I know i sent this article to a few of you, but I found it thought-provoking, at the least:
Dave Sabo's worst nightmare
By utilitarian philosopher Peter Singer, arguing that rationing health care isn't necessarily a bad thing.
Certainly there are almost an infinite number of aspects dealing with the initiative to reform health care that are ripe for discussion. One of the most interesting questions is why a middle-class family, with a steady income and good health care plan, should be interested in reforming the health care system.
Nobody can dispute the portions of the plan dealing with infusing IT into the health care industry or having a panel of experts, not Congress, determine which treatments Medicare should be paying for. Those benefits are obvious, and it's pitiful that these proposals haven't been enacted sooner.
But beyond the possible (?) moral imperative of providing coverage to the 1 in 6 uninsured individuals in our country (1 in 10 voters), why should a middle class individual with health insurance care?
The name of the game here is saving on the cost of your health care. I'm not sure why this argument hasn't been emphasized more.
(1) A "public option" -- as long as it plays by the same rules as insurance companies (e.g. wouldn't be allowed to continually run in the red) seems like a perfectly legitimate option. Conservatives constantly make the argument that government-administered services are less efficient than those delivered by private firms in the market. If that's the case, why don't we let the market prove that? I just don't see what we have to lose by initiating the public option. If individuals want treatment not covered in the government plan, they can purchase supplemental insurance. If the government plan isn't working, people will opt out. But if it is working, it will force insurance companies to become leaner -- driving down everyone's premiums.
(2) America spends $6k-6500 more per person on health care, and receives no better care than other developed nations. What is causing that? It has to be the inefficiencies created by the private system. I just don't understand where else that number comes from. Why are Americans spending $1 out of every $6 on health care. Why is that number expected to go to $1 in every $3 in 20 years or whatever? I suspect that, at least part of the problem, is that there is no incentive for insurance companies and doctors not to take on the most expensive treatments, and then bill the American middle class. If they're all doing it -- what's your other option, to become uninsured and pay out of pocket? To write them a sharply-worded letter to please stop giving everyone expensive treatments so that your premiums don't go up? With a government plan to compete against, that will at least provide some sort of incentive for efficiency.
(3) It also seems only logical that mandated insurance would reduce everyone else's costs, as well. If those who can afford insurance are required to have it, we know problems will be treated early -- we won't have to treat individuals who have gone without medical attention and now require costly treatment for advanced complications.
The larger point is that 60% of bankruptcies resulted from medical bills. Whether those individuals were insured or not, medical bills should not be causing bankruptcy to happen in this country. I would argue that the public option and mandated insurance would begin to address this issue.
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In regards to the article - we put a monetary value on human life all the time. Why should health care be any different? As for reforms to our system, I strongly believe in the Japanese system. Completely privatized, with price ceilings on all health care.
ReplyDeletePat: Thanks for the comment and for getting us started! I will have a more in-depth post regarding health care reform tomorrow morning, but I would like to make a few comments directly addressing some of your numbered points:
ReplyDelete1) As you noted, if a "public option" (one WITHOUT government subsidies/advantages not given to other market players) were to have a positive affect on health care costs, then everyone would benefit with lower premiums. However, if this were to occur then we would have to assume that a government run health care company could outperform companies already in the market. This seems unlikely for two reasons:
First, because the health care industry is relatively filled with players, one would imagine that costs are at or near their bottom, given the current structure of the health care system (i.e. mainly government/employer based health care plans). If all it took was a non-profit company to come in and create a health care plan that can stay viable (out of the red) in the current market, then why the hell are we blogging?...we should just create that company. Or, more likely, why wouldn't a company already in the market make changes to cut their costs? It seems a bit unreasonable that we would need to rely on the government for this.
Harvard Economist Greg Mankiw does a better job explaining why this line of reasoning defending the “public option” here: http://www.nytimes.com/2009/06/28/business/economy/28view.html?_r=1.
And, second, just because conservative pundits make the assumption that a private company will better perform in a market than the government is an assumption, it is not necessarily a poor one. It would seem that history has shown that government’s tend to handle business entities less efficiently than private companies in a free-market. While this assumption might not always hold, I think that it is fair to assume that a large market of private companies are going to compete to a more efficient place than a market crowed out by a large government player.
In all likelihood, the only way that costs for individuals could be reduced under a "public option" is through government subsidies. I think that this is what many critiques of the current plan have and rightfully so. If the “public option” ends up crowding out private insurance - which, according to projections, seems likely - then, in the long-run, there won’t be as much competition as there otherwise would be, and, therefore, costs will also e in the market to control costs
2) Incentives are undoubtedly out of whack in the health care system. But the idea that only through a government plan “competing” with the private market can those incentives be realigned to a more optimal setup seems like a fallacious assumption to me.
In fact, I think that there are some general ideas floating around that might allow for a more efficient to accomplishing our two goals: maximizing health care coverage and minimizing health care costs; I will discuss this more tomorrow.
I think we need to consider that this article was written by Peter Singer who also believes all sentient beings (beings that feel pain) should have totally equal moral standing. This means that the rabbits living in a hole on the property I just bought have absolutely equal right to live there and so it would be wrong for me to dig a basement and build a house if it meant evicting them. Not to mention that under his philosophy we would all be vegetarians. His credibility is questionable in my mind.
ReplyDeleteI also tend to agree with Dante's point about government subsidies being a risky approach. As we have seen with energy, and especially biofuels, government subsidization is a essentially a way of picking winners or deciding in advance what approach will work best rather than allowing the market to determine which approach is most efficient. While reform is clearly necessary, large increases in government subsidization could be risky and hard to turn back from if we discover, sometime down the line, that they were a mistake.
"America spends $6k-6500 more per person on health care, and receives no better care than other developed nations."
ReplyDeleteSays who? By what measure? That x number of people don't get care? That x number of people have life-saving treatment here versus country Y? How can anyone possibly purport to measure how much "better" the care is in a given place on such a grand scale. Certainly, I'd rather be at the Clinic than anywhere else for heart problems etc., but I don't think this "We're no better than anywhere else" argument holds water empirically. I don't think Obama or Rahm Emanuel will go to Cuba, Germany, or Canada to receive important medical treatments. They'll stay here. It's telling that so many rich foreign nationals, including politicians and international tycoons, generally come to our country to receive what must be better care than is available in their home countries.
Overall Pat, if you are prepared to concede that rationing care is the ultimate end result of government health insurance (and we all know indeed it is), then you will make health care in this country an even more elite privilege than ever: All the superelites, the Bill Gates, the Steve Jobs, the Hiltons etc. will be able to pay for their own personal medical care, while people that once had great coverage are left in the dust, waiting in line for urgent heart surgery, chemo, and the like.
Before you cry slippery slope on me, understand what this "market" that Obama purports to create entails: All the small and medium-size insurers will summarily go out of business. A few giant ones, like Aetna and United, will pull through by the skin of their teeth and possibly a merger or two. Here in Ohio and many other states, medium insurers rate the highest in quality and customer satisfaction because of their excellent coverage and customer service. So, above the rubble, you will have a few giant insurers (frequently rated middle of the road, at best) and the federal government. Now, we all know the efficiency problems giant insurers have... take an honest look at Medicare and Medicaid and tell me if those are efficient. To think that this is going to lead to more efficiency in the long run without addressing underlying problems the left wants to sweep under the rug is mere crackpot realism.
You are onto something with the "early treatment" hope in hoping that since everyone is insured, they will get treated early. Preventive medicine is not one of our system's strong suits, and indeed it would do us all good if people got conditions treated early (i.e., diagnosing a cholesterol problem and taking Lipitor early on, instead of receiving bypass surgery down the road). Unfortunately, here, even with universal insurance, the power is in the people. Lots of people simply don't want to face the reality that they might have health problems and don't go to the doctor to find out what they may be. Even before that, lots of people simply choose not to live healthy lifestyles that can prevent many of the most costly and frequent illnesses.