Blog of Jeff

One of the weird symptoms of Obama’s approach to health care is that he managed to get seniors opposed to his plan. That’s a very interesting point because it means that the people in this country on Medicare, which is the group that is the happiest with their health care, the people who have a single payer system, the people who have completely 100% socialized medicine (At least, that’s what Reagan said when he fought hard to prevent Medicare.) are now working diligently to prevent anyone else getting any of those things. What the hell did we ever do to them? And when did they start thinking entitlement program cutting, Reagan-loving republicans are friendlier to Medicare than democrats?

Anyway, the other major problem that Obama and the democrats have is that seniors carry even more weight as a voting block in mid-term elections than in presidential elections, which is why congressmen with any sort of competition are getting nervous. Several politicians are already campaigning on their opposition to Obama’s vision of health care reform knowing that polls show seniors really, really hate fear it.

Obama is in danger of destroying his entire party because of his failure to build a message for seniors. Would it have been so hard to use simple language, like “we’re not cutting Medicare benefits, the government isn’t going to decide what care is best for you, etc.” Instead, he talked about the long-term cost curve and the fact that health insurance will devour the GDP in twenty years if we don’t do something. He also feels obligated to mention that we’re going to have to ration care someday instead of clearly saying that we’re not going to ration services in this plan. (It’s a stupid argument for him to have anyway because we already ration. People without insurance don’t get basic care or preventative care. That’s rationing. In fact, a message that he’s going to reduce rationing by giving more people access to care would have been a simply delightful answer.)

Here’s a point that Obama might ought to have considered when framing that argument. People who are in their 70’s don’t give a damn about the long term cost curve. They care about seeing their doctor tomorrow and surviving dialysis next week. They are the most powerful voting block in the country and they care about the here and now. And they probably would have stayed quietly on the sidelines if Obama had been able to just reassure them that he wasn’t going to cut their benefits, force anything on them, or even not kill them. He couldn’t do any of those things and now his whole party has a problem.

It’s driving me really nuts that Obama, a house majority, and a senate majority are going to blow this. I want the big, major, “change the nature of the country” kind of reform that can only happen when one party controls everything. And it’s looking more and more like we’re not going to get it. Obama’s not going to have those congressional majorities for much longer, so in future years, he will be even wimpier than this.

I really like Ezra Klein (public policy guru who writes for the Washington Post) but I don’t quite agree with his dismissal of the recent deficit news as being irrelevant to health reform. His basic take was that the deficits were largely the fault of the past republican leadership in DC, that the recent miscalculations reflect good governance (stopping a depression, lengthening COBRA, more unemployment insurance, etc.), and that since Obama has committed to a deficit neutral health reform, the recent news that the deficit will be worse than expected just doesn’t matter. I agree with points 1 and 2 but the I think the deficit does matter on a couple of fronts related to how Obama’s messaging is failing with both his supporters and detractors.

First, there is the basic question of how much trust can we put into political leaders to make any “deficit-neutral” program when they miscalculated the deficit by over a trillion dollars. The deficit news is a huge hit to the credibility front in that area. My guess is the argument there is that if the law is written to have automatic cuts or matching revenues, it will be guaranteed to be deficit neutral. But again, there is a basic lack of trust that health reform will have those provisions.

And, even if it does, it brings up the second point, which is that many Americans fear that health reform will bring about reductions in the quality of services they are currently receiving (seniors worry about Medicare cuts and privately insured citizens worry about their plans going away). It is not unreasonable to think that Americans who believe that health reform will be deficit neutral might start wondering what services will have to be cut to maintain that promised deficit neutrality. If health care reforms cost an extra 200 billion than expected and the law mandates corresponding cuts, then services will get cut.

This is where Obama’s messaging is really bad. People who don’t trust him have a reason to be afraid of the plan (may cost way more than advertised) and people who do trust him have a reason to be afraid of the plan (may require service cuts to meet his budget promises). I lean fiscally conservative but support major health reform, including a full-fledged public option. I’d even be OK with a single-payer system. (You know, like Medicare, that crazy socialist program that Reagan swore would kill us all …)

The fiscal conservative in me just wants Obama to come out and say that health reform is going to be expensive but will be worth it. Instead, he’s promising to expand coverage, avoid increasing the deficit, maintain everyone’s existing health insurance plans, not cut any services, and wondering why people are skeptical. Basic math screams “liar, liar, pants on fire.” And once reasonable people start thinking he’s a liar, it’s really easy for less reasonable people to start talking about death panels and the British secret desire to kill Stephen Hawking because of the cost of his care.

A very fundamental issue in health insurance reform is one that isn’t really getting a lot of discussion. Is it truly possible for a group of business executives who have a fiduciary duty to maximize shareholder wealth to also provide quality health insurance? In most countries, health insurance is either a non-profit industry or it is replaced by a single payer (government) system.

Business schools continuously pound home the idea that a manager’s primary duty is to maximize shareholder wealth. That is why insurance companies seek to have the highest possible premiums, use pre-existing conditions to avoid covering sick people, and use all sorts of strange processes to deny claims. There is no mystery to why that happens nor should it be unexpected. We shouldn’t even blame the health insurance companies because that is what for-profit industries try to do; they seek to make profits.

With that in mind, I don’t see how any health care reform that relies totally on for-profit health insurance companies can possibly give people the peace of mind that people in this country really want. The fear of not being able to get coverage, the fear that claims really won’t be paid even with insurance, and the fear of suddenly losing coverage are all fears based on insurance companies seeking profits.

I’d much rather face an inefficiency and apathy of a DMV-style governmental agency that doesn’t care about me at all than deal with an insurance company paying very smart people to work very hard to make sure I don’t take up more of their resources than they are willing to allow. Give me apathy versus direct opposition any day of the week.

Hello,

I haven’t blogged in ages and I’m starting to think about a new direction for the website. I’m not doing much commercial writing at this point since I have started working on my Ph.D. in Public Policy at Walden University. My interests on this blog kind of steered me in that direction because I realized that I have a strong interest in many public policy issues.

I haven’t quite decided when and how I am going to re-orient this site more toward my scholarly work and it will only be a few minutes here and there but I am actively thinking about it now. That’s at least a first step.

I have also been told that this version of Word Press is very obsolete so it’s like I’m blogging on an electric typewriter or something compared to all the new tools. I may have to bring in a consultant or something to get me up to speed.