Anyone afraid of big government has plenty of reasons to dislike the “Obamacare” healthcare reforms likely to become law sometime early next year. Like any massive program or policy, however, the revisions of the American healthcare system that the House and Senate have passed will create winners and losers. The new legislation has plenty of downsides but an honest look at it from a conservative, free market perspective reveals a few bright spots too. Five that stand out follow:
1. Electronic medical records will become more widespread.
Everyone who deals with healthcare—left, center, and right—agrees that medical record keeping needs serious improvement. Nearly two decades after every other industry computerized its databases, most medical records still get kept on paper in filing cabinets. Those computer systems that do exist usually can’t exchange data. As a result, many patients fall through the cracks. Literally millions of unnecessary tests get run each year simply because nobody can find records. Drug prescription errors, likewise, kill thousands. Entities like the Department of Veterans Affairs’ system, Utah’s Intermountain Health, and Kaiser Permanente that make widespread use of electronic records tend to get better results. Dated anti-trust statutes and recalcitrant medical professionals have delayed widespread electronic medical records standard setting for too long. Along with money from the “stimulus,” however, the new healthcare laws should speed the long-overdue adoption of electronic medical records.
2. More people will pay something for medical care.
The current American medical system encourages freeloading and, in some respects, this may decline under the new laws. Plenty of people—including many who probably don’t need them—will get taxpayer subsidies under the laws. Even if the total number of people receiving explicit subsidies increases (it will), many people who don’t currently pay for medical care will find it attractive to start paying something to buy a basic insurance policy under Obamacare. (Hardly any of the new subsidies provide entirely “free” care.) As individual mandates and subsidies reduce the number of people without any insurance, hospitals and doctors have more resources to go after those individuals that still genuinely want to freeload.
3. Medicare Advantage subsidies, a form of corporate welfare, will shrink.
Since 1997, Medicare has encouraged beneficiaries to pick “private” plans through a program now called Medicare Advantage (Medicare Part C in the statute) as an alternative to “plain vanilla” Medicare. This sounds good in theory—and probably benefits some of the individual participants—but a noble experiment has turned into a corporate welfare bonanza. While they provide only minor additional benefits like (e.g. routine dental coverage), a variety of “private” taxpayer-financed plans receive larger subsidies than the “plain vanilla” Medicare. If these nominally “private” plans provided better care, then maybe one could justify this. But there’s no hard evidence that they do and some that they don’t. The current law’s numerous restrictions on private decision making—the participating providers have very limited ability to design their own benefit packages—probably lies at the root of its problems. But there’s still no excuse for the size of the subsidies. If it’s to accomplish its goals, Medicare Advantage needs an overhaul. The big subsidies need to go and, under almost any circumstances, they’ll be cut significantly.
4. More people will get health insurance away from the workplace.
Employer-based health coverage is a bad idea. It discourages anyone from taking responsibility for healthcare costs, decreases choice, and sometimes leads people to stay in jobs they’d rather leave simply to keep the benefits. New “employer mandates” in House and Senate bills seem likely to keep this broken system in place at least in the short term. But even if not a single employer decides to drop coverage, raise wages, and encourage its employees to shop for insurance in the private market, new “exchanges” and mandates will almost certainly increase the absolute number of people buying insurance on their own. Significant problems (particularly price controls) exist with the mechanisms the legislation uses to encourage private health insurance purchase, but if individuals end up getting better care and being more satisfied than those who receive care through their employers, it may result in a shift away from workplace provided care on a broader scale. And that would be a good thing.
5. Moderately sick people will be better off all-around.
The American medical system is probably the best in the world for two groups of people: the well and the very sick. Well Americans can find primary care doctors without much trouble, get all sorts of expensive tests if they feel a bit down, and do it all without a lot of waiting around or bureaucracy. They rarely pay more than a little out of pocket. Very sick Americans, on the other hand, can rely on quick access to high tech diagnostics, no waiting lists for new, high-tech treatments, and hospitals that treat them pretty well. While overall costs may be high, even those without insurance can almost always sign up for a public program (Medicare or Medicaid) or get charity care.
People with moderate problems—everything from a serious but not-life-threatening physical injuries to chronic diabetes—don’t get a very good deal under the current system. People with any sort of chronic condition often find coverage virtually unavailable in the private market. Since the hospital system focuses mostly on the well and the very sick, furthermore, people with moderate problems often get shunted aside, wait too long for necessary care, and end up with very hefty medical bills if they don’t have insurance. The changes to the healthcare system may very well hurt care for the well and very sick. At least in the short term, however, the moderately sick will probably get better care and pay less for it.
58 responses so far
1 sinz54 // Dec 27, 2009 at 9:38 am
I agree that these are all good things,
but I don’t understand what #5 has to do with a “conservative, free market perspective.”
Giving health insurance coverage to those who are otherwise uninsurable on the free insurance market (i.e., those with a serious pre-existing chronic condition) represents an interference with that market. It needs to be done in order to level the playing field for Americans in the job market–but it’s still interference.
Contrast #5 with the proposals on health care from the libertarian free-market Ludwig von Mises Institute:
I’ve always said that a purely free-market approach to health care must necessarily lead to Social Darwinism. What we conservatives needed to make clear, on this and many other issues, is what distinguishes us from libertarians and Randian Objectivists. We need to do a better job of that in the future.
2 COProgressive // Dec 27, 2009 at 10:32 am
First, very nice article Eli, coming from a conservative.
Second, 1 sinz54 // Dec 27, 2009 at 9:38 am
I’ve always said that a purely free-market approach to health care must necessarily lead to Social Darwinism. ( I agree) What we conservatives needed to make clear, on this and many other issues, is what distinguishes us from libertarians and Randian Objectivists. We need to do a better job of that in the future.
Sinz, what is the “conservative, free market prospective”, and how does the “free market” balance with a civilized society’s desire to care for the sick and injured?
I wonder if Ludwig’s belief in the “libertian free-market” would hold if it were his young daughter with a serious cronic illness. Would he cut off subsidizing her care to “would strengthen the will to live healthy lives and to work for a living”?
3 sinz54 // Dec 27, 2009 at 10:54 am
COProgressive:
If it had included more on cost containment, RomneyCare would have been a good model of how a conservative can create a workable health care system. (Romney had pushed for universal coverage even before the Mass legislature did.) I live in Massachusetts, and the system is working, though costs are rising. RomneyCare provides a public option for the truly needy, which is working OK the last time I checked. But it’s strictly means tested, so it can never compete with private insurers for the more affluent market. That’s what distinguishes the conservative approach from the liberal approach.
Romney had punted on cost containment, because he was afraid that providers or insurers would back out of the deal. But more cost containment will now be added to it, like encouraging doctors to form groups out of which they are salaried, moving away from fee-for service medicine toward outcome-based payments, etc.
Health care costs are rising all over the Western world at an average rate roughly 1.6% above the rate of GDP increase–even in nations with single-payer systems. That strongly suggests that attacking health care costs requires more than just diddling with how health care is paid for–it requires dealing with how health care is done.
That’s why #1, #2, #3, #4 from Mr. Lehrer’s article, are cost containment features that conservatives should like. In the current health care fight, it was pure demagoguery for conservative Republicans to take the side of Medicare Advantage. Medicare Part C was badly designed in the first place.
Finally, I recall that years ago, the conservative Heritage Foundation had endorsed the idea of a health insurance exchange. But when the Dems insisted on strictly regulating the types of plans that can be offered through it, the Heritage Foundation reversed itself and opposed the exchange.
4 COProgressive // Dec 27, 2009 at 11:32 am
Thanks Sinz. As a progressive, I really dislike much of what this bill keeps and adds to our healthcare system. First, I’m against the individual mandate. Requiring the purchase of private insurance is nothing more that a citizen sponsored subsidy for the S&I Insurance industry.
Second, I see very little in cost containment. There are at least two profit layers built into our current system, the profit and overhead of the providers and the profits and overheads of the S&I Insurance companies. To remove one of them, and create a single payer model, would help to reduce cost by removing an expensive layer of cost and waste between the patient and the provider. Right now, any excessive markup of costs and additional items bill the patient and sent to the insurance companies receive the insurance companies markup and possible denial of payment. The insurance companies have no interest in driving down providers costs as the higher the bill they receive, the higher their markup. Which would you rather have, a 30% markup on a $150,000 bill, or a 30% markup on a $250,000 bill? The insurance industry, to my mind, is simply skimming their 30% and could care less about cost containment. In fact, isolating the providers from meaningful cost containment.
Third, I don’t believe there’s a “free market” in healthcare and we need to move away from our notion that Healthcare = Insurance. What I think most of the other industrial nations of the world with single payer believe is that payments into healthcare should be thought of as a Trust Fund to care for its citizens. We need to change to that mindset as well. Buying a YEARLY S&I Insurance policy, spending thousands of dollars on it as well as employers spending 10’s of thousands, 100’s of thousands, even millions of dollars on S&I Insurance policies to cover employees, and then come December 31st have NOTHING to show for the expense is ludicrous.
5 COProgressive // Dec 27, 2009 at 11:35 am
I should proof-read before I hit “Submit”. Sorry for the errors. I hope you can grasp my meanings.
6 melpol // Dec 27, 2009 at 12:20 pm
Two savages fighting over a coconut is not a cultural clash but only a fight for survival. The solution would be if they split the coconut. But there are those that say that the stronger savage should use the coconut for dessert and cook the loser for the main meal.
7 sinz54 // Dec 27, 2009 at 12:46 pm
COProgessive:
You keep assuming that “profit” is a major cost driver for why health care costs keep escalating. Studies in the U.S. show something very different: In America anyway, the biggest contributors to health care costs are the increasing lifespan of the population (you can now spend the last third of your 90 year life span battling arthritis, for example); the use of increasingly expensive high-tech medicine; and various social pathologies, especially poverty.
The fact that NO Western nation has been able to keep health care costs from rising faster than its GDP (even those with single-payer) suggests that the way that health care is paid for isn’t as important as the way health care is done in the society. And all those nations with government-monopoly health care have been forced to resort to rationing of care. The waits for MRI, CT, elective surgery in Canada, are all significantly longer than in the U.S. And the British NHS goes much further. They work off Quality Adjusted Life Years. They simply refuse to pay for treatments that would extend your life by less than 0.5 QALY. Instead, you die. They have genuine “death panels,” not the phony ones that Sarah Palin claimed the Congress would create.
I understand that you’re opposed to making a profit off health care on moral grounds–but you haven’t defended the notion that removing profit from the health care system will contain costs in the long run. You’ll get a one-time saving, that’s all.
Finally, I have challenged ALL proponents of single-payer–and I challenge YOU–to prove that you can design a single-payer system without being forced eventually into the kind of rationing of care we’ve seen in Canada and Britain. So far, I’ve had no takers.
8 franco 2 // Dec 27, 2009 at 1:13 pm
A few “bright spots” can be found anywhere. What really is your point? You wanna pass this government takeover?? If not, bright spots are irrelevant.
9 SpartacusIsNotDead // Dec 27, 2009 at 2:19 pm
Sinz wrote: “Romney had punted on cost containment, because he was afraid that providers or insurers would back out of the deal.”
RomneyCare put off cost containment because cost containment requires certain stakeholders to lose revenue. However, none of the stakeholders will give up that revenue without a fight that prevents substantial reform from occurring. Doctors have been forming groups with salaried pay for many years. This is neither a new concept nor a game-changing one.
I am amazed at the conservative myth that there can be meaningful cost containment without financial harm to certain industries or without interference with the marketplace. It cannot happen, and most liberals recognized this a long time ago, hence the support for the public option.
Conservatives opposed the public option purely for ideological reasons. There is no empirical data to support the conservative allegation that a public option would harm actual care or ruin the private insurance marketplace. There is, however, plenty of empirical data showing that a public option (1) puts downward pressure on premiums, and (2) provides affordable coverage for all participants.
I’m still looking for the conservative counter-argument to the following:
http://www.allbusiness.com/insurance/insurance-policies-claims-insurance-premiums/13354009-1.html
10 SpartacusIsNotDead // Dec 27, 2009 at 2:32 pm
Sinz wrote: “Finally, I have challenged ALL proponents of single-payer–and I challenge YOU–to prove that you can design a single-payer system without being forced eventually into the kind of rationing of care we’ve seen in Canada and Britain.”
The French, Dutch, Germans, Japanese, Spanish, Italians and Singaporeans have all taken that challenge and proved you wrong. Why do you keep insisting that the Canadian or British systems are the only possible outcomes for the plans proposed by liberals? You keep arguing against a straw man.
Moreover, there have been plenty of conservative Canadian posters (e.g. Conservativemoderate) on this blog who have made clear that the kindof “rationing” that has become the favorite conservative boogeyman in this country simply does not exist there. No one is dying or having their health worsened as a result of delay in the provision of services. Of course, as you well know, there is plenty of rationing in the U.S., and tens of housands of people have died or suffered worsened health as a result of such rationing. And, many many more have suffered financial ruin, including bankruptcy, because of our system. All of this is true even though we spend twice as much on healthcare as the Canadians or the British.
Sinz, you know enough about healthcare and the insurance industry in this country to know that many of your arguments are straw men. You also know enough to not deny the obvious advantages that most other systems have over the U.S. system. It’s appropriate to point out the advantages the U.S. system has over other systems, but that argument should not deny the obvious or rely on straw men.
11 WillyP // Dec 28, 2009 at 8:49 am
actually, canadianmoderate has told me several times that there is rationing, much like people have been describing here. of course there’s rationing. there’s rationing with any system. the question becomes: which system must ration more because it provides less overall? and, of course, the answer is the public/single payer plan; because, just like all those attempts at central planning last century, it’s based off a flawed and perpetually ruinous model.
12 sinz54 // Dec 28, 2009 at 9:41 am
SpartacusIsNotDead:
It’s going to take too long to discuss every single one of those systems. But I will take up the French system, because it’s arguably one of the best.
It’s the best because it PAYS more for health care than other countries–and forces patients to pay more too.
It pays about 12% of GDP for health care, which is much more than most of those other countries. It also remains solvent by reimbursing patients for only 70% of routine health care costs (100% for serious illnesses). So for routine stuff, the patient has considerable “skin in the game”–more than in the U.S. where the insurer picks up the full charge of the doctor visit for just a $20 co-payment.
Even with the French system, an increasing number of French citizens are turning to so-called “complementary insurance,” which pays for extras not covered by the public system–such as medications and much dental care. So you still have a two-tier system, in which the affluent can pay for more coverage.
You don’t get something for nothing. If we moved toward the French model, most patients would pay more for care that didn’t involve life-threatening illnesses. They would pay more for drugs and dental care. And those who could afford it, would still purchase private insurance to cover these things.
However attractive the French model sounds (and I agree that it’s superior to the mess we have in America), that’s why it’s a non-starter here in America.
You liberals have to understand once and for all that you can’t FORCE tens of millions of Americans to accept less than they already have, in order to achieve a “reform” that might benefit others. You can get away with Soaking The Rich, simply because there aren’t enough of them to vote you out of office. But when you start Making The Middle Class Sacrifice, you end up getting kicked out of office.
Ask Jimmy Carter or Tom Foley.
13 sinz54 // Dec 28, 2009 at 10:12 am
COProgressive:
By the way, there’s someone who’s been posting to Politico.com with the same user name as you use here. Did YOU post this in a thread about the terrorist attack???
You should stick to talking about health care.
You clearly don’t know what you’re talking about when it comes to counter-terrorism.
Here’s a hint: To a suicide-bomber, jail is neither a punishment nor a deterrent.
14 WillyP // Dec 28, 2009 at 10:32 am
SpartacusIsNotDead links to California’s system.
California, which is in more debt than the totality of Eastern Europe, which itself is bankrupt.
Hello? Do you have a brain?
15 PracticalGirl // Dec 28, 2009 at 11:53 am
Eli left out one big plus, if we get a bill passed: Finally, the United States begins to tackle the subject that we’ve hidden our heads in the sand over for decades.
Sinz-
You bring up getting rid of serious pre-existing conditions as an argument against good free market practices. You discount, however, the fact that the private insurers currently can deny coverage under the pre-existing umbrella to anyone they choose with little or no consequence. Thus, somebody who has once used insurance to fund treatment that actually turns a “pre-existing” condition into “nonexisting” can-and is- still penalized at an alarming, collusive rate by private insurers across the board. And the many consumers inthis position are locked out of responsible coverage, at any cost.
How is the ability to turn down a customer based on things the consumer has no control over good for our free market? This only encourages (forces) more people to stay unisured and contributing to the no-pay/slow-pay pattern for regular health care that cripples providers.
16 WillyP // Dec 28, 2009 at 12:13 pm
practicalgirl,
Did it ever occur to you that you were not born, nor was I, with a claim on somebody else’s time or money? Why must a private insurance company be forced to insure people who will be a drain on their pool? Moreover, why don’t you support providing individuals with the same tax incentives as employers for purchasing coverage?
I may feel that these people have every right to live, and enjoy the treatment of our first class medical system. But I would prefer this be done through charity, not through the state.
What is the point in learning to be moral and decent if you have no choice in the matter anyhow? Might as well legislate all behavior, and make charity compulsory.
17 PracticalGirl // Dec 28, 2009 at 12:32 pm
WiilyP:
You seem devoid of the ability to comprehend what you read. The question was about whether or not it is, indeed, a healthy “free market” when an entire group is allowed to act in concert against large groups of people who had the need to utilize coverage (a no-fault situation) and now are classified as “pre-existing”,, whether or not it is true.
Example: A healthy, no smoking female age 44, is denied private insurance coverage for a “pre-existing” condition that was surgically eradiated a decade ago, and therefore not only isn’t “pre-existing” but is “non-existing”. Our current system, however, allows all the private carriers to deny this person private insurance not on the basis of her health today (perfect) but based on something that happened 10 years ago. Should private, for-profit companies legally be allowed to treat a person like this (and there are many, many in this boat) exactly the same as a lifetime smoker? They can and they do.
So what, then, are the private insurers allowed to classify as “pre-existing”? Anything they damn well please, is the right answer. Strictly speaking, this is the very definition of a free market, but it is one of the things that is bankrupting our citizens and our country.
18 PracticalGirl // Dec 28, 2009 at 12:41 pm
WillyP:
“I may feel that these people have every right to live, and enjoy the treatment of our first class medical system. But I would prefer this be done through charity, not through the state. What is the point in learning to be moral and decent if you have no choice in the matter anyhow? Might as well legislate all behavior, and make charity compulsory.”
You have obviously not thought this through. The taxpayers-you and I alike-already have “compulsory charity” in the form of unpaid medical bills that get charged off and help cause hikes in insurance rates and costs.
In the situation described above, the person does not need “charity”, she needs “parity”, in the form of a system that forces companies that insist on cornering a market to evaluate cases based on what they really are, not based on what the companies collusively decide they are.
Your idea is not only morally bankrupt, it’s unworkable and is the very mindset that has caused costs-insurance and services-to soar.
19 WillyP // Dec 28, 2009 at 12:48 pm
practicalgirl,
yes, I think “whoever they damn well please” is how I view the right of private insurance.
people, of course, do get covered with several “pre-existing” conditions all the time. they are pooled in with lower risk people, and so coverage is made affordable. this is the nature of insurance as a business model.
i look to expand the pool by ending the employer monopoly on employer-provided benefits (what amounts to a subsidy), thus extending coverage to millions of young people who work at no benefit jobs, and expanding the risk pool -> decreasing the required payments required by those who use the system most. this is in line with how car insurance works, and since car insurance is not bankrupting the country, perhaps we should follow the model as employed by geico, all state, progressive etc..
i maintain the only way to provide someone with health coverage who is unable to pay for it is charity. you prefer your charity state directed; i prefer mine voluntary. you tell me its the greedy insurance corporations; i tell you the world isn’t perfect, but insofar as things can work, they are being short circuited by government.
i do not have any trouble comprehending what i’m reading. you, on the other hand, are so ideologically fixated on a government takeover of our healthcare system that you cannot bear to read plainly written and logically argued alternatives. insurance companies are not run by greedy, evil people who would rather see people die than extend coverage. quite the contrary – they are stuck dealing with employers, not individuals, because of a quirk in the tax code.
you libs like to ask “what’s the root of the problem?” when considering esoteric questions of war and hate. erroneously the libs answer “poverty” and “racial discrimination.” well, i’m addressing the root of the national health insurance problem. what say you?
20 WillyP // Dec 28, 2009 at 12:58 pm
practicalgirl says:
“Your idea is not only morally bankrupt, it’s unworkable and is the very mindset that has caused costs-insurance and services-to soar.”
excuse me? I am not the one who spends their time arguing for an American health politburo. You might want to question your own mindset, as it is reminiscent of commies and fascists. You know, East Germany had national health insurance in the 1950s, as did Soviet Russia. I don’t think their plans failed because the commies wanted them to fail – this would (and did) only breed resentment and dissidentism. Clearly, then, it was a problem with the economic model itself.
Whether you are able to comprehend this fact, I question. But rest assured, it is the model that fails, not the intentions. Good intentions are worthless if you adopt a failed model. Milton Friedman made this point again and again, and then, correctly, labeled HIS OPPONENTS the ones who should do some soul searching. Self congratulations for adopting your favorite “system,” one that has proved incapable of addressing societal needs, is properly called VANITY.
What are your intentions here? To make the population, as a whole, healthier, or to feel good about your party line vote?
21 PracticalGirl // Dec 28, 2009 at 1:01 pm
WillyP:
You’re completely uninformed. “People” are being denied coverage due to NON existing conditions all the time. And nowhere in my example did I talk about somebody else paying for the coverage? The example cited (and there are many, many) is ready to foot the bill for her own coverage yet NOBODY will extend it. To a healthy, non-smoking, issue free woman.
Perhaps you should step back and learn a little about what’s really going on in the free market and why it’s unhealthy for the country when it comes to health insurance. I am talking about one of the “root problems”- uncovered people and unpaid bills- that has led us to where we are.
Again: Is it healthy for the free market as a whole when insurers are allowed to deny converage for a healthy person who is willing to pay but “classed” out because she once had to utilize coverage for something that was not the fault of life style and in fact no longer exists?
And please do tell us who “pays” for the charity you endorse. And what happens when that “charity” dries up? Do people stop getting care? Of course not. They just stop paying for it, meaning that the “charity” is paid by all-especially those responsible (and lucky) enough to get insurance coverage.
22 PracticalGirl // Dec 28, 2009 at 1:08 pm
WillyP:
Like most right wingers, you seem to be unable to have a discussion about real issues without delveing into parroting of somebody else’s ideology. Congratulations. You’ve read a book. Now go out and do some research on what’s really going on in this country. Start with how much your insurance coverage has been raised, year by year, to contend with the uninsured costs that go unpaid.
23 PracticalGirl // Dec 28, 2009 at 1:29 pm
WillyP:
Forgot to answer your question:
“What are your intentions here? To make the population, as a whole, healthier, or to feel good about your party line vote?”
You’re pulling assumptions about “my party line vote” out of your butt, but that is the way of the right winger. Makes you feel good; so be it.
Of course, we need to make the population, as a whole, healthier. Getting more people covered is a great way to help do that, stem the rising costs in both care and insurance due to the uninsured, and help lower the federal deficit along the way, as the CBO says the current plan would. A “healthy” population also includes one that isn’t footing the bill for all by some.
24 WillyP // Dec 28, 2009 at 1:35 pm
practicalgirl,
you don’t get it. the government, yes – the government – has caused the current dislocation. why would anyone in their right mind advocate further, destined to fail, interventionism?
you’re quite right this is an ideological battle. you are a statist, through and through. you do not like insurance companies because they act out of profit. you might as well acknowledge this, or at least stop acting like it’s so offensive for someone else to call you one.
what’s going on this this country? we are in the midst of a huge, huge economic catastrophe caused by federal government policies. we are not recovering because of further government policies of interventionism . the # of unemployed continues to grow, and likewise the # of uninsured continues to grow. the nation is also facing a debt problem that is soon going to rival world war 2 in terms of indebtedness.
in the midst of this, you sit here and advocate a timelessly bad idea, one which will add significantly to the debt, and create further dislocation and shortages. meekly, you attack me for daring to question your ideology.
how about YOU enter the real world, and figure out how to deal with a debased currency, massive debt, moral hazards for the financial industry, and an entire party dedicated to hating private business?
25 PracticalGirl // Dec 28, 2009 at 1:45 pm
WillyP:
Why would you classify as a “timelessly” bad idea one that requires a monopolistic industry to cover a healthy person? And, really, what’s wrong with the ideology of expecting such an industry to act responsibly, even within a for-profit model? It is clear that you are annnnnggggrrryyyyy…But does that prevent you from staying on topic? Apparently.
How has the government caused the health care crisis? And, please, do tell, who do you propose pay for the “charity” that will apparently, in your world, take care of billions and billions of dollars of unpaid health care every year?
26 Carney // Dec 28, 2009 at 2:01 pm
#1 sounds appealing, but if it were indeed more efficient, wouldn’t insurance companies, for-profit hospitals, doctors in private practice, etc., be doing so with more speed and enthusiasm? I mean, we didn’t need government spending, mandates, or subsidies to encourage the spread of ATMs and online banking.
27 WillyP // Dec 28, 2009 at 2:07 pm
practicalgirl,
a monopolistic industry? first of all, collusion, which you apparently believe is rampant, would not exist if there were a MONopoly.
second, if you are concerned with monopoly, why don’t you at least recognize that when you eliminate the need to make a profit to stay “in business,” you almost always create a monopoly, or close to it. can you say public schools? matter of fact, the term “monopoly” originally referred to the government grant of special privilege.
if you weren’t so incredibly dense, you would know how the government has caused the healthcare crisis, because i’ve written it countless times – SUBSIDIES TO EMPLOYERS TO PROVIDE HEALTH INSURANCE. state governments mandate what policies must cover on a state to state basis. you cannot purchase insurance over state lines. there is licensing up and down the whole system, from nurses and doctors, to drugs. the fda serves to protect parochial interests of u.s. drug manufacturers, keeping us from importing and selling drugs that have been in use in europe, sometimes for decades. all of these things RAISE COSTS and DECREASE COMPETITION.
in my world, there would likely be a comparatively small need for charity because the economy would not be in a tailspin, and people could purchase insurance on the open market. for the cases that require charity – truly disabled people who are unable to sell their labor on the open market – voluntary associations would be established, as they have been in the past, perhaps through churches or other community centers.
28 Carney // Dec 28, 2009 at 2:20 pm
PracticalGirl, I dispute that there is a “crisis” at all.
According to Fox, 93% of insured Americans who suffered a serious illness were satisfied with their coverage.
If you reject Fox on knee-jerk grounds, ABC News and the Washington Post report the same findings: among insured people who’ve experienced a serious or chronic illness or injury in their family in the last year, an enormous 91 percent are satisfied with their care, and 86 percent are satisfied with their coverage.
For the uninsured, there are a plethora of free clinics, non-profit and church hospitals, emergency room care, and massive handouts like SCHIP and Medicaid.
To the extent that there are health care problem, many are indeed caused by government.
The whole employer-based system is a relic of World War 2 wage freezes imposed by the government during World War 2 to prevent companies from bidding against each other to attract scarce labor (in the shockingly ignorant belief that high wages rather than monetary mismanagement leads to inflation – confusing a symptom of inflation for its cause). It has led to people getting or keeping jobs they hate solely for the health care benefits, or losing their health care when they leave or lose their jobs.
Health plans are stiflingly regulated, stuffed with unnecessary coverage as a result of government mandates – so in effect every plan is now a Cadillac plan. But what if you just wanted to buy a Kia for basic workaday coverage, leaving out AIDS and other unlikely things? Not allowed, for your own good. Also plans are forced to take patients whom they KNOW will cost more than they’ll bring in (“pre-existing conditions”) – forced to be welfare or charity providers, and those costs are then passed on to everyone else. And then the politicians wail about how health plans are unaffordable!
Finally, when a third party pays for everything, you ignore cost – this keeps costs up. If you paid a fixed amount every month for a government mandated unlimited quantity of food, you would eat better and so would your dog. Or if there were government regulated electronics purchasing plans that reimbursed manufacturers for the costs of their products, DVD players would still cost $1,000 as they did a dozen years, because nobody would have an incentive to cut prices, because consumers won’t pay or feel the price but would feel entitled to continue demanding “access” to top quality DVD players.
In so, so many ways government bollixes everything up. The hilarious or sad part is we are scared to let go – like a Soviet refugee wondering how we can all just like wherever we want without getting official permission from the Housing Ministry. Wouldn’t that cause mass chaos, with everyone trying to jam into some places and emptying out others, etc? Being told it all works out would seem like unintuitive, inexplicable madness to him.
29 Carney // Dec 28, 2009 at 2:22 pm
I meant “live” wherever we want, not like.
Lame, non-editable FrumForum comment system.
30 SpartacusIsNotDead // Dec 28, 2009 at 2:27 pm
Sinz wrote: “If we moved toward the French model, most patients would pay more for care that didn’t involve life-threatening illnesses. They would pay more for drugs and dental care. And those who could afford it, would still purchase private insurance to cover these things. . . However attractive the French model sounds (and I agree that it’s superior to the mess we have in America), that’s why it’s a non-starter here in America.”
Thank you for addressing the question directly, however, you’ve still gotten it wrong. If we moved toward the French system Americans would not pay more individually or through government; we would pay substantially less. As a government we would only pay about 12% of GDP. As individuals we would pay only the very small premium for supplemental insurance; we would not be paying the full premiums we currently pay to insurance companies.
If you add up what Americans pay in insurance premiums plus what they pay in taxes (all taxes) and you compare it to what the French pay for supplemental insurance and what they pay in taxes, you should readily conclude that for healthcare (and many other public goods) the French (and many of the other countries I listed in my earlier post) are getting a much better value.
Having said that, I agree with you that the French system, while better, is probably not politically viable, but only because so many Americans (mostly on the Right) are ignorant (often willfully) of better alternatives in other countries. I’m not recommending we drop wholesale our current system and adopt the French system or any other system. I am, however, saying we should incorporate features of those other systems that can and will address the problems in our current system, which include cost containment and universal coverage. This is why so many of us on the Left have argued for a robust public option (not single-payer and not the French system).
Unfortunately, the Right is opposed to a PO not on the merits, but on ideology alone. I’m still waiting for the conservative rebuttal to the link I posted @ #9.
31 PracticalGirl // Dec 28, 2009 at 2:31 pm
Carney:
Are you suggesting that we dismantle the insurance system altogether?
32 WillyP // Dec 28, 2009 at 2:48 pm
spartacus:
WillyP // Dec 28, 2009 at 10:32 am
SpartacusIsNotDead links to California’s system.
California, which is in more debt than the totality of Eastern Europe, which itself is bankrupt.
Hello? Do you have a brain?
33 WillyP // Dec 28, 2009 at 2:49 pm
carney, i agree. there is no real “crisis.” it’s largely manufactured. to the extent the crisis is acknowledged by more and more people, this is a function of the increasing levels of unemployment, another symptom of out of control government.
34 PracticalGirl // Dec 28, 2009 at 3:04 pm
WillyP:
The current insurance industry is certainly holds a monopoly on consumers in the US. If you truly believe that there is “competition” within the industry, then you have obviously not shopped for policies lately, either individual or company. Price controls and fixing exists. With no outside competition, this will never change.
The fundamental problem with having for-profit corporations solely in charge of health insurance is that they have very little motive to affect prices downward, especially the top ten largest insurers 9 of which are public and beholden to their shareholders first, not their customers. A system of out of control health care costs which helps them justify higher premium costs actually feeds into their business model. Higher costs trickle down, not to the bottom line of the insurers or providers, but to the businesses and consumers who pay the premiums. And there is no incentive, in the current system, for either providers or insurers to participate in any meaningful cost containment measures. Bottom line, that’s why you pay $12 for 2 Tylenols in the hospital and nobody bats an eye.
35 WillyP // Dec 28, 2009 at 3:23 pm
practicalgirl,
you belie your own logic with every word.
where is there more competition? on the “street” (i.e., drug stores) or in (largely state run) hospitals? where is the consumer directly making the purchase, and where is there a middle man? notice the parallelism between this and the current model, which i have repeatedly advocated changing.
what company is not ultimately beholden to their customers? better: how the heck are public school’s accountable to their customers? to what extent are PTAs a model we’d like to emulate in healthcare?
“Higher costs trickle down, not to the bottom line of the insurers or providers, but to the businesses and consumers who pay the premiums.”
Higher costs ALWAYS
36 SpartacusIsNotDead // Dec 28, 2009 at 3:25 pm
WillyP,
I noticed you repeated your response to my post. I stopped reading all of your posts quite some time ago because they seem like the internet equivalent of fringe talk radio – heavy on ideological and inflammatory hyperbole, very light on facts and analysis. I don’t think you contribute anything worthwhile to this blog, and I doubt I could have an exchange with you that could benefit either one of us or anyone else.
Feel free to continue to respond to my posts if you’d like, but I won’t be responding to any of yours absent a dramatic change in them.
37 WillyP // Dec 28, 2009 at 3:26 pm
ugh… let me try that again
Higher costs ALWAYS trickle down to customers. This is a fact that you’ll never be able to change. The most you can do is redistribute costs, which always leads to shortages!
“A system of out of control health care costs which helps them justify higher premium costs actually feeds into their business model.”
Well, then create competition – real competition – not a government bureaucratic nightmare. You’re going to pay the costs one way or the other. What you need to ask is whether you like dealing with FedEx or the USPS. FedEx makes a profit; you subsidize the USPS in taxes.
38 WillyP // Dec 28, 2009 at 3:27 pm
spartacus,
good! spares me a headache!
here’s a piece on your utopia california:
http://www.claremont.org/publications/crb/id.1650/article_detail.asp
39 WillyP // Dec 28, 2009 at 4:39 pm
spartacus,
“I noticed you repeated your response to my post. I stopped reading all of your posts quite some time ago because they seem like the internet equivalent of fringe talk radio – heavy on ideological and inflammatory hyperbole, very light on facts and analysis.”
Analysis is plentiful, and in line with how these matters are analyzed intelligently (rather than abusing statistics to “prove” a very minor point). Hyperbole is an integral part of rhetoric, and if used properly utilized, contributes to understanding.
40 WillyP // Dec 28, 2009 at 7:28 pm
says sinz (a long while ago):
“I’ve always said that a purely free-market approach to health care must necessarily lead to Social Darwinism.”
Actually, it would not “lead” to social Darwinism. It IS social darwinism in action – at least for the corporations/institutions that provide health care. In this way, the poor performers would go under, and we’d get more of the successfully modeled firms. But it has nothing to do with eliminating the sick and poor. Perhaps if we did away with charity, sure. But you act as though the conditions of the sick and poor were only improved under state provided care. If anything, state care tends to stagnate, creating problems that linger on, generation after generation. The market system rewards innovation and solving problems. I would bet the sick and otherwise infirm would be better off if care was provided by private charities.
41 franco 2 // Dec 29, 2009 at 8:59 am
Finding the good in Frum Forum…WilleyP …and Carney
42 WillyP // Dec 29, 2009 at 10:17 am
franco, few and far between here…
tom sowell on obamacare
http://article.nationalreview.com/print/?q=Njg4ZjliNTRiMzlkMTlmYTJiOTAyYWYzYTM1NjA2MDU=
43 balconesfault // Dec 29, 2009 at 12:10 pm
But you act as though the conditions of the sick and poor were only improved under state provided care.
The conditions of the sick poor have been greatly improved by having access to state provided care.
44 WillyP // Dec 29, 2009 at 1:02 pm
balcones, you sound like a ChiCom.
“The conditions of the sick poor have been greatly improved by having access to state provided care.”
Really?
45 WillyP // Dec 29, 2009 at 1:04 pm
Hahaha, all you angry libs. This should give you an idea of how your “reform” actually works, despite our loathsome president’s rhetoric:
http://www.marketwatch.com/story/health-industry-execs-poised-to-make-a-bundle-2009-12-29
Oh! Those DAMNED insurance companies!
46 balconesfault // Dec 29, 2009 at 1:08 pm
tom sowell on obamacare
tom sowell doesn’t get it.
First, I guess since healthcare played such a small part of the Republican political process in 2008, Sowell forgets that it was a major theme during the Democratic Primaries. Had Obama not pledged to pass something, then Dems would have nominated someone else. And what is passing is pretty close to what Obama pledged to deliver. He is, in other words, fulfilling the promises he made both during the primaries and election. It is part of what he was elected to do.
Just like Bush was elected in 2004 to radically change Social Security. Wait – you say that he really never mentioned that during the 2004 campaign? I wonder if Sowell was wondering what the hurry was back in 2005 when Bush tried to push privatization out of the blue?
Second, Democrats in Congress were whipping this fire to push legislation through now. Sowell acts like the Dems are some sort of Obama personality cult, like the Repubs were a Bush personality cult much of the decade. If you’ve followed the dynamics behind the healthcare bill process, you’d know that this is far from the truth. Passage of a healthcare bill was a priority for the great majority of the Democratic Caucus (contrasted with passage of the Medicare Drug Bill in 2003 which was clearly a matter of Bush dragging the Republican Caucus somewhere where it wasn’t particularly enthused about going). Any sitting President was going to be facing a bill from Congress. Because it was Obama in the oval office, and Dems tried to pay homage to his desire for “bipartisanship” the process probably dragged on much longer than it would have otherwise. Remember that there were 4 bills passed from Senate Committees early last summer, including Kennedy’s … without Obama pushing for bipartisanship there’s no way Baucus would have been allowed to keep the Finance Committee sitting around for so long waiting for one Republican to vote it out of committee.
Third, some major provisions kick in immediately. The House bill would require insurers to immediately cover reconstructive surgery for children with deformities. It would also immediately prohibit insurance companies from denying coverage based on domestic violence incidents that now are sometimes classified as pre-existing conditions. The Senate bill would immediately prohibit insurers from denying coverage to children with pre-existing conditions. Were it not for budget obsessed blue dogs, the subsidies would no doubt be kicking in much sooner than 2013.
Maybe some Republicans would want to vote for a bill to kick in the subsidies sooner? That would remove that concernn for Sowell.
47 balconesfault // Dec 29, 2009 at 1:10 pm
balcones, you sound like a ChiCom.
Willy, you sound like a blind ideologue.
48 WillyP // Dec 29, 2009 at 1:17 pm
balcones, a ChiCom is a blind ideologue, but I digress…
“Were it not for budget obsessed blue dogs”
Ha! Budget obsessed?!?! Hardly! Almost all, if not all, voted for the budget busting stimulus! Ah you’re so incredibly naive…
And what if they were budget obsessed (which they are clearly not)? Would this be a bad thing? Have you seen the national debt lately?
http://blog.mises.org/archives/011307.asp
49 balconesfault // Dec 29, 2009 at 1:20 pm
Budget obsessed?!?! Hardly! Almost all, if not all, voted for the budget busting stimulus!
Yes, because they saw tax revenues plummeting during a depression as being a much greater threat to our budget (with its committments to social spending and a 700 billion military) than temporary spending increases.
Have you seen what the projected 2009 deficit was before the stimulus bill was passed?
50 WillyP // Dec 29, 2009 at 1:21 pm
Err, that’s the deficit, but the point holds.
Here’s the debt:
http://rrycrawsblog.blogspot.com/2009/03/us-government-debt-projection.html
51 balconesfault // Dec 29, 2009 at 1:36 pm
yeah yeah – there’s the debt
I don’t understand the bar chart, however – our national debt hit 11 trillion in March 2009. The numbers for 2008 look wildly low.
Granted, it’s a serious problem – but it has resulted from our overstripping during the last decade the ability of domestic capital sources to primarily fund the debt
which happened in no small part thanks to two things – the Bush tax cuts, and the Middle Eastern wars.
that said – do you remember this?
http://news.bbc.co.uk/2/hi/business/411973.stm
52 balconesfault // Dec 29, 2009 at 1:38 pm
by the way – when one talks about the “budget”, it is proper to talk about deficits. Debt plays a part in that it contributes to the deficit (via debt servicing) – but if you’re going to talk about “busting budgets” that refers to an annual deficit. Debt is an accumulation of deficits.
53 WillyP // Dec 29, 2009 at 1:52 pm
i know the difference in terminology between a deficit and (total) debt. i was correcting myself, as i incorrectly pointed you towards the deficit while calling it debt.
you’re exactly right – we have not paid for 2 wars, and were under the false illusion of prosperity created by a credit boom that forced us to eat out savings. we’re in that pit now.
instead of creating the mother of all entitlement programs – obamacare – when clearly the rest we’ve created are already going broke – we should be SLASHING government spending, reducing taxes, and leaving the damn money supply alone.
clearly, we are not only getting some of it wrong, but literally all of it. i would recommend reading a book on the 1930s, because that’s how we’re positioning ourselves. the only saving grace is the 22nd amendment.
and, as predictable as ever, the corporate interests do get their way after being coerced by government – health insurance execs will make off like bandits.
http://www.marketwatch.com/story/health-industry-execs-poised-to-make-a-bundle-2009-12-29
sometimes i wish i were wrong more often!
54 balconesfault // Dec 29, 2009 at 2:36 pm
we should be SLASHING government spending
Had we done that in late 2008 as a response to the economic collapse, we’d be sitting around with a 25% unemployment rate by now.
And yes, you are right, the health insurance execs will make off like bandits. For that we can largely thank Joe Lieberman, Ben Nelson, Blanche Lincoln, and the entire Republican caucus. They served their constituency very well.
55 WillyP // Dec 29, 2009 at 3:43 pm
Maybe unemployment would have spiked at 20%. It’d also be on its way down now, rather than stagnating. It will rise again because the commercial real estate market is about to go belly up, and the Fed’s easy money policy is funding unsustainable ventures. Hey, let’s add on the largest entitlement program the world has ever conceived. Seems like a prudent time, right?
Ah, the Obama recovery!
56 balconesfault // Dec 31, 2009 at 1:06 pm
Hey, let’s add on the largest entitlement program the world has ever conceived.
Seriously? About 650 million Chinese belong to the New Rural Co-operative Medical Care System, which is heavily subzidized by the Chinese government.
Have you no sense of reality?
57 WillyP // Dec 31, 2009 at 4:20 pm
balcones, relative to what we spend now on entitlement programs, what the estimated obamacare program will cost, and especially what it will actually cost, the Chinese program is SMALL:
From Wikipedia:
“On January 21, 2009, the Chinese government announced that a total of 850 billion yuan will be provided between 2009 and 2011 in order to improve the existing health care system.”
A yuan is about $0.15 on the dollar, so ~130 billion U.S.D. over 2 years – pitifully small compared to what our plan would cost.
Social security paid out $612 billion alone in 2008. $682 billion for Medicare in Medicaid in the same time period. And you want to add a public plan, which will rival these costs AT LEAST.
To answer your question: Yes, unfortunately I do have a sense of reality, which makes your denialism that much more unstomachable.
58 Pass the Healthcare Bill – NOW! « Uncle Max's Musings on Politics and Culture // Mar 13, 2010 at 9:27 pm
[...] This bill contains many good measures. From a pure moral perspective, we cannot continue to have 40+ million people to be without [...]
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