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When Government is the Better Option
Nicholas Kristof approaches the health care debate from a starting point that I and others have previously acknowledged, namely: We don’t leave everything to the free market. There are certain areas in which we commonly acknowledge that government is the better actor. Perhaps health care coverage is one of them.
Granted, Kristof seems to suggest (upon first read at least) that we go further with government health care than even I’m comfortable conceding, but he also offers compelling data to bolster his case and force at least this one unresolved mind to question its numerous reservations.
That does not mean I will start advocating a single-payer system. But it does nudge forward my evolving openness to a properly structured “public option,” along the lines of what I’ve read about the approach in Germany and elsewhere.
Of course, no matter where my mind is, the votes may not be there for a public option, as Ezra Klein hints in a post to which we linked earlier.
24 Responses to “When Government is the Better Option”
Profit negates morality. The two are mutually exclusive. Any area of human concern that involves morality and especially the Hippocratic Oath, must not be, by definition, wholly left to profiteers to manage or run. Imagine a fire brigade, privately owned, that decided only to respond to those fires where the household had paid a hefty montly ransom to gain their protection? Meanwhile the rest are left to burn as they may. That is what is going on with health care today. What difference does it make if someone dies of a preventable or curable disease or by fire if money is the hinge that determines it?
The problem with any “public option” or market-based approach is that who pays is, in the end, does not fix the systemic problems responsible for the high and rising cost of healthcare. It's an attempt to treat the symptom, not the problem.
Kristoff reminds us that we need government to provide police and fire departments, a conclusion with which few argue, given the Hobbesian world we inhabit with its “all against all” configuration. We do, however, have lots of private protective agencies, even for government entities, and many private libraries and educational institutions. I suppose Kristioff knows that, as he knows that we have huge government health care providers, like the VA, Medicare and Medicaid.
That said, should we have only government health care? And more importantly, can we pay for what we want? I don't think so.
The demand for health care, in my estimate, is just about infinite, as is the expense of it, making some limit on its distribution mandatory. In other words, rationing. How then shall we distribute this increasingly scarce, expensive resource? The centralized distribution of scarce resources hasn't got such a hot reputation, thus our traditional reliance on the dreaded “market forces”.
No one should be denied access to health care, and very few should get it for nothing. Just as now there are clinics and hospitals for the very poor, those could be expanded and improved. It takes some money, tho not trillions of dollars. For the rest of us, insurance with big deductibles so we are forced to be better consumers, and no caps on coverage by insurance so nobody is impoverished because of bad health.
Some will have to forsake their second car, or a vacation, or a third TV in order to pay for their routine health care. Tough choices will be required. That's what grown-ups do.
“No one should be denied access to health care, and very few should get it for nothing. Just as now there are clinics and hospitals for the very poor, those could be expanded and improved. “
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But people are being denied. They are being asked to decide between mortgage payments and getting well. That is the most cowardly denial of all. They cannot make their premiums so they die….or become homeless. MedMob gets at once to deny coverage and act like they are providing it for those other than the “very few” who should get it for nothing. The wool is off our eyes MedMob. Stand up you cowards and tell us how it really works.
And enjoy your caviar…I hope you choke.
I'm getting so sick of this debate and all of the fear mongering about rationing and socialism. Germany is a great example of how public and private options compete…it works there. It isn't perfect, but it is far far better than the system we have here in the US.
“But people are being denied”
If half of the people in the anti-public option side of the debate actually understood how quickly their insurance can be revoked for…not dotting an “i”…this debate would be over.
“We don’t leave everything to the free market.”
Kristof just demonstrates the desperation (reviving something very old) and pathetic state of the Pros.
“does not fix the systemic problems responsible for the high and rising cost of healthcare”
In fact, health care, Medicare and related programs, and elderly-directed (retirement-related) social spending problems' unsustainability and future breakdown, and related problems throughout our economy and society, are far more real and far more important than perverse-political global warming nonsense.
“That said, should we have only government health care?”
The problem with that argument is that it's far from what is actually being suggested and/or proposed. What is actually in HR3200 is what I can most easily (though not best) describe as a miniature version of the FEHBP– basically a government program though which portable PRIVATE plans can be purchased, with a step up in government programs such as Medicaid and Medicare. Everyone who can afford coverage will be required to purchase it or get it through an employer just as they are now. The biggest change is that in order to participate plans will have to be fully portable and coverage cannot be denied if you get sick or get older. They will have to cover a MINIMUM of benefits and include a cap on out-of-pocket expenses. (The last number I heard was $10,000, but that could be wrong.)
Other than the coerced purchase of coverage, how is 3200 any different than what is mandated by HIPPA?
Isn't coverage purchased invoking HIPPA fully portable, provide guaranteed rates, assure renewal and limit pre-existing conditions?
My question is why does the population need a second HIPPA?
The problem is not “government” vs. “non-government” although the extreme of both wings want to put it in those terms. The real problem is the HR 3200 hairball that Obama and Axelrod have been promoting. They need a better product to sell and they need a better pitch selling it.
“Keep It Simple Stupid” is the first rule of sales. Of course this president has never been in business or sales. He is a lawyer and he thinks like a lawyer who is trying a case. Good luck with that.
If I were to guess what the American people really want with health care reform, it would be something that can be articulated pretty simply and emerges from some basic American values of fairness and common sense:
1. Every American gets a baseline level of solid health care. No one is left behind.
2. No American need be at risk of financial ruin or bankruptcy because they get sick.
3. The program is manageable and fiscally responsible. Americans want to feel reasonably certain we won’t see mushrooming costs like with Medicare and the prescription drug plan.
A problem with the ObamaCare HR 3200 hairball is that it at best accomplishes one of the three. Interestingly, the Wyden-Bennett Healthy Americans Act (S 391) actually does accomplish all three.
Simple.
MW, I've listed on numerous occasions specific examples of reform measures that could and should be substituted for what is being sought. And, for example, as AL Moderate wrote:
“The biggest change is that in order to participate plans will have to be fully portable and coverage cannot be denied if you get sick or get older. They will have to cover a MINIMUM of benefits and include a cap on out-of-pocket expenses.”
There's no need for the public option to accompany this. (Note that the minimum benefits package should be kept reasonably small and affordable.) Subsidies or vouchers could assist the poor.
But that's not the issue. The public option is the core of the effort and any legislation, because what is sought is “crowding-out” (substitution and eventual replacement) of private “payers” by Washington.
“Of course this president has never been in business or sales. He is a lawyer and he thinks like a lawyer who is trying a case.”
Here and now, he has been acting as though he is presenting poor and desperate arguments to a gullible jury (and mistakenly assuming that more of the jury is gullible than actually is true, it seems).
He has been in sales, in campaign mode all year, increasingly so as the Dems' situation gets worse.
The campaigning is off-putting to normal people. We already know Obama won and is President now!
Silhouette–
You absolutely correct and I enjoyed your simplistic Fire protection analogy. There has been so much garbage propaganda broadcast over the last two decades that our population is, as a whole, confused. This irrational “fear” of government is distorting the public’s ability to effectively form their own government in their own best interest. If there was ever a case made for subversion, right media is it.
I am in complete favor of a single payer, full government nationalization of the healthcare industry. It is absolutely the ONLY way costs can be controlled effectively now and in the future. We are the only modern nation that does not do this and we are suffering immensely for our pure capitalist design. It is inconceivable to me that any insurance option will ever solve any healthcare cost problem what-so-ever. This problem must be controlled by government and as in all other modern countries, if you want something special from healthcare, you can still purchase private insurance. What is very interesting, is that private insurance is far cheaper within nationalized healthcare countries.
Other nations have solved this healthcare problem. Obviously we can do the same by emulation. The will of the people to do so is being subverted by those whom stand to loose money by spreading irrational fear of our own government that we Constitutionally control every two years.
It is certain money special interests against the people’s Constitutional right to form their own country to their own self interests that is preventing, by a fear mongering media, the rational creation of a national healthcare system. We need to take care of all our people, not just some people.
“It is absolutely the ONLY way costs can be controlled effectively now and in the future”
That's simply not true. There are a multitude of ways in which we could approach the problem that just fits your idea of the way it “should” be. That doesn't automatically mean you're wrong but ideological BS do nothing to advance the discussion and make you no different than those who decry socialism, you are just on the other side.
May I point out that the current system does not “leave everything to the free market”. It might be more accurate to say the current system leaves most things to the states, which regulate insurance companies. I agree with mw that it's not necessarily a question of more or less government. It's about effective government. Personally, I wouldn't mind seeing more regulation on insurance companies on the access side (cost fairness and consumer protections), and less on the coverage requirements side.
“Some will have to forsake their second car, or a vacation, or a third TV in order to pay for their routine health care. Tough choices will be required. That's what grown-ups do.”
Your comment made me look up some quick numbers.
Percentage of families that have cable TV: 65% (http://www.clickorlando.com/technology/2872965/…)
40th percentile household income: $36,000 (http://www.visualizingeconomics.com/2006/11/05/…)
Under the newly expanded SCHIP program, a family of 4 making up to $88,000 can receive government subsidies. I'm sympathetic to the argument that we need to help the poor, especially when considering the high cost of health care. I know there are many families that genuinely can't afford adequate health care. However, should our subsidies go to people who think that they can afford cable TV (and/or other non-necessities)? If so, are we subsidizing health care, or cable TV subscriptions?
AD, when you refer to people “who think they can afford cable tv,” it's really just tv you're talking about, right? I mean, you're referring to people who can afford to have a tv set with reception, I assume.
Also, how do you know the families with cable tv are the same families that need the help with health insurance?
When government is the better option?
Given the governments past track record, Never seems to be the obvious answer. So far they have mangled all their healthcare services pretty much at extreme cost to the taxpayers.
“AD, when you refer to people “who think they can afford cable tv,” it's really just tv you're talking about, right? I mean, you're referring to people who can afford to have a tv set with reception, I assume. “
No, the number I referred to is 65%, which is the percentage of families with cable TV.
“Also, how do you know the families with cable tv are the same families that need the help with health insurance”
By doing the math with the numbers I cited above. 65% have cable TV. 40% of families make less than 36,000. SCHIP can benefit families making up to $88,000 (which is well more than 40% of the population, which mean that under SCHIP (and, if I'm not mistaken, the Democrat's health care plan has that same income limit for health insurance subsidies), there are families who have cable TV, but who qualify for subsidies.
AD,
What I'm saying is that “cable tv” is redundant. There IS no other way to get tv reception most places in this country without cable or some similar subscription service.
I don't intend this as a grammatical or syntax correction. I intend it as a meaningful clarification. I want to be clear on what you're saying. It's not having the cable subscription that makes this group of Americans you're talking about too well off for SCHIP. It's the fact that they have a television set (assuming they have the set to watch programs and not just for decorative purposes).
I do not intend this sarcastically. I think it's an important point. If you are saying that in your view having a television set — any television set; I'm not talking about a humongous, movie theater sized flat screen — is a luxury, or non-essential item that should disqualify a family from receiving SCHIP assistance to pay medical bills for their children, then I just want to be certain in my own mind that that is what you are saying.
I would disagree with you, but before I get into that issue, I just want to be sure I'm not misunderstanding.
It is VERY TRUE. Nothing will reduce costs by 80 or 90 percent in order to fall in line with the cost associated with healthcare in literally all other modern countries. This save a little hear, pinch a bit there, approach the republican party and their insurance company supporters are advocating, simply will NOT solve the problems we are having with healthcare costs in the United States. It just will NOT. The problem, don’t forget, is that people lose everything they have to pay for healthcare sometimes even when they have insurance! It is a BIG problem when 65% of the people losing their homes in bankruptcy is directly due to healthcare cost!
That is Unacceptable and the healthcare industry as well as the healthcare insurance industry are the guilty parties.
There is NO way, other than nationalized medicine, that is capable of solving this problem. That is exactly why every little move toward socialized medicine is being fought so hard by those whom are getting these massive windfall profits. They don’t care about America or Americans, they care about money they don’t deserve.
Type your comment here.Leonidas, there is no problem with the American Government's Past Track record.
You are just repeating a propaganda myth started by conservative talk radio two decades ago.
We have an excellent Government track record when programs are funded properly.
Kathy,
I don't think that having a television set means you are not in need of financial help. I wouldn't consider a modest television set to be a luxury necessarily. For one thing, you use it to get important informations (news and weather). And it's not as expensive as a cable subscription. I guess you could make the argument that you don't really need one, and you're probably right. I could have used the example of TV in general, but I think that's a matter of where you can draw the line, which is a debate I was trying to stay out of by choosing an item that is clearly a luxury.
“There IS no other way to get tv reception most places in this country without cable or some similar subscription service.”
I don't know much about tv reception across the country, but in the places I've lived it seems tv reception is always available. Even if you are technically right that most *places* in the country can't get tv reception, I would ask how many people live in those places. In other words, what percentage of the 65% of families who have cable TV have it because they live in areas where they can't get tv reception? I think it would be a small amount, but if you know specific numbers, please share. So, I would think that even if you subtract that number from the 65%, I could do a similar analysis with the numbers and come up with the same conclusion: that there are people who have cable tv *and could get tv reception without it* who still qualify for subsidies.
My point was not to got bogged down in the cable tv question. It's just one example: the question is whether the people who qualify for government help really need it. I know some of them do. I have no doubt there are some people making $88,000 who have certain health conditions, or other extraneous financial situations, that makes it difficult for them to get health care. But the law doesn't distinguish between them and a perfectly healthy family making $88,000 who who can afford luxury items, but who might still qualify for subsidies.
AD,
Okay, thanks for the clarification. I have a few thoughts.
First, the argument you advance hypothetically about why a television set might not be a luxury (albeit, strictly speaking, not essential — it's not food), is exactly the argument I had in mind. Also, as you suggest, television sets are not necessarily expensive (it's not the 1950s anymore!). I have a television set, for example, that I got about eight years ago at a then-neighbor's yard sale. I have no idea how old it was at that point. It worked fine then, and it still does now. I actually almost never watch it (I'm far more of a reading person than a tv-watching person), but it does make me feel a bit more secure to have it.
And yes (moving on to my second point) I do get reception through a cable connection. At least where I live (northern NJ — greater NYC metropolitan area) it is quite and totally impossible to get reception w/o cable or Dish Satellite or something similar.
I think (third point) that in general the question of whether any given family has unusually high medical expenses that would justify SCHIP benefits for their children even though they have television and/or even though their income is $88,000 is not easy to determine just by crunching the numbers. Numbers never tell the whole story. Given the cost of living in many parts of the country (not all, I know), $88,000 for a family of four is not a lot of money. I say this as someone who never made anything near that amount at the highest earning point in my life. I know any number of people who, from the outside, look as if they're doing great financially, but if they lost their health insurance would not be able to manage health care expenses on their own.
I prefer (fourth point) to put the focus on the cost of health care in this country rather than on the putative ability of American families to pay for their children's health care (or their own) at arbitrarily chosen income levels. In other words, the problem is not that families making $88,000 a year can darn well afford to pay for their children's health care w/o help from the government. The problem is the cost of health care in the U.S. Because the per-person cost of health care in the U.S. is stratospherically high — so much higher than in any other country that has at least some form of universal or close-to-universal coverage system that when you see the numbers, it's jaw-dropping. We're doing something wrong in the way we make health care accessible to our people, AD. I think we should focus on that, and not on setting or defining arbitrary income limits.
Regarding your first point: Agreed. I don't consider a modest television set to be an irresponsible use of money, even for someone who doesn't have a lot of it. And so I wouldn't be critical of the government giving money to people who have television sets in order to buy other necessities.
Regarding your second point: I have to plead ignorance. I just don't know how common it is to not be able to get reception. My argument is based on the assumption that it is uncommon, but I don't have numbers on thats–it's just my impression.
Regarding your third point: I agree that $x is very different in one part of the country than another. That seems to be a good argument for why the federal government should not be setting such arbitrary and sweeping caps. These sorts of things are best kept to the states, and even then they should have some more nuance (ie. someone who is chronically ill, or for whatever other reason that is not their fault is in a financial bind despite a higher income should get more help then someone who makes the same but has no such problems).
Fourth point: I agree that it is the cost of health care that is the main problem here. If I remember previous discussions on this topic, I think we disagree fundamentally on the way to decrease that cost. I do support helping people with their health care costs who truly can't afford it, but doing so is not a cost-saving measure. In fact, it is probably the opposite as that only increases the demand for health care. That necessarily evil has to be offset (and then some) by cost-saving (not just cost-shifting) measures. I think you would agree with that, but again we disagree on the method to achieve that.