Stop Me Before I Vote Again

Paine's latest strategy in fronting for the HMOs sham "public/private" hybrid plan is to loose a torrent of metaphor and long-winded prolixity not seen since the last time Robert Byrd mounted the podium in the Senate.

Paine characterizes the advocates of single-payer as a group of ultraleft ultimatist Radical Ricks who fail to understand the need for incremental reform, who want to storm the Bastille today rather than seeing the need to chip away at the foundations stone by stone, etc., etc. (At least I think that's what he's saying--his post is like a Superfund site of into which he has dumped such a huge pile of verbal garbage, one can't be sure.)

So in Paine's bizarre political construct, the ultraleft of American politics is populated by . . . whom? The Spartacist League? The Socialist Workers Party? ISO? Revolutionary Communist Party, USA? No . . . the ultraleft consists of the following beady-eyed Bolsheviks: Ralph Nader, Joseph Stiglitz, Paul Krugman, Russell Mokhiber, Rose Ann de Moro (head of the California Nurses Association), John Conyers, Dennis Kucinich, Physicians for a National Health Plan, etc. Their ultraleft sin? Pushing for single-payer and opposing any compromise such as the phony-baloney HMO-rescue hybrid plan so beloved of the DLC mainstream Democrats now ensconced in the White House and Congress . . . AND, their unpaid toady here at SMBIVA, Owen Paine.

The shortcoming of Paine's posts on this subject are many: the usual insufferable, bluffing orotundity, to be sure, but that's the least of it. The guy is just obtuse--completely unable to grasp one simple essential truth of this matter than has been conclusively demonstrated to him several times now: the Stark public-private option plan is NOT a reform or a step forward of any kind. It is not an incremental advance toward single payer. It is expressly designed to sabotage single-payer permanently by gaming the system so decisively in favor of the private HMOs that the public sector will be made to look impossibly expensive and unworkable.

The problems of the current profiteering chaos are legion: complete lack of coverage for tens of millions, premium price-gouging, huge deductibles, gaps in coverage--the whole profiteers' bag of tricks to extract the maximum bucks for the minimum coverage. The benefit of single-payer (or multiple-payer nonprofit) systems in the rest of the world is RISK POOLING--by having the sickest, oldest, and the poorest in the same pool as the healthiest, youngest, and wealthiest, risks and therefore costs are averaged out in a way that makes the system as a whole far more efficient. It does away with all the worst aspects of the current rookery: no more siphoning off of profits, no more stratospheric executive compensation, no more wasteful staffing to track billing and exclude coverage.
The hybrid plan so beloved of Paine and the DLC centrists (of which Paine is one at heart, as I've repeatedly demonstrated) is that IT SOLVES NONE OF THESE PROBLEMS. In a Stark-like plan, the HMOs would be able to use aggressive and unscrupulous marketing to cherry pick the young and the healthy; the old, sick, and poor would be shunted into the public sector. Unburdened of the worst risks, the private plans could then substantially undersell the public plan; the public plan, saddled with the worst risks, would incur untenable costs. Far from driving the private HMOs out of business, the Stark plan would drive single payer out of business--for at least another generation. AND THAT'S THE WHOLE POINT--it's the HMOs plan B--they'd rather have no public sector at all. But if you let the government in, make it on circumstances so unfavorable that you end up winning anyway. For the HMOs, not matter which corporate plan is on the table, it's "heads I win, tails you lose."

So here's the point, Paine, and listen VERY CAREFULLY this time so that the point doesn't escape you YET AGAIN: your Stark hybrid plan is not "reform" any more than welfare reform was "reform." It's putting lipstick on the pig of this country's unconscionable, barbaric system of profiteering off of human illness and death. The Stark plan comes not to praise single player (with a partial concession to it), but to bury it by burdening the public sector with untenable risks and costs.

The hybrid plan will achieve neither of the key objectives of real reform: achieving universal coverage or reducing costs. In the Stark plan, the public sector will have to charge premiums--probably uncompetitive premiums because of its risk-laden cohort. This plan will not reduce costs--the HMOs will still go their merry inefficient, gouging way. The law will mandate that all purchase one or the other coverage, but not all will be willing or able to pay for it, so millions will remain completely uncovered.

So single payer is the only way to reform this system. The half-measure of the Stark plan is a con--it's a rigged game that will retain the status quo. Far from serving as a half-step toward single-payer, it will starve the public plan and thus politically bury single payer, while leaving all the toxins of the current system firmly in place.

Why would Paine, a professed Marxist/socialist, be pushing this arrant corporate PR con game? It makes him feel like a "knowing," "wise," "practical," political insider, in contrast to all those rabid ideologues who don't understand the "limits" of "real political choice." These are precisely the buzzwords of the corrupt K street Washington political elite that controls both parties, and it's more than a bit unsettling to see Paine echoing these sickening rationalizations for complacency and greed so pitch-perfectly on a putatively radical-left blog.

Here's the real formula: the single-payer activists are real reformers. The Stark plan is classic DLC reaction and corporate whoredom embroidered as "reform." It is the impulse of callousness, greed, and cynical deception demagogically couched in the rhetoric of a vague "progressivism."

And here on SMBIVA Paine is the full-time surrogate for this New Democrat strategy of reaction smartly turned out in the lying language of the PR industry.

Paine orated:
"What's a hardened cadre to do but try, by cargo-culting and rain-dancing and Tinker Bell wishing, somehow to bring on the radical conditions for change in the hearts and minds of the wage smurfs. And if that's not working too swiftly, maybe we could whip up a decent majority out of minority helots of all flavors and conscience-stricken plebs and meritoids."

Again--I'm not sure what Paine is saying here (try to remember Paine, that in prose often LESS IS MORE), but the majority for single payer need not be wished into reality by "cargo-culting and rain-dancing." Poll after poll has shown that 60 percent of Americans ALREADY favor single-payer Medicare for all. A survey in the Annals of Internal Medicine shows that 59 percent of physicians favor it. The chief obstacles are the HMOs and their paid flunkies in the White House and Congress--and their unpaid flunkies such as Owen Paine.

For documenation, see the following, "Inside the Beltway Baucus," by Russell Mokhiber:

http://www.commondreams.org/print/41566

The primary obstacle, the only real obstacle, is the insurance industry. Health insurance is just another way we are being taxed to subsidized the rich. And while we are on the topic insurance, why not make all forms of insurance (auto, home owner, extended warranties etc) single pay and socialized. Why stop with health care? And finally, let's socialize the internet. It was developed with public money and effectively stolen from us.

By the way, the public are patently in favor of socialized medicine. The only person I know who isn't is my father, a surgeon -- go figure!

Peter--
I agree with you entirely--that's an excellent point about private insurance being a tax on working people to subsidize the rich.

By the way--the single-payer bill being proposed by Conyers in the House (and in a somewhat different version in the Senate by Bernie Sanders) is not fully socialized medicine. All the hospitals, labs, etc., would remain in private hands, whether profit or nonprofit. There would be, however, a single payer--the federal government--much along the lines of Medicare or the Canadian system. These bills to not propose a British-style nationalization of the whole health system.

That distinction gives the lie to Paine's claim that single-payer is a maximalist, ultraleftist demand (tut tut to those Bosheviks at The Nation and the PDA, all to the left of Paine!). It is, in fact, an incremental reform. The hybrid plan he keeps hustling for is no reform at all, for reasons I have already cited.

Van M: I dunno if Paine is saying what you think he is. I think he's saying that single payer is the reform position, since it is not an attack on the whole but only a part of it. Single-issue change, however radical, leaves the whole structure in place, and thus will eventually be outflanked, coopted, etc.

Now, you might call this a cruel position, that only a Lenin could maintain, letting millions of people suffer while waiting for full revolutionary conditions to ripen. Or, you could say it's a word to the wise, that partial measures, however worthy in themselves, are doomed to fail.

My position would be that anything that Democrats are backing is less than a trial baloon, more like a lame skeet tossed out simply to be shot down. And it's not our business to help the careers of people like Kucinich or Ralph Nader by pushing their plans. It's our business to educate, to build organizations, to be ready for a future when cracks begin to appear in the walls.

OP's whole persona of wild and whirling words is not that of a smooth agent of the middle, but Don Quixote on a broken down Rocinante.

hce--
You're quite wrong about Paine. Of course, his writing is so florid and opaque that I don't think even he knows what the hell he's saying half the time. He just sort of likes to take the old gray mare of his preening prose style out for a trot once in a while.

In this lastest post Paine singles out adamant insistence on single payer--in effect, wiping out the HMOs--as a form of unrealistic radicalism. He fancies that the HMO hybrid plan is a sage alternative that will bleed the HMOs drop by drop, that sort of thing. He fancies himself a world-class intelligence, but on this issue he has been duped by corporate propaganda. Go back to the previous thread on this issue--the one with all the medical/pharma graphics in the header--and you'll see Paine's position clear as day on this.

Moreover, I've already quoted--more than once--Paine's resounding prose-poem declaration of hope that the Dems will turn their back on the imperial project and undertake fundamental reform of the economy. This is the classic mainstream "pwog" Kool-Aid that Paine gulps with gusto.

Finally, I don't know how you can equate pushing for single payer with promoting the careers of Ralph Nader and Dennis Kucinich. If they were careerists, they'd be jumping on board with the DLC-approved HCAN hybrid plan that Obama, Baucus, Pelosi, and Paine have been pushing. The momentum for single-payer extends way beyond a few left-wing Dems--most Americans support it, most doctors support it, and the only holdup at Peter points out, is the powerful HMO lobby in D.C.

It would be a huge step forward for the American people to have free, universal health care coverage with no crippling private premiums and deductibles--the kind of system that exists in every other industrialized country.

Some 50 million Americans lack any health insurance, and millions more will join those ranks with the massive loss of jobs that were the only source of insurance. Others who have it can barely swing the premiums and deductibles, etc.

This is literally a life-or-death issue for tens of millions of Americans--too serious an issue to dismiss with facile snark about Nader or Kucinich, and to serious to trivialize, as Paine does, with talk about hybrid plans that simply rearrange the deck chairs on the Titanic.

earing aide

"Now, you might call this a cruel position, that only a Lenin could maintain, letting millions of people suffer while waiting for full revolutionary conditions to ripen"

ear
worse the better ??? me ???
i hope i'm not coming across as saying that

reform fights are fought out to their limit
in fact quite to the contrary
of worse the better
my take is what will be will be
get your class barings and plunge in
reforms are reforms
know the game and the table stakes and play accordingly

the more successful the reform movement
the better..obviously

every reform victory
emboldens the masses eh ?

if the regime is forced to conceed ground excellent keep pushing keep mobilizing

my point was simple enough
don't confuse reform movements with
making "revolutionary " demands
don't pit one against the other

hence dear rosa's pic

regardless of whether or not
pub op succeeeds or fails
single payer is the inevitable end product
we fight on for
but its compatible with private exploitation
so kool the jets
don't pull out all the stops
if it turns out all we get is a pub op
we fight to push further
what's so hard about grasping that ??

what is wrong i think is to fake up the stakes
hype the jeopardy turn a reform into a sacred crusade blast the elements that compromise

ie its just a reform stupid
the stakes are meliorative
reforms can be fought within the system
so unlike moments of system failure unlike times of stateless opportunity
other cheeks get turned odd bed fellows tolerated
yes in a revolution points arrive when decisive action must be taken or literally all may be lost

not so with a reform

you wake the next morning to the same system win or lose

the article by the delightful ms redmond
is a fairly understandable one issue
heart felt prophecy

but making a habit out of
hysterical outing of" compromisers"
and the use of preposterously hyped up lingo is decidely counter productive
tomorrow you may join forces with these compromisers eh ??

its amateurish self expression and moral preening to condemn these folks

its hot gas

and if all i do here is hot gas
so be it
i'm not under party discipline no body gives half a shit what i write

to repeat

you unite with anyone u can in a reform movement

single payer is a health reform movement aim
so you push for it as far as it will go allied with those you can ally with

and no

pete stark is not a secret agent
of the hmo's
he's a simple pwog hopper

questioning his motives is idiotic
he's a professional electoral politician

is he the "moral" equivalent of ralph nader ??
no
would he prolly prfer to see the hmo's sink below the water line like we all do ??
yes
does he prolly share my view
that pub op can be a beach head
and not just a cruel trick ??

yes

unlike our peter ward's noble call for uncle to become single insurer
for everyone and everything
which gets to being close to a commanding heights strategy

---hey next you'll call for uncle
to be single creditor ...---

at any rate
unlike these bold aims of peters
mr stark knows the call for single payer
is really a garden variety reform
in the long run that can be reach in steps
despite ms redmonds heart felt convictioon
anything less then immediate destruction of the hmo's means doom

single payer is in our future because corporate america wants it to be ion our future
the obvious fact is
single payer
will make american corporate capitalism function
all the smoother

oh ya
and this is directed at no one in particular
except myself
lets try to keep the spear chucking aimed at real big outside targets
like max factor baucus

lets end the utterly pointless
in some cases needlessly bad faith
and silly chitter
about traitors and trots
lurking
right here under father smith's
marriage bed

talk about a fools mission

my itching my trot tic was a mistake

let's save our flaming balls of lard
for the real public black hat players
of whatever stripe

don't you all agree
we're better off keeping
our side line roll in perspective here ???

playing at big league polemicist
is embarassing

this site remains
strictly an under the toad stool operation
where views are aired best and fullest and most honestly
without some ding bat flying off the rails
and trying to out one of us

its tiresome and stupid
and hell
there are plenty of public targets more worthy of our attentions
if we need to rant at
a specific humanoid target

okay if we step on each others toes by flaming each others idols

so be it..each to his own here eh ??
take it like a mate or move on

Which amongst us knows what old DQ was really thinking? Certainly not Pancho, the symbol for us all...But there certainly was a point, wasn't there?

Meanwhile, it's true. Single payer would be a net plus to what remains of US capitalism, which I dare say is a hair less than our own DQ thinks. But allowing SP would be an even greater admission of the error of royalist/supply-side ideology, which remains the excuse for folks sleeping on the street, and/or nearly so.

With rich people, it's all about keeping the money, and tomorrow is always another day.

Paine wrote:

"regardless of whether or not
pub op succeeeds or fails
single payer is the inevitable end product"

and "if it turns out all we get is a pub op
we fight to push further
what's so hard about grasping that ?? . . . ie its just a reform stupid"

"pub op can be a beach head
and not just a cruel trick "

OK--I give up. This guy Paine is just STUPID. Yes, thick as a brick, a doorstop, a block, a stone, a worse than senseless thing. It's OBVIOUS to anyone who has studied the details of the Stark proposal and the like from HCAN and Obama and Baucus and Pelosi--the usual corrupt and slimy suspects--that, for reasons already elaborated in painstaking detail, that this hybrid plan will not be a half or even a quarter step in the direction of single payer--it will so disadvantage the public sector, so privilege the HMOs, that the public sector will stand permanently indicted among the political class and its lapdogs in the media. The Stark plan--as is clear to all people on the left--is a carefully laid trap to sabotage single payer once and for all.

MOREOVER--like all the state experiments in hybrid plans, it will neither reduce costs nor increase coverage. It is simply another cynical maneuver by Washington Democrats to have it both ways--bend over for their campaign donors while paying sham lip service to the needs of the populace. It's the oldest con game in town, and Paine is so stupid that he doesn't get it. Either that or he is temperamentally so conservative that he simply falls into line with the temporizers and liars of the Dem side of K street who gussy up their corporate servitude with populist marketing pap.

CLEARLY--Paine is either a dumbass or a centrist conservative. Anyone who believes that the Stark plan is any kind of meaningful reform is no leftist of any stripe--the evidence is already in from state experiments of this sort, and they're all failures. The ONLY common denominator here is a desperate effort to keep the HMOs in business, no matter what the cost to the American people in health, in finances, in life itself.

Paine makes one accurate observation: "pete stark is not a secret agent of the hmo's." True enough--he's an OPEN agent of the HMOs. SO is Paine, who pathetically bends over for them gratis.

Clarifying this issue on this list is important for two reasons: if anyone on this blog can be freed from the grip of Paine's centrist obfuscations, that might be one additional body put in the service of single payer activism--every body is critical in a molecular process of building a movement.

Second, now that Paine has been exposed as an intellectual fraud and a centrist whose political outlook is essentially at odds with the stated purpose of this blog, maybe people will feel freer to call BS on him, and maybe his sterile, self-aggrandizing jags of pretension will recede here, making room for coherent, productive dialogue.

As for Paine's closing sanctimonies--he's all for peace and love now that he's pinned to the mat. Let him up again and he'll be the first one to bare his fangs again, as has always been the case here.

". Single payer would be a net plus to what remains of US capitalism, ... But allowing SP would be an even greater admission of the error of royalist/supply-side ideology, which remains the excuse for folks sleeping on the street, and/or nearly so"

ya

we'll ge sp because the general will of private corporate capitalism wills it

why?
because its better for them

the rub

why the state mediation of course

though all risks are best born by the largest relevent unit
in this case of health payments that would be society as a whole
and just as obviously
the state with its taxing and seigniorage powers
is the best possible agent of any society wide system so ...
sp

but despite the logic of this

the special corporate units actuallu in the profiteering of health game
are to be losers

so how does the corporate general will win out
in this caee over one section of our nearly hegemonic FIRE sector ???

consult any text on the struggle
between a small tightly organized group
with lots to lose and a large poorly organized group with just something or other to gain

recall the arms industry
has lost a few rounds over the years
in this case the insurance industry will lose

biggest example the belated ...no hideously belated end to the us-soviet atomic potlatch

the point obviously even if sp wins this year it faces the personal account movement
just like SSI unemployment comp etc etc etc

for every social solution there's
going eventually to appear a restorative countering "private " solution
till we end privateer corporations for ever
and a day

ps this doesn't even introduce the knock fight to control costs beyond payment system costs

the big pharma big hospital sectors
await their show downs
and they know sp or even pub op are dangerous developments
the feds obviously given monopsony power could control costs effectively
as i've suggested a mark up cap and trade system tied to general price level expectations would be a neat solution

of course we could apply one of those mechanism games even to the existing system

i guess this text is a good place to start

mingula on stark pub op:

firs there's this surprisingly un boiler plated passage of pure truth

"The problems of the current profiteering chaos are legion: complete lack of coverage for tens of millions, premium price-gouging, huge deductibles, gaps in coverage--the whole profiteers' bag of tricks to extract the maximum bucks for the minimum coverage"

bravo no one can gainsay that
but cometh the pub op stark plan

"this hybrid plan will not be a half or even a quarter step in the direction of single payer--it will so disadvantage the public sector, so privilege the HMOs, that the public sector will stand permanently indicted among the political class and its lapdogs in the media."

thats the thesis folks

" The Stark plan--as is clear to all people on the left--is a carefully laid trap to sabotage single payer once and for all."

yes "once and for all"

ie its either sp now
or we're better off sticking with the status quo
pub op is worse then the status quo
because it will fail
and i guess lead
to a counter move like
the great society led to
the welfare reform of the clinton dispensation

as this claims:

"the Stark public-private option plan is NOT a reform or a step forward of any kind. It is not an incremental advance toward single payer."
in other words stark is worse then nothing
because

"It is expressly designed to sabotage single-payer permanently by gaming the system so decisively in favor of the private HMOs that the public sector will be made to look impossibly expensive and unworkable."

why ?? well

"like all the state experiments in hybrid plans, it will neither reduce costs nor increase coverage."
now most honest sp supporters don't claim
this

they usually -- quite correctly --
claim
pub op stark will only cut admin cost
a fraction of the amount sp would cut those costs

and cover more but ot all
who are either now under-insured
or flat out uninsured

my point

why over state things here ??
who are you trying dishonestly to manipulate
who are you patronizing
to who is the truth not enough ??

"It is simply another cynical maneuver by Washington Democrats to have it both ways--bend over for their campaign donors while paying sham lip service to the needs of the populace. "
that has lots of truth under its hysterical over statement but here rhetoric comes in as a point to notice
i guess mingula like myself
never expects to dialogue wuth these sell outs

other less pink types i suspect
do expect to work with say pete stark's ilk in the future
so they can't play ape flinging feces
hey this pot ain't gonna call ming's kettle black on that score ...

back to the carefully reasoned argument

"The benefit of single-payer (or multiple-payer nonprofit) systems in the rest of the world is RISK POOLING--"

note we now have non profit multipayers on the scene

"by having the sickest, oldest, and the poorest in the same pool as the healthiest, youngest, and wealthiest, risks and therefore costs are averaged out in a way that makes the system as a whole far more efficient. "

that mates is gibberish

any one risk pool indeed averages out premia to cover pay outs from the pool
but efficiency is hardly in a single risk pool

if there are multiple pools then admin costs are increased maybe not as much as they are now but boundary wars will remain so long as multiple payer exists

the notion here must be non prof insurers would be passive pure head counters
trying to max heads not select out
sick bodies from healthy bodies
rich wallets from poor wallets
i guess because they'd have no incentive to risk select or default select
because they are not profit driven

well there is littel if any evidence
non profit hospitals cure the selection problem

they have budget constraints
even if they don't hhve profit max objectives

at any rate mingula is not an economist so how could he evaluate the claims he parrots back at us

the notion here is a regulation requiring these no propfits to take everyone and have only one pool

well one pool is not optimal

in fact efficency would call for a maximum of risk pools based on objective criteria
in the context of a single payer

ie
to minimize total risk you reward risk avoiding behaviours

this is hardly surprising stuff
consult any econ con text

okay so now what ??

migula sez stark will be restricted to a come one come all one pool one premium system

but in fact the privates will not

he some how adds all this gaming up to a total loss for all categories of insured
and a gain only to the profiteers

which is not possible statically at least
how can yuo lure in low riskers without cutting their premia upping their coverage and /or lowering their co pays etc

obviously healthy youth
many who now have no plamn but under a universal federal mandate would be required to join a plan
would in fact face lower premia under a pub/pri hybred
because the pri sec would select them and reject the oldsters like me

now if to be fair the pub op has multiple risk pooling
the pri sec will get clobbered

the feds can cut the legs out from under them

dynamically one pool fits all
covering a total population increases
risk taking why wouldn't uncle multiple pool

now there is the question of affordability

the subsidy built in to the fed plan
could hardly justify itself as applicable only to the sickest

the healthy poor in a multi pool public system would receive a subsidty too

this gets to be fun for me right about here as it gets more wonky
but i think you get the point
none of mingulas caveats are inevitable or fatal

and
to sum up
the struggle will continue after any pub op
is created
to push it as rapidly as possible to take over
the market

here we face the problem
medicare already faces

where because the privates can't fairly compete they get a subsidy
ie
the exact opposite of mingula's fear

well obviously some hideous proces like that can keep the hmo's in the game
and we'll need to battle it tooth and nail

if we get single payer

we'll have to battle personal accounts like face SSI already

hey these are reforms

the system remains intact ready and able to restore itself
even if transmogrified into lemon socialists

OY! Paine just butchers the whole analysis of single-payer vs. his beloved Stark hybrid plan--the passion for which he shares with Obama, Pelosi, and Baucus and which places him far to the right of even tepid progressives such as Stiglitz, Krugman, Kucinich, The Nation, and the PDA, all of whom reject the hyrbrid plan in favor of single payer.

Paine's last post is so dementedly incoherent, rambling, misinformed, and just plain ignorant and stupid that one doesn't know where to begin or end--he addressed points I didn't make, and fails to address points I did make.

For example, Paine dribbles the following:
""like all the state experiments in hybrid plans, it will neither reduce costs nor increase coverage."
now most honest sp supporters don't claim
this"

This statement by Paine is simply a lie. Paine has no idea what proponents of single payer are arguing because he hasn’t read the basic literature and is grossly ignorant in this area—his authoritative posturing is just his usual blowhard bluffing.Proponents of single payer make this argument all this time—because it’s true, and one of the strongest reasons to oppose a hybrid plan. For example, Len Rodberg, M.D., of PNHP writes,
“In spite of this, all we are hearing about today are mandate plans that would require everyone to buy the same private insurance that is already failing us. These proposals don’t regulate insurance premiums, they don’t keep the insurance companies from refusing to pay many of our bills, and they don’t improve the insurance we now have. Some offer a “public option,” but this will quickly become too expensive as the sick flee to the public sector as private insurers avoid them, abandon them, or make it too difficult for them to get their bills paid. . . . These proposals won’t work, either to expand coverage or to contain costs. Plans like these have been tried in many states over the past two decades (Massachusetts, Tennessee, Washington State, Oregon, Minnesota, Vermont, Maine). They have all failed to reduce the number of uninsured or to contain costs.” for further documentation about the repeated failure at the state level of hybrid plans of the kind DLC Paine is campaigning for, see S. Woolhandler, et al., “State Health Reform Flatlines,” International Journal of Health Services, 2008.

Second, he’s hopelessly confused about the issue of risk pooling. The serious analysts who have studied this issue all reach the same conclusion: a hybrid plan destroys the economic efficiencies of risk pooling to the disadvantage of the public sector of a hybrid plan. Marcia Angell, professor of social medicine at Harvard Medical School, puts it this way: “Many proponents hope that a parallel Medicare-like system would eventually crowd out its less efficient private competitors, that under a play-or-pay requirement, employers would gradually decide to stop providing coverage and just pay into the common pool. However, this wishful thinking overlooks the power of the private health industry, through its huge lobby, to influence the rules so that it continues to profit while the public system is undermined.
Rose Ann De Moro, the head of the California Nurses Association, puts it this way: “The bone the coalition sponsors throw to single payer advocates is the false promise of a public plan side by side with private insurance. The public plan, they contend, will be so much more attractive that the private plans will just wither away. Don't count on it.
"The insurance companies will always be able to lower their prices with cut rate plans with lower standards that they can aggressively market through massive advertising, tele-marketing, even door to door salesmen (as some do now) with a marketing campaign that the public plans will not have the funding to be able to match.
The private plans can then continue to cherry pick the younger and healthier patients while the sicker and older patients are dumped in the public plan, wrecking the whole idea of a risk pool and driving up the costs for the public plan to operate. The competition won't starve the private plans and cause them to wither away, they'll starve the public plan.”
For a sharp analysis of the problems of risk pooling and adverse selection, see Krugman’s March 2006 article in The New York Review of Books.)

Paine appends some impenetrable blather about multiple payers—Germany, for example, has a multiple-payer system, but the multiple payers are all NONPROFIT groups; it is illegal in Germany to profit from health-care coverage; the multiple payers are simply administrative tools, not independent, competitive entities, and are subject to strict regulations, and everyone in principle is in the same risk pool.

By the way, just for the record: Paine mutters, “migula sez stark will be restricted to a come one come all one pool one premium system.” I said no such thing. I said that the problem is that everyone will have to pay premiums, but because in a hybrid plan the healthiest and youngest will be grabbed by the profiteering private sector, they will be able to charge lower premiums than the public sector, saddled with the sickest, poorest, and oldest. This is one of the reasons that the state hybrid programs have never worked: by maintaining separate pools of the young/healthy and sick/elderly, they are deprived of the benefits of risk pooling, just as the Stark plan would be.

You see that Paine grandly announces what he takes to be the features of this or that proposal or what advocates say about it, but he makes no specific citations—because his knowledge in this area is superficial and ridden with errors and misconceptions. In brief, he has no idea what he’s talking about.

The short version is this: Paine is a centrist liberal who favors keeping the HMOs in the game. In this respect he is the HMOs flack in SMBIVA. His style and analytical approach to this subject mirror his posts in general: high-toned, ornate oracular rambles, the verbal density and supercilious tone of which are an elaborate disguise for his intellectual shortcomings: he really can’t follow or parse and argument clearly, and his command of the facts is shaky or nonexistent. So he spins his oracular prose poems, replacing logic with ad hom contempt (“mingula,” “hysteria,” etc.), deploying stylistic overkill to distract from his basic analytical incompetence.

Trust me, folks—Paine is a glib phony, a pontificating fraud, a centrist liberal establishment type posturing as a Marxist. His opaque prose poem style expressly seeks to veil ignorance with empyrean declamation--it's all an act and a fraud.

Paine's desperate and increasingly tangled and incoherent attempts to rationalize a role for the HMOs has escalated from the merely silly to the bizarre, a waste of everyone’s time. What this conservative, babbling windbag is doing on a radical left blog is a mystery—perhaps MJS would care to favor us all with an explanation that extends beyond mere personal attachment.

A couple of other points about Paine's tangle of mendacity, misinformation, and ignorance. He writes, "now if to be fair the pub op has multiple risk pooling
the pri sec will get clobbered

the feds can cut the legs out from under them"

This is just beyond belief. The "feds," as currently constituted, are owned by the HMOs--in a hybrid plan there would be no effective regulation of the private HMOs, any more than there is any effective regulation anywhere anymore. For the reasons already elaborated, it's the public sector that would get "clobbered" in this arrangement, not the private sector.

He then write, "well there is littel if any evidence non profit hospitals cure the selection problem they have budget constraints
even if they don't hhve profit max objectives" WHAT???? The confusion here is so dense that one has no clue about where to begin. Hospitals, profit or nonprofit, are in the business of treating patients, not allocating resources in a risk pool--the latter is the function of either private insurers or public funders. I mean this guy HAS NO CLUE. He's totally confused, way in over his head, and so he just babbles and hopes that because his babbling is impenetrable that people will mistake his ineptitude and stupidity for profundity and expertise.

In addition, he writes, "the notion here is a regulation requiring these no propfits to take everyone and have only one pool

well one pool is not optimal

in fact efficency would call for a maximum of risk pools based on objective criteria
in the context of a single payer." Again this is just meaningless froth--the benefits of a single risk pool are obvious and are disputed by no serious medical or economic authority who has studied this matter. Paine's counterargument here is simply from outer space.

Finally, Paine writes, "at any rate mingula is not an economist so how could he evaluate the claims he parrots back at us." First, I frankly don't believe that Paine is a qualified economist. His analyses are so sloppy, so careless about facts, so full of bluff and bluster, that it's hard to believe that he has ever scrupulously or seriously thought about anything if he can perpetrate these monumental frauds constantly on this blod. Second, he must not have read MJS's devastating exposes of what MJS calls the credentialing sector. The very concept of social science in general and of economics in particular is a mammoth cultural con job. There is no such thing a social science--it's an excuse to wrest sinecures for people who arrogate that title to themselves. Economics is the biggeset fraud of all: if it were a science, you wouldn't have its greatest authorities at loggerheads over the most basic facts and theoretical precepts.

Larry Summers is an economist; Milton Friedman was an economist--yet no two men have done more to perpetuate chaos and misery in the world than they. The mere fact that Paine attaches such importance to these bourgeois fantasies of expertise and "scientificity" among the ideological knaves who run roughshod over this planet tells you all you need to know about him: he's a an elitist conservative by temperament and political conviction. Hence his obsessive apologetics for the Stark hybrid plan flow from who he is essentially, both personally and politically. In Paine's case, the personal is the political--the old lesson on gruesome display with each increasingly fractured and incoherent post.

Van Mungo:

When complaining about verbose site owners, one might avoid posting twelve paragraph jeremaids that completely miss the point.

Just sayin' you know?

mingula:

"like all the state experiments in hybrid plans, it9a national pub op) will neither reduce costs nor increase coverage."

my response:

"now most honest sp supporters don't claim
this

they usually -- quite correctly --
claim
pub op stark will only cut admin cost
a fraction of the amount sp would cut those costs "

a source ???

single payer champion
Himmelstein

“The proposed plan would realize only a small fraction – at most 16% – of the administrative cost savings that could be achieved through single payer,” Himmelstein said.

he goes on to establish the superiority of single payer:

“That’s because insurance overhead – which might well be lower in a public option plan – accounts for a small part of the overall administrative costs of the current system. The need for hospitals and physicians to continue to bill dozens of different insurance plans would mean that their internal cost accounting and billing apparatus that causes most of the excess paperwork at present would continue.”

van you are trying to bluff and blow past the truth

it may work so long as people simply read your
patchy deceptive renditioning of this dialogue

if you persist in saying i oppose single payer prefer just a pub option
you are simply avoiding reality where it suits you

as with risk pooling

what is it about the seperation of risks into different pools based on actuarial metrics
that he uses to claim an advantage for the pri secs
and then forgets when its combined with a public option

again
is this just jam job stuff

"sure i cut corners here its agit prop
its to promote a higher good
what is it about this sites few readers tyhat make you feel just the unvarnished facts won't be enough

that you have to over blow the consequences and avoid the obvious answers to your parrot's boiler plate
its perhaps you that fails to grasp the details
perhaps its not necessary to think this thru for your self

pasting up pieces of opther people's positions and reasoning
and then throwing in silly invective
hardly advances the discussion
here

let's cut out the repeat charges
and delve on deep[er into the economics
lets find what you do know and don''t know
not what you can paste up

and really if i've destorted your views notice that and respond

two examples
i've claimed

you really don't grasp adverse selection
even if you can spell it better then i can
you have desplayed no grasp of the dynamics of
moral hazard obviously
with your throw every one in a single pool

you now wave regulation at me

well thank you
we ccan get into that

but obviously regulation is another dimension of the subject

one can regulate the hmo's eh ??

force em to play by level rules

i'm not sure why this hysterical fear of pub op exists

except fear it will suffice and on the road to single payer we'll stall out
and that leads to over stated claims of doom

bad reform agitprop if you are adddressing thinking folks vansky

so do you
prefer the status quo to pub op ??
its the logical deduction from your
pub op
will "only" and can "only"
lead to diiscrediting a state role in health insurance

"The insurance companies will always be able to lower their prices with cut rate plans with lower standards that they can aggressively market through massive advertising, tele-marketing, even door to door salesmen (as some do now) with a marketing campaign that the public plans will not have the funding to be able to match."

or so sez the estimable unionist
Rose Ann De Moro

but this boils down to an argument
quite valid
that parallels the present hmo sudsidy play in the medicare advantage segment of the market

i'll be clear if repetitive

this threat
of corporate lobby power
always exists
as medicare getting saddled with this boon doogle proves

okay so if we destroy the economic market for hmos
by going single payer
are you thinking the insurance lobby will disappear ???

again this is still a corporate run state
in fact my contention is the general will of the major non insurance corporations will prefer single payer

of course the insurance corporations
will take a shot at a come back
hell they're trying to weasil
into germany
a weakness of multi payer npos
like our own now defunct
blue cross blue shield npo era

speaking of the state

conflating existing or proposed single state pub op plans
with a national plan
well this simply fails to convince me
and i suspect anyone else who thinks this thru

in fact thank god for repub lite plans
like in mass
they instruct us as to where some of the problems will emerge

and no one has shown me a fatal problem uncle couldn't like
if the lobbys can't sap the wil to win

which brings up a key point:

lets face the double talk here

if the lobby can lick pub op
how is it it can't like single payer ??
i'd like an answer
first to how you plan to pass this
thru the lobby ???
if the lobby can morph pub op
into a suicide spiral of adverse selection
what prevents the sabotage of single payer ??

most of all van m i'd like you to vamp your knowledge of multi pool risk graded systems of insurance

i still bet you are not up to speed
on this fundemental
micro economic area
or that gibberish about single risk pool efficiency
would have withdrawn summarily as
a goof up

i'm posting this un edited
and unreviewed
lets try to conduct this as a none nit pick session

substance here substance as woody allen sez in "the front"

You call my posts "verbose" and state that they "miss the point."

Care to give examples? I'll be glad to take you on on this subject. Just step up to the plate.

I tried to be as scrupulous in examining Paine's insane divagations on this subject as he is unscrupulous. That requires a point-by-point response to his volcanic spews of nonsense. I'm just responding in kind.

You seem to show such tender solicitude and veneration for the office of list "ownership." I take it that this means that you, like Paine, are not really by temperament or conviction a leftist or socialist of any kind either.

So, bk, show us your stuff. Where do I miss the point? No quips--be precise. I'm sure I can take you on one-handed and blindfolded.

btw

the attack on economics doesn't allow you to escape logic
nor the two economists stig and krug
you wave at me like talismens

i'm sure they'd know what i'm driving at here
about risk pools and efficiency
risk pooling calls to you mingula
like the sirens

risk pools migula
and efficiency

sure you don't me equity

i might find a discussion on those lines stimulating
which this isn't this is like playing scales
chords and hand cross overs

please develop your thinking
here
not your invective
you flutter and fuss and fume quite well
but..at some point substance must have out

no don't scurry for some authority
answer the challenge
or do you really deserve to be called a parrot??

if the extyent of your econmomics

is
workers gooooood

profits baaaaad
and a few phrases from the monthly review
and bert cochran ..
well get ye to a book like my johnny one not recommendation your talisman joe stiglitz
whither socialism

its all words and graphs mingy
any one can understand it

it nicely touches on
market failures
in risk pricing
with behavioral interactions

i was hoping you'd make a smart point
like health insurance has negligable
moral hazard

btw

if the pub ops risk pool is actuarily
riskier the private pools
how could this be seen as a disgrace to the pub sec plan

the obvious answer would be set up a similar pool you privateering pricks
and see if you can beat us fair and square

no
the more i envision this fight evolving the more i like it

bring it on...

Paine--
I accuse you of being an ignorant, bluffing fraud.

First of all, on cost cutting--you've got to be kidding me. First you claim that that failure to cut costs is not a major argument--but stating that a hybrid plan would fail to achieve 84 percent of the savings of a single payer plan is, in substance, the same point. You're just splitting hairs here. What a waste of time! A 16 percent savings in a system that is twice as expensive per capita as those of any other industrialized country is pretty much no savings at all--pretty much a joke.

I referred you to Krugman's analysis of risk pooling and adverse selection in the March 23, 2006 New York Review of Books to help you clear up your confusion on this issue.

You respond with another round of your psychopathic prose-poem burbling--none of it makes any sense. I defy you to cite an authoritative source of any kind that supports your bizarre arguments about risk pooling.

Your posts are just chockablock with absurdities. You state, "this threat
of corporate lobby power always exists
as medicare getting saddled with this boon doogle proves okay so if we destroy the economic market for hmos by going single payer
are you thinking the insurance lobby will disappear ???" Yes--if the industry is made illegal and put out of business, it can no longer lobby. You ask, "if the lobby can morph pub opinto a suicide spiral of adverse selection what prevents the sabotage of single payer??" What prevents it is that there can be no lobby of a nonexistent industry. DUH!

You're a fraud, Paine. You don't address all my points--you just charge out on new tangents of indecipherable Paine-speak. I doubt that you have an advanced degree in economics--do you really? Actually wrote a dissertation? On what? And even if you did, you're a prime example of MJS's shrewd deconstructing of the credentialing sector--any sector that would credential you is by definition fraudulent.

Here's the acid test: not one of your prose-poem rambles on this blog would ever be considered for publication in a peer-reviewed journal--not even as a review or executive summary.

C'mon, Paine--out with it. Cite a single serious, authoritative source who supports your "argument"--really just incoherent blather--on risk pooling.

"PDA Continues the Fight for
HR 676 Single-payer Healthcare

Dear comrade owen

After many long years of informing, and fighting for national single-payer healthcare, our opportunity to pass HR 676 is upon us. But certain high-powered Democrats have taken it “off the table” and minority Republicans are happy to go along.

We need you to take effective action in support of HR 676 starting with the May 13 National Lobby Day and Rally in D.C.

If you can't make it, save the date to send an email to your member of Congress in support of HR 676. If your representative has signed on as a co-sponsor, offer your thanks and ask them to stand firm for the single-payer solution. If your representative is not a co-sponsor, ask him to support what the majority of Americans and doctors want--single-payer healthcare. .

Some organizations seeking healthcare reform have compromised the single-payer solution by promoting a private/public-option mix. Tweaking our current system will neither produce the savings and sustainability of single-payer healthcare, nor provide businesses with better ability to compete globally. It will, however, further enrich wealthy healthcare corporations with a government mandated give-away of our hard-earned dollars. Ask Democracy for America and MoveOn why they do not support the single-payer solution; click here.

In alliance with the Leadership Conference for Guaranteed Healthcare, PDA is working hard to put it back on the table by heightening the pressure on Congress to seriously debate the single-payer solution.

It falls to us to motivate our friends and neighbors to take action for the single-payer solution. Polls indicate majority support--we need that majority to contact their members of Congress. Please pass this on!

Yours in the struggle,

Tim Carpenter
PDA National Director "

"Tweaking our current system will neither produce the savings and sustainability of single-payer healthcare,"
very true
no one here thinks a pub op
is either superior or dynamically stable

the question is does it necessarily lead to its own collapse
or can...CAN IT LEAD TO SINGLE PAYER CONSOLIDATION IN THE END

a decisive point long term:

"...nor provide businesses with better ability to compete globally"

yes corporate america will find its inner single payer
fort precisely the stated reason

"What a waste of time! A 16 percent savings in"

my point was your untrue hyperbolics
this mingulism :

"like all the state experiments in hybrid plans, it will neither reduce costs nor increase coverage."

why the distortion

"First you claim that that failure to cut costs is not a major argument-'

where
of course single payer is vastly superior
no one is disputing that mingy

its your clain the a pub op would be worse then the staus quo

which you won't flat out say

here it is krug

show me the passages
where you stake your tent :

Thirteen years ago Bill Clinton became president partly because he promised to do something about rising health care costs. Although Clinton's chances of reforming the US health care system looked quite good at first, the effort soon ran aground. Since then a combination of factors—the unwillingness of other politicians to confront the insurance and other lobbies that so successfully frustrated the Clinton effort, a temporary remission in the growth of health care spending as HMOs briefly managed to limit cost increases, and the general distraction of a nation focused first on the gloriousness of getting rich, then on terrorism—have kept health care off the top of the agenda.

But medical costs are once again rising rapidly, forcing health care back into political prominence. Indeed, the problem of medical costs is so pervasive that it underlies three quite different policy crises. First is the increasingly rapid unraveling of employer- based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attack. Third is the long-term problem of the federal government's solvency, which is, as we'll explain, largely a problem of health care costs.

--------------------------------------------------------------------------------

--------------------------------------------------------------------------------

The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.

Before we talk about reform, however, let's talk about the current state of the US health care system. Let us begin by asking a seemingly naive question: What's wrong with spending ever more on health care?

1.
Is health care spending a problem?
In 1960 the United States spent only 5.2 percent of GDP on health care. By 2004 that number had risen to 16 percent. At this point America spends more on health care than it does on food. But what's wrong with that?

The starting point for any discussion of rising health care costs has to be the realization that these rising costs are, in an important sense, a sign of progress. Here's how the Congressional Budget Office puts it, in the latest edition of its annual publication The Long-Term Budget Outlook:

Growth in health care spending has outstripped economic growth regardless of the source of its funding.... The major factor associated with that growth has been the development and increasing use of new medical technology.... In the health care field, unlike in many sectors of the economy, technological advances have generally raised costs rather than lowered them.
Notice the three points in that quote. First, health care spending is rising rapidly "regardless of the source of its funding." Translation: although much health care is paid for by the government, this isn't a simple case of runaway government spending, because private spending is rising at a comparably fast clip. "Comparing common benefits," says the Kaiser Family Foundation,

changes in Medicare spending in the last three decades has largely tracked the growth rate in private health insurance premiums. Typically, Medicare increases have been lower than those of private health insurance.
Second, "new medical technology" is the major factor in rising spending: we spend more on medicine because there's more that medicine can do. Third, in medical care, "technological advances have generally raised costs rather than lowered them": although new technology surely produces cost savings in medicine, as elsewhere, the additional spending that takes place as a result of the expansion of medical possibilities outweighs those savings.

So far, this sounds like a happy story. We've found new ways to help people, and are spending more to take advantage of the opportunity. Why not view rising medical spending, like rising spending on, say, home entertainment systems, simply as a rational response to expanded choice? We would suggest two answers.

The first is that the US health care system is extremely inefficient, and this inefficiency becomes more costly as the health care sector becomes a larger fraction of the economy. Suppose, for example, that we believe that 30 percent of US health care spending is wasted, and always has been. In 1960, when health care was only 5.2 percent of GDP, that meant waste equal to only 1.5 percent of GDP. Now that the share of health care in the economy has more than tripled, so has the waste.

This inefficiency is a bad thing in itself. What makes it literally fatal to thousands of Americans each year is that the inefficiency of our health care system exacerbates a second problem: our health care system often makes irrational choices, and rising costs exacerbate those irrationalities. Specifically, American health care tends to divide the population into insiders and outsiders. Insiders, who have good insurance, receive everything modern medicine can provide, no matter how expensive. Outsiders, who have poor insurance or none at all, receive very little. To take just one example, one study found that among Americans diagnosed with colorectal cancer, those without insurance were 70 percent more likely than those with insurance to die over the next three years.

In response to new medical technology, the system spends even more on insiders. But it compensates for higher spending on insiders, in part, by consigning more people to outsider status—robbing Peter of basic care in order to pay for Paul's state-of-the-art treatment. Thus we have the cruel paradox that medical progress is bad for many Americans' health.

This description of our health care problems may sound abstract. But we can make it concrete by looking at the crisis now afflicting employer-based health insurance.

2.
The unraveling of employer-based insurance
In 2003 only 16 percent of health care spending consisted of out-of-pocket expenditures by consumers. The rest was paid for by insurance, public or private. As we'll see, this heavy reliance on insurance disturbs some economists, who believe that doctors and patients fail to make rational decisions about spending because third parties bear the costs of medical treatment. But it's no use wishing that health care were sold like ordinary consumer goods, with individuals paying out of pocket for what they need. By its very nature, most health spending must be covered by insurance.

The reason is simple: in any given year, most people have small medical bills, while a few people have very large bills. In 2003, health spending roughly followed the "80–20 rule": 20 percent of the population accounted for 80 percent of expenses. Half the population had virtually no medical expenses; a mere 1 percent of the population accounted for 22 percent of expenses.

Here's how Henry Aaron and his coauthors summarize the implication of these numbers in their book Can We Say No?: "Most health costs are incurred by a small proportion of the population whose expenses greatly exceed plausible limits on out-of-pocket spending." In other words, if people had to pay for medical care the way they pay for groceries, they would have to forego most of what modern medicine has to offer, because they would quickly run out of funds in the face of medical emergencies.

So the only way modern medical care can be made available to anyone other than the very rich is through health insurance. Yet it's very difficult for the private sector to provide such insurance, because health insurance suffers from a particularly acute case of a well-known economic problem known as adverse selection. Here's how it works: imagine an insurer who offered policies to anyone, with the annual premium set to cover the average person's health care expenses, plus the administrative costs of running the insurance company. Who would sign up? The answer, unfortunately, is that the insurer's customers wouldn't be a representative sample of the population. Healthy people, with little reason to expect high medical bills, would probably shun policies priced to reflect the average person's health costs. On the other hand, unhealthy people would find the policies very attractive.

--------------------------------------------------------------------------------

You can see where this is going. The insurance company would quickly find that because its clientele was tilted toward those with high medical costs, its actual costs per customer were much higher than those of the average member of the population. So it would have to raise premiums to cover those higher costs. However, this would disproportionately drive off its healthier customers, leaving it with an even less healthy customer base, requiring a further rise in premiums, and so on.

Insurance companies deal with these problems, to some extent, by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums. But such screening is itself expensive. Furthermore, it tends to screen out exactly those who most need insurance.

Most advanced countries have dealt with the defects of private health insurance in a straightforward way, by making health insurance a government service. Through Medicare, the United States has in effect done the same thing for its seniors. We also have Medicaid, a means-tested program that provides health insurance to many of the poor and near poor. But nonelderly, nonpoor Americans are on their own. In practice, only a tiny fraction of nonelderly Americans (5.3 percent in 2003) buy private insurance for themselves. The rest of those not covered by Medicare or Medicaid get insurance, if at all, through their employers.

Employer-based insurance is a peculiarly American institution. As Julius Richmond and Rashi Fein tell us in The Health Care Mess, the dominant role of such insurance is the result of historical accident rather than deliberate policy. World War II caused a labor shortage, but employers were subject to controls that prevented them from attracting workers by offering higher wages. Health benefits, however, weren't controlled, and so became a way for employers to compete for workers. Once employers began offering medical benefits, they also realized that it was a form of compensation workers valued highly because it protected them from risk. Moreover, the tax law favored employer-based insurance, because employers' contributions weren't considered part of workers' taxable income. Today, the value of the tax subsidy for employer-based insurance is estimated at around $150 billion a year.

Employer-based insurance has historically offered a partial solution to the problem of adverse selection. In principle, adverse selection can still occur even if health insurance comes with a job rather than as a stand-alone policy. This would occur if workers with health problems flocked to companies that offered health insurance, while healthy workers took jobs at companies that didn't offer insurance and offered higher wages instead. But until recently health insurance was a sufficiently small consideration in job choice that large corporations offering good health benefits, like General Motors, could safely assume that the health status of their employees was representative of the population at large and that adverse selection wasn't inflating the cost of health insurance.

In 2004, according to census estimates, 63.1 percent of Americans under sixty-five received health insurance through their employers or family members' employers. Given the inherent difficulties of providing health insurance through the private sector, that's an impressive number. But it left more than a third of nonelderly Americans out of the system. Moreover, the number of outsiders is growing: the share of nonelderly Americans with employment-based health insurance was 67.7 percent as recently as 2000. And this trend seems certain to continue, even accelerate, because the whole system of employer-based health care is under severe strain.

We can identify several reasons for that strain, but mainly it comes down to the issue of costs. Providing health insurance looked like a good way for employers to reward their employees when it was a small part of the pay package. Today, however, the annual cost of coverage for a family of four is estimated by the Kaiser Family Foundation at more than $10,000. One way to look at it is to say that that's roughly what a worker earning minimum wage and working full time earns in a year. It's more than half the annual earnings of the average Wal-Mart employee.

Health care costs at current levels override the incentives that have historically supported employer-based health insurance. Now that health costs loom so large, companies that provide generous benefits are in effect paying some of their workers much more than the going wage—or, more to the point, more than competitors pay similar workers. Inevitably, this creates pressure to reduce or eliminate health benefits. And companies that can't cut benefits enough to stay competitive—such as GM—find their very existence at risk.

Rising health costs have also ended the ability of employer-based insurance plans to avoid the problem of adverse selection. Anecdotal evidence suggests that workers who know they have health problems actively seek out jobs with companies that still offer generous benefits. On the other side, employers are starting to make hiring decisions based on likely health costs. For example, an internal Wal-Mart memo, reported by The New York Times in October, suggested adding tasks requiring physical exertion to jobs that don't really require it as a way to screen out individuals with potential health risks.

So rising health care costs are undermining the institution of employer-based coverage. We'd suggest that the drop in the number of insured so far only hints at the scale of the problem: we may well be seeing the whole institution unraveling.

Notice that this unraveling is the byproduct of what should be a good thing: advances in medical technology, which lead doctors to spend more on their patients. This leads to higher insurance costs, which causes employers to stop providing health coverage. The result is that many people are thrown into the world of the uninsured, where even basic care is often hard to get. As we said, we rob Peter of basic care in order to provide Paul with state-of-the-art treatment.

Fortunately, some of the adverse consequences of the decline in employer-based coverage have been muted by a crucial government program, Medicaid. But Medicaid is facing its own pressures.

3.
Medicaid and Medicare
The US health care system is more privatized than that of any other advanced country, but nearly half of total health care spending nonetheless comes from the government. Most of this government spending is accounted for by two great social insurance programs, Medicare and Medicaid. Although Medicare gets most of the public attention, let's focus first on Medicaid, which is a far more important program than most middle-class Americans realize.

In The Health Care Mess Richmond and Fein tell us that Medicaid, like employer-based health insurance, came into existence through a sort of historical accident. As Lyndon Johnson made his big push to create Medicare, the American Medical Association, in a last-ditch effort to block so-called "socialized medicine" (actually only the insurance is socialized; the medical care is provided by the private sector), began disparaging Johnson's plan by claiming that it would do nothing to help the truly needy. In a masterful piece of political jujitsu, Johnson responded by adding a second program, Medicaid, targeted specifically at helping the poor and near poor.

Today, Medicaid is a crucial part of the American safety net. In 2004 Medicaid covered almost as many people as its senior partner, Medicare—37.5 million versus 39.7 million.

--------------------------------------------------------------------------------

Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. Between 2000 and 2004 the number of Americans covered by Medicaid rose by a remarkable eight million. Over the same period the ranks of the uninsured rose by six million. So without the growth of Medicaid, the uninsured population would have exploded, and we'd be facing a severe crisis in medical care.

But Medicaid, even as it becomes increasingly essential to tens of millions of Americans, is also becoming increasingly vulnerable to political attack. To some extent this reflects the political weakness of any means-tested program serving the poor and near poor. As the British welfare scholar Richard Titmuss said, "Programs for the poor are poor programs." Unlike Medicare's clients—the feared senior group—Medicaid recipients aren't a potent political constituency: they are, on average, poor and poorly educated, with low voter participation. As a result, funding for Medicaid depends on politicians' sense of decency, always a fragile foundation for policy.

The complex structure of Medicaid also makes it vulnerable. Unlike Medicare, which is a purely federal program, Medicaid is a federal-state matching program, in which states provide on average about 40 percent of the funds. Since state governments, unlike the federal government, can't engage in open-ended deficit financing, this dependence on state funds exposes Medicaid to pressure whenever state budgets are hard-pressed. And state budgets are hard-pressed these days for a variety of reasons, not least the rapidly rising cost of Medicaid itself.

The result is that, like employer-based health insurance, Medicaid faces a possible unraveling in the face of rising health costs. An example of how that unraveling might take place is South Carolina's request for a waiver of federal rules to allow it to restructure the state's Medicaid program into a system of private accounts. We'll discuss later in this essay the strange persistence, in the teeth of all available evidence, of the belief that the private sector can provide health insurance more efficiently than the government. The main point for now is that South Carolina's proposed reform would seriously weaken the medical safety net: recipients would be given a voucher to purchase health insurance, but many would find the voucher inadequate, and would end up being denied care. And if South Carolina gets its waiver, other states will probably follow its lead.

--------------------------------------------------------------------------------

Medicare's situation is very different. Unlike employer-based insurance or Medicaid, Medicare faces no imminent threat of large cuts. Although the federal government is deep in deficit, it's not currently having any difficulty borrowing, largely from abroad, to cover the gap. Also, the political constituency behind Medicare remains extremely powerful. Yet federal deficits can't go on forever; even the US government must eventually find a way to pay its bills. And the long-term outlook for federal finances is dire, mainly because of Medicare and Medicaid.

The chart in figure 1 illustrates the centrality of health care costs to America's long-term budget problems. The chart shows the Congressional Budget Office's baseline projection of spending over the next twenty-five years on the three big entitlement programs, Social Security, Medicare, and Medicaid, measured as a percentage of GDP. Not long ago advocates of Social Security privatization tried to use projections like this one to foster a sense of crisis about the retirement system. As was pointed out last year in these pages,[1] however, there is no program called Socialsecuritymedicareandmedicaid. In fact, as the chart shows, Social Security, whose costs will rise solely because of the aging of the population, represents only a small part of the problem. Most of the problem comes from the two health care programs, whose spending is rising mainly because of the general rise in medical costs.

To be fair, there is a demographic component to Medicare and Medicaid spending too—Medicare because it only serves Americans over sixty-five, Medicaid because the elderly, although a minority of the program's beneficiaries, account for most of its spending. Still, the principal factor in both programs' rising costs is what the CBO calls "excess cost growth"—the persistent tendency of health care spending per beneficiary to grow faster than per capita income, owing to advancing medical technology. Without this excess cost growth, the CBO estimates that entitlement spending would rise by only 3.7 percent of GDP over the next twenty-five years. That's a significant rise, but not overwhelming, and could be addressed with moderate tax increases and possibly benefit cuts. But because of excess cost growth the projected rise in spending is a crushing burden—about 10 percent of GDP over the next twenty-five years, and even more thereafter.

Rising health care spending, then, is driving a triple crisis. The fastest-moving piece of that crisis is the unraveling of employer-based coverage. There's a gradually building crisis in Medicaid. And there's a long-term federal budget crisis driven mainly by rising health care spending.

So what are we going to do about health care?

4.
The "consumer-directed" diversion
As we pointed out at the beginning of this essay, one of the two big reasons to be concerned about rising spending on health care is that as the health care sector grows, its inefficiency becomes increasingly important. And almost everyone agrees that the US health care system is extremely inefficient. But there are wide disagreements about the nature of that inefficiency. And the analysts who have the ear of the Bush administration are committed, for ideological reasons, to a view that is clearly wrong.

We've already alluded to the underlying view behind the Bush administration's health care proposals: it's the view that insurance leads people to consume too much health care. The 2004 Economic Report of the President, which devoted a chapter to health care, illustrated the alleged problem with a parable about the clothing industry:

Suppose, for example, that an individual could purchase a clothing insurance policy with a "coinsurance" rate of 20 percent, meaning that after paying the insurance premium, the holder of the insurance policy would have to pay only 20 cents on the dollar for all clothing purchases. An individual with such a policy would be expected to spend substantially more on clothes—due to larger quantity and higher quality purchases—with the 80 percent discount than he would at the full price.... The clothing insurance example suggests an inherent inefficiency in the use of insurance to pay for things that have little intrinsic risk or uncertainty.
The report then asserts that "inefficiencies of this sort are pervasive in the US health care system"—although, tellingly, it fails to match the parable about clothing with any real examples from health care.

The view that Americans consume too much health care because insurers pay the bills leads to what is currently being called the "consumer-directed" approach to health care reform. The virtues of such an approach are the theme of John Cogan, Glenn Hubbard, and Daniel Kessler's Healthy, Wealthy, and Wise. The main idea is that people should pay more of their medical expenses out of pocket. And the way to reduce public reliance on insurance, reformers from the right wing believe, is to remove the tax advantages that currently favor health insurance over out-of-pocket spending. Indeed, last year Bush's tax reform commission proposed taxing some employment-based health benefits. The administration, recognizing how politically explosive such a move would be, rejected the proposal. Instead of raising taxes on health insurance, the administration has decided to cut taxes on out-of-pocket spending.

Cogan, Hubbard, and Kessler call for making all out-of-pocket medical spending tax-deductible, although tax experts from both parties say that this would present an enforcement nightmare. (Douglas Holtz-Eakin, the former head of the Congressional Budget Office, put it this way: "If you want to have a personal relationship with the IRS do that [i.e., make all medical spending tax deductible] because we are going to have to investigate everybody's home to see if their running shoes are a medical expense.") The administration's proposals so far are more limited, focusing on an expanded system of tax-advantaged health savings accounts. Individuals can shelter part of their income from taxes by depositing it in such accounts, then withdraw money from these accounts to pay medical bills.

What's wrong with consumer-directed health care? One immediate disadvantage is that health savings accounts, whatever their ostensible goals, are yet another tax break for the wealthy, who have already been showered with tax breaks under Bush. The right to pay medical expenses with pre-tax income is worth a lot to high-income individuals who face a marginal income tax rate of 35 percent, but little or nothing to lower-income Americans who face a marginal tax rate of 10 percent or less, and lack the ability to place the maximum allowed amount in their savings accounts.

A deeper disadvantage is that such accounts tend to undermine employment-based health care, because they encourage adverse selection: health savings accounts are attractive to healthier individuals, who will be tempted to opt out of company plans, leaving less healthy individuals behind.

Yet another problem with consumer-directed care is that the evidence says that people don't, in fact, make wise decisions when paying for medical care out of pocket. A classic study by the Rand Corporation found that when people pay medical expenses themselves rather than relying on insurance, they do cut back on their consumption of health care—but that they cut back on valuable as well as questionable medical procedures, showing no ability to set sensible priorities.

--------------------------------------------------------------------------------

But perhaps the biggest objection to consumer-directed health reform is that its advocates have misdiagnosed the problem. They believe that Americans have too much health insurance; the 2004 Economic Report of the President condemned the fact that insurance currently pays for "many events that have little uncertainty, such as routine dental care, annual medical exams, and vaccinations," and for "relatively low-expense items, such as an office visit to the doctor for a sore throat." The implication is that health costs are too high because people who don't pay their own medical bills consume too much routine dental care and are too ready to visit the doctor about a sore throat. And that argument is all wrong. Excessive consumption of routine care, or small-expense items, can't be a major source of health care inefficiency, because such items don't account for a major share of medical costs.

Remember the 80–20 rule: the great bulk of medical expenses are accounted for by a small number of people requiring very expensive treatment. When you think of the problem of health care costs, you shouldn't envision visits to the family physician to talk about a sore throat; you should think about coronary bypass operations, dialysis, and chemotherapy. Nobody is proposing a consumer-directed health care plan that would force individuals to pay a large share of extreme medical expenses, such as the costs of chemotherapy, out of pocket. And that means that consumer-directed health care can't promote savings on the treatments that account for most of what we spend on health care.

The administration's plans for consumer-directed health care, then, are a diversion from meaningful health care reform, and will actually worsen our health care problems. In fact, some reformers privately hope that George W. Bush manages to get his health care plans passed, because they believe that they will hasten the collapse of employment-based coverage and pave the way for real reform. (The suffering along the way would be huge.)

But what would real reform look like?

5.
Single-payer and beyond
How do we know that the US health care system is highly inefficient? An important part of the evidence takes the form of international comparisons. Table 1 compares US health care with the systems of three other advanced countries. It's clear from the table that the United States has achieved something remarkable. We spend far more on health care than other advanced countries—almost twice as much per capita as France, almost two and a half times as much as Britain. Yet we do considerably worse even than the British on basic measures of health performance, such as life expectancy and infant mortality.

One might argue that the US health care system actually provides better care than foreign systems, but that the effects of this superior care are more than offset by unhealthy US lifestyles. Ezra Klein of The American Prospect calls this the "well-we-eat-more-cheeseburgers" argument. But a variety of evidence refutes this argument. The data in Table 1 show that the United States does not stand out in the quantity of care, as measured by such indicators as the number of physicians, nurses, and hospital beds per capita. Nor does the US stand out in terms of the quality of care: a recent study published in Health Affairs that compared quality of care across advanced countries found no US advantage. On the contrary, "the United States often stands out for inefficient care and errors and is an outlier on access/cost barriers."[2] That is, our health care system makes more mistakes than those of other countries, and is unique in denying necessary care to people who lack insurance and can't pay cash. The frequent claim that the United States pays high medical prices to avoid long waiting lists for care also fails to hold up in the face of the evidence: there are long waiting lists for elective surgery in some non-US systems, but not all, and the procedures for which these waiting lists exist account for only 3 percent of US health care spending.[3]

--------------------------------------------------------------------------------

So why does US health care cost so much? Part of the answer is that doctors, like other highly skilled workers, are paid much more in the United States than in other advanced countries. But the main source of high US costs is probably the unique degree to which the US system relies on private rather than public health insurance, reflected in the uniquely high US share of private spending in total health care expenditure.

Over the years since the failure of the Clinton health plan, a great deal of evidence has accumulated on the relative merits of private and public health insurance. As far as we have been able to ascertain, all of that evidence indicates that public insurance of the kind available in several European countries and others such as Taiwan achieves equal or better results at much lower cost. This conclusion applies to comparisons within the United States as well as across countries. For example, a study conducted by researchers at the Urban Institute found that

per capita spending for an adult Medicaid beneficiary in poor health would rise from $9,615 to $14,785 if the person were insured privately and received services consistent with private utilization levels and private provider payment rates.[4]
The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting adverse selection, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.

At the same time, the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers.

The second source of savings in a system of public health insurance is the ability to bargain with suppliers, especially drug companies, for lower prices. Residents of the United States notoriously pay much higher prices for prescription drugs than residents of other advanced countries, including Canada. What is less known is that both Medicaid and, to an even greater extent, the Veterans' Administration, get discounts similar to or greater than those received by the Canadian health system.

We're talking about large cost savings. Indeed, the available evidence suggests that if the United States were to replace its current complex mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall. That's what happened in Taiwan, which adopted a single-payer system in 1995: the percentage of the population with health insurance soared from 57 percent to 97 percent, yet health care costs actually grew more slowly than one would have predicted from trends before the change in system.

--------------------------------------------------------------------------------

If US politicians could be persuaded of the advantages of a public health insurance system, the next step would be to convince them of the virtues, in at least some cases, of honest-to-God socialized medicine, in which government employees provide the care as well as the money. Exhibit A for the advantages of government provision is the Veterans' Administration, which runs its own hospitals and clinics, and provides some of the best-quality health care in America at far lower cost than the private sector. How does the VA do it? It turns out that there are many advantages to having a single health care organization provide individuals with what amounts to lifetime care. For example, the VA has taken the lead in introducing electronic medical records, which it can do far more easily than a private hospital chain because its patients stay with it for decades. The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.

In summary, then, the obvious way to make the US health care system more efficient is to make it more like the systems of other advanced countries, and more like the most efficient parts of our own system. That means a shift from private insurance to public insurance, and greater government involvement in the provision of health care—if not publicly run hospitals and clinics, at least a much larger government role in creating integrated record-keeping and quality control. Such a system would probably allow individuals to purchase additional medical care, as they can in Britain (although not in Canada). But the core of the system would be government insurance—"Medicare for all," as Ted Kennedy puts it.

Unfortunately, the US political system seems unready to do what is both obvious and humane. The 2003 legislation that added drug coverage to Medicare illustrates some of the political difficulties. Although it's rarely described this way, Medicare is a single-payer system covering many of the health costs of older Americans. (Canada's universal single-payer system is, in fact, also called Medicare.) And it has some though not all the advantages of broader single-payer systems, notably low administrative costs.

But in adding a drug benefit to Medicare, the Bush administration and its allies in Congress were driven both by a desire to appease the insurance and pharmaceutical lobbies and by an ideology that insists on the superiority of the private sector even when the public sector has demonstrably lower costs. So they devised a plan that works very differently from traditional Medicare. In fact, Medicare Part D, the drug benefit, isn't a program in which the government provides drug insurance. It's a program in which private insurance companies receive subsidies to offer insurance—and seniors aren't allowed to deal directly with Medicare.

--------------------------------------------------------------------------------

The insertion of private intermediaries into the program has several unfortunate consequences. First, as millions of seniors have discovered, it makes the system extremely complex and obscure. It's virtually impossible for most people to figure out which of the many drug plans now on offer is best. This complexity, coupled with the Katrina-like obliviousness of administration officials to a widely predicted disaster, also led to the program's catastrophic initial failure to manage the problem of "dual eligibles," i.e., older Medicaid recipients whose drug coverage was supposed to be transferred to Medicare. When the program started up in January, hundreds of thousands of these dual eligibles found that they had fallen through the cracks, that their old coverage had been canceled but their new coverage had not been put into effect.

Second, the private intermediaries add substantial administrative costs to the program. It's reasonably certain that if seniors had been offered the choice of receiving a straightforward drug benefit directly from Medicare, the vast majority would have chosen to pass up the private drug plans, which wouldn't have been able to offer comparable benefits because of their administrative expenses. But the drug bill avoided that embarrassing outcome by denying seniors that choice.

Finally, by fragmenting the purchase of drugs among many private plans, the administration denied Medicare the ability to bargain for lower prices from the drug companies. And the legislation, reflecting pressures from those companies, included a provision specifically prohibiting Medicare from intervening to help the private plans get lower prices.

In short, ideology and interest groups led the Bush administration to set up a new, costly Medicare benefit in such a way as to systematically forfeit all the advantages of public health insurance.

6.
Beyond reform: How much health care should we have?
Imagine, for a moment, that some future US administration were to push through a fundamental reform of health care that covered all the uninsured, replaced private insurance with a single-payer system, and took heed of the VA's lessons about the advantages of integrated health care. Would our health care problems be solved?

No. Although real reform would bring great improvement in our situation, continuing technological progress in health care still poses a deep dilemma: How much of what we can do should we do?

The medical profession, understandably, has a bias toward doing whatever will bring medical benefit. If that means performing an expensive surgical procedure on an elderly patient who probably has only a few years to live, so be it. But as medical technology advances, it becomes possible to spend ever larger sums on medically useful care. Indeed, at some point it will become possible to spend the entire GDP on health care. Obviously, we won't do this. But how will we make choices about what not to do?

In a classic 1984 book, Painful Prescription: Rationing Hospital Care, Henry Aaron and William Schwartz studied the medical choices made by the British system, which has long operated under tight budget limits that force it to make hard choices in a way that US medical care does not. Can We Say No? is an update of that work. It's a valuable survey of the real medical issues involved in British rationing, and gives a taste of the dilemmas the US system will eventually face.

The operative word, however, is "eventually." Reading Can We Say No?, one might come away with the impression that the problem of how to ration care is the central issue in current health care policy. This impression is reinforced by Aaron and his co-authors' decision to compare the US system only with that of Britain, which spends far less on health care than other advanced countries, and correspondingly is forced to do a lot of rationing. A comparison with, say, France, which spends far less than the United States but considerably more than Britain, would give a very different impression: in many respects France consumes more, not less, health care than the United States, but it can do so at lower cost because our system is so inefficient.

The result of Aaron et al.'s single-minded focus on the problem of rationing is a somewhat skewed perspective on current policy issues. Most notably, they argue that the reason we need universal health coverage is that a universal system can ration care in a way that private insurance can't. This seems to miss the two main immediate arguments for universal care—that it would cover those now uninsured, and that it would be cheaper than our current system. A national health care system will also be better at rationing when the time comes, but that hardly seems like the prime argument for adopting such a system today.

Our Princeton colleague Uwe Reinhardt, a leading economic expert on health care, put it this way: our focus right now should be on eliminating the gross inefficiencies we know exist in the US health care system. If we do that, we will be able to cover the uninsured while spending less than we do now. Only then should we address the issue of what not to do; that's tomorrow's issue, not today's.

7.
Can we fix health care?
Health policy experts know a lot more about the economics of health care now than they did when Bill Clinton tried to remake the US health care system. And there's overwhelming evidence that the United States could get better health care at lower cost if we were willing to put that knowledge into practice. But the political obstacles remain daunting.

A mere shift of power from Republicans to Democrats would not, in itself, be enough to give us sensible health care reform. While Democrats would have written a less perverse drug bill, it's not clear that they are ready to embrace a single-payer system. Even liberal economists and scholars at progressive think tanks tend to shy away from proposing a straightforward system of national health insurance. Instead, they propose fairly complex compromise plans. Typically, such plans try to achieve universal coverage by requiring everyone to buy health insurance, the way everyone is forced to buy car insurance, and deal with those who can't afford to purchase insurance through a system of subsidies. Proponents of such plans make a few arguments for their superiority to a single-payer system, mainly the (dubious) claim that single-payer would reduce medical innovation. But the main reason for not proposing single-payer is political fear: reformers believe that private insurers are too powerful to cut out of the loop, and that a single-payer plan would be too easily demonized by business and political propagandists as "big government."

These are the same political calculations that led Bill Clinton to reject a single-payer system in 1993, even though his advisers believed that a single-payer system would be the least expensive way to provide universal coverage. Instead, he proposed a complex plan designed to preserve a role for private health insurers. But the plan backfired. The insurers opposed it anyway, most famously with their "Harry and Louise" ads. And the plan's complexity left the public baffled.

We believe that the compromise plans being proposed by the cautious reformers would run into the same political problems, and that it would be politically smarter as well as economically superior to go for broke: to propose a straightforward single-payer system, and try to sell voters on the huge advantages such a system would bring. But this would mean taking on the drug and insurance companies rather than trying to co-opt them, and even progressive policy wonks, let alone Democratic politicians, still seem too timid to do that.

So what will really happen to American health care? Many people in this field believe that in the end America will end up with national health insurance, and perhaps with a lot of direct government provision of health care, simply because nothing else works. But things may have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology

"Yes--if the industry is made illegal and put out of business, it can no longer lobby."
so now your outlawing insurance companies
they have other "products to sell decides health plans

they will hammer away
as they do now
as they showed by entering the medicare sysatem by medicare advantage
where they grab a subsidy to stay afloat

don't tell me you think
hmo's as they stand now are
the only privateers ready to pile in if a profit opporunity thru pub sec rent seeking emerges

It's not a distortion to say that hybrid plans are not effective in cutting costs. When you have twice the costs per capita of any other industrialized nation, an 8-percent saving is negligible compared to a 50-percent saving.

The point is that your beloved hybrid plan does not achieve SERIOUS, SUBSTANTIAL savings in any case where it's been tried. If you're going to hang your hat on the idea that hybrid plans have occasionally achieved insignificant savings, you're refuted your own argument.

What an ass you are!

It it's illegal to profiteer in health insurance--as it would be under Conyers--it would be illegal. The HMOs would be wiped out. Hence unable to lobby.

What are you saying--that it's pretty much an equivalent risk to the population to have HMOs still in business under the Stark plan and out of business under the Conyers plan?

I think you're just nuts.

Look--you've already made the point for me. The PDA is to the left of you on this issue.

You're a crank--you need psychiatric help.

mingo

u really can't understand my points ???

i doubt that

i'll give you some time to digest them

and reprint the fatal krugman passages

your still need to savoid staying on point
by going off on my bona fides

fine suit your self
its not impressing any one here
if there is any one here

let me add
i wanted to do this mano a mano but mingula exhibitionist that i guess he is
wanted a show down here

fine lets at it

btw tomorrow i'm traveling

secret dlc mission

there may be a gap

but it won't be because i'm stumped

i'm always prepared to admit i'm wrong

as i did why my silly going on about trots
implying poor mungula is such a chimera

lets go mingy lets rock baby

all substance no orthography

btw could you please correct my typos and mispellings when you quote me

it might both aid comprehension
and flush out mis understanding

some of my typos are howlers eh ???
and my spelling well ill confess
i'm proud of that spelling coach
uncredentialling short fall

C'mon, Paine--out with it. Cite a single serious, authoritative source who supports your "argument"--really just incoherent blather--on risk pooling.

Still no answer on this one, Paine?

And you post Krugman's entire piece without even having read it? What an ass!

You're clearly demented.

Your credibility is shot forever out here.

Anyone who reads through this thread knows that you're an ill-informed fraud desperate to rationalize a mistaken attachment to a DLC con game.

NEXT!

One of Paine's weakest arguments is that single-payer will emerge, in some misty future, even from the Stark/HMO con, because American business wants it.

But here again Paine the Fraud is grossly ignorant of reality.

Here's Russel Mokhiber's summary of the reality:
Dr. David Himmelstein, co-founder of Physicians for a National Health Program (PNHP), was at a health care forum a couple of years ago sponsored by the Business Roundtable. And the moderator asked the audience – made up primarily of representatives of big business – to indicate their preference of health care reforms. And the majority came out in favor of single payer. Why then is the Business Roundtable opposed? Himmelstein put it this way: “In private, they support single payer, but they’re also thinking – if you can take away someone else’s business – the insurance companies’ business – you can take away mine. Also, if workers go on strike, I want them to lose their health insurance. And it’s also a cultural thing – we don’t do that kind of thing in this country.”

American business has long bitterly OPPOSED single payer for just these reasons, presumed self-interest notwithstanding. They feel they have more to gain from keeping strikers uninsured and from keeping that huge swath of the GDP out of the public sector, lest a precedent be set for other private sectors that might be nationalized.

Clueless Paine, ever the Fraud, ever the Ignoramus.

are we better off status quo or with a pub op

mingy
answer that

its so simple

yes or no

so we can get past your hiding behind single payer
which is not at issue here
since we all prfer it

and pretending i don't is fear on your part fear

"What are you saying--that it's pretty much an equivalent risk to the population to have HMOs still in business under the Stark plan and out of business under the Conyers plan?"

no i'm not saying that and you know it

cut out the high school debate gambits
this is about getting at the truth not
scoring silly points
if you could just respond to my questions
and please if i haven't responded to one of your points
restate it so i can

btw lest keep each comment to one claim or counter claim point or counter point
its more "efficient"

i will from now on

obviously we are far far better off with single payer
and that is not now or ever has been in dispute

the naive notion
making a profit on health insurance
unlawful

avoids the reversals
like glass seagell

so long as we have private insurance companies we will need to battle the privateers

personal accounts present a far graver threat
because they might actually work better for the corporations then even single payer

look into it

uncle milty died trying to make em happen

"They feel they have more to gain from keeping strikers uninsured and from keeping that huge swath of the GDP out of the public sector"

well why in private are they for it then ??

the first point about strikers has validity
but it must be weighed against the massive
social cost reductions you never fail to correctly mention
that single payer will produce

the strikers benefits pail in comparison

the socioal cost obviously are reflected ultimately
in lower real wages and or lower real profits
system wide

"from keeping that huge swath of the GDP out of the public sector, lest a precedent be set for other private sectors that might be nationalized."

i would think the reversals of nationalized sectors and the privitizing on public sector functions
ought to have demonstrated to you
this is far from a one way street

the corporate sector in sweden holland
danmark etc
seem to be able to co exist with huge pub secs
thouggh these corporations are for ever trying to bite of profit potential chunks
but that's rent seeking
not ideology

But they are NOT for it, really. They profess to be for it but then explain why they're not. David Lindorff, who has done quite a bit of research in this area, has found the business community to be generally bitterly opposed to single payer, because the employer-based system keeps employees more effectively tied to the corporations.

The corporations don't care about social costs--they care about their bottom line. They have always assumed their bottom line would benefit more from a cowed and subservient and dependent work force than from having to incur medical-insurance expenses.

“In private, they support single payer, "

let that sink in

the rest btw
sounds like speculation by doc himmel
isn't it ?/
i don't know
but
what corporate type would blabber this to a single payer advocate

" if you can take away someone else’s business – the insurance companies’ business – you can take away mine"

or was the doc operating in cognito

how exciting if so ....

I've explained and re-explained why the hybrid plan is not real reform: no real cost savings, no universal coverage, in many cases inadequate coverage, a public sector that will be perhaps fatally disadvantaged in costs by adverse selection. The ONLY reason to favor such a plan is if you're a whore for the HMOs yet still need to appear like a public servant of some sort. Seriously, Paine--do you work for an insurance company or an HMO? Afraid of losing your job or something?

Why do you think that even left Democrats like the PDA oppose it?

Seems everybody in the world can see through the con but Paine.

No--reread the passage; the businessmen TOLD him why they really oppose single payer even when they profess to favor it. Lindorff has heard the same story from them for years.

"bitterly opposed to single payer"
is this a catch phrase

the point is they recognize the social cost savings

"the employer-based system keeps employees more effectively tied to the corporations"

good point looking backwards

the unions got fringes
and corp[orations used fringes as re4cruitment tools
but it works
only so long as some outfits lack coverage
or pay a smaller percentage
if we get a universal mandate that's bye bye

"The corporations don't care about social costs--they care about their bottom line. "

yes true

but med sec costs impinge on their costs
and squeeze their margins

the key however is competition with foreign outfits with lower internal costs
because their health sec is smaller

the fact is really not in dispute
by corporate types
american t health costs must be contained
and reallistically only the federal gub can make serious head way here

the parallel between the hmo's and the weapons industry is nice here

you still haven't answered a simple question
do you prefer the status quo to
one with a pub op system ??
are you just being stubborn

if we need to exchange demanded answers ask me one and i'll exchange it gladly for an answer to that question

you still haven't answered a simple question
do you prefer the status quo to
one with a pub op system ??
are you just being stubborn

if we need to exchange demanded answers ask me one and i'll exchange it gladly for an answer to that question

so you think corporate america
"bitterly opposes "
what they know would be a better system

do they think its not
better for corporate profits ???
then why do they personally prfer it
to seems ethical ???

this is really a side lining here
my guess yes there are trog tower types that oppose sp
but they will be eventually convinced or overwhelmed by reality

by the way how are you going to pass sp over their resistence

or is this just a doomed agit prop mission your on
to recruit cadre for the entry into the green party ?/
if so drop the hearts and flowers shit about saving lives

you aren't even willing to compromise for any
reduction in misery

or are you really saying the status quo is superior to a system including stark
on the misery level ??

i've got to leave off for an indefinite period
i'll be back tonite some time however
so i hope to be confronted by
a mighty series of steel clad points
and answers

like where krug and i diverge in our understanding of moral hazard

vague gestures toward that piece hardly get it done

where are the passages ???

Purely technical question: what's the economist's case (leaving politics momentarily out it) for any division of the entire population's "risk pool" into sub-pools? Does it all turn on the notion of moral hazard -- nonsmokers shouldn't pay for smokers vel sim. -- or is there some other angle that I'm missing?

The hybrid Stark plans being floated are not preferable in any key dimension to the status quo. As the state experiments with these plans show, they do not achieve real reform in any of the key failings of a private insurance system: they do not achieve substantial cost savings; they do not achieve universal coverage. They are a huge diversionary con game to convince the public that there is reform in this area while essentially maintaining the status quo.

These hybrid plans are nothing but elaborate tricks to keep the blood-sucking HMOs at full throttle while pretending to do something for the general public. The public plan in these hybrid scams is a joke--still have to pay premiums, still don't have universal coverage, don't substantially reduce costs. So what's the point, other than to engage in cynical flim-flam for the HMOs?

Do I really have to be explaining this stuff to Paine? This blog is supposed to be dedicated to a left-wing critique of the Democratic Party. The co-leader of the blog is well to the right of the PDA on this pivotal issue. What's wrong with this picture?

MJS--
I don't know of any credible progressive economist who advocates a division into subpools. And I have no clue what Paine is talking about when he broaches this issue--and I don't think he does either.

Right-wing economists simply don't think health care is a right; it's a commodity that you can either afford or not. I once heard Dick Armey say that if you consider health care a right, it's only a small step to declaring food and shelter a right, too. UH-OH!

These assholes understand all too well the implications of making health care a collective social responsibility--that's why they're fighting it tooth and claw.

The abject failure and chaos of the American health care system--and the success of the Canadian and European models--has trashed all the free-market rationales for handling health care. Clearly, empirically, they don't work.

Paine wrote,
"so i hope to be confronted by
a mighty series of steel clad points
and answers"

This coming from a fraud who has proffered nothing but borderline-psycho stream-of-consciousness prose poems, piling lunacy upon lunacy with not a relevant fact or rational argument in the whole godawful mess. If a steel-clad point came anywhere near you, you would flee from it like Kryptonite.

I've provide by now at least a dozen sources on this issue. You insist on riding your hobby horse for the HMO scam plan. You're a fraud and a disgrace to this blog.

Go steel clad yourself--you need it.

Van --

Putting "credible" and "progressive" and "economist" together in one phrase creates such a combinatorial explosion of cognitive dissonance for me that I just have to re-boot.

Very likely no "progressive" economists have a good word to say for subdividing the social risk pool. My own gut feeling agrees that it sounds like a bad idea -- for what that's worth.

But my gut hasn't thought much about this stuff, or read much, and it would be interesting and educational to hear the reasoning of anybody who thinks different -- especially of anybody who thinks different but isn't just a mere Friedmanite.

Which Owen is not, I do assure you.

father
i'm not sure what you have in mind

but at any rate

multiple risk pools
for any public plan option
allows the pub sec to capture the low risk bodies
young healthy etc
any plan that lacks this feature needs to evolve one pronto

i note mingula catures the dark side of this

ie a system where the pub op must take all and has but one pool
vs hmo's that can sharp shoot

the concern a legitimate one
that the hmo's could focus on skimming off low risk bodies is only combated otherwise by
a one pool per hmo system regulation
PLUS
some requirement to maintain a census that has average body type characteristics
sort of like fleet characteristics in car emission regs

this gets complex obviously
and gameable
better i think to just let the pub option create as many pools as it needs to

now as to the single payer system
i'd still suggest a multi pool system
to reward risk avoiding behaviour
like your smoking non smoking example

and i'm troubled by a system that is to leveling
my gut sez
youth ought to have lower premia

i realize some kind of intergenerational transfeer must exist
but how much
to me the minimum that preseves the system

ie

the elderly oughta face higher premia

as the represent higher risks

yes they have a life time to buy extra insurance to cover this as part of providing for their retirement

this is obviously controversal
and what interests me about health insurance
is this aspect
plus cost controls system wide

let me repeat
the deeper long run problem
faced by any health payment system
is on the supply side of the actual medical services and drugs etc

but that is not part of this discussion

i note my subconcious interest here
when i substituted npo hospitals for npo insurance plans like blue cross blue shield used to be

krug
describes adverse selection

"The insurance company would quickly find that because its clientele was tilted toward those with high medical costs, its actual costs per customer were much higher than those of the average member of the population. So it would have to raise premiums to cover those higher costs. However, this would disproportionately drive off its healthier customers, leaving it with an even less healthy customer base, requiring a further rise in premiums, and so on. "

nothing to comment on here
and yes if the pub option is flat footedly required to run only one pool with one premium
this process would occur

but what sez this must be so ???
the pub op just needs to demand a level playing field
it ought also to be a part of medicare no reason to duplicate administrative systems

the point ??
yes the pub op could get fucked
like medi part d
nicely described by krug

"they devised a plan that works very differently from traditional Medicare. In fact, Medicare Part D, the drug benefit, isn't a program in which the government provides drug insurance. It's a program in which private insurance companies receive subsidies to offer insurance—and seniors aren't allowed to deal directly with Medicare......the private intermediaries add substantial administrative costs to the program. It's reasonably certain that if seniors had been offered the choice of receiving a straightforward drug benefit directly from Medicare, the vast majority would have chosen to pass up the private drug plans, which wouldn't have been able to offer comparable benefits because of their administrative expenses. But the drug bill avoided that embarrassing outcome by denying seniors that choice. "

and medicaid oughta get consolidated into medicare while we're at it

these are all rationalizing
and ultimately necessary steps

can they be broken up into seperate stages of struggle ??
well i suspect we'll be forced to find this out

oh how much easier it would be if the hmo's just caved in to single payer
but .....

"C'mon, Paine--out with it. Cite a single serious, authoritative source who supports your "argument"--really just incoherent blather--on risk pooling.

Still no answer on this one, Paine?"

what's to answer
krug provides a formal narrative
it only needs application
to a hybred system with a pub op plan

i figure its so common placeanyone can go to wiki and read up on it

the application is where the cross talk enters
and i think the caveats here are covered in prior comments

Owen -- Believe me, I don't have anything at all in what I humorously call my "mind". My gut, however, is talking to me rather loud.

My gut says that rewarding nonsmokers and penalizing smokers sounds a lot like liberal soul-engineering at best, and profiteering off people's human frailties at worst.

As for the young paying for the old -- well, I'm pretty old after all, so maybe there's some selfishness at work here. But most young people -- if they're at all lucky -- will grow up to be old. Why not think of it as a lifetime averaging of risk?

If you die young, admittedly you lose. But you leave a prettier corpse, which is something. And there are some sorrows you will have avoided.

Another thing that my gut tells me is that trying to optimize is a bad idea. I've never seen any good come of it. Over-engineer, build in a generous fudge factor, and sleep like a baby at night -- that's my motto.

there is no reason to drag in uncle milty

he's for presonal accounts
which krug also nicely demolishes

the solidarity aspect of all this can mean
some combination of

price rationing or service rationing

note
service rationing is put at 100% if you go to one pool

this issue has dimension folks

diletantes and parrots need to approach it with a certain humility

i certainly do

let me be prefectly clear as my idol would have said at this point

the present discussion covers
the reform process
it faces one choice
either go ahead with a pub option and fight for its expansion and enhancemennt over time

or face single payer going down in flames

that is unless some one here actually thinks
a popular majority can over ride
the corporate control of the congress

corporate america might stand for a slow bleed
we'll justy have to see if it will allow the people's will
to remove the hmo's with one stroke of the pen

i have to assume
migula agrres with me that the status quo is worse then a system that included a public option

regardless of the utter superiority of single payer
in a reform struggle you take outcomes and move forward

raging and foaming are counter productive

parroting the single payer arguments
out of so utterly
peanut brittle ideology
vs
reviewing the practical advantages
is hysterical posturing

well of course you are right

funny but super al and i were exchanging thoughts on the nudge school of social engineering just today

in your noble effort to rescue us from nurse ratchet

maybe the main point was lost

the pub op needs this
to combat pri sec gaming

as to life cycle averaging of risk

"trying to optimize is a bad idea. I've never seen any good come of it. Over-engineer, build in a generous fudge factor, and sleep like a baby at night -"

never fear a knife edge asspergering here father
the quantities are too uncertain

might i note in closing

facing high premia at age 100 might lead some of us old fucks to off ourselves

this is not such a comic point

we need to nudge oldster life hogs
to shoot on thru

the world is for the young
johnny swift created an island where this dilemma is played out as you know

but hey who am i to impose this on anyone
its really down the road

lets get to single payer first
and i'll agree
lets run life cycle risk averaging
up the pole
and see who solutes it

i'm content either way
so long as i get to ration the services availible to mingula as he approaches his
90th year

"Insurance companies deal with these problems, to some extent, by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums'"

oh that's krug

"or charging them higher premiums "

ie multi pooling

When is Paine going to leave on his vaunted trip already so the stench of obfuscation can be cleared from this thread?

Paine dribbles on maniacally about multiple pools but cannot cite a single authority who has proposed or elaborated such an idea in relation to a public option plan. It's inherently self-defeating to have such multiple pools because it intrinsically defeats the idea of risk pooling.

And when he asserts that the public plan will get all the young, healthy patients--this is simply off the wall.

I have cited serious scholarship and analysis on this issue to support the idea that the K-street-spun public-option hybrid plan is a recipe for disaster. Paine is pleased to call citations such as this "parroting" because he--despite his claims to be a great economist--can cite no creditable authority to back his daft irrational babble, so he's a bit jealous. In fact, every quotation and source he's come up with has been culled from material provided by . . . me. The guy is not only dumb as a brick but almost completely illiterate in this area. He mistakes his schizoid "reasoning" as a form of "genius." this is truly pathetic--I don't know how MJS stomachs it.

MJS's comments are a refreshing breeze of lucidity amid Paine's stink bombs of doubletalk. Michael--you express distate--or incredulity at the idea of progressive credible economists. But contrast the pellucid explanations of Krugman--and the effectiveness of his arguments for single-payer--with the bizarre parodies of rational analysis served up by Paine--whose support of the HMO plan is certainly not progressive or left in any sense, and whose ludicrous prose poem blather does not qualify him as creditable or an economist. I think you get the idea.

Paine wrote:
"i have to assume
migula agrres with me that the status quo is worse then a system that included a public option"

The guy can't think, can't spell, can't read. Quite a resume for a genius.

I have already made it quite clear--about half a dozen times--that I don't think the hybrid plan is even a half step forward; it has not solved any problems or increased coverage in the states where it has been tried.

In fact, for reasons already elaborated more than once, I believe that it could prove a major setback for single payer for the havoc it would likely wreak on the disadvantaged public sector.

well now you're on the record

"I don't think the hybrid plan is even a half step forward; it has not solved any problems or increased coverage in the states where it has been tried.

In fact, for reasons already elaborated more than once, I believe that it could prove a major setback for single payer for the havoc it would likely wreak on the disadvantaged public sector."

ie

plan op is worse then the status quo

thank you

we will see what we will see

mean while vaningula

get out there and try to make single payer happen or go down gloriously in flames
daning the bitter opposition of corporate america
and its quislings
among the peoples' representatives

glory be to the mouth of the struggle
americans now living in misery cry out to you
and they deserve no less then your 100% activation

no time for gabbling with idiots like me

organize mingo organize hit the bricks
throw yourself head first into the struggle

and with that i depart
this thread and this location

gob bless you one and all
especially u mingoo
its been a frolic

until another day and another thread

No, Paine, time for another lesson in explication du texte. What I wrote was that the plan op (that is, Owen Paine plan for keeping the bloodsucking HMOs in business) is DEFINITELY no better than the status quo--which is why even the PDA opposes it--and COULD be worse if it ends up sandbagging and discrediting the public by gaming the system against it.

Paine sneers that any persistent struggle on behalf of meaningful reform is a kind of death wish--a determination to "go down gloriously in flames." It's not the first time he's defamed activist struggle in this way.

This is precisely the snicker we hear from DLC types in relation to the left--they're "true believers," "purists," "masochists," they make "the perfect the enemy of the "good," etc. Paine has the entire catechism of DLC PR sophistry down rote. As I said--he is a glaring anomaly on this list, for manifold reasons I need not belabor any further--at least I hope not.

van mungo's aim is that of a well-trained, calm sniper:

The shortcoming of Paine's posts on this subject are many: the usual insufferable, bluffing orotundity, to be sure, but that's the least of it. The guy is just obtuse--completely unable to grasp one simple essential truth of this matter than has been conclusively demonstrated to him several times now: the Stark public-private option plan is NOT a reform or a step forward of any kind. It is not an incremental advance toward single payer. It is expressly designed to sabotage single-payer permanently by gaming the system so decisively in favor of the private HMOs that the public sector will be made to look impossibly expensive and unworkable.

and

Why would Paine, a professed Marxist/socialist, be pushing this arrant corporate PR con game? It makes him feel like a "knowing," "wise," "practical," political insider, in contrast to all those rabid ideologues who don't understand the "limits" of "real political choice."

As a former insurance lawyer who has worked all sides of the insurance game, I have to say that van mungo has OP's number here. OP's objections are excuses for an incremental form of continued insurer profiteering, for precisely the reasons van mungo explained. That OP doesn't see these problems tells me that either OP is ignorant of how the insurance world works, or is not so ignorant, but instead is a knowing shill for corporate donkey / elephant interests. Perhaps there's a middle ground between those two poles, but I'm unable to divine just what that center position is. If OP's posts continue to use turgid metaphors to excess, I'm sure we'll never sort out just exactly what "center" position OP holds.

I do admire OP's comment style in comment threads, but the content of this essay is obnoxious in its naivete and outright sycophancy for an immoral system.

>van mungo's aim is that of a well-trained,
>calm sniper

VM's fulminations sometimes grate on my nerves, but one's got to admire his indefatigability. He pummeled OP into submission, not with one overhand right, but with rounds and rounds of solid work to the body. It helps that on this issue the facts and politics are on his side, as he has made abundantly clear.

gluelicker--
You disappoint me. Why toss in a gratutitous swipe about "fulminations" when it is precisely I who have mustered the "facts and politics." Any reasonable, objective reading of this and other related threads makes it clear that the ad hom fulminations have been gushing from Paine. Yet I have yet to see you muster the guts to call him on his relentless ad hominem streams of abuse--torrents of red-baiting, name-calling, desperate invective (hysteria this, mingula that, exhibitionist this, rage that, hyperpinks, ape flinging feces, hot gas, etc., etc)

You sit on your hands for this, and for the endless cascades of insulting condescension, pretension, and affectation, all deployed to summon an aura of ominiscience that, he hopes, will cow the credulous into silence and submission. Seems to have worked so far with you, gluelicker!

I, on the other hand, simply call BS when I see it.

This situtation is an apt analogue to the old Harry Truman saw: "I tell the truth, and to them it feels like hell." To you it feels like fulmination, whereas obfuscation and posturing seem to elicit no discomfiture in you at all. That's your problem.

VM, I stand by my words. You won the argument (if it can be called that, given OP's elliptical tendencies) on the firm basis of accurate facts and sound analysis. And I was actually admiring how through sheer relentlessness you got OP to equivocate, to dodge, to change the tune. It was a minor miracle. And your fulminating style ("fulminate"="to send forth censures") is indubitably part of your relentless method.

Personally, I tire of you telling us again and again how "orotund" or "opaque" OP is... you made your point, and it's as plain as the nose on my face (and I have a big schnozz). As for OP's illegitimate rhetorical techniques, well, I'm afraid he sometimes (and only sometimes)operates on a different ontological plane than the rest of us. To my palate, his habits are alternatively charming and enervating. On this occasion you made him look downright silly. In any event, his habits are what they are, to use a cliche. To say any more about them is to get bogged down in a sandtrap.

I'm not going to pay excess homage to you and your "victory," because to do so would just amp up the unseemly macho gladiator spirit which has taken over this blog. Unceasing tit-for-tats drive the customers away. In fact in that regard, I may self-nominate. Cheerio...

What rank hypocrisy, gluelicker. You express your distaste for "macho gladiator spirit" and "tit-for-tats," but you bound into this thread with your first post . . . to do what? To toss a nasty barb at me about my "fulminating"--no examples, just a good old-fashioned nasty dart of malice. You're just full of crap--you don't really object to acrimony, because then you'd have no reason to post here.

We've had a nice couple of cordial exchanges on another thread recently, but you just can't contain yourself--just can't resist an opportunity to vent your petty spleen, to let the big boys know that even though you dared to compliment me, you're really still one of them! What a pathetic herd animal you are, gluelicker.

You claim to be concerned about what's good for the "business"" of the blog. I can assure you that untold "customers" have been driven away from this site by MJS's giving Paine free rein to slosh his free-form megalomania and nonsense all over this blog. People come here to discuss left politics, and they are felled by wave after toxic wave of preposterous, involuted prose poems, and you think that's a big attraction? Charming, even? Then you're as nuts as he is.

You could have entered this thread to make a substantive contribution. But instead you show up precisely to throw some personal jabs--all the while piously deploring tit-for-tat. Don't you make even yourself the least bit nauseated with that phony piety?

Your typical post on this blog is short on substance but long on personal acrimony. You quip, you flame, a sentence here, a sentence there, and that's it. You are precisely the blight you claim to deplore. So here's my suggestion: the next time you're tempted to post a comment, ask yourself if you have anything of real substance to add. If not, please just shut up. You're bad for business.

VM: "I can assure you that untold 'customers' have been driven away from this site by MJS's giving Paine free rein to slosh his free-form megalomania and nonsense all over this blog."

Glue: That could very well be, but do you have proof, or is this merely conjecture? It's just as plausible that those who don't cotton to OP just circumvent his postings.

Anyway, VM, you're such a maximalist, and an egotist to boot. I expressed that you clearly triumphed in this exchange, as well as astonishment that you actually made OP back off a bit. But no, that's not good enough for you. I have to second all of your characterizations of OP too! Perspicacious though these characterizations may (or may not) be, they're quite beside the point. And you get all hung up about my use of the word "fulminations"... look it up, it's not the attack your sensitive soul makes it out to be.

I concur, OP's brief for pseudo health-care "reform" is dissonant at best and devious at worst. You made your case well. You also punctuated your case with the usual hyperventilating, because you can't resist getting dragged into the mud. Your marshalling of facts, command of logic, and political perspective may be superior to that of OP (that's the plaudit you want to hear, isn't it -- "superior"?), but your suggestion that you elevate the discourse around here is dubious.

Anyway, I will take your advice about refraining from further comment on your methods. (You do have an amazing talent for browbeating stragglers into compliance... it's kind of illustrative of the soft dictatorial possibilities of rule by consensus.) Substance is what counts.

gluelicker--
You're a bad running joke of hypocrisy.

You write, "I will take your advice about refraining from further comment on your methods"--right after you get off about five more malicious swipes, which seems to be your usual daily quota of cathartic belching of malice into the planetary ether.

Why do you think that it's an important contribution to this blog to alert everybody to your emotional dispositions: what grates on you, what annoys you, what charms you, etc., etc.? Why not, while you're at it, provide a running commentary on the state of your bowels, your sex life, the kind of toothpaste you prefer, whether you floss or not, whether you bite your fingernails or toenails, etc., etc.?

This headline motto of this blog is not "Morbid personal affections, disaffections, and personal dispositions of gluelicker." Based on most of your posts, you seem to think it is. Please think again.

What follows is an unedited post from the comment section of an article on yesterday's protest at Baucus's phony finance-committee health care hearings, from which representatives of this country's most popular reform option--single payer--were excluded while represenatives of the HMOs were ushered in "like royalty," as Donna Smith of CNA observed (the protesters, including a prominent physician, were all handcuffed and arrested for demanding that single-payer be represented at the hearings.

The commenter accurately portrays the roguery that is behind the "public option" plan that Paine has been pushing out here. The comment, with its documentation, vindicates everything I and others have argued about the hybrid plan--it's a scheme to UNDERMINE public health insurance, not to sneak it in the back door, as Paine believes (or doesn't really believe but wants us to believe, along with the racketeers in Washington):

Senator Charles Schumer-D, NY has set about to DESTROY the "Public" option from the pending Healthcare legislation.

From the NY Times:

Mr. Schumer said his goal was “a level playing field for competition” between public and private insurers...

The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

* The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

* The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

* The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

*To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

The full and unedited story at:
http://oxdown.firedoglake.com/diary/5142#more-39730

*** By the time the Senate gets finished the "Public" option of the bill will be absolute garbage worth less than a credit default swap.

From yesterday's commondreams:

Published on Tuesday, May 5, 2009 by KQED (California)
The Uninsured Are the Symptom, Not the Disease

by Claudia Chaufan

I was invited to join the health care reform debate by addressing a set of questions falling under the general theme "Covering the Uninsured". The problem is that to answer these questions I have to challenge fundamental assumptions underlying them - if one asks the wrong question or misunderstands the nature of a problem, the chances of getting the right answer or solving the problem are slim.

And this is precisely what happens with the three questions I was asked, namely, should all Americans be required to purchase health insurance; what options for coverage should the uninsured and underinsured have; and how do you assess when coverage is affordable. They all assume that the problem is the uninsured or the underinsured. But these are only the "symptom". The real "disease" is the financial organization of our system.

In all industrialized economies, but ours, individuals do not "purchase" insurance as you "purchase" shoes or cell phone plans. Rather, they contribute to a system whose goal is to eliminate financial barriers to health care. Those systems, to varying degrees, pool risks and are financed by compulsory cooperative contributions.

What does this mean? Well, pooling risk simply means putting everybody into large pools, the bigger the better, and budgeting for people's medical needs in the same way families budget for their members' nutritional or educational needs. And why would they do this? They do this because given that the goal of the system is to eliminate financial barriers to care universally and according to medical need, these systems seek to optimize the use of members' money.

And pooling risk does so in three ways. First, it allows the system to cross-subsidize, which means that at any given moment the healthy or least costly majority pays for the medical care of the less healthy and most costly minority. Cross subsidizing is critical for any insurance system to be sustainable: if a system includes only sick people it will quickly go bankrupt (this, incidentally, is the problem of our American Medicare, because it enrolls only the elderly, who tend to have higher medical costs, and the disabled, whose costs are the greatest. This problem would be resolved by putting all of us into Medicare, and of course getting rid of all the private middle-men that have corrupted it, e.g. "private fee for service Medicare", "part D", etc.).

The second thing that pooling risk does is to dramatically reduce administrative overhead, i.e., waste that comes from pushing paper around - to separate people into plans, to market those plans, or to underwrite policies (essentially to deny paying for care). While paper-pushing is the lifeblood of private or liability insurance, because it helps it achieve its ultimate goal, which is not to provide a social service but to make a profit, from the point of view of systems whose goal is to eliminate financial barriers to healthcare paper-pushing is waste.

Third and last, pooling risks gives those systems important market leverage, precisely the leverage Americans lack, which is why we pay the highest prices on the planet for services and goods (e.g. pharmaceuticals) that cost a fraction elsewhere. (And don't worry: doctors and pharmaceutical companies elsewhere do just fine!).

What about cooperative compulsory financing? Well, this means that participation is not optional and is based on cooperation, or solidarity, if you will. And by making participation compulsory those systems have a guaranteed supply of money. But the cooperative dimension means that nobody is forced to pay what they cannot afford, because that would defeat the very purpose of the system. So contributions are a proportion of income, a mix of taxes or payroll deductions, and align, more or less, with the World Health Organization (WHO)'s requirement pertaining to "financial fairness". For the WHO, a system that forces you to forego healthcare, or to have to choose between healthcare, rent or food, or that pushes you to bankruptcy (as we do) is decidedly unfair. The rule of thumb is that any system into which people pay over 10% of their income in medical bills (including monthly contributions and out of pocket, extra costs) is "financially unfair". And mind you, we pay at least that much to finance an extremely dysfunctional system, even this system leaves you on the cold when you need health care (Remember that your taxes foot the bill of all public programs, for the elderly, the disabled, or those who qualify as "poor", even before you are eligible for any services yourself. In truth, you are "cleaning" the market of "bad customers" and leaving all the "good customers" to the private health insurance sector).

But what about the questions posed by KQED? Well, let me rephrase them. Should Americans be required to purchase health insurance? As I said, the concept of "purchase" does not fit the systems I just described, which is the one I believe we should have in America, because people elsewhere do not "purchase" health insurance the way we do.

And what "options" should the uninsured and underinsured have? Again, others do not "shop around" for "options", which implies that you need to second guess if you will need an appendectomy, diabetes care, or one week rather than two days in a given operation. Whatever expenses others have for care that the system has considered "medically necessary" will be paid for out of the common pot. If they want over and above that, they pay for it as you do for that pair of shoes that no reasonable person considers is your "right" to have, or is a "basic human need" (especially if like me, you have more than you will ever be able to wear!).

And last, how do you assess your coverage is affordable? Well, if you consider that unpaid medical bills are our first cause of personal bankruptcy, you know where we stand in that one.

Last, will the Obama plan solve our mess? I wish I could believe so, but I do not. For one, it sticks to the wrong conception about how to finance a health care system, assuming of course that the goal of the system is to eliminate financial barriers to health care universally rather than to create a profitable "illness market" or appease the folks who finance your political campaigns. And any system that sends people "shopping around" for policies while leaving the for-profit motive at the center of the system intact is likely to fail. It has repeatedly, for reasons studied ad-infinitum (yes, health policy is not rocket science!) and we have no reason in the world to believe it will be different this time.

© 2009 KQED
Claudia Chaufan, MD, PhD, is an Assistant Professor of Sociology and Health Policy at the Institute for Health & Aging in the Department of Social and Behavioral Sciences at the University of California San Francisco

"an incremental form of continued insurer profiteering,"

of course it is
any thing short of single payer preserves the profiteering option

the question is

a can a pub op be a first step toward
single payer
and
b is stark a pub op
with a real chance of evolving into
single payer

the answer of mungula is clear

no and no

i say yes to a

and as to be well stark's plan so far is too ambiguous to tell

i was hardly beaten into submission
btw
i simply never came back till a few minuytes ago
why ??
well
the thread had reached the point where
i understood mingo's position
as stated most clearly

"the Stark public-private option plan is NOT a reform or a step forward of any kind. It is not an incremental advance toward single payer."

and that is simply a patronizing
over statement
bad faith agit prop
either by him or by those he's parroting
that make that claim

----
looking at a few comments
perhaps its still not clear
what my position is

this part i hope is clear
you will find a consistent support on my part
of single payer
and i urge and have urged those fighting for it to keep fighting for it

the fight for single payer is obviously critical
to enacting any real reform pub op
and if any real reform pub op gets wrung out of the corporate controled congress
it will be because single payer retains the momentum it has now
and continues to push at each stage of the struggle

single payer is inevitable
as a matter of simple economics
demonstrated just north of the border
corporate america can see its brethern corporations and its own branch ops
working quite well in a sp context
and without losing the wage war (unfortunately
i wish single payer could burst the corporate dykes
but it really only strengthens them )

-----

mjs prides himself on his latin

well i lack humility about mattters pub sec micro economical

in fact moral hazard and adverse selection
in particular are subjects
i claim to myself to well understand

lawyers with years of practice
in the field not withstanding

but perhaps in this context
i should have stuck with my first point

for a pub op to work
it must have the same tools as the pri sec
and the pri sec should not have the subsidies it has in the drug plan

the gauntlet will be long on the way to single payer i fear and full of sneaky legislative provisions
the insurance industry and even more so the drug industry will not lay down
even when single payer finally emerges from the gauntlet

ll along profiteering will continue
but like most reform process more or less is the measure of the struggles trajectory
the lawyers point of course
was not about any pub op directly generating profits
but rather not preventing them
i think he some how believes i don't realize that profiteering will continue to go on till we have single payer

well believe me i do
that is a sufficient reason to push on to single payer as fast as possible

btw the fast route is single payer now .....
no one here will gainsay that

now as far as i'm concerned we act from here
and without anyone acting differently

to pass single payer or at least push it onto the agenda and from there as far as it can go

and here's where mingula man of deeply bad faith jumped in

if we end up with a pub op only
the strength of the sp movement will determine whether it has a fighting change as a reform

again to categorically rule out
any pub op as a reform even if a second best reform
is maximalist hysteria

no this is not over mingy
we got rounds and rounds to go

in the mean time learn some
micro economics

i susprect if your still answering the bell we'll get to many more points of "education" for you
i can't waite
but of course if by some stroke of fortune we get single payer this year

then mingula and i ncan get wed ....in iowa

i guess i need to address the last informative post

very interesting by the way

"pooling risk simply means putting everybody into large pools, the bigger the better,"
yes the bigger each pool the better in fact one pool per society per risk grade is a certain optimum

" budgeting for people's medical needs in the same way families budget for their members' nutritional or educational needs"

but ah the one pool suits all approach
means the budget must be larger
because no one is rewarded by the system at least for risk reducing behaviour

is that clear ???

"goal is to eliminate financial barriers to health care"
very important social aim paramount in fact

but that has to do with affordability eh

let me be clear here

if its determined once we have single payer
that no one should have any co pays at all fine with me
then just reward risk avoiding behaviour
nothing sez the pools can't be various levels of rewards not premia
or a combo of both with a zero pool
in the center

is that clear ??
at least to all who wish to understand and
are not just rying to oust a foppish
know it all clown from this site

back to risk pools

pooling "..allows the system to cross-subsidize," yup that's the point its an aggregator and a tranfer system

" at any given moment the healthy or least costly majority pays for the medical care of the less healthy and most costly minority"

that is a stacked statement
yes
within a universal pool
society as a total group pays for
the health costs of everyone collectively out of one pool gathered by some tax
say a value added tax
--we are setting aside co pays and premia of any sort ---

fine
but the healthy don't pay for the sick
the society of both healthy and sick pay the bills of the sick
ie the system distributes according to need
bravo right ??
so why this lingo
well cause it leads to universal pooling and thus bums rushes past the multipool system
by a burst of solidarity

but here's the rub
what if this sysytem produces more sickness then a multi pool systtem
notice i'm not saying
more payments by the sick ie i'm notbtalking price rationing here
ie reducing the demand for health care by
making it costly
that violates the premise of eliminatinfg barriers to health care

i might like that as a sadist plutonian
but for the sake of the principle of
to each aaccording to her/his need

ie by rewarding good behaviours and sendingg shivers up fatherbbS's cast iron spine
we can nudge folks into diet and exercise
or no reward pal

now i'd take the no diet no exercise plan even if it cost me
but some folks would respond to this and get less sick or less sooner or ..well u know

"Cross subsidizing is critical for any insurance system to be sustainable: if a system includes only sick people it will quickly go bankrupt (this, incidentally, is the problem of our American Medicare, because it enrolls only the elderly, who tend to have higher medical costs, and the disabled, whose costs are the greatest."this is not gibberish but it sure is agitprop

who blames medicare for its costs since its a plan to pay old folks health bills only ??

"This problem (??)
would be resolved by putting all of us into Medicare, and of course getting rid of all the private middle-men that have corrupted it, e.g. "private fee for service Medicare", "part D", etc.)."

what problem??
how would medicare work better if universal
beyond scale effects in administration and filtering ???

the middle man thing is like one of mingulas tetegraphed hay makers

i mean ya 400 billions of waste and profits
wiped away with one stroke by enrolling everyone in medicare
ya i guess that might lighten the total load some
as this nicely outlines

"pooling risk .. dramatically reduces administrative overhead, i.e., waste that comes from pushing paper around - to separate people into plans, to market those plans, or to underwrite policies (essentially to deny paying for care). While paper-pushing is the lifeblood of private or liability insurance, because it helps it achieve its ultimate goal, which is not to provide a social service but to make a profit, from the point of view of systems whose goal is to eliminate financial barriers to healthcare paper-pushing is waste."

but whats that got to do with medicare having a problem ?? or being a problem for us non seniors??

now i'll admit my doc nudge plan hass a dead weight loss to it
like the social dead weight loss of excess admin costs and human loss of denigned treatment

" pooling risks gives those systems important market leverage, precisely the leverage Americans lack, which is why we pay the highest prices on the planet for services and goods (e.g. pharmaceuticals) that cost a fraction elsewhere.'
no that comes from single payer not single pooling
monopsony power is indeed hugely important
but its prolly oligpsony power that we need
ie a pub op that is open to every one

notice btw the black hats want to run the pub op seperately from medicare as medicaid is now

weakens the clout of unity eh ???
we white hats need to jump on that loop hole

"What about cooperative compulsory financing? Well, this means that participation is not optional and is based on cooperation, or solidarity, if you will"
that gets a trace slime like
new speak co operative compulsion
wow

its compelled solidarity indeed
but that's the state's gig eh ??
voluntary solidarity like no prof hmo's tried to be
well ..
advers selection entereth here

"Whatever expenses others have for care that the system has considered "medically necessary" will be paid for out of the common pot'
that my fellow duclklings is what i mean by 100 percent quantity rationing
its not about rationing by waiting list
its rationing by "this is what byour ventitled to

like the welfare basket of yore

well i ugh up a bit here
as does super al

btw he ughs up about nudgeonomivs too
unlike yours trullllly
owen totalitarian shithead paine

stark type plans
" .. the wrong conception about how to finance a health care system, assuming of course that the goal of the system is to eliminate financial barriers to health care universally rather than to create a profitable "illness market" or appease the folks who finance your political campaigns"

change the world create to preserve and i totally agree ...obviously

"any system that sends people "shopping around" for policies while leaving the for-profit motive at the center of the system intact is likely to fail."
god that's where we came in

but but but

she doesn't marshall her reasons

"It has (failed) repeatedly, for reasons studied ad-infinitum ... and we have no reason in the world to believe it will be different this time."

god that's where we came in

well convince me its impossible
note she don't say that of course
but convince me of it
and i'll eat my dick

but this i do know if the single payer movement don't blast away till victory and then some

the profiteers may well give pub op an aweful beating

Paine's last two posts make his deeply entrenched stupidity clear on several levels:

1. His continued reliance on addled ad hom blather: "mungula," "mingula man of deeply bad faith," etc.

2. He is resolutely devoid of any understanding of basic economics, notwithstanding his claims--entirely phony, I'm convinced by now--to great economic expertise: to wit, he is completely immune to understanding the concept of risk pooling--he mangles it into pure dada with his sputtering about multiple risk pools.

3. He is temperamentally a market conservative--this is absolutely clear by now. Whatever his claims abstractly to favor some kind of socialism, his heart really isn't in it. He echoes--parrots, in one of his favorite ad hom terms of abuse for those who have sufficient knowledge to actually cite creditable sources--the right-wing line that a single payer system does not contain disincentives to risky behavior. I suppose that he considers the combined threats of death and penury under the present system more efficient forms of discipline? Why not corporal punishment while he's at it? You can easily slap deterrent taxes on cigarettes, junk food, liquor, etc. But consider that Canada and European countries have BETTER health outcomes overall than the U.S. while guaranteeing health care to all--no one ever sees a medical bill in those countries, and they all have better life expectancy and infant-mortality rates than the United States. He has also apparently never thought about the fact that you can regulate and tax sources of ill-health--the socialist solutio--rather than relying on barbaric market "discipline." Paine is too ignorant to have studied the relevant data on this issue. In fact, his lack of familiarity with the data on this issue is truly astonishing for anyone, much less a pompous ass on economics isues.

3. Here's a guy who sniffs that others need to study microeconomics, and he himself is a complete doorstop on many of the basic economic concepts underlying health care.

Finally, MJS, it's clear by now that if you want this blog to thrive--to serve as anything but a vanity forum for Paine's diseased and bloated ego--you need to find a way to rein him in. He's been definitively exposed now as a fraud and dunderhead, an addled strewer of nonsensical prose poems that reveal nothing but the depth of his ignorance and psychological problems. As long as you refuse to intervene to discourage him from staggering over these threads, there will be scant possibility of fruitful discussion. It's bad enough that 80 percent of these threads and comments are occupied by an avowed partisan of market "discipline" who fear-mongers about socialist "rationing"--crap that's right out of the Friedmanite playbook--but to encourage this crap on a leftist blog is simply beyond belief.

You need to do a serious reality check about his. How much do you care about this blog, and how much do you really want it to succeed? If you allow Paine to continue on his current course, it's obvious that the fate of the blog is of secondary importance to you.

Van
--No more nick names
For u
It creates to much indignationary gas--

Thanx for the shooms bit
Indeed he is the lower east side of wall street
He operates a center aisle push cart for the pri sec fire department of haute corporate america

No one least of all me figures a "good" pub op will come out of the
CCC corpprate controled congress
With out enormous struggle

I can well. Imagine as the drafts emerge
Poison provisos like shooomys'
Will rain down upon pub op
Like a monsoon

Unlike your usual
Comment
When u aren't
Replicating an authority
This last post doesn't just contain
Repeats of prior vaguery

Making most of any comment of yours
Tediously gasoid

No This last one
Actually
Address the behaviour mod issue
Much thanx

Your remedy
Sin taxes is
Certainly an alternative method
To rewarding good behaviours by
The fed insurer
U obviously understand moral hazard is enhanced potentially by
No co pay no premia systems
And of course only a legal monopsony/monopoly with
Unlimited credit
And unversal tax power
Could even contemplate it

Its really a nice topic
I prefer to measure and reward outcomes
Internally
Ie by the system itself.being pro active and rewarding improved out comes

Btw I suddenly realized last night
My use of multi pool methods in the context of sp
Is. Confusing
Since pools usually stand alone financially
These would be better characterized as virtual pools
Where

CeRtain behaviour clusters are followed to watch differential outcomes
To determine gains from behaviour mods

It in general would be better
If in good faith we tried to isolate the areas of actual disagreement

And stick to a critique of actual pub op plans
Point by point
Tying failures to specific provisions and providing specific remedies if they exist
If say star has shoomer provisos we scream bloody murder

Of course u persist in your ousting
Phillipics

Btw feel like I'm hanging by a thread

Paine wrote:
"Comment
When u aren't
Replicating an authority
This last post doesn't just contain
Repeats of prior vaguery

Making most of any comment of yours
Tediously gasoid'

Now listen carefully, you deluded hot-air bag. You wouldn't know how to deal with a serious, comradely discussion if it slammed into your nose. I'm not the one "parroting" or "replicating" authority or dogman--I'm using creditable, authoritative references to buttress points--a common practice in rational, scholarly discourse. You sneer at this practice here because you can't cite any authorities to support your points because (a) your points are incoherent bluff and (b) creditable authorities do not engage in incoherent bluff and so cannot be cited to support it.

There has been almost NOTHING of subtance in all your tedious dribble of verbiage on this topic. I'm not the only one who thinks so--all the third parties who have followed this debate have seen through your rhetorical puffery and found it fraudulent--a farcical attempt to conjure an air of expertise with metaphorical doubletalk pretty much on the level of Dr. Irwin Corey, minus the entertainment value.

Ironically, it is you who are "replicating" and "parroting." You pretend to have mastered a vast corpus of economic knowledge--I frankly doubt this, since you cannot put two intelligible sentences together--sometimes not even two intelligible syllables. You patronizingly scold others for failing to rival your economic erudition. Well, excuse me for laughing, but . . . although I've seen you trot a series of names from economic history on this blog, I've never seen any evidence that you have really mastered, much less thoughtfully critiqued, any of their ideas. You take pride in having immersed yourself in the cesspool of bourgeois mystagogy, of religious dogmatism and intellectual whoredom known as modern "economics"? You think that makes you smarter? No--the mere fact that you have swallowed whole so much of this intellectual con game, this mathematical rationalizing of rapacity and cruelty, shows that you have lost the ability to actually think. Instead, you refract every issue through this maze of poorly assimilated and dimly comprehended sophistry grandly self-desginated as economic "science"; you therefore see the world through the eyes of the bourgeois market religionist.

Your views on health care--single payer vs. the Stark "hybrid" plan--positively reek of this ideological obscurantism, this philosophical anthropology of greed masquerading as science. You "mastery" of economics is a form of intellectual petrifaction, a freezing of the critical faculties, a mindless recitation of predigested formulae and catechisms. You see the world through this distortive prism, and so cannot begin to grasp reality with fresh eyes. You--and the rest of the economics professoriat--are what Yeats had in mind when he wrote,

"All shuffle there, all cough in ink;
All wear the carpet with their shoes;
All think what other people think;
All know the man their neighbour knows."

You grandly posture as a savant of the higher that other mere mortals can only sniff from a distance. In reality your disoriented rambles reek of the stench of conventional wisdom--the "wisdom" of humans stuffed into the bed of homo economus, who must be disciplined, punished, thrashed by the market for their sins before they can be deemed fit for something as elemental as the right to life and health.

Despite all your empty presumption of economic mastery, you are really just a small-minded bourgeois prelate, oblivious of the basic insight of Marx when he dismissed the whole pretentious edifice of economics as bourgeois ideology. To you it is not a reified delusion to be critiqued--it is an axiom from which you a priori deduce your own smug illusory view of the human condition.

This grand economic education of yours has left your utterly ill-equipped to smell a fetid corporate fraud like this hybrid pub-op plan, even when it's steaming in your face. To your dogma-wracked sensibility, it smells like roses. You can't even grasp something as simple as the cost efficiency of a combined risk pool, and you can't be bothered to acquaint yourself with facts as simple as the combined massive cost efficiencies and superior outcomes of nonmarket health-care solutions. You, the pseudosocialist marinated in bourgeois-market ideology, can't even begin to perceive the inherent absurdities of a market-based health system. Your desperate involutions of logic and fact on behalf of retaining this market are as appalling as they are pathetic.

Here's the final word: I am not going to respond to your flatulent and preposterous prose poems any more. You either write coherent logical paragraphs that invite serious discourse, or neither I nor anyone else out here can or will attempt to engage you. No more posturing, no more literary pretense, no more bullshit.

Put up or shut up. If others out here wish to humor you in your runaway megalomania and grandiose pomposity, that's their problem. You have your own serious problems. You need to work them out on your own.

I'm willing to discuss politics and economics, but no longer the subtext of your outsize pathologies. THAT discussion is over.

Thus does van
Flee the field of battle

In a final confusion of gabble dee gibber

I a prisoner of my
Pseudo science
Can't under stand
The elementary but decisive advantages of sp

Please

Perhaps belieiving that allows you not to engage on the specifics
So be it

I suggest we split this into two topics since as a combined discussion
Your unable to seperate a critique of pub op

From an. Analysis
Of various sp configurations

So let's talk about pub op
In one thread and stick to it Free
Of general gibber about ousting

The Dlc mole

In another thread I'll try educating you about the sp promised land
Which I hope
Ujnlike moses to enter alive in time
For my final treatments

There is no battle.

There is rational dialogue and your self-referential, tumescent exhibitionism.

If you think anyone still takes you seriously after your serial displays of ignorance and ineptitude on this subject, that's sad--but hardly surprising.

As I said, if you post in coherent prose, I will respond.

I'm not going to act as enabler of your self-parody of a florid intellectual fop anymore. I take these issues seriously, not as a pretext for taking your obsessive megalomania out for a long stroll. For that, you'll have to walk alone.

No more prose poems for me. I will respond only to clear, logical prose. For me, your sad little lounge act has been terminated.

Well I shan't give up my affectations to please a boiler plate specialist van

Line brakes really cause u to fail to comprehend

If so site passages I"ll
Gloss em in long. Line eh?
I beg u please don't ignore me
The sport of it
Passes dull time here at the commercial job site

Many people have commented out here that they usually have no idea what you're talking about. That's your whole infinitely narcissistic scam out here: the prose-poem gimmick makes everything SO DEEP that mere mortals are stopped in their tracks. Perhaps you honestly believe, like an earnest freshmen sounding the existential depths in verse, that your grimly elaborated obscurities will be mistaken for profundity.

Now that I've broken the ice on calling BS on you, it's an open secret that a lot of people here think you're full of hot gas. You alone imagine that your vaporous circumlocutions are the stuff of a great savant. Everybody else--trust me on this, whatever their polite, consoling, even supportive words--simply abides you the way one nods encouragingly at the drooling old uncle endlessly mumbling something or other over there in the corner.

"the drooling old uncle endlessly mumbling something or other over there in the corner"

why must you always deal in worn out wares van

god have u not a particle of originality

every site needs a biting ass hole or two

but grand ma what dull teeth you have
despite fatherS's kind words
if you can't soften hides
we won't throw u out of the igloo
and we won't put you on an ice tray
floating toward the equator
but we will need to find a better biting ass hole
and to be put in the shade wounds a robust ego like yours
maybe you oughta sharpen your incisors
with a nail file ..just trying to be helpful here van
don't blow your boiler
the containing plate is rusty

Paine wrote,
"god have u not a particle of originality"

This from a man who takes endless pride in having had his brain warped by the receive religious dogmas of economic "science."

Originality for Paine would mean having even one idea of his own that hadn't been premasticated by some academic econ hack.

Ya' know the Internet specialized in spawning preening smartasses. Paine is a dime a dozen, yet he thinks he's some kinda ancient Roman coin. How tiresome, and dumb--as dumb as his highfalutin' babble.

Quotes from yeats
Good ones even

I like the roman coin figure

I guess you have
Promise after all
After we remove
Your bite reflex

A C3po of Smbiva ?

Paine wrote:
"I like the roman coin figure"

Paine--you need to get in touch with reality. NO ONE on this blog really cares what you "think" about anything. The problem is that you don't "think." You burble. You posture. You defame. You rage. You froth. You foam at the mouth. But what you absolutely have never done once in any of the posts is "think"--lucidly, compellingly, honestly. Not for one sentence--although you're scarcely capable even of forming a grammatically complete sentence without MJS acting as your crutch.

What a sadly deflated, defeated, demented old fart you are.