Accentuate the positive

At AmSpec Blog, JP Freire makes a good point about the Republican framing of the health care debate:

Rep. Camp recited a good number of the talking points I've heard among the right regarding healthcare. The problem is that the debate is about a feel-good issue (the health of a family), and Republicans tend to highlight the negatives of the other side rather than emphasize positive points. Healthcare beat reporters want to hear the story of how you're going to help that little baby with medical needs, or the old lady who's putting aside surgery because she has to pay her electric bill.

Unfortunately, Rep. Camp stuck with the point that the "45 million Americans who are uninsured" is really an overblown statistic. It's worth mentioning, to be sure, but numbers won't change this debate (otherwise, no one would be talking about socialized medicine anyway).

Comments

When one side of the debate is selling 100% Peter Pan fantasy ("We can all have the best health care, and for free, too, once we get rid of the wreckers and kulaks...all you need to do is wish real hard so Tinkerbell can hear you!"), then there's very little else you can do but point out the grim reality of death, taxes, bad luck and painful economic choices.

Posted by Carl Pham | February 26, 2008 6:35 PM

Only Megan and other deeply delusional libertarians would refer to the plans proposed by Clinton and Obama as socialist. Clinton's plan is essentially the same as the ones pushed by Governors Romney and Schwarznegger, and Obama's is even more conservative. Are Romney and Schwarznegger socialists? Is everyone to the left of Nicholas II a socialist? The world wonders.

Posted by Stan | February 26, 2008 7:10 PM

Re: Are Romney and Schwarznegger socialists? Is everyone to the left of Nicholas II a socialist?

The words "socialist" and "fascist" need to be banned from political discourse. They have become nothing more than all-purpose slur-words that lazy rightwingers ("socialist") and leftwingers ("fascist") use to describe idea or person they dislike, without taking the time and effort to mount a reasoned argument on the subject.

Posted by JonF | February 26, 2008 7:36 PM

Re JonF: When the government controls a sector of the economy, that's socialism.

So in answer to your question, yes Romney and Schwarzenegger are socialists. That's a reason I wouldn't vote for Romney in the primary. I at least don't use socialist (one who advocates govt control of economic activities) or fascist (one who thinks the individual's interests should be subordinate to the group's) as slurs but with very precise meaning and I'll continue using them when appropriate.

Posted by Jody | February 26, 2008 8:38 PM

Jody,

Almost any government function could conceivably be privatized. Is someone who supports a government-run military a socialist? After all, we could hire bands of mercenaries.

My broader point is that if you call someone a socialist because of a position on one sector of the economy, you have to call all non-radical libertarians socialists. And the term becomes meaningless. Let's reserve socialist for someone with broader aspirations than government provisioned health insurance.

Tom

Posted by Tom G. | February 26, 2008 9:22 PM

in cuba they don pay dem doctors and they don pay the nurses and the hospitals are free cuz the govt own them. Health care suppose to be free, that the way God made it. He give us health fo free.

And Cuba has the best health care in the world. If Doctor or nurse don work they shoot them.

So what the big deal? Free health care for everyone. Or else.

Posted by sol vason | February 27, 2008 12:22 AM

Are you guys referring to some other post in which the "Socialist" epithet is thrown around?

In this one Megan quotes another author who calls two health plans "socialized medicine".

To two commenters above, advocating government control of one sector apparently makes the proponent a 'socialist', but I believe neither Megan nor her cited author made such a generalization.

Posted by "Mindles H. Dreck" | February 27, 2008 6:19 AM

Re: Sol
I really need to see your statistics, or even just some facts, before I can believe your assertion that, "...Cuba has the best health care in the world." And please don't quote Micheal Moore at me, I know he never bothers with things like facts.
What I am more interested in, is your assertion that "Health Care is supposed to be free, the way that God made it." In that case, the next time you need any form of medical care beyond what you can give yourself, including just a trip to the drug store, I suggest you pray real hard, so G-d can make you well again!
By the way, what was the name of that pharmaceutical company that supplies the Cuban worker's paradise with all those free, life-saving new drug therapies? You mean they don't have one?

Posted by cas | February 27, 2008 6:32 AM

Romney and Schwarzenegger are social liberals while trying to remain fiscal conservatives. Me, I'm a social moderate, not a social liberal, and a fiscal conservative. Yes, yes, free health care would be nice, but it's impossible to pay for, and even then, a significant number of the poorest families still won't use it when they should. Just look at the free vaccines, or the utilization of free clinics--both not used by a large chunk of the poor.

Posted by Rex | February 27, 2008 7:43 AM

Sol is serious? Surely not once you get to the 'shoot them' part.

Posted by "Mindles H. Dreck" | February 27, 2008 8:45 AM

Nobody is calling for free health care. Clinton's plan and Obama's, like Romney's medical insurance plan in Massachusetts and the one Schwarznegger is pushing in California, call for health insurance subsidies for people who don't get medical insurance as a work-related benefit. In what sense is this "free"?

Posted by Stan | February 27, 2008 8:48 AM

Clinton, Obama, Romney, and Schwarzenegger all are only planning on offering subsidies to those who can't afford insurance?

Clinton's website doesn't offer a lot of details, but here are some highlights:

Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information.

So she's going to require insurance companies to stop accounting for expected costs (pre-existing conditions) but lower prices somehow? And what are "fair prices" for drugs?

Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.

I wonder how this will be enforced. What penalties will there be for failing to buy insurance? Will a wealthy person be able to self-insure? Enforcing this will require that someone set some minimum standards for what qualifies as "insurance"... Who will set this and how low will the minimum be? Will the minimum be a bare-bones catastrophic plan or will everyone be required to get a full-service plan?

Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.

Government doesn't have a good track record of lowering costs. Lower prices can be done by mandate... but costs, not so much.

Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.

I love the rhetoric here... "working families"... who is that, exactly? I suspect this is vague on purpose. Many people will read this and think they are included when they won't actually be. And this goes beyond ensuring coverage to ensuring "high-quality" insurance. So the government will be subsidising full-service health insurance.

Most Savings Come Through Lowering Spending Due to Quality and Modernization: Over half the savings come from the public savings generated from Senator Clinton’s broader agenda to modernize the heath systems and reduce wasteful health spending.

Ah ha! The intermediate ???? step that comes just before "Profit!". Clinton will use the power of government to improve efficiency and reduce waste! We can bring the unmatched efficiency of government bureaucracy to bear on health care.

A Net Tax Cut for American Taxpayers: The plan offers tens of millions of Americans a new tax credit to make premiums affordable-which more than offsets the increased revenues from the Plan’s provisions to limit the employer tax exclusion for health care and discontinue portions of the Bush tax cuts for those making over $250,000. Thus, the plan provides a net tax cut for American taxpayers.

So... is she really saying that her plan will end up costing less overall than the current system? Required insurnace for everyone, subsidised premium health insurance, etc... will ultimately be cheaper than the current system? Somehow the increase in taxes on those making over $250,000 will result in an even greater reduction in taxes to those who make less?

Obama's plan has the following features:

Obama's plan sounds more voluntary, but I doubt it would end up being so...

National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

Vague... but will this exchange be voluntary? Could a company offer a plan outside of the Exchange? Or will everyone be subject to the rules which require no accomodation of expected costs, generous plans, mandated efficiency, etc...

Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.

So who decides what's "proven"? This sounds like there will be some government bureaucracy deciding how people with chronic illnesses should be treated. What kind of accountability will this committee have? When some new treatment comes out, how long will it take to be adopted? Will patients be allowed to use new treatments? If so, will they pay the full cost unless it's "approved" by this committee? New treatments, while possibly more effective, pretty much won't be proven by definition...

Require full transparency about quality and costs. Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

While I agree that we need to see more data collection and analysis of outcomes in medical care, I'm not sure that a government run program is the best way to go. I foresee lots of collecting of easy to collect data as opposed to really useful data. I hope this works better than similar efforts to nationalize tracking of education outcomes...

Align incentives for excellence. Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded for achieving performance thresholds on outcome measures.

Hospitals will stop taking high-risk patients and will focus on the easy cases. I have a friend who works at a local pediatric hospital that specializes in really sick kids. He does pediatric cardiac surgery and they get kids from all over the world that other hospitals can't handle. Needless to say, their outcomes are probably worse than those of hospitals who handle routine cases. Unless someone can come up with an accurate way to account for the difficulty of the procedure, measuring outcomes will punish some of the specialist hospitals that handle more tough cases even if they are more skilled and do better work.

Lower prescription drug costs. The second-fastest growing type of health expenses is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama will also repeal the ban that prevents the government from negotiating with drug companies, which could result in savings as high as $30 billion. Finally, Obama will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big name drug companies from keeping generics out of markets.

Ah... gutting the profits of the pharma companies and eliminating research. I know that this is argued here periodically, but I still believe that this is a bad idea.

Both Clinton and Obama propose a lot of government intervention in the health insurance and care systems that will somehow increase efficiency and lower costs. Neither really offers a convincing argument for how this government intervention will actually reduce costs and provide more coverage for more people.

Both plan on setting standards and implementing price controls. I don't see how they will manage better outcomes than the current system where the consumer is already shielded from the price to the point where incentives to make cost effective choices are low. Under their government run plans, the incentives on the consumers will be even weaker to choose cost effective treatments.

Posted by Earnest Iconoclast | February 27, 2008 10:04 AM

"Both Clinton and Obama propose a lot of government intervention in the health insurance and care systems that will somehow increase efficiency and lower costs."

In Obama's plan if the government isn't as efficient at providing care as the private health insurers, then private health insurance will be cheaper and people will naturally filter that way. Allowing us to purchase drugs at the European prices may force the drug companies to charge fair prices, so that the US doesn't bear the burden of funding research while Europe gets off cheap.

"Hospitals will stop taking high-risk patients and will focus on the easy cases."

Like you said, there will need to be some metrics for the difficulty of the cases. As for information, I do think a little more transparency in health care costs and outcomes is required to make decent market decisions.

Posted by JordanT | February 27, 2008 11:07 AM

Only Megan and other deeply delusional libertarians would refer to the plans proposed by Clinton and Obama as socialist. Clinton's plan is essentially the same as the ones pushed by Governors Romney and Schwarznegger, and Obama's is even more conservative.

Not true, both Obama and Clinton’s plans would create a new set of additional mandates on any private insurance plan sold anywhere in the United States so it would need to be at least as “generous” as the ones sold to federal employees thereby making private insurance even more expensive than it is now. The plan Romney signed into law actually resulted in FEWER not MORE unfunded mandated benefits on insurance (and even then Romney pushed for letting people just buy a major medical policy which is what health insurance is supposed to be).

Both Obama and Clinton are pushing for a “pay or play” mandate that would require employers to provide insurance (now at higher rates) or pay a fine. Romney vetoed this provision in the Massachusetts health care plan but because Democrats control about 90% of the State legislature, his veto was overridden.

So basically both Clinton and Obama are pushing for an employer mandate (that Romney opposed and vetoed) and advocate making private health insurance even less affordable by adding even more mandated benefits whereas Romney’s proposal actually resulted in fewer mandates (but not as few as he would have liked).

Posted by Thorley Winston | February 27, 2008 12:16 PM

Allowing us to purchase drugs at the European prices may force the drug companies to charge fair prices, so that the US doesn't bear the burden of funding research while Europe gets off cheap.

The EU isn't about to let Big Pharma raise prices. Period. Doing so would require citizens and the leadership to endure certain pain now for possible progress later on. Pigs will become aerodynamic marvels before the EU raises drug prices.

Posted by John | February 27, 2008 12:29 PM

Both Clinton and Obama propose a lot of government intervention in the health insurance and care systems that will somehow increase efficiency and lower costs. Neither really offers a convincing argument for how this government intervention will actually reduce costs and provide more coverage for more people.

The only way it would provide more coverage for more people is by getting more people to sign up for his new program by having the taxpayer subsidize their premiums. The problem is that when you look at the details of what he’s proposing to do to people who either get insurance through their employer or buy it on their own, it will end up making it more expensive than it is now.

That’s because the major part of Obama’s proposal is to create a National Health Insurance Exchange ostensibly to “help” people buy insurance in the private market. The problem is that he would require that ANY private plan purchased anywhere in the United States would now have to be “as generous” as his new program. Meaning that when Obama has proposed a plan that covers the same gold-plated benefits as are offered to federal employees including things like “preventive, maternity and mental health care” or whatever else he deems “essential medical services, if you want to buy a plan or your employer wants to buy a plan it has to cover those things whether you want them or not.

Right now the States have their own mandated benefits which are estimated to be responsible for 20 to 30 percent of your health insurance premium. Obama would continue to allow States to add on additional mandates and would in effect make it impossible for anyone to buy actual health insurance that covers just major medical which is a lot less expensive and does what insurance is supposed to do – let people protect themselves from catastrophic events. Instead we are now either going to have to pay more (or our employers will thanks to the “pay or play” mandate) for what amounts to prepaid health care while paying more in taxes to subsidize the premiums of people who sign up for Obamacare.

Posted by Thorley Winston | February 27, 2008 1:38 PM

Thorley's right, except that if NY is the example, the increase will be more than 20 to 30 percent.

I should, however, be thrilled by the fact that my daughter's college physical and the vaccine against meningitis were free.

Posted by MarkD | February 27, 2008 3:13 PM

I guess that's my post in shorter terms... both Obama and Clinton will mandate gold plated insurance for everyone, subsidized by the "taxpayers". They both claim this will be cheaper through magical hand-waving. Oh, and the side-effect is that the government will heavily regulate the insurance industry (well, MORE heavily than today).

Jordan... the government won't be providing health insurance, it will be mandating what "private" health insurance must cover and how much it must cost. There won't be an alternative...

Posted by Earnest Iconoclast | February 27, 2008 5:20 PM

I guess that's my post in shorter terms... both Obama and Clinton will mandate gold plated insurance for everyone, subsidized by the "taxpayers". They both claim this will be cheaper through magical hand-waving. Oh, and the side-effect is that the government will heavily regulate the insurance industry (well, MORE heavily than today).

Jordan... the government won't be providing health insurance, it will be mandating what "private" health insurance must cover and how much it must cost. There won't be an alternative...

Posted by Earnest Iconoclast | February 27, 2008 5:20 PM