Casaubon's Book

A while back I argued that there’s a rule – when the US spends a whole lot more and uses a whole lot more than everyone else, what we usually get back isn’t just less than everyone else gets for the same buck, it is dramatically worse. I called it my rule of 10 times the price = 10 times crappier. It applies to an astonishing range of American actions – from our military budget and its results to the oil we invest in agriculture.

Back then, one of my examples was healthcare, which I pointed out was at least 4 times crappier (and at least 10xs or more for those who can’t get it at all, an increasingly large percentage of the populace) for more than double the price of the average European nation’s health insurance.

Well, we seem to be well on the way to achieving the 10-10 rule with the current healthcare bill. Without a public option, its function will be to force many people to give private industry their money, without dramatically lowering prices. This is an enormous boon for the healthcare industry, who get billions of dollars without actually reforming their practices, and a boon for a percentage of the population that can afford healthcare but can’t get it because of pre-existing conditions. It is an enormous sucky hell for the large number of people who can’t afford healthcare – particularly the struggling folks just over the edge for subsidies.

So the question comes around – does one support this piece of shit legislation or not? The argument in favor is this – if healthcare fails again, it will be a long, long time before it comes around again. With more than 2 out of every 5 Americans with no healthcare, and Medicare expected to be broke in 7 years, we can’t afford to wait another decade. On the other hand, this is so obviously screws so many people and benefits exactly the wrong ones.

I’m not convinced at all that once in place, it will be reformed. On the other hand, I am convinced that if we don’t say yes, a lot more medical bankrupcies and early deaths will result. In the long term, I fear that the coming breaking of the Medicare budget will result in the casting off of baby boomer seniors into the arms of the private insurers as well, with this as a precedent.

My first choice would be to lock the entire American Congress in with a selection of the angrier, larger and healthier friends and family members of millions of people who can’t get decent healthcare, and wait until a better bill emerges. Given that that’s not going to happen, I’m caught between two visions – the middle class family that was almost making it until the shitty healthcare bill forced them to buy insurance, and the person with a medical diagnosis who is skipping dinner to pay for her medications. I don’t like what this does to either of them, but I’m going with the impoverished person with a medical diagnosis. So I guess I’m for it, assuming arranging for the big men with borrowed canes to change the minds of our government isn’t a choice.



  1. #1 Mike Cagle
    December 18, 2009

    Well, it’s not what we hoped for, and it’s frustrating and disappointing, but I think it’s still better than nothing. And it’s an issue that can be revisited in the future. I understand where Howard Dean and others who say “kill it” are coming from, but I don’t agree. I found these arguments persuasive:

  2. #2 dewey
    December 18, 2009

    I disagree. This is just another way of ensuring that every remaining drop of wealth in the now zero-sum economy is transferred to the already wealthy. Having insurance, what with deductibles, copays, etc., does not mean that you can actually afford to see a doctor and buy meds. If everyone in the country is compelled to spend thousands they may not have on insurance, it may mean they lack the money they would still have to spend to get medical treatment the one time they actually need it. And it compels everyone to participate in the cash economy and to make the second destination for their cash income (after taxes) the insurance industry’s fat coffers. You and JMG, two of my favorite thinkers on the subject of adaptation, both argue that we need to be getting as much as possible of our support out of the household economy rather than the cash economy. Mandatory corporate insurance simply chains everyone, even the young and healthy, to corporate wage slavery, making sure that they will not have the time for any pesky dissenting actions like relocalization or subsistence gardening.

  3. #3 Claire
    December 18, 2009

    I am not for the current bill, but then I’m going to be forced either to buy coverage, or more likely because it will be cheaper, pay the fine for not buying coverage. My DH and I chose not to buy so-called “health insurance” because we wished to avoid giving money to the corporations who offer it. Instead, we spent that money on higher-quality food and in other ways that improved our health rather than enriched health insurance corporations. We’re being denied that choice, and I am not happy to be forced to support either the corporations or, if the fine is collected as an income tax (as had been proposed earlier), the wars.

    It is good that some people who haven’t been able to get coverage before (such as those who have maxed out their coverage, or have pre-existing conditions that lead to their being denied coverage) can get it now, assuming they can afford to pay for it. But I am thinking of a recent study that followed a group of men in a city (Boston, I believe) and came to the conclusion that good health correlated with avoiding visiting doctors or using hospitals – that in fact, those who made use of the “health care system” as it currently exists had worse outcomes than those who did not. My recollection is that the researchers claimed this wasn’t because the ones who didn’t visit doctors had intrinsically better health. Instead, it appeared to have something to do with the extra interventions actually causing poorer health. If this is the case, it might be more like 10X more expensive health insurance (of the sort that appears likely to pass) = 100X crappier results.

  4. #4 Sharon Astyk
    December 18, 2009

    Well, as I see it, Dewey, the subsidy looks reasonably generous for low income people – I’m not sure this does much more to tie people to wage slavery than exists at present. In fact, it might do better – because if every job now has a health insurance option, more families can afford to have one earner and one person at home – I know dozens of families where one person works entirely for the benefits. Again, I don’t blame people who oppose this, but I’m not sure that criticism quite works.

    Claire, there is a religious opt-out option, as I understand it. I don’t know if you have ethical issues about lying to get it, but it does exist.

    I truly understand your position – but I also think that for many people, choosing not to have insurance is a luxury of good health. They can choose it as long as they don’t get sick or hurt. In your case, I understand there’s a serious commitment to being fully responsible – but not everyone can do that. Someone with young kids or elderly parents relying on them can say they are committed to doing without insurance, but one car accident or cancer diagnosis means that they are cast on the system, because they can’t afford to choose death or disability.


  5. #5 Alexandra
    December 18, 2009

    I agree with everything Dewey said. Without a public option, this bill is outrageous.

  6. #6 Alexandra
    December 18, 2009

    I would also add that the fate of the “impoverished person who can’t afford medications” depends on the kind of impoverishment and the meds in question. My father is self-employed, middle-income on paper, and diabetic. He is not currently insured, obviously. He can just barely afford to pay taxes (remember, the self-employed pay 15% in FICA alone), buy insulin, and eat, because insulin is relatively cheap. He’s also about to lose his house. There is no subsidy short of /free/ that could make health insurance affordable to him.

    For someone with a chronic condition requiring much more expensive drugs, this bill might help. For a lot of people it won’t.

  7. #7 Claire
    December 18, 2009

    It’s good that the bill offers a religious opt-out for the religious groups that have historically managed health care within the group, such as the Amish. The problem with lying to get the opt-out is that I took a precept against lying within my religious tradition (Zen). There’s no way I can, or want to, massage the precept in an attempt to justify opting-out.

    If the insurance were going to be about the same or less than the fine, I’d suck up and buy the insurance, while continuing to do as much as possible to avoid using it. But for two adults in their 50s, that seems very unlikely, even with a large deductible (it’s certainly not true now given the fine amount I’ve seen mentioned). Our income is unearned so I don’t think we will be able to get a subsidy to buy insurance, although the same amount of earned income would be sure to be eligible.

    The current system really sucks. I wish the bill offered a much better system than the current one. For those who will benefit by the current bill, that is truly wonderful. But the sad thing is that better possibilities might have been able to be realized were the stranglehold of corporations on the political process less of an issue.

  8. #8 curiousalexa
    December 18, 2009

    A friend of mine who lives in Mass tells me he works only to pay for state-mandatory health insurance. Without that requirement, he would have minimal expenses and be able to live off a pittance.

    What happens to people who do not work conventional jobs? Will they be forced to go get paying jobs to pay for health insurance or fines? And how does that work in the current economy where people who actively *want* jobs cannot find them? How does this work for the unemployable, the homeless? Perhaps they are acceptable casualties in the cause for the greater good.

    I like the idea of borrowing canes to talk some sense into Congress, bringing some different perspectives to the table.

  9. #9 dewey
    December 18, 2009

    Sharon writes:

    “I’m not sure this does much more to tie people to wage slavery than exists at present. In fact, it might do better – because if every job now has a health insurance option, more families can afford to have one earner and one person at home…”

    Some married couples might benefit, but if you are single or divorced, you’re on your own to cover all your expenses. Even married couples may get bitten by this; I pay far more for my husband’s coverage through my employer than for my own, and that’s not going to change. So if the employer’s family health insurance costs are higher than the employee can pay, the spouse will still have to go get another job. And if you’re gay, your employer’s health insurance won’t cover your partner at all.

  10. #10 Wendy
    December 18, 2009

    I’m against it, and I’ve been against it from the get-go, and FYI, I was one of the 47 million, because my husband’s our employer dropped our insurance plan when it became too costly – just so you know where I’m coming from.

    There are 300 million Americans. Of those 47 million (about 15%) are not insured (including me, my husband and our three youngest children). Of those, about half are considered “chronically” ill (8%).

    The current bill before Congress is written so that those people who will benefit from the health care “reform” will be the 8% who are currently uninsured but are chronically ill … and those people who have a vested interest in the health insurance industry.

    In short, this bill, like the No Child Left Behind law (and the plethora of other social programs) will benefit a tiny portion of the population, while the MAJORITY of us will either not benefit at all or will be harmed by it from increased demands on our limited resources (i.e. higher taxes or penalties with dwindling incomes).

    I simply can not understand why our national government keeps pandering to the smaller percentages of the population. Eight out of 100 people is 8%. What about the other ninety-two people?

    That aside, however, nothing in this “reform” will change the way healthcare is distributed or handled, and the type and scope of the care one receives will still be governed by one’s insurance policy. Not all policies are created equal, and often the best treatment is one that the pateint can not get (like physical therapy as opposed to surgery) because the insurance company will not pay for the alternatives. Seven years ago my health insurance company would not pay for my home birth midwife, but would have paid for a planned and scheduled c-section, even though a c-section is significantly more costly and has a statistically higher mortality rate than a homebirth.

    The answer is to take our health out of the hands of big business and out of the hands of our government, and make it local and more personal, but there’s little money in that solution, and so that won’t be a solution that is even considered.

    In short, the health care reform is not about making us healthier or making health care more accessible to the tiny portion of the population who can’t get insurance (although they can still get some care). It *is* about the money, and there’s a lot to be made if all 300 million Americans are FORCED to purchase a health insurance policy at an average cost of $2400 per year per individual with a deductible of $5000 per person per year and a co-pay of $25 per doctor visit.

  11. #11 Sharon Astyk
    December 18, 2009

    Wendy, I’m not sure I get your reasoning – for the more than half of the US that has health insurance, the situation will probably be the same or a bit better, based on cost estimates – their health insurance costs may go down. For that 8% – who are non-trivial, and who suffer a lot, and die earlier and who alone would probably justify some intervention, this will be lots better. For people who pay more than $2400 in out of pocket costs per year for health care, this will probably be better. That’s a majority.

    Look, I don’t like the program, and I agree it doesn’t deal with the central issues. But I don’t think you can claim it doesn’t help a majority of people. And frankly, I think “screw the 8% of poor chronically ill people” isn’t a very nice sentiment – what is government for, if not caring for the most vulnerable folk?

    Dewey, but presumably your spouse could quit his job and stay home and grow the garden? I mean, I’ve gathered that probably isn’t going to happen, but in theory… As for single people, they are pretty tied to jobs anyway, if they have dependents. As for gay people, no version of this bill will help them until we hit some kind of federal way of dealing with this issue – and may it be soon.


  12. #12 dewey
    December 18, 2009

    My husband can’t quit his job, mostly because we’d then have the choice of paying his student loan or the mortgage. And if he did, I’d still have to pay for health insurance for him, because he does need prescriptions. So I don’t see how that helps.

    An unmarried person who can’t or doesn’t want to find full-time work (let’s call him Kato) may be able, right now, to get by living with someone else (lover, family member, very tolerant friend; let’s call him OJ) who pays the rent and lets them do the housework. The net monetary cost to OJ for such arrangements may not be very high. But it’s highly unlikely he will be able and willing to spend several thousand dollars per year to get Kato individual health insurance (with more money needed if he wants to be able to actually use the insurance). Kato will therefore need to earn more money.

  13. #13 Brad K.
    December 18, 2009

    I still think the organized labor expectations of taking advantage to force union membership, and union control, of hospitals and health services makes this a really bad proposal.

    I am against any of the health care plans now in Congress.

    The other reason I oppose the health care plan, is that Medicare has already winnowed the field of doctors willing to participate. And language in the current bill drafts, involuntarily, every health care provider into the plan. The bill states that sometime, someone will work out how one might “opt out”. Of course, all a doctor or nurse would need to do would be to surrender their license to practice. Which wouldn’t help a lot of people to get health care.

    Unless black market medicine forms a new under-economy, unregulated and high risk.

  14. #14 knutty knitter
    December 19, 2009

    I’m of the opinion that govt should look after its constituents full stop. Thats what they are supposed to do.

    We don’t have insurance here except for a small subsidy (around $200 per year per adult) towards accidents. I pay about $30 for a doctors visit and medications cost about $2 each (a little more if you are higher income). Children under 6 are free. Hospitals are also free.

    Thats what taxes are for isn’t it? Along with education, law and order and one or two other minor things. Maybe if you reduced the size of your military, there would be resources for actual people.

    viv in nz

  15. #15 billygroats
    December 20, 2009

    viv in nz, aka knutty knitter:

    If the government was the one providing the service, I’d also be for them taking care of the constituents. Here in the USA, however, government’s role is entirely one of wealth transfer: To transfer the wealth of working-income people to the rich, and a little for the poor.

    We were all wondering what happened to the “Peace Dividend” that we should have been getting in the 1990’s. The money saved from having drawn down a large portion of our military was supposed to be used to solve social problems, or at least given back in the form of lower taxes. It never happened, and by the year 2000, the folks in government realized that we were getting very upset about the fact that they were spending more and more money even though we had a smaller military, so, when an excuse materialized to start a war, the goverment took it.

    Now, there’s little to no money left for solving problems in the US becuase so much of it is being used for fighting terrorists overseas (and all the related spending).

    We American voters stopped keeping track of what our elected officials were actually doing in our name and just keep voting for them based on what their ideoligies are. Consequently, we have two political parties that share one and only one goal: The politicians pay companies billions in order to get millions for their electioneering.

    I knew this medical care scheme was doomed from the outset because whenever the Republicans move to the right, instead of pulling back to the left, the Democrats just follow the Republicans’ lead. When it comes to any legislation that matters, the Democrats give and give and the Republicans take and take and they all call it “bipartisan compromise.”

    The only thing we Americans have left to protect ourselves is loopholes in the law, that when quietly exploited, can keep a small portion of us from having everything stripped away.

    I’ve never met a god I didn’t want to kill and bury very deeply, but if this law has a religious exemption, I’m part of that religion from now on.

  16. #16 billygroats
    December 20, 2009

    Sorry for the many typos in the post above.

  17. #17 Claire
    December 21, 2009

    I know it’s really difficult to determine what is a net benefit (is it a reduction in cost? a better health outcome – and if so, who is defining what that outcome is, and is it better in the short term only? and so on). Having acknowledged that difficulty, I am wondering if there actually will be an overall net benefit should the so-called health care legislation be passed and signed. Some number of people will benefit, for sure: those who could not get health insurance before, want it, and can pay for it through their own funds or through subsidies or whose employers can pay all or part of the cost. We’ll call these folks group A. On the other hand, some people will not benefit: they will be forced to buy insurance they did not have to/want to purchase before, will not get a subsidy or will not get enough of one to cover the cost of the insurance and therefore will have less money than they did before, and more than likely will wind up with a high-deductible policy which will force the spending of still more money before they get any benefit. Or if they don’t want to or can’t afford to go this route, they will have to pay the fine for being uninsured, will be out the cost of the fine thus leaving them less money for healthy practices, and still be uninsured. We’ll call these folks group B.

    My questions: which group is larger, group A or group B? Among those in group B, will they be of higher or lower income than group A and/or of the population at large? Of those in group B who have a low income and no savings, might it be reasonable to look at the effect of the bill on them to amount to a regressive income tax, especially if they pay the fine, which will be assessed on their federal income tax form? All these seem to be worth asking for those of us who are considering whether or not to support the health care legislation.

    I’m in group B, but I would support the legislation if it were clear that the number of people in group A is higher than those in group B, or in other words, if there is a clear net benefit, and especially if that net benefit goes disproportionately to those who need it most. Anyone know if that is the case? It seems more likely to me, however, that it’s unclear if there will be any net benefit. There might be a net cost rather than a net benefit. It might even be that poorer people are more likely to be in group B than A, so that the legislation might fail a social-justice test as well. Any info on this possibility?

  18. #18 Sharon Astyk
    December 21, 2009

    Claire, you are absolutely right about this, and that’s just the kind of objective analysis that someone should do. There are versions of this in the Republican and Democratica analyses, but I wouldn’t trust any of them as far as you can throw them. Anyone feel like doing the research? I’m sure if you sort through enough think tank data pools you can probably do it, but I don’t have time.


  19. #19 Wendy
    December 23, 2009

    If you’re still in favor of the current health care reform bill, because “it’s better than what we have,” you should read Senator Olympia Snowe’s (R-Maine) statement. She worked on the Finance Committee to draft the original bill that has been mutated and is nothing like the one she and her five colleagues spent four months drafting. She will not support the current bill.

New comments have been disabled.