…therefore, we need universal care. Megan McArdle, on the insanity of that “argument”:
I hear this argument quite often, and it’s gibberish in a prom dress. Any cost savings you want to wring out of Medicare can be wrung out of Medicare right now: the program is large and powerful enough, and costly enough, that they are worth doing without adding a single new person to the mix. Conversely, if there is some political or institutional barrier which is preventing you from controlling Medicare cost inflation, than that barrier probably is not going away merely because the program covers more people. Indeed, to the extent that seniors themselves are the people blocking change (as they often are), adding more users makes it harder, not easier, to get things done.
It’s not an argument. It’s sophistry in the service of socialism.
” Any cost savings you want to wring out of Medicare can be wrung out of Medicare right now:”
Certainly if Medicare were to be allowed to make drug manufacturers
bid for the supply contracts under Part D, there would be tremendous
savings. If Part D were to require that under the Drug Plan, it is only
Generics and Multi-Source drugs, that would be a tremendous savings.
Medicare should also not pay for ICU stays past a month. People are perfectly able to get insurance for that, if they want more then that.
I think McArdle is wrong about the politics. Medicare costs closely track private costs, which isn’t surprising because they use the same doctors, hospitals, procedures, etc. It would be politically impossible to tell seniors that we need to save money, so we’re going to give them something different and cheaper than what the private systems offer — even if it’s also better.
It is, however, politically possible to offer people who can not currently afford private insurance a new option. Once the performance of that alternative is established, it will be politically possible to move Medicare in the same direction, and private insurance will follow in order to hold onto its customers.
If McArdle has a more politically feasible plan for how to guarantee good health care for all seniors without the costs devouring the federal budget, we’d all love to hear it.
It is, however, politically possible to offer people who can not currently afford private insurance a new option.
Oh, right, Jim, because the people who can’t afford private insurance, which means people without jobs, are so much more numerous at the polling booths than the people who would have to pay for this largesse, i.e. the people who do hold jobs.
Or do you have some other definition of “politically possible” than “would succeed at the voting booth?” Maybe you mean “can be jammed down the throats of an unwilling public” by an appropriate combination of propaganda from useful idiots and cynics, good timing — never let a crisis go to waste! — and good old fashioned obfuscation and deception (“We can pay for this all with a 2% tax on your Coca Cola!”). That seems more likely.
Once the performance of that alternative is established,
Uh huh. If that were an honest statement, you’d be watiing to see what happens in Massachusetts, or exploring the failure of Tennessee’s plan, or otherwise trying small scale experiments, like on a state-by-state basis — or, by golly, with Medicare — to honestly see whether your newfangled scheme really works well before you try it out on 300 million real human beings. Does the FDA allow new drugs to go straight to the general populace, before a clinical trial on a small subpopulation proves its effectiveness and lack of harm? They do not. Would you recommend a complete change in the way heart surgery is done, say, without any empirical evidence at all in some small trial sample of patients that it improved outcomes? You would not.
So what’s the difference with your proposition? That’s easy. You’re dishonest about its actual purpose. The actual purpose is not to provide better healthcare. It’s to erect a structure by which you can control healthcare for political reasons of your own. Clearly, the faster and more completely that structure is erected, the better. Whether it works better or not is of no interest whatsoever. So this is why you want to start right at the top, with a complete system. This is the real reason you don’t want to tinker with Medicare first, try the new scheme out first.
McArdle may or may not know that — she’s a bit young and naive when it comes to motives — but she has certainly picked out the logical incoherence of a position that purports to be about improving medical care, but which eschews the tried and true cautious and fact-based methodology of doing so.
Carl:
Most people without health insurance do have jobs. And even people without jobs pay taxes.
which eschews the tried and true cautious and fact-based methodology of doing so
If you look around the world, you quickly come to the conclusion that the only way for a country to get good health care results without breaking the bank is to have a national system. That’s what’s tried and true and fact-based.
> the only way for a country to get good health care results without breaking the bank is to have a national system
Is Jim really arguing that the health system is the only difference between, say, the UK, and the US?
Is Jim really arguing that the health system is the only difference between, say, the UK, and the US?
No, I didn’t argue anything like that. What I said is that there are numerous existence proofs of national health care systems that deliver good results with manageable costs. There is no example of a non-national health care system that does the same. If you want good results and manageable costs, and you don’t want a national system, the burden of proof is on you to show that such a thing is even possible.
“> the only way for a country to get good health care results without breaking the bank is to have a national system
Is Jim really arguing that the health system is the only difference between, say, the UK, and the US?”
I’d say Jim is arguing that a National health care system would provide
good health care results.
We are pouring 3 trillion a year into a health care system that is facing collapse.
A national system is not exclusive to a private system, but a national system can provide some basic cost savings while providing a standard of care.
Let the private sector provide high end procedures while a national system provides basic care.