What’s Really at Stake in the Health Care Debate
Times are tough for most Americans, but it’s a boom time for government-run health care. Between the $86 billion worth of “economic stimulus” going to Medicaid, the fresh $32 billion for the State Children’s Health Insurance Program (SCHIP), and the proposed $634 billion “down payment” on a massive expansion of federal health care, the Obama administration and the Democratic Congress are determined to make 2009 a year of prosperity and abundance for at least one element of American society.
While this timing may seem strange — giving out raises with taxpayer money, while taxpayers brace for layoffs — it is not surprising. The health care debate is not just about health care anymore. It’s a surrogate debate over the centralization of power in Washington.
Take SCHIP. Ostensibly a program to cover poor children, it will now cover nearly half of all American kids. This begs the question: do you want to be among the half of all Americans whose kids receive public assistance health coverage or among the half who gets to pay for it?
In addition to being an end in itself, health care has become a means to the end of repudiating the vision of the American Founders and of most Americans. The Founders believed foremost in liberty and they set up a government to protect it by decentralizing and separating powers. Today’s “progressive” movement rejects that vision and calls for the centralization and consolidation of power, with the aim of providing for people by orchestrating the coercive authority of the administrative state.
Thus, the issue of health care will determine a great deal about our fate as a nation. Through it, we will embrace our founding principles of limited government and liberty or we will embrace an alternate vision that seeks to triumph over these.
If conservatives doubt that this much is truly at stake here, they should learn from liberals, who suffer from no similar lack of conviction. A tip-off is how over-zealously and irrationally supporters of government-run health care attack any efforts to reform health care along free market lines.
A centerpiece of John McCain’s health care plan involved shifting the health care tax break from employers to individuals. The employer health care tax break, a relic of World War II-era wage restrictions, has long impeded the development of a vibrant free market for health care. It keeps consumers from buying directly from insurers or caregivers, thereby reducing consumer choice and price transparency and reducing insurers’ incentives to develop innovative, affordable plans to meet consumers’ needs. It’s also unfair, as it taxes some people’s health care expenses but not others’.
Obama could reasonably have criticized McCain’s proposal for slightly reducing tax revenue (the projected result) or, amusingly, for being “too much of a change.” Instead, Obama bizarrely attacked McCain’s plan as an attempt to “tax your health care benefits for the first time ever,” and McCain didn’t understand his own plan well enough to rebut the charge. This demagoguing was the least honorable tactic that Obama openly employed in the entire campaign, as he willfully misrepresented McCain’s plan. Why did he do it? To get elected, of course — but also because the Left understands what’s at stake here. A vibrant free market for health care is the primary threat to those whose central goal is to expand government’s role.
Interesting piece. I agree that conservatives need to get on the topic of healthcare – and provide relevant solutions – if they want to regain relevance to a larger part of the American people.
I did want to stress that a lot of the sky-rocketing costs you cite have come in America’s free market medicine, where companies are looking for new and expensive techniques they can charge more for, etc.
You make a logical leap from the fact that the current piecemeal approach to government plans (SCHIP, Medicare), and the fact that they have been subject to rising costs must mean that all government-run healthcare must necessarily be more expensive. Research has shown that costs in many a government-run healthcare system in other country have remained stable, or suffered a rise in cost a lesser magnitude.
http://www.kff.org/insurance/snapshot/chcm010307oth.cfm
You cite the Medicare prescription drug program as a proof of success of the free market. But aren’t many of the drugs subsidized by that program much more expensive than they are in other countries (Canada comes to mind), especially because the government has not been able to impose stricter cost-control and use its bargaining power?
The bottom line in the health care debate is that America collectively spends too much money on health care, and does not get the best care possible. A large portion of the public has not been served by the current market in health insurance, and one would expect this problem to continue under any plan that does not mandate universal coverage. Depending on employers (and hence employment) to secure health coverage is a poor model for health coverage, and it is past time that cradle to grave coverage be part of every American’s birthright. Our health system is broken, and the market is not going to fix it.
Peace.
DS
The American public spends 2.5 trillion on health care per year. The Obama plan is to spend hundreds of billions to reduce the per capita cost from $27,500 to 25,000, a reduction of $2,500 per. The core of reducing the cost is prevention which is $40 billion, and the rest of the designated money is mostly administrative. I have yet to see a design for the prevention plan, and it is easy to assume that it will be 80% administrative and advertising.
The general plan is to adopt the European plan which brings taxes to the 60% level, provides adequate emergency service, rations additional service, and nationalizes the providers. Research and incentive are not necessarily on the table.
I repeat that if someone wants cradle to grave security then they may consider becoming a battery as in the movie The Matrix. The sales pitch for that career is that the person will be very secure, have a life time of deep relaxation, tune into the best of video dreams, be non-polluting, and reimburse the society with watts of participation while remaining comfortable in a peaceful society. Evolution permits that a species has the right to go extinct.
David S,
My turn today.
During periods of my life I have lived in what could be termed “poor neighborhoods”. Many of the households did have low incomes, some were working and some were on government assistance. Some, like myself lived there because costs were low and the vibe was good. You can guess who had healthcare and who didn’t. But there is something more to this, as that many working low income households had the option, say, of buying a new(er) car, paying payments, or purchasing health insurance and getting an old beater. I personally went through the cost/benefit analysis with many individuals on different occasions. But, most people wanted to keep up with the Jones just like in any other middle or upper class neighborhood. Many could have bought insurance. Guess what. Except for the very poorest (between jobs, or waiting for assitance to kick in), there were a lot of newer cars. Those not covered could go to a “free” health clinic for general care, or would go to the emergency room and get “free” care. Nobody went uncared for in almost any case that I knew of. I’m not saying care is there for all, but pretty damn close. You just have to know how to work the system. And everybody knew. The conversations were quite lively, and most adults were well informed about the advantages/disadvantages. I’m not condemning anyone, that’s just how it was.
The major bitch was the length of time (hours) waiting to be treated… Major injuries received immediate care. No bill, or very minimal, and you really didn’t have to pay that either.
It’s already there folks, lose your assets, move to the “good” states, and line up.
The link that brother David (Com 1) gave is to the Kaiser Foundation “Snap Shot” section which examines selected aspects of health care finance. The data is derived from a massive study by the Organisation for Economic Co-operation and Development (OECD). The Kaiser foundation has done all of us a service by presenting the data in graphic form that is easy to understand. Those who fail to peruse this link will be classified as un-educable.
The abstract from the OECD study states the following:
The full report is somewhat of a bear, and can be found as a pdf file here. The report, unlike the Kaiser report, includes health care outcome data. It proves what correspondent David S (com 2#) stated. We are paying more, yet the quality of health care is worse, than other industrialized countries.
Meanwhile, Mr. Lucky (com 4) displays his blazing ignorance of how the health care system works. Today, there are no “free” health care clinics, and assuredly no “free” emergency room visits. Perhaps this abstract from a study in Health Affairs might jolt a bit of reality into his smugness:
The British, with their quaint use of the English language, sum up Mr. Lucky with the phrase ”I am all right, Jack”. Let us hope, that he, and his children, and all other members of his family remain lucky…
Mr Lucky,
I understand what you are saying that at a certain time there was free health care provided by hospitals and clinic in local communities. No longer is that the case. You can thanks the privatization of this country’s healthcare system. I’ve heard of people going to the hospital for a broken arm, being asked they had insurance which they didn’t and these people were turned away. This is the only country that I’ve lived in that this has happened. Most people state that the European model for universal health care provides mediocre service with none of the benefits that a free market health care system provides. Jed I think you brought up this point. Are you basing your assessment upon firsthand knowledge or absolute ignorance? If you are pointing to socialized health in the UK and France I can understand your misconception. If you take a look a a few more countries you will find that and equal amount have something call a single insurer health system where the Government provide the insurance for the individual it took place after WWII and was based on the US Medicaid program. The individual still has choice of the doctor and hospital that they want to go to. The Doctors are not employees of the State, the insurance plan also is not run like an HMO. Here in the US I could not believe that if you had additional medical insurance to your policy from work you have to choice one policy or the other because most providers will only take one. That is something unheard of in Germany also people don’t get turned away if they are hurt or sick.
Peace
DN
Our health care is fundamentally sound.
The manner in which our health care system is managed is completely broken.
The manner in which we pay for health care is utterly and completely broken, and stands as an exception to everything else a consumer pays for.
Both of these problems were created by destroying the free market economics that once controlled the costs and provided motivation for better service. Comprehensive health insurance companies now act as a proxy monopoly that has driven health care costs higher at rates multiple times that of inflation for decades.
The only thing that will fix either of these is going back to a free market system where costs are limited to what the market will support and providers are weeded out or rewarded based on performance.
Placing an utterly corrupt government in charge of a completely broken system will do two things. First, it will completely destroy the quality health care in the U.S. Second, it will open the door to legislation controlling any aspect of our lives that increases the cost of guaranteeing our health – as determined by the government. No thanks.
“Today, there are no “free” health care clinics, and assuredly no “free” emergency room visits.”
You are most assuredly correct. Those who DO pay, pay their share and the share of those who don’t pay. Here in texas, the share who don’t pay are largely illegals. We also do have free county health clinics. Except they of course are not really free, we taxpayers with jobs foot the bills again.
Health insurance needs to go back to being Insurance, As in, protects against catastrophic loss in an unlikely and unforseeable occurance. Car insurance does not pay for gas fill ups and oil changes. Health insurance should not pay for vaccinations and the sniffles. Health insurance also needs to be free market and uncoupled with employment, like car insurance. I can pick up the phone and call 20 companies here in my city for auto insurance quotes, whether or not I have a job. Why should health insurance be different?
The last thing I want is our incompetent government running my healthcare. If they could show one-ONE-healthcare program run by the feds or a state that has been successful, then and only then might they have a leg to stand on. Unfortunately, there is no such thing. Other countries aren’t comparable to us since no other country has our illegal immigrant problem.
Our Paul,
The British, with their quaint use of the English language, sum up Mr. Lucky with the phrase ”I am all right, Jack”. Let us hope, that he, and his children, and all other members of his family remain lucky…
My stepdaughter, who qualifies as very poor, had a kidney operation recently. “Free”. Followed up with resulting care and examinations. “Free”. Because of her poor health, she has had on a few occasions had an ambulance come to her house and take her to the hospital. “Free”. Her son went to the emergency room in a great deal of pain. He had a broken leg. He was then referred to an orthopedic surgeon, who will treat him. “Free”. This has all occurred in the last few years, and with her son, last week. That’s luck? She lives in Oklahoma, very much a redstate. Hmmm…There?
Try a university hospital. Locate to somewhere that best suits your lifestyle. That’s the way it is.
Have you ever been poor or lived among the poor? There are reasons why people live in some places, and sometimes it’s not for the scenery. My brother, who was basically a street person much of his life, always said that if you’re down on your luck, go to San Francisco. He said that they have the best programs around. I worked and lived there. I saw it. You live and get over by your ability to adapt.
I think you underestimate the ability of the poor to take care of themselves, to make things happen, as best they can. And my comments were intended to show this situation in a more positive light, rather than being smug. I think you misinterpreted my intent. Health care is out there, you just have to work at it one way or the other. Open your phone book. Look at the services provided by the county you live in. Go up on the net. Compare state by state. Do some research. Poor does not = stupid.
I’ve heard and seen the horror stories myself. But they are not the rule, from my personal experience. I have known quite a few people who could afford health insurance and have chosen not to go that route. They find a different way that suits them. They do sometimes release themselves to the whims of the system. As I said, I am not condemning anyone. It’s their choice, tempered with what the system presents. I was merely commenting from the other side of the tracks. I live there.
I pay for our health insurance, out of pocket, all the cost. It’s that important to me. Money is short, but we find a way.
People seem to have a lot of difficulty thinking about the problem instead of just cherry picking documents based on their abstracts. Interestingly, the only mention of immigration in the report linked by Our Paul is in regards to the uninsured population. There is a huge amount of immigration to the US, and many of these immigrants grew up with a background that predisposes them to a variety of health issues, many of which get picked up in statistical studies and lower the overall picture. Just one example, and there are plenty more that make using these “overall heath outcome” type rankings extremely dubious.
If I ever develop cancer, I sure as hell I’m treated in the US, as opposed to receiving the “third world cancer care” of the UK(Source: WHO)
Geoff wrote: “If I ever develop cancer, I sure as hell I’m treated in the US, as opposed to receiving the “third world cancer care” of the UK(Source: WHO)”
You might get a little bit better care in the US but not much and it, of course, would depend on the type of cancer you had. However, if you had cancer and really wanted to get treated well then I would suggest going to Germany or France. Their government administered health care programs are among the finest in the world with an extremely high satisfaction rate. Hopefully, Obama’s plan is to model out own health care reform on their model. Germany, for instance, pays form many cutting edge treatment that are not covered here in the US. Also, with the profit mechanism removed treatment protocals are not second guessed by private bean counters who don’t care about your health but just want you to have the cheapest possible treatment in order to maximize profit to shareholders. Bottom line: the only function a private health insurance company has is to ensure that they take in more money in premiums than they pay out in claims — even if that means you die as a result.
One of the major forces that drives the cost of healthcare higher is the cost of malpractice insurance. Yet the Democrats and trial lawyers continually refuse to allow malpractice tort reform or malpractice payment caps. Once the Obama Democrats have pushed us into a government healthcare/single payer system, does anyone honestly believe that suing for malpractice will even be an option anymore? It seems evident to me that this is a way of punishing physicians in private practice into accepting government oversight.
- I’ve heard of people going to the hospital for a broken arm, being asked they had insurance which they didn’t and these people were turned away.
You’ve “heard of people”? I seriously doubt it. Unless it was 25 years ago. What you describe is illegal under the Emergency Medical Treatment and Active Labor Act (1986), which applies not only to citizens but also illegals.
Mr. Lucky, let me outline it for you:
(1) Those with limited or no income, like your step daughter, are not receiving “free medical care”. Their costs are covered through Medicaid a Federal and State program for the poor. You and I pay for Medicaid through Fed, State, and County taxes. Call it what it is, single payer, government sponsored, universal health care for the poor. Oklahoma where your step-daughter lives, assuredly is a Red State (Republican / Conservative). But, they know what side of the bread is buttered: No Federal aid to any Hospital that refuses to accept Medicaid patients. There is no state in the Union that does not have a Medicaid program.
(2) If you make enough money, but not enough to buy insurance, your children may receive Health Insurance coverage through SCHIP, a Medicaid program for financially disadvantage children. You might visualize this as “free” health care, but you and I pay for it by taxes, as described above. Call it what it is, state sponsored, single payer, Universal Health Care for financially disadvantage children, that covers them, but not their parents.
(3)If you are 65 or over, you are entitled to Medicare, a government entitlement program. Medicare funding comes through FICA taxes, which you and I pay or have paid, and will pay about 80% of a health care bill. The other 20% is paid by Medicaid, private Insurance, or out of pocket. Call it partial single pay, universal, government sponsored, Health Insurance for the elderly.
The above covers the “poor” that you claim are receiving “free” medical care. Between this group, and those than can afford a high quality Health Insurance Policy, lie the Great Unwashed, known as the common American man. To understand his plight, I recommend Karen Tumalty’s recent article in Time Magazine.
Take it from me, I have no desire to pick a fight with you, or to mock your way of life. I am just trying to make you think. That means an acceptance of data that cannot be discredited, and a willingness to examine solutions that may run counter to your ideology.
Take for example Geof who prefers this ad hominem attack:
The abstract is presented as a “teaser”, as means to draw people to examine and read the whole paper. If you do not believe what is in the paper, you attack the methodology, not the guy who brought it to the attention of this forum.
You could examine momof3 (com #8) comments. She has identified the causes: illegal immigrants and an incompetent government. But, at these dark hours there is hope. Governor Perry, I am told by the tea bag brigade, wishes to secede from the Union. If he keeps Chuck Norris, I will support his desire to leave the Union.
it is past time that cradle to grave coverage be part of every American’s birthright.
I was thinking about this and noticed that of the rights outlined in the Bill of Rights, all of them are rights that can be exercised without anyone else bearing a burden.
You want to exercise your right to free speech? Go ahead, I can move out of earshot if I don’t like what you have to say.
You want to exercise your right to bear arms? OK, but guns aren’t my style so I’m not going to bother getting one.
Go down the line and you won’t find a single right that requires anyone to take any action on your behalf that they wouldn’t take otherwise. Even the rights involving due process and interactions with the legal authorities are only activated when a representative of the state takes an action against you that is unjustified.
Now, these little pukes want to force doctors to treat people at a certain, government-determined level of compensation because health care is a right? Please. It’s a non-starter to call health care a right because it requires that someone else DO SOMETHING ON YOUR BEHALF INVOLUNTARILY.
It’s indicative of the petty tyrant mindset that infects the left, though.
Our Paul,
I put free in quotes for a reason. I guess you missed the irony, or sarcasm, at any rate. Once again, I think you misinterpret my intent. I suggest you come by for a couple of Keystone Lights and some pork rinds, and then we can discuss the matter face to face.
Ah yes, its not in the constitution crowd has sent their representative to this discussion. As would be expected, venividivici (com #15) is just a bundle of disdain and ignorance, to wit:
Why ignorance? Well for starters Insurance companies set the rate of re-imbursement for physicians, and these rates have historically favored surgical and procedure oriented specialties. It is no secrete that Insurance companies are in it for the money, and have no interest in your state of health. Meanwhile, up to 30% or more of your friendly doc’s overhead is related to billing.
The “little pukes” (what a picturesque and charming term) now include an increasing number of physicians, and the trend is quite clear.
Me thinks our Caesar should spend a bit more time in the vidi pastime in this century, then look to our Founding Fathers. After all, George Washington was treated by repeated blood letting during his terminal illness…
Our Puke,
I’m happy the disdain came through, I thought I might have been sugar-coating it a bit.
Yeah, the only problem with your analogy to insurance companies (and, it happens not to just be a problem but a deal-killer) is that doctors are free not to contract with those particular insurance companies. Health care can’t be a right unless it’s the right to self-treat, in which case, knock yourself out.
Look up the profits for insurance companies. They’re about $50/insured per year. I’ll gladly fork over $4.25/month in profits to keep the government out of the health insurance biz. Those “overhead” studies are as useless as the day is long because they don’t take into account the time value of a patient having to wait to see a doctor, the just measure direct costs. If, in my job as a consultant, I presented those overhead numbers to a CEO, he’d laugh me out of the room and I’d get fired. For lefties, it becomes a talking point.
Reading your link on the trend, if you look at the underlying driver of wanting a “national health plan”, it’s the impact of treating the uninsured. Well, that’s fine, but that doesn’t necessarily lead to a national health insurance plan because there are other market-oriented ways to supply insurance to the uninsured. There’s more than one way to skin a cat and all that.
The 40% of physicians who don’t want to participate in a national health plan should have the right not to and, if forced, should sue the government. I bet they’d win.
And everyone’s in everything for something (money, power, status), man, even the people who work for the government. You can post that they’re not until the cows come home, doesn’t make it true.
Dr. Anderson,
There is no such thing as a “free market”. Nationalized healthcare is no more less a right to the citizens of a society as public safety. Private enterprise can not provide fire or police services via a capitalistic approach.
Neither can capitalism provide healthcare to Americans and effectively address our health needs.
Sincerely yours,
Mr. Schenck
Health Insurance Companies have already ruined the health care system in our country thru their greed and fraudulent actions. Dr.s and Hospitals have been defrauded by the Ins Co’s, which raise rates, and reduce legitimate payouts to heretofore unseen low levels. In a nutshell, they raise the premiums, reduce the payouts and then cry poormouth. And then receive a Trillion dollars in bailout. Just ask A.I.G. how it works. I’m just one private Physician in practice for 29 yrs, and in the last 2 yrs my re-imbursement for services has been reduced $250,000. This from the historical average for services rendered. They suck, lie, cheat and steal. And get paid a Trillion dollars to do it.
In fact, many of our prisons are outsourced to private industry. Here in Georgia, several cities outsource their administration to private contractors specializing in government administration. We have private defense contractors providing public safety in Iraq. Most of our infrastructure projects are handled by private contractors. Any public service can be administered by private industry and in most cases, can do so better and cheaper.
Zerocare will be imposed on all of us using the failed model Medicare, but Medicare Lite…at least from the funding side. This currently underfunded program now forces most of the cost shift in America and is directly responsible for the high cost of coverage. With Medicare paying only 82% of cost to the hospitals, those with high Medicare population like those of us in the South have a huge burden or sick tax to place on the sick and/or their payers.
Zerocare will by necessity be a two tiered system which will “cover” everyone, but the government will have a vested interest in driving the “rich” to seek care outside the system at their own expense by limiting quality and access like the NHS in the UK. When the gap between private medicine and government medicine becomes great enough, people will look to the private system for care and leave in droves thereby cutting the total cost of Zerocare. This is really just a tax increase when one has to pay doubly for the same item.
Look for a national health sales tax as well just like in Canada where it was called teh GST…known widely as the Gouge and Screw Tax. All this will be to provide “free care” just like in Canada or England.
If doctors are forced to participate look for substantial numbers to “retire”, particularly in certain key specialties where shortages now exist because of “central planning”. Overall the future is gloomy for healthcare.
No one may claim a right that concurrently creates an obligation for someone else. For those that claim a right to health care, what gives you the right to stake a claim to another person’s earnings?
I am not my brother’s keeper. My duty is to myself and my family and when someone claims part of my income as their own as part of some “right” they are essentially stealing from me and my family. I and my family have to sacrifice something in order to provide a stranger their “right”.
What right do I gain over someone who has claimed a part of my income? Do I get to dictate that the obese eat less and get more exercise? Do I get to dictate that smokers quit? If these people lay claim to the product of my labor for their own benefit I claim a right to dictate how those claimants live their lives so they make the most of my money.
Nationalized health care will turn taxpayers into indentured servants of the unproductive class.
Most of my patients have already been to HMO, ER, Medicaid clinic – but smile happily (as do I) after careful 15 min exam and treatment for $50 cash.
To reduce cost and have concern for patient, not third party,
get HSA compatible ins. ~ $2,000 deductible, for 1/3 cost BC CA or Kaiser, and self-manage care.
1,200 GR Ins Co employee catastrophic cost was 30% less the year after 95% chose HSAs, indicating better care from doctor paying attention to them rather than insurer.
“Universal” means dictated, regimented, one size fits all.
Dump the do-gooders who want to run your life. THEY are the cost.
@ TRSchenck:
The problem, as defined by Democrats, isn’t health care but health insurance. No one goes without health care if they need it but many are uninsured. The multiple reasons behind that aside, the free-market CAN provide all with health insurance in exactly the same way it provides for ALL other insurance products.
If the government would stop distorting the market via Medicare, Medicaid, SCHIP, the VA, and burdensome regulation at the state and federal level then health insurance could be provided to all relatively cheaply. At least at the cost of a monthly cable bill. And I’d wager that not many uninsured go without cable or cell phones.
The problem, as usual, is too much government interference, not too little government.
Single-payer systems, like the UK’s and Canada’s, are abysmal. How many horror stories have we seen of people dying in ER waiting rooms because no one treated them? Why is it that the UK has to import half of its doctors?
The Feds already control education and finance, why should we allow them to grab control of another 16% of the U.S. economy?
Our Paul:
Don’t confuse the wingnuts by using facts, analysis and logic. It is like casting pearls before swine. They prefer to wallow in the mud of their own ignorance.
27. Robert Hurley:
Our Paul:
Don’t confuse the wingnuts by using facts, analysis and logic. It is like casting pearls before swine. They prefer to wallow in the mud of their own ignorance.
At least you followed your own rules and didn’t use facts, analysis(I’m surprised you know the word. Kudos, you’re more advanced than 99% of your lefty colleagues) or logic in your post.
Pretend I was a young lefty who didn’t know why nationalized health insurance was the best way to go and explain it to me. Wow me with your facts, analysis and logic.
Hurley,
Remember, though, I’m a YOUNG lefty and my brain hasn’t been eaten alive by years and years of propaganda, so just repeating mantras like “The US spends the same amount of money for worse outcomes” is more likely to make me ask follow up questions like “How are you measuring spending?” and “How are you measuring outcomes?” and “What factors are you controlling for in those measurements?” than it is to be convincing.
As this thread fades, let me reiterate.
Our health care problem is not a problem with health care.
Our health care problem is a result of the way we PAY for health care.
The economic relationship between the provider and the consumer has been destroyed. That’s why costs have skyrocketed and ‘standards of care’ now define excellence, rather than what the health consumer market demands. That’s why the cost of most other goods has decreased as quality has increased, while just the opposite has happened with health care products and services.
Turning this completely broken system over to an utterly corrupt government will lead to nothing but ruin. And pretending it’s “necessary”, pretending health care is a “right” – just so the guilt-ridden, moral adolescents in our society can pretend they’ve created some nebulous “safety net” for some nebulous fragment of the population – won’t change that.