Health Care Reform and Ideology

Will Wilkinson comments on Ezra’s Klein’s frustration with Rahm Emanuel’s being willing to compromise on specifics of health care legislation as long as the key goals are met  (which I discussed earlier). Wilkinson wrote:

Bush couldn’t reform Social Security because his plan was unpopular. Obama won’t be able to deliver a health-care bill ideological Democrats want, because what they want is unpopular and legislators know it. So Congressional Democrats want something they can cast as “victory” while doing nothing that could hurt their noble struggle for ongoing political self-preservation. Right now, strongly ideological media liberals like Klein have to decide whether they’re going to (a) act as enforcers, sending the signal to the powers-that-be that they will vocally and publicly count a “trigger” plan as a pathetic failure, or (b) sigh and prepare to declare whatever legislation passes a profound victory for ordinary Americans that shows just how great Democrats are.

I’ve noted many times before, there is widespread support in polls for health care reform, including a public option. Wilkinson is also at least partially correct in commenting:

Reform is very popular in the abstract. Even a government-run system. But most people are quite satisfied with their current plans. So support for systemic changes turns out to be shallow. This is what Clinton learned. As soon as people get the sense a new policy will force a change in their own situation, they break off. That’s what Obama’s people are worried about, and why the constantly return to the “you won’t have to change anything” refrain, even though the goal is to have everybody change into the government plan sooner or later.

When we write about the need for health care reform it only makes sense to concentrate on the millions who are uninsured, under-insured, or have been screwed by the insurance companies. The fact remains that millions of other people are happy with their current plan and prefer to remain in their plan as opposed to being forced into a government-run plan. They might be wrong, such as in thinking they have good coverage only because they have not yet run into a situation where their insurance company has tried to deny coverage, and they might be falling for untrue claims about government-run plans, but they will still vote based upon such beliefs.

A public plan could be advocated either as a way to keep the insurance companies honest or as a back door path to a single payer plan. Those who are pushing for it as a way to get to a single payer plan are unlikely to compromise. For those of us who are more concerned with changing the behavior of insurance companies, it makes sense for Emanuel to stress goals rather than drawing a line in the sand with regards to the public option.

The “strongly ideological media liberals like Klein” might only have the two options Wilkinson mentioned. Personally I chose an alternative option. I have long suspected that we will wind up with a compromise which falls short of what the progressive wing of the Democratic Party wants. The question is not whether they get everything but whether we have a bill which has positive results with regards to improving access to health care and making it more difficult for insurance companies to deny coverage. Even a watered down plan is likely to be far more comprehensive than what the Democrats were running on in 2004.

It isn’t a matter of declaring victory or proving “just how great Democrats are” but in being realistic in hoping for some improvements without expecting perfection. Our political system was set up to prevent the ideological extremes from usually getting everything they want. Sometimes this might be frustrating, but this reality was also beneficial when George Bush was in office.

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  1. 1
    Wes Rackley says:

    Health Care Reform and Ideology – Liberal Values – Defending …

  2. 2
    wesrackley says:

    Health Care Reform and Ideology – Liberal Values – Defending …

  3. 3
    frm. Above says:

    Health Care Reform and Ideology – Liberal Values – Defending …: Will Wilkinson comments on Ezra’s Klein&#3..

  4. 4
    health s wealth says:

    Health Care Reform and Ideology – Liberal Values – Defending …: Will Wilkinson comments on Ezra’s Klein&#3..

  5. 5
    Eclectic Radical says:

    It’s pretty certain, and has been since the beginning of President Obama’s health care discussion, that single payer or ‘socialized medicine’ is not happening in the next four to eight years. None of the Democrats in charge of health care legislation seem to want it, and they would have to want it for it to happen. Nearly every plan being discussed by the Senate leadership, right now, is some variant on Romneycare, with or without a public component. Both the Teddy Kennedy bill AND the conservative Republican bill primarily consist of mandates ordering everyone to buy health insurance. The differences are in the remaining articles.
    Kennedy’s bill would create a public health option and require corporate employers to either supply their employees with private insurance or pay a specific tax to fund the public option. This is not exactly a solution to the huge de facto tax burden the current two payer system already places on employers.
    The conservative Republican bill, on the other hand, is essentially an unfunded mandate supported by tax credits meaningless to anyone who has ever actually needed health care. The credits are capped off so low as to be meaningless to effect real medical bills and are even lower than some ‘bargain’ plans’ deductibles. Which means if you have a cheap plan, your tax credit won’t even cover all of the money your insurance requires you to pay before they step in. Not exactly something to create increased access to care.
    Worst of all, the Republican plan includes a back door plan to force seniors off medical care and into the private insurance market.
    So, right now at this moment, we have the choice between a malicious Republican plan that could make things much worse and toothless Democratic plan that would not make things much better.
    While I do understand my ideal health plan is not passing anytime soon, I’d like to see better choices short of it.

  6. 6
    Tim Backstrom says:

    Health Care Reform and Ideology – Liberal Values – Defending …

  7. 7
    tback22 says:

    Health Care Reform and Ideology – Liberal Values – Defending …

  8. 8
    Fritz says:

    The “public option” seems to me to be a pretty clear step (I am not saying “first step”) along the path to “government pays”, whether you are for or against that future.

  9. 9
    Ron Chusid says:

    It depends partially on the details of the public plan and partially on the behavior of insurance companies. There are differences between various proposals for a public option, with some being much more significant than others. (An overall problem with the health care reform debate at this point is that we don’t have the specifics laid out in legislation yet but many are drawing lines in the sand.)

    If the public option was paid out of general government revenue then it would be much more likely to turn into a single payer plan. Most of the talk now is that it will have to raise money by charging premiums as the private plans do. If the free market is always so superior to government, shouldn’t you be arguing that the government plan would not be able to compete with private plans?

  10. 10
    b-psycho says:

    Ron: From what I can tell, the rationale from the Right has been that the advantage of a government plan is, since it doesn’t have to run a profit, they can just eat costs.  To me, what’s wrong with that is the assumption that there’s something inherently wrong with organization without a profit motive.
    If the question were not yes/no to a government plan but yes/no to any form of non-profit, collectively run plans (note the plural…) — essentially, to the concept of non-profit healthcare, not the substance of it — my answer would be not just yea but Hell Yea.  Call it whatever, I just think a better system would shoot for being substantially less concentrated than what we have now, rather than accepting the concentration as a given and haggling over who holds the reins.
    On that note…is anyone talking about breaking up the huge insurance companies?

  11. 11
    Ron Chusid says:

    Nobody (at least nobody in a position to make it happen) is talking about directly breaking up the huge insurance companies. The question is whether having a public plan will cause the big insurance companies to lose their business in health care.

  12. 12
    Fritz says:

    Ron, the government sets the playing field.  And the public option will rapidly morph to being paid for by the general fund.  Public schools will be the model.

  13. 13
    Ron Chusid says:

    Perhaps, but that is not what is being proposed. I could see that happening if the insurance companies continue to find ways to refuse care to increase profits. Of course if insurance companies did that I see a government take over as inevitable regardless of whether we had a public option.

    As long as the uninsured and under-insured was primarily made up of lower income people with little clout then the situation was able to continue. Now that the numbers have greatly increased, and the problem has increasingly spread to the middle class, it is inevitable that political pressures will increase for government to act. Whether the private insurance companies survive depends far more upon their future behavior as opposed to whether we have a public option at this time.

  14. 14
    Fritz says:

    Ron, do you believe the government health care system will never choose to refuse to pay for medical care?

  15. 15
    Ron Chusid says:

    Of course not. There is a difference between rational reasons to not cover something, and the manner in which private insurance companies deny coverage for purely financial reasons without regard to medical justification.

  16. 16
    Eclectic Radical says:

    As always, I am going to agree with some of Fritz’s observations but disagree with the conclusions he draws from them. 🙂
    There is ample evidence to suggest that, were a quality public option to be introduced, it would grow to the detriment of the private plans. This is actually pretty basic and simple. The current insurance company model, as many have commented on this blog and others, is based on collecting money on the promise to pay it out if necessary and only making a profit when it is not necessary to pay it out. This may be great for home owner’s insurance or auto insurance, but it is clearly a failure for health insurance. Nor are the companies changing the model for financing health care.
    In states (Tennessee, when TennCare was still extant, and Massachussetts now) or demographics (seniors) with public and private options, the public options win overwhelmingly because they provide better access to care at a lower cost. This was the reason for the ‘failure’ of TennCare. It worked much better than the state had expected, everyone who qualified wanted it, and the state was unwilling to pay for its success. The public option being offered in Massachussetts under Romneycare (which, to be critical, is just a government version of a PPO) is, according to some sources, already beginning to draw customers away from private insurers in significant numbers… people the state had thought would keep their own plans, because the public plan is simply better and people trust the state of Massachussetts more than they trust their HMOs or PPOs. Medicare recipients are typically far happier with Medicare than they were with their private insurance and many seniors who could afford private insurance prefer Medicare for its higher access to better quality care and lower cost.
    The essential conservative/libertarian argument breaks down to this: private health care providers cannot compete with a lower cost program that provides better access to a better quality of service on their current operating model. This is true, but they are advancing it as an argument against reform when it is the reason the current model needs to be completely reformed. If the private sector cannot compete with a functioning program that does what it is supposed to do, then perhaps there is a flaw in the business model on which the private sector operates that needs to be fundamentally addressed. Instead, the ‘free marketeers’ are asking to be protected from competition.

  17. 17
    Fritz says:

    What I am interested in seeing is whether the government allows people to purchase incremental improvements to their state-funded care or whether, as in Britain, that is considered unfair and is banned.   I think there will be strong pressure to go with something like the British model.
    And, actually, Ron, there is little that is more rational than “you didn’t contract for that”.  Not pretty, perhaps.  But definitely rational.

  18. 18
    Eclectic Radical says:

    I don’t think the pressure will be to follow the British model. I think the ‘socialized medicine’ supporters (like myself) recognize the flaws in the NHS as well as its strength and would prefer to see those flaws eliminated. Supporters of ‘socialized medicine’ would prefer to see a system modelled on the Austrailian program (which is superior in many ways to both the UK and Canada, though it is more than worth saying that to someone without the ability to pay for health care, the UK and Canadian systems don’t look so bad at all and far too many people on the right forget that) or to the Swedish system, which possesses a robust national system, an equally robust for-profit private system to supplement and incrementalize the national system for those who wish it and an excellent subsidy program to make sure everyone who wishes it has access to their choice of care. Many people advocating more ‘free market’ approaches point to the French and German systems, in which health care is entirely privatized but access to medical care is guaranteed by law and payment is carefully gradated based on income and which contain many more significant consumer protection measures than our own system.
    As for the ‘you didn’t contract for that’ argument, that is rarely the problem. The much more common issue when dealing with private insurance companies (as I can speak from experience from dealing with my partner’s medical bills) is that the insurance company refuses to pay under circumstances which they HAVE agreed to pay due to ‘exceptions’ and ‘technicalities’ designed to delay paying bills they are entirely obligated to pay until forced by lawyers. Frequently, during the interim, they stop paying for all services entirely, claiming the consumer is in non-compliance. This is not ethical business practice, if it were practiced individuals instead of corporations it would be criminal fraud and breach of contract, but because it is practiced by corporations it is considered ‘business.’
    As I have said before, I am all in favor of a capitalist economic system, but fraud, breach of contract, and depraved indifference are criminal acts for which corporations should be held responsible and not merely ‘problems easily solved by the free market.’

  19. 19
    Ron Chusid says:


    “What I am interested in seeing is whether the government allows people to purchase incremental improvements to their state-funded care or whether, as in Britain, that is considered unfair and is banned. I think there will be strong pressure to go with something like the British model.”

    Discussion of the British system is used purely as a scare tactic from the right. There is no support for the British system in this country. Advocates of health care reform oppose the British system.

    Besides, it is untrue that private insurance is banned. There is a thriving market in private insurance there. Actually conservatives often point to the private market as an argument that the government plan has failed.

  20. 20
    Ron Chusid says:

    “And, actually, Ron, there is little that is more rational than “you didn’t contract for that”.  Not pretty, perhaps.  But definitely rational.”

    Often the problem is that people did contract for something but the insurance company finds loopholes to drop them from coverage when they develop a serious problem, or raises rates so high they cannot continue coverage.

    We cannot have a system of insurance where insurance companies, whether or not allowed in their contract, can discontinue coverage because someone is costing the insurance company money. This is “rational” but is a practice which must be stopped. No other country in the industrialized world has such a  poor health care system where someone will lose their coverage because they become sick or lose their job.

  21. 21
    Ron Chusid says:


    I certainly understand your skepticism that private insurance can be trusted, but keep in mind that much of the world does sucessfully use  hybrid government/private plans. The problem here is that the insurance companies have been allowed to continue with a business model based upon increasing profits by denying coverage. While generally I am not a supporter of heavy government regulation, health care is one area where private insurance only works (for the benefit of the insured) when there is heavy regulation.

    Whether private plans can compete with a public plan will depend a lot on the specifics of the legislation. However, conservatives always claim that the government cannot run anything and that private business is always superior. If one holds that philosophy then they I would expect them to argue that private plans will beat out any government plan.

  22. 22
    Ron Chusid says:


    “insurance company refuses to pay under circumstances which they HAVE agreed to pay due to ‘exceptions’ and ‘technicalities’ designed to delay paying bills they are entirely obligated to pay until forced by lawyers.”

    While it may or may not work, the first thing to do when you have problems with an insurance company not paying is to send a letter to the state insurance commissioner with copy to the insurance company. Often they will pay when they see this, and you aren’t out anything if this doesn’t work.

    In Michigan I’ve also found that the insurance commissioner is far less effective than in the past. Years back I would send letters to the insurance commissioner on behalf of patients when bills which should be paid have not been paid. Often this did work. Some time back I got a response that they were no longer accepting complaints from medical offices and the patient had to send the complaint.

    I’m not sure if this is still the case as I have not tried recently. In recent years the number of patients with private insurance have dropped considerably. Most are either in government plans or managed care plans if receiving coverage from employers. The problems with managed care plans tend to be over matters which are parts of their policy and, while patients are still screwed, they aren’t the types of problems where the insurance commissioner could become involved in.

  23. 23
    Fritz says:

    Ron, I absolutely agree that health insurance must be decoupled from employment.   Frankly, I am non-libertarian enough to propose that companies be barred from providing health insurance, just to break that horrible link.
    And, please — nobody should assume that I trust the medical insurance companies.   If someone could come up with a way to force simple contracts, I would be very interested.   I’ve been screwed by that myself.
    I am concerned that the strong “equality” streak in American political life these days will prevent people from being allowed to incrementalize costs, service, or insurance.    An an example, in places with education vouchers, very often schools were not allowed to institute an upcharge over the voucher amount (presumably t0 fund a better education).

  24. 24
    Eclectic Radical says:

    “I certainly understand your skepticism that private insurance can be trusted, but keep in mind that much of the world does sucessfully use  hybrid government/private plans.”
    I know. I specifically mentioned a country that does (Sweden) along with two countries (France and Germany) that appear to be doing well with heavily regulated private systems. I am certainly not trying to claim that ‘socialized medicine’ is the only solution. There are reasons I think it might be the best solution in this country right now, in the current economic climate and corporate culture.
    My main point, however, was to address the fact that private insurance corporations have not been willing to change their business model in the manner necessary to compete with public options in this country and that without changing that model, Fritz and others who say that public alternatives will almost certainly replace private health care on a very wide scale are correct because of that fact. Evidence exists to support that argument very strongly.
    I don’t disagree with you that hybrid systems are very possible. I simply note that as the case stands now, the current providers of for-profit health care services are unwilling and unable to do that.

  25. 25
    Ron Chusid says:

    “My main point, however, was to address the fact that private insurance corporations have not been willing to change their business model…”

    They will not change this business model as long as they can go on making money as they do now. The question is what will happen if the rules are changed. If the laws place the right restrictions on them the insurance companies will theoretically be forced to make money by covering medical care as opposed to finding ways to deny coverage. On the other hand, I certainly see why people are skeptical that this will work and fear the insurance companies will find a way around any regulations.

  26. 26
    Fritz says:

    Ron, I believe people who buy *any* med in Britain are denied further government-funded treatment, at least from news articles I have read.
    Cases in point:
    Am I reading those articles wrong?

  27. 27
    Ron Chusid says:

    There are restrictions on using the public system if someone also has private insurance. I don’t think it is as strict as losing government treatment if you buy “any” med but I don’t know for certain how restrictive they are. Since the UK’s system is not under consideration here I haven’t paid as much attention to all the specifics of their rules.

  28. 28
    Fritz says:

    Ron, I thought it was a pretty good counterexample to the idea that public options will, in the long run, allow people to incrementally improve their care.  This is really what I am concerned will happen here — that the only alternative to the government program will be to pay for a full-cost plan (in addition to the taxes to support the government one) — and incremental improvements will not be allowed (in the name of fairness).
    BTW — can you tell me… Is a physician allowed to add a surcharge to the Medicare reimbursement?  This would, in my mind, be a similar kind of incremental improvement.   Does Medicare allow that?

  29. 29
    Fritz says:

    And Ron, if you read the BBC article, it wasn’t even “having private insurance”.  If the patient chose to buy any drugs out of their own pockets, they were denied care.  And it was explicitly in the name of “fairness”.

  30. 30
    Ron Chusid says:


    That article does make it sound like they are more restrictive than I thought on people who go outside of the system but I would be reluctant to come to any conclusions about the system from newspaper articles. Health care regulations are complex and I find that newspaper reports on regulations in this country are frequently inaccurate. Regardless, the British system is definitely more restrictive than people in this country want (or would tolerate).

    What do you mean by adding a surcharge? If you want a service which is covered by Medicare a doctor who participates in Medicare cannot charge more than what Medicare allows. That is  also the case with most private insurance plans which also have a fee schedule. If you really want to pay more I’m sure you could find a doctor who does not participate in Medicare to charge you more.

    If you want a service which is not covered by Medicare then  doctors who participate in Medicare can still provide the service and charge for the particular services which Medicare does not cover while still charging Medicare for what is covered. I see no reason to believe that if we ever went to a single payer plan that it would act any different and prevent obtaining services beyond what is covered by the plan.

  31. 31
    Fritz says:

    Ron, with my insurance a doctor can charge more than the insurance will pay for a covered service and then I am billed by the doctor for the remainder.  That allows me to choose a higher-priced doctor (who perhaps is more skilled or experienced?) and still receive value for my medical insurance.
    And the Medicare restriction does confirm my fears about the effort to prevent people from adding increments of service to a government system, in the name of fairness.  So, yeah, I’m not feeling cheerier about the prospect.

  32. 32
    Ron Chusid says:


    Some insurance companies will still allow such billing but most plans no longer allow it. You probably have a less restrictive plan than most over at Microsoft.

    As all doctors in a plan have the same maximum fee schedule there shouldn’t be an issue of paying doctors who are more skilled, except there is always the danger that if a plan pays too little doctors might not accept it. I do see some patients who pay cash to see me who are in plans I do not accept.  In some cases insurances will still pay at least partially if they see someone who doesn’t participate but an increasing number of plans won’t pay anything. (The biggest headache come with people winding up in private Medicare Advantage plans without realizing it. They still have the original Medicare card but after billing I find that Medicare rejects the charge and if they are in a Medicare Advantage plan I don’t participate with there might not be any coverage.)

    The Medicare restrictions don’t really prevent people from adding “increments of service.” If there is anything that is not covered by Medicare (or if you want testing more frequently than Medicare might want to pay in cases where they have frequency restrictions) then you can pay for additional services while still having Medicare coverage.

  33. 33
    Fritz says:

    Ron, you already said that a doctor can’t charge an increment over the Medicare rate, so, yeah, that does prevent people from adding increments of service — at least in some aspects.  I’m glad that Medicare allows other increments (like more frequent testing).

  34. 34
    Ron Chusid says:

    If you want to pay more than the Medicare fee schedule you can find doctors who do not particpate in Medicare. Then Medicare would pay part and you can pay the rest just as you do now. Plus of a doctor provides a service not covered by Medicare you can pay if you wish. This is no more restrictive than most private plans and Medicare allows far more flexibility than many plans.

  35. 35
    Fritz says:

    Ron, thank you for the clarification.  You have to admit that “Medicare paying for a doctor who does not participate in Medicare” is a bit baffling as a sentence.  I guess it’s like the “out of plan” fee schedule for private insurance.  Cool.

  36. 36
    Ron Chusid says:

    It does get strange and complicated. Some insurance plans will pay nothing for doctors who do not participate in their plans while others will pay. Medicare will pay non-participating physicians  95% of what they pay participating doctors and they can charge up to 115% of the Medicare fee schedule. If you went to such a doctor you would pay more out of pocket but Medicare would still be paying the bulk of the charge.

    A third option is to be a private contractor. In these cases a doctor cannot bill anything to Medicare and is not bound by the Medicare fee schedule. If you were to see a physician who is a private contractor you would be responsible for their full charge. If they ordered tests performed at a facility which accepts Medicare (either as a participating or non-participating provider) Medicare would still pay as usual. Medicare would also pay as usual if you saw additional physicians who are not private contractors. This would not be like the situation in the articles where a patient forfeits the benfits of Medicare for sometimes going outside of the system.

  37. 37
    Fritz says:

    Ron — I still don’t think that it should be an insurer’s business how much extra I pay a provider.  Maybe I’m being all libertarian here, but once Medicare shells out their 95% of their standard charge, why should they give a rip whether I then double that amount for what I perceive to be a better quality of care?
    If I like a particular auto repair shop, why should my insurance company care (or even have the right to know) how much above their payout I choose to pay the auto repair shop?  It’s, well, my business.

  38. 38
    Ron Chusid says:

    “I still don’t think that it should be an insurer’s business how much extra I pay a provider. “

    Perhaps, but these limits occur with most private plans as well as government plans. At least there is a little flexibility there. With most plans either they will pay me nothing or I must charge no more than their fee schedule. The plans which do not place such restrictions are rapidly dying out.

  39. 39
    Ron Chusid says:

    There are also some potential loop holes if patients really wanted to pay more than Medicare allows. In theory I could charge the regular office call and receive payment under Medicare’s fee schedule. On top of this (assuming there were patients who agreed) it might be possible to charge an extra charge for something such as a preventive medicine exam which is not covered by Medicare. While I believe this would technically be legal (assuming I could document some services beyond the standard office call such as for preventive medicine counseling), realistically I don’t have patients who are begging to pay more than the Medicare allowed fees.

  40. 40
    Fritz says:

    “Did you notice our tip jar?”

  41. 41
    Ron Chusid says:

    I don’t recall ever seeing a Medicare regulation prohibiting accepting tips. If you want to pay more than Medicare allows I’m sure you can find a way.

  42. 42
    Eclectic Radical says:

    Kaiser Permanente, which was my provider in California when I had a job that provided insurance, maintains its own hospitals and offices so is a bit different than other plans… but their system is basically that as long as one goes to their doctors, clinics, hospitals, etc then one’s monthly premiums and copays are all one pays. They allow customers to choose any doctor they want within their system, allow changes of primary care physician at whim for any reason, and do not restrict which hospitals or clinics of theirs one may choose to frequent. If one prefers the maternity ward in Bellflower, CA to the one in Fontana, CA, one simply goes where on prefers. In the main, their doctors are excellent and very patient-friendly and medical decisions are made by the patient and doctor. Members are not denied care under any conditions and will usually be granted care on good faith even if having billing issues with the provider, which is a great deal more than can be said for many providers.
    Their big weakness is their out-of-program service, which typically does not pay for any service from a non-Kaiser office or hospital unless it is an emergency and/or there is no Kaiser facility available. Hospitals have been known to not wish to give care to Kaiser customers out of fear of not getting paid. However, it’s important to note that out of service care in no way affects one’s ability to get care from Kaiser. One is responsible for payment one’s self, but one is not denied service from the provider in the future.
    There is no reason whatsoever a public option or public health service could not operate on such a model. It clearly works. KP is a private entity and yet the government could copy their operations as easily as it could copy the UK NHS. Indeed, the KP system is probably better for someone like Fritz, who feels better paying more money.
    One of the big questions, however, is often whether a quantifiably larger amount of money really coallates with a qualitative different in the available service. Sometimes you get what you pay for. Other times you simply spend more to get the same thing. The process for discerning the facts can be very objective, but highly subjective feelings can affect how someone views the matter.
    However, as merely one example, in 1983 a Buick cost much more than a Chevy, but they were both the same car made in the same plants by the same people. One was paying more in order to pay more, to feel better about one’s purchase.
    I am not saying such a decision is not valid for the individual who makes it and I don’t want to take their right to make that decision away. But I don’t want my right to choose a Chevy instead of a Buick taken away either, because they are the same car.

  43. 43
    Ron Chusid says:

    The good thing about a hybrid system is that there can be choices including private insurance as well as HMO’s. Many HMO’s have been overly restrictive leaving customers unhappy while I have not heard the same types of complaints about Kaiser. If people have a choice without their coverage being tied to employers (who typically look for the cheapest coverage they can get) then better plans will hopefully be the ones which survive.

    In theory people might get a good choice of plans even without a public option. Insurance companies have hurt themselves by leaving many feeling that this is not possible and a public option is therefore needed. It is also hard to have a mandate and not give the choice of a public option with the history of the insurance companies in this country.

    In health care more money sometimes means more quality and sometimes it does not. We spend more in this country than others. Patients are more likely to have expensive tests. Sometimes this means better care and sometimes the tests wind up being done because patients demand them or for medical-legal reasons but they don’t really provide much benefit. Another factor is that often expensive tests are of benefit for only a small number of patients. If you do more MRI’s you might occasionally find something treatable which would have been missed but a huge number of unnecessary tests might be done for the benefit of a very small number of people. There is no clear answer as to what is the right amount to spend in such situations.

  44. 44
    Fritz says:

    Eclectic — maybe the Chevys were built on Monday.
    (For those who don’t know, it is a pretty common story (true or not) that construction quality on American automobiles was notoriously worse on Monday, due to absenteeism and hangovers).

  45. 45
    Eclectic Radical says:

    “There is no clear answer as to what is the right amount to spend in such situations.”
    This is why my focus on health care reform has nothing to do with operating costs and everything to do with consumer costs. I don’t believe, ultimately, you can control medical operating costs (in the way both parties claim to believe you can) without greatly limiting patient choice and doctors’ ability to advise their patients completely. Any place you save money in medicine, you’ll be paying money someplace else instead. The best medicine is not ‘cheap.’ That’s why my focus is on a better, more inclusive system of shared costs for everyone who can pay and subsidized care for those who can’t.
    I’m in favor of any system, whether fully public, hybrid, or fully private, that can effectively share costs to bring down consumer costs for individuals who can pay and successfully subsidize those who cannot pay.
    What I am against, and what is currently being offered in Congress, is an ‘easy’ solution that offers political benefits to politcians and does not give the insurance companies any reason to change their operating model. If that is ‘killing reform from the left’ then I suppose I am guilty, but I don’t think it is. I think it is demanding reform that matters.

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