The Bullshit Artist in Chief

Yup.

I read with interest and re-read with confusion, then checked again with disgust, the President's piece in the Times. No public option.

Awful, just awful.

Where is the spine we need? What is the force causing the diminishing returns on our hope?

I am very upset with the man.

I am going to try to stop paying attention. Fat chance, but if I can, I'll be less irate. Gimme some of that old time ignorance.

Peter

At this point, we have three possible explanations for the Obama Administration's policies: 1) Obama is now and always was a DLC corporate Democrat and never had any intention whatever of enacting any progressive health care plan; or 2) Obama is so obsessed with his fantasy role as a Great Compromiser that he insists on including everyone's ideas even when they are diametrically opposed to his own; or 3) Obama is a naive babe-in-the-woods being manipulated by his corporate backers through the Clintonistas.

Any of those 3 would explain the health care, bailout and foreign policies of this administration. What we can rule out is that Obama is both sincere and capable.

Viewed from outside the US, it's been astounding to watch how Obama's healthcare reform has been derailed by a few outrageous lies propagated by right-wing demagogues. The fact that Obama seems unable to counter these falsehoods augurs badly for the 2012 election.

Obama's looking increasingly spineless, although I'm not sure this image has yet filtered through to the general public overseas. Worth reading is Umair Haque's piece on Obama's 10 leadership mistakes. Where's the clamor for a third party in US politics?

[No clamor... yet. g.]

The defeatism surrounding third party efforts in US is deplorable.

If I mention that I vote Green in elections where safe state principles apply, I get the reaction from people of the "that's your choice" variety — euphemism for being a dumb cluck and not "on board" with the Democrats. It's true I'm not on board with them and never have been.

No peace activist can be supportive of Democratic or Republican policy in good conscience.

Alternately, when I hear the fatalistic "you go ahead and do that" I say, "I can't do it alone."

A co-op system HAS been widely tried. What's left of it is now known as Blue Cross.

As for the public option as a vehicle to back into single-payer, nice idea, but it defies every reality of insurance and politics. The only public option that will ever be implemented is a dumping ground for the "lemons" in our current system.

As for actually eliminating the public option? My insurance background CAN'T BELIEVE the insurance companies would be THAT stupid. They'd be signing their death warrant. With no public option, they have to cover the "lemons". With community pricing replacing experience pricing, that means ALL RATES have to be jacked through the ceiling, and as soon as that happens, John Q. Public goes nuts, and does so all over the insurers. Congress will be quick to follow, already sated on insurance cash and by then merely pandering to public rage.

The real problem is that we've been all over the insurers as THE PROBLEM, and it's not really true. Yes, they are guilty, but only of failing to identify what THEIR problem was. You see, I learned very quickly during my insurance days that our biggest job was to be the proxy for everyone else's cost problems. (This was in the late 70's, BTW. Little has changed.)

Employers didn't like the costs? We'd sell them 4 year old prevailing fee schedules. Guess who their employees bitched at. Doctors going nuts raising their rates? Even with last year's schedule, 100% coverage on the bill is out of the question. Guess who employees bitched at. That was our damned job! We got PAID to eat everyone's bitches, when all we were doing was applying mathematical risk plus reasonable shareholder return to whatever costs we met. So the only scorn insurers REALLY deserve is in not letting the public know sooner what was really going on. And the insurers must now die for that failure.

What was (and is) really going on is that for 35 years the rate of medical inflation has FAR outpaced all other inflation. The ONLY way this can happen is if there is a choke hold on the supply side. THIS IS WHAT THE INSURERS NEVER ADMITTED. Oh, we tried our asses off, but there was NO holding back on medical inflation high above other inflation.

Now it doesn't take much of a genius to know that when the inflation rate of one commodity outpaces all others, something eventually has to give. Otherwise, 100% of everything goes to pay for that commodity. At some point, there has to be a limit that kicks in where either supply rises to meet demand or demand falls to meet supply. Obviously, the first hasn't happened, so we are seeing the second. People are now being tossed off even existing policies when they submit real claims. Pre-existing means you might as well die as try for coverage. Which means we have indeed hit HIT THE LIMIT. We have now, at 16% of GDP, reached the limit of what a society can pay for healthcare. 47 million more people? All those pre-existings? All the folks at Wise County VA and Inglewood CA? Where you going to get the money? Who's now covered who'll accept a new kind of rationing? (Because THIS certainly is the old form of rationing.) So what to do?

Single-payer advocates (and I have been one since 1978 when I told my company (Ætna) their business model was broken for this very reason) say if we can only eliminate the insurers, we can cover everyone for the same money. Sure, that too, but it misses the real problem. We can insure everyone TODAY by eliminating the insurers, but what do we do five and ten years from now as medical inflation continues to soar? Who do we get rid of then?

No, you can't reduce the demand side without choosing who you will kill. You have to attack the real problem: Who and what is choking the supply? The medical complex has to be told in no uncertain terms that this is it. This is the amount of money. Period. This is the job you will do for that amount of money. Period. Fight among yourselves for who gets what of that money and who does what to get it, but that's all there is. Someone has to make less money.

They will figure it out, you know. If we explain to them that they will be nationalized if they don't, they will figure it out. And we are going to have to explain that to them. Now, or later. And THAT is now as inevitable as was my 1978 prediction to my then employer of the eventual demise of his business model. So little has changed.

[International comparisons are very useful. It's not a crisis of rising costs elsewhere, hence it's not necessarily such here. g.]

The only system I can see working in the US is a single payer health insurance system that's mandated. Other countries have different systems, but they're unlikely to work in the US. Private corruption means that regulation of private insurers is unlikely to work. An NHS style system is really for countries that don't already have a health infrastructure in place.

Fortunately it's not my problem.