I’m not going to rant about this, because it was pretty damn obvious what was going on as it happened. However, as a little bit a hypothetical I want to ask you the following:
Let’s just say our last president made some policy announcement about a cornerstone of his administration’s agenda in a wildly publicized and quoted public forum, making a speech reaching out to those not-quite-approving of his policies. Let’s say further that in that speech he made a rather unambiguous promise about how the core part of those same policies would work, trying to win over the crowd he was speaking to.
Let us continue by supposing a week later “White House officials suggest the president’s rhetoric shouldn’t be taken literally.”
In a Bush White House, what would this be evidence of?
A) Bush is a liar.
B) Bush is an idiot.
C) Bush doesn’t care.
D) All of the above.
Why do I get the feeling that in an Obama Administration, the same rules don’t apply?
15 Comments
Steve Buchheit · June 22, 2009 at 12:47 pm
Apples and Oranges, Steve. 1) You can keep you plan (Obama isn’t replacing it) and 2) the speculation is that employers are going to be quick to drop medical insurance with the new regulations (so that would be America’s Employers who are going to force you away from the plans you have now, and how many times in the past decade have you changed insurance plans, I’m up to six if you don’t count adjusting copays and deductables, all at the requirement of the employers). That isn’t the same thing and you know it.
It’s the FUD attacks coming in from the insurance agencies. They’re frightened that they’ll have to change their business.
“Few are predicting a stampede by employers — especially major companies — to drop coverage. But some just might…”
OMG! The sky is falling.
Or, you know, market forces. Yeah, single payer isn’t looking so bad now, is it?
S Andrew Swann · June 22, 2009 at 1:27 pm
This wasn’t about health care (but working the day job where we have a defacto single payer makes me quiver with anticipation as the efficiencies and customer service of the VA, Medicaid and Medicare are rolled out to everyone. The suckage of the current system is no argument that the proposed solution will suck less.) this was about rhetorical bludgeons, and how the acceptability of such tactics depends on whose ox is getting gored. Or do you think the White House shouldn’t be taken literally when it says the president shouldn’t be taken literally?
Whatever the federal government does will be incredibly disruptive (either for good or ill) and to make comments that imply otherwise is disingenuous at best. To make comments that imply that somehow the funding for this will miraculously appear out of “savings” is dishonest. That’s not arguing the merits, that’s being deliberately deceptive.
Steve Buchheit · June 22, 2009 at 2:51 pm
Again, Apples and Oranges. The President isn’t limiting choice, the speculative future is that employers will take the opportunity to drop employer paid health care (which, to be frank, is already happening anyway and given the opportunity most businesses would drop it tomorrow if they felt they could get away with it without having a “public option” for their employees to buy into available yet). The bill, and the President’s thrust will not force any insurance company to close up (much to my chagrin). It is the editorial comments that the President shouldn’t be taken literally, I don’t see a quote from the Press Secretary to such.
And this weekend we received another notice about an insurance claim based on service completed in February. VA, Medicaid and Medicare have administration costs of 5% (if memory serves), where as the private insurance industry averages around 15%. Which is more efficient? Depends on the metrics you want to use.
Also, the federal government currently sends a boatload of money into the health system to cover the bills of the uninsured (payments to hospitals, tax right offs for some of those same debts, cost of covering more and more people under medicaid, etc), those would be cut because there would be less uninsured getting their health care through the emergency room (the most expensive option). So not understanding or giving the full argument is an intentional deception made as a preemptive FUD attack by the health care insurance industry which realizes they won’t have an easy fight this time.
And that the “public option” will be highly disruptive of the current status quo of health care and specifically medical insurance, IMHO, will be a good thing. However, the plan at this point is not to scrap the current philosophy (employer based health care), but to add on. If the private market can’t compete (and they can’t following their current business models, they could if they followed best practices from Germany and Switzerland, but that would require them to go to “Not-for-profit” and follow all those laws regarding executive compensation and oversight), it’s their fault, not the President’s or the program’s.
S Andrew Swann · June 22, 2009 at 4:39 pm
The VA, Medicaid and Medicare have administrative costs of 5% vs public sector insurance because they can mandate that care-givers cover the admin costs they inflict. I work in an agency that is under a constant audit to deal with the regulatory burden, and represents a good chunk of our budget. Another way Medicaid holds down “cost” is by not raising payment for services in the past decade (funny how that doesn’t change how much the services actually cost to provide, fortunately we’re a non-profit so we can offer services at a loss, but there’s a limit and eventually we have to cut services or personnel, or both.) the other popular method of “cost-cutting” is to figure out excuses not to pay us for services that have been already provided, usually by changing how the rules are interpreted for submitting billing information.
I agree whole-heartedly that the current model of employer-provided insurance is broken, but it is an exercise in denial to believe that somehow the federal government will magically self-regulate into a model of efficiency and cost savings. The only way the government knows how to cut costs is by passing a regulation capping the expenditure: which means if no one can provide the service at the price-point demanded by the government, the service will not be provided. So we have a situation where, sure, everyone is “covered” for intensive residential drug therapy but no one is willing to offer the service because the loss taken to provide it is prohibitive.
The other problem with a public payer is the distortion caused by the referee also playing the game. How can you talk public/private “competition” when Congress is talking about taxing the private benefit to pay for the public benefit. i.e. one market “choice” you pay the government, the other market “choice” the government pays you? That scenario requires the government to either force people to stay on private plans to pay into the public system, or allow everyone fall into the public system and try and pay for it from the general fund– i.e. tax everyone.
Daemon · June 22, 2009 at 7:50 pm
Just about every politician makes promises they can’t or won’t keep, at least not in their pure form. Sometimes it’s entirely intentional, sometimes they just aren’t aware of all the details when they make the promise, and sometimes they have to give ground on one issue to make headway on another.
Nobody really expects them to keep their promises anyways. Theoretically, a campaign promise should qualify as a verbal contract, so as to prevent politicans from promising what they can’t deliver. The only time I’ve ever heard of anyone actually try to follow that angle up in court, it was shot down on the basis that no rational adult actually expects a politician to really deliver on all (or even most) of their promises.
People have always tended to back their politician when he screwed up, while jumping all over any perceived lie/error by their oponents. I believe there have been some studies that show that on a psychological level, they will actually see the exact same act differantly depending on whether the politician is one they support or oppose.
So Obama’s supporters will cut him a lot of slack, and his detractors will blow every little thing out of proportion. Just like it’s been with every politician since our species invented politics. I mean, it’s not like Bush supporters didn’t cut him tons of slack when he was in office.
Steve Buchheit · June 22, 2009 at 9:55 pm
Steve, I know that where you work so see a unique side of this. I’ve also done my legwork by asking my healthcare providers about how my insurance treats them (mostly because, as I’ve stated above, it treats us like crap). The response I got back was with the “grouping” of providers into networks, the insurance hasn’t renegotiated fees for that same decade. So even with private insurance the providers are receiving the same pay they were ten years ago. Which is why they sometimes order more tests than necessary (in the fee for service model we have, in other businesses this would be the “making up for profit in volume” model).
When I broke my leg, I had the same provider I do now. They’re a pretty reputable insurance group and in full disclosure I own stock in their parent corp (from when they de-mutualized). I ended up with two emergency room visits and three surgeries to repair my leg (along with a years worth of doctor visits and a full course of rehab). With each of those emergency room visits and the surgeries (for the same injury) I had to fill out a form which was basically asking if there was any way the insurer could deny payment for the claim being covered by some other insurance (workman’s comp, home/property, car). I can understand the first questionnaire, it was an expensive procedure. But the next four?
And don’t get me started with the number of calls we make every year to have the insurance pay for what they should cover and they initially decline (and no, the excuse of the “the office put the wrong claim number on their submission” doesn’t work anymore, not after we double check it). With my Mom’s health, we’ve had to deal with Medicare from the patient side. It is much easier than with our private insurance (even though we’ve also had to call for her stuff as well). With my grandmother, the nursing home we had to have her stay at bumped her out because they screwed up the medicare procedure (actually, they didn’t want to accept just Medicare evidenced by our meeting with their administrator who felt they could keep Grandma longer if we would just cover the costs ourselves).
So private insurance is no better in their behaviors.
S Andrew Swann · June 23, 2009 at 7:38 am
This is why I say running to the government to escape the suck is an exercise in futility. It’s not the fact that the insurance company is a for-profit private enterprise that makes the system ugly, it is the way we’ve decide to pay for health care: everyone piles money in front of bureaucrats, who pay out to providers usually long after the service is provided, and who are more interested in keeping the balance sheet neat than they are in what services are being provided. In a public-pay system we have the exact same perverse incentives (the government doesn’t want to pay out money for services any more than the insurers do, and the bureaucrats are under the same mandate, find any excuse not to pay) and we lose any competitive pressure and add the wonderful new factor of politicizing our health care coverage.
The problems you have with private insurance has little to do with the “private” part of the equation. It has to do with the fact we’ve established a horrible Frankenstein monster of bureaucratic inefficiencies and perverse incentives; we have created private entities that behave in large part, exactly like the government, and for the same reasons. If you expect a public pay option to fix this, you are in for a very rude awakening.
What is needed is not centralization, but disintermediation and transparency so that someone can refer to “choice” with a straight face.
Geoffrey A. Landis · June 23, 2009 at 10:06 am
Well, your question wasn’t addressed to me, because I’m not a liberal.
In general, I would say that ideology is poison, and that goes for liberal, conservative, and libertarian ideologies equally. Once somebody adopts an ideology, their brains start to ossify, and they start seeing things only through filtered perceptions.
Health care reform in the US is such a tangled web of entrenched interests that it’s impossible to think that any changes are ever going to be made without pissing off a lot of people, However, in this case, I think you’re paying attention to spin, not to reality.
There are a lot of people spewing out spin on health care, because there are a lot of entrenched interests.
I detest spin. Take another look at the “sources” that you linked. One of them is an editorial, another one is a blog. What’s even more interesting is that they don’t even link to facts; they link to other blogs. (Did you click the link labelled “according to the Associated Press”? It didn’t link to the Associated Press, it linked to a political blog!) This is not merely facts filtered through ideology– it’s a game of telephone.
You’re listening to spin.
Get the numbers. A good guide in general for avoiding ideology-based brain ossification. Ignore the opinions. Find the numbers.
To quote Heinlein, “what are the facts, and to how many decimal places?”
Even in the links you give, though, the supposed “contradiction” is pretty damn weak. Obama stated that Americans would be able to keep their health plans. A week later, the administration clarified that what this means is that “that government isn’t about to barge in and force people to change insurance.” OK, does that sound reasonably like what he was saying? In fact, my health plan changed last December. The company I’d had decided to go out of that business in my area; I was forced to move to a different plan with a different company. Did you plausibly think that what Obama said was that he going to pass a law requiring that every health plan offered in America in 2009 is now carved into stone, and cannot be changed, ever? That’s absurd.
Now, the proposed government health plan may indeed be an exercise in screwing things up, and I am not holding my breath for wonderfulness to fall down from the air. But the specific outrage you talk about in the top level post is a case of bloviating bloggingheads, not reality.
michelle · June 23, 2009 at 10:53 am
Steve B. – We’ve had the same health insurance coverage for 12 years. We have never had to call because something was denied. Nothing has ever been denied. Perhaps we’re lucky, I don’t know. Conversely, my mother is on Medicare and it has been nothing but an upward struggle dealing with them. The most recent being them refusing to cover her anti-anxiety medicine because it’s “not necessary”, which if you knew my mother, you would know it’s very very necessary. But she can’t afford to pay for it out of pocket and Medicare refuses to cover it. So I guess my 83 year old mother with dementia and a host of other problems is just screwed.
S Andrew Swann · June 23, 2009 at 1:05 pm
Geoff, not to siderail the discussion (too late) but my original post had very little to do with any supposed outrage. It was pointing out that, if this statement was made by the White House under another administration that it would be perceived rather differently. Judging by the responses I’ve been getting, my attempt at engineering a perceptual shift by contrasting the reactions to a given statement across administrations was made of FAIL.
S Andrew Swann · June 23, 2009 at 1:11 pm
PS- the first link is from the AP:
http://www.google.com/hostednews/ap/article/ALeqM5gK8UACQa5gEv1cZ-SRxXDc3XDwRwD98TPSP80
At least, Google says it’s the AP, and it’s copyright by them. The second link was a courtesy to the original source that led me to the AP wire story.
Steve Buchheit · June 23, 2009 at 2:54 pm
Steve, again, it’s an editorial, the “backpedaling” is an editorial comment, not the statement from the White House. If it were, if you can find the quote from Gibbs, I’ll concede the point. Until then, it’s part of the FUD (fear, uncertainty and doubt) attack. Now, if you want to really discuss backpedaling and being held to account, look at what happened surrounding DOMA.
Michelle, if you’ve never had to fight for a claim, you are indeed lucky. We do it multiple times in a year. My wife has gotten pretty good at it. I’m sorry your Mom is having that problem. With my wife we’ve had to fight to have the insurance cover her annual blood tests (she takes thyroid replacement therapy). The “name brand” insurance company also claimed it was “unnecessary” even though we need to track her various thyroid and thyroid related levels (technically twice a year), and the insurance covers one blood test a year in any case (this was the first one).
I would definitely fight to have your Mom covered. Simply because Medicare (or whatever insurance) says they aren’t going to cover it doesn’t mean they won’t when you prove they have to.
As a final note, the difference between a public and private insurance with money in front of them is this, the public insurance (government) must spend that money (there are now rules that allow us to “carry over” some balances, but that is carefully watched by auditors), the private insurance can either hoard it or send it out as “dividends” to their shareholders (which, again, I am one, but I’ve never gotten a dividend) without reserve (well, there are rules of leverage and they have to keep some reserve, but you know what I mean).
S Andrew Swann · June 23, 2009 at 4:58 pm
RE: Editorials. The piece was an analysis by the AP guy doing health reporting @ the White House and I was using it to make a point that has been missed by everyone involved. I just wanted to mention I had linked to the original article not the subsequent blogstorm.
RE: “the public insurance (government) must spend that money”
Of course, the people running the public insurance (government) are making those rules, and enforcing them, and if it makes short term political sense to silently siphon off those funds to the general fund, that’s what will happen. Organization in the public sector is just as flawed, venal and short sighted as organization in the private sector.
Geoffrey A. Landis · June 23, 2009 at 5:05 pm
Steve, your post consisted of links to what I would call manufactured outrage over a non-issue. Now you’re telling me that your point actually is about a hypothetical reaction to a nonexistent statement by (former) President Bush? You’re commenting about what people didn’t actually say, but might have said in some parallel universe? That’s what I’d call meta.
The answer to the question, then, is that the same rules continue apply: opponents will use any opportunity to attach words like “liar,” to the people they’re opposing, while supporters will continue to support the people they’re supporting, That’s what most people call “politics as usual,” although I’d call it background noise.
As for the link you just reposted, what I said of your links was: “One of them is an editorial, another one is a blog.”. That’s the link to the editorial. (The words “according to the Associated Press” were quoted from the second sentence of the other link, the one to the blog. My comment was that, despite the anchor text, it did not link to the Associated Press– it linked to yet another blog. This seems typical of blogs. That’s a good part of why I rarely read blogs. Along with the fact that I’m a curmudgeon who disagrees with pretty much everybody, of course.)
S Andrew Swann · June 23, 2009 at 8:50 pm
Geoff, I misunderstood what you were saying. I thought you were saying my text didn’t link to the AP article.
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