Blogs > Cliopatria > Some Health Care Thoughts

Aug 26, 2009 4:12 pm

Some Health Care Thoughts

From a standpoint of social justice and from a standpoint of cost controls, the present system is broken. The current system provides neither universal coverage nor efficient coverage. Market-based competition does not work well when demand is inelastic, as it is in essential health care, and current insurance regulations make what market competition that is possible even less effective.

This summary of health care in other countries helps to underscore how many ways there are to try to fix this. What I particular liked was the last section which highlights the diversity of approaches currently operating within the United States.

Of course, being for reform is not the same thing as supporting the current proposals. While the Republican Big Lie about Death Panels deserves condemnation—particularly because it incorporates a second lie, which is that the current system does not condemn people to death even when proper health care could save them—its success in generating unease has underscored several key weaknesses in the push for health care reform.

One is the problem that many Americans have decent health insurance, and many of them they fear its dilution more than they support its reform. Not everyone so blessed rejects the notion that good reforms would strengthen their current situation—otherwise there would be a lot less support than there is—but that is hard to feel certain about when the reforms themselves are still in flux. That is the second major problem with the effort toward reform. The result is the sort of unease that reduces vocal support.

This quote from a Republican strategist captures the problem well.

"The lack of a specific Obama plan has created an imbalance in the emotional energy between the two sides," Schnur said."So it's relatively easy for the opposition to find the least desirable aspect of any of those bills and go to town on it."

From the reform standpoint, there is a bit of good news here. It suggests that if decent reforms are passed, the support will be greater than the polls presently indicate. But I don’t know how many politicians with divided constituencies will find that sufficiently encouraging.

Another problem is that many Americans want contradictory things. This summary of an AARP survey is a nice example. Here’s the key quote:

Poll results indicated nearly 65 percent of those surveyed said they oppose increasing taxes to pay for covering the more than 46 million uninsured Americans, the business journal said. However, a majority polled said they believed all people should be covered and 73 percent said they are unwilling to see private health insurance premiums rise to cover those costs.

This is the sort of thing that Rick Shenkman loves to point out.

As I said above, from a standpoint of social justice and from a standpoint of cost controls, the present system is broken. What angers me about the Republican Party leadership is not that they have rejected Obama’s approach; it is that they have embraced that broken system.

The Republican leadership showed no interest in attacking this problem when they controlled the presidency and Congress. In fact, the manner in which they expanded Medicare to include prescription drugs arguably made it worse, because it did not allow the government to negotiate drug prices effectively. They now have made defeating any major Democratic proposal their defining issue for 2010. This is clearly indicated by their proposed “Seniors’ Bill of Rights,” which is dedicated to maintaining the broken status quo, including their own flawed approach to prescription coverage for seniors.

If Obama scales back--going for reforms that improve the current system but that fall short of the “public plan option” that many people, myself included, considered important--can he pass something good? ( This article summarizes what “good” might be.) Maybe. Not all Republicans want to follow their leadership on opposing any successful measures, and some of the wavering blue-dog Democrats could claim a victory. I would support it, too.

But it’s a messy situation out there. And I truly have no idea where we will go from here.

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More Comments:

Mike A Mainello - 8/29/2009

I understand the government has their fingers in your business, just like medicine. But, would you like them to have total control over your business?

Most of us Free Market guys believe in the government, we just don't believe they should be running education or health care.

The government can play an important roll in setting and enforcing standards. Once they enter the market as a player, there ability to remain independent is compromised.

Oscar Chamberlain - 8/29/2009

1. The third paragraph should have begun "Of course there are downsides."

2. I did not complete my thought in the last sentence. I should have added "From what I do know of the Tech Colleges, the majority of their instructors are also addressing these challenges creatively."

Oscar Chamberlain - 8/29/2009

Actually your description of the educational bureaucracy, with the significant exception of the universal degree, is not far from what is happening now.

I'm a strong believer in public support for university and technical education. I think access to education throughout life is important for the well-being of society and of the individual. Government support makes a wider range of education possible for a wider range of people while the competition between institutions for students helps keep them on their toes.

One course there are downsides. Too much overview and intervention (some might say meddling) by the government, whether in content or in the economic management of the systems, and you get inefficiencies that raise costs and detract from the instruction.

Too little oversight, however, has its own problems. The taxpayer deserves good oversight. Technical Colleges and Universities will sin their own sins (probably less concerning ideology than complacency) if left to themselves.

And I haven't even talked about determining the proper level of support and access to education. Defining "proper" is of necessity a political act in this context.

Just as defining proper access and support is a political act in the area of health care.

PS: For what it's worth, the folks I work with aren't feeling too complacent these days. Budget and pay cuts aside, most work very hard to teach well and effectively to students who arrive with a very different range of skill sets than we could assume even a decade ago. Given the speed with which these skill sets are changing, many of us are constantly redesigning courses.

The old image of the professor just reading from the old lecture notes truly is ancient history. I don't know the world of technical colleges as well, but I do know they are dealing with the same challenges.

Mike A Mainello - 8/28/2009

Thanks for the thoughtful response.

One of the major problems revolves around people in general.

Your assumption is that people with pre-existing conditions were dumped by their insurance company, where my thoughts are they waited until they had the condition and wondered why they couldn't afford coverage. Try asking for an insurance quote while your house is on fire. Your quote won't be reasonable.

A major dilemma is getting more people using health insurance - voluntarily. Lifting state mandates and allowing insurance across state lines will help a lot.

I refer you to this article where smaller mandates ultimately lower costs.

I really like the Whole Foods idea because not only does it empower the consumer by allowing them to create a tax free rainy day medical fund, it returns insurance to its rightful role - one of covering a catastrophe, not one of a smorgasbord.

My daughter recently needed some dental work and the cost for 2 root canals was $1600. I questioned the cost and received a second opinion. The second dentist was less expensive and after reviewing her file said she did not need either root canal.

I think you believe an education is important, but do you believe in a Universal College Degree? What if anybody could walk onto your campus and demand you provide them an education at little or no cost to them personally. They just have to fill out a minimum of paperwork. Now you as a professor will have to educate these people and you will have to accept the going reimbursement rate determined by the government (or some government panel). What if your class was very popular and they forced you to not only increase your class size, but you had to increase your workload. I am willing to bet your teaching and research would suffer.

This Universal Health Care utopia sounds great on paper, much different to implement. People must become responsible for their behavior. This is social justice. This is what made America a great country.

I always enjoy reading your posts, though we rarely agree. Hope the fall semester goes well.

Oscar Chamberlain - 8/28/2009

Good to hear from you.

I agree with #1.

#2 makes sense but the "how" of encouragement is of critical importance here.

#3 makes sense, but it brings up the question of government health care systems being able to negotiate prescription drug prices.

#4 is the most challenging thing to do. A number of people support simply requiring private insurers to cover pre-existing conditions. In the absence of a public option, that opens up the possibility of companies simply upping the price over the ability of more to pay. Ironically, that would probably result in the existing government programs that you allude to in point #3 expanding in the direction of a public option.

Concerning your last point, I'm not sure that you are right. While I certainly pay for health care, that payment in normal times occurs before my paycheck is issued. That makes it psychologically kin to the "giveaway" that you oppose.

Yet my having a regular physician (via an HMO) and the chance for discussion over time with the same team makes it easier to weigh options including the refusal or discontinuing of some prescriptions and services. (I am lucky to have a really decent clinic.)

Annual checkups also remind me of my weight and other risk factors and to look for ways to reduce them.

One of the key advantages of the public option was its providing lower middle class people a similar chance for regular care from a relatively stable population of caregivers.

Mike A Mainello - 8/26/2009

1. The market has been manipulated by government. Pass a law that allows health insurance to be sold across state lines.

2. Encourage plans similar to Whole Foods and encourage more people to be in control of their health care spending.

3. Encourage the 10 to 12 million that are eligible for government health care to apply.

4. Then address the real problem of people with pre-existing conditions.

5. Lastly realize it is not social justice to give away health care. It will only encourage more of the same same poor life style behavior. People must have control of their health care dollars and there health will improve. That is social justice.