Scott Brown Wins Massachusetts Senate Race Shocker

By Justin Gardner | Related entries in Democrats, Health Care, health care reform, Massachusetts, Republicans

The results aren’t final yet, but it looks like Brown is going to win 52% to 47%.

And you have to hand it to him. He ran a great campaign and defeated the favorite Martha Coakley in a race that many Democrats thought would be a cake walk.

But let’s remember that Republicans being elected in this state isn’t without precedent. After all, Mitt Romney was Massachusetts’ Governor and passed mandated healthcare that looks a lot like what Obama and the Dems are trying to pass now.

Here’s more info from Rasmussen:

  • 78% of Brown voters Strongly Oppose the health care legislation before Congress.
  • 52% of Coakley supporters Strongly Favor the health care plan. Another 41% Somewhat Favor the legislation.
  • 61% of Brown voters say deficit reduction is more important than health care reform.
  • 46% of Coakley voters say health care legislation more important than deficit reduction.
  • 86% of Coakley voters say it’s better to pass the bill before Congress rather than nothing at all.
  • 88% of Brown voters say it’s better to pass nothing at all.

So this paves the way for the “Obamacare is dead” meme to take shape…even though this is one Senate race. And hey, if this is what kills healthcare reform, then this is what kills it. But I think everybody should realize what killing it means…ZERO progress on one of the most important issues that continues to drive us further and further into debt. And this after the CBO said this plan would reduce our budget deficits.

And if you think Republicans are going to go for the Wyden-Bennett bill, you’re crazy. That’s pipe dream legislation. Americans believe their healthcare should be tied to employment and that’s not going to change any time soon.

One last note…going back to the health care mandate that was passed in Masschusetts by Romney…the state has the lowest percentage of uninsured in the nation (right around 4%) and has covered an additional 439,000 residents.

More as it develops…


This entry was posted on Tuesday, January 19th, 2010 and is filed under Democrats, Health Care, health care reform, Massachusetts, Republicans. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

42 Responses to “Scott Brown Wins Massachusetts Senate Race Shocker”

  1. Doomed Says:

    Lets us hope…….nay…….let us PRAY…that health care reform is NOT dead.

    But that we can actually have reform and not this….whatever this was that they are trying to pass.

    Because as a Republican I will agree with my democratic friends…health care reform is needed….the devil has always been in the details.

  2. Frank Hagan Says:

    Look for a fight within the Dem party to replace the hapless “leaders” who have squandered a super-majority. Reid and Pelosi better watch their backs.

    From Talking Points Memo:

    Less than 15 minutes after the race was called for Republican Scott Brown, the first of what could be many conservative Democrats asks for leadership to put the brakes on health care reform.

    Sen. Jim Webb (D-VA) congratulated Brown on his win and delivered a zinger:

    “In many ways the campaign in Massachusetts became a referendum not only on health care reform but also on the openness and integrity of our government process. It is vital that we restore the respect of the American people in our system of government and in our leaders. To that end, I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated.”

  3. Simon Says:

    God bless the bay state for administering an unexpected coup de grace to the ruinous Obamacare.

    If even Massachusetts can shake of the Democratic incumbency, surely every Dem in a remotely marginal district must now be thinking about joining the trickle of retirements, and if she isn’t, of voting against Obamacare. If even Massachusetts isn’t a safe seat, if Obamacare is radioactive even in the heart of the liberal citadel, it is surely all the more deadly to incumbents “representing” the heartland.

    This election is symptomatic. I think a lot of folks have now woken up and realized just how dumb they were to vote for Obama.

  4. Aaron Says:

    Simon I don’t know about you but I still have no regrets about my vote for Obama. I place the failure of the current HCR bill solidly on the feet of the congressional leaders. If the failure is anyone’s, it is Pelosi’s and Reid’s.

    Also Doomed, I do believe we agree on something. :) HCR is absolutely needed. A system that denies health-care to many citizens, then punishes them for not buying it isn’t HCR. I can hope that Brown will follow his predecessor and push for real HCR.

  5. Nick Benjamin Says:

    @Simon
    If you’re thinking this kills the bill you’re deluding yourself.

    The House can simply approve the Senate bill. It’s not what we planned, but it will get health reform passed. The far left will hold their nose and vote for it because after it’s passed leftist stuff can be passed via reconciliation. Blue Dogs will like it because they really want to end the debate. It is pretty clear quietly supporting health care a la Evan Bayh is a lot better for your re-election chances then being the 60th vote, that the debate itself is more damaging then a passed bill would be, and that the debate will not die until Obama is happy. Moreover this bill is almost exactly what they said they wanted — good on the deficit, no giveaways to the unions, etc.

    Abortion could be a problem, as the Senate Bill is slightly less pro-life then the House Bill. But being the guy who killed health reform because somebody else’s state might opt to let plans on the Exchange cover abortion is probably not great politics.

  6. Tillyosu Says:

    @Nice Benjamin

    If you’re thinking the House will “simply approve” the Senate bill, you’re also deluding yourself. Pelosi is going to face fierce resistance from both the left and right in her party. I predict many progressives will strongly resist just passing the Senate bill, regardless of whatever reconciliation promises are made. Do you really think that the Dems would want to reopen this debate after declaring “victory,” just to satisfy some shallow promises they made to get progressives on board? And many conservatives, terrified by what happened in Massachusetts last night, will resist voting for this bill at all, let alone one with weaker abortion provisions.

    This bill is terrible, and the Dems are boxed in. I think it’s political suicide if they pass the bill, and political suicide if they don’t. The best thing Obama and the Dems can do right now, nay the ONLY thing they can do, is admit that they fumbled the ball and start over. Obama should admit his many mistakes, outline his demands going forward, set an ironclad timetable for passage, and DEMAND participation from the Republicans since they now have real power in the legislative process. That would show real leadership, and force the Republican to take a stand on this highly contentious issue before the midterms.

  7. JimS Says:

    Health care reform is dead. This is not to say that there won’t be some bill passed but that it will be largely cosmetic, accomplishing little to nothing. If you define the needed results of any reform as something that will increase the ability of the millions of uninsured to get care when they need it and to reign in costs on a per patient basis in the future(Instead of the false equivalent of comparing it to current overall spending.) then any bill passed will barely do anything to head towards this goal. Why? It might reduce corporate profits some. Any reduction in those is completely unacceptable to Republicans and some conservative Democrats so it isn’t going to happen. The free market as envisioned by the current incarnation of conservatives in the U.S. does not work in the area of health care when you combine it with the excessive expectations of Wall Street for publicly held businesses. Any excuse for reform designed with maintaining existing profit levels in mind will not be effective and that’s the only thing that can pass in our current environment.

  8. wj Says:

    I am continually amazed at the number of people who think that opposition to the HCR bill(s) currently passed by one house or the other is the came as opposition to HCR period. Some of us manage to think HCR is urgently needed . . . and that these two bills are both a disaster.

    And for us, Brown’s victory may actually be a blessing. Because there is now a chance of getting something passed which actually represents a compromise between different views on the subject, rather than something that represents buying votes with pork.

    It may be a blessing, on a variety of issues, for Obama as well. I seem to recall that Clinton achieved the signature accomplishment of his Presidency (welfare reform) after the Democrats had lost a majority in the House (not just a super majority in the Senate).

  9. Simon Says:

    Aaron Says:

    Simon I don’t know about you but I still have no regrets about my vote for Obama.

    I have plenty of regrets about your vote for Obama. I can’t begin to imagine what y’all were thinking! ;)

    I place the failure of the current HCR bill solidly on the feet of the congressional leaders. If the failure is anyone’s, it is Pelosi’s and Reid’s.

    That is plausible, but, with respect, not persuasive. The White House made the decision to let Congress write the bill with a free hand. They didn’t have to do so: they could have written and proposed the legislation themselves, or given Congress guidelines at one level of specificity or another, within the range from “coloring book” to “join the dots.” So whatever errors Pelosi and Reid made—and there were plenty—flowed from Obama’s initial error.

    I can even tell you why they made that error. Not wholly coincidentally, it goes back to the last time the Democrats got utterly outflanked at the polls. When Hillarycare failed, its proponents needed to rationalize its demise. Because they were dogmatically wedded to the proposal and its underlying assumptions and conceptions, they had to explain Hillarycare’s failure in terms of something external—plausible but ultimately specious—rather than its deficiencies. So their analysis was broken from the foundation up, but you can understand it: To do otherwise would cause serious cognitive dissonance (or worse yet, require them to rethink and admit that their entire political paradigm was fundamentally broken).

    They settled on the myth that Hillarycare failed because the administration presented it to Congress as a package, instead of soliciting broader input. The problem wasn’t that the bill was a crap sandwich, the myth goes: it was that the White House handed Congress a crap sandwich instead of handing them bread, butter, a knife, and some crap, and letting them make their own sandwich.

    Now, say you’re President Obama. if that’s your conception of what went wrong last time, and you believe that America’s just damn hungry for a good crap sandwich that will cost a fortune, it makes a lot of sense to say that this time around, you should let Congress make the sandwich. Because that was what went wrong last time, right? Lack of Congressional input. Let them write it, and they can have all the input they want. It makes all the more sense if you make the false assumption that the country signed up for your agenda, instead of (more accurately) reading 2008 as a howl of voter frustration at the GOP.

    Just wait for it: after last rites are read over this bill, the recriminations will reach gale force. Instead of examining the underlying dogma that shaped the bill, or the deficiencies of the bill as a concept, two competing (and equally erroneous) memes will arise to explain that failure. Some will say that it was the specific details of the bill that doomed it. Others will say it was Obama’s hands-off attitude, which is the tack you seem to have chosen. Either way, both analyses are wrong. This bill fails for the same reason Hillarycare did: the utter incompatability of its premises with the American polity—structurally, emotionally, and intellectually.

    I can understand that there are many reasons why one might wish to heap the blame on Pelosi and Reid. And they did screw up, no doubt about it. Nevertheless, the fact is that their goofs only mattered because Obama goofed in handing this goofy legislation to a bunch of good-for-nothing goofs.

  10. Simon Says:

    Nick Benjamin Says:

    @Simon If you’re thinking this kills the bill you’re deluding yourself. ¶ The House can simply approve the Senate bill. It’s not what we planned, but it will get health reform passed.

    Sure! It’s just. that. simple. All you have to do is “simply” pass a bill that both the fringe and the more centrist Democrats in the House hate, and which the GOP opposes. A bill far more palatable to the House squeaked through by a very nearly a full hair’s breadth last time, which is plenty of margin for error, but now that every Democratic Representative in a marginal district—which, in light of Scott Brown’s victory in a state where Obama’s margin was nearly 13%, appears to be every district—I’m sure that it will be easy to persuade literally any representatives to cast a politically radioactive vote for a bill that a majority of voters oppose.

    Simple? It’s going to be like driving a toaster through a carwash.

  11. Simon Says:

    WJ,
    A compromise has to start from asking the right questions. The key issue in this field is healthcare costs. Having carefully analyzed the driving forces and likely trends of that issue, the question that should be asked is this: what, if anything, can the federal government do—within Constitutional, traditional, equitable, and fiscal limits on governmental power in America—to help?

    That question frames the legitimate perimeter of the debate. It is a great and stately perimeter, allowing of a number of policy responses, some good, some bad, some more effective than others. We can debate possible solutions and compromise once we’re within the ballpark. But that is the ballpark, and “progressives” are trying to play on the other side of the parking lot.

  12. Nick Benjamin Says:

    @Tillyuso
    They’ll bitch and moan about accepting the Senate bill but they have no real choice. Period. Obama’s not going to let them not pass the Senate bill and get away with it.

    The Representative from North Dakota was pressing his house colleagues to speed up last week. That’s the blue dogs. The left has a few other priorities it wants done this Congress. And they ain’t happening until HCR is off the table.

    @wj
    Your attitude is extremely naive. If you want reform this year the Senate bill is the only game in town.

    If it loses Obama will face a choice. He can start over, or quit. Starting over would be high risk even if the GOP did not have 41 Senate seats. But they do. In theory he could compromise some more to get a GOP vote. But who is there to compromise with? Olympia Snowe’s only public problem with the bill in October was the Public Option. Lieberman forced them to strip that out, and she still voted against it. Unless you know some other magical compromise that will get a different GOP Senator onboard this option is simply not viable.

    Therefore if this proposal dies he has to switch to something else ASAP. Screwing banks and prescription drug companies would be good politics and good for the country. Global warming has to be addressed so, if for no other reason, the rest of the world realizes the US isn’t the bad guy on this issue. The Chinese are, and they’re very good at using us for political cover.

  13. Nick Benjamin Says:

    @Simon
    The bill the House passed was not more palatable to the majority of House members. It had a public option, so the Blue Dogs opposed it.

    Now that it’s clear they aren’t getting a public option Progressives don’t have a real choice. They have to support this legislation, and they’ll have to amend it later They have years to do so, and it will be a lot easier for them to fdo that if they can simply get this thing passed today.

    Blue Dogs will bitch, but they always bitch. Progressives will too, to show their base they didn’t keel over to pressure from evil corporations, but they keeled over to pressure from the evil US Senate.

    Abortion is gonna be a pain in the ass. But it always is.

    ———————————————-

    As for the political folly of pushing HCR, I would like to point out that if Ted Kennedy had not died we’d be fine. Moreover not reforming health care in the next five years is national suicide, so it’s a but hard for me to blame somebody for trying.

    If that one guy had lived a few more months Obama would have started to solve a problem that’s plagued Presidents for decades. Which is his job.

    He still probably will get it done. The House Leadership prefers the Senate bill to defeat. Progressives have no choice, and moderates prefer the Senate3 bill because it has no public option. Fanaticval pro-lifers could be trouble, but hey.

  14. Simon Says:

    Nick Benjamin Says:

    wj[,] Your attitude is extremely naive. If you want reform this year the Senate bill is the only game in town.

    WJ can speak for himself, but he didn’t say he wanted reform this year. He said that “HCR is urgently needed.” In isolation, “urgent” doesn’t necessarily mean “this year,” a fortiori when seen in context. You’re assuming an ordering of WJ’s priorities: he said that “HCR is urgently needed … [and] these two bills are both a disaster.” Why assume that his view that HCR is “urgently” needed trumps his misgivings over these two bills?

    Global warming has to be addressed so, if for no other reason, the rest of the world realizes the US isn’t the bad guy on this issue.

    Absolutely. If you want to upgrade the forecasted headwinds for Dems in the fall from “serious” to “gale force,” cap and tax is a great way to do it. The country is worried about the economy and jobs, so focussing on something else (bad) which a great number of voters think is stupid (worse) and which will have the collateral effect of hurting the economy and jobs (worst) would be very nearly the stupidest tack that one can imagine a politician taking in this political environment. And that is so even on the assumption (dubious though it may be) that climate change does “ha[ve] to be addressed” by the American Congress.

    Progressives don’t have a real choice. They have to support this legislation

    Nonsense. Making better the enemy of best is a bipartisan house special.

    Abortion is gonna be a pain in the ass. But it always is.

    I actually thought that progressives’ insistence that healthcare reform include a provision transforming the American government from a passive bystander to an atrocity to an active participant in it had the potential to kill this bill all by itself. Right now, interestingly enough, I wouldn’t say that abortion is even in the top two reasons why the bill is likely to fail.

    As for the political folly of pushing HCR, I would like to point out that if Ted Kennedy had not died we’d be fine.

    How would “we” be fine? You’d have passed the bill. That would leave us in a position very far from “fine”: “screwed” would be closer to it.And “you” (i.e. the Democrats) would be far from fine. You’d be in even deep trouble; you just wouldn’t know it yet. What happened in Massachusetts is the canary in the coal mine moment: you guys can turn and run, or be buried this fall. Fall is coming, either way. But not for this special election, no canary. There’s still time to get out.

    The House Leadership prefers the Senate bill to defeat [on HCR].

    I’m sure, but it’s not up to them. The question is how many backbenchers in the House Democratic caucus prefer HCR to keeping their job. Those folks aren’t stupid; they realize that if this bill killed a Democrat running for Senate in Massachusetts, it can kill them in districts that Obama carried by smaller margins. We’ve already seen a trickle of retirements, and I would have thought that after last night, the House rank and file has reached the point of “every man for himself.”

  15. WHQ Says:

    I think a lot of folks have now woken up and realized just how dumb they were to vote for Obama.

    I might feel that way if I thought there was a viable alternative. McCain-Palin? What were y’all thinking? ;)

  16. Tillyosu Says:

    @Nick Benjamin
    No real choice? Of course they have a choice. It’s called a VOTE. And Obama, no matter how omnipotent you may think he is, can’t force them one way or the other. Sure, he could spend some political capital (if he has any left), or warn them that he’s “keeping score,” but I think Congresscritters are beginning to realize that he’s not the Democrat Superman with sky high approval ratings that he was a mere 12 months ago. I think they sense that he’s a weakened executive whose power to influence the country, and thus Congress, is significantly diminished. In fact, a few Congresscritters have already begun to confirm my comment from this morning, including Barney Frank, Bill Delahunt, Stephen Lynch (what state are they from?), Anthony Weiner, Jerrold Nadler…shall I continue?

    I think John Larson, 4th ranking Democrat in the House said it best: “I don’t think you can find a member in here, prior to or after, who supports the Senate bill.”

  17. TerenceC Says:

    None of this matters. Frankly I am glad the guy won – she was a terrible candidate, a terrible campaigner, and completely wishy-washy on the issues. The process will now shift to a process of Budget Reconciliation if they want to get this done (although I agree with Howard Dean that it’s a waste and should be scrapped). The Filibuster proof majority at 60 no longer matters – frankly most of the major government programs and changes in the last 20 years have all come about through this Reconciliation process anyway- not super majorities. For the Reconciliation process 60 votes are not required in the Senate – only 51. Ben Nelson, Blanche Lincoln, Lieberman – they are no longer needed and since they are Republicans in Blue suits they should be voted out of office anyway (or atleast kicked out of the caucus) if they aren’t willing to enact the D agenda for the American people. The “D” party still has a sizable majority in both houses of Congress – the leadership just needs to grow a pair of cajones and push forward the progressive agenda they were sent there to enact. They could easily do it – but unfortunately they are a pack of gutless F&*k’s who won’t take a stand with their convictions. Quite possibly – maybe – all members of the Senate and Congress are socio-paths who have no convictions – thereby offering a logical explanation for the behavior for most of these 535 members:)

    Lets face it – both the D’s and the R’s are the same party right now, and have been for quite some time. They both serve their corporate and lobbying masters rather than the American people. They both do things that primarily only benefit a global corporate agenda and their ability to get re-elected. Personally I am sick of it – I prefer politicians who will stand by their convictions (regardless of party). I see that very rarely unfortunately, and of those conviction driven politicians they seem to be eventually destroyed or minimized by the media. It’s almost as if we need a revolution if things are going to change for the better.

  18. Simon Says:

    WHQ Says:

    I might feel that way if I thought there was a viable alternative. McCain-Palin? What were y’all thinking? ;)

    I know, the ticket was upside down—what were we thinking?—but I don’t think that that made it non-viable. ;)

    TerenceC:

    both the D’s and the R’s are the same party right now

    That’s the kind of Glenn Beck grade bullshit that Medved eviscerated here

  19. John Burke Says:

    Yes, Justin, “ObamaCare” is dead, dead, dead — i.e., the current Hoise and Senate bills. But it borders on the absurd to say this is a shame because it means no progress on an issue that is driving us deeply into debt.

    These bills did nothing — zero, zlich — to curb net health care costs, whether you’re looking at total costs or federal health care outlays. The 10-year accounting was flim flam, with the CBO forced to score the bills within fantasy constraints.

    The big irony here is apparently lost on you: had the Mass. Dems not chnaged their recently enacted law that called for a special election after EMK died in order to allow Patrick to appoint Kirk as the 60th vote, “ObamaCare” might not be dead!

    Why? Because Reid would have been obliged to seek support from at last one — probably a few — Republicans. That would have totally altered the framework of the “manager’s bill” sent up by Reid. In turn, moderate Dem Senators like Nelson, Lincoln and Lieberman would have had more cover to support a more moderate and bi-partisan bill and significantly, less need to barter their votes for the dirty deals that drove voters in Mass. (and everywhere else) nuts.

    So don’t blame the voters of Mass. for the demise of “ObamaCare.” there was always a sound reason to pay close attention to public opinion and work with GOPers to come up with a reform that made sense.

    Now, there is an opportunity again to do just that. Who knows, maybe Brown will join with Snow, Collins and others to offer a new framework.

    IMHO, this calls for a new Gang of 12 to take the reins away from reid and the White House and forge a workable compromise that will do some of the reforms everyone wants — incrementally. Snowe, Collins, Brown, Grassley, McCain, Graham, Bayh, Leiberman, Dorgan, Ben Nelson, Feingold and Baucus would be my nominees.

    The 60-vote business of ramming something — anything — through was always a bridge too far for swing voters. One analysis in today’s NYT leads with the silly notion that Dems have now lost their “narrow advantage” because they no longer have 60 votes!

    How preposterous is that? So if Franken had lost the squeaker in Minnestoa, there would not have been any health care reform attempted? With the White House, 59 seats in the Senate, and a 50-seat majoritty in the House, Democrats have no advantage? Are hopelessly powerless?

    What complete nonsense. The Dems — and the country — are better off now that everyone knows they must listen to the voters. Remember, the House bill barely made it through with a five-vote majority, despite the Dems huge advantage there. Isn’t — wasn’t — there some “reform” that could capture 250 Dems and 20-30 GOPers? Of course, there is. Time to look for it.

  20. TerenceC Says:

    Simon-

    So you know so much you have to quote someone else to make your point. I’m specifically targeting actions not words. Both parties talk a good game regarding what they allegedly stand for – but the finished product never happens. Both sides spend all their time trying to be different from each other in the public eye, but the end result is always the same. Nothing worthwhile for the American people ever gets done. Only the special interests and corporations regularly get their needs met because they have the inside track to the power and the money to keep them in power. However, they aren’t people they are organizations. Certainly an argument can be made that these Org’s are made up of people, but they do not encompass the majority of Americans only organizations with the majority of political power and money. Both parties are the same because they both feed from the same trough, neither party has the gumption to get anything done, neither party is willing to rock the boat to see that these injustices are fixed, neither party wants to have the political process brought into the “sun light” because it would expose the game for what it truly is. Stacked against the average American. Beck is still a corporate whore, but I unwittingly found out just now that there may in fact be one thing I agree with him about – dammit. If you look at actions and results rather than words my statement is an accurate one. The political process is broken, badly broken and no one in a position to fix it is willing to do so – there’s too much money at stake.

  21. DK Says:

    The Senate bill is dead in the House. No amount of arm twisting is going to get it passed there.

    Reconcilliation isn’t the magic bullet everyone seems to think it is. It only allows debate on line items specifically tied to the budget, and it’s very questionable how much HCR can be done there. No “patient’s bill of rights”, for example.

    Given the comments coming out today from so many Democrats, and even Obama, I expect to see HCR in its current form die and instead we will get a number of smaller bills, each one with a piece of HCR to be voted on seperately. At least a few of these will pass, some progress will be made, Obama/Dems can claim some kind of victory, and we can move on.

    I think in the end what will pass as HCR will be restrictions on the behavior of insurance companies (such as related to pre-existing conditions, etc.) in ways that don’t affect the budget and don’t raise public abortion related situations. We may see profitability restrictions on insurers, or we may see a removal of their antitrust status. I’m not sure what will happen precisely, but I’m pretty sure it won’t involve a public health system or covering the uninsured at taxpayer expense. I think such reforms are not possible in the current political climate.

  22. Justin Gardner Says:

    First off, the CBO scores aren’t flim flam. Come on John, that’s laziness. They do a lot of work projecting that and they always give caveats in their reports.

    Second, reconciliation will be tough. Very tough. But it’s looking like the only way now unless Dems make more concessions. So they have a choice to make. But as I said in another post, if Brown can win by a simple majority in Massachusetts, then the healthcare legislation can too.

    The question now…will Dems do it. Because it could be painful in the short term, but pay huge dividends in the long run as people start realizing, “Gee, insurance companies can no longer deny me coverage or overcharge me anymore. And Dems did that!”

    We shall see…

  23. Simon Says:

    Terence, that may be the most toothless criticism I’ve ever seen–you’re complaining that I used a quotation (a citation, actually) to make a point? (Instead of, presumably, half-baked stale recycled Beck rhetoric)? Gee: touche, sir, touche!

    At any rate, whether you look at actions, results, or anything else, your statement is not an accurate one. Name three issues on which the parties are the same. Are the parties the same on the GWOT? No. Taxes? No. Healthcare? No. Judges? No. Abortion? No way. And that’s just for starters. What are all these issues on which you think they’re identical?

  24. Nick Benjamin Says:

    @Simon
    IMO “urgently needed” implies he wants action in the next few years. And IMO if the Senate bill dies that’s it for HCR for at least four years. Probably more like a decade. We’[lkl get some expansion of current programs, and probably some inneffective populist anti-insurance company programs. But there ain’t gonna be any new cost controls.

    On the Ted Kennedy point we’ll have to agree to disagree. IMO if this bill passes it instantly stops being a political negative, and becomes a positive. That will fire up our base, and give us an accomplishment to run on. Especially since the whole Cornhusker Kickback would be replaced by giving every state the same kickback. IMO allowing it to fail doesn;t help us even with folks who don’t like the reform. By trying we pissed them off, and they ain’t coming back soon.

    @Tilyuso
    There’s choices and there’s choices. If they kill reform they’ll get dinged by the electorate for trying reform, get dinged again for failing, and will have wasted an entire Congress. If they pass the Senate bill they’ll be dinged for trying, but they will have succeeded, and they’ll have a real accomplishment to take home.

  25. kranky kritter Says:

    I agree with the folks who say the current bill is dead. Democrats themselves don’t all agree that its that great, and they know that in the current climate a ram-through would cost them dearly. There just aren’t enough progressive true believer heroes willing to lay it all on the line for a flawed bill full of half-measures and ugly purchased support. That’s the hard truth. What we had was a frankenstein beast supported by mostly lukewarm sentiment.

    I seriously doubt we see anything overarching now. What we might see is a few separate bills passing things that had fairly broad support, as someone above said. I also agree that we are unlikely to see any sort of extensive entitlement passed where the poor uninsured get coverage at taxpayer expense. This is perhaps unfortunate, but I think most of us can agree that public sentiment is against it, and against it because folks are simply afraid there’s no way we can truly afford it.

    The enduring question involves what we do to try to control costs and preserve or expand access. Another 2, 3, 4, 5, 10 years of cost increases in the 8 to 10 percent range should focus our minds on this eventually.

    On that mathematical matter, here’s a little something for folks to chew on, to help you focus on what the immediate future could be bringing. Since so many folks talk about annual cost increases in the 8 to 10 percent range, let’s take a look at 9% annual cost growth. Here’s your quiz:

    At an annual cost growth rate of 9%, how many years will it take costs to double?

    The answer? About 8 years. Yes, that’s right, If your cost is x and grows annually at 9%, you cost will be just about 2x in 8 years, If your healthcare costs are painful now, how painful will they be if they have doubled in 8 years?

  26. Jim S Says:

    I always find it hilarious when conservatives say they don’t oppose health care reform, they just oppose the Democrat’s version of it. Guess what? Nothing proposed by the conservative side will do a thing to help the broken non-system we have. Why? Because they only want to count on the Free Market, the one true religion, to heal us. Hallelujah, brothers and sisters, can we have an AMEN?

    “And for us, Brown’s victory may actually be a blessing. Because there is now a chance of getting something passed which actually represents a compromise between different views on the subject, rather than something that represents buying votes with pork.”

    The quick answer to that statement is no. There is no chance of passing anything unless it is a complete surrender to the Republican Party. And even then I doubt that any Republicans would vote for it if there would be the slightest chance that Obama might get one tiny bit, no matter how small, of credit for it. That is the only thing the Republican Party stands for now, in case you didn’t notice, wj.

  27. kranky kritter Says:

    Just so long as you aren’t bitter, Jim. :-)

    BTW? I always laugh when advocates of a given failing idea x fail to account for the lack of public support for x. How come the public is only wrong or misinformed or being misled when they disagree with the conventional wisdom of a given advocate? A real thinker, that one.

    If this healthcare reform bill was supported by a majority of Americans, reform advocates would be screaming about that like gospel. But when the public has the temerity to disagree, there’s always an alternative hypothesis. **Sigh**.

    Parsimony strongly suggests that HC reform is failing because in its current form Americans don’t think its a good idea, on the whole. When something fails to become law in a democracy due to a lack of public support, that’s not a bug, it’s a feature.

    Healthcare reform advocates should strap on their big girl panties and accept that either the bill was fatally flawed or that they failed woefully in making a compelling case for it.

    I think the primary problem with this bill, and the reason it had trouble getting truly enthusiastic support, is this: in the eyes of folks who looked at the details and did the math, this bill didn’t do anything serious to really control costs. Folks who understood the mechanics of the proposed medicare cuts did not believe they’d really happen. I for one have been consistently unconvinced that cost controls would really materialize in this bill.

    The ongoing effects from annual cost growth anywhere like what we’ve been seeing will be inexorable. Sooner or later (IMO sooner, no more than a decade) there won’t be a f^&*king thing that either progressive or conservative ideologues will be able to do to preserve their particular dogma uber alles schtick.

    Because sorry conservatives, free markets solve the problem of limited supply and unlimited demand by raising prices, which is un, the problem. And sorry liberals, believing we can substantially expand access without increasing costs is a pipe dream that only the mathematically illiterate can dream.

    We’ll need to find ways of rationing to control costs.

    BTW, if you ask me, the smartest cost-controlling thing this bill attempted, if badly, was to begin taxing HC benefits starting with high-end plans. And that was the least popular of ideas. My mother in law was blue in the face and clueless. Talk about an orphan of an idea.

  28. Jim S Says:

    kk,

    If you think public support had anything to do with people actually sitting down and doing the math, that’s funny. The last track I had, polls and surveys showed that the public didn’t have a clue what was really in the bill. Given that, claiming that it’s a sign of rational thought leading to a good public policy outcome just doesn’t quite make sense. Just look at your own comment about your mother in law.

    We have rationing. It’s our current system and the number of people that can’t afford healthcare. Given recent history, it seems to be the rationing system we’ll be sticking with for the foreseeable future.

  29. TerenceC Says:

    Simon

    It’s a matter or perspective. If you look at the political system at the Micro level as you do, then the differences may be apparent in terms of verbal points of discussion. In reality however, you should be looking at the Macro level – in other words watch the organ grinder not the monkeys. Both monkey’s may be wearing different colored suits and holding out their respective donation cups to diffferent parts of the audience but they both collect (your votes) for the same master.

    How are the two parties the same? Both parties spend money they do not have. Both parties consistently reward their largest campaign contributors with large amounts of tax payer dollars. Both parties pay lip service to the issues effecting Americans but neither one does anything about it. Both parties are corrupt. Both parties consistently raise your taxes and neither one is willing to discuss the real drain on the national economy (the military). Both parties are against a fair tax. Both parties are controlled by very rich people. Both parties consistently enrich those groups in our society that need it the least, while taking away from those groups that need it the most. The similarities are astounding frankly – neither party wants to do anything except get their members re-elected.

    The various points involved in the HC regulations are off the table – and although the majority of the American people do support HC regulation – a majority of the elected officials do not. We’ll see numerous line items from the current HC bill reconciled with spending bills through October of 2010. Nothing substantial, but just enough to make it look like our elected leaders have done something – which they haven’t since the lobbyists wrote the majority of the legislation. It’s big business and powerful organizations against the average American – for a long time the average American had Big Labor to stand up for them – but that’s been gone for 25 years and nothing has taken it’s place. So now we have 2 political parties that get their money and direction from the same campaign contributors – no one sees a problem with that?

  30. Sick and Tired Says:

    I live in Massachusetts and have been following the national “health care reform” debate since Mitt Romney announced Massachusetts’ insurance mandate in 2006. The problem, though I believe Obama is intelligent and geunuinely concerned about the costs of rising medical costs, is that in just about all of his speeches on the issue he frames the uninsured as both victims and scapegoats. During his speech to congress in the fall of 2009, he said that a mandate was necessary so that those who do not have insurance would not “game the system.” If individuals are not penalized for not purchasing health insurance, he argued, then nothing will stop them from buying insurance when an illness or medical issue arises and then dropping coverage once they are well. He also called for the uninsured, who can afford health insurance but who refuse to buy it, to be more “responsible” so that the insured aren’t left paying higher premiums and increased medical costs. He also said that part of the problem is that the uninsured are using medical/hospital services they cannot afford and do not pay for. He effectively blamed the high costs of hospital care/medical costs on the uninsured. In the same speech, he also stated that the uninsured cannot afford basic health care/medical services because they cannot afford the high cost of insurance and/or have been denied coverage by “cherry picking” insurance companies. Here, in the same speech, he frames the uninsured as hapless victims and derides insurance companies that drop coverage or refuse coverage for sick people. Ironically, in his bid to garner support for his initiative, he has drawn on a rhetorical strategy that pits group against group–a strategy that is bound to alienate, offend, create defensiveness, and further polarize the different factions involved in the issue. Are the uninsured victims or scapegoats? Is the insurance industry a villain or a potential savior/hero? Is the insurance mandate a gift or a punishment? Interestingly, Obama has used Mitt Romney’s rhetorical strategies. The difference is that Romney and the state legislature crafted mandatory health insurance out of public view and passed the mandatory health insurance law without public input or awareness. If blogs are any indication, some people are angered by health insurance reform because it blames individuals for high medical costs and suggests that the insurance companies, despite their role in driving up these costs, are the only entitites that can help solve a problem they have helped create. Of course, there are many other reasons for opposition, but these reasons, in particular, must be addressed. It’s time that Obama and those advising him start acknowledging that “divide and conquer” may not be the best strategy for gaining widespread public support for health care reform.

  31. Nick Benjamin Says:

    @kk

    What would you call the cuts to medicare that dictate a low rate of growth in medicare reimbursement, if not price controls? Isn’t this mechanism pretty much the SOLE basis on which democrats contend to make this plan a budget reducer?

    Medicare prices aren’t really government mandated because Doctors can choose not to take Medicare patients. And then they don’t have to accept the government’s fee schedule.

    Moreover controls in the prices paid by Medicare per procedure are not the only (or IMO even the major) Mdicare cost control included in the bill. You’ve also got effectiveness studies, so Medicare can avoid the McAllen Problem; and the elimination of direct Congressional control over Medicare’s fee schedule. The elimination of Medicare advantage is also a major source of savings.

    And if you’re gonna talk about the plans deficit reduction you’ll have to mention the new taxes. The excise tax is an extremely important part of that, because if the cost controls don’t work the excise tax brings in a lot more money.

    Look Nick, I am fine recognizing that you think liberal ideas on this issue are better. What is so troublesome is your utter unwillingness to acknowledge that conservatives, many of whom are extremely intelligent and well-informed, believe differently than you do. In good faith. You’ll never be any better than a partisan tool until you are willing to recognize that there are many conservatives who, upon thinking deeply, differ on some basic principles about this world. Their passion, faith, and sincerity is no different than yours. You should grow up and notice this.

    All right. BTW you are implicitly admitting conservatives want to solve the same problems I mentioned before, rather then claiming they don’t want to control costs or make health care affordable.

    Please describe the program that is more conservative then the Senate bill, and will also work. Particularly the part where they beat the adverse selection death spiral without a mandate, and thus avoid the need for both subsidies and taxes.

    Because when a person says “Other people may have other ideas that would work just as well,” and then refuses to say what they are, I have a certain amount of trouble believing them.

    You still haven’t responded to my points about conservatives in other countries. Areyou claiming the Torys are not really Conservative?

    President Obama has repeatedly appealed to Americans for a ratcheting down of partisan rhetoric and demonization. And here you are declaring that conservative ideas won’t work and are fairy tales. You’re letting the President down.

    I tried not using loaded terms.

    But after a few days of debate, in which you repeatedly refused to explain these conservative ideas that are a) right of the Senate bill, and b) would work I got a little frustrated.

    I have looked into many ideas on health care. I pride myself on not being ideological on this issue. Compared to many, many, many of my leftist allies I am not. And as far as I can tell the only conservative ideasnot included in this bill are tort reform (which has not worked), and allowing insurance companies to sell across state lines (which can’t fix the adverse selection death spiral).

    The GOP has repeatedly claimed that some mysterious idea would miraculouslysavethe health care system, withou amandate, subsidies, or taxes. They have yet to explain what this idea is. Youy may be willing to give them a free pass on that, but I’m not.

    @Tully
    Your faith in the power of the market is impressive.

    Unfortuneately I sincerely doubt it’s justified. Particularly this market. Many providers are monopolies because most of the country doesn’t have the population density to support two heart hospitals every 300 miles. Insurers are also largely monopolies (or duopolies) because they need huge risk pools to stay in business.

    Then you have to consider that it’s very rare for the actual customer (a patient) to refuse a treatment the doctor reccomends. This means that the local monopolies can create their own demand. Artificial demand is apparently the reason McAllen Texas spends so much more then the rest of the country per Medicare patient:
    http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

  32. Tully Says:

    A word on “effectiveness studies,” which Nick seems to think are magic bullets.

    Over the past decade, federal “choice architects”—i.e., doctors and other experts acting for the government and making use of research on comparative effectiveness—have repeatedly identified “best practices,” only to have them shown to be ineffective or even deleterious.

    For example, Medicare specified that it was a “best practice” to tightly control blood sugar levels in critically ill patients in intensive care. That measure of quality was not only shown to be wrong but resulted in a higher likelihood of death when compared to measures allowing a more flexible treatment and higher blood sugar. Similarly, government officials directed that normal blood sugar levels should be maintained in ambulatory diabetics with cardiovascular disease. Studies in Canada and the United States showed that this “best practice” was misconceived. There were more deaths when doctors obeyed this rule than when patients received what the government had designated as subpar treatment (in which sugar levels were allowed to vary).

    Lots more good stuff there, especially for people more interested in reality than fantasy or ideology, or ideological fantasies.

  33. Tully Says:

    @Tully–Your faith in the power of the market is impressive.

    You seem to have your threads mixed up, Nick, as this is my first appearance in this one. (PS — The GOP is ignoring the 800-lb gorillas of the health care problem as well.)

  34. kranky kritter Says:

    Medicare prices aren’t really government mandated because Doctors can choose not to take Medicare patients. And then they don’t have to accept the government’s fee schedule.

    And if they do that en masse, then will we realize the cost savings that democrats are claiming from the CBO estimates? This bill is quite clearly using medicare price controls as a way of making this bill LOOK like it’s a money saver. The price controls won’t happen, because they will lead to reimbursement too low for providers to provide care. Since you can’t win that argument, you’re trying to win an argument about whether these mechanisms are “price controls” by some specific definition? What a waste of time.

    You still haven’t responded to my points about conservatives in other countries. Areyou claiming the Torys are not really Conservative?

    I don’t believe that british conservative means the same thing as american conservative. Further, I have serious doubts about how useful it is to look at how other placed have “solved”healthcare, especially if their basic economic systems are quite different. Perhaps there are some good ideas here and there/More likely, they would be changes that brought pluses along with minuses. Personally, I’m very uninterested in expanding the scope of our discussion down that road. If you think its relevant, please explain to me what your general point is again, because I didn’t get it.

    BTW you are implicitly admitting conservatives want to solve the same problems I mentioned before, rather then claiming they don’t want to control costs or make health care affordable.

    I am “admitting” no such thing, implicitly or explicitly. Of course, I DID respond to a question in which you framed things precisely this way, in your whole silly “a smart conservative would…” schpiel. If you are reading this implication, it’s due to the frame that you constructed, not any belief of mine.

    And now you’re using my previous failure to deconstruct that to you rhetorical advantage. Some conservatives may well want to solve the same problems you mentioned before, but not all, or even most. What you seem unwilling to acknowledge is that conservatives think that big government “solutions” are actually problems.

    I am not a conservative myslef, but I allow conservatives to HAVE their point of view. Please take care to notice that I didn’t enter into this discussion to defend conservative ideas or positions per se. My objections center on your faulty sense of what a “smart conservative” ought to support. I don’t think you have any idea what a “smart conservative” ought to support. Unless we are talking about a “smart conservative” who shares your specific framing of the issue, and so is really not a conservative at all.

  35. Nick Benjamin Says:

    @Tully:
    That’s only one cost control in the bill.

    Effectiveness studies have their limitations. However they are one of the few ways we have to control health care inflation. Therefore they need to be present in any bill that’s serious about controlling health costs.

    You’ve also got depoliticizing the Medicare fee schedule, eliminating Medicare Advantage, the excise tax, etc.

    @kk:

    And if they do that en masse, then will we realize the cost savings that democrats are claiming from the CBO estimates? This bill is quite clearly using medicare price controls as a way of making this bill LOOK like it’s a money saver. The price controls won’t happen, because they will lead to reimbursement too low for providers to provide care. Since you can’t win that argument, you’re trying to win an argument about whether these mechanisms are “price controls” by some specific definition? What a waste of time.

    You do realize that if Medicare’s fee schedule constitutes a “price control” it’s already there?

    In other words this particular cost control, which is not the only cost control in the bill, is not an expansion of the government.

    And now you’re using my previous failure to deconstruct that to you rhetorical advantage. Some conservatives may well want to solve the same problems you mentioned before, but not all, or even most. What you seem unwilling to acknowledge is that conservatives think that big government “solutions” are actually problems.

    I acknowledge it.

    What I dispute is that a) conservatives are so opposed to the idea of “big government” all conservatives (by definition) oppose all government intervention in the economy, and b) that this proposal is actually big government.

    It eliminates one government program, controls costs in another. The Exchange is no more big government then your local farmer’s market. The taxes and subsidies could be seen as big government, but half the point of the Excise Tax is to discourage people from buying high cost insurance policies. I thought most conservatives thought taxing things we want to discourage was a great idea. I do know Michigan’s Conservative State Senate much prefers raising taxes on cigarettes to anything else.

    The mandate and subsidies are bigger government. But even there many people who are clearly conservative support similar policies in education. Every kid has to go to get an education, paid for with vouchers.

    Unless you want to claim that pro-school voucher folks are (by definition) not conservative you might have to acknowledge conservatives can support this bill.

  36. kranky kritter Says:

    What I dispute is that a) conservatives are so opposed to the idea of “big government” all conservatives (by definition) oppose all government intervention in the economy, and b) that this proposal is actually big government.

    My continued dispute is with your claim that this bill is one that smart conservatives should support.

    I never said all conservatives oppose all intervention.

    You are of course entitled to your opinion about whether this bill represents big government. But no amount of disputation from you seems likely to remedy the fact that many conservatives, smart and otherwise, think that it IS big government. I believe that the primary basis for that opinion among conservatives is the size and extent of subsidies it will provide to low-income Americans.

    You’ve proven willing and eager to minimize the extent of everything that a conservative might object to. The subsidies aren’t that bad, the price controls aren’t new, and so on.

    But these are your opinions as a liberal, and they are ones conservatives don’t agree with. And that’s why they don’t support this bill, no matter how many liberals opine that it incorporates ideas conservatives <ishould like.

  37. Tully Says:

    Effectiveness studies have their limitations. However they are one of the few ways we have to control health care inflation. Therefore they need to be present in any bill that’s serious about controlling health costs.

    Translation from the real world: “Only by manufacturing cut & paste rules for medical care can we ration medical care with a proper fig leaf for the rationers, even when the manufactured rules are shown to be counter-productive to their own stated goals of improving quality of care.” LMAO.

    I do enjoy the attempts of ideologues to redefine things so that they can be labelled away as not really being what they actually are. Especially when the efforts are so transparently explicit. It amuses me. Such as the attempts to claim that a multi-trillion-dollar takeover of a sixth of the economy is somehow NOT big government.

    **And that’s why they don’t support this bill, no matter how many liberals opine that it incorporates ideas conservatives should like.**

    But Obama told us that there were no GOP ideas being offered at all. He told us! You’re not calling him a liar, are you? Chuckle.

    The point, that because a bill incorporates a few things which the GOP originated and support on their stand-alone own does not make the totality of the Frankensteinian package acceptable, is well taken.

  38. kranky kritter Says:

    Effectiveness studies have their limitations. However they are one of the few ways we have to control health care inflation. Therefore they need to be present in any bill that’s serious about controlling health costs.

    Translation from the real world: “Only by manufacturing cut & paste rules for medical care can we ration medical care with a proper fig leaf for the rationers, even when the manufactured rules are shown to be counter-productive to their own stated goals of improving quality of care.” LMAO.

    Isn’t that the conundrum in a nutshell? People believe that ideally we can use study and lengthy development of systems to come up with rules and best practices which tell us what the right thing is to do in every conceivable situation.

    And that belief drives the growth and development of virtually all big systems, be they government agencies, corporations, or some other institutional form. But when the number of conceivable situations is vast, notions about best practices are most effective when they are restricted to being guidelines applied by responsible experienced good-faith-acting individuals.

    Any system with strict inflexible guidelines entraps responsibility, making it difficult or risky or sometimes even legally impossible for individuals to act in morally responsible ways.

    I personally have great faith in human intellect to continually and relentlessly find better ways and better approaches. But when we do this, we must always work to find ways to allow individuals to exercise free choice, employ sound judgement, and make good-faith decisions based on the responsibility with which they have been entrusted.

    That’s the most important challenge that any reform establishing a big new program really needs to meet.

    But Obama told us that there were no GOP ideas being offered at all. He told us! You’re not calling him a liar, are you? Chuckle.

    Well, if we are going to play gotcha politics, then I think Republicans have just as much responsibility to speak to this as Obama does. But I think we’re probably better served looking past that. I’d like to see republicans at least say what parts of this bill, if any,m they think are worthwhile or acceptable approaches. And I’dlike them to sketch out what they thin ti would take to get some support for them.

    Because leaving aside whose ideas have made up this bill, I think it’s manifest that congress hasn’t worked together like they should. And I think Obama is spot on to say that the eternal campaign, gotcha politics, and deification of partisan tactics is a big part of the problem.

    There are a host of plausible reasons for Republicans to cite in opposition to this bill. And as I have said, it’s plausible to say that it doesn’t stress the kinds of primary approaches that conservatives favor. But my sense is that their opposition is primarily reactionary, composed of negative criticisms of the most objectionable approaches currently included.

    What I don’t ever see answered sufficiently by conservatives is whether they even truly believe it’s worth making health insurance for poor Americans a priority. Conservatives seldom if ever speak to that notion aside from briefly alluding to the idea that some rising free market tide will raise all boats a little bit.

    That’s why I continue to support something like the current bill, because it will provide sane access to non-emergency medical care for poor Americans. I think that’s a worthwhile priority, and I am unconvinced that conservatives truly believe it deserves to be on the short list.

  39. Nick Benjamin Says:

    @Tully
    You complain about ideologues “redefining things,” and then you redefine my simple statement of fact.

    Do you have an alternative to comparitive effectiveness studies that will work, and has not failed before?

    And do you have a solution to th problem of out-of-control health costs and that many Americans cannot afford care, that is cheaper then this is? Because if you do I’ll happilly support it.

    Heck go ahead and give me the policy that would control Medicare costs without spending massive amounts of money. If possible with realistic political constraints. For example it’shighly unlikely a party with an elderly base would support the elimination of Medicare, or anything that would reduce benefits.

    @kk
    At one point in this argument you said conservatives would not be conservatives if they suypported this bill. In other words the Senate bill is so liberal that a flat-taxing, creationist, gun-toter who votes for it is not conservative (by definition). Was that hyperbole?

    As for minimizing GOP objections,that is true. I do it because there is no magical, way to cut regulations and spending that will solve the two problems I’ve mentioned. It’s possible somebody will think of one, but if they have they haven’t bothered to tell me about it.

    To a conservative this is the least objectionable bill that will work, therefore unless they want us to go bankrupt, and leave millions of Americans without healthcare, they should support it.

  40. kranky kritter Says:

    At one point in this argument you said conservatives would not be conservatives if they suypported this bill. In other words the Senate bill is so liberal that a flat-taxing, creationist, gun-toter who votes for it is not conservative (by definition). Was that hyperbole?

    Nick, thanks for always giving folks the “in other words” cue every time you inaccurately restate my position, It’s quite handy. But I’ve already made myself clear on this point. Ther’sno reason for me to speak to it further.

    To a conservative this is the least objectionable bill that will work, therefore unless they want us to go bankrupt, and leave millions of Americans without healthcare, they should support it.

    Nick, now as then, you give none of us any reason to think that you have a credible sense of what conservatives should support. I appreciate that the statement above is apparently what you truly think. But it’s no less preposterous to non-liberals now than it was the first time you said it.

  41. Tully Says:

    No, Nick, I pointed out that your criteria (save money) does not remotely match with the goals and intents of “best practice” effectiveness studies: improving QUALITY of care outcomes. Cost and quality are not always incompatible goals, but that’s the way to bet. You would happily reduce quality of care to lower cost by substituting check-list medicine for the medical judgement of physicians who actually have some knowledge of their individual patients. Monkey with #2 pencil versus the doctor who actually knows you and how you respond to differing treatments, and what the individual complications of your case are.

    The juvenile attempt to shift the burden of proof to me is laughable. You propose changes, YOU bear the burden of proof. I already noted that a bad reform is worse than no reform, which satisifes your criteria, even if you can’t bother to read what I actually wrote. Likewise, you seem to have missed the many points I have offered (going back a decade online, even) that would improve system efficiencies (providing more resources for actual care) and increase supply.

    That tight supply, BTW, is one of the prime drivers of cost. So, without calling in Garrett Morris, President of the New York School for the Hard of Hearing, to explain it to you LOUDER, I will hit that aspect one more time:

    We already have a major shortage of primary care providers, and it is set to get much, much worse. This shortage is perhaps THE primary driver in the lack-of-access problem, and is a major contributor in cost problems as well, as patients are pushed up the ladder to higher-cost specialty practices when they don’t need to be.

    Medical students leave school with an enormous amount of student-loan debt, as in six figures. It is therefore not a surprise that they heavily opt for higher-paying specialties over lower-paying primary-care specialties, and heavily favor going into practice in major urban/suburban areas rather than more rural or inner-city low-income areas. A few good steps to address that problem: First, expand the number of training slots available for primary care residencies. Second, forgive the student loans of doctors who go into same. Third, forgive the student debt of ALL doctors (and advanced-degree nurses) who go into practice in underserved areas and communities.

    And you know what? We’ll still have excess cost growth in health care, because no matter how much we have we demand MORE. Every single developed nation in the world has that same problem, even the single-payer government-run systems. We are not remotely unique in that regard, we just started from a higher baseline. Among OECD countries we are “middle of the pack” in excess cost growth.

    Rationing care will not produce MORE care, nor will it produce higher-quality care, or even maintain current quality of care. It will produce guaranteed shortages and impede quality, as we have seen over and over again. The more we try to control cost through fiat rationing, the greater the shortages will be, the less the overall quality of care received. The only way to really “bend the cost curve” is to increase supply. And even that won’t stop what is a structural feature of a high-demand good that comes in second-tier in the Maslovian hierarchy, namely, that once first-tier needs are adequately covered, each additional dollar of income will be spent increasingly on higher-tier goods, with those in the greatest demand showing the highest expenditure growth. The overall spending on such goods will always grow faster than societal income (GDP), at least it will in any non-dictatorship.

    The non-innumerate among you can figure out how that plays. Once first-tier needs (food, clothing, shelter) are met, the highest-demand second-tier goods will show the highest overall societal spending growth. The wealthier a nation is, the greater that second-tier spending growth will be. Period.

  42. kranky kritter Says:

    That’s pretty cool linking psychology (Mazlow’s hierarchy) with economics like that.

    Maslow’s hierarchy was one of a handful of really useful models I took away from studying psychology. The version you linked to seems a little more elaborated upon than what I remember.

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