Tag Archives: HEALTH CARE

Fabian: Focus or Obama: Fabian Progressive

The point of this post in modelled behavior is that President Obama may have one overarching goals:  more spending on health care.  That seems right as it is the thing that he has focused on more than anything else, including jobs and economy writ large.  Given the long pursuit of US national health in some form, and movement toward it may pay off.  I’m not sure that Obamacare as passed is desreable, but the debate is I think.  Especially because other issues like the budget imbalance are part and parcel of the healthcare debate.

…..

I’ll offer some amateur outside the beltway strategery analysis. Given the behavior of the Obama White House, it looks to me like their primary objective is to secure an expansion in the scope of government funded health care by avoiding conflict on all other issues.

This explains the steady even if bloody push to pass the PPACA. It explains the seeming disinterest in meaningful shifts in policy in other areas. It explains why Obama was for the stimulus when it seemed popular and conceded to austerity when it seemed popular.

This is a classic Fabian approach. Avoid engaging the enemy when time is on your side. This also seems like an accurate description of the progressive movements position. While at the moment Progressivism may lose a head-on confrontation, time is indeed on its side. Its opposition is older and grounded in institutions which are losing power. The intellectual base of the right is eroding. Political opinion is solidifying around the notion that there will be some form of universal health care.

As always the Fabian defense is unpopular with hawks, who would prefer that the enemy be engaged and crushed. However, it is successful.

Now as always I think the politics of these big issues is not that important. I suspect that in the end the equilibrium will be determined by fundamentals. However, if you were going to play a pro-progressive political strategy this doesn’t seem like a bad one.

Filed under: Economics, Health Care, Society

Obama: Fabian Progressive
Karl Smith
Tue, 12 Apr 2011 14:43:06 GMT

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A question to an Obamacare critic

Here’s a good review of the impact of the 2010 healthcare law. I don’t think its going to be a be all end all for American healthcare at all. I’m skeptical of the claims of singe-payer as well. But in its passage, I hope that a national discussion that will last year will produce improvement over the status quo.

The most disappointing thing about the discussion isn’t I don’t see many really comprehensive alternative to the 2010 bill that address the failings of the status quo, and yet the failings of the status quo seem evident. Check out this graphic:

image

The high cost of health care would be easier to understand if we clearly had the best access and the best health results.  Overall we do well in treatment of some conditions, but we don’t have even close to the best life expectancy in world, and many people lack insurance if not access to healthcare.

image

Setting all that aside, I visited a blog of a severe critic of “Obamacare”, the term of choice of the law’s critics.  He has a pretty good chronicle of the numerous criticism of the law:  how it was railroaded into law, will ration care, cost to much (I think this emphasized the most), will redistribute wealth, end the development of new treatments, and provide care for conditions that people may have brought on themselves.  But in all that criticism, I didn’t really get a feel for any good alternative, especially one that would improve access to care for those who don’t have it.  I put this question to the blog author.  I’m curious to see what answer I get.

Question

Doesn’t this really boil down to:

Do you think the current health system is in need of a major changes?

Are you in favor of increased access to healthcare for those who don’t have it , even at the cost of higher premiums and taxes for yourself?

You pretty clearly would answer no to these questions.

I think I’d answer yes to both questions (for what its worth I have pretty good medical benefits and I pay taxes). I’m not sure the ACA is what we need, because we need a better way to control costs. I just don’t want to end up like we did after the 1993 health debate which was with basically the status quo. You and most of your citations clearly argue for no “Obamacare” to mostly people who don’t like Barack Obama for a variety of reasons, but I don’t know what you suggest instead.

Can you clarify?

There may be no way to reach anything close to a consensus, because those on different sides of the health debate basically want a different end state as the good society.   They make different value judgments.

I’d like to move even if more slowly may than the current law to better access to health care for those who don’t have it, even if some of them are drug addicts, or illegal aliens, or arguably don’t “deserve” it.  I don’t think healthcare is a beach house as Rush Limbaugh recently asserted

The strongest critics of “Obamacare” seem to see health care as just another good you get if you work hard and earn it.  This a value judgment that can’t be shown to be wrong or right with facts, but it bothers me that this is usually not explicitly stated.  Its hard however to not draw this conclusion from the lack of policy suggestions that address the access issue for those of modest means.

Ultimately we as a society will make its value judgment about who should get access to healthcare.  I hope we try to improve on the status quo and not treat health care as a beach house.  Unless conservatives can actually suggest a way to improve health care access, one has to assume they think of health care as a beach house.

Should all this be for nothing??

The “pass the damn bill” refrain is everywhere.

I tend to agree that the Democrates are going to pay a political price for 8 months of work on healthcare.  It’s too late to avoid that, even if they back away from the bill now.

That being said, shouldn’t they actually act like leaders and eanact a policy they want, and accept the loses that will happen in the short run regardless.  Chait agrees.

http://www.tnr.com/blog/jonathan-chait/if-health-care-dies-who-will-the-murderer-be

From James Kwak

The deficit rag!!!

This post is very insightful coming from a deficit hawk who understands why that doesn’t any sense in the 2-4 years. We need ultimately to get our house in order, but not by making the recession deeper.

Here it is with input by your truly (in CAPS):

Last night I read a post by Brad DeLong that made me so mad I had trouble falling asleep. (Not at DeLong, mind you.) There’s really nothing unusual in there — hysteria about the deficit, people who voted for the Bush tax cuts and the unfunded Medicare prescription drug benefit but suddenly think the national debt is killing us, political pandering — but maybe it was the proverbial straw.

First, let me say that I largely agree with DeLong here:

I am–in normal times–a deficit hawk. I think the right target for the deficit in normal times is zero, with the added provision that when there are foreseeable future increases in spending shares of GDP we should run a surplus to pay for those foreseeable increases in an actuarially-sound manner. I think this because I know that there will come abnormal times when spending increases are appropriate. And I think that the combination of (a) actuarially-sound provision for future increases in spending shares and (b) nominal balance for the operating budget in normal times will create the headroom for (c) deficit spending in emergencies when it is advisable while (d) maintaining a non-explosive path for the debt as a whole.”

Now, let me tell you what I am sick of:

1.

People who insist that the recent change in our fiscal spending is the product of high spending, without looking at the numbers, because their political priors are so strong they assume that high deficits under a Democratic president must be due to runaway spending. And it’s not just Robert Samuelson.

PEOPLE WHO BUY THIS OBAMA THE BIG DEFICIT SPENDING DEMOCRAT HAVE NO CONCEPT THAT MUCH OF THE INCREASE IN THE DEFICIT THIS YEAR IS REDUCED REVENUES. I DON’T THINK THEY EVEN THINK ABOUT THIS.
2.

People who forecast the end of the world without pointing out why the world is ending. Here’s Niall Ferguson, in an article entitled “An Empire at Risk:” “The deficit for the fiscal year 2009 came in at more than $1.4 trillion—about 11.2 percent of GDP, according to the Congressional Budget Office (CBO). That’s a bigger deficit than any seen in the past 60 years—only slightly larger in relative terms than the deficit in 1942.” But does he mention that the reason for the 2009 deficit is lower tax revenues due to the financial crisis and recession? No. Here’s Ferguson on the 10-year projection: “Meanwhile, in dollar terms, the total debt held by the public (excluding government agencies, but including foreigners) rises from $5.8 trillion in 2008 to $14.3 trillion in 2019—from 41 percent of GDP to 68 percent.” Does he mention that, as early as January 2008, that number was projected to fall to 22%, and the majority of the change is due to lower tax revenues? No.

SAME POINT AS ABOVE

3.

People who posture about our fiscal crisis who voted for the Bush tax cuts — shouldn’t shame require them to keep silent?

THIS I HAVE MORE MIXED FEELINGS ABOUT: I LIKE TO GIVE PEOPLE BACK THEIR MONEY

4.

People who say, like Judd Gregg, “after the possibility of a terrorist getting a weapon of mass destruction and using it against us somewhere here in the United States, the single biggest threat that we face as a nation is the fact that we’re on a course toward fiscal insolvency,” as if this is a new problem, when it’s been around since 2004 (see Figure 1) — when, I might add, Judd Gregg was a member of the majority. (Tell me, was Niall Ferguson forecasting the end of the American empire in 2004, when everything he says now about long-term entitlement spending was already true? That’s a real question.)

DURING THIS PERIOD WE ALSO PASSED A DRUG ENTITLEMENT WITH NO MATCHING REVENUES, AND THE GOP SEEMS TO WANT TO PROTECT MEDICARE. ALL OF TODAY’S “CONSERVATIVES” ASSUME I THINK THAT THE DEFICIT IS SOMEHOW DUE TO TRANSFERS TO PEOPLE LESS WELL OFF THAN THEY. FURTHERMORE I DON’T THINK MOST CONSERVATIVES ARE UP FOR ANY PERSONAL SACRIFICE TO CURE THE DEFICIT.

5.

People who say that we can’t pass health care reform because it costs too much, ignoring the fact that the CBO projects the bills to be roughly deficit neutral, ignoring the fact that the Senate bill has received bipartisan health-economist support for its cost-cutting measures, and ignoring the fact that our long-term fiscal problem is, and always has been, about health care costs (see Figure 2).

THIS CONCERN I SHARE BECAUSE I THINK THE BACKERS OF THE REFORM MAY NEVER DELIVER THE CUTS INTENDED TO PARTIALLY PAY FOR IT. IF I COULD BE REASSURED ON THIS POINT I’D AGREE.

6.

People who say the Obama administration is weak on the deficit (Ferguson refers to Obama’s “indecision on the deficit”, and he is gentle by Republican standards), when by tackling health care costs head-on — and in the process angering their political base — they are doing the absolute most important thing necessary to solve the long-term debt problem.

AGREE

7.

People who cite “financial ruin” purely, absolutely, incontrovertibly as a political tactic to try to kill health care reform (courtesy of DeLong and Brian Beutler)…

ALMOST CERTAINLY TRUE. YOU USE THE DEFICIT TO DEFEAT LARGESS THAT YOU DON’T GET A PIECE OF.

8.

Joe Lieberman.

NOT SURE WHAT I THINK