28 March 2010

The bill...

So, it's been a busy week but I'd be remiss not to post some thoughts about The Bill, as we've taken to calling it - especially given that I am preparing for a class debate about Medicare and have spent an inordinate amount of time learning about the system. (Incidentally, while I'm not crazy about single-payer, reading about Medicare makes it seem much, much more attractive.)

Das Binky has a great post about why mandated insurance is such an important part of the bill. Jacob Hacker - quoted on these pages before - agrees that, while not perfect, the bill is a good first step.

And despite concerns about the constitutionality of all this "mandating" - there seem to be some pretty capable minds who say, yes, this is all fair. I tend to agree with them because to take the other side literally would make, say, a progressive tax scale unconstitutional, and we all know that courts have repeatedly asserted that a progressive tax scale falls within the constitutional provision to tax and does not run afoul of any equal protection provisions.

On a side note, it was particularly rewarding to see my prof - an alum of the Clinton health reform wars - so excited in class this past Wednesday. "We've been teaching this class for years, and this is the first time we've had an expansion of entitlements of this magnitude in the history of the class!" she crowed. Later, she interrupted herself mid-sentence to gush about how excited she was to be finally moving in this direction.

Which is very germane because, going back to Hacker, government programs are especially subject to path-dependence. Half of the genius of Hacker's book/dissertation is chronicling how little steps can significantly restrict the range of choices going forward. Given Hacker's involvement in the writing of the public option and his support for even this neutered bill, he evidently believes that this version will ultimately put us on a path toward a public option which is, of course, fine by me.

It'd be nice if the plan did a bit more. Cost containment is of course the biggest issue, and to the extent that Medicare is successful in containing costs, this is largely a result of Medicare's stinginess. When you pay 81% of the rate that private insurers pay, and you cover fewer services, of course your expenses per enrollee will be lower. But Medicare provides a useful baseline for private insurers to measure their own fees against for a good that is notoriously difficult to properly value. However, the arguments against the bill, near as I can tell from Paul Ryan's roadmap - are basically just variants of the same old "market market market" argument, and I really dare anyone to argue credibly that health care is a normal good, and that health care consumers behave like consumers of other products and services. Not to mention the fact that the Paul Ryan plan is just phooey, from a budgetary standpoint.

I'm not sure where the cost containment will come from until we are able, as a society, to tolerate care that's just good but not ideal. In reality, we always demand the best, the most up-to-date, the most sensitive - and all of that costs more. Unless we are willing to have an honest debate about marginal gains in efficiency compared to marginal increases in cost without someone yelling out "death panel!", I'm not sure how we'll be able to ultimately contain costs. Tort reform is, sure, a part of it (because tort reform also eliminates incentives to always offer the most up-to-date-and-super-expensive care, and lest it sound like I'm arguing for crappy care, I'll just say that if we demand the best and always the best, we should be willing to pay for it. If we are happy to get good enough, we should be ok with the mild loss of quality too. And ideally, we'd be able to put a price on that trade-off, though this is also, of course, notoriously hard to do in the confusing patchwork of American social spending.

07 March 2010

RIP





Mark Linkous made a ton of beautiful music while he was alive. I remember driving through West Virginia about ten years ago and not being sure of what I was looking for. Listening to "Good morning Spider."

A few years later, I was seeing the Flaming Lips on the Yoshimi tour, and for the opening act, this weird guy came out and played a few songs by himself in front a weird projection screen. He wasn't announced before taking the stage nor was he officially on the bill, but by the second song I knew for a fact it was Mark Linkous. Everything I saw that night was consistent with the little that I knew about him - reclusive, shy, tentative. As the years went on and I heard more and more about him collaborating with fairly big names - Tom Waits and Danger Mouse, to name a few - I figured it was a sign that Linkous had realized he belonged, that he had peers, and I kind of tuned out.

The news of his suicide and the grizzly details are really hard to stomach. I rarely mean the phrase "rest in peace" literally, but I really hope Mark Linkous can.

02 March 2010

Still beer o'clock!

But first, let's test your memory. Remember how I once wrote about the Audacity of Hops Inaugurale? No? Fine.

Maybe you remember that more recently I wrote about JJF having some Westvleteren? Oh, you don't remember that either? Fine. I don't know why I bother somedays.

Anyway, readers and fractions thereof, I stand before you today to tell you that worlds are colliding. (When two worlds collide, no one survives, no one survives...)

The guy who brewed the Inaugurale apparently is in Belgium? Or something? That's what his gchat status says. But more importantly, he has a beer blog, and what's the first post I see when I head over to his blog? Worlds colliding, people. Perhaps the Onion was right. I'm getting a real Jacob's Ladder vibe from all this, and it's not just because tonight is Lostnight. Be careful out there, kids. The reddest of reds, the bluest of blues - the saddest of songs I sing for you (if you're beer-less.)

Soundtrack for this post courtesy of the late Mark Sandman.

01 March 2010

Eels! Again!

Slate has a great piece about the life of an eel, but of course, astute readers of Abstract Citizen (all 2.7 of you!) already knew all about it from this post. Right? RIGHT???