Check out this "argument":
Uninsured patients get sick faster and die younger. Two medical reports, summarized in today’s New York Times, provide comprehensive evidence that lack of health insurance is seriously harmful to a patient’s health. The reports, from Harvard Medical School and the American Cancer Society, found that uninsured people suffer significantly worse health outcomes particularly for heart disease, stroke, diabetes, and cancer. Unsurprisingly, the uninsured cancer patients had lower survival rates, especially for cancers where adequate screening tests are available, such as breast and colorectal cancers.
If ever there were a case for universal health care, this is it.
(Record scratch.) OK, ok. First of all, medical reports that show people without health insurance consume less healthcare is kind of a duh moment for the medical establishment and for our intrepid blogger. Despite the fact that poor, uneducated people tend to live less healthy lifestyles, it’s also the case that poor people go uninsured. And if you consume less healthcare, you’re less likely to be healthy. (Again, duh.) But the staggering conclusion to this for our "progressive" healthcare-grows-on-trees friends is "universal healthcare", which means either a) socialize medicine and create a single-payer system, or b) force people to get health insurance or threaten them with some penalty a la Clintoncare 2.0.
Of course, they never bother to ask the question: "why don’t people have greater access to healthcare?" which is similar to asking "why is healthcare so expensive?"
I happen to know that avowedly more caring, passionate, elitists don’t care about the means, they only care about the ends, while never stopping to consider the whys and wherefores of the distributive injustices that exist in the current system. They call this ‘pragmatism’ but it is actually rather unpragmatic to fail in asking about the pathologies of a healthcare system. (It would be rather like a doctor treating a condition without diagnosing it!) But I digress. Our healthcare system has serious problems. And the only way to cure them is to change the underlying pathology: lack of access and affordability, which arises from:
a) Too many onerous state mandates that drive up costs (coverage mandates and community rating).
b) Lack of a competitive interstate insurance environment, driving up costs.
c) Lack of a competitive intrastate insurance environment (due to regulations in a)), driving up costs.
d) The inability to pool risk effectively in the individual market, driving up costs.
e) Insurance policies that encourage overconsumption, driving up costs.
f) A tax code that priveleges employees of companies that can afford to offer insurance, but doesn’t help people buying insurance on the individual market.
g) Hospitals and doctors that benefit from a third party system that encourages not cost consciousness, but overconsumption, which drives up costs.
h) Failure of tort reform to cap damages against doctors and hospitals, driving up malpractice insurance claims and cost.
i) Creeping socialism via SCHIP expansion which removes children from the risk pool and drives up costs for those that remain, causing many to self-insure.
j) Terribly high costs for attempting to treat people at the end of life with heroic measures that invariably fail, but drive up costs anyway. (Or, similarly, keeping people in vegetative states for months and years praying for miracles that never come, while the insurance pool pays.)
k) Failing to charge people higher rates for unhealthy lifestyles to encourage healthier lifestyles.
l) Failure of information processing for patient records and other data that would help prevent cross-prescription or help doctors understand relevant patient history that would prevent complication.
m) I could go on, but…
These pathologies must be addressed, not ignored (or worse treated with the leaches and witchcraft of single payer). My top remedies?
1) Allow interstate purchase of insurance immediately.
2) Give tax credits to people to get health insurance if they’re on the individual market (level the tax code.)
3) Implement tort reform — especially caps on malpractice damages that made wealthy bloodsuckers like John Edwards rich.
4) Allow people to contract directly with physicians for pre-paid subscription maintenance care (not insurance).
5) Migrate more people onto HSAs and HDHPs so that they can save more money (tax protected) until old age, and have incentives to shop around and consume just what they need in healthcare, rather than go to the doctor for a cold or athlete’s foot.
6) Get people off of Medicaid and help them buy insurance on the market — to help stop the death spiral.
7) Deregulate insurance so that HMOs are not protected monopolies.
-Max Borders
A friend of mine sent me his insightful comments on the issue of affordability:
1.The tax code encourages people to get health coverage through an employer or the government, where it seems free
2.Their incentive has been to seek more generous benefits, because those benefits are tax exempt
3.They have no reason not to use services (and as Richman and Havighurst point out, wealthy white folk are more likely to use them) because they only pay one dollar of every seven
4.Doctors get paid for procedures, not care, so they spend little time with patients and order lots of stuff that the patients are willing to take – malpractice also affects these decisions
5.Scope of practice restrictions, non-compete clauses in provider contracts with insurers and government, government program expansions, mandated benefits, certificate of need laws, and tax advantages for the Blues also increase cost by limiting choice
Max…This is the same laundry list of “solutions” you’ve been hustling for as long as I’ve known you.
If you want to be useful rather than monotonous, why don’t you write a post telling us how you plan to have your swell ideas implemented? A few of your ideas actually make sense. But, as I’ve stated here before, your ideas did not gain traction with a Republican president and a Republican-controlled Congress. I think you’re wasting your time.
The point of my post was to remind all of us that the longer we delay universal access to healthcare, the more people die unnecessarily. It was meant to serve as a useful reminder, not an epiphany.
My solution remains unchanged: elect a Democratic president and veto-proof Democratic majorities. All of the leading Democratic contenders have health plans which would increase access to healthcare. The fact that you don’t like the means by which universal healthcare could be achieved does not concern me. I believe a majority of Americans agree with me. We’ll find out in November.
The solution is simple. Treat healthcare like any other service and it will be forced to compete for higher service and lower prices like any normal industry.
Max: The Republican you speak of is pansy when it comes to real fiscal and economic conservativism. There is one candidate which talks about these issues, and he’s a medical doctor to boot: Ron Paul.
Disclaimer: Now, I try hard to not be one of those Paulites who look for any excuse drop his name, but I do honestly believe that Paul is the only candidate which really understands the economic reasons for our current health crisis.
Anyways, great post.
P.S. You’ve been dugg.
If partisanship and the will of the teeming masses is your answer to all policy questions, Steve, why bother to think about them or comment? “We’ll see in November…” or “The Republican Congress failed…” is not a positive policy prescription. Thus, your admonition is misplaced. Besides: A D or an R could implement any of the above very easily. Just because I’m repeating myself doesn’t make me wrong. Challenge my position not a party. Think critically.
P.P.S.: Sorry, I thought the name of the poster went over the comment. I meant to direct my second paragraph to Steve, not Max.
Thanks for the Digg, Isaac.
The left has done a great job confusing this issue by manipulating the language of the debate. The purposefully misleading term “universal healthcare” is really universal insurance. There is no guarantee that citizens will receive any given level of actual health care services.
Guaranteed “access” to milk doesn’t do me much good when the shelves are empty.
Max…How’s this for critical thinking.
I think you can sit in your office and type a weekly version of this post for the next five years. Unless you have the political apparatus in place to implement your policies, you have accomplished nothing. Nothing at all. You have put the cart before the horse.
On the other hand, I’m satisfied with the health plans and the policies of the Democratic candidates. For me, the “policy debate” is over. It’s time to see if the candidates I agree with can get themselves elected and implement the policies I agree with.
It’s the same argument we have had before. I’m not concerned whether your policies are right or they are wrong. I am saying they are irrelevant.
Speaking of which, I have a serious question for you (and Brian, too, if he wants). What if you guys sit in your office for the next 5 years analyzing and formulating policy and none of it matters? What if none of the positions you have advocated for over the years ever becomes law? What if a Progressive wave overtakes the country, and free-market ideology is discredited or marginalized? What if Art Pope sees the writing on the wall and pulls the plug on his pet projects?
What will you have accomplished? It seems to me that it’s not enough to “fight the good fight” if your job is policy analysis. Don’t you actually have to see some of your ideas implemented?
Steve,
By your own statements, you and your like-minded friends should have abandoned universal health care years ago.
It was considered all but “dead” in 1993, by your accord, the Clintons, Z Smith Reynolds and the labor unions should have just packed up and moved on to another issue and just accepted the fact that it wasn’t going to happen.
So then, why should we quit fighting for the free market?
Fight to “free” the markets all you want, Chris. I’d rather work for something more tangible, like better health outcomes for sick people. You fight your battles, I’ll fight mine.
I’m just pointing out to Max that he is naive to pretend that political power is not the primary determinant by which policies are implemented. The power brokers don’t really care how elegant or well-reasoned your policiy prescriptions are. In fact, they are bored by it, or worse. Remember the mainstream media blowback against Al Gore for being too wonkish? It put George Bush in the White House, among other things.
The idea is that what “We the People” want, matters. In Max’s writings he can barely hide his contempt for what he calls the teeming masses. Max likes to accuse those who disagree with him as being elitist, but it looks like a classic case of projection to me.
You’re admitting something very serious and unpleasant about yourself and your cohort, Steve: a) that you don’t care to think critically about policy issues in a non-partisan way (better watch that blogging for an avowedly “non-partisan” organization); b) that the world is and should be ruled by power brokers don’t care about effective and just means to get at a goal we may both share, and c) for your “political apparatus” the ends justify the means. It’s starting to look like I should reinsert the jackboot trope. Personally, I think politicians are power-hungry. And while I may be naive in thinking I can create change with a blog post, you’re naive to trust people who would use you coercively for their ends and convince you they are right to do so.
Steve,
Chris got it right in his comment, but I’ll add my two cents.
If it is true that “what “We the People” want, matters” – then why is it that what the people here at Civitas and the countless millions of others who recognize the moral and utilitarian superiority of free markets across the country want is deemed by you as “irrelevant”?
What we engage in is the discussion of ideas – something you seem incapable of.
Let me pose a question to you: Republicans have won the White House in five of the last seven presidential elections, none of which advocated universal health care. Doesn’t that make your ideas irrelevant? Why do you continue to post your propaganda?
If you claim that the power brokers don’t care about policy prescriptions, then what “battle” exactly are you “fighting”?The political pendulum swings both ways.
Now, to answer your question, if in five years none of our “positions” ever become law, I enter year number six with the same mission.
Freedom is a timeless ideal.
Your rhetoric about “the debate is over” and your obvious wish that folks like us and Locke would just go away is truly irrelevant, because humans will always desire freedom and individual sovereignty. It also reveals the fact that you are truly incapable of critical thinking and unable to argue your positions when confronted with the slightest bit of scrutiny.
Max…you’re not listening very well.
a) I’ve already thought critically on healthcare…for me, the debate is over. I’ve rejected your proposals as undesirable or unfeasible. The solutions that are palatable to me are only coming from Democrats. In fact, the Republicans can hardly be bothered to discuss healthcare at all. Being partisan on healthcare is perfectly consistent with my values. I would be a fool not to support the Democratic candidates on this issue. That will not prevent me from criticizing the Democrats when I disagree with them. (For the record, as you know, I’m not part of NC Policy Watch. I am an unpaid, occasional, guest blogger. Anybody can submit a post over there…you should try it.)
b) I did not say that power-brokers SHOULD “rule the world,” only that they have an inordinate amount of influence on policy and that you ignore them at your peril. Moreover, as I stated above, I am in favor of “We the People” becoming more informed and involved politically to wrest some of the power back from corporate interests (ie power-brokers).
c) What “means” is my political party using that you find unjustified? Sounds to me like we are fighting hard, on the issues, to legitimately win elections in a democracy. What part of that do you think the Founding Fathers would disapprove?
d) If I am an informed voter, who analyzes a candidates position…and I choose freely to support them because I agree with their policy positions…that is not being coerced.
That’s fulfilling your responsibility as a citizen. You should accept that we have different values. We can both think critically on an issue and arrive at different conclusions.
By the way, Steve, free markets produce very tangible results. It’s been clearly demonstrated ad nauseum that nations with greater economic freedom (i.e. freer markets) are wealthier by comparison. In short, the best antidote for poverty is the free market. As William Easterly said in his book “The Elusive Quest for Growth,”
“Poverty is not just low GDP, it is dying babies, starving children, and oppression of women and the downtrodden.”
Or is that not “tangible” enough for you?
“What “means” is my political party using that you find unjustified? Sounds to me like we are fighting hard, on the issues, to legitimately win elections in a democracy. What part of that do you think the Founding Fathers would disapprove?”
Oh, I don’t know, maybe blog posts titled “Why does George Bush hate children” because he vetoed SCHIP.
Advocates for socialized medicine like yourself have the easy end of the debate. Just successfully scare people that they are going to be left without insurance and with massive health care bills. The whole argument used by the left is one based on fear and emotion. There’s no rational fact in it.
It’s much harder to convince people that they need to take responsibility for their own actions and be cost conscious in their decisions when it’s much easier to “just let someone else pay.” Especially when they see millions of other people getting free rides for doing little to nothing.
And you’re whole, “the debate is over” is eerily reminiscent of Al Gore statement on global climate change. Great tactic by your side, just declare the debate over before it’s begun and convince the public with fear mongering that drastic action must occur NOW!
If you think market arguments for reform are wrong, Steve, enlighten us as to why…
Chris,
So I guess when the “swell idea” of SCHIP expansion failed, it became irrelevant. So by their own logic, the “debate is over” and any further discussion of it would be “wasting their time.”
Moreover, “I’ve already thought critically on healthcare…” is purely laughable coming from the same person who admitted that “I don’t know or care” what is causing the rising costs of health care.
(Apologies for the double comments. I did not see Brian’s comment until I had submitted the one above.)
Brian…Once again you overestimate my interest in “arguing my position” with you. That is a debate that is truly irrelevant. We have different values, and each of our positions is a non-starter for the other. The only reason I’m here at all is that Max linked to a post of mine.
You are also wrong when you say that I “obviously wish people like you and Locke would go away.” For me it would be a waste of time, but you should choose to lead your lives however you want.
Having said that, I do think you guys give yourself too much credit and take yourselves too seriously. You write:
“Freedom is a timeless ideal. Humans will always desire freedom and individual sovereignty.”
C’mon, Brian. Do you really think you are the sole guardians of freedom? How did the USA survive for 200 years before the conservative think-tanks came on the scene 30 years ago?
So you like free-markets…fine. God Bless. Go Forward. Debate among yourselves all you want. Just don’t get annoyed when I don’t think you are some type of revolutionary freedom fighter.
Apparently you have an interest in arguing something with us, otherwise you wouldn’t continue to comment. If you’re not interested in arguing your position, then what?
No, Brian, I do not have an interest in arguing with you. I do have an interest in making sure my opinions are not distorted.
At various times you and Max have called me a socialist or a Marxist or a Communist. All untrue. If you must use labels you can call me a liberal Democrat or a left-winger. Or, just as accurately, you can call me a capitalist. As a small business owner, I suspect I compete in the free-market to a much greater extent than the analysts at Civitas. I always find it a little bit amusing when you guys deign to lecture me on the glories of the free-market. I face the rigors of the free-market on a daily basis, while the Civitas and Locke employees are largely insulated from it. Go figure.
Additionally, guys, the red-baiting thing you do is both absurd and intellectually weak. Am I a socialist because I want to roll back top marginal tax rates to Clinton-era levels? If so, it’s a little embarassing for you the amount of wealth and prosperity that was generated in the 1990’s.
As to healthcare, you in particular Max should be ashamed to accuse me (or any of the leading Democratic contenders) as advocating “socialized medicine.” I believe a national health insurance (single-payer, Medicare-for-all) plan is worthy of consideration because I believe it would be the least costly, most efficient way to cover all the people (I know, Max, you disagree). Nobody is advocating a UK or Cuba style government run health service, and you know that.
However, what I have consistently and explicitly called for is an Edwards/Clinton type healthplan, which offers a menu of public and private sector solutions. Heck, Max, some of your solutions could easily be integrated into the Edwards model. You should jump on it since your solutions are unlikely to see the light of day otherwise.
I see too many disparities in the unregulated market capitalism that you guys are pushing. Too much inequality, too little social mobility. I believe there are policy prescriptions which can soften the hard edges of your brand of capitalism, much like what we had in the 1930’s- 1970’s (another impressive era of growth and prosperity).
I understand that you not only disagree with my opinion, but that your employment is predicated on that disagreement.
No, Brian and Max, I’m not interested in arguing with you. I’d be satisfied if you didn’t mischaracterize my positions.
“No, Brian and Max, I’m not interested in arguing with you. I’d be satisfied if you didn’t mischaracterize my positions.”
You do a good job of that yourself.
“I believe a national health insurance (single-payer, Medicare-for-all) plan is worthy of consideration”
“Nobody is advocating a UK or Cuba style government run health service”
Who would run a “Medicare-for-all” system, then? Under a “Medicare-for-all” system, the only “solutions” being introduced would be from the government – unless you intend to convince us that someone else is in charge of Medicare.
I’m curious to your explanation so that we don’t mischaracterize your view (as if you aren’t EXTREMELY guilty of distorting our views, Mr. All Conservatives Are Racists and Don’t Care if Children Die)
Oh, and about that “Too much inequality” you express concern over, while proclaiming
“I want to roll back top marginal tax rates to Clinton-era levels”
Check the stats:
Distribution of Income
Top 1 percent Next 19 percent Bottom 80
1991 15.7% 40.7% 43.7%
1994 14.4% 40.8% 44.9%
1997 16.6% 39.6% 43.8%
2000 20.0% 38.7% 41.4%
Oops. Looks like that concentration of wealth you’re so concerned about intensified under Clinton.
Brian…you have no business discussing healthcare policy if you don’t know the difference between Medicare (government health insurance) and a government health service (where all healthcare workers are government employees, all hospitals are owned by the government, all clinics are government run, etc.)
I see numerous Medicare patients every day in my private clinic. In general, I have no interference from Medicare in how I manage those patients. On the other hand, with BCBS, Cigna, UnitedHealthcare, and Aetna there are daily hurdles to care with preauthorizations, etc. Believe me, you get alot less interference from the government than you do private insurers.
Brian…about your stats. You agree, then, that it would not be “disastrous for the economy” to roll back the top marginal tax rates to Clinton-era levels? Glad we can finally agree on something. It’s also interesting that you excluded the Bush 43 years from your data. If you want to see it, go here:
http://www.cbpp.org/3-29-07inc.htm
What you will see is that the concentration of wealth in the top 1% in 2005 (the most recent data available) is the highest since 1929.
What interests me most, though,is this analysis from Professor Krugman:
“One other thing that’s striking from the report, by the way, is that over the 26 years the estimates span, the only significant gains for the bottom two quintiles, and most of the gains for the middle quintile, took place during the Clinton years. Exactly why is an interesting question, but the empirical fact is that over the past generation the only good years for lower and middle income families were when a Democrat was in the White House.”
Brian and Max…I don’t want to get into a statistical tit-for-tat, but isn’t it better for our country, and the economy, when all socioeconomic groups make significant gains?
What the good doctor is failing to see is that while there are “administrative” hurdles by BCBS to the provision of services to his patients, the lack of hurdles by Medicaid (and also Medicare) has added up to $300+ million in fraud that we have to pay for. At least there are some checks against doctors who want to benefit willy nilly from patients. (That may include the good Doc, who could be prescribing unnecessary treatments, tests, etc.)
Turner,
1) In regards “the difference between Medicare (government health insurance) and a government health service (where all healthcare workers are government employees, all hospitals are owned by the government, all clinics are government run, etc.)” If government (Medicare)is the sole provider of funds for workers, hospitals and clinics, what really is the difference functionally?
2) “In general, I have no interference from Medicare in how I manage those patients.”
Doesn’t Medicare establish your reimbursement rates and determine which services are covered? I guess that doesn’t count as “interference.”
3) “You agree, then, that it would not be “disastrous for the economy” to roll back the top marginal tax rates to Clinton-era levels?” Nobody made that claim, so who is mischaracterizing now?
4) “It’s also interesting that you excluded the Bush 43 years from your data.” No, it’s not really interesting because I was pointing out the concentration of wealth under the Clinton years. You bemoan the evils of wealth concentration at the top, but then long for tax policy from a decade in which that very evil intensified.
5)”Exactly why is an interesting question, but the empirical fact is that over the past generation the only good years for lower and middle income families were when a Democrat was in the White House.”
Nice, unbiased reference there. Funny how you attempt to draw a conclusion from a passage that admits it can’t explain why something happened.
Please, in your own words, describe for me how higher marginal tax rates lead to these “good years,” if that is what you are trying to imply with that quote? Any number of macroeconomic theories will suffice, such as: Solow growth model; the production function; supply/demand shocks; acceleration of M1 money supply; or simply a theoretical framework discussing the change in incentive structures.
Until you can do that, you have no business discussing tax policy and other economic issues. Further, until you can quantify the cause of rising health care/insurance costs, you have no business discussing health care policy either.