What is going on with healthcare reform?

Being in Taiwan and being distracted by other issues lately meant I've been out to lunch on US news and politics for a while. Thus when I started casually browsing the blogs for an leisurely early morning read I was shocked to see this item:

What’s the latest assessment from those closely monitoring health care reform? Prognosis negative.

“Health reform is, I think it fair to say, in danger right now,” wrote Ezra Klein this morning at the Washington Post.

“Attention fellow liberals who want health care reform,” wrote Jonathan Cohn yesterday at the New Republic. “You are in danger of losing the fight for universal health insurance. And it’s not only — or even primarily — because of the public plan.”

“Anyone else think the net result of health reform is going to be that insurance companies have even more political power?,” twittered Atrios this afternoon.

But...Barack Obama won! The Dems control both chambers of congress! Obama said healthcare reform is a priority and the polls show that the American people are behind him! We won! We won BIG, baby!

So how the...did we get to this place?!

The man once slated to head Barack Obama's health care system overhaul is now coming out against one of the chief components of that effort.

Former Senate Majority Leader Tom Daschle said on Wednesday that the Obama White House would likely have to scrap a federal public option for health insurance coverage if it wanted to get the votes needed to pass systematic change.

"We've come too far and gained too much momentum for our efforts to fail over disagreement on one single issue," the Senator and one-time HHS Secretary nominee said, according to ABC News.

Like Atrios said: "reform without a public option is actually likely to make things worse, pouring even more money into the corrupt insurance industry and giving them even more political power."

This is surreal. This is like taking a break with your team ahead by five runs only to find that they've blown their lead by the time you got back to the couch with the popcorn. Or coming home to find that everyone else in the household has been turned into zombies.

NonononononoonoNOOOO!

In which I reveal myself to be an embarrassing fangirl

Inspired by Gene (my husband and an excellent digital artist), I bought a tablet for my computer the other day. Then I downloaded Gimp, which is kinda like photoshop but free, and started messing around.

Can you guess what I decided to work on?

Mandate versus Penalties

[First up, before we get going, I just want to say that even though I prefer Clinton to Obama on the issue of healthcare, Obama still has the coveted Battlepanda endorsement (but not my vote since I can't be arsed to vote in the primary from abroad) because of other non-healthcare issues.]

The most persuasive defense of Barack Obama's healthcare policy is summed up by Mark Kleiman:

[T]wo plans, both with guaranteed availability of insurance regardless of health status, both with subsidies. One has a mandate with (as yet undefined) enforcement mechanisms. The other has no mandate but (as yet undefined) financial disincentives for free-riding. Until the two plans are better specified, there is no basis on which to estimate how many people will wind up not buying insurance under either plan, and therefore no basis for any firm estimate of costs to the taxpayer.

Mark (and Dean Baker) acknowledges that the adverse-selection problem have to be dealt with. Clinton does it with a mandate, Obama does it with penalties. Potayto, potahto? Hardly. We all know that young people are disgustingly healthy for the most part. Under a penalties based system, it might be decades until a healthcare catastrophe serious enough to make the now-not-so-young grasshopper wish to come back to the fold. Do you really see Obamacare setting the penalties high enough to recoup the lost premiums of all these years? The longer a person who opts out (and presumably rack up more penalties), the less incentive they have to get back in the system, unless they are really, really sick. Way to collect the sickest of the sick in the system while giving those who remain outside of the system and reasonably healthy growing incentive to stay out with every passing year.

As for pointing out that Hillary have not detailed how the mandate will be enforced, that's true as far as it goes but the problems with enforcing a mandate is hardly insurmountable. We have no problems enforcing that other mandate, social security. In contrast, I find it hard to think of penalty structure that will allow people in and out of the system without some seriously skewed incentives.

Primary care providers

Dammit. I'm not a Hillary fan. But this Paul Krugman op-ed clearly underlines the unpalatable fact that when it comes to the issue of healthcare, Clinton has got Obama's wrongheaded plan whomped.

But while it’s easy to see how the Clinton plan could end up being eviscerated, it’s hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects.

You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.

If Mr. Obama gets to the White House and tries to achieve universal coverage, he’ll find that it can’t be done without mandates — but if he tries to institute mandates, the enemies of reform will use his own words against him.

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

Sigh. If there are any pro-Obama people reading this, please defend his healthcare plan for me. I really want to support the guy, and I really don't want to support Clinton. But getting it wrong on healthcare...that's a biggie.

With Dems like these...who needs Republicans?

I just cannot believe the Obama campaign went there. What's next? Are they going to start handing out Hillary nutcrackers?"Hillary's health care plan forces everyone to buy insurance, even if you can't afford it," goes the tagline.

If they can't afford the insurance, how are they supposed to afford the doctor's bills when it comes?

Healthcare is not fancy dinners out at Per Se. It's not getting a third car for the household so the teen of the house can toot themselves around without waiting to borrow the family car. Healthcare is a reality for every single family in America, and I guess for every single person too, although most of us young-uns can get away with ignoring that reality for a while most of the time. It's not an optional extra.

The decision is not whether or not you want a healthcare bill but whether you want to get stuck a huge, unpredictable one every once in a while or a manageable one that spreads the risks. People buy insurance for all sorts of things (such as life insurance) purely for the risk-spreading factor even though they have to pay a significant premium to do so (every dollar that goes into running and promoting insurance companies is a dollar that does not go towards payouts, and then there are profits...)

But the dividends are even greater for healthcare, as collective bargaining brings down prices from medical service providers.

This ad campaign, to quote Paul Krugman's blog, is just "poisoning the well for health care reform".

After Edwards dropped out, I find myself in the Obama camp by default. And I still am, despicable mailer or no despicable mailer. But still. Blech!

My only hope is that this piece of crap is somehow not actually an official sanctioned product of the Obama campaign but the work of some "sympathetic" group not actually affiliated with. Anybody have word?