Network News

X My Profile
View More Activity

Republican ideas

PH2010020901941.jpg

The New York Times asked five conservatives to offer their prescriptions for health-care reform. It's not a bad list, so far as these things go. The partisan bombast is kept to an appreciated minimum (these efforts usually have a lot of "my idea is to not set up death panels in every town across the country, but I've not been invited to the president's table, now have I?"). But it is a strange list.

Bill Frist wants Medicare to "reimburse providers not for each discrete service they provide but for managing a patient’s condition over an entire episode of care." This is called "bundling," and it's one of the central Medicare reforms in the bill.

James Pinkerton says that "President Obama’s health care reform plan was doomed from the moment the American people figured out that his goal was to spend less on health care." Of course, Obama isn't spending less, he's trying to reduce the rate of growth, which is a necessity if the country is to avoid bankruptcy. On the other hand, the specific thing Pinkerton wants is more money spent on disease research: That's not just in the bill, but it was actually in the stimulus bill, which funneled $10 billion to the National Institute of Health.

Mark McClellan, who's the only health-care expert consulted in the feature, knows these reforms are already present in the bill (and has said so previously), so he mainly counsels that Republicans propose "further" efforts to help "Medicare strengthen its capacity to provide data and measure patient outcomes."

Charles Kolb, meanwhile, wants something more like the Wyden-Bennett act, and Newt Gingrich disingenuously suggests that the estimated $600 billion we spend for unnecessary care each year would be solved through tort reform (he should read this paper, or this CBO analysis of tort reform, or this article on unnecessary care in a state that already enacted tort reform).

Bottom line? The Senate bill actually includes most of the best ideas out there. That isn't to say it includes all of the most interesting conservative ideas out there. But the big conservative ideas -- think John McCain's proposal to end the employer-tax exclusion or Paul Ryan's effort to privatize Medicare -- are radical and could be unpopular, and so establishment Republicans are shying away from them to avoid letting the Democrats swing the spotlight around to the downsides of the real conservative alternatives.

Photo credit: By Pablo Martinez Monsivais/Associated Press

By Ezra Klein  |  February 22, 2010; 4:29 PM ET
Categories:  Health Reform  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: The Democrats to watch
Next: Rush Limbaugh: Health-care reform is 'reparations,' a 'civil rights act'

Comments

Let us just say that the summit meeting should be interesting to watch. Or at least, the frenzied spin that will happen before/during/afterwards. It will define the narrative of the health care bill.

The question is, how will it define it?

Republicans have been very busy bees telling everyone who will isten to them that this is a "trap", a "setup". Woe is certain for any Republican who even shows up.

I'm amazed their more devoted followers aren't having anxiety attacks from worry that John Stewart wasn't right and there will be bobby traps and tigers waiting for the Republican leadership there. :-)

So we'll see. I'll have my popcorn ready, either way.

Posted by: JERiv | February 22, 2010 4:47 PM | Report abuse

Wait, you're telling me that the health care bill ISN'T a radical socialist nazi takeover and actually includes bipartisan policy?

Also, gotta love Pinkerton arguing against spending cuts. Cognitive dissonance is fun.

Posted by: etdean1 | February 22, 2010 4:50 PM | Report abuse

Ezra,

A couple of thoughts:

1) Tort reform. There are credible studies suggesting costs may equal up to 10% of health care spend annual. See McClellan's studies on the topic, for example. The right answer is that its a very hard question to pinpoint, the actual answer is somewhere between 0 and 10%, and the intuitive answer is that its clear its higher than zero, because the fear of lawsuits has some effect. Nearly every clinician says so, with reason-- they've all done it. The pressure is real. You'd do yourself so good in stopping to pretend this issue is clearly immaterial. Its not. And there are real reasons for thinking its higher nothing. That's why CBO has begun changing its tune. Its not a surprise to me where they'll be on this issue in another decade from now. Its not lower than $5 billion/year, that's for sure.

2) Frist isn't asking for "bundling pilots" with deliverables in 2014, but actual changes in Medicare reimbursement rolled out by that point, if not earlier. HIPAA was rolled out on that timeframe across the whole system, the same could be done here. Its not. Pilot projects don't count.

3) McClellan said more than that. His first line was "They should insist on adding reforms that would do more to reduce costs." He also touched on malpractice for the reasons I mentioned above. He's just not a silly DC-type that's going to put an actual dollar figure on a complex issue.

4) Pinkerton has a smart point of focusing on "health" rather than "health care." As I argued last week, $100 billion/year investments in "health" would do more for health outcomes than insurance coverage.

Posted by: wisewon | February 22, 2010 4:51 PM | Report abuse

Oh come on Ezra, if the GOP wanted to reform health care, health care would already be reformed. They don't want to, or to be more precise, they can't reform health care. Not without angering the health insurance companies or putting the entire thing on the national credit card.

The GOP managed Medicare Part D by not paying for it. Heck, the GOP even went so far as lying about how much it would cost and threatening to fire Medicare Chief Actuary Richard Foster if he spilled the beans on the estimated cost. Of course, Medicare Part D was about giving back to Pharma for all the campaign contributions, not about providing drugs to seniors. If it were really about providing drugs to seniors it would have allowed for collective bargaining on drug prices.

Given their track record, I'd guess that any true GOP health insurance reform would be something like this: Provide everyone with health insurance, add the costs to the national debt and hope like heck that the other party is in power when the bill comes due. That way the other party will be blamed for the GOPs junk legislation and the GOP can tar them as being fically reckless.

I still consider myself a fiscal conservative, and in my book it is far more "conservative" to pay for what you get as opposed to charging everything on the credit card. Every time I hear a talking head advocate for tax cuts to solve everything from budget deficits to herpes I want to scream! Can taxes be too high? Sure they can, but they can also be too low.

Posted by: nisleib | February 22, 2010 4:56 PM | Report abuse

*Frist isn't asking for "bundling pilots" with deliverables in 2014, but actual changes in Medicare reimbursement rolled out by that point, if not earlier. *

From a small-c-conservative perspective, it is probably wise not to overturn the whole Medicare system so quickly without doing pilot projects first.

Posted by: constans | February 22, 2010 5:01 PM | Report abuse

Wow! What a great acummulation of straw men!!!

Now when you are serious to look at Republican ideas, try these:

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/07/AR2009100703048.html

http://www.newsweek.com/id/233915/page/1


ANYTHING BUT RELYING ON THE FEDERAL GOVERNMENT FROM USURPING THE ACCESS TO HEALTHCARE BY ALL MIDDLE CLASS FAMILIES!!!

PS: Why are Medicare cuts even included in this bill!!! Medicare is in Red Ink! If you are going to cut money from Medicare, DO IT!!!! It has nothing to do with the rest of Obama & Pelosi's ridiculous bill----its a gimmick to make it look less expensive.

Posted by: FastEddieO007 | February 22, 2010 5:03 PM | Report abuse

How about a very simple bill to decouple employment from healthcare....give the tax break to everyone!

Its the first step to a straight-forward bipartisan healthcare plan!!!

Posted by: FastEddieO007 | February 22, 2010 5:07 PM | Report abuse

"Senate bill actually includes most of the best ideas out there."

And one of the worst -- a mandate.

Republicans don't want good ideas included, they want them *instead* of bad ideas. Take out the ideas only libs want, and leave in the ones both sides agree on. It's called working for "the common good."

Posted by: cpurick | February 22, 2010 5:11 PM | Report abuse

cpurick - The individual mandate was a Republican idea

"It was invented by Mark Pauly to give to George Bush Sr. back in the day, as a competition to the employer mandate focus of the Democrats at the time."

http://www.npr.org/templates/story/story.php?storyId=123670612

Posted by: nisleib | February 22, 2010 5:17 PM | Report abuse

Good writing as always Ezra, but my comment's on the photo - Awesome - they look like baddies from a batman movie all dark and sinister - love it.

Posted by: ChicagoIndependant | February 22, 2010 5:31 PM | Report abuse

That is the least orange I have ever seen Boehner, in any picture. (But to achieve normal coloring for him, the photographer had to make McConnell translucent.)

Posted by: Janine1 | February 22, 2010 5:42 PM | Report abuse

"The individual mandate was a Republican idea"

While I wish I could say that makes it a better idea, it doesn't. It's still a problem with this bill.

Posted by: cpurick | February 22, 2010 5:52 PM | Report abuse

"While I wish I could say that makes it a better idea, it doesn't. It's still a problem with this bill."

Hey, I don't like the idea either, but when you are dealing with risk aggregation the bigger the pool you have to deal with the less volatile the pool is. In other words, insuring an entire population is more efficient and stable then insuring only a fraction of a population. Therefore the goal is insuring everyone.

I like single payer, it would be the most efficient and easily managed system available. But because of our politics that is not possible. Given this, the question becomes how do we get as many people as possible in the pool? And the answer is either an employer mandate or an individual mandate.

Nobody likes paying for health insurance when they aren't sick. I pay $700/month and almost never go to the doctor. But for the system to work we (all of us) need to be in it all the time, not just when we need it. This is especially true if we are expecting insurance companies to do away with pre-existing condition recissions.

Posted by: nisleib | February 22, 2010 6:03 PM | Report abuse

And from today's Washington Post:

"A plan for a new "individual mandate" is outlined under the heading "Improve Individual Responsibility." In the most recent Post-ABC poll, 56 percent said they back a requirement "for all Americans to have health insurance, either from their employer or from another source, with tax credits or other aid to help low-income people pay for it." On this question, polls have consistently revealed wide swings in opinion depending on the details. For example, a June Post-ABC poll had support for the individual mandate range from 44 percent if sanctions were included for noncompliance to 70 percent if a tax credit accompanied the rule. (The president's proposal features both.)"

Posted by: Lee_A_Arnold | February 22, 2010 6:07 PM | Report abuse

"In other words, insuring an entire population is more efficient and stable then insuring only a fraction of a population. Therefore the goal is insuring everyone."

I'm sure that's a nice, practical rationalization as long as "freedom" is pretty low on your priority list.

And it calls for a distinctly liberal and expensive solution -- universal access, where the problem is simply rising rates.

Voters want cheaper insurance for those who are willing to buy it; not an entitlement for those whose coverage is most likely to drive up costs.

Young healthy people are not your slaves for funding the care of the sick. Quite frankly, it disgusts me to see this happening in our once-free country.

Posted by: cpurick | February 22, 2010 6:16 PM | Report abuse

Cpurick, are you in favor of Medicare? Yes or no?

Posted by: Lee_A_Arnold | February 22, 2010 6:20 PM | Report abuse

cpurick: Young, healthy people get sick too and need insurance. Eventually, most of them will be older and less well too. I've been pretty healthy my whole life and a few weeks ago, I developed a little pain right were my appendix was then located.... I'd like to know that I have access to reasonably priced health insurance from now until I get socialized, er, Medicare.

Ezra: What wisewon said about defensive medicine. You repeatedly misrepresent the problem. Although malpractice premiums are noise level to the cost of healthcare, estimating the cost of defensive medicine is difficult, and "tort reform" would have little or no effect on the problem. IT'S STILL A PROBLEM. The VA docs whose efficiency you so admire, are federal employees and they can not be sued for malpractice.

Posted by: J_Bean | February 22, 2010 6:31 PM | Report abuse

"Cpurick, are you in favor of Medicare? Yes or no?"

I'm not in favor of welfare for anyone with the means to cover their own costs. I think Medicare should be overhauled, and I think Medicare's insolvency, as Obama has cited it, is a pathetically poor reason to reform everyone else's care.

Posted by: cpurick | February 22, 2010 7:55 PM | Report abuse

"Young, healthy people get sick too and need insurance."

Ah, but young healthy people are very cheap to insure. In fact, if they could be insured entirely on the basis of their actual risk, at least some of the famous 47 million uninsured could or would buy insurance without any mandate.

The function of the mandate is to force young healthy people to buy insurance at higher rates than their actual risk reflects, so that liberals can capture the difference to subsidize the care of the sick.

In other words, the mandate views young people as slaves who must pay for the sick.

Posted by: cpurick | February 22, 2010 7:59 PM | Report abuse

Cpurick, So you are in favor of covering people who don't have the means, i.e. you are in favor of universal coverage?

Posted by: Lee_A_Arnold | February 22, 2010 8:16 PM | Report abuse

"In other words, the mandate views young people as slaves who must pay for the sick."

And the mandate that you carry auto insurance (or post a liability bond) views safe drivers as slaves who must pay for the unsafe.

That's how insurance works, and that's the only reason it does work.

And there is not one "healthy" person in this world, at any age, that ~knows~ with any certainty that he or she will stay healthy.

An uninsured person doesn't feel very free when they are stricken with an injury or disease that is ruinously expensive to treat.

Posted by: Patrick_M | February 22, 2010 8:20 PM | Report abuse

And if those young, healthy people are indeed healthy (and look both ways before crossing the street), then eventually they will be older people. You can either view young healthy people as paying a premium price to support their elders or you can view them as pre-paying their own rising insurance costs. Hardly "slavery".

Posted by: J_Bean | February 22, 2010 8:30 PM | Report abuse

"And the mandate that you carry auto insurance (or post a liability bond) views safe drivers as slaves who must pay for the unsafe"

God, that's a whole wheelbarrow full of manure. Drivers are only required to insure for their own risks. Good drivers get discounts and drivers who generate claims pay more.

The useful idiots are specifically trying to keep high risk insurees from having to pay for their increased claims, and that is why the system will not permit young people an accurate discount for their good health.

Posted by: cpurick | February 22, 2010 8:40 PM | Report abuse

"You can either view young healthy people as paying a premium price to support their elders"

Slavery.

"or you can view them as pre-paying their own rising insurance costs."

That's something called a Health Savings Account. Funny how you libs won't allow those, but you ask people to try thinking of your redistribution scheme in that light.

Have you ever stopped to wonder why liberals need to pretend their schemes are something they aren't in order to build support for them?

Or why the right supports a plan that really does exactly what yours can only pretend to do?

Does the dishonesty really never catch up with you???

Posted by: cpurick | February 22, 2010 8:46 PM | Report abuse

No, smoothing out health insurance costs over a lifetime is not the equivalent of an HSA. That's a silly comparison.

If, for instance, I finish college at 22 and start an HSA, but then at age 24 am diagnosed with multiple sclerosis, I'm out of luck. On the other hand, if I have access to reasonably priced INSURANCE, then I get the expensive drugs and care that I need. HSAs are a nice way to save a bit of tax money on predictable expenses or even later in life chronic care, but they aren't insurance against catastrophic needs.

I currently subsidize people who get into car accidents and people whose houses catch fire. I'm okay with that, because I'm a liberal, I guess (or because I know that disaster could happen to me, too).

Posted by: J_Bean | February 22, 2010 8:59 PM | Report abuse

"Good drivers get discounts and drivers who generate claims pay more."

And we would all pay less if there were no uninsured drivers, so that's one of several reasons that auto insurance is mandatory under law, and one of the reasons it makes sense to get everyone, including the young, into the health care pool with the same kind of mandate.

Sure there are discounts for safe drivers, but the safe are always paying for the unsafe (or the unlucky)...auto, fire, you name it, if you unlucky enough to have a loss it will be covered by a zillion other people who are not experiencing the same loss.

Would it increase your sensation of freedom if Big Brother monitored your eating and exercise and vices, in order to charge you higher premiums for risky behaviors?

People without losses subsidize people who have losses. Insurance is not a savings account. That's how insurance works.

Posted by: Patrick_M | February 22, 2010 9:01 PM | Report abuse

Another steaming crock of Patrick.

The point of the mandate is that you can only really soak the young to pay for the sick after denying them the same option of walking away that they have with every other insurance product they buy.

Thanks to the mandate, subsidizing the uninsured is no longer just some incidental cost of insuring the young like it is with every other insurance -- in this case, it is THE cost you intend to force them to pay.

You see them as something you could feed on. It's disgusting parasitism. Do you realize you probably have ancestors who came to this country specifically to get away from people who held the same beliefs as you?

"That's how insurance works."

No liberal on Earth has a clue how insurance works. Insurance is about risk. People with low risks are cheaper to insure. People with high risks are more expensive.

Insurance is something you buy to hedge against unforeseeable catastrophic costs. Getting regular checkups is not a catastrophic cost. Having babies or getting old are not unforeseeable. Stupid libs don't want insurance for these -- what they want is payment plans -- specifically, payment for each according to his needs, and by each according to his abilities.

People with "pre-existing conditions" aren't risks at all -- they're sure-fire sinkholes of expense. But they have needs that must be fed. And young healthy people are just feed stock.

Posted by: cpurick | February 22, 2010 9:48 PM | Report abuse

"If, for instance, I finish college at 22 and start an HSA, but then at age 24 am diagnosed with multiple sclerosis, I'm out of luck. On the other hand, if I have access to reasonably priced INSURANCE, then I get the expensive drugs and care that I need."

Clueless.

You buy insurance for the unlikely catastrophic costs -- like MS at age 24. AND you invest for certain costs, like needing more medical care after you're old.

As you get old and your health needs become inevitable, insurance should get more expensive, and should cover less and less, while you begin tap into a lifetime of health savings to cover the costs of aging.

Posted by: cpurick | February 22, 2010 9:56 PM | Report abuse

"People with "pre-existing conditions" aren't risks at all -- they're sure-fire sinkholes of expense. But they have needs that must be fed. And young healthy people are just feed stock."

Yes, cpurick, that's how insurance works. And today's "feed stock" routinely become tomorrow's "sinkholes" (and you have a nice way of thinking about someone with a chronic condition). You buy life insurance when you are a young piece of feed stock and lock in a good rate for when you become an old sinkhole. Houses that sustain no damage during a flood or earthquake are the "feed stock" for those that are damaged. Some element of risk is predictable, but much is pure chance and thus the system depends on the biggest possible risk pool to make the overall risk exposure predictable and hold costs down to the minimum.

You really are not arguing against reform here, you are arguing against the very concept of insurance itself, on the grounds that spreading risk across the biggest possible pool is communism, or slavery, or some such nonsense.

When you have a mortgage, the bank enslaves you by requiring home insurance. When you buy a car, the state (and your lien holder, if any) enslaves you by requiring auto insurance. "Slavery" everywhere you look, but the mandates make perfect sense for the individuals and for the society at large.

Posted by: Patrick_M | February 22, 2010 10:07 PM | Report abuse

There's no need to call me "clueless". How about a respectful exchange of ideas?

Our hypothetical young person is 23 and gets a disease (e.g. MS, type I diabetes, even type II diabetes) that will require increased chronic care. How do they get insurance? They've got a big, pre-existing condition, almost nothing saved in an HSA, and "catastrophic coverage" that will cover hospitalizations -- except that they don't need hospitalizations, they need MRIs and a zillion dollars worth of Copaxoneer the next 10-20 years. What's your solution to that? What's the advantage of "catastrophic insurance" plus an HSA over comprehensive insurance? I was smart enough to make it through medical school, I'm probably smart enough to understand your argument, if you can make one without insults.

Young people need insurance and young people turn into older people. Medical expenses are more likely than house fires, but still unpredictable. That's why you need insurance.

Posted by: J_Bean | February 22, 2010 10:22 PM | Report abuse

I saw that same set of pieces and actually wrote the NY Times a letter to the editor about it -- because almost all the ideas they were suggesting are already in the bills, as you point out as well. Where is the reporting responsibility here????

Posted by: LindaB1 | February 22, 2010 10:24 PM | Report abuse

"Houses that sustain no damage during a flood or earthquake are the "feed stock" for those that are damaged."

No, lib. Houses that are outside the flood zone, or nowhere near the fault line, are supposed to be cheaper to insure, and are not even required to get flood insurance. You, however, want to force them to buy the flood insurance to subsidize someone living in the flood zone. That's different, as you know, but it's always entertaining to watch you rationalize.

"spreading risk across the biggest possible pool is communism, or slavery,"

If you were a mortgage insurer looking for ways to distribute the costs of claims against your customer base, that would be one thing.

But in this case the government is looking at costs that some sick people can't afford, and it intends to force other people to pay for that care. That *is* slavery. Giving them insurance whose actual value is only a fraction of what you're charging them is just more rationalization. Just another in a long list of lies liberals tell themselves so they won't feel guilty for doing what liberals do.

Maybe you'd feel better if we stopped calling these young healthy benefactors "people." Maybe we should just refer to them as "tissue." That's always made it easier in the past.

Posted by: cpurick | February 22, 2010 10:24 PM | Report abuse

"Our hypothetical young person is 23 and gets a disease (e.g. MS, type I diabetes, even type II diabetes) that will require increased chronic care. How do they get insurance?"

Ah, well, that's not apples to apples. Before, you said they *need* insurance in case they get MS, because an HSA won't do the trick. Now you're saying insurance won't do it either? Then maybe you shouldn't have listed insurance as an alternative to HSAs, huh?

Look, if you can buy life insurance, then maybe you should be able to buy insurance against chronic disease, too. This is hardly a new idea.

And if you get sick and you're going to need a lifetime of expensive care that you can't afford, then I see no reason why you shouldn't be able to qualify for Medicaid after you've exhausted all of your own assets. That's the definition of welfare, as is all that money Dems propose to throw at people so they can afford insurance.

And yes, clueless is the right word as long as we're talking about ways to help people get their care at other people's coerced expense. What we should be talking about is how to legalize the sort of care poorer people can afford.

Posted by: cpurick | February 22, 2010 10:41 PM | Report abuse

Cpurick, all that seems to indicate that you are in favor of universal coverage, although you do not care to pay for any it.

But how does your system control the healthcare price increases upon current policyholders? Let's not hear the old cross-state purchasing + tort reform canard, if you please. That won't do it.

Posted by: Lee_A_Arnold | February 22, 2010 11:14 PM | Report abuse

"No, lib. Houses that are outside the flood zone, or nowhere near the fault line, are supposed to be cheaper to insure, and are not even required to get flood insurance."

Evidently, you can't follow the metaphor. Even within the flood zone, the flood does not take all the houses. With health insurance, everyone is within the flood zone. We are all at risk, although illness will not immediately claim us all (eventually it will, but not immediately).

If you live outside the "flood zone" of possible death or injury, you are likely a supernatural creature, so maybe you can apply for an exemption from the mandate.

Everybody else, from a newborn baby to an elderly citizen, can get hit with a life-changing health shock tomorrow. If we are all in the same pool, we lower the overall cost of care, and lower the cost increases we will all otherwise look forward to from the current patchwork of inefficiences.

"But in this case the government is looking at costs that some sick people can't afford, and it intends to force other people to pay for that care. That *is* slavery."

No, that *is* just mandatory participation in insurance; slavery is something else.

Your definition of slavery is certainly demeaning to actual slaves. By your logic, the payment of worker's compensation and disability benefits are slavery, as are any tax-supported benefits for people in distress, like FEMA aid to disaster victims. If I am being taxed for the building of a road somewhere else that I won't personally use, that is slavery too.

I am saddened for you to think that you feel "enslaved" in so many ways you have lost count. The ongoing pain of victimhood is just the worst, isn't it?

Be well.

Posted by: Patrick_M | February 23, 2010 1:36 AM | Report abuse

"Cpurick, all that seems to indicate that you are in favor of universal coverage, although you do not care to pay for any it."

That would be incorrect, except for the part where you correctly note that I shouldn't have to pay for your care. That's *your* job.

Posted by: cpurick | February 23, 2010 7:25 AM | Report abuse

"Evidently, you can't follow the metaphor. Even within the flood zone, the flood does not take all the houses. With health insurance, everyone is within the flood zone"

But young people are not in the flood zone. The metaphor doesn't work because it describes actual insurance, and what you want is not insurance -- it's redistribution.

You are not pooling like risks. You are pooling unlike risks. And the purpose of the mandate is to keep those of low risk from escaping a disproportionate burden of the costs of people with higher risks.

Everything you say to explain it is politically correct BS to make it sound "fair" or "logical." Because if you spoke *honestly* it would be job-killing, money-sucking, tax-frenzied socialism.

Posted by: cpurick | February 23, 2010 7:39 AM | Report abuse

"Your definition of slavery is certainly demeaning to actual slaves."

No -- it is your definition that is incomplete and naive. But keeping you compliant requires that you not understand what slavery is. So you have been taught to associate it exclusively with one man's ownership of another, when it is really about whether any man lives for himself.

Hayek didn't call it "The Road to Slavery" -- called it "The Road to Serfdom." You should look closely at the exchange that was implied by serfdom, because it sounds like any common liberal explaining what people pay taxes for today.

Liberals think of American taxpayers using the language of serfdom, all while carefully separating it in their minds from slavery. The word "slavery" is still un-American in your mind, but the definition of slavery has changed so that you will submit willingly.

And yet medieval serfs, who paid lower taxes and were subject to less regulation than many middle class Americans, were slaves by textbook definition.

You advocate slavery every day. You live in it, because you've bought into a lie that tells you your slavery is a good thing, while only other types of slavery are bad. You're the best kind of slave. You like it on the plantation, and you help hunt down others who are escaping -- like healthy people who don't want to pay your higher premiums just to provide care to the chronically sick.

Posted by: cpurick | February 23, 2010 8:15 AM | Report abuse

How in the world can anyone say they like Medicare.

It underpays doctors. It denies services more than private insurance, and after all that its more in the red than almost any Government-run entitlement.

On top of all that, Democrats are seeking to cut $500 billion from it----not so that it is no longer in the red, but very crazily as an excuse for creating a bigger entitlement bankruptcy mess.

This is like accumulating $500 billion of gambling debts, and then getting a concerned uncle to give you a check so you can square away your debt, but instead using it all to bet on Red 7 at the Roulette Table.

Explain to me why you Democrats are so reckless with the future of this nation-----this is not like a dispute over the expense of going to war in Iraq---a temporary expenditure which disappears over time-----this is like committing to a lifetime membership into an exclusive club that spends 96% of your income.

Do you think the poor's access to healthcare will be better or worse after this country's international credit rating goes down the drain!!!! You're not FIXING anything!!! You are going to make everything worse----especially for the poorest in this nation. I honestly believe you have the best of intentions, but such policy recklessness is HORRIBLE!

Posted by: FastEddieO007 | February 23, 2010 9:21 AM | Report abuse

A better way:

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/07/AR2009100703048.html

http://www.newsweek.com/id/233915/page/1

Posted by: FastEddieO007 | February 23, 2010 9:21 AM | Report abuse

Cpurick, it's still unclear. You are against universal coverage, and you are against covering the poor?

Posted by: Lee_A_Arnold | February 23, 2010 9:30 AM | Report abuse

FastEddie, come on man. While that ideal by Feldstein is a way to reform, its really not much different than Wyden-Bennett. If you could get support for that from the GOP, I'm all for it too...but guess what you can't.

Heck, Bob Bennett is getting primaried by the GOP in Utah for having the gall to say that the gov't should start taxing HC benefits. Face it Eddie, even if there are policy solutions from the right, no one in the GOP wants to actually push them.

That policy is actually much more radical than Obamacare as it completely ends the tax break for insurance, and it ends the employer-based models. Noble goals, but they rarely get further than academia.

Posted by: truth5 | February 23, 2010 9:48 AM | Report abuse

And as far as Ryan's roadmap....that's been discussed several times on this blog. If you can name one more politician on the right, other than Ryan, who will stand and suppport that plan, then we can take it seriously.

Until then, sorry, its not a reasonable alaternative. Somehow the GOP is going to argue against $50B/year cuts in Medicare on one hand, but then supports Ryan's plan to turn Medicare into a capped voucher program for private insurance?

Posted by: truth5 | February 23, 2010 9:51 AM | Report abuse

Fast Eddie, stop advocating a "better way" from someone who was on the board of directors of AIG Financial Products when it almost singlehandedly bankrupted the entire financial system of the U.S. That doesn't bode well.

Posted by: Lee_A_Arnold | February 23, 2010 9:53 AM | Report abuse

Cpurick can't be taking seriously when he's quoting Hayek on one hand and then espousing GOP style conservatism on the other. They aren't compatiable. Hayek himslef rebutted the monkier of conservative in the 70s when he was still alive. He stated that conservatives were fixated on staying put, not moving forward, and he wanted no part of it. He was a classical liberal, who could no longer use the term liberal becuase its original meaning had be so distorted by the likes of Cpurick.

Posted by: truth5 | February 23, 2010 9:55 AM | Report abuse

Eddie, Eddie, Eddie....You just advocated in two posts NOT cutting Medicare and then a "better way" by.....CUTTING MEDICARE.

I'm not a big fan of Medicare, but most seniors are happy with it, and compared to a lot of the junk insurance on the individual market, it is a better product. That said, I don't support going to a Medicare for all.

But of course, that's NOT what the current plan from Obama does at all. It relies entirely on PRIVATE insurers and PRIVATE providers (docs, hospitals, etc)

Posted by: truth5 | February 23, 2010 9:59 AM | Report abuse

"Cpurick, it's still unclear. You are against universal coverage, and you are against covering the poor?"

Lee, we've been over this how many times?

I'm in favor of legalizing care at standards far below the accepted American norm. Care more like what patients receive in utopian Cuba, which could easily be afforded by poorer Americans.

I'm in favor of legalizing care that everybody can afford, instead of pretending that subsidizing unaffordable levels of care will make it accessible to all.

Which part of this is unclear?

Care is not expensive because providers demand too much money. Care is expensive because there is not enough for everyone to have all they want. "Expensive" is how we draw the line between who gets it and who does not.

I'd like people who can't afford this particular gold-plated care to have access to lesser quality care that would still satisfy most needs. And not by pretending the care is just as good -- by telling people to go buy cheaper care.

Posted by: cpurick | February 23, 2010 9:59 AM | Report abuse

Cpurick: "Care is expensive because there is not enough for everyone to have all they want."

This is incorrect. Even Hayek says so, in The Road to Serfdom.

Hayek argues in FAVOR of the state helping to organize comprehensive social insurance, including medical.

Posted by: Lee_A_Arnold | February 23, 2010 10:03 AM | Report abuse

Cpurick, then what's the answer? Fund more community clinics instead?

Posted by: truth5 | February 23, 2010 10:04 AM | Report abuse

Cpurick made the big mistake of attempting to quote Hakek, when what he really supports is Randian philosophy where gov't has limited to no role in any social function.

Hayek spent his time and works arguing against central planning. Not against any and all social programs.

Posted by: truth5 | February 23, 2010 10:10 AM | Report abuse

Cutting Medicare to improve the solvency of Medicare makes sense.

Cutting Medicare as a pretext for spawning Medicare's new evil baby brother---a private-proxied Federal Single-Payer System is outrageous!

Its like getting a loan to pay off a gambling debt, but then using the money to bet on Red 7.

What don't you get about that distinction?

Posted by: FastEddieO007 | February 23, 2010 10:10 AM | Report abuse

Fast Eddie, you too are a bit shy of economics. Medicare isn't being cut, one part of it is being reduced in growth rate, in order to help fund a system that might reduce the cost growth of health care overall, which might in turn reduce the need for spending in Medicare later. But don't take my word for it -- pick up any introductory economics textbook.

Also, the present bill INCREASES spending in Medicare part D, helping to close the "donut hole" on drug costs -- which is why anyone on Medicare who has looked at it, is very happy.

Posted by: Lee_A_Arnold | February 23, 2010 10:26 AM | Report abuse

$500 Billion is being cut from Medicare under the current legislation being considered by congress. Period.

Posted by: FastEddieO007 | February 23, 2010 10:56 AM | Report abuse

What is it about this site attracting silly young Randroids like cpurick?

Posted by: pseudonymousinnc | February 23, 2010 11:37 AM | Report abuse

cpurick says:

"You advocate slavery every day. You live in it, because you've bought into a lie that tells you your slavery is a good thing, while only other types of slavery are bad. You're the best kind of slave. You like it on the plantation, and you help hunt down others who are escaping -- like healthy people who don't want to pay your higher premiums just to provide care to the chronically sick."

Somehow I expect that McConnell and Boehner will frame the argument against HCR a little differently when speaking to the President on Thursday.

:)

However, it is enlightening to know how the conservatives really think.

Thanks for all that, cpurick. Good luck to you with your escape from the "slavery" that is health insurance.

Posted by: Patrick_M | February 23, 2010 11:43 AM | Report abuse

pseudonymousinnc,

It seems that Ezra's blog is a plantation from which the Randroids are unable to escape.

Posted by: Patrick_M | February 23, 2010 11:51 AM | Report abuse

"Cpurick made the big mistake of attempting to quote Hakek"

Only if by "quoting Hayek" you mean "using the title of one of his books to illustrate the liberal misunderstanding of 'slavery'."

Posted by: cpurick | February 23, 2010 12:31 PM | Report abuse

"Care is expensive because there is not enough for everyone to have all they want."
"This is incorrect. Even Hayek says so, in The Road to Serfdom.
Hayek argues in FAVOR of the state helping to organize comprehensive social insurance, including medical."

It's funny to see you citing Hayek, Lee, since Hayek never pretended that people who receive government services have some right not to go bankrupt.

Hayek also noted that the standard of care under government-managed medicine would stagnate at a lower average level, and that such a program would create a conflict that would favor taxpayers over the chronically and terminally ill. You know -- the people Barack tells to just shut up and take the pain pill?

So I guess you could say Hayek favored more state involvement, as long as you can admit to the costs he said that would entail -- costs which I've been warning of, and which you've been steadfastly denying.

Methinks you only agree with Hayek where it's convenient to your agenda.

Posted by: cpurick | February 23, 2010 12:51 PM | Report abuse

"Hayek himslef rebutted the monkier of conservative in the 70s when he was still alive."

Modern conservatism is not about keeping things the same -- it's about sticking with what works. And unlike modern liberalism which has nothing to do with liberty, classical liberalism is today's libertarianism -- a movement much more closely aligned with conservatism.

Posted by: cpurick | February 23, 2010 12:57 PM | Report abuse

"But young people are not in the flood zone. The metaphor doesn't work because it describes actual insurance, and what you want is not insurance -- it's redistribution.

You are not pooling like risks. You are pooling unlike risks. And the purpose of the mandate is to keep those of low risk from escaping a disproportionate burden of the costs of people with higher risks.

Everything you say to explain it is politically correct BS to make it sound "fair" or "logical." Because if you spoke *honestly* it would be job-killing, money-sucking, tax-frenzied socialism."

cpurick,

Again, you are not arguing against socialism, you are arguing against insurance...specifically health insurance, which you do not seem to understand.

When you say:

"You are not pooling like risks. You are pooling unlike risks. And the purpose of the mandate is to keep those of low risk from escaping a disproportionate burden of the costs of people with higher risks."

...you demonstrate your failure to grasp that this is exactly how private health insurance pools operate today, right now, already, in the status quo that you are hoping to preserve.

The insurance folks have a term for this "pooling of unlike risks" that they do, and it is called "community rating."

Look it up. Information is your friend.

Posted by: Patrick_M | February 23, 2010 12:57 PM | Report abuse

Cpurick: "Hayek also noted that the standard of care under government-managed medicine would stagnate at a lower average level, and that such a program would create a conflict that would favor taxpayers over the chronically and terminally ill."

No, he wrote that later in regards to a completely state-run system: government control of doctors, hospitals, the whole works. Because without market forces, supply won't rise to meet demand, and innovation will be squelched.

It is definitely NOT was he was writing about in supporting comprehensive medical insurance in The Road to Serfdom, and it is not what is in the present healthcare reform bills.

Cpurick, do you still believe that the supply of healthcare is now at its maximum level, while the demand for healthcare is infinite? You insisted that both of these things are true, in our discussion under Ezra's post, "Will health-care insurance save your life?" (February 12.) Both are completely wrong.

Posted by: Lee_A_Arnold | February 23, 2010 2:19 PM | Report abuse

Fast Eddie, $500 billion less in upward cost growth -- over how many years? Ten years? Twenty years?


Will it help other people with medical costs? Will it make those people freer to take care of the elderly in their family?

Posted by: Lee_A_Arnold | February 23, 2010 3:06 PM | Report abuse

"do you still believe that the supply of healthcare is now at its maximum level"

Irrelevant. What I believe is that we get our money's worth for what we currently pay, more or less. You libs want to cover more people (including some who will consume unimaginable amounts of care). Obviously you're not going to ask them to pay it, so your plan will either cost the rest of us more money, or it will require cuts to our existing care, or both.

Thus, promises of deficit-neutral expansions of coverage, with no reductions in care or increases in premiums, are a lie. There will be rationing of care and reductions in quality before this is done. What you propose to do is very, very expensive.

Your question's irrelevant because you are in denial about the very premise of what you're trying to do. I'm happy to discuss who's worth spending more money on as soon as you acknowledge the choice that's really being made.

As long as you pretend that Obamacare will give everyone all the medicine their doctor thinks they should get, then any attempt at honest debate with you completely ignores the 800lb gorilla in middle of the room.

Guaranteeing coverage to sickly people will introduce new demand. It's not like there's a lot of empty hospital beds and idle MRI machines laying around. We will have to accept more poverty in other parts of our lives as the price of funding this massive new welfare program.

Posted by: cpurick | February 23, 2010 3:42 PM | Report abuse

"The insurance folks have a term for this "pooling of unlike risks" that they do, and it is called "community rating.""

Yes, I'm quite aware of this. It's why young healthy people with virtually nil healthcare needs already decline to buy employer-based insurance -- because it forces them to subsidize less-healthy co-workers.

But you -- you're upping the ante. As if paying for their co-workers wasn't bad enough, now you want to force them to cover the costs of the uninsurable.

Read a textbook description of adverse selection, say, in the used car market. Those who leave the system are escaping victimization. Now consider the liberal view of adverse selection with regard to healthcare -- in any honest assessment of what's going on, you're siding with the bad guys.

Posted by: cpurick | February 23, 2010 3:49 PM | Report abuse

"Yes, I'm quite aware of this. It's why young healthy people with virtually nil healthcare needs already decline to buy employer-based insurance -- because it forces them to subsidize less-healthy co-workers."

You again fail to understand the utility, for everyone, of community rating. Young healthy people may be at lower risk, but that does not mean that any one of them has a certainty that he or she will not encounter devastating injury or disease. So the yound and healthy benefit by having coverage, and the rest of us benefit that (just like reducing the number of uninsured motorists), we don't have a population among us that is going through life with their fingers crossed. Lastly, the "young and healthy" benefit again when (inevitably) they are no longer young and healthy.

The insurer benefits too, because the bigger and more representative the pool becomes, the easier it is to determine actuarial risk, and that lowers the overall premiums.

"But you -- you're upping the ante. As if paying for their co-workers wasn't bad enough, now you want to force them to cover the costs of the uninsurable."

Persons with pre-existing conditions are not "uninsurable." If you bring them into the community rating system, along with those young and healthy new customers, the community rating looks roughly the same. This is the value of universal coverage.

Bear in mind that with most group coverage, a pre-existing condition usually subjects you to a waiting period, not a permanent exclusion. Even now the insurer does not treat you as "uninsurable." Later, the insurer may use a purportedly undisclosed pre-existing condition as an excuse for recission of the policy, leading to horror stories like the lady who testified that her coverage for life-saving cancer treatment was denied because her physician had failed to advise the insurer that she had once been treated for acne. We can have a less dysfuctional health care system than that in the USA, although people such as yourself might prefer otherwise.

You call it socialism or slavery, but it is really plain old insurance -- it is just taking the currently existing model for private group health insurance and expanding the pool by removing exclusions and enlarging the customer base, getting individuals, small business employees, people who can't afford coverage, and those with pre-exisiting conditions all into the system.

You have already stated your objection to the insurance concept, which I understand: it is your unwillingness to pay "premiums just to provide care to the chronically sick."

I get it, and I'll leave it right there, rather than continuing to go over the same ground with you to no end.

Posted by: Patrick_M | February 23, 2010 4:23 PM | Report abuse

Cpurick: "What I believe is that we get our money's worth for what we currently pay, more or less. You libs want to cover more people (including some who will consume unimaginable amounts of care). Obviously you're not going to ask them to pay it, so your plan will either cost the rest of us more money, or it will require cuts to our existing care, or both."

This could not be more wrong. You are NOT getting your money's worth out of the healthcare system.

Plus, you are ALREADY paying for other people's coverage -- and far MORE than you need to. And in a couple of major ways:

(1) People are showing up in the worst possible shape at the last minute without money at emergency rooms, where treatment is most expensive of all. We all pay for this, in increased premiums and/or increased local taxes. But this isn't even the WORST of it:

(2) You are also paying in another way, because over time, and throughout the economy, you buy LESS goods and services for your dollars than you should be able to. This is a result of reduced productivity and innovation, by both entrepreneurs and labor.

Proof of the pudding? U.S. productivity rates and economic growth rates are down at the level of the main European countries -- which are much smaller economies. U.S. growth has been pathetic -- the U.S. should be far ahead of them. They are even with us because they have better social insurance including universal healthcare.

You aren't more free. You are less free, and you are hallucinating. You should take a course in basic economics.

Cpurick: "Guaranteeing coverage to sickly people will introduce new demand. It's not like there's a lot of empty hospital beds and idle MRI machines laying around. We will have to accept more poverty in other parts of our lives as the price of funding this massive new welfare program."

We cannot increase supply without making the suppressed demand to be EFFECTIVE. The healthcare reform delays its policies to give hospitals, doctors, and other providers the time to do market analyses, to be ready with increased supply to meet the demand.

Again, you should take a course in basic economics -- this is a very telling mistake.

(Indeed it leads you to self-contradiction, since it is obviously NOT "irrelevant," as you claim, that you believe the falsehood that the supply of healthcare is now at its maximum level.)

Posted by: Lee_A_Arnold | February 23, 2010 6:50 PM | Report abuse

@CPURick:

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision.

Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance - where, in short, we deal with genuinely insurable risks - the case for the state's helping to organize a comprehensive system of social insurance is very strong."

[...]

"Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken," - Friedrich von Hayek, The Road To Serfdom (Chapter 9).

RTFB!

Posted by: atlasfugged | February 23, 2010 6:55 PM | Report abuse

"Young healthy people may be at lower risk, but that does not mean that any one of them has a certainty that he or she will not encounter devastating injury or disease."

And that is all true, which is why the young and healthy would buy more insurance if it was available priced according to their own actual low risks rather, than priced according to people with pre-existing conditions who need help with their costs.

Imagine a pool composed exclusively of 20-25 year-olds with typical risk factors and no pre-existing conditions. Yes, some will get sick, but most will remain healthy for two whole decades. How much would they really have to pay to cover the needs of that group for a year?

Now imagine how much they're going to have to pay under a mandate, with their surplus premiums going to cover sicker people. Yes, they benefit from the insurance, but the mandate isn't because we're worried they'll get sick: it's because we want, no, make that *need*, their premiums for the other group.

The difference between what their insurance needs actually cost and what you plan to take from them is what the mandate is all about. That's supposed to be some incidental cost, some statistical anomaly in actuarial statistics. But in this case that anomaly is an end unto itself, and the mandate is simply the means of achieving it.

But screw freedom, because this is liberaltopia we're talking about!

Posted by: cpurick | February 23, 2010 7:22 PM | Report abuse

"You are NOT getting your money's worth out of the healthcare system."

Actually, we are, if you understand that end of life treatment is very costly and only marginally effective. We throw a lot of money at dying patients.

We also spend a lot of money ruling out statistically unlikely diagnoses because doctors and insurance companies don't want to get sued.

But every penny of this has medical merit, or it wouldn't be authorized by insurers. Do I agree with these decisions? No. But the money is spent on excellent care. At the margins, where even nominal gains in outcomes are very costly.

I don't agree with the choice to spend it, but I hardly think the money's wasted. It's spent on something I disagree with, and often on people who haven't earned it.

And I'm even okay with spending 25% less -- even if it will only cost us one life for every thousand patients.

But this brings us back to the same place we always end up, where you pretend those lives would not be lost. Of course they would. That's the plan.

"U.S. productivity rates and economic growth rates are down at the level of the main European countries -- which are much smaller economies. U.S. growth has been pathetic -- the U.S. should be far ahead of them. They are even with us because they have better social insurance including universal healthcare."

First, I'd like to see the link. And then I'd like to see how those claims have stood up to scrutiny. And after that, I'd like to see the proof that "better social insurance" is the factor.

Libs only believe what they want, so if it's all the same to you I think I'll hold out for actual facts. Such claims have a track record of being, well, shall we say "misrepresented"?

Posted by: cpurick | February 23, 2010 7:39 PM | Report abuse

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision..."

And so once again we see the one snippet of Hayek that all liberals read, yet which none actually understand.

People in this country can buy insurance. Those who can't find insurance can have Medicaid as soon as they run out of their own money.

Life sucks. But all the stuff you libs want everyone to have doesn't exactly fall from the sky.

Posted by: cpurick | February 23, 2010 7:44 PM | Report abuse

Cpurick: "First, I'd like to see the link. And then I'd like to see how those claims have stood up to scrutiny. And after that, I'd like to see the proof that "better social insurance" is the factor."

I think you should do your own homework. And you can start by learning why healthcare supply is not limited, and why healthcare demand is not infinite.

Posted by: Lee_A_Arnold | February 23, 2010 8:32 PM | Report abuse

@CPURick: I read the book. It was in my lap when I wrote my comment. I understand what the passage means, and the context in which it appears, and I believe that it is consistent with the economic philosophy put forth by Hayek in the "Road to Serfdom". If I've misunderstood what the passage means, please elucidate.

I am curious. How do you reconcile Hayek's "very strong" support of "a comprehensive system of social insurance", social insurance being a system that society collectively pays into, with an interpretation of "The Road Serfdom", whereby social insurance leads inevitably to not just serfdom, but to slavery as well?

PS: If your purpose here is to engage in an intelligent and civil discourse, then you should refrain from reflexively classifying everyone who doesn't agree with you as being a liberal or, worse, making presumptions about their ability to comprehend things that you have yet to demonstrate having any clear grasp of.

Posted by: atlasfugged | February 23, 2010 8:41 PM | Report abuse

"I think you should do your own homework."
And I think you should back up what you say with supporting evidence. What a convenient standoff for you!

"healthcare supply is not limited, and...healthcare demand is not infinite"

And yet EVERY single universal healthcare system has waiting lists for all kinds of resources and procedures that you can get within hours here. Meaning, at the very least, that those enviably cheaper systems are all either underfunded or oversubscribed.

But our universal healthcare will be the magical exception. Because unlike all those other systems, investment in our system will make it grow, huh? Even though Obama has already identified healthcare as the next revenue source for Social Security?

The lies you libs tell yourselves simply never cease to amaze.

Government couldn't even estimate the cost of the Cash for Clunkers program. It has absolutely no credibility for estimating the demand for universal health insurance.

And I realize you don't care because you're more concerned with the ideal than with its viability. The fact is that you're willing to pay whatever such a program will cost. You don't bat an eye at a trillion, and you'd be just as happy with two trillion, or even five. We'll worry about paying for it after we get it.

Start there and see how your own ability to reason is blinded by what you want. You're incapable of saying no to this -- there's no reason I should expect your defense of it to be grounded in reality. I expect you to repeat any lie, embrace any potential evidence, ignore any fishy smells, to make this happen. So if it's all the same to you, I'd like to see the "evidence" that "supports" your claims. Even Ezra claims healtcare reform is "popular" by citing a story which concludes that only 32% want this bill passed. This place is a Marxism echo chamber, a vacuum of reason.

Let's see what that the facts really say.

Posted by: cpurick | February 24, 2010 8:13 AM | Report abuse

atlassfugged:

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision."

Is "getting old" really an uncertain common hazard of life against which few individuals can make adequate provision?

Is being more sickly when you're old really uncertain? And doesn't a person have a lifetime to prepare for aging?

Is "having babies" really an uncertain common hazard of life against which few individuals can make adequate provision? Just how much does a midwife really cost, anyway?

If you want to discuss having people pay for their own routine needs, I'll be happy to discuss how the state might "assist" once they've run out of their own money due to "hazards." It would be rather different from (and considerably cheaper than) the socialtopia free-for-all of "universal healthcare."

Posted by: cpurick | February 24, 2010 8:29 AM | Report abuse

Cpurick: "And yet EVERY single universal healthcare system has waiting lists for all kinds of resources and procedures that you can get within hours here. "

This too is incorrect. All systems in the developed countries have emergency and critical care on immediate demand.

While in the U.S., wait times for non-emergency and elective procedures are also weeks to months (and U.S. wait times are lengthening) -- UNLESS you have a gold-plated plan or pay extra out pocket, as you can ALSO do to reduce wait times in the other countries. The only exception I know of is England, which is changing.

This wouldn't correct your basic errors about supply and demand, however. Nor your errors about changes in them.

Markets and governments allocate by different methods -- prices or votes -- and a combined system is the most effective, as history (and the smooth function of universal care in other developed countries) shows.


There is a basic indicator that these other countries are meeting total healthcare demand very well -- poll after poll shows huge majorities in favor of their systems.

When they want to change something about care delivery, it becomes a minor campaign issue between candidates. Then it is fixed. There is no mystical maximum level of supply, no slavery, no libertarian hallucinations.

Posted by: Lee_A_Arnold | February 24, 2010 9:26 AM | Report abuse

"All systems in the developed countries have emergency and critical care on immediate demand."

And yet patients still die on waiting lists in every one of them. Universal coverage is not universal care. It must be rationed. It is everywhere else. It is here. And it always will be.

Th argument is not rational -- it's just the delusion you tell yourself to support the solution you've already chosen.

"Errors about supply and demand" LOL. NO country is meeting all demand. And neither will we.

The only error here, about supply and demand, is that we can or will somehow reinforce supply to meet all demand. Nobody has done so. Demand is sufficiently close enough to infinite that for practical purposes it can't be met. Even if you want to haggle about whether demand for care is theoretically finite.

Posted by: cpurick | February 24, 2010 9:45 AM | Report abuse

Cpurick: "'Errors about supply and demand' LOL. NO country is meeting all demand. And neither will we."

No, you mean neither DO we. Right now.

The U.S. has all the imperfections of the other developed systems, and none of the virtues. People die waiting in the U.S., or because they aren't covered or are rescinded. On the other hand, other developed countries even do good medical and pharmaceutical innovation.

In other words, everything else is a toss-up -- except for U.S.' excessive cost overruns (compared to the other countries) PLUS the U.S.'s lack of universal coverage.

Posted by: Lee_A_Arnold | February 24, 2010 10:26 AM | Report abuse

Thank you Lee, for pointing out what I've said all along: The cost of rationing in our current system is only meaningful when compared to the cost of rationing in other systems. People die on their lists, too. And people will continue to die on lists here when we switch to some other model of rationing. And it will be rationing, though I'm sure you will continue to live in denial.

This leaves us debating who, then, should get the care first. And I'm happy giving it to those who pay first. Not those who pay taxes, but those who pay for insurance and care. As it should be.

I should also point out that one of the benefits of our current system is better general care for the insured, and better emergent care for the uninsured. Be sure to include that as one of the costs you're willing to pay for your socialtopian solution.

Posted by: cpurick | February 24, 2010 12:04 PM | Report abuse

Cpurick: "I should also point out that one of the benefits of our current system is better general care for the insured, and better emergent care for the uninsured."

Again incorrect. U.S. isn't getting better health outcomes -- while its costs are 40% higher and people's live are harmed for lack of universal access. Mortality per capita isn't the only comparison. Nobody even talks about the additional nonmonetized transactions costs in time and worry for people who aren't covered and people who are losing their coverage.

Posted by: Lee_A_Arnold | February 24, 2010 7:11 PM | Report abuse

The comments to this entry are closed.

 
 
RSS Feed
Subscribe to The Post

© 2010 The Washington Post Company