Tag: health care reform

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Accountability folly ideological culture moral hazard nannyism national politics & policies too much government

Bernie’s Bogus “Medicare for All”

Medicare for All, Bernie Sanders, healthcare, analysis, bogus, Common Sense, illustration

Bernie Sanders promises universal health care, but, up until the other day, just waved his hands in the air, without specifics. Now he has a plan.

Sort of.

Ezra Klein, writing at Vox, says Sanders’s “Medicare for All” is not a plan at all. It’s a “gesture towards a future plan.”

But that doesn’t mean that the thing isn’t “well sold.”

After praising the Obamacare/​Affordable Health Care Act for giving “health insurance” to more than 17 million people, the preamble of Sanders’s proposal made its most predictable statement: “Twenty-​nine million Americans today still do not have health insurance and millions more are underinsured and cannot afford the high copayments and deductibles charged by private health insurance companies that put profits before people.”

Forget that deductibles are integral to the very idea of insurance. Forget that profits are absolutely necessary for the success of an industry. Forget that profits come from serving people.

Remember, instead, the leftist clichés.

Sanders’s plan, such as it is, is a lie — or, in Klein’s phrasing, “has nothing to do with Medicare.” Sanders aims to get rid of deductibles and copays, on which Medicare depends. It’s what makes Medicare distinct from, say, socialized medicine.

Insurance covers individually unforeseeable but actuarially manageable risks. Socialized medicine gets rid of the idea of “payment for service” on every level — and thus the very idea of insurance — and turns the whole thing over into a tax-​and-​spend program, i.e., what Sanders really wants.

That won’t be cheap, as Megan McArdle demonstrated some time back during the Vermont “single payer” kerfuffle.

The only option for increasing value while lowering prices? Go the opposite direction from socialism.

This is Common Sense. I’m Paul Jacob.

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So Now We Know!

Bernie Sanders, Medicare, plan, healthcare, health care, socialism, big government, Common Sense, meme, illustration

Bernie’s health plan will WORK (and save money!) through (wait for it!)…

GOVERNMENT EFFICIENCY!

Click below for high resolution version of this image (great for screensaving and sharing).

Bernie Sanders, Medicare, plan, healthcare, health care, socialism, big government, Common Sense, meme, illustration

 

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ideological culture national politics & policies

War and Broccoli

The art of polling is similar to almost any effort where interpretation is required: Context is important.

The Reason-​Rupe pollsters seem to get this. Their recent survey covers not only a lot of ground (the president’s job performance, possible candidates in the upcoming elections, health care, morality and war) but goes into some depth on a number of the issues covered. For instance, each of Obama’s major challengers is put in the context of several competitive scenarios — Obama vs. Romney, Obama vs. Santorum (the poll was conducted before Santorum dropping out), Obama vs. Gingrich, Obama vs. Paul, etc.— with even possible third-​party runs brought in. All very interesting.

The biggest section of the poll concerned health care. These questions also probed alternatives, eliciting opinions explicitly in the context of possible options and outcomes. But the results regarding Iran’s nuclear capabilities were especially provocative. Nearly half of Americans tend to favor military action against the country were we to discover that the Iranian government was developing nuclear weaponry. But, when the conflict was considered as a long, dragged-​out affair — of the same variety as happened in Iraq — support dwindled, and the numbers opposed to intervention went well over half.

Not shocking. Costs matter. Context matters.

The most amusing element of context in the poll emerged in one pair of questions regarding Obamacare. Is the federal requirement to carry medical insurance unconstitutional? Over 60 percent said yes. But switch that mandate to requiring Americans to buy broccoli and other healthy foods, and those crying “unconstitutional” shot up to 87 percent.

Now that’s Common Sense. I’m Paul Jacob.

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First Amendment rights ideological culture national politics & policies

Contra Mandated Contraception Coverage

Regulators spawned by “Obamacare” have mandated that employer-​provided medical insurance plans provide contraception as a benefit. 

The problem, as currently reported and debated, is that only churches are exempted — church-​run or ‑affiliated hospitals, for example, are not. And so Catholic hospitals, along with other religious-​based charitable endeavors, must conform, despite their commitment to age-​old ideas about the sanctity of life, which they say contraception and abortifacients, especially (some contraceptive methods are de facto abortion-​inducing), abridge.

Many conservatives argue that the mandate thus runs afoul of the First Amendment. But it turns out that many Republican politicians have supported similar mandates in several states.

Mike Huckabee signed one such mandate into law in Arkansas.

No big news that GOP politicians are often just as bad as Democrats, of course. But forget, if you can, the First Amendment angle. The mandate runs afoul of something even more fundamental: common sense.

Adding an umpteenth mandate to the list of regulations government places on contracts amongst employers, employees, and insurance companies hardly passes the smell test. The more benefits that government insists you contract for, the higher your insurance rates. The higher the rates, fewer are those who would willingly buy, thus scuttling the whole point of “health care reform.”

We ostensibly want more people to purchase major medical insurance. Not fewer.

It’s possible that some reformers seek precisely that, to put insurance companies out of business, leaving only government to take up the slack, as a “single payer.”

In the case of Republican reformers, however, is there a hidden agenda or just mere foolishness?

This is Common Sense. I’m Paul Jacob.

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free trade & free markets national politics & policies Tenth Amendment federalism too much government

A Compact Solution

“We shouldn’t have to leave our country to have a reasonable health care system,” says Eric O’Keefe, chair of the Health Care Compact Alliance.

I agree, but what to do with Obamacare, at present secure from repeal?

O’Keefe points out that Article I, Section 10 of the Constitution permits states to enter into compacts with one another provided they get congressional approval. States have done so since colonial times; there are currently 200 state compacts in force dealing with issues from driver’s licensing to wildlife.

The Health Care Compact would allow states to “get rid of all of Obamacare,” and to tell the federal government, as O’Keefe puts it, “You keep your regulations; send us back our money.”

“It’s not just a way to block Obamacare,” O’Keefe explains. “It includes Medicare and Medicaid, creates a block grant of all the money and it goes into the compacting states for them to manage as they see fit. So the citizens and the legislature will work it out in their state.”

States that join the compact could set up their own health care system with the money they currently receive from the federal government, sans regulations and mandates. While some states might experiment with single-​payer systems, others could expand medical savings accounts and other market-​oriented reforms.

Georgia, Missouri, Oklahoma and Texas have already passed the Health Care Compact, and will likely apply for congressional approval once a dozen or more states join.

Who’s next?

This is Common Sense. I’m Paul Jacob.

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free trade & free markets too much government

Reform Challenge

Taxpayers fund about half of all medical industry transactions, and governments regulate that as well as a huge chunk of the rest. No wonder medicine is in chaos.

Economist Charles Sable asserts that he knows how to make health care better. Arnold Kling, on EconLog, reports Sable as saying that “health care providers need to be able to improve by learning from and correcting mistakes. He then proceeds to offer legislation to force that.”

But Kling offers an interesting challenge: “If you know a better way to run health care organizations, why don’t you start a health care organization?”

As opposed to dictating by law how others should manage theirs.

Kling, an economist who has run a business or two, thinks that when “a liberal/​progressive proposal is supposed to do X,” the liberal “expert” should “start a private entity to do X.” He sees no reason why the medical industry would be immune to such challenge: 

If health care providers are doing a bad job, what stops you from implementing a better model and taking over the market? Are consumers too stupid to know the difference between providers who make lots of unnecessary mistakes and providers who don’t? If they are so stupid as consumers, why do you expect them to be smart as voters?

In the real world, we could use people with ideas who really run with them — not stand back and tell some other folks how to run yet another bunch of folks’ lives and businesses.

This is Common Sense. I’m Paul Jacob.

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free trade & free markets national politics & policies too much government

Free Markets: Poison or Cure?

Most foes of Obamacare support reform, but reform that liberalizes, rather than further burdening, the health care industry. Individuals have a right to liberty, and free markets prove inherently better than rule-​bound bureaucracies at providing goods and services. Yes, even medicine.

At least one health-​care commissar admits this superiority … but then promptly suppresses that knowledge.

Donald Berwick, President Obama’s Medicare czar, opines in the Wall Street Journal that the “right way” to bring down health care costs is by improving health care. 

“Computers, cars, TVs and telephones today do more than they ever have, and the cost of these products has consistently dropped,” says Berwick. “The companies that make computers and microwaves didn’t get there by cutting what they offer: They achieved success by making their products better and more efficient.”

They did, eh? And did profit incentives, competition, and the coordinating functions of prices that are characteristic of market processes have anything to do with it? Are the firms that sell these improved products mere departments of the government — or profit-​seeking companies obliged to satisfy consumers or go out of business?

Berwick points to one of the least subsidized and regulated sectors of modern life, and yet the idea of a freer market for health-​care products and services doesn’t occur to him. The key to emulating freer, more successful industries, he burbles, is to further hamper an already hobbled medical market. 

It’s like saying we’ll cure a guy with pneumonia by also giving him emphysema.

This is Common Sense. I’m Paul Jacob.

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free trade & free markets national politics & policies

Competition Works Even With Limited Info

Few of us understand all our options when we shop for homeowners’ insurance. 

The New York Times’s Paul Krugman riffed on this, arguing that “When people call for ‘consumer choice’ in health care, what this mainly comes down to isn’t comparison shopping on actual care … but rather comparison shopping on insurance policies. And that’s basically impossible even for home insurance, which is a lot simpler than medical insurance.”

Krugman calls a free market in medical insurance “fantasy.”

Yet the illusions involved in buying insurance also apply to non-​market medical coverage. 

Consider: Most people with low-​price insurance like their coverage at least so long as they don’t have to make many claims against it. That’s because insurance is one of those things you buy hoping not to have an occasion to require it. 

Something similar happens in single-​payer medicine. Some Europeans (especially the young and healthy) praise their state systems that cost them next to nothing out of pocket, patching up their scrapes, mending their bones “for free.”

But wait till they are old and really sick, and on a multiple-​month waiting list for an MRI or cancer treatment. Rationing-​by-​waiting can be a killer.

Bottom-​line this: In a competitive insurance market, on learning of poor performance by your carrier, you can drop your insurer like a hot potato. In single-​payer systems, you’re stuck. In line. Hoping not to get something too taxing on the system.

But you do have a choice in coffins.

This is Common Sense. I’m Paul Jacob.

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national politics & policies

One Industry’s Boom Time

The current economic slump lumbers along, but one industry is booming: Health-​care lobbying.

Over 180 groups have registered to help shape the new health care law, prompting CNNMoney to explain that “President Obama’s drive for health care reform has been a years-​long boon for lobbyists”: 

Over 2009 and 2010, $1.06 billion was spent on lobbying, with more than $500 million spent on lobbying the issue in each year.… In addition, lobbyists for 1,251 organizations disclosed that they worked on health care reform in 2009 and 2010.… The number of individual lobbyists who reported working on health related legislation last year hit 3,154.…

Bad or good?

Well, it’s to be expected. The more the federal government involves itself in any domain of life, the more reactions to expect from those engaged in that domain. And it’s not just big business petitioning government for favors or forbearance or simply an ongoing “in.” Unions and associations and non-​profits are onboard, too. After all, a simple line or even a word in a law can make or break a concern. 

Besides, if our legislators insist on regulating every aspect of life, they’ll need all the help they can get. But since that “help” inevitably emanates from ever larger legions of back-​slapping lobbyists huddling with glad-​handing politicians, it’d be better if Congress left well enough alone.

This is Common Sense. I’m Paul Jacob.

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national politics & policies too much government

Fine-​Tuning the Shackles

Loathe handcuffs and leg irons? No problem. We’ll adjust the restraints slightly. Shave a gram off the weight. Paint them a new color. And throw away the key.

Feel liberated?

Nobody in a chain gang would be fooled.

But the Obama Administration expects phony “concessions” in the implementation of last year’s Patient Protection and Affordable Care Act (“Obamacare,” for short) to be treated as a sign of generous and reasonable compromise. The president supports an amendment to the health care law that, according to the New York Times, would “allow states to opt out of its most burdensome requirements three years earlier than currently permitted.”

If you dislike the program’s taxes and mandates, which after all constitute Obamacare’s most burdensome requirements, you’d approve. Right? All we need do is move in 2014 to some state that has opted out …

Not so fast. The state programs would have to cover just as many people and be just as “comprehensive and affordable” as the federal program. How to do this except by forcing people to participate?

The amended legislation would also allow states to establish single-​payer systems in which the state government is the only insurer of health care. Compromise?

As Michael Cannon observes, “President Obama’s move is not about giving states more flexibility. It’s about moving the nation even faster toward his ideal of a Canadian- or British-​style single-​payer health-​care system.” Which is where Obama and many Democrats have been hankering to go all along.

This is Common Sense. I’m Paul Jacob.