Tuesday, March 7, 2017

Strange Health Care Goings On

So the Republican House leadership has offered the outline of their healthcare bill. The reaction from liberals has been "Holy cow 10 million people are going to lose insurance." The reaction from a lot of other people has been, "What, exactly, is this bill supposed to accomplish?"

Peter Suderman at Reason:
After months of confusion and secrecy, House Republicans have finally revealed their Obamacare repeal legislation. While it's useful to have House Republicans on the record with a legislative plan, the plan doesn't offer any estimate for how much it would cost, or how many people it would (or wouldn't) cover. In general, it's not clear what problems this particular bill would actually solve. . . .

More broadly, it's not clear what constituency this bill is designed to satisfy, aside from Republican congressional leadership. It doesn't go far enough for conservatives, but may not be generous enough to appease more moderate Republicans either. (Democrats are, at this point, virtually certain to uniformly oppose the bill.) It's a muddled version of the House GOP plan, which was itself a muddled vision of what a political compromise might look like, in some hypothetical world where Republicans actually agreed about health policy.

The GOP's real problem, in terms of passing legislation, isn't that the party can't agree on specifics, or that legislators need to bargain their way toward a compromise that gives everyone something they want. It's that they don't agree on, or in some cases even have, basic goals when it comes to health policy. This bill, and the aura of secrecy surrounding it, seems more like a wish and a hope that this essential problem goes away rather than an attempt to truly solve it
Ezra Klein:
This bill has a lot of problems, and more will come clear as experts study its language, the Congressional Budget Office release its estimates, and industry players make themselves heard. But the biggest problem this bill has is that it’s not clear why it exists. What does it make better? What is it even trying to achieve? Democrats wanted to cover more people and reduce long-term costs, and they had an argument for how their bill did both. As far as I can tell, Republicans have neither. At best, you can say this bill makes every obvious health care metric a bit worse, but at least it cuts taxes on rich people? Is that really a winning argument in American politics?

In reality, what I think we’re seeing here is Republicans trying desperately to come up with something that would allow them to repeal and replace Obamacare; this is a compromise of a compromise of a compromise aimed at fulfilling that promise. But “repeal-and-replace” is a political slogan, not a policy goal. This is a lot of political pain to endure for a bill that won’t improve many peoples’ lives, but will badly hurt millions.
I don't think Obamacare is the best possible healthcare system, so I am open to discussion of alternatives. I can even see the case for the more extreme libertarian approaches to health care. But this plan is nothing like them. This plan is a muddle wrapped in a mess inside an obfuscation. Its only clear aims are 1) cut taxes on the rich, and 2) do something that can be sold to voters as Obamacare repeal. Is that really the best way to make policy for such a big part of our economy?

It is probably telling that Ryan wants to rush through the House before the Congressional Budget Office comes up with a "score" of how much it will cost and how many people will lose insurance coverage. He must be worried either that giving lobbyists and constituents time to respond will only further weaken the resolve of his members, or else that the score will be so bad it will cost him votes.

This seems to me to be another "we have to do something" Washington boondoggle. To which I say, if you don't know how to make things better, leave them alone.

6 comments:

Shadow Flutter said...

This shows how badly we need redistricting reform. Redistricting reform then health care reform.

David said...

It seems to me that our problems with health care reflect very well where we are as a country. We possess an elaborate science of health that enables us to promote human wellbeing (regardless of still-unsolved technical problems, such as our inability to predict whether and which back surgery will work) and prolong human life (and the fact that in some or even many cases this prolongs misery or isn't worth it doesn't change the principle). But we don't want to pay for it. And at the same time, we don't want to proclaim bluntly that these methods are essentially luxuries that are the rewards of good fortune and success, and, if you can't afford them, work harder next time. And so we wallow in these chaotic half-measures and chase the false promise of cheaper health care for more people. To be blunt, I am deeply unwilling to have my life, or the life of anyone, shortened just so that others can keep more of their money. It seems to me that our nation is far from the sort of material emergency where we have to think about rationing things. And if we are already there, I'd have to see some rationing of other things before I'd be willing to give up elaborate medical care (like, how about an indefinite moratorium on the construction of new sports stadiums? I mean, if we're really at the point of Keep Calm and Carry On . . .).

pootrsox said...

Shadow Flutter has it in one! Thanks, ma'am or sir! And I also agree with David.

G. Verloren said...

@David

Sports stadiums, sadly, are the perview of city level government, not federal. I say sadly because people would never stand to have their federal taxes wasted on sports stadiums, but they seem perfectly happy to have cities throw away their entire budgets trying to appease the movers and shakers (and conmen) in the professional sports industry.

That said, while I agree with you entirely in principle, don't underestimate the average American's irrational love for professional sports. Bread and circuses is still a potent political tool, and for many millions of Americans I think sports genuinely matter more to them than medicine for the sick and poor. As long as they still get to tribally rally behind their favorite team and engage in ritual war on their chosen rivals, they'll be happy.

That said, even the ridiculousness of professional sports can be said to have demonstrable value. While sports teams notoriously over represent the economic benefits they bring to cities (and shadily leverage their positions to get exclusive monopoly rights on many of the sources of income related to their operation), the fact remains that they do contribute to the economy in the form of various service industries and tourism.

No, if we were going to cut spending anywhere, the most logical place to start is the military. We spend more total funds on war than the next eight largest militaries in the world COMBINED. We spend 10 times as much as Russia, and nearly 3 times as much as China.

Of course, what would make even more sense would be to not decrease spending, but rather to increase income by taxing the ultra wealthy. But for some reason, no politician ever wants to do that. Strange, isn't it?

Shadow Flutter said...

"No, if we were going to cut spending anywhere, the most logical place to start is the military. We spend more total funds on war than the next eight largest militaries in the world COMBINED. We spend 10 times as much as Russia, and nearly 3 times as much as China."

True, but the U.S. have taken on the responsibility of world enforcer. The U.S. is expected to have a presence in the East and West and effectively and quickly respond to multiple threats around the world. Other countries' budgets don't require this. The U.S. gets criticized around the world for excess and arrogance, but they would rather the U.S.do it than they do it, and the U.S. would rather do it than allow them to do it. All this comes at great cost (and not just in money). So exactly what should the annual military budget be given this reality? Simply comparing countries' military budgets and saying See! see how much more we spend than other countries doesn't seem very useful. Nor does comparing military budgets to GDPs. Of course the U.S. budget is much larger than other countries' military budgets. But what's the correct budget? What's the correct comparison? What should the U.S. military-GDP ratio be given what it does?

Seems to me we can't significantly reduce the military budget without first changing the world order, a world order in which we are no longer the enforcer or at least the only enforcer. Personally I think that time has arrived. It's getting too expensive. Nations that have caught up economically should share more of the burden. But how would Americans react to that? Would they feel more or less secure? And what about the jobs lost to a shrinking military budget?

David said...

FWIW, I suggested sports stadiums on purpose, knowing full well that they are not part of the federal budget. My point was that, if we really have to ration care and deny a lot of people coverage, then we must be in some sort of Blitz-like emergency that transcends mere questions of federal budget, where we have as a people to start cutting back on all sorts of things and alter our way of life accordingly. And if we're not in that sort of emergency, what is our actual problem? I think it does come back to taxes, the question of what we're willing to say is our common good, and the basic resignation of millions of better-off Americans from any notion thereof, except the protection of property. Saying let's cut this, or let's cut that, misses the point. If we really can't afford to help everyone, we need to cut everything. And if we can but don't want to, woe to us.