Reframing the debate.

[alexandraerin]

Here's the question we should be asking all public figures who are against a public option or other form of national health insurance:

"[Senator/Congressman/Pundit], how long have you believed that France is better than America?"

It's fairly easy to point to the failings in the Canadian health care system... a system, incidentally, that neither President Obama nor the Democrats in the legislature are looking to as an example... but France, which has a system closely resembling the much-denigrated "public option", has the top-rated healthcare system in the world.

France can manage to provide quality health care to their entire population and we can't? And it would be too expensive for us to match the feat, when they do it while spending less money per person than we do?

I'm sorry, I don't buy it.

I'm sure the reason that the supporters of the public option have been pointing to France is... well... as I've said before, liberals have a real problem with sitting back and allowing their opponents to frame debates. "Speak softly and carry a big stick" worked fine for Teddy Roosevelt, but it wouldn't have worked so well for his cousin Frank, who had to speak loudly and often just to make himself heard. If we pointed to France and said "We want our country to be more like that.", the right would jump on it in an instant... I mean, we're talking about people whose response to half of the things our president does is to say "arugula" like they've made some great and telling point about policy.

But with France using the public option and not just making it work but making it work so well that they have the best medical care in the world, consider the implication being made any time somebody says that the public option wouldn't work in America or that it would result in worse care for most people:

America is less capable than France.

In my previous post on the subject, I framed things in terms of goodness vs. greatness. Well, let's talk about greatness. As I said, we put a man on the moon. Is there any reason we couldn't take the number one spot away from France if we wanted to?

A lot of our political representatives and media figures seem to think so. Let's put them on the spot and ask them why that is.

Comments

[bisquick-deh.livejournal.com]

I agree with you. If we want to be better than France, what's stopping us? I give to you, alternative plans to the current bill posed by the Democrats. Not all of the ideas resonate with me (who can truly agree on everything?) but a lot of it makes sense to me. Some of them *gasp* are essentially the same idea the democrats have as well.

http://www.gop.gov/solutions/healthcare

I hope I am not overstepping my bounds by providing the link above. Let me know and I'll not post anymore.

[alexandraerin.livejournal.com]

Sure, the talking points are the same, but without the public option (which is at the heart of what France has accomplished) there's no teeth or guts to any of it. It's a love song to the insurance industry being passed off as reform, and if it passes, then when things don't actually improve they'll be able to say, "Well, we were against this to begin with. We only did what we did as a compromise. Now that government has failed it's time to let the free market take over."

"Competing across state lines" means every insurance company can do business from whichever state gives them the most beneficial regulations instead of having to be licensed to do business in each state.

It means if Delaware says "FUCK THE LITTLE TAXPAYER, WE WANT INSURANCE COMPANY MONEY", you and I have no leverage to exert against them and no real recourse since all the insurance companies are now doing business out of Delaware.

A public option means that the insurance companies have to provide value no matter what state they're doing business from. They can stay in the game by offering things that the government can't/won't... but the public option means they have to compete.

Without a public option, penalties for people who don't have coverage are essentially a tax that exists purely to enrich a single industry. Without a public option, we can give the industry all the "incentives" in the world and it's not going to get universal coverage, nor will it make sure that coverage is meaningful.

[cluudle.livejournal.com]

I am curious what you think of the opposition theory that we cannot take money away from the big businesses of health care because they use that money to fund research into cancer and AIDS drugs and flu vaccines that otherwise would remain undiscovered because no other country is willing to throw that much money at medical research. (It is not my theory, so I am paraphrasing, but I think I cover the key point.)

[alexandraerin.livejournal.com]

I'd have to see the money trail between the insurance industry and the research hospitals and scientists before I could seriously entertain that theory.

I would think that if we kept spending the same amount of money per capita we are spending on health care (which is double what France is) but weren't spending so much of it on the bureaucracy and overhead of the "health care industry" (i.e., the insurance companies and HMOs) then there would be more money available for other things.

[gamercow.livejournal.com]

Its hogwash. Yes, American companies funnel more money into research than most European companies, but the research companies usually have little to nothing to do with the insurance companies. They are usually interdependently funded, or self funded, or horrors, GOVERNMENTALLY funded, including the biotech initiative put forth by Obama that is pumping billions of dollars into the research industry.

[thoughtgolem.livejournal.com]

If we can't handle the metric system or the theory of evolution, what makes you think we can handle national health care? France has embraced nuclear energy too...how many in Congress are ready to support a nuclear power plant in their home state?
America is diving towards mediocrity. Whatever health care package ends up getting passed will just be more of the same.

[centauress.livejournal.com]

Nuclear power is highly unpopular, period.

It's just as unsustainable as oil, too, just another hundred years' plus a few million holding the waste (which is more radioactive stuff than you started with, by a thousandfold)

[aaron-mu.livejournal.com]

This is pretty silly. Obviously the congressmen you want to answer this question don't believe that France is better than America, and they'll give you long rambling responses about American Exceptionalism and how we're the ones developing new technology and medications and blah blah blah. The fact is that the people you want to pin down with your brilliant line of inquiry don't even acknowledge that France provides better health care than the United States.

I wish you were writing more spanking stories and not getting so worked up about health care reform.

Oh, and check out Bill Maher's interview of Rep. Weiner if you haven't seen it already, you'd probably have to torrent it.

[hnmic.livejournal.com]

I wish you were writing more spanking stories and not getting so worked up about health care reform.

I wish you were a better human being who treated AE as a real human being who has thoughts and opinions on the world and didn't think she existed solely to provide you with masturbation material.

Frankly, if you don't want to read what she has to say about real issues maybe you should be staying in the ae_stories comm. We all love her stories, they are what brought us here, but some of us care what AE thinks about, y'know, real life, she being a highly intelligent individual with developed and often insightful opinions.

[alexandraerin.livejournal.com]

I wish you were writing more spanking stories and not getting so worked up about health care reform.

Man, me, too. It'll be awesome when America decides to rejoin civilization and I don't have to get worked up over this.

[alexandraerin.livejournal.com]

And yes, it would be silly to suppose that any of them really do think France is better than America. The point of all this is to call attention to the fact that what they're claiming is impossible for Americans to achieve has already been done elsewhere. I don't expect this technique would change the hearts and minds of the loudest and shrillest, but I do think it could diminish their ability to sway the middle.

[pgranzeau.livejournal.com]

Unfortunately, trying to make those Senators and Representatives who are against a health care bill is a helpless tast. I bet there aren't five people in Washington capable of changing their minds on the subject.

[alexandraerin.livejournal.com]

It's really not about changing their minds, though... it's about pointing out the ridiculousness underlying their position to everybody in the middle whose minds are capable of changing.

[bisquick-deh.livejournal.com]

Being the only serious "opposition" in this thread currently, I hope that we can keep the tone civil. I am doing my best to be respectful, particularly since I'm a newcommer here.

Let switch gears here. Meaning let me try and find some common ground. I agree that there needs to be significant reform to our healthcare system in this country. It's long past due. One of the biggest problems I have with the current bill is the government control. I'm not just picking on Democrats here, my skepticism is firmly laid at both parties' feet. I'm not convinced that it will be sustainable as a viable program. the CBO is already saying it will cost way more than the President is saying. What is there to convince me that it can be run smoothly, effectively, and better than France? (that's sort of a joke, heh) Medicare and Medicaid certainly aren't good examples, they've done nothing but steadily cost more money, and pay out less and less. I know in my early thirties, I'm not counting on assistance for my medical care in my golden years. How about Fannie Mae and Freddie Mac? Nope, I think that's pretty obvious. USPS? Their hand is out too. http://www.msnbc.msn.com/id/29877702/

Maybe it will run well for while. But I just don't see it being viable in fifty years. Politicians will screw it up with endless revisions, and pushing the adjenda of whatever party is in power at the time. Look at how difficult it is to get anything done with medicare reform. I don't think I want that for the rest of our health care too. At least with privately controlled health care there is the almighty dollar that keeps thier course fairly predictable. Regulation, demand, competition, and litigation can work to keep them in check. None of those are on the table when dealing with the government option. I am by no means in favor of the rediculous profits insurance companies make, but I would think those are easier to control than a government entity once entrenched.

[alexandraerin.livejournal.com]

Dude.

What's the profit margin on the USAF?

What kind of shareholder value does your local police department give you?

When's the last time you got a decent dividend check from your fire department?

What are the 3rd quarter earning reports like on your state department of roads?

These things are alllll giant money holes. We throw tax payer dollars at them and never see a penny back. And why should we? We don't keep these things around because they're sound business investments. We support them because they're necessary parts of a modern 21st century society that stretches from sea to shining sea.

The USPS's only problem is that we let the Republicans turn them from a pure public service organization into a sort of public-private hybrid (when they went from being the United States Post Office to the United States Postal Service) that was designed to fail so that the anarchists oligarchs free market enthusiasts could claim that the government runs things into the grounds. The post office should never have been in the business of business. It's a public service. The revenue it takes in are offsets to its expenses that lower the tax burden of it.

If you don't think a post office (or an army, or a health care access agency) is a necessary public service, that's a whole separate issue... I think there's room to debate some of those things... but arguing that it's unprofitable--the crux of what you're saying here--is missing the point.

Fannie Mae and Freddie Mac, likewise, embody that kind of stupid public-private partnerships that manages to combine the worst of government with the worst of business.

Medicare, meanwhile, has an 80% customer approval rating and only spends 3 cents out of every dollar on overhead, as cited by someone elsewhere in this discussion. It's only "in trouble" because the Republicans keep looking for ways to hamstring it and then claim that government intervention has failed again.

Every business out there has its hand stretched out, all the time. Jesus H. Christ, I just gave Wal-Mart a hundred dollars a week ago in exchange for the goods I needed from them, and tonight when I went in there they wanted more of my money? Talk about a failed business model. Hey, I got paid by readers last month and this month I got paid by them again. If you're shocked that government institutions require ongoing taxpayer support, these revelations ought to just about send you to the emergency room, but that's how it goes. A taxpayer supported institution will always be supported by taxpayers. A business will always be supported by customers. An artist will always be supported by patrons.

Let's make a deal: you quit eating for a month and then I will entertain your argument that requiring ongoing taxpayer support is a weakness for a government program.

I'm sure that the party in power will screw it up with its own personal agenda, when that party happens to be the party whose agenda is to torpedo any collective action by We The People in order to "prove" the point that collectivization doesn't work. This is a reason to keep the conservatives out of power, not a reason to stick with the "predictable course" of the insurance companies that FYI is literally killing... literally killing... that is not hyperbole... your fellow Americans.

I am more worried about some of my friends with medical problems than I am about my friends who are serving overseas, because every day that passes the folks serving overseas are closer to safety, while each that day that passes my friends with serious medical problems are closer to the point of no fucking return.

[centauress.livejournal.com]

Wait, so the fact that we have the Internet and e-mail means that the USPS wasn't able to be a profitable company for a hundred odd years?

Because conservatives reduced regulation and saddled Fannie and Freddie with thousands of unsustainable loans? Because income for the group they've been loaning to has been stagnant for thirty years, they weren't successful for sixty years?

How about the other times the US has nationalized or created a national industry with federal dollars? Is the Rural Electrification with its hand out? Did the Feds lose their shirt creating Ma Bell to carry to every town, and be interchangeable? Did the feds lose their shirt when they were saddled with what they turned into Conrail?

Do you actually have any suggestions, other than examples of how Republicans make terrible administrators, and Democrats are fine?

[blue-x.livejournal.com]

bisquick,

I don't think you really are "opposition" here. I imagine you agree with the fundamental facts: health care is a right, not a privilege. People should have access to health care, like they should have access to food and shelter.

The majority of "the other side" doesn't think health care isn't a right - it just doesn't think government would do better controlling it than private companies do. Trying to make the argument into, "This is so obvious that the other side is stupid and evil" is counter-productive. Most people who argue against national health care don't think we should let people die in a ditch (okay, some do, but not most). They think our particular government system is not competent to meet our national need.

Because we aren't France. There are many things we do differently than France. We're also a lot bigger. Could we learn a lot from them? Yes. My mother still rants about the time my father fainted in a French restaurant and got emergency care, and how the secretary in the emergency room looked insulted when my mother tried to offer her credit card. But that doesn't mean doing the exact same thing would end up accomplishing the exact same thing, because we're different people with a different culture. Also, we have a different entrenched system-- and I don't just mean health care, but the entire rest of our budget, and how our medical and legal systems work, which would all need to change to make us "like France."

In short? It isn't an easy answer. People rejecting this attempt aren't evil people who think the poor should DIE; they're people who think this particular bill won't work in the long run. A lot of them say, if you actually listen, that they would be for a better plan - but so far, no one's come up with a plan they think will work.

I live in Massachusetts. We did some healthcare reform recently that was supposed to improve the situation, and let me say I think it just made it worse. Step in the right direction? Maybe, but in the meantime it screwed a lot of people, and now I have friends who aren't just uninsured, but the state of Massachusetts is charging them for being uninsured. So guess what? I'm opposed to the current MA health reform. I guess that means I'm the idiot who is uncivilized and too stupid to realize France can do it, so why can't Massachusetts?

Stop demonizing the other side and assuming they're too stupid to live, and maybe we can learn from each other.

Fannie and Freddie

[jkirk3279.livejournal.com]

Yeah, about that.

Fannie and Freddie were originally government owned and operated agencies.

And they were making a small but comfortable profit.

Then someone got the idea of spinning them off. Which led to deregulation, bad loans, and collapse.

If they'd stayed as government services, this wouldn't have happened, as nobody's allowed to speculate or profit from a government agency.

Likewise, Social Security. Originally, all those deposits were kept in a private fund.

Somebody got the bright idea of stealing that money and putting it in the General fund.

If the money had stayed where it was, SS wouldn't be in any trouble at all.

We need to reverse that course, and put all future deposits back in the private fund. Too late to demand the money back, but not too late to reverse the ongoing drain.

Any business whose model is to sell products or services to other companies, and it has nothing to do with banking, or insurance, generally can do fine.

It's only when a business starts to gamble on moving pieces of debt around that we run into problems.


That's when a little Federal regulation can prevent disasters like the banking collapse.

[mazzon.livejournal.com]

Healthcare's nice.
It's good to be proud of one's homeland too, probably.
I'm not quite so keen on hubris so deep it paints as unpatriotic failure to consider all other countries inherently inferior. It has a nasty aftertaste of justification of atrocities to me.

[alexandraerin.livejournal.com]

Not all other countries.

Just France.

That's already part of the American national psyche... I didn't put it there. :P

[delynfirebrand.livejournal.com]

...not to be too off-topic, but aren't you supposed to be keeping your argument-related stress levels down?
No heart attacks for you, please!

[chaosherder.livejournal.com]

First time commenter. I'm not really on either side here (or maybe I'm against both sides) and I'm sure at points I'm going to stray over into "EVIL" territory but there are fundamental flaws here in the a public health option does not address the problems, only kicks the can down one further iteration. I'm going to try to organize this by problem but I'm tired and I've been prepping a lot of stuff on this so it all starts to jumble together.

First, may as well get the evil part out of the way. I do not believe health care is a right. We live in the real world and in the real world there is less health care available than what people want to consume. A human right is something that should be given to every human without question. At the point where giving health care to someone means denying health care to someone else (and this is the situation and will be the situation for the foreseeable future)I cannot in good conscience call it a right. okay, onto flawed assumptions/problems not being addressed much in the current debate countrywide.


1. French Health Care.

The problem with switching to a French Health Care system is that France is currently leaning toward switching to a US style HMO system to control costs and France faces the exact same problems as America despite being multi-payer rahter than private. Payroll taxes in France have increased from 13% to 20% to cover HC, benefits are being reduced, and there is a large gap of lower-middle class people (about 33% of french population) who have no access to things such as basic dental and vision care. The problems here are that the french are the largest per capita consumers of health care in the world, especially for trivial shit (they spend less $ per capita because of price controls), and as they have adopted more american style eating habits (fast food, etc) many of the chronic diseases associated with the american lifestyle (coronary disease, liver disease, type II diabetes) are becoming more prevalent. Because french health care reimburses 100% for chronic disease costs are spiraling out of control despite price caps. French HC is currently 49 billion euros in debt with no end in sight. which is why they're looking at introducing HMOs. Food and societal costs lead to the second point...


2. Agribusiness

Agribusiness is arguable the single most powerful lobby in congress. their regulatory capture is complete (more on regulatory capture later) and they receive more welfare than any other group. (the annual farm subsidies bill is tragic and the only reason i almost supported mccain is that he has expressed intermittent opposition to it) food corn subsidies drive a food industry that is leading to all types of preventable chronic disease. last year america spent $116 billion treating type II diabetes alone, another $147 billion treating obesity. for those keeping track, that's 10% of total US HC spending right there. On completely preventable diseases. This doesn't even include a variety of other diseases which are diet related. some estimate 30% of US HC spending is on this type of disease.

And it's only going to get worse. 15% of adolescent caloric intake is in the form of soda. Helllooooo, type II diabetes. If the french system cannot handle the burdens with less obesity and diabetes per capita, how can america withstand a similar system without as stringent of price controls? short answer is that it can't.

Food reform is the single most important issue (well, water may be more important, so second most) facing this country and almost NO ONE is talking about it. we don't talk about how food corn subsidies make cheap soda possible. We don't talk about corn being a nutrient intensive crop, leading to increased fertilizer use, leading to more nitrogen runoff, leading to a huge algae bloom in the gulf of mexico, killing off sea life. we don't talk about how no health care reform can work until we fix food.

And that is the absolute truth. any HC reform without food reform just pushes the catastrophe back. it doesn't solve anything.

http://www.nytimes.com/2009/09/10/opinion/10pollan.html

good recent op-ed on the subject.



...character limit, splitting post

[chaosherder.livejournal.com]

3. Adverse Selection

http://en.wikipedia.org/wiki/Adverse_selection

Okay, from politics to theory. Adverse Selection is the primary cause of market failure in insurance markets and why I support gov't intervention in such. In a nutshell, adverse selection happens because insurance firms know less about consumers than the consumers. Couple that with the people most wanting to consume insurance are those most likely to need it, and you end up with a cycle of inflating costs.

Because of the cost structure of HC and the distribution of risk insurance demand ends up with a higher mean than median, so to speak. because firms try to maximize profit (basic assumption, profit v non-profit HC is another debate for another time) their actuarial models tell them to increase prices. however, basic market models tell us that as price goes up, quantity demanded goes down. The problem is that the drop in demand quantity is not from those driving up costs in the first place; healthy people are much more likely to drop insurance due to cost as health care is less valuable to them. So healthy consumers leave the market, and costs to insurance firms go up, leading them to futrther adjust prices up, leading to more force out, etc. of the 45 million americans that lack health coverage, over 2/3rds simply choose not to buy it. this is the root cause.

A problem with both american and french health care systems is that they do nothing to address adverse selection, and in fact make it worse. speaking specifically of the american system, tax structures give incentive to the purchase of insurance through employers. this causes the problem of healthy coworkers subsidizing unhealthy coworkers. and then as the healthy coworkers drop out (which is more valuable, the $600/month insurance through work or the $500 extra after taxes that can purchase the same coverage for $350?), again, costs to the insurer go up so costs to the employer go up so costs to everyone go up. by clumping people together we make adverse conditioning worse...okay, getting tired, lot more to cover...less rant/more concise needs to start.

and yes, the insurance companies, specifically the executives, make too much money. part of this is due to americans being conservative in nature and over consuming insurance. but the bigger part is america's corporate culture and the legalized theft it allows.

4. Corporate Culture.

Corporations are not evil. they are risk spreading devices. yes, santa clara v southern pacific railroad and other corporate personhood issues are troubling, but the root problem isn't corporations but the regulatory clime.

Not going to go as deep into this but basically the top of america's corporate ladder is a rich boys club where everyone votes to give everyone else huge pay raises (they all sit on the exec boards of each others corporations). combine this with regulatory capture and you get legalized theft, both from consumers and shareholders. what is currently happening in america is not how corporations are supposed to work. they have gained control of such bodies as the SEC and as such use regulation to force out competitors rather than to ensure market function. so again, we have market failure.

5. Regulatory capture.

http://en.wikipedia.org/wiki/Regulatory_capture

getting really lazy, wiki can answer this one. for more info look also into game theory and public choice theory. basically the market fails because when everyone acts in their own interest those who have the most interest in a regulatory agency end up, essentially, buying it. and everyone who does not have interest lets it happen because it is not in their best interest to spend billions of dollars fighting it.


There are probably other problems i'm forgetting...


okay, way past my bedtime. if you want to look at a functioning health care system, look at singapore and into governmental reinsurance. more to say on this but that would require a third page...sorry if i got ranting. there's also more to be said on education reform, tort reform, etc, but the big problems are food reform and control of adverse selection. I'm probably not going to post again as i prefer reading and lurking (love your work btw AE) so, yeah.

[vox-vocis-causa.livejournal.com]

France has the second biggest spending deficit in the EU behind Germany, primarily because of its employment policies and healthcare program.
I am all for reducing spending on healthcare, stopping insurance companies dropping people for using their policies, and covering the uninsured but I don't think it should be discussed as a moral issue. Rather we should be discussing, practically, how we can make those things happen.
Rather than focusing on being "great" we should be focusing on solving a problem that we, as a people, have identified as a concern.

[centauress.livejournal.com]

Except those protesting don't agree that it is a concern or that we've agreed that it needs fixing. They're all for supporting politicians who have decided they will vote against any suggestions, even their own.

Heck, 'death panels' and etc were all items added by Republicans.

I don't know how we could focus more on the issues than just plain ignoring the Republicans and seeing what we can pass with 51 Democrats.

In conclusion...

[blue-x.livejournal.com]

In conclusion, AE, you really need to write more. I come to your journal to see if there's any note about stories, and I end up arguing on the internet.

I think eight to ten chapters a day might keep me from doing anything stupid. What do you think? ;)