Is Rush dumber than my shoe, or just evil?

Jul 28 2009 Published by under Health care reform, Medicine

Yes, I know, the two are not mutually exclusive, but I still think it's a good title. The latest bit of evil idiocy? More fanning of fears about health care reform. Don't misunderstand, there's plenty of potential pitfalls to health care reform, but Rush is an idiot. He calls it "Five Freedoms You'll Lose Under Obamacare". Let's see what he's talking about.


I'll let you in on his absurdist intro just for the fun of it:

One of the best points that anybody could make in describing the uniqueness and greatness of this country, do you realize that the history of the world is tyranny? The history of the world is dictatorship. The history of the world is dungeons and torture chambers. That's why this country is so unique.


Multiple Choice:

"Guantanamo isn't a dungeon because:"
A) It isn't underground
B) Cheney says it's really a "Freedom Field"
C) Only bad people are imprisoned

OK, moving on to health care. Rush says of we Americans, "who's going to vote for torture, who's going to vote for tyranny, who's going to vote for dictatorship? But we did. We did. And you see it slowly encroaching. " He's not talking about the Bush administration's suspension of habeus corpus or any such real tyranny. He's talking about the Obama administration---just in case you weren't sure.
Anyway, his list of Five Freedoms is really his riff on a CNN piece, so while the FF's are not unique to him, his analysis certainly is.
Freedom 1: Freedom to choose what's in your plan.

The federal government will impose a minimum list of benefits that each plan is required to offer. ... Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization." Many states require these "standard benefits packages" and they're a major cause for the rise in health care costs along with tort reform.

Of course, that has nothing whatever to do with an individual freedom. Most Americans have no "freedom" to choose what their health plan covers. Most Americans get their health care from their employer or the federal government (Medicare). An employer does not typically give you a choice other than perhaps between an HMO and a fee-for-service plan. This is different from "choosing what's in your plan". Companies offer plans, you choose the plan. Hair transplants are not a commonly covered entity. But there are services that people wish they had but do not, such as coverage for female oral contraceptive pills. Typically, states may impose coverages based on what patients and providers demand. One person's hair transplant is another's dialysis. This is a much more complicated topic than The Great Oversimplifier would have you believe. It's really about rationing.
Freedom 2: Freedom to be rewarded for healthy living, or pay your real costs. That doesn't sound like a freedom at all, but like a benefit. Currently, many health plans offer rewards (such as reduced premiums) to people who quit smoking, check their blood pressure, etc. This is becoming the norm. But what Rush is really upset about is risk-pooling. Insurance works by taking a large number of people, having them all pay into the system, and using that money to pay for the needs of the members. Inevitably, some members will use more services, some less. Insurance doesn't work unless the pool contains lots of healthy people. To allow healthy people to pay significantly less defeats the purpose of insurance.
Freedom 3: Freedom to choose high-deductible coverage. What's that, like freedom to get involuntarily sodomized? High-deductible plans may help drive people to more economically-driven health behaviors, but what it really does is discourage people from seeking preventative and proactive care. (I'm also not sure whether or not any plan that gets passed will forbid this; it may be true, it may not be.) Patients are not economic rational actors. When you're sick, you are irrational. High-deductible plans are idiotic.
Freedom 4: Freedom to keep your existing plan. I don't know how many Americans care whether or not a health care reform bill will preserve this "freedom". Most Americans just want decent coverage, regardless of who provides it. And what does this freedom mean? Let's say a small business, under the new plan, is given a choice between providing coverage to employees or paying an additional tax and letting them go with a public or other private option. That's a market-driven decision. That's capitalism. If private insurers can't keep their overhead down and compete, then that's the way it is.
Freedom 5: Freedom to choose your doctors. This is perhaps the most ridiculous "freedom". First of all, if you're not insured, you can't choose any doctor. And do you know what plan has the most "freedom of choice"? That's right, it's the government plan, Medicare. Any provider can choose to participate in Medicare, and most do. The most restrictive choices are by HMOs provided by employers as part of their "lower tier" insurance (see Freedom 3).
People don't understand health care, and this makes them easy targets for ideologues. Let's face it: Rush Limbaugh, Glenn Beck, Barack Obama---none of these folks is going to have a problem getting care. The rest of us have a horse in this race, and it's time to start paying close attention to the facts.

13 responses so far

  • Russell says:

    Evil.
    This was a poll, right?

  • John McKay says:

    Dumber that your shoe, especially if you have dumber than average shoes.
    I'm surprised that he didn't mention the freedom to keep your grandmother, since the latest meme is that healthcare reform will lead to euthanasia of old people.

  • JohnV says:

    May I please be excused from my "freedom to get involuntarily sodomized"?

  • PalMD says:

    May I please be excused from my "freedom to get involuntarily sodomized"?

    Are you an American? A real American? Cuz real American's don't just give up their freedoms.

  • Terrie says:

    I honestly don't have much stake in the health care debate. Why? Because my major health concern is severe anxiety. Currently, what I get is pretty limited and lousy. Under a government, what I would get is limited and lousy. When it comes to problems with your brain, be they developmental or emotional, our health care system is failing.

  • D. C. Sessions says:

    Try reading it again with an eye to those who really do have those "freedoms:" large corporations. After all, that's the fundamental unit of American society.

  • Scott says:

    What always floors me is this notion that if we provide medical coverage for everyone, that you're somehow going to "lose" your "freedom of choice". You always have the freedom of choice. If you have the money, you can chose any doctor you want, whether you have insurance or not. If you don't have the money, and you don't have insurance, then you have no choice at all.

  • D. C. Sessions says:

    What always floors me is this notion that if we provide medical coverage for everyone, that you're somehow going to "lose" your "freedom of choice". You always have the freedom of choice.

    But you won't have the freedom to spit on all those losers who don't have any health care options at all. It's not where you are that counts nearly so much as where you are relative to others.

  • JScarry says:

    “High-deductible plans are idiotic.”
    I'd like to seem some evidence for that statement. Especially considering the number of bloggers who work in ER and say they are overwhelmed by patients with no insurance (i.e. no deductible) who come in for colds, minor aches, etc. Making people pay for service would weed out a significant number of people who should be seeing a primary care physician or just waiting a few days for their cold to go away.
    I have high deductibles on all of my insurance. $10,000 on health, no dental, no optical, $5,000 on homeowners, $2,000 on my current car, $5,000 on my plane. I save several thousand dollars every year. I've had one major loss on an uninsured car but overall I'm way ahead.
    We go to the doctor when we need to. We don't go when we don't need to. If I had a low deductible for the same cost I'd probably go to the doctor more often, but I doubt if I'd be healthier. My teeth would be a bit cleaner since I'd probably go every six months instead of 9 months. I'd do the skin cancer screening a bit more often and I'd probably get a few moles removed 'just in case' they could turn cancerous, but not much would change in my overall health.
    With low/no deductible, health care will be rationed on the basis of who is willing to wait the longest—much like in the ER waiting room now. With a deductible set high enough to matter, rationing won't be as much of an issue.

  • I'd like to seem some evidence for that statement.

    I've got anecdotal evidence. I've been on every major service and every major outpatient level of care in the last year. In my limited experience, patients who came to the ER or the OR with catastrophic conditions (IE, MI, stroke, sepsis, osteomyelitis) were more likely to come from the uninsured/self pay population, and the high deductible population.

    Especially considering the number of bloggers who work in ER and say they are overwhelmed by patients with no insurance (i.e. no deductible) who come in for colds, minor aches, etc. Making people pay for service would weed out a significant number of people who should be seeing a primary care physician or just waiting a few days for their cold to go away.

    To be clear, this statement is actually retarded. You need to have absolutely zero knowledge of healthcare to think that this is a coherant argument. Uninsured people don't come to the ER with minor complaints because they have no deductible. They come to the ER with minor complaints because they can't see a PCP, because there are shortages of PCPs and as PCPs are already having a hard time keeping doors open, PCPs generally pick patients who can pay for their services.
    Making people pay more makes people use less healthcare services preventatively, this is true. It also makes them more likely to come to the ER with catastrophic complaints.
    50 years of 5 4 dollar prescriptions for hypertension and 50 years of PCP and cardiologist appointments is orders of magnitude cheaper than 1 million dollars for 1 year of keeping a CHF patient alive on a LV assist pump.

    I have high deductibles on all of my insurance. $10,000 on health, no dental, no optical, $5,000 on homeowners, $2,000 on my current car, $5,000 on my plane. I save several thousand dollars every year. I've had one major loss on an uninsured car but overall I'm way ahead.

    Ah, so the crux of the matter is that this is about justifying your choices? Well by and large, doctors think your choice is stupid. Deal with it.

    We go to the doctor when we need to. We don't go when we don't need to.

    And if you had stage 2 hypertension, your deciding to go to the doctors when "you need it" would mean you'd be screwed. hypertension is genreally asymptomatic until you have end organ damage. So a hypertensive who only goes to the doctor when they feel they need it is a hypertensive who dies young, and sufferingg. Also expensively.

    If I had a low deductible for the same cost I'd probably go to the doctor more often, but I doubt if I'd be healthier.

    And you know how much about medicine? So I should trust your personal doubt because? I hate know-it-alls who think having read a few blogs means they understand medicine, the economy, and the healthcare system all at the same time. It's arrogant as all get-up.

    With low/no deductible, health care will be rationed on the basis of who is willing to wait the longest—much like in the ER waiting room now. With a deductible set high enough to matter, rationing won't be as much of an issue.

    Right now healthcare is rationed by giving it to those with the most money, or most expensive conditions. We don't pay for cheap prescriptions and primary care, we do pay for catastrophic failures that have poor outcomes, and cost alot of money.
    I disagree with your assertion that a deductible set high enough will decrease wait time based rationing. Setting a deductible sufficiently high would just mean we don't save money.
    The real way to healthcare savings in the long term is primary and secondary prevention stopping people from getting to chronic conditions like end stage hypertension, diabetes, CHF.

  • george.w says:

    JScarry, with low deductibles, people will go to the doctor instead of the ER. The cost of one ER visit is about 25 doctor visits.
    That high deductible might seem like no big deal to you, but to someone living paycheck-to-paycheck, it could mean choosing the medical bill, the prescription meds, or the rent.

  • Will TS says:

    JScarry - You have a $5000 deductible on your plane? What about your yacht? And your ski chalet? Please tell us more about how your high deductibles are not limiting your ability to get regular botox injections and dental veneers. Ass.

  • Dan says:

    How is calling commenters "idiots" and other names contributing to dialogue on health care reform? When I hear someone using ad hominem, their level of credibility declines.