RSS Feed MenuThe next great public policy debate in the United States will involve a health care reform idea championed by an academic who has no medical background and doesn’t serve in the Obama administration, and whose original proposal was published in a largely unread book.
Jacob S. Hacker first caused a stir in 1997 when, as a Yale graduate student, he described the failure of President Clinton’s health care efforts in The Road to Nowhere. In the years since, he has continued to criticize Democratic overambition on health policy, eventually fashioning his own alternative. His idea has become the focus of a heated and increasingly bitter debate on Capitol Hill. House Speaker Nancy Pelosi, a Democrat, has declared it essential for any health care reform; Republican Senator Mitch McConnell calls it a deal-breaker. Conservative and liberal organizations are gearing up for a grand skirmish.
The idea? Americans would have a new government-run plan, modeled after Medicare, as an option for health insurance. No one would be compelled to enroll in it. Democrats contend that people would have more choice, and the competition would improve all coverage.
Though it may seem modest, the Democratic idea of introducing a public-plan option is worth fighting over. For the Republican minority in Congress and even for moderate Democrats, this is the line in the sand. They believe that instead of encouraging competition, the public-plan option will actually undermine it, will increase red tape, and will exacerbate inefficiencies in the health care system. It could even spell the beginning of the end of private insurance.
To read the rest of the lengthy essay from New Atlantis that I co-wrote with Manhattan Institute senior fellow Paul Howard, see here.
ModerateGal // May 27, 2009 at 8:59 pm
Dr. Gratzer, apparently France and Italy can have public and private health insurance that coexist well. Why do you think that the U.S. is too stupid to do it as well as they do? I actually believe that my country is as intelligent as those other two countries, but obviously you do not.And, yes, Dr. Gratzer, we get it. You do not want any sort of public option for health insurance, but why don’t you stick a finger up in the air and see which way the wind is blowing. Every time I see a post from you, I just roll my eyes with how out of touch you are. You should go write another book out in your ivory castle.Honestly. Do you really think that the average household out there that does not have health insurance really can afford it and just said “no thanks”? I want to hear it from you exactly how much health insurance costs.
// May 27, 2009 at 11:12 pm
ModerateGal wrote: “Every time I see a post from you, I just roll my eyes with how out of touch you are.”You are so right about this guy. I don’t even bother to read his posts anymore b/c they have ZERO credibility. You’ll notice his posts used to get many more comments, but I think everyone has just tuned him out b/c NOTHING he says makes any sense.
gibberish // May 28, 2009 at 5:04 am
At least Dr Gratzer has stopped posting those “someone died in Europe due to medical error therefore all changes to US system will kill us all” stories. As if no medical horror had ever happened in the USA. They were unworthy of this website.This posting uses the method of “I won’t bother to argue much whether this is a good proposal or not – I’m going to spend my time undermining the credibility of the guy who came up with this idea”. Maybe the rest of his “lengthy” article is more serious – I am deterred from finding out by the 1st paragraph and his history
gibberish // May 28, 2009 at 6:12 am
To be fair – having read the article – there is (almost an afterthought) an actual proposal for health reform.I thought this was meant to be a blog for building a conservatism that can win again? Surely this would mean constructive commentary on health issues – perhaps proposals sane Republicans can get behind? But, even though it seems he has ideas of his own, Dr Gratzer doesn’t seem to think this the right forum for anything with intellectual contentDr Gratzer’s posts here rarely do more than attack all idea of change – can’t we leave this sort of thing to the Limbaughs?
Mike K // May 28, 2009 at 7:02 am
The Canadian system is an example of what not to do and, I fear, it is the model that Obama is using. The Medicare example in the article is the Canadian model. Medicare originally was a gold plated program that made a number of errors resulting in severe inflation of health care costs. In recent years, it has slashed payments and become far more bureaucratic as costs grew. More and more physicians are withdrawing from the program now. The internal medicine practice management consultants recommend no more than 10% Medicare in a practice. Do you wonder why ? Medicare does not, for example, allow private arrangements between doctor and patient. If you need to be seen more often than Medicare allows, you are out of luck.I am finding more and more physicians dropping out of Medicare altogether, a new development. Several physicians have been prosecuted for providing more care than Medicare allowed. These were cases of elderly patients or cancer victims. I am even learning that busy surgeons are dropping out of Medicare and choosing to do a cash business with patients. That, of course, is a lot more difficult for hospitals but I wonder how Obamacare will cope with these changes that are anticipating an IRS-style bureaucracy.I notice in the comments below a refusal to consider some of these issues. The biggest supporters of single payer, and the most dismissive of concerns by physicians, are the well who don’t like paying premiums. The sick are far more interested in the problems with the system. Physicians deal with the sick every day. “At least Dr Gratzer has stopped posting those “someone died in Europe due to medical error therefore all changes to US system will kill us all” stories. As if no medical horror had ever happened in the USA. They were unworthy of this website.”So you don’t want to read “unworthy” comments ? You have the president you deserve.
sinz54 // May 28, 2009 at 7:15 am
ModerateGal: The reason I’m concerned is that on the liberal blogs, liberals like Robert Reich are touting a public plan that is nearly “free”–extremely low premiums and co-pays–so as to lure Americans out of the private market and eventually kill the private market. Hence leaving us with a single-payer system by default, which is what liberals like Reich are now openly admitting their real goal is. It looks like the hard-core Left that campaigned for Obama wants no private market at all. They even want to drive Blue Cross out of business.I am not totally dismissive of a public plan. But I would insist on the public plan being a true fair competitor, not an artificially subsidized lure to kill the private market. (Would FedEx and United Parcel Service still be in business if the U.S. Postal Service offered to deliver packages for free, counting on subsidies from tax revenues to pay for the service?)In addition, it’s real hard to sue the Government, as you know. So private plans are always laboring under the cost of having lawyers to protect themselves from lawsuits, while the public plan would enjoy the luxury of Government immunity. Another example of unfair competition.The kind of public plan I have in mind would charge competitive (but NOT unfairly low) premiums, and be subject to the SAME consumer-protection laws as the private plans. That means the public plan could even be sued for bad service, just like a private plan. That would help prevent the public plan from crowding out the private plans.Senator Schumer has proposed such a public plan. His plan is worth considering.
sinz54 // May 28, 2009 at 7:48 am
The GOP refuses to face a basic fact: Health care, by its very nature, makes a free market in health care impossible. For two reasons:1. Many chronic illnesses, particularly those of old age, have no cure. Only extremely expensive treatments, that must be continued throughout the patient’s remaining life.2. Almost nobody wants to die, and nearly everybody wants to be as healthy as they can be. Hence demand for health care services will always exceed supply. Costs must rise continually, unless SOME kind of arbitrary cap or rationing is imposed.This means that government MUST intervene into the health care market in ways that free-market purists won’t like. Otherwise, the percentage of U.S. GDP devoted to health care will continue rising, as it is now–till it reaches unsustainable levels.
gibberish // May 28, 2009 at 8:44 am
@Mike K. Obviously I read them – but personally I’d prefer to read postings with content, wouldn’t you? More seriously if they make this website look a bit low quality it will undermine Frum’s project.
danbmil99 // May 28, 2009 at 9:18 pm
This is the perfect storm caused by the complete collapse of the GOP as a viable opposition party.By being so adamantly against any reform for so many years, the right has little voice in this fight. Everything we say from a conservative perspective is looked at as suspect. We are considered the mouthpiece of big pharma and insurance companies.With no counterbalance, the left, unchecked, looks poised to enact a huge boondoggle of a bureaucracy. At a minimum, we should be fighting hard on the tort reform part. This is a huge factor in the cost of healthcare and private insurance. Problem is, that argument looks like mean rich people telling sick people to f* off and die. It’s a PR loser.I feel like I’m watching a train wreck in slow motion.
sinz54 // May 30, 2009 at 5:37 pm
danbmil99: That wouldn’t stop the GOP today from at least *proposing* a plan now. It would still get covered on the news channels.The problem is not the GOP leadership, or even noted GOP political figures, or the GOP’s past history. Governor Mitt Romney, for example, had implemented health care reform in Massachusetts, where I live. Though costs are rising (which is no different from elsewhere in America) and will need to be addressed, the plan does work and does cover nearly everyone in the state.But there’s a more fundamental problem here: The true believers in the GOP base won’t accept anything other than purely free-market solutions. Yet when it comes to health care, a pure free market must necessarily lead you to Social Darwinism–health care will be determined by one’s ability to pay for care, not by the severity or criticality of one’s illness. Who wants to live in a society like that.Because the Romney plan depended on mandating all Massachusetts residents to purchase health insurance, the GOP base hated it–and in his campaign for the Presidency, Romney was actually forced to run away from his achievement.Last year, McCain proposed a plan that was more free-market (and, incidentally, less workable) than the Romney plan–yet the GOP base still didn’t like it, because it still preserved *some* role for the Federal Government. The true believers in the GOP are simply going to have to face the reality that a 100% free market in health care is politically impossible–it would require the poor to simply accept worse care or less care or both. That’s a nonstarter.