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Why I Do Not Support Obama-Care

To be honest, I had a hard time paying attention to anything President Obama said Wednesday night after he said this, let alone taking him seriously on the subject. From near the beginning of his speech:

"There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's -- (applause) -- where we would severely restrict the private insurance market and have the government provide coverage for everybody. On the right, there are those who argue that we should end employer-based systems and leave individuals to buy health insurance on their own.*

"I've said -- I have to say that there are arguments to be made for both these approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch."
And what I say, then, is, I believe it makes more sense once you've said that to put it off until we have an actual Democrat, or gods help us even a liberal Republican like Richard Nixon, in the White House. Someone who would actually support Medicare for All, instead of some god-awful patchwork of public-private partnerships that's going to be an even bigger handout to already malevolent and wealthy corporations than Medicare part D and TARP were.

If nothing else, I insist that this makes more sense than the President's approach because the President's approach just plain flatly will not work. Contrary to what he claims, the reason that medical expenses in the US are skyrocketing is not inefficiency and waste. Nor, contrary to what the Republicans are claiming, is it malpractice insurance; this was solved at the state level two years ago, and malpractice insurance rates are down across the board. The main reason that health care costs have skyrocketed is honest-to-gods scarcity. And that scarcity is entirely artificial. And his approach does nothing to address the artificial scarcity of doctors, or the artificial scarcity of newly (wrongly) patented drugs. And the other reason why health care costs have skyrocketed is flagrantly corrupt profiteering in both the insurance and pharmaceutical industries.

Come back to me, either after the President has smartened up or after we get a new, smarter President with a plan that does these things:

  1. It should flat-out ban private health insurance. Private health insurance companies, without exception, cost 17% more than government-run systems do. They try to gain lock-in of doctors, hospitals, and practices and thus competitive advantage through incompatible billing and other paperwork systems. They have more layers of bureaucracy than even the most bloated bureaucracy in Washington, and they pay their managers way more, dozens or hundreds of times more for the top layers. They rake off yet more to funnel to stock market speculators who provide no health care at all. And because they're stuck competing for the scarce resource of medical specialists, they don't negotiate prices at all well, getting into bidding wars with each other over the most profitable specialists, which ends up driving up costs. The supposed "competitive efficiency" that we have repeatedly been promised that was supposed to make up for all of these administrative and overhead costs just plain doesn't exist. That the insurance companies keep insisting that any kind of a public plan, even one like Obama has proposed which would receive no subsidies and be funded entirely by its competitively priced premiums, would put them out of business is all the proof we ought to need that they should be put out of business. There. There's 17% savings, right away.

    And unlike private insurance companies, a government that takes your premiums and then denies you the benefits you paid for is accountable in the next election. If taxpayers paid for coverage and then got cheated out of it, it'd be a national scandal. But if you pay your premiums to Aetna, Cigna, or Kaiser Permanente and they then manufacture bullcrap excuses to deny you the benefits you paid for, all you can do is cry ... and no, this bill isn't going to change that, either. It'll just make them come up with new excuses to deny coverage. And they're highly incented to do so; they're not answerable to anyone when they do, and it's the only way they can keep raking off the maximum possible amount of all of that lovely free money that President Obama proposes to require us to give them.

  2. It should at least double the number of students admitted to medical and dental school, immediately. This will, within 8 years, bring doctors' salaries in the US down to where they are in the rest of the developed world, about 30% lower. There's another 30% savings, right away. Even if this was the only thing we did, it would solve the problem. People are entirely right to worry that increasing the number of people who can afford a doctor, without increasing the number of doctors, means more people will die on waiting lists to see a doctor. And if we what we have now were all of the doctors that it's possible to have, that would provide some economic justification (if not moral justification) for rationing who can and can't see a doctor. But medical schools turn away as many qualified applicants as they accept, because the AMA and the ADA have flatly opposed letting the number of doctors and dentists who graduate each year increase at the same rate that the population has increased. Solve that problem, and Republicans' entirely slanderous hypothetical "death panels" don't have to ration health care: nobody rations something if it isn't scarce.

    At its heart, Obama-Care is about price controls. It isn't supposed to look like price control because it's supposed to increase volume and decrease costs at the same time it (entirely unsuccessfully) attempts to control prices, but it is still a price control scheme. Price controls don't bring costs down. Eliminating scarcity, not dictating prices, is how you bring down prices, and all of the scarcity in our health care system is artificial. All of it.

  3. Speaking of scarcity, patents are an entirely legal way of enforcing scarcity. And that's why the government should immediately fund comparative effectiveness research for all patented pharmaceuticals. Where the drug companies can prove that their treatments are actually more effective than the drugs that are in the public domain, they would be allowed to bill Medicare for All for them. Where they can't, those drugs should just flatly not be covered until and unless the patient has tried the public domain alternative first. To pick an especially egregious example, we could have saved an awful lot of people an awful lot of heart attacks if more arthritis sufferers had been told, as we now know, that Celebrex doesn't work any better than aspirin for 999/1000 arthritis sufferers, and we would have all saved a ton on our insurance premiums if we'd known that, too. Or leave the heart attacks out of it: the best comparative-effectiveness study out there, the gold standard, is the one that compared plain old so-cheap-they're-free diuretics to "state of the art" patented blood pressure medicines, and found out that for every single patient tested, the diuretics controlled their blood pressure better. Where the science actually shows that the patented medicines work better, we should be finding some way to make them affordable for every patient that needs them. Where the science shows that the patented medicine works worse than the public domain alternative, we should be prescribing the public domain alternative and funding it, no matter how high the patented drug's manufacturer's advertising budget is.

  4. And speaking of patents, while we're at it, reform patent law. The metabolites of a drug with an expired patent are not a new invention. Adding time-release coating to a drug with an expired patent is not a new invention. Adding an extraneous ion or two to the end of the molecule that doesn't actually interact with the targeted cells, just to change the brand name, is not a new invention. Patent law requires that an invention be non-obvious before it qualifies for a patent; on all of the above, the courts have just plain gotten the law wrong. It's long past time for Congress to clarify the law.
That? That would be health reform. It would extend life and health for all Americans, and it would do it at a cost of 25% to maybe even 60% or 70% less than we're spending now. And it would do it without forcing people to just hand the insurance companies however much they ask for, and leaving the taxpayers on the hook for the "tax credits" to cover the difference between what Washington lobbyists decide you could afford to spend and what the insurance companies conspire to charge -- something that, not incidentally, candidate Obama and Senator Obama promised to oppose, that now President Obama boneheadedly supports.

As I said to someone else this morning, Democratic primary voters turned down John Edwards because he was too combative, too uncompromising, and too liberal. So instead we ended up with Barack Obama, who won't fight for anything worth fighting for, compromised away single payer before the negotiations even began, and has consistently been, on economic and health care issues, perceptibly to the right of Richard Nixon. I'm with Howard Dean, who said weeks ago on Rachel Maddow's show:

"It‘s just about—it‘s about money. It‘s about money, because when you have 72 percent of the American people thinking that they should have the choice instead of Congress, this is about money. And the insurance industry gives out of a lot of money. And, you know, this is going to be a hell of an issue in 2010 because—you know, honestly, what‘s the point of having a 60-vote majority in the United States Senate if you can‘t produce health insurance reform out of it? I don‘t—or excuse me, health care reform. You can get health insurance reform.

"This bill is going to cost a lot of money and isn‘t going to do anything if this compromise, this so-called compromise is true. This compromise does nothing except it will reform insurance. That‘s a good thing to do, but they ought to strip the money out of it because we reformed insurance like this in Vermont 15 years ago. It‘s a fine thing to do, but it doesn‘t insure more people. It‘s not worthless because it makes it fair, but it‘s not health care reform, and nobody should pretend that it is."
But then, I'd think so, wouldn't I? I voted for Dean in the primaries. And I'd do it again. I'd trust Howard Dean with health care reform; unlike Barack Obama, Howard Dean knows what he's talking about and his heart and his head are in the right place. Give me Howard Dean in the White House, or somebody else more like him than they are like Barack Obama, and then I'll be ready to talk about health care reform.

* Footnote: Straw man argument. And not for the first time. They let you graduate from Harvard Law, arguing like that?



Sep. 10th, 2009 03:24 pm (UTC)
It should at least double the number of students admitted to medical and dental school, immediately. This will, within 8 years, bring doctors' salaries in the US down to where they are in the rest of the developed world, about 30% lower.

Thank you for saying this. I've been saying EXACTLY this ever since this entire farce of a debate started: that there is an obvious supply problem. Every place I've lived there are FEWER hospitals than there were twenty years ago.. and the population has increased, so that has never made any sense to me.