Poll Shows Most Americans Want Public Health Care
The poll is the New York Times/CBS News latest:
Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.
The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.
Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents’ own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.
That paradox was skillfully exploited by opponents of the last failed attempt at overhauling the health system, during former President Bill Clinton’s first term. Sixteen years later, it underscores the tricky task facing lawmakers and President Obama as they try to address the health system’s substantial problems without igniting fears that people could lose what they like.
These poll results add to the evidence provided by the NBC/Wall Street Journal poll that came out a few days ago (emphasis mine):
Yesterday’s NBC/Wall Street Journal poll has both good news and bad news for health reform. Public opinion is mixed on “Barack Obama’s plan” (odd, as Barack Obama doesn’t currently have a plan). About a third think it’s a good idea. About a third think it’s a bad idea. About a third don’t know. That suggests that we’re still early enough in the process that the bulk of people with opinions are the partisans who didn’t need to actually form one. Indeed, a few questions later, the pollsters describe the plan in more detail, and support shoots to 55 percent, but opposition barely budges.
But make no mistake: There are elements of health reform that are important, but will be sharply unpopular. Almost 60 percent, for instance, oppose efforts to tax generous health care benefits. I’d guess that when people hear about penalties in the individual mandate, that policy will prove controversial too. Luckily, there are some elements of health reform that meet with overwhelming public approval. Among them is the public plan. According to the poll, 76 percent of Americans believe it’s either “extremely important” or “quite important” to “give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.”
Much in health reform is unpopular. The choice of a public insurance option isn’t. And given the many hard and controversial choices that will need to be made to achieve health reform, it’s not clear to me that the Democrats can afford to lightly remove the genuinely popular aspects of the legislation.
Conservatives who are ideologically opposed to public health care are not about to come around just because it’s what most Americans want — although, to be fair to them, they don’t agree that most Americans DO want a public health care option. Those conservative bloggers who posted responses to the New York Times/CBS News poll are implying, or saying, that — to quote one — the poll was rigged. Donald Douglas implores us to think of the children. No, not this child, silly. Look at the picture again, you’ll figure it out.
Jason Arvak at Poligazette pays me the compliment of mentioning me several times in his fairly lengthy post on the Times/CBS poll and the health care debate in general. He makes a number of specific points with regard to my views:
This stridently dishonest approach has been eagerly embraced by the ideologues of the left, who prefer slogans to debate. A characteristic example is TMV’s Kathy Kattenburg, with her no-discussion-tolerated demand “We Need Single-Payer Public Health Care — NOW“. Kattenburg’s post does identify a legitimate problem that requires reform (the practice of “rescission” — the arbitrary denial of coverage using flimsy and even dishonest excuses), but its willingness to only consider one possible solution and its intolerance for any discussion of problems or alternatives makes it a dangerous diktat rather than a progressive proposal. …
If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem. But continuing experience in Canada, for example, shows that serious problems with availability and rationing in critical care areas such as cancer treatments persist in single-payer systems. The hostility to debate and discussion among single-payer advocates like Kattenburg is thus revealed as more than simply self-righteous arrogance — it is a serious threat to the viability of a future post-reform system. Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality. And the economic logic that causes rationing is impervious to proclamations from high atop a moral white horse: Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment. Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future. As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand. The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.
But, of course, such matters are of little interest to self-righteous purists like Kattenburg. All that matters to them is demonizing the other side enough to score an easy rhetorical “win” before blithely moving on to the next item on their infinite list of political vendettas. Actually making the system work is Somebody Else’s Problem. And, after all, any problems that do crop up can always be blamed on Republicans, conservatives, or “the rich”. A big advantage of refusing to even talk to your critics is that you can continue that same practice to evade accountability later on as well.
Fortunately, not everyone embraces this vicious and irresponsible approach. Moderate Democrats in the Senate are eschewing the temptations of the extreme purists and are trying to craft a compromise that might address some of the legitimate concerns about single-payer health care. Whether such proposals can gain steam in spite of the dogmatism of the purists remains to be seen, but the willingness of pragmatist liberals like Justin Gardner at Donklephant to actually recognize and discuss legitimate concerns about purist approaches to health care reform is a very hopeful sign.
The bottom line is that the choice is entirely in the hands of liberals. Partisan Democrats dominate the entire political playing field, from the Congress to the elite media to the blogosphere. If they choose to embrace the intolerant purism of their Kathy Kattenburgs, then Americans may have little more to look forward to than a dreary march to technological stagation, rationing, and the decreased quality of care that results from decreased timeliness of care. The fact that enlightened liberals will have “won” over evil insurance companies will be of little comfort to the breast cancer patients who see their tumors metastitize while they linger on the waiting list for radiation and chemotherapy treatments. But if they instead adopt the willingness to compromise of Senator Kent Conrad and Donklephant’s Justin Gardner, a centrist consensus might just be possible.
As Jason knows, I cannot respond to his points in Poligazette’s Comments section. However, I can certainly do so here. Without going on at great length, here are a few of my thoughts in response to his (Jason’s comments are in italic):
If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem.
Jason is using a very common rhetorical device here. (I have been known to use it, too, on occasion, so I cannot judge Jason too harshly on this one.)
Of course single-payer is not nirvana, and in truth, there are no advocates of single-payer who claim it to be nirvana. I think it goes without saying (but maybe not) that no system devised by human beings can ever be nirvana — by definition, since human beings are imperfect. In the countries where some form of universal public health care exists, however (which is, to my knowledge, all industrialized nations except the United States), that type of system does a better job of delivering basic health care to all citizens than does the privately administered, for-profit model that exists in this country.
Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality.
I agree, but refusing to discuss potential problems is not, in my view, the sticking point — I think most people are willing to discuss potential problems with a public health care option (as well as potential problems with the for-profit model), and to figure out ways to address those problems. There is a difference, though, between discussing potential problems and possible solutions, and giving up. I cannot speak for anyone else, but for me, the inclusion of a public health care option as part of any reform package is non-negotiable. Note that a public option is already a step down from single-payer. A public option is already a compromise. I don’t know what line in the sand, if any, Democrats in Congress will decide to draw — but for me personally that line is labeled “public option.” No public option, no go.
Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment. Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future. As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand. The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.
Check out this recent 60 Minutes segment, Jason. Cancer patients without health insurance are dying right now in our country because the low-cost or no-cost hospital-based clinics they rely on for essential care are being closed due to recession-fueled budget cuts. The rationing and waiting lists that exist in some public health care systems are bad — but not getting the health care services at all because you are uninsured and don’t have the money to pay for them is worse.
98 Responses to “Poll Shows Most Americans Want Public Health Care”
I said it could become an “under-performing bureaucratic nightmare” if we failed to pay attention to flaws as well as virtues. For example, if we fail to account for disincentives to equipment investments, what is a problem for a few hundred patients in Canada could wind up being a problem for many thousands in the United States. The size and complexity of our society means that errors could be compounded in their impact.
My goal is to try to slow people down enough to get a good reform program that addresses all the issues as much as is possible, not to block all reform. I think those who respond to me with the assumption that I am just reading from an anti-reform script keep running off the rails with their responses. Having personally and intensely experienced both the virtues AND the flaws of our current health care system over the past year, I find myself outside the prepared scripts of both left and right on this issue. And I am frustrated by the unwillingness of both left and right (pretty much only the left is well represented on this site) to break out of their scripts.
I said it could become an “under-performing bureaucratic nightmare” if we failed to pay attention to flaws as well as virtues. For example, if we fail to account for disincentives to equipment investments, what is a problem for a few hundred patients in Canada could wind up being a problem for many thousands in the United States. The size and complexity of our society means that errors could be compounded in their impact.
My goal is to try to slow people down enough to get a good reform program that addresses all the issues as much as is possible, not to block all reform. I think those who respond to me with the assumption that I am just reading from an anti-reform script keep running off the rails with their responses. Having personally and intensely experienced both the virtues AND the flaws of our current health care system over the past year, I find myself outside the prepared scripts of both left and right on this issue. And I am frustrated by the unwillingness of both left and right (pretty much only the left is well represented on this site) to break out of their scripts.
I think the primary focus comes down to funding and its impact. Mr. GreenDreams is accurate that Medicare is more cost effective than private in spite of the fact Medicare deals with solely the highest risk health groups. This tends to support the contention that single payer is less expensive regardless of environment. In addition, a lot of major strides have been made in geriatric treatment originating in the competitive market. However, Jason, you should realize by now I am not a purist. I expect competitive contracts even in a one payer system for services and suppliers to be evaluated for both. cost and effectiveness.
By the way, Mr GreenDreams, I think the days of employer provided health insurance are coming to an end regardless of which way health insurance goes.
Starleys: “Dr J. This link gives per capita costs for healthcare.”
Starley, the US spends more per capita for everything: clothing, recreation, alcohol, you name it, so it's no surprise the same is true for health care. And even spending more on shoes, we're probably not nearly as fashionably shod as the Italians, but that doesn't mean the government should take over Nike.
“My concern however is we cannot sustain this level.”
Like I say, that's exactly my concern as well. Even without the effects of the recession, costs are going up by 5% a year, and it's not like we're getting 5% healthier a year. Costs have come unhinged from value delivered, and we need reform that will hook them back together.
“I do agree with the single payer system however. It allows for universal coverage and contract providers who would compete to provide care and allow for better oversight by a unified authority.”
My concern is that's more or less what we have today. Medicare and private plans *do* attempt to get better deals out of providers by setting rates they feel are aggressive. As a result, not every doctor accepts every insurance plan (including Medicare), because they're not always willing to take what is being offered.
But Medicare and private insurers all have limited leverage over the providers. They can't help anyone without a decent number of doctors signed up, so at the end of the day they pay whatever's Usual, Reasonable and Customary–which is to say whatever the providers vote they should be paid. And they pass the cost on to us, whatever it might be.
This competitive process is broken two important ways. First, it only happens once a year when these contracts are up for renewal, so it happens at a very high level and everyone forgets about cost control the rest of the year. Second, it happens on the basis of price per treatment, not price per outcome. Medicare and Blue Cross have no idea if you actually feel better from that $10K worth of tests and treatments you got, so providers are competing on the basis of the quantity they can deliver, not the quality. This is where reform needs to focus: making sure we're paying for what we really want.
Don't worry. I'm sure our government will find a way to make a health care system that stifles innovation and is more expensive than the one we have now.
The only thing that will definitely get better is access.
It is also worth remembering that private health insurance is effectively subsidizing Medicare. Many providers make up ground on services that they provide at a loss to Medicare by increasing billing amounts to non-Medicare patients. This de facto subsidy would disappear under a single-payer system. While that is not necessarily a bad thing, it could wind up being bad if the result was either to significantly raise the costs beyond what we thought (based on current Medicare) would be the cost of certain services OR if the disappearance of the way to make up losses wound up forcing providers to simply no longer provide services for which Medicare did not pay enough.
Starleys,
This plan was first put together in the early ‘90s to counteract HillaryCare.
First off, it recognizes that the main ingredient missing from either a government single-payer or a private insurance run operation is the dignity of managing your own healthcare. Whether an uncaring bureaucrat or a greedy insurance employee, the emphasis is not on caring for you, but denying anything that costs money.
Back in the ‘90s, the percentage of the healthcare budget that went into clerical and billing matters exceeded 22%. Most was centered at the provider to substantiate claims for payment and to maintain documentation in case of litigation. A vast majority of this cost would be eliminated by customers paying via debit cards from medical savings accounts (MSAs).
MSAs could be individually, employer or government funded, depending on the individual. Once an MSA hit the $8000 minimum in one year, anything over that amount can be withdrawn for any purpose. So, an employer could encourage employees to spend carefully on healthcare by paying a certain amount into the account each year, regardless if the account was at it’s minimum or not, thus allowing the employee the choice of taking a “bonus” or leaving the greater amount in the account.
There is a “donut hole” designed into the system to encourage prudent spending. This allows first-dollar payments out of the account all the way up to the $8000 balance, but allows for an additional $7000 of unfunded expenses to accumulate before the government catastrophic plan kicks in. The $7000 is paid through the credit function of the MSA debit card, and is repaid either by the individual or through tax refund or earned-income tax credits. As stated, this “hole” is for the purpose of inflicting a measured amount of pain for excessive (even if necessary) use. Illness needs to be monetarily as well as physically painful to keep it something to be avoided.
Mentioned in an earlier post was the need for the socialized single payer catastrophic portion of the plan to place limits on services based on the type of procedure and the age and physical condition of the recipient. The vast majority of healthcare dollars are spent trying to keep the dying from dying 6 months sooner. By using government to play the “bad guy” in making the decisions of how old, what is reasonable and what is not, the healthcare crisis could easily be solved.
Next: Why every doctor should be a specialist.
Actually, MSAs sound really good until you see your first bill for an MRI. That alone would eat an entire MSA. After seeing the billed price of cancer treatments, I lost all interest in MSAs as a realistic response to health care problems.
Very complicated. How do you measure results and establish rates? In this area I ask for suggestions.
Every Doctor a Specialist:
This healthcare plan was designed by first asking how a person would want their medical treatment delivered, as opposed to simply wondering how to fund the existing practices. By looking at the problem from a blank slate, savings can be designed into the system.
One of the first is the primary contact. When someone is sick, the last thing they should need to do is drag themselves to an inconvenient office filled with other sick people in order to spend 3 minutes with a hurried doctor who is most likely going to order tests or refer them to a specialist.
A higher quality and less expensive alternative is for a Advanced Degree Nurse (ADN) with 6 years experience as an RN and 18 months advance training, to come to the home of the patient. This ADN would have the patient’s and the patient’s family’s medical history and be able to see, hear, smell and possibly taste the environment the patient is in. This ADN would be trained (and have the experience) to listen to patients and ask the questions needed (in the manner needed) to draw out a full description of what the symptoms are. ADNs would be equipped with portable devises for routine tests and be able to transmit this data to whatever specialist (or diagnostician) the ADN deems appropriate.
What this method does is use lower-cost personnel to better perform a function now being done by highly paid doctors. It saves the patient time and trouble, prevents cross contamination with other patients, exposes environmental factors to aid in diagnosis and eliminates an entire category of cost by bypassing the general practitioner to go directly to a specialist.
Specialists would thrive in an atmosphere of free market healthcare. Physicians could hyperspecialize to the point that developing new efficient procedures and facilities geared toward specific illnesses and injuries would bring higher profits for the provider and better quality of service to the customer. If a doctor spends his life treating one specific thing, he will become very good at that one thing. He may franchise his specific knowledge to allow others in different areas benefit from his expertise. This brings efficiencies that would be inconceivable in the normal healthcare model we live in today.
Instead, rationing combined with under-investment in equipment has often served to make the system into an underperforming bureaucratic nightmare that denies effective treatments to many people who need it.
Which is an excellent description of the system we have now in the U.S. for everyone who lacks health insurance and does not have the discretionary income to pay for health care out of pocket.
I'm prepared to consider a public option in a competitive system provided that competition is actually maintained.</i?
Which means, in practice, a continuation of exclusionary coverage practices. “Competition” in this context does not mean that private insurers will be increasing coverage and access to meet the high standard of care provided by a public option. It means that the public option will be lowering its own standard of care so as not to be more attractive to consumers than what they can get from the private insurers. “Competition” in practice means that doctors will choose higher paying private practice over treating patients in a public option, unless the government agrees to pay the same amount those doctors can get in private practice.
I am thankful that the “profit-based” system that we have ensured rapid access for my wife that saved her life.
Of course you are, and it's entirely understandable that you would be. But would your wife have had that rapid access if she or you did not have health insurance and/or the ability to pay on your own? Would you be as thankful if your wife or your sister or daughter were one of those cancer patients who couldn't get treatment because the charity care clinic closed?
I also know about treatment for UTIs and can testify from first-hand experience that rapid and effective treatment was also available for that condition in the United States — Minnesota specifically.
Yes, yes, yes! if you have the money or the insurance!
Perhaps if you could take a minute to acknowledge that I am not, in fact, an apologist for the status quo, we could find more productive common ground in discussing BOTH pluses and minuses.
I haven't said or (I think) implied that you are an “apologist” for the status quo. But I do wonder what you mean when you say things like “I'd prefer to slow down a bit and see if we can't find a way to get both (both universal primary care and top-flight crisis medical care for those who are insured or can afford it).” I don't understand what you mean by “slow down a bit.” The problems we have with health care delivery, access, coverage, and costs in this country have been with us for all of my adult life (I will be 59 on July 4), and getting steadily worse. How much slower do you want to go, Jason?
And as I have REPEATEDLY said, I do not support the current system. Geez. How many times do I have to repeat it before you will stop reading off your script?
I guess as many times as you stop reading from your “public health care is evil” script.
Everything you warn against in a public health care system or option — bureaucratic dysfunction, rationing, not enough and outdated medical equipment, waiting months or years for treatment (or not getting treatment at all) is already happening in our “competitive,” private, for-profit health care system. So when you keep warning aginast public health care while simultaneously saying you don't support the current system, there is something of a disconnect for the listener (at least in my case).
Jason,
On the MRI example, they are expensive because of the inefficiencies and cost shifting built into the current system.
In my system, before someone agrees to receive an MRI, they would know the average cost and the cost of the last 10 similar MRI’s done in their zip code (or adjoining zip codes if not enough have been performed locally). Now it becomes a matter of cost versus benefit.
On the provider side, the MRIs are high dollar sales until the free market kicks in. A scan that someone used to charge $8000 for will drop substantially when customers start saying no. Now the payment on the million dollar machine is due and monthly revenues don’t add up. Time to lower the price to increase the volume. The operators who lower it the most, provide the best service for the best price will thrive.
Look for commercials like this:
“Hi folks, I’m Earl Schieb and I’ll scan any body, any color, for only $49.95. That’s right folks, if you can walk it, roll it or drag it into any one of 16 metro locations, I’ll scan that body in our new, exclusive GE machines while you wait.”
Never underestimate the power of the free market.
Kathy: “Everything you warn against in a public health care system or option — bureaucratic dysfunction, rationing, not enough and outdated medical equipment, waiting months or years for treatment (or not getting treatment at all) — is already happening in our “competitive,” private, for-profit health care system.”
That's because we don't have a competitive private health care system, we have a bloated semi-public/semi-private system in which providers compete very little and on the wrong things.
Starley: “Very complicated. How do you measure results and establish rates? In this area I ask for suggestions.”
This problem has largely been solved in every other industry, by simply freeing consumers to make decisions about where money gets spent, and where necessary standardizing disclosures so they have the info they need to make them. This doesn't happen today, because patients are not really customers. You can find dramatically more information to decide where to go for dinner than where to go for surgery. How broken is that?
You need an MRI. Without it you will possibly die. Want to negotiate?
Starley, you need food too, even more urgently. The free market does a great job of supplying it, with good quality and in tremendous variety, without gouging anyone.
Wow, is that ever a misrepresentation of my advocacy. I propose that the public option (implemented through an overlapping system of co-ops rather than a single national system — even the public options could compete with each other) be paid for by the government for those who cannot pay for it themselves or that the value of that option be given as a voucher to supplement the purchase of private insurance. And I would contend that the practice of rescission should be closely regulated to stop the abuses of the practice and ensure that even for those thus removed there exists a backup public option.
See, now you're not even trying to be honest, Kathy. I never said anything of the kind and have repeatedly and specifically endorsed reform. I only want it done in a way that pays attention to potential flaws and tradeoffs.
But apparently you prefer a Manichean world where only good and evil are options. Very sad.
This problem has largely been solved in every other industry, by simply freeing consumers to make decisions about where money gets spent, and where necessary standardizing disclosures so they have the info they need to make them.
Do you know where I could find the necessary standardizing disclosures to free me to make a decision about whether I should spend my money paying my rent or getting a mammogram?
Are you a real doctor?
And now we see the inevitable final degeneration — questioning the dissenters' personal integrity.
The free market does a great job of supplying it, with good quality and in tremendous variety, without gouging anyone.
Can you take me to your planet, Dr_J? It sounds like a great place to live.
More poison from Kathy.
Posted to PoliGazette thread:
UPDATE 6/22 5pm: Well, Kathy Kattenburg's respectfulness didn't manage to last the day before she returned to the purist approach of misrepresenting and demonizing all opposition. This is the dysfunction that seems likely to continue to plague the health care debate in this country — self-righteous purists who believe in win-at-all-costs actively destroying debate from the left and know-nothing purists refusing to even offer debate from the far right. Meanwhile, the moderate majority stuck in the middle can look forward to paying the higher tax bills for a poorly designed system built on ideology rather than analysis.
“Note that a public option is already a step down from [100% public, federal]. A public option is already a compromise. “
True. But there's nothing sacred about 100% public (federal) nor is that what we “should” be doing; it is an issue of what we want. Also, if you're negative, you again don't see things clearly or correctly (a Left common fault). The correct thing to note is that a public option is an incrementalist tactic (which is not clever or deceptive, but is openly transparent), attempted by those firmly in favor of public health care, to condition the public to encounter and even experience public health care, for the public is wary of loss of rights and choices under a 100% government system, as it is wary overall of the current growth of the federal government and its encroachment into the economy and people's lives (without suffient effort or attention being paid to finance this and the rest of the government properly, an additional widespread concern).
* * *
“I am someone who does believe that health care is a human right.”
It is not a human right, despite how often you or Physicians for a National Health Plan may state this.
If you want to make it a (federal) entitlement (most people don't want to waste time or involve complexity and disparity arising from having the state governments do this, which is the logical and constitutionally faithful way to do this), and you can convince Congress to create this entitlement (say, extend Medicare to everyone), fine, but at least be honest about it, not emotive or incorrect about it.
“Is clean water and sewage a right? Is clean food? What about safe playgrounds? Good schools? Are those rights or accessories?”
None of these are rights. Nor is something I saw in an activist book about the evil automobile and the lack of sufficient (to the activists) provision of alternatives to people — they said that there is a “right” [sic] to transport. There is no such right to any of these things (including health care). If we want to provide it by government to people, that is a separate thing altogether.
* * *
“childish rants of the intellectual midget / hack JasonArvak”
Gee, Steve, I see you're abusing others for no reason, too, as well as continuing to engage in effective mirror talk.
* * *
“purist, no-compromise approach implied by your original headline and reinforced by many others on your side of the issue, most notably Paul Krugman in today's NYT”
Krugman is a Dem hack, simply adding fuel to the fake-”Crisis!” fire now, on cue, to support Obama and the Dems in Congress, among other things.
“Purist” actually is elegant and attractive in its simplicity and (assuming existing programs would be used) relying on something already extant rather than inventing something new. But “no-compromise” is out of order, out of line, given it's driven by errors, misconceptions in many cases, emotions rather than facts (it is a lefty position), and even childishness. Incrementalism is the logical way to go, which is why the Dems have done what they've done with S-CHIP in the past and are trying now with the “public option” (hardly leaving the private sector in a fairly competitive position — the proponents know what they're doing).
I've said it before and can say it again — it's smarter and more effective than what the whining lefties have done and what they're doing now (mumbling and bumbling). Why not start by expanding Medicare to children (in addition to likely taking Medicaid into Medicare and relieving the states of this burden fully)? Going for children appeals to many people's emotions as well as constitutes the classic age-based “pincer” strategy. (Incrementalism at its utmost eventually provides for everyone but the taxpaying middle class, which then will demand they enjoy the benefits as well and consequently, demand the universality the lefties are often too ambitious, impatient, or premature to attain fully from the start of their efforts.)
But that (again) is too smart and not childishly impatient or emotive enough for most of the activists.
* * *
“I am just saying we should take care to acknowledge the trade-offs and other issues that will affect any reformed system.”
Aside from trying to show time after time that the current state of federal entitlement programs is set to fail, I've also tried time after time [sigh] to make it clear to people (who can't see or don't wish to, in case it conflicts with their unrealistic dreams) that if we went from private to public we'd exchange one set of problems for another. There will still be an intermediary who will be interfering with decision-making, too.
Kathy there's no reason we shouldn't have a big, publicly accessible database of medical outcomes, just like we do for census results. Put in your age and other relevant information, and it will tell you the average outcomes of everyone who did or didn't do X or Y. At your age it will probably tell you a mammogram is a good idea, without you having spent $200 and two hours on a consult.
But if your point is that mammograms cost too much, we're on the same page. The cure for that is competition.
PhD.
“an overlapping system of co-ops rather than a single national system — even the public options could compete with each other”
It also dispels, or at least could ameliorate some of, the apprehension so much of the public has with total government (federal) control, which even many Dems at least acknowledge, which is why Sibelius and others have mentioned the multiple co-op alternative (not necessarily overlapping or competing — a similar scheme that is avoided because those in Washington want control and the left also disfavors it is to have the state governments provide or at least fully control health care rather than having the federal government do it — I cannot recall when any mention of having the state governments administer or form their own health care programs has entered contemporary discussion. So many look immediately to Washington even though it should be last rather than first as a party to become involved, traditionally.)
The public currently (a majority, 69% in a recent poll, which passes the real-world observation test) is nervous about the extent to which the federal government has extended and deepened its reach into the economy and people's lives. Much of the public is already concerned about deficit and debt and federal finance. Note that the current health care effort in Congress (far from “Medicare for All,” obviously) lacks cost information and specifics on how to pay for it (much of the public would be willing to pay for more public health care, according to recent polling data).
Of course, the more childish, militant folks will instinctively reject and attack anything other than 100% federal health care as “a compromise” (more honest and revealing would be something like “lack of complete faith and belief in the cause, without the slightest hesitation, question, or thought whatsoever”).
“we don't have a competitive private health care system, we have a bloated semi-public/semi-private system in which providers compete very little and on the wrong things”
The scope of this statement of yours encompasses much, much more than merely health care, of course.
And now we have Gummint Motors. Even die-hard Detroiters fear this will become one hell of a wreck.
Now wait. We have an interesting situation. I still like one payer for cost effectiveness and universal coverage. But think of an effective process.
Go to Doctor or trained RN for diagnosis at fixed charge He recommends treatment plan or referral to specialist. Referal department locates most cost effective sources. Treatment is given.
If patient select another source then insurance only pays what original cost would have been.
This is simply a giant hmo nationwide and basically the same service we had in the military.
At your age it will probably tell you a mammogram is a good idea, without you having spent $200 and two hours on a consult.
I don't have the $200 to spend on a mammogram, though. So finding out from a database that it's recommended at my age (which I didn't need a database to tell me, anyway) doesn't help me.
I do get $200 a month in food stamps, though. So if I can find someone who will agree to let me buy their groceries with my Families First card and pay me back in cash, I can get a mammogram. Of course, I won't eat until the next month,but that's all aprt of the dignity of choices.
I would agree that mammograms and all other preventative screening tests should be covered for everyone that does not have private insurance by a government health care plan.
I would say, however, that there are many different ways to implement such a provision, ranging from full-on single-payer health care, to regional co-ops, to vouchers for the purchase of private coverage.
Debating the differences and possible permutations among such a range of choices won't meet the “NOW!” demand nor would the outcome be emotionally satisfying to purists and those motivated only by beating the other side. But it would result in a much better system for everyone.
I can see why you of all people would be against that, Kathy.
Kathy: “I don't have the $200 to spend on a mammogram, though. So finding out from a database that it's recommended at my age (which I didn't need a database to tell me, anyway) doesn't help me. “
Ah, but it does. We should help people get health care by simply sending them a check. That's a much better way for government to be involved. And then if, based on the database, you decide to play the odds, you've got an extra $200 to spend on liquor and gigolos.
We should help people get health care by simply sending them a check.
Well, that's an interesting idea.
And then if, based on the database, you decide to play the odds, you've got an extra $200 to spend on liquor and gigolos.
Okay, you definitely have a better sense of humor than Jason.
Wow. It's been a couple of years before we've had a comment thread this long. Sadly, I think I stopped reading after comment #30. As much as these heated exchanges amuse me, I thought I would offer a few words of caution.
1) Let's not confuse “positive” freedoms with “negative” freedoms. “Negative” freedoms are based on the classic liberal interpretation of “rights”–that is–the freedom to not have others coercing you into doing something or forcibly preventing you from doing something. “Positive” freedoms are a much newer concept and based upon the rather progressive notion that some things are so important, that people are entitled to these things, even if it comes at the expense of someone else.
When someone argues that “healthcare is a human right” it's important to get past the feel good rhetoric and decipher exactly what that person is implying. To the extend that everyone has to right to health care without someone else forcibly preventing them from obtaining it–that's an example of “negative freedom”, and I doubt that anyone would argue against this right. But to the extent that everyone is entitled to health care, even if it means forcing others to pay for that person's health care–that's an example of “positive freedom”, and that is a far more debatable point.
Personally, I don't think it's intellectually consistent that call something a “right” or a “freedom” when it calls for violating someone else's rights.
2) On Krugman being a Nobel Prize Winning Economist and therefore beyond reproach. I'm not going to question Krugman's intelligence or knowledge of economics, but Krugman is not by any stretch of the imagination a balanced source on economics. As others as pointed out above, Krugman is extremely left wing when it comes to fiscal/economic issues, and by that, I mean he unapologetically supports Keynesian economic theory as well more expansive government in the economic arena.
3) Good intentions do not necessarily make for good political policies, and even those programs with the more sincere of intentions end up having negative unforeseen consequences. Government programs rarely cost what politicians say they will–they always end up costing more. So before you start criticizing those for who oppose univesal health care/single-payer health insurance/public health care or any other flavor of government involvement in the health insurance arena, I suggest you come up with a way to pay for it.
4) Arguing that public health care will “compete” with private health care is not the most accurate way of painting this new proposal. Public health insurance–by its very nature of being controlled by the government–will have overwhelming advantages over private insurance companies such that private insureres will never be able to truly “compete” with it. For one thing, since the government is not concerned with making a profit (as evidence by our nation's mounting debt), it can mandate price controls for public health care and set prices as low as it wishes. Private insurers, on the other hand, have to make a profit in order to stay in business and therefore cannot set prices below a set amount. Under such a situation, no private insurer would be able to compete with public insurance on a level playing field.
5) Before we go name calling bloggers at other blogs whom we don't agree with, I suggest we have a firm footing from which to do so. Don't get me wrong, there are jerks, liars, and partisan hacks out their in the blogosphere that ought to be called out. But before we start calling people “intellectual midgets” I suggest we ask ourselves whether our comment passes one simple test test–that is, i.e. is this negative characterization of another blogger so important that it's worth risking the reputation of TMV?
Just to correct the record and protect the innocent, I will point out that the only person who threw around the direct personal attacks like “intellectual midget” in no way is an indication of TMV's reputation. He is not a TMV contributor or administrator. And TMV's actual administrators were very helpful in addressing this problem. I have no complaints about TMV's reaction to this situation and I think it would be very unfair to taint them with the over-the-top statements of a mere commenter.
Kathy: “Well, that's an interesting idea.”
Well, maybe this is the disconnect going on. My position has never been that we shouldn't help the poor. It's that we should split health care reform into two problems and address them separately:
1. Building an efficient system of doctors, hospitals, drug companies, regulators, etc that can deliver the maximum health per dollar spent.
2. Providing financial help to people who can't afford #1.
The way to do #1 is a free-market system where competition forces all the players to work hard to deliver results, while minding the dollars being spent. It should be built around consumer choice, demanding transparency from providers, and should not be controlled by big bureaucratic gatekeepers like today's system is.
The way to do #2 is by writing checks, or giving tax rebates, or issuing vouchers, or I'm sure other approaches would work fine too. The only requirement is whatever we do must not micromanage the providers by dictating prices or policies, but should let them stay focused on goal #1: maximum health per dollar spent.
We have to do both of these things. We can't just do #2, because today that group consists of darn near everyone, more than we can subsidize. We also can't just do #1, because we'd leave darn near everyone high and dry without coverage.
Jason, your demonizing of “the left”, which from your blog, appears to be your style, is ironic, especially as you seem fond of demonizing lefties for demonizing righties. We actually could have a rational discussion, but we're so polarized that it always seems to degenerate into something like this. Too bad.
Nicera, I brought up Krugman and did not ever imply he is “beyond reproach”. So many straw men here. I also mentioned a couple doctors, the WHO, and glad to cite others if you want. My point is independent of your opinion of Krugman. It is that experts in relevant fields think nonprofit health care is a sensible and timely idea, most of the public wants it (convenient dismissals of the NYT poll are irrelevant. Other polls show the same thing), and most doctors want it (again, according to multiple polls.)
To the concept of competition, in terms of patients negotiating down costs or going elsewhere, I'm surprised anyone thinks that would work. Patients are not really in a position to negotiate with doctors or hospitals, even if they didn't need care urgently. Additionally, that idea that we could chisel down costs with savvy patients holding the purse strings, is in stark contrast to the assertion that doctors won't accept lower payment e.g. from Medicare (though 97% of docs do take new Medicare patients). Then we have the idea of using less expensive care givers, further reducing the income of doctors. Also kinda reminds me of the cynical 70s era joke, “cut your employee expense by a third. Hire women.”
We also have the assertion that a single payer (or public option) system might not save anything (“we can't assume the savings”) but yet doctors are shifting costs to insured patients because Medicare doesn't pay enough. (BTW, Medicare pays about 19% less. Think we could negotiate any lower than that?)
In my own experience it isn't true that docs can shift costs, thus “subsidizing” the Medicare patients, but I'm open to evidence. My doctor takes Medicare patients (ahem. I'm not one of them). A close friend who's a physician doesn't. My own doctor is not allowed by insurance companies to charge more than the doc who has no Medicare patients. I frankly don't believe hospitals are allowed to either, but please enlighten me with something credible if so.
As to the points about “rights,” I have avoided using that term, though others did. Rather, it's a public policy decision about whether or not we will care for our citizens. That's hardly a new or progressive idea. It's strictly caveman. The health of every tribe member was considered essential to the success of the tribe. That concept of taking care of our own *for our own good* is as ancient as we are. Perhaps with some military background people could understand the idea of not leaving someone behind, even if it costs us, inconveniences us, or even presents a mortal risk to us.
Don't get all touchy Jason. These comments are general and not from some script or aimed at you. Sheesh.
“Patients are not really in a position to negotiate with doctors or hospitals, even if they didn't need care urgently.”
Consumers are in no better a position to negotiate with grocery stores or oil companies or airlines. But grocery stores compete aggressively on price and quality. Oil is a competitive, efficient commodity. You don't even have to talk to an airline to shop for the best flights and prices, just go to a search engine that lets you choose. A far cry from anything available to us for health care.
Haggling is actually the sign of a market inefficiency. If people don't have good information about what the real market clearing price is, they test each other to try to find such a middle point. Doing it can be expensive, too–for example a strike may go on for weeks as both sides try to figure out where the real bottom line is, during which both labor and management are losing a lot of money. Provide a stable, transparent market, though, and no one has to bother.
“2. Providing financial help to people who can't afford #1.”
Vouchers (for health care only, even without monetary value, but denoting what the person can receive) — the alternative is to end all such assistance programs of all kinds (not only health care) and just give people cash (even a “guaranteed minimum income” or “basic income guarantee,” to use the two favorite terms that describe this concept and objective). The simplicity is appealing, as well as the termination of so many counter-productive and harmful programs and bloated bureaucracies. (AFSCME and other organizations would never want the programs ended, but expanded instead, in addition to the income entitlement.)
* * *
“Haggling is actually the sign of a market inefficiency.”
I'm not sure. The potential is always there, as no two people or parties are alike, and moreover, we're seeing an upswing in haggling (the ability of buyers to negotiate prices downward, to be more specific here), which is a sign of a continued downward movement, decline, recession, depression, you name it.
“experts in relevant fields think nonprofit health care is a sensible and timely idea”
Many in academia (“experts”) are more liberal than the public and form a liberal community; I would look at doctors, and others who are actual _providers_.
Many of the providers are ready to go to public health care, to simplify and ease paperwork as contrasted with what they face with the insurance companies.
They also want the lawsuit-abuse problem corrected, but I doubt a Dem administration will correct this.
“the assertion that a single payer (or public option) system might not save anything”
I've never said that. There are up-front savings and it's logical to assume that Medicare for All would be “streamlined” compared to what we have now. But there won't be a permanent cap or brake on the costs, because the demographics (aging of the population) and increasing expense of improvements in medical treatments will force costs upward. “Wellness” emphasis that goes beyond the well-known preventive care will not achieve miracles, and there are limits, anyway, to what people should be expected or worse, required [compelled] to do in the name of wellness or prevention, or what restrictions, taxes that aim at medical-related social engineering, or prohibitions people should be subjected to. Wellness at the cost of too much freedom or quality of life ends up being the well-meaning equivalent of keeping the very elderly and sick (near death) alive at an effort that some routinely argue is not justified, and in fact is inappropriate.
Food for thought…
“As to the points about 'rights,' I have avoided using that term, though others did. Rather, it's a public policy decision about whether or not we will care for our citizens.”
Absolutely. There is no “right” [sic] to this (nor to so many other things that in practice are claims on others' time, labor, and money). It is merely a decision to create an entitlement, that word being fully sound not only legally but conceptually.
A significant fraction strongly want public health care, and plenty among the many who are wary of too much government and loss of freedom (and privacy, etc.) would still look to it as a default alternative if everything else seems worse or intolerable eventually.
“care for our citizens”
Note the correct meaning of that word “care” here means specifically, “provide medical care,” not anything more general or broad and subject to being a rationale for all kinds of entitlements as well as a way of satisfying feelings or cravings some might have.
“Krugman is extremely left wing when it comes to fiscal/economic issues”
Well to the left (far left of the public, like a left-wing Dem or even playing with Green-dom). Part of where he appears at any time (what words he chooses) depends on the lib Dem point of view on the issue of the moment about which he wants to contribute.
Krugman is like other “economists” notably in the Northeast who are well left of the public and routinely mix their economics with politics.
“I would agree that mammograms and all other preventative screening tests should be covered for everyone that does not have private insurance by a government health care plan.”
But then you run into a serious problem. What you say (and other examples I can think of) appeal wonderful in theory, but you'll find that in many cases, the tests, for example, have been considered by people already in the government(s) and rejected as not cost-effective.
This is something to keep in mind as the scope of public health care grows (as it is likely to do).
Good comments, DLS. When the fight is over, regardless of what happens, we still have to deal with the major reason for cost increases. We have a high cost burden for end of life procedures that place a major part of an individual's lifelong medical care cost in the last few months of life, plus we have only a few % of individuals who incur especially high costs. Clearly we will need to set some limits, and that will be harder and more contentious even than who pays, which is the focus of the current fight.
As for prevention, through lifestyle or other incentives, we could do much there. I think most are not aware of how poorly we do in this area. In the US, we have only 4 preventive medicines available over the counter: fluoride toothpaste, sunscreen, seasickness prevention and aspirin. There is actually a 5th, formerly ulcer medicines, now approved for “indigestion prevention.” When we talk about “preventive medicine” we usually mean early disease detection (mammograms, prostate check, cholesterol testing). The realm of preventive medicines is relatively unexplored, except in the dietary supplement world.
GreenDreams, I do criticize lefties but I don't think I demonize them. And I would love to have a rational debate among alternatives and moving towards a compromise on health care. But as long as people like Kathy keep inserting into the debate their presumption that anyone who disagrees with them or even doubts their purist demands for a second is not only wrong but a bad person, I don't think that is likely.
Unfortunately, people like Kathy have no reason to alter their openly vicious rhetoric as long as their fellow liberals and leftists remain silent about it while at the same time criticizing the other side any time it puts so much as a rhetorical toe out of line.
Wow. That's an impressive persecution complex Jason's got there.
[...] Poll Shows Most Americans Want Public Health Care (themoderatevoice.com) [...]
Personally I would have preferred the Insurance Companies, Hospitals, Drug companies would have been willing to make health care affordable rather spend 1 trllion dollars we don't have. But guess what folks it's this thing called greed! So now we have to look at another alternative. If the private sector rather risk going under becuase of pending profit margins than so be it! I guess that means some CEO will not be able to purchase his yacht!
[...] Poll Shows Most Americans Want Public Health Care (themoderatevoice.com) [...]