Conservative Thoughts On Health Care Reform
Writing for The American Conservative, Phillip Giraldi points out what I agree is a problem with trying to convince people of the necessity for health care reform.
It seems to me that the problem with most “conservative” commentators on the Obama health care reforms and on the health care situation in general is that few of them have been victims of the current system. They have had good health insurance through their employers all their lives and think that anyone outside the system is a deadbeat or an illegal immigrant. Having experienced first hand the downside of the system I would like to make a few comments. I would note that the current insurance structure basically stinks. It denies insurance to those who actually need it unless they are employed by a company that offers that benefit (fewer and fewer do). Insurance companies exist to make money, not to make people healthy, and there is no money to be made in paying out for those who are sick.
And over at the League of Ordinary Gentlemen, E.D. Kain has some thoughts that I largely agree with about the shape that health care reform should take:
Regulations and reforms I’d like to see:
- Taxation of employee benefits: insurance should be personal and portable rather than temporary and tied to a job.
- Deregulation of insurers to allow national competition: with proper rules in place, more competition will only help consumers.
- An end to “pre-existing conditions” clauses and abuses of rescission. These smart regulations can be achieved with…
- Two-way mandates: insurers would be required to provide insurance and citizens required to buy it. In the end, if we want costs to be well distributed across the system, everyone needs to at least have catastrophic coverage, and we should not maintain a system that crowds out those who need it the most.
- Cost-assistance in the form of vouchers. Any public option should be offset by vouchers to keep it honest, especially if the public option is a national one. This also helps stave off monopolization.
- Any reform should be fiscally sound and not be a drag on the economy. Reform should work to bolster the economy, free up businesses to be more competitive, and free up employees to be more mobile and confident.
- An end to protectionism in the health care market, especially in the form of pharmaceuticals which keep costs artificially high.
- Relaxing of medical provider regulations that have led to cartelization of the industry. You don’t need an M.D. to sew stitches.
Both posts are worth reading in full. And as for the proposals on the table, I think that Wyden-Bennett is a superior plan for reform than the current House bill, though I don’t think that Wynden-Bennett is politically feasible. This is largely because the Republicans in Congress have dug in their heels so deep that they’ve made themselves not players anymore. You’ll notice that the big debate is not between Republicans and Democrats, but rather between liberal Democrats and conservative Democrats. I think that if Wyden-Bennett got some more, serious support from the GOP, it would stand a better chance. As it stands now, though, I don’t think that’s the case, so we’re stuck with the House bill which, as bad as it is, is still better than the status quo.
I agree with everything you wrote in that post, Alex, with the exception of the last few words. The House bill is worse than the status quo because not only does it not reduce costs (as the CBO has noted) it actually increases them.
E. D. Kain and I have been ping-ponging back and forth on this issue for some time. Basically, we’re in mutual agreement. However, there’s one thing that I think is worth mentioning that none of the plans at hand deal with: the lack of availability of healthcare. Underserved communities are a serious problem and none of the plans on hand including Wyden-Bennett do much to address that problem. That’s why some of the reforms you’ve quoted above are important.
I think that the CBO hasn’t taken into account the fact that the number of employers offering health insurance is on a downward trend and that premiums for even the employed are steadily increasing. The confluence of the two will increase costs under the status quo. At least, that’s my read.
Still, even if I agreed that costs would be worse, some provision to help out those who are simply financially incapable of buying health insurance is a necessity. I consider the current evil of people being too poor to be treated to be worse than the possibility of higher costs.
That said, yes, I would hope that the problems of access and cost were more directly addressed in current reform proposals.
I don’t think the problem is with trying to convince people we need health care reform. I think the problem is trying to convince people we need it at this minute, at what will surely be at more cost than proposed and it’s being proposed by people who have not read it nor is it good enough for the proposers. Our system needs repair…not complete overhaul, particularly right now. It doesn’t help that people are reading from one of the three bills and being told by their Reps. that “that isn’t in the bill”.
You can sell a crap sandwich to some of the people some of the time…..
Alex, if it is so necessary to change this system right away, why is it if I like what I have, I can keep it? Do you notice any inconsistency with that notion? The President has said the system as is, is not sustainable however he has stated over and over again if you like what you have you will not be forced to take something else. Then I suggest you read page 16 of the House bill that is out of committee.
My view is that there is no way that political support can be maintained for universal coverage in the absence of serious cost controls.
Obama says Wyden-Bennett is too radical, so let’s blame the Republicans.
This whole “health care” debate has gotten out of hand.
There is no problem with an employer-based system.
If you are too lazy to get a job with benefits, then you deserve to suffer at the hands of the medicaid mills.
If your job’s insurance plan sucks, it gives you incentive to move to a better job.
I can tell you that the best and most profitable companies generally have the best health care. Hell, at Goldman Sachs their plan pays for over-the counter drugs.
The good, profitable companies attract the best talent. Having a stupid “universal” system will get rid of the impetus to excel.
Many profitable companies do the smart thing and refrain from hiring people prone to get sick. Weeding out the weak and infirm keeps premiums down, quality up, and enhances productivity since you don’t have a bunch of lazy sick bums not coming into work.
The only “critics” of the current system are lazy liberals who want the nanny state to take care of them–if that’s what they want, they should move down to Cuba.
The problem with liberals is that they got so used to demonizing conservatives that they can’t stop even when said conservatives mostly agree with them. Basically, we agree that reforms are needed, agree largely on what kind of reforms are needed we just disagree on whether the current disaster being contemplated in congress will do anything to solve them.
Telling people that largely agree with you that the only reason for the disagreements left is their short-sightedness isn’t going to help you win them over.
Dave: As the fear of potential cost controls somewhere down the line has almost derailed this latest effort, I question whether there will ever be sufficient political support for serious efforts control costs.
Also, I think a good way to help pay for needed reform is to SERIOUSLY slash what we pay towards pensions and health care of politicians. They need to have the same options available to everyone else.
And that’ll happen about the same time pigs grow wings, I know….
Triumph – that makes no sense at all. The employer based system is about as far from the ideal market solution as you can get. It’s grossly monopolized, takes personal accountability and individual choice out of health care decisions, and places a huge burden on businesses (similar to minimum wage laws in many ways.)
Conservatives should oppose the status quo. It’s bad news for economic growth and individual autonomy.
Actually you are wrong on all accounts.
No one forces you to take a job with an employer (at least not yet–who knows what Hussein Obama has up his sleeve next).
If you don’t like the health plan of your employer, you just go to a better job. Take a look at Goldman’s health plan–it fricking rocks. People with talent are in demand and businesses seeking to benefit from that talent respond with good benefits.
Businesses have no burden in this system. They are the ones who designed this system in the first place–When Red Roosevelt and Harry “Not Reid” Truman were floating national health care plans, business was at the front lines saying “no.”
The reason–a national plan would make workers less motivated to work and excel.
Hell, big business was also against Medicare also–for precisely the same reason.
Businesses want what all Americans want–choice to do what is in their interest. If a business wants to offer kick ass health plan and a golf club membership to its employees, they do it because they will get the best people. If they don’t give a damn, and they can get the workers they need, then they dont.
If a worker finds himself in a crap job, with no benefits, they can work hard and get to a decent job.
If you are in a job with great benefits, conversely, you will be diligent so you won’t get fired and have to work for crap wages and being a doctor’s visit away from bankrupty.
By giving everyone equal benefits, you are destroying the impetus to succeed in society.
But that is precisely Barry O’s plan.
Still, this makes no sense. This isn’t how I purchase my car insurance or my house insurance or my food or anything else. My employer is there to provide me with money so that I can buy those things, and in exchange I provide them with my labor. I should not have to switch jobs to get new car insurance any more than I should have to switch jobs to get new health insurance.
And beyond this, the fact that the interim between jobs will leave me essentially uninsured makes my ability to move from job to job that much more risky and difficult.
If you’d step outside your comfort zone momentarily you’d see that many other countries have far better free-market (as in, not “nationalized) systems than we do.
Sorry, but that’s how the system works.
If you don’t like it, you can build your own business–like Bill Gates–and insure you won’t get fired and then buy a kick-ass health care plan.
Price is a reflector of value. Things are often valued because there is high demand and a low supply. If we think of health care as being something valuable, it makes sense to keep the supply low. If too many people have decent care, they will abuse the system and go to the doctor all the time.
It would be like everyone were Michael Jackson wanting a doctor living with them.
As we see in the Jackson case, care would ultimately suffer.
But, of course, Barry O and his death panel would love that result.
E.D. Kain,
Triumph is the site’s satirists. His political views are actually some sort of cross between Stalin’s and Khomenei’s.
PD – yes, I see. Well in that case then I agree with him entirely….
Personally, I think health care reform should begin with how much it costs. Medical care, even if you DO have health insurance, can be prohibitively expensive.
Strawman much? I don’t think that at all, even if I am a “conservative.” Why do you endorse such gross mischaracterizations? I have asked before why it is necessary to disassemble what works for many to provide something less for others, and I’m still waiting on an answer. FYI, my excellent heath care plan for my company has seen premiums increase a total of 4% through two renewals since 2007.
Perhaps you saw Megan McArdle’s post this morning. I would add to her argument that government rationing invites corruption to levels that do not exist under market rationing. I do not look forward to one system for the hoi polooi and another system for the politically well connected.
Some of Mr. Kain’s proposals make excellent sense, though I might argue that bullet three tries to make unsurance something it isn’t, bullet four is ananthema to conservatives and business owners who are extremely tired of mandates that cost them money to fund someone else’s good idea, bullet six isn’t a proposal so much as a goal and pure fantasy as far as that goes, and bullet seven is a variant of killing the goose that lays the golden eggs, so I am opposed to it. Nevertheless, I can support some variation of bullets one, two, five, and eight. So, how about some incremental legislation to help us get there instead of this throw the baby out with the bathwater approach so we can start over? See, I’m not opposed to all reform. But Obamacare is to reform what the Stimulus Package was to true Keynesian economic stimulus, a wolf in sheep’s clothing masquerading as something it is not to achieve goals other than those stated.
As for Republican support for political effort, it can’t be a surprise that Republicans aren’t all that supportive of the Democratic Leadership considering how they have been treated in the past seven months. While obstructionism in and of itself isn’t a good thing, holding out until the voters have a chance to chance the face of Congress in fifteen months seems like a viable alternative right now.
Contrary to President Obama’s implied threats not implementing his plan for the next fifteen months is not the same thing as doing nothing. Obamacare is the proverbial bridge too far. He and the Congressional leadership could have done some good things to help a lot of people but instead decided to roll over everybody with a complete solution out of the gate. You’d have thinked they would have learned from Hillarycare, but I guess not. Just another reason to not trust their instincts when you get right down to it.
“I think that the CBO hasn’t taken into account the fact that the number of employers offering health insurance is on a downward trend and that premiums for even the employed are steadily increasing. The confluence of the two will increase costs under the status quo. At least, that’s my read.”
Agreed. Insurance companies make most of their money through investments. Their stocks have been hit just like mine. Insurance costs are going to up a lot over the next year or two. Ours would have gone up 26% this year if we had stayed with the same plan.
Steve
Anyone who thinks the screaming is too loud now might want to buy a set of earplugs before the end of the year. It looks like there will be no cost-of-living increase in Social Security benefits for 2010 but Medicare premiums will definitely be going up causing net benefit amounts to decline. (I can’t find it at the moment, but I read somewhere recently that odds were good that there would probably be no need for cost-of-living adjustments to Social Security benefits until 2013.)
@Charles
Contra Megan, see John Holbo’s post, Rationing By Any Other Name?, over at Crooked Timber.
As one of the (mistakenly) “conservative” commentators on health care I find this statement repulsive and insulting…so much so it is almost deserving of a real time punch in the mouth.
Must be nice to dismiss critics as uncaring buffoons.
Logic check. I don’t see how the former has much to do with the latter. That is, we could tax employee benefits and still have insurance be non-personal and non-portable. Unless of course, we have the employee purchase his own insurance either as an individual or via some sort of pool/group. Paging commenter Stan, Stan please pick up the white courtesy phone….
Excellent. Competiton usually results in more innovation, lower prices and more choice.
Here’s the problem, I’d bet that this is where much of the current spending on health care comes from. Such a regulation, while good hearted is likely to lead to problems on the cost side.
I’m actually coming around to the idea that adverse selection is mostly a theoretical construct (Hi Michael!) and not really much of an actual problem. Most mandates are to bring in the high risk/high cost market participants, not the low risk/low cost participants. As such, the premise is false and the recommendation is in doubt.
If you are going to do this why not get rid of the public option. Switzerland doesn’t have one, and their system isn’t nearly as bad a shape as the U.S. I don’t think the Netherlands does either. Can’t recall about France. In other words we don’t need a public option to move in the right direction. Further, I think there are valid reasons to fear that the public option would be used to create a single payer system like in England and Canada. And those systems suck…really bad from a fiscal/cost perspective. How does a 16 week waiting time sound?
The “make businesses more competitive” argument is complete and utter bullcrap. Its just wrong. Other than that, this is a no-brainer…problem is the current reform bills under serious consideration have been scored by the CBO as getting failing grades on this front. Anyone care to address this?
Why not seriously reform intellectual property laws. These laws create monopolies. Monopolies have no positive redeeming features. Monopolies raise prices, reduce output, limit innovation, reduce competition, and are inefficient. If another model could be found that provides the same or similar levels of innovation without the use of monopoly and all its attendant costs, we’d be foolish not to switch.
Absolutely, more competition. Competition is almost always a good thing. It lowers prices, increases innovation, maximizes output, and provides more choices. For some inexplicable reason technocrats like Obama find competition to be abhorrent.
Logic check again. You can’t help anyone if you don’t have the resources to help them. As such failure to address the cost side of the problem pretty much kills the expanding coverage side of the problem. You’re doing it wrong.
I actually would prefer that there were no public option. I didn’t make that clear. I support vouchers one way or the other, though.
Insuring a precondition? I wonder if i wreck my car and don’t happen to have insurance at the time except for PL and PD if I can get the company to sell me collision so I can get them to pay for a preexisting condition. Wait that would not be insurance. Try the same thing with life insurance. Try to get a policy for someone who died yesterday (a preexisting condition) and try to collect the death benefits without being charged with fraud. Just for the record go look in a dictionary to see what the term “insurance” means.
Alex –
As Dave noted I agree with every word of the post……..except I have a few more “buts” (but I’m largely in league)
1. Dave and I have an ongoing anecdotal debate about health care because – just as Giraldi noted – we obviously have had different experiences. Indeed, perhaps in a moment of hyperbole, Dave noted that his vet was more competamnt than his internist. Ouch! My experience has been nothing short of first rate. And I’m a guy with a first order hyperlipidemia issue, and two cervical fusion operations. I’ve touched the medical system. Why the differences I cannot say.
2. And yet, yes, others are not so enamored. So we have to ask why. That said, most people are relatively happy with their current siutation. To throw out the current system to adopt the current house bill is ludicrous.
3. And now, the remaining laundry list:
“Taxation of employee benefits: insurance should be personal and portable rather than temporary and tied to a job.”
Agreed. This government malformation has been awful policy for many decades. Fix it.
“Deregulation of insurers to allow national competition: with proper rules in place, more competition will only help consumers.”
Of course.
“An end to “pre-existing conditions†clauses and abuses of rescission. These smart regulations can be achieved with…
Two-way mandates: insurers would be required to provide insurance and citizens required to buy it. In the end, if we want costs to be well distributed across the system, everyone needs to at least have catastrophic coverage, and we should not maintain a system that crowds out those who need it the most.”
Look, a major problem with the current system is that its not insurance, its maintenance. So who could argue with catastrophe insurance?
“Cost-assistance in the form of vouchers. Any public option should be offset by vouchers to keep it honest, especially if the public option is a national one.”
Velly, velly dangerous.
“An end to protectionism in the health care market, especially in the form of pharmaceuticals which keep costs artificially high.”
I’m inherently suspicious of this. Drugs for various issues are the most cost effective health care innovation of the last 20 years. Political whipping boy, I understand. Villain? No.
“Relaxing of medical provider regulations that have led to cartelization of the industry. You don’t need an M.D. to sew stitches.”
Be very, very careful here. We’ve got a medical malpractice issue as it is. Now nurse-care for cost control? And I’ve got a scar on my neck that says the notion of seamstresses is just preposterous.
“Absolutely, more competition. Competition is almost always a good thing. It lowers prices, increases innovation, maximizes output, and provides more choices. For some inexplicable reason technocrats like Obama find competition to be abhorrent.”
You are aware of the studies showing that simply having more doctors drives up costs rather than reduce them? I assume there is a point where that is no longer true, but no one knows where that is. You will need to find a way to force competition. That will take government regulation. How will you foster competition in smaller communities where there is only one specialist or one group of primary care docs? Why dont the insurance companies within states compete? Why will they suddenly be more likely to compete if they now work across states?
You assume that interstate competition will lower costs, I think, because costs are lower in one state than another. What if that just reflects lower costs of living?
Lastly, much of this sounds good on paper (if you actually work in health care there are obvious big holes.) If all of this is so obviously wonderful. why hasnt some red state, presumably free market oriented, adopted these reforms (excluding the ones that require federal intervention)? Why don’t you look more at places that provide higher quality care at lower costs like the Mayo? You seem to consider the systems of France, The Netherlands, Switzerland as better in some ways? SO do I. What is the chance of passing reform that would copy a European plan in this political climate?
Steve
YES! I like it.
Screw Disney/Pfizer. Now anyone can make a Mickey Mouse watch/lifesaving drug!
PS, I think it’s awesome that E.D. Kain (just to drop a name) and the other guys at LoOG are hashing out alternate health care reform ideas that don’t dip into Sarah Palin’s crazy. Ah, if only these guys had some pull in mainstream conservatism!!!
Some of the whining going on around here about how liberals are demonizing conservatives and how Republicans are not cooperating because of how they have been treated is awfully rich considering that the GOP/conservatives did the exact same things when they were in power…I suppose the Dems could do better than their political opponents now that they are in power, but I guess it would be far too much to expect either political party to take the higher road…
@Steve Verdon: If you are going to do this why not get rid of the public option. Switzerland doesn’t have one, and their system isn’t nearly as bad a shape as the U.S. I don’t think the Netherlands does either.
We have a basic mandatory package, for which every insurer has to accept people no matter what pre-existing conditions they may have. On top of that we have additional insurance packages that you can choose, where insurers can exclude you (i.e. for dental insurance when you need 3 crowns).
Not having read said studies I can’t comment on them, but it sounds like a dubious claim. And I’m not saying more doctors, but more compeition. As the OP notes, you don’t have to be a doctor to sew stitches. Letting non-doctors do it would increase competition, IMO and quite possibly lower costs.
I think you have it backwards. Most cases where you have less competition you find the more regulated markets.
Ahhh the strawman argument, an oldie, but a goodie. Try again Herb.
No AIP, its more due to the fact that I’m not a “conservative” but I often get lumped in with them and then tarred as like in the quote in the OP. Its indicative of a weak mind.
Thanks Dutch. I have to say, it looks like the Netherlands has a rather good system. Costs are rising at a significantly lower rate than most other places, coverage is close to universal, and health outcomes look good. And it has some strong market based components. I think it is a system definitely worth looking at and considering for health care reform. Unfortunately the abortions our Congress are considering don’t go in that direction.
The term “health insurance” does not actually refer to insurance, much like the term “blow job” does not actually refer to an occupation.
When people refer to health insurance, they mean “a third party payment system for health care that distributes costs and risks not unlike insurance to avoid bankrupting families in case of significant medical expenses.”
It’s a compound word. Those who try to quibble over the term by breaking the compound word into its mildly related subwords are just trying to confuse issues.
Why would they do this? Probably because they are bad people.
“I think you have it backwards. Most cases where you have less competition you find the more regulated markets.”
Most. You speak from theory. I speak from watching what my fellow physicians are doing. You assume that free markets can work for selling food or clothes, so it must work for everything else. That is just not what I see. In most areas of the country, physicians are forming larger groups. It solves the issue of call coverage (something non-medical folks do not get at all) and lets them emphasize maximizing earning potential. They have little reason to compete if they are the only group in town, or one of just two groups.
Anyone can stitch? Again your ignorance of how medicine is actually practiced is showing. PA’s already do most of the routine sewing in lots of ER’s and do most of the closing in a lot of OR’s. There is not nearly the savings there that you think. Just using that as an example? OK. Same thing happened when someone suggested robots. Keep coming up with theoretical ideas, but try to find someone who knows medicine well, especially someone familiar with it as is practiced in big cities, medium ones and rural areas. Some of what you assert sounds like it comes out of a textbook. It makes very good theoretical sense. It falls apart when you try to apply it.
Steve
Steve,
I’m actually coming around to the idea that adverse selection is mostly a theoretical construct (Hi Michael!) and not really much of an actual problem.
I find this an interesting comment. In a realm where people can buy genetic screening but insurance companies are prohibited from requiring genetic screens, I would think that the uneven playing field would exacerbate adverse selection and moral hazard issues. Why do you think it is mostly a theoretical construct?
Steve V, straw man? I think you misunderstood me, because…dude, that wasn’t sarcasm or a straw man. I agree with you on medical IP reform. I just took it a step further…
I think anyone should be able to make a Mickey Mouse watch without paying royalties to Disney Corp. And I think any medical Big Pharma company should be able to manufacture the next life saving drug, even if Merck has the patent.
I also realize this makes me an IP heretic, but oh well. I’m okay with that. At least I’m not freaking out over “death panels.”
I’ve heard few practitioners address the issue.
Steve, do you have ideas for reform? Is reform even necessary from your standpoint?
re: Steve Verdon August 11, 2009 20:25
Actually, I wasn’t directing those comments towards you (reading your posts here, I realize that you aren’t a “conservative”)nor was I linking them to Giraldi’s blanket statement…he’s writing at the American Conservative so one would assume that he isn’t some raging liberal/Democrat…my comments were directed towards others who were complaining about how Democrats/liberals are treating Republicans/conservatives but didn’t seem to have the same concerns when the reverse was happening at different points over the last 8 years…
Lest we forget, it was the left’s trade unions that managed to put health-care into the controls of the business owner in the first place.
I believe either taxing them (more money for the gov. to waste, or buy votes with) or allowing tax credits for an equivalent amount to those that don’t receive such tax free benefits, would be one fair move. But to allow the government to use the $$$$ for their games is obscene and counter productive to saving on costs.
The big issues with Obamacare still aren’t costs but the forced intrusions of the almighty state into a million avenues of our lives and our freedoms.
For you liberals supporting such socialistic nonsense, perhaps you haven’t noticed the regularity with which these Obama types throw their own under the proverbial bus once they no longer serve their purpose. In short -you’re next!
Herb,
Apologies then, I thought you were being sarcastic.
As for Mickey Mouse, actually that is one where I totally agree with you. I belive the initial copyright for MM expired, but like all good mega-corporations with a boatload of toady pols, they managed to get copyrights extended.
TangoMan,
Because the information is not just in one’s genes. Granted, signal extraction from things like a medical history is harder, but insurance companies have an incentive to try and do it. Look at automobile insurance. Same thing. You know if you are a bad driver. All the insurance company can look at is your driving history. The latter is not as good as the former, yet mandatory insurance laws are to get the bad drivers to buy insurance and subsidize them as well, not the other way around. That is the good drivers usually have the minimum insurance and more as well.
Health care insurance might not be as easy as automobile insurance in terms of figuring out how is high risk vs. low risk, but I bet insurance companies could do it to some degree even without genetic testing.
steve,
Yes, and reading Boldrin and Levine’s free pdf book on intellectual property and monopoly. They point to specific examples where regulation (in this case IP laws) coincide with declines in innovation and competition. The latter leads to higher prices.
Forming cartels is illegal. I’d sic the Justice Department on them, or change the laws that stripped physicians of some of their barriers to entry. Or even better…both.
Strawman. Strawman. Strawman. Strawman. Strawman. I did not say that. I said you don’t have to be a doctor to sew sticthes, a very different claim.
I’m done. I’m tired of pointing out arguments I didn’t make.
@Steve Verdon
For folks interested in the Dutch system, see this: Healthcare: The [Dutch] medical system
I agree with Steve, that does look pretty good.