As Congress gets to non debating a National Health care initiative that will not be change anyone can believe in, a new scam is percolating in the back of the Internet that will certainly become front and center if the current Baucus plan becomes "The Plan".
Unfortunately, as the last eight years have made really obvious, any corner not defined and held accountable by somebody will be cut by any company willing to do so and thus hold advantage over any company not willing to cut those corners. As well, the lower costs achieved by cutting those corners will not go to lower prices but to higher profits, not even for the shareholders but for the CEO.
In a case where the Insurance Company cannot cherry pick outright, they will cherry pick anyway that they can and this new scam is particularly pernicious. As their Ideology dictates, it will be profit and not need that sets policy and poor people with great need are less profitable. If price alone will not send them away, the new scam is to not offer services where they live.
By buying up and closing Hospitals that offer less profitable care you can force those not able to travel easily to travel farther to fancier hospitals, or stay away from any health care at all. Of course if the Insurance company refuses to make arrangements with doctors in redlined areas, then the Doctors will find that the preponderance of their business will be those "dumped" paitients on what will probably be the Government plan, and once again Taxpayers will be subsidizing Insurance Company profits, amid howls of protest that the Government plan is costing too much, and needs cutting.
Institutions that actually do something, like doctors or even hospitals, might indeed find ways to change practices in a way that has a chance of actually make more money and improve service (and even that not witout oversight) But an Insurance company can only be the middle man, it cannot add value to the equation, but only take its half out of the middle. It will have no purpose to be except that which it can gerrymander itself into false necessity.
Some examples http://www.youtube.com/watch?v=XmaJEvvMZ7c
http://www.bio-medicine.org/medicine-news-1/CNA-Presents-New-Data-on-Sutters-Medical-Redlining-4650-1/
http://www.news-medical.net/news/11717.aspx
Everyone wants control over their own life, but to accomplish most things in life, people have to work together. How they decide what and how is the definition of politics. I consider each such group a separate government. How that particular government is organized, who decides and how the others hold that decider responsible, is the fine grain of freedom or tyranny, and differs in each case.
For basic thoughts check out the sidebar starting at basic concepts.
Sunday, May 31, 2009
Saturday, May 23, 2009
A question of Agency & Accountability
When Obama was elected I had high hopes. I knew that if he advocated the progressive agenda outright that there would be a barrage of calls that he was implementing the kind of leftist agenda that indeed most folks who voted for him hoped he would and that there would need to be sustained activity to back that agenda.
When he put together his team in December I was dismayed that of all the names that would spring to mind from Krugman to Dean as having been at the forefront of the fight to get where we were, were either not brought in or tossed under the bus. We were told that this was a stealth move by Obama, that Bush needed to actually leave office, and we could trust that Obama would be setting the rules and pushing all those folk who were against the Left agenda to move further left than their prior actions would indicate.
Then we were told there was a secret framing agenda, that measures that looked like the normal Bush policies actually were different in the details that fully reversed what Bush was up to. But there was no prosecutions of crimes that are now prima facia, or even investigations of them. We are still in Iraq and it looks like for a long time, and Afghanistan is getting worse with mostly the same tactics that dis not work before.
To hear the screeching and lamentations from the Right one would think that all the correct things were being done, but when their blather is sifted out the only thing they actually oppose is the name of the party with supposedly the levers of power. There have been a few things happen at the margins, but no great strides and nothing that could not be quickly swept aside has happened on almost every front.
Even the abandonment of Habeas Corpus that ruled all English and American law for a thousand years that should have been restored instantly with prosecution of those who denied it (before even getting into the Torture "Debate") is not the focus. Only that it was illegal and should be abandoned by passing a law legally abandoning this bedrock of Western Values.
This is a final class battle that is technically not even the very rich against the rest of us, but a whole range of gatekeepers who are supposedly the agents of a whole range of folk, mostly feeding the very rich even when they are supposed to be overseeing them, but even more feeding and supporting themselves to the expense of everyone, rich and poor alike.
As agents they do not actually accomplish any goal but assign pathways and tasks to those who actually accomplish the goals, and then assign benifits among those achievers. It is a position with great, but supposedly borrowed power, responsible often to many interests that at one time was able to hold them accountable, but breaking free they have perverted the system beyond stupid.
Banks, Insurance companies, other financial "innovators" come easily to mind, but every Large Corporation has become equally divorced from the "owners" that are buried in layers of Pension Fund, or "Mutual" Fund that itself is only marginally aware of it's agency position.
And other large bureaucracies that act as a class of themselves are a step further removed from that agency position that their very existance as an industry perverts hao a Society operates are one more step into the Morass. Universities, Military, and their further parasites of Manufacturers, and now Mercenaries, and similar satrapies of insurance companies, hospital complexes, and pharmaceutical firms or the sphere of Agrabusiness, chemical companies and "food" delivery, or the mass that is essentially WalMart.
In every situation this gatekeeper agent class gets special rules, while the folk who do the work get less and less, and even the Investors are shortchanged, but worse the bureaucracy works to make itself ever more necessary and monopolistic so wars are started just so Mercs can fight them, or education is defined by the ever growing need of the proper degree, and not the learning that used to define it, or medicine is defined by pills like people were so much bags of soup, or "food" defined by packaging and corner cutting rather than taste or value.
Unless these Parasite Satrapies are broken or removed from power completely there will not be a society anyone now alive would wish to live in. Health Care is at the moment front and center in the fights (having lost the fight with the banks).and our best hope of eliminating any of the Parasites. If they are left in place in any form that fight will also be lost, and that is about the easiest fight that we face.
When he put together his team in December I was dismayed that of all the names that would spring to mind from Krugman to Dean as having been at the forefront of the fight to get where we were, were either not brought in or tossed under the bus. We were told that this was a stealth move by Obama, that Bush needed to actually leave office, and we could trust that Obama would be setting the rules and pushing all those folk who were against the Left agenda to move further left than their prior actions would indicate.
Then we were told there was a secret framing agenda, that measures that looked like the normal Bush policies actually were different in the details that fully reversed what Bush was up to. But there was no prosecutions of crimes that are now prima facia, or even investigations of them. We are still in Iraq and it looks like for a long time, and Afghanistan is getting worse with mostly the same tactics that dis not work before.
To hear the screeching and lamentations from the Right one would think that all the correct things were being done, but when their blather is sifted out the only thing they actually oppose is the name of the party with supposedly the levers of power. There have been a few things happen at the margins, but no great strides and nothing that could not be quickly swept aside has happened on almost every front.
Even the abandonment of Habeas Corpus that ruled all English and American law for a thousand years that should have been restored instantly with prosecution of those who denied it (before even getting into the Torture "Debate") is not the focus. Only that it was illegal and should be abandoned by passing a law legally abandoning this bedrock of Western Values.
This is a final class battle that is technically not even the very rich against the rest of us, but a whole range of gatekeepers who are supposedly the agents of a whole range of folk, mostly feeding the very rich even when they are supposed to be overseeing them, but even more feeding and supporting themselves to the expense of everyone, rich and poor alike.
As agents they do not actually accomplish any goal but assign pathways and tasks to those who actually accomplish the goals, and then assign benifits among those achievers. It is a position with great, but supposedly borrowed power, responsible often to many interests that at one time was able to hold them accountable, but breaking free they have perverted the system beyond stupid.
Banks, Insurance companies, other financial "innovators" come easily to mind, but every Large Corporation has become equally divorced from the "owners" that are buried in layers of Pension Fund, or "Mutual" Fund that itself is only marginally aware of it's agency position.
And other large bureaucracies that act as a class of themselves are a step further removed from that agency position that their very existance as an industry perverts hao a Society operates are one more step into the Morass. Universities, Military, and their further parasites of Manufacturers, and now Mercenaries, and similar satrapies of insurance companies, hospital complexes, and pharmaceutical firms or the sphere of Agrabusiness, chemical companies and "food" delivery, or the mass that is essentially WalMart.
In every situation this gatekeeper agent class gets special rules, while the folk who do the work get less and less, and even the Investors are shortchanged, but worse the bureaucracy works to make itself ever more necessary and monopolistic so wars are started just so Mercs can fight them, or education is defined by the ever growing need of the proper degree, and not the learning that used to define it, or medicine is defined by pills like people were so much bags of soup, or "food" defined by packaging and corner cutting rather than taste or value.
Unless these Parasite Satrapies are broken or removed from power completely there will not be a society anyone now alive would wish to live in. Health Care is at the moment front and center in the fights (having lost the fight with the banks).and our best hope of eliminating any of the Parasites. If they are left in place in any form that fight will also be lost, and that is about the easiest fight that we face.