Jay Reding.com

A Little Radicalism Is Good Medicine

Ramesh Ponnuru has an interesting pice in Time on why the GOP’s health care platform represents a radical shift. Instead of health care being something that you get through your employer, many of the Republican plans would see health care as something you have—just like auto insurance, life insurance, or homeowner’s insurance.

That’s the way it should be. The only reason we have the system now is because the tax system forces it—there’s no economic reason why risk pools have to be so small or why health coverage shouldn’t be portable from job to job. Losing your job should not mean losing your health insurance. Moving to a new job shouldn’t require you to have to think about what coverage you’ll get. People who work from Mom’s Apple Pie Bakery should have access to the same level of care that someone who works for Microsoft has.

The Republicans need to push back on health care, because despite all the hew and cry, it’s a winning issue for them. Even after years of scurrilous attacks, polling shows a market-oriented approach being more popular, winning over the Democratic plan 49-40%. When confronted with the options of having a federal bureaucracy or having real choice, it’s not hard to figure out why Americans tend to choose the latter. The last thing we need in this country is more bureaucracy in medicine.

Emphasizing personal choice is key to this issue. The electorate is justifiably upset at the status quo in which the HMO bureaucracy makes health care more expensive and harder to get. The huge rise in health care costs in this country is due to the fact that we have an unworkable system: the Democrats want to make that system bigger, the Republicans want to fix it. Instead of forcing everyone into a federalized Mother of All HMOs that combines the efficiency of the DMV with the caring service of the IRS, it’s a much more attractive option to give people real choices.

Put the only way something like this will get passed is if the GOP is willing to fight for it. The Democrats are promising the moon, but giving us more bureaucracy. Nobody (other than Democrats, who take it as an article of faith) really believes that things run better when the government takes them over. Healthcare is no different. The GOP has the right policy, but they have to have the political will to see that policy enacted. That will mean actively fighting back against all the pressure groups backed with special interest cash who are invested in the broken status quo.

It’s a battle worth fighting, both politically and on behalf of the American people who need real choice in health care. The question is who will be willing to lead that fight?

10 responses to “A Little Radicalism Is Good Medicine”

  1. Mark says:

    The “ownership society” is dead, Jay. Just as Americans made it clear that they don’t want to forfeit their Social Security checks for a personal retirement account, they’ll be just as uninterested in financing their own health care coverage. The fact that any serious person is entertaining the notion that LESS security in the American health system is a good idea is horrifying, and speaks volumes why the Republican Party brand is so radioactive these days.

    With that in mind, I encourage you guys to run full steam ahead on a campaign message telling voters they don’t want to surrender their employer’s health care plan for “socialized medicine”, but should instead surrender their employer’s health care plan so that they completely self-finance their medical costs. Should be a winner!

  2. Jay Reding says:

    The “ownership society” is dead, Jay.

    Odd, since I don’t recall seeing a bunch of socialists seizing power today. Then again, I didn’t go out for lunch…

    Just as Americans made it clear that they don’t want to forfeit their Social Security checks for a personal retirement account, they’ll be just as uninterested in financing their own health care coverage.

    They already do. Here in the real world, the insurance fairy doesn’t leave a health care plan under your pillow at night. People already pay for insurance, the difference is that under the GOP plans they can have a choice of what plan they pay for rather than being forced to pay for whatever their employer tells them they have to have.

    The fact that any serious person is entertaining the notion that LESS security in the American health system is a good idea is horrifying, and speaks volumes why the Republican Party brand is so radioactive these days.

    Yes, having health care coverage that doesn’t end if you lose your job is less security. Also, hot snow falls up and your dog hates steak.

    With that in mind, I encourage you guys to run full steam ahead on a campaign message telling voters they don’t want to surrender their employer’s health care plan for “socialized medicine”, but should instead surrender their employer’s health care plan so that they completely self-finance their medical costs. Should be a winner!

    Or we could tell people that it’s idiotic to have someone else tell them what health coverage they want and instead they should have the freedom to choose whatever health plan they want, same as they can choose whatever auto insurance plan they want. You can shop around for auto insurance, why shouldn’t you be able to shop around for health insurance as well?

    The fact that you have to invent the straw-man of “self-financing” health costs rather than being able to pick an insurance plan only exposes how weak your arguments really are on this topic. No wonder even after all the FUD, half the American people still support free choice.

  3. Mark says:

    “No wonder even after all the FUD, half the American people still support free choice.”

    FUD? Guess I’m not up on my right-wing acronyms. I’d like to see exactly how the question was framed in that poll. If the public was really so enamored with these HSA’s, why aren’t they dropping their employer-based coverage and starting up their own in any significant numbers? HSA’s seem to be the wet dreams of free-market radicals (none of whom ever seem to talk about how great their own HSA is working out for them, curiously) who want to set up another tax shelter for the wealthy and foist even more financial burden on the backs of the peasantry.

    It’s simply amazing that you think a $10 an hour worker (or even a $20 an hour worker) could afford to forfeit a health care plan paid for mostly by his/her employer and, for the benefit of “choosing” his/her own plan, spend exponentially more money out-of-pocket. That this is even a consideration as a solution to the nation’s health care woes in an era of wage stagnation and soaring costs of health care goes a long way to explaining why you and so many other righties are science fiction fans.

  4. Jay Reding says:

    FUD? Guess I’m not up on my right-wing acronyms.

    http://en.wikipedia.org/wiki/Fear%2C_uncertainty_and_doubt

    I’d like to see exactly how the question was framed in that poll.

    When it comes to the issue of health care, which of the following two options would you prefer to help cover those without health insurance?
    Option A: Requiring all Americans to have health insurance, with the federal government helping pay for health insurance for low-income families.
    Option B: Providing health savings accounts and tax credits to help individuals and employers purchase health insurance.

    http://online.wsj.com/public/resources/documents/wsjnbcpoll20071108.pdf

    If the public was really so enamored with these HSA’s, why aren’t they dropping their employer-based coverage and starting up their own in any significant numbers? HSA’s seem to be the wet dreams of free-market radicals (none of whom ever seem to talk about how great their own HSA is working out for them, curiously) who want to set up another tax shelter for the wealthy and foist even more financial burden on the backs of the peasantry.

    Because the current system is weighted against them. Right now, HSAs are “use it or lose it” — if you don’t use your money at the end of the year it goes away. Part of a reform package has to make that money bankable.

    The other big reason why HSAs aren’t as common as they should be is because companies don’t get any kickbacks from insurers when they go with HSAs.

    And I just love how you refer to working-class Americans as “peasantry”… what a brilliant Freudian slip!

    It’s simply amazing that you think a $10 an hour worker (or even a $20 an hour worker) could afford to forfeit a health care plan paid for mostly by his/her employer and, for the benefit of “choosing” his/her own plan, spend exponentially more money out-of-pocket.

    Good thing they won’t have to.

    Here’s one person’s experience with an HSA which tracks with what other people I know who have had them. Even with all the unnecessary restrictions they have, they’re still a better deal for most people over traditional HMOs.

    Again, FUD. Fear, uncertainty and doubt. The reality is that HSAs, even in their limited form, work. A system that lifts the silly restrictions like not allowing them to be portable from job to job and making sure that any money left at the end of the year stays with the individual would make them even better.

    Just keep spreading your FUD. The reality is that socialized healthcare traps people in the HMO from hell. It takes everything that’s wrong with the current system and magnifies it. No wonder the only justification for it seems to be in spreading fear…

  5. Mark says:

    A $2,650 deductible? That alone would price most working-class people out of an HSA.

  6. Jay Reding says:

    A $2,650 deductible? That alone would price most working-class people out of an HSA.

    Except you only hit that once you expend your HSA account – it’s basically an additional catastrophic plan on top of the HSA for emergencies. In this person’s case, he had an emergency, and he still ended up paying only slightly more than he would have had he gone with the HMO plan. That deductible is high, but that’s the maximum you’d pay in a year no matter what.

    It’s also works out to less than $2,650 because the amount spent up to the deductible can be taken off your taxes at the end of the year.

    The biggest problems with HSAs now is that they’re not portable and you typically don’t get to keep what money you have left at the end of the year. Fix that, and there would be little reason to go with a typical HMO.

    Of course, if someone wanted to keep an HMO-based plan, they could. The whole point is that individuals would have the choice to pick whatever plan they wanted free of interference from their employers.

  7. kj says:

    You probably don’t realize that the two most efficient health care systems in the US are Medicare and the VA, both government systems. Democrats take it as an article of faith because anyone who has actually looked at those two systems in comparison to our ridiculous hodgepodge of ineffecient private insurers sees the blaringly obvious. I suggest you start by comparing administrative costs (http://healthcare-economist.com/2006/07/27/medicares-true-administrative-costs/) and then move onto patient satisfaction (http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=221504) and end that with comparative outcomes for a few different maladies (http://www.time.com/time/magazine/article/0,9171,1376238-3,00.html). Or you can cover your ears and scream, “government bad” if you’d like. I’ve long ago given up trying to convince market fundamentalists with actual numbers. Hopefully you aren’t a market fundie.

    As for HSAs, they are a cost-shifting scheme that one can’t really call insurance. They are fantastic if you are healthy and terrible if you are sick. But perhaps I am not understanding your new and improved HSA. If you had an HSA for say, the first $3000 with help for low income folk, and covered everything after that, then I could support such a scheme but that is not clear from your post. If, however, you are out of luck once you blow through your HSA, then this is not insurance at all. The problems with an HSA as I currently understand it are made clear in this Kaiser foundation chart: http://kff.org/insurance/snapshot/chcm111006oth2.cfm; where 20% of people make up 80% of our healthcare costs. In order for an HSA to work, it would have to guarantee access to catastrophic insurance to everyone regardless of pre-existing conditions and age. Otherwise its not insurance at all. Community rating is key to any real health care reform.

    I agree with you completely on the portability thing. That is a travesty. But that’s why single-payer appears to be the best bet as it will clearly be the most efficient. I also think the choice thing is a red-herring. I care about choosing my home, my school, my car, and my mp3 player, but I could care less who administers my paperwork to pay my medical bills. I want to go with the most efficient actor and clearly the government handles this one the best as proven by our own Government run insurance programs and the lower costs enjoyed by other Western nations. The only innovations available to private insurers over government are better advertisements and a bunch of corporate bureaucrats trying to figure out how not to pay for my medical procedure. That’s innovation and choice I can live without.

  8. Jay Reding says:

    kf: Let’s assume for a moment that Medicare and the VA really are the most efficient providers right now. (I don’t think that the facts support that conclusion, especially with Medicare.)

    The question is whether you can scale that system to nearly 400 million people. Look at the problems we have with our current entitlement system. Our current level of spending is not sustainable over the long term. The financial effects of adding more to that system would be catastrophic.

    Even the latest report from the Trustees of the Medicare system paints a dire picture. The costs of Medicare are draining more and more money from the treasury, and will be a major drain on our budget as the Baby Boomers hit retirement age.

    We can see exactly the same phenomenon at work in Britain and Canada, both of which have had to start looking at alternative private programs to meet shortfalls. The only way that the government can keep costs down is to start rationing services. There’s only so much you can cut or make efficient. If the same system were applied to the United States, it would fail even faster because we have a larger population and more immigration which puts more pressure on a system that just can’t scale well.

    The conceit that government does better than the market just doesn’t hold—certainly Canada and the UK are facing that problem firsthand. Single-payer healthcare doesn’t work because it runs against a fundamental principle of economics: the more you isolate the users of a service from the people who pay, the worse results you get.

    Even if Medicare is better now (which again, I disagree with), we can’t sustain the current system we have, no less make it bigger. A system of single-payer healthcare will not work in this country, as we’re just too large for such a program to scale, and the costs would quickly become unmanageable.

  9. kj says:

    Well, I guess you can disagree with the efficiency of Medicare if you wish but that would mean you were ignoring all the evidence. But I encounter this a lot with market fundamentalists. They aren’t too interested in evidence that counters their market fetishes. And the budget issue is not relevant to our conversation. Medicare costs are out of control because all health care costs are out of control. Centralizing insurance, as it has in every other Western nation, will help contol out of control medical costs. It won’t be a panacea but it will certainly help. And besides a universal Medicare for all program will get substantially more revenue. Instead of me dishing out $500 a month (with another $700 a month from my employer) for my family plan, that would go to a vastly more efficient government run insurance system that doesn’t have the extra costs of marketing, profit, and whole bureaucracies trying to figure out who not to insure.

    My only contention is that the government sometimes does better than the market and healtcare insurance is one such area. And please don’t use Canada and the UK as your prime examples. Those systems work better than our current one, but are not the model we should go for. Look at France and Germany and perhaps Japan which have single-payer systems with private hospitals and doctors that cost less and out perform or perform on par with us on every comparable measure. And the people there like it way more than they like our system. If you do a comparison, it really is a no-brainer.

  10. Jay Reding says:

    Centralizing insurance, as it has in every other Western nation, will help contol out of control medical costs.

    And the way that happens is by rationing care. There’s a limit to how efficient medicine can be, and a floor to how much you can artificially reduce costs without being forced to ration what people get in terms of services.

    And your whole “market fundamentalist” thing is silly. If you’re going to come out of the gate accusing anyone who doesn’t see things your way of being a “fundamentalist” you’re not really interested in really debating the issues, are you?

    Read the the Trustee’s Report for Medicare. The system we have is already not fiscally sustainable over the long term. There’s no magic pixie dust that government can wave that makes healthcare suddenly so efficient that a centralized system can be effective. The way they keep costs under control is the way that all “universal” single-payer systems do—by rationing care.

    You can’t compare France and Germany to the US because those countries have significantly smaller and less diverse populations. Again, a system that works in a small, homogenous population won’t necessarily work in a country with 400 million people, many of whom are recent immigrants from countries with poor healthcare to begin with.

    Your whole conceit is that government is somehow vastly more efficient than the private sector in allocating resources—which the entire history of the 20th Century says is manifestly not the case. Yes, government can control costs, but they way they do so is by telling patients that if they want an MRI or an experimental cancer treatment, they’re out of luck.

    There’s a reason why such a plan has not passed in the United States, and that has to do with the fact that given the choice no one wants to substitute one massive bureaucracy for one that’s even larger and even less responsible.