Sunday, March 21, 2010

Help Me Out Here

Look, I travel in pretty liberal circles. Most people I know think like I do.

But I understand those who disagree. I know that many smart, kind, loving people really believe in lower taxes and smaller government. I respect that. (I also know that it's easy to beat the shit out of someone who thinks education should be handled on the local level by painting that person as "opposed to education funding.")

I understand the political realities that have given us huge deficits, low taxes, and lots of government spending.

I am painfully well-informed and like to think I'm open-minded.

But I don't understand the opposition to health care reform.

At all.

I mean, I get the policitally motivated "capitalize on the frightened, misinformed electorate" sentiment. I think it's irresponsible, but I understand the political calculation.

I know we often think that if people who disagree with us just understood the issue, they would agree with us. I know that belief is usually misplaced. It leads to shouting and anger and hatred.

But I don't understand the well-informed, thoughtful, well-reasoned other side of this. Is there one?

Someone help me.


Violet said...

Yep it's hard for me to get too. The only thing I can think of is that those who are health insured, fear that their own access to healthcare will degrade because there'll be more people wanting the service.

Peggy said...

I can't speak for the rest of the dissenters, but for me, I'm not opposed to insuring the uninsured. What I am opposed to is how the reform has been designed. It's not going to insure everyone and the long term cost is going to bankrupt us. And the oversight that is going to be needed to implement and maintain this system is huge.

Covering medical costs is expensive - unless benefits are low or out of pocket costs are high, which doesn't seem to be the case here. I think people are going to be suprised when this is implemented and the actual benefits and premiums are known.

Showing that this will reduce the deficit at the end of the 10 year projection period is very misleading. I think you'd get a much different answer if you looked at things over a longer period. And, if they are going to pay for it by charging assessments against the insurance and pharma industries, how about charging the for-profit hospitals and medical conglomerates? Insurers aren't the only ones making a profit.

Also, I can't stand all of the non-related pork that gets thrown onto bills in order to get them passed (what do student loans have to do with health care reform?). I know that's the way things are done, but I think it's wrong.

This is an extremely complicated issue and I don't know what the answer is, but I don't think the bill that was just passed is the right one.

Okay, stepping down from my soapbox now. Btw - I'm a Democrat.

Auntly H said...

My biggest problem with those who oppose the HC reform cite reasons based on lies. Telling me that my doctor and I will no longer be able to make decisions about my care implies that we can now. But, in fact, my insurance company makes those choices and appears to make them based on a short-term financial basis. They don't expect to be covering my medical costs later, when the benefit of good self-care and preventative work now would benefit everyone, including my insurance carrier.

And I get that people don't like to be told they have to buy something. If you don't want to buy car insurance you don't HAVE to drive. So, if you don't have to buy health insurance, are you ok getting NO care whatsoever beyond what you can pay cash (or get a loan) for, prior to the care being delivered?

I could keep going, but it'll get dull fast. It's clearly a very complicated issue and I'm not sure that this bill is a full solution, but I do believe it's a big step in the right direction so I watched the vote live last night and cheered when it passed.

Lumpyheadsmom said...

Thank you for a thoughtful response. I know many think the bill is flawed. It should have done more, should have been done differently, or costs too much.

Do you think the bill is so flawed it's worse than doing nothing?

"Don't let the perfect be the enemy of the good" is often repeated on Capitol Hill, and it's true. The bill, in its current form, was the one that could pass.

Sometimes the wrong kind of reform is worse than no reform. Is that how you feel? Is the current system better than the one proposed in the bill? (I'm not trying to be combative - I think that's a fair position to take - just wondering if that's where you are.)

Peggy said...

I think what concerns me most about the bill is that we're not getting a complete answer about what the true cost will be (both to the country at large and to individuals in the form of taxes and premiums). It's been glossed over.

I do think our current system is better than what is going to be created by this bill. But that's not to say that I think our current system should stay as is. It definitely needs improvement and more, if not all, people should have a basic level of coverage. I think a few interim steps should have been taken before this bill, such as getting a handle on what's actually charged for services and lowering malpractice costs. Maybe do it in steps starting with Medicaid expansion. But unfortunately, in our political climate, working slowly and methodically doesn't win elections. Not to sound trite, but I think we've bitten off more than we can chew. Hopefully I'm wrong.

ps - it's very nice to have a thoughtful discussion about this!

CaraBee said...

I agree with much of what Peggy had to say. A huge issue is money. This bill is guaranteed to drive up costs. All of those taxes and fees on drugs, medical devices, insurance, etc that are meant to pay for all of this are sure to be passed on to consumers. So that raises both the cost of insurance and medical care.

This bill is so financially unsustainable, it makes the nearly bankrupt Social Security look like a good investment. The CBO can only score a bill based on the facts as laid out in the bill, and this bill doesn't account for how we'll pay for all of the subsidies for people who are forced to buy insurance. Nor does it take into account the financial impact of a full 10 years of activity. The taxes and fees in this bill start right away while none of the benefits start for years. Of course you can show a profit if you tax for 10 years but only pay out for 6.

But more importantly, care simply won't improve. The majority of doctors already refuse Medicare/Medicaid because the reimbursements are so low. And this bill reduces that even further. So you'll have more, more, more people expecting care from fewer medical professionals. How does that not translate into long wait for care? In addition, Medicare/Medicaid already refuse more claims (by DOUBLE!) than the average insurance company. I think it's a safe bet that they're not going to become more lenient when they are working with fewer resources and greater demand.

Listen, we all want everyone to have access to quality health care. I'm a pretty hardcore conservative/libertarian, and I definitely do. But the complete lack of bipartisan effort, (Not even one of the many republican suggestions was taken into account. Why no tort reform? Or interstate insurance?) does not tell me that the democrats who rammed this through with back room deals and bribes really care what the other half of the country wants or thinks.

According to liberals, we're all racist, selfish, uncaring teabaggers. I can't tell you how disheartening it was for me to see all of that and so much more all over the internet and twitter recently. It has made me very sad because I try to be respectful of everyone and people have been downright nasty. It really changed my opinion of a lot of people who I had previously liked and respected. Politics can be so divisive, I just wish there could be more honest, respectful debate like this. Thanks for the opportunity!

Lumpyheadsmom said...

Thank you for the thoughtful, intelligent response.

I hoped for some insight into why people oppose health care reform; but in fact, no one opposes health care reform. People *do* object to the bill that was passed, though, for reasons that are not racist, reactionary, partisan, or foolish.

I think nearly everyone agrees that the health care system is in trouble. It is unsustainable in its current form. The disagreement lies in what to do about it.

If you put a bunch of health care experts in a room - cordial colleagues who respect one another deeply - to discuss the issue academically, you would get spirited debate and wide disagreement on how best to address the health care system. The problem is hugely complex, expensive, and theoretical.

But add raw politics, high emotion, and a general lack of understanding, and you get what we have.

There are people who want radical change that the public doesn't support, obstinate party zealots who are more concerned about the next election than the future of the country, and some justifiably angry health care consumers. There are people intentionally spreading rumor and misinformation because they think it benefits them somehow or because they really don't know any better, people who are just plain crazy, and a confused and frightened public.

Plus a bill that is under negotiation until the last minute, so even the well-informed aren't sure what it contains.

But that's how the sausage factory works.

I'm sure Congressional leaders would have been willing to include ideas from the other side of the aisle if it secured GOP votes for the bill. (So long as those proposals did not send an equal or greater number of Democrats fleeing, of course.) But the mood on the Hill was certainly not one of collaboration and compromise. It was clear the bill wasn't getting Republican support even if Ronald Reagan Himself rose from the grave to endorse it. ("That's not really Ronald Reagan!" "If it is, the disease that killed him makes him an unsuitable expert!" "He's biased, he used government-run health care!" "Abortion!" "Canada!" "Louisiana!" "She's a communist!" "Yeah, she's a socialist!" "Your stupid!" "My stupid what? You're stupid." "Public option!" "Death Panels!" "Someone find a moron to spit and yell obscenities!")

Ahem. Anyway . . .

Personally, I'm satisfied with the result. Happy? No. But we need to do something - immediately - and the bill that passed was the only bill that could.

nonlineargirl said...

I appreciate that people are worried about costs (heck, cost is why my state has not implemented health reform on our own yet). But - the CBO just came out with savings estimates and said it would reduce the deficit by $138 billion over the next 10 years.

Even if you disagree with the CBO estimates (and some do), my big thing as a health policy wonk is: right now anyone who has insurance pays for care for the uninsured. About 10% of premium cost is due to "uncompensated care" costs. Hospitals and other providers have to make up for free care somewhere, so they charge the insured more. We are already paying to pay for others' care, we just do it in an inefficient way. Paying for insurance is a much better use of funds than paying for ER care.

merseydotes said...

Okay, I am married to a thoughtful, considerate libertarian-leaning Republican pollster. He supports health care reform but not this bill. He says that he (and most Americans, and since it is his job to poll Americans, he may well know) think the system needs an overhaul. But the problem is not covering the uninsured; it's addressing the rising costs of health care itself. He says the bill that was signed does nothing to lower the costs of healthcare, so while more people may be covered, the costs of care will continue to escalate and people who are already insured (most Americans) are not going to see their insurance costs go down. Plus, he thinks that the price tag for the nation is just too large right now, but he is one of those "government should keep its hands off most things" idealogues anyway.