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Don't listen to Texas

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Texas's Rick Perry and Mars's Newt Gingrich have an op-ed in The Washington Post this morning presenting the Lone Star State as an example of all the whiz-bang health-care innovation being generated at the state level. "Texas," they write, "has adopted approaches to controlling health-care costs while improving choice, advancing quality of care and expanding coverage." Sounds awesome! The evidence is a tort reform bill that the state passed in 2003. And how's that working out?

Well, Texas currently leads the nation in the rate of uninsured, with more than 25 percent of the state's residents lacking health-care coverage. If you limit the analysis to residents under age 65, which takes seniors covered by the national Medicare program out of the data, 28 percent of Texans are uninsured.

It would be interesting to hear Gov. Perry explain why this is, but this teensy little fact doesn't appear anywhere in his op-ed. Presumably, that's because there is no good explanation: Texas, despite its much-touted $9 billion rainy-day fund, simply has not made it a priority to fix its health-care system, and so it has deteriorated into the worst in the nation.

Letting Perry serve as the spokesman for a federalist solution to the health-care system is a bit like letting Dick Fuld testify on the adequacy of self-regulation on Wall Street, or Donald Rumsfeld explain that occupations are easy. Gingrich should have picked a different co-author. Mitt Romney, as governor of Massachusetts, and Jon Huntsman, as governor of Utah, have both made real strides on health-care reform. Romney, however, disowned his bill after he realized the Republican base didn't like health-care reform, and Huntsman probably isn't trusted now that he's technically an Obama appointee.

Photo credit: Donna McWilliam/AP.

By Ezra Klein  |  November 6, 2009; 11:19 AM ET
Categories:  Health Reform  
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Comments

Agreed, substituting Romney for Perry would've allowed for a stronger argument on health care reform while sacrificing nothing in terms of potently coiffed hair.

Posted by: etdean1 | November 6, 2009 11:42 AM | Report abuse

As a Texas resident, I do not see how we have improved choice, quality or access to care. I am shocked that Texas would be held up as a poster child here. Our numbers are and continue to be near the bottom of the stack.

This is yet another delay tactic: we have tried everything else, now it is "the states should handle it". God forbid.

As for the tort reform issue, I do not know if the outlier is the 2003 Christus payment of $100m or the 2008 payment of $2+m. More datapoints would be nice. Even better would be to see how tort reform has impacted the cost of insurance that Christus has to carry. Lets see how the tort insurers feel about the efficacy of the law.

Posted by: scott1959 | November 6, 2009 11:53 AM | Report abuse

Well-reasoned piece.

Nice to see some reality in the WaPo. Why is the op-ed page becoming a murderer's row of neo-cons?

Today we had Krauthammer, the aforementioned Gingrinch and Perry tandem, Feldstein, and Gerson. Hackery.

Posted by: bcal921 | November 6, 2009 11:58 AM | Report abuse

Many thanks for posting this, Ezra. It's also worth pointing out that there's no evidence of significant cost savings from med-mal reform in Texas. Arguably there has been a little at the margins, but it's dwarfed by the other cost-drivers.

Posted by: Sophomore | November 6, 2009 11:59 AM | Report abuse

So, being uninsured equals no health care?

Why can't you ever get past that nonsense, Klein?

Posted by: msoja | November 6, 2009 12:05 PM | Report abuse

Atul Gawande got there first, and made the point that in McAllen, TX, "healthcare innovation" meant "property speculation".

Yet again, though, the WaPo seems willing to open up its (supposedly) valuable op-ed space to any 'winger who spams Fred Hiatt's inbox. That's a real institutional problem.

Posted by: pseudonymousinnc | November 6, 2009 12:13 PM | Report abuse

Msoja - that's not what Ezra said. Not even close.

Being uninsured means being at risk for bankruptcy, and a near certainty of receiving substandard care.

If you think there's no drop-off in quality for people without insurance, you must be well-insured, very young, or very very lucky.

Posted by: Sophomore | November 6, 2009 1:14 PM | Report abuse

@Msoja

And for a great number of people, having no insurance does actually mean no care. If you have an expensive illness but no health care, and if you are lower middle income, you probably aren't getting any care until your illness turns into acute or emergency conditions. It also means you are likely not to have any routine checkups or preventative care.

Posted by: StokeyWan | November 6, 2009 1:34 PM | Report abuse

--"that's not what Ezra said."--

If Klein doesn't mean to conflate the two than what's the point of continually harping on levels of insurance coverage?

It used to be that having insurance was the exception. The more people that have it, the less is it a hedge against catastrophe that it started out being. When everyone is *forced* to buy it, then it simply becomes a way to redistribute wealth, i.e., socialism, communism, or whatever flavor of the collectivist month ism suits yer particular outlook.

It has been the unending drive toward universal insurance coverage of some type that has pushed things to where they are today. I see no evidence that more government force and control will do anything but worsen health care as a whole for the country.

Posted by: msoja | November 6, 2009 1:35 PM | Report abuse

The uninsured don't matter in Republican comsmology b/c being insured is like being unemployed -- a sign of deep moral failure. Once again, if you were "responsible" you would have been born rich.

Posted by: NS12345 | November 6, 2009 1:52 PM | Report abuse

"When everyone is *forced* to buy it, then it simply becomes a way to redistribute wealth, i.e., socialism, communism, or whatever flavor of the collectivist month ism suits yer particular outlook."

Your point? As long as it's effective, I don't care if its socialism.

"If Klein doesn't mean to conflate the two than what's the point of continually harping on levels of insurance coverage?"

Because in many ways, coverage does equal adequate care. Without it, you either have to go to the emergency room (expensive), rely on charity (patchy), or negotiate payments with the doctors (expensive, and chancy).

"I see no evidence that more government force and control will do anything but worsen health care as a whole for the country."

Then why does Germany have better care than the US? Why does Canada have similar care, in spite of universal coverage?

Posted by: guardsmanbass | November 6, 2009 2:01 PM | Report abuse

"I see no evidence that more government force and control will do anything but worsen health care as a whole for the country."

A statement that is full of facts, NOT!

Posted by: RogerThal | November 6, 2009 2:44 PM | Report abuse

"I see no evidence that more government force and control will do anything but worsen health care as a whole for the country."

I'd love to see your explanation for the better statistical outcomes -- infant mortality, life expectancy, cancer survival, and so on -- in countries with universal health care.

Posted by: Janine1 | November 6, 2009 2:48 PM | Report abuse

--"I'd love to see your explanation for the better statistical outcomes -- infant mortality, life expectancy, cancer survival, and so on -- in countries with universal health care."--

It's a well known fallacy that infant mortality, life expectancy, etc., correlates with a particular country's health care system type. You could look it up. The differences have to do with cultural norms, individual life style choices, assorted demographics, as well as reporting and data gathering mechanisms.

And really, ripping the statutes out of Canada's federal register and pasting them into the U.S. version won't give us the wonders of Canada's socialist health care. What's being attempted will be a monumental undertaking and will likely go very badly.

Posted by: msoja | November 6, 2009 3:43 PM | Report abuse

--"As long as it's effective, I don't care if its socialism."--

Ah, a let's-get-the-trains-running-on-time kind of guy. Freedom be damned. You want the other guy to pay for your stuff and you don't mind use a little government coercion to make it happen.

You'll excuse me if I think the less of you? Thanks.

Posted by: msoja | November 6, 2009 3:48 PM | Report abuse

A "well-known fallacy"? That's a great way to sweep aside all contrary evidence without having to grapple with it. (First thing they teach in law school: when someone says "it is well-established ..." that's often a flashing neon sign that it's not.)

As for cultural norms, it's interesting that the cheese-eating, chain-smoking French still live longer than we do. Though I'll concede that the shorter work weeks, longer vacations, and better social safety net give them a substantial advantage over us in terms of stress and the physical toll it takes over a lifetime.

"And really, ripping the statutes out of Canada's federal register and pasting them into the U.S. version won't give us the wonders of Canada's socialist health care."

Nice straw man, considering that's not what anyone is suggesting.

Posted by: Janine1 | November 6, 2009 3:57 PM | Report abuse

--A "well-known fallacy"?--

You *could* look it up. It's not that hard. Try plugging "life expectancy vs health care system" into yer fav search engine. Because, you know, I bet they also teach you in law school that standing before the judge and declaiming, "He said it was 'well established!!!'" doesn't count as a compelling reason to acquit the accused.

--"Nice straw man"--

So changing health care systems is as easy as changing one's socks? You're the credulous type, within the parameters of your biases, aren't you?

Posted by: msoja | November 6, 2009 5:00 PM | Report abuse

msoja, I took your challenge. The first three results were posts showing that the US spends way more on h/c than other OECD countries and has results that are no better, and often much worse, as measured in life expectancy, etc.

What was your point?

And, please, your last comment was completely off-topic.

Posted by: JohnHuss | November 7, 2009 8:58 AM | Report abuse

soggy lives in his own head. He prefers the cool purity of arguing for things that don't exist, never existed and will never exist.

This may well be an indictment on mental health provision in the USA.

Posted by: pseudonymousinnc | November 7, 2009 4:59 PM | Report abuse

What a joke Texas is trying to say they should be the poster child for good health care. Maybe they mean good health care for the rich. Then maybe it would be a good model.

Posted by: McSameChalin | November 7, 2009 8:37 PM | Report abuse

msoja,

Maybe since 45,000 people a year die because they do not have health care. And studies have shown if you put an equally healthy person with health insurance against an equally healthy person without health insurance, the un-insured person has a 30% more chance of dying than the insured person. It taint rocket science, but you do need a 3rd grade education at least to figure it out. So, maybe I am asking too much.

Posted by: McSameChalin | November 7, 2009 8:40 PM | Report abuse

I'm starting to believe that it's useless to discuss this issue with msoja, because the facts don't seem to matter.

"I see no evidence that more government force and control will do anything but worsen health care as a whole for the country."

We're not operating in an evidence-free world. Our peer countries have more government regulation (though only Britain has a truly "socialized" system) and health outcomes comparable to ours on a whole range of measures, while we spend around 50% more than they do. Yes, lifestyle may account for some fraction of that difference--but it takes a lot of suspension of disbelief to say it accounts for such a huge disparity.

One can check out these 5-year survival comparisons for various illnesses at http://www.nytimes.com/imagepages/2009/06/17/business/17leonhardt.graf01.ready.html Hard to say what we're getting for our money here.

"When everyone is *forced* to buy it, then it simply becomes a way to redistribute wealth, i.e., socialism, communism, or whatever flavor of the collectivist month ism suits yer particular outlook."

Everyone is "forced" to buy into our public education system. There is no market for educating people who couldn't afford it themselves. Having an educated workforce is essential to our economic survival. But since it's "redistributivist," we should get rid of it? I'm "forced" to buy a lot of defense spending I don't think I need. There are lots of things we're forced to do; welcome to democracy.

"Ah, a let's-get-the-trains-running-on-time kind of guy. Freedom be damned."

Yes, those poor oppressed people in Canada, Europe, and New Zealand. We should send in the troops to liberate them immediately.

Lack of access to quality health care also impedes one's liberty. If a family member has a preexisting condition, earners may purposely decline jobs that would pay them above the income level where they would no longer qualify for Medicaid. People may not change jobs or start their own business because they'd lose their present coverage. Uninsured people forgo treatment because they fear bankruptcy. I'd say those can be pretty severe restrictions on one's freedom, especially as any one of us could be in any of those situations someday.

Posted by: dasimon | November 7, 2009 10:37 PM | Report abuse

Why do people keep responding to the nonsense from this "msoja" character? He/she clearly cannot be reached. Why bother trying? Nothing better to do?

Posted by: MarkFromOhio | November 8, 2009 8:16 AM | Report abuse

Why are liberal voices like Klein's restricted to WaPo's blogs, while oped space in the print edition is almost wholly given over to conservatives?

Posted by: enochsoames | November 9, 2009 9:14 AM | Report abuse

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