Wednesday, March 24, 2010

Another Post From Me On Health Care

For a while, now, I've been having a pretty good exchange with Niceguy Eddie, from "In My Humble Opinion," over this health care bill, now law. I'm not a fan of the law. He is, albeit a qualified one. Today, he's put up "One more post on health care, then I'm done," intended as a closing shot on the subject. Eddie offered to let me have the last word, and, while I thought about just posting "Word" and leaving it at that, I decided I'd actually try to hold up my end of things, instead.

To tell the truth, Eddie, I was disappointed to see some of the common misrepresentations of characters like myself--essentially ad hominems--come out again in your post, particularly given the fact that you basically make them the heart of your argument. I'm not some wild-eyed character on an ideological jihad who "puts ideology ahead of pragmatism." I'm sure there are some hardcore single-payer-ites of whom that could be said, but I'm not one of them. My arguments against the new law have always been practical, not ideological. I've always explicitly rejected that notion of making the perfect the enemy of the good, and though I'd prefer single payer, I wouldn't portray it as remotely "perfect." You'd have a better chance of snaring a jackalope in the wild than of finding "perfect" in our politics.

Given this, imagine how disappointing it is to read something like this:

"To say that doing away with the most egregious abuses of the system is not reform is to clearly put ideology ahead of pragmatism, to let the perfect get in the way of the good."

Does the new law do away with the most egregious abuses of the system? That's the question your comment, there, begs. The answer is that it doesn't, and that's one of the major points I've been making against it. The long Rachel Maddow commentary you quote rolls out, at great length, the standard propaganda in favor of the new law. What I've been pointing out is that this propaganda isn't accurate. The new law doesn't do away with pre-existing conditions, it doesn't do away with rescissions, etc. If it did those things, that would be a mark in its favor, but it doesn't, and it isn't. You say "the biggest problems with the for profit system--namely that those profits came from DENYING care, rather than providing it--have been swept away" by the new law, but they haven't, and they won't, under this law, in 2014 or at any other time.

I don't think it's a good idea to base a health insurance system on the profit motive. That isn't because there's something inherently wrong with profit. It's because, with something like health care, people's lives are at stake. Practically speaking, it's always a very bad idea to put lives on a scale vs. profits. That is, in fact, one of the central lesson of human history. With health care, nearly everything that has made the current system monstrous have been a consequence of that profit motive. When you follow, to its source, the trail of whatever outrageous trend, anecdote, pattern of abuse with the current system you can name, you'll almost always find that it tracks back to someone making money. The new law on health care doesn't eliminate that. It doesn't even try to incentivize positive outcomes. It just leaves in place, props up, and makes nearly invincible (by putting their corrupt practices on the public dole) the same rotten interests that brought us to the point of needing reform in the first place.

When it's more cost-effective to deny payment for care than to provide it (as with the case with a lot of the serious pre-existing conditions under the new law), the payment will not be provided. When pay-outs become expensive, premiums will go up. Insurers are not going to eat a loss, particularly for such human considerations as pity or a sense of justice. Those aren't what drive them, and, in fact, are things that play no part in their deliberations.

If such a system could be made to work for people, I'd be all for it, but I'm skeptical that it could, and I know the new law doesn't accomplish it, or anything resembling it.

I've done a lot of ranting about how the new law is going to set up a corrupt triangle of money that will put the insurers' purchase of legislators and manipulation of our electoral process on the public dole, and make real reform impossible. In your post, I find this very important point reduced to this:

"To say this bill is bad because it makes a system you don’t like WORK BETTER, is routing [sic] against the system every bit as much as the Right has been rooting against America since 20 January, 2009. In my opinion the liberal opposition to this bill amounts to no more than: If you make the for profit system work, we’ll never get a ‘single payer’ system. But from my own POV: If the for-profit system can be made to work, WHO CARES?"

No one would. My opposition to the present "reform" effort wasn't driven by the fact that it "makes a system [I] don't like WORK BETTER"; it was driven, in part, by the fact that it won't make it work better, but will make it impossible to fix in the future. That isn't some narrow concern about crushing hopes for single payer in the future; it's about preventing any positive reform. You say "there will inevitably be other issues that come up. We’ll simply deal with them." I find the word "simply" there to be particularly astonishing. You say, of the new law, "This can work. And if it doesn’t? Well… polls show that the American Public will support MORE reforms. So we’ll just keep going until it does, or until we have single payer." Just like the 65+% public support for the public option resulted in its swift-and-easy passage under the current system, right? It was a point repeatedly stressed by supporters of this law to people like me that it represents "progress" and "reform," and that its shortcomings can be fixed later. The truth is that, under this new law, we'll be entirely at the mercy of these government-financed, for-profit entities for the foreseeable future. That is, to put it mildly, not a good place for us to be; any reformer worthy of that title can only view the prospect with abject horror.

That's where I stand, Eddie. While this may signal the end of our back-and-forth on this particular subject, though, I somehow doubt it's going to be the end of this discussion.



"Niceguy" Eddie said...

As usual, very well said. I dispute none of your points. And I respect your opinion. But I'll stand by my own.

classicliberal2 said...

Ha! Unfortunately, it would be too late for you to change, anyway!