Framing the Health Care Debate
On today’s PoliGazette talk radio show, I got into a brief debate with Pamela Leavey from Democratic Daily about Democrats’ proposals for universal health care. Pamela argued that universal health coverage would involve costs that are a relatively easy load on individuals and would substantially reduce the current escalation in overall health care costs. During the show and the after-show, I pointed out that universal health care proposals do not take into account may of their secondary costs, including the necessity of rationing and the loss of incentives for investment in research and development upon which all universal health care systems — including those in Canada and Europe beloved by many liberals — ultimately rely.
A column in today’s Wall Street Journal adds some additional points.
For example, like other entitlement programs that are already transferring massive amounts of wealth from young workers just starting out to retirees that often are already much better off (and Medicare already fills the gap for those who are not), universal health care constitutes a tax on the young and healthy and a subsidy for the sick and elderly. Those who are young use relatively few services, but they would pay a disproportionately of the taxes necessary to sustain a universal system. Most of Democrats’ universal health care plan take advantage of young people as cash cows, removing from them the lower premiums that they currently have access to.
The other points in the Journal article are less persuasive, however. The allegation that rising health care costs can be blamed on immigrants is risible and the claim that uninsured people do not result in more emergency room visits relies on data that addresses only a tiny part of the actual scenario. But the Journal article does highlight something that is an endemic problem in our national debate over health care: Advocates in both parties do a very poor job in actually responding to the complexities of the problem. Republicans tend to brush off the problem too quickly or assume that market mechanisms can take care of it too easily, even in spite of clear evidence of market failure in areas like catastrophic care and preventative care. Democrats, on the other hand, tend to highlight the benefits and ignore the costs, making health care just another trough that somebody else will pay for (”the rich”, no doubt) and remaining blind to the changes in incentives for overuse of services and reductions in research and development that would likely result from a national mandate (as they have in other countries with national mandates).
A more comprehensive and non-partisan framing of the issues is necessary. It used to be that the media took care of that, but in the hyper-partisan atmosphere of the looming 2008 elections, most media outlets are tacitly signed up with one of the parties by now.
For example, like other entitlement programs that are already transferring massive amounts of wealth from young workers just starting out to retirees that often are already much better off (and Medicare already fills the gap for those who are not), universal health care constitutes a tax on the young and healthy and a subsidy for the sick and elderly. Those who are young use relatively few services, but they would pay a disproportionately of the taxes necessary to sustain a universal system.
Bingo. Of couse, the elderly already get coverage via Medicare, it’s the extra cash that could be wrung out of the young & healthy uninsured that make them such a big target for universal coverage schemes. Dragging in ALL the uninsured is theoretically a "profit" situation. (In practice, once insured those people would start using non-essential services they have previously avoided using, so the cost-benefit analysis breaks down.)
Yes. That is the biggest flaw on the Democratic side — anything that is free or reduced in cost will inevitably encourage overuse. That is what necessitated rationing in Canada and the UK. On top of that, rationing was made more severe by the disincentives under single-payer health care to do any research or equipment acquisition. MRI machines, for example, tend to be rare in single-payer countries because there is no financial incentive for hospitals to acquire them.
In spite of that, unlike most conservatives, I am not completely opposed to universal health care proposals. But I would like their Democratic advocates to start taking the debate more seriously and stop just offering people the illusion of something for (nearly) nothing.
In spite of that, unlike most conservatives, I am not completely opposed to universal health care proposals.
Me neither. I believe we’re rapidly reaching the point where a "basic health care" single-payer system, with all its flaws, could be a major improvement over our current system. I just don’t believe that it’s a complete solution. There will ALWAYS be means for the better-off to purchase more and better health care, as the current major growth in "health care tourism" shows.
We already have rationing of health care. Those with "good" insurance go to the doctor. Those without don’t; leaving aside the Emergency Room phenomenon, if they don’t get better quickly indeed these people will have decreased quality of life, potentially decreased ability to work for a living, and pose a potential public health catastrophe should they have a communicable disease such as Tuberculosis.
But please, let’s stop calling the various Democratic proposals "universal health care." Each one of those proposals (save Kucinich) is actually a "mandatory health insurance" proposal not terribly unlike the one implemented in Massachusetts.
Even if we can’t agree on a true universal health system, we must address the fact that our employer-based health insurance system not only impedes job growth (both through its sheer expense and through its stifling effect on entrepreneurship), it results in a disproportionate number of our uninsured Americans being children. In short, kids don’t have employers. We need to stop whining about "won’t somebody think of the children" and develop a MediKids program to cover all American children (and ideally, students under age 22 so young adults don’t have to forego college in favor of a job with insurance benefits). Vermont had universal coverage for kids when Howard Dean was Governor; it can be done.
But you then go on to say.
Your just splitting hairs on what term is nicer or not.
Did Pamela mention any method as to how overall health care costs would be even leveled out much less substantially reduced?
What is all this "rationing" everyone so casually refers refers to that’s supposed to be going on in the U.K. and Canada. Can anyone cite some actual facts that don’t come from links to advocacy articles and sites? We have rationing right here in the U.S. right now–it’s done by the insurance companies’ rate schedules and their claims adjusters.
Actually it’s done by price, Cardenio, and to a lesser extent by hospital utilization review committees. If you can pay for it, they’ll generally do it.
Of course, if you don’t have the right insurance or a hefty personal fortune, you might not be able to pay for it.
I enjoyed the BlogTalkRadio discussion with Pamela on health care and wanted to hear more; I’m pleased with this follow-up. I agree with Jason and Tully (2 & 3 above) that some form of national health insurance is acceptable, though I’m skeptical of government’s ability to magically deliver the product cheaply and fairly. I cringe when I hear someone like Pamela naively posit that it’s a simple, no-nonsense fix that will save money and be fair to all. Somehow, I’m guessing it won’t be simple, cheap or fair- partly because of (a) increased demand and fixed supply, (b) the federal government’s unique inefficiencies, and (c) as Huckabee argues, we have a health crisis as well as a health care crisis. Neverthless, Schuler and Tully are correct the status quo’s health care system is in dire need of revamping. I’d just feel more confident in the Dems if I sensed a healthy skepticism of the fix.
The #1 cause of injury, disability, and DEATH in America is, Health Care. More people die now from contact with the American Medical Health Care system than from any other cause of death. More than from Cancer, Heart disease, or Stroke. More than any other country in the world. Many times more than any other people in the world. Contact with the American medical health care system is the #1 risk factor now for injury, disability, and premature DEATH in America. This fact is a catastrophic indictment of the entire US Health Care System.
Driven by greed. And a rush to profit. Thousands of Americans are killed, and injured daily in America. By compromised health care. Cutting corners. Over, and under treatments. And poisonings with all manor of toxic, poisonous pharmaceuticals. Especially the children. America only makes up 2-4% of the world population. But Americans buy, and consume 50% of all pharmaceuticals world wide.
This is an emergency. America is in a crisis. And more Americans have died from this health care crisis than have died in all the wars in US history.
But the tide has turned. And the message is getting out. And taking hold about the fact that we have a very serious, and major health care crisis going on in America. Hurting everyone. Especially our precious little children. Rich, and poor alike. And most all Americans seem to understand now that "HR 676 Not For Profit Single Payer Universal National Health Care For All (Medicare For All)" is the way to go. Like all the other developed countries have done. Americans want government managed, tax payer supported health care Now. Medicare for all. Like other developed countries have. And like older Americans have now. Accept no substitute.
I am sick and tired of hearing how the candidates, and politicians health care plans are going to protect, and preserve the private for profit health insurance companies that have been killing, and ripping off the American people. And now the politicians want to mandate (require) that every American has to support the private for profit insurance company’s that have been killing, and ripping you off. Or you will be fined, and PENALIZED. Thats right. PENALIZED. Ridiculous! The politicians really think you are all detached idiots. CASH COWS! To lead to the slaughter. Don’t put up with that.
Just look at what is already happening with Massachusetts insurance mandates. It’s a catastrophe. Financially, and medically for all the people of Massachusetts. And the private insurance companies just raised their rates by as much as 16%. And everyone has to pay now. It’s a slaughter.
It’s NOW TIME to bring out the BIG GUNS!! The BIG GUNS!! are you. The American people. And anyone else that wants to help. From now until HR 676 is passed into law. I want every person to reach out and touch their fellow Americans every day if you can. I want you to take a phone book. And call at least one of your fellow Americans every day. And ask them to pickup the sword of HR 676 Single Payer Not For Profit Universal Health Care For All (Medicare For All).
Call more than one each day if you can. And ask them to do the same as you are doing if they can. And also to put maximum pressure on their politicians to get HR 676 done. And to make sure their politicians support HR 676. Accept no substitute. HR 676 is a no-brainer. It’s the best way to go on health care. It’s the only moral, and ethical way to go. That is why every other developed country has done it. Most did it years ago. See sickocure.org, and http://www.house.gov/conyers/news_hr676.htm
I know that many of you have been doing a fabulous job of spreading the word by talking it up with family, friends, and co-workers. And putting pressure on the politicians to get HR 676 done ASAP. The phone calls to your fellow Americans will increase the pressure. And increase momentum for HR 676 at an astonishing, and exponential rate. And I know many of you have been wanting to do something more to help. The phone calls to your fellow Americans is something you can do every day to help.
Trust me. It will be something to see. But you have to keep the focus, and pressure on getting HR 676 passed pronto. They will try to distract you. With all manor of other crises, and catastrophes. And other plans. Don’t be distracted. HR 676 Single Payer Not For Profit Universal Health Care is the #1 concern of the American people. Thousands of Americans are dieing daily now. And you or your loved ones could be next.
There is no good reason HR 676 cannot be passed into law well before the coming elections. And SCHIP should have been passed by now. Even if it was for 3x the 35 billion congress ask for. Do not tolerate delays. If it is not passed before the coming elections. All America will know which politicians are on the side of the American people. And which are not when they vote. Well before the elections. This is supposed to be a democracy. And well over the majority of Americans want tax payer supported single payer government managed health care for free for all Americans as a right. Many of the politicians will be soliciting your financial, and political support for the coming elections. Make sure you send a note telling them that you expect them to support HR 676 if they expect you to support them.
Everyone can do this. Most of you are well informed about HR 676. This truly is one of those no-brainer’s. Be considerate of your fellow Americans when you call. But be comfortable about calling. These are your fellow Americans. Some will be receptive. And some will not be. Some maybe rude, and mean. Just thank them, and move on to the next. Most will be with you. And if you get a call from one of your fellow Americans about HR 676. Let them know you are already on board. And thank them for calling. Build them up. And keep them strong. They are fighting for all of us.
Keep fighting. Pickup that phone, and call your fellow Americans. It’s the right thing to do. It’s time to start swinging your political sledge hammers. Until your government gets the message you want HR 676 NOW! And nothing else. No more insurance mandate bait, and switch. Or hokey tax deduction open market lunacy, and lies. Market solutions don’t work. That is what we have now. You cant seek the low bid for your child’s brain surgery.
Start using all your powers Now. There are at least 250-300 million of you that want HR 676. The insurance, and medical industry want to keep our disgraceful system as it is. And force you through mandates to continue to pay them to rip you off, and KILL you, and your loved ones.
Everyone knows the true story now. If we continue to let them get away with this through our politicians, and our corrupted political system. The American people will be known as the worlds biggest bunch of lazy chumps, and dummy’s. Don’t let that happen. Start swinging your political sledge hammers with all your might until HR 676 is law. That is the only way we can have the best Universal Health Care system in the world. Bless you all… KEEP FIGHTING!!!!! Be creative. Your doing great!
"Most of Democrats’ universal health care plan take advantage of young people as cash cows, removing from them the lower premiums that they currently have access to."
Insurance companies would still be able to charge lower rates based upon age due to the overall lower cost to cover them.
Regarding research, there sure seems to be a large number of pharmaceutical which are being developed by European companies (although perhaps it is the profits in the American market which finance this). One difference between the US and Europe is that the US spends a considerably higher amount per person on health care per person. Actions to repair our system, which has many faults, would not necessarily change this or eliminate the profits which are drive research. Quite of bit of research is also funded by government money.
"It used to be that the media took care of that, but in the hyper-partisan atmosphere of the looming 2008 elections, most media outlets are tacitly signed up with one of the parties by now."
The real problem isn’t being signed up with one of the parties but that the media spends too little time on real analysis of the issues and concentrates on the horse race. When they try to objectively look at issues, the media will quote the views of each side but make little effort to try to analyze which claims of each side makes sense and which don’t.
When I saw that you were discussing health care I put on the audio while doing other things (so it is possible that I might have missed a couple of points.) Unless I missed it, I was surprised that you did not confront Pamela on her use of her daughter’s coverage as an example. It costs quite a bit less to cover young, generally healthy college students as opposed to the general population. The cost of her daughter’s PPO is hardly relevant with regards to the effects of universal health care on costs.
I also disagree that Clinton’s plan is closer to Kerry’s plan than the plans of the other candidates. I’m sure you could make spread sheets to make any candidate’s plan look closer to anyone else’s based upon what you stress, but in the important issues Clinton’s is not the closest.
Biden’s plan was the closest to Kerry’s 2004 plan, but he never had a chance and is now out of the race. Of the remaining candidates, Obama’s plan is much closer to Kerry’s. The greatest controversy lately has been over mandates, and Kerry specifically decided not to include mandates in his plan.
It also isn’t so universally agreed as Pamela argues that mandates would result in less expensive care. Even old Clintonista Robert Reich has argued in favor of Obama’s plan.
We did discuss that during the after-show. I believe it is available in the archives, but I am not sure. In addition to the problems you describe, I also noted that colleges enjoy a wide variety of subsidies not present in other areas of the economy. Thus, the price paid for coverage for a college student might have little or no relationship to the per-person cost of a universal health care or health insurance mandate.
Jason,
I did recall you speaking about the subsidies, but in that case Pamela did have a good response that her daughter has a PPO which provides coverage anywhere. I don’t recall you discussing the lower costs of covering college students, but it is certainly possible I missed a quick comment while doing other things.
Ron Chusid, "Most of Democrats’ universal health care plan take advantage of young people as cash cows, removing from them the lower premiums that they currently have access to."
That is pure insurance company HOG WASH! Young people are the ones that stand to gain the most. The will never have to worry about having health care again. Whether they have money or not. Or a job or not. The will never have to worry about medical bills again. Or loosing their homes. Or filing bankruptcy because they get sick.
Oh Yeah, I almost forgot. They will never have to pay health insurance premiums, deductibles, or co-pays ever again.
Add to above "if they get hr 676 passed into law"
The young people will be the ones paying ALL the premiums, deductibles, and co-pays, both for themselves AND for those who are not workers like retirees. Just like with Social Security, the young people will pay most of the bills and enjoy less of the benefits. And they will only have an unrealistic HOPE that the pyramid scheme will survive long enough to still be there when they are old enough to exploit it. That’s how funding entitlements through taxation works, Jack.
You seem the type that de Tocqueville warned about — the voter who believes that the benefits enjoyed from the public trough are cost-free because “the rich” can magically pay for it all while requiring the other 99% to do nothing more than enjoy the easy life. It is an unsustainable fantasy, but one that is unfortunately very politically popular among those who don’t ever trouble themselves to learn basic economics. In reality, funding for the entitlement programs that we have ALREADY created might require tax rates on workers as high as 75% by 2050 (unless we get more enlightened about immigration, of course). A blanket entitlement for having all medical care paid for through taxes would be unsustainable even without the unsustainable promises we have already signed ourselves up for.
P.S. Nice try on the demonization. Everyone that disagrees with you is in league with the “insurance company”, huh? Are they affiliated with the Legion of Doom, or are they freelance? Just curious.