Vindication

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Paul Krugman admits that Sarah Palin was right:

Eventually we do have a problem. That the population is getting older, health care costs are rising…there is this question of how we’re going to pay for the programs. The year 2025, the year 2030, something is going to have to give…. …. We’re going to need more revenue…Surely it will require some sort of middle class taxes as well.. We won’t be able to pay for the kind of government the society will want without some increase in taxes… on the middle class, maybe a value added tax…And we’re also going to have to make decisions about health care, doc pay for health care that has no demonstrated medical benefits . So the snarky version…which I shouldn’t even say because it will get me in trouble is death panels and sales taxes is how we do this.

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Here’s the deal – we have to make some hard choices in the near future. We can offer everyone unlimited health care for life, but it will be very expensive. Or we can try to put some reasonable limits on coverage. The problem is defining “reasonable”.

Health care costs money. We can try to control costs, but we can’t make it free. We can let the poor go untreated or we can agree to cover the costs for the needy. We can pay for health care in premiums, or in taxes, or in cash. But we will still have to pay for it.

Socialized medicine and single payer spread the cost around based on ability to pay but they don’t necessarily control costs. To control costs we either have to limit how much we pay for services, limit what services we pay for, or both.

There are no magic solutions. Ronald Reagan said “There are no easy answers, but there are simple answers.” In this case there are no simple answers either.

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People need health care, not health care insurance

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Fareed Zakaria:

Curbing the cost of health care

Many liberals believe that the Affordable Care Act — Obamacare — is unpopular only because most Americans don’t understand it. There is some truth to this: Studies show that the core provisions of the bill are more popular than the bill itself. But there’s also a reason, rooted in reality, why many Americans worry about Obamacare — its cost.

Most Americans have health care. What they worry about is the cost of insuring 20 million to 30 million more people. Unless the meteoric rise of health-care costs is slowed, a big expansion of coverage might well remain unpopular, no matter how it is explained.

Republican alternatives to Obamacare, such as Rep. Paul Ryan’s plan, don’t bother with expanding coverage, which is a mistake because they leave in place a broken insurance model in which people can freeload. But most do have a strategy to control costs — get consumers to pay for more of their health care. The basic idea is intuitively appealing. Markets produce efficiencies; they presumably would do the same thing in health care.

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People aren’t “freeloading”, they are opting out. If you are young and healthy and only see the doctor for annual check-ups and occasional minor injuries and illnesses, paying $1000 month for health insurance is a bad bet. Whether we privatize or socialize the cost of health care we still need to control it.

We spend twice as much (or more) per capita on health care as other industrialized nations. ObamacareTax does nothing to address that disparity. The problem isn’t that health care is inaccessible, it’s that it’s unaffordable.

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Rectal Myopia

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Greg Sargent:

How did legal observers and Obamacare backers get it so wrong?

Many people have blamed Obama Solicitor General Donald Verrilli’s poor defense of the law for the sudden jeopardy Obamacare finds itself in, and there’s no denying he was unprepared to answer questions that we’ve known for months would be central to the case.

But there’s another explanation for the botched prediction: Simply put, legal observers of all stripes, and Obamacare’s proponents, including those in the administration, badly misjudged, and were too overconfident about, the tone, attitude and approach that the court’s conservative bloc, particularly Justice Scalia, would take towards the administration’s arguments.

Keep in mind: Many observers, Obama officials included, spent weeks treating Scalia like a potential swing vote on the case. Lawyers defending the law wrote some of their briefs and opinions with an eye towards persuading Scalia. They consciously invoked Scalia’s own words from a 2005 opinion affirming Congress’s power to control local medical marijuana in hopes it signaled he might be open to the administration’s defense of the individual mandate.

This now looks like a terrible misjudgment. During oral arguments this week, Scalia invoked the broccoli argument to question the goverment’s case. He mocked the government’s position with a reference to the “cornhusker kickback,” even though that’s not in the law. As Fried notes, this language is straight out of the Tea Party guerrilla manual that was written during the battle to prevent Obamacare from becoming law in the first place.

All of which is to say that the law’s proponents were badly caught off guard by the depth of the conservative bloc’s apparent hostility towards the law and its willingness to embrace the hard right’s arguments against its constitutionality. They didn’t anticipate that this could shape up as an ideological death struggle over the heart and soul of the Obama presidency, which, as E.J. Dionne notes today, is exactly what it has become.

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Gee Greg, I saw this trainwreck coming a long time ago. Some of us didn’t have our heads up our own asses. This is what happens when you get high on your own Koolaid.

Let’s forget for a minute that Obamacare is a bad law. It’s already unpopular and it hasn’t even taken effect. Let’s look at the constitutional argument.

The U.S. Constitution created a government with enumerated powers. Any powers not enumerated in the document are reserved to the states or the people.

Obamacare is an unprecedented expansion of congressional power through the Commerce Clause. It requires people to purchase health care insurance from private companies. Supporters of Obamacare think the Necessary and Proper Clause allows congress to make people buy health insurance whether they want to or not.

If they can do that, what is the outer limit of congressional power? Can they order you to buy broccoli too?

Maybe you Journolistas should have fought for Single Payer instead of selling us out for the Public Option that we never got anyway.

Asshats.

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One of these things is not like the others

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Why does our health care cost so much?

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Ezra Klein:

Why an MRI costs $1,080 in America and $280 in France

There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.

That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.

There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”

As it’s difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.

“The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do,” they concluded. “This suggests that the difference in spending is mostly attributable to higher prices of goods and services.”

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Ezra is a Village Idiot so he can’t tell you the truth. As Bob Somerby can tell you any informative discussion about health care costs is absolutely taboo among the professional media. That’s what makes this article so amazing.

But it isn’t nearly enough. There are major gaps in the information.

Here’s one example:

The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States — the pharmaceuticals industry and the medical device industry — sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability.

The players sitting across the table from them — the health insurers — are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That’s a signal that the sellers have the upper hand over the buyers.

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According to at least one source with first-hand knowledge, Big Pharma is laying off everyone except the suits. But merely telling us what a company’s profit margin is doesn’t tell us why it’s that way or how much in actual dollars we’re talking about.

Here’s another:

“There is so much inefficiency in our system, that there’s a lot of low-hanging fruit we can deal with before we get into regulating people’s prices.” says Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. “Maybe, after we’ve cut waste for 10 years, we’ll be ready to have a discussion over prices.”

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Why can’t we do both simultaneously?

Ezra gives us a glimpse behind the curtain, but what we need is comprehensive data we can trust. We know how much we spend, but exactly where does it go?

For every dollar we spend on health care insurance, how much goes to pay for health care? I’ve seen estimates that 30% of each dollar stays with the insurance companies. How much of the money they keep goes to administrative costs, executive salaries, commissions, bonuses, lawyers, etc?

For every dollar that goes to pay for health care, how much goes to pay doctors, nurses, administrative staff, office costs, equipment, tests, malpractice insurance, lawyers, etc?

How do we make informed choices if we don’t have all the information?

We can’t. Which is pretty much the point of keeping us in the dark.

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