Republicans Still Oppose Government Health Care

March 2, 2009

Comments

In an era where everything is the worst somethingorantother since the Great Depression or some other time, I suppose retro comparisons are just in style. I’ve seen several references of late to the Republicans being stuck in 1997 or 1993 or whathaveyou. Hell, I’ve made them myself.

This one, though, puzzles me:

With health care reform as President Obama’s main agenda item this week, Greg Sargent digs up a 1993 William Kristol memo that argues Republicans could make significant electoral gains by derailing President Clinton’s own health care reform effort. It will be interesting to see if Kristol’s points are reflected in GOP talking points this week.

The Democrats still favor nationalizing health care. The Republicans still oppose it. Where’s the gotcha in that?

If Obama is recycling HillaryCare, why wouldn’t Republicans recycle the tactics that successfully killed it? After all, it was good enough for Barack Obama in the Democratic primaries.

Ezra Klein argues that things are different now because Obama is more popular than Bill Clinton was then and so is his plan. We shall see, I guess. I’ve long argued that nationalization of America’s health care system is inevitable — that the only question is how long we can delay it and what form it will eventually take. But that doesn’t mean we should give up without a fight.

22 responses to “Republicans Still Oppose Government Health Care”

odograph

March 2, 2009 at 11:51 am

Glancing back, I see that Senator McCain proposed “universal” health care funded in part (or for the poor) by “tax credits.”

Go back a little bit further in time, and I’m sure that would be “nationalization.”

(We’ve descended into semantic litmus tests rather than a search for good architecture.)
Dave Schuler

March 2, 2009 at 12:58 pm

I’m reminded of Keynes’s comment: “When the facts change, I change my mind. What do you do?”

Open borders without universal health care is bad public health policy. Open borders with universal health care is bad public policy.
James Joyner

March 2, 2009 at 1:00 pm

Open borders without universal health care is bad public health policy. Open borders with universal health care is bad public policy.

And closed borders are a practical impossibility.

The options ain’t all that good!
Pete Burgess

March 2, 2009 at 1:01 pm

Speaking of architecture, do we need to change the attitude about how Americans use health care? Should health care be used similarly to how we use other insurance systems ie. catastrophic versus hang nail? If the govt ends up having to ration coverage, that is no different from those covered making the rationing decisions themselves, except that the govt solution will be much more expensive. So, can the problem be solved BETTER with govt incentives versus govt management?
Jim

March 2, 2009 at 1:39 pm

Why is it that both liberals and the media now feel that any questioning of their ideas is now unpatriotic? First those who voted against the stimulus bill were deemed less than legitimate…the tea parties were ridiculed and now opposing universal healthcare is now taboo. Between 2001 – 2008 dissent was patriotic – in 2009 is dissent treasonous? Sometimes it sure feels that way.
odograph

March 2, 2009 at 1:45 pm

Here Pete is one clue to possible rationing:

From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages. Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.

Does our system over-allocate to the terminal? I would not want to deny anyone a genuine chance for a life-saving or life-extending treatment, but I have heard that our insurance system, as opposed say to British National Health, allocates a lot to the last 30 days of life.
Dantheman

March 2, 2009 at 2:10 pm

Jim,

“Between 2001 – 2008 dissent was patriotic”

Boy, are you living in a different world than I am. In the one I live in, anyone circa 2002-5 commenting negatively about the Iraq War was asked “Why do you hate the troops?”.
Pete Burgess

March 2, 2009 at 2:29 pm

Odograph, That sort of rationing is understandable, but does it not lead to ethical dilemmas that should be outside the purview of govt regulations and rules? It is a cost that must be balanced against the overuse of coverage benefits by people used to today’s attitude.ie; What is this pain in my shoulder? Oh well, I have coverage for X-rays, so let’s go find out. Conversely, can I live with the pain, does it hurt enough for me to pay out of pocket? I just think that regardless of where the coverage comes from, new rules for coverage should be implemented to help change the attitude of the users.

I think as long as we keep the oppressive, regressive federal tax code, then we should get significant tax breaks for spending our own money on health coverage.

It just seems that the answer to this problem does not lie with dropping it at the feet of the govt and all taxpayers. I am a small business owner who does not provide coverage for my employees, but I have gotten my personal doctor to agree to see my employees for a rate less than the “covered by insurance” rate. Additionally, if I have a possible workman’s comp case, I try to cover it as a business expense rather than file it which costs everybody more money.
anjin-san

March 2, 2009 at 3:11 pm

that the only question is how long we can delay it and what form it will eventually take. But that doesn’t mean we should give up without a fight

If you feel it is inevitable, why not give up a pointless fight and work to make it better when it comes?
Michael

March 2, 2009 at 3:12 pm

It is a cost that must be balanced against the overuse of coverage benefits by people used to today’s attitude.ie; What is this pain in my shoulder? Oh well, I have coverage for X-rays, so let’s go find out. Conversely, can I live with the pain, does it hurt enough for me to pay out of pocket?

Do you know how much it would cost you, out of pocket, to get an X-ray? Who has the cheapest X-ray service in your town?

You can’t make a rational cost/benefit analysis about your health care, when you don’t know the cost. In many cases, you’re not even told the cost until after you’ve agree to pay it.
odograph

March 2, 2009 at 4:20 pm

Do you know how much it would cost you, out of pocket, to get an X-ray? Who has the cheapest X-ray service in your town?

What I don’t like about our latest quasi-national system is that with health savings account, we sign up for a relationship with a provider, who makes no commitment to us for low costs at all.

I haven’t sprung for the HSAs, but I gather that I’d have this HSA policy with my HMO, and they’d tell me, after the X-Ray, how much to cough up (no pun intended).
anjin-san

March 2, 2009 at 4:28 pm

Why is it that both liberals and the media now feel that any questioning of their ideas is now unpatriotic?

A few suggestions:

1. Turn off Rush
2. Turn on Brain
tom p

March 2, 2009 at 4:47 pm

that the only question is how long we can delay it and what form it will eventually take. But that doesn’t mean we should give up without a fight

If you feel it is inevitable, why not give up a pointless fight and work to make it better when it comes?

James, this was my initial reaction as well. There are a # of good conservative reasons to be against “national health care” as it is presently perceived. If one just says “I’m against it!” does not one run the risk of being froze out of the discussion altogether?

I for one would prefer to see both sides of the aisle at the table so we can get the best of both worlds together in one plan.
tom p

March 2, 2009 at 5:14 pm

Do you know how much it would cost you, out of pocket, to get an X-ray?

Michael, yes, I do, it is a standard deductible set by my insurance.

Who has the cheapest X-ray service in your town?

Whoever my insurance sends me to (they negotiate the rates).

You can’t make a rational cost/benefit analysis about your health care, when you don’t know the cost.

I don’t need to… my insurance knows the cost. They decide.

In many cases, you’re not even told the cost until after you’ve agree(d) to pay it.

My cost is fixed at a set copay. (by the by, I am a union carpenter, so I have good health care, but that does not mean I don’t pay for it… Our contract is for a set $ amount, yr by yr, if it all goes to health care, so be it)

Michael, I know where you are trying to go with this. But, can you not see how the “system” has failed us in this particular situation? I haven’t had a raise in years (because of HC costs & inflation) and I am one of the guys who are better off.
James Joyner

March 2, 2009 at 5:19 pm

James, this was my initial reaction as well. There are a # of good conservative reasons to be against “national health care” as it is presently perceived. If one just says “I’m against it!” does not one run the risk of being froze out of the discussion altogether?

I think helping shape the debate makes sense. But one can be opposed to it in principle and fight the principle. There’s always time to negotiate later.
Stan

March 2, 2009 at 5:25 pm

What do you mean by “nationalized health care”? Do you mean a government controlled plan, like the UK National Health or the plan used by the US military? Do you mean a single payer plan like Medicare or the medical insurance systems used by France and Canada? Do you mean an individual mandate plan, like the ones used by Germany, Switzerland, and the Commonwealth of Massachusetts? You have a PhD. Why don’t you use it and raise the discussion above the level of Joe the Plumber?
Jim

March 2, 2009 at 5:47 pm

Anjin-San:

I have to thank you for proving my point with your response: the left is surprisingly intolerant of dissent.

You respond to my post with a crude insult:
“A few suggestions:

1. Turn off Rush
2. Turn on Brain”

and then you attempt to stifle Dr. Joyner by stating:

“If you feel it is inevitable, why not give up a pointless fight and work to make it better when it comes”

Did you take your own advice before we invaded Iraq?
Steve Plunk

March 2, 2009 at 6:58 pm

We continue to argue about how to pay for health care when the real problem is why does it cost so much. Until we address costs we are wasting time. Make it cheaper and insurance becomes more affordable. Make it cheaper and the uninsured could even pay cash for some services. Make it cheaper and the problem gets better.
tom p

March 2, 2009 at 7:39 pm

I think helping shape the debate makes sense. But one can be opposed to it in principle and fight the principle. There’s always time to negotiate later.

Like with the stimulus bill? Mind you, I am left of center, but I feel things could have been better if the Repubs had brought more to the table than “anything but Obama!!!”

This is politics after all.
tom p

March 2, 2009 at 7:44 pm

Until we address costs we are wasting time. Make it cheaper and insurance becomes more affordable. Make it cheaper and the uninsured could even pay cash for some services. Make it cheaper and the problem gets better.

So Steve, as one who has no idea how to tackle that particular aspect of the problem, (ya know, the aspect that is running at double the rate of inflation?)

what do you suggest?
Michael

March 2, 2009 at 8:47 pm

Michael, yes, I do, it is a standard deductible set by my insurance.

I was specifically asking about Pete Burgess’ suggestion that without insurance coverage, people would be force to make cost/benefit decisions on what health care to get. Since you are insured, the question is moot, as all the decisions have been made for you.

I would note, however, that very rarely has my standard deductible been my only out of pocket expense for anything more than a routine checkup. Radiology services regularly send me bills saying that I owe the balance between what they felt like charging, and what they agreed to let my insurance pay. Insurance doesn’t always negotiate the best prices for you.

We continue to argue about how to pay for health care when the real problem is why does it cost so much.

And I continue to agree with you. It is ridiculous that a 5 minute session with a doctor, followed by 10 minutes of a nurse doing the actual work, should cost me several hundred dollars.

what do you suggest?

Remove the artificial barriers to receiving basic health care. Allow nurses, who are more than competent enough, to perform more functions without an MD.

Make the legal system for trying negligence slightly more sane, there is a big difference between a doctor being negligent and a doctor being wrong.

Make them advertise the costs of their services up front and in the open. I can’t think of any profession that doesn’t do this.

Finally, doctors should make their best effort to help you, not every possible effort regardless of how likely it actually is to help you.
odograph

March 3, 2009 at 7:57 am

Yikes, on costs, read the first few paragraphs here.