Ross Douthat Op-Ed at the Times

So, Mr. Douthat writes some interesting columns at the Times. As most in the paper's employ, his columns are fairly thoughtful--even for a conservative! This time though I'm mighty peeved.

Douthat suggests that we consider the plans of Martin Feldstein. I haven't read his plan, but Douthat's summary of it is atrocious.

The basic problem with healthcare now, beside the lack of insurance for 30-40 million Americans, and the terribly inadequate care for millions more, is that the costs are rising well beyond what anyone can reasonably be expected to pay. Douthat sums that up well. Where I think he errs, is that he advocates for universal catestrophic coverage. As anyone who has ever had catastrophic plans can attest to--this is an utterly implausible idea.

His words:

"Such a system would provide universal catastrophic health insurance, in other words, while creating a free market for non-catastrophic care. In the process, it would marry a central conservative insight that we'll never control spending so long as Americans are insulated from the true price of their medical care” to the admirable liberal premise that nobody should go bankrupt paying for life-saving treatment.

The details would vary depending on your political predilections. Under the more free-market approach, championed by Harvard's Martin Feldstein, the government would provide vouchers for the purchase of private catastrophic plans. Under a more liberal version, like the one sketched out by Berkeley's Brad DeLong, the government itself would act as the insurer. And liberals and conservatives would no doubt disagree about where to set the income threshold, and what additional interventions to support."

First of all, insurers always argue what merrits a catastrophy, and there's no reason to suggest the government would act differently. So that's debunked. Also, as several commentators point out--the main issues with rising healthcare cost is that current costs are based on a catastrophic coverage already. There isn't enough preventative care, which is cheap and effective, so that people are forced to wait until problems become catastrophic. My gf is a case in point. She was having terrible abdominable pains. For months she sat on them, and just lay beside me on the bed at night, moaning in pain. And she couldn't go to see a doctor, because that was two-three hundred dollars per visit that she didn't have. Finally she was admitted to the hospital, and the bill ended up going into several thousand dollars. Which her catastrophy insurance paid for--and the catastrophic treatment was largely ineffective anyway.

This phrase was particularly offensive to me, "it would marry a central conservative insight that we'll never control spending so long as Americans are insulated from the true price of their medical care." Fuck you Douthat. We are well aware. Every stinkin' one of us. Even the insured. But two or three hundred dollars to have a doctor prescribe advil until things get worse? Bullshit.

I had an ankle sprain earlier this year. My healthcare provider paid for three months of therapy. And they hate that. But if I hadn't had that therapy--I couldn't have gone back to work for months, and may well have had that injury permanently. But no catastrophic plan would ever have paid for that. And left to my own devices, I never could have either.

There is a moral imperative here. The welfare of the people is the government's only going concern. And it's in their best interest. The more we work, the more we earn, the more we pay. Is that free market enough for ya?

And vouchers? Seriously? The voucher system is lousy, ineffectual, and adds entirely too much beauracracy.

Costs are rising. Largely because the government is prevented by law from bargaining with providers, and drug companies. This needs to change. The government is the single largest purchaser of drugs and healthcare--if they're not in the market, then the market prices are inflated and controlled by an oligarchic industry.

Health Insurance

My last three weeks have been absolutely frantic, so I've missed most of the healthcare "debate." Even so I'll throw in my two cents. The idiotacracy which broadly and self-congratulatorily slaps itself on the back about how much "choice" we Americans have in our healthcare is entirely deceived.

1) Universal healthcare has nothing to do with you if you already have health insurance. None of the proposals have done away with private healthcare.

2) Who gives a flying fuck about your choices, if you have healthcare, you should take a back seat to the 50+ million people who don't. Get over yourself. People are dying, worse, people are suffering completely needlessly over the selfishness of a tyrannical majority.

3) This is what kills me. Very few Americans with healthcare have a choice. Your employer has a choice. If you have a spouse, or you are old enough to be on medicare, you have a choice. Otherwise you are fucked. I think my health plan stinks. To be sure, it's a hell a lot better than not having one. But I can't go anywhere else for care. If my health insurance carrier won't provide for my treatment, I don't get it. How's that for choices.

Moreover, every doctor I've had has told me that the healthcare companies that have provided me with health insurance (two companies over the past few years) have screwed them [the doctors] over at every turn.

But saying that the American "system" is diverse and competitive, and provides people with choices is the worst kind of lie. Like Hitler's "the big lie." It's so grossly untrue, ludicrous even, that you don't even know whether to laugh at it or debunk it. That's right, I brought out Hitler. Swatting houseflies with a cannon? Hardly, the beast that is the opposition to healthcare has reared its ugly head for fifty years in this country. It's disgusting. Mostly, it's embarrassing at how selfish, base, and uneducated the majority of universal healthcare's opponents are.

4) Lastly, I heard a Republican Congressman on Bill Maher's show the other night. He was saying, and I paraphrase, "if a college student, or a teenager doesn't want to have to have health insurance, I think they have the right to make that choice." I heard this and had to turn off the podcast. I was revolted. I went without health insurance for 4 years because I had to. Sure I was a 20 something in New York. And I was very lucky. And the one time I did get really sick, the city's free clinics (socialism!!!) provided respite. But it wasn't a choice. It was pay 600 dollars a month (the same as my rent at the time--and there was no way I could have afforded it) or take a chance with my life, and with my credit. Again, I was incredibly lucky. What is it about Republicans and Blue Dog Dems that means they have utterly lost the capacity to feel empathy for their fellow man?

The other great joke about healthcare in the US is that, my private healthplan is perfectly capable of forcing me to accept or not accept treatment. My employer, and most mid-size to large companies are like this, refuse to employ workers who do not accept healthcare. Why? Liability, plain and simple. So instead of being forced by the oppressive hand of government. You're forced by the oppressive hand of the market. (Part-time and low wage workers are clearly a different story. But they too are forced by the oppressive market)

Quite simply, it's as that great Phil Agre article says. Conservatism is nothing less than a reformulation of monarchial aristocracy. Some people are better than others, some people deserve better than others, and we deserve to maintain control over them. You'd think that would be completely repugnant to most people, considering that the elite is less than 10% of the world. It isn't, clearly. Agre does a better job of explaining it, but I'll say this: It is a testament to the perpetual myopia of humankind that even if they might not be the cats meow, they are perfectly willing to admit that they're a hell of a lot better than someone else.

Vonnegut put it well

Americans, like humans everywhere, believe many things that are obviously untrue, the monograph went on. Their most destructive untruth is that it is very easy to make money. They will not acknowledge how in fact hard money is to come by, and, therefore, those who have no money blame and blame and blame themselves. This inward blame has been a treasure for the rich and powerful, who have had to do less for their poor, publicly and privately, than any other ruling class since, say, Napoleonic times.