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March 09, 2010

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Bruce

Jodi,

Are you familiar with the work of David Graeber? If not, you might find his work interesting. http://en.wikipedia.org/wiki/David_Graeber

Alain

This is precisely what is wrong with private health insurance. they only make money if they deny coverage or push the cost on the patient or a third party (like the school). I have been paying tens of thousands of dollars a year on health care the last several years and it is a scam. And unfortunately, even the current "reform" simply wants to pass more of the cost on the insured and the government, and does very little to limit what the insurance companies can charge. And this seems to be the chief issue for progressives who are critical of the President's bill - there is not enough to controll costs without increasing the burden on all of us.

Jodi

Thanks for the comments.

Bruce--I've of course heard of Graeber but haven't read him. The wikipedia article links to an interesting article on debt in Metamute. And this makes me think that I should try to get him to submit an article to Theory and Event. Thanks!

Scu

This is something I've found myself unable to stop talking about. I think it is probably because my family has twice almost had to declare medical bankruptcy.

But the idea this is some sort of bailout for the insurance companies is a logic that hasn't made much sense to me. And it doesn't seem to make much sense to the insurance companies, who have launched several campaigns to stop reform no matter what. For example, see this article http://www.washingtonpost.com/wp-dyn/content/article/2010/02/27/AR2010022703253.html?nav=hcmodule

Also, I've noted elsewhere there are several reasons the insurance groups hate health care reform, http://criticalanimal.blogspot.com/2010/01/more-on-health-care-why-insurance.html

Lastly, I think the idea of judging the bill's qualities based on how much it hurts insurance companies has a personal, affective appeal, but is really a terrible metric. Why not judge it based on its ability to decrease medical costs for most people? Decrease bankruptcies? Expand coverage and improve health outcomes? Increase both economic and health security for millions of individuals? Those seem like far more important metrics than the amount of revenge I can get against institutions (health insurance companies) I hate.

Rebecca Hope

Hi Jodi

this is a bit unrelated.. but I'm a big fan of your blog..and your writing on Zizek.
have you read "After Finitude" by Quentin Meillassoux?
I am really struggling to get my head around how it fits in with other contemporary philosophers such as Zizek.. in particular the correlationist circle notion.. does this include Zizek? i think he means it includes everyone.. just i am new to philosophy and trying to get my head around how one person's writing relates to another...
anyhow I'd be really grateful for any advice thanks a lot.. Rebecca

Alain

Scu, I think most progressives do not support the bill because they think it forces people to buy expensive insurance (with the help of government subsidies) that doesn't provide good coverage and pushes more of the out of pocket costs on people who already cannot afford it. I have looked at several different cost analyses and I think these criticisms have some merrit. I think this has less to do with punishing insurance companies and more to do with mediocre legislation.

Scu

Alain, that is also an argument, but I am not entirely sure where it comes from.
There will be an individual mandate (which is the only way to make the exchanges work), and as you point out there will be subsidies (and also exceptions). And if you decide not to purchase insurance, there is a raise (I believe 2%) in your income taxes. So, I find it hard to believe that this will economically crush people. As far as the insurance being worthless, that seems the strangest point to me. Right now, there are only state regulations on what has to be offered by insurance companies, in the exchanges there will be federal mandates (and also state mandates) for what a basic plan will have to offer. Is there some objection in particular you feel that the insurance won't cover?
There will also be caps put on out of pocket expenses. This is necessary for people not to come close to the brink of medical bankruptcy (or go over it). Jonathan Cohn has some excellent charts about this, over here http://www.tnr.com/blog/the-treatment/what-reform-means-families-reponse-firedoglake-others

There are some other charts I am still trying to find on this issue.

What are the cost analysis you have found persuasive?

And my comments about punishing insurance companies comes from the refrain that this is a bailout for insurance companies, a giveaway, etc.

Scu

Sorry to double post, but I found the link to Nate Silver's graph on health care. And I should add that the subsidies have become more generous, not less, since he made this graph.

http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html

Alain

Scu I need to look for the online sources of my skepticism but even Nate's handy chart doesn't look all that great to me. This imaginary family could still be paying up to 17% of their income on health care (cost of insurance plus out of pocket cost). While Nate is correct that it is better than the status quo, it isn't that much better considering the imaginary family has the option currently of not buying any insurance and praying they don't get sick. I have also read that there is a giant loop hole in the Senate bill that allows the insurance companies to set “reasonable” annual caps on coverage. But what’s a “reasonable” cap? The bill doesn’t say and I would think the insurance companies have some creative ideas.

I am like you and have almost had to declare bankruptcy because of medical bills (and I have what is considered pretty good insurance). Everything I have read about the Senate bill doesn't seem to address the underlying problems of cost. My understanding is the "medical loss ratios" are set at a minimum of only 80%. That isn't much of a base line to work with.

I am not someone who wants to demonize the insurance companies (I in fact work for one in a different industry) but it is clear that the current bill is at best a down payment on real health care reform and at worst a giant subsidy for individuals to buy expensive insurance.

Alain

Here is one of the posts I was thinking of : http://emptywheel.firedoglake.com/2009/12/27/affordable-health-care/

Interestingly, Nate actually engages with this criticsm and I believe there is back and forth between the two. I do not remember the details, but I do recall that i found Nate's arguments lacking. But honest folks can disagree about this and even though I do not like the Senate bill, I support it for the simple fact that it does put into law the worthy notion that the government has a responsibility for ensuring everyone can get health insurance - however imperfect.

Jodi

Thanks, Scu and Alain, for your discussion. Both of you raise good points. I take Scu's point about demonizing the insurance companies as applying to me. It's a good point--anger and emotions can lead to poor politics. And they can lead to efforts to change policies. My own sense is that without a public option, strong coverage, and caps on price increases, we don't have national health care at all but forced privatization. I might be wrong. And even if my point isn't wrong my implication (that this is bad) might be wrong--it might be the first step toward something better. And even if it is not a step toward something better in the next 5 years, it could be 5 years after that.

Thanks, Rebecca. Yes, I've read "After Finitude." Actually, Zizek first recommended it to me. I don't know exactly what he thinks about it; my recollection is something like he thinks that Meillassoux isn't wrong but that his solution had already been found, perhaps by Hegel? Zizek has an appendix in Adrian Johnston's new book where he discusses Meillassoux. So you might look there.

Peter Hallward has a review of "After Finitude" in Radical Philosophy that is helpful:

http://www.radicalphilosophy.com/default.asp?channel_id=2369&editorial_id=27454

and, a response (not by Meillassoux)
http://speculativeheresy.wordpress.com/2008/11/16/on-after-finitude-a-response-to-peter-hallward/

Scu

Alain, thanks for the link. When I get more imaginary free time I will try to go over the numbers a bit more. Needless to say, I would like for higher subsidies and lower caps on out of pocket expenses. As a matter of fact, when it became obvious we weren't going to have a strong public option, I with the left would have fought more for those things than for a weakened public option.

Jodi: I certainly am not saying that strong emotions (including anger, rage, etc) cannot help ground a good politics. But in this case I think it is a poor metric.
The public option is obviously off the table for the time being, but there are fairly decent protections put in place to manage price increases (definitely better than the none existent protections in the status quo). And I am still not entirely sure what people mean when they feel that strong coverage is not being offered. The minimum insurance products being allowed in the exchanges look pretty decent to me.

I'd agree that this bill doesn't do as much as I would like, but I also think you are right to talk about creating structures. The idea of regulated exchanges that act as prudential purchasers and force community ratings on insurance companies is a whole different ballgame. Especially when we include that non-profit insurance companies will be in every exchange. Also, the more people who end up in something like the exchanges end up creating a large political class for better insurance regulations.

The other thing I'd like to talk about is that the health care bill is filled with changes to the delivery system of health care. About half of the bill, actually, is devoted to these various reforms. Most of them are pilot projects with the ability to gather data and be fast tracked into direct changes in medicare reimbursement rates (which helps shift the entire medical field). These actions are crucial if we are going to be able to produce better medical outcomes while also reducing the costs of medicine. The bill also contains more funding for comparative research in best practices. An editorial in today's LA Times helps show the importance of this http://www.latimes.com/news/opinion/commentary/la-oe-hochman10-2010mar10,0,3812725.story

This is one of the many ways that the way we practice medicine in this country is way too privatized. While the more vocal discussion has been about the relationship between privatized insurance vs public insurance, (in other words the degree that coverage should be public), not enough has been focused on how the present bill begins to alter the practices of medicine in fundamental and important ways. Bundled payments, better information to doctors, incentives for hospitals to keep you healthy and not getting infected while in the hospital, etc., are all in the health care bill. These are necessary and exciting reforms in the delivery system of health care itself.
In general I think the bill begins the job of setting us on the right path. Expanded coverage, better insurance products, the end of the wild west of the individual market, a system that we move out of the employer based model to, the government taking an actual role in helping people pay for coverage, and also half a bill on changing the ways medicine is practiced in this country.

Rebecca Hope

Hey Jodi

thanks for the links both really useful, I'll have a look for Adrian Johnston's book also.
Your health care debate is a little scary.. I am in the Uk, I work as a nurse, am so glad that I dont have to worry about whether my patients have health care insurance before I treat them.. yet the politicians are desperate to get out of having to finance the NHS.
We could all be moving towards the US model come our elections in May.. so will keep watching to find out what happens..
thanks again Jodi

Jonathan Versen

Hello jodi,
I don't know if it would make any difference, but you could write to your state departments of insurance and state attorney general offices regarding the threats from your insurance company, with photocopies of the letters you got from the insurer. Preferably sending them registered letters, and rather than being irate simply expressing your concern, and let the insurer then also know you have done this.

If you do that, then you have recorded the threat with government agencies prior to any subsequent actions they may take against you, and a paper trail. I am not a lawyer, but it occurs to me that

1.they will be less likely to jerk you around at that point, and

2.generally speaking, everybody who gets the heavy treatment from their insurers should do things like that, because the more complaints that state AG offices have, the more likely they are to act against said insurers.

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