleshed out yet. Insurance comanies still need to ciut back becuse of the up and comig ratios to expenses and true costs. No more big boners . . . oos I meant bonuses.
Yes, the Health Care and, by deflagration, the Health Insurance Bidness are Monoploists. So are the Higher Education Providers.
Rising costs and falling service are always the give away. Only one type of business can really do it. Monoplists.
The theory of utilitiy business structure is completely applicable. Same with the Mult-National trade.
It is really about time for the dumb shit Americans to wake up, vote Democrat on Tuesday.
Hey, and while were talking about crap American bidness structures, how the military. What a bunch of pussies. We spend more money feeding the military pig than all other countries on the earth, combined, and they can’t contain the fight against a people that get their cash flow from the equivalent of pop bottle recycling ?
Jeezuz H Christosovith. The poor whittle tea bags, flailing against the ghost.
What a bunch of pussies, the military, that is. Brings to mind the question: WTF is our objective in Iraq and, especially, Afghanistan ?.
This is a fair question. What is it that we want to accomplish. It appears to me that we simply want to destroy a whole lot of ordanance and (Soviet Style) human lives ( Who gives a).
Or, am I wrong, is their actually a purpose for doing what we are doing ? I think some rich skisofrenic is determining our future. Some arab guy may bring a thing and do something and I have to have the where-with-all to do something drastic. Maybe I need to threaten those dirty little( expletives) that work for me to do more to disuade the SOB’s that oppose me.
That F**king N****er I elected is not doing enough to help me. I need to kick some ass ***
Welcome to America – 2010.
The big question in our civil society: Is Barrack O’Bama a rookie, making time with the power brokers from both sides of the aisle ?. No waves, no changes to the status quo, like the last people of their persuasion we promoted in the military and the FTC.
In the last round, on their knees begging for redemption, the FTC granted the rich guy, Rupert Murdoch, carte blanche, to reorganize 200 years of the 4th estate. He did the same thing in Britain. Tabloid crap is always much cheaper and profitable because most people are not smart and find solace in a life of mystiscism. I have to admit that I do too (JC). But USA Today has destroyed Journalism by $.40/unit to the Hilton Hotel chain. Same as in Britian. Those dumb bastards have nothing to offer the USA except tragic stories about how their empire fell apart and now they need to steal peoples money through the “city’s financial distrrict.
Barack O’Bama has an extraordiny intellect. He is a worthy leader and, God bless him, he is faced with an extraordinary challenge. Maybe the diety really has a plan for this great earth. Surely a power greater than ourselves is at work ? The welfare queens running the tea bag movement, and their handlers, seem to agree. Like the Jews of the New Testament, they simply can’t see the Messiah, like the tea baggers can.
How can we dismember the Goliath that has taken root in the good old USA, the Bankers, speaking of the former Judea-Christian New Testament. One quote, “it would be easier for a camel to pass through the eye of a needle than for a rich man to reach Heaven”. The disconnect with the Christian Right is obvious. I never did cotton to Billy Graham, sniveling at the gates of power.
When the Gi’s came home, they were a Band of Brothers. Putting together the greatest society, in all respects, on the face of the earth. As my Father lyes, dying, a Union man all his life making sure that he made a living wage and raising and educating 7 children, I grieve for this country. The wealthy have become emboldened like the English Aristocracy that was the very impetus for the creation of this great nation.
Now we have conscription of the everyman, at the discretion of the king. George Bush Jr would never have been elected without the activities of the Supreme Court, an institution greater than any of the POS now sitting. Clarence Thomas has been accused by more than one woman of sexual aggression yet he is determining the future of the rule of law in America.
Abraham Lincoln is the father of the Republican party. Teddy Roosevelt was a Rpublican. There is scant similitude in the ideals of AL and TR with the likes of Karl Rove.
Any tea bags out there living on Social Security and Medicare, riding around in your Medicare funded moto-chairs, we will make all the crap you put on the children of this country, retroactive, without recourse in bankruptcy court.
You may owe hundreds of thousands of dollars, which will put your pathetic welfare asses in the street, where they belong. Living in your car, unless the Marshall comes and takes it away. I am comijng for you. I have nothing better to do. I will take away your Goddamn Social Security check, which you never paid for, and your Goddamn Medicare plan, and come after your savings, your house, and all of your assets to lessen the burden of the tax payers. You pricks.
I just reakized Chris nathhews is a Creep playing both sides again the other. Hey Chris, FU.
Except that the margins aren’t high. Yes, these companies make a lot of money sometimes, but that is because of volume, not because of margins. Most of these companies have a profit margin that is significantly less than companies in other industries. Squeezing that more is not really introducing competition. I’m going to base this on facts, not on rhetoric. Take Wellpoint (Ticker: WLP). Wellpoint’s current profit margin is 8.42%. (pulled from Yahoo Finance). What are some other profit margins: Microsoft, 30%, Berkshire, 9.42%, Apple, 21.48%, JP Morgan, 17%, Simon Property Group, 9%.
What’s the point? They aren’t making huge margins, and if, through regulation, that goes down closer to zero, companies will leave the market, which will make it MORE, not LESS monopolistic. Of course, then the government could insure everybody, which will eliminate monopolies, right? Oh wait, no, it will eliminate competition. We will put the government into a zero profit margin business with no competition, and then we will expect good results?
I’ve lived in two countries that had nationalized health care (England and Costa Rica). In both of the systems, the healthcare was slow and access was limited, but people that were wealthy enough bought supplemental insurance so that they could use private healthcare instead when necessary. The problems get worse, not better when you squeeze so hard that you eliminate incentives for companies to exist and compete.
I don’t believe our system is great today, but the current trend is to encourage the bad parts of our system, and move more towards a monopoly than we are even today.
Well, I’m impressed that there is another out there with the grit to post thoughts such as the Sandi has, as also, A.B. for allowing the print for a wet rainy morning. Dare I say, Hoo ray!
I think that you’ve cherry-picked your margin comparisons. While 8.42% isn’t a”raking in money hand over fist and cackling gleefuly” margin of the kind that your comparisons have, it’s still pretty good, especially if it is stable year-in and year-out.
By the way, Insurance companies make most of their money off of the float, not margins.
At the very least, the margins health insurers make shows that they are gouging or that their profits are at the heart of health care inflation is a big fat lie.
Sector: Healthcare
Industry: Health Care Plans
Net Profit Margin: 4.8%
Sector: Healthcare
Industry: Hospitals
Net Profit Margin: 3.4%
Sector: Consumer Goods
Industry: Beverages – Brewers
Net Profit Margin: 14.5%
Y’all just buy the idea that it takes 20 or 30% of premium dollars to run a claims operation. I don’t because I know it can be done efficiently for about 2% of premiums (in SSA’s case, FICA revenues.) Government managers are cheap because there’s no more where that came from and it might disappear without warning.
CEO’s and other executives of insurance companies are generously compensated, to put it mildly. Obviously, if their compensation were less, they’d have more profit. Also, if the InsCo’s have a float big enough to invest, they are not the poor struggling organizations they say they are. The ethic (if you can call it that) of these outfits enables them to deny benefits to dying children. Great people. I would suggest that any reorganization of their enterprises include revisiting their basic business practices to include some basic moral responsibility. NancyO
The so called float for insurance companies has three components. The first is premiums collected from plan participants, the second is the return on general account assets (investments) and the third is claims paid. The left over is profit. Any change in the mix affects the results of the opertation. Most insurance companies are mutual entities meaning that profits are held to the beneift of the plan participants. You are definantley barking up the wrong tree if you beleive that insurance companies drive health care costs. Insurance companies are nothing more than payment plans. In the end, we as consumers pay for the services provided.
Most health insurance companies, certainly the largest ones who dominate market share, are not mutuals.
According to Milliman the actual Medicare admin expense is closer to 6% while private health insurers are around 17% including commissions, profits and premium taxes.
Their basic business model is to profit by not delivering health care. The only reorganizaton of these fucks that I’m interested in is for them to disappear. And, I would think the same would be true for anyone else that actually gives a shit about moral responsibility.
Big time premature. I’ve been following the NAIC and the MLR discussions. MLR waivers anyone???
If insurance companies are nothing more than middle men, what added value do they provide to justify their existence? Why isn’t a government-run single payer plan vastly more cost efficient?
True, I did lump in all types of insurance carriers in my statement above. Certainly BCBS, Aetna, etc. are not mutuals…
What you said, drb48! With bells on! NancyO
I found and purchased a high deductible policy a few years back via E-healthinsurance.com. (Think travelocity). it was very easy.
I don’t see how subisidizing demand and taxing supply will lower costs. If anything it will be the opposite.
The legislation also has all the appearance of increasing oligopolistic tendencies in the health insurance market. I expect Aetna, Wellpoint and United Health in particular to do very will on this bill.
To me this looks like a huge giveaway to a few healthcare companies.
drb48, you are correct insurance companies do not deliver health care services. Hospitals and medical practitioners fill that role. Insurance companies merely provide a means to finance health care services. Certainly you can opt to not have insurance. That would cut your premium costs to 0%, but raise your out-of-pocket expenses to 100%.
Medicare should be opened to anyone who wants it. I don’t know any seniors that complain about the coverage and benefits.
Insurance companies (1) negotiate rates of services from health care providers on behalf of policy holders, (2) they screen health care providers for quality of care, and (3) they finance health care costs.
A single-payer system would not have these advantages because (1) a single negotiator creates an imbalance of market pricing…basically take it or leave it pricing…which produces a supply shortage of health care providers…see Canada (lack of medical equipment, wait times, etc.) and the UK (wait times and the importation of medical personnel), (2) screening of health providers would not be possible…see teachers unions, and (3) government has shown an inability to financing government expenditures…see the national debt and other unfunded liabilities such as Medicare and Social Security.
@Caden – re insurance companies not delivering health services, see my response to your other comment below.
Except that I would wager that less than half of health care providers accept Medicare because the re-imbursement rate is less than the cost of services provided.
I have looked into a high deductible plan for my company. We could pay 100% of the HD premium and “fund” HSA accounts to their max on the employees’ behalf for less than the employer portion of our current insurance premiums.
1) isn’t working because premium costs have continued to rise faster than inflation for decades
2) is questionable because cost – to the extent it can’t be passed through and thus reduces profit – has priority over quality of care
3) they don’t finance shit – the premium payers do – the insurance companies simply add another layer to the cost
The idea of “insurance” is to spread risk. The maximum “spread” is everyone. Single-payer -would include everyone by definition. Space and time limitations here prevent me from making a complete refutation of your claims but suffice it to say that the disadvantages of the current for-profit approach far outweigh any possible benefit. Look at the delta in per-capita spending on health care between our system and other advanced nations to produce generally poorer outcomes for ex. The national debt, unfunded liabilities, etc. is a straw man IMHO and requires another lengthy argument. However in short they represent a failure of our political system due to its capture by corporations. The appropriate response isn’t less government services IMHO, it’s less control of the government by the plutocracy.
Correct, nanute. NancyO
(1) Here is the equation for a for-profit or a not-for profit health insurance entity to continue as a going concern:
Premiums + investment returns > payments to providers
If investment returns are lower than the actuarial tables (as they are currently) then premiums must rise. Additionally, as the cost of health care providers rise then premiums must rise (as they are currently.)
(2) Care is effected. If your plan does not include the doctors that you prefer you look for a different plan. Although this is hard to accomplish with an emloyer provided plan. But if we have complaints about the quality of care that our insurance pays for then we will complain to the insurance carrier or take our business elsewhere.
(3) Of course health insurance companies finance medical expenditures, just like auto and life insurance companies. As the consumer you have to pay into the system, remember TINSTAAFL…
As for per-capital spending and outcomes of services is that the metrics used in these studies are so very different here in the US than the ROTW…look at differences in demographics, geographics, treatment variation, etc. I wish there was a way to use these studies, but there really are no substantive peer groups for the US.
I do not agree with your assertion that corporations are to blame either. The only difference between a for-profit, a not-for-profit or a government agency is a tax designation. The sytems comes down to money in and money out. If a for-profit or a not-for profit loses money it goes out of existence. If the government loses money it just takes more money from you and me.
Yeah except the most critical component of Medicare, Part B, requires a premium. In addition most Medicare recipients have a Medicare Supplement insurance policy that covers the things Medicare doesn’t cover.
So that’s two premiums!
The supplemental insurance covers the 20% not covered by Medicare. My mother’s part B premium for last year: 1,156.80. That is all she pays, and it comes out of her SSI benefits. If you have 40 or more quarters of SSI credits, the Medicare part A premium is zero. If you are enrolled in a Medicare Advantage program (she is), you don’t need and can’t use a Medigap policy.
Thank you Nancy.
Phill:
I agree the profit margins are not high and Healthcare Insurance companies rank 87th (?) for profitability. The issue is what percenatge of the premiums go for actual healthcare which is the reason for the ratios being put in place for group and individual coverage. I believe them to be 85% and 80% with the youngest paying the lowest rates and the risker groups paying more as a percentage of that rate for the healthiest and youngest. It is possible for the youngest groups to see rebates.
Oh but they are gouging, they drop the riskiest and insure only the healthiest.
Yes and investments
Caden:
If all things were a constant and no changes in the policyholders were enacted, your model would be correct. The fact remains we are discussing insurance of all people and not just the healthiest or those who can afford premiums. This in itself creates a higher cost for insurance companies and a need to raise premiums higher than what those not so healthy could afford. Instead insurance companies drop the higher risk citizens and keep those who are healthier.
Urban Policy Institute does a nice study: “The Cost of The Failure to Enact Healthcare Reform” http://www.urban.org/uploadedpdf/411965_failure_to_enact.pdf
“In 29 states, the number of people without insurance would increase by more than 30 percent.
Businesses would see their premiums continue to increase—more than doubling in 27 states.
Every state would see a smaller share of its population with employer-sponsored insurance (ESI).
Every state would see its Medicaid/CHIP spending rise by more than 75 percent by 2019.
The amount of uncompensated care in the health system would more than double in 45 states. “
Yes, Part B is a good deal for enrollees. Does your mom have to pay a premium for her MA plan? Is she satisfied with the insurance company that administers the plan? Do you have any opinions on the consequences of the PPACA on MA plans?
To your first point, I suggest you look at this study. As for this:
If a for-profit or a not-for profit loses money it goes out of existence. If the government loses money it just takes more money from you and me.
The for-profit system also takes money from you and me. Where in the name of all that’s holy do you think it comes from? The difference is that instead of paying directly in taxes for the actual cost of health care to the government, we have to add in all the additional overhead for a multitude of over-lapping private for-profit administration, the “profit” of the for-profit system, and the added cost of the uninsured showing up at the emergency room because they’re excluded from primary care by cost. The for-profit insurers are nothing but blood-sucking vampires on the rest of us.
The argument claiming that significant efficiency is possible by streamlining the part of the equation related to the insurance industry is a horse that has been dead for decades. Why Caden would be made to patiently explain that this particular turnip has no blood is symbolic of just how confused so many were left by the deceit that was rife throughout the lengthy debate last year.
The problem with health insurance as well as socialized medicine is that these remove the moral hazard of cost. As compared to auto insurance for example, which has built-in moral hazard due to what might be best described as a ‘fear factor’, that is to say that consumers of auto insurance are constrained in their use of this type of insurance because they do their best to avoid accidents. While, conversely, with health insurance there is an opposite incentive to get as much care as possible for the money invested. Needlessly extending the lives of people who have no chance of recovering from comas etc. would for example be far less prevalent if it were being paid for out of pocket. And this is an area along with countless other unnecessary expenditures that has much room for improvement.
The other way that costs could be cut, but again unpopular as a subject, is through improvements in health. The US, relatively, has very high prevalence rates of diet-related diseases, and of injuries mainly due to the fact that Americans do so much commuting by autos. Lots of illness and injury leads to lots of cost.
The health-care industry in Maryland has been used as part of a study going back about 30 years. Maryland went from being about 25% above the national average in terms of overall cost, down to 2% below the national average. But if every state in the union were to become as efficient as Maryland it is hard to estimate what that would equate to in terms of national health-care costs as measured by percentage of GDP, because when rising prevalence rates of illnesses and injuries are considered the 17% of GDP number is not likely to come down much, if at all. The plain truth is that Americans have collectively ‘let themselves go’ and they, also collectively, believe that their lives are more valuable than what their productivity can pay for.
Here is an article about the study of Maryland’s HC:
http://online.wsj.com/article/SB125288688445707403.html
Profit margins “aren’t that high” but that’s because “Profit” is only part of the picture. Basically insurance is a racket that spends money on non-benefits to avoid spending money on benefits. They set up claims processing systems to make it difficult for anyone to collect. They cherry pick. They cancel polcies. They generously play executives and lobbyists. Etc. All this costs money which isn’t profit, exactly, but is overhead to the process of actually providing healthcare.
little john: No premium for MA It is paid out of the Part B premium. She’s relativly staisfied with the administrator. (Blue Cross.) On the effects of PPACA on MA plans: Since the PPACA has reduced the cost to administer the plans (what critics call 500 billion in cuts to medicare), I suspect there will most lilkely be some cost shifting. In fact, I’ve noticed her co-pay for doctor office visits is going up 10.00 per visit. I noticed that her perscription co pay, and drugs that are covered has already been impacted by the changes. (Anticipation?) The MA’s have revised the drugs that are covered under the plan, and I’ve noticed that certain prescriptions are more expensive, and the co-pay in general for drugs has gone upprior to the PPACA. I don’t know how the MA plans compare to traditional Medicare coverage in this regard. I’ll look and see if I can do a comparison.
That’s good info. Thanks. I saw a letter from the chief SSA actuary saying that MA plan benefits may be decreased due to the PPACA but I wasn’t sure if MA enrollees were feeling it.
little john; An interesting way of phrasing things. Is it a decrease in benefits, or an increase in cost of benefits? (I’m not being critical, just an observation.) I don’t think benefits have decreased; cost for the same servies have gone up.
It should also be noted that the primary reason for PPACA giving less money to the MA’s is because it was argued the MA’s could administer the plans cheaper than the government. The reality is that the MA’s have not been able to provide the cost savings.
Thanks for the dialogue. nanute
ray:
While I agree citizens could use a spat of walking rather than driving to begin living a better life style; you know as well as I do that when LA attempted to limit the numbers of fast food places in a particular area already saturated, business had a fit.
Insurance can and will be made more efficient with the 85% and 80% ratios being applied to them in this healthcare reform law. People will have to pay a moral hazard fee as the cost of insurance will vary by ratio based upon risk, age, etc. There will be substanial subsidies for those who are poor.
Maryland became efficient because it started to negotiate hospital costs. Maryland also takes into account how many of the hospital cases are charity cases. The uninsured get the same rates as the insured. In Maryland, Medicaid pays the same rates as Medicare to hospitals. This is applied across both public and private hospitals.
The clincher? Much of what Maryland is doing will be in the recent healthcare reform. http://www.healthbeatblog.com/2010/02/how-maryland-broke-the-curve-a-solution-for-massachusetts-part-3.html “How Maryland Broke the Curve: A Solution for Massachusetts” Maggie Mahar, Healthbeat Blog
Run,
I don’t disagree with anything you said, essentially. But I have 2 ‘things’. One, should we allow business interests to dictate whether we are healthy, and, competitive in the global marketplace? (no need to answer that one, I know that you are not advocating otherwise)
Secondly, the MLR is clever because it puts the insurance industry in a position that incentivizes them to put more negotiating pressure on providers. That is where some potential gains from increased efficiency exist, with the providers. The insurance industry could perhaps be slightly more efficient too, of course, but not as much as the medical folks, they could use a good squeeze. But, as the Maryland study shows, there is not nearly enough room to improve without improving health and injury factors and the biggy is of course the ‘keep-Granny-alive-at-any-cost’ that looms largest. The Dems should have stood-up to the ‘death-panel’ crowd but instead the Dems cowered and so without any progress on this largest of the wasteful cost factors there can be no major change anytime soon.
As you may remember, my main concern about the HC reform effort is that it obscured these ‘unpopular’ issues, and especially the diet-related disease issues. The Dems tried to sell a program that has no chance of bringing down the HC% of GDP in a significant way and so it could do more harm than good by delaying the inevitable fight we must have over food and health and death etc. The Dems, whether you are ready to accept this yet or not, are ‘unintended consequences waiting to happen’, and they have been so as long as I can remember. And putting business interests ahead of the nations health is yet another example of waiting until the unintended consequences are out of control before acting upon them. I am of course not suggesting that the Repugs are anything other than worse in their own peculiar ways. But if Dems are not seeing just how unhealthy Americans are collectively, it is because they don’t want to see it. And of course with health-care so unaffordable they have some built-in statistical convenience due to the fact that so many folks who need care have so little access to it. But if one cares to see how unhealthy the US is, one need to only look around.
Ray:
I believe you will find that both Beverly Mann and I both write in a similar fashion as to how Big Business rules the courts and going up against them is a losing proposition. In 1978, Brennan wrote the deciding opinion on eliminating State Usury Laws in Marquette versus First Mutual. Since then we have seen labor intensive industry give way to capital appreciation becuase you could make more money doing . . . nothing. No Dem or Repub will go against corporacy. The days of Gideon and SCOTUS searching him out are long gone.
The efficiencies in Healthcare Reform will come from from Medicare leading the charge with their planned pilot programs which will wring the efficiencies out of medical care for the elderly. Insurance will follow suit.
Thank you for your reply Ray. It has been a bit.