The dialogue on this post about single-payer started out in the predictable manner — with libertarian Doug decrying the very idea that I would want him (which is the way he reads the words "we" and "us") to be a part of what I see as the common-sense sense solution to a critical need we have in common as a society.
But you have to read past that. One of the problems Doug and I have discussing issues is that he likes the "how" of specific proposals, whereas my interest lies more in the broad concept. As an INTP, I intuitively understand his frustration, but that’s the way I approach things.
And once you do get to proposals, the ideology falls away enough for Doug to say things that I agree with. For instance, he set forth these five suggestions for taming the health-care-cost monster in America:
1) Reduce drug patent lengths to allow competition from generic makers
2) Require insurance companies to offer coverage that is portable, not revokable under any circumstance, and restricted in the percentage increases in premiums to a limited range across all policies
3) Abolish HIPAA rules that only add expensive overhead costs to the system
4) If healthcare for all is a national concern, pay for it by cutting government costs in other areas rather than simply adding another tax on top of the waste already built into the government. The money is there already to easily cover every one who doesn’t have insurance.
5) Go back to the days where drug companies could not advertise on TV, radio, or print media. All that marketing cost gets passed onto consumers. I really don’t care if I ever see another commercial for Viagra, Ambien, or any other product that has "oily discharge" as a frequent side effect.
With the exception of item No. 4, which is simply a libertarian article of faith (which is why I initially read right over it), this seems like a list I could go for. (As much as I’d like to have a clean sweep,that one is just a spoiler condition. While you or I or anyone can come up with a list of federal expenditures that we could do without, that’s not how representative democracy works — such decisions are made collaboratively, and one person’s waste is another person’s essential. This fact lies at the root of so much libertarian alienation. Anyway, the bottom line is that in the real world, if you say you’ll only agree to a national health plan if you cut an equivalent amount elsewhere, you are for practical purposes saying let’s not do it at all. But in the interests of furthering dialogue, let’s set that aside.)
I was a little surprised that Doug went for No. 1 even more wholeheartedly than I would, since it’s about property rights. And I always thought that HIPAA (which I hate) was about privacy (another libertarian priority), and specifically about trying to achieve Item No. 2 by preventing insurance companies from knowing your medical history. But fine. I’m all for it. And I prefer the more direct, regulatory way of approaching No. 2 — if you insist on still having insurance companies.
I was even more pleased and surprised when Doug, later in the dialogue, proposed that we just make the plan that federal employees are on available to everybody. I would have to study this a lot more closely (and those of you who deal intimately with that system, please weigh in), but I have to applaud Doug’s willingness to do something that bold, even if it’s not single-payer.
Of course, he threw in the caveat that we could cover the cost by cutting spending elsewhere — once again, a fine idea until you try to do it, and something that can’t be an absolute condition if we want to get anything done.
But the really cool thing is that, when we get down to such specifics, we’re no longer arguing about the need for universal coverage. We’re just haggling over the price.
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Brad it’s fine to agree on general principals but the devil really is in the details. Often you’ll find that a concept that looks good as a general proposal really doesn’t pan out very well once details are considered. (Maybe that’s why you are so reluctant to come out against Green Diamond. It sounds like a great idea for government to promote economic development and you just can’t see the staggering details that render that whole thing nonsensical.) But I digress.
With healthcare we agree because the reality is we’ve both seen the details of the existing system and it sux. So I’m willing to scrap this whole mess and simply start over. Going back to my 4 tiered idea for a minute I can find absolutely nothing objectionable about implementing tier 1 immediately. Right off the bat you eliminate a huge amount of “free-market” red tape by simply recognizing that government, one way or another is going to pay for certain types of treatment. If you’re uninsured and get hit by a car you will be treated. Let’s just go ahead and as a society accept that reality.
But for the other 3 tiers you simply can’t just say we need to address this issue and then walk away from the details. That is not intellectually very productive. So Doug’s harping to get you to provide details is appropriate.
bud, if reform is dependent on me coming up with the details, we’re sunk. I’m just not capable of doing it. I could quit my job (thereby losing my expensive benefits) and spend a year immersing myself and sweating over it, but at the end of that year I would remain so overwhelmed by the possibilities that I’d still be holding back my plan while I obsessively agonized over whether I’ve covered all the possibilities and considered everything. Such things paralyze me. We all have our strengths and weaknesses. That’s mine. I drown in unlimited possibilities.
I can react to your details because they are finite. If I try to come up with my own, I would never be satisfied that THESE were the right, proper and inclusive things to consider. To give but one example, I would NEVER have confidence in my ability to compute the costs of a plan; and that’s pretty key to selecting any specific proposal.
It’s like a lot of people would be intimidated having to write a column for the newspaper — or so they tell me. I am not. Different strokes.
Anyway, the subject is so complex that it’s taken me a lot of years to get to the point that I can say with confidence that what we have is fundamentally flawed (that it’s not just case of a few uninsured; it’s a bad deal across the board), and that the biggest thing that is wrong is that we expect private employers to help us purchase insurance from for-profit providers, and do so from the relatively weak position of having purchasing pools no larger than the companies’ respective rosters of employees.
That leads me to single-payer (and if you want to see that spelled out as a specific proposal, see HR676), and the way I approach that — knowing how complex this is — is by asking my readers to help me find flaws in it that maybe I’m missing. After we go through that for a while, I might gain the confidence to say that yes, I endorse that bill.
The bottom line is, I’m not as arrogant as I look. So if you’re waiting for detailed plans to come from me like Minerva springing from the brow of Zeus, you should go to another blog.
I’m testing.
The drug patent issue is an artificial monopoly that increases prices. This is an area where I think the government SHOULD step in. Unleash the power of the market and of intelligent scientists to help everybody. And do it with virtually no cost – simply change the law.
As for HIPAA, it’s a Libertarian’s perfect example of why the government should not be allowed to do such things. It’s a solution in search of a problem. Rather than targeting unethical insurance companies with a focused set of laws, we have a huge bureaucracy created to generate forms and rules and overhead that probably doesn’t do anything to stop those same unethical insurance companies. But what it does do is force my deaf 86 year old father in law to fill out multiple forms EVERY year so his two daughters can talk to doctors about his care. It’s a joke.
The reason I don’t trust the government to implement a health care solution is based on experience. Is there anyone who would call the Medicare Prescription Drug program anything but a complete mess? If the government can’t get that one thing done right, how can you expect them to take over the whole system?
I don’t know why you are so opposed to looking at the solution from the perspective of prioritizing spending. Given a choice, I bet the American public would prefer cheap medicine over a Department of Education. Given a choice, I bet the American public would prefer free mammograms and other preventative care measures instead of farm subsidies. Given a choice, I bet the American public would prefer quality nursing home care for seniors over billions of foreign aid to Pakistan.
Doug, you can ditch the U.S. Dept. of Ed. in a heartbeat as far as I’m concerned, and ditto with the farm subsidies.
I’m less certain about Pakistan. I think we need all the leverage there we can get (and I think we need to be a lot smarter about using it than we have).
But say you and I are the only ones who have to make the decision, and we decide to ditch DOE and the subsidies. We are still far from paying for this.
Note that I’m trying not to sugarcoat this. I know it will cost. I just believe that overall, less money will be coming out of American’s pockets than is now, and we’ll have everybody covered for a change.
Socialized medicine has been tried in other countries and has not reduced the costs. It can’t. All the government can do is shift the costs to other people and to other forms.
* Wage controls on treatment discourages the best people from becoming doctors and nurses.
* Price controls on drugs and devices discourages investors, R&D, and the wages of scientists and engineers.
* Rationing care and witholding care, especially for critically ill patients who die while waiting, saves monetary costs for the government by extracting a human cost on its victims.
There is no such thing as “American’s pockets”, and no one knows what socialism will cost, because socialists don’t have the financial responsiblity of private businesses. Bureaucrats don’t care about controlling costs – their salaries are a cost.
The only reason most backers of government programs back them is because they plan to transfer money from some other individuals’ pockets into their own pockets. Those who pay their own way know they will have to settle for mediocre care because their medical budget will be confiscated to buy mediocre care for the freeloaders.
Farm subsidies?
Why don’t we get rid of pregnancy subsidies first?
I don’t get it! Don’t those that oppose universal coverage understand that we already have it-its called the emergency room! And, for all those good liberterians who don’t want to be forced to be covered, isn’t it convenient that they can have an accident and not be denied services. The cost of those services are then passed on to those of us that do pay-through higher insurance premiums. And finally, whats the differentiation between a tax and a premium. All of us presently paying would continue to pay (so-no new tax there). So only those that can pay (means tested) that don’t now would have to pay.
I don’t get it! Don’t those that oppose universal coverage understand that we already have it-its called the emergency room! And, for all those good liberterians who don’t want to be forced to be covered, isn’t it convenient that they can have an accident and not be denied services. The cost of those services are then passed on to those of us that do pay-through higher insurance premiums. And finally, whats the differentiation between a tax and a premium. All of us presently paying would continue to pay (so-no new tax there). So only those that can pay (means tested) that don’t now would have to pay.
who is gonna pay for all those fat kids and thier problems? Those young porkers are gonna cost us a fortune.
Socialism at the emergency room needs to be abolished. It is a good microcosm example of how all socialism works.
Nutritionists are already blaming the school lunch programs and Food Stamps for creating so much obesity among children. Cut out the fat in that program before offering free treatment to those made sick by other socialist programs.