This is great stuff:
We lost. They won.
We are:
Progressives who favor a single-payer system
Libertarians who favor HSAs
Moderate economists who favor cost control to free up money for other societal goals
They are:
Doctors
Pharmaceutical companies
Hospitals
Private prepaid health plans (for some odd reason referred to as “insurance companies”)
Medical device makers
And many other special interest groups
Minor quibble with “doctors,” as certain specialties will benefit and certain ones will not, but still, that basically covers it. What’s most interesting (at least for me, because confirmation bias is lots of fun) is his comments on the (completely insane) idea that regular health maintenance (doctor’s visits, normal drugs) and catastrophic care (car accidents, cancer) are still being treated as the same thing:
Private prepaid health plans (for some odd reason referred to as “insurance companies”)
[...]
The way to achieve this is with a combination of HSAs and catastrophic insurance.
His “odd reason” above highlights the insanity: insurance is for low risk, high cost events. It should not cover doctor’s visits or birth control. This is not to say that you can’t (or shouldn’t) have a plan that pays for those things, but it is emphatically not insurance, and should be treated and regulated differently.
I also like his proposed alternative (take that, reformers who say no one else has any better ideas!):
Sometimes I think the two political extremes blew an opportunity. Let Medicare take over catastrophic insurance for everyone, and let HSAs cover 95% of health care bills. Then provide a subsidy to low income workers’ HSAs. Voila, no private insurance companies.
That would work, (the vital component is the different treatment of maintenance and catastrophic healthcare) but again, at the risk of being nitpicky, I’d split the “catastrophic” care segment, by establishing some dollar amount “medicare opt-out” that you could elect to take. That way, if you felt like you could do better on your own, you could go that route, but you’d be ineligible for medicare forever. Oh, and no healthcare reform (well, you know, other than the one we just passed) is complete without repealing the current bias in the tax code for employer provided insurance over individual provided. Still, these are minor nitpicks.
What it comes down to is this: libertarians warned that this hallmark of progressive policy making would end up getting completely corrupted by precisely those groups progressives hate most, to great financial and political gain. And they were right. But then, maybe I just want thousands of poor people to die, so who are you to believe?
It’s really strange how when a crisis occurs, all the policies that people have been proposing for years suddenly become solutions to that crisis. And so it is with this line from President Obama:
In a nationally televised address marking his first six months in office, Obama said overhauling the U.S. health-care system is “central” to his prescription for rebuilding the economy and making it stronger.
As far as I know, Democrats have been wanting health-care reform for decades, even those that didn’t contain economic recessions. What’s the chance that this was the solution for our economic ills all along? Or is it more likely that the President read the opinion polls and saw that everyone was worried about the economy, so decided to sell the healthcare reform plan as a solution in order to get their attention?
The problem is that giving more people health insurance is going to cost money. And right now we’ve been spending a lot of money, and we’re going to have less money — that is what a recession is, right? So then Obama (who is actually, at the time of this post, at the Cleveland Clinic in a private meeting with its CEO) has this weird disconnect:
Members of both parties are balking at the proposed $1-trillion price tag — and how to pay for it.
But Obama insisted the country’s budget deficit will continue to grow unless skyrocketing health-care costs are brought under control. He said the consequence of inaction will be higher premiums and out-of-pocket costs and thousands more people losing coverage every day.
“The budget deficit will grow unless we spend billions more dollars!” If in response to my complaints (yes, hubris alert), the President is actually stopping by my town’s high school (not exactly enemy territory, if you know our voting tendencies) later in the day to address concerns and answer questions. A good question would be “How the heck are we going to pay for this?”
But even some moderate-to-conservative members of Obama’s party — the so-called Blue Dog Democrats — say they are concerned about the potential side-effects of health-care reform, such as tax hikes, government control and an even larger deficit.
But Obama reiterated his pledge that any bill he signs will not add to the country’s soaring deficit. “And I mean it,” he said.
He also vowed to reject any measure “primarily funded through taxing middle class families.”
Look, you can’t just blatantly say these things. People will ask questions. You can’t have a trillion dollars of healthcare reform without A) increasing the deficit or B) increasing taxes on some middle class people. Or you could C) cut lots of spending elsewhere — but if someone on Obama’s team has a list of a trillion in spending they could cut, I havent’ seen it. And both A and B seem like bad ideas during a poor economic climate. It’s almost as if the recession makes massive spending bills like healthcare reform less likely, instead of necessary. (more…)
Andrew Sullivan posts a reader email:
I own two businesses. My health care costs for my employees have more than doubled in the last five years, while the benefits provided for those services have decreased.
Mickey’s post is insane. When I purchase new computer equipment, it is better and more advanced than that which was previously available. Not true of health care.
First of all, the benefits have improved. This might sound a little elitist to say, but laymen like us aren’t that good at determining when quality increases in medicine — compared to say, computers. It’s easy to see that previously I got 1000 blorgahertz and now I get 2000 for half the price. Quality in medicine HAS improved — certainly not at the same rate as computers, but then what does? Interestingly, at least some of that improvement is due to improvements in computers. Computers leaping along the curve of Moore’s Law power lots of the high tech medical equipment, as well as the mundane (but still important) medical IT systems.
But if you want to learn, pick up a medical journal and look at one of the articles about a new study revealing that treatment X is superior to Y, so doctors should use it instead. (The extent to which I’m simplifying this is absurd — seriously, go pick up a copy of the NEJM or JAMA.) That’s quality improvement. And it doesn’t happen uniformly. Some types of illnesses get a huge improvement in our ability to treat, some do not. To highlight one example — my sister was born with a congenital heart defect that requires massive cardiac surgery at the age of six months. Even though I’m only three years older, if I had been born with the condition, the chances of me surviving would have been much lower: I would probably not be alive today (or on a pacemaker) due to complications. A few years before that, someone suffering from this condition simply would have been a dead infant. What was the value of the improvement in “healthcare” over those three years? Well, the benefit to my sister was pretty darn high. What would have been an appropriate cost for saving her life? I don’t know, but it certainly feels to me like it’s a lot better than a new computer.
It’s almost impossible to equate to computers, because well, healthcare isn’t the same as computers, just like cars aren’t like computers. Now, is the quality improvement justified by the cost increases? I don’t know. But neither does this reader. Sometimes things increase in price without corresponding increases in quality, due to input cost increases — you might be familiar with the idea of labor, in medicine we call them “doctors.” They like getting paid!
It’s important to remember the reader’s perspective — that of employer. When he thinks of quality, he’s meaning the listed benefits on his insurance contracts, and the satisfaction that provides to his employees. If the insurance is $500 more this year, but it buys one of his employee’s kids a life-saving heart surgery that wasn’t available last year (like it did for my parents a quarter century ago), how do you compare this?
Next up, the “fair competition” idea:
If the free market is better than government, let the government offer a public option and see how the private companies compete. I think you will find their rates dropping almost magically.
Strange, I don’t often hear this argument in reference to education. Ah well, I’ll let it slide. It’s interesting — what does he mean by “public option?” If he means something provided by the government, but also has a cost (or perhaps a voucher-like system) like his private health plans, then that’s fine — we can see if they provide something better for the value. But if he means something subsidized or free, then it’s hard to understand what he means. It’s like saying that private schools are “competing” with public schools — but one is provided “free” at general taxpayer expense, and the other must be paid for by the individual on top of their school taxes.
Let’s apply this to his business. If the government opened up a taxpayer funded program that provided the same services as his for no direct cost, would he consider that fair competition? Would he be so even-handed about letting things fall as they may?
Finally, there’s a lot of generally faulty assumptions being revealed here. To take one: he talks about “the private system” and his hypothetical “public option” as if they didn’t already exist and interact with each other. A great deal of the costs in the private system are in fact already being determined by a “public option” — some of us call it “Medicare.” This is Grade A ignorance of how healthcare works in this country. If the government really wanted to lower private costs, they could do so by manipulating what they reimburse for those services for Medicare patients. That they aren’t implies that perhaps these services really do have costs that must be accounted for — costs that even bureaucrats can’t deny exist. Or, perhaps more accurately, costs they won’t reduce because of extensive lobbying by doctors to keep them high, since that’s basically their salary. Is it too high? Is it too low? I don’t know, and neither does he. Even if his hypothetical “public option” appeared, who is to say that medical lobbyists wouldn’t convince the government to raise the prices higher, which would cause the private insurers to raise their prices as well — you know, exactly like how they are doing right now?
