POLITICS MARCH 5, 2010
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When you consider the differences between Democrats and Republicans on health care, you probably think in terms of scale. Democrats want to enact a big reform, while Republicans favor incremental progress. House Minority Whip Eric Cantor coos, “We want to take a much more commonsense, modest, incremental approach, trying to address the first issue first, which is cost, and then go on to try to deal with some of the things that the president and Speaker Pelosi want to do.” Within a recent six-month span, Republicans on the Senate floor used the phrase “step-by-step” to describe their approach to health care an astonishing 173 times.
The reality is quite different. What separates the two parties is not how far to go, but in which direction to go. The divide is simple. Democrats propose to shift resources from the rich and the healthy to the poor and the sick. Republicans want to do just the opposite. Republican health care plans reflect the party’s increasingly widespread belief that good health, like other forms of prosperity, is a matter of personal responsibility. Democratic plans to help the sick at the expense of the healthy therefore amount to socialism.
Health insurance, if you think about it, is a redistribution scheme. It transfers money from the winners (people who don’t need much medical care) to the losers (people who do). It differs from other redistribution schemes because, unlike programs that redistribute from rich to poor, the winners and losers can’t be sure in advance which category they’ll be in. That’s why people enter into it voluntarily--today I might be healthy, tomorrow I may contract some horrible disease.
The problem with this system is that, while you can’t be certain who will win and who will lose in the medical lottery of life, you can make some educated guesses. The health insurance industry is good at making those guesses, and getting better all the time. The business of insurance is to keep expensive customers out and cheap customers in.
Left to their own devices, millions of Americans could not afford to buy health insurance, because their expected medical costs are too high--they’re the losers of the medical lottery--or their incomes are too low. Obviously, many Americans are left to their own devices, with horrifying results. But many more are not, because they’re lucky enough to get insurance through their job. In an office insurance pool, everybody pays the same rate, meaning the healthy subsidize the sick.
The Democrats’ health care plan aims to create pools for people outside of the employer market, joining healthier individuals together with the sick, so that the former effectively subsidize the latter. The common element of all the Republican plans is to do the opposite-to separate the healthy from the sick.
Republicans have long championed Health Savings Accounts, which give individuals who buy insurance a tax deduction for money they set aside for a high-deductible plan. Since tax deductions are worth more to people in higher tax brackets, and since high-deductible plans appeal more to those with lower medical expenses, the plans attract the rich and healthy, leaving the poor and sick behind.
The thrust of the GOP ideas currently on offer is to reduce health insurance regulation. Republicans would create financial incentives that, according to the Congressional Budget Office (CBO), would encourage states to cut regulation; they would also let businesses and individuals buy insurance from other states. (Health insurance is regulated by state governments.) As a result, health insurance regulation would sink to the level of whichever state offered the laxest regulations. If it worked like the credit card industry, governors would be competing to undercut each other’s regulations in order to lure insurers to their states.
Some state regulations are meant to protect all consumers, by requiring licensing of doctors, a fair appeals process for claims, and so on. But many are specifically aimed at helping sick people. Some regulations require that certain procedures must be covered--cancer screenings, diabetes treatment, and so on. Others limit the degree to which insurers can charge higher rates to small businesses or individuals that have higher health risks. Reducing these regulations would reduce costs for the healthy, but raise them for the sick. The GOP’s solution for those with preexisting conditions is to shunt them into state high-risk pools, which (as my colleague Jonathan Cohn has explained) work very poorly and which the Republicans would deny adequate funds.
Republicans boast that the CBO says their plan would reduce insurance premiums. This is true. The CBO predicted this would happen because the GOP plan would reduce premiums for healthy people, bringing more of them into the insurance pool, and raise premiums for sicker people, driving more of them out.
Why would Republicans favor a result like this? The better question might be, why wouldn’t they? The modern Republican domestic agenda is, above all, an attack on redistribution, a crusade to free society’s winners from shouldering the burdens of its losers.
The core of this philosophical divide was on display in last week’s health care summit. Senator Tom Harkin, a traditional liberal, denounced policies that “allow segregation in America on the basis of your health.” Harkin’s point was that the only way to protect the sick is to pool them with the healthy. Conservatives seized upon Harkin’s remark. “Having people pay their own way,” mocked an incredulous Jeffrey Anderson, a former health care speechwriter in the Bush administration, “is apparently an injustice akin to segregating them by race or creed.”
“Pay their own way”--that gets to the heart of the party’s new vision of health as a consequence of personal morality. “I think a national health care act substitutes for a lack of personal responsibility,” complained Republican Representative Steve King last August. Newt Gingrich gloats that Americans have moved “away from the idea of government-run health care and toward more personal responsibility.”
Liberals have reacted with astonishment to conservative accusations of socialism against Obama, whose plan relies mostly on private insurance and closely resembles proposals put forward by Senate Republicans in 1993 and Mitt Romney in 2005. It is, however, socialistic in the broad sense of spreading the risk of medical misfortune. This is a goal that Republicans increasingly abhor.
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27 comments
"The modern Republican domestic agenda is, above all, an attack on redistribution, a crusade to free society’s winners from shouldering the burdens of its losers." Well said. Modern Republicans, at their core, are selfish; many modern Democrats, at their core, may be jealous of society's winners. Isn't it short sighted of society's winners to think that they will be better off if society's losers are not cared for? Wouldn't society's winners be better off to be slightly poorer but still be winners in a society where the suffering of the losers was mitigated to some extent? Can't Obama say, "Look Eric Cantor, you will be rich and powerful for the rest of your life regardless of whether or not the sick and poor have health insurance, but you will be better off as a rich and powerful person in a society where the sick and poor suffer less than they do now in our society." Modern Republicans have a higher tolerance for suffering among the sick and the poor than do Democrats. How do modern Republicans (and The Family) reconcile their lack of responsibility to alleviate the suffering of the sick and the poor with their Christian faith?
- sharib
March 5, 2010 at 6:06am
Personal responsibility is essential to a free and prosperous society. And the Obama HCR plan promotes it by requiring all Americans to pay their fair share of health care costs. Today, the irresponsible, as well as the poor and those with pre-existing conditions, don't pay their health care costs, instead relying on the ER at the local hospital or the good works of local providers for "free" health care. But we know that there isn't anything free about it, as hospitals and providers charge their insured and well-off patients more to make up for the "free" care. The Obama plan will require most Americans to buy health insurance, with the net premium paid by lower income folks less in order to make it affordable. That way most everybody pays. Personal responsibility, a key feature of the Obama HCR plan.
- raylward
March 5, 2010 at 7:30am
Excellently put, raylward. Meanwhile, shortsightedness has been a key feature of Republican policy for some time now. "I mean, people have access to health care in America. After all, you just go to an emergency room." -George W. Bush, July 10, 2007. I wish that Obama would have figured out how staunch the opposition was ten months ago and just switched to starker arguments. Here's what he should have said yesterday: "What's the hurry? Well, the Republicans have stalled the process for a year and 30,000 people have died since we started talking because they don't have insurance. 30,000 dead. Ten 9/11s. Every other modern country has solved this problem, most decades ago, and I'm not willing to have another death on my conscience to appease Republican hatred of the poor."
- janus
March 5, 2010 at 10:13am
If you want a preview of how class resentment with a few super rich and everyone else has little to nothing, and how it foments instability, just take a look south at Latin America. It's not a pretty picture. A winner-take-all society is one that becomes unstable. And I'd call the modern GOP anything but Christian. At it's core, Christianity is a bleeding heart, borderline communist religion. If you study the ancient Church, as professed by Christ, it wasn't too far off an idealized version of Marxism.
- tnmats
March 5, 2010 at 10:35am
One need not look only to Latin America. One can look at any political entity anywhere in all of human history. The one law of human society that is applicable in all times is this: Material wealth and political power cannot long be separated. Republican government distributes power widely, and so it cannot long survive if wealth is not also distributed widely. When a very few hold greatly concentrated wealth, either the wealthy few will use their wealth to take power from the many, or the poorer many will use their power to take wealth from the few. In either case, liberal democracy cannot survive the struggle. In the United States, the breadth of the middle class permits more concentrated wealth at the top than in most previous or contemporary republics. The danger is the generational ossification of wealth, and there the United States is already in grave peril. America has much lower levels of social mobility than most developed republics; personal initiative and merit plays a smaller role in determining a person's place in America than in just about any other self-governing nation. And it's precisely the mechanisms of state and culture that counter the rise of dynastically concentrated wealth that conservatism attacks. Many conservative policies actually run counter to the interests of anyone seeking to create a fortune, but conservative policy in every instance favors the interests of those who, having a fortune, wish to pass it to their heirs. Thus with healthcare too, where the caprices of fate make medicine a Bizarro-world lottery where at any moment, the average person could have a hard-earned fortune taken from him, while those seeking to preserve wealth, not build it, can afford to ride out any medical emergency. Our current healthcare system acts as a randomized barrier to the accumulation of earned wealth.
- rhubarbs
March 5, 2010 at 11:07am
Rhubarbs, you mean the death tax and affordable health care not tethered to a job is a good idea?? No way. That's not what Sarah Palin told me.
- tnmats
March 5, 2010 at 11:33am
"Newt Gingrich gloats that Americans have moved “away from the idea of government-run health care and toward more personal responsibility.”" How in the hell does the GOP square this sentence with support for Medicare? Forget the GOP, how the hell does Gingrich square this with his attacks on supposed Medicare cuts? I'd love for once to see them propose abolishing the VA system and Medicare. Get government out of the health care business and mean it. We'll see how that works. Not. The rank hypocrisy and lies from the GOP never cease to nauseate me. I could handle their Dickensian attitudes if they actually worked to implement their ideas in the open but they won't.
- tnmats
March 5, 2010 at 11:39am
It would be so much easier to accept the critiques of public health insurance by Gingrich, Cantor, King and the rest if they were not entitled to practically unlimited, low-deductible health insurance for the rest of their lives by dint of their current or former employment as public elected officials. Or is the fact that they managed to win election to Congress in gerrymandered districts proof of their being "winners" in the game of life, thereby entitled to the fruits of low-cost, affordable health insurance in perpetuity?
- wildboy
March 5, 2010 at 12:20pm
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- candide
March 5, 2010 at 12:44pm
Candide, that would be a nice philosophy if we were really talking about the poor -- but we're not, we're talking about the middle class and the rich. The poor, remember, have Medicaid and SSI and state and federal welfare programs to cushion their poverty. Republicans may want to eliminate all of those in their perfect world, but they don't dare touch them in this economy. What we have instead is a policy that actively favors the wealthy and those who are healthy (today) versus those who are middle class and not healthy (today or tomorrow).
- wildboy
March 5, 2010 at 1:05pm
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- candide
March 5, 2010 at 1:36pm
That's a good idea, Candide, but why don't we take it further -- let's see to the healthy lifestyles practiced by the likes of John Boehner (chain-smoking and artificial tanning), Newt Gingrich (love of ice cream and cake) and Dick Cheney (multiple heart attacks, general lack of exercise other than sitting in duck blinds), just off the top of my head. Now let's imagine if all of them were not entitled to cheap, government-paid health care for the rest of their lives and see whether any of them could afford health insurance at any price.
- wildboy
March 5, 2010 at 2:07pm
Candide, with all due respect, your comments are nauseating. My mom did everything right - ate carefully, never smoked, rarely drank, was physically active and "caught" leukemia nevertheless. She died, age 50. Besides the anguish of losing a person like my mom, treatments for serious illnesses can bankrupt a family. How would you like it if your insurance company denied coverage for livesaving treatments, kicked you off your plan or made it impossible for you to get coverage in the first place? These are literally life and death issues and to assume that people "deserve" illness is outrageous. This is the situation confronting millions of Americans - some of the most poignant cases involve children who suffer from chronic disease and therefore are denied coverage. Charles Dickens? The Republican attitude - sick people here, well people there - huh. This reminds me of something way worse than Charles Dickens.
- Sophia
March 5, 2010 at 2:24pm
"The poor you have always with you. And there will always be a ruling class. What to do about it? History shows that doing less is more likely to do good than doing more." Examples please. Concrete examples.
- tnmats
March 5, 2010 at 2:57pm
How did all the wacko wingers start appearing on these boards? JC, you guys must be getting spammed in some weird way. One serious poster that I do miss is Tep. Wonder what happened to him.
- tnmats
March 5, 2010 at 3:03pm
Thanks Wildboy. You show yet again the rank hypocrisy from the GOP.
- tnmats
March 5, 2010 at 3:10pm
While I undertand the point of your piece, characterizing health insurance as "socialistic" and as a redistribution from the healthy and the wealthy to the sick and the poor is misleading and simplistic. (Though I am sure it is music to GOP ears.) The GOP has treated health insurance reform as though it is a form of welfare, warning the American people that insurance reform forces those who work hard for a living to pay for lazy slackers who get sick because they don't take care of themselves. But disease and illness strike people at all ages and at all points on the income scale. There are plenty of middle class, upper middle class, and even "wealthy" Americans who have no insurance coverage because they have become uninsurable. Though people at the higher end of the income scale have more resources, only the very, very wealthy can afford to pay the costs of catastrophic care such as bypass surgery or aggressive chemotherapy. Rather than characterize insurance reform as a transfer of resources from the wealthy to the poor, I would say it is a transfer from those who are (for the time being) insured to those who have been dumped or exluded from the insurance market.
- kkamisar
March 5, 2010 at 3:14pm
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- candide
March 5, 2010 at 4:19pm
As I expected, a true believer. Hitler and Stalin showed up. Figures. Why'd you waste your $30+?
- tnmats
March 5, 2010 at 4:31pm
Candide, the fact that your last post is redolent of reactionary Catholicism makes your name on this forum all the more ironic.
- wildboy
March 5, 2010 at 4:41pm
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- candide
March 5, 2010 at 5:20pm
Herein lies the simple distinction between the GOP and Democrats and other progressives pushing for HCR. The GOP and other HCR opponents like to paint HCR as a distribution of wealth. But it really amounts to is whether or not you view basic health care as a human right or a privilege. If you see all forms of health care as a privilege of wealth then there is no need for HCR. However, if you see basic health care as a basic human right, much like clean water, clean air and basic shelter, then support of HCR would be a given. The GOP purposely conflate basic health care access and services with the privileged ability to pay for elective plastic surgery for your nose and breast implants. As someone who has had no coverage for several years because I couldn't afford it and my employer didn't offer it, to having variations of the HMO, PPO and HSA, I would still support HCR because I actually "think" it would help everyone - from upper middle class on down to working-class poor, have access to and be able to afford reasonable health care insurance and have access to basic health care services. I also understand the idea of the 'Common Good' and what that means as a participant in not just a democracy by name but as a participant in a civilized and modern democracy.
- singlspeed
March 5, 2010 at 5:45pm
Health care isn't a right or a privilege -- it is a basic, human responsibility. One of the basic moral, mutual responsibilities that are required to create a productive human society; the young and strong are responsible for the vulnerable and elderly, adults are responsible for children, the healthy and whole are responsible for the care and comfort of the ill and dying. A society that hasn't, can't or refuses to develop workable, humane ways to discharge these basic human responsibilities is weak, decadent and depraved. Candide, you can't be actually suggesting that your attitudes come from the Catholic Church? Try running that notion by the Sisters of Mercy or Providence.
- esmense
March 5, 2010 at 6:23pm
We have all seen caricactures of Obama's proposed takeover of one sixth of our economy as socialistic, with jokes about "Big Brother," death panels, and people calling each other "Comrade." This makes people who favor passage of the healthcare bill roll their eyes, saying, "Come on now, that's just silly." So imagine the response of people who are against this government takeover of our healthcare, when their viewpoint is caricaturized as "Dickinsonian?" Personally, my response is "Oh, pulease!" It's a cheap argument, because the government-takeover people don't have logic on their side and they have to re-sort to ridiculous emotional hyperbole like this. How about this? Let's say the government decided to take over UPS and turn it into a government agency, like, hmmm....the Post Office? Most Americans would say, Oh, God, please don't do that! And surprise, surprise, the Post Office is about to go bankrupt, due to the typical government way of mis-managing things. Now they're going to cancel Saturday service because they can't afford to keep it going. (On the same evening that was announced, I saw two expensive, irresponsible Post Office TV Ads---a private sector company would not be running ads if it was about to go bankrupt, believe me). Would there be any good argument to switch to a government mail service, and wipe out UPS? Of course not. So, anyone advocating the takeover would have to make some emotionally manipulative argument that pictures the UPS man as some sort of evil Dickinsonian character, say, Scrooge because he represents a profit-making enterprise.... Ridiculous? So is your article.
- wisemom
March 5, 2010 at 7:38pm
wisemom -- The postal service hasn't been a "government agency" since the 70s. It is a business that must make a profit and survives without government assistance. It also processes more than 50% of the world's mail and delivers for UPS and Fedex on weekends and in those areas where those private carriers do not offer service. It is not in any way going "bankrupt" -- it is suggesting that service cuts may have to be made to keep it profitable. I run a mail order business, I know, it's clear, a lot more about this than you do. If the Post Office went under, it would be bad news not only for businessness like mine but for UPS and Fedex which could not begin to operate profitably without the postal service to rely on for back up. Now, if Fedex went under, it wouldn't affect my bottom line at all -- they don't have sufficient coverage in the rural communities where most of my customer base lives. They have limited their service to the easiest and most easily profitable jobs in the most populated parts of the country -- everything else is left to the US Postal Service. If you had to depend on Fedex for all the things you now get from the post office, you'd be singing a very different, and far angrier, tune. As for health care, there is nothing of course in any of the plans put forward so far that amount to a government takeover of health care. A few rules for the road for the PRIVATE health insurance industry and a little extra funding so that some people can better afford health services from PRIVATE providers is all that is being suggested. So, wisemom, I think you need to wise up. And learn a little bit more about shipping, health care and your country.
- esmense
March 5, 2010 at 8:06pm
"The health of the people is really the foundation upon which all their happiness and all their powers as a state depend." Benjamin Disraeli Speech of 1877-06-24 and wasn't it Bismark, that other conservative, who introduces healthcare to Prussia in 1883?
- jdyer
March 5, 2010 at 10:49pm
A bit of history from our own Social Security Administration: http://www.ssa.gov/history/ottob.html Germany became the first nation in the world to adopt an old-age social insurance program in 1889, designed by Germany's Chancellor, Otto von Bismarck. The idea was first put forward, at Bismarck's behest, in 1881 by Germany's Emperor, William the First, in a ground-breaking letter to the German Parliament. William wrote: ". . .those who are disabled from work by age and invalidity have a well-grounded claim to care from the state." Bismarck was motivated to introduce social insurance in Germany both in order to promote the well-being of workers in order to keep the German economy operating at maximum efficiency, and to stave-off calls for more radical socialist alternatives. Despite his impeccable right-wing credentials, Bismarck would be called a socialist for introducing these programs, as would President Roosevelt 70 years later. In his own speech to the Reichstag during the 1881 debates, Bismarck would reply: "Call it socialism or whatever you like. It is the same to me." The German system provided contributory retirement benefits and disability benefits as well. Participation was mandatory and contributions were taken from the employee, the employer and the government. Coupled with the workers' compensation program established in 1884 and the "sickness" insurance enacted the year before, this gave the Germans a comprehensive system of income security based on social insurance principles. (They would add unemployment insurance in 1927, making their system complete.)
- roidubouloi
March 5, 2010 at 11:30pm