Feel Good Health Care

Paul Krugman, one of the few honest analysts remaining on the left, writes today about the candidates' stances on health care:

Yet the McCain health plan — actually a set of bullet points on the campaign’s Web site — is entirely based on blind faith that competition among private insurers will solve all problems.

As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.

Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”

That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.

Mr. McCain, then, is offering a completely wrongheaded approach to health care. But the way the campaign for the Democratic nomination has unfolded raises questions about how effective his eventual opponent will be in making that point.

Indeed, while Mrs. Edwards focused her criticism on Mr. McCain, she also made it clear that she prefers Hillary Clinton’s approach — “Sen. Clinton’s plan is a great plan” — to Barack Obama’s. The Clinton plan closely resembles the plan for universal coverage that John Edwards laid out more than a year ago. By contrast, Mr. Obama offers a watered-down plan that falls short of universality, and it would have higher costs per person covered.

Worse yet, Mr. Obama attacked his Democratic rivals’ health plans using conservative talking points about choice and the evil of having the government tell you what to do. That’s going to make it hard — if he is the nominee — to refute Mr. McCain when he makes similar arguments on behalf of such things as privatizing veterans’ care.

Voodoo Health Economics

The two key points here are that the current VA health system, which is both efficient and effective, came out of Bill Clinton's administration, and that Hillary Clinton's proposals for universal coverage is the best, most detailed one of any remaining candidate. We can call this the "Be Good" health care approach because it is focused on getting everyone cared for. Hillary actually wants you, personally, to stay healthy.

In contrast, both McCain and Obama offer a "Feel Good" health care approach, because they really don't give a shit about you. They want their constituents to feel good about some bullshit they call plans that we can only hope won't be enacted. McCain wants to feel good that he has kept the free market going and Obama wants to wave his hands in the direction of the idea of maybe possibly someday getting to the point where his "experts" can sit down and discuss the potential for something that could turn out to be health care for people who want coverage, can afford it, and are willing to pay for it. Which doesn't sound a fuck of a lot different than McCain's holy grail of free competition to me.

I walked around with a low grade infection in my lungs for four years, struggling to get through each flu season, playing a waiting game with the insurance companies so that they would treat my pre-existing condition. They would pay kinda sorta for stop-gap measures to treat the symptoms - like sinking a shunt in my chest and infusing me with bags of liquid anti-biotics to stop a blood infection - but would not agree to the surgery that would remove the damaged portion of lung. I have permanent damage as the constant infections and bouts of bronchitis left much of my right lung scarred. It's like having untreatable asthma. I wheeze and choke and cough, but there's nothing to treat, it's all just torn up air passages.

Good health insurance would have gotten me a faster diagnosis and helped put together a treatment plan that included treatment of symptoms before they became life threatening, lung surgery, and rehab.

My parents right now both have chronic health issues that require treatment, with my mother in the worst shape. I have a sibling who needs mental health care counseling and drug therapy to manage depression. My husband's family has similar stories.

One of the reason we older, less "hip" folks aren't impressed with The Precious is because of the aches in our hips, the deteriorating condition of our once youthful forms, and the frustration of dealing with an insurance system whose only desire seems to be to insure that our family's care is too little and comes too late. These are things that affect us materially every day.

We trust Hillary, who cares for her elderly mother and has supported her husband through major heart surgery. She is right there in the middle of all this with us. She has fought these battles before and returns, undaunted, to make it happen for us. She knows what she's talking about, has staked out significant ground, and is determined to add health insurance to the New Deal foundation.

I already live in Obama's world of health care for the lucky to be insured, and I don't feel good about it at all. I want a system where quality insurance is a matter of law, not luck.

Anglachel