
(Today's guest poster is Henry Farrell of Crooked Timber. He and author Jacob Hacker join us to chat today. This is quite an important work and I urge everyone to read Henry's post and spend some time with the two of them in the comments, it is no doubt a book we're going to be referring to again and again here — JH)
Jacob Hacker has written a very important book. One of the biggest problems that progressives face in American politics is that the game is rigged against them. Over the last thirty years, right wing think tanks and pundits have succeeded in changing the center of gravity of American politics. Ideas such as gutting social protection used to belong to the Birchers and other flat earthers at the fringes of debate. They’re now received wisdom among the chattering classes. Jacob Hacker wants to reverse this. He’s a political scientist; much of his previous work has shown how the right has worked under the radar to undermine basic social protections. This book, however, isn’t a standard piece of political science commentary. It’s an attempt to change politics by reshaping the collective wisdom closer to what progressives want.
This is a highly ambitious project. Hacker wants to push back some of the ideological gains that the right wing has made over the last thirty years. A diffuse coalition of conservatives, libertarians and business interests has sought to get rid of broadly based social security and medical benefits and to push for ever lower taxes. They haven’t done everything that they set out to do, but they’ve succeeded in changing the language that policy makers use to think about these issues. The result has been that politicians have been unwilling to protect people from the new risks caused by globalization and market pressures. Indeed, instead of protecting ordinary people, government has helped pile more risks on their heads.
Some examples. Medical costs are growing ever higher, and the health insurance industry is a mess. The result is that people, especially those with no insurance or limited coverage, face ever more financial risks. According to a recent study a quarter of families affected by cancer had to spend all their savings to pay for treatment; one in ten had skimp on food, heat or housing to bear the burden, and 13% went into major debt. As Hacker documents, instead of proper health insurance reform, we’re being given individual Health Savings Accounts, which transfer the risks and hard tradeoffs to individuals. Employment is becoming ever more unstable in a globalized world, but government doesn’t seem very interested in protecting vulnerable workers. Ordinary families who are faced with these pressures can’t easily seek refuge in bankruptcy any more thanks to recent legislation which drastically weakens bankruptcy protections. Finally, traditional defined benefits pension plans have been replaced over time by defined contribution plans, in which individuals bear the risk of stock market slumps. Now, conservatives and libertarians want to get rid of Social Security and replace it with so called ‘personalized’ accounts, regardless of the massive transition costs that this would involve.
The right has been so successful in getting these changes through because it has redefined the middle ground of American politics. By relentlessly pushing mantras like “personal responsibility” and “increased choice,” it has reshaped the boundaries of the politically possible, making some options available which were previously impossible, while taking others off the table. This has in turn paved the way for major political changes weakening social protections that already exist, and making sure that new protective measures aren’t created to address new risks. While the right has managed to disarm some of the opposition to these changes, it hasn’t been able to make them popular. Despite the boosterism of the business press, middle class Americans aren’t very happy in the modern economy. They have very good reason to feel insecure. Hacker shows how economic risk has increased dramatically over the last few decades. However, politicians in both the Democratic and Republican party have mostly ignored this problem, where they haven’t actively made it worse. Because the space for allowable political argument is so conservative-friendly, real, far-reaching policies haven’t been able to get off the ground.
This is what Hacker wants to change. He wants to redefine the terms of debate, showing how Americans are far more vulnerable to economic risk than in the past, and how politics has worsened the problem. Everywhere that right wing pundits talk about “personal responsibility,” he wants to highlight the real and profound risks that ‘responsibility enhancing’ measures involve for ordinary families. Not only that – he wants to show how these risks would be far lower if government was doing its job properly. Government could do a lot more to make people’s lives less risky if it reformed social insurance and expanded Medicare. There isn’t any necessary reason why it can’t do this. Governments in other countries have been far more active than the US in protecting their citizens. The real problem has been one of political will. Politicians aren’t responding to ordinary people’s needs, at least partly because it’s hard to articulate these needs in a political language that has been reshaped by the right wing.
This imbalance of debate reflects a broader problem that the netroots are increasingly coming to focus on. As Digby said a couple of weeks ago, one of the reasons that Democrats are repeatedly sucker-punched by the right is because they are working within intellectual limits that have been set by right wing foundations and pundits over the last few decades.
The conservative consensus says that low taxes, limited government, individual rights, strong national defense and family values equals a better life. Many people, including many liberals, have absorbed that message into their worldview and it's going to take some work to unravel it. It won't happen through issue advocacy. People already favor all the government programs they depend on (and some they that don't even exist, yet.) But they have been disconnected from government itself — their ownership of it and their obligation to keep it working. Until we successfully challenge the conservative consensus with new language and new ways of thinking about government and politics, it's going to remain in place. And it's going to be very difficult to successfully advance the progressive agenda until that changes.
Progressives have had difficulty even beginning to conceptualize how they might create a coherent agenda, because they think with concepts developed by people whom they fundamentally disagree. George Lakoff and others who claim that progressives just need to repackage their arguments are missing this point. Democrats need to reframe their agenda. Progressives don’t need to work on how they use maternal and paternal imagery. They need to develop basic concepts that allow them to change the ways in which they think about politics.
This is exactly why Hacker wants to reshape the way in which Americans debate and think about economic issues. He has laid out the beginnings of a very ambitious project. But it’s the right kind of ambitious. If the mid-term elections demonstrated anything, it’s that ordinary Americans want politicians to address the real uncertainties and worries that they feel when they think about their economic future. Hacker provides some of the intellectual foundations for a smart economic populism that would help provide answers for these Americans
There are a lot of points for discussion in this book; I haven’t even begun to touch on some of Hacker’s major arguments (you’ll have to buy the book yourself to find out more). Here are three points for starters.
(1) Kos wrote back in June about how John Edwards’ speech about the “Working Society” provides the kind of “big ideas” that the Democratic party needed. However, Kos was unsure about whether Edwards’ plan would appeal to the middle class. Can Hacker’s emphasis on risk and insecurity help bring these ideas home to middle class voters? (I suspect that Edwards himself thinks so; he describes Hacker’s book as an important book for anyone concerned about the continuing vitality of the American dream).
(2) Is there a trade-off between focusing on risk and focusing on inequality? Matthew Yglesias and Ezra Klein have argued that Hacker doesn’t pay enough attention to growing economic inequality, and the need to enhance the bargaining power of workers. Both Mark Schmitt (on the same page) and Hacker disagree in different ways. Schmitt argues that fighting risk isn’t quite the same thing as trying to redistribute resources, and Hacker claims that fighting insecurity is an important initial step in tackling inequality too. Which of these positions is right, and what does that mean for the political priorities that progressives should adopt?
(3) Could this agenda be hijacked by the right? Two conservatives, Ross Douthat and Reihan Salam have recently argued in the Weekly Standard that the Republicans need to respond to liberals like Hacker by focusing on health care and income volatility themselves. Does this suggest that if Democrats don’t start providing answers to these problems – and soon – their lunch will be eaten by the Republicans?



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Thanks so much to our guests for being here today. I loved this book and I can see why it’s making all the right wing heads explode — it really takes a sledge hammer to all the myths they’ve used to con the country into, essentially, embracing mechanisms that make the rich richer and everyone else more vulnerable to economic insecurity.
(As always with book salon, please limit comments to the topic of the book — if you want to talk OT you can do it on the previous thread.)
Professor Farrell thank you so much for leading the discussion today about The Great Risk Shift. I apologize, this is kind of an off the wall question. Considering you are at Georgetown University, you may or may not be familiar with the old Jesuit General, Pedro Arrupe, S.J. If you are familiar, could you speak to any moral overlap between Fr. Arrupe’s teachings on “Faith and Justice” and Professor Hacker’s The Great Risk Shift?
Welcome to our guest poster, Professor Henry Farrell, and to the author of our featured book, Professor Jacob Hacker.
We are delighted to have both of you here.
Welcome Jacob Hacker and Professor Farrell – thanks for delineating the theft of the public commons (our water, air, land, food, communities, etc.).
Thanks also for devising tools by which we may retake them – the commons belong to us, not the megacorps or their wholly-owned “elected” (bankrolled) officials.
Nice to be with you guys. John – I am now at George Washington University, which isn’t Georgetown (though it’s very easily confused). My earlier education was at the hands of Irish Benedictine monks, who are Jesuits’ rivals for influence over young minds, and they didn’t tell me anything about Arrupe. More generally though, I think that there is a lot in Christian, Jewish and Islamic traditions (the three that I know a little about) which speaks to the need to recognize that others have done less well than you, and to help protect them from an unfavorable environment. The story of St. Martin and his cloak comes to mind …
Welcome, Henry. I agree with you with regard to Edwards’ arguments on the “two Americas” and the relationship to some of what Hacker is saying on risk shifts, especially. With the rise of “populism” as a theme lately — via Lou Dobbs, as a media example leading the charge with his “assault on the middle class” rhetoric — where do you see this going in the lead-up to the 2008 Presidential campaign? Do you dare hope for some real discussion on the issues involved…and, if so, from whom?
It’s very difficult, as a practical matter, to break people from their addictions to the mantra words “personal responsibility” and “free markets,” and I’m wondering what advice you have for us, Jacob and Henry, as to how we, using our media platform here, can help change the terms of the national thought process, bit by bit?
Thanks so much for joining us, both of you!
The contrast of our economy with those of western Europe provides mixed results in my opinion. Even countries devoted to cradle-to-grave services such as Sweden are evaluating and retrenching.
Isn’t there inherently some swinging of the pendelum between all YOYO = You’re On You’re Own, and all government? I understand your central argument that the right used their bulldozer to push this off the cliff.
Christy, I think that this is one of the key issues for the Democrats. There is clearly a lot of populist energy out there, which both the Democrats and Republicans have ignored in one way or another (the less pleasant side of this is some of the anti-immigration hysteria which some Republicans have been trying to whip up). Ideally, I would like to see this populist energy focused on what I think should be its real targets – the growing inequalities in American society, and, as Jacob documents, the way that the burden of risk is increasing for ordinary people. My purely personal take on this is that Edwards is the candidate who seems to get this, and to be willing to make it a major theme of his campaign. What Jacob’s book does, among other things, is to show how these aren’t just issues for the poor, but also for the struggling middle class, and to show also how real solutions lie within reach for these problems, if there is the political will.
Thanks much to our distinguished host and author. This is exactly the book we need. We’ve lost the ability to defend the concepts we know to be correct and need to recapture the language that explains this. There are reasons for government and reasons why civilized people turn to government to solve certain problems. We understood this with FDR and the New Deal, then we forgot. I hope this book helps us reclaim the ability to explain/defend that.
Pachacutec @ 7
I guess a big part of the job is going to be taking back the language that they’ve focused grouped to death and twisted tortuously toward ends that have nothing to do with what their true objectives are.
Gentlemen, do either of you have observations on how the precautionary principle may be used to help shift risk back to the megacorps?
Henry@9,
You say that
Political will on whose part? The electorate? The politicians? How do we go about pushing the political will in that direction to a degree that it is noticeable?
Edwards in the 2004 campaign talked about poverty as a moral issue, something which has not been a part of our discussions for a long time.
His insistence that tens of millions were only one paycheck away from poverty sounded harsh at the time, but increasingly on the mark now.
Probably he read Professor Hacker’s earlier books on the subject!
Parachutec – again purely personal, but I think that Jacob’s book points to some of the ways that you can do this. Whenever someone starts talking about “choice,” start asking questions about whether (a) there is real choice involved or just bogus ideology, and (b) whether the people who are supposed to be making the ‘choices’ are in a good place to make them. Hammer home the ways in which basic social protections that Americans rely on are being undermined, bit by bit, and how new risks aren’t being addressed at all. What I think this points to is the need not for progressives to concentrate on framing, but on what their core values are. Creating an economic safety net is clearly one of these core values – although this has been partly forgotten in the age of the DLC.
Egregious – certainly, all systems provide mixed results, and some of the West European economies (esp. those in Southern Europe) have real problems. I think that the extent to which there is real retrenchment in Sweden is greatly overstated. The right won the recent elections – but only because they promised only to tinker around the edges a bit (in the previous elections they had advocated major reforms and gotten walloped very badly as a result).
Hi, Henry! Welcome to book salon. I’d like to ask what you think about the leader of the Christian Coalition getting ousted because he wanted to help the poor rather than bash the gays and restrict abortion rights. Why is it that the poor are so stigmatized in this country? It’s like Americans think of poverty as some kind of moral failing.
Do you think this is part of what has so consistently inhibited real economic reform in this country?
Thank you again for coming today.
Henry at 9 — That is the question, isn’t it, ultimately whether or not we will have the political will to make the necessary changes. I have never understood why those who have a lot cannot see that everyone benefits from those who have less being able to get a larger piece of the whole, thereby raising everyone up another notch. We all benefit by the tide raising everyone’s boats. It’s just that, incrementally, the folks in the yachts don’t get to feel their rise as much and lord it over the rest of us…which is to say, I suppose, why so many of them don’t feel any incentive to make the effort in the first place.
Switching from a “me, me, me” society to contemplating things in terms of “we” is going to be difficult after years of indoctrination in “Reagan speak.” Which is where Jane at 11 is exactly right. Targeting the speech idiocyncracies is going to go a long way toward making independent thought on the issues possible. But where to start on that is a tough call to make, I think.
I can’t wait to get and read the book. After having fought these SOBS for the past four years on foreign policy, I look forward to educating myself on another flank of the war that needs to be fought. Joe
I don’t know whether Edwards read Jacob’s earlier books, but he surely has read this one (he blurbs it enthusiastically), and I believe that he invited him and others to participate in a major policy workshop last year on how to fight inequality etc.
It’s always a great honor to have Ambassador Wilson at an FDL Salon.
Welcome! to Host Henry Farrell and Author Jacob S. Hacker.
Does Populism require a Great Person to articulate most clearly in the public square? Is personal history and background informative and dispositive toward selection, or elevation, of a spokesperson? My roots affect my viewpoint; do the American people deserve a leader whose populism evolved naturally from rising above adversity and personal challenges?
Thank you so much for your work.
Thank you for your response about Sweden.
In Germany I observe severe downward pressure on wages in manufacturing, for example, autos, as eastern Europe becomes more economically active.
Is this a good parallel to the United States loss of manufacturing and downward pressure on factory wages because of developing world alternatives?
Welcome, Ambassador Wilson! Always a privilege to see you.
Welcome back, Joe! We’ll make a dirty hippie of you yet!
From Reagan onward, part of the Republican mantra is that government doesn’t work, can’t help the average schmo, and is simply a sinkhole for one’s hard-earned cash.
The Bushies have actually been trying their best to prove that all those things are true, in part so that their adherents can say, in effect, “see for yourself–government didn’t work on 9/11, on the Gulf Coast. It can’t work. Only the free market can.”
Which brings me to the point–I don’t think Democrats have been entirely willing to embrace the proper rejoinder (”it doesn’t work when screw-ups are running it and are trying to destroy it”) because they’re partially complicit and beholden to the same interests seeking to profit from the privatization of government.
Is that a reasonable view at this political moment? The general tide has turned a bit in the last election, but, still, this election was full of “anything’s got to be better these guys” rather than a fundamental embrace of Democratic policies, such as they are known to the public.
Welcome, Ambassador Wilson!
We try and stay on topic in Book Salon threads, but some time soon, I think it would be great if you would do a question and answer session about the mounting chaos in Iraq.
In fact, what are you doing later tonight? I was going to write about the war tonight for Late Nite.
John Casper @ 20
Thanks. I am hear to learn. It has always befuddled me that we cannot see the utility in taking better care of our own. When I was in government we had access to all sorts of programs that provided coverage at favorable costs because we were a large cohort.
The military is the single largest example of cradle to grave socialism in our society, yet the officer class is republican. They have theirs so screw everybody else. Doesn’t make a lot of sense to me.
Kirk – I think the precautionary principle is important, but applies primarily to non-economic risks in areas like scientific development, GMOs etc.
RevDeb – I think that this is a lack of political will – or, to use the scientific term, gutlessness – on the part of political leaders rather than ordinary people. I think there is a real constituency out there for this.
TRex – I hadn’t seen that story. As stated, there is a religious tradition of protecting the weak etc which has mostly lost out in modern conservatism (or at least not been translated into actual politics). People like Grover Norquist have been at pains to make sure that this tradition stays lost in conservatism – see the fight they had in Alabama a few years back. But it may well be that as the Norquist/Abramoff wing lose influence among conservatives, this comes back to the fore. This should give real pause to Democrats – if they don’t take up this set of ideas themselves, someone else is likely to, and maybe use them in ways that Democrats and progressives don’t like very much.
TRex @ 25
I have kid duty later tonight. I would be happy to try to answer some questions on Iraq, but with every passing day the situation becomes ever more grave. I worry that we might actually have to fight our way out. There are no magic bullets.
egregious at 22 — it’s certainly a very good argument for trade negotiations that include wage raising provisions for countries who tend to suppress that sort of thing for workers (i.e. using prison labor and captive labor paid a pittance to keep prices low, etc.) There is a whole picture that most folks in this country, myself included, forget to include in the thought process far too much of the time. And that ripples out to every aspect of labor here and abroad as a result. And simply saying that “the markets will equal it out in the end” glosses over a whole helluva lot of ramifications that need discussion.
John Casper @ 20
I am here to learn.
montag @24 has some good points.
This administration and many before it have done everything in their power to try to undo the FDR legacy, economically, socially, governmentally and ideologically (all fear all the time v. nothing to fear but fear).
FDR’s way was charted by the depression and the very real need for people to help one another through it. Contrast that to succeeding generations who have been taught that getting ahead of everyone else is the goal.
Can we really come back to a more equitable society without having to crash first?
Over at kos, Sirota argues that people currently framing our political and economic arguments live in a small number of places along our coasts.
His point is their arguments lack reality because they have no contact with regular people in the rest of the country. Perhaps we can help out with that.
I’ve got a brother in Indiana, graduate of Northwestern, who’s working the night shift at Target. He has a few choice observations about the economy.
This is one of the main reasons I am so grateful to have Edwards and Tester in the party. I believe they can serve as an economic conscience to counter against the Blue Dog/Ellen Tauscher crowd who are running as fast as they can into the arms of K Street.
And Trex – I should also say that there is a longstanding tradition (esp. in some versions of Protestantism) of seeing worldly success as evidence of godlieness and vice versa.
montaq – I think that both of your points (Republicans trying to prove that government is screwed up by screwing it up themselves, and Democrats being to some extent complicit) are fair points. Nor do I think that the tide has changed yet for the Democrats. They did much better than they did previously, but I really think that they need to create a new coalition, using the ideas in this book and others, over the next two years, if they’re going to make those successes into something solid.
Henry,
Just a reminder that Lakoff is constantly reminding folks that his notion of reframing is NOT about repackaging words- but about being aware of and articulating our deepest values.
That whole miserable Calvinist thing, yep. Predestination. It’s alive and well in GOP policy. “If you weren’t doing anything wrong, then you wouldn’t be poor!”
Christy Hardin Smith @ 29
And child labor.
I ain’t giving up my lunch to any GOPers, that’s fer sure. And if our National Democrats are so disconnected from their base — and so connected to their corporate teat — that they give away this advantage on our party’s core issue, their next forty years in the political wilderness won’t be enough.
Henry, — The health “insurance” example in the main post is interesting because we almost always think of the problem as lots of people without “insurance.” No insurance => no health care. But that paradigm is itself a limitation on policy choices and one focused on private insurance companies.
It’s possible to have a universal health care system in which the notion of privately purchased “insurance” from insurance companies is not essential. The “insurance” feature is simply one way of covering costs of care through some mechanism that collects revenues to pay for it. But taxes also pay for social services that can be universally provided, without forcing each citizen or family to purchase “insurance” or to be employed by a company that provides some insurance program.
When we cast the problem as everyone needs “insurance” we are forced to figure out how each member pays for this insurance — but the solutions for many folks always return to pooled revenue solutions, paid for by taxes, and probably administered by government, not just insurance companies.
Is this what we’re talking about here?
Welcome Ambassador Wilson!
If I weren’t already asking questions today, I’d be too shy to post.
Thank you for your patriotism and your service to our nation!
Professor Farrell – thanks for addressing the precautionary principle question.
And gentlemen – a follow-up question…
The megacorps and their elected vassals have successfuly diverted the public – their victims – from the corporations’ deliberate sustained assault upon our physical and social well-being.
One of the most common and most shattering consequnces of these crimes is the soaring rate of malignancies (cancer).
Sandra Steingraber – in her evocative book Living Downstream – personalized (for the reading public) the link between individual cancer survivors and the epidemic increases in malignancies generated from massive release of pesticides and industrial pollution.
Today one-quarter to one-third of Americans may now expect to develop cancer: the army of cancer surviviors and their loved ones may be a potent and compelling political force.
What role – if any – might either of you imagine for survivors of cancer in raising public awareness about the great risk shift?
At a time when electronic media seem to predominately shape public emotions, how can this potential army of cancer survivors share their wisdom about the short end of the great risk shift?
And how might the integrity and power of their suffering push aside the talking heads’ puffery to grab airtime?
I’m thinking that with “The Great Risk Shift” another piece of the jigsaw puzzle comes together.
* Risk shifting from corporations to individuals
* The gini index is still going through the roof
* Lakoff reminds us that the market economy is not some law of nature but a social invention that can be rearranged to improve the lot of all members of society.
* How to start a viral meme that makes being rich or conspicuous consumption a social embarassment (sp)
I am sorry if this seems like a set of disembodied thoughts, but I hope the shorthand makes sense to you.
Thank you so much for this book.
Joe – nice to have you as part of this conversation.
egregious – I think that the cost pressures for Germany are less because of Eastern Europe, than because the market has changed for many of their most important exports. It used to be that the Germans had the super high-quality end of the market for autos, machine tools etc locked up, and everyone else produced to a much lower quality, so that they didn’t compete directly with the Germans. But now there are a lot of producers who aren’t quite as good as the Germans but are reasonably close, and are a lot cheaper, which has transformed the market in ways that make it much more competitive for German producers. Still, they are a manufacturing powerhouse. Italy is in much bigger trouble, because its manufacturing is in sectors such as footwear that are much more heavily exposed. But I could go on about this for pages … this is one of my academic areas of interest.
On your brother, yeah. It’s a general problem of elites, and a particular problem in this country, especially thanks to the weakening of the unions, who were the main go-betweens bringing the problems of guys at Target (which is still, at least in part, a union shop, right?) to the attention of the people in Washington.
TeddySanFran – I don’t think it needs a single person to articulate it, but it helps. The Presidency is the biggest bully pulpit in the country – if you have a powerful President willing to make waves, it makes change a whole lot easier.
Ever since hearing a report a couple of years ago about farm wives getting jobs in town because otherwise farmers couldn’t afford health insurance, I’ve thought that Democrats are going about the healthcare debate all wrong. The rhetoric is endlessly about “the uninsured” and emergency rooms, which is automatically interpreted to mean “the poor,” which is then vulnerable to undermining by conservatives’ crypto-racist “undeserving people might be getting something.”
It seems to me that it would be more accurate (and appeal to a broader audience of voters) to talk about how middle-class people have to desperately cling to jobs with insurance (or hope they don’t get sick, if they don’t have it), and can’t become entrepreneurs, or go back to school, or any other part of that “opportunity society” crap. Of course, that would require pushing for single-payer and universal healthcare and taking on the insurance industry, rather than this incremental, compromise-before-we-start approach we’ve been getting (which I think is another bad decision.)
I haven’t gotten to read the book yet, Professors; do you think this meshes with the risk shift concept?
(BTW, Henry, I’ve been a big fan of Crooked Timber since way back.)
sofistic at 41 — We have seen a bit of a shift in terms of folks with substantial wealth being goaded into charity donations and foundation set-ups, and I attribute that to the public “shaming” that Bill and Melinda Gates and Bono and Warren Buffett and Oprah and…well, you get the picture. Public figures stepping up and establishing a pattern of conduct that had fallen out of style for a while, but which had gone on a generation back in terms of public good foundations. Perhaps it had always gone on, but just not been publicly discussed much for a while, but bringing it out of the shadows has had a good effect in goading others into doing so as well. So that’s a bit of positive pressure, I’d say.
scarecrow – that is a large part of it, although for legal-constitutional reasons, I think that universal health care without some private provision is a non-starter, for better or worse (and private provision, it should be said, isn’t necessarily bad; what is bad is our current system, which is a morass of perverse incentives).
Kirk – follow through the link labeled ’study’ in the third paragraph of the main post for some chilling discussion of cancer and its effects on risk.
Uninsured or underinsured=health insurance insecurity.
Just borrowing from the playbook that changed hunger to food insecurity.
Charity donations and setting up foundations seem like they mostly overlap, but they don’t necessarily.
A lot of wealthy people set up a foundation to avoid estate taxes. The foundation, if set up to be nonprofit, is only required to give away 5% of its assets every year.
In contrast, with a direct donation to charity, the full amount is put to work immediately.
[Disclaimer: my nonprofit foundation gives away 50-80% of its assets every year to the Russian children’s hospital. But a great many stick to the 5%.]
Thank you Henry.
… and thank you, sofistic, for the gini index.
I learn something every day here.
Redshift – I think that what Jacob is doing is exactly trying to show how this is a middle class problem. Now there are some risks to this – which I think lie behind Matt Yglesias’ worries (see link in main post). In particular, programs which are too heavily biased towards the middle class are clearly going to do very little to help those who are even more deeply and seriously screwed. But creating a coalition to bring through changes is about figuring out what are the right compromises, and showing people how they have more in common with those who they don’t identify with than they think. Every couple of months the Economist, which I read every week, makes some snide comment about the politics of class warfare, and how it is destined to fail. We have been seeing the politics of class warfare in this country over the last several decades, and it has succeeded all too well. The Economist has been one of its chief protagonists. And one of the ways in which it has succeeded is in weakening the basis of solidarity and fellow feeling between people who have shared interests. That’s why we need books like this.
Gotta run. I look forward to reading the rest of the thread tomorrow. And to reading the book. Joe
Henry @ 44
I don’t know, Henry, what if we thought in the manner of the founders and invented things outside of the existing set of ideas. If there can be universal health systems in most European and Scandanavian countries, why not here? There is nothing sacred about private versus public funding; it is just a different set of methods to get to the goal.
Henry @ 45
I agree that the choice should be there, but the debate usually denies that choice. I see that in the debate about electricity markets and “choice,” where the original Enron view was that regulators should step out of the way and allow (they meant “force”) each customer to choose from private supply companies at prices negotiated between the customer and the supply company. Fine for large customers, but terrible for small customers, with little/no negotiating power. But there is a common pool alternative, which serves every customer that does not choose a private supplier — it does this automatically and at the lowest cost at which the common pool obtains power. [It’s analogous to allowing the govt to negotiate drug prices) Enron and it’s advocates sought to suppress access to this common pool, and that is the system that eventually blew up in California. Eastern electricity systems have markets and “choice,” but one of the choices is to simply be served by the common pool at the lowest pool price. And it works.
TeddySanFran @ 47
Many many moons ago, I did a masters thesis on income inequality trends, and have followed it all those years since. That’s where I first learned of the Lorenz curve and the gini index.
Henry @ 45
Thanks so much for illuminating that relationship – alas, when I served as psych consultant for a major med school’s oncology program, even our affluent Westside LA patients were losing their assets due to uncovered expenses.
If I am perseverating, please forgive me. Something deep inside me heard so many wrenching accounts of suffering from the great risk shift’s devastating legacy of cancers induced by (avoidable) chemical contamination.
As human opinion-making occurs first in the brain’s emotional centers – and only later in the cognitive centers – some part of me hopes these compelling human narratives can shape opinion against the great risk shift.
Conversely, I may well have completely lost perspective – it wouldn’t be the first time :)
Just a brief comment on an area I know little about- alas- but it seems to me that the issue of universal health care can’t be addressed without also adressing the cost of insurance for health care providers. IIRC, European countries that have some form of what they refer to as socialized medicine exist in a “less litigious environment” – no huge payouts of punative damages, etc. (That was pointed out to me often, when I lived in Britain, way back when).
Henry, maybe you could provide some perspective as to how important this issue might be.
Many blogs have noted the success of Populist Democrats with red state working class voters.
This is the key to victory — crafting populist pocketbook and kitchen table issues that appeal to all working Americans.
Blue collar voters have long said there isn’t a dime’s worth of difference between the parties. Since the Democratic Party was sold out to K-Street by Tony Cuehlo and the DLC and Rahm Emannuel (a Tony Cuehlo wannabe) there is a lot of truth in this. David Sirota has been making this case, but we need to shout it out, loud and clear — Democrats will stand up for working Americans, while Republicans sell them out.
The question of risk is a subject for study not only in economics but in my own field of public health.
Two generations ago a person becoming paralyzed from a helmetless motorcycle crash would bankrupt their own family. One generation ago these were our patients at MGH [Mass General-Boston], and were mostly covered by insurance. I suppose you could argue we are fast swinging back toward the original model.
The helmet risk question brings up the issue of how to being pressure to bear to make changes. Under the original model, if my kid tries to go without a helmet, I can personally try to apply pressure to keep our family from being ruined (and of course, the child above all).
During the years of relatively full insurance (never all–we should not extrapolate the experience of the middle class to everyone) how could people be persuaded to use helmets? It became a government public safety campaign, with lots of complaints about impinging on personal freedom. Ok but everyone pays for that guy to recover in the neurosurgery department.
I absolutely believe in health insurance and in sharing the risk of catastrophic expenses. Yet there is an argument to be made that we are weakening and depersonalizing the kind of social feedback that previously got people to make changes toward less risky behavior.
One could argue the same about cigarette smoking–risk, freedom, feedback, who pays.
sofistic – my understanding is that there would be serious constitutional issues with a universal single payer health care system (although this isn’t my area of expertise; I could well be wrong).
Scarecrow – I think that Enron is a perfect example of the problems of “choice.” Actual choice is great, as anyone who (like me), grew up with in a country with a telecom monopoly can testify to. And there are wonderful things that markets can do. But all too often, lobbying on behalf of “choice” and against “government regulation” is aimed at securing the interests of powerful companies such as Enron, which can then present choices to less powerful actors that aren’t really choices at all. And I think negotiating power is really crucial to understanding this. Many simplistic applications of economic theory don’t get this, because they assume that individual actors don’t have any negotiating power. But in real life, they do, and use it, unsurprisingly, to grab as much of the goodies as they can, and to screw the less powerful.
Thank you Mr. Farrell and Mr. Hacker– now back to read and learn.
One of the things I found very helpful about this book is the focus on what is happening to all spectrums of the workforce. For reasons we continually debate, it’s hard to get the blogosphere excited about labor issues, but in large part I think it’s because people who read the blogs don’t think of themselves as being affected by those issues. It actually made me slightly uncomfortable turning the pages. It’s not that we’re all screwed, but the need to do something now is quite critical. And changing the terms of the discussion, which this book does so well, is critical.
egregious – I think there is a real point here. Not all efforts to make individuals responsible for their own risks are a bad idea – sometimes people should be discouraged from doing stupid things.
Valley Girl – there is a linkage here, but it’s not as strong as people sometimes think. Many European countries are now getting pretty litigious too, which creates stresses and strains on medical systems that aren’t designed to deal well with this. But also, the threat of litigation has served a real social function in the US in the lack of serious regulation. It has often forced companies to behave more responsibly than they would have otherwise for fear of being sued if they don’t (which isn’t to say that all class action law suits have merit, but a lot of them do, and they have served as a sort of rough and ready form of regulation/compensation, especially in the South). Now, of course, we are seeing efforts by Republicans to bring through “tort reform” which is a codeword for making it more difficult to bring through class action lawsuits. This campaign has been waged using some pretty dishonest rhetoric from the American Chamber of Commerce and others. It serves the twin purposes of keeping Republicans’ friends in business happy, and weakening a group (class action lawyers) who are heavy financial contributors to the Democratic party.
I have not read the book yet, but I have a question for professor Hacker: Is there some way to develop a risk index for different groups?
Years ago in one of my misguided projects as a statistical programmer, I developed a risk index for a large health care provider (their risk management department) [I then scurried back to higher ed as fast as I could, heh]
Great topic, look forward to reading it very soon; thank you for being here to chat with us, Henry.
In regards to indexing, one index that I find telling is the Transparency International Corruption Perceptions Index (TI-CPI). It is telling that the USA has fallen on the scale in terms of perception of corruption, and that many of the countries in which risk is more equitably distributed are those that are higher on the TI-CPI scale (seen as less corrupt). This isn’t the kind of information that the general public may digest readily without some crisp framing, but it can speak to the corporatists out there since they ultimately are more exposed to risk if corruption becomes more likely when risk is inequitable.
Iraq is now towards the bottom of the index. Little surprise.
egr — The 5% of foundation assets required to be given away may include expenses to give it away, if I’m not mistaken.
TRex, thanks for that about the CCA, wow.
If I may share a bit of my personal experience with regard to health care and insurance, I shall. Please scroll beyond this comment if it’s not relevant.
Upon being de-employed in June 2005, my health insurance converted to COBRA for 18 months, paid for by the State of California due to the nature of my disability. My former employer had to forgo its $8 monthly management fee to keep the monthly COBRA premium under the State’s $500 limit. At open enrollment (this month) my insurance administrator’s administrator announced new premiums, starting 11/1/06. These new premiums exceed the State’s $500 limit. Therefore, my health insurance will end November month-end, rather than December month-end.
At which point, CAL-COBRA engages, with lower administration fees and no middle-man insurance administrator’s administrator. For another eighteen months (until 6/1/08) and at a lower premium than the previous eighteen months, my health care needs are met by the State. The State will now pay itself to manage, administer, and bookkeep my health care.
The silliness continues, of course, in that my health care is provided by an agent of the State (ultimately) — a UCSF practitioner. Were I able to hand her cash each time I saw her (and were she able to organize her time without state constraints) all the middle-ness would be gone.
I do not understand this vast mechanism that is Non-HillaryCare, but I do see its idiocy, its cruelty, and its fraud from deep within its bowels and recesses. And that’s why I shared this; my view from inside, as all of yours from inside, informs my understanding of it better than the view of those who profit from it, lobby for it, and legislate it.
Like bankruptcy, health care woes will never strike those who legislate it. How have we come to this in America?
Is Professor Hacker related to Prof. Andrew Hacker? Both seem to have the same hard-edge reasoning.
TeddySanFran, yes the 5% can include some of the expenses.
The notion of rugged individualism is a blight on our country. This is seen in the failure of some to refuse government help because they feel that it is an individual acknowledgement of failure. Even when the cause of the trouble is well beyond their control, dust bowls, illnesses, factory closings, and such.
They have no problem with help from their neighbors or kinfolk, but fail to see that their countrymen are, collectively, their neighbors.
We need to press the issue, we need to learn to treat the common good as an ideal, not an aberration. No more “Army of One” oxymorons.
We need to be the teamwork nation, the many heads are better nation, the we can get through this together nation.
“Ask not what your contry can do for you,…”
egregious @ 55
That government action came in part because of pressure from insurers, same with seatbelts, because catastrophic care ate into profits. That may be one way in which feedback between government and the private insurers worked to decrease catastrophic injury, but, we’re now seeing this same impulse taken to extremes for the sake of profit–denying people employment (or insurance) because of smoking or even obesity.
Where exactly does that end? As genetic information becomes more greatly disseminated (and it will), at what point do we begin to deny people the same opportunities to live and work in society because they are a potential future liability? In the case of smokers, we can make reasonable limitations on their effects on the health of others without impinging on their right to work and otherwise participate in society, but, if the bottom line is the profitability of the insurer as a feedback mechanism, should that become an institutionalized model for all risks, which it is rapidly becoming?
This is one of the reasons why I have extraordinary doubts about any health system which depends upon for-profit insurers and hospitals. If profit is the determiner for policy, no good can result for society at large.
Henry- thanks for your answer. I agree completely that the threat of litigation serves a purpose in lack of serious regulation, as you say. Probably impractical/ impractible but I was thinking of something whereby punitive damages (medical) in some part might be funneled back to help support the costs of health care for all.
Montag at 66:
If I recall correctly, the first insurance organizations were co-ops started by the “animal clubs”, eg, eagles, moose, etc. And they were called something like “widows survivors funds,” or something like that. There is no reason, in my estimation, that the non-profit co-op model couldn’t be used for all “essential services” in our society, including health care, insurance, banking, etc.
This is a huge, evolving debate within the men’s gay community about personal responsibility to one’s partner, oneself, and one’s community with regard to HIV transmission. These arguments are made: our community must make it unacceptable for knowingly HIV-positive persons to transmit HIV. The 21st century concept of sero-sorting (having unprotected sex with those of the same HIV-status) evolved from the 1990’s “barebacking.” Barebackers who didn’t “use condoms every time” were demonized. Sero-sorters who don’t use condoms because they only have sex with same-status partners are hailed as the new non-transmitters: HIV Stops With Me!
Demonizing is the danger, but it can be socially re-constructed.
For instance, when I see a motorcyclist without a helmet, driving in the rain, I think, “Stupid.”
When I see a smoker, I think “Addict, and stupid.”
====
Thanks for this discussion, all!
montag @ 67
Yes the profit motive gives them incentives not to pay claims. You are basically forced to pay into a system with no guarantee of payout in the event of catastrophe. This is what we are facing with Homeowners insurance in Louisiana. Homeowners is about 4 or 5 times what it used to be. The insurers won’t even insure you if you flooded at all. They are forcing everyone into the state coverage of last resort. This is going to kill our recovery if it continues.
Part of the problem I think with my preliminary research is that some of the larger compaines have de-mutualized. We used to have mutual companies in the sense that they were policy holder owned. They were beholden to policy owners not shareholders. These compaies competed directly with the publicly traded companies. I think this competition kept the big guys more honest.
Now all they want to do is take on the primo customers with the least risk of all. I think they should have to take at least a portion of the risky folks along with the primo customers. Dumping the risky folks on the state does not help things at all.
egregious – this is indeed one of the major problems of insurance systems with a mixture of public and private care. Unless there are strict rules preventing this, private insurers are likely to “cherry pick” the low risk candidates from the pool by offering them lower rates, eventually leaving universal providers with a pool of extremely expensive patients, who aren’t cross subsidized by the younger and healthier (if you’re an economist or a libertarian, this isn’t necessarily a bad thing; I happen to disagree). Jacob presents an interesting alternative scheme in his book, which he has worked out in detail elsewhere. If he were in the discussion, I would defer to him on this – he hasn’t been able to make it so far I suspect because of Thanksgiving travel problems. My own flight from San Francisco was cancelled last night, so that I arrived home to DC and my computer just 15 mins before the book club was due to start.
Valley girl – some kind of arrangement like this might be possible – but better in my opinion would be proper regulations that would impose serious penalties on employers or others who create the health risks in the first place, and thus give them incentive to stop doing it. There are a lot of really nasty workplace illnesses that are effectively unregulated – look up “popcorn lung” on Google for example.
sofistic 69 – these kinds of groups have been in existence at least since the Middle Ages afik.
montag @ 24
Bush had the gall yesterday to talk about the great work the “armies of compassion” are doing to help people affected by Katrina. I damn well hope some Democrats will seize on this to talk about how clearly it demonstrates that private individuals and organizations, while their work is commendable, cannot make up the slack when government abdicates its responsibilities, and furthermore, that all that tax money that the Republicans “gave back” to rich people and corporations didn’t, strangely enough, go to compassionate causes when they needed it.
Somewhere today in my weekly errand run listening to either Air America or NPR I heard a factoid that shocked me, that when a person is diagnosed with Cancer, that increases the GDP. That becomes income for society but nothing is considered how that diagnosis affects the patient, family and their income/debt ratio.
That is totally wacked.
Henry @ 72
Yes. Sorry about that. I meant to say “in the US.” Not counting european guilds, etc.
Henry @ 73
I saw some of the so called guilds in Venice, Italy. They were created to protect the other members from not being able to have a funeral or having their widow and children starve to death after an untimely death.
I immediately thought of labor unions.
Henry- thanks again- I agree. My suggestion was made supposing “the absence of regulation”. Clearly, regulation has been lacking broadly during BushCo., and before. There was quite a bit of discussion at FDL way back, about regulation of (lack of) mine safety during the mine collapse in WVa, and subsequently about the Bush appointee for “director of mine safety” (can’t remember title). Another example of BushCo. serving the interests of business/ money, rather than that of the people at large.
I guess that falls under the category of self-fulfilling prophesies.
For many, in the cities and the rural sections, as far as they are concerned, they are in a depression. I see poverty everyday. And I do mean endless, useless, open ended poverty. And it doesn’t matter to these folks what happens in the Middle East. They’re way too busy trying to figure out how and what they are going to feed the kids tonight and tomorrow morning.
Within the financial services industry, which I used to call Banking, I discovered an amazing thing: a credit union. I rebelled against BofA and WFargo, their monthly fees and absurd use charges (”Oh, you want your money? Well, that’ll cost you $1.75″). I’m delighted to report that I now receive pennies per month as earnings (I’m a member and members own the credit union!) and I have been entered in a pool for selection for a no-down-payment mort*age when next my CU has to balance its portfolio.
Most of the profit has been wrung out of this model, I guess, although I imagine the executives live well. Which is okay with me. They aren’t buying Tahoe ranchettes and lift tickets with my late fees, monthly fees, and ATM fees, and that’s how it should be.
Co-op!
MsAnnaNOLA @ 71
One of the articles of faith of free-market worshippers is that the market not only will produce the most profitable path, but also the most benefit to society. (This was one of the late Milton Friedman’s big ideas, if I recall correctly.) This is blatantly false, of course. Markets produce social benefits only when those benefits align with profit, which is why private health insurance is so perverse. In theory, insurance companies could be profitable by providing the most satisfaction and being able to charge more for it. But it is much more profitable for them to find creative ways to deny care. It’s made worse by the fact that most health insurance is through employers, who want lower costs but don’t directly experence “the product,” so all they have to do is screw the employees at a low enough level that they don’t revolt and demand something better (which ties into employment insecurity and risk in general.)
Valley Girl @ 55, 68.
Further to Henry’s reply at 61, one potentially salutary effect of malpractice litigation is that it can send a signal about the competency of practitioners. It may not be the strongest correlation ever seen, but there is a correlation between screwing up and getting sued. Which explains why so many settlement agreements in med mal cases now include confidentiality provisions and consents to a motion by the defendant to seal the court files.
Our love affair with free markets and the free flow of information to consumers is not exactly unconditional. :-(
sofistic – wasn’t really trying to correct you as it was clear what you meant, just to add an interesting factoid
AnnaNola77 – yes, it is exactly funeral societies that I am thinking of – they were widespread across Northern and Central Italy, and I think in other parts of Europe too .
montag24 – this is of course the standard right wing rhetorical response – that government action to fight poverty etc is no substitute for private charity. But private charity is a pretty lousy substitute for coherent government action in a large, ethnically diverse society. The people trying to escape Katrina who were turned back at gunpoint by a white township illustrate those limits pretty starkly, to put it in the mildest way possible.
Teddy:
Yes! Co-op
It seems to me that profit is just a drain on the organization, any organization, that inhibits its ability to deliver goods and services. The only thing I can think of that profits are good for is paying back start-up borrowing. After that, it just sucks the blood out of an organization.
As a sales rep, I have experienced first hand how risk can be transferred to the employee. Every year my company changes the compensation plan, or the way they determine how the sales reps get paid. Normally it works like this-you get a base salary and then you get a percentage for everything you sell. You are assigned a quota, and can earn additional dollars for overachieving quota.
Anyway, this year they decided to put in a new wrinkle-you have to have sold at least 75% of your quota every month in order to get paid any commission. So, you could theoretically work the entire year, sell stuff and generate revenue for the company and not get paid a dime for it.
My point for this whole sad story is that the company has shifted much of the risk to its salespeople, who really have no recourse to challenge. They can also have a huge influence on whether or not you are successful by changing your territory or your quota, both of which are completely out of the rep’s hand.
It strikes me that many of us on the left are coming from such a different world view than the right, that it is totally alien and frightening to them. Yet, it is clear that the “creative destruction” of unregulated markets does great harm (usually to the most vulnerable in society). So, how do we bridge the gap between such different world views?
burnspbesq @ 82
Texas’ experience in this is enormously instructive. The voters there were told that capping malpractice would reduce their health costs, and they fell for it. A year after changes to the state constitution were voted in, the primary malpractice insurer (GE) in the state raised malpractice rates 19%, and in doing so, admitted that malpractice awards were “not a significant factor” in its setting of rates (the “fooled you, suckers” corporate model).
Now, Texas is not known for exactly determined oversight of doctors. The Medical Examiners Board there had received (in 2002, I believe) something like 6600 charges of malpractice and had investigated about half-a-dozen. In fact, the last doctor to actually lose a license in Texas was in 1988. Virtually all doctors in trouble receive suspensions which, somehow, still allow them to practice, with restrictions.
AnnaNola and Valleygirl – this is one of the biggest elements of the problem that Christy referred to way upthread. Bad use of economics jargon by semi-educated libertarians who passed Econ 101 do not justifications for real world markets make. I could go on a rant about this, borrowing ideas from friends of mine who write about this more systematically, but the core insight is pretty simple. A lot of economics, especially as it’s practiced in the realm of public policy, is a fancy form of mathematical rhetoric. It sounds scientific, because it’s dressed up with equations, but it really isn’t. If you start with slightly different initial assumptions, your economic models are likely to produce grossly different outcomes. The upshot is that you can prove (within broad limits) pretty well what you want to prove. There are results which suggest that under (highly unrealistic) conditions, free markets produce efficient outcomes, but the point is the unrealistic conditions. They don’t tell us much about real life. And if you don’t believe me, ask Kenneth Arrow, the guy who came up with these results in the first place, and won a Nobel for it. He’s pretty skeptical about grandiose claims for competitive markets, and is himself a progressive social democrat.
Everything is about shareholder benefits. Corporate responsibility died a long time ago. If you have a living wage paying job, no matter how well you do your job, if ‘corporate’ can make more money without you, and you lose your job, life will never be the same. It will not be fun.
Redshift @ 82
Exactly. “the market” is always imperfect. “the market” should be a jumping off point. There is no perfect information so the hand of government needs to intervene in order to make sure that the companies are not colluding, committing fraud and selling unsafe products. Given the opportunity they will do all three.
I think my old HMO was committing fraud. They told me I had “prescription drug coverage” but when I checked the retail costs of the drugs I needed and combined that with the “prescription limitation” for those drugs it turned out I and my co-workers were paying full price for the drug. Now if you are paying the full retail price do you think you have coverage? I think not.
I think this is yet another example of how the system is gamed against you and it further explains why the young and healthy decide to opt out, further raising prices for those left in the system. The “drug coverage” for the drugs I and my even younger colleagues needed were “covered” to this same degree. So in the end you were paying lots of money for a “what if” worst case scenario not the comprehensive coverage that you thought you were getting.
Henry @ 88
Uh, Laffer Curve, anyone? :)
burnspbesq @ 82
I hope BTW that you don’t think that I was advocating a lessening of responsibility or consequences for malpractice on the part of health care providers. I was just trying to think about some additional issues. Having taught many pre-meds, I know that many of them enter the profession for the wrong reasons. So, I’m a bit of a cynic on that account.
Henry at 88:
Absolutely
Look at some of Arrows work at the Santa Fe Institute if you want more of his insight (and many other brilliant people).
http://www.santafe.edu/
One of the most irksome facets of the “market economy” is that not all the players are involved in the risk evaluation process. Shareholders are, within small businesses, but not until after the damage is done in larger corporations. STAKEholders are generally not included, even though some of their resources may be required, like commons, until after damage is done.
And yet there are ongoing conversations every minute of every day within business regarding risk mitigation; where do they put their money (interest-bearing bank account? market in stocks or bonds? capital improvements? tax shelters?), where do they invest their time (new product research, or continuous improvement?), where do they build the next plant (in the U.S., or in China?). They weigh out these investments on the basis of overall costs — but some costs never make it into these conversations, depending on the company, simply because the parties involved never learned to include these costs.
The education I received on the topic of business ethics, for example, is not the same that all business schools offer; my perception of good ethics aren’t the same as other business students, and no hiring manager I ever interviewed with bothered to ask which ones I had. Neither are business ethics discussed during the course on financial management. They are wholly separate creatures, independent in education and independent in real world practice of business, perceived as a luxury or frippery unless forced upon business by regulation and legislation. (Ask Stephen Parrish CPA about the average business’s perception of Sarbanes-Oxley; I’m pretty sure he’ll concur that businesses see this more as a nuisance instead of a protection.)
Do we need to have a conversation about integrating the concepts of stakeholders, real costs, and real risks to our curriculums?
I have always found it ironic that doctors have traditionally, and continue to vote GOP. But then again, medicine has devolved into big, big bidness.
TeddySanFran @ 64
Interesting. I went through COBRA hell about ten years ago, in a state with far fewer protections than CA. The company I worked for went out of business, and the insurance company was required by contract to offer us an individual insurance plan under COBRA with the same premiums and benefits as the company plan (though we’d have to pay the employer part, too.) They tried to sneak through a plan that covered only hospitalization. When they were caught at that, they offered a plan at a massively higher premium. (I don’t know if that was for everyone, or just for me because Ms. Redshift had had some high medical costs.) When challenged on that, it was clear that their attitude was “the company’s out of business and there’s no one to enforce the contract. Take it or leave it.”
It was then that I learned that although denying coverage for pre-existing conditions had been disallowed several years before, there was nothing that prevented them from pricing you out of getting their coverage. This was the origin of one of my mantras, “all insurace companies are evil.”
Please excuse me from the conversation, gotta go be a Mom.
Henry, thank you so much for your insights, hope to have the opportunity to chat with you again.
Jane, can we have him back please?
“Third-way”, NAFTA, CAFTA, Carlyle Group, DLC and so much other selfishness. It’s all so depressing.
Twisted Martini @ 86
Twisted…beware. I worked for a company like this. They lured you into working for them by telling you about the wonderful compensation package but even after I asked what the success rate was, I was blown off.
I learned within one week that they were just filling slots with bodies and had no real interest in sales person success. They wanted you to work for free for 3 or 4 months until they promptly fired you for lack of “success” just before the time when they would have had to pay unemployment benefits.
What a racket.
Henry @ 89
Ah, an economic policy version of “Intelligent Design.”
montag at 88– it’s very sad that neither docs nor lawyers really get investigated to the extent that they should for malpractice unless something earth shattering grabs the public via the corporate media. (peer review is somewhat effective in hospitals, but inadequate imho)
on the other hand, should a nurse or aide do something wrong it’s immediate suspension, followed by dismissal and then loss of license (at least for nurses!)
angie @ 101
Know this well. It also irks nurses no end that they are, despite such liabilities, expected to cover for brain-dead doctors….
montag- thanks for the info about Texas. The healthcare issue is so much on people’s minds, but kind of information you cite doesn’t get enough exposure. Hmmm… maybe it’s time for FDL to start having a regular commenter on this issue, much like Jordan Barab comments on labor issues. FDL for me has been a place of learning and knowledge, and knowledge is power in terms of debating and influencing the issues. Jane, Christy, are you still reading? Montag would make a great “guest poster”- I would love to see this Texas issue exposed.
montag @ 88
On November 7th I sat through an entire day of jury voir dire in a medical malpractice case involving the death of a seven day old infant. I’m sure my opinion about award caps (for them) was the reason I wasn’t picked. I’m in Texas.
Thanks for that info, I’ll have to rethink this ; )
Jane, I’m with egregious, Henry needs to come back, especially after that bit about semi-educated libertarians.
I want to take those morons down at Mackinaw Center for Public Policy in a bad way, before they replicate themselves any farther.
Valley Girl @ 103
All may be true, but I’m not the one to speak authoritatively on health issues (I know about this because I was following it carefully in the process of trying to find an attorney in Texas willing to take the case of a friend who’d suffered unnecessary brain damage because of inaction by a hospital after that constitutional change capping malpractice awards).
Cheers.
Rayne @ 105
I agree. Please bring him back. And I want to know more about the Risk Shift at a technical/statistical level. I think this is an important part of future policy formation, and we need to know more about the nuts and bolts.
I think that universal healthcare is in our future although it will take one or two decades to arrive. It will come about not because we all got ethical or rational but because funding the projected shortfalls in Medicare will force the issue.
As for markets, I repeat my mantra: Free markets don’t exist and have never existed. It is all a question of who is regulating them and for whose benefit.
Oklahoma kiddo @
96
Yeah, it’s more Bill Frist style squillionairing than your friendly, neighborhood practitioners these days.
Valley Girl – what I said about popcorn lung upthread is taken from Barab’s blog. His writing and Nathan Newman’s are both essential reading imo on these topics.
montag @ 106
Montag- I wasn’t suggesting that you be the “regular” in my proposed series. But, I was suggesting that it would make a great guest post at FDL. Not that I make those sorts of decisions, of course. But, there have been guest posters in the past. Jane, Christy? p.s. Montag- you could email them….
montag @
103
yup. It’s no joke. July is not the time to check into a teaching hospital and some docs continue to practice forever despite inhuman “mistakes”.
The best ally anyone can have in a hospital is a great, caring and careful nurse who knows the docs well.
Cozumel @ 104
Punitive damages caps are a profit-driven exercise and do not benefit anyone but the insurers and the culpable. The whole intent of punitive damages are to make poor or dangerous practice unprofitable, and therefore, to discourage those practices.
If an incompetent doctor were not insured for malpractice, his or her practice would end, effectively removing that incompetent doctor from the available pool of physicians. Capping punitive damages simply enables insurers to, first, raise rates on public scare tactics, and second, spread their risks among all insured doctors.
Here’s a fact that the insurers don’t want people like you to know. Before malpractice “reform,” awards amounted to slightly less than 2% of expenses for the malpractice insurance industry as a whole, and yet, malpractice rates have been rising at several times the rate of inflation. If it’s not awards raising the rates, what is it?
Cheers.
burnspbesq @ 83
I was called for jury duty in a local malpractice case some years ago. During questioning I stated that I thought that bringing suit was a poor way to sanction medical providers. The rest of the prospective jurors were sent out of the court room while the lawyers continued to question me.
I was asked if I could support a large award if the verdict went against the defendant, given my views. I said that I could imagine doing so, and that I could see myself going the other way, also.
Did I know any medical providers? Yeah, my mother was an emergency room nurse. So you’re inclined to favor that side? Not really, I remember my mother coming home nearly in tears as she described actions taken by an obviously drunk doctor that killed a patient.
I was excused, not sure which side wanted me least.
Later, I learned some of the details of the case. A young woman and her boyfriend, both drunk, were involved in a one car wreck, boy friend DOA, girl was combative and refused treatment, went home. Readmitted hours later, internal bleeding, died in the OR. Mother of the girl sued, said they should not have let her go the first time. Jury agreed and gave estate several hundred thousand dollars.
The case raised some interesting issues, wish they had kept me on.
I have to sign off now to put baby to bed etc. I’ll try to check in later this evening for another roundup reply. Thanks all for participating (like the last time, it was a lot of fun)
montag- #113- glad I brought up my original naive question, bec. your responses and Henry’s have been so informative. This is the best of FDL- rooting out the mis-information/ doublespeak/ lies. Thanks. and jw too. just saw your comment.
I am a 100% progressive, but one question keeps nagging at me about social service programs like Medicare and Social Security. I wonder if they are infinitely scalable as the country’s population increases, especially if our population grows older as predicted. Or does the paradigm break down at some point, and some other solution to providing services must be found.
I would welcome anyone’s thoughts on this.
Sometimes, you read something, and a little light comes on.
I think I can do something with this.
Go OFG, distill it down for us!
jane hamsher @ 60
Very well stated. Many folks don’t think they have a stake in labor issues and don’t get wound up in it. That is, until they lose their well paying jobs perhaps. As you point out, action IS needed NOW.
Katherine @ 117
The government is ours. “Ownership society” means you are on your own. I reject this. I reject passing war profit debt onto my grandchildren, thus further sacrificing safety nets.
I want my government to work as hard for me as I do for it, and not screw me over and call me a wuss for not being “responsible.”
If taxes must be raised, or the retirement age extended to maintain the viability of social security and medicare, so be it.
But ONLY after loudly and frequently pointing out the political plundering of the overages of social security for years.
Makes ya’ miss the “Iron Clad Lockbox” dunnit.
angie @ 102
Angie, I so agree about this disparity.
In the second or third week of June, 2004, I observed a physician assault a patient at the “flagship” health care center of Catholic Healthcare West (St. Mary’s Medical Center.)
The assault occured in the lobby of the HIV clinic at the Sister Mary Phillipa Clinic.
I immediately reported the assault to to the administrator of the HIV clinic. To his credit, he took it seriously and immediately reported it to the clinic administrator.
The patient also made a complaint to the clinic social worker.
Days went by. The violent physician continued to work there. No one from CHW or St. Mary’s ever contacted me about my report of his witnessed and documented violence.
When the managing nurse of the clinic (with some admin title like patient care coordinator) returned from vacation, I informed her of the assault. She never asked me a question or sat down to speak with me about the matter.
At the end of June, 2004 the clinic administrator met with me – for the first time since the assault. I was told I was “not a good fit.”
A month later, I left that clinic and CHW.
[My immediate predecessor at the clinic - Dr. Kevin Rist - simply stopped showing up. A few months after I started, the CA medical board pulled his license due to drug abuse.
He won’t be the first or last doc in SF ensnared by meth.
In my first few months at the clinic, I discussed with the administrators the risks to public health arising from Dr. Rist’s misprescribing of amphetamines and stimulants for “depression” - a medical failure best depicted in the Valley of the Dolls.]
As I have never assaulted a patient, expanded an HIV epidemic by providing controlled substances to patients who stated they used them for recreational sex with anonymous partners, nor covered up such crimes and malpractice, I’m proud to say I’m not a good fit with such people or practices.
But if anyone’s life depends on peer review in the Catholic Healthcare West System, they are dead meat.
The peer review I saw in real academic medical centers – like UC – seemed to actually protect patients, but most Americans don’t have their care in academic centers.
I wonder if anyone is minding the peer-review store outside of academic centers.
Given what I observe in the treatment histories of the patients I’ve seen the last few years, I suspect not.
But at least the health care chains know how to look out for the administrators’ interests.
[I am happy to provide sworn statements to interested parties. My role as a physician is to be part of the solution, not to cover up the bad actors or bad systems.]
Katherine,
The healthcare system in this country is broken at all levels. It is a wonderful example of how private enterprise isn’t always the best solution and can be the worst one. Medicare amid this mess is one of the better managed and run players but even it will eventually be swamped by the irrationalities of the system and the lack of foresight in budgeting its costs.
As for Social Security, it works reasonably well. But here too there are porblems with long term budgeting. In particular, there is the hoax of the current Social Security surpluses which are in fact excess taxes on the middle and working classes and are spent as ordinary revenues by the government. They are not being held in accounts anywhere or being used to buy assets. That money has been spent and is gone. In the future, it will have to be made up by increased taxes most likely on the middle and working class taxpayers.
Katherine @ 116
Lot of different disciplines have to be tapped to answer that question fully, and one also has to avoid the problem of seeing those questions in terms of absolutes, since none of them are either/or situations and are time-dependent.
In a way, people want to put those questions with an unspoken variable–can we do all those things without raising taxes? In an age where corporations and the wealthy in society have been given exceptional relief from taxation, perhaps we should include that unspoken variable. Can we weather the baby boomers getting old?
It depends upon whether or not we recover some sanity about taxing those most able to be taxed and those who have used the legislative and lobbying process to evade taxes.
In the present milieu, no, we won’t be able to avoid collapse of those systems, especially with thirty years cumulative deficit spending and excess spending on war and defense. We have to change a lot of things to survive the next fifty years.
Katherine @ 117
Whenever the wingnuts or their MSM lackeys say there are multi trillion dollar unfunded mandates in Medicare and Social Security, call bullshit. Social Security is in good shape, but Medicare is broken because the entire health care delivery system is broken.
Social Security is solvent forever, so long as we maintain something like an annual growth rate near two thirds the average rate over the last 50 years (3% per annum).
But here’s the kicker — we will have no problem maintaining a growth rate of 2.5-3% — so long as legal and illegal immigration continues to increase the population.
That’s right, folks — illegal immigrants are the force that keeps Social Security solvent, and keeps the American economy growing.
Medicare is another story — but the entire health care delivery system needs to be overhauled. Whenever a wingnut says “Medicare and Social Security” — smack them down, cause they are spouting bullshit.
We need Medicare for All, in order to become economically competitive again — funding from corporate and payroll taxes, to be determined.
wow, kirk murphy @ 122.
not suprised, but am grateful that I “know” you and that you are in our world.
(btw, I really appreciated your “angry” comment last thread– me too)
Kirk- wow- another powerful post.
So, does anyone know of anyone who blogs regularly about health care issues/abuses/ concerns, in the same vein as Barab does on labor issues? Someone who addresses the issues raised by Montag, Angie, Kirk?
Thanks for stopping by Henry, sorry I missed you. I’ve been busy supplying America’s addiction. I’m in Houston,TX tonight.
Oilfieldguy @ 128
In the Baja again.
Pachacutec @ 7
Pachacutec,
Though I agree, in the main, with your remarks, I would suggest that we not totally denigrate the concept of “personal responsibility”. Certainly, the way in which it is used by the cons, neocons, and libertarians equates to an abandonment of people in need, there is a place for “personal responsibility”. The way I perceive this is that government should allow “personal responsibility” in personal matters, i.e., to negate “personal responsibility” is to allow government intrusion in matters of a person’s reproductive or sexual choices.
Also, if the cons/neocons/libs insist on “personal responsibility”, they must also provide the resources for people to exercise such. When government insists that we are each individually responsible for our every expense, then government must either provide guaranteed employment or guaranteed income. To do otherwise, is totally disingenuous. If you insist that individuals bear the full costs and expenses of existence, then so too must you insist that corporations do the same; no corporate tax breaks, no ’special legislation’, no boltholes for corporations and their executives can use to ditch their responsibilities toward their employees.
Valley Girl @ 127
I second that. Over dinner on night with Christy and Mr. Reddhedd, I broached the subject of healthcare. Who are the bad guys? The good guys? Why can’t we get this right? Is there too much financial inertia for corrective measures?
Valley Girl @ 127
If that niche in the blogosphere is not occupied, might some here on FDL (commenters and/or posters) be interested in filling it?
My niche is concern with precautionary principle/ genetically modified food stuffs and the injuries they cause, and the toxic results or corporate agriculture.
I particularly love to spotlight the vertically-integrated cancer companies: the ones that make carcinogens and chemotherapy drugs.
Now that’s cradle-to-grave coverage!
Long-term, employer-paid disability insurance is another scam, of course, especially if your employer selects a policy that defines “long-term” as 60 months, at which point benefits end. Since benefits never begin, though, pushing the end-date out each month seems the better solution, even for me, the “insured.”
The past eighteen months, four different disability claims specialists have handled my claim: not calling, not writing, not returning calls, not returning emails — from me, my providers and my employer. My claim is now in the hands of a supervisor, who awarded (they make it sound like a sweepstakes!) me the minimum monthly benefit for the covered period, pending further investigation that might raise the monthly benefit to what I am actually due based on my pay. My providers have been slandered (”Dr. won’t provide info we asked for months ago”) and information has been lost (”Well, my predecessor never noted that in your file and I have no record of it.”)
This sounds stupid: but each specialist has been promoted (”I won’t be handling your claim anymore, I’m moving to another area within the organization, my successor will be in touch with you soon!”) based on their excellent performance, which for their employer (my insurer) equals NOT paying claims, NOT expediting claims, NOT providing information about what’s needed from claimants or providers, and NOT letting any $$ leak outside the corporate vessel.
The amount of time and money spent — on their end alone, I’m not counting others’ time and money they’ve wasted, and certainly not MY time and money — could have paid the claim several times over. Seriously.
Co-op!
Oilfieldguy @ 128
enabler!
angie @ 126
wow angie and valley girl -
thanks so much for your kind responses and your presence here. I was raised to be considerate and thoughtful of others – being angry is not comfortable for me.
Yet – in order not to be angry about the VERY WEALTHY PEOPLE who deliberately chose to poison us and our world – I would have to embrace psychosis or perpetual intoxication.
For me, passionate anger at their crimes – and lots of good times with family and friends – is the only way I know to remain sane.
Oilfieldguy @ 131
Thanks OFG, for the second. This is the kind of info that needs to be distilled and put out there. I emailed Jane, but she probably has so much email that it will get lost in the shuffle. So, if you could add an extra voice, that would be great.
Double ditto!
After a bout of breast cancer and my husband having open heart surgery (all within two years)we were forced to file for BK. Then I got cancer again. And my husband got sick again and now with no health insurance. We have huge medical bills. We are both self employed and lost our coverage due to lack of funds. And both of my husband’s conditions were grossly misdiagnosed until the very end of the disease processes. We are now well. But I can’t find work cause I am 57 and have rotten credit. A bad health and credit history coupled with being over 50 knocks me out of contention for most employment. I have not tried McDonalds yet and will not. So, I am one of the folks who has had the risk shifted totally to my little family unit. What will happen next?
Cossack @ 130
This “personal responsibility” moralizing is crap. What does a responsible person do when they:
*)Illegally get prescriptions for oxycontin
*)Illegally get prescriptions for erectile problems
*)Shoot old men in the face and hide from the cops til they sober up.
*)Lie a country into war
*)Torture people
please, feel free to add your own.
Are these people responsible or irresponsible?
Talk amongst yourselves. I’m gonna go eat. bbl
Mary McCurnin @ 137
Mary – please contact me offline @ kmurphy (aaat) riseup (daught) net
We must also insist that they be responsible for the negative externalities, as well. Costs of protecting their raw materials (oil), loss LA tidal marshes (Katrina damages), health costs due to downstream poisoning of the population, opportunity costs to the economy due to shortened years of productive life of same, and on and on.
Mary McCurnin
I am so sorry for your pain and yours is a very good question.
What kind of society does not take care of their own?
I don’t want to be a part of that society.
angie @ 142
Thanks. Yikes, I am suddenly very emotional.
Hey, folks, new suit of threads upstairs
On the general subject of capping punitive awards, I think I should add these factors for rumination by those who still believe in them.
Who is pushing caps on such awards? Near-exclusively, the Republicans. Who pays for their campaigns–the little people, or corporations?
Second, the simple capping of punitive awards prevents people with legitimate cases from filing suit. These changes in awards, whether done by law or by state constitutional amendment, do two things: they restrict the the type of award from which attorneys may draw their fees, and limit the punitive damages from which an attorney working on contingency may draw compensation.
This has two effects. It first prevents attorneys from obtaining fees which cover expenses (expert witnesses must be identified at the time suit is filed and usually must be paid whether they testify or not) and their time (major suits involve thousands of billable hours which can only be recompensed by corresponding award). This has the effect of denying ordinary people the opportunity to obtain justice in such cases. Without professional representation, no individual can succeed in the courts on their own.
Second, the overwhelming number of attorneys working in personal injury and malpractice fields–those working in opposition to corporations–give to Democratic candidates.
Who benefits by such legislation?
Oilfieldguy @ 131
Here’s my .02: There isn’t enough money to do all we want in medical care. There won’t be in the future. We will have to make choices, and they will be painful. There are lots of other issues of course, but to me this is the big one.
I don’t want to blog only on health economic policy. Russian medicine*, mental health, public health, maybe. Will try to think who might want to step up here.
*Speaking of shortages. There is universal health care and it’s free. One little problem: there isn’t any.
I apologize for joining this online discussion so late, but it seems as if I’ve come at the right time to pick up where Henry left off. He has been doing such a wonderful job relaying the argument of the book that I am reluctant to say too much myself. But after having read the extremely stimulating (and sometimes wrenching) comments, I can’t help but jump in with some reactions and thoughts.
First, the need for serious action on health care. You can’t read what’s on this site, or simply the daily news, without coming to the conclusion that America’s patchwork system of health financing is tearing apart at the seams. I have my own views, which are in the book and this article on Slate, about what should be done (basically, I argue that employers should be given a choice between providing coverage on their own or buying into an improved Medicare program for a bargain price). But it seems to me that this is one area where Democrats need to show some real foresight and leadership. The risk (sorry!) is that they’ll embrace a series of well-meaning incremental changes that don’t add up to the kind of comprehensive reform that we need — and, worse, don’t draw the sharp political lines that are required to make this a burning issue on the electoral battlefield.
Second, the role of “populism” in this election. Ruy Teixeira and I have a piece in the current issue of the American Prospect in which we review the role of the economy in the election, and here’s what we conclude.
We then go on to lay out an economic program and message that we think is consistent with Americans’ complex views about the economy — for example, their simultaneous fears about the decline of economic security and their strong belief in individual achievement and success. The shorthand we use for this program is “providing security to expand opportunity.”
Third, the need for better measures of economic risk. A few months ago, the new site http://www.HotSoup.com asked me to name “the most important issue” being ignored by the mainstream media. Having just finished The Great Risk Shift, I immediately said the “economic insecurity of the middle class.” But in my answer (which sounds a little better than it reads — it’s always disconcerting to see your speech in print), I pointed out that one reason for the neglect is that we actually have very few good measures of economic risk — which is why my book devotes so much space to developing intuitive measures of economic insecurity (such as the annual chance of a 50 percent of greater drop in family income).
I have learned so much reading through these comments, and I am grateful to everyone — and especially Henry — for giving my book and the subjects covered by it such serious thought. I wish I had been here earlier to join in the fray, but it’s been a great privilege to participate belatedly.
Thank you Jacob Hacker.
I really do believe that health care is the issue we must seize and we need to get back to it!
Practically speaking, security and safety comes first, always.
Jacob- thanks for your comments. It was a great discussion. Hope folks will be back to read.
Two final responses …
Katherine – there are real debates to be had in the US as elsewhere over how social programs will deal with demographic changes etc. The point, as I see it, is that these don’t have much to do with the kinds of proposals that were being floated to privatize Social Security, which, far from saving money, would have had horrifyingly large transition costs. See the interesting back-and-forth between Brad DeLong and Duncan Black today.
Mary, thanks for talking about your difficult and ongoing set of personal circumstances. It probably doesn’t make it easier that it’s a set of experiences that many people share, with differences in the details. The key take home point from Jacob’s book is that there are political solutions which, even if they aren’t perfect, would provide a better set of protections for you and many others. This is a deeply personal story, but it’s also a political one. There should be a safety net which doesn’t allow these things to happen. There isn’t. It doesn’t have to be this way. It shouldn’t be this way. And if the right things happen, it won’t be this way in the future. Thanks to everyone from me.
Jacob — thanks so much for joining the discussion, and your extended comment is very helpful.
Your prescription for a health policy — “employers should be given a choice between providing coverage on their own or buying into an improved Medicare program for a bargain price” — is consistent with what seems to work in electricity systems — allow folks who want to choose, to choose private suppliers they select at offered prices; but anyone who doesn’t choose purchases from a large pool that obtains the best price for all. All receive basic electricity [or health] service, but some pay their selected provider at the offered price, while others pay the pool price (and pay it to the pool’s billing agent, which might be your local utility [or health care provider]).
One problem is that the health model depends on being employed; some other system is needed for the unemployed, and we may need special rules for small businesses and/or self-employed — the MA model, perhaps? I’d prefer the Medicare — the common pool — model for all of these.
This model works fine in electricity and covers everyone without exception; it is more complex in health, because health service is not a single commodity (electricity is); it is a changing mix of services and products for each patient. But Medicare sorts this out for some, and I see no reason it couldn’t do it for others.
Again, thanks for coming by, and thanks for the great book.
From Henry:
From Jacob:
I think we have our agenda for the next two years.
“Just as businesses and entrepreneurs are encouraged by basic protections against financial risk to invest in economic growth, so adequate security encourages families to invest in their own future — something many now find quite difficult….”
I can see the advertising campaign now..
A trapeze artist on his perch, one hand grasps the bar. A look of determination on his face.
He steps out, swings higher..higher.. and goes into a triple twisting backwards flip…turns to grasp his partner… and misses.
…Falls into a net…
Narration: With the right safety net, he can go for it without worrying that a miss will ruin his life. You deserve the same.
I swear I saw Don Evans during a break between shows on PBS make a business announcement, saying how small business could make money by selling their small business to forigeners. I felt like he was encouraging the further sell out of American businesses.
Montag @ 145:
Don’t forget to close that loop. Plaintiffs’ lawyers are perceived as (and sometimes are) big contributors to Democrats at the state level. Cap punis = defund the left.
It’s all a seamless web. Which is fine if you’re a spider. If you’re a fly, not so much.
Jacob — thanks for joining us, maybe we can have you on at another time to talk about the topic, it seems to have sparked a lot of interest and I would very much like to keep it alive.
And Henry, thanks as always for doing an amazing job. It’s a great book, thanks so much for bringing it here today. I hope its influence becomes as pervasive as we all hope.
pigboy @
154
He is. That’s something to keep an eye on.
Sorry I just ran across this thread—somehow in holidaying I didn’t notice that Hacker’s book was on the slate; my copy is on the way, though. I notice that up in comment 59, Henry Farrell takes on the “individaul choice” meme. His example of the forced choice of privatized power companies is wonderful for a discussion of risk-shifting, because it illustrates that privatization—especially of utilities and the like where the demand is pretty inflexible, while the options for purchase at best are fairly few—can become a forced choice for consumers about what level of risk they have to accept.
Now, continuing the electric power example, there might be some consumers out there for whom the choice of the chartreuse company over the taupe one is more “meaningful” than the choice between a system where, say, a municipal or publically regulated utility company is required by law to commit to a well-defined price policy for a known period of time. However, in the name of trying to stay below my quick-rising anger level, please accept my apology for slipping into the Allardician mode of many economics textbook writers: I will leave the detailed analysis of the merits of the choice-as-a-universal-good argument for privatizing many goods whose markets work like public utilities, to the reader, as an exercise.
I recently ran for the Oregon House and below is my basic outline for a plan to cover everyone in Oregon with basic health insurance:
* The Oregon Health Plan would cover every child with Universal Health Coverage based on their families ability to pay.
* Every Oregonian would receive a wellness and prevention benefit. Check-ups, visits to clinics, visits to Primary HealthCare Providers and common medical screening will be available for a nominal co-pay based on your ability to pay. Health care experts and science would determine which screenings and tests would be available under the Plan
* The Oregon Health Plan would cover catastrophic illness with a stop/loss of $100,000. Oregonians would be required to sign a living will or similar such document to qualify. Hospice care would be part of this program
* The Health Insurance Industry and Medicaid would cover everything in between with some caveats. They must provide coverage for Mental Health and Women’s Reproductive Health.
* We’ll reduce prescription drug costs by allowing individuals and small businesses to benefit from the state’s bulk purchasing power.
* The Oregon Health Care Plan and the Health Insurance Industry would form a public/private Insurance company to cover those with chronic disease or those who would not be able to receive Health Insurance except at an exorbitant rate due to pre-existing conditions.