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Author, Teacher, Screenwriter


Friday, September 18, 2009

Did O'Reilly really support a public option?

"All impulses of thought have a tendency to clothe themselves in their physical equivalent"--Napoleon Hill. I have found that there are two ways people react to this: those who find ways to disagree, and those who look for ways to agree. The latter group strike me as more successful overall, and happier as well. To put this rule another way: "we become what we think about." This single sentence, properly considered, will change your life. Thought changes feelings. Feelings influence action. Actions give results and information allowing you to create a positive feedback loop. If you will pay attention to those results, and constantly work to clarify your goals and self-image, work to ensure that your beliefs and attitudes are in alignment, and remain positive about yourself AND other people...It is my sincere conviction that you are on your way to the life of your dreams.

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Did Bill O'Reilly really support a public option? It would seem possible, based upon some recent comments on his show. I would be spectactularly happy if he did. I fail to see why Conservatives are so determined to control my behavior--why it is so damned important to them that I NOT be able to purchase a plain-vanilla non-profit health care policy run by the government. It could clearly be made deficit neutral (like...allowing people to buy into Medicare for cost plus 10%?) I don't want to pay bloated salaries, or for advertising. I fail to see how this benefits me, and Republicans want to force me to do it. If they believe in the free market so much, they would HAVE to believe that a government-run system would be inferior. And unless you think that people are too stupid to know how to spend their money, it would certainly not threaten the Health Insurance industry. If it WOULD, then I guess government isn't as incompetent as they say. I don't see how both could be true at the same time. Make up your mind.

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But...if O'Reilly is for this, then that's more evidence to me that he is a Conservative Republican, not a crazy person. And I'd take a much closer look at the Liberal programs he opposes, and his arguments against them, because he would seem much more like an honorable, reasonable person who holds opposing views, and not the kind of two-dimensional blowhard many accuse him of being.

32 comments:

Mike Ralls said...

A lot of conservative fears over the public option are over the extras that will be thrown in with it.

IE, in many of the bills being proposed everyone will be forced to either buy the public option, private insurance, or a pay a fine. Now, maybe it's good and maybe it's not that everyone will be forced to buy some type of insurance, but it is a decrease in liberty (people's ability to make their own choices) and many conservatives fear that.

Dan Moran said...

http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=22410

Harvard researchers find that 45,000 deaths a year can be ascribed to the lack of health insurance. People without health insurance are 40% likelier to die than people with. "This is after taking education, income, smoking, drinking and obesity into consideration."

Frank said...

Mike

A lot of conservative fears over the public option are over the extras that will be thrown in with it.

Or the fact that there is nothing competitive about having access to unlimited amounts of deficit-spending-type cash. Private companies, and non-profits have to live within a budget. Governments clearly don't.

Forcing people to buy insurance is the only way you are going to be able get things like pre-existing conditions waived. You need a large pool of cash from healthy people to cover those who are sick.

This is true with the "public-option", non-profits, or for-profits.

And finally, no matter what, care will by necessity have to be rationed. And I don't want the government deciding who gets what when.

And I'm really sorry if for those who don't see the problem with that.

Dan Moran said...

Erich,

I do see the problem. But the thing is, health care is rationed now. Now, people decide who lives and who dies; it's just done by income levels.

For far less than we've spent in Iraq, every person in this country could have medical care.

Dan Moran said...

And by "Erich," I mean Frank ....

Marty S said...

"I don't want to pay bloated salaries, or for advertising. I fail to see how this benefits me, and Republicans want to force me to do it. If they believe in the free market so much, they would HAVE to believe that a government-run system would be inferior."
If you make this statement about health insurance, you can also make it about cars, TVs, baby cribs and everything else produced in this country. So clearly the government should own all the means of production. Well we know what that economic system is called. Its called Communism and where its been tried it has really worked all that well.

Dan Moran said...

Marty, communists don't permit private production. Everything is owned by the state; the scenario where a private entity competes with a state-run entity doesn't exist.

bud said...

You're cOnfusing Bill O'Rieilly with a Conservative. Bill O'Rielly is a schtick on wheels.

If the man has any principles, other than "what is good for Bill O'Reilly", I've never seen them.

The man epitomizes "spell my name right".

Marty S said...

Dan: Steve's assertion that we shouldn't pay for advertising and bloated salaries and that we could avoid that with a government run plan.I assume he is referring to health care insurance. I simply took that one step further and said I don't want to pay for advertising and bloated salaries in anything I buy so lets have the government run everything. If you do that then there is no private entity competing with the government.
Oh! On that 45000 death estimate I am extremely skeptical. The number was put out by a pro UHC group and the numbers don't make sense. There are about 660,000 deaths per year in the United States. About 1/6 of them are uninsured so all things being equal you would expect about 110000 deaths total among the uninsured. Now about 50% of the uninsured are under age 30 and the main causes of death in this age group are accidents,homicide and suicide so this probably brings the total down around 80,000 or 90,000. So to get to 45000 extra deaths you would need a bigger multiplier than the 40% they give which is probably exaggerated already. A previous study they did claimed 25%

Dan Moran said...

Marty,

By that logic the existence of the post office should prevent UPS and FedEx from existing.

Dan Moran said...

BTW, I'm skeptical of your numbers. How do you get that 1/6th of all people who die are uninsured? I'm guessing you got it by dividing the number of dead by the percent of uninsured -- 16% of the population, or about 1/6th -- and assuming that accounts for 1/6th of all the deaths, as well.

Essentially (I suspect) your first calculation assumes that deaths are proportional across the population, when the entire point of the Harvard study is that they're not.

In any event, whether it's 45000 or 25000 deaths a year attributable to lack of health care, it's a preventable number, and should be prevented.

Marty S said...

Dan: I completely agree with you that it really doesn't matter how many deaths might be prevented. We do need to do something. I just have this thing about people with an axe to grind coming up with numbers based upon assumptions favorable to getting the result they want. In my career as a statistician I have seen just too many phony estimates made that way.

Frank said...

Dan,

Most everything is rationed by monetary value; that's the point of money. Things are priced based on supply and demand.

Now we could decide that health care should be exempt from this, but even if you did that, you don't need to make government the single source of health care.

For instance, the government could mandate that all health care providers operate as not-for-profit organizations. You could require that everyone buy health insurance and you could require that only the government, not states can mandate what minimum coverage means and allow insurers to compete nationally based on Federal Government regulations.

The worst possible solution is a single provider that is the government.

The second worst possible solution is a hybrid of government and non-government providers as we have now. Everyone should be clear that while it may be true that those on Medicare mostly like it, Medicare runs a severe deficit and worse, Medicare costs everyone in higher insurance costs through cost-shifting.

For those of you not familiar with cost-shifting, Medicare has a schedule of payments that is the maximum it will allow for a given procedure. Now it happens that this schedule allows the government to pay below market value. So health-care providers that accept medicare, have to make up the cost by charging everyone else above market-value.

In this respect, Medicare is similar to the uninsured in its cost-shifting ability.

A "public-option" would only add yet another cost-shifting mechanism into the mix.

the scenario where a private entity competes with a state-run entity doesn't exist.

Sure it does, Boeing competes with Airbus everyday. In fact the WTO just ruled against Airbus (and the European Union). ExxonMobil competes with Petroleos de Venezuela everyday.

By that logic the existence of the post office should prevent UPS and FedEx from existing.

Neither UPS nor FedEx delivers mail. And neither UPS nor FedEx can run a deficit like the USPS does every single year. The USPS is currently running a $7 billion deficit which taxpayers are on the hook for paying in addition to the cost of mailing a letter or a package.

Medicare and Medicaid are running huge deficits which the taxpayers on the hook for paying in addition to their other health care costs.

Clearly an argument could be made that our costs would go down if these government entities disappeared; but to say the solution is to have more government entities involved is delusional.

And none of this even addresses the supreme folly of putting the government in charge of decisions about your health care. And this is especially true of the "public option" where the government would be in charge of poor people's health care; people who have little other recourse and are at the complete mercy of the government.

The lessons of history with regards to allowing government in charge of providing health care are learned the hard way. It would be a shame if we decided to forget those lessons and had to relearn them.

The hard way.

Lynn Gazis-Sax said...

I think that there are some things that work better if the government runs them, and other things that work better if private industry runs them. The answer as to which is which may not be the same for every time and place, but one way to test is to look for what advantages government provides, and what advantages private industry provides. For example:

Free trade: Works much better than central planning at allocating just how much you should be making of what good and what goes where. (See, for example, the Great Leap Forward in China, for how disastrous it can be when the central government decides it's really important to make lots of steel, at the expense of other things the economy needs.)

Government: Works well at providing services that everyone needs to buy into in order for them to work well. Example: putting out fires. Private fire departments have been tried, and they didn't work as well; you need to put out fires anywhere they appear to keep them from spreading to other houses, and so it doesn't do to have services only for subscribers.

Steven Barnes said...

"I don't want to pay bloated salaries, or for advertising. I fail to see how this benefits me, and Republicans want to force me to do it. If they believe in the free market so much, they would HAVE to believe that a government-run system would be inferior."
If you make this statement about health insurance, you can also make it about cars, TVs, baby cribs and everything else produced in this country. So clearly the government should own all the means of production. Well we know what that economic system is called. Its called Communism and where its been tried it has really worked all that well."

--You are making a rather blatant straw man argument, exaggerating my position and then attacking the exaggeration. No, I couldn't make that argument, for the very reason you suggest: THERE ARE NO ROLE MODELS OF SUCCESS. You are also talking about PRODUCTS, while I am discussing SERVICES. If every other industrialized country had government produced cars that were cheaper, better, safer cars...damned straight I'd look at that. But they don't. And I watch Conservatives tying themselves into knots trying to deny the WHO statistics on health, and don't buy their explanations for a second. I'm only interested in results, and think the stats are on the side of the biggest insurance pool possible, and removing profit from the equation. Conservatives do not. Fine. I can live with that divide. But in all honesty, I think that the millionares and billionares who want to keep those cushy profit margins as long as possible are about as ethical as tobacco executives, and are laughing at you.

Mendur said...

Mike Ralls said:
"Now, maybe it's good and maybe it's not that everyone will be forced to buy some type of insurance, but it is a decrease in liberty (people's ability to make their own choices) and many conservatives fear that."

Did you just say that Conservatives fear that their freedom to choose will be taken away?

Forgive me for laughing out loud at that one.

As someone who has had health insurance for most of my life but went nearly two years without it because of trouble finding full time work, I have to say that the fears I had in those two years were palpable (fear of an illness wiping out my savings and my credit, fear of an injury requiring physical therapy I could not afford to buy, and so on) and the relief when I found a job with insurance benefits was tremendous. For that reason, I am in favor of making sure every American has enough basic insurance to avoid being subjected to those fears, especially in these times of 10-20% unemployment ... even if it means giving up the "choice" of gold-plated health plans I can't afford anyway.

http://mendur.blogspot.com

Dan Moran said...

Frank,

Most everything is rationed by monetary value; that's the point of money. Things are priced based on supply and demand.

Some things shouldn't be based on supply and demand, even a little bit. Justice, for example. Health care, in broad. I don't have a problem with the wealthy getting better health care; I have a problem with the poor getting none.

The worst possible solution is a single provider that is the government.

That's an emotional statement. British Conservatives are pretty happy with the NIH, and that's exactly what you describe, a single provider.

A "public-option" would only add yet another cost-shifting mechanism into the mix.

I'm not a huge fan of public option; I'd prefer single payer. It's proven to work, and no more Republicans could vote against it than will vote against the public option. And, this is a huge bonus, they wouldn't be completey dishonest when they screamed "Socialism!" :-)

Boeing competes with Airbus everyday.

Within communist economies, state run entities don't compete against private entities. (And to the degree that it happens, as in China to some degree in the present day, it's by definition not a purely communist system.)

Neither UPS nor FedEx delivers mail. And neither UPS nor FedEx can run a deficit like the USPS does every single year. The USPS is currently running a $7 billion deficit which taxpayers are on the hook for paying in addition to the cost of mailing a letter or a package.

I wouldn't mind if the USPS went out of business. Would barely impact me. Of course, people in rural communities -- Republicans, mostly -- would be hosed. Some days I think we should let those communities have what they want -- take their medicare away. Make sure they don't get more money from the federal government than they pay in -- you do know that it's rich liberal states who get most hosed by the federal redistribution of wealth, right?

Clearly an argument could be made that our costs would go down if these government entities disappeared; but to say the solution is to have more government entities involved is delusional.

NIH. Happy British conservatives.

Frank said...

British Conservatives are pretty happy with the NIH

Well, perhaps they are but

A group of senior British doctors expressed concern Thursday about the treatment of the terminally ill, saying some people are dying prematurely because of guidelines for dealing with patients in their final hours.

In a letter to The Daily Telegraph newspaper, the six palliative care specialists criticized the "tick-box approach to the management of death" in guidelines used by hundreds of hospitals within Britain's universal health care system...

On Thursday, a leaked consultants' report recommended drastic cuts in the U.K.'s National Health Service to help cope with the ever-rising cost of supporting universal health care — a development that opponents of the U.S. health care reforms are likely to welcome.


It's called push meeting shove.

That's an emotional statement.

Is it. So we have never in the past seen a health-care system used by government to purge "undesirables"? We have never in the past seen a health care system deem certain people "mentally ill" for expressing anti-government opinions?

Dan Moran said...

The Daily Telegraph is a Murdoch publication. You might as well quote badly sourced Fox news editorials.

And yeah -- it's an essentially emotional statement. Europe is full of your worst case scenario, and the Europeans like it, including European conservatives, and no "perhaps" about it.

I don't see European conservatives begging for American-style health care, I'll tell you that.

http://www.news-journalonline.com/NewsJournalOnline/News/Headlines/frtHEAD02092009.htm


Ranking: U.S. 1st in health care spending, 37th in health


By ANNE GEGGIS
Staff Writer

For the money spent on health care, Americans are getting rooked.

It seems health is one of those things that money can't buy. All international studies show that Americans spend the most, as measured by the percentage of gross national product spent on health.

But all that spending has only bought the country 37th place in overall health-system performance, as measured by indicators such as a nation's overall health and the effectiveness of its system, according to the World Health Organization's ranking of nations. The ranking was formulated in 2000 but is still used as a primary resource by governments and health organizations.

Marty S said...

Dan: If one carefully reads the report of the WHO, one finds two interesting things. 1) The criteria used for ranking countries includes not just the heath of individuals, but the WHO perception of the financial fairness of the system. 2) Te U.S. was ranked number one in responsiveness, just the thing usd critics of UHC are have stated we are most afraid of losing.

Frank said...

The Daily Telegraph is a Murdoch publication.

Huh? That link was to the Star Tribune sourcing an AP story.

I'm not a huge fan of public option; I'd prefer single payer.

The bottom line is we are not going to single payer health care run by government. Not going to happen.

So you might as well be considering solutions that are possible and will accomplish your goal: "I don't have a problem with the wealthy getting better health care; I have a problem with the poor getting none."

We can do this without the government being involved.

Scott said...

Summary here:
www.slideshare.net/danroam/healthcare-napkins-all

Lynn Gazis-Sax said...

We can do this without the government being involved.

"Without the government being involved" isn't exactly more likely to happen than single payer. Especially given that the government is already heavily involved in health care.

Steven Barnes said...

Frank:
you've overstepped your argument. The WORST possible solution is government single payer? Meaning that every other developed country has the worst possible option? If that were true, American health care, the single shining beacon of "how it should be done" would beat every other country in the world, by every reasonable measurement...and that simply isn't the case at all. And I'm sorry for anyone who can't see THAT.

Dan Moran said...

The bottom line is we are not going to single payer health care run by government. Not going to happen.

Not this year. Eventually I think we will. I've got great, cheap health insurance at my work ... but all that means is that the cost is being deducted from my paycheck before I ever see it. Over the last decade, employer sponsored health insurance premiums have more than doubled: I assure you, my salary has not doubled within the same time period.

I make enough money, and my skills are portable enough, that decamping to another country with sane health care costs is an option for me -- I spent a year recently in such a situation. Most Americans can't do this, and they're either going to be bankrupted or end up with something like single payer, going forward.

Health care costs are expected to nearly double (again) in the next decade. To speak of push coming to shove ....

Frank said...

Steve

you've overstepped your argument. The WORST possible solution is government single payer? Meaning that every other developed country has the worst possible option? If that were true, American health care, the single shining beacon of "how it should be done" would beat every other country in the world, by every reasonable measurement...and that simply isn't the case at all.

I did not say that the US is the single shining beacon of how it should be done.

One of the arguments I'm making is that it is a bad idea philosophically to have government the sole practitioner of health-care. And I say that because we have seen historical examples that a federal government can very easily abuse that power.

Look at it this way: everyone knows that conservatives are baby-eating, racist, curmudgeons who hate the poor. And someday, the IQ of Americans will drop off a cliff (again) and elect conservatives into power (again).

Do you really want these greedy bastards in charge of your health care system?

Secondly, for the sake of argument let me grant you that country's with government-run health care have better results than we do. Does that mean that government-run health-care is the best possible option?

Marty S said...

Of course government health care is good and all the UHC countries do better than us. Take for example my daughter in-law's experience as a resident of Ottawa, Canada. She developed a rash on her face. So she called the dermatologist and made an appointment. The first available appointment was six months from the day she called. In three months the rash went away so there was no cost involved. Here in the U.S. she would probably have waited at most a few days and had the expense of a doctor's visit and probably the cost of some prescription cream. Clearly the Canadian system worked better. At least if you don't mind living with an irritating rash for three months.

Lynn Gazis-Sax said...

to have government the sole practitioner of health-care

It seems to me that there's a big difference between these three options:

1) Government sole practitioner of health care.
2) Government sole supplier of basic health care insurance (possibly with private companies offering supplemental insurance, the way I can buy supplemental insurance against long term disability to add to what I'd get from the government). I.e., single payer, something like Canada, or like offering Medicare to everyone.
3) Government provides one of several competitors in an insurance exchange, the others being provided by private companies (the "public option").

Frank said...

Lynn Gazis-Sax

Again, Federal Government involvement in anything but a single-payer system would just create more cost-shifting (as I explained above) and cost everyone not on the government program more. This does not reduce or contain health care costs.

Even a single-payer system run by Government would likely attempt to contain costs by paying doctors and hospitals less as is evidenced by all the countries that have government-run health care.

You can work an insurance exchange without government involvement.

You can assure the poor have access to good health care without government involvement.

Why are people so quick to settle on government solutions when there are less drastic solutions available in the marketplace with new guidance and regulation?

After all, we always have government as a last resort if things don't work out. But it seems to me we should exhaust all other options first.

Lynn Gazis-Sax said...

Again, Federal Government involvement in anything but a single-payer system would just create more cost-shifting (as I explained above) and cost everyone not on the government program more. This does not reduce or contain health care costs.

It does if it moves some of that health care out of the expensive emergency room (which is already legally required to treat people who don't have money, and therefore cost shifts their care to the rest of us) and toward taking care of things earlier with regular doctors' office visits.

As it stands now, the uninsured are basically getting much less cost effective care in the emergency room that the rest of us then pay for through higher hospital costs (generally billed to our insurance, which then passes the costs on to us in the form of higher rates).

You can assure the poor have access to good health care without government involvement.

I don't see how. "Assure" implies that the government's doing something. Do you mean, "with the government subsidizing their ability to purchase insurance on the exchanges, rather than supplying one of the insurance options itself"? Or are you saying that if we left the private market completely to itself, without any government subsidies or regulation whatsoever, we could still ensure that the poor are covered? I'm not clear on whether you're specifically arguing for something like the proposed exchanges without the public option, or whether you're arguing that all the currently proposed health care reform initiatives involve too much government interference, and we should be more purely libertarian.

Frank said...

Lynn

"Assure" implies that the government's doing something.

You're correct, I was being imprecise. The government is needed to set up a new framework but I am trying to avoid the government getting into the healthcare business any more than it is already.

I'm not clear on whether you're specifically arguing for something like the proposed exchanges without the public option, or whether you're arguing that all the currently proposed health care reform initiatives involve too much government interference, and we should be more purely libertarian.

Fair enough.

I am OK with people receiving tax deductions and/or credits to pay for healthcare obtained in the private sector.

I'm OK with the government mandating the elimination of pre-existing conditions and disallowing people to be dropped in exchange for demanding that everyone be insured.

And I think that if you do that, the government then has to take healthcare regulation away from the States and mandate minimum coverage (that does not include, for instance, aromatherapy as some States now require) in exchange for insurance companies being able to compete nation-wide.

I would also propose that tort-reform with regards to medical malpractice should also be included.

I say instituting such measures would go a long way towards reforming the health care system and addressing the cost issue and we could then step back, see how that works, and revisit the issue with new data.

Frank said...

Uh oh.

A rebuttal to Steve's argument comes from the New York Times (of all places):

The conventional answer to this question has been: anywhere but the United States. With its many uninsured citizens and its relatively low life expectancy, the United States has been relegated to the bottom of international health scorecards.

But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis. . . . Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

As it is, the longevity gap starts at birth and persists through middle age, but then it eventually disappears. If you reach 80 in the United States, your life expectancy is longer than in most other developed countries.


I suggest you read it all...