Dumb Things Politicians Say About Health Care Policy

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Yves here. I know it’s not fair to make fun of Republicans, since they can’t help themselves. But still…

On a slightly more serious note, you’ll notice that virtually all the arguments are based on an updated version of “deserving poor”. If you need health care, it’s your fault because you made bad lifestyle choices (as if, say, anyone would choose to be a job that gave you repetitive stress injuries) or choose the wrong parents or are female and decided to do what women are supposed to do, have babies.

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal

There have been multiple legislative attempts at major health care reform in the US.  Typically, such attempts feature considerable public debate, including speechs, congressional committee hearings, sometimes progressing to debates by the House and Senate.  (For example, see this Frontline chronology of the proceedings up to the passage of the Affordable Care Act, aka “Obamacare,” in 2009.)  Usually the discussion includes some real experts on health care policy, and some real health care professionals, and at least appears to reference some data about medicine, health care, and health economics. Whether previous debates were truly evidence-based is not clear, but it appeared to me that they at least acknowledged the importance of evidence, and maybe even at times a rigorous approach to it.

However, the proceedings up to the passage of the American Health Care Act seemed somewhat different.  There were no public committee hearings or debates.  Per a Los Angeles Times article in April, 2017 (via the Chicago Tribune):

President Trump and House Republicans, in their rush to resuscitate a bill rolling back the Affordable Care Act, are increasingly isolating themselves from outside input and rejecting entreaties to work collaboratively, according to multiple healthcare officials who have tried to engage GOP leaders.

In particular,

And senior House Republicans and White House officials have almost completely shut out doctors, hospitals, patient advocates and others who work in the healthcare system, industry officials say, despite pleas from many healthcare leaders to seek an alternative path that doesn’t threaten protections for tens of millions of Americans.

‘To think you are going to revamp the entire American healthcare system without involving any of the people who actually deliver healthcare is insanity,’ said Sister Carol Keehan, president of the Catholic Health Assn., whose members include many of the nation’s largest medical systems.

While the experts have been shut out, some of its supporters of the AHCA in the US House of Representatives have been free with their explanations of their actions.  Some have been rather alternative, so to speak.   Some recent examples, in chronologic order,

Rep Roger Marshall (R-Kansas): the Poor “Just Don’t Want Health Care”

As reported by the Washington Post, March 9, 2017

‘Just like Jesus said, ‘The poor will always be with us,’ ‘ Marshall said in response to a question about Medicaid, which expanded under Obamacare to more than 30 states. ‘There is a group of people that just don’t want health care and aren’t going to take care of themselves.’

He added that ‘morally, spiritually, socially,’ the poor, including the homeless, ‘just don’t want health care.’

‘The Medicaid population, which is [on] a free credit card as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising. And I’m not judging; I’m just saying socially that’s where they are,’ he told STAT, a website focused on health-care coverage.

The problem is that Marshal, who is a physician, did not provide evidence that there is some essential characteristic of the poor that causes them to make bad health decisions, or discus whether perhaps the poor face constraints on their health care decision making that the rich do not.  The implication appears to be that Marshal is treating an promoting an ideological or religious opinion as if it were derived from epidemiology.

House Speaker Paul Ryan (R-Wisconsin) The Problem with “Obamacare” is “the People Who Are Healthy Pay for the People Who Are Sick.”

As reported by MSNBC, March 9, 2017

Take today, for example, when the GOP House Speaker did a little presentation on Capitol Hill for reporters in defense of his controversial American Health Care Act, which some have begun calling ‘Trumpcare.’ At one point during the slideshow – complete with Ryan’s sleeves rolled up – the Wisconsin Republican tried to explain what he sees as the Affordable Care Act’s fatal flaw:

‘The fatal conceit of Obamacare is that we’re just gonna make everybody buy our health insurance at the federal-government level, young and healthy people are going to go into the market and pay for the older, sicker people. So, the young healthy person is going to be made to buy health care, and they’re going to pay for the person, you know, gets breast cancer in her 40s or who gets heart disease in his 50s. […]’

‘The whole idea of Obamacare is … the people who are healthy pay for the people who are sick. It’s not working, and that’s why it’s in a death spiral.’

As MSNBC reported, the problem is with that is

that Ryan doesn’t seem to understand what “insurance” means.

Look at that quote again: The whole idea of Obamacare is … the people who are healthy pay for the people who are sick.’ Well, yes. The whole idea of health insurance is to establish a system in which the people who are healthy pay for the people who are sick.

This really isn’t that complicated. In fact, it’s incredibly common for the vast majority of Americans: we pay premiums, the money goes into a pool, funds from that pool pay for care. It’s Insurance 101.

If Ryan disapproves of this model – which is weird, given that his own reform bill is built on consumers getting coverage through traditional insurance – there are effectively three alternatives. If the healthy aren’t going to pay the sick, who will? The sick can try to pay for themselves, the government can pick up the tab, or the sick simply won’t get care.

Rep John Shimkus (R-Illinois) Why Should Men Have to Purchase Prenatal Care? 

As reported by the Washington Post, March 9, 2017, regarding a hearing in the House of Representatives Energy and Commerce Committee

‘What mandate in the Obamacare bill does he take issue with?’ Doyle asked Shimkus, using the formal parlance of congressional committees.

‘What about men having to purchase prenatal care?’ Shimkus said.

At that point, one could hear the room start to stir.

‘I’m just . . . is that not correct?’ Shimkus said. ‘And should they?’

Rep Shimkus, apparently like Rep Ryan, does not seem to understand the concept of health insurance.  The Post article put it this way,

Here’s how insurance expert and columnist Nancy Metcalf answered a similar question from a Consumer Reports reader that year:

Health insurance, like all insurance, works by pooling risks. The healthy subsidize the sick, who could be somebody else this year and you next year. Those risks include any kind of health care a person might need from birth to death — prenatal care through hospice. No individual is likely to need all of it, but we will all need some of it eventually.

So, as a middle-aged childless man you resent having to pay for maternity care or kids’ dental care. Shouldn’t turnabout be fair play? Shouldn’t pregnant women and kids be able to say, ‘Fine, but in that case why should we have to pay for your Viagra, or prostate cancer tests, or the heart attack and high blood pressure you are many times more likely to suffer from than we are?’ Once you start down that road, it’s hard to know where to stop. If you slice and dice risks, eventually you don’t have a risk pool at all, and the whole idea of insurance falls apart….

Rep Mo Brooks, (R-Alabama): “People who Lead Good Lives” Do Not Get Sick

As reported by Vox on May 2, 2017, Rep Brooks said in an interview on CNN to explain why people with pre-existing conditions should personally pay for their health insurance

allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives. They’re healthy; they’ve done the things to keep their bodies healthy. And right now, those are the people who have done things the right way that are seeing their costs skyrocketing.

He seems to be arguing first that people who virtuous (“good”) are healthier than others.  He certainly provided no evidence for this assertion, which, like the assertion by Rep Marshall above, appears to be ideological or religious judgment disguised as epidemiology.

Rep Paul Labrador (R – Idaho) “Nobody Dies Because They Don’t Have Access to Healthcare”

As reported by CBS News on May 6, 2017

Labrador made the comments the day after the U.S. House passed a GOP-led health care bill repealing and replacing chunks of Obamacare. Labrador, a member of the conservative House Freedom Caucus, was responding to an audience member who expressed concern about how the bill would affect Medicaid recipients.

‘You are mandating people on Medicaid accept dying. You are making a mandate that will kill people,’ the audience member said, before being drowned out by Labrador’s response.

‘No one wants anybody to die,’ Labrador said. ‘You know, that line is so indefensible. Nobody dies because they don’t have access to health care.’

It is not completely clear whether Rep Labrador meant access to health care, or access to health care insurance. A person with appendicitis, acute bacterial pneumonia, a myocardial infarction, etc, etc who fails to seek acute care because of lack of a means to pay for it could well die. As an absolute, this statement is obviously untrue.

Mick Mulvaney, Director of the Office of Management and Budget: “The Person Who Sits at Home, Eats Poorly and Gets Diabetes” Does Not Deserve Health Insurance

As reported by the Huffington Post on  May 12, 2017

he drew a distinction between people like Kimmel’s son, born with a congenital heart disease, and people who end up with conditions like diabetes. ‘That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes,’ Mulvaney said, according to a Washington Examiner account consistent with real-time social media reports. ‘Is that the same thing as Jimmy Kimmel’s kid? I don’t think that it is.’

This is not exactly the clearest statement but it seems to imply that only people who make unhealthy life-style choices get diabetes, which certainly as an absolute is not true; and furthermore that people who develop diseases due to poor life-style choices do not deserve care.  The juxtaposition suggests that driving this is an ideological or religious judgment about who is deserving.

Video diversion: would Mr Mulvaney think this person deserves “health care?”

Summary

In 2003 I published an article entitled “A Cautionary Tale: the Dysfunction of American Health Care,” which summarized the views of health care professionals about the causes of health care dysfunction.  One of the major findings was the importance of ” attacks on the scientific basis of medicine.”  In turn, I hypothesized that some of these attacks stemmed from the rise of post-modernism, then a fashionable intellectual affectation on university campuses, mainly of the avant garde left-wing.  I wrote then:

Postmodernism is ‘an attempt to question the fundamental philosophical and political premises of the West.   It argues that many of the concepts we take for granted—including truth, morality, and objectivity—are culturally ‘constructed’’  To postmodernists, truth is just what the powerful say is true.

Now it seems that post-modernist “thought” has escaped the confines of left-wing humanities departments, and infiltrated political discourse, and for some unfathomable reason, seems to particularly affect some of those who profess to be conservative. After all, in January, KellyAnne Conway, a senior White House adviser, defended the administration’s arguments as “alternative facts.” (Look here.)

Facts, however, are stubborn things.  Evidence is evidence, no matter what politician it might offend.  Basing legislation on the sorts of alternative thinking displayed in the cases above could lead to real life, or life and death consequences for the sick, injured and vulnerable.  True health care reform requires clear thinking and the input of people who actually know something about health care.

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87 comments

    1. DH

      Most of them are typically over the age of 50, and therefore high risk. It makes sense that they should be on their own financially to address their health care needs. I think they should all be part of their states’ high-risk pools once they establish those in the new health care bill. After all, they chose to become older than 50.

      Reply
    2. RUKidding

      That’s my question, and should be the question every citizen asks.

      Let ’em use the same “health care” system they wish to impose on us feckless, amoral, fat, ugly, icky female, sinning populace.

      Reply
      1. craazyboy

        I’m still in deep contemplation over $300 haircuts. Then they brag about what Idiots they are! Just get a hat to wear. Jeez.

        Reply
      2. John Zelnicker

        @RUKidding – In fact members of Congress are required, under Obamacare, to buy health insurance through the exchanges. They are using the same system they imposed on us.

        Reply
          1. John Zelnicker

            @Bobby Gladd – I said nothing about how much they pay for their insurance, only that they have to obtain it through the exchanges.

            Reply
    3. jrs

      with much of Congress being millionaires they’d have fine healthcare regardless. Without us paying they would have the same healthcare you would have … if you were a millionaire that is.

      A few meetings with lobbyists will take care of a few other niceties. And if that’s not enough they can insider trade stocks to add to the millions.

      Reply
  1. cojo

    It’s unfortunate journalists are unable to call out such blatant rubbish on a real time basis. The real sad thing is that politicians can get away with stating such things without being run out of office for dereliction of duty.

    Reply
    1. Disturbed Voter

      Journalists are paid shills. In ancient Athens, some offices were filled by lot from the pool of eligible citizens. Persona-non-grata could be exiled for 10 years, by popular vote. We need to bring this back.

      Reply
  2. DH

    Based on Paul Ryan’s logic, we should be able to eliminate FEMA flood insurance. It is unreasonable that people who are not being flooded should pay for those that are. Since FEMA flood insurance is also subsidized by the federal government, people who can never be flooded because they live on high ground are also paying for that insurance, which is completely unreasonable and should be stopped in the coming budget.

    Reply
    1. RUKidding

      Flood insurance is one of those tricky areas.

      I used to live in small city with a river that only flooded periodically, but it was definite that it would flood periodically. Yet the City Council – in their infinite “wisdom” (and payola) – gave permission for housing to be built on a known flood plane.

      I didn’t need to buy flood insurance, but those that did weren’t thrilled that they had to pool their lower risk of flooding with those home owners who purchased housing on a known, documented flood plain that would definitely flood periodically.

      But that’s different from health care insurance, where I have no idea whether I’ll really need help with some condition or accident, despite the fact that I’m in amazingly excellent health (for my age group), and I lead very healthy life-style. Disaster could strike me at any moment, but it would be hard to determine that I was somehow responsible for getting sick or getting in an accident… and I’m not in a position where I can predict that such things will or will not happen to me.

      Reply
      1. Synoia

        If you need Flood Insurance you are NOT in a pool with those who do not need flood insurance. It is separate insurance, because it is a separate risk.

        The login being is that you can elect to buy a home which is not in a flood plain.

        With Health Insurance the only choices are to live, in which case you are in the pool of living people, or die, in which case even the FIRE sector has no succeeded in either selling you what you don’t need, nor monetizing the dead.

        I’d note that people do not have the choice of being born.

        A disgusting aspect of Health Insurance is the existence of separate groups of people for profit.

        Reply
        1. lyman alpha blob

          I believe flood insurance is a federal government program as private insurers are smart enough not to insure houses that will definitely be flooded at some point. So while those not living in a flood plain don’t have to pay premiums, we are all definitely in the pool when it comes time for Uncle Sugar to pay out.

          Lots of people don’t realize that yes, they are helping to finance those with expensive beachfront property built in known hurricane zones.

          Reply
          1. CD

            But climate warming will solve all that. No need for flood insurance when all the homes on your strip wash away. When everything is washed away.

            Mother Nature has the answer to flood insurance.

            Reply
    2. Disturbed Voter

      Don’t forget how those of us without beachfront property, keep paying higher property insurance … to pay for all the damage Mother Nature causes … to those of us with beachfront property.

      Reply
  3. jerry

    I prefer the newest GOP tactic for addressing healthcare showcased by Greg Gianforte in the montana congressional race:

    Body-slam anyone who questions you!

    Reply
    1. yamahog

      Yeah but quoting the CBO is hate speech and you gotta punch people who assault you with hate speech.

      Reply
    2. RUKidding

      Yes, and it’s a two-fer bc now the worthless reporter automatically comes with a pre-existing condition, so no insurance for you, you sinning sucker.

      Reply
  4. Denis Drew

    Single payer Medicare does nothing to prevent the proliferation of financialization * in medicine — which mirrors that in every other American enterprise. Cannot as long as there is no countervailing force. Choose whatever system you like from whatever country. 6% labor union density in the private economy equates to 20/10 blood pressure: starves every other healthy process.

    * https://www.amazon.com/American-Sickness-Healthcare-Became-Business/dp/1594206759/ref=tmm_hrd_swatch_0?_encoding=UTF8&qid=&sr=

    Reply
    1. grizziz

      Part of the desire for single payer is that the organization/institution providing the payments would be given the mandate to bargain for lower payments to the providers and driving profits out of the providers pockets. Conyer’s H.R.876 would do this through the budgeting process. However, since it relies on historical usual and customary prices as the basis and those bases are currently at their highest point ever, it is unlikely to immediately have any effect on the prices on the cost of care.
      The administrative overhead of about 15% of total health insurance coverage paid to insurance companies and support services would be eliminated. Of course, this would eliminate jobs and reduce GDP, but the newly unemployed could find work with UBER.

      Reply
      1. marym

        HR 676 Expanded and Improved Medicare for All

        Only states:
        Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation…” [emphasis added] and it’s an annual process.

        Contains provisions for salary continuation, training, and priority job placement for insurance industry workers. They would of course also have healthcare insurance, as would Uber workers.

        Reply
  5. Jim Haygood

    Ryan doesn’t seem to understand what “insurance” means.

    Indeed Ryan doesn’t. But neither does the author.

    Insurance is a means of covering catastrophic expenses. Auto insurance covers liability and collisions, but not tires and brake pads, which are routine maintenance expenses that every auto owner faces. Routine maintenance is not insurable, as there is no economic benefit in pooling and sharing such expenses.

    Much of what is called health “insurance” in the US is actually indemnification coverage, developed for the entirely different purpose of boosting corporate benefits during WW II when wages were frozen. States and Congress have piled on to this broken model, mandating coverage for all kinds of routine expenses.

    Contraception is the poster child of a routine health expense that most adults incur during their lives, and which is neither catastrophic nor insurable. It does provide fertile ground for religious and ideological wars, though, which is why the Depublicrat party loves it to divert attention from America’s dying imperial economy.

    Reply
    1. Disturbed Voter

      Everyone wants a free lunch. They see that Congress gets a free lunch, so they feel since their representative is their “employee” then they should do. Insurance never works mathematically, except for rare, undesirable, one time events. This is why the closed CDS market for example, is a complete rentier fraud, while it technically is insurance (to avoid regulation). But then you shouldn’t be able to make a profit off of business failure, bank failure nor treasury failure.

      Reply
      1. yamahog

        Shorting equities or going long on puts is a way to profit off business failure – but they’re probably good for financial markets. Sure, the transactions are zero-sum, but the possibility of profiting off failure is a great mechanism to keep people rational about the future.

        Reply
        1. Disturbed Voter

          Only if the “Shorts” aren’t covered by the Fed. But now we know they are … so the “Shorts” don’t meet any market function (bring out your dead). You can profit on the upside, and on the downside, even if you bet wrong, because Uncle Sugar has you covered. But not you nor I.

          Reply
    2. Synoia

      Insurance is a means of covering catastrophic expenses.

      That’s actually a definition health Insurance with deductibles.

      In which case your augment is moot.

      Reply
      1. yamahog

        But ACA-compliant plans offer free things like physicals and birth control – that’s hardly insurance. Additionally, the existence of deductibles means that consumers are incentivized to use their health insurance network even when they could probably get some care for less money on their own.

        In my state, some people’s copays for their prescriptions are higher than cash price of their prescriptions. People have to make a choice between paying cash or paying more for the privilege of counting their prescription towards their deductible.

        That’s hardly a good example of something that just spreads risk around. And when individuals’ deductible exceeds their ability come up with money, it’s hard to argue that they can actually use their insurance effectively.

        Reply
        1. tegnost

          physicals are revenue generators, and opportunities to prescribe medications and administer tests, and so obviously no they’re not free, can you say deductible?

          Reply
    3. Anthony Noel

      The problem with your analogy and your position is that there is demonstrative economic benefit in pooling and sharing routine expenses since they tend to be preventative.

      To use your auto insurance example, we can easily show that inability to properly maintain vehicles does lead to increased catastrophic occurrences. If I can’t pay to get my brakes done until next month’s paycheque or buy a new set of winter tires, there’s an increased chance that I will cause or be involved in an accident causing increased cost payout from the insurance pool.

      Reply
  6. Jim Haygood

    Ryan doesn’t seem to understand what “insurance” means.

    Indeed Ryan doesn’t. But neither does the author.

    Insurance is a means of covering catastrophic expenses. Auto insurance covers liability and collisions, but not tires and brake pads, which are routine maintenance expenses that every auto owner faces. Routine maintenance is not insurable, as there is no economic benefit in pooling and sharing such expenses.

    Much of what is called health “insurance” in the US is actually indemnification coverage, developed for the entirely different purpose of boosting corporate benefits during WW II when wages were frozen. States and Congress have piled on to this broken model, mandating coverage for all kinds of routine expenses.

    Contraception is the poster child of a routine health expense that most adults incur during their lives, and which is neither catastrophic nor insurable. It does provide fertile ground for religious and ideological wars, though, which is why the Depublicrat party loves it to divert attention from America’s dying imperial economy.

    Reply
    1. craazyboy

      Looks like Ryan is rather innumerate when it comes to math, however. 850% increase for jobless old people?

      Usually you would wanna check over your math once, or have Sister Mary look it over, before letting some big guy do it for you?!

      Reply
    2. craazyboy

      there is no economic benefit in pooling and sharing such expenses.
      ====

      Other than exercising purchasing power, as Medicare does and still would.

      But we know that already.

      Reply
      1. yamahog

        There isn’t really value to purchasing power in a competitive market. Firestone probably pays roughly the same price for Akebono brake pads as Amazon or Walmart customers. Sure, you might cut out the middleman’s markup but the value might just as easily get squandered by (unaccountable) bureaucrats.

        Reply
    3. Art Eclectic

      That ultimately gets to the heart of the problem. Insurance is not health care. Insurance is designed for unusual catastrophic events that are unplanned.

      What we’ve been doing is shoehorning normal heath care expenses into plans and calling them “insurance”. The insurance companies have gotten massively wealthy on this mistake and are not at all keen to give up their revenue stream. The result of turning health care into insurance has been financialization and obscene profits because the game is on and all the usual suspects have bought into the con. It is absolutely a wealth transfer from the healthy to the sick, there’s no arguing that. The argument is how do we get regular people affordable health care? The Dems have one flawed plan and the Reps think that just getting all those damned sick people out of the pool will solve the problem (it won’t, they’ll just find newer and better ways to extract they expected profit levels. Sick people are a profit center, take away that profit center and they’ll find another).

      And, since you brought up birth control, it always stuns me that a party that loathes the poor as much as Republicans do isn’t pushing birth control from every street corner in every low-income neighborhood. I guess they really just get their ya-yas from watching people suffer (much like Mother Teresa).

      Reply
      1. Disturbed Voter

        Most capitalists are Marxists. They desire the reserve army of the poor (and have no borders, to extend this army overseas).

        Reply
      2. Paul art

        No the GOPer game or for that matter any old money bags game is to have a vast pool of cheap labor. Those who get sick, injured etc are easily and simply replaced by others. Its the old lame horse routine – send it to the knackers yard or put it down. How dare you ask us rich people to pay for its care? (Not that rich people pay exclusively for the cost of society but then that is what they think)

        Reply
    4. jrs

      I think this would work better, if still far from ideally, if the U.S. was a middle class country like say I don’t know Switzerland where most people were doing pretty well. The U.S. is somewhat closer to a 3rd world country (although with a small middle class) with truly massive amounts of poverty though. So ability to afford even a mere doctor visit isn’t so easily arranged when there is so much poverty.

      Americans have already made very different birth control choices etc.. because of cost. Europe’s favorite birth control is the IUD, in the U.S. it’s the pill.

      Reply
      1. jrs

        And the pill isn’t even cheaper over the life of the birth control as it were, it’s just a much cheaper upfront cost.

        Reply
  7. Jim Thomson

    re: Shimkus’ comments on pre-natal care.
    And heaven knows we would not want men to pay for Mrs. Shimkus’ pre-natal care.

    This whole collection is stupefying in the heartless, sociopathic, meanness of it all. A claim of ignorance would be the only defense but then that is an admission that these people are unqualified for their jobs (oops).

    Reply
  8. craazyboy

    Donald and KFC

    Jeebus. More fake news. Those are Chicken K Nuggets. Also looks like re-fried beans in the container. That would be the “Touch base back at home, then hitch a new coyote ride back to the, “Sanctuary City Of Your Choice”, immigration policy.

    No suckers will take that one up.

    Get a tourist visa at the border crossing. Makes things easy!

    Reply
  9. yamahog

    I appreciate the sentiment of this article but it’s full of snark and half-truths.

    We all agree that insurance is a way to pool risk, right? Well, the low degrees of freedom upon which insurance companies can calculate the cost of insurance means that we’re pooling certain costs as much as we’re pooling risk.

    Diabetics with a history of managing their blood sugar poorly will certainly use more insulin in the next year than a 22 year old who adheres to a ketogenic diet. But insurance companies have to spread around the cost of insulin as much as they have to spread around the risk that either of the parties gets brain cancer.

    Imagine car insurance, what if insurance companies couldn’t charge more money to people with serial DUIs? What if your car insurance also covered oil changes? Safe drivers with electric cars are pooling their risks with people who are much riskier. Could you blame anyone responsible for saying “I don’t think it’s worth participating in this racket, I’m going to bike to work”?

    To the extent that we discuss managing costs, we have to discuss people who misuse the system. I’m sure there are people with private insurance that misuse the system. But any ER health care provider can tell you about ‘frequent fliers’ on the public system. Homeless people who feign heart pain to get food and beds add immensely to the cost of the system, parents who drop their kids off at the ER for baby sitting consume immense resources, and people who serially overdose on recreational drugs take attention away from people with broken bones in the same ER. Heck, look at the cottage industry around drug rehab – that’s a case of failed incentives if I’ve ever seen one (for those who don’t know, addicts complete ‘rehab’, relapse, and rack up massive bills)

    Now, if we want to provide free homes, daycare, and safe legal drugs – I’m all for it, lord knows we have the resources. But it’s not a success for healthcare that someone gets rich while playing ‘catch’ and ‘release’ with drug addicts – it’s a wealth transfer from those who pay their bills to the health insurance executives, the politicians who take health insurance money, and health care admins. And we need to break that cycle – and giving people the choice to opt out or cutting the liability of the State to those people who use it for their own ends is a start in the right direction.

    Reply
    1. PKMKII

      Could you blame anyone responsible for saying “I don’t think it’s worth participating in this racket, I’m going to bike to work”?

      But there’s the rub; you can freely enter and leave the car market. You cannot do so with health care. The only way you can leave the health care market is by dying.

      But any ER health care provider can tell you about ‘frequent fliers’ on the public system.

      Most of the things you list there suggest a resource failure in other areas. Homeless feign conditions to get a bed and meal, because the homeless shelter and housing programs are inadequate. Parents use the ER as baby sitting because there’s no affordable child care options. Recreational drugs, well partially the failure of the war on drugs, but the health care industry itself bears responsibility for overprescribing painkillers in the name of big pharma profits. Getting tough on these people via health care regulations will just shift this inefficient resource access to another system.

      Reply
      1. jsn

        And it would likely cost a great deal less to simply pay responsible people to provide reasonable assistance to everyone that needs it with whatever health, shelter or diet/access to food issue they have rather than paying private salaries in the FIRE sector to prevent such needs being met.

        Reply
    2. a different chris

      >parents who drop their kids off at the ER for baby sitting

      Cites? This sounds like the sh*t that people go bankrupt because they “live beyond their means” when the vast majority of them do because, ahem, the cost of medical care.

      Reply
      1. Otis B Driftwood

        Agreed. Babysitting indeed. People go to ERs when conditions become acute. They’ve waited because they could not see a GP sooner or didn’t have access to preventive care. This is an enormous inefficiency and cause of needless misery for those without access to basic care – checking the tires, as another commenter so glibly put it.

        And there’s another class of ER patient (I know directly from my own experience with my mother) who have basic care but don’t take their medications as directed because they worry about the high cost of prescriptions.

        The amount of callousness on this thread is nauseating. I may have to go see my doctor.

        Reply
        1. witters

          “The amount of callousness on this thread is nauseating. I may have to go see my doctor.”

          Totally agree, and it does make it easier to understand the exploitative horror that is the US health disaster.

          Reply
        2. WeakenedSquire

          Round these parts, people, especially elderly and disabled folks, go to the ER because it’s a one-stop shop. They don’t have to waste time and energy and risk missing appointments by seeing the primary care doctor, getting a referral to a specialist, etc.

          Reply
    3. JustAnObserver

      “Add immensely” ? “consume immense resources” ?

      In both cases the (ab)use of “immense” is, IMNSHO, unwarranted without citation of actual figures and the sources of said figures. I hesitate to say this but it sounds remarkably like the “cheating welfare queens” cr*p used to to justify the 90’s Clintonite destruction of what was already an extremely weak social safety net in the US.

      To put it differently: The argument I usually use in these circumstance is to ask the questions:

      o What is what we might call the error rate of invalid vs. valid claims ? In percentage terms *not* in those big scary figures waved around by pols & journos.

      o What error rate are we willing to accept ? Note that no matter how much we might wish it 0% is unachievable in any practicable insurance scheme … social or private.

      Of course, sadly, using this line of argument typically ends with me getting called a socialist :-((. Whereas, of course, its just standard in science/engineering.

      Reply
      1. yamahog

        I wouldn’t know where to find the data source and I wouldn’t trust any data source. Hospitals have a clear incentive to play along with homeless people with medicare/medicaid – I’m sure their bills reflect that.

        But I can tell you that I think the fraud / misuse rate should be 0 so even having anecdotes I can fall back on proves the rate is >0 and too high.

        But don’t take my word for it:
        http://www.ocregister.com/2017/05/21/rehab-riviera-editors-note-on-our-investigation-into-southern-california-rehabs/

        Do you think the people paying for those rehab services are getting good value for their money? Would you support funding all those rehab centers?

        Reply
        1. marym

          The providers in your example are for-profit entities. Maybe a part of reducing financial abuse would be for publicly funded providers to be public or private not-for-profit entities. Oh wait…there’s a bill for that:

          HR 676 Expanded and Improved Medicare for All

          Section 103

          (1) “No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned.”

          “(6) “The payments to owners of converting for-profit providers shall occur during a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits.”

          Also, it’s not useful to claim that an accurate assessment of the extent of any fraud is irrelevant to claiming that fraud is a factor in deciding whether to keep or change a system.

          Reply
  10. Greg Buser

    Considering that no one who is sick can be denied treatment, means that we will incur the cost of the uninsured either through taxes covering them or higher insurance premiums reflecting the added costs of hospital emergency rooms being used as primary care facilities. Either way a private insurance based system that excludes higher risk groups and lower socio-economic classes, will just be another example of the, privatization of profit and socialization of risk, model that poses as capitalism in America.

    Reply
    1. reslez

      I have no idea what you’re talking about. Sick people who can’t pay are denied care every day in the US.

      You seem to be operating under a delusion that springs from the Emergency Medical Treatment and Active Labor Act of 1986. But all that says is if you’re actively dying, an emergency room that accepts public funds has to stabilize you before they kick you out. They don’t pay for your care. They will come after you for it. And no, they aren’t going to treat your cancer or anything else beyond immediately stabilizing you.

      Just another myth that makes conservatives feel better about themselves, like the one that says only unworthy people get sick.

      Reply
      1. Futility

        The comment didn’t say ‘cured’. It just says ‘cannot denied treatment’. Thus, its point is valid. It is a transfer of wealth from the public to private enterprise, without the benefit of actually curing the person (and thus ensuring possible future profits)

        Reply
  11. PKMKII

    Now it seems that post-modernist “thought” has escaped the confines of left-wing humanities departments, and infiltrated political discourse, and for some unfathomable reason, seems to particularly affect some of those who profess to be conservative.

    Conservatives: hate moral relativism, love epistemological relativism.

    Reply
    1. a different chris

      That was ridiculous.. WTF did it come from? It wasn’t a summary of anything that went before, it makes me wonder about the so-called brain behind what I had read up to that point. People I admire did something bad but leftists made them do it so punish them!!!

      “And now let’s take a break for some hippie-punching” should have been the heading, not “Summary”.

      Reply
  12. Deloss Brown

    Mr. Haygood, think of the ACA not only as catastrophic coverage, as when you run your car into a tree, but also as an extended warranty, or a vehicle service contract, which covers circumstances which are not catastrophic–unless not attended to. The analogy is not perfect, but most of us take our cars to the dealer when the “CHECK ENGINE” light comes on, and most of us have a routine physical checkup from time to time. Pregnancy is a normal, natural process, but most women like to have the process monitored by an obstetrician. “Routine maintenance” is generally not covered by a warranty, but the routine physical checkup is covered by many health insurance policies–for the obvious reason that you want to identify a problem–let’s say a cancer–as early as possible, while the treatment may be relatively minor and inexpensive (and successful). It makes very good sense for health insurance to cover contraceptive services. An unwanted or an unaffordable baby is a catastrophe for everyone involved, and for society in general.

    I sincerely hope this explanation has been helpful.

    Reply
    1. tegnost

      an imperfect analogy is an attempt to deceive. The ACA is indefensible. Health care is not better today than it was before the tax was enacted.

      Reply
  13. paul

    As someone who has consistently made bad lifestyle choices, I am bitter that there was not a better selection.
    Luckily I grew up with a national health service.

    Reply
  14. Crazy Horse

    The Congresswhores quoted in this article are beyond rehabilitation. Since they never will become functioning human beings, they should simply be consigned to lifelong incarceration where their basic needs will be satisfied and they will have no opportunity to harm others.

    Reply
  15. wmkohler

    Great article, up until the bizarre conclusion. Associating Trump and the Republican Congress’ loose relationship to facts with Derrida and Foucault would be a stretch even for, well, Derrida or Foucault.

    Reply
  16. John Zelnicker

    Good ol’ Mo Brooks. The representative from my state has once again stuck his foot in it (at least I’m not in his district).

    He really is one of the dumbest representatives in Congress.

    Reply
  17. craazyboy

    Maybe Donald will have a word with the Rs when he returns from the Vatican? Looks like he hit it well off with the Pope. Melania even wore a scarf, after being chastised by some in the press here [and probably Spiegle] for going bare nekkid in the ME. Both Arabs and Jews have ideas about this, tho different. But it was a good political strategy back home for the deplorables well read enough to noodle out the pushback imagery.

    However, maybe I read too much into it and Melania just doesn’t trust old men wearing robs whom haven’t had it in a very long while.

    I heard a while back the Rs have their Nun Consultancy and Ryan has consulted with Sister Mary. He was advised by Sis that the Vatican Holding Co. had re-organized, and that the VHO, Inc. had designated hospital functions of the Church to be “cash cows”. Legacy divisions of the Church have to fend for themselves and pander for donations or go on Marches for various self, and Jesus serving causes.

    I’m thinking this isn’t fair and the Pope could do something? I mean Italy has way better and cheaper healthcare than we do! What did the Romans know that we don’t?

    Anyway, The Pope could fix that with a wave of his Crucifix, or use the rumored wooden stake strapped under that robe [dunno how that rumor got out. It was a long time ago.]

    Reply
  18. Tony Wikrent

    The dumbest — and most evil — thing Republicans, conservatives, and libertarians say is “No one has a right to health care.” It should be easy to crucify anyone who says that, but to do so you need a thorough understanding of the importance of the General Welfare mandate in the USA Constitution as a pinnacle of Enlightenment political development (i.e., the historical transition from feudalism and monarchy to republicanism and democracy); which is why you so rarely hear a good retort from Democrats and the left in general.

    Of what use are life, liberty, and the pursuit of happiness, if you have no right to health care? Do all people have these inalienable rights, or not? The right to health care is a self-evident necessity for the enjoyment of these inalienable rights. Else, what has been the point of the past millennia of development and advances in the knowledge and practice of medicine and public health? Deny the right to health care, and you throw away the Enlightenment, both political and scientific.

    Reply
    1. Louis

      Another way of looking it as to think of healthcare not a right but rather as a public good.

      There is no constitutional right to fire protection. Going some time back in history, there was a period when each property would contract with a fire company. Trouble was if a fire started on your neighbors house and they had a different fire company, you company wouldn’t do anything until it spread to your house. Eventually, people realized that this didn’t work so well and we got the system we have now where fire protection is a public good.

      Reply
      1. mary

        If you do a search on “privatized fire department” you’ll see an alarming push in the opposite direction.

        I agree with you though. We need a language of the public good, things we can provide better if we provide them for all of us, things that shouldn’t be a for-profit business, etc.

        edit: user name typo – s/b marym

        Reply
  19. Tim

    The author makes a valiant attempt and his overall point is good, but the direct addressing of these questions leave something to be desired.

    Labrador’s comments were prefaced by EMTALA. So for emergency level care, which he was talking about, health insurance is irrelevant, but there is a big hole left to address people that don’t go in to deal with a cascading degrading health where they don’t feel they have the finances to seek medical care until the problem is too debilitating and by then it is too late.

    The real concern with much of the statements isy correlation does not equal causation. THe thing about poor people not eating right and using preventative medicine. It’s pretty hard to do that when you don’t make enough money to afford decent food, settling for a hi carb poor nutrition diet, and working multiple jobs and taking care of a family that leaves you with little time for health maintenance, which often still has a co-pay. And if you are living day-to day are you really concerned with preventative care?

    Most Christians know to look out when Televangelist or a Politician starts quoting the Bible. It is likely to be twisted out of context to support their own position. Christians like everybody else are wising up to the facts about single payer over time and it is showing in the polls of increasing support for it.

    Reply
    1. Adam Eran

      Interestingly enough the “liberal” Democrats and their house organs have lined up to oppose SB562. I counted no fewer than five unfavorable Sacramento Bee stories and editorials with the “Eeek! $200 billion in costs!” headline since SB562 hit the Finance Committee in the Senate. The Bee regularly publishes letters accusing it of “liberal bias,” but won’t publish anything that calls it out as a publication with a Business Section, but no Labor Section…or a publication with a history of labor problems and a multi-millionaire CEO…

      One story reports that SB562’s single-payer health care will cost $50 million more than the combined total of current state and private employer health care spending, but says nothing about how the figures currently available are very preliminary, or about employee contributions declining!

      These stories never include mention of the uncontroversial fact that single-payer systems worldwide cost roughly half what U.S. patients pay and deliver better outcomes, something based on experience, not preliminary estimates or studies purporting to predict the future.

      [sigh!]

      Reply
  20. JMarco

    What Republicans & Pres. Trump are trying to do is repeal ACA coverage & replace it with revenue neutral or reduced federal deficit program over ten yr. period. To do that it means that they will deny millions of current & future US citizens ability to buy or have some reasonable coverage. The end result that they are striving for is to be able to pass major tax reduction bill in August with only 50 Senate votes margin. Without revenue neutral health care Senate passage would harder to get and not filibuster proof The real goal is not better health care but a big tax reduction.

    Reply
  21. d

    what also seems to be covered up is that Tumpcare will impact more than just the individual market, your employer plan will also be impacted, since the same waivers will impact them too. so your company benefits will be less. and you will be more likely to end up in bankruptcy too

    Reply
  22. John B

    Use of the term “postmodernism” as it originated in the arts, to describe theories of social policy, is too far-fetched as anything but humor.

    The term had no very sound basis in the arts and has largely been abandoned as indefinable, except to describe an era of rebellion against traditional artistic forms.

    If postmodernism in social policy analysis challenged the concepts of truth, morality, and objectivity, then it disqualified its adherents from social policy analysis.

    Reply
  23. Stephen Douglas

    It should have been clear to the author of this piece that the problem is most certainly not post-modern thought, although, in other areas of life, that is indeed a problem.

    No, as the author concludes for almost every nonsense quote stated by each politician in his article, the problem is moralistic and religiously-based conclusions and “scriptures,” more specifically, the standard, Puritan moral stance of America: if you are “immoral” you deserve nothing (but do deserve to die a miserable sinner’s death and to then rot in Hell).

    This pervasive concept–as stated clumsily by the politicians in the article–drives the drug “war,” foreign policy, the student loan scam, propping up the banks but letting those home owners who made “bad choices” get foreclosed on, and just about everything you can think of going off the cliff in America right now.

    It’s not so-called alternative facts. It’s the morals thing. And you can see new evidence of this every single day in almost every single area of living.

    It is sad that the author could write such an article nailing it, and then go completely off the rails with the preposterous conclusion that it is the rich who say whatever truth it is they want to and that that is the problem. No. That is the problem with identity politics, political correctness much of current feminist thought and practice, and social justice foolishness at every turn.

    But that is not what is happening here. Until the “moral” bit–deeply, deeply ensconsed in the American psyche–is rooted out, the problems of health care in the US will not be solved, will only get worse, and much else that’s bad-wrong now in the country stands no chance of being solved either.

    Unfortunately, that “morals” bug is in us all, more or less: the urge to punish, to make suffer, those who one sees as “immoral.” As if you can build a great society a great country on such a concept.

    Trump promised health care that would include everyone. He was elected for that reason. He cannot NOT do that and survive in power. Period. The “morals” morons can say and they can do whatever their little “moralistic” hearts desire.

    If the result is not health care for all? There will be Hell to pay. Because the “morals” bug is 2-edged–since it is in all of us, the powerful can just as easily be seen as “immoral” and consequently deserving of the whrilwind. they will sow if they continue on their “moralistic” path.

    Reply
  24. robnume

    Wow. Just wow. The “representatives” quoted in this article take stupid to a whole new level. What a bunch of self-righteous sob’s. They sound positively maniacal.
    I have noticed during my years here on this planet that a whole lot of the time politicians are incredibly stupid human beings, on an individual level. They can frequently be absolutely clueless as to anything real going on around them.
    I think that this is the reason that their financial donors like them so much. These pol’s are very easily controlled because they simply can’t think for themselves.
    Plus, they are generally totally unprincipled people, too.
    A winning combination, ladies and gentlemen.
    Thanks, Yves, for a galling, but necessary, post.

    Reply
  25. saurabh

    I’d like to snipe at the final “evidence is evidence” bit. Unequivocally, no. If this were the case, we wouldn’t require peer review, publication of methods, sharing of data, etc. We would not debate what is science and what is pseudoscience.

    While members of the scientific and medical establishment would like to pretend they have a methodology for producing objective truth to cement their status as secular authority, they absolutely do not. Science is a consensus process and the knowledge it produces shifts constantly depending on convention, not “truth”.

    This whole article is lamenting the fact that doctors and other experts are not given their due deference. While I might agree that their opinions are worthy of consideration, this is certainly not because they have a lock on truth, it’s because they are an interested party with relevant domain knowledge. We don’t ask doctors to gaze into their magic objectivity ball (which, again, does not exist) on climate change or tax policy, because they don’t have relevant domain knowledge.

    Reply
  26. rps

    I don’t want health insurance. I don’t want insurance premiums and co-pays. I don’t want to choose between bankruptcy or long-term care for me or a loved one. I want Universal Healthcare for every citizen of the U.S. I want to be like the Nordic countries who choose family first and provide healthcare and education for each and every citizen.

    I remember when the United States was once looked upon by the world as the progressive model for humankind. LBJ’s Great Society was the continuation of FDR’s policies. I remember LBJ’s war on poverty, “Our aim is not only to relieve the symptom of poverty, but to cure it and, above all, to prevent it.”

    We’ve gone from a war on poverty to a war against the impoverished. We are a two-party self-serving system of millionaires and billionaires warring against our citizenry. The puppet masters pull the strings of their weak-willed politicians who cloak themselves in judge’s robes decreeing who’s deserving and who isn’t.

    Looking back to a time when we believed in the possibility of a egalitarian society, today, I can see how far we’ve traveled backwards to the years before the Great Depression.

    Today we are plagued by the buzzing rhetoric of vainglorious politicians claiming to love America, but who openly and vehemently hate Americans.

    Reply

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