Tag: single-payer

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free trade & free markets ideological culture too much government

Finns Fail at Fix

Bernie Sanders, Finland, health care, socialism, single payer, costs, spending

Finland’s government-​run health care system is a mess. 

This normally wouldn’t faze me much. I have to navigate our American mess, er, system. But Finland’s medical service delivery system is relevant to Americans — as is Denmark’s and Norway’s and Sweden’s — because the current crop of Democratic presidential hopefuls tout these “Scandinavian socialist” programs as models to follow.

Yet Finland’s program is in crisis.

How bad is it?

Bad enough for Finland’s government to fold early, before an election, with Prime Minister Juha Sipilä throwing in the towel earlier this month. He had been struggling “to get social and health-​care reforms that he made the cornerstone of his government’s four-​year term through parliament,” The Wall Street Journal informs us. Finland’s health care system is somewhat decentralized, and that quality of service varies district by district. Silipä had been trying to centralize administration while also allowing for some privatization.

Left-​leaning parties have balked at this, hence the impasse.

So, what is the lesson? A medical delivery system should be anti-fragile, capable of functioning despite incompetents or corrupt officials in government, despite voting blocs at loggerheads. A vast segment of the service industry should not be held in hock to the political machinations of special-​interest groups.

Behind all of it, though, is the looming demographic crisis: the population of Finland, like here in America and throughout the First World, is aging. This puts heavy stressors on welfare-​state systems run on a Ponzi-​like re-​distributive basis.* Of course costs will increase and service levels will fall, given how it’s all set up.

But once in place, government-​run medical systems do not heal themselves.

This is Common Sense. I’m Paul Jacob.

* An endemic problem for socialists, which they try to ignore. See “Finland: Government Collapses Over Universal Health Care Costs, #Bernie2020 Hardest Hit.”

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Bernie Sanders, Finland, health care, socialism, single payer, costs, spending

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The Worst Is the Enemy of the Cure

Obamacare, healthcare, single payer, Ryancare, Trumpcare, government, Affordable Care Act

You’ve heard the adage: “the perfect is the enemy of the good.” This can be true in politics, where opposing an ameliorating reform because it is not ideal means, sometimes, getting stuck with unmitigated policy disasters.

But there’s a corollary: in politics the worst is likely to emerge … when practiced compromisers succumb to fearing the best, because unpalatable, or perhaps not in line with political interests.* Trying to avoid the “best is the enemy of the good,” we’re left with the outrageously awful.

Cures worse than the disease are not uncommon. The Democrats’ “Affordable Care Act” (ObamaCare) was a clumsy, badly drafted hodgepodge designed to fix problems by doing the opposite of what made sense.

And it immediately started having ill effects, pushing up costs for many, many health-​care and medical insurance consumers.

No wonder Republicans ran year after year promising repeal.

But now that Republicans have the chance for a real cure, they’re chickening out. The Senate just debuted their ObamaCare replacement. And Senator Rand Paul (R‑Ky) calls it “worse than ObamaCare.”

Why worse?

Because Republican politicians are better at promising than delivering. Fearing how those who directly benefited from ObamaCare might squawk, and how badly the GOP would be treated in the media because of this, moderates went with what they know: snake oil. 

Fortunately, Rand Paul’s opposition may kill the bill. If one other senator joins Dr. Paul — and Sen. Susan Collins (R‑Maine) who announced her opposition for other reasons — in not voting for the monster, it will not pass. 

Which is great, because going for a cure worse than the previous cure leaves us all with the worst possible outcome.

This is Common Sense. I’m Paul Jacob.

 

* Like many cures. Politicians these days no longer have the knack for the necessary “spoonful of sugar” to help medicine go down. They prefer distributing just sugar pills.

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DumpCare

healthcare, Trumpcare, Obamacare, medicine, costs, regulations, Medicaid, single payer

Speaker of the House Paul Ryan insists that his “TrumpCare” plan to replace ObamaCare will decrease medical insurance rates. Others argue that his American Health Care Act will increase those rates. Likewise, he expects it to reduce strain on federal budgets; others deny this outright. The “coverage” issue is just as contentious.

TrumpCare is a mess because it is isn’t “DumpCare.” What’s needed is not yet another regulation-​plus-​subsidy system. We need repeal and then … more repeals.

Unfortunately, President Donald Trump has never really been on board with this. He has promised that no one would lose “coverage,” assuming that “coverage” is “health care.”

It is not. State charity programs like Medicaid (upon which ObamaCare relied way too much) are merely ways to pay for services. Dumping a gimcrack payment system is not the same as decreasing medical services. “DumpCare” wouldn’t dump care, only insane government.

For example, we know that health care outcomes for poor folks without Medicaid turn out to be better than poor folks with Medicaid.* Increasing the number of people on formalized subsidy programs is no panacea.

Besides, ObamaCare severely under-​delivered on “coverage.”

New programs, nevertheless, are traps, regardless of demerit: once you provide a benefit, folks come to rely on it and demand more — objecting when it’s taken away. Which is why few programs are ever repealed, despite failing to meet original expectations.

So far, the “small government party” hasn’t found the courage to actually limit government. Do Republicans really believe what they say, that fewer regulations and subsidies will lead to lower costs and better service?

It seems Republicans won’t take their own prescription.

This is Common Sense. I’m Paul Jacob.

 

* Oregon’s 2008 Medicaid “natural experiment” provides reasons to question the merits of the program. As the initial, randomized, controlled study found, “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services.…”

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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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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 too much government

Snappy Put-​downs Do Not a Debate Make

There is a political struggle going on over reforming how Americans obtain and pay for medical assistance.

But is there a debate?

Mostly what we hear, instead, are snide put-​downs. Gail Collins recently wrote in the New York Times that “members of Congress are getting yelled at about socialized medicine by people who appear to have been sitting in their attics since the anti-​tax tea parties, listening for signs of alien aircraft. But on the bright side, they’ve finally got something to distract them from the president’s birth certificate.”

That’s kind of funny. But it doesn’t address anyone’s fear or reasonable suspicion. It’s just more liberal scorn thrown at people who disagree with “big government knows best.”

I’ve heard Rachel Maddow make similar sniping comments. According to her, all folks have against the Democrats’ reform ideas is that Obama wants to kill old people. She laughs. Dismisses it out of hand.

But there are real arguments embedded in such concerns. As I wrote recently on Townhall​.com, it’s not that advocates of single-​payer medical systems want to kill old people; it’s that, over time, budgetary demands force them to institute some sort of rationing. Older folk die by waiting in week-​long, month-​long lines for medical assistance in Canada and Great Britain right now.

This is a very real concern. It deserves honest debate, not snappy put-​downs and sniping retorts.

This is Common Sense. I’m Paul Jacob.