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Socialized Healthcare: WWRRD?

Submitted by Stephen Gordon on Mon, 01/19/2009 - 03:03
in

"...the political survival of the Republican party probably depends on its defeating whatever health-care plan emerges from the scrum created by Messrs. Obama, Baucus, Kennedy, and Wyden.

"If the GOP fails, the beating it took in 2008 will pale in comparison to the decades-long drubbing that will follow." -- Cato's Michael Cannon, November 18, 2008

It seems that in recent national GOP debates, whether they are between presidential candidates or RNC Chairman hopefuls, there is a direct competition to see who can appear the most Reaganesque.

With respect to socialized healthcare, it seems that the GOP is divided into four factions: those really opposed to socialized healthcare, those who don't think socialized heathcare can be defeated, those who don't care that much about socialized healthcare but wish to gain as much political turf as possible over the issue, and those who actually favor additional government intervention into the healthcare marketplace.

I'd like to briefly address each of these four groups (after the jump).

Those really opposed to socialized healthcare:  You already know the speaking points and how difficult the battle will be over the next few years.  Many of you are veterans of the battle we fought over this issue in the nineties.  In case you missed them, here are a few more bullets I've recently found which may help in upcoming battles.

Those who don't think socialized heathcare can be defeated: I agree with Michael Cannon.  If the GOP doesn't go after Obama and the Democrats on this issue, whatever small-government vestiges remain of the GOP brand will be forever lost to history.  I also remember prominent Republicans making this argument right after Clinton won his first election.  They were wrong then; those making this argument today are wrong now.  It's merely a matter of how many resources the right is willing to put into this particular battle.

Those who don't care that much about socialized healthcare but wish to gain as much political turf as possible over the issue: A lot of Republicans I know fit into this category.  I recall a fundraiser I attended in the mid-nineties where a certain GOP Senator was the guest of honor for a Congressman running for reelection.  My wife and I ended up talking with that particular Senator a lot that evening.  Most of the conversation I recall was about how much he deplored Hillary's healthcare plan and my wife and I left the event with a favorable impression of him.  He sent us a nice letter after the event, which we framed and placed in a prominent place in our house.  Fast forward a few years and he's one of the key people promoting the largest expansion of federal intervention into the healthcare marketplace this country has ever seen. Obviously, that letter no longer graces our wall.

While I preferred Mitt Romney to many of the other 2008 GOP presidential candidates, what he did in Massachussetts is no better than Medicare Part D. "Healthcare one can't refuse" is just as damaging to patients as the big donut hole in Part D.  As my wife, who is a physician, told me tonight: "It really doesn't matter if the boot on one's neck is red or blue, my patients suffer equally."

Perhaps it's time for Republicans to remove the boot from the necks of my wife's patients.

Those who actually favor additional government intervention into the healthcare marketplace: While I'd prefer simply to spit you out of my mouth, I'll try a different approach.  As I see it, you have two options facing you.  You can either become more of a Democrat Lite and lose even more elections or follow the example of all of your recent GOP presidential and chairman wannabes: Selectively invoke the spirit of Ronald Reagan for your Machiavellian purposes.

You will win nothing but laughs aimed in your direction by trying to appeal to the dark side.  There may be some future political advantage to at least pretending that you prefer a free market approach to healthcare.

 --------------------------------------------------------------------------------------------------

Before the Goldwater election, when an earlier version of this battle was being waged, Ronald Reagan had some sage words of advice.  I'd recommend that people from each of these four categories spend ten minutes to listen to what he had to say on the topic:

 

 

 

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Comments

As long as our argument is against socialized medicine...

Submitted by davidfarrar on Mon, 01/19/2009 - 06:07.

...while not providing the uninsured access to affordable medical insurance, we will lose this argument every time.

The fact is, Congress has failed to control medical costs again and again, while stuffing medical and pharmaceutical PAC money into their pockets.

You don't want socialized medicine, fine. Tell a part-time Walmart employee how she can afford medical insurance for herself and her family.

ex animo

davidfarrar

The Reagan ordinary people now remember

Submitted by Ironman on Mon, 01/19/2009 - 08:27.

was the President who was either unwilling or unable to dismantle most of the government programs he railed against as a political speaker.

Now this may not fit into some statistical analysis done by an Austrain economist  but I pay out of pocket for one of those "gold plated" insurance policies that the Republican think tanks deride. Ya know, having a special needs kid does that to you. I voted for McCain even though I was one of the people who would have been cost money from shiting the tax exemption on heath insurance to individuals because of the cap.  Needless to say, my arguments for McCain did not include this flawed plan, which he couldn;t explain very well anyway.

DF is dead on. This is an issue where you have to offer something; not nothing. And since the public wants to get more health care than it is willing to pay for; and providers want to be paid above market rate; this ain't no picnic.

One idea I would float is that health care is an essential; but so is shelter and nutrition. The government deals with low income people not being able to buy into those markets by virtue of subsidiies that enable them to obtain these goods from conventional private sector vendors (food stamps and Section 8 vouchers), We've found with housing, that the public sector doesn't do providing apartments very well compared to private landlords; so we let people "buy" into the existing system.

Would a form of "health stamps" work? I dunno. I think single payer would be a disaster---the experience in the UK and Canada demonstrates it's just having a monopoly HMO---but trotting out half century old arguments is a suboptimal response to the problem.

Single payer -- Multi provider

Submitted by WoodbridgeVa on Mon, 01/19/2009 - 09:26.

Ironman --

What you are describing is commonly known on the Hill as "Single Payer -- Multi Provider".  It allows the federal government to pick up the majority of healthcare costs while avoiding most (but not all) of the downsides of Single Payer plans like those in the UK and Canada.  The general idea commands a great deal of quiet support among moderate Republicans and Blue Dog Democrats.  It's primary weakness is that it fails to satisfy the extreme idealogues on either side of the aisle.  Most people who have examined the issue closely agree that SP-MP linked to some sort of requirement for individuals to obtain health insurance in the same way they are required to obtain auto insurance is the most workable solution.  Unfortunately the left attacks this idea because it allows too much latitude to the insurance companies and the right attacks it because it assumes federal funding, includes a mandate for individuals to purchase insurance and does not give primacy to HSAs. 

 

The weakness in SP-MP...

Submitted by davidfarrar on Mon, 01/19/2009 - 10:05.

...is that is does nothing to control the costs of health care.  All it seems to do is find yet another ingenious way to feed more funding to the health-care industry as a whole.  As long as we fail to control costs, it really doesn't matter the delivery system.

The only thing I can see is requiring all to pay medical insurance, as suggested above, like automobile insurance, but always have at least two choices available. As it relates to health insurance, one choice can be government sponsored health insurance, being run without profit it can therefore obtained at a lower price than private health insurance, or private health care insurance.

The same can be said for health care providers. Either the government health-care program or the private health care system. The point here is to create real structure competition between the two systems to compel the lowering of costs, much the same that was evident with the government ran the Public Health Service.

ex animo

davidfarrar

mandatory health insurance & single payer

Submitted by chemjeff on Mon, 01/19/2009 - 10:27.

The only thing I can see is requiring all to pay medical insurance, as suggested above, like automobile insurance, but always have at least two choices available. As it relates to health insurance, one choice can be government sponsored health insurance, being run without profit it can therefore obtained at a lower price than private health insurance, or private health care insurance.

This is actually the same as single-payer because what will happen is that employers and individuals will drop their present coverage and migrate to the state-provided coverage.  This has already happened in Hawaii.  Let's not repeat this mistake.

There is no need for a government sponsored plan

Submitted by WoodbridgeVa on Mon, 01/19/2009 - 10:50.

There are no government sponsored auto insurance plans.  Why should a SP-MP program need government sponsored health insurance plans? 

Keep it simple.  Provide a refundable tax credit set to allow individuals or families to purchase a median priced health care policy fully covered by the tax credit.  Announce that anyone seeking medical care will have one of three options: 1) pay for it with their health insurance policy, 2) pay for it out of their own pockets, 3) make retroactive payments for the premiums on the most expensive health insurance policy available from the time the individual became eligible for the tax credit until the time they sought medical care.  Make clear that individuals or families who choose not to obtain health insurance could face bankruptcy under options 2 or 3 and there will be no leniency.  Add a provison for HSAs but make clear they are a supplement to and not a replacement for health insurance and will not relieve an individual or family from facing option 2 or 3 if they do not purchase health insurance.  Allow insurance companies to sell policies across state lines under federal rather than state regulation. Adopt tort reform measures to reduce malpractice lawsuit abuse.  Let the market work. 

The very wealthy will probably choose option 2.  Many risk takers will choose not to obtain health insurance and face option 3.  A few will get lucky, most will not.  Their loss not mine and they can live with the consequences.  Most people will choose option 1. 

Yes, all of this involves federal subsidies of private health care; but it does so with the least interference in the private health care market and gives consumers the most choice and responsibility.  Yes, it will be expensive.  The alternatives, other than doing nothing, are more expensive and doing nothing is not a realistic option in a democracy where the majority of voters clearly want some action to address health care.

ok in principle

Submitted by chemjeff on Mon, 01/19/2009 - 14:57.

I like your ideas in principle.  In practice it is only a stop-gap measure, unless we can fundamentally change people's thinking about the role of government in health care.  People currently think it's a "right" to have not just the ability to walk into any emergency room and get immediate treatment, but also to get a sterling health insurance package.  This is what's got to change.

Actually, HSA's require individuals to get high-deductible health insurance already.

 

You are correct

Submitted by davidfarrar on Mon, 01/19/2009 - 13:59.

This is actually the same as single-payer because what will happen is that employers and individuals will drop their present coverage and migrate to the state-provided coverage.

Perhaps they will. But let's not forget just how unpopular the Public Health Service was back in its day. In additional, let's also remember just how inefficient the government is when it acts as the monopoly.

The goal here is to create more or less two structurally competing systems. Should one, as you say, become economically irresistible, we would simply be creating one health-care provider monopoly to replace another.

In the end, I am not sure we have that much of a choice. Indeed, this may be the only real choice we have left, i.e., if we have to have socialized medicine, at least let's have structurally competing systems.  We have simply allowed this single-provider health-care monopoly to continue far, far too long without addressing its raising costs.

This is just another example of yet another conservative failure lying at the heart of the socialization of our society.

In addition, if we are going to have a socialized health-care system, why not create socialized health-care insurance as well, to be run at cost rather than for profit?

Mind you, I don't like these choices any better than you do. But the political issue before us is health care accessibility

ex animo

davidfarrar

Spitting dialogue

Submitted by lgm on Mon, 01/19/2009 - 09:39.

Stephen Gordon says about people who support what he calls "socialized medicine":

While I'd prefer simply to spit you out of my mouth, I'll try a different approach.

This seems to be the Republicans' preferred form of political discourse.  Maybe the rebranded party can become more civil?

Are highways "socialized transportation"?  Maybe, but Americans want the government to provide them, and government built highways have cost advantages over private ones. 

Since we're not really willing to deny medical care to our fellow citizens -- the downside of our "Judeo-Christian value system" -- we should provide it as efficiently as possible.  The present system is laughably inefficient.  The Brits, and the French, and the rest of the developed world do it better and cheaper. 

Sure they gripe, but having reached a certain age, every family affair I attend devolves into stories of this or that incompetent doctor or botched procedure.  Statistics do not show that our system is better, even for those who pay.  And pay we do -- many times more than others.

Like highways, government run medical care is something Americans want.  It's efficient.  Republicans should stop spitting at each other and start figuring how to do it conservatively.

The people who use roads pay for them

Submitted by Ironman on Mon, 01/19/2009 - 11:30.

via gas taxes. The more you use the roads , the more you pay for them.  Are you suggesting a similar funding mechanism for UHC?

By the way, Big Brother will soon be collecting the road use fee in Oregon  . Given the way Joe the Plumber's records got leaked by government agencies, yeah, single payer will really protect our privacy

From the Texas Highways Department

Submitted by NextRightNando on Mon, 01/19/2009 - 12:27.

link 

no road pays for itself in gas taxes and fees. For example, in Houston, the 15 miles of SH 99 from I-10 to US 290 will cost $1 billion to build and maintain over its lifetime, while only generating $162 million in gas taxes. That gives a tax gap ratio of .16, which means that the real gas tax rate people would need to pay on this segment of road to completely pay for it would be $2.22 per gallon. This is just one example, but there is not one road in Texas that pays for itself based on the tax system of today. Some roads pay for about half their true cost, but most roads we have analyzed pay for considerably less. To conclude, in the SH 99 example, since the traffic volume for that road doesn't generate enough fuel tax revenue to pay for it, revenues from other parts of the state must be used to build and maintain this corridor segment. The same is true across the state, meaning that, as revealed by the tax gap analysis, overall revenues are not sufficient to meet the state’s transportation needs.

 

so people in places without new roads

Submitted by Ironman on Mon, 01/19/2009 - 12:51.

who benefitted from gas tax revenue used to built the roads they presently use (paid for by users statewide) now get to pay taxes to pay for new roads in other communities.

Perhaps there's some regional equity problem (maybe Dallas is now subsidizing Houston; inner ring suburbs paying to open up the exurbs) but, hello, this is not new.

I'm sure when Eisenhower built the Interstates the traffic volume across the Plains wouldn't have paid for 4-lane roads; which got subsidized by other users of the system so as to maintain a complete system.

The point is across a state or nation as a whole there is a nexus between quantity of road use and cost to the user.

UHC tends to work in directly the opposite manner. The heaviest users of medical services tend not to pay in proportion to their use. Since lifestyle choices impact the level of health care utilization; the cost of bad behavior gets socialized and passed on to the prudent and healthy.   

Are highways "socialized

Submitted by centerfire on Mon, 01/19/2009 - 16:16.

Are highways "socialized transportation"?

Of course.

Maybe, but Americans want the government to provide them

So?

and government built highways have cost advantages over private ones. 

Proof, please.

Since we're not really willing to deny medical care to our fellow citizens

Who's "we", paleface?

we should provide it as efficiently as possible.

Then why in God's name does anybody want the government to have anything to do with it?

The present system is laughably inefficient. 

Due entirely to existing government interventions in the system.

The Brits, and the French, and the rest of the developed world do it better and cheaper.

Depends on what metrics you're using for "better" and "cheaper".

Like highways, government run medical care is something Americans want.

And I want a free pony. Goverment does not exist to cater to the electorate's desire for a free lunch.

It's efficient.

On Planet LGM, perhaps. Not Earth.

Republicans should stop spitting at each other and start figuring how to do it conservatively.

It cannot be done conservatively. There is no stable state between socialism and a free market. You may as well tell Republicans to stop spitting at each other and start figuring out how to make the clouds turn to butter and fall from the sky.

 

A stable state between socialism and a free market

Submitted by davidfarrar on Mon, 01/19/2009 - 22:05.

If you structure both a socialized health care system as well as a private health care system to compete against each other for the same clients, the two systems may reach an equilibrium, while reducing cost (in order to attract more clients). Mind you, it's just a theory. But hey! You said come up with some conservative answers and we have thus far assumed there is no stable state between socialism and a free market and have therefore never really gone into these uncharted waters.

ex animo

davidfarrar 

Better and cheaper

Submitted by lgm on Mon, 01/19/2009 - 21:37.

Pretending that your post was civil, I'll just reply that health care in Europe is better in that it does a better job of keeping Europeans healthy, and it is cheaper in that it costs less.  I didn't provide links because any serious article about health care will say this.  There are some narrow areas in which US medicine is slightly better -- very expensive treatments for nearly fatal conditions that extend lives a short time.

When I say "we" are not willing to deny health care to our citizens, "we" refers to the vast majority of the American people.  Hospitals do not turn away patients who cannot pay.  One of the inefficiencies of our system is that many people use the emergency room as a very expensive (but free to them) way to get routine care.  Everyone would be better off if we (the US government in some way) provided this care in a cheaper way.

I see little point...

Submitted by centerfire on Mon, 01/19/2009 - 21:59.

in being civil with collectivists.  They are, as I have said before, worse than thieves, in that thieves don't hold themselves out as high-minded protectors of the commonweal as they rob you.

You write:

I'll just reply that health care in Europe is better in that it does a better job of keeping Europeans healthy, and it is cheaper in that it costs less.

Are those the only two meaningful metrics for "better" and "cheaper"?  Cato has done a rather smashing job tallying up the various hidden costs of European-style social welfare systems; in an apples-to-apples analysis they don't actually compare favorably to the U.S. system.

Hospitals do not turn away patients who cannot pay.

Seems to me that you've identified a pretty core component of why our existing healthcare system is too expensive: we're handing out free lunches.

One of the inefficiencies of our system is that many people use the emergency room as a very expensive (but free to them) way to get routine care.  Everyone would be better off if we (the US government in some way) provided this care in a cheaper way.

By "everyone", I take it that you mean "everybody except the healthy and the responsible, to whom the healthcare costs of the freeloaders will be shifted if the government is providing care"?

 

That won't fly.

Submitted by Jon Sandor on Mon, 01/19/2009 - 22:04.

health care in Europe is better in that it does a better job of keeping Europeans healthy

Any evidence that Europeans are healther then Americans, correcting for the usual demographic factors?

Hospitals do not turn away patients who cannot pay.

I don't think that "we" have much input into that.

One of the inefficiencies of our system is that many people use the emergency room as a very expensive (but free to them) way to get routine care.

Yes. Deporting the illegals would solve that problem, they being the people you're refering to.

Everyone would be better off if we (the US government in some way) provided this care in a cheaper way.

Not everybody. The people who'd be taxed to pay for universal healthcare would not be better off.

Orthopedic treatments?

Submitted by Ironman on Mon, 01/19/2009 - 22:25.

There are some narrow areas in which US medicine is slightly better -- very expensive treatments for nearly fatal conditions that extend lives a short time.

Hmm, how about knee replacements and hip replacements?

Wait list in the UHC Euro countries is immense; in the US it's relatively short.

I might also point out that most of these procedures are performed on 40-65 year olds who a) are going to live a good long time and ought to be able to enjoy it and b) regain greater earning potential post-injury, thus increasing societal productivity. Then again, given the ghastly level of chronic, noncyclical unemployment in most EU countries, maybe adding folks to the labor force isn't that high a priority.

Yes, Medicare pays for a lot of expensive surgery on very old and very sick patients. And which Democratic politician is going to tell seniors they are going to stop doing this so we can align our medical system to the standards of the UK NHS?

 

They're not your fellow citizens.

Submitted by Jon Sandor on Mon, 01/19/2009 - 22:17.

The people without health-care are, for the most part, illegal aliens.

There already exists an elaborate and expensve network of government health-care programs for poorer Americans.

The network of government

Submitted by acinphx on Mon, 01/19/2009 - 22:35.

The network of government health-care programs would be ...???  Not being snarky, just curious what you're referring to?  If such a thing exists, John McCain and his campaign were even more laughably inept than I thought -- it should have been easy for him to point to the existence of this network to make Obama look like a fool for even talking about a need to address health care.

I wouldn't think that illegal aliens account for the majority of uninsured ER visitors outside of border states.  Can you cite a source for the statement that people without health care are mostly illegal aliens? 

one problem with SP

Submitted by Ironman on Mon, 01/19/2009 - 09:46.

is to the extent it reduces administrative costs it would have to come by lopping off now redundant staff at private sector insurance firms. Living in CT that is not something that would help us and I don't understand CT liberals who favor it. Then again, they want to repeal the Bush tax cuts in a state where high earners pay much of the way and got a disproportinate benefit, and during the 80's favored nuclear disarmament when the Trident sub program was probably the biggest single employer in the CT economy.  The irrationality of CT liberals never ends.   

I'm not a health care wonk, but I had heard fears that what you described would essentially morph into a NHS. This is not good and I would appreciate knowing how serious a threat that would be. 

On the McCain plan, perhaps the right ought to figure out how not to disrupt the existing arrangements people make when procuring health care for their family. Many of us take jobs with less cash compensation or less desirable amentities (longer commutes; less interesting duties) for the benefits.  Politicians usually appreciate fear of loss motivates more than greed for gain; they didn't on this one. 

HSA, HSA, HSA

Submitted by chemjeff on Mon, 01/19/2009 - 09:52.

While I too deplore the abomination that was Medicare Part D, the same legislation also brought us greatly expanded HSAs, so that was a small silver lining.  They are not as sexy (nor oppressive) as socialized medicine but they represent one important aspect of the proper conservative approach to health care.

http://www.ustreas.gov/offices/public-affairs/hsa/

http://www.cato.org/pub_display.php?pub_id=6395

http://www.catostore.org/index.asp?fa=ProductDetails&method=cats&scid=33&pid=1441272

 

HSA's - Yeah, but...

Submitted by Evil Conservative on Mon, 01/19/2009 - 17:05.

there needs to be a significant improvement in the healthcare environment for HSA's to really work well.

I work in the employee benefits industry and HSA's can be good, but there's a lot to it and it's certainly no silver bullet.

I'll be happy to write more if others on this site want to hear. The healthcare industry is just so messed up. Insurance companies try to weasel out of claim payment. Doctors try to squeeze every margin out of the insurance companies. And patients glut the system with hypochondriac nonsense which causes doctors to perform a million tests to avoid a malpractice lawsuit and doctors try to overbill the insurance company for those tests and the insurance company trys to weasel out of paying the claims.

Nice cycle, isn't it?

I'd love to hear it, honestly.

Submitted by RisingTide on Tue, 01/20/2009 - 14:10.

I live with a non-hypochondriac, who just happens to have severe medical problems from something that most people don't find terribly problematic (allergies).

Also, my HSA won't pay for the $700 air purification system, the hypoallergenic linens and other forms of dust mite prevention, the humidifiers, etc. All of which end up costing more than I spend on medicine each year.

THIS IS AWESOME!!!

Submitted by dean2 on Tue, 01/20/2009 - 14:02.

It's a constant relief that "conservatives" still can't figure out the health care deal.  I love when you call it "socialized" medicine.  Do you actually know what "socialized" means?  Apparently not, as not one single credible national health care policy amounts in any way to "socialized" medicine.  (Can you even name the one - 1 - nation in the westernized world that has truly socialized medicine?  Come on, there's only one, and they're a good friend of ours.)

Frankly, I'm glad you're too dense to understand the difference.  And I'm glad that once national health care passes I'll no longer have to pay inflated prices for the 47MM+ people using the emergency room instead of regularly visits to a primary care physician. 

What's sad is that, like former President Bush, you refuse to look at data to drive your decisions.  You continue use your irrelevant dogma, which will cause you to fail again and again and again at the polls.  Suckers.

Socialized medicine is...

Submitted by Stephen Gordon on Wed, 01/21/2009 - 23:12.

...when the money for healthcare purposes comes from public funds, whether or not the end service (or good, in some cases) is provided by a governmental or private entity.

This is my definition.  I well aware that neither the economics community nor the healthcare community has come up with a lasting definition which everyone can agree upon.

My two cents on health care.

Submitted by cdm on Wed, 01/21/2009 - 02:33.

I have a post up on my blog in regards to the health care delimma, as well as what the Dutch have done to reduce the cost of healthcare.  My thoughts can be found here:

http://cdmpolitics.blogspot.com/2009/01/next-right-health-care-challenge...