Tuesday, December 29, 2009

Health care deform

One hilarious outcome of the current health care "debate" is the consistent Republican insistence upon eliminating Medicaid and replacing it with health insurance subsidies. The problem with dropping Medicaid is that Medicaid is *much* cheaper than private health insurance. We currently spend less than HALF as much per-patient with Medicaid as the average private health insurance premium. This is part of why the Massachusetts experiment resulted in exploding health care costs there -- most Medicaid funding got diverted into health insurance subsidies there, and the result was a huge increase in costs compared to simply giving hospitals uncompensated care Medicaid funding for caring for the uninsured. I thought Republicans were about fiscal prudence? Oh wait, Ronald Reagan and George W. Bush. Never mind ;).

Regarding the question of "is government subsidies and regulation of health insurers Constitutional", the Constitution mentions "the general welfare" *twice*, in the pre-amble and in the section describing the powers given to Congress (the power to pass laws to improve the general welfare -- as vs. the welfare of specific individuals -- being one of them). The Supremes already danced on this with Medicare and Medicaid. It's a non-starter -- there is no (zero) Constitutional barrier to setting up a mandatory health insurance program (like Medicare) or provide health care subsidies for the poor (Medicaid), or provide whatever regulation of private insurers is needed in order to insure the general welfare (as vs. the welfare of specified individuals).

As for all the theoretical mumbo-jumbo about how government should not be in the business of health insurance, look. We have a practical problem here: A huge number of uninsured, and a huge number of insured people who are not getting the care they're paying insurers for due to recissions, lifetime limits, and simple refusals to pay. "Let them eat cake" is *not* a viable policy for government in a democracy. It simply isn't. The majority (those who are being told to eat cake) will *not* tolerate it for a long time. Either they will overthrow any government which tells them that the solution to their health care problems is "eating cake" via voting it out of office, or if that doesn't work, they will overthrow it violently, but they *will* overthrow it. This is America. We may be sheeple most of the time (just stand in line at the airport "security" checkpoints to see that), but we're also a violent, vicious people who do *not* take well to being subjects rather than a free people. The overwhelming majority of Americans, in all polls, even Fox News polls, say that health care is a right that government must guarantee. As in, 70% to 80% of Americans in *ALL* polls say this.

In a democracy, no government can ignore this except at its own mortal peril. What that means is that however this plays out (and I'm as disappointed with the current bills in the House and Senate here as anybody is), government is going to *have* to do something to guarantee health care for all Americans, regardless of any theoretical quibbles, or end up on the street -- or under the graveyard after Madam Guillotine Time happens (just ask Marie Antoinette about *that* consequence of "let them eat cake" ignoring the will of the majority, oh wait, you can't, the majority chopped her head off). I realize that many conservatives hate democracy (they sneer at it as "the tyranny of the majority"), but what's the conservative alternative? The only alternative I've seen is a tyranny where jackboots enforce the will of a minority upon the majority. That never turns out well.

-- Badtux the Practical Penguin


  1. Medicaid is more expensive than letting poor people die, which is what kkkonservatives really want, even thought they can't bring themselves to say it publicly. And they'd also like to let old people die by eliminating Medicare, but ditto for not admitting it out loud. That's the underlying kkkon desire. They're just lying about it.

    As for how long people will put up with being left to die of treatable illness without revolting? I think they'll tolerate a lot. Look at the flocks of folks who show up at these traveling medical free clinics in Appalachia and Los Angeles and elsewhere. They've got rotten teeth, cancerous tumours, knees so inflamed from arthritis that they can't put their pants on... They suffer in somnolence because to be an American is to be culturally conditioned that you should take your lumps, sucker, because you deserve it.

    I've been reading a book titled "Memoirs of Extraordinary Popular Delusions and the Madness of Crowds." Because it was written in 1852 and is in the public domain, you can read it for free online if you want to learn how economic lunacy has played out through the ages. The chapter on the "Mississippi Bubble" that destroyed France's finances in the early 1700s was instructive.

    This was a huge speculative finance scheme that swept up the entire nation, and ruined its monetary system. Good times rolled for a few years, then it crashed, bankrupting nobles, wiping out the middle class and unleashing poverty amongst the working classes. The economic calamity set the stage for the French Revolution -- but it did not take place for another 50 years!

    And the French were no strangers to communal bloodletting -- they had the recent examples of the Huguenot massacres, the 100 Years War, Crusades, all manner of violence. Much more prone to unsheathing swords than coddled Americanos. But they stayed mostly placid despite degradation.

    So I think the USA will eat a lot of shit sandwiches for years and never lash out UPWARDS, only sideways.

  2. I do not share your optimism on this one, Badtux. The Bush years have proven that people are okay with being spied on, being tortured, preemptively invading other countries, not having proper healthcare, etc. Now along comes Obama and ties us all to the very same broken healthcare system that many people have been suffering from for years. Sure you have some grumblings of discontent here and there, but by and large the Republicans and their supporters are marching lockstep under the banner of single-payer=teh socialismz=teh deathzpanelz while the congressional democrats have aided and abetted them every step of the way. Either the Democrats are afraid of appearing weak or they want the same goodies that soft money brings that have been going to the Republicans. They know that their supporters will never abandon them during elections because the only option would be to vote Republican which would be much worse.

    No, I do not think that the American people are ever going to stage a nationwide call for political overhaul since the majority of us still labor under the illusion that we are Bestest Nation on Earth. Any call for massive improvement is either shot down out of a fear of change or because our political racketeers have other priorities in mind. America is not heading for a revolution, but merely a rapid spiral into decay and dilapidation as our national identity and body politic stagnate to the point of no return. India and China are poised to pass us by while laughing in our faces. The US is already showing some disturbing signs of degenerating into a third world country.

  3. Neurovore, the majority of Americans love kicking ass and had no problem with invading Iraq. Six months after the invasion, the majority of Americans approved of it. America turned against the invasion only after it became obvious that the occupation of Iraq was going to result in a constant drip drip drip of bodies back.

    Same deal with torture and spying. The majority of Americans have no problem with the notion of torturing brown people or warrantless spying on "bad guys" (because of course they've never done anything wrong and thus surely the government isn't spying on *them* -- poor naive fools!). There's a *reason* why "24" is one of the most-watched television shows in America.

    In short, Americans are a violent, myopic, vicious people, and heartily approved of most of the Bush Administration's programs until it became clear that they were disasters.

    Regarding healthcare: It's like the Iraq war. The political establishment is dragging their feet, but you'll notice that we're slowly getting out of Iraq. Things move slowly in the USA. We're a somewhat dim people, remember, 50% of Americans are below average, and average ain't so bright nowdays. The Republican circus isn't accomplishing much other than damaging their brand, such that it is. I don't like the bills coming out of Congress, but I've read the polls carefully, and the approach taken by Congress meets with the approval of over 70% of Americans if you ask them whether they like it or not completely divorced of any particular bill. For better or for worse, it seems we're going to end up with something like an odd amalgam of the Swiss and German systems. It's not what I would want, but it's what the polls support. And while you're right about the Democrats being spineless, they can read polls too...

    - Badtux the Poll-readin' Penguin

  4. Bukko - thanks for the link. I've been wanting to read that for a long time.

    Neurovore - I think you nailed it.

    Tux - I only partially agree with you. Yes we are a violent, myopic, vicious people - towards the "other."

    Seriously, though - can can there ever be a revolution of the disaffected left, when all the gun toters are on the right? And we 'Merkuns always rally behind our overlord in time of war. One of the reasons Bush invaded Iraq in '03 was to get re-elected in '04.

    I really don't know what to think about where we're going. Most people want serious health care reform, but the antis get all the press coverage.

    Basically, I think we're pretty well fucked. Corporations own both parties, and the god-damned voting machines.

    Ah, shit.
    JzB the we are so fucked trombonist

  5. Yes, Democrats can read poll numbers too, but they did not seem to care that this proverbial turd of a health care bill that they helped pass will simply hurt them in 2010. If and when they when they lose in future Congressional or Presidential elections, they will simply fall back on the same ridiculous strategy that they have been using for years: go further and further right. By doing this, they can possibly peel off from the right some of the less crazy voters who would normally vote Republican, and then tell the progressives and more left-leaning Democrats to go fuck themselves. Once again, it will simply be a choice of batshit crazy (Republicans) and increasingly rightward creeping Republican Lite (Democrats).

    Progressives and liberals with strong convictions will be facing a stark Sophie's choice between a capitulating party that ignores them and will probably continue to do so or forming a third party. As our electoral system has systemically made it impossible for third parties to gain a foothold in our political structure, it would be very unlikely that it would allow progressives to achieve their goals. The Democratic party knows that it has most of its base over a barrel as the alternative in the form of the Republican party is so vile.

    I am sorry for being Mr. Sad Sack today, just that I think that the US does not have the political will or interest in truly reforming or correcting the faults that are causing it to die a slow death from within. America has done some great and interesting things in the past, but now the torch might have to be passed to somebody else because we are so intent on running ourselves into the ground. I hope that I am wrong and merely worrying over nothing, but some of the signs on the political horizon have been disturbing to say the least.


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