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  • Paul Krugman is wrong about Medicaid

    Paul Krugman suggests in his New York Times column today that continuing the expansion of Medicaid is the answer to the outlandish cost of health care in the United States. He’s wrong. Medicaid is a lifeline for the impoverished, but the program would have to be reformed to the point that it would no longer be recognizable as Medicaid to be satisfactory for most Americans.

    The reason Krugman likes Medicaid is the program’s success at controlling costs. He says that of all the health care delivery systems in the country, Medicaid is the one most like those in Europe, which have much lower costs than ours. If that’s true, it’s only because most of the rest of our fragmented system is completely fucked up.

    Among the primary aims of European systems is health care equity — providing everybody with the same access to high-quality health care regardless of income or station. Medicaid does not come close to doing that. Krugman says that care from Medicaid providers is good and that lack of access is greatly exaggerated. In my experience the former is sometimes true and the latter, never.
    Continue reading Paul Krugman is wrong about Medicaid

    I drink because I’m worried, people; I don’t drink because I’m dry

    Updated 11.22.2013

    I know that there are millions of Americans who are content with their health care coverage — they like their plan and, most importantly, they value their relationship with their doctor. They trust you. And that means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. (Applause.) If you like your health care plan, you’ll be able to keep your health care plan, period. (Applause.) No one will take it away, no matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.”

              — Barack Obama

    I’ve seen a number of Obamacare supporters arguing that the President’s promises about keeping plans and doctors carried a silent qualifier to the effect of “if they’re compliant with the new regimen.” Somewhat less frequent but still common are remarks to the effect that people whose plans have been cancelled should have known better, or that they’re stupid to want to keep their crappy plans. Probably they should have known (although Obama supporters who are ordinarily incensed with people who don’t take the President at his word are now incensed with people who did). Maybe they are stupid. Regardless, we wouldn’t be having this discussion if the President hadn’t lied — and it was a lie — repeatedly. Supporters of the legislation thought that the illusion of choice was critical to the success of the effort. The promises were an epic bait-and-switch, rivalled only by the disappearance of the vaunted “public option.”

    In the excerpt from Obama’s 2009 address to the American Medical Association, the line about keeping one’s health care plan, period, is, I suppose naturally, subordinate to the line about keeping one’s doctor, period. Can you spot the silent qualifier in that clause? Yeah, me neither. And with the furor over the cancelled plans on temporary hiatus, awaiting the verdict on the state of the federal exchange in nine days and the verdict of insurers and regulators on extending the plans, the problem of losing one’s doctor is about to take center stage.

    Continue reading I drink because I’m worried, people; I don’t drink because I’m dry

    I don’t find this stuff amusing anymore

    Updated 11.20.2013

    “I think we probably underestimated the complexities of building out a website that needed to work the way it should,” [President Obama] told the annual meeting of the Wall Street Journal CEO Council.

    The [security] experts said the site needed to be completely rebuilt to run more efficiently, making it easier to protect. They said HealthCare.gov runs on 500 million lines of code, or 25 times the size of Facebook, one of the world’s busiest sites.

    One of the most important repairs remaining deals with the information pages that the system provides to insurers about coverage applicants. These so-called “834s” have been riddled with erroneous information and, despite weeks of repairs, they continue to spit out incorrect data.

    The enrollment, to give you a general sense of what’s happening, for a health plan that might have to sign-up 100,000 people in order to get their share of the 7 million Obama administration’s national enrollment objective, has grown from perhaps 10-15 enrollments a day a few weeks ago to 40-50 a day now … Backroom error rates being committed by Healthcare.gov, when enrollment data are transmitted to the health plans, are still far too high to transition to high volume processing without serious customer service issues.

    The last quote is from an insurance industry insider, so take that into account in whatever fashion you think appropriate. I was too lazy to google the security experts cited in the bit about that aspect of the site, but 500 million lines of code? Holy crap. Can that be true?
    Continue reading I don’t find this stuff amusing anymore

    We can do better than this

    Below the fold you’ll find the first in a series of “Medicare for All” graphics I’m developing. At the moment they’re just to look at, but they’ll include a call to action as soon as The Search Committee finds an appropriate one.

    The ongoing Obamacare drama presents an opportunity to raise the visibility of single-payer and to draw new adherents to it from a variety of positions. Everybody everywhere likes them some Medicare, except the people whose profits are diminished by it. Nobody likes insurance companies, except the people whose profits depend on them. This is one of those rare moments when just about everybody is talking about health care and 90% of the people who are talking about it are saying “lord god this is fucked up.”
    Continue reading We can do better than this

    All across America, insurance company executives and insurance commissioners are doing spit takes

    (Updated 11/14/2013)

    Obamacare: despise it or hate it, it’s now the law of the land and we all need to accept it and make it … wait, what’s that? The President just changed the law? Okay then.

    As you know, people and Republicans have been making a big noise, first about the continuing web site enrollment woes, and then about insurance company customers who are getting cancellation notices for their insurance policies after the President emphatically said for three years that “if you like your plan, you can keep your plan.” (You most likely couldn’t keep your plan but in fairness to the President, he probably thought nobody would want to.) In response to this less than joyful noise, the administration has come up with an administrative fix that they think will put the screws to the insurance companies they blame for the mess, but is almost certain to backfire: they’re allowing insurers to reinstate the cancelled plans if the various state insurance commissioners permit it.
    Continue reading All across America, insurance company executives and insurance commissioners are doing spit takes

    Shared sacrifice: In which both sides agree to throw some old folks and some poor into the volcano

    For whatever reason, the occasion of tax and spending cut negotiations has inspired tough-minded liberal thinkers to suggest that there’s virtue to be found in beating up poor people and Medicare-bound older folk. Full disclosure: I benefit from Supplemental Security Income (SSI), the program Nick Kristof hopes will be cut during the negotiations, and . . . → Read More: Shared sacrifice: In which both sides agree to throw some old folks and some poor into the volcano

    Soon, my petition will be a real boy, plus: Canadians don’t want Canadians to know what they know about Tommy Douglas

    My petition requesting the Obama administration to commission a National Intelligence Estimate on climate change is 19 signatures shy of achieving visibility on the White House petitions system, meaning that it’ll start showing up when people search for climate change-related petitions. It is also a mere 24,869 signatures shy of mandating an administration response. . . . → Read More: Soon, my petition will be a real boy, plus: Canadians don’t want Canadians to know what they know about Tommy Douglas

    Democrats agree to push for single-payer health care system if mandate falls

    BTC News has learned that senior Congressional Democrats are quietly directing staff members to organize an effort to pass Medicare-for-all legislation in the event the Supreme Courts strikes down the individual mandate provision of the Affordable Care Act, also know as Obamacare.

    The staff members are reaching out to leaders of key advocacy groups for support of the effort. Speaking on condition of anonymity, a Democratic Congressional Campaign Committee official told BTC News that the fight for universal health care in America will play a critical role in the reelection campaign of President Obama, and in the efforts of Democrats to regain control of the House and solidify control of the Senate.

    Continue reading Democrats agree to push for single-payer health care system if mandate falls

    Alan Fucking Simpson! plus: SS v. ACA: comparing apples and a mouthful of tacks

    Alan Fucking Simpson! is a former Senator from Wyoming. He hates Social Security and the “greedy geezers” who rely on it to sustain them in their later years, and he doesn’t understand why anybody who already gets Social Security cares about preserving the program for younger people when anyone can see that it’s none of their business. He is the co-chair of the current president’s completely gratuitous National Commission on Fiscal Responsibility and Reform, a name that translates to “the National Commission on Cannibalizing Social Insurance and Safety Net Programs.”

    President Obama created the bipartisan commission when Congress, in an uncharacteristically sensible move involving some characteristically skeezy motives, decided not to. The prospective Congressional commission prefigured the late, unlamented Super Committee, which was designed to do the same thing—produce a list of proposals that Congress would either approve without amendment or disapprove. The president supported the plan, but most Senate Democrats opposed it and it went down when several Republicans who cosponsored the legislation voted against it on the grounds that the commission might somehow do something that could possibly redound to Obama’s benefit.

    Good for them. Unfortunately, the president then appointed his own commission, but without the legislative imperative. He named Erskine Bowles, a conservative Democrat and wealthy investment banker, to represent liberals and the poor, and to hold down the cannibals’ corner he appointed the aforementioned cannibalistic Republican Alan Fucking Simpson!

    Continue reading Alan Fucking Simpson! plus: SS v. ACA: comparing apples and a mouthful of tacks

    How the patience of the Greeks spells doom; plus, Crazed Doctors for Sanity

    The European countries acting on behalf of Greece’s creditors are bullies. Americans are saps. And a group of sane doctors may get the right result for all the wrong reasons.

    As is the bully’s practice, the more the Greeks concede, the more the bullies demand. To this point the bullying has worked (for the bullies) but now the country’s managers are in fear for their political lives, at least, so the country looks as likely to default on its debts as to accept the latest turn of the screw.

    Continue reading How the patience of the Greeks spells doom; plus, Crazed Doctors for Sanity