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Archives for Media Criticism

Don’t Blame The VA


I like to combat the odd Republican in my columns in Spot-on, but it’s fairly unusual that the object of my humorous chiding is a fellow Spot-on-er. But this week Scott Olin Schmidt reworks the tired argument over Walter Reed Army Medical Center saying that since the hospital was revealed as a disaster some months back the government has no hope of competently running health care facilities, and by extension no hope of successfully running any type of health care organization including health insurance.
The evidence that Scott introduces – based on a somewhat misleading Associated Press story – is that Jim Nicholson Secretary of the Department of Veterans Affairs (VA) has resigned, apparently because of the Walter Reed scandal. Scott then makes the huge leap to say that if you don’t want to see the kind of problems Walter Reed represents, then you should be opposed to the very notion of universal health-care. And for good measure, he suggests that it is all Hillary Clinton’s fault as she “would apply the VA model for healthcare to everyone with one single-payer.”
The problems at Walter Reed were indeed severe, but they were mostly concerned with the incredibly disorganized treatment of outpatients, and their being housed in shameful conditions, while the system essentially ignored them. No one is denying that these were terrible problems, or that whoever was in charge should have fixed them. But blaming this on the VA as a knee-jerk reaction reveals a teeny tiny error.
Walter Reed is not a VA-run hospital. It is an army hospital, run by the U.S. Army and the Department of Defense. They are different organizations.
First an observation: The U.S. does an incredibly bad job looking after its veterans. In amongst all the propaganda about supporting the troops, we’ve spent 35 years leaving some of our veterans on the street and without all the care they need. But this has no connection to the VA system, or at least not much to its performance in the last decade. It has even less connection to the capability of the government to run healthcare facilities. And it has absolutely no connection to the concept of universal health-care.


Posted by Matt Holt at 3:59 AM | Permalink

Is the Drug War Nearing an End?


Little by little by little there is some hope that the “war” on drugs is becoming a political issue – the first step in undoing a set of policies that make little sense no matter how you look at them. Now, only a brave and sloppy analyst would claim there was really any reason to expect a major rethinking about the 35 disastrous years of the drug war by American law enforcement and politicians. But for the first time in a while, there’s hope.

After all, these days Americans – lots of them – are questioning other not-so long-standing wars. Nobody rational – in either political party – seems to be genuinely defending what we are doing in Iraq any more, and it’s clear that America will leave within a year or two with nothing accomplished other than huge debts and a power vacuum in the Middle East. Meanwhile, the shenanigans at Guantanamo Bay and other places where “terrorists” have been imprisoned have set America’s reputation back by a least a quarter-century, and have given great positive publicity to some of the most barbaric bigots in the world. So much for our war on a noun.

Both these wars had their model in the war on drugs declared by Richard Nixon and energized by Ronald Reagan, House Speaker Tip O’Neill, and a phalanx of unthinking politicians. And none of the current Democratic Presidential candidates have raised the issue yet, either.

The one honorable exception to this line-up is Rep. Dennis Kucinich, but although I supported him last time because his beliefs and policies coincided with each other (rare) and with mine (rarer still!), I’m not deluding myself that he’s a realistic contender. Kucinich has long been opposed to the war on drugs and is an advocate for medical marijuana – based on his simple human decency. It’s also worth noting that he was the only main candidate in the Democratic presidential primaries in 2004 to actively oppose the Iraq war from the start and also to demand universal health insurance.

Essentially the Democratic party has caught up to him on these two issues, so perhaps it’s worth thinking that they might do it on the third.


Posted by Matt Holt at 2:23 PM | Permalink

Looks Good, Doesn’t Fly


Two weeks ago, what seemed to be a very interesting survey appeared in The New York Times. It suggested that most Americans were supportive of universal health care, and more importantly were interested in considering raising taxes to pay for it. Several gleeful commentators on the left, and even a few on the right, considered this was a new dawn for the health reform movement.

Unfortunately this is nothing new. Americans have always been in favor of universal health care. At least they have been when you ask them about it in surveys. Unfortunately there are several other things they say in surveys that they are also in favor of that undermine the prospects for “universal” coverage. For example, in 2003 by small plurality, Americans said they preferred the Canadian health care system to their own. But don’t worry they said the same thing in 1989! None of these polls mean either that Americans do actually prefer the Canadian system (especially given how little they know about how either country’s system actually works) or that something similar will actually hop the border and come to the lower 48 any time soon.

What it does mean is that Americans have some vague idea that they don’t like what they have now. And honestly, what’s to like? There’s no need to go into a long litany of the problems of the US health care system here – again – other than to note – once again – that it is expensive, unfair, and essentially run for the benefit of providers and suppliers.

The truth is that the Times survey showed a very similar interest in universal health-care reform and raising taxes to pay for it as did one done in the middle of the Clinton reform effort in 1993. John Cohn of The New Republic was very quick to jump on this – pointing out that the numbers in the current survey were actually not quite as good as they had been in September 1993 – right at the time that Clinton made his speech introducing his health reform plan. But as I pointed out in a much longer piece about the prospect of reform at The Health Care Blog a couple of years back, Americans have always said in surveys that they’re willing to pay more taxes in order to cover the less fortunate.


Posted by Matt Holt at 7:02 AM | Permalink

Why Healthcare Reform Won’t Work


It’s taken quite a bit of time. But the efforts by Republicans George Bush, Arnold Schwarzenegger, and Mitt Romney have finally convinced the national press that the rash of cancellations in the individual insurance market is a story worth writing. Perhaps it’s because we’re now discovering that this is a national phenomenon.

It’s somewhat older news here in California where it looks as though the state may decide that any retroactive cancellation of policies needs to be reviewed by an independent official. One Californian insurance company, Kaiser Permanente, while caught with its own hand in the cancellation cookie jar, has already proposed something similar. But it’s less likely that competitors WellPoint (Blue Cross of California’s parent), HealthNet and Blue Shield of California will be quite so thrilled.

Blue Cross of California, one of several plans being sued in California, says that it rescinds an average of 1,000 policies each year out of about 260,000 new individual enrollments — less than one-half of 1%, says spokeswoman Shannon Troughton.

WellPoint is strictly speaking right to say that less than 1% of its applications get cancelled. But it’s evident from the various testimony already leaked from depositions of Blue Cross of California’s employees that the applications of any individual policyholders submitting high claims were routinely subjected to a review looking for the slightest excuse to cancel the policy. But that’s not the heart of the matter.

The issue is that we have an individual insurance market which is designed to stay away from the care of sick people. And that’s why healthcare reforms, as they are currently proposed won’t really work.

You may believe that the point of insurance is to distribute unexpected costs amongst a large group. And you’d be right. The problem, as I’ve pointed out several times, is that health care costs are not distributed that unexpectedly. In fact any decent insurer can do a pretty good job of figuring out who is going to need expensive medical services, and can therefore avoid them.


Posted by Matt Holt at 7:50 PM | Permalink

Risky Business: Bush’s Health Plan


I was awakened during my slumber through the State of the Union by a mention from President George Bush of a health care proposal that I almost agreed with.

No, I haven’t come around on health savings accounts, and association health plans. Nor did I join the Republicans in their standing ovation for malpractice reform. The Bush proposal that woke me up was the creating a tax deduction for health insurance that would apply to everyone. Potentially this really matters, and inside it is the germ of the right idea. But I guarantee you that most Americans won’t have a clue where this came from, and why it made it into the president’s speech.

Let me explain a little. Health insurance for the vast majority of Americans (60%+) comes from their employers. 99.9% of Americans think that this is a natural relationship that costs them nothing and they, in general, have no idea what it costs their employer. This is though a historical accident, with its roots in a wage freeze policy during WWII when employers added benefits to attract workers because they couldn’t raise pay rates. The idea became fixed after the Supreme Court ruled that health benefits didn’t count as taxable income.

So, today, you’re better off getting insurance paid for by your employer than taking the cash, getting taxed and buying the same insurance yourself. Lately self-employed people have also been able to deduct their health insurance costs so the only saps left paying for health insurance with post-tax dollars are those who are not self-employed, don’t get it from their insurers and actually buy it themselves.

You may think that’s not very fair, and you’d be right. Which is why Bush’s proposal is interesting.


Posted by Matt Holt at 12:13 AM | Permalink

Sacramento, We Have A Problem


When looking at the Golden State’s governor, Arnold Schwarzenegger, and his attempt to fix health care, I am reminded of a movie. Not one of his, rather the scene in Apollo 13 when the crew on the ground had to figure out some wacky mechanical fix that would enable the guys out in space to filter their oxygen without using more than the two amps of power they had available. It seems that we have a similar situation. The prognosis is grim, but the political reality is that, like the Apollo crew, we need to use the limited resources at hand.

Schwarzenegger taken on a big job and, it seems, entering his final four years as governor – a political career that began on a whim – he doesn’t much care who he takes on. Given that California is roughly 10% of the nation, with a higher than 10% share of the nation’s uninsured, most people were expecting that Schwarzenegger would identify covering all children as the extent of his health-care ambition. Children are politically palatable – when it comes to health and medicine. But Schwarzenegger didn’t stop with the children. Instead he actually believed all the stuff he was saying about all options being on the table to cure the system and has acted accordingly.

In an address on Monday he introduced a plan that actually went further towards universal coverage than the one State Senator Pro Tem Don Perata introduced late last year. Schwarzenegger called for full universal coverage, and promised to get there by a mix of what’s known as pay or play – a mandate that employers must cover their employees or pay a tax – and an individual mandate compelling citizens to buy health insurance. The details of the plan are very complex but understandable.

Once employer mandates are in effect, Schwarzenegger essentially wants to get to universal coverage by boosting Medicaid to cover anybody who is still isn’t covered. Employers get the choice of covering employees or paying a very significant payroll tax into a fund that will support the Medicaid expansion. Finally in order to make the concept of accepting Medicaid patients attractive to physicians and hospitals, the proposal suggests increasing payments for the Medicaid program. The way it funds that increase is to tax revenues from doctors and hospitals. This is a tax tacked on to payments made by richer people to their doctors and hospitals in order to raise the Medicare payments made by poorer people to their doctors and hospitals. These groups are, of course, served by different doctors and hospitals – unless an army of Paris Hiltons are moving from Beverly Hills down to South-Central for more than just TV schtick.


Posted by Matt Holt at 2:54 AM | Permalink

Fashions and Fads in Health Care Legislation


Will you can’t trust politicians, can you? I spent all last year explaining why the time wasn’t quite right for health care reform by 2008, than just because they eke out a small electoral win, the Democrats and every sensible Republican comes out with a health care reform plan.

The new Congress hasn’t even met and already Senator Ron Wyden (D-Wash.) has introduced a comprehensive plan to eliminate employer-based health insurance, and transform it to a highly regulated individual market. Not to be beaten to the punch, AHIP, the insurance industry lobbying group, has announced a universal insurance plan that doesn’t get us close to universal insurance, but miraculously involves lots of government subsidies for insurance companies. Even more bizarrely, Kaiser Permanente, which signed on to the AHIP plan despite the distaste with which they must view the other members of the AHIP board, introduced their own separate plan for California. Meanwhile Democratic Presidential hopeful John Edwards has kicked off his 2008 presidential campaign by announcing that he is now for universal health insurance too. And of course Massachusetts Governor and Republican presidential hopeful Mitt Romney will be running for his party’s nomination pushing his individual mandate as their version of universal health insurance and claiming he brought universal insurance to Massachusetts without a tax increase.

The action isn’t just at the national level, in fact it’s really all going off in the states. Basically everywhere you turn, politicians of every stripe in every state are talking about health care. Which brings us close to home in the biggest state: California. The saying: As goes California, so goes the nation may, once again, apply.


Posted by Matt Holt at 8:13 PM | Permalink

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