T.R. Reid

Dave Leonhardt in the NY Times today has an article on why the Senate bill will be better on dealing with health care cost issues. So maybe some of my pessimism is not warranted. And it is not given that premiums will rise. Healthier people are supposedly being added to the pool as well as riskier.

T.R. Reid's appearance on Frontline last night was interesting. I was disappointed that the show was a rerun from last year. Isn't this November? His book The Healing of America is a welcome look at how other wealthy democracies deal with health care. He says that while the US "does well when it comes to providing medical care, it has a rotten system for financing that care." He argues that what other countries have that we don't is a unified system; everybody is included in the same system and covered by a single set of rules. This doesn't necessarily mean a Canadian-style single payer system. Germany has more than two hundred different insurance plans. Japan has more than two thousand. And in Germany, these plans cover people their entire lives. They don't have Medicare.

He also argues that universal coverage has to come first because it is "an essential tool to control costs and maintain the overall quality of a nation's health." Only this will create the political will to accept limitations and cost-control measures within the system.

Maybe we are on the right track. It is a slow track, but we are not going to be able to change everything at once. Reid's book is a good place to start thinking about it. Let's try to learn from what others have done rather than reinventing the wheel.

The Health Care Bills

I have not studied the bills in-depth, so I may easily change my mind. But first, I think we need to pass a bill. And what we pass is not going to effectively address the big elephant in the room, costs. But it is going to do some good stuff, including giving access to most of those people who cannot get insurance and eliminating preexisting conditions as a basis for denial. By doing so, premiums are going to rise. You add riskier people to the pool. The public option question at this point is only about the small percentage of people who will not be able to get insurance. Who are these going to be anyway? If we have an exchange where these people can choose the coverage they want, how important is a government-run program? So liberals, get over it. The right wing focus on the public option is stupid, but it is not that important. In the long run, we are going to have to return to look at the single payer option anyway when we finally get around to addressing costs. Continuing to link health insurance to employment is not the future. You can look at any other wealthy democracy to see this. And Medicare needs to be independent from Congress to eliminate special interests from blocking reform. Ultimately we need to do things like eliminate fees for services payments. If Medicare shows that it can deal with costs in a more innovative and effective way, then you have an argument for Medicare Part E (for everyone). I happen to think exchanges that give people choices are a better way to go, but that is partly an empirical question to which we do not know the answer. And you could always have both, a basic Medicare program along with exchanges for Medicare supplemental insurance. What happens in the future is dependent on what has happened in the past and what is happening now. We need to get a health care reform bill passed now. But knowing the Senate works, you have to be skeptical. After all, the Senate managed to keep blacks from exercising their civil rights in the south, including voting, for 100 years after the Civil War. One of the most effective methods was the registration test, graded by local board members so that no black could pass. Or having to have a sponsor to register. Let's also realize that many of the provisions do not go into effect until 2013. The debate about costs needs to continue. Holding out for the perfect plan now is less likely to result in healthy reform in the long run.

Addendum: For the fiscal year 2008, Medicare cost per enrollee was over $11,000. According to the Kaiser Family Foundation, cost per enrollee was $7439 in 2004. The fair amount for someone who is not subsidized by the government is cost per enrollee. No insurance company profits to figure in. So, instead of creating a whole new agency, why not let those who cannot get insurance sign up for Medicare and pay the premium? I would like to give them some different options.

20 Years Ago

Of course, 20 years ago the Berlin Wall fell. There were already hundreds of thousands of East Germans fleeing their country for the West because their living conditions were so abysmal. It raises the issue of the failure of communism. One of the most potent criticisms is the lack of an ethical dimension, which combined with the view that one was on the right side of a mechanistic history, gave people permission to do terrible things. I ran across this article which largely expresses my own views. And here is an interesting article on ethical reasoning. In my own study of Marx twenty-five years ago, I came to realize that he had no theory of the state and that his belief in the revolution was a quasi-religious one of conversion. And, of course, his idea that the world would be split into two classes has been proven false in successful countries. But why should one think the world will be better when the proletariat take over?

Addendum: This post does not convey what an enormous moment this was in Europe, as you may have seen on various news reports today. It also assumes that one knows how many well-meaning intelligent leftists in the 20-40's supported communism, even the Stalinist state. And it does not acknowledge the hysterical reaction to communism in this country, often manipulated by our leaders. The movie The Invasion of the Body Snatchers is in its own way a comic take on this attitude.

The Tribune and Disability

Here is a column from the Salt Lake Tribune last week on the rise of Social Security disability claims. You will see my comment at the bottom. I did not mention that the assertion that 13% of cases are approved at the administrative law judge level is laughably false. It is over 50%. I wrote a letter to the editor pointing this out as well as why a couple assertions by Mr. Allsup are ridiculous. They refused to print it. We know newspapers are in trouble, but when I read stories like this on an issue I know something about, and they are so wrong, I wonder about other stories. This is lazy journalism. Get a couple quotes from somebody, no matter how disrepected he is in the professional community, and a response from somebody else, and call it journalism. And explain nothing. The aging of boomers has already caused an increase in disability claims and this recession has been hardest on older men. If you lose your job, you are less likely to get hired for another job. Disability rules reflect age. If you are over 55 and cannot do your past work, the rules are more lenient. Of course, when many are unemployed and prospects are slim, people are looking for a way to get by. But the author could have at least explained what "silver tsunami" means and why it is occurring.

The Great Game Cont.

I am reading Three Kings; The Rise of an American Empire in the Middle East After World War II by Lloyd C. Gardner, a professor of history at Rutgers. So far, the action is taking place during WWII. In 1941, Russia and Britain occupied Iran, although it was nowhere near the war zone. This was another episode in the contest between the Russian Empire and the British Empire over the land south of Russia, called The Great Game. Of course, everyone knew that there was a lot of oil there. This is when FDR began his negotiations with Ibn Saud for access to Saudi oil and a military base on Saudi soil. We managed to fund Saud's government during the war by using the lend-lease program, even though the Saudis were not in the war's theatre (as Presidents began creating funding mechanisms that did not need the approval of Congress). Saud proceeded slowly, partly playing the Brits against the U.S., but also because he was held personally responsible for keeping the land around the sacred sites "free from the taint of foreign occupations" (bin Laden's primary complaint...and he attacked the base there in 1996).

It is perhaps well-known that the British had no intention of relinquishing their empire after WWII and that this was opposed in principle by FDR (in the Atlantic Charter). But everyone was working behind the scenes during the war to determine what would happen in the oil-rich middle east after the War. FDR's freedom of self-determination of countries took a second seat behind practical considerations around oil and bases for air power, which was the emerging force in the capacities of armies and in transportation. And the Truman doctrine, which immediately was about aid to Turkey (under pressure from Russia) and Greece (under pressure from local communists), but was also one of the first political announcements of the Cold War (after Churchill), was also an ideological chimera behind which real political decisions took place. Anything could be justified by an appeal to the fight against "international communism."

The Good Soldiers

I started The Good Soldiers by David Finkel earlier this week. I would read a chapter and then have to go blow my nose and wipe tears out of my eyes and that was usually enough for one day. Last night I picked it up and couldn't put it down until I finished at about 1 a.m. This is very powerful book. It is written by a reporter embedded with the 2-16 batalion in East Baghdad during "the surge," and takes place from April 2007 to March 2008. I don't believe that anyone who has not been in a situation like that can really imagine it, but this book gives you a vivid sense of the human consequences of war on soldiers. This particular war, with multiple deployments, better medical care in the field, and better armor has led to many more soldiers being saved, but many more damaged in different extreme ways, including severed limbs, closed head injuries from explosions and PTSD. I'm not sure how a human being couldn't have some PTSD after going through that. A great piece of writing.

Health Care Costs

Here is Ezra Klein raising the question of why every unit of health care, e.g. drugs, doctors, hospital care, costs much more in the U.S. than other wealthy democracies.

And even in Medicare Congress refuses to accept cost-saving measures because of lobbying from interest groups. Can we really hope to reign in costs with Medicare Part E (Medicare for Everyone)?