Wednesday, July 11, 2007
When it comes to healthcare, states are not good laboratories
Ezra Klein argues persuasively that the various attempts by individual states to move toward universal or, at least, quasi-universal healthcare coverage probably will not succeed. Bonus political insight: "When you’ve managed to put Jesse Jackson and the Chamber of Commerce on the same side, you’ve lost pretty much everyone."
8 Comments:
By 
, at
Wed Jul 11, 10:57:00 PM:
I didn't find Ezra's article to be persuasive at all. A few quick thoughts:
1) The devil is clearly in the details on a lot of these efforts. The failures in different states weren't exactly of the same ilk. Take Washington State - apparently, when you force insurers to offer coverage at "affordable rates" to "everyone," insurers leave. Go figure.
2) Klein acknowledges that the Massachusetts attempt has a shot at success - but then contrasts this with other, poorer states where the revenue supposedly isn't available. Well, okay then... if the average individual state can't afford to provide universal coverage, what exactly is it about aggregating all of these states to a national program courtesy of our federal government that will magically make it affordable?
By 
Miss Ladybug, at
Thu Jul 12, 01:59:00 AM:
Two years ago, David Asman, an anchor for Fox News Channel, wrote about his experiences with British socialized medicine when his wife suffered a stroke while they were vacationing there. You can read his account here.
If this is what we can expect from "free healthcare", I don't want it. Ever hear the saying "You get what you pay for"?? We'd be "paying for it" alright...
By , at
Thu Jul 12, 03:36:00 AM:
Universal is code for "free to bums, the self-employed, and anyone else who isn't willing to work for, pay for, or develop themselves to get healthcare coverage as part of their compensation". It's also code for "if you have it now, get ready to pay more for giving it to those who don't currently have it, and for paying more to maintain the same level you work for today". That's not a favorable plan for me.
I recall the NYT running a big thing about this early in the Clinton years, when Bill's husband was making the rounds. They spoke of some independent software guy, making a bundle, who didn't want to pay for his own plan, so he was "uninsured".
There's also little or no emphasis on healthy living in the "debate", only arguments for the small proportion of those who are "born" with genetic predispositions, or actual lifelong health issues. MOST of us, since the US population is HUGE, would benefit from eating less, drinking less, watching less TV, and generally living more active healthy lives.
If people stopped smoking, eating trash, and shut off the tube in favor of a walk, far fewer would need this miracle "cure" called Free Health Care.
Just one fat, cigar smoking, beer drinking guy's opinion, mind you.
By TigerHawk, at
Thu Jul 12, 06:45:00 AM:
A few background notes:
Klein is a very thoughtful guy on healthcare. He believes, for example, that progressives should let go of the idea of a single-payer system. There are many other versions that might work.
As excellent as American healthcare is for people at the top, we are not getting a particularly good deal. We spend a higher percentage of GDP on healthcare than any rich country on Earth, and by most objective measures we get worse results for it. There are many reasons for this, some of which can be addressed and others we probably do not want to address.
For those of you who think an ounce of prevention is worth a pound of cure, note that our system does poorly in that respect because nobody has a financial stake in long-term health. If people switch insurers every time they switch jobs, it does not pay any insurer to try to get you walk more and eat fewer chips.
Howard, your points are well-taken. A couple might be made in response. First, most reformers (including Ezra) have a long list of things that they would do to take costs out of the system. The problem is, most of those things would require essentially national changes in practice. Second, the federal budget obviously has a lot more play in it on both the taxing and the spending side than any state budget. It just has many more fiscal options.
My own skepticism about most healthcare reform proposals arises from two or three big objections. First, I don't see how you do it without lowering the rate of return on becoming a doctor or inventing a new drug or device. If you lower the rate of return, you will get much less of all of that stuff (particularly drug and device innovation). That's a problem. Second, I think that the US is likely to do a poorer job of any system that requires a lot of new government bureaucratic machinery than other countries progressives also cite as examples. Why? Unlike Continental Europeans and especially the French, we just do not get our best people, or even our second best people, in government. The top Americans seek their fortunes elsewhere, and that makes it culturally difficult for us to succeed with huge government programs. Third, no program will succeed without an extended discussion of which health care is "necessary" and which is, essentially, a lifestyle decision. In many European countries, those decisions are made by bureaucratic fiat and they survive because the other constituencies cannot communicate around the government to the population. Medical advertising, for example, is banned. In this country, the First Amendment prevents the government from stifling even paid commercial dissent, so the pharmaceutical companies can tell the voters what they are missing out on. Big problem for any system that would save on healthcare spending by denying coverage.
By , at
Thu Jul 12, 09:35:00 AM:
TH,
Thanks for the comments. I'd be interested in reading more about the national nature of the cost-cutting changes that Ezra suggests - am only just starting down the path of reading about serious health care policy stuff. As such, I don't doubt that there are such arguments to be made - only that they weren't really broached in the linked piece.
Leaving aside the national cost-cutting opportunities, I would take issue with your federal budget vs. state budget response. Obviously, the federal budget has naturally greater flexibility by virtue of being able to run a deficit ad infinitum. That said, unless the federal government can run such a program more cheaply per capita than a state government, we're really only talking about cost shifting (either in terms of where the added taxes go or which generation pays them - no free lunch here).
Claiming that a particular state can't afford its desired universal healthcare program is really another way of saying that the people of the state don't have the appetite to pay sufficiently higher taxes for the funding. This problem doesn't go away when rising to the federal level - it just becomes easier to paper over.
By , at
Thu Jul 12, 11:40:00 AM:
Anonymous said...
--------------------------------
Universal is code for "free to bums, the self-employed, and anyone else who isn't willing to work for, pay for, or develop themselves to get healthcare coverage as part of their compensation".
---------------------------------
Gosh, I never new having the drive to start your own business and make a living would put the self employed in the same class as bums.
Anonymous if you would put some effort, work, and money into developing yourself you might eventually have enough skills to be self employed.
You would also discover that you could actually pay for your own health insurance to boot.
Cheers,
TJIT
By Miss Ladybug, at
Thu Jul 12, 04:38:00 PM:
When I moved back to Texas two and a half years ago, I got back in touch with an old friend from junior high school. Last time I'd seen him, he was engaged to be married and working for some internet/computer-related company. Now, he is self-employed, and his wife does some sort of catering business. They don't have insure, by choice - he and his family have been lucky enough to not have major medical problems (they do have 2 chidren), and they decided to put what they would pay for insurance premiums into a medical savings account.
When I first moved back, I came for a job at a very small company. In the interview process: "Yes, we offer health insurance". I should have asked how much - for just me, it would have been $400+ a month. Then, I went back to school and was able to pick up the group/student insurance. Although I've graduated, I'm able to carry that insurance through the end of the cycle (August). Now, I just have to get that first teaching job and get new coverage that is part of my compensation package. But, I'd like to be able to get to the point of doing a medical savings account like that old friend of mine....
By SR, at
Thu Jul 12, 09:56:00 PM:
TH: You could run a piece per day on healthcare, and you will get a nice chain of comments. There are so many problems with governmentally provided healthcare, it is hard to know where to start. Point one I'd make as a physician is that most politicians are interested in job security more than in actually providing healthcare ( which is natural because they aren't trained to deliver care, and besides there is somebody else they can force to do it). The package always proposed is first dollar coverage. This is silly, as nobody proposes national food insurance, or anything else deemed "essential." There is no incentive to cost effectiveness, and any plan will ultimately ration and restrict access, not to 15% of the population, but to everybody. I only hope the 85% that get world class American healthcare realize this, and that any plan proposed meets the same fate as Hillarycare. Are you out there Harry and Louise?
