Also sprach 'sbvpav'

Mr. Poster 'sbvpav' illustrates how even good guys listen pretty selectively. His summary of the health care agenda of President Summers and Mr. Obama is half right. Since 'sbvpav' is a good guy, the other half is not wingnuttified into "false witness," it is just plain AWOL, omitted altogether.

Mr. Poster says (P-0) "no one is going to be forced into the public option," which merits being numbered as zero because S&O are not, of course, starry-eyed libertarians out to increase the sphere of everybody's self-freedomisation.

His (P-1) "keeping private insurers honest by providing competition, where there is none now, and over time lowering the over-all cost of insurance for all" is more to the point, unless you think it is two points. Here one can actually find Mr. Obama saying more or less the same thing,

"Point number two, it has to bend the cost curve. What that means is that we've got to create a -- a plan that experts credibly say will reduce health care inflation. Because if all we're doing is adding more people, but we're not controlling costs, that will blow up the deficit over the long term, and it will blow up the burdens on individual families and businesses. We've got to get control of our costs. We spend $6,000 more than any other advanced country per person on health care. That's number two."

Then there is Mr. Poster's (P-2), universality of coverage, "not [to] lose sight of the goal: health insurance for all, a right not a privilege." That paraphrase does not, as it happens, correspond to anything that Mr. Obama said to Neocomrade M. Smerconish on Thursday afternoon, although probably he and President Summers are indeed for universality in principle. (Mr. Obama may have been pandering by his silence to the passionate desire of many at Wingnut City to have uncredentialled wetbacks drop dead in the street rather than crowd the emergency rooms. But God knows best.)

(P-3) is "the ability to purchase affordable health care for yourself and your family even with a pre-existing condition; assurance and the security of knowing when you get ill, your insurance will be there for you and not canceled." This one is soundly based. Mr. O. said

Number three, we've got to have the insurance reforms I talked about for people who already have health insurance, and that means making sure you can get health insurance even if you've got a pre-existing condition, making sure that you're not burdened by lifetime caps, making sure that insurance companies can't drop you just because you get sick or because you're older or because you're not as healthy. So making sure that there are basic insurance protections, that's very important."

Mr. Poster's (P-4), "preventive care such as routine yearly exams and nutritional counseling," was not in Mr. Obama's 20 August bullet points at all. Unlike universality, I don't think that angle was left out merely by accident or as part of a deliberate anti-reactionary strategy of persuasion. Probably Summers and Obama really do take only a contingent interest in medical prevention: if it helps cut costs, fine, include it under that rubric. But prevention may not cut costs, and in any case it is not an end that S&O seek for its own sake.

(Presumably 'sbvpav' does think of prevention as an end in itself. That passage sounds to me as if Dr. Procrustes wants to fit the Administration’s program into a preconceived agenda of his own and finds the job a bit challenging: wrench, twist, fold, staple, mutilate! But God knows best.)

Finally (P-5) is another one that might be numbered zero, "the financial security of Medicare sustainable for all when they reach 65 and the closing of the doughnut hole in prescription drug prices." That is great stuff and I'm all for it, and so is Mr. Obama, almost certainly, and maybe Larry S. is for it as well -- BUT this is "flowers that bloom in the spring" stuff as regards the actual case at hand.

Unless I have misunderstood radically, Medicare and Medicaid, pensioners and poor folks, are simply not what the now fuss is about, though no doubt universality will require that certain persons who are already eligible for these programs get hooked up to them. Plus naturally if closing "doughnut holes" in them saves money that can be spent on the actual objectives, that is OK too. But bucks are fungible: patching holes in the Pentagon budget, or that of the National Endowment for the Arts, would do just as well.

***

I have already cited Mr. Obama's second and third bullet points, (O-2) "bend the cost curve" and (O-3) regulate the secret-sector insurance industry with unrelenting rigor.

As I began by complaining, that leaves half the Administration’s stuff out. The other half went like this, as told by Mr. Obama to Neocomrade M. A. Smerconish and the dittoheads:

(O-1)"Now, Tracy, you had a good point about, what are the bullet points that I want? Number one, it's got to be deficit-neutral. This has to be paid for, because in the past some of the health care plans that we've put forward have not been paid for. A good example of this was the prescription drug benefit for seniors. That was an important thing to do, but we never actually figured out how to pay for it. That just went directly into the deficit and the national debt. We can't afford to do that. So that would be point number one." (O-4) "Number four is, I want to make sure that we have a health exchange, as I just described, that is similar to what members of Congress have, where you will have a set of options. If you're a small business, if you're an individual, self-employed, you have trouble getting health insurance right now, you can go and look at a bunch of options, and we've got to make it affordable for middle-class families. So part of the plan has to be that, if you can't afford a market-based premium, that we're giving you a little bit of help and you're able to get health insurance."

I daresay President Summers feels quite as passionately about "deficit-neutrality" as Mr. Poster feels about "Death to obesity!" But, life being unfair, it is Larry who gets to set the agenda.

Mr. Obama's fourth bullet is admittedly not as clear and crisp as one would wish. "A health exchange" may or may not be the same thing as "a public option that people could sign up for." It may or may not be the same thing as "a coöperative." (The first quoted scrap is from Mr. Obama, the second, from Neocomrade M. A. Smerconish.)

Mr. O. never mentioned coöps at all, which falls in with my own guess that the Administration is not really much interested in that particular gimmick. But I could be wrong. If avoiding the subject was intended as another wingnut-management technique, why Mr. Obama should think coöperatives particularly obnoxious to Rio Limbaugh would be a puzzle: the GOP base and vile would, I think, need a stiff course of agitprop before they grasp how monstrous a threat to the blessèd AEIdeology coöperative medical insurance would be. At the moment the typical neocomradely response would be along the lines of "Huh?"

Hearing Mr. Obama live, I thought it plain that he did not have his bullet points written down in advance of Neocomradess ‘Tracy’ askin’ him to set them forth. (Mr. Obama has been getting better at ex tempore lately, I am happy to imagine.)

In context it sounded as if the phrase "health exchange" came in as a description of the current program for (civilian) Fedguv employees, Neocomrade ‘Ernie’ havin’ set the stage for it as follows:

"Congress has voted, to my understanding, not to join the public plan once it passes, because they want to keep their good federal plan. Would you be willing to either urge Congress to have the federal employees join the public plan or would you be willing to urge Congress to somehow open up the federal health plan to all Americans?"

Now strictly speaking, USAID is beside the point for the same reasons that Medicare and Medicaid are beside the point. Probably the Veterans Administration can be tossed in as well, to make four parts of the existing system (or ‘system’) that do not urgently need to be fixed because they are not obviously broke. Mr. Obama was perhaps alluding vaguely to the non-brokenness of USAID when he promoted "a health exchange" to the status of an ad hoc bullet point. He gave the Smerconishian dittohead (what I thought) rather a good exposition of how and why USAID works, culminating as follows,

"Now, what we have said is, let's make a public option one choice of many choices that are available to people who are joining the exchange. And I see nothing wrong with potentially having that public option as one option for federal employees, as well."

I am not entirely sure what is going on here, although it does look as if Mr. Obama thinks a longer menu to choose from is always eo ipso a better menu. Call it ‘diversity’! Maybe. [1]

But God knows best.

Happy days.


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[1] President Summers is not likely to be quite so great a fan of diversity. With him, "bend the cost curve" is, as befits a past master of Chicagonomics, pretty well the whole megillah. Presented with an immensely long menu of options, I betcha the first thing Larry would do is click to sort them by "Price: Low to High" just as we humble do over Chez Amazon.

(But God knows best about President Summers!)