Gaps in Coverage and in Logic

In an article in the Washington Post this morning it came to light that President Bush would veto bipartisan legislation to continue a program that provides health insurance to low income children who’s families are not poor enough to qualify for Medicaid and aren’t rich enough to afford private insurance.

Now I could write a post about how President Bush has squandered an opportunity to pass important compromise legislation and finally start to reclaim that “compassionate conservative” moniker he was peddling back in 2000, but I won’t. Everyone in this country is aware of President Bush’s ideological zealotry to all things conservative, no matter the consequences. This has made him a literal God-send for many and the proverbial Anti-christ to others.

Instead, inspired by the file Sicko, this will examine how critical a program like this is, as well as serving as a primer for my own economic analysis of healthcare and the paradoxical conflict within the healthcare industry that our country has yet to solve. I won’t focus on the political sniping in Sicko, as I think those are Michael Moore’s weaker, or at least, more-open-to-interpretation arguments.

The program, known as the State Children’s Health Insurance Program, provides coverage to the most helpless among us when their families can not afford health insurance coverage. Apparently President Bush thinks their families should pull themselves up by the boot straps and find coverage at the expense of education, gas for their cars, or maybe food. It’s hard to say where these working poor are supposed to go for affordable coverage. Why is there no affordable coverage? Because your basic economic model is topsy-turvy when applied to the health care industry. We’ll look at a basic economic principle everyone should know and how the health care industry distorts it.

Competition:
In your everyday marketplace prices of good and some services face constant downward pressure from competition within in the industry. Factors like substitutability of goods and price elasticity prevent products from reaching perfectly competitive price levels where the consumer completely determines the price.

Let’s take an example. You find a shirt at Abercrombie & Fitch (because that’s how you roll) for $45. This is your standard issue Tshirt except this one has the Abercrombie & Fitch logo on it. You’re not quite sure you want to spend the money on it. You decide to shop around for different Tshirts which may not have the A&F logo on them, but very likely will be cheaper. Finally you find yourself at target and see a Tshirt of lesser quality and sans A&F logo, but it costs $15. This process of searching has taken 72 hours. You decide that in actuality A&F is not how you roll and buy the shirt at Target for $15. The substitutability of the Target shirt was sufficient for you to warrant buying it.

Let’s apply this to the healthcare industry. Let’s go back to the mall. You find yourself in Abercrombie & Fitch again, pining over a different hipper shirt, when suddenly that food court Chinese food completes the mounting arterial blockage, thrusting you into a severe heart attack at an early age. Medical personnel rush to your attention. They have sworn and oath to assist people who are ill regardless of fiscal status. They throw you in the back of an ambulance. Sirens ablaze they get you stabilized in route to the hospital, but you have since ceased being conscious. No one has quoted you a price or if the sirens cost extra. You arrive unconscious at the hospital and after looking over your vitals it becomes clear you’re still in dire straits and need bypass surgery very soon or else risk dying. So they we’ll you up to the OR, while unconscious. You’re unconscious so they don’t ask if you want standard, premium, or super premium care. Worse yet, they can’t even ask you if you’d just rather die to avoid the expense. By the way they don’t tell you how much this is going to cost. In all likelihood they can’t tell you. They are doctors and nurses bound by the Hippocratic Oath to care for your sorry A&F gazing ass whether you’re rolling AMEX Platinum or moths fly out of your wallet. The doctors are successful, you life is saved and you regain consciousness to find yourself with a killer new scar and lots of painkillers in your blood stream. Total expense $50,000. You protest, “Wait, someone could have done this for less. I’m almost certain Wal-Mart put a surgical center next to the Tire and Hair Care center.” Yet your protests are to no avail. The market has failed you because you couldn’t choose in those moments of unconsciousness. Decisions were made for you and charges were accrued in your name without your knowledge, like identity theft, only this time Visa doesn’t forgive the $3000 some charged at Chipotle for apparently a year’s supply of burritos. No, you’ve got to pay it now.

“But wait.” my critics will quickly retort, “the competition comes in the selection of health insurance.” Does it? When you take a job, nearly any job, if it comes with health insurance do you pick the provider or do you pick the plan? Typically people working for large organizations who usually get some of the best coverage pick a plan, Chinese menu style, from a brochure from one insurance company. So what really ends up happening is that your large company picks a large health insurance company to provide coverage to its workers. Neither of these entities care too much about your well being. They are entities motivated by profit, for your company that means selecting a provider with coverage just good enough to entice people to work there. That is a low bar when people just desire to be covered. For the health insurance agency it means doing everything possible to pay as little as possible. Neither entity is wrong to want to maximize profits. That is their motivation in the economy and a noble one that has propelled the U.S. forward, but it is not way to price health coverage.


Healer Profit Margins
My final retort is based as much on morals as it is on economics. People should not profit from healing others. Doctors should be afforded a certain level of luxury. It is a life calling they have signed on for with extensive schooling and near constant mental and physical stress to accomplish their task, but insurance executives, pharmaceutical executives, and medical supply executives should not get rich making things people need to live. Those who make life saving drugs and then make sure no one can afford them, or those that promise to cover the exorbitant expenses of healthcare by accepting a customers premiums and then refusing to pay are morally weak people.

Humanity and healing should not have a price and they should not have a profit margin. The industry is broken because the industry fails to adhere to the economics that drive every other market and because they profit from the pain of others.

This is not a blanket endorsement for nationalized health care. There are many pitfalls to such a system, but at the very least, shouldn’t this country do what it can to ensure every child is insured? Shouldn’t that be beyond ideological squabbles of public vs. private enterprise? Aren’t children the unquestioned future of our republic? Shouldn’t we do whatever we can to give them at least the best physically capable bodies to follow their dreams? Apparently for this president the answer to all these questions is no.

[President Bush] [Sicko] [healthcare]

Ignorance is Not an Excuse

In the Washington Post this morning there is an article which outlines how Attorney General Alberto Gonzales may have lied to Congress by stating that no civil liberties violations had occurred in the course of the FBI utilizing the PATRIOT Act, despite being furnished with a report that detailed several such violations.

It would appear that most of the civil liberties infractions that have been reported occurred due to procedural or clerical error. This does not excuse the infractions, but at least no malicious infractions have yet been cited.

Now for Gonzales to be prosecuted for lying to Congress it must be proven that he read the reports. This would seem to imply that the White House and the Justice Department will simply state that Gonzales didn’t see or read the reports. I don’t know about you, but I can’t stomach incompetence or ignorance as excuses for lying anymore. You can almost hear the choir now. “AG Gonzales didn’t read the report.” “AG Gonzales couldn’t read the report, because too much paper crosses his desk.”

I’m sorry but ignorance is no excuse and incompetence, while perhaps preventing you from being a liar, makes you incapable of handling your job. Guess what happens in the real world when you fail to read important reports and give (let’s assume unwittingly) false statements to the people that represent your boss. Let’s remember folks, while the Attorney General isn’t elected he is responsible to us the people at the end of the day, as if everyone in our government. You get fired. You get dragged before your supervisor and let go.

This isn’t a new refrain, but it’s time for Gonzales to go. Either he is a liar and should be prosecuted or he is incompetent and should be fired. Regardless there can be little doubt that he lacks either the ethical fortitude or the intellectual capacity to lead the legal battle in this War on Terror.

Will he be fired? Probably not. President Bush is loathe to go through a confirmation process with a Democratic Senate, but just because he doesn’t like how the game is played doesn’t mean it’s fair to the American people. We deserve competent and ethical leadership in this country. Attorney General Alberto Gonzales has repeatedly shown, through the firing of US Attorneys, through his abysmal appearance on the Hill to explain said firings, and this most recent revelation that he is unfit to lead the Justice Department in these most treacherous of times.

Ignorance is no excuse. Incompetence is no explanation. I won’t go so far as I’m sure some of my blogging brethren will do to claim that Gonzales is a liar, but he is a managerial idiot and in the America I know if you grossly neglect the responsibilities of your job you get fired. Of course it’s proven true many times before that President Bush doesn’t comprehend the America I know.

[Alberto Gonzales] [FBI] [Congress]

Why Libby Didn't Go To Jail

I am not a conspiracy theorist. If you read my posts at our sister blog, The District Dialogue, you know that I might simultaneously be overly idealistic and morally pliable, but I am no conspiracy theorist. I tend to believe that every decision the White House has made over the past 6.5 years has been done in the pursuit of what they thought was right, or at the very least what was in their self-interest. Now these two decision motivations are often times in conflict and I have two reasons as to why I think Bush commuted Libby’s sentence.

Reason #1
Bush commuted Libby’s sentence to protect the White House. You see, if someone is pardoned they can no longer claim fifth amendment rights regarding the crime either in a courtroom or a Congressional hearing room. Libby was almost certainly involved in nearly every aspect of the War on Terror and the constitutionally questionable procedures cranked out by the administration. As Dick “The Angler” Cheney’s number one guy, there is little doubt that Libby knows a whole lot about the internal deliberations inside the White House.

Libby could have been subpoenaed by Congress and, had he been pardoned, compelled to provide any information he had at the very least regarding the Valerie Plame imbroglio. As it stands right now, with Libby committed to appealing the verdict, he can not be compelled to reveal anything.

This sounds very conspiracy theory-ish, but really it’s just good politics and if there is one thing everyone has to admit, it’s that the Bush administration plays politics like few that have come before. Is it a brand of secret and poisonous politics that has thrust this nation into a period of constitutional decay and governmental crisis, yes, but it has been artful.

Reason #2
The other reason Bush simply commuted the sentence is to ease people into a full pardon. How many times have we seen the administration slowly back track from positions? There was the torture debate, then the NSA wiretapping, and now Scooter Libby. Bush was facing very loud calls from his conservative base to fully pardon Libby. He was also facing the possibility of driving his approval ratings further into the ground with a full pardon. So let the back tracking begin. First anyone involved was going to be fired. Then he wasn’t going to comment. Then he wasn’t going to say what he was thinking regarding a pardon. Finally faced with a judiciary that reasonably and responsibly reviewed the case said that Mr. Libby would not be roaming the streets as the case meandered through our legal system, the president stepped in.

You’ve already heard the talking points. Mr. Libby still has to pay a $250,000 fine. He’s still a convicted felon. Seems tailor-made to blunt the blow back from his commutation. “No, see, Libby is being punished, he’s just not going to jail.” I would not be at all surprised to see Bush fully pardon Libby on the last day of his term. Let the masses roar then, when Bush flies out of Andrews and on to Crawford. It’s really hard to hear the cries of injustice when you’re cutting down brush in your backyard.


I could write a dissertation on why conservative pundits are ludicrous when they attack the legal process, but I won’t. The arguments lack merit in fairly obvious ways. Suffice to say that there shouldn’t be exceptionalism in the American justice system. There will always be cases that deserve a second look, but this was not one of them. I give the president credit for finding the middle path that resulted in irritating everyone without having the full hammer stroke of disapproval come down.

Also, congratulations to Scooter Libby who managed to avoid jail time after lying during the course of a federal investigation in the leaking of the name of a covert CIA operative. We’ll never know the full extent of the damage caused by this leak and the deception that came in its wake because Valerie Plame’s agency assets will never be revealed, I just hope no one died to protect this White House. Wait. Well I hope that no one died in relation to this incident. I feel disgusted a little right now.

[Libby] [Bush] [commuted]