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jducoeurSo the Republicans yesterday managed to do something that I hadn't actually thought possible: they made me sympathetic to Mitt Romney. Yesterday's pile-on was *so* cynical that I found myself feeling sorry for the poor bastard, and the way that a completely out-of-context remark turned into a firestorm.
For those who aren't following the blow-by-blow in the Presidential Gladitorial Stadium: yesterday in NH, somebody asked Romney about Obamacare, and specifically what he would do instead. A fine question, and his answer was that he believes that individuals should get their *own* insurance, instead of being indirected through company plans, so that they can make up their own minds. Unfortunately, the way he put it was (paraphrasing from memory): "I want to be able to fire my insurance company. I like to fire people, and the insurance company shouldn't be any different."
Admittedly, it was an incredibly dumb gaffe (especially because he committed the cardinal sin of confirming everybody's worst expectations of him), but it's been blown a tad out of proportion by the other candidates shouting from the rooftops, "Romney likes to fire people!".
That isn't really what annoys me, though -- he kind of walked into the firestorm, and should have known better. What annoys me is that, in the heat of the soundbite moment, everyone's ignoring the fact that he said something *really* interesting. I mean, saying that we should replace the current insurance system with direct insurance to individuals is not some sort of minor tweak -- hell, it's not even a patch the way the new healthcare law is. It implies a total overhaul of the system.
Consider: Romney is 100% correct that the key flaw of the current system is the indirection in it. You may hate your health insurer, but you usually have little say in the matter -- you get the insurance that your employer dictates. And the employer's considerations are a bit ethereal from your point of view, having only a modest amount to do with you personally: instead, they are focused on finding a reasonably good price for insuring a pool of employees, and providing enough quality of care that it is at least not a net negative in trying to hire people. This isn't exactly a recipe for effective and appropriate competition between insurers. Plus, since your cost of care has little to do with how much you pay, you have little incentive to use the service appropriately. What Romney is suggesting, essentially, is that we should really break this system down, and redo it in a way that promotes effective competition and provides better motive to use it well.
In airy economic terms, this is entirely sensible -- the economist in me kind of loves it. Unfortunately, it has a lot of fairly horrible real-world problems -- not least, the fact that insurers really do not want to insure anybody who really *needs* it. I suspect that it could be made to work, and it wouldn't actually surprise me if it could eventually work considerably better than what we now have, but not without a lot of interim pain and eventually a *massive* new regulatory framework.
None of which anybody is talking about. Instead, everybody is talking about the soundbite. The more highbrow networks are talking about the people talking about the soundbite. Nobody is talking about the incredibly controversial thing he actually said, which is far more interesting.
*Sigh*. It's going to be a long year...
For those who aren't following the blow-by-blow in the Presidential Gladitorial Stadium: yesterday in NH, somebody asked Romney about Obamacare, and specifically what he would do instead. A fine question, and his answer was that he believes that individuals should get their *own* insurance, instead of being indirected through company plans, so that they can make up their own minds. Unfortunately, the way he put it was (paraphrasing from memory): "I want to be able to fire my insurance company. I like to fire people, and the insurance company shouldn't be any different."
Admittedly, it was an incredibly dumb gaffe (especially because he committed the cardinal sin of confirming everybody's worst expectations of him), but it's been blown a tad out of proportion by the other candidates shouting from the rooftops, "Romney likes to fire people!".
That isn't really what annoys me, though -- he kind of walked into the firestorm, and should have known better. What annoys me is that, in the heat of the soundbite moment, everyone's ignoring the fact that he said something *really* interesting. I mean, saying that we should replace the current insurance system with direct insurance to individuals is not some sort of minor tweak -- hell, it's not even a patch the way the new healthcare law is. It implies a total overhaul of the system.
Consider: Romney is 100% correct that the key flaw of the current system is the indirection in it. You may hate your health insurer, but you usually have little say in the matter -- you get the insurance that your employer dictates. And the employer's considerations are a bit ethereal from your point of view, having only a modest amount to do with you personally: instead, they are focused on finding a reasonably good price for insuring a pool of employees, and providing enough quality of care that it is at least not a net negative in trying to hire people. This isn't exactly a recipe for effective and appropriate competition between insurers. Plus, since your cost of care has little to do with how much you pay, you have little incentive to use the service appropriately. What Romney is suggesting, essentially, is that we should really break this system down, and redo it in a way that promotes effective competition and provides better motive to use it well.
In airy economic terms, this is entirely sensible -- the economist in me kind of loves it. Unfortunately, it has a lot of fairly horrible real-world problems -- not least, the fact that insurers really do not want to insure anybody who really *needs* it. I suspect that it could be made to work, and it wouldn't actually surprise me if it could eventually work considerably better than what we now have, but not without a lot of interim pain and eventually a *massive* new regulatory framework.
None of which anybody is talking about. Instead, everybody is talking about the soundbite. The more highbrow networks are talking about the people talking about the soundbite. Nobody is talking about the incredibly controversial thing he actually said, which is far more interesting.
*Sigh*. It's going to be a long year...
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(no subject)
Date: 2012-01-10 04:02 pm (UTC)HEY, DOC!
(no subject)
Date: 2012-01-10 04:03 pm (UTC)(no subject)
Date: 2012-01-10 04:41 pm (UTC)(no subject)
Date: 2012-01-10 04:29 pm (UTC)Furthermore, relying on employer-provided insurance is *terrible* for the sort of "quit your job and start a new initiative!" individual entrepreneurism that the USA claims to cherish.
(*) = Or get hit with a massive jump in premiums for COBRA.
(no subject)
Date: 2012-01-10 04:54 pm (UTC)This is part of what annoys me about the "Obamacare" mudfest. (I won't dignify it with the word "debate".) No, the new healthcare law isn't even remotely perfect, but it's not trying to be. It's trying to be an *improvement*, and in several important respects it is. This is chief among them: having a healthcare safety net (which is basically the main point) is a major boost for job mobility, and I suspect a net economic plus in the long run.
And this, in turn, is why I found the question and answer so interesting. It's a great question, and I was downright surprised to find that Romney actually was willing to give a non-pablum answer. I would *love* to see people press him on this, to see if he's actually thought at all about the ramifications...
(no subject)
Date: 2012-01-11 02:37 am (UTC)It won't save lots of money -- any reform that would do that would be torpedoed by the lobbyists of whomever is currently pocketing that money -- but some.
(no subject)
Date: 2012-01-10 04:58 pm (UTC)(Yes, I know that MA already has universal healthcare -- it's one reason I still consider the idea sane. But I also know that the system is still new and a little half-baked still, so it's scary.)
(no subject)
Date: 2012-01-10 05:08 pm (UTC)(no subject)
Date: 2012-01-10 05:05 pm (UTC)At this point, though, we need insurance to survive even the small things. I couldn't pay $350 for a routine pediatrician's visit, and yet in order to have my two kids in school that's a guaranteed $700 every year. Sure, the cost of having kids. But the costs have been driven up by an industry we're increasingly beholden to.
Sure, I'd like to be able to "fire" an insurance company, but they know better. As long as they all have similar practices, there's no-where else for me to go. They have no incentive to change. Yes, someone who breaks that mold might get customers, but as long as the majority holds fast the upstart will go under due to economic realities. From my perspective, what we have really sucks, but it can't change without a fundamental re-write, and a change in societal attitude as well.
So I think Romney's intent with his sound bite was naive at best. He's in a position where he *can* do that, because he's got enough money to cover himself should insurance not live up to expectations, and he can afford the gold plan. Most of us can't, and thinking that somehow individual insurance would make that *better* is cute but really out of touch.
I also have little sympathy for the squirming he's doing. Yeah, the quote was out of context, but there was a connection. What's more, the quote does seem to reflect his prior actions. He may not have taken any joy in it, but he *has* fired many people. Remember when he ran for Senate in 1994? Remember the march that fired Staples workers organized during the election season? One reason why the quote resonates is because (for some people) it's believable.
I have little sympathy - less than none - for another reason. He and his campaign did their own little out-of-context quoting a little while ago against Obama, but they did one better (or worse). They took a few words from an Obama speech and threw it up all over the airwaves: "If we talk about the economy, we'll lose." And that resonates also, because the economy sucks and many people want to blame Obama for it. The big problem is that *Obama* was imagining a quote from someone else at the time (John McCain), so it's not that they were really even his words in any meaningful sense. It's beyond an out-of-context quote; it would be like if someone recorded Romney reading a bedtime story and only aired "I'll huff and I'll puff and I'll blow your house down." He _should_ be squirming, since his little trick was far sleazier.
(no subject)
Date: 2012-01-10 06:06 pm (UTC)That said, I found it refreshing that he was even willing to say something as concrete as he did. I don't actually expect any of these politicians to have fully workable plans, but I would *love* for them to get into a debate that actually had some substance. As you say, fixing things is going to require a deep re-examination of the system, so seeing somebody willing to open that particular Pandora's Box, even if I don't think their approach is fully plausible, is encouraging in its own way...
(no subject)
Date: 2012-01-10 06:14 pm (UTC)(no subject)
Date: 2012-01-10 06:29 pm (UTC)(no subject)
Date: 2012-01-10 07:00 pm (UTC)(no subject)
Date: 2012-01-10 07:49 pm (UTC)Seriously? I mean, the answer's straightforward: it's backed up by tax records and fines. A leaky system, but one with some actual teeth.
We are clear on the point of the mandate, right? It has nothing whatsoever to do with benefiting individuals, and has never pretended to. It has to do with making the system economically feasible to the point where insurance companies are willing to play ball. Otherwise, you can huff and puff about what's fair and right, but nobody's going to be willing to actually *do* it.
As I mentioned to Lackey above, in some ways it is socialized medicine through the back door, or at least the first step in that direction memetically, getting people used to the idea that universal health care is a Good Thing. I consider that a good step -- not by any means ideal, but politics is, as always, about what is possible rather than what's ideal.
(no subject)
Date: 2012-01-10 08:19 pm (UTC)But encouraging the insurance companies to play ball? How so? "Here, take this large pot of money. Some day we might ask you for a favor"? I didn't see any intention to go further with it, but perhaps I'm too cynical. Given Romney's previous positions, statements, and the like, I saw it as a way of saying that everyone is now covered by health insurance, not as a wedge into actual reform. And with the additional subscribers, premiums went up this last year by 25-40%. While I never really believed that it was devised to benefit individuals, it *was* billed that way, and he crowed about it (at least within the commonwealth).
(no subject)
Date: 2012-01-10 08:42 pm (UTC)Ah, I had missed your point. I think the analogy's imprecise (I had taken it to refer to the fact that violations of the seatbelt laws are rarely *caught*), but you may be correct that a rational actor would ignore the insurance and pay the fines. So long as the fines are appropriately distributed to the insurance companies, the economics still make reasonable sense -- essentially, it sets a minimum floor on the price of the insurance policy, with the benefits being nothing.
But encouraging the insurance companies to play ball? How so?
Well, the primary benefit is to society, not individuals -- it is at least a rudimentary way of providing a minimum level of health care, which has benefits like improving job mobility, and taking some of the cost burden off emergency rooms. (At least, if implemented adequately; I think the jury is still out on whether that's true in MA.)
But the key point is that without the mandate, insurance companies will not insure the unemployed and sick or risky, at least not for any sane amount of money. Essentially, the entire tab for the sick and infirm would necessarily be picked up entirely by the government. With the mandate, the economics make some sense from their point of view: they can set insurance prices that amortize the sick and non-sick, so that the people who most need the care aren't *entirely* screwed and the companies still make a reasonable profit.
Seriously, I think you're treating the insurance companies and the model even more harshly than they deserve. (Which isn't easy.) The companies are relatively rational actors, with an eye on the bottom line. They will insure the poor risks *if* there's something in it for them; the individual mandate says that what they get out of it is, on average, some profit from the younger and healthier people. That's a bit cold-blooded, but it's probably about the best one can get *without* truly tearing the whole thing down and starting over from scratch, and is probably strictly necessary to make an insurance-based model work at the societal level.
Mind, I'm not disagreeing with you that an insurance-based model is probably inappropriate, and that the whole thing could be done better. I'm just unconvinced that the better models are politically feasible in this country today, and I'm unwilling to indulge in wishful thinking, or make the best the enemy of the good. "Better" isn't "perfect" -- but it's better...
(no subject)
Date: 2012-01-10 09:07 pm (UTC)In the long run, the individual mandate trades off full government responsibility for unemployed and underemployed people for the additional expenses of administering those plans and programs. I don't know whose numbers to believe; many of them that I've seen say that the program is only afloat because of the influx of federal dollars, that it's not self-sustaining. Certainly the perfect should not be the enemy of the good, but when dealing with politics and populations I've had one observation: nothing gets better until it gets worse.
Allow me an explanation by way of a digression. Near my house is an intersection with a traffic light. That intersection is a small nightmare; at certain times during the day it took quite a while to get through the intersection. About 8 years ago someone was proposing to create a senior housing complex on the other side of that intersection. The outrage was tremendous: there are already too many people, the roads there are already unsafe, people can't walk on that road now, and things will get even worse with another 1500 car-trips a day going through that traffic light.
People just didn't get it. As long as they can continue to cope - by tolerating the bad intersection, by taking detours, by making do with band-aid solutions - the real problem will never get fixed. It's much easier to do the bare minimum that needs to get done in order to get by; it's much harder (in work, in political capital, in sheer comfort level) to actually *fix* the problem. The situation has to actually be bad enough to enough people to motivate them to get off their and do something.
My fear is that, as a coping mechanism, the individual mandate is just enough to get by, at least until the next crisis with the next band-aid. No, it's not the best, yes, it does *something*, no, that something doesn't address the actual problems. All well and good, but if it allows people to get by without allowing things to degenerate then this is all that will happen. I'm not trying to advocate that things actually get that bad, but in my experience nothing else will get better until people perceive that they *have* gotten that bad.
(no subject)
Date: 2012-01-10 11:10 pm (UTC)Honestly, I think you are greatly underestimating this effect.
The thing is, it qualitatively changes the decision. I am pretty confident that I am highly employable, and that I'm not going to be out of work for *very* long. So leaving an unsatisfying job is, in and of itself, a fairly easy decision for me to make rationally, and it is *much* easier to find a new one when I'm not currently working.
But now, factor in healthcare issues. In the current environment, I *cannot* be without health insurance. Not for a minute -- one piece of bad luck while uninsured could destroy my life. That changes the psychological equation a lot. It makes me hold onto my current job more tightly, even if it's a weak fit. I am potentially less productive; certainly I am more conservative about job movement. I am less willing to take a flyer for a little while on a startup that isn't quite fully-fledged. I wind up blocking career entry for younger employees who are still trying to find their way in.
It's just a statistical effect, mind. But I'd bet that it costs a percent or two of overall employment, simply by dint of gumming up the system a bit. And even a 1% effect is still something like a million people -- not exactly a trivial number.
when dealing with politics and populations I've had one observation: nothing gets better until it gets worse.
I can understand that viewpoint; indeed, I've made this argument myself from time to time. (Especially in the context of the SCA, where I occasionally wish the Corporation would simply commit an atrocity bad enough to cause it to fall apart, instead of continuing to boil the frog.)
But it's a risky approach, especially because a complex dynamic system like the US economy is *wildly* unpredictable. I don't think it's at all obvious how much worse it has to get before the meme of "US health care sucks" overwhelms the one of "socialized medicine is EEEEEVIL". It might have to get a *lot* worse yet, with a great deal of pain in the meantime.
And I don't think it's at all obvious what the societal reaction would be once it got to that point. Asking for a revolution gets you a revolution. Whether it gets you something better on the other end depends tremendously on the wisdom of the people who wind up in charge, and the historical track record isn't terribly encouraging.
Or in other words, I am leery of saying, "It can't possibly wind up any *worse*", despite the frequency with which I think that. I suspect it's not actually true...
(no subject)
Date: 2012-01-11 02:33 am (UTC)(no subject)
Date: 2012-01-11 02:41 am (UTC)(no subject)
Date: 2012-01-10 06:55 pm (UTC)Leukemia in children (or adults, for that matter), used to be very inexpensive. If your child was diagnosed with leukemia, you took your child home, made your peace, and held a funeral within two weeks. Very inexpensive, medically speaking -- with nothing physicians could do, there were minimal expenses.
Today on the other hand, we can give north of 80% of all kids with leukemia indefinite survival -- essentially, we can treat the cancer to the point where it won't be the leukemia which kills them. We're at the point where we will discuss freezing sperm and eggs for our kids prior to attacking the tumor with chemo, because we have the expectation that most of them will be around to use them, ten or twenty years hence. But the three years of intense, sequenced chemotherapy needed to get there -- let alone the cost of a bone marrow transplant, if we need one -- is *enormous*.
Even in completely nationalized health care systems, with all of the enormous cost savings of scale and elimination of profit that come with it (like the Nordic nations), total cost of an uncomplicated leukemia in a child is in the ballpark of $150,000 -- and the cost in the United States, which does *not* have any of the economies of scale a fully nationalized health care system has, is surely vastly higher. At approx. 2,500 new cases per year, for one single sub-diagnosis that's hundreds of millions of dollars in costs today's health care system is bearing, that the health care system of the 1940's didn't.
Multiply this over and over again -- in the 1940's, if you had kidney failure, the levels of toxins simply rose in your blood until you went to sleep and never woke up. Very inexpensive. Today instead, between dialysis and transplant, kidney failure in children or young adults is no longer an obstacle to a life of normal length and quality -- but the up front costs of a transplant, and the perpetual costs of immune suppression, are enormous. In the 1980's, if you had HIV, you basically suffered horrific infection after infection, tumor after tumor, until you died. Today, if you have access to HIV drug regimens, you can essentially hold off death by HIV indefinitely -- at a cost of multiple tens of thousands of dollars a year. And so on, and so on, and so on.
Medicine has successfully given millions of people the gift of extra *decades* of high-quality life -- but at enormous financial cost. How to pay that cost is a question most other nations have addressed in a systematic fashion. America... has not. The resulting hodge-podge of independently acting parties either scrambling to make ends meet, or angling to suck the maximum profits possible, results in the totally schizophrenic, totally dysfunctional, incredibly inefficient system we have today.
(no subject)
Date: 2012-01-10 05:23 pm (UTC)(no subject)
Date: 2012-01-10 06:07 pm (UTC)(no subject)
Date: 2012-01-10 05:23 pm (UTC)Romney is late to the game, bless his heart. I note he is still further ahead than anyone else has been who is currently running, second only to Obama himself. This is by no means a new idea. In the industry this is the long term anticipated Writing On The Wall. We have been working on understanding that this is the direction we must eventually go since the 90s.
The current system is not a proper "system". What I mean by that is that it has not been designed by anyone. Most gamers and Network engineers put more deliberate thought and structure into their systems than the current US Health Care "System". What we have is a hodgepodge of custom and history, expectations and traditions and if it does not serve the greater society we should ditch it. We are clearly not in a place where we can ditch it and use the European model. Ergo... this the "individual coverage" model is mostly what we got. It's more in keeping with how Americans think and feel and believe than the European Model.
Here is the deal though, it won't work (IE be affordable to the individual) unless pretty much everyone is in the system. Insurers don't mind insuring the people who really need the care, provided enough people who don't (currently) need the care are also enrolled to cover the costs of the people that do. That is how "insurance" works. Everyone pools their money and some people draw on that money pool a lot, and some people draw on it only a little. The math don't work any other way. Either everyone is in and the government pays for it, or everyone is in and the individuals pay for it... or everyone is not in and we try to keep the big money consumers of the product out.
So... individual coverage as a model can work, but it will come with Romney's stick... Everyone has to be in the pool or you get fined. And the fines have to go into covering the difference for the healthy people missing out of the pool. Romney the businessman gets this. The Republican Ideological candidates probably won't or will refuse to. This, as you say, comes with a massive new regulatory Framework...which as we all know means "big government". It's hilarious to me that the Republicans are talking about this at all. Most of them seem have all the outrage about it and none of the actual ideas or ability to shift their ideology to get it to work.
And as is always true when I comment on health care... these are my opinions and not the opinions of my company.
There. Rant sort of over....
(no subject)
Date: 2012-01-10 06:22 pm (UTC)And I concur that Romney is probably the only Republican who actually groks it. In that respect, I'm mostly astonished that he was even willing to whisper about it during this stage of the campaign...
(no subject)
Date: 2012-01-10 06:56 pm (UTC)Profit would have to be a small amount charged to each customer above the negotiated rate. This works best in volume. The company I work for has about 80,000 employees. If this company I propose could get 1,000,000 customers, it could get the same deal that my company gets with one health care company, but offer it for 10 health care companies. Individuals could then get choice and a decent rate.
(no subject)
Date: 2012-01-10 07:12 pm (UTC)We call that plan Medicare, Medicaid, and Tricare.
It succeeds in holding costs down, precisely as you'd predict. (http://economix.blogs.nytimes.com/2011/12/30/wyden-ryans-unrealistic-assumptions/?pagewanted=all).
Allowing ordinary Americans outside of the poor and elderly to buy into that plan was called the Public Option.
(no subject)
Date: 2012-01-10 07:16 pm (UTC)Plus Medicare is partially funded by the government. This would be doing the same thing but making it able to support itself for a higher price than Medicare but a lower price than an individual buying their own insurance directly
(no subject)
Date: 2012-01-10 07:58 pm (UTC)Just to start with one angle of the problem: the first step is organizing large numbers of people to purchase insurance together. Which means you first have to reach out to those people, which requires money for commercials, fliers, etc. Which requires you to find someone who will provide that start-up capital, and convincing them to do so. The way you usually convince people to give you start-up money, is by assembling a business plan which demonstrates that you will be able to reply that start-up capital with profit. But then, that ultimately means you're going to have to figure out a way to squeeze profit out of the process, which automatically raises your expenses (since you have to budget x part of your revenue coming in as profit going out), because if you *can't* squeeze enough profit out, you're going to find it very difficult to convince someone to give you the money needed to even get started.
There's plenty of other problems when you get down to the practicals of actually carrying out your idea -- every step of the way there are major challenges and substantial structual obstacles to any private organization trying to accomplish what you propose to do. It's a whole succession of chicken-and-egg problems and problems of scale. Unless you're *already* a big enough organization with wealthy enough coffers -- like, say, a major corporation -- you're going to find the going intractably difficult without the unique advantages a government can bring. Which is precisely why such private co-operatives *haven't* gained a major foothold or have a major impact in our health care system. If it could be easily done, it would already have been done.
(no subject)
Date: 2012-01-10 07:42 pm (UTC)That said, there's a huge problem with the idea, which is selection bias. Once again, the people who buy into such a "company" would tend to be the *least* healthy, implying that its rates would necessarily wind up relatively high. That's the reason why the individual mandate is crucial to making any sense at all out of the current muddle: it amortizes the costs down to a hopefully manageable average, by mixing the young-and-generally-healthier with the older-and-generally-less-so.
Note that, from a ten thousand foot view, there's not that much real difference between socialized medicine and individual mandate. The one conceptual advantage of the latter is that it can *theoretically* lead to better competition. (Although in practice, the big stick of single payer may actually be more effective in that regard. I suspect the relative merits depend on your priorities...)
re: "Employer"
Date: 2012-01-11 05:32 am (UTC)Re: "Employer"
Date: 2012-01-11 03:06 pm (UTC)(no subject)
Date: 2012-01-11 04:17 pm (UTC)(no subject)
Date: 2012-01-10 07:06 pm (UTC)Unfortunately, that does not appear to me to be the version of Romney that is running for President. And I think that the fact that Romney's response to the pressures of the Republican primary was to go hard right, answers the question of what a President Romney faced with the same pressure from his party would do. To me, the candidate Romney driven hard right by Santorum and Paul and Gingrich, will be the President Romney driven hard right by Boehner and Cantor and McConnell.
(no subject)
Date: 2012-01-10 08:22 pm (UTC)In some ways, yes. Both are relatively technocratic and wonkish, and generally quite smart. Both are hamstrung by strong oppositions. Both have their own medium-grade leanings to the left or right, but are a bit too pragmatic to believe in the more extreme rhetoric, or to espouse it with much fervor.
There are some subtle but important mindset distinctions, IMO. I never got the sense that Obama believed in his own messianic reputation -- he's simply too much of a geek to do so. He let it carry him to victory in '08 -- there's no political gain in puncturing your supporters' inflated hopes -- but somewhat failed to understand how badly those expectations would backfire on him later. Even in the thick of it, though, his emphasis was always very much the community organizer: his emphasis was *we* can, even though many people missed the point of that.
Romney, OTOH -- honestly, I just plain don't *understand* him, and I find that unsettling. His whole life has been one long stage-play, designed to achieve a final act with him as President; he's never even hidden that very well. I expect politicians to have outsize egos, but I find that a tad creepy, and always have done.
(I've also never forgiven him for, IMO, stabbing Massachusetts in the back during his last presidential run: he used us as the butt of his jokes from time to time, and he's never apologized. I find that distasteful in a former leader. I understood the political reasons, but found it cowardly.)
To me, the candidate Romney driven hard right by Santorum and Paul and Gingrich, will be the President Romney driven hard right by Boehner and Cantor and McConnell.
Could be. I suspect that the reality is that Romney would be something of a panderer in office, blown this way and that by political expediency. That's not entirely a bad thing -- I thought Clinton was a broadly good president, and he was a panderer par excellence -- but you're correct that, if the legislature is in the hands of the right wing, Romney is unlikely to hold back their excesses.
OTOH, I also suspect that Romney wouldn't be *totally* at war with a Democratic legislature -- at least, not to quite the knives-drawn extent of the current mess, simply because the Democrats aren't suicidal or cynical (or organized) enough to play that level of hardball. By contrast, most of the Republican candidates (with the exception of Romney and probably Huntsman, far as I can tell) would wind up in a stalemate much like now, with the labels reversed...
(no subject)
Date: 2012-01-11 02:23 am (UTC)(no subject)
Date: 2012-01-11 02:51 am (UTC)True, it hasn't been designed as a whole. But every time there's any change to it, there are plenty of people "designing" what direction that change should go -- mostly in the direction of more taxpayer money going to private companies. The 2010 health care reform bill is no exception: it wouldn't have passed if it didn't feed more taxpayer money into private companies.
After however-many-decades of this kind of "reform", it's no wonder that the system is the most expensive in the world; that's exactly what it's been "designed" to do!
(no subject)
Date: 2012-01-10 08:41 pm (UTC)Quoting:
It’s also a form of karma that Romney’s being skewered over words being taken out of context, when he did the same thing to Obama in November. Remember the ad showing the president saying, “If we keep talking about the economy, we’re going to lose,” and implying it was a recent clip, about the current election cycle – instead of a 2008 clip quoting a John McCain advisor. Romney’s folks spun the ad by saying it was the kind of thing the president could have said recently, given the sputtering economy.
(no subject)
Date: 2012-01-10 08:43 pm (UTC)(no subject)
Date: 2012-01-10 09:48 pm (UTC)Insurance is what you use to cover yourself from damage from high-damage, but low-probability events. This is fine if what you're trying to cover is broken bones but it is entirely inappropriate for dealing with health maintenance - getting your vaccines, working with your doctor to prevent heart disease as you get older, managing your diabetes long term, and so on.
Paying for health care in this way is like expecting your auto insurance provider to manage your oil changes. It's fundamentally the wrong model.
(no subject)
Date: 2012-01-10 10:50 pm (UTC)(no subject)
Date: 2012-01-11 03:05 am (UTC)Good point.
So what if we had a health-insurance system that really was only about high-cost, low-probability events? I guess the danger is that when people are short on cash, they'll skimp on routine preventive care, and thus make those low-probability events more likely, thus increasing the total cost of the system.
On the other hand, suppose we acknowledge that a significant fraction of the cost of the system will be routine preventive care, and that the costs of that are fairly evenly distributed (at least, more evenly than the costs of catastrophic care). Since "insurance" is about distributing costs evenly among a pool of customers, "insurance" has very little to say about routine preventive care. Theoretically, if most people's routine care costs $X/year, you could add $X/year to everybody's premium and include it, or not add $X/year and not include it, and it would make no difference...
Except the psychological difference that, if routine preventive care were included, people wouldn't have the incentive to skimp on it. This is a way to lock yourself in advance into sensible behavior, like diverting a certain amount of each paycheck into savings, or throwing out all the potato chips in the house, or Odysseus having himself tied to the mast. People know what they're going to be tempted to do, and in many cases they take the rational decision to reduce their future choices in order to avoid temptation.
(no subject)
Date: 2012-01-11 08:30 pm (UTC)