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 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 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
Or something like that.
After greasing the skids for Wall Street’s economic vandalism as head of the New York Federal Reserve Bank and then opening the national vaults to banksters and brokers as US treasury chief, Timothy Geithner is making his Wall Street employment official. The man who once boasted of “foaming the runway” for banks with the frothy remnants of liquefied former homeowners has accepted a job supervising the mailroom at private-equity giant Warburg Pincus, where he hopes to work his way to the top after gaining experience in the industry while avoiding charges of cashing in on his government service.
Continue reading JPMorgan Chase goes for the (comedy) gold; crushed by guilt, former New York Fed chief and treasury secretary Tim Geithner retreats to a monastery
John Boehner’s next job could be as a safety buoy bobbing gently in the waters of the Fiscal Shoals, warning off the unwary. (“These are not tears,” he will say with a sad little smile; “it’s only the life-giving waters of the sea in my eyes.”) If he falls, he’ll likely give way to one among the group of 40-something white guys who call themselves The Young Guns, which right there gives you multiple insights into some of the things troubling the Grand Old Party.
House and Senate staff members will take an 8.2% pay cut if their bosses don’t get a tax and deficit deal done before the end of the first federal pay period in 2013. Collectively, the staff are looking at more than $100 million in cuts for the year. Possibly this will have an impact on the negotiations. Their bosses, who included themselves among America’s Warriors and others so valuable or vulnerable as to warrant protection from any budget reductions, face a 0% cut (although their foreign currency conversion allowance will take a brutal hit). Even John Boehner will still get paid despite demonstrating live on national television that he can’t do the job for which he draws a larger pay check than anyone else in the House.
(“Who should get pay cuts?” “Well, let’s start with the obvious: not us. VA nurses first.”)
Continue reading Bobbing for sharks with Orange John Boehner
Don’t stop me if you’ve heard this before.
One would like to believe that in the face of a massive and growing emergency, our benevolent governors will recognize the need to do something, figure out what to do and then, do it. With respect to climate change, none of that is happening. I have created a very modest little mechanism through which anyone concerned can help exert some pressure on the Obama administration to at least begin developing a plan for coping with climate change, which I’ll get to downstream a bit.
Everyone who acknowledges the reality of climate change recognizes that it constitutes a crisis. Five years ago, a staid military think tank called the Center for Naval Analyses commissioned and published a report on the national security threat posed by climate change.
In the national and international security environment, climate change threatens to add new hostile and stressing factors. On the simplest level, it has the potential to create sustained natural and humanitarian disasters on a scale far beyond those we see today. The consequences will likely foster political instability where societal demands exceed the capacity of governments to cope.
CNA is populated by retired admirals and generals whose climate change concerns run mostly toward preparing the US military to cope with the consequences of long-term, escalating global unrest. They’re not a group of flamboyant alarmists. Neither are the technocrats and fat cats at the World Bank, whose concerns are keeping the world safe for development, and who last month issued a frankly terrifying report on climate change called “Turn Down The Heat,” in which they predict a 4-degree rise in global temperatures by the end of this century if the threat is left unaddressed. There is, say the authors, “no certainty that adaptation to a 4°C world is possible.”
In other words, if we proceed as we are then the next generation but one may get to witness the fabled end of the world as we know it, and we’ll all walk down a long mile of very bad road in the meantime.
Continue reading Pressuring the Obama Administration on climate change, redux
The giant sucking sound Ross Perot wants you to hear these days is him endorsing Mitt Romney on the basis of Romney’s presumed fiscally responsible policies. Perot, who wasn’t born yesterday, posits that history began in 2009 and says experts support Romney’s contention that the mome raths outgrabe.
Democrats, meanwhile, are shocked, shocked! that the company Romney once owned and still profits from is outsourcing jobs to China in a particularly callous fashion — requiring American workers at Sensata, an auto parts maker, to conclude their own employment by training their Chinese replacements. Illinois Senator Dick Durbin (who recently declined to sign a letter pledging to block Social Security cuts) is joining Sensata workers today in a show of solidarity.
Continue reading Free trade, terracotta candidates and cardboard bicycles
The invasion of Afghanistan and the overthrow of Libya’s Qaddafi are supposed by liberal interventionists to have been good wars. Most of them have by now had their fill of Afghanistan and want out, but getting out is likely to be a nightmare. The Libyan adventure is still quite popular, when it is remembered, but is well on the way to becoming a classic case study in blowback. A recent story in Foreign Affairs magazine, the house organ of the Council on Foreign Relations, named some of the harsh consequences of the war for nearby countries and Libya herself.
First, there are the weapons: The neighborhood, especially Algeria, Mauritania, and Niger, was always uneasy about Libya’s civil war. Many feared that it would pry the lid off Tripoli’s sizeable weapons cache and lead to the dispersal of arms across the region. It turns out that they were right to be worried. Then, there is the money: Locating Libya’s financial assets after the war has been another complicated matter. Members of Qaddafi’s inner circle who know where the money is stashed are missing or unidentifiable. Basically, billions of dollars might wind up in the hands of individuals who could use the cash to sponsor terrorism or otherwise destabilize Libya. And finally, there are the refugees: Tens of thousands of Africans, no longer welcome in Libya, returned home this year. Besides the fact that many of them are ripe for jihadi infiltration, they will further strain the region’s weak economies. Already, food security is becoming a major issue and famine looms.
Continue reading The good wars: Libya metastasizes and Afghanistan has a cobra snake for a necktie