RSS Feed MenuLike many, back in January, I was willing to give the new Administration a chance.
Let’s be clear: many elements of the healthcare agenda, as set out on the campaign trail, seemed problematic. That said, the President tapped good advisors who “get it” – recognizing, among other things, that an employer-based health care system is less than ideal for employers, employees, and the economy. Politically, I felt that it would be reasonable for Republicans to try and work out some sort of a compromise with the White House.
These past months have been a rude awakening. In 16 years, Washington hasn’t seen such a dramatic, aggressive and, frankly, radical healthcare agenda. The bill passed by the House on Saturday stands out not simply because I disagree with the ideological underpinning of proposals like the public option, but because HR 3962 is bad legislation (running at 1994 pages and creating some 111 bureaucracies and agencies).
I’ve put the pen to paper. This week, my pamphlet – Why Obama’s Government Takeover of Health Care Will Be a Disaster – has been published. It’s available at Amazon.com; in the coming days, it will be distributed to Barnes & Noble stores across America. The 44-page essay, written in clear and concise language, explains what’s wrong with ObamaCare and points to a free-market alternative. You can read more about it here.
The pamphlet has already been mentioned on Instapundit.com. And there have been more detailed mentions of my essay and others in Encounter Books’ Broadside series (see here and here).
My friend and colleague Paul Howard discussed the essay recently on a podcast.
And for FrumForum readers interested in a sneak peek, here are the opening paragraphs:
World War II Veteran Jack Tagg is losing vision in his right eye. He suffers from macular degeneration, a progressive illness that causes blindness. A drug could slow the deterioration, but the government refuses to pay for it. Why? He’s not blind enough. With his left eye spared so far, a government panel has denied funding the pharmaceutical even though his doctor feels it’s needed.
No one doubts that Mr. Tagg is suffering. No one denies that medications would help him. The issue is cost. Mr. Tagg, frankly, isn’t worth it, according to a government bureaucracy charged with making the funding decision. Mr. Tagg isn’t alone.
This government panel has considered other drugs: a kidney cancer drug, which is expensive but proven to extend life; a new and lifesaving breast-cancer drug; an Alzheimer’s drug shown to slow the deterioration of the patient’s mind. Each time, the government panel has said no. Is this the future of American health care, with a group of well-meaning government bureaucrats standing between a doctor and a patient, determining—quite literally—who will live and who will die?
Well, it’s the reality of health care in Britain, where a government committee decides which drugs are worth funding by considering the monetary value of a year of life and measuring it against the cost of the medication. For those who feel that the United Kingdom has nothing to do with the American debate over health reform, consider this: One of the core ideas of ObamaCare is to create a British-style government panel to steer treatment decisions on this side of the Atlantic.
Rationing by committee. It’s one of the ideas that will radically transform American health care, leaving us with a shattered private insurance market and a huge government bureaucracy. Look to Britain to see the result—mass protests against government rationing decisions and people waiting for the most basic care.
See it in Canada, where the new president of the Canadian Medical Association has declared, “We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize.” See it across the Western world. See it, and realize this: Americans deserve better.
On the trail, candidate Barack Obama offered modest, simple ideas to better the health-care system, such as bringing in electronic health records and cracking down on Medicare fraud. He emphasized that he believed in bipartisanship. He also made a single, reassuring promise: “First of all, if you’ve got health insurance, you like your doctors, you like your plan, you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you.”
The year 2009 has been about passing 1,100-page bills without reading them because of the urgency; dumbing down health policy to cartoonish simplifications with miracle cures (prevention), easy choices (a blue pill and a red pill), and villains (insurance companies and doctors); and reworking one-sixth of the nation’s economy with practically no discussion.
There are winners with these reforms: trial lawyers and lobbyists. And there will be one big group of losers: the American people.
That’s because the proposed reforms are dangerous to our health. The basic problem is not just the hardball, Chicago-style political strategy employed or the promise-breaking challenge to the status quo. The problem with President Obama’s health proposals rests in their very ideological underpinning: that only with a new, massive role for the federal government will we better American health care.
This approach has proven a failure in other countries, leading to the rationing of care and the lowering of standards. It will prove disastrous here—a public-policy malpractice.
SpartacusIsNotDead // Nov 14, 2009 at 2:50 pm
Sinz wrote: “But conservatives like you are talking right past liberals like “teabag”–because you don’t have the same goals. . . The goal of conservative Republicans like yourself is cost containment, evidently.”
You repeatedly mischaracterize the Liberal position on healthcare reform. Liberals are absolutely concerned about cost containment because they know that is the only way universal coverage will be sustainable. That is why they support a very strong, robust public option, which would lower the deficit and control cost more than any other reform proposal that’s being considered.
You’ve also mischaracterized the Conservative position on healthcare reform. Conservatives have not made a single proposal that would have a substantial effect on cost containment – not now and not over the past decade. The one idea that was heavily promoted by conservatives (HSAs) proved a miserable failure at cost containment.
The only ideas conservatives have proposed for containing costs are tort reform, selling insurance across state borders and removing the requirements on what insurance plans must cover. None of these ideas will actually lower the cost of coverage or care in a meaningful way. At best, they only lower the amount of coverage and care that will be provided.
So both sides have said they care about cost containment, but only Liberals have proposed actual cost containment measures.
Incidentally, your reference to having to pay for someone else’s cosmetic surgery is a complete straw man. Insurance plans do not cover elective cosmetic surgery and even if they did, the costs of this is rather trivial in the grand scheme of things.
SpartacusIsNotDead // Nov 14, 2009 at 3:00 pm
Sinz wrote: “What’s our real goal here–universal coverage despite the high cost, or lowering the cost for those who are already insured? These two goals are in conflict, and liberals and conservatives just don’t agree on what the real goal is.”
This is not true. Except for Alex K and Barker who used to post here, I don’t know of any people on the Right who are opposed to universal coverage. I also don’t know of any people on the Left who are opposed to cost containment, which is why they support the recently proposed cuts to Medicare. The issue is whether universal coverage and cost containment can be achieved at the same time and, if so, is the method for achieving that acceptable?
Well, we know for a fact that universal coverage and cost containment can be achieved simultaneously. Every other Western country in the world does it. So the question is whether the method for doing this will be acceptable in the U.S.?
SpartacusIsNotDead // Nov 14, 2009 at 3:12 pm
Dragon Lady,
The Massachusetts reform plan failed because it offered no cost containment measures. By Sinz’s own acknowledgement, the cost containment measures were deliberately left out in order to get the bill passed. So I agree, under no circumstances should we repeat the MA failure on a national basis.
But try coming up with a plan that cuts costs enough to expand coverage on a widescale basis and also eliminate pre-existing conditions and you simply won’t be able to do it without relying on a public option or similar plan as used in other Western countries. ALL of the conservative proposals for cost containment do nothing more than nibble around the edges.
Also you seem to have drawn a connection between innovation and outcomes that does not appear to be supported by the evidence. While we may lead the world in medical innovation (although there are seveal Swiss, Israeli and French firms who would strongly disagree), these innovations have not produced better outcomes. And, you will discover the same thing within the U.S. as MDJoey has pointed out several times on this blog. The latest and most advanced therapies often do not produce better outcomes, they merely cost more.
MI-GOPer // Nov 14, 2009 at 8:00 pm
BlankHead at 48 tries to cheer up his fellow trolls with: “Just to be clear, I do think that the election provided a mandate for the Democrats to make good on Obama’s campaign promise of moving towards universal healthcare, with affordability guaranteed by the government.”
Ahhh, yes. The mandate that could have been undone with less than 443k votes on election night?? That mandate?
Of course, for the last 6 months, the Democrats have held the national agenda hostage with talk of a public option and promise of health care reform… while waging full scale war on Rush, on Bush, on Cheney, on Medicine, on FoxNews, on Wall St, on banks, on executives, on Republicans, on conservatives, on fishey-talking fellow citizens, on the Tea Parties, on the Townhallers and on anyone who isn’t already on Obama’s Enemies List.
And what has all that talk about health care gotten the Democrats? What have all those mini-wars gotten the White House? What has tossing bipartisanship under the Obama Bus faster than they tossed Bill Ayers or Rev Wright under that same Obama Bus?
Well, 56% of Americans think America is definitely on the WRONG TRACK. (RCP).
Of course, that makes sense because most Americans placed health care “reform” or universal coverage as the very last, dead last item on a long long litany of issues for the incoming Obama Administration to focus in on. Dead last.
Too bad the Obama didn’t listen to that polling as readily as he listens to the polling on nearly every other major issue.
It really is looking more and more like JimmyCarter’s Second Term. And that’s probably the best anyone with some realism can say about Obama’s team right now. The wave in their campaign logo? That’s the movement they’ve spawned by default and poor leadership coming to wash out the trash at 1600.
teabag // Nov 14, 2009 at 8:22 pm
You ARE a Parody. So funny.
dragonlady // Nov 14, 2009 at 8:25 pm
Spartacus,
What outcomes are you talking about? For example, a cardiac defibrilator will improve outcomes for someone with cardiac disease. It’s been reported that can lower the risk of dying by 50%: http://www.nhlbi.nih.gov/health/dci/Diseases/icd/icd_lifestyle.html. While numerous scientists in other countries have contributed to researching a defibrilator, the heavy lifting and $ invested in making it workable was done in the US. Even when the research is done elsewhere, the US leads in converting that research to workable commercial technologies. We’ve also got the vast majority of Nobel Prize winners in medicine in the last decade.
If you’re talking about life expectancies, these outcomes also depends on lifestyle choices. Innovation doesn’t singularly benefit only the US when you’re comparing life expectancies–other countries also use what we produce, and innovation takes lot of investment capital. The US spends much more $ than these other countries on biomedical research. One of the reasons that cancer survival rates are better in the US than in other systems is that 1) there is not govt bureaucratic rationing so patients are seen/diagnosed sooner 2) our patients here have more timely access to the latest cancer drugs that have been developed here in the US.
I’m not saying the most expensive thing is necessairly the best, but I have a hard fathoming that you seem to think innovation doesn’t matter and want to throw it overboard. If that’s not what you mean, I’m sure you’ll correct me.
As far as cost containment, since the Dems are in power, I rather see the govt do this first with Medicare before trying to put in place these measures to the entire industy. Doesn’t that seem prudent to you? You seem to think the GOP is nibbling at the edges, but I’m not convinced these ideas won’t have more of an impact on cost. Take a look at what tort reform has done for the state of TX: http://tlrfoundation.com/beta/files/Texas_Tort_Reform_Report_2008.pdf
The majority of Americans want portability and tort reform. We’ll see if the final bill includes it.
anniemargret // Nov 14, 2009 at 8:37 pm
sinz54: #19… you explained it well. And I have no problem with cosmetic surgery coming under a different heading than someone in my family or yours, or you, me, or any other citizen of this country suffering a fate that should not occur in the ‘greatest nation in the world.’ There is a moral imperative here.
Yes, I understand the libertarian philosophy of not being their ‘brother’s keeper.’ They want the ‘choice’ to donate or not . I suspect many of them do. I suspect many of them do not. What do we do as a nation for those who are not? Do we allow Americans to fall in bankruptcy because of medical bills? Lose their homes, their families suffer the repercussions? Do we watch as babies die or children die because Mom and Dad lost their jobs and no longer have health insurance?
I cannot answer for all American, but this is basic human kindness to me. Yes, we ARE our brother’s keeper, because no man is an island. Catastrophic illness, mental illness, loss of job, etc… may eventually hit every family. Sooner or later. I prefer living in a country that cares, even if my taxes are raised for it . Better for that than ill-advised wars costing billions and getting us nowhere.
sinz54 // Nov 15, 2009 at 9:26 am
anniemargaret: Yes, we ARE our brother’s keeper, because no man is an island. Catastrophic illness, mental illness, loss of job, etc… may eventually hit every family. Sooner or later. I prefer living in a country that cares, even if my taxes are raised for it .
And on that note, the battle is joined.
On the other side are conservatives who don’t want to be mandated to purchase insurance and to have their taxes raised to be forced to “care” for total strangers. Especially if that “care” includes abortion services.
That’s a clear difference of moral principles between you liberals and us conservatives.
At least by stating our basic principles up front, we can eliminate much of the noise and shouting past each other.
sinz54 // Nov 15, 2009 at 9:36 am
SpartacusIsNotDead: But try coming up with a plan that cuts costs enough to expand coverage on a widescale basis and also eliminate pre-existing conditions and you simply won’t be able to do it without relying on a public option or similar plan as used in other Western countries.
A public option that has to negotiate fees with providers (as the Pelosi bill does) won’t lower costs either. The providers will simply cost-shift Medicare patients (whose care is strictly cost controlled) onto the public option, knowing that the Government won’t ever let the public option go insolvent, even if it requires subsidies from general revenues. It’s going to be Fannie and Freddie all over again.
Like Fannie and Freddie, everybody is going to assume the public option has an implicit Government guarantee of success. That makes it a cash cow every provider is going to try to milk.
As I’ve said before, because human lives are priced as if they’re infinitely precious, demand for health care services will always outrun supply. And that gap between demand and supply keeps increasing as the population ages, picks up more chronic diseases, and is treated with ever more expensive high-tech medicine to keep patients alive as long as possible.
It matters not whether you have private insurers or public options or single-payer. Health care resources will need to be strictly allocated (I’m trying to avoid the word “rationing” here), no matter what health care system you have. Health care costs are rising all over the Western world, at a rate of about 1.5% per year over inflation. The rise in health care costs in America is not out of line with the rates in European countries or Japan (though they start from a lower base because of rationing). That’s because of adults having fewer children and living longer.
So that’s the issue that must be faced, but that no politician is willing to discuss openly. The original public option assumed it would be tied to Medicare rates (a euphemism for “price controls”). Now even Pelosi got rid of that.
dragonlady // Nov 15, 2009 at 1:49 pm
Politico just released a report that the Pelosi bill won’t cut costs at all–it actually increases them by $289 billion. Among other highlights:
-Pg. 6 – A public plan would cost 4 percent more than private plans because its utilization rules would not be as strict as the private sector.
Pg. 7 – About 3 million more people would get coverage through their employers. The report figures that about 15 million more people would gain employer coverage but 12 million would lose it because it would be cheaper for their employers to let them buy coverage through the public insurance exchange.
Pg. 7 – 18 million people will remain uninsured and choose to pay the fines for not carrying insurance rather than buy coverage.
Pg. 8 – The bill reduces Medicare payments to hospitals and nursing homes over time based on productivity targets. The idea is that by paying institutions less money, they will be forced to become more productive. But it’s doubtful that many institutions can hit those targets, which could force them to withdraw from Medicare, the report says.
http://www.politico.com/livepulse/1109/CMS_House_bill_increases_health_care_costs_.html
dragonlady // Nov 15, 2009 at 3:48 pm
Sinz, I’m just curious–don’t you view human lives as precious?
The conventional wisdom on health care costs never ending rise may be wrong. Some economists predict that medical costs are in still in the build out phase, started by baby boomers in expectation of the surge of boomer retirements. While the sustainability of the build out phase is what’s in jeopardy, costs will actually level out after the peak of baby boomers retire. The medical system we’ve constructed then enters a maintenance phase which will be less expensive than the build out. There will need to be some forcing of younger generations to pay for the costs of the final build out phase, but we will not need to expand capacity once we enter the maintenance phase because we already will have it.
While new medical technologies are expensive, that’s only true to a point. Medical technologies that are effective and become useful to large segments of the population tend to decline in price as they proliferate in the market: see portable defibrillators. They were once $10K and now many are available for $1,500. Drugs also become cheaper once their patents expire. One thing that would make the incentive for technology (and health care costs generally) to be cheaper is to switch to a consumer driven approach. There’s not much of an incentive for the average person who gets health care through their employer to be cost-conscious, so they don’t economize. The effect is we artificially drive up consumption by the prosperous, driving up prices for everyone else to include the not so prosperous.
Also, we spend more on health care because we are richer than previous generations. That’s not necessarily a bad thing if we’re happy with a health care. Don’t get me wrong–I realize we need to address the cost issue because it’s too high for most, but as noted in my earlier point, with the right incentives, costs may level out.
balconesfault // Nov 15, 2009 at 4:12 pm
the CMS scoring also says we’ll go from 17% uninsured in America without the Pelosi bill – to 7% uninsured after the bill is implemented.
as for utilization rules – you do know what a simpler term for utilization rules is, right? That would be … rationing.
Is that the contention here – that we’d be better off if a federal healthcare plan rationed healthcare as vigorously as PPOs and HMOs?
Seriously, if that’s the real concern, why weren’t Republicans pushing for greater rationing of healthcare as part of the Pelosi bill as a cost control. Wouldn’t that have been … conservative?
dragonlady // Nov 15, 2009 at 9:36 pm
balconesfault,
The majority of uninsured Americans are uninsured by choice, and not because they can’t afford it. They don’t want to spend $ on it. Depends on your philosophy whether you want to coerce them to buy insurance by threatening them with jail time or a big fine.
There’s a big difference between rationing conducted by insurers and rationing by a govt process. Insurers are responding to market prices. B/C employers are choosing plans for their employees, insurers have to keep them happy with quality service. When govt does it, the goods rationed tend to decline in quality or providers of that good exit the marketplace. When the govt rations by setting the price below the market price, a shortage results. If you don’t ration by price, then you do it by queues or waiting. Waiting doesn’t make people better off–usually your time was worth more than the original price, not to mention whatever negative impact it may have had on your illness or medical condition. There is also little incentive for providers now to innovate b/c the govt probably won’t reimburse them well for it, and/or will want them to stick to their rube goldberg mathematical formulas of the bureaucratic process. There’s not even much incentive to produce adequate supply.
Not convinced? Exhibit A is the post office. The only reason the they exist and can stay afloat is 1) it’s a power given to Congress in Article II of the Constitution to establish a post office and 2) the govt guarantees them a market share by prohibiting Fedex and others from first class mail service. Even then, the post office still operates at loss—nearly a billion $ loss a quarter. And that’s a pretty simple service compared to health care.
The market is much more efficient than the govt in how goods are allocated. That’s one of the reasons why conservatives aren’t big on govt rationing.
Independent // Nov 16, 2009 at 7:47 am
“You (ni-gop) ARE a Parody. So funny.” –teabag, like jon stewart, always trying to make a pathetic cut-down appear slightly funny.
i think there are lots of people here, teabag, who think of you as the parody of a democrat troll. but they’d be wrong.
you are not a parody; you’re the real thing. 100% politically-manufactured outrage, 100% trolling to incite or inflame on sites that are diameterically opposed to your caustic, bitter views.
you are a troll, like rbottoms and otto, who also delight in destroying the discussion, relish the opportunity to piss all over the public square of debate.
it is a shame that the webmasters of this site aren’t responsible enough to manage it properly. i know your pals at the dailykos or democraticunderground would never allow the obverse conduct on their sites.
you are pathetic, teabag. and you underscore what’s really wrong with politics and why the far left and democrats are not sincere in trying to fix any of it. troll suits you to a t.
sinz54 // Nov 16, 2009 at 10:36 am
dragon lady: Medical technologies that are effective and become useful to large segments of the population tend to decline in price as they proliferate in the market: see portable defibrillators. They were once $10K and now many are available for $1,500.
But the technology to extend life is always going to be state of the art–because as soon as new ways of extending life come on line, desperate patients will demand them. Portable defibrillators can stop a heart failure in progress. But to prevent it, you may need a quadruple bypass operation as Bill Clinton did–or even a heart transplant. That’s incredibly expensive.
Of course I consider life to be infinitely precious. But the ECONOMIC consequence of that is that the demand and supply curves for life prolongation will never intersect at a price point that ordinary Americans can afford to pay. No one is going to say “Well, since that quadruple bypass operation costs too much, I’m willing to die of a heart attack instead.” Bill Clinton didn’t say that, did he?
Life expectancy will continue to increase, as the latest and greatest technologies (stem cell? bionics? genetic engineering?) come on line. And since everyone wants to live as long as possible and be as healthy as possible, no one is going to eschew these technologies, despite their staggering initial cost.
I used to suffer from chronic sinusitis. The bugs tend to become resistant to the usual antibiotics quite quickly. We sinusitis patients used to watch for any new antibiotics to be approved–so we could dash to our doctors and demand them immediately.
sinz54 // Nov 16, 2009 at 10:42 am
dragon lady: Also, we spend more on health care because we are richer than previous generations.
And that is a virtual admission that the rich spend more on health care because they can.
America’s poor want the same dialysis, the same triple bypass operations, the same liver transplants, that the rich get for their illnesses. They just can’t afford them.
sinz54 // Nov 16, 2009 at 10:45 am
dragon lady: 18 million people will remain uninsured and choose to pay the fines for not carrying insurance rather than buy coverage.
That’s true–the fines were set way too low.
The fines for refusing to pay your Federal income tax are MUCH higher (and can even include jail). That’s the benchmark.
sinz54 // Nov 16, 2009 at 10:49 am
balconesfault: Is that the contention here – that we’d be better off if a federal healthcare plan rationed healthcare as vigorously as PPOs and HMOs?
That is EXACTLY what I believe.
It’s crazy for a public plan, supposedly aimed at preventing catastrophic illness for the poor, to be more generous than private health care plans.
I absolutely want ALL Americans to be able to have adequate treatment for catastrophic illness.
I do NOT want a public plan to pay for labiaplasties and Botox injections and other fripperies.
And the public plan should force its policyholders to have skin in the game, just like the private plans. It’s crazy for a public plan to require no deductibles or co-pays–unless, as I’ve been saying for months, liberals’ real intention is to LURE Americans off of private plans with an ultra-generous public plan with no co-pays or deductibles.
youngdoc // Nov 16, 2009 at 12:42 pm
Round-table reference to “life-style related illnesses” is not prominent enough in their recommendations. I am convinced that the obesity pandemic will be the greatest health care challenge world wide this century, and as such will impact every other aspect of our lives.
Gov’t does have an obligation to protect our individual pursuit of happiness, and the millions of people dragging down our national economy due to their inability to sustain a healthy weight has a strong impact in our individual ability to prosper.
But is not that simple. Obesity in many cases is a sign of addiction to glucose, there’s growing evidence of this that I’m exposed to regularly as a young psychiatrist, and addiction by definition implies severe disruption of a person’s free will in terms of their substance of abuse. Basically, addiction means self-distructive behavior. I would know: as a psychiatrist and life-time weight watchers member after losing 66 lbs. in 2008.
Neither the free-market nor universal health care will save us from this pandemic, but in desperation people will turn to gov’t to solve their problems. If you wish to see the free-market endure in our health care, immediate action most be taken to educate the public about what they are facing and creating incentives for people to change. In practical terms, the carrot and the stick model. Funnel gov’t resources to education about nutrition, addiction, biology from very early on, and to promotion of fitness while at the same time adopting differential insurance pricing based on well-established, easily measured, standards of health such as BMI, blood pressure readings, and hemoglobin A1C levels to promote responsible behavior, a standarized electronic medical system would be needed for this.
However, we won’t get out of this mess with more technology, only would a more educated, empowered people. Medicines, surgical procedures are mainly enablers of our own self-distructive behavior. Large segments of the health and food industries are taking our money while we self-destruct.
dragonlady // Nov 16, 2009 at 9:35 pm
Sinz, you’re posts are more emotional laden than logical, different from your usual posts. I’m not sure what you’re getting at–I am not Michelle Malkin. I am not pushing to repeal Medicare or Medicaid, nor am I stating that vulnerable people should not have access to health care. I’ve stated support for guaranteed insurance on this blog. If you don’t think it’s worth it to have the innovation and technology, we’ll agree to disagree. If you think we should have every American family buy a health care plan worth $15K to $20K (depending on the assumptions), also fine. If you’re not troubled that govt rationing will hurt health care quality, fine. But you haven’t refuted any of my points from an economic standpoint. I’m discussing the economic impact of the current bill, and it seems that I’m not out of the mainstream on this. An AP poll released today shows the majority of Americans are concerned about costs of the health care bill.
dragonlady // Nov 16, 2009 at 9:44 pm
“And since everyone wants to live as long as possible and be as healthy as possible, no one is going to eschew these technologies, despite their staggering initial cost”
Actually, I’m not sure this is true. There are many people who don’t want to live forever, and many folks have living wills. But let’s say you’re right and more people want to live forever than people who don’t. If you want them to think seriously about the costs, then you should support consumer driven health care. Then, for example, an 80-yr old can weight the cost benefit ratio with their dr of wanting to live an extra year or two with surgery, or taking the chance of going without it.
youngdoc // Nov 17, 2009 at 10:28 am
dragon lady, most people are not very objective when it comes to their own mortality or that of those they love. It’s just human nature. That is what makes healthcare an ethical dilemma. Because often people are willing to pay as much as it takes to get better the potential for abuse is greater than in other industries. Competition by itself doesn’t solve the problem. Problems can be at times emergent and there’s a great differential in knowledge between consumers(patients) and providers(doctors, nurses, insurance companies, hospitals, pharma). These issues make the healthcare industry very different from others. Only strong ethical principles stand in the way of severe abuse of power against patients. Market economics can and do erode often those ethical principles. For example, a surgeon could simply tell this 80-year old you used as an example that the procedure is not recommended with little chance he’ll be refuted when the real reason is poor compensation from the pt’s insurance provider. In many cases, pt’s will not seek a second opinion out of respect for the physician’s opinion. It’s very different from buying a car.
dragonlady // Nov 17, 2009 at 4:57 pm
youngdoc, I don’t necessairly disagree with your comments. The market at times has sub-optimal outcomes for what our society views is beyond our moral limits. When that happens, we ask govt to intervene. I just fail to see how the current House bill will make those outcomes any better. There’s also a big difference in consumer choice in say, going to the dr for cold medicine versus treating a chronic disease for your child. And in this information age, people learn quickly which insurers reimburse better than others, and will optimize for those plans if we guarantee insurance regardless of pre-existing conditions. But as a patient, I’d have to say nothing would destroy my trust in the dr-patient relationship more than if I think the govt is starting to incentivize or dictate certain treatments to my dr. B/C I know the govt is much more coercive than any other insurance company can ever be.
dragonlady // Nov 17, 2009 at 5:06 pm
“If you wish to see the free-market endure in our health care, immediate action most be taken to educate the public about what they are facing and creating incentives for people to change. In practical terms, the carrot and the stick model. Funnel gov’t resources to education about nutrition, addiction, biology from very early on, and to promotion of fitness while at the same time adopting differential insurance pricing based on well-established, easily measured, standards of health such as BMI, blood pressure readings, and hemoglobin A1C levels to promote responsible behavior, a standarized electronic medical system would be needed for this.”
On a theoretical level, I agree with this. But the bills under consideration says we can’t charge people different prices for those in poor health or deny them coverage altogether. On the latter, I’m fine with guaranteed issue. But it really provides no economic incentive for people that choose poor lifestyles to start re-thinking them.