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Steve Likes to Curse
Writing, comics and random thoughts from really a rather vulgar man
What smart, rational conservatives have to say about healthcare 
Monday, August 24th, 2009 | 05:15 pm [commentary, politics]
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Jesus Christ, have I been posting enough about healthcare reform lately or what? I never realized what a fascinating issue it was until the entire country decided to spend the last month talking about nothing else. Now I can’t get away from it. It’s just like last month, during which I listened to more Michael Jackson music than I had in the previous twenty-nine years all together. I’m such a follower, it’s pathetic.


As I’ve mentioned a few times recently, I’m not thrilled about the reforms proposed in Congress presently and championed by President Obama. My problem isn’t that the reform plan is too socialist — my problem is that the reform plan isn’t nearly socialist enough. Healthcare is one of the many issues on which I am a total, unrepentant bleeding heart liberal. I agree with Roger Ebert, who wrote in yet another brilliant article on the subject, “I cannot enjoy health coverage and turn to my neighbor and tell him he doesn't deserve it.”


Ebert has had a very rough go of it the last few years. He underwent multiple surgeries to remove cancer from his mouth and jaw, nearly died from bleeding while in recovery (actually would have died, he estimates, had he not had the good luck to bleed out before he left the hospital), lost his ability to speak aloud, and has nearly exhausted his considerable private health insurance policies. Luckily, he writes, he qualifies for Medicare.


My own recent health history is not nearly so harrowing, but who knows what will happen in the coming decades of my hopefully long and hedonistic life? Shit, I eat at Wendy’s an awful lot . . . But even my relative good health has buckled occasionally. Seven years ago I was afflicted with pneumonia and spent a week as a patient at Washington County Hospital. I was working at Pilot at the time. I had health coverage, but no paid medical leave. I missed over two weeks of work. Luckily I had a strong relationship with my boss, who was a good man who valued my work and did not fire me, despite the fact that I had signed a contract when I was hired that gave the company every right to do so for any reason at any time. I also had a family, parents and grandparents, who were willing and able to help me out financially in the wake of missing two weeks of work, helping me buy my prescribed medications and buying me groceries to tide me over until I was back getting regular pay checks. Even with my health insurance covering most of the cost, I was still left with a liability of nearly $1,000 that on my meager wages took me a full year to pay off.


Here’s what I want, if I could wave that hoary old rhetorical magic wand and establish my notion of an ideal healthcare system in the U.S. It’s simple, really:


I want every citizen of the United States to be issued a card not unlike the cards you are issued by your private insurance company, or Medicare. When I am sick or injured, I want to go to the doctor or clinic or hospital of my choice, present my card to the receptionist, and receive any and all treatment that my physician(s) deem necessary for my optimal recovery. When the doctors are through with my treatment/examination/what-have-you, I want to go home. I want my universal government health insurance policy, which will be subsidized by my and everyone else’s taxes, to reimburse the medical professionals who treat me for 100% of their costs and wages.


Is that a pipe dream? Maybe. Maybe not as much of one as you might assume. But even if it’s an impossible pie-in-the-sky fantasy, am I really expected to believe that there is no achievable compromise between my ideal system and the mess we have now, where millions are not insured, and costs are through the roof and “death panels” empowered by private insurers are an everyday fact of life for those who are? Did we lose a fucking war or something?


But I digress. As you may have guessed from the title, what I really wanted to do today is spend a bit of time airing the opinions of conservatives on this issue. Not the Hannitys and Limbaughs and Becks and Levins — the ones with big mouths and no arguments (screeching “WE LOVE LIBERTY!” into a microphone is not an argument against universal healthcare) — but the thoughtful, intelligent, even eloquent voices from the right. Their rationality and lucidity and game attempts at intellectual honesty and critical thinking have earned them the ire of the bullies and radicals on their side — Mark Levin likes to call them “squishes” — but that only raises my esteem for them.


No surprise, I’m taking these quotes from David Frum’s excellent website New Majority, which has been conducting a symposium of sorts on the subject of universal healthcare. David Frum asked his regular contributors to respond to the following question:


Tens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal?


Following are quotes from and links to a handful of my favorite responses. First, from Tom Qualtere, whose response to the question is titled “Universal Coverage: Not a Right, Nor a Conservative Obligation.” Guess what he thinks.


In general, the GOP is the party of liberty; the Democrats are, more or less, the party of equality. Freedom is our alpha value, fairness is theirs. It is the conservative movement’s deep commitment to human freedom and the conditions that preserve it that animates and binds Republicans. Thus, we wholeheartedly endorse the idea of equality of opportunity as strongly as we oppose forced equality of outcome. . . .


Conservatives are right to totally oppose the public option, which even the left admits is an evitable road to a single payer system, which itself is an outright affront to free enterprise, the Constitution, and much more. David Frum recently called it our “line in the sand” which, now judging from the chatter here in Washington, appears unlikely to be crossed. Thus, now on the brink of the collapse of President Obama’s health care hopes, Republicans must responsibly rise to the occasion.


We on the right can still win the healthcare debate, and we can do so without retreating from all that we stand for. Getting behind a co-ops plan is one such way to do this. The left’s attack on our Constitutional principles (the public option) would be averted, and our values would indeed be a major foundation of a plan that shows Americans that Republicans don’t recklessly hate the government but truly know how to wisely manage it better.


Whether a health insurance co-ops plan ala Romneycare in Massachusetts materializes and is able to pass through Congress remains to be seen. But if it does, it will be because conservatives chose to be proactive in defense of the free market, a primary obligation, of which universal healthcare was not.


Okay, so he’s tossing around “liberty” too, suggesting that the conservatives are the only ones standing up for it while the liberals are busily conspiring to deprive us all of it, but notice how he contrasts the Democrats as “the party of equality” and not, say, “the party of tyranny,” which is what Mark Levin and Sean Hannity have been barking about at full pitch ever since Obama was elected. I definitely don’t agree with Qualtere, but I can respect his position. He’s not calling me a freedom-hating commie for holding a different opinion.


Next, this is from “Universal Coverage Will Only Lead to a Single Payer System,” by Brad Schaeffer.


I believe that universal coverage, while in theory a noble concept, in reality will never work for an extended period of time and thus the GOP should absolutely not endorse it under any circumstances. Why? Here are a few, though by no means all, of the reasons I would oppose such an option were I a representative.


1) No government program ever comes in on budget and the potential for a fiscal runaway train in such a mammoth entitlement is daunting. All one need do is look at Medicare, Medicaid and recently MIMA’s initial projections to see this.


2) The nation is already running record deficits. This is not the time to embrace government activism whose price tag cannot be realistically projected (see above).


3) This is not a winning political issue as there is no overwhelming popular demand for such a program. The majority of Americans do, in fact, have health insurance, and the majority of them are satisfied with their care, although they would like to see reform of costs. As seniors too are both a growing voting bloc as well as consistent voters, they see this, rightfully, as a raid of Medicare to pay for others.


4) As a businessman, common sense tells me that I cannot compete with any entity (in this case the federal government) that both unilaterally decides (regulates) what products we both must offer and then not only need not worry about making a profit, but which can run in effect a bankrupt institution ad infinitum.   This is the equivalent of “dumping” by undercutting competitors’ prices, even at a loss, to take market share — but without the hit to earnings that some companies are willing to take. The Democrats see this as an option to “keep insurance companies honest.” I see it as a first step to what Obama et. al. have repeatedly clamored for over the years (new rhetoric notwithstanding). A first step towards an ultimate take-over of the entire healthcare system by the “single payer” entity… Uncle Sam.


5) This goes to 4. This will undoubtedly quell competition and also reduce the level/quality of service. I know of no business that is not driven by the profit motive and also provides superior service/products. It is the antithesis of the capitalist “invisible hand.” Profits drive innovation and competition.


6) The verdict is still out with other nations’ universal healthcare models. This is a long term play.


7) Finally, it is not who we are as a nation. We are not a welfare state. And what better way for the GOP to reclaim its more libertarian side than to oppose such a plan.


Universal coverage will only lead to a single-payer system? Then I say bring it on! Schaeffer at least admits that it’s “a noble concept,” he just has some pragmatic concerns. He thinks it’ll cost too much, and that this is a bad time to attempt such a massive new government program. This seems to be a common worry among the calm, thinking conservative types — the ones who aren’t going to town hall meetings holding up signs depicting Obama with a Hitler moustache, screaming about wanting “their country” back.


This next piece, “Forget WH Assurances: The Public Option Would Crush Private Competition,” is by Henry Clay, legendary 19th century member of Congress and Secretary of State under President John Quincy Adams.


As Washington struggles to figure out what went wrong with Obamacare, and what will become of its centerpiece — the public option — much of the focus has been on the strategy, or lack thereof, for passing this complex legislation.


Should the White House have waded into this debate earlier and made clear that the public option was a sine qua non of health care reform?


Should Democrats have pushed the comparatively radical Medicare-for-All proposal of its Progressive caucus, understanding that the public option would be a negotiated fall-back?


Should the White House have pushed reform and the public option on moral grounds, rather than as cost savings devices?


All are legitimate questions. But this inside-baseball strategic debate misses perhaps the central variable in Obamacare’s collapse — the public option must sound incredibly odd to those citizens who do not spend their lives thinking about politics. In other words, as progressives rush to defend the public option, it is easy to forget just how weird their key proposal likely appears to the town-hallers.


Consider the arguments of Rep. Anthony Weiner (D-NY). Earlier this week, he made the cable television rounds to defend the public option. Against the charge that the public option would crush private insurance companies, Weiner responded that such an outcome would be acceptable because that is how competition works. . . .


What Weiner and the left argue matter of factly — that it is entirely consistent with free markets to have the government providing services in competition with private industry — has to sound off-the-wall when pitched to citizens at these town hall meetings. When defended openly and aggressively, as Democrats are defending it now, the public option appears fundamentally at odds with the understanding of free markets and liberal societies experienced and expected by the vast majority of Americans. The government should be in the business of providing public goods that private industry cannot provide. But it emphatically should not be in the business of competing with private industry. As the polling indicates, this expansive understanding of the government, as not only a market regulator but as a market actor and creator, is proving a tough sell to an American public that goes to Best Buy and finds Toshiba and Sony competing with each other and providing decent products, even absent a government-option in the television market.


With progressives taking the lead in selling the public option, it has become ever more clear that the difficulties for Obamacare are far too significant to be solved by some shift in strategy.  The problem for the left is not merely overcoming the fear (Democrats would argue the misconception) of citizens that the public option will displace existing health coverage with inferior care and a higher tax burden.   And their problem isn’t in the selling. The problem is that with their attempt to have government competing with private companies, Democrats are pushing a foreign sounding product that the American people just won’t buy.


And no amount of Washington strategery is going to change that.


Remarkable how a 19th century legislator who’s been dead for 150 years is able to speak so intelligently about such a modern issue, ain’t it? “Henry Clay” is actually the pseudonym of a government employee who chooses not to write for New Majority under his own name so that he may speak freely. I guess. Since when is the government so hostile to conservatives that they can’t publish on fucking websites under their own names?


Last but not least, because I couldn’t resist, here is an argument in favor of universal healthcare written by New Majority’s token Democrat, Eugene Debs (another pseudonym — is the government hostile to liberals, too?). His article is titled “Universal Coverage: A Disgrace It’s Taken So Long.” Guess what he thinks.


[I]n every other advanced capitalist country, the question which David Frum has posed to New Majority is a settled issue, as banal and uninteresting as pondering whether the earth circles the sun. And note this, NM conservatives: This is an axiomatic policy for conservatives in all of these countries, too. While conservatives in France, Canada, the UK, and Germany may vigorously criticize their healthcare systems (as do those on the left), none of them would ever propose as a remedy the following: “Why don’t we eliminate lifetime insurance coverage for 15% of the population, including children and the near poor? If they can make it to an ER, great. If not, tough luck.” The notion that ad hoc ER services is in any way equivalent to broad health insurance can be addressed as follows. You’ve all heard, of course, recently, of how Investor’s Business Daily ignorantly argued that the British NHS would have, essentially, put Stephen Hawking to death if Hawking had had the bad luck to be British. Of course, Hawking is British — and immediately issued a statement saying that the NHS provided him with excellent treatment his entire life, had indeed saved his life (he suffers from a very rare variant of ALS that can result in chronic survival with many of the symptoms that ALS compresses over just a few years).


An easy hit for advocates of universal insurance, that one. But did it make any of you wonder: What would happen to an American who suffered from what Hawking suffers from — or cancer, or severe heart disease — who lacks health insurance? Say, even the least sympathetic case, one of those arrogant 25-year olds, who think they are going to live forever, and wake up with a deadness in their legs, and are diagnosed with MS — I know someone like that, perhaps you do, too. What happens to those people in America when they don’t have insurance? What happens after they “show up at the emergency room”, in Bradley Smith’s inelegant phrase? This is what a number of you seem to think is fully the equal of having quality health insurance (of the kind you yourselves have, about which more later). So you’re diagnosed with MS or ALS, or you found some blood in your stool time and again, and you go to the ER, and you’re diagnosed with colon cancer. So: you followed Mr. Smith’s advice, and you showed up!! Now what? Is the ER going to refer you to a specialist whom you can’t afford to pay for? If you have cancer, is the ER going to provide you with chemotherapy or a radiation protocol? If you have ALS like Stephen Hawking, what should you do? Go back to your house and cry? Try to get on Oprah, and hope that people will pity you, and provide you with charity? Just crawl up in a spastic ball on the street and die? American conservatives: tell uninsured Americans—your fellow countrymen and women, you who evoke love of country so frequently–about what they should do after they’ve “showed up at the ER.” What’s the next step in their treatment plan? These are questions that your peers, i.e. other conservatives in every other advanced country on earth, never think about. Because they have accepted the premise that healthcare is not a commodity like a personal computer or a car. If someone lacks the money for a car, or a more expensive car than they can afford, we say: too bad, that’s the market system. You get what you can pay for. But we don’t do that with healthcare, do we? If we really did that — if you all were really as rigorously libertarian as you claim to be — you wouldn’t even bother with the fig leaf of the ER coverage. People who couldn’t afford care would just be left to die on the street — after all, if they can’t afford healthcare, tough luck. Just as if they can’t afford to buy that car, or a house, or sofa, or a lamp. We don’t say, “Just show up at Crate and Barrel — you’ll get an emergency sofa, if you’re just ‘dying’ to have one.” Nor should we. But, um, healthcare is different isn’t it?


Yes, you can’t quite bring yourselves to an entirely ruthless conclusion, can you? You don’t have the guts, American conservatives! Alas, you can’t bring yourselves to do what every other conservative in the Western world has done either — admit that your position is intellectually and morally incoherent and unsustainable. No, healthcare is not like any other commodity in a capitalist economy. In fact, it’s not a commodity at all. It’s why we call ourselves “patients” when we go to a doctor, not “customers.” It’s why we keep those ER’s open — to salve our conscience, right, Mr. Smith? Even if we all know that a visit to an ER is not remotely equivalent to the sustained medical attention that a cancer sufferer would need over the course of his or her illness. Nor is it, ironically enough, like the sustained care that Stephen Hawking received from the socialists at the NHS. And isn’t it odd, too, that we act as if people in these other countries we know well — entirely civilized, advanced countries like Canada, Denmark, the Netherlands, Germany, France, even the UK — are dropping dead on the streets of the cities and town as if from the Black Plague every day. Oddly enough, many of us have been to these places, and this isn’t true — people receive excellent medical care at less cost than our system provides. And most of those citizens are quite happy with their care. But it’s like the old joke about the adulterous husband: “Who are you going to believe, me or your lyin’ eyes?”


I couldn’t have said it any better myself. Which is, I suppose, why I chose instead to quote extensively from someone else’s work. Ya’ll have a nice evenin’ now, ya hear?

Monday, August 24th, 2009 | 11:55 pm (UTC)
There is just so much to comment on! These are very rich excerpts from some very interesting authors.

I love the writing about the ER that comes from an often used argument of anti-reform person.

I was also impacted by the writing about the perception of the 'public option' of townhallers. Indeed it is completely alien sounding to them.

Sadness is about all I can muster with the last month of 'dialogue' about health care. Until we see for-profit health care as the problem I don't think we will make any meaningful changes.

Thanks for gathering some other points of view... I spend so much time reading on the internets but I can't get to it all.
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