HCR repeal vote: symbolic and yet…
Yesterday I called the House vote to repeal HCR “merely symbolic.”
In retrospect, I realize the term I used may have been misleading, because many readers thought I meant “meaningless.” I did not.
There are many “mere symbols” that are fraught with meaning. In fact, that’s what a symbol is: something that in and of itself does not accomplish anything, but can stand for something else quite important. It was in that sense I used the term.
The vote means that, at least this time, the Republicans have kept their word. It means they listened to what the people have been saying as far back as the summer of 2009 when the previous Congress ignored the wishes of the people expressed in town meetings in many states.
Without follow-up, however, the vote will remain “merely” symbolic. Republicans campaigned on the cry not only of “repeal,” but of “replace.” One thing I hope the long fight over the HCR bill will have accomplished by the time it’s over is to spur action to truly reform health care insurance in this country in ways that actually help the situation rather than hurt it. I am an incrementalist in this regard; I don’t believe we have to destroy the system in order to save it.
It won’t be easy. The problems are weighty: health care of the high-tech type that we’ve developed over the last few decades is inherently expensive, and covering everyone on some basic level will be expensive, no matter how it’s done. Right now it’s already there for the majority of people, but in a piecemeal, haphazard, and probably not cost-effective way. There is no lack of ideas for how to streamline the system and make it more flexible as well (such as allowing catastrophic coverage to be more available), as well as to fill in the gaps and provide coverage for the non-covered. But none of them will come cheap, and the details are what’s important.
Replacement probably cannot be done until after the 2012 election, at the earliest. The president still has veto power, and the Senate is in Democratic hands. But in the meantime, there might be small parts of the bill that can be repealed, as well as work on defunding. Until then, these “symbolic” votes will show voters the direction in which the Republican Party intends to be headed if it does manage to win control of the Senate (and the presidency) in 2012.
The problem lies not with Neo’s use of “symbolic” but with her use of “merely.”
Now she raises another usage problem: “Right now it’s (health coverage) already there for the majority of people, but in a piecemeal, haphazard, and probably not cost-effective way.”
Cost-effective? Whaddaya mean, precisely? Who defines what that is in healthcare context? Is it putting Granny on an ice floe?
Piecemeal?
Haphazard?
Piecemeal perhaps refers to the States, each having its own legislature and insurance regulator, so IVF is included in mandated coverage in MA but not in AL.
Haphazard? Whaddaya mean exactly? Haphazard to me suggests chaotic randomness. That all human endeavors are inherently flawed by individual human conduct is impossible to deny, but haphazard?
Tom: I was actually attempting to refer to the history of health care insurance. It developed in a piecemeal, haphazard way. And some of its current problems reflect that, although some are inherent in the thing itself (I consider effective health care insurance reform to be quite difficult, including in it the law of unintended consequences).
Neo,
Going back to yesterday’s comments on repeal of exemptions, Ed Morrissey posts on the congressional investigations into how exemptions are decided. It’s a good piece that shows the Dem’s poor grasp of legal principles.
http://hotair.com/archives/2011/01/20/house-begins-probe-into-222-waivers-for-obamacare/
Whether intended or not, the vote on the repeal serves the un-symbolic and thoroughly practical of purpose of forcing Democrat pols elected from conservative districts to be on record about Obamacare when they come up for reelection in 2012.
“The president still has veto power, and the Senate is in Democratic hands.”
Ergo it’s important to get them to veto and vote down such measures many, many times between now and 2012. Just so nobody forgets who is voting for and against.
My bet is that as 2012 approaches the number of dems voting to hold the line against repeal votes in the senate goes down.
I’m glad you mentioned “catastrophic” care. There’s a big difference between paying for ordinary things like flu shots and paying for super-expensive treatments. I don’t think “society” should pay for my groceries, my rent, or my clothes. Health care is no different.
However, we as a society should be able to come up with a system for sharing the costs of MRIs, etc. in the same way that we share the costs of road resurfacing.
I love it when Neo writes what I was thinking. This morning’s online Washington Post announced the vote with a “news” headline to this effect (it’s gone now and I don’t remember it verbatim): “In largely symbolic gesture, House votes to repeal health care bill.” I thought of posting a comment to the effect that symbols matter, and that the symbolism of this vote is highly significant . . . but then I decided to stay out of the fever swamp and go to work instead. I came home to find that Neo has once again said what I wanted to say, only better than I would have said it.
Neo:
I accept you were intending reference to the history of the evolution of health care insurance in the USA. But your verdict that it is presently “probably not cost-effective” calls for some clarification.
I repeat my request for same, with the caveat that I see cost-effectiveness in medicine as a profound and possibly invalid issue, especially viewed from my concerns about people as individuals and as individual patients, not as members of herds.
Promethea:
Catastrophic care and hospitalization were what insurance used to be for, before government mandated coverage, HMOs, copays, etc. I remember a type of insurance called “major medical” which was for exactly that. People paid for routine doctor visits, minor injuries requiring stitches, etc. out of pocket.
An example: I had gum problems a few years ago, and required treatment that has seemed to arrest the deterioration. Since then, I’ve been going for checkups and teeth cleaning four times a year instead of the usual two. I noticed that they would charge me $5 for one visit, then $85 for the next, then $5, then $85. I asked the receptionist about it and she said my insurance only covers two visits a year. I asked her, “So is $85 the list price, the price you would charge if I walked in off the street without any insurance?” She said yes. I don’t think $85 for a checkup and cleaning is unreasonable at all. It can go a long way towards preventing more expensive problems down the road.
We’ve gotten to the point where we have become used to going to the doctor, dentist, or pharmacy and spending only a token amount. Providers get a fixed reimbursement from insurance companies or Medicare. Consumers have no incentive to shop around, and providers have no incentive to compete on price. Making people pay for routine visits and minor procedures out of pocket could go a long way towards reintroducing an element of free-market competition and should bring down costs generally.
Yes, it’s symbolic. I’d argue, however, that there’s nothing “merely” about it, no matter what the Democrats say. (They, of course, want to shut down debate by claiming there’s nothing to discuss.)
One: this sent a message to the voters, that this is no Obama-ish bait-and-switch. They campaigned on it, and they’ll give it their all, regardless of whether or not the Democrats stand in the way.
And two: this sent a message to the Democrats in the House, Senate, and, yes, the White House. It tells Congress that they’re in no mood for compromise, and can stop the Legislative Branch in its tracks if they want; it is now the Democrats who must do some compromising, if they want to get anything done.
And to the President, this says: “Guess what? This time WE won.”
I, for one, am very glad this was done; ditto for the proposed $2,300,000,000,000 budget cuts. You need an extreme position to determine where the middle is. Now Republicans can propose a one trillion dollar cut… and call it a compromise.
respectfully,
Daniel in Brookline
Tom: I was thinking about the fact that emergency rooms are required to treat people, so some people without insurance or money use them as the first line of defense, for smaller health problems rather than the way they were intended. We all end up paying for that sort of health care at premium prices. Also “haphazard” and “not cost-effective.” I also believe that, without effective tort reform, many doctors understandably practice defensive medicine and order tests they wouldn’t otherwise, in order to cover themselves in case of lawsuit. This is not cost-effective either.
Thanks, Neo.
But I reluctantly must observe that cost-effectiveness is normally a two-armed (at least) numeric process: Option one costs X per Y, vs option two that costs Z per Y, so one determines which is less costly and that option is the more cost-effective.
The ER service mandate is by Federal law, and while I don’t have that bill or its vote at hand, the odds favor my belief it was passed by a dominantly Dem vote; basically an unfunded mandate. Tort reform, as you and the rest of us know, will never happen while Dems have any power. The two largest occupational sectors contributing to the Dems are public sector unions and plaintiff (aka trial) lawyers of the John Edwards variety.
My trauma surgeon friends on retirement all sing the same tune: They will no longer (Yahoo!) be called out at 3AM to fix up drunken, combative uninsured auto accident victims who retain a 100% ability to sue for malpractice, egged on by trial lawyers who intend monetary settlement because defense costs so much in time, lost revenues, and legal costs.
I once proposed to 2 state legislators, both attorneys (of course) that since Medicaid was paying us 20 % of our usual insured-patient fees, that perhaps the litigating Medicaid patients should have their awards capped by the same %. They laughed.
neo, you’re right that health care as we know it currently is expensive. But we needn’t accept the proposition that it is inherently expensive and that there are no less expensive ways to achieve the same end result.
Competitive forces are not at work in health care. Once the power of the purse is put back into the hands of the consumer (and not their employer or the State), then the competitive forces will be at work once again and I would expect to see many of the current costs and inefficiencies of the health care system to simply whither away.
We’ve lived with this bogus system for so long (since World War II!) that we can’t see it being done any other way. But there are other ways.
I think it was largely symbolic, another act of political theater which is really all we see anymore. The real decisions are made out of sight and we don’t even know who all the players are. I believe that the Republicans will tweek Obama/Nixon/Johnson/Truman/Roosevelt Care in a way that benefits the insurance and drug industries, which means the individual mandate will stay. And they will declare victory and proclaim that they took back the Constitution from Socialist Obama. And people will believe them. Its all theater.