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The Copernicus Theory of Health-Care Reform

I meant to post this a few months ago when reader Lensch sent it to me in an e-mail. But you know how these things go. Some committee or another decides to reform a fifth of the American economy and suddenly your whole day is shot.

Sigh.

Anyway, Lensch just reposted it in comments, and it's worth hoisting.

Before Copernicus, people generally believed the sun revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last few iterations of the Ptolemaic system were incredibly complicated messes that were almost beautiful.

That's what we are doing today with health care reform. We want a "uniquely American solution." So we have weak plans, strong plans, coops, exchanges, individual coverage, community ratings, etc., etc., etc. I still haven't seen we are going to handle the problem of people with pre-existing conditions. If we cover them, people will take out minimal insurance until they get sick and then switch. We need some more epicycles.

If Copernicus were alive today, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."

By Ezra Klein  |  July 15, 2009; 3:34 PM ET
 
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Comments

"If we cover them, people will take out minimal insurance until they get sick and then switch."

I thought I read that you'd only be able to change plans once a year.

Posted by: SteveCA1 | July 15, 2009 3:57 PM | Report abuse

Is that the same lensch who believes Social Security is "healthy" because it's about to start assessing $1.5 trillion in taxes from the general fund? And Medicare, which is in even worse shape -- we should all be on that, when we haven't yet even begun to feel the full cost of that program with the people who are already on it???

Get real. Seriously.

Posted by: whoisjohngaltcom | July 15, 2009 3:59 PM | Report abuse

I think Krugman referred to the considerable work Americans have to do to ensure they (or their employees) have adequate health insurance, as economic friction. The endless fear of losing HI, of not being covered for a particular treatment, or for the length of hospital stay, etc, is a completely unnecessary background toll on our productivity (and health).

Citizens of other developed nations simply do not worry about all these potential traps. Why, oh why can't we be like them!

Posted by: jimvj | July 15, 2009 4:01 PM | Report abuse

Hi Ezra

As I skeptic, could you explain to me why putting everyone under Medicare will control costs? Medicare has no track record of controlling costs--which is one reason in fact why it is popular among recipients. If your idea is that once everyone is under medicare, then we'll have the leverage to basically turn it into a giant HMO--either by squeezing providers or limiting treatments, how do you think this will play out given that HMO's were roundly rejected by their own members. Expanding insurance coverage might be a good idea on its own merits but I don't think you've made the case that it will control costs. I look forward to your response.

Posted by: panza2mil | July 15, 2009 4:02 PM | Report abuse

I'm really getting tired of people giving all this credit to Copernicus. The Copernican system was not particularly elegant, either. Copernicus modeled the solar system with heavenly bodies revolving around the sun in circles, which isn't quite right and was actually a *worse* model than the Ptolomaic system. Copernicus's model required *more* epicycles than the Ptolomaic system without giving better predictions.

Kepler, on the other hand, understood that the movement of the planets traced out *ellipses* around the sun, had the insight to create a model that was accurate and elegant, as well as being heliocentric.

Posted by: constans | July 15, 2009 4:09 PM | Report abuse

constans beat me too it. Copernicus kept the epicycles (but got rid of some of the other tricks, like the equant). Kepler (using better data collected by Tycho Brahe) cleaned everything up by replacing circles with ellipses. There were two big problems with the Ptolemaic system, geocentricity and circular orbits, and astronomy was a mess until we got rid of both. The analogy to our health care system is left as an exercise to the reader.

Posted by: you-dont | July 15, 2009 4:27 PM | Report abuse

whoisjohngaltfanboy you might want to get some facts right before challenging other peoples chops.

One the DI (Disability Insurance) portion of Social Security or OASDI started taking General Fund dollars in 2006, the event you suggest is 'about' to happen already happened. Nobody noticed because it was a non-event, as will be the case in 2017 or so when OAS starts doing the same thing. Mainly because the dollars on an annual basis are very small and remain so until about the 2030s, and even then don't get that big in context.

And where do you get $1.5 trillion? The current Trust Funds are sitting at $2.5 trillion and are projected to grow to a peak of over $4.2 trillion after 2020. If you are going to use scary numbers plucked right out of their actual context you might as well use the bigger more scary ones that actually exist rather than just making a number up.

Plus that 'tax assessment' is known to people in reality land as 'getting the money you lent back on the terms established when the loan was made'. It is funny how people seemingly obsessed with the difficulty of repaying this particular debt have no problem continuing to compound it by further borrowing. If you don't want the money have your Republican Representative introduce a bull temporarily cutting FICA down to the level needed to maintain current benefit payments. A filing that will happen after the porcine rapture I suspect.

Posted by: BruceWebb | July 15, 2009 5:17 PM | Report abuse

BruceWebb:
"One the DI (Disability Insurance) portion of Social Security or OASDI started taking General Fund dollars in 2006, the event you suggest is 'about' to happen already happened."

The demographic event that's about to happen is that there will be 2.2 workers for each retiree; meaning that each worker's withholding will on average have to cover some 45% of another person's benefit.

"and even then don't get that big in context"

Right. I don't know what I was thinking. I'm so used to "trillions" being a lot of dollars; I keep forgetting that now it's all in a day's spending. What was I thinking?

"And where do you get $1.5 trillion?"

lensch's figure. Ask him -- I don't know where he got it. Democratic Underground, probably. I'm sure you've been there.

"Plus that 'tax assessment' is known to people in reality land as 'getting the money you lent back on the terms established when the loan was made'."

Reality land??? LOL! You must be a complete idiot. Stay out of accounting, or you'll end up in prison. This is a tax on children to "repay" money a generation's collected in the name of retirement and then spent buying votes. You actually sanction this form of slavery on your own kids, huh?

"It is funny how people seemingly obsessed with the difficulty of repaying this particular debt have no problem continuing to compound it by further borrowing."

Speak for yourself. Just because I'm powerless to stop it doesn't mean I condone it -- on any level, or by any party.

Posted by: whoisjohngaltcom | July 15, 2009 5:50 PM | Report abuse

And then there is the comment of King Alphonso X "The Wise" of Castile upon studying the Ptolemaic system: "Had I been present at the creation, I would have given some useful hints for the better ordering of the universe."
And any reordering of the Insurance Universe that does not kill pre-existing conditions is a failure.
You-dont, I would hazard a guess that "heliocentricity" equals Single Payer.
The parabolic orbits? A bit trickier, but perhaps an insurance system that covers the patient for a limited but steady return instead of denying coverage for big profit.

Posted by: mrbill30560 | July 15, 2009 5:53 PM | Report abuse

If Copernicus were alive today, I am sure he would say, "Seriously, you got me nothing for my 500th birthday? What, are you waiting for the big 1K?"

Posted by: itch | July 15, 2009 8:47 PM | Report abuse

GaltBoy

I am fully aware of future dependency ratios. I also understand why the component of dependency ratio represented by what is known as covered worker to aged is not as key as key as people who have not examined the numbers in depth seem to think. Let me leave you with this: every demographic fact you cite is already built into the models. And Social Security is still not broke.

My Social Security series at econoblog Angry Bear runs about 100 posts to date and is linked in the upper left sidebar on that site. I invite you to join the discussion, you might learn something beyond your lazy Cato/AEI talking points.

Posted by: BruceWebb | July 15, 2009 10:11 PM | Report abuse

Plus the ratio of worker to retiree over the medium-long term peaks at .362 in 2040. The figure you cite includes all beneficiaries including minor children survivors and the disabled.

Posted by: BruceWebb | July 15, 2009 10:31 PM | Report abuse

"I invite you to join the discussion, you might learn something"

Yeah, sure, I might learn that it's okay to tax my kids to make up for money that I failed to save for my own retirement.

Maybe I'll learn that planning for my own future is "lazy," while robbing my own kids is the pinnacle of responsibility.

Will the government health plan include some kind of ethics removal surgery? B/C I think I'm gonna need one of those before I can be fully assimilated.

You're an embarrassment to the principles that founded this country. Do you take money from your kids' piggy bank, too?

Posted by: whoisjohngaltcom | July 15, 2009 10:33 PM | Report abuse

And please, don't explain it to me. I think about it the way it really works; a character flaw makes it impossible for me to rationalize dishonesty. There's no explanation that changes what this really is.

Instead, why not take your kids aside and have the talk with them? After all, it's gonna be on their nickel.

Posted by: whoisjohngaltcom | July 15, 2009 10:41 PM | Report abuse

O.K. I'd better put in my 2 cents. I wanted it titled "A Helicentric Theory of Health Care Reform,: but left the title of my posting.

Come on guys, I know about Kepler. I wasn't trying to give a history lesson. The point is Copericus was easy to correct by more simplification because he got the main idea right while the Ptolemaic guys had to resort to more and more complication.

I will ignore any comment by whoisjohngalt.

As for SteveCA, a year is a long in which to die or at least get worse so it you are correct, it really doesn't solve the problem.

As for Panza2mil, my point is that because of the high overhead and patient and physician compliance costs and high drug costs due to maketing (which I think Medicare can control), we can have Medicare for everyone and our total health care spending won't increase. But look, even if this works out, we will still be spending twice as much as everyone else (per person), so there will still be a lot of savings to wring out. But meanwhile we won't have people dying or going bankrupt because of lack of health insurance.

I think Medicare should be better able to control costs than private insurance because it will have national data and could put a lot of pressure on on physicians to reform a la Mayo, but I will admit that there not a lot of evidence on this. On the other hand there is no evidence that anything will get our physicians to reform their practice methods.

On the third hand, there is evidence that a government program is good at controling costs. Look at any other industrialized country. If you believe in CBO (et al) projections, Ezra has found a little graphing calculator that shows that government run systems will do much better than our mess in the future. http://www.cepr.net/calculators/iousadeficit/calc_iousa_deficit.html

Posted by: lensch | July 15, 2009 10:42 PM | Report abuse

Well, the commenters weren't wild about my analogy, but undeterred, I will try again.

Here is a number analogy.

Suppose we had the problem of determining 2 + 3. We had been using 23 as the sum which seemed pretty reasonable, but it hadn't been working out so hot. The rest of the world has been using 5, and they've been getting pretty good results. They live longer than we do. Their babies weigh more at birth. And so on. AND they've been saving a bundle.

So we say we're gonna reform our 2 + 3 policy. We gonna consider every and all possibilities and pick out the best. I like 6; it works well for the product. Why not for the sum?

BUT wait a minute. We want a UNIQUELY AMERICAN solution. We will not consider 5. We won't even discuss 5. Our newspapers will delete 5 from their fonts. If you try to talk about 5, YOU WILL BE ARRESTED! We sure don't want to do what them damn feriners do.

Posted by: lensch | July 15, 2009 10:48 PM | Report abuse

Re constans and youdont: absolutely right about Copernicus and Kepler. (The health care equivalent might be: Copernicus = public option and health exchanges; Kepler = single payer or a government-run system). In any case, this is an opportunity to recommend Thomas Kuhn's first book, The Copernican Revolution. It's elegant, brilliant, a great read, and in my opinion more convincing in arguing for paradigm shift than The Structure of Scientific Revolutions.

Posted by: robbins2 | July 16, 2009 9:15 AM | Report abuse

lensch, the only way to analogize the health care plan to Copernicus is
to say, "the new health care plan is a slightly worse, more complicated
system than we currently have that several decades from now will be easier
to incrementally change into an overall better system than we have now." I
sometimes worry that this analogy is actually a good one.

To put it in your latter analogy, calculating 2+3 currently gives us 23, but the "Copernican" system gives us 25. Which has a "5" in it, but is further away from "5" than 23 is.

It's just... I wish people would stop praising Copernicus as a revolutionary, simplifying genius. It's not simply that Kepler improved on his system to "perfect" it. It's that *the Copernican System was more complicated and gave worse answers than the Ptolemaic system.*

Posted by: constans | July 16, 2009 9:17 AM | Report abuse

O.K., O.K., change every mention of Copernicus to Kepler if you want. My point was our heath care system now has a fundemantal flaw, for profit health insurers, and what we are now doing is adding complication without fixing the fundamental flaw. I still think this is more analogous to Copernicus than Kepler (which I would compare to the whole Franch system), but it's not worth arguing about.

Posted by: lensch | July 16, 2009 9:28 AM | Report abuse

This is an enormous trivialization of Copernicus's profound insights and truly history-changing insights. Dragging his name into this is ridiculous. Why not throw in Galileo, Darwin, Einstein, Newton, while you are at it?

Posted by: ferrellms | July 16, 2009 9:55 AM | Report abuse

This is really amazing. On one side we have constans & robbins yelling at me for giving Copernicus too much credit and now we have ferrelims accusing me of trivializing him.

YOU GUYS ARE MISSING THE POINT!

This is an anology, not a lesson in the history of science.

Posted by: lensch | July 16, 2009 10:02 AM | Report abuse

Furthermore, read what I wrote. I never said Copernicus got everthing right. I just talked about the problems the Ptolemaic guys had because they had a basic wrong assumption.

Also, clearly my last paragraph was meant to be humorous. Sheesh! If Copernicus were alive today, he would have any idea what we were talking about.

Posted by: lensch | July 16, 2009 10:51 AM | Report abuse

I meant "he would NOT have any idea what we were talking about."

Posted by: lensch | July 16, 2009 11:57 AM | Report abuse

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