Sunday, October 06, 2013

Jack Kelly in/on the shutdown

This is my comment on todays Jack Kelly column "Shutting down the Democrats: They have more to lose than they might think". Let me note the PG online has gone behind a paywall; you might get a few as five clicks in month, so keep that in mind.

"This "shutdown" is over Obamacare, which most Americans dislike." I heard a number, which now I forget, but a Google search indicated 2.8 million people visited the online exchange web sites in the first couple of days (actually that number may be low, a different source said 2.5 million visited the web sites in New York alone, on the first day). That is certainly not "most Americans" but it is a sizable number of people, all of whom presumably do not have health insurance now. Jack Kelly wants to see 2.8 million specific Americans go without health insurance.

"Americans blame Republicans more for the "shutdown," polls indicate, but by smaller margins than in the past. Most of the few who will suffer real pain typically vote Democratic." I have no idea if the first sentence is true, but giving Mr Kelly the benefit of the doubt, that is probably because of partisanship and literally years of the Republicans saying "Obamacare is bad" without giving specific verifiable reasons why it is. And the second sentence is Jack Kelly implying that he does not care if people who vote democratic suffer real pain or not.

I have yet to meet a Republican/conservatives who addresses the issue, in an aggregate manner, of every other high income country - all of Europe, Canada, Japan, Australia, New Zealand - having a universal health care system that costs less per capita and has better public health outcomes. Yes, when asked about this Republicans make up mythical wait times and invariably talk about foreign citizens who come here. But never do they deal with the comparison of the entire systems statistic for statistic.

Now that reliance on the foreign visitor anecdote should tell us two things, neither of which Republicans/conservatives explicitly admit. First, pretty much by definition a foreigner who comes here for treatment is coming for treatment for a exotic or at at least very serious and *expensive* condition, meaning they are wealthy themselves. And second, no one denies that at the top price level, we have the best health care in the world. But literally 99% of Americans can not afford that level of health care. In some senses we have three levels of health care. One is for the wealthy, the second, being trimmed away every day, is for the middle class with health insurance, and the third is no health insurance, which is the one where a visit to the emergency room mean that if your credit wasn't ruined before, it is now. And you better not have a chronic condition, because then the emergency room will stabilize you and release you to die some time in the future, with those tens of thousands of medical bills.

That Republicans/conservatives see the pre-ACA system as more desirable than the ACA, with its increasing share of the GNP and large numbers of people dying prematurely and/or going personally bankrupt, tells you quite a lot. I will say that Republicans do have plan to reform health care, I guess. The only one anyone has mentioned involves allowing health insurance companies to sell insurance across State lines. Wait a minute, you say, doesn't Aetna show up in multiple state? Yes they do, but they have to follow the rules of each particular state. So the Republican plan is to allow insurance companies to follow the rules of the *least* strict state to sell insurance. And noticing the natural consolidation of the banking industry (based on the big guys gobbling up the little guys), what we would be left with only a few huge health insurance companies, unanswerable to anyone below the millionaire level.

That is the real meaning of this column.