Kneejerkin: Health Care Edition

It takes a lot to make my head explode these days, but reading about Martin Shkreli, the hedge fund brat who bought the drug used to treat toxoplasmosis and raised the price from $13.50 a pill to $750, accomplished exactly that. While the Times piece on Shkreli rightly generated a groundswell of outrage, it made me think of all the previous injustices in our health care system that didn’t. All the abuses of private health insurance companies prior to the ACA — the dropping of sick patients, the exorbitant premiums for those with pre-existing conditions, the flat-out denials of coverage dooming people to death or financial ruin — were just as evil, yet not as easily located in the scandalous behavior of one unsavory person. Remember this article about hospitals charging $137 for a $1 IV drip bag? In a sense, Shkreli simply puts a face on everything that is wrong with America’s predatory, profiteering health care system.

The Affordable Care Act was desperately needed to curb its worst excesses, and has worked extremely well. Shkreli serves to remind us of the need for regulation of an industry that obviously cannot be trusted to serve the public interest or behave ethically on its own.


  • Benjamin Schwab

    Of course the ACA has also been quite beneficial for health insurance companies, the group primarily intended to benefit from the legislation. A google search for articles gives a mixed result but large health insurance companies have seen significant stock price increases since before the passage of the ACA and largely seen increased and more frequent dividends: Aetna, Humana, Cigna, Molina, and Centene. A traditional single payer system would be disastrous to the private health insurance companies. It seems that the ACA is a reform in the opposite direction of a single payer system.

    In a previous comment, I asked someone who seemed to want to engage with me what xir redline was for what proposal would be conservative enough as to not support it. I gave mine and for those who don’t remember it was the existence of a public option. The ACA with the public option would have my support but without it, it didn’t. I don’t think the ACA was a horrible reform nor would I think an ACA with a public option would be a great reform. What I do think is that the ACA wasn’t worthwhile to support and the ACA with the public option would have been worthwhile to support. Note that worthwhile to support or not is not the same as good and bad.

    It is important to know where one’s redline is or decision point or demand conditions or whatever one wants to call it is. If it is “anything better than what the Republican’s propose,” then one is in effect supporting what the Republican’s support. You are giving permission for Democrats to get arbitrarily close to the Republic position and you would still vote for them. The incentive you are sending is for Democrats to move closer to the Republicans and thus for more conservative policies. If you never had such a point where on one side you would support the ACA but on the other side you wouldn’t it is likely that your point was the same as above.

    The message sent in the support and praise of liberals to the ACA is to reinforce the message that Democrats need to be just a little bit better than Republicans to get liberal votes. This means that the next time health reform occurs there won’t be a single payer system. The implementation of a single payer system or any system to bring us in line with the countries that spend less than us on healthcare and get better outcomes (there are lots of examples of how to do things better then here even under the most rosy view of the ACA) is delayed by liberal cheerleading of the ACA and the general lack of backbone liberals have in their blanket support for Democrats.

    I disagree with Paul Krugman and others about how ultimately beneficial the ACA will end up being. I think in 15 to 25 years we will be in a position not that dissimilar to the one we were in 7 years ago. I think the subsidies with become harder to get and less in amount over time because that’s how these political programs play out. I don’t think that under the ACA 95% of the population will have health insurance when the next round of healthcare reform takes place but I’ll give ACA supports the benefit of the doubt in this argument and accept the 95% figure. 95% is certainly better than 85% and providing health insurance to those approximately 30 million people is important but the lack of insurance to the approximately 15 million people is also important.

    This is the hardest calculus to do. The stakes are life and death and a choice has to be made in which some people live and in which some die. This can be emotional especially if one knows or is a member of one of the groups effected and the decision if difficult enough without such emotion. The choice is between action A and action B where both actions save some people and let others die and the people saved and die are different. In either case one is letting some die so that others may live.

    I tend to have a longer term outlook then most people. I’m not saying my perspective is better just explaining some of who I am. The quicker that the society that I live in, that I’m a part of, adopts a single payer system or any system in which someone who needs medical treatment has trivial access to it, the better. It is in my judgement that doing this will provide the biggest benefit in the long run and I am choosing to criticize and to have opposed the ACA (I don’t support efforts to repeal it now that it is law) as well as to withhold support for its supports in order to further this goal. I respect someone making a different choice then me. I have no claim that my calculus here is correct or that others should accept it but only that based on all the knowledge, intelligence, and wisdom that I have that it is the one most likely to be true. I have no problem with someone coming to a different conclusion.

    I respect those of you who disagree with me on this issue. I will continue to advocate for what I believe because I think that is useful. This includes the belief that until Democrats by and large support actually liberal policies, voting for democrats is detrimental to the goal of seeing liberal policies enacted.

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Jen Sorensen is a nationally-published political cartoonist. She is a 2017 Pulitzer Finalist and recipient of the 2014 Herblock Prize and a 2013 Robert F. Kennedy Journalism Award.