Shorter NY Times opinion on Florida Medicaid: It’s so screwed up that screwing it over more can’t make it any worse, and really Florida Republicans are deserving of our trust, as they’ve proved their fairness to their poorer and darker-skinned citizens so often in their history (as in the 2000 election).

The Industry Veteran has been a little quiet of late. But you wouldn’t expect him to keep too quiet about an event like Katrina. Given the way that the whole thing has been turned into an Iraq-style feeding frenzy by the Republicans eager to run a privatized New Deal Mk II, here’s his sage perspective.

It’s interesting that even displays of shock and regret about Katrina, together with the belated recognition of larger problems concerning class and race uncovered by the hurricane, show an ugly side of the American character.  Read this op-ed piece from Harold Meyerson of the Washington Post and the LA Weekly.  He makes the point that American culture at its core is indifferent to the well being of the larger community.  With some minor qualifications, Meyerson is certainly correct.  This country was founded on the dark side of John Locke’s Whig philosophy, the idea that property constitutes the basis of liberty.  While “possessive individualism,” as it came to be called, can possibly be pushed in directions to show strong fellow feeling, its more typical implementation over the course of American history has been, “I’m looking out for me and mine, screw everyone else.”Reagan-Bush hucksters have self-righteously propagated the current incarnation of possessive individualism over the past 25 years by adding a fillip regarding the sanctity of markets.  According to their dogma, if any goods, services or social action appears desirable or necessary, a market will emerge to fill that need.  It is a manifest evil, according to these cowboy capitalists, for government to act in lieu of such a market or, even worse, to somehow alter the operations of an existing market to account for such an unmet need.  Of course if a market consisting of the poor and minorities makes it difficult to derive profits and, as a result, such a market is slow to emerge or never emerges, well, life’s unfair.  The free market fascists contend that government planning in the face of a market system’s well documented failures is, by definition, elitist.  Now here we have a natural disaster marked by the worst job of US government planning and response since the end of World War II and what do the Republicans propose to remedy the situation?  Well more of the same “free” market thinking that produced the problem should do the trick.  Doesn’t it make sense that generations of socially structured inequality can be remedied by granting liability exemptions to hospitals and physicians while businesses can be encouraged to hire the dispossessed by temporary exemptions from environmental safeguards?  Temporary exemptions from the estate tax will really help rebuild New Orleans as a city that provides greater opportunity, won’t it? See Wall Street Journal, 9/15/05.

The darker side of American character also helps explain the Democrats’ largely spineless failures to attack either the tactical failures or the pernicious social philosophy of Republicans.  The Democrats’ timidity comes from the fact that Republicans won the last two presidential elections, and all the off-year Congressional elections since 1994, by appealing to the dark side of the political center: prosperous suburbanites who aren’t terribly concerned about the general welfare.  As John Dickerson wrote in Slate, “For [suburbanites in SUVs], hurricane Katrina isn’t so much about race or poverty, it’s about homeland security—about what would happen if someone bombs their mall.”  The Democrats remain desperate to curry favor with this voting segment and only gauche party crashers such as Howard Dean will acknowledge that an understanding of hurricane Katrina requires us “to come to terms with the ugly truth that skin color, age, and economics played a significant role in who survived and who did not."  While the Democrats continually try to out-center the Republicans, the latter take the center for granted, favoring instead their fundamentalist and plutocratic bases.If studying social disasters is useful because they reveal a country’s underlying values and the way things really work, then I am even less sanguine about the prospects of significant health care reform than I was three weeks ago.

Over at Signal Health Tom Hilliard has been having an entertaining time with Mark Pauly and the boys from Cato. Go over there and take a look at the latest round of back and forth. Suffice it to say that if Mark Pauly had to buy his insurance in the individual market rather than receiving from the Ivy League Ivory Tower he sits in, I suspect that he would be rather more concerned about the way the individual market works, particularly the 20% he acknowledges doesn’t work well.

Meanwhile, Eric Novack and I are both reading Cato’s Michaels Cannon and Tanner’s latest work which is out today. (I had planned on a pre-publication review but then again…) We’ll be discussing it in another podcast sooner or later, but you’ll get the basic idea from the SignalHealth discussion.

Meanwhile, Health Affairs has some numbers out about the rise of the HDHP and the HSA.  You can see the full article here. But here’s the abstract pull:

Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 million workers. Deductibles, as expected, are relatively high, averaging $1,870 for single coverage and $3,686 for family coverage in high-deductible health plans with an HRA and $1,901 for single coverage and $4,070 for family coverage in HSA-qualified high-deductible health plans. One in three employers offering a high-deductible health plan that is HSA-qualified do not contribute to HSAs established by their workers.

The last line is by far the most significant (hence my bolding it).  Even though the HSA is supposed to be the employees benefit, in fact in a third of the cases setting up a HDHP is straight cost-shifting to the employee. You were getting something and now you’re getting nothing to deal with the first chunk of medical expenses. So at least those employers have figured out how not to screw over their own risk pools (assuming that they keep some of that money that would have ended up in the HSAs in reserve to cover the expensive cases). You know that the rest of them will go down that path too — in fact a survey that was covered in this THCB article confirmed it a while back. Oh, the joys of a "jobless recovery".

And of course employers are getting out of the game of providing insurance anyway.  Another Kaiser Foundation survey this morning confirms that the percentage of employers offering insurance has gone from 69% in 2000 to 60% in 2005. In effect the HDHP over time offers the employer a way to get out of the game without having to bear the shame of leaving the field completely.

This of course continues to boil the frog….

Finally, it does make me chuckle that in the comments to this post about Medicare Part D, Eric Novack is apparently appalled that a combination of lobbying from drug companies, PBMs, health plans and providers mixed in with the endemic scratch my back corruption of the current Administration and its leaders in Congress ended up with a welfare plan for them all called Medicare Drug Coverage. But it’s a little weird that he thinks that the water-carriers for the Administration over at Heritage are actually surprised. The guys from Cato might be forgiven for being true believers, but Heritage, AEI and the rest sold their souls long ago, and know exactly how they’re dealing with.

CODA: I hate to link to Tech Central Station given how dishonest it is in its lack of transparency, but if the funny Cato boys will insist on writing there, then this one from Randy Balko is worth a chuckle.