Thursday, March 3, 2011

A [fill in desirable health care/insurance outcome] in every pot

[I wrote this in March of 2010. I was going to junk it - I’m cleaning up my computer files - but part of it still resonates so here it is with a nice new footnote.]

Movin’ Meat has up a post in which he cites the case of Anthem Blue Cross Blue Shield paying claims late and says:

Actually, that's pretty much SOP for most insurers: deny and delay at will, and dare providers/consumers/regulators to punish them. Fines (when there are any) just go back to the insureds as increased premiums, and any time the providers/consumers are fatigued out of demanding the insurers actually pay, that's pure profit for the insurance company.

Pass. The. Damn. Bill.

As I said in the comments there, I don’t see how any of the three (perhaps soon to be four) health care reform bills that might be passed would eliminate this issue. The bills don’t get rid of insurance companies so the business models for the companies won’t change and bad insurance companies won’t suddenly become good ones. I suppose supporters can argue that Federal law will be better at regulation than State law but in rebuttal I would simply mention the Great Financial Crisis of Twenty-Aught-Eight. Whoever was at fault in that Crisis, no one can argue that having the Federal government regulating the financial industry made companies behave in a saintly manner. Incentives are incentives even for the best companies in any industry and every industry has some bad apples. All the Federal law in the world won’t change that.

What intrigues me about this is that it’s representative of a firm belief in some quarters: passing Obamacare will make all the problems with our health care and our health insurance magically disappear. Movin’ Meat believes Obamacare will make insurance companies stop delaying claim payments. Yet Obamacare doesn’t get rid of health insurance companies. Similarly, at the health care summit, Representative Louise Slaughter said:

I have a constituent that you won’t believe and I know you won’t, but her sister died, this poor woman had no dentures. She wore her dead sister’s teeth which of course were uncomfortable and did not fit. Do you believe that in America that’s where we would be?

Yet according to The New Republic:

The Senate and House health reform bills are relatively silent about dentistry. (The word "dentist" appeared once in the 1,502-page Senate Finance committee draft bill.) Child coverage has been expanded. Provisions are included to strengthen the dental work force and to address other infrastructure concerns. Yet these bills do relatively little to ensure adult access or to apply a careful delivery reform lens to dental services. (The status of stand-alone dental plans within proposed insurance exchanges raises delicate concerns, for example.)

Based on that analysis, I don’t know why Slaughter would think Obamacare would magically produce dentures for her constituent.

A week ago, Movin’ Meat was claiming that we had to pass the health care bills in order to eliminate rescission. Yet the House health care bill still allows for rescission in the case of “clear and convincing evidence of fraud” subject to third-party review. The Senate bill is even more gentle, allowing for rescission in the case of fraud or intentional misrepresentation; this is not an improvement over most State regulations and existing Federal regulations. When the Exchanges are up and running in 2014, everyone will have to buy health insurance so there will presumably be no conditions under which rescission can happen. But until then passing Obamacare will not eliminate rescission.

This is really just another version of what puzzles me so terribly about the Left’s support of Federal government health care reform. The Left believes the Federal government constantly and chronically fails in its regulatory, moral, and fairness obligations: the financial crisis; the environment; the Wars; Guantanamo; enhanced interrogation; restricting campaign financing; hate crimes; education; lifting people out of poverty; protecting the rights of women and minorities; and on through the endless list. Yet the complaints that our national government is failing us at every turn are always accompanied by demands that the Federal government do more. How does this make sense? If the Federal government is doing things so badly, why will increased action on their part make things better?

My belief is that if the Federal government is doing something badly then either this is not a task that the government should be attempting or that imperfection is the best we can hope for. In the former category, I put education: the Federal government has no business in education. In the latter category, I put Guantanamo: it’s the best of a whole armful of lousy options. Sadly, my belief does not appear to be widely shared.*

My impression is that a lot of people never even consider that doing something badly means either that the Federal government shouldn’t be doing that thing or that doing it badly is sometimes the best we can do. Instead they cling to the conviction that if government is doing something badly then either it isn’t trying hard enough or it isn’t run by the right people. They seem to believe the government can do anything and do it very well, perhaps perfectly. All that is required to turn the government’s poor performance into perfection is more money, more effort, more laws, more regulation; the right people running things (this is crucial); and a way to make everyone else do what they’re supposed to. Reality-based, my foot.

If Obamacare passes, it will be interesting to see what happens to all the stories about people who suffer from denied claims, delayed claims, lack of dental care, and being dropped by their insurers because they left something off their applications. I don’t believe the problems will magically cease. I do believe it will no longer be those on the Left who are talking about them.



Except for polishing my concluding language, I wrote this post yesterday. This morning I read a letter from the Red Queen to President Obama (Via Blue Lyon). The whole letter is worth reading (language warning) but what struck me was the contradiction I see between the first and last sentences in this fragment:

Thank you, President Obama, for destroying any hope (or should I say delusion) that I had about our government's efficacy.

Thanks for giving me the change (and by change I mean the spare change I'm going to start asking for on street corners) I can believe in.

I am just one little person in a sea of millions of little people all drowning in this financial crisis. I do not have the clout that say a few "savvy" banksters do. I'm just a mom, with no income, no health insurance and a kid who has a toothache and can't go to the dentist.

And what I need from my government is for it to work for me.



* In the year since I’ve written this, it’s been interesting to watch the Left’s position on Guantanamo now that it’s Barack Obama’ baby. They seem to either be ignoring it (no links, obviously) or still criticizing it (Glenn Greenwald is the obvious link here). Now, I can see that Greenwald’s continuing criticism of Guantanamo could be a sign of admirably steadfast principle. But I do wonder why no one on the Left is looking at the similarities between what the George W. Bush Administration did in the Global War on Terror and what the Obama Administration is doing in that same conflict, and saying to themselves:

Hmm. If two Presidents with such dissimilar world views are both doing the same things, maybe it’s the best we can manage to do.