Mittens has a secret plan for uninsured

The Romneybot clanked and computed and spit out to Jay Leno that his health plan was going to take care of the uninsured who were uninsured through no fault of their own, but the uninsured who were uninsured by choice would just have to die. He did not / could not reveal details of his secret plan, but it exists, he claims, because he said so and robots cannot lie, right?

Of course, we already know the Romneybot's secret plan for the uninsured:

1. Don't get sick
2. If you do, die quickly.

Alrighty, then!

-- Badtux the Snarky Penguin

Why ObamaCare won't solve denied claims problem

Okay, let's say that you have a choice of two insurance policies, policy A and policy B. Policy A charges $500 a month, and policy B charges $600 a month. Which one are you going to buy?

But wait. Obamacare caps profit margin that an insurer can make. So how can insurer A sell insurance for cheaper than insurer B? Well, either insurer A has healthier people -- but because Obamacare allows you to pick a cheaper policy regardless of pre-existing conditions, so why wouldn't the sicker people decide to go to insurer A? -- or insurer A is doing something nasty and evil -- they're arbitrarily denying claims.

So why would they arbitrarily deny claims? Because that's the only way to make more profit if you're required to take everybody and your profit margin is capped. The way to make more profit is to have more customers. The way to have more customers is to have lower rates. The way to have lower rates is to deny claims. It's a vicious cycle because insurer B will then decide that *they* have to arbitrarily deny claims too, in order to get back the customers they're losing to insurer A... repeat all over the industry, and you get denied claims galore.

But wait, I hear you say. There is a medical review panel mandated by Obamacare too, they can't just deny claims arbitrarily! Well, you show me a government regulation, I'll show you a dozen lawyers rubbing their hands with glee figuring out some way to get around it. My guess is that they'll either dump so many people on these medical review panels that there's no way to review all those denied claims, or drag out the proceedings for so long that people die before their claims get reviewed, or they may not even do any of that -- they may simply hope that a percentage of the people whose claims they deny don't know about the medical review panel and won't appeal the denial of the claim. And before I hear you say, "but... but... that's unethical..."... bwahaha! Ethics? These people have only one ethic: Making money. The Almighty Dollar is their God. Their notion of ethics is "greed is good".

So what's going to happen? Well, what eventually happened in *other* nations that have tried this scheme is that the insurance companies were eventually either nationalized and became branches of the federal government (see: Germany, prior to recent re-privitizations), or they became heavily regulated utilities with rates and profit margins both set by the government, meaning no incentive structure to deny claims beyond what's necessary to preserve their profit margin (since they can't reduce rates to steal customers from other insurers). Well, actually, there's a third possibility: Medicare For All, with the insurers relegated to the role of Medi-gap providers. This is what Taiwan did. But this is usually the end game of heavily regulated insurers deciding that health insurance isn't profitable enough to be worth their time -- that's why Taiwan's insurers didn't fight Medicare For All there, they were already so heavily regulated that they could make more money selling Medi-Gap on the unregulated market than by selling the core insurance as heavily regulated insurers.

Because one thing is certain: A continued spiraling downward of the services paid for by insurers won't be tolerated by either the general public or by regulators. If Republicans try to push that mule harder, they're gonna end up with the imprint of a horseshoe on their forehead. Just sayin'.

- Badtux the Health Care Economics Penguin

The economics of employer-paid health insurance

There's a wide variety of folks who claim that employer-paid health insurance was a side-effect of wage freezes during WW2. The claim is that employers couldn't raise their employees' pay due to the Federally-mandated wage freezes, so they instead started providing health insurance.

The thing is, this is unadulterated balderdash. If it had been a response to the wage and price controls, then employers would have immediately dropped the health insurance plans once wage and price controls were lifted after the end of the war and instead raised wages by that amount. But the reality is group health insurance is cheaper than individual health insurance, and that's why it became standard even for employers where 100% of the cost was paid by employees. The tax break is one reason, but by far not the only reason -- until recently, the cost of health insurance simply wasn't big enough to make the tax deduction a big deal, I paid something like $40/month for health insurance when I was a young adult for example, back when dinosaurs roamed the Earth and penguins lived in Antarctica rather than in the Silly Cone Valley.

So anyhow, why do I say that group health insurance will invariably win out over individual health insurance in a free market for health insurance? Let us list the reasons why:

1. Reduced marketing costs. There are 10 million businesses in the USA. There are 115 million households in the USA. You do the math -- group plans have 1/10th the marketing costs.
2. Reduced billing and collection costs. Again, 10 million bills, 10 million checks to process, rather than 115 million bills and 115 million checks to process.
3. Increased reliability of collections. Businesses tend to pay their bills on time due to having automated processes for collecting the money out of people's paychecks then cutting a check to the insurance company (or e-paying them). Individuals pay when they pay, and you have to deal with late pays, missing pays, and all sorts of other billing issues if you're billing individuals.
4. Homogenization of product. Individuals would want all sorts of different insurance policies and you'd need to provide all of them or your competitors would win the business for the ones you want to provide. But by selling to businesses, you can sell one of a very few insurance products, which greatly reduces your cost of selling and administering insurance plans, because businesses are primarily interested in getting the cheapest insurance acceptable to their employees.

The reality is that in countries that have evolved a universal health care system, a large number of them started from the viewpoint of having businesses pay for and administer the plans. For example, traditionally in Germany the only time you got health insurance provided by the government was if you and everybody else in your family was unemployed -- otherwise your employer handled registering you and your otherwise-uninsured family members with the health insurer for your region and employer type, and sending them the check for your health care costs. Japan works like that too -- employers handle the collection and registration part of providing health insurance. Given that in today's capitalist countries virtually everybody is employed, it's simply easier/cheaper to have the employer enroll you and take the money out of the paycheck and send it to the insurer, rather than to directly bill or enroll individuals.

In short, in virtually every country that doesn't have centralized socialist healthcare where everybody is automatically insured and automatically gets the money taken out of their paychecks as taxes, you'll find employers directly involved in the enrollment and provision of insurance, because it's simply cheaper. There is only one Switzerland (where insurance is provided on an individual basis rather than group basis), and even Switzerland has been Switzerland for less than twenty years (before that the primary funders of healthcare were employer-based group plans like the USA) and individual insurers haven't been driven out of business by cheaper group plans there only because group plans have been banned by government fiat. When you have group plans and individual insurers in the same system, people buy individual insurance only when they're self-employed... because otherwise, it's simply cheaper to buy it through your employer, even if you're paying 100% of the cost out of pocket.

-- Badtux the Healthcare Economics Penguin

Firing customers

Some customers are just more trouble than they're worth. They're always complaining, they're always threatening to sue you, they demand far more of your time than they're willing to pay for, and they think they know your business better than you do and demand that you act in ways that violate your professional ethics. In the end, you're better off firing them, because not only are they time-wasters, they're also much more likely to sue you -- and defending against even the most frivolous lawsuit in Federal court will cost you at least $100,000.

So now I hear that pediatricians are telling parents who refuse to vaccinate their children to find another doctor, and I understand completely. We now know that the only study to ever show a connection between autism and vaccines was a complete and utter fraud, and that removing mercury from vaccines had no effect on autism rates -- that is, there not only isn't a connection between vaccines and autism (other than the fact that vaccines tend to be given at the same time that symptoms of autism become evident), but the only theories about how vaccines might cause autism turned out to be either balderdash or outright fraud, while vaccines have saved millions of lives over the past fifty years.

So basically, if you have a parent today insisting that you don't vaccinate her child, what you're facing is basically a kook who believes she knows better than the entire medical profession, a kook who, because she thinks she knows more medicine than you do, will sue you in a heartbeat if you don't treat her little darling in ways that violate your professional ethics. This is the same sort of patient who would insist on treating her child's cancer with herbal remedies that have been proven to be ineffective and become extremely upset and sue you when you reported her instead to Child Protection for endangering her child's health via neglect by refusing to allow a pediatric oncologist to treat her child.

Given that, it's amazing that *only* 30% of pediatricians will fire customers who refuse to vaccinate their children. Those customers are lawsuits waiting to happen, and the fact that 70% of pediatricians will gulp and do their best to care for the child despite a parent who is an utter abusive loon pretty much is proof that the majority of pediatricians are saints. Because they're certainly not in it for the money (I make more money than the typical pediatrician and work nowhere near as hard)...

-- Badtux the Healthcare Penguin

The Coming Epidemic, redux

If you search the box at the top left of the screen, you'll find I've already talked about the coming epidemic multiple times. We're making a lot of poor people and forcing them to live under horrific living conditions with poor nutrition and in jobs that pay no sick leave so they go to work sick all the time and spread their contagion. But the biggest reason we're going to have an epidemic is not because of the poor living conditions and poor nutrition of our poor. The poor in hundreds of other countries have it even worse. It's because we give them just enough healthcare to stay sick, whereas in other third world countries they die. This provides an incubator for mutation of germs to resist antibiotics and antivirals, since the poor cannot afford a full course of either and thus breed resistant germs.

This is a problem. It's a problem that needs solving. So how do various groups solve this problem?

1. The GOP solution: If you're sick and you're poor, die quickly.
2. The Democratic solution: If you're sick and you're poor, patch the current broken system with band-aids and rube goldberg contraptions and pretend it works, except it won't and can't, so nothing changes.
3. The solution if you're not a sociopathic lizard person: Free access to healthcare for all, paid for by a payroll and/or income tax dedicated to healthcare. This solves the problem of access, mostly.

But we are ruled by cold-blooded lizard people from Planet Sociopath, so that last one -- the solution that any caring human would support -- will not happen.

And lest the rich think they can simply stock up on antibiotics and antivirals and survive the epidemic -- the whole point is that the epidemic bug will be resistant to any existent antibiotic and antiviral. So they'll get sick and die just like everybody else. But because lizard people have lizard brains, apparently they think being cold-blooded sociopaths will save them. It is to laugh.

- Badtux the Warm-blooded Penguin

Grayson was right

The crowd at the Teabagger Debate *cheered* yesterday when the scenario of a 30 year old dying due to lack of health insurance was introduced.

Cheered.

Don't believe me? See for yourself:

What kind of people cheer at the thought of dead human beings? Not humans, surely. Surely that must have been a crowd of lizard people from Planet Sociopath, right? Right?!

It seems that Alan Grayson was right...

-- Badtux the Sickened Penguin

We already have socialized medicine in America

It's called "Federal Prison". And one man was in such pain that he robbed a bank just to be sent to prison, because that was the only way he could get health care.

America. Where prison, shower-room rapes and all, looks good compared to the alternative. U S A! U S A! U S A! Fuck yeah!

-- Badtux the Snarky Penguin

A note to old people

If you vote for Paul Ryan to eliminate Medicare for all of us under age 55 because his plan protects your Medicare, we will vote to eliminate Medicare for you too, because "I got mine and fuck you" is an attitude that gets the same back in return. Us younger folks pay into Medicare because we'll get it when we become old farts too. If you vote to ban it for us, hell no we won't pay... you saying "let them eat cake" to all us younger folk is *not* going to go unnoticed or unpunished. Just sayin'.

-- Badtux the Vicious Penguin

Health care reform

Left: The Free Market Fairy prepares to wave her(his?) magic wand over the health insurance marketplace.

I have two choices for health insurance at work:

1. A major national insurance company with a reputation for "losing" your claims forms and not paying doctors. If you get sick, you'll end up being tens of thousands of dollars out-of-pocket and likely have to declare bankruptcy. That's if you survive -- if you need something really expensive where doctors won't even start treatment until they've gotten pre-approval from an insurer, good luck.
2. A major regional HMO which avoids paying for expensive treatments by simply not doing them and hoping you die before the appeals process with the state insurance commission is complete and the courts force them to provide the contracted-for treatment. They have calculated that, for example, the cost of treating leukemia (roughly $1M) is far higher than the amount of premium income they get from a typical employer group, so even if your employer threatens to move their entire company to a different insurer, they just shrug and say "Go ahead, we're still ahead of where we'd be if we paid for your employee's leukemia treatment."

These are the companies that PelosiReidCare is forcing me to have insurance with. (I call it PelosiReidCare because Obama had nothing to do with it, other than signing the final bill). Apparently the best health care plan for me is, "don't get sick." Wish me luck :(.

Soo.... why isn't the magic free market fairy (see left) not providing me with health insurance that actually, like, pays for the healthcare I need if I get sick? Two reasons:

1. Health insurance is inherently anti-capitalist. Health insurance is to capitalism what kryptonite is to Superman. In capitalism, businesses make money by providing services. In capitalism, for example, a restaurant makes money by cooking food and serving it to you. If they didn't cook food and serve it to you, they would make no money. Health insurers, by contrast, make money by not providing service. The more health care they don't pay for, the more money they make. In short, health insurance simply is incompatible with the profit motive because it profits by not providing service.
2. Health insurance is largely provided by employers as a benefit, rather than purchased by individuals (less than 7% of all health insurance is individual policies), and employers buy the cheapest insurance, not the best. The HMO above is not-for-profit but was formed by employers to keep their health care costs down, and still pursues that mission with a vengeance. The only way private insurers can compete with an HMO that was formed to deny as much care as possible is to, duh, deny as much care as possible.

In short, the entire system was set up to systematically deny care, not provide care, and this is what PelosiReidCare enshrined as national law. I would gladly pay to buy into Medicare and Tricare like my mother and stepdad (military retiree) receive. They get the care they need when they need it and don't have to worry about dealing with insurance companies trying to deny care. But PelosiReidCare give me no option to do so, which is why when the GOP runs against "ObamaCare", it's getting resonance amongst those who don't pay much attention (who haven't figured out yet that the GOP's health care plan is "don't get sick, and if you do, die quickly"). Forcing people to be part of a system that is inherently broken is never going to be popular, no matter how much people said they wanted "the current system, just a bit improved" back when Pelosi and Reid were doing their polling to decide what PelosiReidCare would look like...

-- Badtux the Healthcare Penguin

Reality vs. the right wing

• Reality: Health insurance for a 61 year old man costs over $2,000 per month, or $24,000 per year. And more expensive for every year over that.
• Paul Ryan's universe: An $8,000 per year voucher for everybody age 65 and older will suffice to buy them health insurance on the free market. And a pony.
• Reality: Health insurers prior to the passage of Medicare in 1965 had no desire to provide major medical insurance to the elderly and basically the only way you could get health insurance in 1963 if you were elderly was if you were retired from a job with a major corporation and got it as part of your pension plan. Insurers make their money when insurance isn't used. The elderly (who are approximately 13% of the population) use half the healthcare used in America, because they're engaged in the process of dying (duh), and thus aren't a profitable market because you can't charge them enough to make a profit (because they use half the health care but do *not* earn half the income because, well, they're in the process of dying, duh!).
• Paul Ryan's universe: Health insurers are eager, eager I say, to provide health insurance to the elderly for the bargain basement price of $8,000 per year, because they're just nice people and are charities, not major corporations with stockholders demanding massive returns on investment!
• Reality: The United States is the wealthiest nation on the planet, wealthier than every nation that provides top-quality health care to every single one of their citizens.
• Paul Ryan's universe: The United States is an impoverished third-world backwater which cannot afford to provide health care to every American, so those Americans who aren't rich will just have to die. Sorry, they're just surplus population, so they're going to have to make room for their betters. Just a fact of living in a third world nation where nobody has any money and everybody lives in mud huts and the only doctors are witch doctors and the only medicines are whatever herbal remedies you can find in the country side, y'know?

There's only one question I have left after making up this list: What color are the unicorns in Paul Ryan's universe?

Alrighty, then!

-- Badtux the Snarky Penguin

The American Lifestyle

Saw this on another blog I frequent, and had to snag it. This is Edie Brickell on her new self-titled album, with her song "Pill".

-- Badtux the Music Penguin

State of Texas inadvertently supports socialized medicine

The free market types say that private business will always work better than government, despite the many examples to the contrary (for example, does anybody believe that mall cops are anywhere near as competent, well-trained, and well-equipped as your city's police force?). So what about medicine? Same deal there.

Well, except that the State of Texas is getting whanged big-time for neo-natal ICU care, and... claims it's because hospitals are money-grubbing capitalists who are ripping people off (including the State of Texas's Medicaid program). They didn't use those exact words, of course. But that's what they basically said: That capitalism doesn't work for medical care, because hospitals will suck you dry for every dime they can, regardless of whether it's warranted or not.

Waiting for wingnut heads to explode... err... never. Because they'll just say "Nuh-uh, not so!" and petulantly stamp their feet and put their hands over their ears and say "nyah nyah nyah I can't hear you!", then call you a Communist for daring suggest that capitalists could ever be, well, evil. Uhm, sorry, honeys. That wasn't me saying it. That was the Texas Health and Human Services Commission, a division of the Texas state government.

-- Badtux the Snarky Penguin

Ten billion reasons why Obamacare sucks

I suppose you saw the $10 *BILLION* fine that United Healthcare has been appealing because they illegally refused to pay claims they were legally obligated to pay? Does anybody think the other health insurance companies are any more honest? If by law I'm going to have to pay a healthcare "tax" anyhow in order to not be a deadbeat, why should I be mandated to pay it to crooks like United Healthcare who want to kill me if I get too expensive? Shoulda just gone Medicare For All and be done with it. If Medicare's good 'nuff for the prunes and the disabled, why not the rest of us?

BTW:

1. Don't say we can't afford Medicare For All because "the country is bankrupt". The country isn't bankrupt. The wealth of a country is its assets, the "stuff" it has and makes, the resources it extracts, and so forth, and we have more of that than we had ten years ago, we just have fewer dollars in circulation (because so much money is sitting under mattresses rather than circulating) and thus fewer being collected as taxes (since by and large we tax money only when it changes hands and becomes "income" or "sales", not when it sits under a mattress). There's an easy way to handle that. It's called the PRINTING PRESS, and it's been around for over 600 years but for some reason people ignore it. All that the U.S. Treasury needs to do is exchange T-bills for freshly printed dollar bills at the Federal Reserve's window until sufficient dollars are in circulation, and voila, problem solved. No possibility of the Federal government not being able to pay its bills as long as it can pay them with freshly printed dollars. Actually, it's even easier than that, because it's all done *electronically* nowadays -- no paper required.
2. The health plan had been worked on by Congressional staffers for over ten years, so it's not a case of nobody knowing what was in it (well, other than Congressmen, who by and large are idiots whose staffers run things for them). The problem with the health plan is that it was modeled on the Swiss health plan, and unfortunately American healthcare companies aren't as honest as the Swiss.

So anyhow, that's just ten billion reasons why Obamacare sucks. Paying a healthcare tax to these assholes is like being told at gunpoint that I gotta subsidize the Mafia... it ain't something that anybody should have to do, yo.

-- Badtux the Healthcare Penguin

The Lowden Health Care Plan

Tastes like chicken. A few weeks ago, I figured Harry Reid was pretty much toast in Nevada, Sue Lowden was gonna run him out of office. Then she started up with the nonsense of you don't need health insurance, just pay for your health care with chicken.

As I've repeatedly pointed out on this blog, healthcare consumes 16% of GDP but sick people don't make anywhere near 16% of GDP, and if you go with what people can afford out of pocket, you're back to 1960 healthcare, when things like kidney disease, liver disease, heart failure, etc. had no treatment other than "send patient home with palliative care to die." But Silly Sue appears to have not gotten the message. So:

Sue: You want doctors to be paid in chickens. If elected, will you agree to accept your Senatorial salary in chickens?

Sue: You say bartering for health care was good 'nuff for your parents and thus should be good enough for you. If elected, if you become ill, will you agree to pay for your health care with chickens rather than via filing an insurance claim with the Congressional health insurance?

Oh who am I kidding, we both know Sue Lowden isn't going to agree to either of the above. What's good for the doctor isn't good enough for the senator, apparently. Alrighty, then!

-- Badtux the Snarky Penguin

The "competition" thingy in healthcare

One common right-wing meme is that the whole problem with healthcare costs is the middlemen. People don't care what healthcare costs because their health insurers are paying for it, and they don't care how much their insurers are paying for it because their employers are paying the insurers for the insurance.

So, is this true? Well, there's an easy way to test it. If it's true, then the uninsured -- who presumably do care what healthcare costs -- will shop around and pay less for healthcare than the insured do, since they have a financial reason to choose cheaper healthcare. So let's go look at the prices that the uninsured pay for health care, they'll surely be less than what the insured pay, right? Err... no, wrong. The uninsured are routinely charged up to four times more than what insurers pay for the exact same procedures.

So that middleman thing just doesn't work. If the middlemen were the problem, if the insurers were the problem, if competition worked in healthcare, the uninsured would pay LESS, not four times MORE, because competition would allow them to find less expensive healthcare. But that doesn't happen. How can this be, you ask? Well, it's simple. What costs most money is not the routine family health type stuff. You going to your family doctor with the sniffles doesn't cost a lot of money. What costs money is the big procedures, the stuff to treat life-threatening illnesses, where it is literally your money, or your life. And since people value their life more than they value their money, they fork over their money.

In the end, competition in the healthcare field is about as real as the Tooth Fairy and Santa Claus -- it just doesn't happen, because of the "your money, or your life" nature of the business. Might as well talk about competition in the field of Central Park muggings at that point. That is why I think insurers have been unfairly demonized by both the left and the right -- they're trying to police the Central Park muggers, and yeah, they need to be regulated because they're also taking out some of the pedestrians on the sidewalks too by firing at will in all directions like an Iraqi Army unit taking sniper fire (the so-called "death blossom"), but the core issue with health care costs here is providers with the power of life and death using that to extract people's wallets, not insurers or middlemen or anybody else.

- Badtux the Health Care Penguin

OMG Teh Jackboots iz cuming!

The right-wing blogosphere (and lots of the left-wing blogosphere too) is in the midst of a collective freakout about the possibility of the IRS enforcing the new healthcare tax that'll happen in 2014 if you don't buy health insurance by then. Now, I'm sort of baffled by the notion of the IRS enforcing a tax being somehow unconstitutional -- that was sorta decided in 1794 when President George Washington called out the U.S. Army to enforce the whiskey tax after the early version of the teabaggers refused to pay the tax -- but then, everybody knows that George Washington was an America-hating big government advocate, unlike that great patriot Ronald Reagan, who in his tax reform bill of 1986, err... forced everybody to either get a mortgage, or pay a tax on the money that would be used to pay a mortgage. Hmm... why did Ronald Reagan hate America?!

But nevermind any of that. First of all, the IRS is not going to come audit you to see if you have health insurance. As explained by the IRS commissioner, you're going to get something like the 1099 forms that are issued by your bank for interest income, except it's going to come from your insurance company and be issued if it's an HHS-certified "qualified health plan". As with your 1099 form, the IRS is automatically going to get it, and if the IRS audits anybody, it'll be the insurance company, not you. Furthermore, it was recently broken on the right-wing BigGovernment.com site that even if you don't pay the healthcare tax, the IRS is specifically prohibited from sending jackboots to seize your home or throw you in jail. You won't get your tax refund, but that's it. Furthermore, if you read the actual government document referenced there, you'll find that if buying the minimum health insurance needed to fulfill the "qualified health plan" requirement would cost more than 8% of your family income, you're automatically exempted from the tax -- which, give that the average individual plan costs over $5,000 and the average family plan costs over $12,000, means that individuals making under $62,500 and families making under $150,000, i.e., over 75% of Americans, are exempt from the tax to begin with.

In other words, Republicans (and left wingers) whining about jackboots blah blah blah are pulling shit out of their ass, as usual. But as the right-wing BigGovernment.com site points out, the fact that most Americans are exempted from the tax, combined with the mandate upon insurers that they must provide coverage, creates another problem -- as they point out, why would anybody buy insurance before they get sick, if they know they can get it at any time if they get sick? The result is that only sick people would buy insurance... and as I've previously pointed out here, sick people spend 16% of the national income of the United States, but earn only 3-4% of the national income of the United States. It's not a sustainable model, in other words -- the health insurers would go broke swiftly because to pay their insurance claims they'd be trying to suck more money out of the few people enrolling than those people actually earn.

Congress knew this, of course, but they caved to the right-winger paranoia about jackbooted IRS agents enforcing a tax by taking your home blah de blah. They're hoping that the incentives they have for getting health insurance -- the subsidies, the tax credits to businesses, etc. -- will suffice to motivate most people to get insurance without them having to jack up the enforcement side of things. Unfortunately the incentives being offered are likely insufficient to do so. What that means is that in 2014, we're going to have some problems. Unfortunately those problems are only hypothetical right now, so Congress has no incentive to fix them until they see exactly what form those problems take. We could have resolved all these problems ahead of time by simply going to Medicare For All and adding an 8% tax on payrolls and unearned income (you're already paying this "healthcare tax" anyhow, might as well pay it to the government rather than to a private insurer), but that would have required Democrats to have a spine and choose the less popular option for providing health coverage. Rather than do anything now, they decided to punt it down the road to 2014, at which point they have to do something or everything collapses. Sad to say, as Winston Churchill pointed out, Americans seem to do everything but the right thing until they have no choice but to do the right thing... and as was true of American support for Britain early during WWII, so it is true today of healthcare today.

-- Badtux the Healthcare Economics Penguin

Sometimes you get what you want... alas

The easiest thing to have done with health care would have been to simply issue a Medicare card to everybody with a Social Security card, then fund the whole thing with a payroll tax plus an equivalent tax on unearned income. We're spending the money on healthcare anyhow, it makes no sense to collect the money for healthcare in such an expensive and duplicative way as having health insurers duplicate the IRS's money collection mechanisms and Medicare's bill processing systems.

So why didn't Congress do it this way? Why did Congress create over 2,000 pages of kludges and workarounds to try to make the strange conglomeration of the Dutch, Swiss, and German systems that they came up with workable? Was it a conspiracy by insurers? Did the Trilateral Commission contact individual Congressmen and give them marching orders for how to create the New World Order? Did drug companies bend Congress into doing their bidding? Gosh, there's just so many conspiracy theories going around about why we have such an enormously complex health care bill that will only imperfectly cover most Americans, when the actual reason can be summed up in one word: Democracy.

Democracy is the notion that the common people know what they want and deserve to get it, good and hard (H.L. Mencken), and this bill gives the common people what they want, in spades. Currently over 80% of Americans have health insurance either from private or public sources, the majority of those with health insurance have it via private sources, and over 90% of Americans who have private health insurance have it through their employer. Various non-partisan public health foundations, the most prominent being the Kaiser Family Foundation, set out in the aftermath of the blowup of the Clinton health plan to perform tracking polls to see what health care proposals are most popular. What they found was that the proposals that polled the best were proposals that combined a mandate on employers with subsidies for those who could not afford insurance and restrictions on insurers to keep them from kicking people out of the system. As in, roughly 70-80% support stable over more than a decade.

The single-payer alternative has never polled at even 60% even when polled as "Medicare For All", and generally rarely cracked 50% in the tracking polls. Since democracy is the notion that the common people know what they want and deserve to get it, good and hard, our politicians then sat down to give us what we wanted, good and hard. And that, my friends, is that -- we got what we wanted, a system that largely keeps health insurance for working-age families in the hands of our employers, which thus required 2,000 pages of workarounds and kludges to sort of make it into a universal healthcare system if you squint hard enough. And which, of course, does include pieces of pork here and there on behalf of one special interest or another, but if you look carefully at the bill and at the fifteen years of tracking polls at the kff.org site, it's clear why it looks like what it looks like -- its core proposals are what polled best.

In short, there was no conspiracies involved here in the basic bones of what came out of Congress, it was very carefully crafted to include the policy proposals that polled best over the past fifteen years of tracking polls... along with a bunch of nasty kludges needed to make those proposals sort of workable (for example, the individual mandate, which is needed because otherwise the system goes into a death spiral). What happened to the simple notion of handing out a Medicare card at the same time a Social Security card is issued was something called "democracy", which is the worst of all possible forms of government save for all others that have been tried. So it goes.

- Badtux the Democracy Penguin

And it's final

The House today passed the final reconciliation bill for the health care reform, and the whole thing is now law. The resulting system looks like a weird crossbreed between the Dutch system and the Swiss system with a little German thrown in, not the system I would have set up if I had my druthers, but one whose fundamental structure has proven workable internationally. As I've mentioned it's a profoundly mediocre bill and we'll spend the next twenty years patching up the problems in this bill, but it's a helluva lot easier to fix problems once they're real than it is to fix them while they're still hypothetical. Americans aren't too good at that whole hypotheticals thingy.

As for the death panels, and why they haven't showed up at your doorstep yet, patience! I got my invitation to be on an ObamaCare death panel yesterday, and our first meeting is next Monday, so clearly we haven't had time to dispatch MIB's in black helicopters to take the lucky duckies to the Soylent Green processing centers. What, you didn't get your invitation to be on an ObamaCare death panel yet? Uh-oh....

-- Badtux the Snarky Penguin

The power to tax

One wingnut talking point being used in the lawsuits filed against the new health care bill (which will be law sometime in the next week) is that it unconstitutionally forces you to buy health insurance. Err, no. Read The Bill. You can choose to not buy health insurance. You are then charged a tax to be paid into the Uncompensated Care Fund (since it is assumed you will be drawing from said fund sooner or later), but you don't have to buy health insurance. You'll go to jail if you don't pay your taxes (like, duh?), but you won't go to jail for not buying health insurance.

In case you haven't figured it out, the power to tax is one of the enumerated powers in the body of the Constitution, and one of the first things done by the newly elected Federal government of President George Washington was to levy a tax on corn whiskey. That also led to the first tax revolt in American history, the Whiskey Rebellion, which ended when General Washington took charge of the U.S. Army and marched into the rebellious area, at which point the rebels gulped, and went back to paying their taxes. In other words, George Washington was kinda the anti-Tea Party dude, the Tea Party loons of his day didn't want to pay their taxes, and he rammed it down their throats with the full force of the U.S. Army. In the end the whiskey tax was not repealed until after Thomas Jefferson won election in 1800, 12 years after the Constitution came into effect.

So anyhow, if the Federal government wants to levy a tax on insurance -- or on non-insurance, for that matter -- it's one of the enumerated powers in the Constitution. So suck George Washington's big, long... musket, wingnut assholes. And, uhm, what's this stuff about Obama ramming things down throats again? Do you dudes have to use homoerotic language for everything? Dudes. Can you say "Suppressed homosexuality"? Sure you can!

-- Badtux the Snarky Penguin

Health care reform passes (again!)

Hearing the tighty righties fuming about the passage of Romneycare and claiming that it will put Obama in your proctologist's office (because, of course, you know that those buck negros just *love* sticking it up tighty whitey asses) is enough to make a penguin laugh. As is the fulmination from the left about how Romneycare will result in insurance company executives coming into your proctologist's office to stick their gold-plated reamers up your ass.

The reality is that health insurers don't deserve the demonization they got from the left during this debate -- yeah, they've done some evil things, but mostly because providers are escalating costs out of control and they're making some boneheaded moves to try to rein in providers. The high costs of health care, as I've previously pointed out, aren't caused by insurers. They're caused by providers who compete based on how many high-tech goodies they have in their offices, rather than on cost, because when your life is on the line you try to get the best doctor, not the cheapest doctor (because your life is literally priceless to you -- if you're dead, what does money count?). The bill caps their MLR's (Medical Loss Ratios) so that insurers will make out okay, but they won't be able to make the sort of huge profits that some people claim will happen. And of course it goes without saying that Romneycare won't put Obama in your proctologist's office. Indeed, for over 90% of those who are currently insured, Romneycare will not make any difference at all -- they're getting insured through their employer, and the only real difference is now their employer will get some incentives to keep providing insurance.

In short, this is a mediocre bill that has some important reforms in it to improve medical coverage -- see the LA Times, Washington Post, and New York Times summaries -- but will decidedly not cause the imposition of a corporate fascist dictatorship or a Marxist Communist dictatorship or whatever nonsense is getting shouted by the extremists. There's a lot of fixes that are going to have to made to the system set up by this bill over the coming years, but there's nothing inherently broken about the fundamental system set up by the bill -- plenty of other countries similarly provide universal healthcare via various combinations of regulation, mandates, subsidies, and private insurers. The sky isn't falling, folks... and shouting that it is, just makes you look like a buncha loons.

-- Badtux the Moderate Penguin

Funniest quote of the day: MITT ROMNEY ACCUSES BARACK OBAMA OF TREASON FOR FORCING AMERICA TO ADOPT ROMNEYCARE. Bwahahahaha! And yes, that's basically what Mitt Romney said. What a dumbass!