I think it has as much to do with the gradual public realization that "government provided" does not mean everything stay the same, except you no longer have to pay for it. As the bills have become more specific, more Americans seem to have realized the consequences of a government run option, whether it be more federal control in personal decision making (the Stupak amendment) or more cost (taxes, deficit, etc.)
I think you mean "The more lies Americans hear about health care reform, the less popular it gets."
By all means, let's just keep doing what we are doing. Sure, 15%-20% of the workforce has no jobs (unemployment plus "discouraged") and their COBRA coverage is wearing out. Sure, in 20 years health care is going to consume 30-35% of our GDP.
But hey, there are political points to be had by ignoring all the problems, calling the President a socialist, and ignoring the lessons from all other countries in the industrialized world.
Yes, I know, this health care legislation doesn't directly address the 800 pound elephant in the room: overutilization. But it's a start. If we never start that process, we will never do anything to solve it.
It's not the lies. I don't believe it's a more informed public rejecting reform either. It's the unemployment you just mentioned.
People saw the government (and the opposition) discussing health care to the death in the last 6 months while the number of unemployed kept growing. They don't feel government is prioritizing our current main problem. This translates in resentment shows towards the current initiatives of the Administration. Consistently, in this period approval numbers of both parties have gotten lower.
How about lowering cap gains taxes to encourage investment? Start-ups need cash and investors today are not as willing as they once were to risk their money in the face of the taxes they will pay if the company is successful. You want jobs then encourage people to fund start-ups. The Democrats are doing exactly the opposite with their tax and regulatory burdens.
#1 Stop fantasizing about ways to add cost to business. ie STFU about cap-n-tax, healthcare "reform", card check, "repealing" the bush tax cuts etc.
Health care is costing business more every year. So I don't know what the hell you are babbling about.
#2 Redirect the porkulous spending to a payroll tax holiday
What kind of holiday do you mean? What about all those with out jobs?
#3 Encourage the banks to lend again.
Thank you, Rip Van Winkle!! In case you haven't noticed, banks aren't lending because their balance sheets are a mess. What do you suggest that Geithner and "B-52" Ben do that they haven't already? If it's lend or be tossed in jail, that's something I can get behind.
What is big government supposed to do about private sector unemployment big guy?
This question supposes that there's nothing the government can do about private sector unemployment and surely Democrats aren't advocating that ... are they?
The government mandates a 40-hour work week ... does it not? What is magical about this number? Nothing. It could easily be 35 hours ... or 30. Lowering this number would increase employment. Certainly there would be negatives ... but that would be a positive.
But I think the larger point is that no matter what ideas anyone comes up with that would actually increase employment EletronHayek and his fellow travelers would merely point out some negative associated with the given tactic in order to suggest that it would be a waste of time to even attempt it. Do nothing is their standard response.
Democrats seem to want very high unemployment and believe it helps them get their other agenda items enacted ... as evidenced by the tactics they use to shoot down all arguments for raising employment.
So, as long as Democrats are allowed to be in charge things will not get better. So, we should just fire them.
How about stop the huge deficit spending which is taking money from the private credit sector, and moving it into government bonds. Bonds are literally robbing the private sector of critical funds that would normally be used to fund small business loans and diverting it to long-term bonds...that money is now no longer able to fund those loans that are needed to fund the growth that would create lasting jobs.
Thats on the short term. In the long term, reducing taxes (or not allowing tax cuts to lapse) would free funds IMMEDIATELY for use in funding small business growth. Small businesses are traditionally the engine which produces wealth and permanent jobs. What this administration has done is to spend more than 5X's the dollars for temporary job creation (almost $2 million per job, where as the private sector spend roughly $300k per job) that will have to be refunded yearly.
So what can the government do? Why they could do a lot, but this administration and those who are in control of Congress have no real desire, or the knowledge of economics, to actually do anything that would produce long term growth outside of government circles. Gov't doesn't PRODUCE anything, it merely acts as a brake on the economy by taking funds out of it and wasting 75% of them in projects that are in the end...useless. That, in brief, is what government can do.
Well, not to mention what happens to the private market in general. Especially with a single-payer option, but even just an "exchange" will likely cause some of the insurance companies to go out of business
ND, a "fee" a "penalty" and a "tax" are the same thing, only different labels. If you place a penalty on a small company for not offering "affordable health insurance" (because they literally can't afford to do so, and still remain even reasonably profitable) it is the same thing as a tax.
If you place additional "fees" on energy usage it takes away money from those who would use it to purchase products...made by small businesses.
You want affordable health insurance, remove those barriers that are presently in a number of states (CA, NY, NJ, MD, for example) that prevent more than 1290 of the 1300 health insurance companies from doing business within the state. Those states listed above only permit SIX!!! 6 Health Insurance companies to conduct business within their borders. Is that real competition? Nope, not at all.
You want to use less energy? That's relatively easy one...reduce the weight of vehicles on the road today. It's possible to produce a vehicle the size of a Chevy Tahoe, but weighs 1/6th the weight. How? Carbon fiber. instead of require a huge block V8 engine, if the Tahoe weighed in at 1200 lbs, then it would only need a 2L engine to power it...that engine would get 40+ MPG...instead of pushing a 7000 lbs truck with a 6L engine that gets less than half. A 4 passenger care would weigh in around 700 lbs and get even better milage with 2 or 3 cyl engines...that would reduce carbon emissions in this country by 2/3rds if not more.
Solutions? There are many out there, but this country wants easy ones, so tax, fee, regulate, yep make things more expensive that's the way to reduce emissions...NOT!
I would almost agree, Nimed, except the larget drops in support occurred from 2007-2009, before Obama took over. Since the administration took over, its dropped about four points. The Administration advocating health care reform has only been in power for a short period of time during that drop in support, thus not very probable that resentment toward that administration is the real problem.
It's not the last six months that seem to be the real issue.
The last six months saw the lines cross for the first time ever.
Sure, but that seems like a fairly arbitrary event and only part of a larger trend. I think my point was that from 2007 onward we saw a pretty steady decline of support for government resposibility of health care supplies. That doesn't really translate as "resentment shows towards the current initiatives of the Administration" as Nimed suggests, rather I think people were more generally concerned with the decline in the economy. When things were economically good, support was high. When the economy faltered, support faltered.
It's not the lies. I don't believe it's a more informed public rejecting reform either. It's the unemployment you just mentioned.
I disgree. The public may not be informed policy wonks, but health care reform has moved from being a vague concept onto which people could project their hopes into a concrete proposal that can be criticized. The signal-to-noise of the debate is low, and the amount of attention being paid outside of a few partisans is also low, but I think that is one factor.
Another factor is that the public wants debt reduction, not debt expansion.
The third is that Obama and the Democratic Brand are more tarnished than they have been for a while.
By all means, let's just keep doing what we are doing. Sure, 15%-20% of the workforce has no jobs (unemployment plus "discouraged") and their COBRA coverage is wearing out.
Gosh, it's almost like tying insurance to employment is a really horrible idea. Something conservatives have been saying for years, while liberals have continued to push even more obligations and expenses onto employers.
while liberals have continued to push even more obligations and expenses onto employers.
I could go all Tonto on you, but I won't. I haven't heard conservatives singing the praises of single payer, or other methods of covering people with out it being tied to their job. So I'd like to know what obligations and expenses you are talking about.
Conservative economists and wonks have opposed the (highly regressive) tax break that is responsible for employer converage for a very long time. Without that tax break, employer-sponsored coverage would be about as common as employer-sponsored housing and company cars, i.e. nearly non-existant. Everyone would be in the market for individual insurance. Those who could afford great insurance (and were willing to pay for it) would have great insurance. Those who could afford minimal insurance (and were willing to pay for it) would have minimal insurance. Those who could not afford it (or were not willing to pay for it) would have no insurance. Just as for home, auto, and life insurance.
Conervative politicians have not been pushing for this very hard, because employer-sponsored insurance is politically popular.
As for pushing "more obligations and expenses onto employers", it's not hard to think of examples. Minimum wages, mandatory parental leave, mandatory sick leave, and health insurance requirements are all policies that limit the contracts that employers and employees can negotiate, and have all been widely supported by progressives.
Gosh, it's almost like tying insurance to employment is a really horrible idea. Something conservatives have been saying for years, while liberals have continued to push even more obligations and expenses onto employers.
Nonsense. Plenty of liberals have been saying the same thing. Indeed, the one substantive proposal out there to radically alter the system was written by a liberal, Ron Wyden. Of course, while Wyden's bill isn't politically feasible, at least the two Democratic proposals under consideration in Congress do potentially put us on the path to severing the link between employment and health insurance by setting up exchanges and (in the Senate version) beginning to tackle tax code support of this arrangement.
First let me say, Muzzybelly, that this is an awesome way to foster discussion.
Second, just because I don't support the current bill does not mean I don't think something needs to be done. I absolutely agree there are large problems, and have yet to call President Obama a socialist. In fact, when he first began discussing the subject, I was wary but receptive, because it seemed to begin with his awareness of the Gawande article and Darthmouth study, which indicates huge spending disparities in different regions with no difference in outcome. However, the liberal side of the Democratic party decided to change reform into expansion. I believe we need to reform first to lower costs, so as to be able to afford expansion. Also, I prefer the government have little or no role in what I want in my health insurance.
I'm not talking about everyone who opposes the bill. There is always a reasonable opposition.
The problem is that much of the opposition to this bill is unreasonable. Death panels and government taking away Medicare and socialized medicine BS.
You are wrong that the "liberal side" changed reform into expansion. It has always been the plan to expand health care coverage to universal or near-universal coverage. The question is how much reform would accompany that.
It's also worth noting that the vast majority of anti-reform energy has come from conservatives. Liberals want a system with tighter cost controls, evidence-based medicine, and scientific allocation of resources. Liberals are the ones who want to address the huge disparities in spending. Conservatives are the ones who equate these things to death panels, socialism, fascism, government bureaucrats deciding who lives and dies, etc.
I agree much "anti-reform" energy has come from conservatives, and I agree that conservatives are the ones usually throwing around socialism, fascism, etc. However, as far as governments deciding who lives and dies, conservatives were crazy to say that, but somehow pro-choice liberals are free to berate the Stupak amendment because it doesn't allow women to choose abortion? This is what conservatives were trying to express as a fear: once the government runs health care, every part of coverage necessarily becomes political, and conservatives historically (the party has gotten away from this, but there are still those of us that believe it) oppose additional government interference in our lives. Was this fear blown out of proportion with words like socialism and fascism? Absolutely. Was it ingenuous or shouted simply so Obama could not get his way? No. In fact, Obama did some lying too (http://nobamablog.wordpress.com/2009/08/12/obama-doctors-may-choose-amputation-because-of-reimbursement/), and while he was quite obviously wrong, I understand what he was trying to address, and don't shout "liar!" every time he says something despite the fact that he has done it in the past.
Your 3 parts of reform are incredible vague. Evidence based medicine and tighter cost controls sound nice, but the former is a very vague term and has little or nothing to do with cost controls (much non "evidence based medicine" is used to address patients that can't handle or can't afford the appropriate medication, treatment, etc.) and the latter is something government has never been good at. But if they were serious, they would reform and control costs in Medicare during the 3 years before the bill takes effect and write into the bill that it would not be allowed to take effect without meeting certain actual cost savings. I believe in this situation that many liberals and Democrats did honestly think of expansion when reform was first discussed, but that was not how Obama presented it. He presented it as reform which would lead to reduced costs which would allow more affordability. This current plan is expansion that will hopefully control costs, which again I think is a terrible order.
Muzzybelly Says:
"The problem is that much of the opposition to this bill is unreasonable. Death panels and government taking away Medicare and socialized medicine BS"
Muzzy, "Death panels" is a rhetorical exageration that points to the side effects of politicizing healthcare.
When the govenment pays for all medical care it will control what gets covered. This is illustrated to "progressives" howls with the abortion ban.
It is not unreasonable to think that politics will be the driving consideration for what is covered and who gets treatment.
It won't be long before the best treatment goes to politicians and those that are politically connected. Among other evils, this will open up a whole new area of political graft.
I agree with Nola. Reform before expansion. We simply cannot afford to add another trillion to federal spending without a clear plan for how we will save money in existing health care entitlements. The House Bill punts on reform, so just expands the size of the health care cost problem.
"... independent voters are starting to take an interest and don't like what they see."
They were told by Barack Obama that he would not raise their taxes (any of their taxes). He claimed, in order to get elected, that he would pay for all of his initiatives by raising taxes only on people making more than $250,000 a year.
He lied.
Independents can read. They see they are now mandated to purchase hugely expensive and bad insurance policies - a thinly-disguised tax increase in everything but name.
So, like with George H.W. Bush, they'll unemploy head Liar In Chief. And he'll be lucky if that's all they do.
No, no, no. It's all because of Republican lies. If the people knew the truth about the wonders of public option/single payer they would support it 70-80%!
I think he means to imply that people already covered by the government might have different feelings than people who aren't. I'd be curious to see which way that goes too.
That poll looks very suspicious to me - I can't believe 69% of Americans ever sided with government responsibility for health care - back in '07 that meant every democrat and independent and quite a few republicans. Look at the Gallup site it may have made some sense in relation to the other questions asked but I don't see where they post the poll in its entirety.
I can believe that 69% of respondents support the concept of government making sure that a guaranteed minimum amount of health care is available to everyone. But today asking that question is effectively a proxy for "do you support the current health bill", which goes far beyond that.
As much as I would like to believe this correlation, try searching Google for health care new stories limited to particular years. It looks like the correlation actually runs the other way when you compare the Gallup graph to the number of Google results for corresponding years; when there are more health care stories, the government responsibility % goes up and vice versa (yes, there have been fewer health care stories this year even when scaling up by 12/10.5)
Most of the coverage of health care reform since the summer has been critical. Also, the longer something gets debated without action, the more the public tends to lose patience, and "no" wins by default. This is precisely why the Senate Democrats hurt themselves more and more each day they dither and fail to offer solutions.
The problem with that is selection bias - countries whose populations are more socialist will prefer it more, and are more likely to have voted in a government that would provide it at some point in the past.
If those other countries are so wonderful, why don't we have an emigration outflow from this country to them?
Seriously, people emigrate to countries where they think life is better. If you assert that health care and/or life in general is better in, say, the UK or Canada than in the US, wouldn't there be a Berlin Wall phenomenon, with all the emigration outflow running toward the UK or Canada?
Maybe people don't actually want to move to a country where the government health service tells them to wait an unconscionably long time for a needed medical treatment.
First, we aren't talking about how "wonderful" those countries are in general, but about their health care systems. It's quite possible for their health care to be a heck of a lot of better than ours, but other aspects of American life to be better.
Second, even if we were talking overall quality of living, the gap has to be fairly huge before it spurs people to move. People aren't going to on a whim just pick up and leave their friends, their culture, their life to move to a strange place. It's one thing to leave totalitarian regimes or destitute poverty to look for a better life. It's another thing entirely for a middle-class American to pick up and leave.
Third, do you know there aren't emigration outflows? Or are you just surmising? I know a lot of people who have left the US to work in Europe. Some of them came back; some of them didn't; some of them I don't know. And of course, there are lots who come from Europe to here.
Fourth, what are immigration restrictions in Europe like? I don't think it's so easy to emigrate there. I would love to live in Switzerland. Unfortunately, I don't yet have the net financial worth that is required for a non-Swiss to emigrate there.
I have lived and worked in Switzerland. Unlike the U.K., France, and Canada, Switzerland does not have anything even close to single-payer insurance, nor does the system have more than a passing resemblance to the bills now in Congress.
It does have a few features that progressives would like: a mandate, community rating, guaranteed issue, and subsidies for the poor. But it also has many provisions that U.S. progressives have blanched at, and those are mostly the ones that actually cut costs. There is no employer-sponsored insurance and no counterpart to medicare: everyone is thrown into the individual market. The mandate is only for catastrophic coverage; preventative care, mental health coverage, contraceptives and all the other requirements that U.S. progressives like to pile on are not required.
Aside from the problem of the high effective marginal tax rates that the subsidies for the poor create, I actually like the Swiss system pretty well. Give me a call when you have a U.S. bill that eliminates medicare and the tax break for employer-sponsored coverage. Such a bill might get my support.
You remind me of the people that left MA because of high taxes, crime incompetent government, no jobs and bad schools.
Then immediately started voting for the policies/programs that created the mess left behind.
Since summer, the opponents of health reform has released an avalanche of lies , the likes of which have not been seen since the heyday of Pravda and Goebbels.It has gone largely unopposed by the Democrats, who seemed to have adopted the same failed strategy that Kerry used against the Swift Boaters-the belief that the American public could sort through the horses**t unaided.
Instead of responding, the Democrats have been fighting among themselves, compromising with Republicans, and creating a bill that only a policy wonk like Ezra could understand.
This wsn't what the public had signed up for when they elected Obama with a mandate to enact universal health care. They have noted that the Democrats have been spending more time trying to accommodate insurance companies, drug companies, doctors and hospitals than trying to achieve access to affordable health care for all. They have also noted that the one really popular feature of health reform- the public option- has been watered down and may not be in the final bill.
Finally, they have noted that Obama has apparently been content to let Congress squabble and draw out the process for a seeming eternity. Now Obama may be very patient, but the US public isn't. They will wait for a reasonable time, but then they expect results.
As a result, they are souring on the whole process. In short, its time-past time- for Obama to get in there and mix it. He and Harry Reid have to whip the Democrats into united action and get the best bill he can past the finish line.
Once it passes it, I expect the approval ratings will go back up.
Since summer, the opponents of health reform has released an avalanche of lies...
And apparently they've just now caught up with the avalanche of lies told by proponents of socialized health care.
They have noted that the Democrats have been spending more time trying to accommodate insurance companies, drug companies, doctors and hospitals than trying to achieve access to affordable health care for all.
Uh...yeah. That's how the political process works. Which is why it's a very bad idea to put important sectors of the economy under the control of the political process.
Of course. Because as we all know, the only way to change the system is THIS bill. It's inconceivable that someone could be against government takeover of health care but also think that the system needs reform.
You could drag out a less tired and childish liberal mantra. It's become the liberal version of "if you don't support the decision to go to war, you don't support the troops."
They have noted that the Democrats have been spending more time trying to accommodate insurance companies, drug companies, doctors and hospitals than trying to achieve access to affordable health care for all.
Maybe the reason people are skeptical about the government playing a larger role in health care is because it's been so transparently shown to us that our leaders don't serve us, only the people who bankroll their campaigns. It takes a major leap of faith to believe that the political class that has been running the health care reform process will do a better job running actual health care.
Then we need a better political class. But you are right-the people see a Republican opposition bought and paid for by the insurance industry blocking reform, aided by their fellow travelers the Blue Dog Democrats. Cynicism is truly in order.
And they also see Obama turning down special interest groups left and right as an example for all of us! Unless it's trial lawyers (tort reform) or Unions...
And they also see House Dems crying foul about taxes on Cadillac insurance plans, even though most experts recommend this as one substantial mechanism to expose consumers to healthcare costs and thereby control cost explosion overall. And they see many Dems trampling on Ron Wyden's sensible proposals about consumer choice and options outside of employment-based coverage. Surely the fact that Dem labor union constituencies vociferously oppose both of the foregoing measures for reasons of self-interest has nothing to do with the Dem legislators' position on these items (which, incidentally, are favored by many or even most serious-minded healthcare policy wonks).
They have noted that the Democrats have been spending more time trying to accommodate insurance companies...
Amazing. It would make so much political sense to eliminate a business sector that provides hundreds of thousands of jobs when unemployment is over 10%. Stick to your guns their guy. If your dreams come true the government will pretend to pay us while we pretend to work.
The first paragraph is just sad, and reflective of the kind of defense of this bill of which people have grown tired.
If you actually think the POTUS was elected with a mandate to enact universal health care, your delusions about what this country wants runs too deep to be part of a reasonable debate.
I find it funny that muzzybelly was called out for being sarcastic and snarky when so many commenters are snarky and sarcastic all of the time and are never called out. Could it have something to do with his politics on this issue...I wonder?
Seriously though, it seems as if a very large issue is often ignored in this debate, and that is the plight of the entrepreneur who must close his/her doors or never opens the doors because he/she can't find insurance for him/herself. People talk about the "small business owner" being hurt by this legislation, and they usually mean the small business owner with other employees to insure. Since I have not read the bill yet and only have rhetoric and hyperbole from both sides upon which to rely, I can't comment on that issue right now.
What I can say is that there are currently a lot of potential small business owners who are dissuaded from or simply cannot afford to quit their secure jobs and open their small business because they cannot afford or are simply ineligible for health insurance. This is a serious market inefficiency that leads to stifled competition and entrepreneurship based upon this barrier to entry which may now be eliminated (or at least greatly reduced).
Unlike most commenters here, I am still undecided on this bill and am trying to figure it out with an open mind and filter out the noise. I very well may come out against it, but I have this nagging need to hear more media coverage about the sole proprietor who never fulfills his/her dream because of the insurance issue, and the effects of that on our economy. It can't be good.
ds;
I agree with you that currently, buying single coverage can be difficult. I would say that eliminating employer based coverage would go a long way to solving not only that problem, but also help with cost containment as well.
As far as my sarcasm, I honestly don't know what to say about the vague "Lies!" claim anymore. While I certainly make no claim that Republicans haven't been misleading, deceptive, and frankly dirty with some of their tactics, it is in no way limited to their side of the aisle. I will admit I sometimes respond more harshly than I usually would, but as a medical student this is an issue very important to me. I have obviously made up my mind, but it was not based on my politics (usually Republican), but rather that I believe expanding a broken system with the hopes of fixing it later is a bad idea.
I agree, and that's one of my big objections to the Democratic Party proposals we have now: they take the broken system we have now, where nearly all health care is paid for by comprehensive health insurance (driving costs up and having medical decisions made by insurance company bureaucracies) predominantly funded as an employee benefit that can be lost by becoming unemployed or self-employed, and they attempt to make it bigger by forcing as many uninsured people as possible into it. Medical insurance is not the solution; medical insurance, other than catastrophic coverage with high deductibles, is the problem. It's already had catastrophic effects on health care; I expect that expanding it will make it worse.
Aside from the fact that I personally prefer market solutions in general, I find it hard to envision out and out public health care as any real solution. Instead of having an oligopoly, we'd have a monopoly. Instead of having insurance company bureaucrats answerable to shareholders, we'd have government bureaucrats answerable to Congress, and through Congress to lobbyists . . . and special interest groups are always more effective at lobbying than the general public. There's really not a lot of difference between the existing corporate system and the state system, and what there is is to the state system's detriment.
After all, elementary and secondary education in the United States is virtually a state monopoly; you have to be either rich or incredibly motivated to pay taxes to support the public schools, and also pay tuition at private schools. And how well is that working out? Large numbers of children outright failed by the system, low standards of success for those who don't fail, and domination of educational policy by massively influential public employee unions that can't clearly distinguish between sound educational policy and their own self-interest. Doctors are already arrogant enough; I don't want to see medical policy dominated by a doctors' public employee union.
I'd like a move toward a free market system. I don't see that as a Republican solution; it was Romney who came up with the mandated insurance system the Democrats are now touting as "progressive," and Schwarzenegger tried to foist it on California . . . "We'll give the uninsured help: We'll force them to buy insurance, give them inadequate subsidies, and punish them if they don't" really is a quintessentially right wing approach to health care. I see it as a libertarian solution, and much too radical for the Republicans to touch. But I think it's one that would actually attack the source of most American health care problems.
I agree that what we are calling health insurance is mostly just prepaid healthcare. Maybe a universal system of catastrophic health insurance coupled with mandates to participate and contribute to personal health savings accounts could go a long way toward reducing health care costs. But I think even this sort of system would require significant government subsidy for lower income folks. But I can support that too. I can't support expanding the broken system we have, and labeling that "reform." And I don't believe the promises that it is a first step toward reform. Clearly, the first step is in the wrong direction.
I agree that health insurance is the root of the problems with our current system and expanding "coverage" will only intensify the problems we now have.
People should pay for their own care out of pocket with high deductible ($50,000?) catastrophic insurance. Over time this will lead to lower prices and better care. More importantly it will put the patient at the center of the system.
The idea that someone else should pay and have control over my healthcare is a bizarre idea.
Would anyone want some 3rd party to be in charge of:
where you live?,
what you eat?,
what clothes you wear?,
what work you do?
Well, when the issue was vague and without specific proposals, yes, people might answer yes. Now that there are concrete proposals on the plate, not so much. This isn't rocket science, and it really should not be that surprising.
The $64 trillion dollar question is, is there a set of concrete proposals that could attract general support. Not just that you, or I, or anyone else here thinks they ought to like if they understood them. I think that radical free market reforms would greatly improve American medical care, but I'm also pretty sure that there would be overwhelming opposition to any proposal to make such changes, not just from special interest groups but from a lot of the public. But it seems that when we look at having the government actually take explicit responsibility for delivering health care, then suddenly what health care gets delivered, and to who, and at whose expense, and how much it costs, all become not just personal choices but political issues, and there may not be any possibility of consensus on them, or of any answer that the voters won't hate and punish.
Which is as much as to say that I wonder if the United States has become ungovernable now, as any possible substantial change deeply offends some powerful special interest group or large faction. I find it grim to think that I hope to be saved from a disastrous new policy by the sheer ungovernability of the country, and as part of it by the bloodymindedness of a bunch of right-wing theocrats. It makes me understand Churchill's comment about an alliance with Satan.
Human beings, by nature, are conservative creatures. The problem with reform, good and bad reform, is that most people are satisfied with their healthcare today. It will always be difficult to enact any significant reforms because of this. Just look at how Obama repeatedly promises that nothing will change for most people. The people, though, are now looking at real proposals and realizing that Obama's promises are not going to be kept. At that point, they have to decide whether or not they are willing to take the chance that these proposals will make things worse for them personally. A lot of them are concluding that it isn't good for them. I happen to agree with this stance. However, the reforms I and you believe would be a benefit are going to suffer from the same natural conservatism.
Absolutely. That's why I think we can start smaller, with reforms to Medicare payment schedules attempting to reduce disparity in payments, and phase out the employer-based insurance system. If done slowly, possibly with government subsidies and more regulation of pre-existing conditions, this might help citizens realize that health insurance doesn't mean someone else pays for their health care, just that it takes longer for the bill to get back to them.
I'm the first to admit that, in discussions concerning education and health care in our country, just shouting "Look at Europe!" is a lazy argument that generally doesn't help. Blah blah, we have a different culture and political system, path dependence and all that.
But it's still a very good, and extremely tempting argument, when someone is saying stuff like:
I find it hard to envision out and out public health care as any real solution. Instead of having an oligopoly, we'd have a monopoly.
There's really not a lot of difference between the existing corporate system and the state system, and what there is is to the state system's detriment.
After all, elementary and secondary education in the United States is virtually a state monopoly; you have to be either rich or incredibly motivated to pay taxes to support the public schools, and also pay tuition at private schools. And how well is that working out?
Which is in essence claiming that the origin of all our problems is too much government, and the only way to solve them is introducing free-market solutions.
But our K-12 education system is crappy compared to other monopolistic education systems. Our health care system is inefficient and costly compared to systems in which the government plays a greater role. Maybe there are wonderful free market cures to our ailments in health care and education. But, in these areas, it's the free market that bears the burden of proof. We really shouldn't start by assuming that the monstrous monopolistic government can't, even in principle, provide good solutions.
uh, private school is demonstrably better than public school. homeschoolers also post better outcomes, as far as that goes.
i would see data that public schools in america have better outcomes even with correction for rich parents in certain districts where the students are cherrypicked (the, uh, health care situation, actualmente).
Those are not meaningful comparisons. Stoddard, Nimed and pretty much every sane person agrees that our public education is terrible. I think Nimed's point was that they don't have to be that way in principle.
The comparison with homeschooling makes even less sense. A "student" has one self-selected and highly motivated tutor just for him/her (plus possible brothers).
Education is mostly a cultural value. Cultures that value education do well at education no matter where they are. There's no reason to think public education ever does better than private or home.
A [homeschooled] "student" has one self-selected and highly motivated tutor just for him/her (plus possible brothers).
And yet they outperform buildings full of highly-compensated publicly-employed "education professionals." I think that's sort of the point.
If we gave people a voucher good for home schooling or private schooling based on per-pupil costs, society would be much better off.
Nimed,
Either I have learned to understand you better, or you are learning to write better.
This is the best, most balanced, most persuasive comment I've seen you make.
Thanks. Even though I'm still unpersuaded, I really appreciate this as an excellent and fair addition to the debate; especially refreshing considering how it can often go ballistic so quickly and easily.
I would agree that our education system is crappy compared to other monopolistic educational systems. The question remains: Why? From this example, I'm not sure the burden of proof remains on the free market. The fear I have, and that I suspect many others have, is that a greater government role in our health care system would also give a crappier result than other government-dominated systems, and would be worse for more people than the current inefficient and costly system. Given our politicians' and governments' less-than-stellar performance in education, home loan manipulation, Medicare, airport security, etc. ad nauseam, then for me the burden of proof would seem to lie with the government. It's just not good enough to say that something works for someone else's government.
Of course, I could give you a much longer list of government successes-in health care, no less. I mean, " What have the Romans ever done for us?" http://www.youtube.com/watch?v=ExWfh6sGyso
Apart from abolishing smallpox and polio, and treating veterans,and immunization campaigns, and clean water, and universal access to health care for seniors and funding basic research for medicine, and on and on ad nauseam, what has the bloody government ever done for us?
Mean while, we had a free market in health care prior to 1930. Do we want to go back to that? Really? Patent medicines for everyone, and let's bring back typhoid epidemics!
On well-defined programs with specific targets, yes - even the government archer can hit the target. But do you really want to include "treating veterans" and "universal health care for senior citizens" in your list? Granted, they may be the programs most like the health care bill being pushed now, but if the quality, expense, and efficiency of Medicare and the VA is the best our politicians can do, then your argument hasn't made much headway. Creating huge, inefficient, expensive, inflexible, redundant bureaucracies is something politicians are good at, but I'm not sure we can afford the "improvements", fiscally or physically.
--But our K-12 education system is crappy compared to other monopolistic education systems. Our health care system is inefficient and costly compared to systems in which the government plays a greater role. ...We really shouldn't start by assuming that the monstrous monopolistic government can't, even in principle, provide good solutions.
Actually, you've provided strong evidence that the *United States Govt* can't provide good solutions, even if other governments can.
Our K-12 is a perfect example of what's wrong with US Federal and State level controls--it's a disaster. The "public option" exists; it provides a terrible service with outrageous spiraling costs that no one can control. State-private sector partnerships haven't helped. The public option has in fact driven up the cost of available private alternatives as it has put out of business the less expensive private alternatives--why bother going to a private school that costs 4k when you can get a 6k education for free? Only the 30k education remains as an alternative to the public option. And yet, we are going to have to ration education to control costs, and we already have terrible educational outcomes.
Our current healthcare system is a mess. Making the federal government introduce hundreds of new bureaucracies isn't going to help--even if it would in Europe.
But our K-12 education system is crappy compared to other monopolistic education systems.
No, it's worse than private schools (even those that spend far less money) and home schooling.
Our health care system is inefficient and costly compared to systems in which the government plays a greater role.
It's the best health care in the world -- best cancer survival rates, best access to new drugs, best access to surgery. Saying it's "inefficient and costly" misses the point: the most efficient health care systems are the ones that provide almost no medical care, because the cheapest things (antibiotics, vaccinations) are the most effective.
Neurosurgery may be costly and save way fewer lives than antibiotics, but if you have brain cancer you'd like to live somewhere that can do it, preferably without a 2-year wait.
It's the best health care in the world -- best cancer survival rates, best access to new drugs, best access to surgery.
TallDave: Old people are disproportionately affected by cancer (and other diseases); so higher survival rates simply point out that Americans with access to single payer care -- in other words older Americans on Medicare -- tend to get very good care. To put it another way, it's an argument that our government-run system tends to deliver better or more robust care than theirs. (Which obviously might lead to the conclusion that we ought to extend government-run healthcare forthwith, as we're clearly pretty good at it).
Now, this situation -- robust care in the US for those who tend to get chronic diseases -- the elderly -- flows from the fact that the American system in the aggregate not only shuns explicit rationing, it emasculates the normal functioning of price signals by excessive use of third party payers. And so a tsunami of money flows into the healthcare black hole in a mannner that has approximnately nothing to do with the free market.
Anwyay, not surprisingly, a system with lavish resources tends to deliver good results to those with access to those lavish resources. Your argument really boils down to "America's system is awesome because it insures that a vast amount of money is spent on healthcare, and it also prevents a big percentage of the population from getting any healthcare at all, and so those outside the 'no care at all' group get very robust care indeed."
Problem is, such a system is eroding living standards in the here and now, and is unsustainable in the long run (and is causing tens of thousands of premature deaths yearly). And it's is unfair and inefficient: the aforementioned lack of care drives the US down the ranks of rich countries when it comes to total amenable mortality. But sure, if you want to cherry pick groups who get robust coverage under our system -- and focus on the maladies they tend to suffer from -- of course you'll get good. Some accomplishment!
Jasper:
I see what you're saying, but disagree (or likely unclear) with one or two things. Yes, there is a lot of market distortion, but money going into the health care system does not necessarily mean good care. I think if we cut down on the market distortion, we'd get less unnecessary testing/procedures, because the average person would no longer think "Well, I'm paying for insurance, and if I don't use the money someone else will". As far as cancer survival in the elderly, they survive less often than the young regardless of money, so while I see your point, I think it has less effect than you imagine.
Again, I agree that the current system is eroding living standards. That does not mean a government run system is any more efficient. The key is to discover what to change about our system to maintain our high standard of care, but reduce inefficiency, and I simply do not see how allowing the government control will increase efficiency. Bureaucracies everywhere have a storied history of doing exactly the opposite.
This case for more government care might make sense if the disproportionally affected "old people" you mention actually have a survival rate the same or higher than others....not so much.
I think if we cut down on the market distortion, we'd get less unnecessary testing/procedures, because the average person would no longer think "Well, I'm paying for insurance, and if I don't use the money someone else will".
Nola Dawg: Then you should support the Democratic proposals, because they at least begin to chip away at this problem. Regrettably the votes don't exist for a total overhaul of the system like Wyden's bill (assertions to the contrary, ObamaCare is not a "government takeover" but a highly incrementalist, conservative approach to reform).
Yes, there is a lot of market distortion, but money going into the health care system does not necessarily mean good care.
True. I don't think anybody who's seriously looked at the US model doubts there's a lot of unnecessary healthcare being delivered, and that this unnecessary care sometimes even kills people. So, the allocation of resources in the US model isn't optimal. Still, the system is bound to yield a lot of robust healthcare to many of those on the receiving end of the lavish resources, even if it occasionally is counterproductive.
Again, I agree that the current system is eroding living standards. That does not mean a government run system is any more efficient.
Who's proposing a "government-run system?" The Democrats want to prohibit rescission, and they want to require community rating and guaranteed issue. That's what they do in higher-performing rich world healthcare systems like those in Germany, Switzerland, Japan, etc. The Democrat also want to extend coverage via mandates/subsidies -- again, in similar fashion to Switzerland or Germany. But that would mean buying your coverage and getting your healthcare delivered by, you know, private sector actors. It's possible, of course, that the legislation would allow for a new government insurer, as well, but it's not looking terribly likely.* And even if it transpires, it will only be an option for two or three percent of the population. Hardly what I call a "government-run system."
In fact, what ObamaCare is going to give us is an American version of Switzerland or Germany, and those systems -- while absolutely not reasonably characterized as "government run" -- are in fact more efficient by any reasonable standard: that is to say, they may not be superior to the American model in all facets, but it's pretty difficult to say that they don't beat us at least when it comes to efficiency, as they're both high-performing models that deliver excellent results while doing so far more cheaply and far more universally than the US.
*My own view of the public option is that, while potentially a useful concept, the White House and a lot of Democrats in Congress have been touting it more for bargaining position reasons than for anything else. So, the GOP might end up hailing the "defeat" of the public option as a "great victory" while in the end having to swallow the bitter pill of a bipartisan bill that delivers Swiss-style UHC to the US under Obama's leadership. I think this is the most likely explanation for what's going on now, especially with respect to Reid's apparent lack of concern that Lieberman has backed himself into a corner on the public option: Democratic leadership and the White House don't care if it's in the Senate bill or not, and would just as soon it not be included in the final bill.
I may have a bit of a different view or expression of the legislation, but the "exchange", despite it being through private insurance companies, presents a host of problems to me. With an exchange, the government is allowed to mandate certain types of coverage, all of which will bu subject to interest groups rather than common sense or what's best for the insured/economy. The same problem exists for mandates. Thus I (mistakenly) characterize an exchange as government run.
As far as the legislation chipping away at the problems, I disagree. I don't see how they attempt to control costs, which I believe is only possible by exposing patients/citizens to the costs of the unnecessary tests/drugs/procedures that they are often requesting. Certainly physicians and hospitals share some of this blame, which is why I've shared Dr. Atul Gawande's position of moving toward the Mayo clinic model, something else this legislation fails to do.
Again, I think the problems are much more in the area of actual health care, and possibly the interaction between health care and health insurance, than health insurance itself. The government already has a lot of power to alter how insurance companies function by changing Medicare, on whose payment schedules almost all insurance companies base their own payment schedules. I think the government needs to show it is serious about reform by fixing Medicare before it covers everyone, then tries to fix Medicare. I would have much less of a problem with this bill if contained the exception that, if Medicare does not limit costs by the time the bill is to be implemented, it will not go into effect.
I also think the one sticking point about foreign countries' health care systems as a model is medical innovation. I know many other countries save a lot of money by paying next to nothing for patented drugs, allowing the US to shoulder the burden of at least pharmaceutical innovation.
TallDave: Old people are disproportionately affected by cancer (and other diseases); so higher survival rates simply point out that Americans with access to single payer care -- in other words older Americans on Medicare -- tend to get very good care.
People in their 40s and 50s get cancer too. Even looking at just Medicare patients, what it means is they probably get better care than Europeans. It says nothing about whether single-payer is providing a better or worse outcome than private care. Also, many of those people have Medicare Advantage.
Now, why would the U.S. single-payer system be doing better than the European version? Hmmmm. Maybe it's that giant free market the U.S. has that Europe doesn't. You know, the one that gets drugs a year earlier, does twice as many surgeries, has twice as many MRIs, does most of the medical research...
"...ignoring the lessons from all other countries in the industrialized world."
Funny, that's what I would argue the Democrats are doing. I live in Europe (Austria) after having spent many years in the United States. The idea that the health system here is any sort of a model is not the slam dunk case many posters here seem to think. The level of care is noticeably lower than I was accustomed to in the U.S. -- everything from technology to basic protocols to wait times. And many of my friends here have traveled to the States for major procedures. And that doesn't even consider that the U.S. system is responsible for the vast majority of medical innovations that we Europeans happily take advantage of. The burden of proof is most certainly NOT on the more free market system, as someone here asserted.
"Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States."
See, this is what I'm talking about. Who are you, Baron von Rothschild?
You have "many" friends who have traveled to the US for "major" procedures? Many friends who have the need and finances to travel to the US and get treated for "major" procedures in US hospitals? Give me a break.
The number of world citizens who come to the US for treatment is greatly exaggerated. My father is a national expert on treating a certain type of cancer, and is a surgeon in one of the top 5 or 10 medical centers in the country. He gets his share of foreign nationals. Mostly sheiks from the middle east or rich magnates from places like Malaysia, Indonesia and India. But he gets like 2 of them a year. He's had about two dozen Europeans come in 30 years of practice. The department maybe gets a dozen or so foreign nationals a year -- a major department in a major medical center.
Let's put the matter another way. If so many Europeans are coming to the US to seek medical care, then why the heck are we allowing this? We're allowing millions of Americans to go without treatment so middle class Europeans can come over and consume our medical resources?
If so many Europeans are coming to the US to seek medical care, then why the heck are we allowing this? We're allowing millions of Americans to go without treatment so middle class Europeans can come over and consume our medical resources?
Uh, because those medical resources aren't "ours". They belong to the clincs, doctors, and other service providers that own them. And those owners, quite reasonably and ethically, sell them to the highest bidder.
I agree, by the way, that numbers of medical tourists to the U.S. are relatively small. But it is nonetheless significant that people for whom money is no object do tend to come to the U.S. for treatment. It's not the only quality metric, but it is a quality metric, and the U.S. is pretty clearly ahead on it.
I agree, by the way, that numbers of medical tourists to the U.S. are relatively small. But it is nonetheless significant that people for whom money is no object do tend to come to the U.S. for treatment.
It's no more significant than the fact that people for whom money is no object tend to go the Sweden for treatment. And to Britain. And to Switzerland. And to Singapore. And to France. The US is not the only rich country whose high end medical facilities attract wealthy medical tourists.
Because of its sheer brevity, this is an impressive example of stonetools' argumentative style, which not only oversimplifies the issues, but misrepresents them so badly as to have nothing to do with the point being made.
"I'm rich": stonetools would have you think that this was crucial to Conor's argument; Conor in fact does not even discuss his own health care situation
"my friends are rich": stonetools says this as if it meant "my American friends" and probably wants you to think they are rich Americans who are indifferent to the needs of poor Americans; in fact they are rich Austrians whose health care situation is a product of the Austrian health care system. Or, at least, Austrians with enough money to fly across the Atlantic and pay out of pocket for medical procedures; I don't know if I would count that as "rich." Americans who fly to Thailand for medical procedures usually are doing so to save money.
"we have no problems getting health care" is a flat falsehood. Conor's point in fact was precisely that his friends DO have problems with getting health care . . . out of the Austrian health care system, which is presumably the kind of health care system that stonetools wants. Of course they have enough money to pay once for their own country's health care system, which doesn't give them what they need, and then pay again to travel to the United States and buy medical services out of pocket. Whatever kind of evidence that is about American health care, it's not favorable evidence about Austrian health care, and thus about European-style health care delivery.
"so what could be wrong?": Conor in fact is saying that there is something wrong with Austrian health care. stonetools would have us think that Conor is upholding the American system as perfect; I don't see that as being done. From the statement "I don't want to change our system to follow an approach that I know produces worse results" it does not at all follow that our system does not need to be changed; only that it doesn't need to be changed for the worse. (If you have roaches in your kitchen, you probably don't want to use a flamethrower to get rid of them.) stonetools' whole argument rests on the premise that there are only two choices: to accept the Democratic Party's proposals for reform (whatever those are—stonetools has been making the same arguments through a whole series of inconsistent versions of "reform"), or to maintain the status quo forever. Once you admit that it is possible to adopt a different set of reforms, that whole argument is exposed as manipulative.
If there are no better arguments for the Democratic Party schemes than these, then the Democrats are intellectually bankrupt.
The problem is that Conor was quite transparently lying or exaggerating. His credibility as a commentator of Austrian health care ended when he said he had "many" friends who came to the US for "major" procedures.
As it happens, I know a little bit about Austrian health care because I have a close friend who was an Austrian doctor. I don't know enough to give a complete assessment. I know enough to know that Austria, like any other health care system, has its problems. They do a poor job of providing auxiliary medical services like physical therapy and their mental health system, if I recall correctly, is a joke. They also have a hangup with homeopathy.
But deficient provision of necessary major procedures is not one of them. Certainly not in the cities. I can't speak for the countryside.
No system is perfect. I don't think any serious person believes that the US ought to adopt a model just like country X because country X has it just right. The point is that we can do better than what we have by taking cues from what other countries are doing.
Muzzy, what exactly is wrong with having "a hangup with homeopathy"? I'm in favour of healthcare systems not ascribing medicinal properties to water, myself.
The idea that the health system here is any sort of a model is not the slam dunk case many posters here seem to think. The level of care is noticeably lower than I was accustomed to in the U.S.
Besides the obvious fact that you're citing anecdotal evidence, what you're saying argues against adopting Austria's system. It's not an argument against making changes at all. I have a feeling an underemployed, uninsured American with three kids would happily opt for whatever method of universal health care is used by Austria.
I recommend watching the Frontline episode T.R. Reid's did for PBS last year - it's most enlightening (you can watch it online if you want):
I think there are clearly some rich world universal healthcare systems that are plagued by serious problems -- and are probably not models American would want to adopt (and for all I know Austria's is one of them). But I must say the Swiss, German and Japanese systems are highly impressive (and are highly reliant on the private sector, as it happens).
Here's a good question for the opponents of "this bill." What would you have us do?
Keep in mind that Republicans aren't interested in supporting any health care reform whatsoever. They've made that perfectly clear. At least as long as Obama is in office, they are about frustrating any and all health care reform efforts. From time to time, they've trotted out a few token proposals of their own, none of which even pass the straight face test. They don't even bother to promote them. It was mainly for show, so they could waive their bills when Obama was speaking.
So if this bill doesn't pass, then nothing will happen until 2012 at the earliest. If Democrats don't get it done now, they aren't going to get it done in a year or three. Nothing about the politics or policies of the issue are going to change.
In 2012, if Obama wins re-election, Republicans will return to obstruction. If he doesn't, we will have gridlock -- it is very unlikely that Republicans will be able to take back the Senate even under their most optimistic scenarios. The Republicans, meanwhile, don't have a serious plan, let alone one that Democrats would find acceptable.
If this bill fails, health reform will be dead for at least another decade. And in the meantime, what? More spiraling costs. More people dying from lack of access to health care. More dysfunction in labor market caused by employer-tied insurance.
That's a decade that we could be using to make incremental changes and start to chip away at the problem. A decade we could use to experiment with policies, learn how to make them work better, collect data, and so forth. But no, for the sake of scoring some short-term political points, let's flush it all away.
Do you have any idea how much better off we would be had the Clinton health care plan passed in 1994? I don't know of a single person, right, center, left, libertarian, who thinks our current health care system is better now than it was in 1994. Basically, we ended getting pretty much what the Clintons proposed, except at much greater cost and less efficiency.
I'm not saying that bill would have worked. I have no idea. But it would have been a start. Ten years later, we would have unsettled some of the deeply vested interests. We'd have much better understanding of what works and what doesn't. We'd have data. We'd have better ability to control ridiculous regional disparities in spending. We might have Medicare under control. Maybe we would have rolled it back to something else. We could have done something, though.
That's what we need to do now: something headed vaguely in the right direction. And unless you are a bizarre, heartless ideologue out of touch with the reality of life without access to care, universal coverage is a step in the right direction. This bill might be wrong in many respects. There are a lot of things I don't like about it. But it is needed, even if it creates something worse than the status quo in the short-term.
The ball is much easier to steer once it is rolling.
You make a lot of claims that doing something now is better than doing nothing. And I have to agree that the window of opportunity to do something is fast closing. But the "something" coming out of the House looks worse than what we have. Which is why many American are very frustrated with our current political class. We aren't the tea-party crowd. We are the ones who voted for Obama hoping that he could lead us to genuine and positive change. And I still have hope that he is the leader I hoped he would be. But I am starting to worry that he is not much different than the majority of politicians who care more about their chances for re-election than being part of making things better for our country. Yes, the House bill will provide more Americans with health insurance. But they will have the kind of insurance that is bankrupting both business and government. So the future subsidies needed to continue their coverage will not be affordable. I feel for those who do not have health insurance, and feel strongly that they should have better access to health care. But we need to fix the problems with health care cost first. These same problems have plagued the Medicare and Medicaid programs for years, and our government has yet to "chip away" at those problems. So I think your confidence in future abilities to reform the House bill are misplaced. I hope the Senate can come up with a better solution. Maybe there is some courage in that chamber that we have not yet seen.
So what are the conservative proposals for controlling health care costs? There are none? Awrighty then.
That's proof positive that conservative/libertarians aren't serious about controlling health care costs. Meanwhile, the same people had no problem with spending more money in ONE year on TARP than the current House bill will spend on a DECADE on health care.
Those same people also aren't saying" Let's fix the constant massive overruns on most defense programs before we spend any more on defense".
I feel for those who do not have health insurance, and feel strongly that they should have better access to health care.
Well they are dying, so a little more is called for than sympathy
The last article claims 7,000,000 children are w/out insurance and as a result 17,000 die. That's .24%. For adults in the other article, that rate is .1%. Now advocates can't claim that those people would have lived if they had insurance. Don't you think there's a better way than throwing $3 trillion at an inefficient monstrosity Congress is trying to create? After all, "guaranteeing" health care for all doesn't necessarily eliminate needless deaths.
When people start saying "think of the children" I know the result is going to be bad laws with unintended consequences. It's too easy a button to push.
The PNHP study is highly flawed. It's best not to cite it's claim of 45,000 people per year dying from lack of insurance, because the study doesn't provide good evidence of this.
The 47 million uninsured number we heard all summer is false too, and even Obama has backed that down to 30 million.
One reason people are wary of Pelosicare is the bogus numbers that have been used to scare us into supporting it.
I don't think there are any credible proposals from the Republicans either. And yes, there is plenty of waste in other government programs. But that should not justify planning to waste more, especially when our national debt is becoming increasingly unsustainable. There are some good ideas out there that do not go under the heading of conservative or liberal. Some of those were outlined in a very good article in the Atlantic. If our political leaders would have the courage to consider these changes, we could both save the lives of those children and address the health care cost problem. Some of them are big changes that would require individuals to take more responsibility for our health care. But good leadership could educate us on the benefits of change for us and our children's future. Yes, action is what is needed. But the action proposed by the House bill is not the action we need.
The 47 million uninsured number we heard all summer is false too, and even Obama has backed that down to 30 million.
He decided to exclude the illegal immigrants. But the previous number wasn't "bogus".
The PNHP study is highly flawed.
In what aspects? It's my understanding that they supply an estimate. But there's nothing wrong with that. Electoral polls are pretty accurate - even the worst ones don't err by much.
PNHP is a single-payer advocacy group (two of the authors of the study are co-founders). They claim a 40% higher rate of death for the uninsured; other studies have found about 3%.
It's pointless to argue about "the real number". They are all real numbers, and people disagree about which one is more relevant. Some people gave Obama grief for excluding illegal aliens.
The fact that PNHP is an advocacy group is irrelevant. The study was published in a peer-reviewed medical journal. What other studies are you referring to? And are they articles published in scientific journals or in non-reviewed think-tank publications?
As for conservative reforms that control costs? I favor the usual: allowing insurance companies to sell policies across state lines, more tort reform-although I am not certain whether it's better to simply continue this at the state level or push for a national reform, getting rid of the tax break for employers and instead providing it to individuals and families, etc.
As for dealing with the problem of pre-existing conditions, I think the re-insurance idea sounds interesting, but I do agree that it's a problem that conservatives should be discussing more.
Here's a good question for the opponents of "this bill." What would you have us do?
Here are a few items:
1. Eliminate the employer tax deduction for insurance. It makes no sense that employment is linked to health care. It also discriminates against individuals and promotes overuse of insurance.
2. Promote Health Savings Accounts so that people pay for health care with their own dollars and shop around for the best deals. This would drive down costs massively.
3. End medical licensing, which restricts the supply of medical professionals and drives up costs. And please don't give me nonsense about how millions would die because of quack doctors. Licensing serves the establishment, not consumers. I am, however, all for voluntary certification as a means of good doctors signaling their competence.
4. Allow interstate competition in health insurance. If you want more competition, this would be an easy move which would cost nothing for the federal government.
5. Replace Medicare and Medicaid with a voucher system, similar to food stamps.
Furthermore, the argument that this bill -- or the Clinton bill -- is better than nothing at all because we need to "do something" is insane. No, sorry, a bad bill which makes things worse is NOT preferable to doing nothing.
By the way, does it bother advocates of greater government involvement in health care that such approaches on the state level have failed in Maine, Oregon, MA and Tennessee? Does it bother you even a little?
Also, does it bother you that the free market has worked in Lasik, where insurance isn't used and quality has increased while prices have declined? How about cosmetic surgery? Or the free market approach tried by Whole Foods? Doesn't this suggest a certain course of action?
And please don't respond that people need health care while Lasik is elective. Food isn't elective either, yet the free market produces low prices and good quality there too.
Good list. You could even throw in an expansion of Medicaid. Anything but this monstrosity.
It's hard to believe they are actually criminalizing the decision not to carry health insurance -- even if you can easily afford to pay for your health care without insurance!
1. Eliminate employer tax deduction for health insurance. That's reasonable. I'm quite positive that if Republicans wanted to work for a bipartisan solution, that could be arranged. Actually I know this, because the Dems were all for it if union benefits under current contracts were excepted (which is fair because unions negotiate long-term contracts against settled law; it is unfair to change the law and screw them over).
If some conservatives were serious about getting with the program, this would be done.
2. Health Savings Accounts are not a real solution for a number of reasons. Most importantly, they run contrary to the whole point of having a health care system -- namely, the cross-subsidy from healthy to sick. That's a necessary feature of any "insurance" system or health care system. If you're going to go all John Galt with a "we don't need you" attitude, then you just remove yourself from serious discussion.
3. End medical licensing. Please. It's not going to happen, and you know it. That's not anywhere close to a serious idea. Also, if you had taken Health Care Economics 101, you'd know it wouldn't work. The problem in health care isn't that there is too little supply; the problem is that supply creates demand.
4. Interstate competition raises more problems that it solves. What's to prevent one state from allowing its insurers to sell really lousy health care plans that look good superficially, but which are actually terrible in the fine print? It's all fine to say let people decide, except that we have a national economic crisis in part because a lot of people in this country are not capable of understanding the terms of a mortgage and choosing wisely. What makes you think they can do it for health care plans?
5. A voucher system for Medicare and Medicaid? I have no idea if this is a good idea. I do know that it's unrealistic, so move on.
6. LASIK is the example libertarians always trot out. The example, because there aren't others. The problem is that Lasik isn't a health care service per se. It's a medical procedure, but it has nothing to do with health. It's akin to cosmetic surgery, or getting a tattoo. It's nothing like providing kidney dialysis to chronically sick people.
It's also completly false that Lasik has enjoyed some sort of technological flowering foreign to other regulated medical areas. We have had far more advances in care of heart disease. It's just that those advances have increased cost because they have increased life expectancy, and because the development of non-invasive interventions has made it possible for lots more people to get the service. LASIK is a one-off procedure. Again, it's simply nothing like it.
7. Health care is not like other goods. Again, that's health care economics 101. Free market approaches simply do not work, at least not to the standards that most people consider to be working. Which is why there aren't any good free-market health care systems anywhere in the world.
1: So it's ok to change the law to benefit unions, like with auto bailouts, but we can't change anything else? Republicans have proposed this, but they don't receive millions in campaign contributions from unions, and have no interest in subsidizing their health care. The block here has been from liberals, who are terrified of offending unions.
2: HSA's are not perfect, but they are not as bad as you make them sound. It is certainly better than the current system, where there is absolutely not accountability for spending on the part of the consumer, such that if they feel sick for a week they don't schedule a cheap GP visit and wait until it's unbearable, heading to the ER for a very expensive bill that they don't really pay. I think we have people smart enough in policy to arrange HSA's to apply to these smaller types of costs used in tandem with some sort of catastrophic coverage. In any event, they should not be so arbitrarily dismissed, although I certainly acknowledge they have issues that need to be considered.
3: Agreed with ending medical licensing. The amount of information and practice physicians require is staggering. I've gone through 3 years of it, and cannot imagine having to be a physician. It is absolutely necessary to be licensed, because the body is ridiculously complex, and the more we discover, the more we have to know.
4: I see where you're coming from with wariness of interstate insurance, but if car, life, auto, and home insurance can do it, why not health? Would it have to be regulated? Absolutely. But again, the possible benefits are huge considering the poor state of competition between insurance companies right now.
5: Interesting, but likely difficult to pass, so I'm with you
6: LASIK most certainly does not have more technological advances than other areas, but the costs are interesting to investigate. However, one way or another I think we're going to have to stick with insurance of some kind, so negotiating prices for many procedures will remain the responsibility of insurance companies. The shopping around more applies to things like generic medications, unnecessary procedures, exercise vs gastric bypass, etc.
7: Health care is unlike many other products, but the insurance is not that different. True, demand can be created by the supply, but that's why a combination of multiple insurance companies and accountability on the part of consumer is so necessary. In a government run system, I worry that physicians will be underpaid, which will lead to a poorer quality of physician or to gaming the payments system (as hospitals, physicians, etc. already do with medicare and medicaid) to make sure they actually make a profit. Saying "no one else in the world does it" is not a good argument.
Cafeteria-style health reform has the benefit of being simple to enact. It doesn't take a 1300 page bill to roll back tax benefits for employers who provide pre-packaged medical coverage.
HSA are a reasonable solution to much of the problem. The average person doesn't need chemo, dialysis, and a triple-bypass every year. They go to the doctor a couple times a year for a checkup, a Z pack for a head cold, or maybe shots for their kids. None of that is so ruinously expensive that you couldn't pay for it out of pocket.
From HSAs, you advance to public price lists, coupled with public outcome statistics. Hospital A is better and cheaper than Hospital B, so it gets more business and we, as a society, spend less on healthcare while realizing better outcomes.
As to medical licensing, I'd actually suggest lowering licensing requirements. The bulk of regular medical care is provided by nurses anyways, so why not just formalize the situation and recognize the de facto authority they already have. With HSAs and LPN's providing regular care, you've hugely decreased the cost of regular care. My understanding is that this is one of the ways that the VA reduces costs.
The best part of all this is that it provides actual, factual, measurable cost reductions. If, after you're done, you still haven't reduced the cost of catastrophic medical insurance, you can then go back and revisit single payer. In fact, because you've defanged the largest argument against it (i.e. it's so damn expensive), you've got a better chance of success.
1. The taxing medical benefits issue comes down like this. Republicans floated a version of the idea for show, because they knew it would punish unions. Obviously, that's not remotely likely to pass nor is it fair. Democrats responded by saying, OK, with a partial exclusion for unions, and Republicans withdrew all support.
The issue isn't specific to unions. But think about it. Who would a tax on benefits hurt the most? Exactly. Union labor. It would be a hugely regressive tax, and that's usually a terrible idea. The reason, of course, is that union members, unlike most employees, can't really change their benefits packages in response to changing tax laws, because they are locked into collective bargaining contracts.
I don't particularly like unions. But fair is fair. Changing the rules of the game to hammer working class people is terrible, terrible policy. The proposals I read would exempt current pension plans (i.e. negotiated long ago) and apply to unions starting at some future date, to give the collective bargaining process a chance to reset in response. That's fair and decent.
2. Sure, HSAs are useful in the way co-pays and deductibles are useful. I have nothing against them, but understand, they are a policy tool. Not a policy. The higher you make the limits, the more punitive they are on people who are sick. But lower limits are useless in controlling costs. And there isn't very much evidence to suggest that putting financial decisions in the hands of consumers does much to control health care costs. That's what supplier-induced demand means.
3. Once you admit that interstate insurance has to be "regulated," then pretty much it loses its value as a policy tool. The whole point of interstate insurance, as I understand it, is to take state insurance commissioners out of the equation -- stop having them pass meddling regulations that require health plans in their state to have features X, Y and Z. So-called mandates add very little in cost, and are hugely protective.
There was a study posted here a few months ago about how state "mandates" added 20% to insurance premiums or something like that. Except that when you actually looked at the study, nearly all of the "mandates" were things that really ought to be included in even a minimal definition of health coverage. Sure, mandates for fertilization treatments are a bad idea and rightfully get bad press, but they really don't add very much to the nation's costs.
Meanwhile, mandates were responsible for forcing health plans into providing even the inadequate level of mental health coverage that they have now. For a long time, mental health was woefully undercovered. Maybe people didn't want to pay for behavioral coverage because they didn't think there was any risk they would go "crazy," but in fact, mental illness is prevalent, can be enormously debilitating and hugely costly to society. Chalk one up to mandates.
7. As for physician salaries, I too worry about them. I'm not a doctor, and my dad is close to retirement, but I don't want medicine to go the way of public school teaching. Part of the problem is that salaries in financial services are going so high that they are crowding smart people out of any number of useful activities, channeling them into socially useful, rent-dissipation (i.e. zero sum) activities like trading.
My most fundamental problem with this bill is: instead of trying to cut costs by squeezing reimbursements, it should have raised reimbursements in exchange for cooperation from doctors in reducing utilization. Utilization is the long term driver of costs. Getting doctors on board would have been great from a policy and political perspective, and I believe that tradeoff is one that we will have to make at some point. More money per procedure, in exchange for far fewer procedures.
Republicans could have played a useful role in this, since doctors tend to lean red. Alas, they chose pure obstruction, and Democrats for whatever reason did not make a sincere effort to reach out to doctors, at least not one that I saw.
1. No, HSAs are a serious solution. You save for your own medical expenses. Combined with a high-deductible insurance plan they are proven to save money:
2. Medical licensing may not be feasible, but it would help. They unquestionably drive up costs and reduce supply. Also, your statement The problem in health care isn't that there is too little supply; the problem is that supply creates demand. isn't terribly insightful. Supply creates demand everywhere, something was observed by Jean-Baptiste Say:
3. We have interstate competition in other industries and it seems to work fine. If a company has a bad reputation people won't use them. BTW, here in Washington DC I have access to what is essentially interstate competition as the district does not have mandates. Is DC a hellhole of people buying bad insurance policies? Not that I am aware of. In fact, I currently buy my own insurance for $79 per month.
4. No, lasik does have to do with health. It improves your eyesight. Or maybe you don't think hip replacements have to do with health either?
7. Every good is unique. But so what? If free market health care doesn't work, show me examples of its failings. Where has it been tried and failed? And please don't insult your own intelligence by citing the US, where regulation is rampant and the government accounts for something like half of all health care dollars spent.
Muzzybelly:
I agree with some of what you say here, but you also seem to be mixing a lot of fact with a lot of conjecture. You're premise seems to be that passing anything is progress and will move us closer to something better, and I disagree, I think some legislation can push us further in the wrong direction. I do think we need to start somewhere, and that is part of my problem with the current legislation. If it's so difficult to do, why not start small? Start by fixing and expanding medicare, but perhaps instead of full coverage institute government sponsored catastrophic care for those that can't afford health care, but also don't qualify for medicaid. Remove the tax subsidies that reinforce employer-subsidized health care. Remove state sponsorships of insurance companies, and allow insurance to be traded across state lines. Pass legislation to adjust that awful practice of rescission, and give an insurance company perhaps 6 months to investigate pre-existing conditions, after which they are barred from denying coverage based on pre-existing conditions.
There are a lot of ideas, and Republicans are "promoting" them. But the mainstream media isn't, certainly not to the extent that they are giving coverage to the Democratic plans. I agree we need to start the ball rolling, but start the ball small so we can adjust where it rolls. This legislation leverages a boulder down a mountain with no way of guiding it.
Here's a good question for the opponents of "this bill." What would you have us do?
They'd have us do nothing. They know full well a victory for ObamaCare creates a very powerful argument against the proposition that government programs aren't capable of helping to deliver increases in living standards and quality of life. Anybody who has traveled to Western Europe realizes they are, at least sometimes. Soon, even Americans who haven't done much travel might find this out. And that wouldn't be helpful, would it?
I've lived in 3 European countries. I have a European girlfriend. I don't know what the hell you are talking about.
Colin: You don't think European safety nets have helped deliver increases in living standards? Really? Really?
Apparently people who actually do live there -- such as, oh, I dunno, citizens who can vote in elections -- as opposed to anonymous libertarian blog commenters who clearly don't know what the fuck they're talking about -- disagree with you. I mean, in Europe even parties of the right generally don't mess with the safety net. Because they'd lose votes. Because it's popular. Because it helps people live better.
Heck, one could even make the same claim about the United States, as well, to the extent that the US maintains a safety net. Social Security and Medicare, most obviously, have substantially increased living standards for millions and millions of people. And the existence of these programs hasn't prevented the US from continuing to grow ever-richer. And I don't see the Republican party making much progress with respect to dismantling these programs.
Jasper (re your response to Colin re European safety nets): So people who live in European countries wouldn't vote to end redistributive programs? Well, thieves wouldn't vote for effective laws against theft, either, nor would slaveowners in the old South have voted to abolish slavery. An abusive or exploitative majority will never vote to give up its power over a minority. But for that very reason, majority approval doesn't strike me as a sound standard of ethics. Here in the United States, we have a constitution that can only be amended by a substantial supermajority precisely because its authors realized that majorities cannot be trusted; and if their constitution did not succeed in protecting us from "paper money, or the abolition of debts, or the equal division of property, or any other improper and wicked scheme," it was a good try while it lasted.
"You don't think European safety nets have helped deliver increases in living standards? Really? Really?"
Jaspar,
you're absolutely right, I have a number of friends and business associates that have immigrated here from various European countries and they all agree that the socialist system is much better than what we have here. So much so that most of these expats eventually become US citizens.
I mean, in Europe even parties of the right generally don't mess with the safety net. Because they'd lose votes. Because it's popular. Because it helps people live better.
Really? You don't think center-right governments in Europe have ever trimmed the social safety net?
commenters who clearly don't know what the fuck they're talking about
Colin: You don't think European safety nets have helped deliver increases in living standards? Really? Really?
No, I don't. My observation has been that the standard of living is lower in Europe. People in Europe tend to live in smaller houses, have fewer and smaller cars, and generally own less stuff. And this isn't because they are high-minded and less consumer oriented, it's because they can't afford it. When they travel to the US they go nuts and buy tons of stuff because it is so much cheaper.
Just two weeks ago I was visiting NYC and hanging out with a Dutch friend of mine who was over for a week. During his trip he bought a MacBook, a new suitcase and plenty of clothes. His girlfriend did the same. While he was living in the US 2 years ago he bought a car and shipped it home because it was so much cheaper. Everytime my Spanish girlfriend goes home she gets requests from relatives to bring homes ipods and other goods.
But standard of living is in the eye of the beholder. I do know, however, that more Western Europeans emigrate to the US than vice versa:
Keep in mind that Republicans aren't interested in supporting any health care reform whatsoever. They've made that perfectly clear....From time to time, they've trotted out a few token proposals of their own, none of which even pass the straight face test.
Wrong. Republicans have proposed many bills and the Democrats have responded with hardball political games. The Democrats control Congress and the fact that none of these Republican bills have seen the light of day is because the Democrats don't want real reform to compete with their power grab and delusions of grandeur.
Do you have any idea how much better off we would be had the Clinton health care plan passed in 1994? I don't know of a single person, right, center, left, libertarian, who thinks our current health care system is better now than it was in 1994.
I don't have any idea who you know, but they are probably mostly liberals which means they are inherently clueless and bitter. As far as curing the sick, our health care system is definitely better than it was in 1994, the problem is that it is more expensive. You seem not to understand that Hillarycare was modeled on the Canadian system which is in the process of imploding. Brian Day who is a past president of the CMA (and a socialist) is a leading proponent of changing Canadian law to expand the ability of Canadian doctors to provide healthcare privately, outside the government system.
Also, since so many seem intent on providing anecdotes, last year I had back surgery. Specifically, I had a micro-discectomy using techniques that hadn't been developed in 1994. It was performed at a state of the art clinic in Marina Del Rey, CA that didn't exist in 1994. It was very expensive (my insurance was billed approximately $108,300 and they actually paid about 65-70% of that amount). The clinic (which only has two surgeons) has hundreds of international patients every year. I know this because they asked me to be part of their marketing campaign and they interviewed me and video taped my post surgical recovery. That clinic, and the innovation that it currently utilizes, occurred since the Hillarycare debacle. There have been literally thousands of major improvements in American medicine since 1994 (from statins that prevent heart attacks, to new medicated heart stints, to CT angiograms that avoid the need to stick a probe in someone's heart, to surgical techniques like LASIK, etc., etc.). So you can count me as one person who believes our health care system is better now than it was 15 years ago. The inefficiencies, high cost and linkage of health insurance to employment need to be addressed but Obamacare isn't going to do anything about those problems.
Humph! I think the answer is obvious. The federal government making sure everyone has health care coverage sounded like a great idea to the shufflebutts until they found out that didn't mean the government would pay for their health insurance but rather would fine them if they didn't buy it. That wasn't at all what they had in mind.
Yes I agree with you TallDave, Swen, Naturalfake, Nola, Colin and others: I too find something hopeful about the graph. (Some) people are beginning to see the light. The left-lemmings will still follow BHO over any cliff. Apparently potential voters classify themselves as about 40% conservative, 40% progressive and 20% uncommitted, so if BHO is losing the moderates I would have expected more than 50-47 against government responsibility for health care coverage. It is however reassuring that the tide is flowing in the right direction. In the meantime Republicans have been doing a remarkably poor job of running a meaningful opposition. Yet a large part of the responsibility for the failures of our governing system rests with the Founding Fathers who gave us a deeply flawed Constitution, from the inadequately circumscribed Commerce Clause, the inadequately emphatic Enumeration of Powers Clause which is presented almost as an afterthought when is should have been seen as a fundamentally rule governing the design of the entire document, the unclear Second Amendment, the ill-defined powers of the Supreme Court, to a poorly designed voting system for and within Congress leading to donor-controlled composition and voting of Congress, resulting in the fact that each Congressman and Senator votes preponderantly in interests other than those of the United States as a whole - bring home the bacon and get reelected. And we get a Congress elected apparently by voters who are not qualified to make a decision about anything. Have you seen Jay Leno's sidewalk forays to ask passersby their thoughts and opinions?
My wife and I run a "mom and pop", I guess you would call it, with 20 employees, all of whom have the option to buy heavily subsidized health care. The problem is that there is so much uncertainty right now about what next year will look like, what taxes are going to look like, what the business environment will be like that nobody is finalizing contracts. Cap and Trade is part of this Health Care "Reform" is part of this, the trillion dollar deficits are part of this.
Liberals seem to think that the answer to business people who have become defensive is to tell them that it is all in their head, and they should go ahead and sink what last year was their working capital, but this year is potentially their retirement stash, if they can hold on to it, go ahead and sink it an not to pay any attention to what their business knowledge and instincts say.
That is a real winning argument, Liberals. These arguments about saving small business money by dealing with health care is ridiculous. The immediate effect of this plan will be to make health care an even larger percent of our GDP, beggaring all kinds of other businesses in the process
Thank you for the adjusted numbers, Colin. Apparently the 40-20-40 split included illegal immigrants in the progressive column. If we can exclude them (temporarily?) and discount the intentions of ACORN then the adjusted figures are 20-40-40. I would still like to have more moderates see the light.
Well, after 123 posts, conservatives have had a chance to present cost control measures. What have they presented? Interstate competition, HSAs, and abolishing licensing requirements. Do any of those things control costs? Is there a peer reviewed study-indeed any study-that says these ideas would control costs if implemented? Nope. Awrighty then. We can now say that cost control is not really as crucial to the anti reformers as they say. Stopping reform, however, is.
We should always remember that the Republicans had every chance to propose health reform between 2000 and 2006. They didn't.
They were invited by Obama and major Democrats to contribute ideas to the health care reform bill this year. They weren't interested. The Republicans didn't present their version of health care reform until the other day, and they haven't even bothered to promote it-probably because the bill sucks. Ezra and the CBO sums it up:
Late last night, the Congressional Budget Office released its initial analysis of the health-care reform plan that Republican Minority Leader John Boehner offered as a substitute to the Democratic legislation. CBO begins with the baseline estimate that 17 percent of legal, non-elderly residents won't have health-care insurance in 2010. In 2019, after 10 years of the Republican plan, CBO estimates that ...17 percent of legal, non-elderly residents won't have health-care insurance. The Republican alternative will have helped 3 million people secure coverage, which is barely keeping up with population growth. Compare that to the Democratic bill, which covers 36 million more people and cuts the uninsured population to 4 percent.
But maybe, you say, the Republican bill does a really good job cutting costs. According to CBO, the GOP's alternative will shave $68 billion off the deficit in the next 10 years. The Democrats, CBO says, will slice $104 billion off the deficit.
So the Republican plan-a plan that incorporates most of the ideas listed above- scores worse than the Democratic House plan in virtually every respect-including cost control. So it goes in the real world.
Competition also drives down costs. I heard President Obama say it himself. Although he somehow believes competition only works if the government provides it.
Licensing requirements are a barrier to competition, which drives down supply and increases prices.
Uh, no. The Democratic plan cuts costs by increasing taxes and fees, and through cuttings of services that no one, including the CBO, thinks will really happen. You're comparing apples and oranges. If you included all the revenue measures from the Democratic plan, the Republican plan would gain a trillion dollars.
Er, where does the CBO say that these cuts won't happen? Please provide a link.
Of course, conservatives SAY that the cuts won't happen, but the CBO says no such thing.
Well, here is a NYT article quoting Democrats and health economics experts claiming that the cuts are unlikely to happen. When the CBO scored the latest bill, it took pains to point out in its summary that its cost estimates were strongly reduced by the automatic cut provisions of the bill. In order words, the cost actually implied by the economics of the bill is much higher than the headline cost, which is imposed by legislative fiat. No Washington insider believes that Congress would ever let an automatic 50% cut in Medicare spending take effect.
In your post above, you rather misleadingly use "cost" in the sense of net cost when comparing the Democratic and Republican proposals. Under that definition, if we were to just raise taxes enough to eliminate the deficit, government would cost us nothing. That is not what people usually mean by "cost". Under the usual meaning of actual outlays, the Democratic bills cost about 16x more than the Republican proposals. Of course, the Democratic bills also insure a lot more people, since that is what matters most to Democrats. But whether spending 16x as much money to get an addtional 10% of the population covered is hardly an un-debatable question.
I'm still waiting for the conservatives to come up with their cost control plan. Telling the uninsured IGMFU , as the Republican bill does, doesn't cut it. At least the Democrats are TRYING for universal coverage, while instituting cost containment-even if all the measures won't succeed.
Conservatives are pretty good at:
1. TALKING about cost control
2.Criticising Democratic cost control measures
while not suggeszting any plan of their own.
I might also point out yet again that when it comes to programs that conservatives like-defense-they don't even PRETEND that cost control is an issue.
1. Creating a hugely wasteful and repressive gov't plan that will only make things worse
2. Claiming opponents don't have a plan becuase they can't spend 10 seconds Googling or reading the thread they're posting in
At least the Democrats are TRYING for universal coverage,
We already have universal health care. "Universal coverage" means forcing people who don't want insurance to buy it at gunpoint, even if they can afford to pay their own bills.
"At least the Democrats are TRYING for universal coverage, while instituting cost containment-even if all the measures won't succeed." David and I have responded to you already. There is no real attempt at cost containment here. The Democrats want to pass a health care bill, so they have to hide the cost and pretend it isn't there.
President Obama began by saying that the point of this was that the economy couldn't recover without fixing the rising costs of health care. It began quickly clear that that wasn't true, but that didn't end the plan!
The Republicans don't need a "cost control plan". Institute a free market, and costs will be controlled in the usual fashion - people will spend as much as they want on health care, just as they do on computer software (spending on which has risen much more in the last decade than health care). Certainly it won't break the federal budget _not_ to have a government health care system.
And I don't agree about defense. We have to have a budget that works, and defense is no exception. We need to decide what our defense needs to accomplish and how urgent each piece is. Then we need to figure out how that fits into the budget, the same as everything else.
Unlike progressives, lots of us fiscal conservatives are coming to the realization that a collapsing economy kills people too. A lot of them. I feel the same way about it as progressives seem to feel about Global Warming.
The Republicans don't need a "cost control plan". Institute a free market, and costs will be controlled in the usual fashion - people will spend as much as they want on health care, just as they do on computer software
You know, this is the kind of BS that conservatives eventuallyy fall back on in the health care debate. You might as well substitute the phrase " rule by giant magical ponies " for "free market" in that sentence, and it would make as much sense. What does " institute a free market" even mean in this case? Let's start with the most "socialistic" part of the US health care system- the Veterans Administration. Let's abolish it, and toss veterans unaided into the private health insurance market. That would save the government a lot of money, after all, and cut down the now all important deficit . Now it would be a giant FU to all veterans and those people stupid enough to sign up to guard our liberty , but hey, that's how things are in free market. Thanks for your service, and good luck getting private health insurance with your prosthetic.Believe me , it will be just as easy as going into Best Buy and buying computer software.
I could go through with same analysis with Medicare, Medicaid, SCHIP, The NHI, the CDC, the FDA, the EMTALA. Every single one of those things are government interventions in the free market -and every single one of these things are good for health care. Yes, they are expensive. So is a National Park Service, a NASA, or a separate US Marine Corps. We could save money by abolishing each and every one of those things, but we decided that it's a good thing for the USA to have these things.
And I don't agree about defense. We have to have a budget that works, and defense is no exception.
Wow, welcome news! You must not have gotten the memo sent to all conservatives that defense spending isn't government spending, but is in a holy and separate place. I wait for the spate of conservative/libertarian articles calling for "deficit nuetral" defense programs.
Anytime you hear government claim they will contain costs, run.
Because what's actually going to happen is what happens every time government starts using price controls and bureaucracy to try to achieve a better outcome than free markets: rationing on top of less efficient delivery of services, and criminalization of economically undesirable behavior (today they're talking about imprisoning people who don't buy health insurance... but aren't tobacco users costing the health care system more? and those people who don't exercise are going to be costing taxpayers billions).
Certain goods like national defense or policing can only be provided by government, because of the state's monopoly on force. But there is zero reason to think anything that can be provided by free markets should be provided by government.
So government SHOULDN'T try to control costs. Got it.
Let's hear no more about how the health reform bills are deficient because they don't control costs.
But there is zero reason to think anything that can be provided by free markets should be provided by government.
again, what does this even mean in the context of this discussion? I repeat once again, NOBODY, BUT NOBODY, IS CALLING FOR DIRECT PROVISION BY THE GOVERNMENT OF HEALTH CARE.
Ahem, hopefully, that was loud enough. (I'm pretty sure, it wasn't :-(.)
BTW, if you against all government provision of health care, you should be calling, loudly, for the abolition of the VA. I notice that you haven't been. What's up?
C'mon Stonetools, you are playing word games here. You are smart enough to understand the distinction.
If the government undertakes to guarantee everyone a LCD television, it had better have systems in place to control its costs, because neither consumers nor producers have any incentive to hold back. If everyone is responsibe for buying his own LCD television, the government should not attempt to control costs, because the market will ensure than only those tranactions will occur that make both parties better off.
Similiarly, there is no reason for the governent to hold down freely chosen consumer spending on health care in a free market. There is every reason for the government to hold down its own outlays on health care, which are funded via the involuntary contributions of taxpayers.
You are a worthy debating partner. Don't demean yourself by constructing fake "gotchas".
The comparison of health care services with LCD televisions are unhelpful. See points muzzybelly made about supply-induced demand.
Also stonetools' Hayek quote "Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance..."
Sam Roberts: Consider the phenomenon of "supply-induced demand" in various contexts.
Start with a world where people are simply paying individually for their own health care. Then "supply-induced demand" simply means that people are willing to pay for new therapies. Presumably you would agree that government should not act to limit such exchanges, even if people decide that new therapies are worth 30%, 40%, even 50% or more of their income.
Now imagine socializing those cost by creating insurance pools subject to a mandate, guaranteed issue, and community rating provisions. Now no one has any incentive to limit his consumption of health care, because the marginal cost of the next treatment is divided among everyone in the pool. Spending rises wildly.
This same effect is observable in something as simple as water billing for appartment complexes: if the bills are divided among all appartments, spending on water is much higher than it is if appartments are individually metered. The issue isn't that health care is special, the issue is that socializing the cost of any good has bad side-effects.
I am always mystified why you think you are somehow immune from getting to the age of 55, with a heart condition or breast cancer (yes men get it too) and finding you are unable to work and uninsurable. The current health care financing system is indefensible.
I am convinced that real reform would start with removing the tax deduction for businesses to provide health care and then imposing a mandate on individuals and sound regulation on insurance companies. It takes a leap of faith in free markets, though, to expect that companies would provide the equivalent of the current health care benefit in wages/salaries so that individuals could buy their own insurance. Making sure this necessary step occurred would have been seen as remarkable leadership. This is the only path that makes any sense to a working 50-year-old taxpayer.
The Catholic Church, though, has weighed in that it wants the current system extended to all, and that includes its Latino constituency. BHO has shown how far he will go to gain and hold both Latino and Catholic support. The GOP is not going to go up against the Catholic Church. If the BHO plan is bad for the anti-union South, well that concerns the Catholic Church not at all. I do not think that Joe Lieberman, as full of himself as he is, has the spine to take on the Catholic bishops and hospitals. The silence from the GOP following this major concession by BHO is very telling. I think the GOP leadership hopes Democratic feminist women will do their work for them, and blow the process up, but that is not going to happen. The bill extending our current system will include the Stupack language and will pass before Christmas.
"What does " institute a free market" even mean in this case? Let's start with the most "socialistic" part of the US health care system- the Veterans Administration." Etc. I guess you think people agree with you on these things. But they don't.
The average citizen cannot afford to buy full comprehensive health insurance for himself, so it is dishonest to pretend that the nation as a whole can provide it for everyone. On the other hand the nation can afford catastrophic coverage for all, without rationing, by eliminating over-regulation and insurance companies. A small shopkeeper cannot afford to carry the risk of window-breakage so he pays to pool the risk. A mega-corporation or the government doesn't need to pay anyone to pool the risk; the risk is already pooled. We can pay for whatever else we need/want ourselves. We do not need to buy insurance to cover ordinary needs such as clothing, groceries, oil-changes or routine health needs. The alleged savings from preventive care are minimal or unproven. Lifestyle is the most important factor. Tuberculosis was diminishing before antibiotics became available. Public attitude is everything. Smoking is disappearing but is being replaced by an obesity epidemic which will not be cured by gastric surgery. Malaria was rapidly disappearing until the egg-shell-DDT myth appeared. DDT killed insects diminishing the food supply of birds hence fewer birds. Vaccines were of inestimable benefit but their hay day is passing. The man-made-global-warming myth can potentially do enormous damage to global health by lifestyle degradation.
So our crying need today is for national catastrophic coverage, paid for by those who can and by vouchers for those who can't. The government doesn't need to pay insurance companies to run the food-stamp program.
"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance - where, in short, we deal with genuinely insurable risks - the case for the state's helping to organize a comprehensive system of social insurance is very strong... Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken," - Friedrich Hayek, The Road To Serfdom (Chapter 9).
Here's a long-ish post on how Hayek felt about government-run health care systems. It quotes at length from his The Constitution of Liberty, which was published in 1960. Needless to say, Hayek is critical of government-run health care. Although his most popular work, The Road To Serfdom, published in 1944, is one of Hayek's many works and should not be treated as the summation Hayek's thoughts.
Hayek, in "The Constitution of Liberty" is opposed to an UHC system similar to the U.K., in which doctors are direct employers of the state. Needless to say, nobody is proposing such a system. The excerpt presented by stonetools and the quotes of the post you linked are perfectly compatible.
"Certain goods like national defense or policing can only be provided by government, because of the state's monopoly on force"
It is because the government was given a near-monopoly on force that it has been chafing under the shadow of the Second Amendment ever since. It is always the policing agencies that protest loudest about the Second Amendment, and, let's face it, the Second Amendment has been de-fanged already. The government will always have bigger guns than the people. But in any case, guns are not the weapons of the future, brains are, and Congress and the W.H. seem shortchanged on that account.
"Do you really believe that consumption doesn't increase when people don't pay for what they consume? Do you really believe that more competition doesn't lead to lower prices? Do you really believe that supply creates demand? Do you really believe that medical liscensing is about safety and not about restricting the supply of doctors?"
1. Medical licensing was originally about consumer safety. Today, it is clear that there is a supply-restriction component to it. I really haven't thought about the possible effects of easing licensing restrictions. Because there is absolutely zero chance of that ever happening. We will have single-payer before we have unlicensed medical professionals.
2. In medical services, supplier-induced demand is the #1 fundamental principle of the economics of the field. It's not unique to doctors. Same thing goes with lawyers. But it is absolutely 100% a real phenomenon, one accepted by every serious health care economist.
If you open your mind a little bit, it's really not hard to understand. You go to the doctor with a tummy ache. Doctor says to you, "well, it might be a virus, but it might also be a gastric ulcer." You say "well, what does that mean?" and doctor says "well, if untreated, it could lead to severe complications. We should rule that out with a series of X-rays."
What do you say? Most people say that OK, doctor says I need this done, I should get it done. The same way that if an attorney says you need to file X, Y and Z motions in your litigation, or else maybe you lose, most clients go ahead and pay for X, Y and Z. It's a general problem with services provided by experts.
3. Because of supplier-induced demand, competition does not lead to higher prices. This has been proven in empirical study after empirical study. When doctor concentration in an area increases, guess what happens? Prices stay the same, or even go up (see McAllen, TX). Utilization increases.
Another way of looking at the question is this: for which patients are doctors' fees most competitive? For the uninsured, of course. They are the ones who pay out of pocket. And yet, as we all know, doctors charge uninsured people much higher prices than those with insurance. That's a tell-tale sign that doctor competition doesn't decrease prices.
4. In general, doctors' main "competition" isn't other doctors; it is the decision "no medical care." And the decision "no medical care" is frequently driven by lack of supply or complete lack of affordability (i.e. people will often spend their last dollar on health care). This is why more doctors is not the answer. Better and more intelligent rationing is.
5. When people pay out of pocket for health care, consumption does decrease. But not necessarily in a good way. Sometimes, people who shouldn't be going to the doctor don't go. That's good. But more often, what happens is that well-to-do people who don't need to see a doctor go anyway, and they crowd out less affluent people who really do need to see a doctor but can't get an appointment or can't afford it.
This happens all the time with most goods. There are people who have 10 Lexus cars and yet buy an 11th that they don't need. Whereas I might feel that I "need" that Lexus more than they do. TS for me. I should make more money.
But with certain goods, it is considered inhumane to do that. The Irish potato famine is a classic example. People were starving, the landlords insisted on having their contracts honored so they could buy yet more goods that they didn't "need." Same with health care. It is absolutely a travesty to think that people are dying from lack of care (this does happen, frequently, despite right-wing lies to the contrary), while others pay for care they don't need.
Not to mention, poor rationing of health care is extremely expensive. Healthy people are productive people. When people don't get the care they need and their health deteriorates, they can become disabled or less able. Would you rather pay for the health care, or the lifetime of disability payments? Would you rather have workers of high productivity, or ones who miss work frequently?
"1. No, HSAs are a serious solution. You save for your own medical expenses. Combined with a high-deductible insurance plan they are proven to save money:"
Well, sure. You could also save money by establishing a sales tax of 500% on health care. High-Deductible Insurance (HDI) can be useful under certain circumstances, but it is a feature, not a policy. I would expect the public option to offer an HDI plan, but they aren't appropriate for most people.
HSA/HDI does little to get the care to the people who need it. And they unfairly penalize those who are sick. Right-wingers like to talk about incentives. That if you have to pay for your health care, you are more likely to invest in your health. I have seen no evidence that is true. And medical science is finding that more and more medical conditions have genetic components. So how fair is that? A person has a genetic disposition to bipolar and has to pay 10K out of pocket each year to have it treated?
Policy should try to socialize unavoidable costs. That is consonant with most consistent moral systems. To claim that people should be poor because they have bad genes (for instance), or because they were the victim of an accident, is morally bankrupt. Yes, I understand that genetic endowments affect wealth in market systems, and the reason that is tolerable is that it is Pareto-optimal. It makes everyone better off. That is not true when the goods in question are life-determinative (like education, health care, food).
To put the matter another way, "To each according to need; from each according to ability" is a defensible and decent moral principle. It is an incredibly poor economic principle, because it completely ignores effort and incentives. If wealth were 100% determined by endowment effects, then the prinicples of equality and freedom would demand substantial redistribution. Of course, in the real world, that's nowhere near true, and so redistrubtion has hugely important real costs.
But in health care, health is determined to a very large extent by endowment. So socialization of costs is desirable.
2. Say's principle has nothing to do with supplier-induced demand. It's not the same thing at all. I don't want to get into an argument about Say's law, except to note that Say never claimed that supply creates demand; at most Say's law means aggregate supply creates aggregate demand and that no demand can exist without supply. But that's a very different thing than saying a seller can create demand for his product. The latter is a misunderstanding of the concept of supply and demand.
Anyway, it's much easier to talk about examples. Car salesmen generally have limited ability to make you buy a car. If you don't go to the lot intending to buy a new car, you're not likely to do so. Car mechanics, however, are a different story. You take your car in to get something little fixed, and you're told you need $1K of repairs to fix the problem properly. People often end up paying this. Most people who aren't knowledgable about auto mechanics have at least had occasion to agonize over this type of decision.
3. I didn't say Lasik isn't about health at all. But it is categorically different from orthopedic surgery, kidney dialysis, cancer treatments, etc. It is much more like cosmetic surgery. You're being dishonest if you don't make this distinction. Lasik's benefit is avoidance of wearing glasses. Hip replacement is avoidance of being invalid.
4. Interstate competition is not the problem. Lack of regulation for industries that need regulation is. Interstate competition in credit cards has proven a disaster. If not for federal intervention, credit card companies would completely prey on the vulnerable (and still do).
I am completely honest that I am talking about paternalist regulation. Now is a bad time to be arguing against paternalist regulation in principle. We had an entire economy collapse in part because a lot of people got suckered into purchases of importantly, costly things (mortgages, CDOs, CDSs) that they didn't understand, couldn't afford, and turned ruinous.
If we let insurance companies design products under the weakest set of regulations they can find, I guarantee you we would be seeing a lot of people having the health-care equivalent of foreclosure. They'd find they need services and no insurance to cover them.
I would expect the public option to offer an HDI plan
You might expect it, but you would be wrong. Catastrophic coverage plans are going to be outlawed for a very, very simple reason- such plans are a way for young and/or healthy people to avoid the goal of supplying comprehensive medical services to everyone else.
HSA/HDI does little to get the care to the people who need it. And they unfairly penalize those who are sick. Right-wingers like to talk about incentives. That if you have to pay for your health care, you are more likely to invest in your health. I have seen no evidence that is true.
Safeway began offering financial incentives for people to take better care of their health -- and they responded!
Further, I think the real benefit is not in people maintaining their bodies better, but in shopping around when they need a procedure done.
And medical science is finding that more and more medical conditions have genetic components. So how fair is that? A person has a genetic disposition to bipolar and has to pay 10K out of pocket each year to have it treated?
Genetics also determine factors like athletic ability, height, beauty and intelligence. They are not evenly distributed. Yes, life isn't fair. What we can do is make treatment for these conditions as cheap as possible. The free market holds the only hope of driving down costs and increasing quality.
You take your car in to get something little fixed, and you're told you need $1K of repairs to fix the problem properly. People often end up paying this. Most people who aren't knowledgable about auto mechanics have at least had occasion to agonize over this type of decision.
Information asymmetries exist everywhere. That's life. Is the solution to the car mechanic problem government-run car service? The best antidote to charlatans and poor quality is competition.
I didn't say Lasik isn't about health at all. But it is categorically different from orthopedic surgery, kidney dialysis, cancer treatments, etc. It is much more like cosmetic surgery. You're being dishonest if you don't make this distinction. Lasik's benefit is avoidance of wearing glasses. Hip replacement is avoidance of being invalid.
No, actually you DID say Lasik isn't about health at all. Your quote: "It's a medical procedure, but it has nothing to do with health."
You are the one being dishonest if you don't think Lasik has big implications for health care. Not all medical procedures are a matter of life and death. Many, like Lasik, simply affect quality of life. There should be no reason not to shop around for a joint replacement just like you shop around for Lasik. In fact, we already have this to a limited extent with medical tourism, where first class care can be obtained for dramatically lower prices abroad.
Interstate competition is not the problem. Lack of regulation for industries that need regulation is. Interstate competition in credit cards has proven a disaster. If not for federal intervention, credit card companies would completely prey on the vulnerable (and still do).
Is it any coincidence that our most problematic sectors -- finance, health care -- are also the most regulated? A lack of regulation is certainly not the problem, and actually corresponds with increasing problems.
Lastly, you still have not provided examples of failed free market approaches in health care. But in the spirit of generosity maybe you should read this Salon article on health care in India. Key excerpt:
Almost 25,000 doctors graduate from India's medical schools every year. Because there is so much competition, doctors and hospitals are forced to keep their prices low to get patients. Residents, who go to medical school straight from high school, only make the equivalent of a few hundred dollars a month. An average surgeon's salary would be around $8,000 per month. The take-home pay to fix a hip fracture, for example, might run between $100 to $300, out of the $1,000 fee to the patient, says orthopedic surgeon M.S. Phaneesha. At his hospital in Bangalore, he says, there are 20 orthopedic surgeons alone on staff. For 1,600 beds, the hospitals employs around 700 doctors full-time; 300 of them are surgeons. In the U.S., by comparison, a first-year resident might take home around $2,500 each month, and the average surgeon more than $20,000 per month. A hip fracture would cost a patient around $30,000, of which the surgeon's charge is $5,000. Even general practitioners in America earn on average more than $100,000 a year.
Another factor in India's costs is the tiered system of beds that most hospitals employ. One night in a general ward at the private Artemis Health Institute in a New Delhi suburb, for example, costs around $20 per night. One night in a single room, or a deluxe, or a suite, though, will cost you between $100 to $200. Services are similarly tiered. A general ward patient at Artemis would only pay $2 for an X-ray, while single-room patients would pay more. There are so many hospitals, says Artemis' chief operating officer Jose Verghese, that rates at the lower end stay low.
I already answered most of your points. Yes, genetic disparities exist everywhere. That's no reason to abandon commitment to equality.
Less-intelligent people are easier to dupe than smart people. We have laws against fraud largely to protect those less-intelligent people from being swindled. Some people are mentally retarded. We expend social resources on providing special education for them and ensuring they have a decent life. We rejected the model of the "village idiot." We typically don't permit people to lose just because they are genetic losers.
The main reason we permit unequal genetics to lead to vastly unequal quality of life is that it is impossible to separate genetic talents from acquired skills. Incentives matter. This is not really true in health (to some extent it is, but much less so than in, say, entrepreneurship), and even if it was, it is not remotely fair to punish sick people.
But if your idea of a just society is one where people who are genetically predisposed to bipolar disorder should be impoverished their whole life . . . well that would say volumes about you.
The answer to your question about failed free-market health care is quite obvious. All of them. All medicine in Europe and the US was originally fee-for-service. Over time, they have all migrated away from that model, for essentially the same reason: that model doesn't work properly.
As for India, you've never lived there obviously. My wife is from India. The health care there is horrible and non-existent for poor people. My father-in-law had a tummy ache from eatin street food. He went to the doctor, who gave him an injection of a really bizarre antibiotic that almost killed him. His fever spiked to 104, but the hospital was not an option. We were doing cold compresses all night. I read on the internet about this drug and there is no way it should have been used in that situation. Mind you, this was in a fairly major Indian city, a capital of one of the larger states.
And to address some miscellany: supplier-induced demand is not the same thing as an information asymmetry. They are different and you'd understand the whole issue better if you took time to understand why. Indeed, the second most fundamental fact about health care economics is the importance of information asymmetry. Except the asymmetry is that the patient knows more about his or her health than the payer or the doctor.
As for LASIK, I have said all there can be said about it. It is a highly elective procedure akin to cosmetic surgery. The primary driver of lower cost is not competition with other laser surgeons but competition with glasses and contact lenses. If you continue to believe that it is a good model for the provision, then that's your choice but you'd be far outside the realm of rationality. I may have overstated my original point about LASIK if I said it was "unrelated" to health but it is much more of a cosmetic procedure, and has little to do with medical necessity.
Muzzybelly's last couple of posts pretty much win the thread. Dunno why the hell the Democrats haven't been able to make the case for universal health insurance as well as MB. I might add that the insurance exchange set up by the House bill gives the benefits of simply lowering barriers to interstate competition-while avoiding the drawbacks. Despite that, Republicans keep harping on interstate competition. Here is a primer by bthe respected nonprofit the Kaiser Family Foundation.
That's a good point about the insurance exchanges.
To make my case for universal health insurance, I used a couple of thousand words at least. Much, much harder to do when you have only a 30 second or one minute soundbite. Also, I get to express my own views, not try to cobble together some consensus. It's not as if anything I have said here is particularly ground-breaking. It's been said, and said, and said, by policy analysts for a long time.
But nobody listens to policy analysts anymore, which is one reason I got out of that game a while back. At least in the last three years we have seen a dramatic increase in policy-related blogs, which beat the heck out of TV news shows. But the blogs themselves are often minimally informed by actual economic/policy analysis, or are overly argumentative and/or dishonest. And posts often last a couple hundred words only.
In some quarters, it's a form of heresy to suggest that we turn the news channels off and let the experts do the lawmaking. Indeed, I would never suggest that seriously, because democracy is our system, it's a good system and robust public debate is a part of that. Still, I don't think the Founding Fathers (or Locke or Rousseau for that matter) had any idea what would happen to public discourse with the advent of 24 hour news and constant internet everywhere. . .
Yeah, I appreciate muzzybelly's comments, but I hope you appreciate TallDave's and others. Hard enough to live in an imperfect world without everyone thinking that his own point of view is the only one there is.
And that, of course, explains "why the hell the Democrats haven't been able to make the case for universal health insurance as well as MB". Surely it is silly to think that (1) I'm right, so (2) The reason not everyone agrees with me is that they have had it explained well. Perhaps they come from a different perspective.
For what it's worth, I don't really care for the concept of thread winner or loser. I believe I am right on this issue -- indeed, why would post these things if I did not? -- but "scoreboard" is not a good way to approach discussions. I hope my comments helped enlighten some people as to facts and reasoning they didn't otherwise know. That is all.
I think it has as much to do with the gradual public realization that "government provided" does not mean everything stay the same, except you no longer have to pay for it. As the bills have become more specific, more Americans seem to have realized the consequences of a government run option, whether it be more federal control in personal decision making (the Stupak amendment) or more cost (taxes, deficit, etc.)
I think you mean "The more lies Americans hear about health care reform, the less popular it gets."
By all means, let's just keep doing what we are doing. Sure, 15%-20% of the workforce has no jobs (unemployment plus "discouraged") and their COBRA coverage is wearing out. Sure, in 20 years health care is going to consume 30-35% of our GDP.
But hey, there are political points to be had by ignoring all the problems, calling the President a socialist, and ignoring the lessons from all other countries in the industrialized world.
Yes, I know, this health care legislation doesn't directly address the 800 pound elephant in the room: overutilization. But it's a start. If we never start that process, we will never do anything to solve it.
The more lies Americans hear about health care reform, the less popular it gets
So by all means, keep lying!
It's not the lies. I don't believe it's a more informed public rejecting reform either. It's the unemployment you just mentioned.
People saw the government (and the opposition) discussing health care to the death in the last 6 months while the number of unemployed kept growing. They don't feel government is prioritizing our current main problem. This translates in resentment shows towards the current initiatives of the Administration. Consistently, in this period approval numbers of both parties have gotten lower.
What is big government supposed to do about private sector unemployment big guy?
How about lowering cap gains taxes to encourage investment? Start-ups need cash and investors today are not as willing as they once were to risk their money in the face of the taxes they will pay if the company is successful. You want jobs then encourage people to fund start-ups. The Democrats are doing exactly the opposite with their tax and regulatory burdens.
"What is big government supposed to do about private sector unemployment big guy?"
#1 Stop fantasizing about ways to add cost to business. ie STFU about cap-n-tax, healthcare "reform", card check, "repealing" the bush tax cuts etc.
#2 Redirect the porkulous spending to a payroll tax holiday
#3 Encourage the banks to lend again.
#4 Roll back minimum wage laws.
The Democrats are doing exactly the opposite with their tax and regulatory burdens.
Cite?
#1 Stop fantasizing about ways to add cost to business. ie STFU about cap-n-tax, healthcare "reform", card check, "repealing" the bush tax cuts etc.
Health care is costing business more every year. So I don't know what the hell you are babbling about.
#2 Redirect the porkulous spending to a payroll tax holiday
What kind of holiday do you mean? What about all those with out jobs?
#3 Encourage the banks to lend again.
Thank you, Rip Van Winkle!! In case you haven't noticed, banks aren't lending because their balance sheets are a mess. What do you suggest that Geithner and "B-52" Ben do that they haven't already? If it's lend or be tossed in jail, that's something I can get behind.
#4 Roll back minimum wage laws.
Why? This isn't the 1890's.
What is big government supposed to do about private sector unemployment big guy?
This question supposes that there's nothing the government can do about private sector unemployment and surely Democrats aren't advocating that ... are they?
The government mandates a 40-hour work week ... does it not? What is magical about this number? Nothing. It could easily be 35 hours ... or 30. Lowering this number would increase employment. Certainly there would be negatives ... but that would be a positive.
But I think the larger point is that no matter what ideas anyone comes up with that would actually increase employment EletronHayek and his fellow travelers would merely point out some negative associated with the given tactic in order to suggest that it would be a waste of time to even attempt it. Do nothing is their standard response.
Democrats seem to want very high unemployment and believe it helps them get their other agenda items enacted ... as evidenced by the tactics they use to shoot down all arguments for raising employment.
So, as long as Democrats are allowed to be in charge things will not get better. So, we should just fire them.
How about stop the huge deficit spending which is taking money from the private credit sector, and moving it into government bonds. Bonds are literally robbing the private sector of critical funds that would normally be used to fund small business loans and diverting it to long-term bonds...that money is now no longer able to fund those loans that are needed to fund the growth that would create lasting jobs.
Thats on the short term. In the long term, reducing taxes (or not allowing tax cuts to lapse) would free funds IMMEDIATELY for use in funding small business growth. Small businesses are traditionally the engine which produces wealth and permanent jobs. What this administration has done is to spend more than 5X's the dollars for temporary job creation (almost $2 million per job, where as the private sector spend roughly $300k per job) that will have to be refunded yearly.
So what can the government do? Why they could do a lot, but this administration and those who are in control of Congress have no real desire, or the knowledge of economics, to actually do anything that would produce long term growth outside of government circles. Gov't doesn't PRODUCE anything, it merely acts as a brake on the economy by taking funds out of it and wasting 75% of them in projects that are in the end...useless. That, in brief, is what government can do.
Moverty, actually the French experience with mandating fewer hours suggests it actually increases unemployment by increasing business labor expenses.
Agreed, that is a major part. Especially with the tax increases in the bills, although I believe that only affects people in the top brackets.
And guess who invests in start-ups? Now they have even less money to invest in addition to less incentive to invest it.
Well, not to mention what happens to the private market in general. Especially with a single-payer option, but even just an "exchange" will likely cause some of the insurance companies to go out of business
ND, a "fee" a "penalty" and a "tax" are the same thing, only different labels. If you place a penalty on a small company for not offering "affordable health insurance" (because they literally can't afford to do so, and still remain even reasonably profitable) it is the same thing as a tax.
If you place additional "fees" on energy usage it takes away money from those who would use it to purchase products...made by small businesses.
You want affordable health insurance, remove those barriers that are presently in a number of states (CA, NY, NJ, MD, for example) that prevent more than 1290 of the 1300 health insurance companies from doing business within the state. Those states listed above only permit SIX!!! 6 Health Insurance companies to conduct business within their borders. Is that real competition? Nope, not at all.
You want to use less energy? That's relatively easy one...reduce the weight of vehicles on the road today. It's possible to produce a vehicle the size of a Chevy Tahoe, but weighs 1/6th the weight. How? Carbon fiber. instead of require a huge block V8 engine, if the Tahoe weighed in at 1200 lbs, then it would only need a 2L engine to power it...that engine would get 40+ MPG...instead of pushing a 7000 lbs truck with a 6L engine that gets less than half. A 4 passenger care would weigh in around 700 lbs and get even better milage with 2 or 3 cyl engines...that would reduce carbon emissions in this country by 2/3rds if not more.
Solutions? There are many out there, but this country wants easy ones, so tax, fee, regulate, yep make things more expensive that's the way to reduce emissions...NOT!
I would almost agree, Nimed, except the larget drops in support occurred from 2007-2009, before Obama took over. Since the administration took over, its dropped about four points. The Administration advocating health care reform has only been in power for a short period of time during that drop in support, thus not very probable that resentment toward that administration is the real problem.
It's not the last six months that seem to be the real issue.
It's not the last six months that seem to be the real issue.
The last six months saw the lines cross for the first time ever.
The last six months saw the lines cross for the first time ever.
Sure, but that seems like a fairly arbitrary event and only part of a larger trend. I think my point was that from 2007 onward we saw a pretty steady decline of support for government resposibility of health care supplies. That doesn't really translate as "resentment shows towards the current initiatives of the Administration" as Nimed suggests, rather I think people were more generally concerned with the decline in the economy. When things were economically good, support was high. When the economy faltered, support faltered.
2007 is (roughly) when the 2008 presidential campaign began (i.e., when discussion of health care reform picked up again).
Any way we can blame Hillary for this? ;-)
It's not the lies. I don't believe it's a more informed public rejecting reform either. It's the unemployment you just mentioned.
I disgree. The public may not be informed policy wonks, but health care reform has moved from being a vague concept onto which people could project their hopes into a concrete proposal that can be criticized. The signal-to-noise of the debate is low, and the amount of attention being paid outside of a few partisans is also low, but I think that is one factor.
Another factor is that the public wants debt reduction, not debt expansion.
The third is that Obama and the Democratic Brand are more tarnished than they have been for a while.
while liberals have continued to push even more obligations and expenses onto employers.
I could go all Tonto on you, but I won't. I haven't heard conservatives singing the praises of single payer, or other methods of covering people with out it being tied to their job. So I'd like to know what obligations and expenses you are talking about.
Calvin:
Conservative economists and wonks have opposed the (highly regressive) tax break that is responsible for employer converage for a very long time. Without that tax break, employer-sponsored coverage would be about as common as employer-sponsored housing and company cars, i.e. nearly non-existant. Everyone would be in the market for individual insurance. Those who could afford great insurance (and were willing to pay for it) would have great insurance. Those who could afford minimal insurance (and were willing to pay for it) would have minimal insurance. Those who could not afford it (or were not willing to pay for it) would have no insurance. Just as for home, auto, and life insurance.
Conervative politicians have not been pushing for this very hard, because employer-sponsored insurance is politically popular.
As for pushing "more obligations and expenses onto employers", it's not hard to think of examples. Minimum wages, mandatory parental leave, mandatory sick leave, and health insurance requirements are all policies that limit the contracts that employers and employees can negotiate, and have all been widely supported by progressives.
Nonsense. Plenty of liberals have been saying the same thing. Indeed, the one substantive proposal out there to radically alter the system was written by a liberal, Ron Wyden. Of course, while Wyden's bill isn't politically feasible, at least the two Democratic proposals under consideration in Congress do potentially put us on the path to severing the link between employment and health insurance by setting up exchanges and (in the Senate version) beginning to tackle tax code support of this arrangement.
First let me say, Muzzybelly, that this is an awesome way to foster discussion.
Second, just because I don't support the current bill does not mean I don't think something needs to be done. I absolutely agree there are large problems, and have yet to call President Obama a socialist. In fact, when he first began discussing the subject, I was wary but receptive, because it seemed to begin with his awareness of the Gawande article and Darthmouth study, which indicates huge spending disparities in different regions with no difference in outcome. However, the liberal side of the Democratic party decided to change reform into expansion. I believe we need to reform first to lower costs, so as to be able to afford expansion. Also, I prefer the government have little or no role in what I want in my health insurance.
I'm not talking about everyone who opposes the bill. There is always a reasonable opposition.
The problem is that much of the opposition to this bill is unreasonable. Death panels and government taking away Medicare and socialized medicine BS.
You are wrong that the "liberal side" changed reform into expansion. It has always been the plan to expand health care coverage to universal or near-universal coverage. The question is how much reform would accompany that.
It's also worth noting that the vast majority of anti-reform energy has come from conservatives. Liberals want a system with tighter cost controls, evidence-based medicine, and scientific allocation of resources. Liberals are the ones who want to address the huge disparities in spending. Conservatives are the ones who equate these things to death panels, socialism, fascism, government bureaucrats deciding who lives and dies, etc.
I agree much "anti-reform" energy has come from conservatives, and I agree that conservatives are the ones usually throwing around socialism, fascism, etc. However, as far as governments deciding who lives and dies, conservatives were crazy to say that, but somehow pro-choice liberals are free to berate the Stupak amendment because it doesn't allow women to choose abortion? This is what conservatives were trying to express as a fear: once the government runs health care, every part of coverage necessarily becomes political, and conservatives historically (the party has gotten away from this, but there are still those of us that believe it) oppose additional government interference in our lives. Was this fear blown out of proportion with words like socialism and fascism? Absolutely. Was it ingenuous or shouted simply so Obama could not get his way? No. In fact, Obama did some lying too (http://nobamablog.wordpress.com/2009/08/12/obama-doctors-may-choose-amputation-because-of-reimbursement/), and while he was quite obviously wrong, I understand what he was trying to address, and don't shout "liar!" every time he says something despite the fact that he has done it in the past.
Your 3 parts of reform are incredible vague. Evidence based medicine and tighter cost controls sound nice, but the former is a very vague term and has little or nothing to do with cost controls (much non "evidence based medicine" is used to address patients that can't handle or can't afford the appropriate medication, treatment, etc.) and the latter is something government has never been good at. But if they were serious, they would reform and control costs in Medicare during the 3 years before the bill takes effect and write into the bill that it would not be allowed to take effect without meeting certain actual cost savings. I believe in this situation that many liberals and Democrats did honestly think of expansion when reform was first discussed, but that was not how Obama presented it. He presented it as reform which would lead to reduced costs which would allow more affordability. This current plan is expansion that will hopefully control costs, which again I think is a terrible order.
Muzzybelly Says:
"The problem is that much of the opposition to this bill is unreasonable. Death panels and government taking away Medicare and socialized medicine BS"
Muzzy, "Death panels" is a rhetorical exageration that points to the side effects of politicizing healthcare.
When the govenment pays for all medical care it will control what gets covered. This is illustrated to "progressives" howls with the abortion ban.
It is not unreasonable to think that politics will be the driving consideration for what is covered and who gets treatment.
It won't be long before the best treatment goes to politicians and those that are politically connected. Among other evils, this will open up a whole new area of political graft.
I agree with Nola. Reform before expansion. We simply cannot afford to add another trillion to federal spending without a clear plan for how we will save money in existing health care entitlements. The House Bill punts on reform, so just expands the size of the health care cost problem.
I think you mean "The more lies Americans hear about health care reform, the less popular it gets."
I agree, Obama's lies have really hurt health care reform.
You're such a disinterested party on this issue, I know I can count on sober political analysis.
That's kind of a cheap shot. There's no political analysis in the post. Only the results of a poll you (and I) don't like.
Yes we know Megan is concern trolling. She should really just STFU about progressive issues.
Progressive = Shut Up
That's why you fucking free-speech Nazi's will be taken down a notch shortly.
From the poll demographics-
it means that the independent voters are starting to take an interest and don't like what they see.
"... independent voters are starting to take an interest and don't like what they see."
They were told by Barack Obama that he would not raise their taxes (any of their taxes). He claimed, in order to get elected, that he would pay for all of his initiatives by raising taxes only on people making more than $250,000 a year.
He lied.
Independents can read. They see they are now mandated to purchase hugely expensive and bad insurance policies - a thinly-disguised tax increase in everything but name.
So, like with George H.W. Bush, they'll unemploy head Liar In Chief. And he'll be lucky if that's all they do.
No, no, no. It's all because of Republican lies. If the people knew the truth about the wonders of public option/single payer they would support it 70-80%!
If we only had an articulate President who could cut through the Republican lies and tell truth.
I thought Obama was supposed to be your brilliant messiah who was 10000x better speaker then Booooosh. What went wrong genius?
Sir Electron - "What went wrong genius?"
Sorry, I left off the tag.
I'd be curious to know what percentage of seniors and veterans answered "no".
Do they not get votes?
I think he means to imply that people already covered by the government might have different feelings than people who aren't. I'd be curious to see which way that goes too.
That poll looks very suspicious to me - I can't believe 69% of Americans ever sided with government responsibility for health care - back in '07 that meant every democrat and independent and quite a few republicans. Look at the Gallup site it may have made some sense in relation to the other questions asked but I don't see where they post the poll in its entirety.
I can believe that 69% of respondents support the concept of government making sure that a guaranteed minimum amount of health care is available to everyone. But today asking that question is effectively a proxy for "do you support the current health bill", which goes far beyond that.
As much as I would like to believe this correlation, try searching Google for health care new stories limited to particular years. It looks like the correlation actually runs the other way when you compare the Gallup graph to the number of Google results for corresponding years; when there are more health care stories, the government responsibility % goes up and vice versa (yes, there have been fewer health care stories this year even when scaling up by 12/10.5)
Most of the coverage of health care reform since the summer has been critical. Also, the longer something gets debated without action, the more the public tends to lose patience, and "no" wins by default. This is precisely why the Senate Democrats hurt themselves more and more each day they dither and fail to offer solutions.
Also, the political process of passing laws is a horrile way to build any complex system.
Someone should go to all the countries where the government does provide healthcare and ask the same question.
The problem with that is selection bias - countries whose populations are more socialist will prefer it more, and are more likely to have voted in a government that would provide it at some point in the past.
If those other countries are so wonderful, why don't we have an emigration outflow from this country to them?
Seriously, people emigrate to countries where they think life is better. If you assert that health care and/or life in general is better in, say, the UK or Canada than in the US, wouldn't there be a Berlin Wall phenomenon, with all the emigration outflow running toward the UK or Canada?
Maybe people don't actually want to move to a country where the government health service tells them to wait an unconscionably long time for a needed medical treatment.
Did you think before you wrote this?
First, we aren't talking about how "wonderful" those countries are in general, but about their health care systems. It's quite possible for their health care to be a heck of a lot of better than ours, but other aspects of American life to be better.
Second, even if we were talking overall quality of living, the gap has to be fairly huge before it spurs people to move. People aren't going to on a whim just pick up and leave their friends, their culture, their life to move to a strange place. It's one thing to leave totalitarian regimes or destitute poverty to look for a better life. It's another thing entirely for a middle-class American to pick up and leave.
Third, do you know there aren't emigration outflows? Or are you just surmising? I know a lot of people who have left the US to work in Europe. Some of them came back; some of them didn't; some of them I don't know. And of course, there are lots who come from Europe to here.
Fourth, what are immigration restrictions in Europe like? I don't think it's so easy to emigrate there. I would love to live in Switzerland. Unfortunately, I don't yet have the net financial worth that is required for a non-Swiss to emigrate there.
I have lived and worked in Switzerland. Unlike the U.K., France, and Canada, Switzerland does not have anything even close to single-payer insurance, nor does the system have more than a passing resemblance to the bills now in Congress.
It does have a few features that progressives would like: a mandate, community rating, guaranteed issue, and subsidies for the poor. But it also has many provisions that U.S. progressives have blanched at, and those are mostly the ones that actually cut costs. There is no employer-sponsored insurance and no counterpart to medicare: everyone is thrown into the individual market. The mandate is only for catastrophic coverage; preventative care, mental health coverage, contraceptives and all the other requirements that U.S. progressives like to pile on are not required.
Aside from the problem of the high effective marginal tax rates that the subsidies for the poor create, I actually like the Swiss system pretty well. Give me a call when you have a U.S. bill that eliminates medicare and the tax break for employer-sponsored coverage. Such a bill might get my support.
Muzzy,
You remind me of the people that left MA because of high taxes, crime incompetent government, no jobs and bad schools.
Then immediately started voting for the policies/programs that created the mess left behind.
Since summer, the opponents of health reform has released an avalanche of lies , the likes of which have not been seen since the heyday of Pravda and Goebbels.It has gone largely unopposed by the Democrats, who seemed to have adopted the same failed strategy that Kerry used against the Swift Boaters-the belief that the American public could sort through the horses**t unaided.
Instead of responding, the Democrats have been fighting among themselves, compromising with Republicans, and creating a bill that only a policy wonk like Ezra could understand.
This wsn't what the public had signed up for when they elected Obama with a mandate to enact universal health care. They have noted that the Democrats have been spending more time trying to accommodate insurance companies, drug companies, doctors and hospitals than trying to achieve access to affordable health care for all. They have also noted that the one really popular feature of health reform- the public option- has been watered down and may not be in the final bill.
Finally, they have noted that Obama has apparently been content to let Congress squabble and draw out the process for a seeming eternity. Now Obama may be very patient, but the US public isn't. They will wait for a reasonable time, but then they expect results.
As a result, they are souring on the whole process. In short, its time-past time- for Obama to get in there and mix it. He and Harry Reid have to whip the Democrats into united action and get the best bill he can past the finish line.
Once it passes it, I expect the approval ratings will go back up.
Since summer, the opponents of health reform has released an avalanche of lies...
And apparently they've just now caught up with the avalanche of lies told by proponents of socialized health care.
They have noted that the Democrats have been spending more time trying to accommodate insurance companies, drug companies, doctors and hospitals than trying to achieve access to affordable health care for all.
Uh...yeah. That's how the political process works. Which is why it's a very bad idea to put important sectors of the economy under the control of the political process.
I'm sure that your preferred option-doing nothing- will achieve the goal of universal health care-NOT!!
Of course. Because as we all know, the only way to change the system is THIS bill. It's inconceivable that someone could be against government takeover of health care but also think that the system needs reform.
And Nola makes sense again.
You could drag out a less tired and childish liberal mantra. It's become the liberal version of "if you don't support the decision to go to war, you don't support the troops."
Then we need a better political class. But you are right-the people see a Republican opposition bought and paid for by the insurance industry blocking reform, aided by their fellow travelers the Blue Dog Democrats. Cynicism is truly in order.
And they also see Obama turning down special interest groups left and right as an example for all of us! Unless it's trial lawyers (tort reform) or Unions...
And they also see House Dems crying foul about taxes on Cadillac insurance plans, even though most experts recommend this as one substantial mechanism to expose consumers to healthcare costs and thereby control cost explosion overall. And they see many Dems trampling on Ron Wyden's sensible proposals about consumer choice and options outside of employment-based coverage. Surely the fact that Dem labor union constituencies vociferously oppose both of the foregoing measures for reasons of self-interest has nothing to do with the Dem legislators' position on these items (which, incidentally, are favored by many or even most serious-minded healthcare policy wonks).
Until we get that better political class, it might be better to wait on health insurance reform.
"But you are right-the people see a Republican opposition bought and paid for by the insurance industry blocking reform",
Is that why the dems bill is built around mandatory insurance purchase?
if you think insurance companies suck now just wait until you're forced to buy their product.
They have noted that the Democrats have been spending more time trying to accommodate insurance companies...
Amazing. It would make so much political sense to eliminate a business sector that provides hundreds of thousands of jobs when unemployment is over 10%. Stick to your guns their guy. If your dreams come true the government will pretend to pay us while we pretend to work.
The first paragraph is just sad, and reflective of the kind of defense of this bill of which people have grown tired.
If you actually think the POTUS was elected with a mandate to enact universal health care, your delusions about what this country wants runs too deep to be part of a reasonable debate.
It must be very, very loud in your echo chamber.
I find it funny that muzzybelly was called out for being sarcastic and snarky when so many commenters are snarky and sarcastic all of the time and are never called out. Could it have something to do with his politics on this issue...I wonder?
Seriously though, it seems as if a very large issue is often ignored in this debate, and that is the plight of the entrepreneur who must close his/her doors or never opens the doors because he/she can't find insurance for him/herself. People talk about the "small business owner" being hurt by this legislation, and they usually mean the small business owner with other employees to insure. Since I have not read the bill yet and only have rhetoric and hyperbole from both sides upon which to rely, I can't comment on that issue right now.
What I can say is that there are currently a lot of potential small business owners who are dissuaded from or simply cannot afford to quit their secure jobs and open their small business because they cannot afford or are simply ineligible for health insurance. This is a serious market inefficiency that leads to stifled competition and entrepreneurship based upon this barrier to entry which may now be eliminated (or at least greatly reduced).
Unlike most commenters here, I am still undecided on this bill and am trying to figure it out with an open mind and filter out the noise. I very well may come out against it, but I have this nagging need to hear more media coverage about the sole proprietor who never fulfills his/her dream because of the insurance issue, and the effects of that on our economy. It can't be good.
ds;
I agree with you that currently, buying single coverage can be difficult. I would say that eliminating employer based coverage would go a long way to solving not only that problem, but also help with cost containment as well.
As far as my sarcasm, I honestly don't know what to say about the vague "Lies!" claim anymore. While I certainly make no claim that Republicans haven't been misleading, deceptive, and frankly dirty with some of their tactics, it is in no way limited to their side of the aisle. I will admit I sometimes respond more harshly than I usually would, but as a medical student this is an issue very important to me. I have obviously made up my mind, but it was not based on my politics (usually Republican), but rather that I believe expanding a broken system with the hopes of fixing it later is a bad idea.
I agree, and that's one of my big objections to the Democratic Party proposals we have now: they take the broken system we have now, where nearly all health care is paid for by comprehensive health insurance (driving costs up and having medical decisions made by insurance company bureaucracies) predominantly funded as an employee benefit that can be lost by becoming unemployed or self-employed, and they attempt to make it bigger by forcing as many uninsured people as possible into it. Medical insurance is not the solution; medical insurance, other than catastrophic coverage with high deductibles, is the problem. It's already had catastrophic effects on health care; I expect that expanding it will make it worse.
Aside from the fact that I personally prefer market solutions in general, I find it hard to envision out and out public health care as any real solution. Instead of having an oligopoly, we'd have a monopoly. Instead of having insurance company bureaucrats answerable to shareholders, we'd have government bureaucrats answerable to Congress, and through Congress to lobbyists . . . and special interest groups are always more effective at lobbying than the general public. There's really not a lot of difference between the existing corporate system and the state system, and what there is is to the state system's detriment.
After all, elementary and secondary education in the United States is virtually a state monopoly; you have to be either rich or incredibly motivated to pay taxes to support the public schools, and also pay tuition at private schools. And how well is that working out? Large numbers of children outright failed by the system, low standards of success for those who don't fail, and domination of educational policy by massively influential public employee unions that can't clearly distinguish between sound educational policy and their own self-interest. Doctors are already arrogant enough; I don't want to see medical policy dominated by a doctors' public employee union.
I'd like a move toward a free market system. I don't see that as a Republican solution; it was Romney who came up with the mandated insurance system the Democrats are now touting as "progressive," and Schwarzenegger tried to foist it on California . . . "We'll give the uninsured help: We'll force them to buy insurance, give them inadequate subsidies, and punish them if they don't" really is a quintessentially right wing approach to health care. I see it as a libertarian solution, and much too radical for the Republicans to touch. But I think it's one that would actually attack the source of most American health care problems.
I agree that what we are calling health insurance is mostly just prepaid healthcare. Maybe a universal system of catastrophic health insurance coupled with mandates to participate and contribute to personal health savings accounts could go a long way toward reducing health care costs. But I think even this sort of system would require significant government subsidy for lower income folks. But I can support that too. I can't support expanding the broken system we have, and labeling that "reform." And I don't believe the promises that it is a first step toward reform. Clearly, the first step is in the wrong direction.
I agree that health insurance is the root of the problems with our current system and expanding "coverage" will only intensify the problems we now have.
People should pay for their own care out of pocket with high deductible ($50,000?) catastrophic insurance. Over time this will lead to lower prices and better care. More importantly it will put the patient at the center of the system.
The idea that someone else should pay and have control over my healthcare is a bizarre idea.
Would anyone want some 3rd party to be in charge of:
where you live?,
what you eat?,
what clothes you wear?,
what work you do?
Well, when the issue was vague and without specific proposals, yes, people might answer yes. Now that there are concrete proposals on the plate, not so much. This isn't rocket science, and it really should not be that surprising.
The $64 trillion dollar question is, is there a set of concrete proposals that could attract general support. Not just that you, or I, or anyone else here thinks they ought to like if they understood them. I think that radical free market reforms would greatly improve American medical care, but I'm also pretty sure that there would be overwhelming opposition to any proposal to make such changes, not just from special interest groups but from a lot of the public. But it seems that when we look at having the government actually take explicit responsibility for delivering health care, then suddenly what health care gets delivered, and to who, and at whose expense, and how much it costs, all become not just personal choices but political issues, and there may not be any possibility of consensus on them, or of any answer that the voters won't hate and punish.
Which is as much as to say that I wonder if the United States has become ungovernable now, as any possible substantial change deeply offends some powerful special interest group or large faction. I find it grim to think that I hope to be saved from a disastrous new policy by the sheer ungovernability of the country, and as part of it by the bloodymindedness of a bunch of right-wing theocrats. It makes me understand Churchill's comment about an alliance with Satan.
William,
Human beings, by nature, are conservative creatures. The problem with reform, good and bad reform, is that most people are satisfied with their healthcare today. It will always be difficult to enact any significant reforms because of this. Just look at how Obama repeatedly promises that nothing will change for most people. The people, though, are now looking at real proposals and realizing that Obama's promises are not going to be kept. At that point, they have to decide whether or not they are willing to take the chance that these proposals will make things worse for them personally. A lot of them are concluding that it isn't good for them. I happen to agree with this stance. However, the reforms I and you believe would be a benefit are going to suffer from the same natural conservatism.
Most people don't like change. It is that simple.
Absolutely. That's why I think we can start smaller, with reforms to Medicare payment schedules attempting to reduce disparity in payments, and phase out the employer-based insurance system. If done slowly, possibly with government subsidies and more regulation of pre-existing conditions, this might help citizens realize that health insurance doesn't mean someone else pays for their health care, just that it takes longer for the bill to get back to them.
William H Stoddard
I'm the first to admit that, in discussions concerning education and health care in our country, just shouting "Look at Europe!" is a lazy argument that generally doesn't help. Blah blah, we have a different culture and political system, path dependence and all that.
But it's still a very good, and extremely tempting argument, when someone is saying stuff like:
I find it hard to envision out and out public health care as any real solution. Instead of having an oligopoly, we'd have a monopoly.
There's really not a lot of difference between the existing corporate system and the state system, and what there is is to the state system's detriment.
After all, elementary and secondary education in the United States is virtually a state monopoly; you have to be either rich or incredibly motivated to pay taxes to support the public schools, and also pay tuition at private schools. And how well is that working out?
Which is in essence claiming that the origin of all our problems is too much government, and the only way to solve them is introducing free-market solutions.
But our K-12 education system is crappy compared to other monopolistic education systems. Our health care system is inefficient and costly compared to systems in which the government plays a greater role. Maybe there are wonderful free market cures to our ailments in health care and education. But, in these areas, it's the free market that bears the burden of proof. We really shouldn't start by assuming that the monstrous monopolistic government can't, even in principle, provide good solutions.
Just look at Europe!
uh, private school is demonstrably better than public school. homeschoolers also post better outcomes, as far as that goes.
i would see data that public schools in america have better outcomes even with correction for rich parents in certain districts where the students are cherrypicked (the, uh, health care situation, actualmente).
Those are not meaningful comparisons. Stoddard, Nimed and pretty much every sane person agrees that our public education is terrible. I think Nimed's point was that they don't have to be that way in principle.
The comparison with homeschooling makes even less sense. A "student" has one self-selected and highly motivated tutor just for him/her (plus possible brothers).
"actualmente"?
Education is mostly a cultural value. Cultures that value education do well at education no matter where they are. There's no reason to think public education ever does better than private or home.
A [homeschooled] "student" has one self-selected and highly motivated tutor just for him/her (plus possible brothers).
And yet they outperform buildings full of highly-compensated publicly-employed "education professionals." I think that's sort of the point.
If we gave people a voucher good for home schooling or private schooling based on per-pupil costs, society would be much better off.
Newark NJ spends $17,000 per year per student. This is a district that graduates less than 1/2 of the students that initially enroll.
Nimed,
Either I have learned to understand you better, or you are learning to write better.
This is the best, most balanced, most persuasive comment I've seen you make.
Thanks. Even though I'm still unpersuaded, I really appreciate this as an excellent and fair addition to the debate; especially refreshing considering how it can often go ballistic so quickly and easily.
Again, thanks.
I would agree that our education system is crappy compared to other monopolistic educational systems. The question remains: Why? From this example, I'm not sure the burden of proof remains on the free market. The fear I have, and that I suspect many others have, is that a greater government role in our health care system would also give a crappier result than other government-dominated systems, and would be worse for more people than the current inefficient and costly system. Given our politicians' and governments' less-than-stellar performance in education, home loan manipulation, Medicare, airport security, etc. ad nauseam, then for me the burden of proof would seem to lie with the government. It's just not good enough to say that something works for someone else's government.
Of course, I could give you a much longer list of government successes-in health care, no less. I mean, " What have the Romans ever done for us?"
http://www.youtube.com/watch?v=ExWfh6sGyso
Apart from abolishing smallpox and polio, and treating veterans,and immunization campaigns, and clean water, and universal access to health care for seniors and funding basic research for medicine, and on and on ad nauseam, what has the bloody government ever done for us?
Mean while, we had a free market in health care prior to 1930. Do we want to go back to that? Really? Patent medicines for everyone, and let's bring back typhoid epidemics!
Or, in plain English, you know that free market in health care is best and can not be seriously attacked -- so let's resort to smears instead!
On well-defined programs with specific targets, yes - even the government archer can hit the target. But do you really want to include "treating veterans" and "universal health care for senior citizens" in your list? Granted, they may be the programs most like the health care bill being pushed now, but if the quality, expense, and efficiency of Medicare and the VA is the best our politicians can do, then your argument hasn't made much headway. Creating huge, inefficient, expensive, inflexible, redundant bureaucracies is something politicians are good at, but I'm not sure we can afford the "improvements", fiscally or physically.
--But our K-12 education system is crappy compared to other monopolistic education systems. Our health care system is inefficient and costly compared to systems in which the government plays a greater role. ...We really shouldn't start by assuming that the monstrous monopolistic government can't, even in principle, provide good solutions.
Actually, you've provided strong evidence that the *United States Govt* can't provide good solutions, even if other governments can.
Our K-12 is a perfect example of what's wrong with US Federal and State level controls--it's a disaster. The "public option" exists; it provides a terrible service with outrageous spiraling costs that no one can control. State-private sector partnerships haven't helped. The public option has in fact driven up the cost of available private alternatives as it has put out of business the less expensive private alternatives--why bother going to a private school that costs 4k when you can get a 6k education for free? Only the 30k education remains as an alternative to the public option. And yet, we are going to have to ration education to control costs, and we already have terrible educational outcomes.
Our current healthcare system is a mess. Making the federal government introduce hundreds of new bureaucracies isn't going to help--even if it would in Europe.
It's ex
But our K-12 education system is crappy compared to other monopolistic education systems.
No, it's worse than private schools (even those that spend far less money) and home schooling.
Our health care system is inefficient and costly compared to systems in which the government plays a greater role.
It's the best health care in the world -- best cancer survival rates, best access to new drugs, best access to surgery. Saying it's "inefficient and costly" misses the point: the most efficient health care systems are the ones that provide almost no medical care, because the cheapest things (antibiotics, vaccinations) are the most effective.
Neurosurgery may be costly and save way fewer lives than antibiotics, but if you have brain cancer you'd like to live somewhere that can do it, preferably without a 2-year wait.
TallDave: Old people are disproportionately affected by cancer (and other diseases); so higher survival rates simply point out that Americans with access to single payer care -- in other words older Americans on Medicare -- tend to get very good care. To put it another way, it's an argument that our government-run system tends to deliver better or more robust care than theirs. (Which obviously might lead to the conclusion that we ought to extend government-run healthcare forthwith, as we're clearly pretty good at it).
Now, this situation -- robust care in the US for those who tend to get chronic diseases -- the elderly -- flows from the fact that the American system in the aggregate not only shuns explicit rationing, it emasculates the normal functioning of price signals by excessive use of third party payers. And so a tsunami of money flows into the healthcare black hole in a mannner that has approximnately nothing to do with the free market.
Anwyay, not surprisingly, a system with lavish resources tends to deliver good results to those with access to those lavish resources. Your argument really boils down to "America's system is awesome because it insures that a vast amount of money is spent on healthcare, and it also prevents a big percentage of the population from getting any healthcare at all, and so those outside the 'no care at all' group get very robust care indeed."
Problem is, such a system is eroding living standards in the here and now, and is unsustainable in the long run (and is causing tens of thousands of premature deaths yearly). And it's is unfair and inefficient: the aforementioned lack of care drives the US down the ranks of rich countries when it comes to total amenable mortality. But sure, if you want to cherry pick groups who get robust coverage under our system -- and focus on the maladies they tend to suffer from -- of course you'll get good. Some accomplishment!
...of course you'll get good. Some accomplishment!
That should read: "of course you'll get good results. Some accomplishment!"
Jasper:
I see what you're saying, but disagree (or likely unclear) with one or two things. Yes, there is a lot of market distortion, but money going into the health care system does not necessarily mean good care. I think if we cut down on the market distortion, we'd get less unnecessary testing/procedures, because the average person would no longer think "Well, I'm paying for insurance, and if I don't use the money someone else will". As far as cancer survival in the elderly, they survive less often than the young regardless of money, so while I see your point, I think it has less effect than you imagine.
Again, I agree that the current system is eroding living standards. That does not mean a government run system is any more efficient. The key is to discover what to change about our system to maintain our high standard of care, but reduce inefficiency, and I simply do not see how allowing the government control will increase efficiency. Bureaucracies everywhere have a storied history of doing exactly the opposite.
This case for more government care might make sense if the disproportionally affected "old people" you mention actually have a survival rate the same or higher than others....not so much.
Nola Dawg: Then you should support the Democratic proposals, because they at least begin to chip away at this problem. Regrettably the votes don't exist for a total overhaul of the system like Wyden's bill (assertions to the contrary, ObamaCare is not a "government takeover" but a highly incrementalist, conservative approach to reform).
True. I don't think anybody who's seriously looked at the US model doubts there's a lot of unnecessary healthcare being delivered, and that this unnecessary care sometimes even kills people. So, the allocation of resources in the US model isn't optimal. Still, the system is bound to yield a lot of robust healthcare to many of those on the receiving end of the lavish resources, even if it occasionally is counterproductive.
Who's proposing a "government-run system?" The Democrats want to prohibit rescission, and they want to require community rating and guaranteed issue. That's what they do in higher-performing rich world healthcare systems like those in Germany, Switzerland, Japan, etc. The Democrat also want to extend coverage via mandates/subsidies -- again, in similar fashion to Switzerland or Germany. But that would mean buying your coverage and getting your healthcare delivered by, you know, private sector actors. It's possible, of course, that the legislation would allow for a new government insurer, as well, but it's not looking terribly likely.* And even if it transpires, it will only be an option for two or three percent of the population. Hardly what I call a "government-run system."
In fact, what ObamaCare is going to give us is an American version of Switzerland or Germany, and those systems -- while absolutely not reasonably characterized as "government run" -- are in fact more efficient by any reasonable standard: that is to say, they may not be superior to the American model in all facets, but it's pretty difficult to say that they don't beat us at least when it comes to efficiency, as they're both high-performing models that deliver excellent results while doing so far more cheaply and far more universally than the US.
*My own view of the public option is that, while potentially a useful concept, the White House and a lot of Democrats in Congress have been touting it more for bargaining position reasons than for anything else. So, the GOP might end up hailing the "defeat" of the public option as a "great victory" while in the end having to swallow the bitter pill of a bipartisan bill that delivers Swiss-style UHC to the US under Obama's leadership. I think this is the most likely explanation for what's going on now, especially with respect to Reid's apparent lack of concern that Lieberman has backed himself into a corner on the public option: Democratic leadership and the White House don't care if it's in the Senate bill or not, and would just as soon it not be included in the final bill.
I may have a bit of a different view or expression of the legislation, but the "exchange", despite it being through private insurance companies, presents a host of problems to me. With an exchange, the government is allowed to mandate certain types of coverage, all of which will bu subject to interest groups rather than common sense or what's best for the insured/economy. The same problem exists for mandates. Thus I (mistakenly) characterize an exchange as government run.
As far as the legislation chipping away at the problems, I disagree. I don't see how they attempt to control costs, which I believe is only possible by exposing patients/citizens to the costs of the unnecessary tests/drugs/procedures that they are often requesting. Certainly physicians and hospitals share some of this blame, which is why I've shared Dr. Atul Gawande's position of moving toward the Mayo clinic model, something else this legislation fails to do.
Again, I think the problems are much more in the area of actual health care, and possibly the interaction between health care and health insurance, than health insurance itself. The government already has a lot of power to alter how insurance companies function by changing Medicare, on whose payment schedules almost all insurance companies base their own payment schedules. I think the government needs to show it is serious about reform by fixing Medicare before it covers everyone, then tries to fix Medicare. I would have much less of a problem with this bill if contained the exception that, if Medicare does not limit costs by the time the bill is to be implemented, it will not go into effect.
I also think the one sticking point about foreign countries' health care systems as a model is medical innovation. I know many other countries save a lot of money by paying next to nothing for patented drugs, allowing the US to shoulder the burden of at least pharmaceutical innovation.
TallDave: Old people are disproportionately affected by cancer (and other diseases); so higher survival rates simply point out that Americans with access to single payer care -- in other words older Americans on Medicare -- tend to get very good care.
People in their 40s and 50s get cancer too. Even looking at just Medicare patients, what it means is they probably get better care than Europeans. It says nothing about whether single-payer is providing a better or worse outcome than private care. Also, many of those people have Medicare Advantage.
Now, why would the U.S. single-payer system be doing better than the European version? Hmmmm. Maybe it's that giant free market the U.S. has that Europe doesn't. You know, the one that gets drugs a year earlier, does twice as many surgeries, has twice as many MRIs, does most of the medical research...
"...ignoring the lessons from all other countries in the industrialized world."
Funny, that's what I would argue the Democrats are doing. I live in Europe (Austria) after having spent many years in the United States. The idea that the health system here is any sort of a model is not the slam dunk case many posters here seem to think. The level of care is noticeably lower than I was accustomed to in the U.S. -- everything from technology to basic protocols to wait times. And many of my friends here have traveled to the States for major procedures. And that doesn't even consider that the U.S. system is responsible for the vast majority of medical innovations that we Europeans happily take advantage of. The burden of proof is most certainly NOT on the more free market system, as someone here asserted.
Do you have any evidence that there is more innovation in USA then Europe? I keep hearing that from conservatives, but I want cites.
"The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country" http://www.hoover.org/publications/digest/49525427.html
Drug R&D is mostly done here, too, because it's easier to get access to our free markets that way.
The U.S. gets new drugs 1 year sooner "On average, the FDA approval came 1 year ahead of clearance by the European Medicines Agency (EMEA)." http://www.nature.com/nrd/journal/v6/n4/full/nrd2293.html
"Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States."
See, this is what I'm talking about. Who are you, Baron von Rothschild?
You have "many" friends who have traveled to the US for "major" procedures? Many friends who have the need and finances to travel to the US and get treated for "major" procedures in US hospitals? Give me a break.
The number of world citizens who come to the US for treatment is greatly exaggerated. My father is a national expert on treating a certain type of cancer, and is a surgeon in one of the top 5 or 10 medical centers in the country. He gets his share of foreign nationals. Mostly sheiks from the middle east or rich magnates from places like Malaysia, Indonesia and India. But he gets like 2 of them a year. He's had about two dozen Europeans come in 30 years of practice. The department maybe gets a dozen or so foreign nationals a year -- a major department in a major medical center.
Let's put the matter another way. If so many Europeans are coming to the US to seek medical care, then why the heck are we allowing this? We're allowing millions of Americans to go without treatment so middle class Europeans can come over and consume our medical resources?
If so many Europeans are coming to the US to seek medical care, then why the heck are we allowing this? We're allowing millions of Americans to go without treatment so middle class Europeans can come over and consume our medical resources?
Uh, because those medical resources aren't "ours". They belong to the clincs, doctors, and other service providers that own them. And those owners, quite reasonably and ethically, sell them to the highest bidder.
I agree, by the way, that numbers of medical tourists to the U.S. are relatively small. But it is nonetheless significant that people for whom money is no object do tend to come to the U.S. for treatment. It's not the only quality metric, but it is a quality metric, and the U.S. is pretty clearly ahead on it.
Amazingly, I'm with ElectronHayek. For some reason, that's been happening a lot lately.
I don't know if the U.S. is "pretty clearly ahead on it" until we have numbers on the foreigners who travel here AND the Americans who travel abroad.
U.S. does 2x as many transplants as OECD average http://en.wikipedia.org/wiki/Organ_transplant#Demographics
I agree, by the way, that numbers of medical tourists to the U.S. are relatively small. But it is nonetheless significant that people for whom money is no object do tend to come to the U.S. for treatment.
It's no more significant than the fact that people for whom money is no object tend to go the Sweden for treatment. And to Britain. And to Switzerland. And to Singapore. And to France. The US is not the only rich country whose high end medical facilities attract wealthy medical tourists.
Wow, ain't this typical. Shorter Conor: I'm rich, my friends are rich, we have no problems getting health care, so what could be wrong?
Because of its sheer brevity, this is an impressive example of stonetools' argumentative style, which not only oversimplifies the issues, but misrepresents them so badly as to have nothing to do with the point being made.
"I'm rich": stonetools would have you think that this was crucial to Conor's argument; Conor in fact does not even discuss his own health care situation
"my friends are rich": stonetools says this as if it meant "my American friends" and probably wants you to think they are rich Americans who are indifferent to the needs of poor Americans; in fact they are rich Austrians whose health care situation is a product of the Austrian health care system. Or, at least, Austrians with enough money to fly across the Atlantic and pay out of pocket for medical procedures; I don't know if I would count that as "rich." Americans who fly to Thailand for medical procedures usually are doing so to save money.
"we have no problems getting health care" is a flat falsehood. Conor's point in fact was precisely that his friends DO have problems with getting health care . . . out of the Austrian health care system, which is presumably the kind of health care system that stonetools wants. Of course they have enough money to pay once for their own country's health care system, which doesn't give them what they need, and then pay again to travel to the United States and buy medical services out of pocket. Whatever kind of evidence that is about American health care, it's not favorable evidence about Austrian health care, and thus about European-style health care delivery.
"so what could be wrong?": Conor in fact is saying that there is something wrong with Austrian health care. stonetools would have us think that Conor is upholding the American system as perfect; I don't see that as being done. From the statement "I don't want to change our system to follow an approach that I know produces worse results" it does not at all follow that our system does not need to be changed; only that it doesn't need to be changed for the worse. (If you have roaches in your kitchen, you probably don't want to use a flamethrower to get rid of them.) stonetools' whole argument rests on the premise that there are only two choices: to accept the Democratic Party's proposals for reform (whatever those are—stonetools has been making the same arguments through a whole series of inconsistent versions of "reform"), or to maintain the status quo forever. Once you admit that it is possible to adopt a different set of reforms, that whole argument is exposed as manipulative.
If there are no better arguments for the Democratic Party schemes than these, then the Democrats are intellectually bankrupt.
The problem is that Conor was quite transparently lying or exaggerating. His credibility as a commentator of Austrian health care ended when he said he had "many" friends who came to the US for "major" procedures.
As it happens, I know a little bit about Austrian health care because I have a close friend who was an Austrian doctor. I don't know enough to give a complete assessment. I know enough to know that Austria, like any other health care system, has its problems. They do a poor job of providing auxiliary medical services like physical therapy and their mental health system, if I recall correctly, is a joke. They also have a hangup with homeopathy.
But deficient provision of necessary major procedures is not one of them. Certainly not in the cities. I can't speak for the countryside.
No system is perfect. I don't think any serious person believes that the US ought to adopt a model just like country X because country X has it just right. The point is that we can do better than what we have by taking cues from what other countries are doing.
Muzzy, what exactly is wrong with having "a hangup with homeopathy"? I'm in favour of healthcare systems not ascribing medicinal properties to water, myself.
Besides the obvious fact that you're citing anecdotal evidence, what you're saying argues against adopting Austria's system. It's not an argument against making changes at all. I have a feeling an underemployed, uninsured American with three kids would happily opt for whatever method of universal health care is used by Austria.
I recommend watching the Frontline episode T.R. Reid's did for PBS last year - it's most enlightening (you can watch it online if you want):
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/
I think there are clearly some rich world universal healthcare systems that are plagued by serious problems -- and are probably not models American would want to adopt (and for all I know Austria's is one of them). But I must say the Swiss, German and Japanese systems are highly impressive (and are highly reliant on the private sector, as it happens).
Here's a good question for the opponents of "this bill." What would you have us do?
Keep in mind that Republicans aren't interested in supporting any health care reform whatsoever. They've made that perfectly clear. At least as long as Obama is in office, they are about frustrating any and all health care reform efforts. From time to time, they've trotted out a few token proposals of their own, none of which even pass the straight face test. They don't even bother to promote them. It was mainly for show, so they could waive their bills when Obama was speaking.
So if this bill doesn't pass, then nothing will happen until 2012 at the earliest. If Democrats don't get it done now, they aren't going to get it done in a year or three. Nothing about the politics or policies of the issue are going to change.
In 2012, if Obama wins re-election, Republicans will return to obstruction. If he doesn't, we will have gridlock -- it is very unlikely that Republicans will be able to take back the Senate even under their most optimistic scenarios. The Republicans, meanwhile, don't have a serious plan, let alone one that Democrats would find acceptable.
If this bill fails, health reform will be dead for at least another decade. And in the meantime, what? More spiraling costs. More people dying from lack of access to health care. More dysfunction in labor market caused by employer-tied insurance.
That's a decade that we could be using to make incremental changes and start to chip away at the problem. A decade we could use to experiment with policies, learn how to make them work better, collect data, and so forth. But no, for the sake of scoring some short-term political points, let's flush it all away.
Do you have any idea how much better off we would be had the Clinton health care plan passed in 1994? I don't know of a single person, right, center, left, libertarian, who thinks our current health care system is better now than it was in 1994. Basically, we ended getting pretty much what the Clintons proposed, except at much greater cost and less efficiency.
I'm not saying that bill would have worked. I have no idea. But it would have been a start. Ten years later, we would have unsettled some of the deeply vested interests. We'd have much better understanding of what works and what doesn't. We'd have data. We'd have better ability to control ridiculous regional disparities in spending. We might have Medicare under control. Maybe we would have rolled it back to something else. We could have done something, though.
That's what we need to do now: something headed vaguely in the right direction. And unless you are a bizarre, heartless ideologue out of touch with the reality of life without access to care, universal coverage is a step in the right direction. This bill might be wrong in many respects. There are a lot of things I don't like about it. But it is needed, even if it creates something worse than the status quo in the short-term.
The ball is much easier to steer once it is rolling.
You make a lot of claims that doing something now is better than doing nothing. And I have to agree that the window of opportunity to do something is fast closing. But the "something" coming out of the House looks worse than what we have. Which is why many American are very frustrated with our current political class. We aren't the tea-party crowd. We are the ones who voted for Obama hoping that he could lead us to genuine and positive change. And I still have hope that he is the leader I hoped he would be. But I am starting to worry that he is not much different than the majority of politicians who care more about their chances for re-election than being part of making things better for our country. Yes, the House bill will provide more Americans with health insurance. But they will have the kind of insurance that is bankrupting both business and government. So the future subsidies needed to continue their coverage will not be affordable. I feel for those who do not have health insurance, and feel strongly that they should have better access to health care. But we need to fix the problems with health care cost first. These same problems have plagued the Medicare and Medicaid programs for years, and our government has yet to "chip away" at those problems. So I think your confidence in future abilities to reform the House bill are misplaced. I hope the Senate can come up with a better solution. Maybe there is some courage in that chamber that we have not yet seen.
So what are the conservative proposals for controlling health care costs? There are none? Awrighty then.
That's proof positive that conservative/libertarians aren't serious about controlling health care costs. Meanwhile, the same people had no problem with spending more money in ONE year on TARP than the current House bill will spend on a DECADE on health care.
Those same people also aren't saying" Let's fix the constant massive overruns on most defense programs before we spend any more on defense".
I feel for those who do not have health insurance, and feel strongly that they should have better access to health care.
Well they are dying, so a little more is called for than sympathy
http://www.pnhp.org/news/2009/september/harvard_study_finds_.php
Thousands of those are children
http://www.medicalnewstoday.com/articles/169216.php
Sympathy is nice, but action is what's needed.
The last article claims 7,000,000 children are w/out insurance and as a result 17,000 die. That's .24%. For adults in the other article, that rate is .1%. Now advocates can't claim that those people would have lived if they had insurance. Don't you think there's a better way than throwing $3 trillion at an inefficient monstrosity Congress is trying to create? After all, "guaranteeing" health care for all doesn't necessarily eliminate needless deaths.
When people start saying "think of the children" I know the result is going to be bad laws with unintended consequences. It's too easy a button to push.
Nice job. You proved that the only argument you win is when you supply both sides and completely misrepresent the GOP/conservative intent and content.
The PNHP study is highly flawed. It's best not to cite it's claim of 45,000 people per year dying from lack of insurance, because the study doesn't provide good evidence of this.
The 47 million uninsured number we heard all summer is false too, and even Obama has backed that down to 30 million.
One reason people are wary of Pelosicare is the bogus numbers that have been used to scare us into supporting it.
I don't think there are any credible proposals from the Republicans either. And yes, there is plenty of waste in other government programs. But that should not justify planning to waste more, especially when our national debt is becoming increasingly unsustainable. There are some good ideas out there that do not go under the heading of conservative or liberal. Some of those were outlined in a very good article in the Atlantic. If our political leaders would have the courage to consider these changes, we could both save the lives of those children and address the health care cost problem. Some of them are big changes that would require individuals to take more responsibility for our health care. But good leadership could educate us on the benefits of change for us and our children's future. Yes, action is what is needed. But the action proposed by the House bill is not the action we need.
The 47 million uninsured number we heard all summer is false too, and even Obama has backed that down to 30 million.
He decided to exclude the illegal immigrants. But the previous number wasn't "bogus".
The PNHP study is highly flawed.
In what aspects? It's my understanding that they supply an estimate. But there's nothing wrong with that. Electoral polls are pretty accurate - even the worst ones don't err by much.
The real number of people who are legal U.S. citizens, don't have insurance, can't easily afford it, and want it is about 12 million.
http://classicalvalues.com/archives/2009/08/whos_afraid_of.html
PNHP is a single-payer advocacy group (two of the authors of the study are co-founders). They claim a 40% higher rate of death for the uninsured; other studies have found about 3%.
It's pointless to argue about "the real number". They are all real numbers, and people disagree about which one is more relevant. Some people gave Obama grief for excluding illegal aliens.
The fact that PNHP is an advocacy group is irrelevant. The study was published in a peer-reviewed medical journal. What other studies are you referring to? And are they articles published in scientific journals or in non-reviewed think-tank publications?
No, that study really is bogus. See John Goodman here:
http://www.john-goodman-blog.com/does-lack-of-insurance-cause-premature-death-probably-not/
As for conservative reforms that control costs? I favor the usual: allowing insurance companies to sell policies across state lines, more tort reform-although I am not certain whether it's better to simply continue this at the state level or push for a national reform, getting rid of the tax break for employers and instead providing it to individuals and families, etc.
As for dealing with the problem of pre-existing conditions, I think the re-insurance idea sounds interesting, but I do agree that it's a problem that conservatives should be discussing more.
Here's a good question for the opponents of "this bill." What would you have us do?
Here are a few items:
1. Eliminate the employer tax deduction for insurance. It makes no sense that employment is linked to health care. It also discriminates against individuals and promotes overuse of insurance.
2. Promote Health Savings Accounts so that people pay for health care with their own dollars and shop around for the best deals. This would drive down costs massively.
3. End medical licensing, which restricts the supply of medical professionals and drives up costs. And please don't give me nonsense about how millions would die because of quack doctors. Licensing serves the establishment, not consumers. I am, however, all for voluntary certification as a means of good doctors signaling their competence.
4. Allow interstate competition in health insurance. If you want more competition, this would be an easy move which would cost nothing for the federal government.
5. Replace Medicare and Medicaid with a voucher system, similar to food stamps.
Furthermore, the argument that this bill -- or the Clinton bill -- is better than nothing at all because we need to "do something" is insane. No, sorry, a bad bill which makes things worse is NOT preferable to doing nothing.
By the way, does it bother advocates of greater government involvement in health care that such approaches on the state level have failed in Maine, Oregon, MA and Tennessee? Does it bother you even a little?
Also, does it bother you that the free market has worked in Lasik, where insurance isn't used and quality has increased while prices have declined? How about cosmetic surgery? Or the free market approach tried by Whole Foods? Doesn't this suggest a certain course of action?
And please don't respond that people need health care while Lasik is elective. Food isn't elective either, yet the free market produces low prices and good quality there too.
Good list. You could even throw in an expansion of Medicaid. Anything but this monstrosity.
It's hard to believe they are actually criminalizing the decision not to carry health insurance -- even if you can easily afford to pay for your health care without insurance!
A libertarian wish list is not a plan of action.
1. Eliminate employer tax deduction for health insurance. That's reasonable. I'm quite positive that if Republicans wanted to work for a bipartisan solution, that could be arranged. Actually I know this, because the Dems were all for it if union benefits under current contracts were excepted (which is fair because unions negotiate long-term contracts against settled law; it is unfair to change the law and screw them over).
If some conservatives were serious about getting with the program, this would be done.
2. Health Savings Accounts are not a real solution for a number of reasons. Most importantly, they run contrary to the whole point of having a health care system -- namely, the cross-subsidy from healthy to sick. That's a necessary feature of any "insurance" system or health care system. If you're going to go all John Galt with a "we don't need you" attitude, then you just remove yourself from serious discussion.
3. End medical licensing. Please. It's not going to happen, and you know it. That's not anywhere close to a serious idea. Also, if you had taken Health Care Economics 101, you'd know it wouldn't work. The problem in health care isn't that there is too little supply; the problem is that supply creates demand.
4. Interstate competition raises more problems that it solves. What's to prevent one state from allowing its insurers to sell really lousy health care plans that look good superficially, but which are actually terrible in the fine print? It's all fine to say let people decide, except that we have a national economic crisis in part because a lot of people in this country are not capable of understanding the terms of a mortgage and choosing wisely. What makes you think they can do it for health care plans?
5. A voucher system for Medicare and Medicaid? I have no idea if this is a good idea. I do know that it's unrealistic, so move on.
6. LASIK is the example libertarians always trot out. The example, because there aren't others. The problem is that Lasik isn't a health care service per se. It's a medical procedure, but it has nothing to do with health. It's akin to cosmetic surgery, or getting a tattoo. It's nothing like providing kidney dialysis to chronically sick people.
It's also completly false that Lasik has enjoyed some sort of technological flowering foreign to other regulated medical areas. We have had far more advances in care of heart disease. It's just that those advances have increased cost because they have increased life expectancy, and because the development of non-invasive interventions has made it possible for lots more people to get the service. LASIK is a one-off procedure. Again, it's simply nothing like it.
7. Health care is not like other goods. Again, that's health care economics 101. Free market approaches simply do not work, at least not to the standards that most people consider to be working. Which is why there aren't any good free-market health care systems anywhere in the world.
1: So it's ok to change the law to benefit unions, like with auto bailouts, but we can't change anything else? Republicans have proposed this, but they don't receive millions in campaign contributions from unions, and have no interest in subsidizing their health care. The block here has been from liberals, who are terrified of offending unions.
2: HSA's are not perfect, but they are not as bad as you make them sound. It is certainly better than the current system, where there is absolutely not accountability for spending on the part of the consumer, such that if they feel sick for a week they don't schedule a cheap GP visit and wait until it's unbearable, heading to the ER for a very expensive bill that they don't really pay. I think we have people smart enough in policy to arrange HSA's to apply to these smaller types of costs used in tandem with some sort of catastrophic coverage. In any event, they should not be so arbitrarily dismissed, although I certainly acknowledge they have issues that need to be considered.
3: Agreed with ending medical licensing. The amount of information and practice physicians require is staggering. I've gone through 3 years of it, and cannot imagine having to be a physician. It is absolutely necessary to be licensed, because the body is ridiculously complex, and the more we discover, the more we have to know.
4: I see where you're coming from with wariness of interstate insurance, but if car, life, auto, and home insurance can do it, why not health? Would it have to be regulated? Absolutely. But again, the possible benefits are huge considering the poor state of competition between insurance companies right now.
5: Interesting, but likely difficult to pass, so I'm with you
6: LASIK most certainly does not have more technological advances than other areas, but the costs are interesting to investigate. However, one way or another I think we're going to have to stick with insurance of some kind, so negotiating prices for many procedures will remain the responsibility of insurance companies. The shopping around more applies to things like generic medications, unnecessary procedures, exercise vs gastric bypass, etc.
7: Health care is unlike many other products, but the insurance is not that different. True, demand can be created by the supply, but that's why a combination of multiple insurance companies and accountability on the part of consumer is so necessary. In a government run system, I worry that physicians will be underpaid, which will lead to a poorer quality of physician or to gaming the payments system (as hospitals, physicians, etc. already do with medicare and medicaid) to make sure they actually make a profit. Saying "no one else in the world does it" is not a good argument.
A libertarian wish list is not a plan of action.
Cafeteria-style health reform has the benefit of being simple to enact. It doesn't take a 1300 page bill to roll back tax benefits for employers who provide pre-packaged medical coverage.
HSA are a reasonable solution to much of the problem. The average person doesn't need chemo, dialysis, and a triple-bypass every year. They go to the doctor a couple times a year for a checkup, a Z pack for a head cold, or maybe shots for their kids. None of that is so ruinously expensive that you couldn't pay for it out of pocket.
From HSAs, you advance to public price lists, coupled with public outcome statistics. Hospital A is better and cheaper than Hospital B, so it gets more business and we, as a society, spend less on healthcare while realizing better outcomes.
As to medical licensing, I'd actually suggest lowering licensing requirements. The bulk of regular medical care is provided by nurses anyways, so why not just formalize the situation and recognize the de facto authority they already have. With HSAs and LPN's providing regular care, you've hugely decreased the cost of regular care. My understanding is that this is one of the ways that the VA reduces costs.
The best part of all this is that it provides actual, factual, measurable cost reductions. If, after you're done, you still haven't reduced the cost of catastrophic medical insurance, you can then go back and revisit single payer. In fact, because you've defanged the largest argument against it (i.e. it's so damn expensive), you've got a better chance of success.
1. The taxing medical benefits issue comes down like this. Republicans floated a version of the idea for show, because they knew it would punish unions. Obviously, that's not remotely likely to pass nor is it fair. Democrats responded by saying, OK, with a partial exclusion for unions, and Republicans withdrew all support.
The issue isn't specific to unions. But think about it. Who would a tax on benefits hurt the most? Exactly. Union labor. It would be a hugely regressive tax, and that's usually a terrible idea. The reason, of course, is that union members, unlike most employees, can't really change their benefits packages in response to changing tax laws, because they are locked into collective bargaining contracts.
I don't particularly like unions. But fair is fair. Changing the rules of the game to hammer working class people is terrible, terrible policy. The proposals I read would exempt current pension plans (i.e. negotiated long ago) and apply to unions starting at some future date, to give the collective bargaining process a chance to reset in response. That's fair and decent.
2. Sure, HSAs are useful in the way co-pays and deductibles are useful. I have nothing against them, but understand, they are a policy tool. Not a policy. The higher you make the limits, the more punitive they are on people who are sick. But lower limits are useless in controlling costs. And there isn't very much evidence to suggest that putting financial decisions in the hands of consumers does much to control health care costs. That's what supplier-induced demand means.
3. Once you admit that interstate insurance has to be "regulated," then pretty much it loses its value as a policy tool. The whole point of interstate insurance, as I understand it, is to take state insurance commissioners out of the equation -- stop having them pass meddling regulations that require health plans in their state to have features X, Y and Z. So-called mandates add very little in cost, and are hugely protective.
There was a study posted here a few months ago about how state "mandates" added 20% to insurance premiums or something like that. Except that when you actually looked at the study, nearly all of the "mandates" were things that really ought to be included in even a minimal definition of health coverage. Sure, mandates for fertilization treatments are a bad idea and rightfully get bad press, but they really don't add very much to the nation's costs.
Meanwhile, mandates were responsible for forcing health plans into providing even the inadequate level of mental health coverage that they have now. For a long time, mental health was woefully undercovered. Maybe people didn't want to pay for behavioral coverage because they didn't think there was any risk they would go "crazy," but in fact, mental illness is prevalent, can be enormously debilitating and hugely costly to society. Chalk one up to mandates.
7. As for physician salaries, I too worry about them. I'm not a doctor, and my dad is close to retirement, but I don't want medicine to go the way of public school teaching. Part of the problem is that salaries in financial services are going so high that they are crowding smart people out of any number of useful activities, channeling them into socially useful, rent-dissipation (i.e. zero sum) activities like trading.
My most fundamental problem with this bill is: instead of trying to cut costs by squeezing reimbursements, it should have raised reimbursements in exchange for cooperation from doctors in reducing utilization. Utilization is the long term driver of costs. Getting doctors on board would have been great from a policy and political perspective, and I believe that tradeoff is one that we will have to make at some point. More money per procedure, in exchange for far fewer procedures.
Republicans could have played a useful role in this, since doctors tend to lean red. Alas, they chose pure obstruction, and Democrats for whatever reason did not make a sincere effort to reach out to doctors, at least not one that I saw.
Muzzy,
Do you really believe that consumption doesn't increase when people don't pay for what they consume?
Do you really believe that more competition doesn't lead to lower prices?
Do you really believe that supply creates demand?
Do you really believe that medical liscensing is about safety and not about restricting the supply of doctors?
You must live in a bizarre "progressive" universe.
1. No, HSAs are a serious solution. You save for your own medical expenses. Combined with a high-deductible insurance plan they are proven to save money:
http://www.marginalrevolution.com/marginalrevolution/2009/08/consumer-drive-health-care-plans.html
2. Medical licensing may not be feasible, but it would help. They unquestionably drive up costs and reduce supply. Also, your statement The problem in health care isn't that there is too little supply; the problem is that supply creates demand.
isn't terribly insightful. Supply creates demand everywhere, something was observed by Jean-Baptiste Say:
http://en.wikipedia.org/wiki/Jean-Baptiste_Say
This isn't unique to health care.
3. We have interstate competition in other industries and it seems to work fine. If a company has a bad reputation people won't use them. BTW, here in Washington DC I have access to what is essentially interstate competition as the district does not have mandates. Is DC a hellhole of people buying bad insurance policies? Not that I am aware of. In fact, I currently buy my own insurance for $79 per month.
4. No, lasik does have to do with health. It improves your eyesight. Or maybe you don't think hip replacements have to do with health either?
7. Every good is unique. But so what? If free market health care doesn't work, show me examples of its failings. Where has it been tried and failed? And please don't insult your own intelligence by citing the US, where regulation is rampant and the government accounts for something like half of all health care dollars spent.
I will reply to JoshinHB and Colin's points at the bottom of the thread. Too much indented discussion is hard to follow.
Muzzybelly:
I agree with some of what you say here, but you also seem to be mixing a lot of fact with a lot of conjecture. You're premise seems to be that passing anything is progress and will move us closer to something better, and I disagree, I think some legislation can push us further in the wrong direction. I do think we need to start somewhere, and that is part of my problem with the current legislation. If it's so difficult to do, why not start small? Start by fixing and expanding medicare, but perhaps instead of full coverage institute government sponsored catastrophic care for those that can't afford health care, but also don't qualify for medicaid. Remove the tax subsidies that reinforce employer-subsidized health care. Remove state sponsorships of insurance companies, and allow insurance to be traded across state lines. Pass legislation to adjust that awful practice of rescission, and give an insurance company perhaps 6 months to investigate pre-existing conditions, after which they are barred from denying coverage based on pre-existing conditions.
There are a lot of ideas, and Republicans are "promoting" them. But the mainstream media isn't, certainly not to the extent that they are giving coverage to the Democratic plans. I agree we need to start the ball rolling, but start the ball small so we can adjust where it rolls. This legislation leverages a boulder down a mountain with no way of guiding it.
"First of all, to do no harm."
Here's a good question for the opponents of "this bill." What would you have us do?
They'd have us do nothing. They know full well a victory for ObamaCare creates a very powerful argument against the proposition that government programs aren't capable of helping to deliver increases in living standards and quality of life. Anybody who has traveled to Western Europe realizes they are, at least sometimes. Soon, even Americans who haven't done much travel might find this out. And that wouldn't be helpful, would it?
I've lived in 3 European countries. I have a European girlfriend. I don't know what the hell you are talking about.
Colin: You don't think European safety nets have helped deliver increases in living standards? Really? Really?
Apparently people who actually do live there -- such as, oh, I dunno, citizens who can vote in elections -- as opposed to anonymous libertarian blog commenters who clearly don't know what the fuck they're talking about -- disagree with you. I mean, in Europe even parties of the right generally don't mess with the safety net. Because they'd lose votes. Because it's popular. Because it helps people live better.
Heck, one could even make the same claim about the United States, as well, to the extent that the US maintains a safety net. Social Security and Medicare, most obviously, have substantially increased living standards for millions and millions of people. And the existence of these programs hasn't prevented the US from continuing to grow ever-richer. And I don't see the Republican party making much progress with respect to dismantling these programs.
Jasper (re your response to Colin re European safety nets): So people who live in European countries wouldn't vote to end redistributive programs? Well, thieves wouldn't vote for effective laws against theft, either, nor would slaveowners in the old South have voted to abolish slavery. An abusive or exploitative majority will never vote to give up its power over a minority. But for that very reason, majority approval doesn't strike me as a sound standard of ethics. Here in the United States, we have a constitution that can only be amended by a substantial supermajority precisely because its authors realized that majorities cannot be trusted; and if their constitution did not succeed in protecting us from "paper money, or the abolition of debts, or the equal division of property, or any other improper and wicked scheme," it was a good try while it lasted.
"You don't think European safety nets have helped deliver increases in living standards? Really? Really?"
Jaspar,
you're absolutely right, I have a number of friends and business associates that have immigrated here from various European countries and they all agree that the socialist system is much better than what we have here. So much so that most of these expats eventually become US citizens.
I mean, in Europe even parties of the right generally don't mess with the safety net. Because they'd lose votes. Because it's popular. Because it helps people live better.
Really? You don't think center-right governments in Europe have ever trimmed the social safety net?
commenters who clearly don't know what the fuck they're talking about
Ahem.
Colin: You don't think European safety nets have helped deliver increases in living standards? Really? Really?
No, I don't. My observation has been that the standard of living is lower in Europe. People in Europe tend to live in smaller houses, have fewer and smaller cars, and generally own less stuff. And this isn't because they are high-minded and less consumer oriented, it's because they can't afford it. When they travel to the US they go nuts and buy tons of stuff because it is so much cheaper.
Just two weeks ago I was visiting NYC and hanging out with a Dutch friend of mine who was over for a week. During his trip he bought a MacBook, a new suitcase and plenty of clothes. His girlfriend did the same. While he was living in the US 2 years ago he bought a car and shipped it home because it was so much cheaper. Everytime my Spanish girlfriend goes home she gets requests from relatives to bring homes ipods and other goods.
But standard of living is in the eye of the beholder. I do know, however, that more Western Europeans emigrate to the US than vice versa:
http://togetrichisglorious.blogspot.com/2009/01/voting-with-your-feet.html
Europe is far from some kind of hellhole, but spare me how their standard of living is higher.
Keep in mind that Republicans aren't interested in supporting any health care reform whatsoever. They've made that perfectly clear....From time to time, they've trotted out a few token proposals of their own, none of which even pass the straight face test.
Wrong. Republicans have proposed many bills and the Democrats have responded with hardball political games. The Democrats control Congress and the fact that none of these Republican bills have seen the light of day is because the Democrats don't want real reform to compete with their power grab and delusions of grandeur.
Do you have any idea how much better off we would be had the Clinton health care plan passed in 1994? I don't know of a single person, right, center, left, libertarian, who thinks our current health care system is better now than it was in 1994.
I don't have any idea who you know, but they are probably mostly liberals which means they are inherently clueless and bitter. As far as curing the sick, our health care system is definitely better than it was in 1994, the problem is that it is more expensive. You seem not to understand that Hillarycare was modeled on the Canadian system which is in the process of imploding. Brian Day who is a past president of the CMA (and a socialist) is a leading proponent of changing Canadian law to expand the ability of Canadian doctors to provide healthcare privately, outside the government system.
Also, since so many seem intent on providing anecdotes, last year I had back surgery. Specifically, I had a micro-discectomy using techniques that hadn't been developed in 1994. It was performed at a state of the art clinic in Marina Del Rey, CA that didn't exist in 1994. It was very expensive (my insurance was billed approximately $108,300 and they actually paid about 65-70% of that amount). The clinic (which only has two surgeons) has hundreds of international patients every year. I know this because they asked me to be part of their marketing campaign and they interviewed me and video taped my post surgical recovery. That clinic, and the innovation that it currently utilizes, occurred since the Hillarycare debacle. There have been literally thousands of major improvements in American medicine since 1994 (from statins that prevent heart attacks, to new medicated heart stints, to CT angiograms that avoid the need to stick a probe in someone's heart, to surgical techniques like LASIK, etc., etc.). So you can count me as one person who believes our health care system is better now than it was 15 years ago. The inefficiencies, high cost and linkage of health insurance to employment need to be addressed but Obamacare isn't going to do anything about those problems.
Congress doesn't even want to be on their health plan. The Democrats voted down a bill that would put them on their own plan.
It seems no matter where you go, laws are only for the little people:
PRESIDENT OBAMA MEETS WITH TAX-EVADING ALIEN
http://naturalfake.wordpress.com/2009/11/13/president-obama-meets-with-tax-evading-alien/
Yeah, it's real.
By the free flow of information, we have the power!
Humph! I think the answer is obvious. The federal government making sure everyone has health care coverage sounded like a great idea to the shufflebutts until they found out that didn't mean the government would pay for their health insurance but rather would fine them if they didn't buy it. That wasn't at all what they had in mind.
Hehe. Charting the demise of magical government unicorns.
I love this graph. You can just feel reality settting in.
Yes I agree with you TallDave, Swen, Naturalfake, Nola, Colin and others: I too find something hopeful about the graph. (Some) people are beginning to see the light. The left-lemmings will still follow BHO over any cliff. Apparently potential voters classify themselves as about 40% conservative, 40% progressive and 20% uncommitted, so if BHO is losing the moderates I would have expected more than 50-47 against government responsibility for health care coverage. It is however reassuring that the tide is flowing in the right direction. In the meantime Republicans have been doing a remarkably poor job of running a meaningful opposition. Yet a large part of the responsibility for the failures of our governing system rests with the Founding Fathers who gave us a deeply flawed Constitution, from the inadequately circumscribed Commerce Clause, the inadequately emphatic Enumeration of Powers Clause which is presented almost as an afterthought when is should have been seen as a fundamentally rule governing the design of the entire document, the unclear Second Amendment, the ill-defined powers of the Supreme Court, to a poorly designed voting system for and within Congress leading to donor-controlled composition and voting of Congress, resulting in the fact that each Congressman and Senator votes preponderantly in interests other than those of the United States as a whole - bring home the bacon and get reelected. And we get a Congress elected apparently by voters who are not qualified to make a decision about anything. Have you seen Jay Leno's sidewalk forays to ask passersby their thoughts and opinions?
Actually you are giving the left too much credit. Only about 20% of voters describe themselves as progressive, while 40% are conservative:
http://www.gallup.com/poll/120857/conservatives-single-largest-ideological-group.aspx
My wife and I run a "mom and pop", I guess you would call it, with 20 employees, all of whom have the option to buy heavily subsidized health care. The problem is that there is so much uncertainty right now about what next year will look like, what taxes are going to look like, what the business environment will be like that nobody is finalizing contracts. Cap and Trade is part of this Health Care "Reform" is part of this, the trillion dollar deficits are part of this.
Liberals seem to think that the answer to business people who have become defensive is to tell them that it is all in their head, and they should go ahead and sink what last year was their working capital, but this year is potentially their retirement stash, if they can hold on to it, go ahead and sink it an not to pay any attention to what their business knowledge and instincts say.
That is a real winning argument, Liberals. These arguments about saving small business money by dealing with health care is ridiculous. The immediate effect of this plan will be to make health care an even larger percent of our GDP, beggaring all kinds of other businesses in the process
Thank you for the adjusted numbers, Colin. Apparently the 40-20-40 split included illegal immigrants in the progressive column. If we can exclude them (temporarily?) and discount the intentions of ACORN then the adjusted figures are 20-40-40. I would still like to have more moderates see the light.
Well, after 123 posts, conservatives have had a chance to present cost control measures. What have they presented? Interstate competition, HSAs, and abolishing licensing requirements. Do any of those things control costs? Is there a peer reviewed study-indeed any study-that says these ideas would control costs if implemented? Nope. Awrighty then. We can now say that cost control is not really as crucial to the anti reformers as they say. Stopping reform, however, is.
We should always remember that the Republicans had every chance to propose health reform between 2000 and 2006. They didn't.
They were invited by Obama and major Democrats to contribute ideas to the health care reform bill this year. They weren't interested. The Republicans didn't present their version of health care reform until the other day, and they haven't even bothered to promote it-probably because the bill sucks. Ezra and the CBO sums it up:
Late last night, the Congressional Budget Office released its initial analysis of the health-care reform plan that Republican Minority Leader John Boehner offered as a substitute to the Democratic legislation. CBO begins with the baseline estimate that 17 percent of legal, non-elderly residents won't have health-care insurance in 2010. In 2019, after 10 years of the Republican plan, CBO estimates that ...17 percent of legal, non-elderly residents won't have health-care insurance. The Republican alternative will have helped 3 million people secure coverage, which is barely keeping up with population growth. Compare that to the Democratic bill, which covers 36 million more people and cuts the uninsured population to 4 percent.
But maybe, you say, the Republican bill does a really good job cutting costs. According to CBO, the GOP's alternative will shave $68 billion off the deficit in the next 10 years. The Democrats, CBO says, will slice $104 billion off the deficit.
http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_th.html
So the Republican plan-a plan that incorporates most of the ideas listed above- scores worse than the Democratic House plan in virtually every respect-including cost control. So it goes in the real world.
What have they presented? Interstate competition, HSAs, and abolishing licensing requirements. Do any of those things control costs?
Yes, they do. HSAs:
http://www.marginalrevolution.com/marginalrevolution/2009/08/consumer-drive-health-care-plans.html
Competition also drives down costs. I heard President Obama say it himself. Although he somehow believes competition only works if the government provides it.
Licensing requirements are a barrier to competition, which drives down supply and increases prices.
You're welcome.
Uh, no. The Democratic plan cuts costs by increasing taxes and fees, and through cuttings of services that no one, including the CBO, thinks will really happen. You're comparing apples and oranges. If you included all the revenue measures from the Democratic plan, the Republican plan would gain a trillion dollars.
Er, where does the CBO say that these cuts won't happen? Please provide a link.
Of course, conservatives SAY that the cuts won't happen, but the CBO says no such thing.
Well, here is a NYT article quoting Democrats and health economics experts claiming that the cuts are unlikely to happen. When the CBO scored the latest bill, it took pains to point out in its summary that its cost estimates were strongly reduced by the automatic cut provisions of the bill. In order words, the cost actually implied by the economics of the bill is much higher than the headline cost, which is imposed by legislative fiat. No Washington insider believes that Congress would ever let an automatic 50% cut in Medicare spending take effect.
In your post above, you rather misleadingly use "cost" in the sense of net cost when comparing the Democratic and Republican proposals. Under that definition, if we were to just raise taxes enough to eliminate the deficit, government would cost us nothing. That is not what people usually mean by "cost". Under the usual meaning of actual outlays, the Democratic bills cost about 16x more than the Republican proposals. Of course, the Democratic bills also insure a lot more people, since that is what matters most to Democrats. But whether spending 16x as much money to get an addtional 10% of the population covered is hardly an un-debatable question.
(Shrug)
I'm still waiting for the conservatives to come up with their cost control plan. Telling the uninsured IGMFU , as the Republican bill does, doesn't cut it. At least the Democrats are TRYING for universal coverage, while instituting cost containment-even if all the measures won't succeed.
Conservatives are pretty good at:
1. TALKING about cost control
2.Criticising Democratic cost control measures
while not suggeszting any plan of their own.
I might also point out yet again that when it comes to programs that conservatives like-defense-they don't even PRETEND that cost control is an issue.
Lefties are apparently pretty good at
1. Creating a hugely wasteful and repressive gov't plan that will only make things worse
2. Claiming opponents don't have a plan becuase they can't spend 10 seconds Googling or reading the thread they're posting in
At least the Democrats are TRYING for universal coverage,
We already have universal health care. "Universal coverage" means forcing people who don't want insurance to buy it at gunpoint, even if they can afford to pay their own bills.
"At least the Democrats are TRYING for universal coverage, while instituting cost containment-even if all the measures won't succeed." David and I have responded to you already. There is no real attempt at cost containment here. The Democrats want to pass a health care bill, so they have to hide the cost and pretend it isn't there.
President Obama began by saying that the point of this was that the economy couldn't recover without fixing the rising costs of health care. It began quickly clear that that wasn't true, but that didn't end the plan!
The Republicans don't need a "cost control plan". Institute a free market, and costs will be controlled in the usual fashion - people will spend as much as they want on health care, just as they do on computer software (spending on which has risen much more in the last decade than health care). Certainly it won't break the federal budget _not_ to have a government health care system.
And I don't agree about defense. We have to have a budget that works, and defense is no exception. We need to decide what our defense needs to accomplish and how urgent each piece is. Then we need to figure out how that fits into the budget, the same as everything else.
Unlike progressives, lots of us fiscal conservatives are coming to the realization that a collapsing economy kills people too. A lot of them. I feel the same way about it as progressives seem to feel about Global Warming.
This proves that global warming is a big hoax. Good work Megan.
Thread winner, right here.
The best part? It wins whether or not pdzxc believes in global warming or not.
The Republicans don't need a "cost control plan". Institute a free market, and costs will be controlled in the usual fashion - people will spend as much as they want on health care, just as they do on computer software
You know, this is the kind of BS that conservatives eventuallyy fall back on in the health care debate. You might as well substitute the phrase " rule by giant magical ponies " for "free market" in that sentence, and it would make as much sense. What does " institute a free market" even mean in this case? Let's start with the most "socialistic" part of the US health care system- the Veterans Administration. Let's abolish it, and toss veterans unaided into the private health insurance market. That would save the government a lot of money, after all, and cut down the now all important deficit . Now it would be a giant FU to all veterans and those people stupid enough to sign up to guard our liberty , but hey, that's how things are in free market. Thanks for your service, and good luck getting private health insurance with your prosthetic.Believe me , it will be just as easy as going into Best Buy and buying computer software.
I could go through with same analysis with Medicare, Medicaid, SCHIP, The NHI, the CDC, the FDA, the EMTALA. Every single one of those things are government interventions in the free market -and every single one of these things are good for health care. Yes, they are expensive. So is a National Park Service, a NASA, or a separate US Marine Corps. We could save money by abolishing each and every one of those things, but we decided that it's a good thing for the USA to have these things.
And I don't agree about defense. We have to have a budget that works, and defense is no exception.
Wow, welcome news! You must not have gotten the memo sent to all conservatives that defense spending isn't government spending, but is in a holy and separate place. I wait for the spate of conservative/libertarian articles calling for "deficit nuetral" defense programs.
Anytime you hear government claim they will contain costs, run.
Because what's actually going to happen is what happens every time government starts using price controls and bureaucracy to try to achieve a better outcome than free markets: rationing on top of less efficient delivery of services, and criminalization of economically undesirable behavior (today they're talking about imprisoning people who don't buy health insurance... but aren't tobacco users costing the health care system more? and those people who don't exercise are going to be costing taxpayers billions).
Certain goods like national defense or policing can only be provided by government, because of the state's monopoly on force. But there is zero reason to think anything that can be provided by free markets should be provided by government.
So government SHOULDN'T try to control costs. Got it.
Let's hear no more about how the health reform bills are deficient because they don't control costs.
But there is zero reason to think anything that can be provided by free markets should be provided by government.
again, what does this even mean in the context of this discussion? I repeat once again, NOBODY, BUT NOBODY, IS CALLING FOR DIRECT PROVISION BY THE GOVERNMENT OF HEALTH CARE.
Ahem, hopefully, that was loud enough. (I'm pretty sure, it wasn't :-(.)
BTW, if you against all government provision of health care, you should be calling, loudly, for the abolition of the VA. I notice that you haven't been. What's up?
C'mon Stonetools, you are playing word games here. You are smart enough to understand the distinction.
If the government undertakes to guarantee everyone a LCD television, it had better have systems in place to control its costs, because neither consumers nor producers have any incentive to hold back. If everyone is responsibe for buying his own LCD television, the government should not attempt to control costs, because the market will ensure than only those tranactions will occur that make both parties better off.
Similiarly, there is no reason for the governent to hold down freely chosen consumer spending on health care in a free market. There is every reason for the government to hold down its own outlays on health care, which are funded via the involuntary contributions of taxpayers.
You are a worthy debating partner. Don't demean yourself by constructing fake "gotchas".
The comparison of health care services with LCD televisions are unhelpful. See points muzzybelly made about supply-induced demand.
Also stonetools' Hayek quote "Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance..."
Sam Roberts: Consider the phenomenon of "supply-induced demand" in various contexts.
Start with a world where people are simply paying individually for their own health care. Then "supply-induced demand" simply means that people are willing to pay for new therapies. Presumably you would agree that government should not act to limit such exchanges, even if people decide that new therapies are worth 30%, 40%, even 50% or more of their income.
Now imagine socializing those cost by creating insurance pools subject to a mandate, guaranteed issue, and community rating provisions. Now no one has any incentive to limit his consumption of health care, because the marginal cost of the next treatment is divided among everyone in the pool. Spending rises wildly.
This same effect is observable in something as simple as water billing for appartment complexes: if the bills are divided among all appartments, spending on water is much higher than it is if appartments are individually metered. The issue isn't that health care is special, the issue is that socializing the cost of any good has bad side-effects.
TallDave,
I am always mystified why you think you are somehow immune from getting to the age of 55, with a heart condition or breast cancer (yes men get it too) and finding you are unable to work and uninsurable. The current health care financing system is indefensible.
I am convinced that real reform would start with removing the tax deduction for businesses to provide health care and then imposing a mandate on individuals and sound regulation on insurance companies. It takes a leap of faith in free markets, though, to expect that companies would provide the equivalent of the current health care benefit in wages/salaries so that individuals could buy their own insurance. Making sure this necessary step occurred would have been seen as remarkable leadership. This is the only path that makes any sense to a working 50-year-old taxpayer.
The Catholic Church, though, has weighed in that it wants the current system extended to all, and that includes its Latino constituency. BHO has shown how far he will go to gain and hold both Latino and Catholic support. The GOP is not going to go up against the Catholic Church. If the BHO plan is bad for the anti-union South, well that concerns the Catholic Church not at all. I do not think that Joe Lieberman, as full of himself as he is, has the spine to take on the Catholic bishops and hospitals. The silence from the GOP following this major concession by BHO is very telling. I think the GOP leadership hopes Democratic feminist women will do their work for them, and blow the process up, but that is not going to happen. The bill extending our current system will include the Stupack language and will pass before Christmas.
"What does " institute a free market" even mean in this case? Let's start with the most "socialistic" part of the US health care system- the Veterans Administration." Etc. I guess you think people agree with you on these things. But they don't.
The average citizen cannot afford to buy full comprehensive health insurance for himself, so it is dishonest to pretend that the nation as a whole can provide it for everyone. On the other hand the nation can afford catastrophic coverage for all, without rationing, by eliminating over-regulation and insurance companies. A small shopkeeper cannot afford to carry the risk of window-breakage so he pays to pool the risk. A mega-corporation or the government doesn't need to pay anyone to pool the risk; the risk is already pooled. We can pay for whatever else we need/want ourselves. We do not need to buy insurance to cover ordinary needs such as clothing, groceries, oil-changes or routine health needs. The alleged savings from preventive care are minimal or unproven. Lifestyle is the most important factor. Tuberculosis was diminishing before antibiotics became available. Public attitude is everything. Smoking is disappearing but is being replaced by an obesity epidemic which will not be cured by gastric surgery. Malaria was rapidly disappearing until the egg-shell-DDT myth appeared. DDT killed insects diminishing the food supply of birds hence fewer birds. Vaccines were of inestimable benefit but their hay day is passing. The man-made-global-warming myth can potentially do enormous damage to global health by lifestyle degradation.
So our crying need today is for national catastrophic coverage, paid for by those who can and by vouchers for those who can't. The government doesn't need to pay insurance companies to run the food-stamp program.
BTW, let me put this out there:
"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance - where, in short, we deal with genuinely insurable risks - the case for the state's helping to organize a comprehensive system of social insurance is very strong... Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken," - Friedrich Hayek, The Road To Serfdom (Chapter 9).
http://andrewsullivan.theatlantic.com/the_daily_dish/2009/09/quote-for-the-day-1.html
Guess this makes Hayek a socialist (H/T Andrew Sullivan).
That sound you hear is Tall Dave's head exploding:-). Road of Serfdom tastes better with salt.
LOL. A while back STD also offered his insights on Orwell. It ended up with him referring to the nonexistent 1984 term "doublespeak".
Apparently, STD bases his political opinions on what he believes it's written on a bunch of books he never read.
Here's a long-ish post on how Hayek felt about government-run health care systems. It quotes at length from his The Constitution of Liberty, which was published in 1960. Needless to say, Hayek is critical of government-run health care. Although his most popular work, The Road To Serfdom, published in 1944, is one of Hayek's many works and should not be treated as the summation Hayek's thoughts.
Hayek, in "The Constitution of Liberty" is opposed to an UHC system similar to the U.K., in which doctors are direct employers of the state. Needless to say, nobody is proposing such a system. The excerpt presented by stonetools and the quotes of the post you linked are perfectly compatible.
"Certain goods like national defense or policing can only be provided by government, because of the state's monopoly on force"
It is because the government was given a near-monopoly on force that it has been chafing under the shadow of the Second Amendment ever since. It is always the policing agencies that protest loudest about the Second Amendment, and, let's face it, the Second Amendment has been de-fanged already. The government will always have bigger guns than the people. But in any case, guns are not the weapons of the future, brains are, and Congress and the W.H. seem shortchanged on that account.
JoshinHB wonders:
"Do you really believe that consumption doesn't increase when people don't pay for what they consume? Do you really believe that more competition doesn't lead to lower prices? Do you really believe that supply creates demand? Do you really believe that medical liscensing is about safety and not about restricting the supply of doctors?"
1. Medical licensing was originally about consumer safety. Today, it is clear that there is a supply-restriction component to it. I really haven't thought about the possible effects of easing licensing restrictions. Because there is absolutely zero chance of that ever happening. We will have single-payer before we have unlicensed medical professionals.
2. In medical services, supplier-induced demand is the #1 fundamental principle of the economics of the field. It's not unique to doctors. Same thing goes with lawyers. But it is absolutely 100% a real phenomenon, one accepted by every serious health care economist.
If you open your mind a little bit, it's really not hard to understand. You go to the doctor with a tummy ache. Doctor says to you, "well, it might be a virus, but it might also be a gastric ulcer." You say "well, what does that mean?" and doctor says "well, if untreated, it could lead to severe complications. We should rule that out with a series of X-rays."
What do you say? Most people say that OK, doctor says I need this done, I should get it done. The same way that if an attorney says you need to file X, Y and Z motions in your litigation, or else maybe you lose, most clients go ahead and pay for X, Y and Z. It's a general problem with services provided by experts.
3. Because of supplier-induced demand, competition does not lead to higher prices. This has been proven in empirical study after empirical study. When doctor concentration in an area increases, guess what happens? Prices stay the same, or even go up (see McAllen, TX). Utilization increases.
Another way of looking at the question is this: for which patients are doctors' fees most competitive? For the uninsured, of course. They are the ones who pay out of pocket. And yet, as we all know, doctors charge uninsured people much higher prices than those with insurance. That's a tell-tale sign that doctor competition doesn't decrease prices.
4. In general, doctors' main "competition" isn't other doctors; it is the decision "no medical care." And the decision "no medical care" is frequently driven by lack of supply or complete lack of affordability (i.e. people will often spend their last dollar on health care). This is why more doctors is not the answer. Better and more intelligent rationing is.
5. When people pay out of pocket for health care, consumption does decrease. But not necessarily in a good way. Sometimes, people who shouldn't be going to the doctor don't go. That's good. But more often, what happens is that well-to-do people who don't need to see a doctor go anyway, and they crowd out less affluent people who really do need to see a doctor but can't get an appointment or can't afford it.
This happens all the time with most goods. There are people who have 10 Lexus cars and yet buy an 11th that they don't need. Whereas I might feel that I "need" that Lexus more than they do. TS for me. I should make more money.
But with certain goods, it is considered inhumane to do that. The Irish potato famine is a classic example. People were starving, the landlords insisted on having their contracts honored so they could buy yet more goods that they didn't "need." Same with health care. It is absolutely a travesty to think that people are dying from lack of care (this does happen, frequently, despite right-wing lies to the contrary), while others pay for care they don't need.
Not to mention, poor rationing of health care is extremely expensive. Healthy people are productive people. When people don't get the care they need and their health deteriorates, they can become disabled or less able. Would you rather pay for the health care, or the lifetime of disability payments? Would you rather have workers of high productivity, or ones who miss work frequently?
Colin writes:
"1. No, HSAs are a serious solution. You save for your own medical expenses. Combined with a high-deductible insurance plan they are proven to save money:"
Well, sure. You could also save money by establishing a sales tax of 500% on health care. High-Deductible Insurance (HDI) can be useful under certain circumstances, but it is a feature, not a policy. I would expect the public option to offer an HDI plan, but they aren't appropriate for most people.
HSA/HDI does little to get the care to the people who need it. And they unfairly penalize those who are sick. Right-wingers like to talk about incentives. That if you have to pay for your health care, you are more likely to invest in your health. I have seen no evidence that is true. And medical science is finding that more and more medical conditions have genetic components. So how fair is that? A person has a genetic disposition to bipolar and has to pay 10K out of pocket each year to have it treated?
Policy should try to socialize unavoidable costs. That is consonant with most consistent moral systems. To claim that people should be poor because they have bad genes (for instance), or because they were the victim of an accident, is morally bankrupt. Yes, I understand that genetic endowments affect wealth in market systems, and the reason that is tolerable is that it is Pareto-optimal. It makes everyone better off. That is not true when the goods in question are life-determinative (like education, health care, food).
To put the matter another way, "To each according to need; from each according to ability" is a defensible and decent moral principle. It is an incredibly poor economic principle, because it completely ignores effort and incentives. If wealth were 100% determined by endowment effects, then the prinicples of equality and freedom would demand substantial redistribution. Of course, in the real world, that's nowhere near true, and so redistrubtion has hugely important real costs.
But in health care, health is determined to a very large extent by endowment. So socialization of costs is desirable.
2. Say's principle has nothing to do with supplier-induced demand. It's not the same thing at all. I don't want to get into an argument about Say's law, except to note that Say never claimed that supply creates demand; at most Say's law means aggregate supply creates aggregate demand and that no demand can exist without supply. But that's a very different thing than saying a seller can create demand for his product. The latter is a misunderstanding of the concept of supply and demand.
Anyway, it's much easier to talk about examples. Car salesmen generally have limited ability to make you buy a car. If you don't go to the lot intending to buy a new car, you're not likely to do so. Car mechanics, however, are a different story. You take your car in to get something little fixed, and you're told you need $1K of repairs to fix the problem properly. People often end up paying this. Most people who aren't knowledgable about auto mechanics have at least had occasion to agonize over this type of decision.
3. I didn't say Lasik isn't about health at all. But it is categorically different from orthopedic surgery, kidney dialysis, cancer treatments, etc. It is much more like cosmetic surgery. You're being dishonest if you don't make this distinction. Lasik's benefit is avoidance of wearing glasses. Hip replacement is avoidance of being invalid.
4. Interstate competition is not the problem. Lack of regulation for industries that need regulation is. Interstate competition in credit cards has proven a disaster. If not for federal intervention, credit card companies would completely prey on the vulnerable (and still do).
I am completely honest that I am talking about paternalist regulation. Now is a bad time to be arguing against paternalist regulation in principle. We had an entire economy collapse in part because a lot of people got suckered into purchases of importantly, costly things (mortgages, CDOs, CDSs) that they didn't understand, couldn't afford, and turned ruinous.
If we let insurance companies design products under the weakest set of regulations they can find, I guarantee you we would be seeing a lot of people having the health-care equivalent of foreclosure. They'd find they need services and no insurance to cover them.
You might expect it, but you would be wrong. Catastrophic coverage plans are going to be outlawed for a very, very simple reason- such plans are a way for young and/or healthy people to avoid the goal of supplying comprehensive medical services to everyone else.
HSA/HDI does little to get the care to the people who need it. And they unfairly penalize those who are sick. Right-wingers like to talk about incentives. That if you have to pay for your health care, you are more likely to invest in your health. I have seen no evidence that is true.
Well, here is some evidence for you:
http://online.wsj.com/article/SB124476804026308603.html
Safeway began offering financial incentives for people to take better care of their health -- and they responded!
Further, I think the real benefit is not in people maintaining their bodies better, but in shopping around when they need a procedure done.
And medical science is finding that more and more medical conditions have genetic components. So how fair is that? A person has a genetic disposition to bipolar and has to pay 10K out of pocket each year to have it treated?
Genetics also determine factors like athletic ability, height, beauty and intelligence. They are not evenly distributed. Yes, life isn't fair. What we can do is make treatment for these conditions as cheap as possible. The free market holds the only hope of driving down costs and increasing quality.
You take your car in to get something little fixed, and you're told you need $1K of repairs to fix the problem properly. People often end up paying this. Most people who aren't knowledgable about auto mechanics have at least had occasion to agonize over this type of decision.
Information asymmetries exist everywhere. That's life. Is the solution to the car mechanic problem government-run car service? The best antidote to charlatans and poor quality is competition.
I didn't say Lasik isn't about health at all. But it is categorically different from orthopedic surgery, kidney dialysis, cancer treatments, etc. It is much more like cosmetic surgery. You're being dishonest if you don't make this distinction. Lasik's benefit is avoidance of wearing glasses. Hip replacement is avoidance of being invalid.
No, actually you DID say Lasik isn't about health at all. Your quote: "It's a medical procedure, but it has nothing to do with health."
You are the one being dishonest if you don't think Lasik has big implications for health care. Not all medical procedures are a matter of life and death. Many, like Lasik, simply affect quality of life. There should be no reason not to shop around for a joint replacement just like you shop around for Lasik. In fact, we already have this to a limited extent with medical tourism, where first class care can be obtained for dramatically lower prices abroad.
Interstate competition is not the problem. Lack of regulation for industries that need regulation is. Interstate competition in credit cards has proven a disaster. If not for federal intervention, credit card companies would completely prey on the vulnerable (and still do).
Is it any coincidence that our most problematic sectors -- finance, health care -- are also the most regulated? A lack of regulation is certainly not the problem, and actually corresponds with increasing problems.
Lastly, you still have not provided examples of failed free market approaches in health care. But in the spirit of generosity maybe you should read this Salon article on health care in India. Key excerpt:
http://www.salon.com/news/feature/2009/09/03/india/index.html
Almost 25,000 doctors graduate from India's medical schools every year. Because there is so much competition, doctors and hospitals are forced to keep their prices low to get patients. Residents, who go to medical school straight from high school, only make the equivalent of a few hundred dollars a month. An average surgeon's salary would be around $8,000 per month. The take-home pay to fix a hip fracture, for example, might run between $100 to $300, out of the $1,000 fee to the patient, says orthopedic surgeon M.S. Phaneesha. At his hospital in Bangalore, he says, there are 20 orthopedic surgeons alone on staff. For 1,600 beds, the hospitals employs around 700 doctors full-time; 300 of them are surgeons. In the U.S., by comparison, a first-year resident might take home around $2,500 each month, and the average surgeon more than $20,000 per month. A hip fracture would cost a patient around $30,000, of which the surgeon's charge is $5,000. Even general practitioners in America earn on average more than $100,000 a year.
Another factor in India's costs is the tiered system of beds that most hospitals employ. One night in a general ward at the private Artemis Health Institute in a New Delhi suburb, for example, costs around $20 per night. One night in a single room, or a deluxe, or a suite, though, will cost you between $100 to $200. Services are similarly tiered. A general ward patient at Artemis would only pay $2 for an X-ray, while single-room patients would pay more. There are so many hospitals, says Artemis' chief operating officer Jose Verghese, that rates at the lower end stay low.
I already answered most of your points. Yes, genetic disparities exist everywhere. That's no reason to abandon commitment to equality.
Less-intelligent people are easier to dupe than smart people. We have laws against fraud largely to protect those less-intelligent people from being swindled. Some people are mentally retarded. We expend social resources on providing special education for them and ensuring they have a decent life. We rejected the model of the "village idiot." We typically don't permit people to lose just because they are genetic losers.
The main reason we permit unequal genetics to lead to vastly unequal quality of life is that it is impossible to separate genetic talents from acquired skills. Incentives matter. This is not really true in health (to some extent it is, but much less so than in, say, entrepreneurship), and even if it was, it is not remotely fair to punish sick people.
But if your idea of a just society is one where people who are genetically predisposed to bipolar disorder should be impoverished their whole life . . . well that would say volumes about you.
The answer to your question about failed free-market health care is quite obvious. All of them. All medicine in Europe and the US was originally fee-for-service. Over time, they have all migrated away from that model, for essentially the same reason: that model doesn't work properly.
As for India, you've never lived there obviously. My wife is from India. The health care there is horrible and non-existent for poor people. My father-in-law had a tummy ache from eatin street food. He went to the doctor, who gave him an injection of a really bizarre antibiotic that almost killed him. His fever spiked to 104, but the hospital was not an option. We were doing cold compresses all night. I read on the internet about this drug and there is no way it should have been used in that situation. Mind you, this was in a fairly major Indian city, a capital of one of the larger states.
And to address some miscellany: supplier-induced demand is not the same thing as an information asymmetry. They are different and you'd understand the whole issue better if you took time to understand why. Indeed, the second most fundamental fact about health care economics is the importance of information asymmetry. Except the asymmetry is that the patient knows more about his or her health than the payer or the doctor.
As for LASIK, I have said all there can be said about it. It is a highly elective procedure akin to cosmetic surgery. The primary driver of lower cost is not competition with other laser surgeons but competition with glasses and contact lenses. If you continue to believe that it is a good model for the provision, then that's your choice but you'd be far outside the realm of rationality. I may have overstated my original point about LASIK if I said it was "unrelated" to health but it is much more of a cosmetic procedure, and has little to do with medical necessity.
Muzzybelly's last couple of posts pretty much win the thread. Dunno why the hell the Democrats haven't been able to make the case for universal health insurance as well as MB. I might add that the insurance exchange set up by the House bill gives the benefits of simply lowering barriers to interstate competition-while avoiding the drawbacks. Despite that, Republicans keep harping on interstate competition. Here is a primer by bthe respected nonprofit the Kaiser Family Foundation.
http://www.kff.org/healthreform/upload/7908.pdf
That's a good point about the insurance exchanges.
To make my case for universal health insurance, I used a couple of thousand words at least. Much, much harder to do when you have only a 30 second or one minute soundbite. Also, I get to express my own views, not try to cobble together some consensus. It's not as if anything I have said here is particularly ground-breaking. It's been said, and said, and said, by policy analysts for a long time.
But nobody listens to policy analysts anymore, which is one reason I got out of that game a while back. At least in the last three years we have seen a dramatic increase in policy-related blogs, which beat the heck out of TV news shows. But the blogs themselves are often minimally informed by actual economic/policy analysis, or are overly argumentative and/or dishonest. And posts often last a couple hundred words only.
In some quarters, it's a form of heresy to suggest that we turn the news channels off and let the experts do the lawmaking. Indeed, I would never suggest that seriously, because democracy is our system, it's a good system and robust public debate is a part of that. Still, I don't think the Founding Fathers (or Locke or Rousseau for that matter) had any idea what would happen to public discourse with the advent of 24 hour news and constant internet everywhere. . .
It isn't all that intellectually honest to declare the post "winner" to be someone who agrees with your own views.
I could just as easily declare both you and muzzybelly thread losers, and it would carry just as much weight.
Yeah, I appreciate muzzybelly's comments, but I hope you appreciate TallDave's and others. Hard enough to live in an imperfect world without everyone thinking that his own point of view is the only one there is.
And that, of course, explains "why the hell the Democrats haven't been able to make the case for universal health insurance as well as MB". Surely it is silly to think that (1) I'm right, so (2) The reason not everyone agrees with me is that they have had it explained well. Perhaps they come from a different perspective.
For what it's worth, I don't really care for the concept of thread winner or loser. I believe I am right on this issue -- indeed, why would post these things if I did not? -- but "scoreboard" is not a good way to approach discussions. I hope my comments helped enlighten some people as to facts and reasoning they didn't otherwise know. That is all.
Impressive. muzzybelly wins the thread again.