red-blue dialogue on health care part n+3

Read Don's latest post here.

I thought in my last post we were making some progress in this discussion, but it seems we've backslid to talking points and exaggerations. So now I'm feeling much less optimistic that we'll be able to achieve even the most basic level of mutual understanding as a result of this exchange.

Don said: "I don't know how a reasonable person can look at the proposed legislation and describe it as "modest" or "proscribed and constrained". If a program spending $1.6 trillion over ten years can now be described as modest, the word has surely been redefined when I was not paying attention."

National health care has been debated for almost a hundred years in this country. This proposal is incremental (it builds upon the existing system) and less far reaching than ideas that have been proposed, even by Republicans, in past decades -- in that sense, it is modest. Every developed nation in the world offers universal health care except the US. Our country will spend far more than $1.6 trillion over the next ten years on health care. These reforms aim to constrain those other expenditures, leading to net savings. It's meaningless to quote the expenditures without the savings. It's like saying "this will cost $1m" without noting that it will save $2m. The President has said this program will not add one dollar to the deficit. But I know you don't believe anything the President says.

This go-to-jail thing is another ridiculous misrepresentation. This is based on the handwritten note given to Ensign? Have you read the note?
http://www.politico.com/static/PPM110_090925_document2.html
It's talking about willful tax fraud penalties. There's nothing in the current code that connects that to health insurance, and there's no way the reform will work like this. In fact, there are exemptions in the proposed reform for people who can't afford to buy in. Please, Don, can we talk about substance as opposed to these canards? You really think the government is going to start throwing people in jail for not getting health care?

You say this reform is on par with Marxism. Hard core Marxism advocates violent revolution to reclaim politico-economic power for workers from the bourgeoisie. It is a completely discredited ideology that has no major advocates left in the Western world. This reform proposes changes in regulations so that everyone in the US can get access to health insurance. If you truly see those things as equivalent then I don't know how we can discuss this rationally.

You say, "This bill is an authoritarian power grab bigger than any in American history." Really? More than the declaration of martial law by Lincoln during the Civil War? More than the poll tax during Reconstruction? More than the forced relocation of Native Americans? Please.

By saying "If we strengthen the rules so that insurance companies cannot drop coverage unfairly or deny coverage for non-material reasons, anyone can avoid the situation of being without coverage due to a preexisting condition by purchasing insurance when they are young and healthy and keeping it..." aren't you de facto agreeing that regulation is necessary? But wouldn't that regulation (forcing people to get insurance when young and keep it) defeat the principle of flexibility and portability that you just agreed is important? That opens the door to more abuse, because it locks people into bad plans where the abuses can continue.

You oppose the public option, equating it with co-ops (even though they're entirely different) and suggesting anything along those lines will be "anti-competitive." You claim a public option (already available in several states, by the way) will be almost a threat to the republic, but you have no conceivable scenario to back up the assertion... you say government cannot run things effectively, and then you argue that every person in the world will sign up for the public plans and they'll put insurers out of business. But the CBO estimates no more than 11 or 12 million people will sign up. How could this possibly lead to an "authoritarian power grab bigger than any in American history?" Why haven't the state options led to the negative consquences you assert?

It sounds like you reject pretty much any mandate -- you "flatly reject a public option, mandates on individuals to buy medical insurance, mandates on employers to provide it, mandates on insurance companies to cover preexisting conditions..." -- so I admit I was far too optimistic in asserting that we were in agreement on the majority of topics under discussion. You just want to tweak the rules a little bit and let the supposed magic of the market solve everything. But I hear no concrete proposal -- nor have I heard any concrete alternative proposals from anyone on the right, only criticisms and dire warnings about where this is all heading. You admit the status quo is worse, but you offer only spotty suggestions of what you will and won't support. Paint me a picture of your preferred solution, and how it addresses all the problems we agree upon. Because I don't see it.

By the way, I reject the Fannie Mae analogy... first, it's completely different than health care -- there's no speculation on health care insurance premiums, and there's no bubble; second, Fannie Mae provided mortgages for decades without incident prior to the mortgage crisis, and put millions of people into homes that they paid for with no problems; and third, Fannie Mae is a single private institution with its own shareholders and a focus on profits. Fannie Mae isn't anywhere close to equivalent to a public health insurance option... it's closer to a for-profit insurer. You think the auto insurance analogy was flawed? This analogy is way more off base.

There's nothing in the reform proposal that would disincent people in local communities to take care of each other. This Federal vs. local argument is a false dichotomy. All health care provision is by definition local... it all must be provided by individuals in immediate proximity to the individual in need. It doesn't make sense to say everyone should be helped by local resources, and only if those fail, should they move on to federal resources. Everything works in concert. The Feds aren't going to fly in to take your temperature. The reform is to create a system to cover the costs and prevent systemic abuse, that's it. All the care will still be delivered on a local level. You'll go to your same local hospital, with the same local doctors and nurses, they'll just get their reimbursements from a different payor. Why is that so threatening?

"Washington has spent years convincing people that the Federal Government should be the primary safety net." Can you give me one example of a government communication that says that? The right says that incessantly, but I've never seen or heard a government agency say anything remotely along those lines. Also: "...politicians should stop their self-serving promotion of dependence on government as a natural and normal state for most of the people most of the time." Likewise, I'd like to see one example of a politician promoting dependence on government. It's just not true.

We can discuss advanceable, refundable tax credits, the Baucus proposal, and minimum income levels for subsidy (though I couldn't find anything with that $85k number you cite -- I think in the Baucus bill that has to do with prescription discounts) -- personally, I think that's minutiae compared to the real issue at hand. We can get wrapped around the axle debating these little points (which will inevitably change a dozen times before legislation becomes a reality) and miss the forest for the trees.

Fundamentally, from my perspective, we have people who can't get or afford insurance under the current system -- tens of millions of them. They get sick and they're forced to pay medical costs out of pocket until they go bankrupt, or they go without medical care and suffer and/or die unnecessarily. My original facebook status suggested that shouldn't happen. You suggested this was like legislating away a natural disaster (e.g. futile or impossible to affect with legislative action) and asked for details... and over the past few weeks we've gone through those details in a very deliberate manner. Your counter-arguments make unfounded exaggerations about Marxism/tyranny/authoritarianism, rely on easily debunked talking points from talk radio, get caught up on intentional misrepresentations or one-off quotes that are supposed proof of larger secret agendas, cite out of context quotes from historical figures like Madison and C.S. Lewis, and assert that if only we had a free market this would all go away -- when in fact it's the unregulated actions of the for-profit actors that are causing most of these problems in the first place.

At core I still suspect the reason why you minimize the struggles of millions of your fellow citizens in favor of your pronouncements about liberty and Marxism and tyranny is because you don't really have empathy for the actual suffering that's going on out there. You'd rather score the political point and see the party you disagree with dealt a defeat than address the problem. And you think these medical doomsday scenarios aren't going to happen to you, only to illegal immigrants and welfare cheats and other irresponsible types, so let them suffer the results of their irresponsibility. Not once during this discussion have I heard you acknowledge the need of any of the families being victimized by very real flaws in the current system, or express a genuine desire to help them. That's why I said you were cold hearted. You can hide that behind ideological points on market efficiency and liberty and Marxism all you like, but over the course of this exchange I think my initial assessment has been proven quite accurate.