The Schrug

• The discussion is flawed from the get-go. You can’t simultaneously rail against the private health care insurance industry and insist that everyone should buy into it. (See comment below regarding pre-existing conditions.)
• To tamp down on partisanship, they should have mixed up the seating arrangements so that Democrats and Republicans were intermingled. I’m sure the legislators said “no way.”
• Can anyone imagine George W. Bush convening a forum like this and talking for 10 minutes without a script?
• It’s a huge stretch for Lamar Alexander to say the American people have expressed disapproval of the Senate plan. When polled on the specifics, most people support the goals of that plan.
• Alexander put the GOP on record as being in favor of reducing health care costs. Will they then attack Obama for proposing cuts in Medicare? Yup, did just that less than five minutes later.
• Wow. GOP’s position is that “we don’t do ‘comprehensive’ well.” That explains so much about our country’s politics. What else do you really need to know?
• Pelosi’s “job lock” argument sounds like a winner. It’s a catchy phrase.
• Kennedy’s “health care is a right, not a privilege,” on the other hand, is a loser.
• What is the fascination with anecdotes? (Like the family whose baby was born with the cleft palate.)
• Good for Reid for bringing up the Kaiser Foundation poll to rebut Alexander!
• “You’re entitled to your opinion, but not your own facts.” Cute, but you can only say that if you yourself are acknowledging ALL the facts, not just the ones that support your position.
• Good for Reid for pointing out that part of the reason the current bills are so large is that they contain GOP amendments.
• The distinction between “good insurance” and “bad insurance” is critical. You can be “insured” if you have a policy that costs $10 a month and pays you a maximum benefit of $100 if you’re hospitalized. But that doesn’t mean you’re going to get good health care.
• Coburn is saying good things about problems with the system (e.g. lack of preventive care) but why is he so intent on blaming government? Government may be paying for bad medicine, but government isn’t actually providing that care or setting up the structures that incentivize it. The private sector is responsible for this as well. I find it extremely hard to believe that the fraud rate in the private sector insurance market is 1%. Even if that’s the actual reported rate, the private sector insurers have less incentive to detect fraud because they can just pass the costs along to their customers.
• Reid is coming across as a bit of an a-hole.
• Obama very quick to point out, in rebutting Coburn, that saving money in Medicare/Medicaid doesn’t help lower the costs of private sector insurance. This guy is sharp.
• Someone should have been standing at a white board writing down all the areas of agreement.
• Good for Obama to ask GOP specifically what they object to about the concept of a health insurance exchange. Kline goes back to advocating a step-by-step approach. So the main objection that Republicans have is that it’s a big bill? I just don’t get that.
• Baucus compares health care exchange to Orbitz and Expedia. Brilliant!
• It’s funny to hear Dems like Hoyer and Baucus heading up the cheering section for competitive markets. GOP can’t possibly object to that.
• Camp goes back to tort reform. Dems need to (a) put the realistic cost reductions of tort reform in context and (b) explain what happens to victims of malpractice if tort reform goes too far.
• Glad to see Camp referring to very specific provisions in the bill that he objects to. If that’s the level of debate, then we might actually get something done. It’s too bad that Obama shut him down on that. Hope they get back to that in the afternoon.
• Camp now objecting to mandated benefits. This is an argument worth having. Somebody needs to decide in advance what health care is worth paying for, as they did in Oregon.
• I have to say I am impressed by how these legislators are debating this stuff without relying on prepared statements and whispers from staff.
• Good for Obama to distinguish between government-imposed regulations on minimal standards in health insurance policies and “government takeover of health care.”
• Nice plug by Schumer for Atul Gawande’s article in the New Yorker about how costs are driven up by financial incentives. Everyone should read that article.
• Good for Schumer for pointing out GOP hypocrisy in railing against cuts in Medicare while also complaining about how Medicare wastes money.
• C-Span’s feed was more reliable than the White House’s feed on Facebook.
• Hopefully people are getting more educated about how health care economics work and the difference between types of insurance coverage. Kyl goes back to this question about premium costs going up because the benefits get better. Most people don’t object to paying more in order to get more.
• Obama points out that current Federal plan has mandated minimum benefits and Republicans aren’t howling to get those cut down.
• Boustany once again brings up the step-by-step approach. Obama and Democrats need to come up with a definitive rebuttal to that – why incrementalism won’t work in this case. (Either that, or agree to an incremental approach.)
• Boustany advocates HSAs, but as someone (Baucus?) points out, HSAs only work for the people who have extra cash to put into them.
• Republicans seem to have a lot of faith in the American consumer to navigate through a wide range of choices presented to them by health insurance providers and pick the one that makes the most sense for them. I don’t share that faith. The health care and health insurance market is simply too financially and emotionally complicated to let the market run free. What happens to the people who think they can get away with very cheap plans but then end up needing extensive benefits? We’ll end up with the same problems we have now.
• McCain says dealmaking was “unsavory,” but he says that “with respect.” Right.
• McCain wants to go through bill taking out concessions to special interests. OK, but that’s different from starting with a blank page.
• Sebelius is boring.
• Eric Cantor says he’s worried about 8 or 9 million people who might lose their existing coverage. Even if that’s true, should their interests trump the much larger number of people who are currently uninsured or underinsured? Obama replies those folks would end up with a BETTER deal! Take that, Cantor!
• Obama willing to admit that health care is complicated and needs a lot of pages. Calls out Cantor’s political stunt. Nice.
• Obama points out that food would be cheaper if we had no meat inspectors or food storage regulation. Yes!
• Obama points out that GOP agrees there should be SOME regulation. Forces them to point out which regulations they object to. Smart guy.
• Obama explains that you can’t prevent insurers from excluding people with pre-existing conditions unless you have something like universal coverage. That’s right. Are people willing to accept that?
• Cantor points out that in a perfect world everyone would have everything they want. Yes, that’s the problem … Americans have been led to believe that this is achievable.
• Joe Biden’s ten seconds last a lot more than ten seconds.
• Louise Slaughter gives some history of discrimination against women in health care research and insurance and why legislation is needed to fix this kind of problem. Nice.
• The debate about how to deal with pre-existing conditions puts the lie to the idea that a health care system based on the concept of insurance can work. Every other type of insurance is allowed to make rate adjustments (or deny coverage) based on pre-existing conditions. But we think – rightly – that it’s immoral for people to be driven to premature death or bankruptcy because of a medical condition. That’s why we have to throw the concept of health insurance out the window and come up with an entirely different model.

OK, time to break for lunch.