To save money, don’t exclude the poor, exclude the sick

The Republican privilege-principle of Tyler Cowen, Bryan Fischer and Rick Perry isn’t just morally monstrous, it’s also bad economics.

“We need to accept the principle that sometimes poor people will die just because they are poor,” says Cowen.

“There is simply no way to control the cost of health care if hospitals are obligated to provide healthcare to all regardless of their ability to pay,” says Fischer.

But they’re both wrong. Poor people aren’t the source of the runaway cost of health care, and — even though there are so many of them — denying poor people access to health care still wouldn’t save much money.

It’s sick people, not poor people, who are responsible for the high cost of health care. There’s no savings to be had from excluding the poor, but trillions can be saved by excluding the sick.

Insurance companies figured that out a long time ago. That’s what all that “pre-existing condition” stuff was all about.

I appreciate that for people like Cowen and Fischer, kicking sick people when they’re down doesn’t provide quite the same emotional satisfaction as dancing on the backs of the poor, but once they realize the scale of the economic savings at stake here, I think they’ll come around to appreciate the insurers’ position.

They’ll see that, to paraphrase Cowen, “We need to accept the principle that sometimes sick people will die just because they are sick.” And if we’d just allow that to happen without trying to interfere, we’d at last have a real free market in health care.

This shift — rejecting the sick instead of rejecting the poor — could also provide what Cowen and Fischer personally need from a health care system. For Cowen, being healthy, it would reassure him that he is a winner and not a loser. And for Fischer, being healthy, it would reassure him that he is among the righteous and not among the damned.

And when it comes down to it, that’s all either man really needs. The costs and the political wrangling are just a sideshow to what they’re really looking for in health care policy: a sense that their lives have meaning (by which they mean a sense of being better than other people).

OK, enough morbid snark, here’s a more hopeful story as we wait to hear whether or not the Supreme Court has decided that the Constitution requires us to exclude sick people from health care. John Blake of CNN shares the conversion story of a former health insurance executive:

When Wendell Potter first saw them, he froze.

“It felt like touching an electrical fence,” he says. “I remember tearing up and thinking, how could this be real.”

Thousands of them had lined up under a cloudy sky in an open field. Many had camped out the night before. When their turns came, doctors treated them in animal stalls and on gurneys placed on rain-soaked sidewalks.

They were Americans who needed basic medical care. Potter had driven to the Wise County Fairgrounds in Virginia in July 2007 after reading that a group called Remote Area Medical, which flew American doctors to remote Third World villages, was hosting a free outdoor clinic.

Potter, a Cigna health care executive who ate from gold-rimmed silverware in corporate jets, says that morning was his “Road to Damascus” experience.

“It looked like a refugee camp,” Potter says. “It just hit me like a bolt of lightning. What I was doing for a living was making it necessary for people to resort to getting care in animal stalls.”

The U.S. Supreme Court’s decision Thursday on the constitutionality of the Affordable Care Act is a colossal legal and political issue. For Potter, though, the issue became a crisis of faith.

  • Don Gisselbeck

    Potter is an outlier, only way the rest of the predator class will change is to guillotine half of them.

  • Tonio

    Improving the health care system by excluding the sick? Frank Burns lives!

    “I wouldn’t mind being a
    doctor if I didn’t have to be around sick people.”

    “I’m sick of hearing about the wounded. What about all the thousands of
    wonderful guys who are fighting this war without any of the credit or
    the glory that always goes to those lucky few who just happen to get
    shot?”

    “It’s the way these yellow devils think. It’s burned into their brains.
    Kill Americans, kill, kill. They don’t respect human life the way we do.
    I’d like to take him out and shoot him.”

    “Funny thing, war: never have so many suffered so much so so few could be so happy.”

    “The way I see it, unless we each conform, unless we obey orders, unless
    we follow our leaders blindly, there is no possible way we can remain free.”

  • Lori

    For Cowen, being healthy, it would reassure him that he is a winner and
    not a loser. And for Fischer, being healthy, it would reassure him that
    he is among the righteous and not among the damned. 

    We don’t actually know that either Cowen or Fischer are healthy. Many health conditions aren’t obvious and neither one of them is such a public figure that his personal business is all over the internet for all to see. Either of them could have diabetes or a heart condition or high blood pressure or any number of other illnesses that could be life-threatening without proper treatement.  And if they are healthy it’s still virtually guarunteed that someone they care about isn’t.

    Which is obviously why they will never come out in favor of excluding the sick instead of the poor. Both Cowen & Fischer have money and feel confident that they will always have money. They know that they may not always be healthy.

    As always, Right wing economics = I got mine, screw you. If they were remotely honest at least half of Right wing blog posts, newspaper columns and talk show appearances would consist solely of those 5 words. That wouldn’t pay though, so they’ll continue to use thousands of words where 5 would do.

  • Lori

    Fortunately, SCOTUS appears to have upheld most of the provisions of “Obamacare”, including the mandate, so Republican attempts to allow poor people to die have hit a bit of a snag.

  • LL

    Almost anything that denies the Republicans a political victory is alright by me. 

    And of course the Republicans focus on poor people. Most poor people don’t appear to vote Republican, if they bother voting at all. The largest amount of health spending in this country goes to old people, who mostly vote Republican. If Republicans focused on the gigantic amount of money being spent to keep old, sick people alive, they’d be attacking their largest (most numerous) constituency.

  • Lori

    Brian Fischer’s tweet about the ruling:

    http://3.bp.blogspot.com/-JeFJscF-qEo/T-xv7wjFJiI/AAAAAAABcns/cMuVztaz3Qc/s1600/fischerscotus.jpg

    Just knowing that he’s unhappy really brightens my day.

  • Nirrti

    I’m game. I have first dibs on pulling the lever. You’ll have to build it, though.

  • Nirrti

    (Warning, crude language ahead)
    -
    -
    -

    Fuck him….just…Fuck his sorry, poor excuse for a snake let along a human being, ass.  And the name of his organization has the word, “Family” in it?

    Since he believes so much in the “family”, take his health insurance away and let his relatives pay his medical expenses. If he gets too old and infirm , just do it like the good old days, sit him on an ice flow in the Arctic and letting him float away.

  • http://apocalypsereview.wordpress.com/ Invisible Neutrino

    Wendell Potter reminds me of the story about the original owner of the Hilton hotel chain, Paris’s grandfather. He became so concerned and worried about the plight of the poor that he carefully crafted his will to donate about 90% of his wealth to various charities.

    His descendants, not satisfied with a decent slice of a growing commercial empire, managed to get the will overturned.

    All it takes for bad to triumph is for good to be less than 100% vigilant.

  • Vermic

    My co-worker is also grumbling about the ruling.  Knowing the Fischers of the world are upset, that to me is a positive thing in itself.  It’s not schadenfreude as such; more a recognition that these people are so reliably retrograde in all ways that when they’re unhappy, it must mean something good has happened somewhere.

  • VMink

    So where was this jackwagon when Bush the Younger imposed ‘Free Speech Zones,’ implemented the idea of the ‘unitary executive,’ arranged for ‘extraordinary rendition’ and torture, and lied us into a war?

    Oh, that’s right.  Said jackwagon was cheering the collapse of the republic along.

  • SkyknightXi

    The idea of the Free Speech Zones is kind of amusing, given that Bush was/is a resolute Christian. Did he not remember Amos 7? (q.v. what Amaziah had to say to Amos)

    As for having to execute the archons…rank fatalism. They have free will, therefore they can be swayed. I see no reason to believe they are merely automatons. Of course, this is also coming from someone who thinks the 1:25 incidence of sociopathy (I forget whether it was in the population in general, or just CEOs; if the latter, then 1:250  or 1:2500 for the former) is kind of high. 1:250,000 maybe…

  • Robyrt

    To a certain extent, yes, we do need to exclude some sick people to save money. That’s what palliative care is all about. But it’s a tough subject and there are lots of opinions on where to draw the line between “do not resuscitate” and “preexisting conditions”.

  • http://jamoche.dreamwidth.org/ Jamoche

    Looks like CNN jumped the gun a bit. Love the historical reference.

  • LMM22

    To a certain extent, yes, we do need to exclude some sick people to save money. That’s what palliative care is all about.

    Medical triage, I think, is more like it.

    And, yeah — the whole process of end-of-life-care is just so ridiculous as to be nonsensical. (There’s *very* solid evidence that, when a doctor actually sits down with a patient and spells out the risks and chances of a last chance treatment, they’re likely to not go through with it. But we don’t pay for that sort of thing.)

  • Monala

    Who was the anti-universal healthcare person mentioned in the movie “Sicko,” whose wife became really ill with cancer? The guy ended up begging for donations for her health care on his blog, and refused a major donation from Michael Moore just out of principle.

  • Dmoore970

    Well, there’s the trouble.  Some people will die just because they are sick.  In the long run, everyone.

  • http://www.facebook.com/people/Charity-Brighton/100002974813787 Charity Brighton

    (There’s *very* solid evidence that, when a doctor actually sits down
    with a patient and spells out the risks and chances of a last chance
    treatment, they’re likely to not go through with it. But we don’t pay
    for that sort of thing.)

    Isn’t that the “death panel” thing? I think that stayed in the final PPACA bill. At least, I don’t remember it being dropped…

  • Mark Z.

    Sure. The health care system has finite resources; therefore it has to do some kind of allocation*. The question then is whether to allocate based on concerns like “how disabling, painful, or deadly your disease will be without treatment” and “whether this treatment will work”**, or to just give the rich first dibs on everything. Cowen’s argument is that the rich have first dibs on everything else, so why should this be any different? That’s because Cowen is both an Objectivist dipshit and a lawyer with lots of money.

    (Isn’t it funny how we can all think of rich and poor Christians, and rich and poor Buddhists, and rich and poor Muslims, and rich and poor atheists, but there are no poor Objectivists? Must be that being an Objectivist makes you so damn cool that money just condenses out of the atmosphere onto your body. Yeah, that’s it.)

    * “Rationing” is what you call it when the allocation is done in a way you don’t like.

    ** In end-of-life care there’s often the option to try some expensive, long-odds treatment that might, say, buy the patient a few extra months. If insurance companies really were in the business of efficient allocation, they’d never pay for crap like Avastin, but they very often do, even while denying basic primary care to the poor. Why? Because insurance companies are machines for allocating health care to the rich. Duh.

  • http://lliira.dreamwidth.org/ Lliira

    There are a couple things that would both save a lot of money and be completely moral and humane and backed up by science.

    First, universal healthcare, period.

    Second, stop focusing on weight loss. It does not work, and there is lots of evidence that shows it causes actual harm.

  • Mary Kaye

     Another thing shown to save lots of money and be moral, humane, and backed by science is regular nurse visits to the homes of babies and toddlers.  I think the estimate was that for every $1 spent on this you save $17 in the long run.

  • Cathy W

    I recall the “death panel” thing being, and I’m not paraphrasing all that much, a requirement for Medicare to pay for your doctor to sit down with you and make sure your end-of-life planning reflects your wishes while you’re not in immediate need of it. That’s not quite what you’re talking about, but I do recall that one of the objections was that your doctor will obviously encourage you to not pursue life-extending treatment in the name of saving precious rationed health-care for the young…

  • Monala

     IIRC, that part of the bill WAS taken out before final passage. But here’s the thing: the requirement didn’t force you to sit down with your doctor and discuss end-of-life planning. All it required was that Medicare pay for the office visit if you chose to have that discussion.

  • Alger

    Back in the young days of RSS I used to read Tyler Cowen’s blog ‘Marginal Revolution’ that he shares with another libertarian economist (Alex Tabrrok), partly because it was a little fun, partly on the principle that knowing what the next wave of Freedom-Fries economics was gonna look like, and partly because there weren’t that many options of RSS feeds.

    For reasons of inertia I kept the blog on my feed for about five years. Right around the time the subprime market blew up, and the auto industry was blinking out, and universal health care became a centerpiece issue the blog changed.
    See before 2007 the blog was an admixture of cheerful economics stories that you could laugh at because they were funny, or because they were so statistically correct that they were abstract absurdities.
    Then right when the world started to fall apart and there was a real desire for hope and  advice from economists the postings got mean-spirited. In the spirit of debate I pointed this out in the comments, pointing to evidence that may a measure of compassion was called for when people were losing their homes, hungry, getting ground down by austerity. From this I learned that you can’t debate with a libertarian, you can only shout.

    Then came the day that I discovered that Cowen had purged all my comments from the blog. I promise you that I was less rude than the gasbags that got to stay.

    So I quit the blog.

    I am reminded of Utah Phillips:
    “Decided that talking to a conservative is like talking to your
    refrigerator… You know, the light goes on, the light goes off; it’s not
    going to do anything that isn’t built into it… And I’m not going to
    talk to a conservative anymore than I talk to my damn refrigerator…”

    My life is all the better for closing the refrigerator door.

  • http://apocalypsereview.wordpress.com/ Invisible Neutrino

    Actually, I thought the guy took the money and then went right on trashing Michael Moore anyway.

  • Ursula L

    “People who are sick will die because they are sick.”

    Isn’t that all of us, in the end?  

    No matter if we are rich or poor, whether or not we have access to good health care, every one of us, eventually, will be sick or injured in a way that we will die from.  Even with the best medical care, we’ll die, just because we’re  sick, that sick.  

    If we structure our health care system to prevent people from dying, it will, in the end, have a 100% failure rate.  

    Health care isn’t about keeping people from dying.  Its for improving their living, how they feel while alive, extending the amount of time when they’re alive.  And a good health care system can’t treat death as the enemy, to be pushed off indefinitely, whatever the cost. It includes things like hospice, which are not about preventing death but about supporting people through the transition from life to death.  

    If we make not dying the standard by which we measure our health care system, then we’re doomed to failure, because no matter how much time, money and energy we throw at the problem everyone eventually dies.  And someone limping about on an untreated broken ankle isn’t dying, and therefore their pain isn’t part of the measure of the success or failure of our system.  

  • Tricksterson

    To me Frank Burns always embodied pure, unfiltered evil.  Although nowadays Joffrey Baratheon-Lannister gives him a good run for his money.

  • Tricksterson

    There are reasons why the French Revolutionary Republic collapsed and wound up with Napoleon.  I wouldn’t reccomend emulating them.

  • Tricksterson

    Actually my father, and me when I was one, were poor Objectivists.

  • Matri

    “It just hit me like a bolt of lightning. What I was doing for a living
    was making it necessary for people to resort to getting care in animal
    stalls.”

    This is what will define us and separate us from empathic compassionate human beings… from the Republicans.

    Which side will you be on?

  • Mark Z.

    I stand corrected.

  • Randall M

     From Wikipaedia:

    “Finally, Moore addresses the audience, emphasizing that people should be
    “taking care of each other, no matter the differences”. To demonstrate
    his personal commitment to this theme, Moore decides to help one of his
    biggest critics, Jim Kenefick. According to a blog posting, Kenefick
    feared he would have to shut down his anti-Moore website because he
    needed US $12,000 to cover the costs of medical treatment for his sick
    wife. Not wanting the U.S. health care system to trump Kenefick’s
    ability to express his opinion, Moore sends Kenefick the money
    “anonymously”.”

  • http://www.facebook.com/people/Alan-Alexander/502988241 Alan Alexander

    For the most part, but Larry Linville managed to find depths despite the writers’ insistence that the character was a 2-D caricature. There were several episodes that hinted at him being subjected to profound psychological abuse by his father as a child, if not physical abuse of some kind. I was always sad that they never even tried any sort of redemptive character growth for Burns comparable to how his pompous bigoted douchebag of a replacement Maj. Winchester was allowed to grow into a character of enormous depth and my single favorite character on the show.

  • Tricksterson

    Well he talked the talk but, being a hopless alchoholic who got fired a lot for not showing up he didn’t walk the walk very well.  Also he had some doctrinal differences with Rand like being against abortion and being a deist instead of an atheist.

    My own problems with her was that she actually believed it was possible to improve the world and, eventually, that there’s such a thing as objective reality in the first place.

  • Don Gisselbeck

    You are of course correct, violent revolutions ususally replace one set of predators with another of different lineage. The problem I see is that propaganda has become so good that there doesn’t seem to be a peaceful way to limit the power of these sociopaths.

  • BaseDeltaZero

    My own problems with her was that she actually believed it was possible to improve the world and, eventually, that there’s such a thing as objective reality in the first place.

    Of all the many valid reasons to disagree with Rand, you’ve managed to find one potentially more frightening than the thing itself…

  • Münchner Kindl

    Potter had driven to the Wise County Fairgrounds in Virginia in July 2007 after reading that a group called Remote Area Medical, which flew American doctors to remote Third World villages, was hosting a free outdoor clinic.

    Sadly, that’s why this epiphany will stay a single instance – a miracle – and not become a turning point in general for executives or politicans: in order to see the effects of their policies, they need to activly get out of their way. The default is that they never ever interact with the poor. And to seek out contact with them already shows an inkling of self-awareness beyond the common sociopathic which the market mechanisms usually award with executive positions.

  • Münchner Kindl

    Wendell Potter reminds me of the story about the original owner of the Hilton hotel chain, Paris’s grandfather. He became so concerned and worried about the plight of the poor that he carefully crafted his will to donate about 90% of his wealth to various charities.His descendants, not satisfied with a decent slice of a growing commercial empire, managed to get the will overturned.

    Sounds to me like the robber-barons of the 19th century who after making milliards by robbing and ruining people, then at the end of their life donated a few millions – with the added bonus of having a concert hall, or a library, or a college building, bearing their name forever.If old man Hilton actually was interested in helping the poor stop being poor, instead of just a few cosmetic feel-good measures, he would have made sure to pay above minimum wage for the invisible people in hotel business (chamber maids, dish washers, linnen washers). He would have started a training program to give poor kids who can’t afford college a chance to become a high-class waiter or similar. And then, esp. since he should’ve known what type of people his family was, he shouldn’t have written his will, but started foundations during his lifetime, with trustworthy people at the top.Once the money is given away, you can’t call it back, so you give during your lifetime not after death. Heck, even in the famous slavery book that’s how things got worse – the nice white man promising to free the black character upon death, but dying without a will. If he had freed him before and kept as employee, the whole dramatic story couldn’t have happened.

  • Ima Pseudonym

    For every Wendell Potter who wakes up, there’s a Tyler Cowen or a Bryan Fischer who looks across that field full of sick and ailing people and feels nothing but cold fury that someone is getting something for free.  Those men have dead souls. 
     

  • Sgt. Pepper’s Bleeding Heart

    Which is why the rich would be better donating their money while still alive.

  • Sgt. Pepper’s Bleeding Heart

    To a certain extent, yes, we do need to exclude some sick people to save money. That’s what palliative care is all about.

    No, palliative care is all about minimising the suffering of dying people. Not saving money. What the hell is wrong with you?

  • Tonio

    Linville said that he left M*A*S*H because he felt he had taken the Burns character as far as he could go. The Winchester character gave me the impression that the writers had learned a little, or else had been watching the intergenerational sparring on All in the Family. Winchester was a more equal antagonist for Hawkeye and B.J. instead of a punching bag. The book and movie versions of Burns appear to satirize a type of arrogance found among some doctors, whereas the TV version might have been an attempt to ride Archie Bunker’s coattails, embodying a broader combination of arrogance and stupidity. Very easy for me to imagine Burns aging into a true Tea Party grump had he lived in a different era – “Keep government out of my Medicare” is a perfect real-life Burnism.

  • http://apocalypsereview.wordpress.com/ Invisible Neutrino

    According to Wikipedia, he had a foundation. His will was set to give 97% of whatever he owned to that foundation on his death.

    You can argue the man’s common sense, but credit him with more faith in humanity than his descendants, because he presumably believed his kids would never be so mean-spirited as to try and get the will overturned. He died before the ‘greed era’ of the 1980s, too, so he had no personal experience of the kind of naked pandering to selfishness that Reagan ushered in and made fashionable.

  • Consumer Unit 5012

    Dubyah Bush _said_ he was a resolute Christian.  I think his actions paint him as a fervent devotee of the Church of Mammon, though.

    “What a lot of people are worshiping MIGHT NOT BE JESUS.” – J. R. Dobbs.

  • Tricksterson

    Keep in mind that the author of the book, while liking the movie hated the series.  He was far more conservative than Gelbart  &Co.

  • Tonio

     Hooker’s political tilt isn’t obvious in the first book, although I caught a reference to a later book where Hawkeye bashes liberals. I suspect that the author’s contempt for the brass might seem foreign to modern conservatives.

  • Beroli

     

    Of all the many valid reasons to disagree with Rand, you’ve managed to
    find one potentially more frightening than the thing itself…

    One? Not two?


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