Stop Me Before I Vote Again

Owen, on either -- or both, for that matter -- it's damned if you do and damned repeatedly as the proposed meliorism slides into the reality of brazen accommodationism. There's just nothing to hold over their heads at this time. There's no threat strong enough to make sure the "half a loaf is better than none" outcome actually gets through. Intransigence looks much better to me. That's the only way even half-assed meliorism has a chance.

When has a "marked solution" ever worked, though--this claim is outright Orwellian; market logic is, in quite a crude way actually, contrary to human welfare? Health care is an obvious case were it works terribly and there is a known alternative, one that a majority appear to want.* Obviously we will all take whatever scraps we can get and I don't think demanding more than what is realistic, if indeed single payer is unrealistic, does any harm, as is implied. On the contrary, it helps get us closer to our goal, like the use of Third Parties advocated on this site in regard to policy in general.

As far as the environmental catastrophe unfolding, it was clearly markets that created the mess--it's like asking Nazi's to shut down the gas chambers--it's crazy.

*Those I know who advocate single payer are more likely to be classified by pigeon-holers as conservatives than pinkos, in fact.

I never believed we had a snowball's chance in August of getting single-payer. I did believe that it would be easy to measure the sincerity of those who claim "compassionate liberalism" (or whatever) based upon whether they used single-payer as their starting point or not. Y'know, the playas and their wannabees profess to know how the system works;to understand reality. But reality to me would dictate starting out demanding everything you want. All of it, right down to the last detail and bellowing loudly that it's the only thing you're willing to settle for. 100%. That you will brook no compromise.

After that, of course, comes the compromise, but starting out at the beginning with half the store given away leads to --well?-- Subtract 50 from 50 and see what that leaves you, Kiddies.

It stands to reason that the weasels who appointed Obama as their lawfully wedded figurehead know all this. They did not start right out of the gate demanding 100% in one voice because they aren't even remotely sincere about wanting to do anything to better the people who voted for them.

Luckily, the people who voted for them have memories no longer than the shouters on the other side of the virtual aisle. Plenty of time for all this to be forgotten in time for the mid-terms.

Wheee...

I dunno, Owen. The details -- available here -- make it sound pretty dismal.

In order to be meaningful a public option needs to be more attractive than its private counterparts, for at least some people whom those private counterparts would like to have as customers, no?

The public option being proposed doesn't look very attractive. It's slightly more attractive than paying a tax penalty and getting no coverage at all -- which is the realistic alternative for most people who would consider it in the first place.

There is some grudging subsidy for the poorest of the poor, but even that doesn't amount to much.

The storyline looks to me like whittling down the public option slice by slice until it's as close as dammit to airy nothing.

I hope you're right and I'm wrong, but so far it looks more like punishment than relief.

BY THE NUMBERS

676 X 350 = 236,600, which is the equivalent of admitting 27 million cars to the hospital for heart surgery and then foreclosing on their garages

FUN FACT

no one knows what the public option will be called, but insiders say the president is seriously learning toward "medicare part FU"

*leaning

When it comes right down to it, it's a mistake to treat either Democrats or Republicans as adults. They're spoiled high school kids. The Repubs play the playground psycho schtick and the Dems play passive aggressive. Their miserable supporting claques and cliques never individuated. They draw what little civic identity they have from the melodramas and temper tantrums of their representatives.

who in Warshington is taking 676 seriously?

by which i mean, what ms_xeno said.

when i went to buy my first car my dad told me to start with "no" when negotiating. even if there was a number in my head i was willing to pay.

the way things are playing out i wouldn't be surprised if the "strong public option" goes by the wayside and we're left with Obama's campaign promise of mandatory health insurance. i imagine such a mandate will be funded by rugged individualism or personal responsibility or some shit.

Krugman, for what it's worth, is arguing against a straw man. The opposition to the "market-based" remedies is opposition based on the track record of cap and trade. It doesn't work. It could work, if we changed our entire political economy, but in the one we have the caps and trades are opaque, filled with loopholes, resistant to due diligence, constitute handouts to polluters and follow the same game of musical chairs peculation as the derivatives, mortgage-backed securities and auction rate securities. There's no shortage of speculation, to be sure, but that's hardly the problem. The fact that Goldman will profit is only insult to very real injury, in the form of increased human misery due to global warming.

The whole thing is a clone of our tax code, the purpose of which is to prevent simple progressive taxation based on simple democratic choices.

The "public option," if it survives at all, is clearly going to be about as widely offered as the EIC, but far worse in operation, given the co-pays.

I'm not sure what the upshot here is

Yup the pub op and the carb cap
Can be turned into the opposite of progress

I guess I wonder if all our policy comments are just more predicates of corporate dictatorship
As super al and md suggest

And abstract model tinkering is just
A funny book romp

Abstraction is distraction

I ought to develop
A thicker skin
For anti market
Fundo lines like wards

And moonless mid nights when all cows are black

And I guess I like noticing when a process might move forward despite itself

certain institutional arrangements
Require
" progress"

Like the universal mandate here will

Take the mitcare exchange in mass

. If not subsumed by a national plan
Could be forced by its own inner workings
To self rationalize

There's a real curiosity in that some of the market hybrids do work. I'd call them corporatist, in the European sense of the word: social benefits arising through commercial activity, with the commercial entities serving as vehicles of delivery. They deliver where command and control do not. They turn a modest profit too. In consumer/producer sentiment, they out-compete the deep pockets rent-seekers. The gallimaufry of them provides an insuring consumer goods redundancy and a decent labor market. That should be scalable to regional and national levels, but to date most people are exposed to them as petit bourgeois boutique and boho enterprise.

I'm tempted into paleo-agrarian harrumphing about cultural inadequacies as the cause of their anemic grip on the broader economy, but there's no shortage of enthusiastic and knowledgeable engagement. And the cultural support is there.

I'm very taken with hyper algorithm systems of mediated exchange at all relevent scales
From global to
regional
To communal

What may or may not seem ironic
To others
Certainly seems so to me

Extreme flat society types
are so wildly divided over markets
As product exchange mediations

some see them as the great kaba stone of liberty
Others see markets
As mammon's snare

To hate and fear free floating unescapable ever more pervasive and invasive
hierarchies is a reaction. Common
To both these folk groups
And yet they couldn't be more
Divided

We have had our "United for Single Payer" "coalition" infiltrated by a bunch of democrat operatives who will not relinquish the floor at our meetings trying to harangue us into being "realistic" about the fact that since single payer won't happen we need to push the "public option."

Same old same old. NGO operatives on the payroll trying to deflect people who are wise enough to know that their "uniquely American option" is a BIG FAT sell-out to the insurance companies.

We will carry on. Check out the Mad As Hell Doctors here: Madashelldoctors.com

Meanwhile, Saint Zero is busy retracting his mild observations about the arrest of Henry Gates...

Meanwhile, FWLIW: Personally, OP-san, I'm not against the concept of "public option." Quite the contrary. But both doors have to be fully open, if greed and democracy/bureaucracy are to be true rivals.

This present thing, if it makes it to 2013 (!!!!), will be about as fighting a thing as a tiger rug vis-a-vis the living cat.

i think
the gig L recounts
has an odd core to it
what do sing pay circles drain money and foot soldiers from pub op circles
i doubt it

so whats the beef
sing pay types demoralize potential pub opers by crying sell out
again i doubt it
or is it the mutually gratifying and consolidating
group v group agon
of two skin ape clubs
rumbling at the water hole

Linda: A question for you: PDA?

Who do you guys think you're kidding?

Doing single-payer work while under the DP yoke is the same -- the exact same -- as doing anti-semitism work under the National Socialist Party of Deutschland.

Fuck! Are you fucking joking?!

http://www.counterpunch.org/redmond07242009.html

helen is at it again over at c section

"We haven’t given up and we haven’t sold out. "

md

you're last comment
is compressed beyond my comprendo

is linda's outfit
single payers united
a pda cut out
or are the floor hog "infiltrators"
the ones from pda ??

"Joshua Holland’s article titled, “We Need Clear Thinking: There Should Be No Clash Between Public Option and Single-Payer,” is the most recent and best example of giving up and selling out single-payer. He too confesses in the piece (three times!) he really is an advocate of single-payer, but … But what? Holland argues, “The public insurance/single-payer rift is a false dichotomy and is distracting us from the real fight.” Dead wrong. The so-called public option and SP as embodied in HR 676 stand in direct opposition to one another. The “real fight” is to pass HR 676. The “distraction” is the public option. Holland then goes on to undercut his argument even further by maintaining, “The proposal before us today, if done right - and the devil is most certainly in the details – achieve a hybrid public-private system with “some single-payer features…” Huh? We already have that system, it’s not working. Holland thinks eventually the public option will “achieve something approaching a single-payer system – through the back door.” I’m gobsmacked by Joshua’s naiveté or is it stupidity? Single-payer health care systems always come in through the front door. They don’t evolve into existence over time. "

helen helen helen

carl g at c section

http://www.counterpunch.org/ginsburg07242009.html

warning
profligate use of profit ahead

"American health care is reeling because it is a profit center where gouging is the norm."

market failure ???

" For-profit clinics and hospitals print money, paying out hefty dividends and huge salaries to management. Not-for-profits operate along similar lines"

carl g at c section

its for profit
even when its not for profit

The (non-)saints in surgical garb need a right-good gob-smack, that's for sure, OP-san.

And then there's the overheaders, the right legions of em... (le marseillaise, chop, chop)

My own health "care" "system" is "not" for profit. Yet, methinks they have more cash than certain whole "nations" do.

Al's excellent description of the two-party system shouldn't go unnoticed:

"Their miserable supporting claques and cliques never individuated. They draw what little civic identity they have from the melodramas and temper tantrums of their representatives. "

Pure Debord!

Al: I snuck your remark into a comment on Ian Welch's post on the two parties (ianwelch.net), and also got in a plug for SMBIVA.

...sing pay types demoralize potential pub opers by crying sell out
again i doubt it...

Demoralizing professional demoralizers?

Nice work if you can get it.

That "Mad As Hell" site is a bit on the minimal side right now, but what the hell? A September road trip would be a hoot, if I've already run out my Unemployment by then anyway. I don't recommend ape suits even in our comparatively mild Oregon summers, however. A surefire ticket to heatstroke.

Ms. X, why do you think this has a snowball's chance in Hades? It strikes me as being wildly unrealistic at each and every point, not least in asking people to incur the expense and trouble of driving to DC and back.

I'll be amazed if it works. Heck, I'll be somewhat surprised if they don't bag it before leaving the state. People don't spontaneously drop everything because they saw a neat van full of doctors -- though I do understand why doctors think so.

Doctors, even nice ones, need a big ego demotion, along with a good old-fashioned pay cut.

Oh, Dawson. Let 'em have their fun, for Chrissake. It's their last chance between now and the mid-terms. And I suppose they're doing as much, or as little, as the average poster to this or any other blog is doing.

I wouldn't be surprised if there are already doctors bartering care and seeing patients under the insurance table, frankly. But for obvious reasons, we're not going to be hearing from them online anytime soon.

Markets are good at what they're good at, but they're not good at everything. It's difficult to see how markets could have built an adequate road network.

Health care in particular seems to have gotten itself into a box that markets -- under some highly theoretical combination of circumstances --might get us out of. But then the question becomes, How likely are those circumstances to occur?

Which displaces the issue from the theoretical -- could "pub-op" get us closer to where we'd like to be -- to the political: will Obie &co. allow a pub-op that might do that?

The answer to the latter question appears to be a very clear "no".

I have a feeling that Owen may come back with the Golem argument: once you create these things they can get out of control, and produce results you didn't intend. Maybe. It seems a slender reed, though, I gotta say.

Markets are good at restaurants, bookstores (when reading isn't a dying habit), food retailing, and personal electronics (once the core technology has been invented by the public sector).

As to medical insurance, if a genuine, full-fledged, non-hamstrung public option were ever permitted, the Chamber of Commerce has it exactly right:

"A government-run public [medical insurance] plan would have 'unfair advantage over private plans, eventually crowding out private plans from the marketplace,' said Bruce Josten, executive vice president of government affairs at the U.S. Chamber of Commerce."

Hmm. Canada manages to support private insurers like Blue Cross. Methinks what Josten means is that American private insurers would be selling supplemental insurance to a narrower range of pigeons than it gets access to now: covering procedures that Gummint deems non-essential and thus not subject to public coverage. His little friends would have to work harder for less money. As we all know, this would be an unique state for anyone in modern-day America to find themselves in.

As soon as I'm done laughing myself silly, I promise to return and lead everyone in twenty minutes of empathetic weeping for poor Mr. Josten and his helpless, beleaguered little friends.

My reed

Corporate america
In part today wants out
And in whole
Ought eventually to want out
Of
The med bene biz

A transition to single payer
Done by uncle starting today
Obviously gets
the corporates out fastest
But I imagine unwinding
The 600k pri sec
Medi insu job force is a task that would be handled by slow steps

insurance markets are indeed ultra failure prone

There exist no better demonstrations
Of
why simple market only production/exchange structures
With out proper institutional super structures
Must deliver
Socially pathological material outcomes

As I too often mention here
Behind the public's back
Over the last 30
Years
Academic micro economics has utterly destroyed the market fundos
Claims

clio's ironic
Playfulness
Required
The bald marketeers rule the public discourse
While the ivy elves are nibbling away the joists

even as we type
krugula steps forth:

http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/

"...a significant number of Americans believe that the answer to our health care problems — indeed, the only answer — is to rely on the free market. Quite a few seem to believe that this view reflects the lessons of economic theory....Not so....health care can’t be marketed like bread or TVs. "

krugs just so story on buying health care :

"There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. ... and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. "
here' comes rationing:

".. this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care."

caveat :
" And you can’t just trust insurance companies either — they’re not in business for their health, or yours."

"This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems."

"... this means that private insurance basically spends a lot of money on socially destructive activities."

fine but then this

"The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping.... That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners."

smith's invisible hand collapses
when selfish agents can't be played off against each other

conflicts with social welfare are inevitable
forget corporatte for profit structures plain commodity production leads to this if the commodity is "unshopable"

"... health care just doesn’t work as a standard market story."

but hey ..wait helen

"All of this doesn’t necessarily mean that socialized medicine, or even single-payer, is the only way to go. "

yup here it comes the pluralism of good enough institutional structures

"There are a number of successful health-care systems, at least as measured by pretty good care much cheaper than here, and they are quite different from each other. "

"There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work."

regulated markets might do just fine
even if free markets won't
ie the mythical
universal exchange
with highly straight jacketed pri sec outfits
prof or non prof
but here's the key
operating esssntially like a monopsonist
by being a top down controled cartel
costs now past thru get cramed down by the wonderland cartel

ps too bad krug uses market and free market interchangeably here
in context no problem but out of context ...

take his post's title

"Why markets can’t cure healthcare"
where's free ???
sloppy

worse yet this

"people who say that the market is the answer are flying in the face of both theory and overwhelming evidence"

he doesn't mean what sing pay folks wish he meant

more krugula nibbling at the jugular:

"Some readers ask why I don’t talk about HR 676, which would establish a single-payer system for health care — similar to Medicare, the single-payer system older Americans already have and love, although they don’t think it’s a government program.

So let me make three points.

1. If I could start from scratch, I’d go for single-payer. Where introducing single-payer has proved politically possible, it’s been a smashing success.

2. However, there are other systems that also work well. The Netherlands, for example, relies largely on private insurers, although they’re tightly regulated and there are extensive cross-subsidies. And they have universal care at much lower expense than we do. So single-payer isn’t the unique ideal.

3. Politically, single payer is not going to happen any time soon. It’s not just the power of the insurance lobby: voters tend to fear the unknown, so that it’s much easier to pursue incremental reform than to make a giant leap into a completely different system. And incremental reform has a good — better than 50/50 — chance of happening this year.

So yes, I’d favor HR676 if I thought it could pass; but I’ll accept something else, even if it’s a bit of a Rube Goldberg device, to get the job done."