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Three Myths About Health Care Reform
Mar 12th, 2010 | 51 responses
They are:
- It’s a government takeover.
- It does nothing to control costs.
- It’s fiscally irresponsible.
Details via the estimable Paul Krugman.
51 Responses to “Three Myths About Health Care Reform”
“This is a reasonable, responsible plan. Don’t let anyone tell you otherwise.”
Bwahahahahahahahaha
Kinda like saying Paul Krugman.is objective.
More to the truth:
1. It's a government expansion. The takeover, as he mentioned, has been happening for decades.
2. It does almost nothing realistic to control costs. He compares doing nothing to the current bill, but doesn't mention any real reform. For instance, the fairly lame “doctor fix” was dropped, because the AMA has too much power. But no one is going to face the groups that are causing the most problems because they are too powerful.
3. It's fiscally irresponsible. Yes, that one's still right, no matter how much try to sell the idea that rearranging the deck chairs really will work this time. He's also ignoring the undeniable fact that everything, including medical, that has been supplemented before has gone up in price enough to absorb the subsidies. History, like gravity, will ignore any attempts to be denied.
Sorry Kathy, but your desire for socialized medicine is making you delusional.
Do you even look at the links I have provided in other threads showing the CBO estimates?
Are you even paying attention to the fact that they will fine and throw people in jail for not having insurance?
That the review authority for authorized medical treatments will be vested in a government bureaucracy?
That the projected INCREASE in costs is at least $1 trillion dollars over 10 years?
That they are now trying to pass it without even voting on it?
This is an insane bill, being pushed through by now insane methods. As Yuval Levin at corner.nationalreview.com put it, Democratic leaders should be asking themselves just how they have gotten to the point that their strategy is to amend a law that doesn’t exist yet by passing a bill without voting on it.
Realistically, health reform is likely to do much better at controlling costs than any of the official projections suggest.”
If you believe that, let me interest you in buying FNMA and FDMC, they only have slight amounts of debt. The taxpayers slid them $100 billion in 2009 and a mere projected $65 Billion for 2010 to dig out of their holes. Now mind you, these holes were not their fault, since they in effect had quota of crappy loans to buy. Yes, Paul, we know, the new Med-a-Soar agencies will all work like Swiss watches (or bankers), things have “changed”, and we have new “hope”.
Are you even paying attention to the fact that they will fine and throw people in jail for not having insurance? '
If that were true, one of the biggest problems with these bills is too small an incentive to buy insurance.
As the bills are written now, there will be “adverse selection', and some will wait to buy since the penalties are so small, and they will be able to get insurance with no pre-existing condition clauses. (Meantime, the Emergency room can be used until the insurance kicks in- but waiting periods may apply.) Bottom line, taxpayer pays, in one way or another. CBO- Car 54, where are are you?
The CBO, often quoted from Mt. Olympus, has not even been able to put a number on the tax losses due to Obama's idea to punt taxation to 2018 (why didn't he say until the next time Republicans are in full control?), some raw figures say about $100 billion in lost taxes over the next 10-years.
Oh, better check Pell grants for your kid's education, while you are sifting the 2700 page HCR bill (I guess it pertains since some kids do go to medical school).
your desire for socialized medicine is making you delusional.
Au contraire, Feisty One. Your desire to retain the current broken system is making YOU delusional.
Do you even look at the links I have provided in other threads showing the CBO estimates?
I have not yet had a chance to look at the links you most recently provided, last night, if that's what you're referring to — but I know from past experience that your links don't always prove what you claim they prove. Besides which, the CBO report on the current Senate bill just came out, yesterday or the day before, and it says the bill will reduce the deficit by $118 billion over the next decade, and over $600 billion over the decade after that.
Are you even paying attention to the fact that they will fine and throw people in jail for not having insurance?
The fine is arguably the best thing about the mandate. The throw people in jail part does not exist.
That the review authority for authorized medical treatments will be vested in a government bureaucracy?
As opposed to being vested in a corporate bureaucracy, as it is now? You'd rather have an insurance employee whose job it is to turn down claims decide if you can have that surgery you need than have a doctor employed by the government decide?
Kathy -
I have stayed many times I think health care reform is needed. Most Americans think health care reform is needed.
But I, and most Americans, know that this is NOT the reform bill we need – it is a fiscal suicide pact.
And you are correct – the Senate removed the jail time that was part of the House bill.
The rest of the industrialized world has some form of health care that provides better service at a small fraction of the cost of the U.S. system. I've yet to hear a good explanation as to why the CEOs of these ultra big health insurance companies get compensated in the order of tens of millions of dollars a year.
You left out the reason this is true… “Single Payer Plans” You'll not hear a good explanation from either the right who are anti-Obama, kill health care reform OR from those on the left who have been convinced that the current bill is the answer, or at the very least the best we can do.
The Senate Bill does not include the Doc Fix and as far as I can tell retains the 21% payment cut to medical providers. The cost of the Doc Fix is estimated by the CBO as $371 billion over 10 years. By my math this means if the bill were actually honest the deficit will be increased by $253 billion.
But hey who knows maybe Democrats will join with Jim Bunning and push through the 21% cut.
the Senate removed the jail time that was part of the House bill.
Jail time was never part of any bill, but beyond stating that, I am not going to spend my energy arguing that fact.
Kathy,
Speaking only of #2 and #3 here, Krugman is entitled to his own opinion, but there isn't much in the way of facts to back him up. Just consider the fact this bill, passed by today's Congress is relying on future Congress' to do (or not do) certain things in order to make it all work out. This Congress left those decisions (like the doc fix) for the future because this Congress doesn't have the votes to put them into effect today. The idea that a future Congress will show more spine or otherwise adhere to the bill this Congress passed is wishful thinking or, at best, a guess.
I think you wrongly assume that “single payer” is the reason the rest of the world is cheaper. Consider that half our system is government-run care and it is only marginally cheaper than the private sector, but that will soon change since costs are growing faster for government – provided health care than for the private sector. If government can't even keep it's own costs near the rate of inflation, how is making government the single payer going to do it?
Oh, you do so love to claim your opinions as fact.
Potential jail time for non-compliance with mandatory insurance requirements most certainly was part of the initial House bill (H.R. 3962, as amended) that was passed. It does not matter how rare those types of prosecutions may be, the fact is it was allowed for.
It was removed in the Senate bill now before the House.
That is the real fact:
http://republicans.waysandmeans.house.gov/Uploa…
http://blogs.abcnews.com/politicalpunch/2009/11…
How is making government the single payer going to do it?
A good question. A follow on: why are costs rising in single-payer countries too?
Here's a few graphs showing how health care costs (hospital, physician, etc.) have risen:
http://www.randcompare.org/us-health-care-today…
Obviously, the insurance model, both government-pushed private, and government-run public, has removed all incentives to control costs.
Here's a very thorough history of medical care through the last century, including how hospitals have pushed insurance as a way of ensuring their incomes in hard times and how it removed their cost control incentives. It also frankly discusses the rise of the AMA:
http://findarticles.com/p/articles/mi_m1094/is_…
It's no accident that government involvement and costs have fed each other's growth.
Andy (Dr. J, too),
You people keep saying the same thing over… and over… and over BUT when shown solid evidence that countries with single payer a) pay less, b) see the doctor more often AND c) live longer than people in the US you suddenly disappear… simply leave the thread instead of comment on the data.
If you think you can prove the data in the National Geographic article wrong, Fine… Here's your chance, your third chance actually, to debunk this graph and/or this article from National Geographic.
It's no surprise Krugman would be a hack, again. (Who on earth ever believes him?)
It's no surprise he's joining the crowd piling on — any help is probably welcomed by the desperate Dems.
Pass a bill, any bill — that's the Dems' desperate strategy at this time (including Dem hack Krugman's).
You suddenly disappear… simply leave the thread instead of comment on the data.
What are you talking about, Steve? We've chewed on those we-pay-more-for-worse outcome stats ad nauseam. I don't dispute the numbers themselves, it's just important to recognize them as statistics–not necessarily lies or damn lies, but one very high-level view of reality.
Here's another statistic: Cuba spends a fraction of what even European countries spend on healthcare, for comparable outcomes. Europe, in other words, isn't a model system at all, it's obscenely bloated. We should redesign ours after Fidel's. Makes sense, right?
My dispute isn't over the stats, it's over the conclusion you're drawing from them: that our system would get cheaper if the government took over the other half. Rather than simply repeating your stats over… and over… and over, perhaps you could address the objections raised on this very page?
I don't deny that countries with single-payer systems pay less. What I question is belief that single-payer is responsible. This is especially the case since few OECD countries are completely single payer. Their private systems are cheaper too. How do you explain that?
In the Netherlands and Australia, for example, the government pays for ~63 and 67% of health care costs respectively, the rest is private and out-of-pocket. If the US increases government provided health care from 50% of expenditures to their levels, or even France's 76%, can we expect our costs to go down at all, much less decrease to the levels that they pay? I don't see any evidence that would happen. That indicates to me that something else is responsible for our high costs besides who writes the check. We have high costs in both our private and public systems. They have much lower costs in both their public and private systems. How, exactly, does single-payer account for such a disparity system-wide?
My view is that our fee-for-service system is the real problem. Almost everyone agrees, right, left and middle, that it is at least a problem and most agree it's serious. It's a problem we've got to solve no matter what method we use to fund health care and I feel pretty confident in suggesting that simply slapping single-payer onto FFS isn't going to make our system affordable.
1) Whether the reform is a “takeover” or not is a matter or semantics. It certainly does expand the federal government's already large (as Krugman admits) influence over health care. Whether that is a “takeover” depends on what you mean by “takeover”, and so not worth much discussion beyond that.
2) Krugman: “There’s good reason to believe that all such estimates are too pessimistic”
I think there's much better reason to believe the estimates are too optimistic. According to the CBO:
“The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time.” (http://www.cbo.gov/ftpdocs/106xx/doc10688/hr396…)
“Whether such a reduction in the growth rate could be achieved through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care is unclear.” (http://www.cbo.gov/ftpdocs/107xx/doc10731/Reid_…)
3) Krugman: “How can people say [that the bill is fiscally irresponsible] given Congressional Budget Office predictions… that reform would actually reduce the deficit”
This is by far the weakest point.
3a) See above
3b) The CBO's number doesn't count an estimated 60 billion in additional spending that is dependent on future appropriation (http://www.cbo.gov/ftpdocs/113xx/doc11307/Reid_… page 5)
3c) The numbers count $430 billion in savings from Medicare that will be redirected to help pay for the bill. Considering the dire financial situation that Medicare is in, any savings derived from efficiencies (if they could be realized) in Medicare should be used to increase the solvency of Medicare (alternatively, you could argue that they should be offset by reduction in the payroll tax intended to pay for Medicare, but I'd prefer to extend it solvency.)
3d) The numbers count $70 billion in “savings” from a new long-term care insurance program, which will obtain such “savings” because people will start paying premiums now and won't need reimbursement until much later. Thus, as if increasing our borrowing from Medicare weren't enough, we are creating a new insurance program to borrow from as well.
3e) As long as we are citing biased economists, Greg Mankiw recently made a good point (http://gregmankiw.blogspot.com/2010/03/problem-…
“Even if you believe that the spending cuts and tax increases in the bill make it deficit-neutral, the legislation will still make solving the problem of the fiscal imbalance harder, because it will use up some of the easier ways to close the shortfall.”
That's something I hadn't thought of before but makes a lot of sense.
There are several problems with the graph (I must not have seen the first two times you posted about it). I've written about it here: http://sovereignmind.wordpress.com/2010/03/12/h…
(This post was sitting in my drafts for a while. Your comment inspired my to finally publish it)
I stand corrected on that point.
Thank you for the cites.
If you don't know what I'm talking about there's nothing I can add other than a link to the first time the article was brought up.
Good post adelinesdad but you, like all anti-single-payer advocates I've read, still fail (refuse?) to acknowledge or even mention the fact that EVERY major industrial (first world?) nation AND many, many developing (third world?) nations have single payer and they all are paying less per capita for health care then we are while covering all their citizens.
Like the old army joke “Look there, everyone in the parade is out of step except my son!”
I hereby acknowledge that many (maybe every, I don't know) other major industrial nations have single payer and are paying less per capita while covering all of their citizens.
That does not imply that we could achieve the same benefits at the same costs by adopting their system. As I explained in the post, a large portion of the cost differential between us and other nations can be explained by factors that have little to do with the system itself (our relative wealth probably being the biggest one).
You'll never get a better bill (especially not with more republicans in congress – they are far more ideological than democrats) and your system is ailing.
You think you will get to keep your own, precious status quo if you stick with the old? Haha, the insurance companies will stab you in the back after you've sided with them.
Either you pass this reform, or you will suffer as a nation – just punishment for spitting on the uninsured and the poor. As long as you are punished for a lack of solidarity, then it's fine by me.
Bingo.
The strategy seems to be for the democrats to sneak out enough items to give a good CBO report card and sneak them back in with other legislation. Smoke and mirrors.
Leonidas I have brought up this issue several times and I don't recall anyone on the left responding to it (my apologies if I missed somebody). I have to think the thinking on the left is they find dishonesty acceptable as long as their bill gets passed, ie the ends justify the means.
there's nothing I can add other than a link to the first time the article was brought up.
You're again just repeating the same statistics we've seen cited on here for a year. No one's arguing with those numbers. Like AD, if it helps I'll be happy to concede that every other industrialized country has a single payer system, they're all cheaper than ours and they produce as good or better outcomes.
Now, please tell me (1) why every one of those countries is struggling with rising costs and (2) how funneling the other half of our healthcare spending through the government will lower our costs.
Its far too common on the right as well. Both sides play games and fudge and outright lie about numbers. The left is in power now so they just do it more, if the right was back in power it would likely be them instead. Hope and Change is just the Status Quo, and so will be its replacement unless voters begin to hold the elected officials more accountable.
Although I'm a right leaning moderate (at least in my own mind) I try to take pains to point out from time to time that Republicans are not guiltless either, they just aren't currently in power. We have to “police” not just the other party, but the one we consider the lesser of two evils as well.
Question “1)” is at best disingenuous the fact of the matter is though they are struggling with rising costs those costs are nothing when compared to the rising costs of Health Care spending in the U.S.
In your question “2)” You are playing or you really this ignorant? If it is ignorance on your part maybe you should take the time to LEARN how existing single payer plans work. Then you will be able to answer your own question instead of constantly repeating the old meme that other countries have proven to be false.
Listen to what you (and all the other 'anti-single payer' people) are saying. “The government is a failure” “The government is bad” “The government is incompetent”… Good God man the words coming off the keyboards of those in the bag with the Health Insurance Industry is about as close to ANTIAmerican as anything I've ever heard in a long, long time.
Dr. J just asked you to explain why you think funneling the other half of our healthcare spending through the government will lower our costs and why every one of those countries is struggling with rising costs.
If you can't do this thats fine, if you can, please do.
. We have to “police” not just the other party, but the one we consider the lesser of two evils as well.
You're right of course. I would liken the Democrat's handling of the Doc Fix to Bush's funding the wars “off the books”. You know the expense will be there but pretend that it won't.
But the topic of this thread is Krugman's claim that the health care bill will cut the deficit, something I have to think he knows is false. I don't think much of him as an economist but he must be knowledgeable enough to understand the Doc Fix issue.
I do not know the specific details (as you do not know the specific details of his naive meme) I do know however that every single country that switched to single payer health care has lowered their costs so I guess you could say that proven track records are the source of my position.
Your turn, Leonidas would you mind explaining, if you can, why since they've all been able to do it why you think we can't.
And again you're not addressing them, you're trying to change the subject. If as you say, “I'll be happy to concede that every other industrialized country has a single payer system, they're all cheaper than ours and they produce as good or better outcomes” you are admitting what I have been saying is true and there is no need for me to continue to waste your time.
You are admitting what I have been saying is true
For the third time, yes, Steve, I'm agreeing with your numbers. There isn't much disagreement on the symptoms of our health care problems.
I disagree that the rest of the world is on a much better cost trajectory. From 2000 to 2007 US health care costs rose 17% faster than GDP. Sweden rose 13%, Canada 15%, Spain 18%, the UK 20%. No one seems to have figured out how to keep the lid on cost increases.
Thank you for acknowledging you don't know how switching to a single payer system here would lower costs. I certainly don't know either. Medicare's record controlling costs so far is not encouraging.
Steve,
FWIW I can only point you to my previous comment. We are talking about cause and effect – in other words, is single payer, or the lack of it in our country, the primary contributing factor to the difference in costs. For single-payer advocates the assumption is “yes.” I simply question that assumption. “Single Payer” simply means that government writes the checks for most health insurance costs. Single payer, as a system of payment, operates over a wide variety of health care systems. In some, almost the entire system is nationalized (doctors are government employees, hospitals owned by government, etc.) while other systems are highly privatized but regulated (see Canada). What you need to explain to me is how putting in a single payer payment system will reduce costs in this country. I don't think it will because I think the problem is our health care system and not our health care payment system. Again, see my last comment.
Thanks Dr J for keeping this conversation at a civil level. We all have our positions/opinions on the matter and as we don't agree I'm sure we both have better things to do with the weekend… We will most assuredly cross swords again in the future. But I'm taking what remains of the weekend off.
Thanks Andy for the back and forth. You raise several points that I will get back to you with… “Come Monday“.
I bet with work we could come to agreement on what the facts are and where the speculation starts. Enjoy your weekend.
“I disagree that the rest of the world is on a much better cost trajectory.”
Although costs are lower elsewhere,
[NOTE: Healthy life expectancy in most developed nations is seventy-plus, as has been noted before.]
http://www.piie.com/realtime/?p=516
they're rising in the rest of the world, and notably in Europe, which is often compared to the USA, and Europe will have worse aging problems than we will have, in addition to a worse labor shortage (the dependency ratios in the future for Europe will be worse than in the USA).
http://europa.eu/legislation_summaries/employme…
Just wait another 10-20+ years for real aging.
European Union:
“The annual number of migrants necessary to keep the potential support ratio constant at its 1995
level would be 15 times greater than the net migration level in the 1990s. Towards the end of the period,
i.e. by 2040-2050, the net annual number of migrants required by the European Union would be
equivalent to half the world's annual population growth.
Thus, if replacement migration were to be used as the mechanism for shoring up the potential
support ratio in the European Union at its present level, by 2050 the total population of the European
Union would have grown to more than three times its present level. In this process, the European Union's
share of world population would have more than doubled, from 6.6 per cent in 1995 to 13.8 per cent
2050. In addition, three quarters of the total population in 2050 would consist of post-1995 migrants from
outside the present boundaries of the Union and their descendants.
In the absence of migration, the calculations in this report indicate that the upper limit of the working
age would need to be raised to 71.3 years to obtain a potential support ratio of 3.0 in 2050, and to about
76 years in order to obtain in 2050 the same potential support ratio observed in 1995 in the European
Union, which was 4.3 persons of working age per older person.”
United Kingdom:
“In the absence of migration, the figures show that it would be necessary to raise the upper limit of the
working-age to 68.2 years to obtain a potential support ratio of 3.0 in 2050, and to about 72 years in order
to obtain in 2050 the same potential support ratio observed in 1995 in the United Kingdom, which was
4.1 persons of working age per each older person past working age. Increasing the activity rates of the
population, if it were possible, would only be a partial palliative to the decline in the support ratio due to
ageing. If the activity rates of all men and women aged 25 to 64 increased to 100 per cent by 2050, this
would make up for only 35 per cent of the loss in the active support ratio resulting from the ageing of the
population.”
United States:
“In the absence of migration, the figures show that it would be necessary to raise the upper limit of the
working-age to 66.9 years to obtain a potential support ratio of 3.0 in 2050, and to about 74 years in order
to obtain in 2050 the same potential support ratio observed in 1995 in the United States, which was 5.2
persons of working age per each older person past working age. Increasing the activity rates of the
population, if it were possible, would only be a partial palliative to the decline in the support ratio due to
ageing. If the activity rates of all men and women aged 25 to 64 were to increase to 100 per cent by 2050,
this would make up for only 21 per cent of the loss in the active support ratio resulting from the ageing of
the population.”
http://www.un.org/esa/population/publications/R…
1.It’s a government takeover.
2.It does nothing to control costs.
3.It’s fiscally irresponsible.
One out of three ain't bad, Kathy. It IS fiscally irresponsible, and it does NOT control costs enough.
“Good God man the words coming off the keyboards of those in the bag with the Health Insurance Industry is about as close to ANTI-American as anything I've heard in a long, long time.”
Criticizing and/or being skeptical of the effectiveness of the federal government is anti-American?
“I do know however that every single country that switched to single payer health care has lowered their costs.”
Can you provide a source for this?
“And again you're not addressing them… you're simply trying to change the subject. “
We have addressed the statistics. There is no dispute over them. The dispute is over how to address the problem. How is that changing the subject? You claim that they mean that if the US implemented single payer, our costs would drop. I and others have brought up objections to that claim which you are not addressing.
“But I'm taking what remains of the weekend off.”
My apologies for flooding you with questions after you've signed off. I have heard that some people do have real lives.:) My questions certainly can wait until Monday, or maybe someone else would like to help out.
“Criticizing and/or being skeptical of the effectiveness of the federal government is anti-American?”
La Brea Tar Pits, temporally as well as politically speaking. Stuck in pre-1980 Washington worship forever.
I'd like to believe like Dr. Krugman but I can't. The unspoken reality is that the federal government now provides nearly 50% of health coverage. And it is going broke in the process. Medicare is busting the budget NOW. The promise of fiscal responsibility in the face of this is folly. I don't believe it.
I don't understand the unwillingness of the Dems to honestly assess the federal government's past performance in this area. When a Rep tells me that cutting taxes will balance the budget, I don't bite. I've heard it before. It didn't work. What's the phrase Dems proudly use? Reality-based.
Yet somehow these same Dems ignore mountains of evidence of fiscal exhaustion and failure in government-sponsored health care. Only this time it will be different. This time it will work. This time will be the exception. Don't pay any attention to the man behind the current. Sadly the result will be returning the tax-cutting GOP back to Congress. No one wants to deal with reality.