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Conservatives on Healthcare
Two pieces in the LA Times today demonstrate why conservatives are increasingly losing the healthcare argument. First up is Michael Tanner of Cato, a guy who's practically an op-ed machine on the subject of healthcare, and right up front he says this about healthcare in America: "It costs too much. Too many people lack health insurance. And quality can be uneven." 
And he admits that "supporters of the free market" — like him — "have been remiss in positing viable alternatives."
A promising start! But his solution is bizarre:
There are two key components to any free-market healthcare reform. First, we need to move away from a system dominated by employer-provided health insurance....Changing from employer-provided to individually purchased insurance requires changing the tax treatment of health insurance....For tax purposes, employer-provided insurance should be treated as taxable income.
....The other part of effective healthcare reform involves increasing competition among both insurers and health providers. Current regulations establish monopolies and cartels in both industries.
These may or may not be good ideas. They might or might not reduce the cost of healthcare. That much is at least debatable. But they'd do nothing to reduce the number of people who lack health insurance. Just the opposite, in fact. If we took his advice, employers would drop health insurance like hot coals and it's a dead certainty that anybody who's over the age of 50 or has a previous history of anything at all would be unable to get replacement coverage in the individual market. This isn't debatable at all. So why does Tanner think any ordinary middle-aged, middle-class op-ed reader is going to support a plan that increases the odds that they'll have no health insurance in the future? That doesn't make much sense.
But at least Tanner isn't crazy. Unpersuasive, maybe, but not crazy. Charlotte Allen, conversely, thinks that in order to free up some much needed healthcare cash, Barack Obama wants to take all our old people and set them adrift on ice floes to die. Do you think I'm engaged in some bloggy exaggeration for rhetorical effect? Let's roll the tape:
The Eskimos used to set their elderly and sickly adrift on the ice or otherwise abandon them during times of scarcity, and that, metaphorically speaking, is what Obama would like us all to start doing.
....The scarcity of resources to pay for expensive medical procedures will only increase under a plan to extend medical benefits at federal expense to the 47 million Americans who lack health insurance. So why not save billions of dollars by killing off our own unproductive oldsters and terminal patients, or — since we aren't likely to do that outright in this, the 21st century — why not simply ensure that they die faster by denying them costly medical care?
The rest of the piece is a weird Soylent Greenish hodgepodge of scaremongering about comparative effectiveness research, fear of jackbooted government bureaucrats pulling the plug on grandma, and a revival of zombie "No Exit" agitprop last seen in 1994. Allen barely even pretends there's any real evidence for this stuff — mainly because there isn't any, I suppose — so instead she just riffs hysterically about what Obama "seems" to believe about how to reform healthcare. Most weirdly of all, though, at the end of the piece the conservative Charlotte Allen herself seems to suggest that Medicare should be funded with infinite amounts of money and there should never be any restriction on how it's spent. Either that or she doesn't realize that Medicare is the way most old people in America get medical care. Or that Medicare is a government program. Or something. I can't really make sense out of it.
Better conservatives, please. These two are hopeless.
I think she's on to something
Take her at her word for it and fund Medicare with infinite amounts of money. That way everyone could be covered and it could be free.
And it's not socialism, because we're sure she's against socialism, so it must be good.
I think she's on to something.
Conservatives have their one solution
The conservative/libertarian solution is to disband what remaining insurer pools there are (e.g. w/employers) and then everybody is on their own, using their miserably-low bargaining power to get a good deal. The conservative claim is that health care insurance is just like a can of peas sold in the grocery store:
-o- A can of peas is a standardized product.
-o- A can of peas comes from multiple suppliers.
-o- A can of peas is frequently bought and sold.
-o- A can of peas is not priced based on who you are.
-o- A can of peas doesn't cost much, so the occasional error in purchasing a bum product is not a disaster.
-o- A can of peas comes closest to an ideal marketplace item.
But health care insurance is not like a can of peas.
They are all helplessly lost.
It is a result of the Faustian bargain republicans made a couple of decades back. Pure Lentzian, Rovian psychologoical marketing, otherwise known as propaganda, wins in the short term, but leaves the practitioners unable to think clearly about things.
Aren't the implied Republican policies very similar to the Eskimo eldercare plan? All those who haven't made it into the top few percent, can simply beg for healthcare, and die off early. Only the successful few deserve medical care.
But, seriously, even with our huge coverage gaps, the exponential increase in healthcare cost that is caused by the present system is clearly unsustainable. Not only is it unsustainable (as is all exponential growth), but it is reaching the point where it simply can't be put off any more. Of course any real reform, would chop healthcare back from 16% of GDP, to something more like the OECD average. But, expect that that huge slice of the electorate who makes their living off healthcare to mightily resist.
health care plan
Let me ask everyone a question: Do you consider price and discount when buying Tylenol and Pepcid? I answer in the affirmative.
Here's another question: Do you consider price when considering brain surgery? I answer in the negative.
Therefore, I suggest splitting health care costs into two categories:
1) Medical goods that a consumer could price and shop accordingly on.
2) Medical goods that a consumer cannot price and shop accordingly on.
Once you do this, you can split up medical costs into:
1) Costs subject to a deductible.
2) Catastrophic Costs.
And, further, you can say the following:
For 1) You don't want third party payers, since you want the consumers to shop for the best price.
For 2) You can have a third party payer. In fact, you can have one: the Federal Government.
Now, here's Milton Friedman's plan:
"A more radical reform would, first, end both Medicare and Medicaid, at least for new entrants, and replace them by providing every family in the United States with catastrophic insurance (i.e., a major medical policy with a high deductible). Second, it would end tax exemption of employer-provided medical care. And, third, it would remove the restrictive regulations that are now imposed on medical insurance—hard to justify with universal catastrophic insurance.
This reform would solve the problem of the currently medically uninsured, eliminate most of the bureaucratic structure, free medical practitioners from an increasingly heavy burden of paperwork and regulation, and lead many employers and employees to convert employer-provided medical care into a higher cash wage. The taxpayer would save money because total government costs would plummet. The family would be relieved of one of its major concerns—the possibility of being impoverished by a major medical catastrophe—and most could readily finance the remaining medical costs. Families would once again have an incentive to monitor the providers of medical care and to establish the kind of personal relations with them that were once customary. The demonstrated efficiency of private enterprise would have a chance to improve the quality and lower the cost of medical care. The first question asked of a patient entering a hospital might once again become "What’s wrong?" not "What’s your insurance?"
I would add a Democratic Party addition to this plan: You could relate the deductible to income.
That's my plan. Everyone covered.
I would add the following: I've no idea what the correct amount of money that we should spend on health care should be. That's why I would like some portion of our medical bills to be subject to our own choice.
More Info
Don:
“…and most could readily finance the remaining medical costs.”
Well that is certainly easy to type. Now could you outline how that would work? Who are the “most” you speak of? And if your plan was in place today, how would they be able to finance “the remaining” medical costs? Could a compound fracture still jeopardize a single parent’s ability to pay the rent?
No, no. The world of Freedman is not the world we live in.
Higher cash wage?
Ending employer provided healthcare would be a double detriment to most employees, and would be devastating to the working poor. Why on earth would a company pass the savings on to their employees? They'll keep it. Privately-owned companies want to squeeze every out penny that they can. Public companies are desperate to impress wall street with big profits, and please shareholders with dividends.
Without a universal system in place as a safety net, employees will be forced to fend for themselves. Low income earners have difficulty already, and many couldn't afford to purchase even meager insurance. Your idea looks like a formula for employers to really put the screws to their employees.
So Friedman was actually an
So Friedman was actually an advocate for universal, government-funded catastrophic health insurance? That's rather interesting. It would be fitting with some of his other general themes, like trying to minimize the government role in the "supply" side of the market (Friedman was the one who advocated replacing all of welfare with a negative income tax - i.e. direct cash transfer from the rich to the poor, in order to raise the poor's annual income). It would also be consistent, since we basically have universal catastrophic care right now (you can't be turned away from the emergency room for inability to pay), and Friedman's plan would add universal catastrophic health insurance to cover it.
The Tanner piece is basically a mess of stereotypes and conservative assumptions. He starts off the piece by repeating the mantra of "America has the best health care in the world" (without any evidence of course, or defining the people who are getting that care - the rich tend to get the best care regardless of where they actually live). He then continues with all the joyful proposals, such as allowing people to bypass state regulations on insurance (without any proposal of national regulations, which basically amounts to a a race to the bottom in terms of coverage and cost on policies), getting everyone on individual health care plans (even though the administrative costs tend to be much higher on those plans, and costs per capita are higher in general due to the loss of economies of scale in coverage), etc.
I agree that Allen's piece amounts to a lot of scaremongering about how "those bureaucrats" will cut off Grandma's care if given half the chance (even though we already have a massive health care program specifically tailored to grandma that is not going anywhere).
Paying double what the rest
Paying double what the rest of the world pays for healthcare isn't sustainable. Paying double and getting worse medical outcomes is stupid. We need to get those costs down or American business will go the way of GM and Chrysler.
To do that we not only need a strong public option but a cost effectiveness commission that studies and recommends/mandates what works, say at the Mayo Clinic where the cost per patient is about $6000, $1000 under the nat'l average, and the medical outcomes are much better than average.
The fee for service model for doctors and filling beds model for hospitals has got to go. It's like paying a baseball player for how many swings he takes at the ball instead of overall stats. Sometimes it's better to draw a walk and sometimes those extra tests, procedures, drug regimens, and therapies do more harm than good and are just revenue driven.
A public option for medical malpractice insurance ought to be included too. There's no correlation between those prices and actual malpractice or jackpot jury award lawsuits. There's a lot between insurance company profits, monopoly pricing and the PR war they, the GOP and the media have waged on us all since the 1970s.
Hole in Friedman's proposal
There is a large hole in Friedman's proposal as laid out above by Don the libertarian Democrat.
Chronic conditions.
Probably the single largest category of medical expenditure is the ongoing expense of caring for a chronic condition. The pharmaceutical companies are doing all they can to create new classes of chronic condition treated by expensive on patent medicines. Have you taken a statin today?
This is at the core of why there is all the screaming about studies of the efficacy of different treatment options.
Do I have to pay for the treatment of my chronic condition out of pocket? I would do so if I had to but there are many who would not or can not. If I didn't take care of myself I would soon have catastrophic problems that the government would have to pay for.
There are very good medical and financial reasons for a health system that spends more money on prevention and treatment of chronic conditions to prevent the expensive catastrophes.
1. Saying "Eskimo" is a bit
1. Saying "Eskimo" is a bit like saying "colored people". It's a name their enemies gave them and passed on to Europeans. "Inuit" is what they call themselves. You can think of it as PC , or think of it as not sounding ignorant, or sounding like an asshole.
2. That whole abandonment meme was rarely done, and only preceded a long grueling winter journey; the old and weak were allowed to stay behind and die in peace, rather than die in mid-journey. You see the same thing in war movies where "Brooklyn" is too hurt to move--he gets left behind with a canteen and a candy bar, and a full clip.
Thank you
I've always found this "Eskimo" meme insulting and ignorant.
I particularly like the part
I particularly like the part where the Cato guy calls for ending government enforced monopolies for health care providers. Yeah, no need to license brain surgeons . . .
An Issue Needing Discussion
I imagine I differ with Charlotte Allen on everything. That said, there is a weakness in the “pro” side of our current health care debate. Few, especially the Obama administration, seem to want to talk specifically about end of life and late stage geriatric care. That vacuum allows folks like Allen a chance to launch nonsense.
Yet it is a huge issue. Most folks I read say that our society could not afford the type of aggressive late stage medical care that at least 50% of our population feels they are entitled to.
Metastatic breast cancer has a poor prognosis. Sure we aggressively treat a 30 yr old. What about a 70 yr old? 85?
Right now these decisions are made, or not made, by thousands of people at thousands of locations. Do “we” have the ability and willingness to centralize those decisions and to implement cut offs. Truly universal coverage, especially if it eventually takes the form of single payer, means those issues need to be addressed.
I have seen the POTUS dance around this issue in several town halls. If this topic is abandoned to the Right, they will fill in the blanks as Ms Allen has.
Better conservatives?
I think getting better conservatives on health care is fundamentally impossible. Modern "conservative" opinion on health care is either disingenuous or unconcerned with actual outcomes. A blind adherence to individual self-reliance and faith in markets is always better, even when it's demonstrably worse. Better health outcomes really aren't the goal with conservatives.
health care plan
In my plan, the govt will buy or provide catastrophic care for everyone. Then, consumers will have a deductible, based on income, in which it is in their interest to spend less than the deductible, if possible.
Private insurers could compete for the catastrophic coverage, and also present plans for the deductible portion.I don't care if the govt competes as well. However, in my view, the govt will have an important function in health care no matter what. The point is to lower costs on the one hand, by having a large customer buy the catastrophic insurance, and give consumers an incentive to save money on bills that they can meaningfully shop on the other hand.
My main point is that shopping for plans provided by a third party is very bad, and so is shopping for plans as individuals. I'm trying to split health care costs into meaningful units, within which it would actually be possible to save money while keeping a high level of care.
The savings will come from magnitude, and from individual choices. I'm less interested in the details than a plan that actually makes sense.
PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON
AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.
STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.
We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.
And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.
Progressive democrats the Tri-Caucus and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).
Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.
In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!
If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.
THIS IS THE BIG ONE!
THE BATTLE OF GOOD Vs EVIL!
Join the fight.
Contact congress and your representatives NOW! AND SPREAD THE WORD!
God Bless You
Jacksmith – WORKING CLASS
On the right track
I think Tanner is on the right track, but doesn't go far enough.
Sure, it would be nice if everyone could buy their own insurance, but long long ago employers decided they would rather get group rates for their employees in order to save money (less per employee than having to pay them to buy individual-rate insurance).
So, as Kevin says, to drop that would be disastrous. How many employers would be capable (much less happy) to pay employees enough to get individual-rate insurance today. It's really outrageously high.
The competition part is good. Tanner at least has an idea of what his ideal would be. But, where are the actual ideas for inspiring that competition? The Dems have a dozen ideas.
Yes, more smarter Conservatives please. But, for now the Dems have solid ideas and energy and focus and will move us toward something better.
I only hope the electorate recognizes this and votes accordingly.
Aren't the implied
tagged as:- solution
- result
Aren't the implied Republican policies very similar to the Eskimo eldercare plan? All those who haven't made it into the top few percent, can simply beg for healthcare, and die off early. Only the successful few deserve medical care.tiffany jewelry
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