Tuesday, February 12, 2008

A couple of interesting/disturbing discussions

Kevin Drum has posted two blogs that present good views on getting out of the Iraq war and on the value of insurance companies in the American health care system.

On the subject of the Iraq war, can whoever becomes President in January either "win in Iraq" (almost certainly not) or "Get American troops out of Iraq in 2009"? (See IRAQ AFTER NOVEMBER.) The answer to getting the troops out immediately is, unfortunately, a very similar "almost certainly not."

As Richard Neustadt's excellent book Presidential Power and the Modern Presidents: The Politics of Leadership From Roosevelt To Reagan pointed out, every decision a President makes either enables or prevents future decisions that President will make. If the incoming President starts by implementing the decision to get the troops out of Iraq in 12 to 18 months, he will "...instantly make Iraq the consuming partisan fight of their presidency." There will remain no room for any other action the President wants to take!

A lot of people consider immediately ending the disaster that is the Iraq occupation as their top single priority. A lot of other Americans consider staying there and not declaring defeat in Iraq their top single priority. Then there are a bunch of us who, while considering shutting the Iraq Occupation down very important, also want to see the federal government do some basic things to correct the destruction of the American Constitution, the American economy and the American government to be of even higher priority than immediately removing all American troops from Iraq. As important is ending Bush's mistake in Iraq is, is it worth the continued destruction of America to do it overnight? I don't think so. Go read Kevin Drum's blog and the articles he links to. If you don't see that the issue is a lot more complicated than "Win Now!" vs "Get out Now!" then you are the kind of single issue thoughtless individual who has made all politics about the either the abortion issue or gay marriage. The real decisions are a lot more complicated than those bumper stickers.

Kevin's other blog LIVING WITHOUT THE HEALTH INSURANCE INDUSTRY is about one of those other issues that the incoming President needs to deal with starting in January and should not let precipitous action on the Iraq occupation sidetrack. What is the role of insurance companies in the American health care system? Their purpose is to make a profit by promising to pay for health care services to those who pay premiums. Note how the "make a profit" is the key word of that sentence and "by promising to pay for health care services to those who pay premiums is a mere prepositional phrase, as befits its status as merely a way to make money. Collection premiums in important, but not paying out benefits is almost as important.

The history of health insurers has been one of finding new ways not to pay benefits. Insure only healthy people, cancel policies on those who need expensive care, refuse to pay for specific treatments, deal only with physicians who will charge less by providing less in the way of services, and charge high administration fees to (1) cover selling the policies in competition with other companies doing the same thing and(2) pay for investigating patients to avoid sick ones and to show reasons for canceling policies when someone requests benefits.

A government single payer system would eliminate most of those negative behaviors and make it possible to lower the costs of medical care substantially, even while covering every American. Interestingly, the cost of excess bureaucracy is one of the faults of the Private health insurers that the government can sharply reduce.

Any organization has to be at least as large as the system that it is attempting to deal with. A lot of business organizations can be limited to sales in a single neighborhood, so they don't need to be very large. But the problems of the health care system are nation-wide. No organization that attempts to deal with a subset of that system is going to successfully provide care to all Americans. It is the nature of organizations for a set of organizations that are too small for the problem they are dealing with to (1) leave out a lot of people who need what they offer and (2) to be subject to runaway costs caused by forces outside the realm the small organizations deal with.

In short, there is no substitute for single payer health insurance. Every argument counter to that is a fantasy by know-nothings or a scam by scamsters.

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