Monday, January 08, 2007
The Sinking of the Tyrannic
This is a fable. I just made it up. It's about California politics, particularly the Governor's plan to provide health insurance for the children. He won't ask for a tax increase, you see, and to pay for the insurance he's going to take some benefits away from people on welfare.
The mighty cruise ship Tyrannic carries 2000 passengers and 20 lifeboats for the passengers. Each lifeboat is big enough to hold 100 adults without capsizing. However, some of the lifeboats are equipped with comfortable seats and wet bars and other amenities for the first class passengers. There are 200 first class passengers and each first class life boat will comfortably accommodate 40 adults. Five of the lifeboats are equipped for the first class passengers; the other 15 are equipped for the second class passengers.
The Tyrannic has struck an iceberg and is sinking. The Captain, Arnulf Svartberg, directs the first class passengers to the first class lifeboats and directs his first mate, Hans Gjarneman, to direct the second class passengers, all 1800 of them, to the second class lifeboats. Hans points out that there are only 15 boats for 1800 people. In order to accommodate everyone, he will have to put 120 people in each lifeboat. He states that the extra weight will almost certainly capsize the lifeboats.
He suggests that 1500 passengers be assigned to the 15 available lifeboats and that the other 300 be assigned to the five first class lifeboats. It would be necessary to remove the wet bars and some of the comfortable seats to make room for the extra occupants, but the result would be that each of the 20 lifeboats would contain one hundred individuals and all of them would then float and all passengers would be saved. Another ship was on the way but would not arrive for several hours.
Captain Gjarneman demurs. He says that it would be very bad business for the cruise line to crowd the extra passengers in among the first class passengers. If word of such a thing got out, wealthy people would no longer book cruises on the line but would travel on other ships. His solution is to assign just the women and children to the 15 lifeboats. The persons left out would all be men. They would be given life jackets so that they would float and not drown immediately in the cold water.
The captain's word is law at sea. 300 men are given life jackets. The other 1500 second class passengers are directed into lifeboats. The 20 lifeboats are lowered to the sea. The 300 men with life jackets jump into the water. The ship sinks. The water is cold, one degree above freezing. By the time the rescue ship arrives, the 300 men in life jackets are still floating, but they've all died from hypothermia.
To relate this fable to our Governor's proposed fix to the health care crisis, the first class passengers on the Tyrannic correspond to the millionaires and wealthy businessmen of California who, the Governor fears, will close their businesses and leave the State if they are asked to pay a bit more in income tax. The uninsured children and the people on welfare correspond to the 1500 second class passengers. The Governor decides which group of residents is the least influential, either politically or economically, and lets them swim or freeze on their own. Children command a bigger voting constituency than families on welfare. In any case, he refuses to disturb the first-class residents.
The mighty cruise ship Tyrannic carries 2000 passengers and 20 lifeboats for the passengers. Each lifeboat is big enough to hold 100 adults without capsizing. However, some of the lifeboats are equipped with comfortable seats and wet bars and other amenities for the first class passengers. There are 200 first class passengers and each first class life boat will comfortably accommodate 40 adults. Five of the lifeboats are equipped for the first class passengers; the other 15 are equipped for the second class passengers.
The Tyrannic has struck an iceberg and is sinking. The Captain, Arnulf Svartberg, directs the first class passengers to the first class lifeboats and directs his first mate, Hans Gjarneman, to direct the second class passengers, all 1800 of them, to the second class lifeboats. Hans points out that there are only 15 boats for 1800 people. In order to accommodate everyone, he will have to put 120 people in each lifeboat. He states that the extra weight will almost certainly capsize the lifeboats.
He suggests that 1500 passengers be assigned to the 15 available lifeboats and that the other 300 be assigned to the five first class lifeboats. It would be necessary to remove the wet bars and some of the comfortable seats to make room for the extra occupants, but the result would be that each of the 20 lifeboats would contain one hundred individuals and all of them would then float and all passengers would be saved. Another ship was on the way but would not arrive for several hours.
Captain Gjarneman demurs. He says that it would be very bad business for the cruise line to crowd the extra passengers in among the first class passengers. If word of such a thing got out, wealthy people would no longer book cruises on the line but would travel on other ships. His solution is to assign just the women and children to the 15 lifeboats. The persons left out would all be men. They would be given life jackets so that they would float and not drown immediately in the cold water.
The captain's word is law at sea. 300 men are given life jackets. The other 1500 second class passengers are directed into lifeboats. The 20 lifeboats are lowered to the sea. The 300 men with life jackets jump into the water. The ship sinks. The water is cold, one degree above freezing. By the time the rescue ship arrives, the 300 men in life jackets are still floating, but they've all died from hypothermia.
To relate this fable to our Governor's proposed fix to the health care crisis, the first class passengers on the Tyrannic correspond to the millionaires and wealthy businessmen of California who, the Governor fears, will close their businesses and leave the State if they are asked to pay a bit more in income tax. The uninsured children and the people on welfare correspond to the 1500 second class passengers. The Governor decides which group of residents is the least influential, either politically or economically, and lets them swim or freeze on their own. Children command a bigger voting constituency than families on welfare. In any case, he refuses to disturb the first-class residents.
Labels: California, Health care for children, Schwarzenegger, welfare
Tuesday, December 26, 2006
More about Universal Health Care
Today (St. Stephen's Day, 2006) blogger and writer Ezra Klein writes in the Los Angeles Times that the days of our present broken health care system are numbered. The present system is based on providing subsidized health insurance as a perquisite of employment. Employers are beginning to abandon the system because of the rapidly increasing cost of health insurance.
What are the alternatives? Klein lists two models:
Mr. Klein sees the acceptance of the failure of the present system as a hopeful sign. There is recognition of the need for health care to be universally available to all regardless of income. One way or another, he feels, we will find our way to something that is better than what we now have. It will be better in that it will be less expensive and will provide better care for everyone. We Americans spend more per person on health care than any other nation on earth, but the results of our system measured in life expectancy and infant mortality are rather poor in comparison with the results in other industrial nations.
I am not as optimistic as Mr. Klein. Big Pharma and big Insurance are too big and too profitable to succumb without a terrific struggle. We saw what they could do in 1994 when they defeated President Clinton's attempt to achieve universal health care. It may be that, for the time being, we will have to be content with a plan like that of Massachusetts that keeps big Pharma and big Insurance as profitable entities. Governor Schwarzenegger, for example, has slhown his disdain for the Medicare or the Canadian models because they both involve a change of funding from private insurance premiums to public taxes. The fact that most individuals will have actually less out-of-pocket expenses under a Medicare or Canadian type of system than at present doesn't convince either him or his hard-line Republican allies that the change should be accepted.
What are the alternatives? Klein lists two models:
- Extend Medicare to provide coverage for every American. Congressman Pete Stark of California favors this approach.
- Establish a legal requirement for every person to buy health insurance and require insurance companies to provide plans at reasonable cost. This is the essence of the Massachusetts plan. In addition, Massachusetts provides financial assistance to low income residents who otherwise can not afford health insurance.
Both of these models are institutions that are currently in operation. Medicare has existed since the mid 1960's. The public knows how it operates. It is a popular program. It's good, if not perfect. The Massachusetts plan has only recently begun to operate. It is too early to assess its performance and popularity with the public. I have written elsewhere that I regard the Massachusetts plan as something like a band-aid applied to our existing broken system. It has the advantage or disadvantage, depending on your point of view, of keeping the private insurance industry in the profitable business of supplying health insurance to healthy, young people.
Mr. Klein has a critical view of a plan put forward by the private insurers:
Mr. Klein mentions three elected officials who propose to support changes in our present health care mess. Pete Stark, a Representative from California and probably the new Chairman of the Health Subcommittee, favors a "Medicare for all" solution. Senator Ron Wyden of Oregon has assembled a coalition of "union leaders and corporate chief executives" to put together a plan similar to the Massachusetts plan that would rely on existing private insurance companies to provide health insurance. Governor Arnold Schwarzenegger of California recently vetoed a bill passed by the State Legislature that would have established universal health insurance as the plan for California. However, he now says that he wants to work with the Legislature and others to create a universal health care plan for the State.The most compelling evidence that resistance to reform is futile, however, is
coming from the insurers themselves. Cognizant that Congress and the nation are
tiring of the current dystopia, the insurance industry recently released its own
plan for universal healthcare.It's a bad plan, to be sure. Its purpose is more
to preserve the insurance industry's profits than improve healthcare in this
country. But the endorsement of universality as a moral imperative, and the
attempt to get in front of the coming efforts at reform, mark the emergence of a
distinct rear-guard mentality within the insurance industry. Their game is up,
and they're turning some of their attention to shaping their future rather than
betting that they can continue protecting their present.
Mr. Klein sees the acceptance of the failure of the present system as a hopeful sign. There is recognition of the need for health care to be universally available to all regardless of income. One way or another, he feels, we will find our way to something that is better than what we now have. It will be better in that it will be less expensive and will provide better care for everyone. We Americans spend more per person on health care than any other nation on earth, but the results of our system measured in life expectancy and infant mortality are rather poor in comparison with the results in other industrial nations.
I am not as optimistic as Mr. Klein. Big Pharma and big Insurance are too big and too profitable to succumb without a terrific struggle. We saw what they could do in 1994 when they defeated President Clinton's attempt to achieve universal health care. It may be that, for the time being, we will have to be content with a plan like that of Massachusetts that keeps big Pharma and big Insurance as profitable entities. Governor Schwarzenegger, for example, has slhown his disdain for the Medicare or the Canadian models because they both involve a change of funding from private insurance premiums to public taxes. The fact that most individuals will have actually less out-of-pocket expenses under a Medicare or Canadian type of system than at present doesn't convince either him or his hard-line Republican allies that the change should be accepted.
Labels: Massachusetts plan, Pete Stark, Ron Wyden, Schwarzenegger, Universal health care
