Thursday, July 23, 2009

Bad Amateur Pundit (but not really) - Now, with Update!

Missed the Obamafest on television last night -- was at my son's baseball game (they won 16-10, by the way) instead. I'm sure that someone else will provide exhaustive coverage of the what the president said.

I did see a 3-minute clip of him here. In it, he says three really risible things:

1) Removing the profit motive will lead to better results
2) Doctors are deciding to remove tonsils because of fee schedules instead of prescribing medication
3) What he is proposing is what the Mayo Clinic is doing.

I assume that anyone who hasn't spent most of their adult life on a university campus can understand why the first point is risible. The second is silly; a tonsillectomy used to be a very common event but these days very few are performed, precisely because doctors are using increasing effective medications to handle most similar issues, all without Obama's interference. The last is silly because the Mayo Clinic has already come out against the Obama plan, to the extent that it (or anyone else, including Obama) can understand what's actually in it.

Go ahead watch the clip on the attached link and see if (a) I misrepresented what he said or (b) if I missed anything else.

Update: the Associated Press takes stock of a few of our President's assertions. My favorite:

OBAMA: "You haven't seen me out there blaming the Republicans."

THE FACTS: Obama did so in his opening statement, saying, "I've heard that one Republican strategist told his party that even though they may want to compromise, it's better politics to 'go for the kill.' Another Republican senator said that defeating health reform is about 'breaking' me."
You'd like to think that he'd realize that he's no longer a backbencher and that people pay great attention to the things he says. I'm not sure he does. And again, I remind you of Professor Althouse's quite sensible point:

The Democrats have dumped a drastic, complicated health care bill on us and they are ramming it through before we can even figure it out. That's what matters, not the fact that the party out of power is squawking about it.

11 comments:

W.B. Picklesworth said...

No one has bit on this one yet? It is so tempting to vent spleen on the president after his performance, but I decided not to this morning. And now I find the whole thing kind of funny. One thing that you can say of Obama, he's got a very high opinion of himself. The next three years should be quite a show!

Anonymous said...

Mark,
I think the healthcare “debate” has been handled dreadfully by both sides. The Obama Administration has been heavy-handed and flat-footed (I will stop the Carlin riff now), and I can’t believe how badly they’ve performed as they moved on this. But that doesn’t mean I think the Republicans have done a great job either. I can’t read the tea leaves on this one, and have no idea how this turns out. But it seems unfortunate to me that this has become such a partisan issue, and I‘ve been struck by how different the debate is on the left and the right. On the left, the wonks are deep in the weeds on policy; on the right, the only issue seems to be objections to a larger federal role, predicated on a principled aversion to interference in markets and a rapidly expanding state. I do not completely disagree with your side here, and am hardly the only person on the left who feels that way. So I am persuadable on many points, and I would expect that many on the right are too. So let me state that I am convinced that there is a need for major reform in the health care sector, and I would think that most fair minded people could agree with that statement, regardless of their ideological affinities. (I might be completely wrong about this). I base this statement on several notions that my left-leaning, but hopefully somewhat objective mind holds as givens: The first is that a situation where close to 20% of the country has no healthcare is untenable, especially given the fact that the number of the un-insured continues to grow at an alarming rate. The second is that the cost of healthcare is rising rapidly as well, so I don’t see how this situation can get anything but worse, at least in the short and medium term. Third is my personal belief that we have a moral obligation to ensure that every citizen has a minimum level of health care, in the same way that we decided everyone should have some baseline level of food. Admittedly, I don’t have a handy metric to gauge what that is, but I am pretty certain that we are falling short of it right now. Fourth is the notion that this is an area that is so big, and one where the government already plays such a significant role, that I suspect the Federal government can play a useful role in pushing many parts of this reform. Especially measures like electronic medical records keeping. My final point, and this is one that I think you might hold near and dera, is that the current system is an economic drag on the economy in that it ties people to jobs they'd otherwise leave, it discourages entrepreneurship and it lessens healthy risk-taking because people fear losing their insurance.
I sincerely hope that we can agree on some of these points.
Regards,
Rich

Gino said...

rich: for starters, we can get the politics out of the medical business.

for ex: my wife and i are beyond fertile yrs, yet a medical plan is required to provide coverage for contraception and abortion. so, i'm forced, by govt fiat, to finance services i will not need, and that i do not believe in.

we need to be allowed to pick our coverages, just like we do with auto insurance.
why should my son, who will never be at risk of pregnancy, pay the same for the same policy that a women his age does? yet, its OK to gender-rate auto insurance because stats show guys are a greater risk?

Mark Heuring said...

Rich,

Too much to respond to in your comment right now, but I'd say this:

1) There are a lot of people who don't have health insurance, but it's not accurate to say that 20% of the people in this country have no health care. Two very different things. And the people without insurance are in that situation for a variety of reasons. Some don't want it (often, young people). Some are in the country illegally. Some are without it temporarily. Different issues that require different solutions.

2) The cost of healthcare does go up, but the quality has, too. And the demographics of the country are such that costs will continue to go up. And some of the drivers of these cost increases (e.g., litigation, malpractice insurance, etc.) don't seem to be addressed in what's on offer.

3) I don't see any need for the federal government to institute electronic record keeping. My health network already does this. I can get my medical history any time I want it. Most of the country will be similarly situated quite soon.

4) I do agree that the current employment-based system does tie people to jobs and that's a big problem. I'm not convinced that a system that ties people to government will be better.

Too much to discuss, though. Could talk about this all day.

Right Hook said...

Just where is the current occupant of the White House or the congress Constiutionally authorized to mandate and/or run any sort of insurance program?

Mark Heuring said...

Just where is the current occupant of the White House or the congress Constiutionally authorized to mandate and/or run any sort of insurance program?

It's all there in Article LXIX, Subsection 22, RH. What, you mean you don't have the latest copy?

Anonymous said...

RH,
I never said that the White House or the Congress was authorized by the Constitution to mandate and/or run any sort of insurance program. But the equal protection clause could certainly be interpreted to suggest that pursuing life without hindrance of health care inequality just might set up a constitutional issue.

As for precedence regarding Government involvement in a health care solution, I would note that there is precedence for this in the history of the modern welfare system. It was created to assure that less fortunate individuals in our society be provided a base level of food and shelter. This necessarily impacts other individuals through taxation, which is a right of government. While I am certainly not expecting to score a lot of points with most of you guys here by noting this, the welfare state has withstood constitutional scrutiny for almost a century.

Look, I'm not a student of the constitution, but I assume that its interpretation should be guided by the Preamble. The Preamble states that the government must PROMOTE (not provide) for the general welfare of its citizens. So, back to some of my original points: There are a large and growing number of people in America who don't have healthcare, most of whom would prefer to have it. (Regardless of what Rush Limbaugh says). Additionally, I believe that we have a moral obligation to ensure that every citizen has a minimum level of health care that I am pretty certain we are falling short. The question is whether the current system adequately provides a minimum level of health care in an adequate way. In my mind, it does not. If enough people agree with me on that point, and I suspect they do, we will probably be seeing some much needed changes in our health care system.

Whether those changes will be for the better or the worse remains to be seen. I would much prefer that the Right get involved in the debate, rather than just trying to stifle it. When George W got involved with and led the reworking of the HSA system, it ended up being a very effective blend of Right and Left policy that works very well for individuals like me who are self-employed. I am hoping the same can happen with this much broader subject.

Regards,
Rich

Mark Heuring said...

But the equal protection clause could certainly be interpreted to suggest that pursuing life without hindrance of health care inequality just might set up a constitutional issue.

The Equal Protection clause is magic! It can do anything!

Rich, dude. Not every issue is a constitutional issue.

Whether those changes will be for the better or the worse remains to be seen. I would much prefer that the Right get involved in the debate, rather than just trying to stifle it.

The Right is not involved in the debate? Do some research, good sir. Every right-leaning think tank has squadrons of people working on this issue. Go read some of it.

And you'll pardon me for wanting to "stifle" a program that will inevitably socialize medicine. Various components of what's apparently on offer (no one really knows for sure, of course) have been floating around since you and I had rattles. Harry Freaking Truman fought this one out a decade before either your I were born. Now, 40 years on, or even 60 years on, we have to have Pelosi and Waxman jam a bill through without debate or committee work?

Anonymous said...

Mark,

I have to submit my response in two parts:

Part 1:
1) the constitutional issue was raised by RH, not me. I was merely responding to it. So I am not sure why your rejoinder is directed to me. Especially since my response was directed to RH.

2) Yes, the Equal Protection Clause is magical:)

3) I was incorrect to say the Right has not been involved in the debate. I should recalibrate that statement and say that the Right has not been involved in any meaningful and constructive way. Unless trying to set up the President's Waterloo, and "going in for the kill" are considered constructive.

My original response involved my positing that there is a crisis in health care coverage and health care expense that needs to be addressed. That the health care industry is in need
need of reforms, and that I suspect most people agree with that statement. In fact, a poll I saw on CNN 10 minutes ago claimed that 55% of respondents think that health care in America is in need of major reform, 40% think it is in need of some reform, and 5% think that everything related to HC is just great (Can 5% of the country by Insurance execs?). So I don't think I was very far off in my assertion.

I admittedly don't know the all of the answers to the myriad problems facing the health care industries, but I am pretty sure that they are not to blithely dismiss the the fact that 47 million Americans don't have health care coverage by stating that they just don't want it, and/or trying to claim that most or all of these problems are caused by lack of tort reform. There are states where tort reform was passed over a decade ago where there have been no notable differences in the cost of HC insurance or medical expenses since the reforms were passed. But by noting that, I am not dismissing tort reform legislation as an unworthy goal. Nor am I saying that I don't think it plays a role in the overall HC solution. It does, and it should. For this to pass and work, everyone is going to have to make some concessions. I have no objection to a formula that determines damage awards in medical malpractice cases (in much the same way that Workers Comp does), rather than relying on the vagaries of the jury system. Such a formula would dramatically diminish the risk malpractice insurers take and significantly lessen the cost of malpractice insurance. And wouldn't a set of payouts based on a formula that factored in relevant differences between cases result in a fairer distribution of award money? I am sure the ABA wouldn't be happy about it, but as I already said, everybody has to give something up to make this work.

Continued...

Anonymous said...

Part 2:
Mark, I am skeptical about the plan(s) progressives intend to put forth, and I share some of your same concerns (cost, fear of excessive state power, and fear of lost innovation). As you noted, America is the leading health care innovator in the world and the quality of health care has increased in America. I don't disagree with that, especially as it pertains to acute care. But you are talking to a guy who hasn't been to a doctor in over 10 years because I only have catastrophic coverage, and I already spend over 7K a year on my children for out of pocket expenses because of their pre-existing conditions (my 3 youngest all have severe asthma and allergies). My dog gets better and more frequent medical coverage than I do. But I am at least covered, so when something catastrophic happens, at least I will have all that innovation going for me.

Finally, in an effort to add constructively to the dialogue, a few random thoughts: We could realize a lot of savings by training non-MD specialists to perform certain discrete medical tasks that shouldn't require a full medical degree. We need more pharmacists, professional bone setters, nurse practitioners, physicians assistants and others to dole out a lot of routine examinations, procedures and cures at a lower cost. Also, the attitude among doctors that patients should keep quiet, refrain from asking questions, and basically remain totally ignorant about the process of diagnosis is absurd. I am in the thick of this right now with my Mom's ongoing treatment. I get more attitude from some of these MDs for asking simple questions than is warranted. People ought to know how their body work and be able to articulate it to patients and there families. And I'll concede that dealing with patients who have self-diagnosed Lou Gherig's disease on WebMD must get pretty irritating, there is a pretty astonishing ignorance about the basics of how the human body works, and the medical establishment seems pretty intent on perpetuating that.

Regards,
Rich

Mark Heuring said...

Rich,

Goodness. Way too much to respond to here. A few things, though:

I should recalibrate that statement and say that the Right has not been involved in any meaningful and constructive way. Unless trying to set up the President's Waterloo, and "going in for the kill" are considered constructive.

Killing socialist programs is constructive in my view. And let's be honest here -- it's hard for conservatives to be involved in any meaningful and constructive way when (a) we don't accept the premises in the first place and (b) more importantly, the gatekeepers (in this case Pelosi and Reid) have no interest in allowing conservative Republicans to offer any alternatives that will ever see the light of day. They would however love to have moderate Republicans aboard to cover their asses.

I admittedly don't know the all of the answers to the myriad problems facing the health care industries, but I am pretty sure that they are not to blithely dismiss the the fact that 47 million Americans don't have health care coverage by stating that they just don't want it, and/or trying to claim that most or all of these problems are caused by lack of tort reform.

Machine-gunning the strawmen again. No one is saying that of the 47 million people (not all American citizens, of course) who don't have health insurance have simply decided they don't want it. Nor is anyone claiming that tort reform in and of itself is a panacea. Tort reform would help bring down costs, especially those related to running a battery of duplicative tests. It would also help to keep more doctors in the game. And you know that, because you say the same thing in your responses.

But you are talking to a guy who hasn't been to a doctor in over 10 years because I only have catastrophic coverage, and I already spend over 7K a year on my children for out of pocket expenses because of their pre-existing conditions (my 3 youngest all have severe asthma and allergies). My dog gets better and more frequent medical coverage than I do. But I am at least covered, so when something catastrophic happens, at least I will have all that innovation going for me.

I would hope there would be a way to get you better coverage than to take away the coverage I have. My employer is privately held. The guy who owns the company would almost certainly end up dumping us all into the government plan. It would be a totally rational move for him, and it would suck for me. There are a lot of potential solutions out there that don't involve federalizing everything. One idea would be to let insurance companies compete over state lines -- you could buy a policy from a provider that might not be otherwise available in Illinois. That's not going to be part of the solution that Obama and the rest of the Democrats are proferring.

And I'm skeptical of the government for good reason -- I know too many people who suffer from the crappy services that the VA provides, or who are effectively warehoused. We also have the cautionary tales of what has happened in Massachusetts and Tennessee.

And one last point on polling: yes, I think a majority of people would like to do something to help people who don't have optimum health coverage. If you ask them if they are willing to give up what they have to get it done, you get figures in the 5-20% range. Most people are satisfied with their current health coverage.