"But war, in a good cause, is not the greatest evil which a nation can suffer. War is an ugly thing, but not the ugliest of things: the decayed and degraded state of moral and patriotic feeling which thinks nothing worth a war, is worse. When a people are used as mere human instruments for firing cannon or thrusting bayonets, in the service and for the selfish purposes of a master, such war degrades a people. A war to protect other human beings against tyrannical injustice – a war to give victory to their own ideas of right and good, and which is their own war, carried on for an honest purpose by their free choice – is often the means of their regeneration. A man who has nothing which he is willing to fight for, nothing which he cares more about than he does about his personal safety, is a miserable creature who has no chance of being free, unless made and kept so by the exertions of better men than himself. As long as justice and injustice have not terminated their ever-renewing fight for ascendancy in the affairs of mankind, human beings must be willing, when need is, to do battle for the one against the other."

Friday, August 07, 2009

I scream, you scream, we all scream about health care

As I mentioned in my last post, I've rarely worried myself overmuch about health care because for the first 18 years of my life, I lived under a single-payer system which I fortunately didn't have to use as I was generally healthy, and for the last ten years I've either been covered by the military or by college health insurance (which again, I never used since I was generally healthy, hangovers aside). So long as I'm in the military, the cost of health care for me and my family won't be an immediate issue. But 1) I won't always be in the military, and 2) with the 'reform' plans currently under discussion, I may not be paying for my own health care but I'll sure as hell be paying for other peoples'; and so will my son, and his son, and his son after that if the Chinese haven't cashed in their chips by then and brought America to her knees. And boy, has this issue become a many-splendor'd thing:

-THE PLANS: evidently there are several, and apart from some small differences they all run over 1,000 pages. The plan is supposed to extend coverage to all Americans, provide a 'public option' for those unsatisfied with or unable to afford private insurance, lower health care costs across the board, improve treatment, have a price tag that is 'deficit neutral', and halt the rise of the oceans (oh wait, that's a different plan). Well, the Cylons had a plan too, and unfortunately for them, it didn't predict the Battlestar Galactica going to ramming speed. The plan's flaws have been percolating to the surface for the last month: it's not deficit neutral, but will substantially add to the deficit well beyond its initial ten-year window; it will actually cause millions of people to lose their current insurance plans; its costs will inevitably result in direct or indirect tax hikes well beyond those who make $250,000 and above (in addition to any tax increases mandated by cap-and-trade, continued bailout programs); and, based on the experiences of the many other countries that've already gone this route, Americans will see their care rationed and the quality of the care they get decline. All this isn't to say that the American health care system is beyond reproach; it's not (as last week's kidney stone saga can attest to), but the fact remains that the United States is blessed with one of the best health care systems on the planet and a complete overhall risks throwing out the baby with the bath-water. Comparing our system with the systems of other countries who've either partially or completely socialized them, we find that turning health care over to the government grants no improvement in life span, mortality rates, or the survival rates of major diseases. Thus, any necessary reform should be targeted to avoid sweeping away the benefits of modern American medicine.

-THE PUBLIC: given these flaws, the public is increasingly reluctant to grant the government more authority in this sphere. There are a few 'bottom lines' behind this: one, 68% of Americans already consider their health insurance good or excellent; two, 74% think the quality of their care is good/excellent; and three, almost 80% believe the current proposals will result in higher taxes. So, a significant majority of Americans like what they have, are afraid government meddling will make what they have more expensive in already tight financial times, and a solid 50% believe 'reform' means what they have will drop in quality. There's also a strong perception that Congress' plan has not been thoroughly analyzed, a perception that only increases when the president himself admits he doesn't know all the details and the Congressional Budget Office's most conservative estimates on cost belie the rosy promises of the president and his congressional leaders. Yet the public is being told that, regardless of all this - the lack of vetting, the cost, the potential drop in the quality and quantity of care - this plan must be passed right here, right now. In the wake of massive Wall Street bailout, a flaccid stimulus, and a runaway deficit thanks to all of the above, many Americans - and a number of their congressmen - are skeptical of the scope and speed of the plan Congress is pushing through.

-THE "DEBATE": so, in the face of the questions raised about the current plans and mounting public criticism, how have the reformers responded? Have they delved into the weeds to explain the plan in detail, showing exactly where costs are saved, insurance is improved, how the predictions of the CBO are wrong? Have Nancy Pelosi and Harry Reid remained cool and collected, taking the time to alleviate specific concerns? Not so much. Instead, they've attacked in another direction. They've aired ads against conservative members of their own party to bludgeon them into line. They've accused Republicans of holding up the legislation, laughable considering they own both Houses and the GOP couldn't mount a filibuster if it wanted to. A special White House email account has been set up in order to track emails full of "disinformation" and where they come from (imagine the outcry had the Bush White House set up a similar account). Americans who've protested against the current legislation have been labeled everything from corporate shills to mobs to neo-Nazis. Insurance companies, who are understandably concerned about being potentially run out of business, are "immoral". The White House has run its own attack ads against protestors using the Michael Moore method of reporting: they show unrelated footage of crazed 'birthers' questioning Obama's citizenship while lumping health care critics into the same category. Critics' sincerity is even attacked because "they're too well-dressed" to possibly be genuinely concerned citizens. And protestors can't possibly represent a grassroots movement because they're organized, when only a few months ago community organizing was touted as the highest calling. The above is not debate, it's an attempt to destroy critics and deflect attention from serious questions to which reformers cannot provide good answers. Oh, I'll grant that it's possible some of the rowdies at recent town hall meetings are merely corporate sleeper cells; I'm pretty sure they're still entitled to express their opinions, and the sleeper cell theory doesn't hold up against poll numbers showing wide swaths of the general public opposed to reform as proposed and rapidly losing confidence in the president's ability to handle the issue. With this type of response, it's become clear that the Democratic leadership doesn't want debate, only meek compliance.

On the whole, I think it's a net good that this issue is now at the forefront and being debated in detail (among the general public, even if not in the halls of power). It's also encouraging to see that one-on-one meetings between representatives and their constituents are generating such interest, and the consituents are holding their elected leaders accountable. But it's troubling when reform's supporters won't deign to debate their legislation on its merits, and believe that only an unthinking "mob" would dare question their diktats. Americans are right to be wary, right to question and demand solid answers as to why they should change a system that's by and large satisfactory, and above all should be extremely reluctant to give the government any kind of hold over the most private part of the private sector: their own bodies.


The Accidental Blogger said...

I'm pretty sure I explained the outlines of the proposal and would be happy to debate the contours of it (i'm not a health care wonk so getting into the weeds would be difficult). Some quick comments...

1. The public option isn't the mechanism for providing people who can't afford coverage with coverage. There are subsidies for individuals from 200% to 400% of the poverty level depending upon the specific bill.

2. The CBO generally scores the bills with a public option as being less expensive than bills without one.

3. By the latest scoring the HELP Senate bill would actually increase the number of people with employer-provided insurance by 3 million within the next five years.

4. America is currently 50th in life expectancy, spends 33% more than any other country on health care as a percentage of GDP (16 to 12) and is middle of the road in many other key indicators (the two areas we do well in are prostate cancer and breast cancer, which is largely due to a combination of increased awareness and aggressive testing). Health care as a percentage of GDP is projected to rise to 26% by 2025. I think its safe to say there is something seriously wrong with the current system.

5. Let's go with some more numbers: generally between 60 and 80% of Americans want a public plan (Rasmussen polling is about as reliable as throwing darts). Link: http://www.fivethirtyeight.com/2009/06/public-support-for-public-option.html

6. Lastly, just because I haven't said it yet on this post. This bill does not make our system socialized or single-payer or communist or entirely government-run. These bills maintain the private market but subject it to more strict regulation.

The Accidental Blogger said...

Oh, one last thing, currently, government spending is 46% of health care, so its not as though we're currently in some Smithian-market panacea. And polling of customer satisfaction almost always find Medicare to be higher than private insurance. An example: http://www.calnurses.org/media-center/in-the-news/2009/june/who-s-afraid-of-public-insurance-1.html

The Accidental Blogger said...

Also, if you're going to accuse supporters of not 'deigning' to debate the issue, I think you should at least be willing to engage them when the information is offered. You want to debate health care, let's have at it. This is the type of thing I'm not 100% sold on and it would be good to have someone push back on some of these ideas.

Cincinnatus said...

Believe me, it is not my lack of interest in true debate that's kept me from replying more quickly; it's simply that I don't have much time when I'm home to blog, leaving free time at work as my best opportunity; and thanks to government network restrictions, I can email posts with ease but can't access the blog pages themselves. I have not stopped thinking on, or researching, the subject; once I get some more time this week - probably while I'm up in Canada for vacation - I can get back to this matter in detail.

Cincinnatus said...

T.B.A, further discussion is inbound, just can't post right now cuz I'm at work and I don't feel like cutting and pasting on the iPhone .

Cincinnatus said...

T.A.B, to respond to your initial set of points, in no particular order:

A) The life expectancy/expenditure issue. I cite here several studies
which specifically address the apparent failure of American health care you raise, namely, that in spite of large expenditures, the United States lags behind a number of other First World countries in its life expectancy. The studies are as follows: http://www.aei.org/docLib/9780844742403.pdf,
http://www.bepress.com/fhep/10/1/3/, and
king_papers. I couldn't open the first on my government computer, but the last, though filled with a fair bit of medical jargon, I found quite interesting. It notes the incongruity between some of the points you made - that the U.S. is pretty good in treating various forms of cancer and other
diseases but has a lower life expectancy than, say, Canada or France - and notes that precisely because of greater American success in treating some of
humanity's deadliest diseases, it seems there must be another culprit at work besides a malfunctioning health care system. The authors note that a higher reported prevalence of certain diseases contributes to higher overall expenditure, but also note that Americans are more likely to get themselves checked for these diseases than Europeans; so, Europeans might have the same
disease rate but lower relative expenditures because they don't know they have said diseases, or spend less time treating them as they aren't caught as early. They also note that there are different cultural factors at work in the U.S., such as higher percentages of people who smoke or are obese,
two conditions which certainly contribute to a shorter life-span. But, while these two trends certainly don't speak highly of Americans' personal choices, they can hardly be blamed on a poor medical system, especially
given its acknowledged success in treating things like cancer. People, not hospitals, are responsible for lighting up or chowing down.

B) In terms of increasing the number of employees who have health covered, Fortune has a new piece
ne/) outlining some of the options employees will actually lose under the current plans, and among those are: the insurance they like. For large companies like GE and Time Warner, there's a five-year period during which business continues as usual; after those five years, however, these companies would be required to adopt a 'qualified' plan offered by government exchanges. For smaller businesses, employees will be immediately required, at the time of bill adoption, to get a qualified plan; those who
have insurance before a bill passes can keep what they have, UNTIL the plan is altered in any way (something which is apparently common every 12 months), at which point, again, employees will lose their coverage. While this does not directly result in fewer employees having coverage, it
increases the overall cost of health care reform, because these qualified plans will have a standard list of benefits that balloon well beyond what
the employee might believe he needs. Some states already have standardized benefit packages, and thanks to extensive lobbying, they can cover everything from hair transplants to hearing aids.

Cincinnatus said...

C) While we're on the subject on employee health coverage, I notice (or at least I've missed noticing) no's one talking about taxing employer-provided benefits and returning the cash to the employee so he can buy whatever insurance he wants. Charles Krauthammer, who I know you love, makes this
and another argument on simple measures we could take to reduce health care expenditures
2933.html). The other measure he suggests is drying the well of
ambulance-chasing lawyers and radically reforming medical malpractice laws. Massive lawsuits increase insurance costs for everyone, and contribute to
one problem Obama complained about; namely, unnecessary tests and treatments. Well, doctors perform those now because they're afraid that if they don't, they'll get taken to the cleaners at court.

D) Polls. I checked out your link on the popularity of a public option, and while the numbers differ significantly depending on what poll who reference, the average seems to work out down the middle. This is hardly a

E) More polls. Today, Gallup asked whether voters would advise their congressmen to vote for or against a health care reform bill after the recess. The results: 35% were for, 36% against, and 29% had no opinion. Compare this to July 14's Gallup poll, which found that 56% of respondents favored voting for a reform bill by the end of the year. This is a drop of 21% in public support. That also follows the general drop in the public's approval in Obama's handling of the health care issue. Again, hardly a mandate or a good reason to rush a bill through by year's end.

Cincinnatus said...

F) Reducing costs. I think all versions of the bill tout expanded
government funding of preventative care as a method of reducing medical costs. But the director of the CBO notes (http://cboblog.cbo.gov/?p=345)
that expanded utilization, promoted by the government, would actually increase costs, because the reduction in future treatment costs for one person would be offset by the cost of screening many people who would never
have had that disease anyway. Furthermore, he notes that extensive preventative care is already being performed and that current insurance plans cover much of this at little cost. Government programs to expand and
encourage such care would thus end up paying more for care that's already being provided.

G) I'm not accusing the current reform plans of trying to turn America into the Union of Soviet Socialist States. However, I believe that the legislation proposed would give government-sponsored plans a huge advantage
to the point where the private market would be significantly shrunk or destroyed, while doing little to improve the quality of care or reduce costs. And let's be honest: many reformists have been quite frank in voicing the idea that a government-option would lead to a single-payer
system (can't embed vidoes but see a recent chat with Barney Frank or
candidate Obama on the campaign trail). Frank, at least, doesn't try to hide his desire to see this happen; President Obama, on the other hand, was (to be charitable) pretty disingenuous when he said in your home state today that "I have not said that I am a supporter of a single payer system". This is flatly contradicted by a town hall speech he gave last August ("If I were
designing a system from scratch, I would probably go ahead with a
single-payer system") and by a number of other statements he made earlier in his career. He said today he dislikes "wild misrepresentations" and wants
an honest debate; he should start by being honest about his own stance.

H) Finally, I'm not disagreeing with his argument that doing nothing is not a solution. Health care is one of those subjects that reflexively cause Americans and their leaders to stick their heads in the sand when it's mentioned. It's easy to be for reform but punt the hard choices reform
requires down the road (c.f. immigration, Social Security), and I think these bills are simply a lot of punting and wishful thinking bound and printed. A really hard choice that could have real benefits would be taking
on trial lawyers and changing the rules for malpractice lawsuits, or, as you mentioned, standing up to pharmaceutical companies and banning the direct marketing of drugs most people don't need. I see no hard choices in these
bills, but a real potential for even greater health care costs which, piled on top of a rapidly increasing deficit (the climb of which could be accelerated by a punishing cap-and-trade bill, or more bailouts and stimuli), spell fiscal disaster down the road.

The Accidental Blogger said...

Apologies for posting my response on my blog but I tried to do this earlier in one comment and comments are just wayyy too restrictive. I lost about 40 minutes of writing to blogger/teh internets. I did include a shout-out to your writing though:)