Health Care Deform

By: Carl | December 1, 2008, 6:49 am

Mike Dennison of Lee Newspapers apparently had a mind meld with Michael Moore over the weekend and wrote this Reporter's Notebook piece advocating a single (government) payer health care system.  It's a preaching-to-the-choir piece repeating the absurd arguments that a government-run system would be cheaper, result in better care, more choice, and all that.  I say preaching-to-the-choir because only a maestro in the echo chambered church of big government nanny state liberalism would cite an AFL-CIO endorsement as evidence of enlightened policy.

This and other endorsements of government-run health care choose to ignore some pretty basic but inconvenient facts.  First, it's not just common sense but economic law and human nature that if you make something cheaper or free, people will demand more of it.  That means that, unless Mr. Dennison has a plan to vastly increase the health care infrastructure in this country, separating the cost of health care from the delivery of health care (from a patient's perspective) will result in either much higher costs for the eventual payer (you, via taxes), or supply shortages like those experienced in other "free" health care systems.  Think 10 month waiting periods for MRI's, higher taxes, and all that.  If you doubt this, go to any hi-line hospital in the state and say "How boot dem Roughriders, eh?" and wait for a Saskatchewan football fan who's waiting for some basic care but might die before getting it for "free" up north to reply "Yeah shuure, I tink dey could take it dis year, eh."  You get the idea.

I've put the challenge out there in lots of conversations with statist friends and students, but have yet to have anybody give me an example of a government program that's run more efficiently than could be done in the private sector with a true free market (our current health care system is not a free market, just like our banking system was not a free market when it crashed).  Don't get me wrong, there are some things that the government can and should do, but they don't do it efficiently.  They're just the ones that can make it happen so we pay our taxes, enjoy the services, and put up with the waste.

But there's a bigger issue here.  "Free" health care advocates say that taking away your ability to choose who treats you and at what cost will somehow empower you.  It won't.  It'll make you a dependent, just like a child is dependent on his parents, but without hope of ever growing out of it.  Our health care system is broken, and that's an article for another time.  But the fix isn't to take options away from people, it's to give them more options.  It doesn't pass the silly test to say that a monopoly with no profit incentive will offer more options and better customer service than a system where customers have the option to walk out the door and go to another provider.  That's the practical side.  The moral side is, again, the question of whether we should continue to separate our freedoms from our responsibilities and allow ourselves to become more and more dependent upon the good intentions bureaucrats. 

And oh by the way, if they are responsible for your health care then they're also responsible for your health because they're paying for maintaining it.  That means your diet, exercise, whether you wear seat belts or a bike helmet or engage in risky recreational activities are all on the table and subject to regulation by someone who's bottom line is how cheaply they can keep you healthy, not whether you're happy.

The point of all this, just in case I've managed to hide it from you so far, is that offering consumers a choice is good.  Choice implies competition.  Competition provides incentives to provide good service and to keep costs down.  Without these incentives, services go down and costs go up.  It's not rocket science, it's common sense backed by two hundred years of economic thought and data.  And it applies to health care every bit as much as it applies to pizza or any other product.  It's just that health care is (I know this is a stretch for some of us) more important than pizza so it's more important that we get it right by not taking away people's options.  Some would even say health care is a right.  Rats, now that I've opened that can of worms, one more paragraph:

You cannot claim as a right something that you must get or take from someone else.  If you're a doctor, you have a right to provide yourself health care.  If you're a, oh I don't know, let's say a think tank president, you don't have a right to make a doctor treat you or to force your neighbor to pay for a doctor to treat you.  That would infringe on their rights, and you don't have a right to do that.  Right?  Still, the doctor might help you or the neighbor might choose to pay for your care on their own; but that's their decision.  It's called charity.  And charity is good.  In fact rich nations like the US of A provide more charity than poor nations.  That's the way it should be.  But if we do silly things like make health care less efficient and more expensive by nationalizing it we won't be rich enough to be charitable or environmentally conscious or any of those things that make us a civilized society instead of a bunch of people running around trying to knock something on the head to put over a fire and eat.  The irony of all this is that the very things the do-gooder big government types want us to do in order to help everyone are the same things that will, in the long run, break us and take away our ability to help anyone. 

It's called responsibility, folks.  Take some home with you.

Comments

anonymous
Posted on: 2008-12-02

It's called lying, dude. Stop it.

Okay, let's talk about pizza.

If every restaurant, every deli, every grocery store, every convenience store, every vending machine, every school cafeteria offered free, unlimited pizza 24/7/365, just how much pizza would you really eat? At first you might be all like WOW !! FREE PIZZA !! but then you'd get tired of it. I know this because I paid for college by working at a pizza place where we could all eat all the free pizza we wanted while we were at work. The management never put a limit on how much we were allowed to eat, they knew that once the novelty wore off, people would go back to eating a reasonable, even a minimal amount of pizza.

So, free health care... Just how many times are you going to get your appendix taken out anyway? Or colonoscopies? I hear they're a lot of fun, are you going to go get one every Saturday morning whether you need it or not? Broken leg? Flu shot? Annual physical? How many people skip that one even when they have a health insurance plan that pays 100% for an annual physical? Got the sniffles? Are you really going to take time out of your day to go to the doctor, or would you just stop at the drugstore on the way home from work and pick up some Nyquil?

10 month wait for an MRI? Doesn't really happen all that often, but you know about it because that data is public in Canada. Lots of people here in the US wait that long for MRIs too, but you don't hear about them, nor do you know how many of them there are, because the insurance companies here are allowed to keep that information secret.

Forced diet? Forced exercise? Restricted recreational activities? Have you ever been to Canada? I have. Canadians eat what they want, exercise as much or as little as they want, and engage in whatever recreational activities they want. Bike helmet laws and seat belt laws? We've got those here; it's got nothing to do with how we pay for health care.

The good intentions of bureaucrats?! Nobody trusts bureaucrats, that's why everything the health care bureaucrats do in Canada is completely transparent, all the information is available to the public. Here in the US, not at all. Unless you're an insurance industry insider, you have no clue how much bureaucracy there is, nor how good or bad their intentions are. That's another thing that insurance companies are allowed to keep secret from you, and they do.

Infrastructure, glad you mentioned that one. We don't have quite as many doctors per million people as Canada does, but we're close. And we don't have quite as many hospital beds per million people as Canada does, but we're close. On the other hand we've got way more MRI units and CT scanners per million people than Canada does.

Can't choose your doctor, eh? That's a flat-out lie. Canadians can go to any doctor, any hospital, any clinic, any lab they want to. And because everyone in the country has the same plan, ALL of the doctors, hospitals, clinics, labs are 'in network' because if you don't restrict people's choices, then you don't need networks to restrict them to. The same is true in Australia, and in England, and in France. I hear it's true of other countries too, but these are the only ones where I have friends or relatives, so they're the only ones I have first-hand knowledge of.

Here in the US, on the other hand, your choice of doctor, hospital, etc, is dictated by your insurance company, and your choice of insurance company is quite often dictated by your employer.

Paying for your neighbor... If I told you that for about half what you're paying for health insurance and health care now, you could pay for yourself AND your lazy, free-loading, good-for-nothing neighbor, would you switch to Canadian-style single payer tax-funded Medicare for all? A few people are mean-spirited enough that they would rather pay more money for their own care if it meant they could deny "unworthy" people "free" care. Most people, though, are smart, and would rather spend less and keep more of their own money in their own pockets, even if it means putting up with a few free-loaders.

Just how much would it cost? If we pass HR 676, also known as Medicare For All, and use John Conyers' proposed method of financing it, a family making slightly less than $60,000/year would pay about $1600 more in taxes. That's about $133/month. In exchange for that your entire family would get all necessary care, from things like annual physicals and children's vaccinations to cancer treatment and quadruple bypass surgery, all "free" [because really you've already paid for it all with your taxes]. And all of this would still be available to you and your family even if you lost your job.

Why is it cheaper this way? Because if we get rid of the for-profit insurance companies, we could also get rid of the health benefits management companies, the radiation benefits management companies, the pharmacy benefits management companies, and the denial management companies. None of which are actually delivering health care; they're all just sucking up money, taking huge bites out of the insurance premiums we pay. Again, just how much money they're all putting into denying you health care when you really need it? That's a secret.

Imagine how good our health care would be if instead of being paper-pushers, all those people were doctors, or nurses, or x-ray technicians, or pharmacists, or dentists, or fitness instructors, or engineers designing and building MRI units or artificial joints, or scientists working on cures for cancer.

nene
Posted on: 2008-12-03

Anonymous: (Applauding) You summed up the situation very well.

I never get the "choice" issue. Regular Medicare doesn't have networks, why not just open up that system? It's ready to go.

anonymous
Posted on: 2008-12-03

thank you for the kind words, nene.

medicare is indeed ready to go. we've been test-driving it for 40+ years now, and it's proven to be pretty darn reliable.

sure, medicare has some financial isssues, but any actuary will tell you that the best way to pay for old, retired, expensive people is to fill up the pool with young, working, inexpensive people.

Carl
Posted on: 2008-12-03

C'mon Nene? "Golly Gee me too." That's your argument? So, I'm assuming you're a big Bush fan since he oversaw the largest expansion in Medicare's history. Wanna go on record with that?

And what about that nasty unfunded liability issue for medicare that goes into the trillions of dollars? No worries about who's going pay for that? Or I guess that's the next generation's problem.

And let's talk about pizza with Anonymous. But first, way to elevate the debate. I disagree with you so I'm a liar? Boy, that really makes me want to hear your side of the story. It must be really credible if you're depending on playground epitaphs to make your point. But anyway, back to pizza...

If every vending maching, cafeteria, and greasy spoon offered nothing but pizza yes, we would get sick of it. But that's the beautiy of the market. Vending machines have pizza, candy bars, sodas, sandwiches and all kinds of other other good stuff that people want. We know that because people voluntarily spend their hard earned money on them. The same goes for greasy spoons. People don't get sick of what's in vending machines and greasy spoons precisely because they don't have only pizza or any other single thing. There's a choice. And that's what make them worth spending money on.

Of course in your world pizza would be the only thing available. I really really hope it's the best pizza there is, because if it's not there won't be a single thing anyone can do about it because that's the only game in town in your world.

Same with your college job. If you worked someplace that offered pizza, burgers, gyros, salads, and lots of other stuff you'd be happier with your choice than you were with only pizza. Hmm....let's see. That's kind of of like having only one source of health care. One entity owns the supply so even if you're sick of pizza that's the only thing on the menu so take it or leave it. Not really a recipe for efficiency on the supply end or satisfaction on the consumer end...unless you really like pizza.

What's next? Let's see. The case for multiple colonoscipies and appendix removals. Yep, I'm with you there. Not much excess demand for those services. However, if there's no cost involved, what about headaches, sniffles, sprains, nicks, cuts, and a host of other things that people can cure at home but won't if there's absolutely no cost to them of going to a doctor to treat. It's just silly on stilts to assert that if you reduce the cost of a service to zero that there won't be a greater demand for it. Show me a case where something became free and people wanted less of it and we'll start the discussion over.

Let's see, reading your long post to my long post where are we? (I'm in a hotel room and it's late so sorry). Transparency. Yep, I'm good with that. Medical costs and services should be more transparent whether provided by government or insurance. No argument there. I just think - and you can call me a liar if you'd like - that if government didn't already own the majority of the health care market through medicare, medicaid, government employee insurance, and the VA, and heavily regulate the rest of the market, that we'd be in a better position to demand more transparency from health care providers as consumers. But since the government is already by far the largest provider and ultimate payer of health care, the individual consumer has little power to allocate his or her personal resources effectively. But I'm sure you think that a non-profit driven bureaucracy will be much more sympathetic to your individual demands for transparency and accountability than would be a company that depends on your good will and satisfaction for its survival. Why, just a couple of years ago when I renewed my drivers license I remember thinking how receptive, courteous and efficient the folks behind the counter were for the several hours it took me to do several minutes worth of business.

Last point: the whole the freedom and responsiblility thing. Where did seat belt laws, smoking laws, helmet laws, lower blood alcohol level laws, open container laws, and a host of other regulatory schemes that restrict our ability to control our property and/or person come from: The claim that if society has to pay the costs than society should be able to set the conditions. New York and California are targeting trans fats. How much more of a stretch to target red meat or any other dietary or lifestyle choice in the name of saving money if we socialize the cost of those lifestyle choices? We can quibble over individual examples or waiting times for MRI's and go back and forth over specific points and clauses. But the bottom line is that any time you separate your decisions, i.e. your freedom, from the consequences of those decisions, i.e. your responsibility, you willingly cede some of that freedom to whoever has agreed to pick up the responsibility. And that's what I'm against...the creeping privatization of gain and socialization of consequences in our society. And single payer, or more accurately everyone payer, health care is a fine example of the trend towards separating rights from responsibilities that result in short term fixes that only make the problems worse over the long term.