So say the American people. They prefer a piecemeal response to this “comprehensive” disaster.
Of course, who are they to have an opinion? The (misnamed) Democrats know what’s best for them.
23 thoughts on “Start Over On Health Care”
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I think right-thinking health care reformists long ago ruled out any sort of incremental reform.
I think right-thinking health care reformists long ago ruled out any sort of incremental reform.
Actually, I think your sentence should read:
I think left-thinking health care reformists long ago ruled out any sort of incremental reform.
That seems closer to reality.
A piecemeal approach seems much more workable…tackle the issue a nibble at a time so that more of the process is defined in the legislation rather than left to bureaucrats to resolve.
Also, it would be more reasonable to expect our legislators and our president to read a series of 30-page bills rather than a single 2300-page one.
Also, it would be more reasonable to expect our legislators and our president to read a series of 30-page bills rather than a single 2300-page one.
Why, that’s crazy talk.
A piecemeal approach seems much more workable
There are times when a piecemeal approach is better; this isn’t one of them. Health care reform is more like building a stone arch — you can’t just put one stone on another and hope to eventually complete an arch — it will all fall down before you finish.
Similarly, if you stop the insurance companies from discriminating against people with pre-existing conditions (something both parties claim to support), but do nothing else, the insurance companies will have a sicker pool of customers. So they’ll raise their rates, which will drive away the healthiest customers, the ones most likely to think they can make do without insurance. That will make the pool sicker still, and the cycle will continue until there are even fewer people with health insurance than we have now.
So if you are going to require that insurers cover people with pre-existing conditions, you need to do what Romney and Scott Brown did in Massachusetts: require that everyone get insurance. And if you are going to require that everyone get insurance, you have to have subsidies for people who otherwise couldn’t afford it.
Also, it would be more reasonable to expect our legislators and our president to read a series of 30-page bills rather than a single 2300-page one.
Have you seen how the bill is typeset? It’s mostly whitespace. If you typeset it like a novel it’d be no longer than the last Harry Potter, which was devoured by millions of 10-year-olds. I think our legislators can handle it.
If you typeset it like a novel it’d be no longer than the last Harry Potter, which was devoured by millions of 10-year-olds. I think our legislators can handle it.
Jim, this may be the stupidest comment you’ve ever posted here (and that’s a pretty high bar).
Let’s just say that the bill writers in US Congress are no J. K. Rowling. And they lack the attention span of a ten-year old…
Jim’s right. We don’t need a small, step by step evolution towards improvement the likes of which brought us the English Common Law or working eyeballs; what we need is a Plan! With checklists and blueprints, and a Master Architect, and at least Five Years to implement it.
Similarly, if you stop the insurance companies from discriminating against people with pre-existing conditions (something both parties claim to support), but do nothing else, the insurance companies will have a sicker pool of customers. So they’ll raise their rates, which will drive away the healthiest customers, the ones most likely to think they can make do without insurance. That will make the pool sicker still, and the cycle will continue until there are even fewer people with health insurance than we have now.
At least you’ll admit that dropping pre-existing conditions raises insurance costs.
So if you are going to require that insurers cover people with pre-existing conditions, you need to do what Romney and Scott Brown did in Massachusetts: require that everyone get insurance. And if you are going to require that everyone get insurance, you have to have subsidies for people who otherwise couldn’t afford it.
Ok, so we’re now dropping pre-existing conditions *and* forcing everyone to have insurance even in the face of rising health insurance costs. Where is the “arch”? I’m just seeing much more expensive health insurance.
When you add in that health insurance often pays out whether you are sick or not (eg, health checkups, preventative care, and elective procedures are often part of the insurance), that is, it encourages the insured customer to consume more health care, then you get a significant increase in demand. My bet is that some bureaucracy will add on mandatory benefits to existing health insurance, increasing demand further. That’s more expensive health care. Which will in turn increase the US’s health care costs further.
And of course there’s the subsidies. Just because everyone is “required” to get health care doesn’t mean that they can afford it, even with subsidies. After all, if you subsidize it too much, then the cost growth will outpace any other part of the economy. More and more people will fall into the “cannot afford health insurance” category. This, of course, leads to the desired result of dropping private health insurance and switching to some sort of national health care system.
How are we going to get affordable health care out of this? How do we get universal health insurance coverage out of this? I don’t see it.
For that matter, even if we did what Jim wanted, how do we get 2000 page bills out of it?
My view is that the piecemeal approach is superior for a variety of reasons. First, no one, including Jim, has demonstrated a need for a single massive change in the system. Second, by making the bills much smaller, we will both understand better what is going on, but also have valid democratic debate on the changes to the health care system.
If the Dems weren’t so obsessed with an outright government take over of health care incremental changes (interstate sales, elimination of pre-existing condition clauses etc.) could have begun being put in place in 1994 after the Clinton plan failed and we could actually have seen some benefits from those incremental changes by now.
Karl:
Note that Chris cites Massachusetts. (Oooo, Republicans voted for THAT health care plan!)
Well, yes they did. And now they realize just how disastrous it is. Not only from a political perspective (how popular is that Massachusetts plan), but from a cost-containment perspective.
Turns out that forcing everyone to buy health insurance doesn’t reduce its use, but instead increases it. Which means more spending.
But, I guess if you throw it to the Feds, then they’ll have more money to spend on it, right? I mean, what’s a trillion dollar deficit or three?
Of course, if you actually ALSO extended coverage to everyone, the costs will skyrocket further.
You have a higher opinion of them than they do.
That right there should tell you something about your views, Jim.
Hey guys, Rube Goldberg socialism solves everything!
Uh guys? guys?
I rarely carry much water for Jim, but he deserves some credit here for ‘fessing up to a huge flaw in the typical set of Democratic talking points.
Eliminate restrictions re: preexisting conditions (full disclosure: I am diabetic, so such restrictions have people like me in mind), and nobody in their right mind will pay for insurance before they need it. At this point, insurance becomes not a business, but a welfare scheme for the sick, financed by the private sector. Since it is extremely unlikely that the private sector is going to go along with this, insurance companies will find various alternatives (higher rates, staggered coverage points, etc.) to discourage this kind of behavior on the part of their ‘customers’.
In order to deal with this problem, we next get mandatory coverage and community rates, along with other price regulations designed to make the system ‘fair’. In the escalating arms race between insurance companies (trying to make a profit) and regulatory agencies (trying to create counters to the insurance companies), the system becomes more and more complex and convuluted, as new waves of unanticipated consequences and paranoid overreactions eventually overwhelm the whole rotten mess.
Ultimately, this is the crentral flaw of liberalism writ large. Liberals (whatever their intentions, good or bad) believe that it is possible to fully comprehend the workings of a complex, emergent system, while believers in the free market understand that this is simply not possible. Markets are, at their core, an excellent method of exchanging information about systemic behavior (‘everything is worth what its buyer is willing to pay’, NOT what the Department of Worth says it is worth…), and thus provide a more useful method of pricing than even the most nobly spirited ‘public servant’.
So, while I applaud your honesty Jim (and I am not being sarcastic here), I point out that you are damned by your own words. Unless/until you can provide a convincing case to suggest that some grand overall plan (your ‘arch’) can truly encompass the complexity of a healthcare system for 308 million Americans, it simply isn’t going to sell. Very few Americans have much faith in the government’s ability to deliver the mail in an orderly fashion, and that is a whole lot simpler task than managing 17% of the GDP.
Nice try, however…
Guys, it’s simple supply and demand. The problem with every plan proposed by Democrats is that it increases demand (buyer subsidies) without increasing supply (more doctors). In fact, it is quite obvious that you simply cannot change supply (outside of small efficiency improvements) in the short run. It just takes too long to make new doctors. The only possible response is that true costs will go up.
And then the Democrats will doubtless try to legislate prices to punish the evil, greedy doctors/pharmaceutical companies. And that will destroy the pricing signal (that was motivating more doctor creation), which will cause fewer people to become doctors. And so again, true costs will go up!
Why don’t they get this? Didn’t everyone have to study this in college?
Ok, so we’re now dropping pre-existing conditions *and* forcing everyone to have insurance even in the face of rising health insurance costs. Where is the “arch”? I’m just seeing much more expensive health insurance.
You pay for the subsidies by ending government giveaways to the politically connected (aka Medicare Advantage) and subsidies for high priced health plans. The latter puts downward pressure on health care spending. There are another dozen aspects of the bills that also restrain cost growth. The overall effect, according to the CBO: tens of millions get health insurance, thousands of lives are saved, health care inflation is reduced, and the deficit goes down.
Ultimately, this is the crentral flaw of liberalism writ large. Liberals (whatever their intentions, good or bad) believe that it is possible to fully comprehend the workings of a complex, emergent system, while believers in the free market understand that this is simply not possible.
The VA and DOD medical care systems show that government has no problem running large systems. The complexity of the health care reform bills before Congress comes from the fact that don’t take over health care; instead they preserve private, usually-employer-paid health insurance, while also extending coverage to the currently uninsured. Blaming “liberalism” for problems created by its attempts to ameliorate market failure is rich indeed.
Guys, it’s simple supply and demand. The problem with every plan proposed by Democrats is that it increases demand (buyer subsidies) without increasing supply (more doctors).
It isn’t that simple. When there is health insurance, the supply of medical services increases demand. All else being equal, more doctors means more doctor visits, not lower prices for doctor visits. There’s lots of research on this — Google “Dartmouth Atlas of Health Care” to start.
Jim, once your precious single-payer socialism has destroyed the market, where will you get your pricing information to avoid shortages?
Existing government programs only prove that socialism can parasitically dictate prices by looking over the shoulder of marketplaces.
Jim, once your precious single-payer socialism has destroyed the market, where will you get your pricing information to avoid shortages?
Do you really think that the market sets prices today? For a dose of reality, read this.
Typical Jim doesn’t answer the question.
Jim, Jim, Jim…
“The overall effect, according to the CBO: tens of millions get health insurance, thousands of lives are saved, health care inflation is reduced, and the deficit goes down”
The CBO was required to look at the costs of Obamacare using ONLY the assumptions in the legislation, i.e. 6 years coverage out of the first 10 years of existence, all the Medicare fee reductions taking place on schedule (and strangely enough, counted as savings in other parts of the budget), etc. Even the CBO acknowleged that premiums would increase, hardly a way to reduce health care inflation. If this is the best that you have got, I would switch to a different brand of Kool-aid, as the stuff you are drinking has gone stale.
As for the DOD and VA health care plans as exemplars of how the government can run health-care, very few people with any choice in the matter have much love for the VA, and the DOD health care programs are monumentally expensive, as well as dealing with a very very limited population. Once again, is this the best you can come up with?
I do admire your honesty in admitting what you really want, a government takeover of health-care in general. Foolish and misguided, but honest and I can respect that. You create a set of ‘reforms’, which in turn require new reforms, and then require still more reforms to fix the holes left by the first group. Rinse and repeat. Unless you have a very simple system (and healthcare is anything but simple, particularly for a society as large as ours), you are simply delusional to claim that any group of bureaucrats (especially as dysfunctional a group as is common in our government) is going to be able to get a grip on even a tiny sliver of the information necessary to set priorities, establish goals, maintain normal function, etc. Gathering and distributing information is what markets do, and they do it (imperfectly at times, I will concede) better than anything else mankind has created, certainly better than modern technocrats.
The problem is that you still don’t address the fundamental objection that I raised, i.e. where do your price signals come from? Government control of health-care would inevitably mean that decisions about health-care (what is provided, and how it is provided) will become political, not medical, since those providing it will ultimately have to answer to the politicians who hold the purse strings. The decision on how much to spend treating heart disease vs AIDS isn’t going to be based upon relative effectiveness, it is going to be based upon which lobbying group has more pull at the moment, and which way the political winds are blowing. Insurance companies do a lot of sleazy things, and their behavior isn’t pretty, but are you seriously attempting to suggest that they are more dishonest than Congress?
As I said before, the problem with liberalism is that it presumes that large, complex systems can be sufficiently analyzed and systematized to be managed by technocratic elites who are somehow posessed of superhuman intelligence and probity. A quick trip to most VA hospitals (whose own inspector general has found them ‘unsuitable’) or a review of DOD treatment records (many make the insurance companies look like Florence Nightengale by comparison) illustrates my point quite nicely.
Finally, Titus makes the excellent point (which you utterly ignore) that the Obamacare approach would inevitably lead to the dissolution of the private sector. Governments are quite happy operating in the red, businesses cannot (in the long run), which means that once government enters into the business of providing insurance, it will inevitably crowd out private suppliers. This is the opening wedge for your ilk (who wants to take over health care in the first place) to declare a ‘market failure’, as an excuse for what you looked for in the first place…
Only people like Jim consider the present economic state of medical care to be a “market” failure.
“Hey, look — it’s that small fraction of freedom’s fault!”
You pay for the subsidies by ending government giveaways to the politically connected (aka Medicare Advantage) and subsidies for high priced health plans. The latter puts downward pressure on health care spending.
Here’s a couple of pretty important things that could have been shunted off to their own little bill. My bet is that they were included in the Monster merely to mask the cost increase of universal health insurance. They could be paying for a more competitive workforce and lower government budgets instead of the harmful goal of more expensive health care.
There are another dozen aspects of the bills that also restrain cost growth.
Really? Name them or link to someone who does.
Well, there’s the death panels and….well, that’s it.