19 September, 2009

Woozle & Mike Debate Thread Mark II

Because you guys really can't hold a conversation whilst waiting for me to release your comments from purgatory.



Woozle said...

Thanks, Dana! This battle ain't over till it's over...

Part 1 (wikified)
Part 2
side thread on gay marriage
mapping of the discussion (currently only the early stages are mapped)

(Mike "lost interest" in the abstinence part of the discussion. Okay. I'll take that as his first step along the road to reconsidering his viewpoint.)

Woozle said...

(This is a response to Mike's last comment here.)

Choosing the nuclear option on healthcare reform, whatever form that may take, sounds good to me.

Dem politicians clearly do need more spine (or "balls" if you prefer); I respect the idea of compromise and bipartisanship, but the current crop of Reps has made it quite clear that they view any such gestures as nothing more than an excuse to make more demands. Rather than a sign of maturity and wisdom, they take it as a signal of weakness and indecision. To make a Star Trek metaphor, there's no point in giving a Klingon a hand-up when you know they're just going to use it to pull you down.

So I'm done with it, and I'm glad that the White House finally seems to be figuring this out too.

[M]: "And seriously, do you honestly think anyone on the Left would be receptive to GOP counter-proposals?"

Well, actually, yes -- if those proposals were any good. All the GOP has offered, from everything I can tell, has been garbage.

[M]: "So here's my proposal: Get the Democrats' plan through, whatever that looks like. Don't be pussies and put 2013 on it and instead make it effective next year."

Absolutely. We can't wait until 2012. We (personally) have basic healthcare needs now which are causing extreme difficulty all around. I never wanted or asked for any delay in fixing the system, and we never believed the Rep propaganda that reform can only be meaningful or lasting if it has bipartisan support. Bipartisanship would be nice, but it's plain that the Reps don't understand the concept.

Mind you, if what the Dems pass doesn't have a public option in it, then there's not really any point; the insurance companies will be back to business as usual, one way or another. (...unless there has been some revolutionary new proposal which I haven't heard about yet, but I would need to evaluate it.)

Mike at The Big Stick said...

I'm curious...I heard a liberal commentator say this morning that two insurance companies control something like 85% of the insurance market in Vermont and this is evidence as to why costs are going up, because y'know, they like control the market. So I was thinking to myself that Colgate and Crest probably control a similar share of the market, despite the fact that Aquafresh might be a superior product and of course that probably drives the cost of toothpaste up as well. So, shouldn't the government step in there as well?

I actually have no problem with a 'public option' for people who are between jobs (for a reasonable amount of time) and in conjunction with co-ops for the self-employed and small employers. What I don't accept is the premise that the government should create a subsidized entity to 'compete' with private companies that aren't doing what the government wants them to do.

Woozle said...

Re comparing healthcare to toothpaste: I've said it before and I'll say it again -- healthcare is not truly a competitive market, from the perspective of the patient-provider relationship; it's as if grocery stores had to give away food to anyone who couldn't afford it, which is hardly conducive to a healthy atmosphere of commerce. This is why the standard capitalist business model won't work in this case, and why government intervention (or some other nonstandard solution) is needed.

To apply this to your analogy: we choose not to buy either Colgate or Crest, but when it comes to major medical we still have to use Duke because they own essentially all the hospitals in this area (not to mention most of the walk-in clinics).

I can think of any number of competition-based medical systems which might work well, but they all fall apart when you introduce the fact that emergency services must be rendered regardless of ability to pay.

If you were running a hospital, wouldn't you want some kind of assurance that every time you spent resources on a patient, there would be at least basic compensation -- regardless of how financially competent each patient was?

[M] "What I don't accept is the premise that the government should create a subsidized entity to 'compete' with private companies that aren't doing what the government wants them to do."

Why not? How would you get them to do it?

Woozle said...

P.S. And people who are out of work beyond "a reasonable amount of time" are, what, chopped liver?

And by "work", do we mean "employed by a big company which can leverage special rates from an insurance company", or "earning money in some capacity"?

Like, for example, I earned $200 the other day repairing a client's computer. Would your temporary public option cover me because I don't have a plan, or would it not cover me because I clearly am earning an income and should be buying insurance like everyone else?

P.P.S. I'll leave it up to Dana to decide if this conversation should be moved to the new unmoderated post or left here for a little while. I have no problem with the moderation delay -- it helps ensure that I don't spend the whole day writing comments...

Woozle said...

P.P.S. The menace of the public option

*casually drops link and walks away, whistling innocently*

Mike at The Big Stick said...

I'm convinced that the best way to fix the system is to detach health insurance completely from employment. That gives workers A) mobility in a flexible market B) purchasing power which will potentially drive down rates and C) eliminates the 'pre-existing conditons' problem that people run into.

Do that, let the govt subsisdize payments for the poor and for children and the problem is solved IMO.

Woozle said...

That sounds like a good start. The reason for the employment tie-in, as I understand it, is twofold:

(1) so groups of individuals can effectively be "unionized" for greater bargaining power with insurance companies (and the convenience of negotiating with a single entity for multiple customers)

(2) as a kind of gatekeeper to prevent people arbitrarily starting and stopping insurance at their convenience (or, looked at another way, to encourage people to get insurance when in circumstances where they can afford it, regardless of need)

There are certainly other (and probably better) ways of handling each of these, especially in the internet age. What about a sort of ebay for insurance, where insurers offer different plans priced according to things like:

* length of interval between sign-up windows
* size of deductable
* extra goodies covered (there should be a basic set of coverage required by law)

Add in the other things you mention -- the requirement to cover pre-existing conditions and the subsidies for lower-income people (paid for by higher rates for higher-income people) -- and I think what you've got is basically Obamacare as it currently stands, since the public option has pretty much gone away.

I hope it's enough.

Mike at The Big Stick said...

Correct me if I am wrong, but weren't liberals opposed to insurance co-ops so people can magnify their purchasing power? If so, me suspects this is a direct effect of being slaves to organized labor.

Woozle said...

Liberals were, and are (as am I), opposed to health-care co-ops in the context of the current health debate because they would take years to set up.

If republicans, at any time when they were in power from 1996-2006, had drawn up legislation to help create HC co-ops, I don't think liberals would have opposed them -- and if this had been done early enough in the GOP reign, we might have some co-ops online by now -- and we would maybe have some idea how well they work.

If republicans had done that, back when they could have done pretty much whatever they wanted to do, and the results had been favorable -- then why yes, republicans could have suggested expanding HC co-ops as an alternative to Obamacare without it being a transparent obstructionist tactic.

Too bad they didn't.

Even now, they could be suggesting starting the HC co-op experiment as part of the reform effort, and perhaps suggesting conditions under which co-ops would replace Obamacare as the dominant healthcare model, if what they care about is providing the best and most cost-effective healthcare possible.

Too bad they don't.

Mike at The Big Stick said...

How long are we talking? 2 years? 3 years? Let's not forget that most of the liberal reforms currently being offered are not shceduled to start until a very convienant 2013. Looking beyond healthcare I could name dozens of issues where liberals are happy with a snail's pace of progress (abortion, global warming, reducing crime, etc). Let's not pretend that you guys are always the party of speedy progress. It's a red herring to say you can't support health care co-ops because of the time-frame.

Woozle said...

The 2013 delay in implementation is not a part of Obmacare that I necessarily support; it is, at best, an administrative necessity, and may have been part of an attempted political compromise with the GOP and Blue Dogs. Do you imagine that Co-ops would be online that soon?

(Note: can you point me at more info about this delay? I don't see anything about that in the Wikipedia article nor can I find it in the actual bill -- there are references to 2013, but also to 2010, 2011, and 2012, all sounding like various deadlines for pieces of work which need to be done but which also take time to do.)

In any case, this objection evades the point that the Republican-led congress had 10 years of unchecked power in which they could have implemented whatever they wanted, and didn't -- so they should just sit down and STFU on this issue, thanks. They already had no credibility left before they started making BS proposals and spreading their hallucinatory fever-dreams ("death panels"???) to scare people.

Your objection about liberals being "happy" with slow progress on other issues is wrong on so many levels that I hardly know where to start.

Who says they're "happy"? You want liberals to fight harder for universal government-funded abortion-on-demand, and drug legalization and prison reform, and global warming mitigation, before you'll accept any other liberal pleas for expediency? Right, pull the other one.

You have heard of "picking your battles" and "not starting multiple wars at once"?... oh wait, you guys were the ones who got us into Afghanistan and Iraq and want to go for Iran...

What needs to change is the way the healthcare field is currently set up to promote profit over public service; unless you somehow level the playing field a bit, the existing insurers would eat the fledgling co-ops for breakfast.

Obamacare addresses this by doing the two basic things which any reform legislation should do: (1) require healthy people to get insurance, and (2) require insurers to cover everyone. How do the co-ops address it?

"Red Herring"? There's nothing in Obamacare which prevents co-ops from being set up. Using co-ops as an implicit criticism of Obamacare (because they're "better") is itself a red herring. You think co-ops are a great idea? Great! Then let's set those up too. Now, what is it that you don't like about Obamacare?

So what was the co-op proposal anyway? I mean, what legislation would be put in place, and how would it make these co-ops happen? On the face of it, the impression I got was that the GOP were basically saying "You don't need us to change the laws; you can just go set up co-ops while we prevent anything else from happening."

Obamacare also makes some regulatory changes to encourage health maintenance rather than treatment (sending you to 6 specialists at $1k each, for total CYA, rather than just getting the treatment you actually need in order to get better). Does the co-op proposal do anything towards this end? Would it include subsidies for poor people? Will it take care of mental and dental?

The co-ops proposal still looks to me like a joke, if it's being proposed as an alternative to Obamacare.

Mike at The Big Stick said...

Food for thought:


Woozle said...

That's a pretty serious mistake, no doubt. License loss doesn't seem completely out of line, though I would certainly like to hear his explanation of what happened.

If you're thinking something like "this wouldn't have happened if abortions were illegal", consider a story I heard from a friend of mine.

Sometime back in the late 50s or early 60s, long before Roe v. Wade, a woman went into the doctor with stomach pains. The doctor diagnosed some kind of organ problem (liver? kidney? can't remember) -- but when they opened her up, they found she was pregnant with twins, which they had just killed due to using the wrong procedure.

The woman in question was my friend's mother... who continued using that doctor afterwards. He didn't suffer any penalties, as far as we know.

Attitudes have changed somewhat since then; at the time, doctors were (as I understand it) huge authority figures (especially to a devout Catholic, as this woman was) -- whatever the doctor said, you did. If he made a mistake, you thanked him for trying.

So presumably now, with several decades of liberal battling against conservative authoritarianism, that sort of thing wouldn't happen; the doctor would be censured for not checking for pregnancy first.

But still, I have to wonder if the consequences would have been less if the doctor had made the wrong diagnosis, rather than aborted the wrong twin.

The latter error actually seems more understandable, on the face of it.

Woozle said...

Did my comment yesterday get lost, or is it just waiting for approval? (Hoping the latter...)

Mike at The Big Stick said...

I'm not citing this as a way of saying that these mistakes could be prevented if only abortion were illegal. I'm saying how horrible is it that pregnant women have the option?

I think it's obvious that the mother placed value on one of her children, but not both. That, in my mind, undermines the 'fetuses have no value' angle used by many pro-abortion folks.

I think when we're allowing mothers to pre-select gender, genetic traits, etc we've gone waaaaay too far as a society.

Woozle said...

[M] "I'm saying how horrible is it that pregnant women have the option?"

You mean the option to abort? Not horrible at all. How is it ever worse to have more options?

[M] "That, in my mind, undermines the 'fetuses have no value' angle used by many pro-abortion folks."

Hate to break it to you, but nobody ever said that fetuses have no value. Nice distortion / straw man, though.

[M] "I think when we're allowing mothers to pre-select gender, genetic traits, etc we've gone waaaaay too far as a society."

What's wrong with that? I wholeheartedly support the right of a parent to make whatever choices technology allows them to make in designing their offspring.

...oh, you mean by selective culling of unwanted variants? That does seem very wasteful, yes. Good thing that's not at all what we're talking about here, and not a cause supported by abortion choice advocates.

You'd think pro-lifers would be more upset about negative eugenics practiced after birth, as is done in some of the more patriarchal societies...

...unless they truly regard a blob of protoplasm with no nerves or functioning organs as worthy of just as much respect as a fully-formed infant with a working and aware brain.

Dana Hunter said...

This comment-moderation stuff is ridiculous. Here's a fresh home for ye.

Mike at The Big Stick said...

"......oh, you mean by selective culling of unwanted variants? That does seem very wasteful, yes. Good thing that's not at all what we're talking about here, and not a cause supported by abortion choice advocates."

It's exactly what we're talking about. Isn't that exactly what the woman did? She asked the doctor to remove an 'unwanted variant' and keep the one that was wanted. Doctors are also now removing healthy fetuses in multiple pregnancies when the mother just wants one baby. The mothers are being allowed to select for gender.

Woozle said...

My response is here.