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Posted by on Jan 9, 2007 in At TMV | 102 comments

Schwarzenegger Proposes Universal Health Care Coverage

Arnold Schwarzenegger, the conservative Austrian governor of California, has now truly broken with the far right.

Joe noted on several occasions by now that Schwarzenegger seems to be re-reinventing himself as a (true) centrist. His latest proposal is one that leaves no room for doubt:

“Prices for health care and insurance are rising twice as fast as inflation, twice as fast as wages. That is a terrible drain on everyone, and it is a drain on our economy,” Schwarzenegger said. “My solution is that everyone in California must have insurance. If you can’t afford it, the state will help you buy it, but you must be insured.”

Schwarzenegger’s plan would require everyone living in California — even illegal immigrants — to have health insurance, at an estimated cost of $12 billion. Individuals who refuse to carry insurance could face reductions in their state income tax refunds or the garnishment of their wages. All businesses with 10 or more employees would have to offer coverage or pay a fee of 4 percent of their payroll into a fund to help the uninsured buy health insurance.

Schwarzenegger also recommended expanding the state’s existing program for children’s health insurance to families that earn less than three times the poverty level, or about $60,000 for a family of four.

The governor also wants to force insurers to offer coverage to people with existing medical conditions. Currently many insurers will not cover older people, those with major illnesses or even people with relatively minor complaints such as asthma or varicose veins.

Schwarzenegger also would require insurance providers to use 85 percent of their premium proceeds on patient care.

The state would increase reimbursements to doctors and hospitals by a total of $4 billion. Money for the program would come from new taxes on doctors (2 percent of their revenue) and hospitals (4 percent), federal funds, and county funds that now pay for emergency care for the uninsured.

As the Post article points out, most opposition will most likely come from fellow Republicans. Ed Morrissey for instance:

The plan appears to be a populist’s dream. While not a single-payor system on the surface, the new regulation would dictate the terms for insurers in such a way that government will effectively take over most of the decision-making for medical coverage and payouts. It takes the bill out of the hands of the consumer and puts it onto both businesses large and small as well as the people who actually provide the medical care.

If California had a reputation for efficiency and good management of insurance programs, this might almost make sense. However, the state has a disastrous workers-comp program that has already provided a large incentive for businesses to look eastward for relocation. It costs employers a fortune and leaves them vulnerable for abuse. Schwarzenegger promised to overhaul the system, but reform has been slow in coming.

Kevin Drum is more positive:

Problems? Sure. California Republicans are already lining up to oppose it, and this matters since tax and budget issues require a two-thirds majority to pass. (Apparently some Democratic supporters are claiming the plan needs only majority support, but this seems pretty iffy to me.) Steve Burd, the CEO of Safeway, points out that the 4% payroll tax is too low a figure to provide a level playing field, since healthcare sets back the average company about 7% of payroll. That may actually encourage companies to stop offering health insurance and instead simply pay the tax. Finally, although I haven’t seen an independent analysis of the numbers, my gut tells me they look lowballed. I have a feeling the plan is going to cost more than Schwarzenegger is fessing up to.

Overall, I’m not a big fan of individual mandates. On the other hand, I am a big fan of community rating, and the whole plan might be worth passing simply to get that enshrined into law. Once community rating becomes established, I suspect there’s no going back, and that might eventually lead to a more rational system all by itself.

So two-and-a-half cheers for Arnold’s plan. It’s not perfect, but few things in life are. For now, it’s probably about as good as we’re likely to get.

Your thoughts on Schwarzenegger’s plan?

As I see it, government influence should be limited as much as possible. However, health insurance is one of those areas in which the government could play a role simply because without this role, many people will be uninsured. Many people meaning “many poor people”.

That being said, any plan for universal health coverage should be based on the idea that the government should only be involved as much as necessary. First try to find other ways of accomplishing the main goal.

Schwarzenegger’s plan is ambitious. It has its errors, as others have pointed out, but it seems to me that a plan must be made and it is – as such – a good development and a good decision by Schwarzenegger to try and deal with this now. The present status quote can no longer be accepted.

UPDATED
Also be sure to read Pat’s post on this over at Stubborn Facts. Pat thinks that “there are several small, not that politically difficult steps which can be taken which would reduce costs and improve access to health care.”

Want to find out what those ‘steps’ are? Go to Stubborn Facts (and leave a comment there or here).

Click here for reuse options!
Copyright 2007 The Moderate Voice
  • Lynx

    Schwarzenegger’s plan would require everyone living in California — even illegal immigrants — to have health insurance

    OK I have several issues with this:

    1-If you are an illegal immigrant living in California and are discovered to be doing so without health insurance, you need to be kicked out of the country, not forced to insure yourself.

    2-And how would they sanction them, if illegals don’t pay taxes? Would they garnish their already illegal wages?

    3-Let’s not forget that even if for some reason illegals were allowed to stay, most of them, being poor (how would you check if they have no regulated income?) wouldn’t be able to pay, so the LEGAL taxpayer (which would include legal, tax paying immigrants) would have to bear the cost of their insurance.

    Universal health care seems right to me, in fact it seems essential, but I see that clause as very flawed, never mind having the potential to encourage even more illegal immigration.

  • There are many smaller steps we can take which would begin to address some of the many problems with health insurance, without what sounds like a very intrusive program.

    For starters, all health insurance should be deductible from federal income taxes, regardless of whether they are purchased by the employer or the employee. One of the reasons we don’t have community ratings for health insurance is because the federal government decided long ago to create powerful incentives to place the responsibility for purchasing health insurance in the hands of employers, not employees. This has been disastrous, over the long term, for small businesses and self-employed people who are not able to purchase insurance. By making all insurance coverage deductible, we would spur the creation of new insurance products aimed at those markets, and which would use a community rating instead of an employer-based rating. What sense does it make to encourage a system where employers (and all of their employees who must pay into the insurance program) willing to hire people with some medical conditions must pay an arm and a leg just because they’ve hired a sicker person who makes more claims? And why should you be tied to a particular job just because you’ve now got a pre-existing condition and no new employer can afford to hire you because of the insurance costs? Health insurance shouldn’t involve the employer at all, and expanding the deductibility of health insurance to individual purchasers would go a long way to removing this perverse structure. Once health insurance is not tied to the employer, community ratings will rapidly develop.

    That’s one good first step which won’t actually stop anything being done now, but will allow the creation of new market products which will alleviate some of the problems.

    Massachusetts has already started a universal health insurance requirement much like what the Governator is proposing; I think California would be wise to let them see how it works first, before adopting such a drastic restructuring. In the meantime, we should all start supporting taking a few minor steps which can only improve the situation before we adopt these massive, all-at-once reform programs which have a very high risk of failing miserably with dramatically escalating costs.

  • The California plan is far from perfect, but it is a start, and that is badly needed because the health-care system in the U.S. is in crisis. This, in large part, is because institutional entities in the business of profit making are running the show — and running it into the ground.

    Adequate health care is not a right, but it comes alwfully close to being one, and as long as greed trumps care, things will only get worse.

  • CStanley

    Pat MHV: well stated, a good explanation of why health insurance shouldn’t be tied to employment, and a good suggestion of how we can move away from the status quo on that.

    Lynx and MvdG: I’ve seen both of you state the European perspective on this several times, that healthcare ought to be considered a universal right that is provided by the state just as education is. I’m always curious why you then stop there: why not also include food and housing as similar universal rights?

  • There are two distinct questions: universal access and rising costs. The California plan addresses the former and is unlikely to do much about the latter. If anything it will exacerbate the problem of rising costs.

    Many analysts of our rising healthcare costs point to excess demand. If they’re right, anything that insulates healthcare consumers from feeling the consequences of their purchasing decisions (which includes employer-paid health insurance), will make the problem worse.

    I don’t happen to agree with that. My own view is that we have both excess demand and a supply bottleneck. As Ed Morrissey notes the California plan is likely to make California’s supply bottleneck worse.

    I agree with Shaun that our healthcare system is in crisis. I don’t think there are any pain-free solutions and that we need to address the demand and supply sides of the equation in parallel.

  • Something must be done. The devil in the details of our current system is that the uninsured are already covered both by higher taxes and higher insurance premiums. Sick or injured poor people currently go to the emergency room for treatment, which is the most expensive care around, and overburdens these critical care departments with health problems that could be better handled by a general practitioner.

    Schwarzenegger’s plan is a recognition that in the final analysis, we will provide medical care because doctors and hospitals will not, cannot and should not turn away suffering human beings because they cannot pay for care (am I wrong? would you leave even an illegal alien to die if you could save her life?). Universal care through a government administered program solves this problem in a way that reduces costs and improves health.

    The major problems with Schwarzenegger’s proposal are that it is still employer-dependent and it attempts to preserve one of the most expensive and needless part of our broken health-care system: insurance company profits. And insurance Co. meddling in medical affairs is worse than government meddling. Medical decisions should be made by doctors, not by actuarial tables.

    Of all the modern industrialized nations, we pay far more because of our broken system, and in every measurable aspect of health, we are behind those countries that provide universal care through a single-payer system. Insurance companies don’t care about health. They care about money. They attempt to improve their profitability by excluding those with pre-existing medical conditions and by denying coverage of needed medical procedures whenever possible.

    While the Republican right objects to anything that might impinge on the ability of insurance companies to maximize their profits, Schwarzenegger is actually offering a plan to save these companies. For the past couple of years, a true single-payer system has been working its way through the California Legislature, and enjoys wide support with both the public and with legislators. It would cut administrative costs from over 25% to less than 5%. Of course most of the savings comes out of insurance company profits. For all the details of the plan set out in California Senate bill S840, take a look here.

  • BTW, health insurance is deductible from federal income taxes. It’s fully deductible by employers and deductible within limits by individuals.

    If employer-paid health insurance were required to be reported as income by individuals and then eligible for deduction along the lines of current rules, PatHMV would be onto something. Otherwise it would just create more demand.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • CStanley

    Dave,
    But what about equalizing the two sides of the equation (in Pat HMV’s proposal) in the other way: make health insurance completely deductible for individuals? You’re correct that healthcare costs are somewhat deductible now but the limits are so extreme that few people claim these deductions. If we were allowed to purchase private health insurance and deduct it completely, then there’d be much less incentive to use employer provided insurance.

    Greendreams:
    One of the few times I’m in agreement with you, at least the part where you point out that we currently ARE providing healthcare to all but we’re doing it in the least efficient manner. I’m baffled as to why no one is suggesting that we devise a system to allow the poor to access preventative healthcare (as in, directly fund this, not necessarily through insuring them, or perhaps through a Medicaid program.)

    I also agree with David about the exacerbation of the demand/supply problem if health insurance becomes mandated for all. I think that any effective solutions have to address cost containment and supply. If we think out of the box, what about an overhaul of the medical education system to modestly increase supply of physicians, increase the role of physician’s assistants for routine healthcare, and perhaps require a certain amount of pro-bono work by doctors and hospitals (and in conjunction with this, incentives could be used such as scholarships for medical students who will agree to additional pro-bono?)

  • SurgeJack

    I think most folks opposing it are intentionally dropping a bit of foresight that you know they have and taking a rough stance against it out of conservative principle.

  • OK, so the blog refuse post my last comment (which I spent a very long time composing). This is a test to see whether it’s just a filter problem. Sorry.

  • C.S. everybody, sick or not, needs food. Most people are normally not sick. They can work and by doing so they can afford food, perhaps not going out to a restaurant every week, but the basic needs can be fulfilled by individuals themselves. When individuals can’t, every Western government helps out: welfare anyone? Food stamps? Do you oppose those?

    The difference is that one needs health care at the moment one is sick or ill. Working for it, then, is impossible. Someone who needs food today, can work today, earn some money and go buy food. Not so with health care.
    Hence the reason that we in the West try to insure ourselves. This means that we pay in advance for it. But what if one does have a job, but is uninsured nonetheless? At that moment it has become completely impossible for one to receive health care (or the health care one must undergo is so expensive that one is locked in debt for the rest of one’s life).

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments (http://www.washingtonpost.com/wp-dyn/articles/A50470-2004Aug31.html)in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose (http://www.youtube.com/watch?v=ABF1uW6wOyg) television series.

  • CStanley:

    The number of docs graduated from U. S. medical schools hasn’t changed much since 1980. And the only reason the number doubled between 1965 and 1980 is that the federal government started paying what’s now $80,000 per year per medical resident.

    A modest increase won’t cut it. What we need is a major course correction in healthcare delivery.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • CStanley

    MvdG: Thanks for the response and I see your point (I wasn’t trying to be argumentative, either, just wanted to see why you view these universal needs differently and I assume you’d agree that food shouldn’t be a resource that is controlled by the govt.)

    I guess where I differ with you is when you get to this point:

    But what if one does have a job, but is uninsured nonetheless?

    My question then is, why is it that people have jobs but are uninsured? Why can’t we look at that and see if there is a way to make it possible for them to become insured, rather than mandating that the govt should step in to provide the insurance for all? I would say that health insurance is unaffordable for some (so, we can address ways to bring down costs) and undesirable for others (who feel that they have other needs or desires that trump the possible future need for healthcare). In the latter case, if he/she is making this choice because his/her wages only cover food and housing, then OK, the govt should provide a safety net. If he/she is making this determination because he/she prefers to have a new car and the latest electronic toys, then he/she shouldn’t be rewarded for these choices.

    And I’m sure I’ll catch flak for that last statement because health insurance coverage is so costly now for private indivuals who are self employed or working for small companies that don’t provide coverage. But keep in mind: I’m talking about instituting that policy AFTER we find ways to bring the costs down to reasonable levels.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • CStanley

    The number of docs graduated from U. S. medical schools hasn’t changed much since 1980. And the only reason the number doubled between 1965 and 1980 is that the federal government started paying what’s now $80,000 per year per medical resident.

    A modest increase won’t cut it. What we need is a major course correction in healthcare delivery.

    Dave,
    The only reason I used the phrase “modest increase” is because I am not familiar with the stats regarding supply of physicians. I just wouldn’t want to lower standards in an effort to increase supply, so that is why I would use some caution in calling for more doctors. What are your thoughts on increasing the role of PAs?

  • (attempt to post old comment)

    While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • Lynx

    CStanley, MvdG explained about the European view on the issue. I’m basically of the same opinion. I would also add that in the case of food, especially, lack of it is not much of a problem, at least here in Europe. Anybody, in the worst job imaginable, even beggars, can afford to eat, though not necessarily well. Soup kitchens provide for the tiny number that might not be able to pay for food. On the other hand medical necessities carry a hefty economic price, and there a millions who can’t afford to pay for it themselves on what they earn.

    If I may, and going slightly off topic, I’d like to turn the question back on you for a minute. I’ve seen many Americans give the argument that health care shouldn’t be universal, should stay private, but I’ve never seen any real opposition to public education. Why do you oppose public health care but support public education?

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    “I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.”

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    “I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military.”

  • C.S.

    My question then is, why is it that people have jobs but are uninsured? Why can’t we look at that and see if there is a way to make it possible for them to become insured, rather than mandating that the govt should step in to provide the insurance for all?

    Those are very valid questions / concerns. Actually, I share them. I celebrate this initiative by Schwarzenegger not because I think that his plan is terrific, but because a large part of the American population works yet is uninsured. There has to be something done about that. So, I celebrate Schwarzenegger for at least trying to come up with a solution. Let others join the debate, but let the goal, then, be clear: those who work have to be insured. Schwarzenegger’s ideas are the first step towards accomplishing a broader consensus.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose TV series.

  • CStanley, MvdG explained about the European view on the issue. I’m basically of the same opinion. I would also add that in the case of food, especially, lack of it is not much of a problem, at least here in Europe. Anybody, in the worst job imaginable, even beggars, can afford to eat, though not necessarily well. Soup kitchens provide for the tiny number that might not be able to pay for food. On the other hand medical necessities carry a hefty economic price, and there a millions who can’t afford to pay for it themselves on what they earn.

    Yes, very well said and this:

    Why do you oppose public health care but support public education?

    is a better comparison then ‘food’ and ‘health care’.

    By the way, I wrote:

    Let others join the debate, but let the goal, then, be clear: those who work have to be insured. Schwarzenegger’s ideas are the first step towards accomplishing a broader consensus.

    This means that the goal should be that those who work are insured and that people try to find the most effective way of accomplishing that. If this means more government interference (which I think it does), you for instance, should be open to that.

  • test

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me.

  • Sorry for all the duplicate comments, but I’m having a real problem with the spam filters.

    While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like s0cialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed s0cialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Hum?hrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socialism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socialism, which is what I had just left. But then I heard Nixon speak.

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like s0cialism,

  • While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like (filtered), which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed (filtered).

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • What are your thoughts on increasing the role of PAs?

    I think that’s probably the most likely course of action. From a political standpoint I think we’re going to have to do an endrun around medical doctors.

    The “lowering standards” issue is a thorny one. In my view arguing that we have fewer smart kids now than we did thirty years ago is absurd (I’m not saying you’re saying that but that’s essentially the argument that we should fix the number of graduates at 16,000). Nor do I believe that we’re no more capable of educating doctors than we were in 1980. Note also that we import an enormous number of doctors (which I think is immoral—we should be exporting doctors if anything).

    I think we need to bring medical education into the 21st century (I’d settle for the 20th—our model of medical education hasn’t changed a great deal since 1910).

    I’ve posted on this subject by the way.

  • Nicrivera: you seem to have some trouble posting quotes? I’d say, just the link is enough for now. Do you use the codes correctly?

  • Dave Schuler: yes I have linked to your post on this in today’s Center of Attention.

  • My apologies to all for the repeated postings. I know it is annoying, but fortunately, since this post went through, I’ve succeeded in getting around the spam filters. Apparently one can’t post a comment with the word “socia1ism” in it.

    ****************************************************************************

    While I’m glad that Mr. Schwarzenegger has finally abandoned the far right (Sean Hannity praised Mr. Scharzenegger and relentlessly touted his campaign during the 2003 recall election), I find this sudden lurch to the left disturbing. Universal Health Care Coverage isn’t the panacea that its advocates make it out to be for reasons that have already been explained above.

    Politically speaking, while this move may win him some support from liberals, it could do much to damage his overall credibility. I seem to remember him making these comments in his speech to the 2004 Republican Convention:

    I finally arrived here in in 1968. I had empty pockets, but I was full of dreams. The presidential campaign was in full swing. I remember watching the Nixon and Humphrey presidential race on TV. A friend who spoke both German and English, translated for me. I heard Humphrey saying things that sounded like socia1ism, which is what I had just left. But then I heard Nixon speak. He was talking about free enterprise, getting government off your back, lowering taxes, and strengthening the military. Listening to Nixon speak sounded more like a breath of fresh air.

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socia1ism.

    And now he’s proposing mandated universal health care coverage?

    And to think that this is the same Mr. Schwarzenegger who once extolled the benefits of the free market in Milton Friedman’s Free to Choose television series.

  • CStanley

    Lynx and MvdG:
    I would say I’m probably a product of my environment and both of you, of yours, in that you see a greater equivalency between the healthcare/education issue than the healthcare/food issue. I guess I’ve been conditioned to believe that public education is a given while healthcare is not, but since you’ve both challenged me, I will try to articulate why I feel it is different.

    First and foremost, education is an investment for the community. Ensuring public education for all is a way for the community to give it’s members the fundamental means to carry out the work that is needed for the community to thrive, as well as assisting the members of the community to have the means to earn wages for their individual survival. I don’t really see the same interest for the govt to ensure the health of the individuals. There’s a humanitarian interest, of course, but IMO not the same “investment” quality to it. That’s why to me, the issue of the need for food seems more equivalent to the healthcare need. And here’s an argument (though I don’t agree with it in it’s entirety) for why we aren’t better off making food OR healthcare universal rights. The premise is that having the govt control the distribution of these resources makes it less possible to have enough of the resource to go around, and to me that is a pretty compelling argument. In fact, Lynx, to touch on your point about food being available: that makes it even more likely that healthcare can’t be provided by the govt. without rationing, because you are proving the point that healthcare is a more scarce resource than is food.

    Now getting back to the comparison to public education. With that resource, I find it makes more sense to define the beginning and end points of what is a basic “free and appropriate public education”. While there is still room to argue about that, we basically in the US feel that our standard K-12 education should be free and available to all, and then some can opt for private K-12 and/or for college. But where do you draw these lines with healthcare, and who decides? There are just too many variables to decide that some types of health care are rights and some are priveleges.

  • CStanley

    Dave,
    What I meant about standards for physicians wasn’t so much in regard to selection of qualified candidates (the issue you raise about whether there oughtn’t be enough smart kids) but more of a concern about the cost of educating them. I would assume that in order to graduate a lot more medical students there would need to be a pretty massive investment in building more medical schools. If we focused instead on increasing supply of PAs, we’d probably get what we need: a large number of professionals with the ability to provide preventative care and treat minor illnesses.

  • Lynx

    CStanley, we really are products of our environment, but I find that if I do a little trick things are going to sound remarkably similar. Watch:

    “First and foremost, health care is an investment for the community. Ensuring basic health for all is a way for the community to give it’s members the fundamental means to carry out the work that is needed for the community to thrive, as well as assisting the members of the community to have the means to earn wages for their individual survival.”

    You can’t have a job if you are not healthy. You can have a job without knowing how to read or do math, just not a GOOD job. Ming you, I’m all for public education, I just can’t see how one can conceivably feel that you can live without doctors but not without school.

  • CStanley

    Nick,
    Thanks for persisting. It was a good post, despite your attempt to use that nasty word! LOL

  • Lynx

    Geez, proof read why don’t you; that’s “mind you” towards the end.

  • I had a company with 20 employees and tried valiantly for years to cover all their insurance, then most, then half, while sheer unmitigated insurance company greed and inefficiency decimated our profits. Premiums rose 40% a year. A year!! Deductibles went up, copays went up, less and less was covered, we changed companies several times, but short of firing our eldest employees to get a better rate, the costs climbed out of control, until finally, we had to stop insuring employees at all or go out of business. Then we all had to try to find individual policies, with our age and pre-existing conditions working against us.

    Medical costs are the number one cause of individual bankruptcy. Requiring companies or individuals to buy insurance from these crooks won’t work. We don’t have prison space left to pack in the people who just can’t afford these costs and still have a decent life.

    Words cannot express how I deplore this sick system, and I would not mind at all watching the entire health insurance industry go down in flames!

    American companies are at a serious disadvantage because of our weird employer-mediated health care system. Other modern countries pay less than half what we do and enjoy better health care, and better health. Go ahead and fight for insurance company profits, but don’t whine when European and Asian countries clean our clocks because they figured this out long ago.

  • CStanley

    Lynx,
    I still see a difference in the return for the community as a whole for an investment in education as opposed to an investment in healthcare. A community can thrive even if individuals are sick and can’t contribute to the community, at least up to the point of massive epidemics (which we recognize and address through public health organizations). Do you see my point? I know it sounds heartless, and I’m acknowledging there is regardless a very compelling humanitarian reason to make healthcare available; I’m simply saying that this is for reasons of compassion for the individuals, not for the more objective return on investment. So then it becomes, how do you best make this vital resource available: by intervening in ways to keep it affordable or by having the govt distribute the resource as it sees fit?

    You also haven’t provided a response to my other point on the healthcare/education difference. That is, do you agree or disagree that it’s easier to define what the basic right is for education (and where the limits of this right should be set) in contrast to healthcare?

  • It’s good to see, by the way, that after a few weeks of relative silence here at TMV, everybody is back and ready to debate again.

    C.S. Lynx gave a great response.

    Investment for the community: without health care for everyone, the community misses out on a lot -> some people cannot work because they are ill / sick. They could have been helped if they were insured, but sadly they’re not. What now happens is that the ‘community’ missess out on what they are capable of. Not because they don’t want to work, not because they don’t want to ‘give’ to the community, but because they can’t.

  • still see a difference in the return for the community as a whole for an investment in education as opposed to an investment in healthcare. A community can thrive even if individuals are sick and can’t contribute to the community, at least up to the point of massive epidemics (which we recognize and address through public health organizations).

    Define ‘community’. Are you talking about all the inhabitents of a nation? Of a State / province? Of a city? Of a neighborhood?

    Also… a ‘community’ (nation) can thrive when there is no public education; quite a lot of people can and will send their children to ‘private’ schools.

    Sure, a ‘community’ thrives more when everybody is able to receive education, but society can thrive regardless of it.

    Again… same as with health care.

  • CStanley

    But regardless of whether or not you agree with my assessment of healthcare not being an “investment for the community”, what about the argument that trying to provide it universally is futile because it is a finite resource? That working only on the demand side will actually make it LESS affordable for those who can now afford it?

  • Nicrevera: persistence pays off;)

    Let’s ignore the fact that Nixon didn’t exactly go on to become the greatest president. The point of Schwarzenegger’s comments were clear: he supported the free market and opposed socia1ism.

    And now he’s proposing mandated universal health care coverage?

    And what if he realizes now that the ‘market’ isn’t effective enough regarding health insurance?

    Also; since when is universal health care the equivalent of ‘socialism’?

  • superdestroyer

    I surprised that no one has pointed out that the proposed system let’s the elite keep exactly what they have now. I guess that Governor Schwarzenegger figured out that even the elitist on the left, the upper middle class, and whites in general will not support a system that has them sitting in the same waiting room as crack mothers and illegal aliens.

    The proposal sounds similar to the require to have liability insurance on your car. It took the illegal aliens, the scammers, and the high risk people about two seconds to figure out a method of avoiding the cost of car insurance. I am sure that they will do the same for health insurance.

  • That working only on the demand side will actually make it LESS affordable for those who can now afford it?

    Have you ever bothered to look at the insurance rates of Europeans and what we pay for health care insurance?

    I pay something like 1400

    a year.

    I’m fully covered.

  • CStanley

    MvdG: I guess it is a quantitative difference, not a qualitative one. You’re right, without public education, enough people would pay for education for their kids so that there’d be an educated class: but enough educated people to provide all of the diverse skills for a modern society? I doubt it.

    But to look at the situation with non-universal healthcare, if 20% of the population (I’m just using the number as an example, I don’t know what it would be) were sick and unable to work, you’d simply have a smaller community of people but you’d still have a diverse set of skells among the healthy (assuming that there wasn’t an illness that selectively affected schoolteachers, or accountants, or what have you 🙂 )

    And I want to repeat: None of this means that I think it unimportant to make healthcare available to all, I’m just skeptical that the govt really can do that through guarantees to insure all individuals. I feel that we already are providing healthcare to all but we’re doing it in a terrible way because it doesn’t give good quality healthcare to the poor and the care they get is unnecessarily expensive (ER treatments instead of primary care).

    But you asked why I have a philosophical difference on the public/private issue so that is what I’ve tried to explain.

  • CStanley, I assure you, society and companies pay dearly for poor employee health through lost productivity, increased sick days and the relentless rise in insurance cost every time our employees need health care. As we seemed to agree before, we ARE going to pay for health care for all. We’re just not doing it in an efficient or cost-effective way.

    And “trying to provide it universally is futile?” Huh? We are the ONLY modern nation that doesn’t already do so.

  • CStanley

    Have you ever bothered to look at the insurance rates of Europeans and what we pay for health care insurance?

    I pay something like 1400

    a year.

    OK, but why are the costs lower there? That’s the essential question that needs to be answered, because what Arnold is talking about doing is ignoring the supply side of the equation and just increasing demand for services. So what I’m arguing is what that would do to costs here vs. what costs here are right now. That is a separate issue from whether our costs could be brought down in line with yours.

  • CStanley

    Greendreams,
    I guess what I meant by that statement is that we can’t provide healthcare universally according to our current paradigm in the US. Addressing only the availability of health insurance will create more problems than it solves. Your previous points about the faults of the insurance industry are well taken, for example. Without changing part of that paradigm, attempts to universally cover everyone in a state or in the nation will be disastrous IMO.

  • BeYourGuest

    I have nothing substantial to add. But hopefully I just turned off the BOLD TEXT tag…?

  • Mikkel

    But to look at the situation with non-universal healthcare, if 20% of the population (I’m just using the number as an example, I don’t know what it would be) were sick and unable to work, you’d simply have a smaller community of people but you’d still have a diverse set of skells among the healthy (assuming that there wasn’t an illness that selectively affected schoolteachers, or accountants, or what have you 🙂 )

    This is overlooking the fact that the small percentage of people that don’t have health insurance make up a disproportionate amount of health care spending and it raises the costs for everyone. It’s to the point where solidly middle class families can’t afford health insurance by themselves…20% without could make it so eventually only 20% could afford it under our current system.

    Now there is a perfectively good capitalist alternative and that would be to just deny care to people that can’t pay. Whenever this comes up, I keep trying to point out that using the concepts of supply and demand don’t work when demand is inflexible and thus everyone can charge however much they want and won’t see business go down a whole lot. The fact that we require emergency rooms to provide care means that if people are out priced on the preventative level, they just wait until they have a serious problem and then they have to be treated. Our current logic would only work to contain costs if they were just denied treatment.

    Personally I am wary of government interference but know that we need some sort of universal coverage for both practical and moral reasons. I believe that there needs to be a concerted grass roots movement to create sustainable health care providers across the board. This means creating companies that focus on creating products that are reasonably priced.

    I’ve seen how the exact same product sold to a science lab (at still outrageous prices) goes up in price literally 5-10 times if sold to a hospital. True a lot of this is theroetically caused by government regulation, so that will need to be looked at as well — but most of it is just because they can.

  • Mikkel

    Haha BeYourGuest you rock. On the first day of the new site I accidentally didn’t close a link and it made the entire page under that part of the link including the submit button so I couldn’t even do what you did. I’ve been too scared to use them since.

  • I agree with you there CStanley. If we want to keep the 25-30% insurance company overhead and profit, we can’t afford it. And much as I enjoy the rising stock value in these companies, you guys are getting screwed if you actually work instead of invest. You might say it’s hypocritical of me to profit from an industry I so despise, but if you want a government mandate that assures their profitability, I’ll go along for the ride. Force companies and individuals to buy their products or go to jail? Wow. I better get some more AIG stock. (BTW, check out China Life, LFC, up 95% since I bought it earlier this year).

    It’s the Republican way. Penalize earned income vs. capital gains, let industry write it’s own rules to maximize profit at the expense of public health, environment, workers and communities, rail against “big government” as a way to demonize any protection of the public interest. Snicker all the way to the bank. Oops, veering off topic here…….

  • Lynx

    Yes, CStanley, I agree that it’s easier to map the limits of education than health care, but mostly because health care involves quite literally vital NEEDS. Deciding whether to cover for Cancer treatment or AIDS medicines is a need, knowing more about biology or calculus is an option. The conversation becomes much less charged when you are discussing knowledge than lives.

    Most jobs require a bare minimum of knowledge. If we wanted we could argue that the state provide the “three R’s” and have parents pay for the rest if they want their child to have more options (the same way we do for college now).

    As for universal health care not working, or being incapable of handling things, or costing too much: Well, the US is much much richer than any single European Union nation, and we all manage to provide universal health care without taking the country to ruin or drowning in taxes. And for those that want better care, that option is always there, there are private insurance policies and private hospitals, but incredibly most Spaniards at least don’t bother, since INCREDIBLY, public health care handles things well enough most of the time.

  • Costs are lower in Europe largely because supply is carefully rationed. You can get medical treatment, but you may have to spend a year or so on a waiting list before you do. I feel fairly certain that for every anecdotal story about a poor person wanting but unable to get care in this country, there is a story about a European who died or got much sicker because of a delay in there care, or because the system just didn’t provide the treatment available here.

    Thanks to Dave Schuler for his point about treating employer-provided insurance as income to the employee. To fully equalize the playing field, that government subsidy (not taxing the value to the employee, while allowing the employer to deduct its share of the cost from its own taxes) should also be removed.

    Over at Stubborn Facts, I’ve posted a list of 4 things I think could be done quickly and easily to begin fixing the problem while we continue to explore and debate what the ultimate solution should be.

  • Pat: post has been updated with a link to Stubborn Facts.

  • I really dont see why there is any argument over this. We’re not talking about some scary hypothetical change in our system, we’re talking about a system that already has been shown to work in other countries.

  • Michael, thanks!

    I also encourage readers to check out the links I provide in my post to the Centerfield discussions last year on the Massachusetts proposal for mandatory health insurance. I haven’t delved into the details yet, but at first glance, I think Schwarznegger and Mitt Romney must have been talking with each other, so the Centerfield discussions on the Mass. policy should be relevant to the discussion of the California proposal.

  • Good point Pat.

  • CStanley

    Mikkel,
    You’re right, of course, that I left out of the equation that the uninsured actually end up being very costly to the system (in that part of my post, I was sort of arguing from the perspective of the pure market, where uninsured wouldn’t have healthcare unless they could pay for it; then I went on to say that I really don’t think that is a morally defensible situation).

    Pat,
    Great list of suggestions at your blog. I agree with all of them, especially one we haven’t mentioned about drug costs being subsidized by the US for other developed nations (a partial answer to my rhetorical question about why Michael can afford health insurance 🙂 )

    I’m not so sure your last point is significant about incentives for doctors to follow best practices. There are already ethical incentives for them to do so as well as legal ones (malpractice cases are determined by whether or not physicians practice according to the prevailing standards of care). Maybe there is something else that you were getting at that I’m missing though.

  • CStanley, thanks. On the last point, there’s a pretty good distance between following “best practices” as described in the WSJ article I linked to (sorry, only the teaser is available at that link for free now) and malpractice and minimum required standards. The “prevailing standard of care” legal standard is a minimal one. A “best practice” would have to be widely followed for a fairly significant period of time before it became part of the prevailing standard of care.

    Take ulcers, for example. It was in the 80s when a researcher demonstrated conclusively that ulcers were caused by a bacterial infection, not excess stomach acid, and should be treated with antibiotics, not just Pepcid. It took at least a decade for that research to fan out into the medical community and become widely adopted, even by the older doctors practicing on their own.

    Anyway, click through to my earlier post that’s linked to in item 4 and it’ll explain a little more what I’m talking about. Really, it’s part of the philosophical basis for the move to HMOs and other “managed care” organizations. The idea was that costs would be saved not so much by rationing care as by ensuring that doctors were following the latest treatment guidelines.

    As I note in the underlying post, at one health system, a quality-control process to promote best practices cut the use of vacuum and forceps use in deliveries from 7.5% of all births to only 4%. The program resulted in cost savings of over $500,000 per year, while noticeably reducing birth complications.

  • Pat, unless you’re willing to join me, comrade, items 2 and 3 are nonstarters. Multinational companies, especially big pharma own our govt. They’re not giving up any of their subsidies. And insurance companies hate preventive medicine because it requires them to pay for something now that may or may not cost them later. The patient may change jobs, insurance companies, or simply die before insurance has to pay for the heart or cancer surgery. It’s all a gamble, but the waiting game pays off for them.

    Let’s dispense with nationalism here. We’re not discussing an untried and risky experiment. The United States lags behind 36 other countries in overall health system performance. Even Cuba does better. I think the oft repeated bit about waiting lists and people dying before they get treatment is propaganda.

    There is no legitimate statistical evidence that shows us to be ahead in any measure of health: longevity, infant mortality, adult mortality, cancer, heart disease, etc. Not one area measured. Am I wrong? Second, Canada pays 36% what we do for health care. If they paid a bit more, say 55% instead of 36%, any of your objections including waiting period could be eliminated, but again, it doesn’t impact meaningful measures of public health. (As an aside, people in the US also wait, and the wait is increasing). Third, I have lots of friends in single payer countries. We have many here on this blog. I think Americans have more complaints–and more legitimate complaints–about “the system” than any of these countries.

    Well, Europeans? Canadians? Anyone want to trade with us?

  • Excellent comment GreenDreams

  • Well, Europeans? Canadians? Anyone want to trade with us?

    No thank you.

  • CStanley

    Greendreams,
    The argument that Pat made in point #2 is about subsidies for European healthcare systems, not for Big Pharma. The point is that the US pays more for drugs when other countries are allowed to purchase at (cost + percentage for profit) instead of (cost + percentage for profit and R&D). Now, your point about those who are subsidized not wanting to give up the subsidy is well taken; I’m sure that Europeans and Canadians would not be happy if we try to change the status quo on this. But that’s a different issue than whether or not pharm co’s and ins. co’s will allow cuts into their profits (you may then argue that pharm companies can alternatively take less profit and use the difference for R&D, but the high costs of this require large amounts of investment with high risk, and that simply isn’t going to happen if high profits aren’t possible.)

  • Lynx

    Uhm, no, that’s ok, I’m cool. I’ll take your net bandwidth though!

  • Lynx

    Damn, I don’t get this quote thing. I’m answering:

    “Well, Europeans? Canadians? Anyone want to trade with us?”

  • Greendreams, I agree with you about insurance companies and preventive medicine. As I said before, one of the reasons HMOs were created was to try to provide financial incentives to promote the preventive care which can help reduce costs, especially in chronic diseases like diabetes. You are correct about the thinking of the insurance companies; the person may change jobs, etc. That’s one of the reasons I want to see us rapidly move away from an employer-provided model of health insurance. Create long-term health insurance policies that belong to the employee rather than the employer, so that changing jobs does not suddenly strip the employee of coverage or foist them on some new carrier. I’d support some mandates, or at least incentives to create this type of coverage, which would provide for keeping the insurance at some guaranteed long-term rate if you are diagnosed with some chronic illness. In other words, you pay a bit more in premium, and you get a policy which can’t be canceled when you are diagnosed with diabetes, but will instead stay with you for life as long as you keep paying the premiums. You could even have a supplemental disability package which would pay those premiums for you if you no longer could.

    Another part of the whole problem has nothing to do with insurance companies. As much as you rail on and on about them, they pay billions and billions of dollars of claims every year, day in and day out. Millions and millions of people have absolutely no problem going to the doctor, paying a modest co-pay of $10 or so, and having the rest paid by insurance, without ever having to fill out a form. If you want preventive care, most policies provide that; you simply have to decide to go get it. And that’s a big part of the problem. A lot of people, for reasons ranging from lack of education to an inability to take time off work, simply don’t try to get preventive care, even when it is available.

    CStanley, thank you for understanding my point about the massive subsidy we’re giving Canada and Europe on pharma R&D costs. So far, you’re one of a very small number of people to get it.

  • Kevin H

    Mikkel made just about the exact same point I was going to make, so I’ll just put it in a different way to see if it sparks any extra agreement or controversy.

    Here we have a rare instance where the humanitarian and the practical go hand in hand. Under the current system, every single American is “insured” by the laws prohibiting Emergency rooms from turning people down. Therefore, I don’t agree with the position that universal health care will significantly increase demand. I thin the real benefit of universal health care is to get more people into efficent health care.

    Emergency rooms are the least efficent way of meeting health needs because:
    1) Conditions that require emergency treatment are futher progressed and therefore harder to treat. and
    2) The risk of expensive complications, both from secondary infections and phyician error greatly increase in the high pressure, messy ERs.

    I think health care costs are high in the US both because of this inefficent use of the system, and because we subsidize the pharma industries R&D, even when compared to europe. I think Universal health care would actually bring prices down because of the first reason. As for the second, we could either wait 17 years until many of the patents on drugs from the current biotech revolution exprire, or we could have the FDA change inspection rules to align with various other countries such as europe or canada which would atleast spread the subsidies to those countries as well.

    One other point, I think that health care must be either universally required or free of charge for the simple psychological reason that people think that they are imortal. Noone assumes they will get sick, but if someone chooses not to get checkups and undergo preventative care, the high costs are shared by everyone.

  • CStanley

    Lynx: Cut and paste the segment you want to quote and then put

    before it and

    after it.

    I liked the idiot buttons better too though, esp for links where the code is longer.

  • Kevin H

    oh, pat, I missed your point about the R&D subsidies. Damn, did I say anything origional?

  • CStanley

    Oh geez, the filter blocked out the code words that I wrote. Should be prior and after.

  • CStanley

    Hah, I give up, Lynx, you’re on your own LOL

  • CStanley

    Kevin H,
    If I understand Pat’s point about the R&D subsidies, it’s that this cost should be spread among all the developed nations and not borne by the US consumer.

    Pat, I think you’re point about people not USING preventative care even when it’s available is an important one too. I’ve seen some studies that indicate this is a big problem (though I don’t remember the source- anyone know of data on this?) It’s certainly something to mull over, because even if we figured out a system of making preventative care universally available, what then if people don’t avail themselves to it? Do we mandate checkups and screening tests?

  • Kevin H

    hmmm, maybe I wasn’t clear CS. Spreading the R&D cost among all the developed nations is what I think bringing our FDA guidelines on drug inspections/imports in line with countries like canada and Europe will do. Because we could ship drugs from england if they were cheaper than over here, the pharma industry would have to respond by spreading that R&D cost over the entier market we could import from.

    sorry if I’m not terribly clear today.

  • Kevin H

    hmm, now every thing is bold AND italics for me…. Much better

  • Kevin H

    well, nm, i thought i got that italics too….. how about now?

  • Kevin H

    okay, sorry for the many posts, i thought italics whas a bracket, then a backlash, then an ‘i’ then close the bracket…. someone please elucidate me

  • CStanley

    I’m not sure about the change to bold and italics either. Testing to see if this works.

  • CStanley

    Hmm, I don’t get it either. Was able to turn off the bold but not the italics, same problem you’re having Kevin.

  • CStanley

    But then of course that time it worked LOL

  • Kevin H

    OHHH, I bet it was just a large nuber of open tags and we had to close down all of them, next time i’ll just put 10 closes in a row =)

  • Whew… thanks to those who closed the tags.

    Kevin, authorizing the reimporting of drugs would work, too, and I have no problem with that. My proposal is simpler, to pass a statute that the government would pay no more for a drug under Medicare/Medicaid than the manufacturer charges for that drug to government health care systems in Europe or Canada.

    On preventative care, here’s the thing… while it undoubtedly saves money when looking at individuals who ultimately require emergency room care, there’s no guarantee that it saves money for the system as a whole. Take all the people who get strep throat. The vast majority of them will get well, eventually, without treatment. Let’s assume for argument that it costs $200 for treatment. Let’s also assume, just to pick a number at random, that for those who do need emergency care, the cost will be $2,000. At that rate, providing the preventative care will save the system money only if about 10% or more of those with strep throat will need hospitalization. Take a sample of 100 people. It will cost $20,000 ($200 * 100) for preventative care. If nobody got treatment and 10 people needed emergency room care, then that also would cost $20,000 ($2,000 * 10). If only five people get sick enough to need emergency room care, then the system would pay only $10,000 ($2,000 * 5) for emergency room care, half the price of providing preventative care.

    I don’t of course know what the numbers are for all the types of preventative care available, just pointing out that providing more universal access to preventative care won’t necessarily reduce the overall cost of health care.

    Another point I like to make in health care debates is that different solutions may be needed for different types of health care. How we control costs and guarantee access to end-of-life care for the elderly may be very different from how we should provide routine health care services, which itself will be different from how best to provide on-going care to chronic conditions like diabetes.

  • BeYourGuest

    Ninety-nineth!

  • Kevin H

    Pat, your proposal sounds ok, but I’m much more in favor of open market solutions when possible, as bureaucratic regulations have a tendency to not work as design and be notoriously bad at foresight. Locking our rates to a handful of particular nations might be good today, but who can say what crazy things might happen in 5 or 10 years.

    As so preventative care, I would argue to factor in lost economic activity as well. Of course it all depends on the numbers, but I think it might be more like $100 for preventative care and $10,000 for an emergency room visit. Although there could be a large difference between what is charged and what the costs are to the system.

    I’d also be fine with a basic system for everyone that paid for general check-ups to catch developing pathologies, and free treatment for life threatening problems while leaving optional treatments for things like flu or strep on a optional, multi-payer system.

  • Jim S

    When it comes to not using preventative care could it have something to do with employers’ attitudes about letting people off for “non-essential” trips to the doctor?

    Why is American health care more expensive? Is European health care the fiefdom of publicly held corporations? I don’t think so. What happens when corporations run health care? You get demands for unrealistic levels of growth and profits from Wall Street. You get American levels of executive compensation. You get corporations who are so afraid of someone getting care that the insurance company doesn’t want to pay for that they generate more red tape than the government ever dreamed of and the expense for processing this paper work is shoved off to the doctors and hospitals as much as possible. In addition there is that additional cost that gets spread through virtually the entire system because of the people who don’t go to the doctor until it’s time for the ER.

    Also, in a related issue that far too many people forget about doesn’t anyone remember the study a few years back that showed that there was a relation between the infections and other problems from bad teeth and heart attacks and other general health issues?

  • Paul Silver

    I am disappointed in the GOP for missing the opportunity to improve health care by improving competition. Apparently they were bought off by the Health Industry. Perhaps we have to have several states try their own solutions until the industry capitulates to a more efficient remedy.

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