consultants are sandburs

Tuesday, October 29, 2013

There are better ways to skin a cat. I and many others favor single skinner as the sensible way to govern. Krugman included.

The insurers wrote the monstrosity bill, and you don't hear them bellyaching over the government website. Instead, they are in their counting houses, counting out the money. UnitedHealthcare owns a subsidiary that will be profiting from applying a fix. This link, on UnitedHealthcare Mr. Fix-it moneymaking; even after admitting catching and fixing its own screwup re its initial slice of the pie (the pie being contracts for setting up the federal registration site). Plus, there is state-plan UnitedHealth coverage gaming reported in California. Much cause to dislike and distrust ...

Moving on -

A Krugman editorial link was emailed me. Krugman, in "The Big Kludge," wrote [links omitted, see original]:

The good news about HealthCare.gov, the portal to Obamacare’s health exchange, is that the administration is no longer minimizing its problems. That’s the first step toward fixing the mess — and it will get fixed, although it’s anyone’s guess whether the new promise of a smoothly functioning system by the end of November will be met. We know, after all, that Obamacare is workable, since many states that chose to run their own exchanges are doing quite well.

But while we wait for the geeks to do their stuff, let’s ask a related question: Why did this thing have to be so complicated in the first place?

It’s true that the Affordable Care Act isn’t as complex as opponents make it out to be. Basically, it requires that insurance companies offer the same policies to everyone; it requires that each individual then buy one of these policies (the individual mandate); and it offers subsidies, depending on income, to keep insurance affordable.

Still, there’s a lot for people to go through. Not only do they have to choose insurers and plans, they have to submit a lot of personal information so the government can determine the size of their subsidies. And the software has to integrate all this information, getting it to all the relevant parties — which isn’t happening yet on the federal site.

Imagine, now, a much simpler system in which the government just pays your major medical expenses. In this hypothetical system you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details. The government would be your insurer, and you’d be covered automatically by virtue of being an American.

Of course, we don’t have to imagine such a system, because it already exists. It’s called Medicare, it covers all Americans 65 and older, and it’s enormously popular. So why didn’t we just extend that system to cover everyone?

The proximate answer was politics: Medicare for all just wasn’t going to happen, given both the power of the insurance industry and the reluctance of workers who currently have good insurance through their employers to trade that insurance for something new. Given these political realities, the Affordable Care Act was probably all we could get — and make no mistake, it will vastly improve the lives of tens of millions of Americans.

Still, the fact remains that Obamacare is an immense kludge — a clumsy, ugly structure that more or less deals with a problem, but in an inefficient way.

The thing is, such better-than-nothing-but-pretty-bad solutions have become the norm in American governance. As Steven Teles of Johns Hopkins University put it in a recent essay, we’ve become a “kludgeocracy.” And the main reason that is happening, I’d argue, is ideology.

[...]

With that teaser lead in quote from the beginning of Klugman's item, how can you not read it all?

It, unlike the private insurers, is truthful.

A reader comment to the Klugman item. In terms of skinning cats, stretching the figure of speech beyond its headlined use above, the comment focuses on cats that might productively be skinned, a how-and-why thought:

Doug Broome - Vancouver

The father of Canadian universal medicare was a Baptist minister named Tommy Douglas who led the socialist party (NDP) to power in Saskatchewan. He was recently named the greatest Canadian in a contest on the public broadcaster CBC.

In his campaigns Douglas used the story of Mouseland, a story very applicable to American politics today. Mouseland had a parliament and two parties, the Black Cats and the White Cats. The two parties battled back and forth for the votes of the mice, making all sorts of promises about how good they could make life for mice, spinning stories of mouse justice and liberty.

But when they got the votes of the mice, they would eat the mice. The mice elected the White Cats, who promised cheese, but got eaten. And then they elected the reformist black cats who promptly kept on eating mice. They mice tried a coalition of black and white cats. Same result.

Then one brave mouse stood up and suggested they elect a Mouse Party. "Socialist!" the Very Serious Mice called her. But some mice thought it worth a try, and they put out some candidates. The cats told the mice they didn't understand free markets. But eventually the mice won, and the cats stopped eating the mice.

The U.S. needs a Mouse Party. The Democrats are a big business, conservative party which needs a shock to its complacency. Something like a Tea Party of the left.

Oct. 27, 2013 at 11:15 p.m. -- Recommended 488

For Tommy Douglas, Greatest Canadian, here. For nostalgia for the better part of the good old days, here. More Tommy Douglas the Greatest, CBC here, Wikipedia here (with links).

What resonates with truth, from that comment, "The U.S. needs a Mouse Party. The Democrats are a big business, conservative party which needs a shock to its complacency. Something like a Tea Party of the left."

If only the Ron/Rand people had a social conscience to go with wanting a closer watch of the banks and downsizing the world's policeman fiction and being a better international neighbor instead of the world's bully. If that, the left could work with people like that.

The place to start really reforming Pentagon size and waste; downsize the entering and graduating classes of the military academies. That is where entrenched bureaucracy love of the military size is spawned. Then, take on the contractors.

_______________UPDATE______________
All of the comments to that Krugman item are worth reading. Another one or two:

Xander Patterson - Portland, OR

Republicans run against government. Once elected, they do all they can to make government as bad as possible - for the 99%. Then they run against the government they have made people hate.

It's a vicious cycle that has worked very well for Republicans since Reagan. Hopefully by shutting government down, and by openly working for the failure of Obamacare - the first time I can recall a party actively trying to sabotage a major government program - they have finally gone too far and made people realize we need a government that works.

Oct. 28, 2013 at 2:26 a.m. - Recommended 429

-and-

Bernice - St Paul, MN

When Mitt Romney imported the European system used by Germany, Norway and other countries, he made a teeny little change and President Obama copied him instead of Europe. The result means we will continue to place the profits of insurers and drug companies ahead of the needs of our people.

The European governments assess the costs of care, drugs and medical equipment each year and tell providers whether or not they can increase their prices. They then TELL insurers exactly how much their premiums can be in order to cover those costs without earning a profit. Citizen participation is mandatory and government provides subsidies to those who cannot afford the premiums.

Insurers, who must all be nonprofit companies who provide identical coverage as specified by the government, then must compete based on the quality of their customer service. This is why the European countries spend a third to a half what we do on health care while leaving zero citizens uninsured.

Imagine how much we could have saved while NOT leaving 30 or 40 million people uninsured in spite of the new system.

Oct. 28, 2013 at 9:49 a.m. - Recommended 139

-and-

Paul M Coopersmith - Inverness, California

Dr Krugman forgets one key reason why we didn't get Medicare For All---Joe Lieberman's bait and switch tactics. If you'll recall, the senior Senator from Connecticut told his colleagues that the only way they'd get his much-needed vote on an Affordable Care Act would be if they started opening up Medicare to people younger than 65, e.g., those 55 and older, to be followed by those 45 and older, and so on. He made this promise to his colleagues, then pulled a switch at the last minute, dealing the death blow to what would have eventually become Medicare For All.

Of the dozens of sell-out actions taken by Mr Lieberman during his decades in the Senate--- including his harsh condemnation of President Clinton, the endorsement of his buddy, John McCain, for President, his relentlessly pro-war stance on Iraq, and on and on---his unilateral defeat of Medicare For All stands as perhaps his most notorious legacy.

Oct. 28, 2013 at 10:32 a.m. - Recommended 212

- and much more. People who can see through the smoke, despite the mirrors. But the Republicans still have the likes of Minnesota's Sixth District to exploit and then ignore and disdain [can you say, "Michele Bachmann?"].

____________FURTHER UPDATE_____________
Buffoons exposed for who they are, what they are, who they've been; their honesty and gravitas on the line over, of all things, Romneycare.

_________FURTHER UPDATE__________
There is some intelligent socialized medicine nay-saying going on, e.g., here. The numbers game of aging percentages of national populations is troubling, and one reason immigration reform is a thorny issue in the US. As well as later retirement being a suggestion for a benefits delay tactic, yet where a normal turnover of "better" jobs to succeeding generations gets delayed; which in turn leads to disenchantment among those generations held back. Republicans do not have the answer any more than the Soylent Corporation had a sound approach, in fiction. (But Alice wonders in Wonderland - Boehner, Cruz, the pack of them - aren't they a fiction?)

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