July 31, 2009

Weiner Goes to Washington

Anthony Weiner awesomely introduces an amendment to completely eliminate the biggest government-run healthcare program:

 (a) FINDINGs.-Congress finds that-
  (1) Medicare is socialized medicine; and
  (2) Medicare is a single payer system.
 (b) ELIMINATION OF MEDICARE ELIGIBILITY UNDER PARTS B, C, AND D.-Notwithstanding any other provision of law, effective for items and services furnished on or after January 1, 2010, no individual shall be eligible or entitled to benefits under part B or part D, or part C insofar as it relates to benefits under part B, of title XVIII of the Social Security Act.

Disappointingly, not a single member of the committee voted to eliminate socialized, single-payer healthcare.

Posted by David at July 31, 2009 07:24 AM

Nice one! Thanks

Posted by: JoceM at August 4, 2009 06:19 PM

I give this an 'A' for gamesmanship, but a 'D' for making a point that changes opinions. Reductio ad absurdum doesn't usually work too well general politics.

Here's my rebutal: how about a bill that puts all of congress on medicare, instead of their 'gold plated' health plan. Would that pass? If medicare's so great, why hasn't this happened?

In any case - it is so dissapointing to me that Obama is missing his chance to use his intellect to change minds. I saw him on TV this morning and he looked just so partisan. Anyone who is opposed is a 'nay-sayer', with 'misleading' arguments trying to trick people.

No, not really. We have legitimate concerns. There are many articles that lay out a seemingly plausible sequence of events on how a public option would eliminate private plans. Why not go on TV and use your intellect to make a logical rebutal to this argument? Not just name calling, but real debate.

Or how about this article? http://online.wsj.com/article/SB124640626749276595.html. I'd love to see a point-by-point open letter reply published by the president.

I'm open. Change my opinion. But don't revert to this ridiculous partisan gamesmanship like Mr. Weiner, or the name-calling that seems far too prevalent these last few months. Make real points.

Posted by: Peter H. at August 6, 2009 02:50 PM

I had to deliberately misspell 'rebutal' above because the blog software seems to have a filter for

b u (double t)

anywhere in text. Interesting.

Posted by: Peter H at August 6, 2009 02:52 PM

Honestly, are these the words of a post-partisan, inclusive president?

"I don't mind cleaning up after them, but don't do a lot of talking."
President Obama, on the topic of health care reform, 8/6/09

Sorry if democracy gets in the way of your plans sometimes.

Posted by: Peter H at August 8, 2009 12:46 PM


You say, "Disappointingly, not a single member of the committee voted to eliminate socialized, single-payer healthcare."

Committee? So this wasn't voted on by the full House?

I ask this because it is being said that no Republican voted "yes" to this bill. I was wondering if Ron Paul had a chance to vote on it.

You are probably a busy guy, but I'd appreciate an email response. Otherwise, I'm not sure where to look for your reply!


Posted by: Kelton at August 8, 2009 05:09 PM

Am away on vacation.

Peter, I'm not sure where you heard that the quote at the Deeds rally was about health care reform. Obama's rally speech was about the economic collapse and the recovery act. More context in video and print:


Kelton - Weiner's stunt amendment never made it out of committee.

Posted by: David at August 9, 2009 06:17 AM

The problem with the healthcare debate is that you don't realize how bad your private insurance is until you get really sick. We have had serious health problems in our family recently, and we have discovered that our best-in-the-world doctor's health plan limits annual payouts on exactly the type of care we need. What's the point of health insurance if it stops coverage when you get very sick?

Even if you have a fat bank account, uninsured medical expenses hit you at the worst possible time: at the same time as loss of a wage earner. Medical expenses are the cause of more than half of personal bankruptcies. And note that 68% of these bankrupt families do have medical insurance at the time they go bankrupt. The insurance they bought is not giving them the security they thought they'd get.

Any shareholder will explain to you, of course, that the whole point of private health insurance is not to pay for your medical care, but to pay for dividends on shares of UNH, WCG, CI, or HUM. If one of these companies were to put the financial needs of their customers ahead of their shareholders, they would be breaking the law.

Private for-profit insurance is not inherently bad - life insurance, fire insurance, disability insurance, collision insurance - these are all far simpler products. You can read the one-page policy and you know exactly what you're buying. Consumers understand how to substitute competitors, so competition works to keep products fairly priced.

But when my health insurance comes with a 1000-page coverage details book listing obscure diseases I've never heard of and doctors I've never met, the only thing I can understand is "the insurer's actuaries have a huge advantage over me." The information gap between the statisticians and consumers works out to about $3b of annual profits at United Healthcare alone.

There is a contradiction between those who, on one hand, say "you would hate being on Medicare," and on the other hand also say "everybody would jump to Medicare, killing private insurance."

The truth, I'm sure, lies somewhere in the middle. But even if I wouldn't choose Medicare, I like the idea that the private insurers need to compete against an insurance plan whose 1000-page book of coverage rules are set by actuaries who are working in the public interest instead of on behalf of shareholders.

Unfortunately, the CBO estimates that extending public coverage (in the way Congress is proposing) would have a pretty small direct impact: after a decade, there would be about 11 million Americans on a public plan.


I bet many Democrats hope that the CBO number is an underestimate. But strangely, it is not Dems, but Republicans who are saying the CBO is guessing too low. Republicans believe far more people would choose a public plan. Conservatives have been citing a Lewin group study that estimates between 42 million and 131 million Americans would jump to a medicare-like plan, depending on how it is offered:


The Lewin group believes that a public plan would be able to attract many more consumers by offering much lower costs. They explain that a public plan like Medicare has excellent bargaining power, and it also does not have to pay insurance sales commissions or shareholder dividends. A public plan would also do a better job at meeting the needs of the very sick. In short, obviously huge numbers of consumers would choose the public plan because it is a better deal.

That sounds all pretty great to me, if a bit overoptimistic. Lower per-person costs, better care, better coverage.

Strangely, Republicans have been holding up the Lewin analysis as evidence that Obamacare is fatally flawed. They say the report is evidence that Obamacare will kill off private insurance, and begin an era of Socialism.

To that, three points: first, if you read the "dire" Lewin analysis, that's simply not what it says. It does say the private insurance industry would shrink due to its inefficiencies compared to a public plan, but the vast majority of Americans would still be on private insurance.

Second point is: the Lewin analysis is not exactly an unbiased analysis. The Lewin group is actually a subsidary of United Healthcare, the (second) most profitable private health insurer in the country, and they have a reason to do a bit of scare-mongering:


Third point is: why are we so worried about private insurance providers? Our health care is provided by doctors and nurses - and pharma and medical equipment manufacturers, hospitals, and researchers.

If somebody showed me a serious analysis that Obamacare would end medical research funding, that might give me pause. But objecting that it makes it harder to rake in profits as a private insurer? Is that really such a threat to the health care system?

As a doctor family, we had to pay for medical school and 12 years of medical training ourselves. NIH grants paid for some research years. We noticed technology improvements from pharma and equipment makers. We noticed the armies of nurses working at all odd hours. We noticed older physicians contributing hours in training the next generation. We noticed the people who changed the hospital bedsheets and the people who scrubbed the floors to an antiseptic shine.

There are many people who have devoted their lives to caring for patients. But last I noticed, Big Insurance only showed up when it was time to collect the money. Insurers have built a system over the last couple decades that makes doctors miserable with by imposing huge amounts of paperwork while still bankrupting their customers. I have not met a single doctor who believes that all the insurance paperwork improves the care that patients are getting. Note that is not true of all bureaucracy - doctors generally believe that UNOS organ allocation committees work well; they believe that medical certification boards generally make sense. The FDA is great. The CDC is terrific. And the NIH really stands at the center of modern medical advances.

The thing that the insurance system does well is generate billions in profits for insurance managers and shareholders. But while they may have served their shareholders well, they have not earned the trust they are asking of us as patients and doctors.

It seems like a good time to step back and reassess the hole we've dug ourselves into with private insurance.

Posted by: David at August 9, 2009 08:00 AM

David - thanks for this very detailed explanation. It's refreshing to get good argument to be able to respond to. I appreciate it.

I think my basic disagreement with this is that I don't believe the government should be in the business of delivering or administrating health care, at all.

I'm genuinely sorry to hear about your troubles with your plan. I want better for you.

However - there is a basic fact which is, public or private, dollars for health care are limited. Thus, there will always be cases of saying "no".

I would much rather have a private system make those "no" decisions than have the government make them.

Do we really prefer to have the government tell us what care we can and can't have, and ultimately in effect have the government decide whether we live or die? Do we want our congressmen doling out health care the same way they dole out tax largess to special interests today?

Here's a different angle. Many studies say that some 50% of the entire cost of care in the typical person's life will be spent in the last year of their life. Is it the government's responsibility to be there to ensure that a person lives not 78 years, but 79?

Finally just the fiscal angle - medicare and medicaid are the two entitlements most direly slated to "bankrupt" the federal government with their growth. I don't see how it fixes anything financially to expand government-provided care.

I am very open to the idea that we need reforms to make differences between plans more transparent, or other reforms to make the private insurance business easier to live with.

However I just do not believe that the government should be in the business of providing health care. We are a capitalist nation. Each person needs to achieve their own destiny. Someone will always have to decide who gets their care funded, and who doesn't. I just reject the notion that the government should decide whether I live or die. I want to be able to make that decision based on the results of my own industry.

Posted by: Peter H at August 11, 2009 02:36 PM

Obamacare isn't about government "deciding whether you live or die". The sad truth when you get sick is "deciding to live" is not always a real option. The real choice is how much of your money you spend on doctors, and you still have that choice under Obamacare, whether you use a government insurance plan or not. You are still free to spend your own bank account down to zero.

What's Obamacare about? It's about trying to squeeze waste out of the system. Which means that, if you're a doctor who makes money by ordering lots of unnecessary procedures, if Obamacare works, you'll get less money.

Most doctors don't try to waste money, so AMA supports Obamacare. Same with the nurses, pharmas, etc. Believe me, if Obamacare tied doctors hands in any way on "whether you live or die", the AMA would NOT support it.

Why does the health insurance industry stand alone in opposing healthcare reform?

Maybe it's because health insurers create profit not by caring for patients, but by creating inefficiencies. By withholding payments to doctors, by double-billing patients, by overcharging premiums when you're healthy and dropping you when you get sick, and by subjecting everybody involved to a massive bureaucracy of insurance rules, the health insurance business makes their profit on exactly the kind of market inefficiency that Obamacare is trying to squeeze out.

My mother-in-law spends about half of her waking hours on the phone with health insurance companies reading their own policies to them, and pointing out all their double-billing. Somebody is getting paid to talk to her all day.

I'm not sure who that benefits.

Posted by: David at August 11, 2009 06:22 PM

On Peter's concern of having "Congressmen dole out health care benes" like they hand out defense contracts today - that is a very real concern.

Doesn't the proposal of empowering MedPac address that concern? Under Obamacare, MedPac would be empowered to make cuts without Congressional action. That would make it politically much harder for Congress to micromanage medicare policy.


Come to think of it, we really could use some sort of MedPac for defense contracts as well.

Posted by: David at August 11, 2009 07:13 PM
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