"Undermining my electoral viability since 2001."

Johnny Sunshine Blows It On Health Care

I disagree with most of my friends. I think the Health Care plan John Edwards proposed yesterday is a massive dud, and I'm very disappointed.

Here's Candidate Edwards looking and sounding pretty good on the issue:

But here's a summary of his plan, which also remarkably light on specifics and isn't available as HTML (wtf?):

  • Require businesses and other employers to either cover their employees or help finance their health insurance.
  • Make insurance affordable by creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs.
  • Create regional Health Markets purchasing pools to ensure that every American has a way to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance.
  • Once these steps have been taken, require all American residents to get insurance.

Emphasis all mine, but notice the difference? Candidate Edwards says the word "insurance" exactly once: to attack a sick and parasitic industry which combines the worst aspects of Socialist Bureaucracy and Capitalist Profiteering, and is rightly loathed by virtually all Americans.

His plan, on the other hand, is all about making insurance affordable and creating new markets and choices for insurance. Oh, and also tax credits for insurance too.

This is a huge mistake, for a couple reasons.

First of all, it's beyond off-message. As I said, nobody likes insurance companies. You may or may not be trying to legislate them out of existence, but your sell is about health care, not insurance.

This indicates to me that either the Edwards campaign is terrifically disorganized, lacking internally coherent strategy for talking to the public, or else they're afraid of arousing the ire of the insurance industry. Both options are problematic and neither bode well for a campaign that needs to gain ground to have a chance.

Secondly and more substantively, this is the wrong way to address the actual problems of health care.

Are You Ready For Some WonkBall!?!?
Insurance plans redistribute wealth. They take money away from all the little people who contribute, pool it, and dole it back out when needed. Public entitlements like Social Security -- which will be around as long as we want it and I fully expect to draw -- can redistribute wealth from the top to the bottom by providing somewhat more generous benefits to the less-affluent recipients vs. what they put in. This is financed by stiffing the rich people, and/or diverting money into the pool from other sources (e.g. taxes on corporations, puppy-killers, and the like). That's nice.

Privately-run insurance corporations, on the other hand, make a profit by not paying out all the money they take. They redistribute from the bottom to the top; the wrong way from a fairness standpoint. They take more from the little people than they pay out to doctors and hospitals, and that money goes to administrative costs (including bulging CEO salaries) and profit (e.g. investors).

Mandating that everyone purchase insurance mandates that everyone join this wealth-redistribution scheme. This is also a problem w/auto insurance FYI. In the context of a private insurance marketplace, mandated coverage means propping up "reverse Robin Hood" redistribution, making the rich richer at the expense of everyone else. Which side of the "Two Americas" are you on, John?

"But!" they say, "The plan says that some public option needs to be available! There will be tax credits! There will be expanded acronyms!"

This is true, and the plan probably does represent some incremental improvement over what we have now. However, it's not a very good plan, and there's no good reason for not doing it right. Here's Atrios:

If you want everyone to sign up, don't "mandate" that they "buy in" to the program. Just, you know, sign them up and take it from their paycheck. If they don't have a paycheck, they're still signed up.

This is the sticking point, and it's unambiguous. From Edwards' 7-page PDF:

Once insurance is affordable, everyone will be expected to take responsibility for themselves and their families by obtaining health coverage.

Contrast this with Edwards' nice rhetorical (and, it appears, purely rhetorical) point that "we've got to stop talking about access to health care." Good point, except your plan stabs you in the back, dawg.

He's talking about putting people into a complex and confusing marketplace (lots of choices, and tax credits too) for "coverage plans." That's access to an insurance marketplace -- once it's "affordable," of course -- not Universal Care. I call bullshit.

Universal Health Care means Universal Health Care. It means you're taken care of. You don't need to worry about it. You don't need an accountant to pay for it. It's there. You get hurt or you get sick? You're covered.

This is how civilized societies treat their citizens. It's how decent human beings deal with one another.

This is not a place to kowtow to "market forces" or to genuflect before some mythological notion of "personal responsibility." This is a place to enact a new right: the right of every citizen to be taken care of should they become injured or fall ill. You don't need to legislate the insurance industry out of existence to do that. You just need to cover everyone. Why is that so hard to fucking do?

Atrios again:

True universality in that people are essentially automatically enrolled... You could default people into Medicare and let insurance companies compete with that to lure customers away, or whatever. The details of course matter, but this absurd extra step of "mandating" that people "buy in" is just dumb. There's no reason for it.


Bringing It All Back Home
Finally, on a personal note, I'm probably harping on this (and I am harping, make no mistake) in part because my Grandmother is going through end of life issues, and my mom is dealing with all the byzantine complexities of our health insurance system. It's hard to communicate how deeply, completely, and inhumanely fucked the whole scene is.

It's fucked. It's totally fucked. The people who profit from this are vampires.

Suffice to say, my second-hand experience alone is enough to give me a serious feeling of "disgusted" that this is considered by young centrist policy wonks to be "a big step forward." Any plan that doesn't address the needless complexity of our current system and which isn't fully universal is not one that will get me excited.

What Edwards offers still leaves us well behind the rest of the industrialized world, and for no reason other than... well, I don't know. Continued subservience to some kind of magical thinking about marketplaces, fear of pissing off the insurance industry (hint: they're going to hit you with everything they've got anyway), or perhaps a reflexive aversion to government programs to support the Public interest. Any road, not what I've been hoping for from Johnny Sunshine.

In the larger context, he can always change up, but this costs him in my eyes. Hillary can be counted on to come in with an even more corporate plan, and Kucinich will do something that will not matter at all. It would be a bold move for Barak "Binding Resolution" Obama to come through with a true Universal Coverage plan here (Vote It Up!), though I'm not holding my breath on that.


I know its just 'the way poitics works' and I know that I 'just gotta live with it because it can't be changed', but it Really pisses me off when any candidate stands up and says things like...

' we stand now and forever for every single man woman and child in America having healthcare, universal healthcare, we will leave no one behind, we will not allow a single family or a single child in America to not have healthcare'

and then you look at the fine print and what they mean is:

"Once insurance is affordable, everyone will be expected to take responsibility for themselves and their families by obtaining health coverage."

This is so completely Fucked.

JOsh, Josh, Josh,
Didn'y anyone ever teach you about the "moral harm doctrine". You see son, if healthcare were completely available, people would abuse it, just like booze, porn, video games, or methamphetamine. People would be going to the doctor all the time, waiting in line, kicking it in the lobby, having a good old time just leeching off society and getting insulin for free. You've got to ration this shit to make it effecient, you know, just like RUmmy did with the body armor, just like that. YO see, josh, the market works.

Moral hazard doesn't apply to health care. People have known this for a while, and it's rather obvious if you think about it. Visiting the doctor is something only a statistically insignificant number of people do for fun. Applying your standards "goods and services" consumer metric makes no sense.

This is why Economics 101 is so dangerous.

Wow I stumbled across this article and it was like a blast from the past. Well fast forward to 2009 with President Barack Obama in the oval office. Hopefully he will finally get national health care for all Americans. Why should we have have it? Every modern country in Europe has health care. Even China has a national health care system.