John McCain Once Again Demonstrates Total Ignorance of Vital Public Policy Debates
One of the frustrating elements of the health care debate in the United States is that not only are the legislative options constrained by the dread “political reality” but the actual conversation around the issue is weirdly hemmed-in by America’s ideological hang-ups. There is, for example, simply no way to dispute the fact that other developed countries with national health care systems also have more efficient health care systems. There’s maybe a credible argument to be made that the United States couldn’t realize those efficiencies, but no serious person can maintain that they don’t exist. And yet here’s John McCain saying “the idea that somehow the government can administer health care in a more efficient fashion than the private sector I think flies in the face of examples of other countries that have done so.”
He went unchallenged on this assertion because in America “everyone knows” that government is inefficient and “everyone knows” that foreign countries are bad. But as Ali Frick points out “McCain is simply wrong” and the American health care system is hideously inefficient:
Compared with five other nations — Australia, Canada, Germany, New Zealand, the United Kingdom — the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.
Efficiency: On indicators of efficiency, the U.S. ranks last among the six countries, with the U.K. and New Zealand ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology and multidisciplinary teams. Also, of sicker respondents who visited the emergency room, those in Germany and New Zealand are less likely to have done so for a condition that could have been treated by a regular doctor, had one been available.
To understand the point about efficiency you have to understand how much more the United States spends than other developed countries. Per capita health spending in Switzerland is 68 percent of what we spend. And that’s the most expensive country! In Canada it’s 57 percent In Denmark it’s 51 percent. In the UK it’s 41 percent. In Finland it’s 38 percent. The OECD median is 44 percent. Under the circumstances, the claim that our system is more efficient is an extremely bold conjecture. The idea would have to be that not only is our health care in some sense “better” than Danish health care, but that it’s actually twice as good in some sense even though Danes don’t seem to be healthier along any metric.
61 Responses to “John McCain Once Again Demonstrates Total Ignorance of Vital Public Policy Debates”
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June 15th, 2009 at 6:03 pm
I think you mean that the Danes are healthier. At least that is my understanding of the situation.
June 15th, 2009 at 6:11 pm
Once more, John McCain’s lifetime experience of healthcare — as military brat, Navy officer and member of Congress — needs to be noted.
He can compare universal healthcare to the Hanoi Hilton if he likes, but the man has been covered by either military-run healthcare or federal health insurance for almost all his life. Has anyone asked him whether his rehab in Walter Reed ought to have been outsourced to the efficient private sector?
June 15th, 2009 at 6:19 pm
The efficiency question is interesting in the context of another rarely-applied fact: the US government already spends more money to cover 27% of the population than the UK does to cover 100% of the population.
So if the UK and the US are comparable, we already spend enough money to pay for a UK-style universal health care system.
June 15th, 2009 at 7:04 pm
Of course the scary thing to remember is that this buffoon and Caribou Barbie got 47% of the vote just last November.
June 15th, 2009 at 7:06 pm
You don’t understand. “Private enterprise is more efficient” is a religious belief, not amenable to factual proof. If you don’t believe it you’re a socialist, which is another word for satanist.
June 15th, 2009 at 7:14 pm
Government-run health care would be wildly inefficient; that’s why private health insurance companies would never be able to compete with a government-run plan.
Yes, that makes sense. 9/11! 9/11!
June 15th, 2009 at 7:31 pm
I like to city my experience in Germany.
As a visitor, I managed to spill hot water over my
leg to get 2nd degree burn. My host took me to the
nearby neighborhood clinic. Those people were totally
disorganized!
Imagine, in few minutes I was seen by a doctor, who
gave short instruction to a nurse who cleaned the wound
and applied an ointment and a dressing. I was instructed
to come back in few days. WITHOUT FILLING OUT ANY FORMS!
I was a bit in a state of shock, so only during my second
visit I broached the topic that I want to pay and to get
a receipt to show to my American insurance. “Next time”.
Only when a dressing was applied for 4th time I managed to pay 100 Euros and get a receipt. I concluded that this socialized system was only minuscule capacity (or inclination, the sin of sloth) to handle paperwork and billing. I bet that forms filled and processed in American healthcare system are more numerous that for the rest of the planet combined.
June 15th, 2009 at 7:43 pm
Half the healthcare, maybe, but twice the FREEDOM! And who can put a dollar value on that?
June 15th, 2009 at 7:58 pm
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June 15th, 2009 at 8:00 pm
And who can put a dollar value on that?
Hey! Freedom isn’t free, you goddam commie!
June 15th, 2009 at 8:08 pm
Do you people really think the costs associated with American health care are a market phenomena?
With Medicare setting it’s own prices and forcing providers to pay them, hospitals and doctors must make up those cost in the private sector. With governments setting what insurance plans must provide, we have effectively regulated cheap plans out of the market. The problems with health care are GOVERNMENT induced.
And now Obama is taking large chunks of John McCain’s own plan to encourage individuals to seek out their health care, and you think he doesn’t know what hes talking about?
Where do Liberals get this shit? Another fucking planet I assume.
June 15th, 2009 at 8:11 pm
Just one thing to remember is that people appointed by someone like John McCain, Sarah Palin or the congress could be running our health care system. It could be a worry. Think about it.
June 15th, 2009 at 8:12 pm
http://www.dailymail.co.uk/news/article-515332/A-E-patients-left-ambulances-FIVE-hours-trusts-meet-government-targets.html
OMG. Government screwing up?! The gini coefficient must be off! I’ll get Krugman to explain how this is purely a result of wild animal instincts!
June 15th, 2009 at 8:16 pm
Of course the scary thing to remember is that this buffoon and Caribou Barbie got 47% of the vote just last November.
They got 45.7%, Obama/Biden got 52.9%.
June 15th, 2009 at 8:16 pm
Also, according to cutting edge statistics that compare Yglesias with five other people, he is the dumbest person of the six! Fascinating.
June 15th, 2009 at 8:22 pm
@ 11 (Nathan),
While I wish the market for healthcare was like the Thai market for knockoff DVDs, in my experience it rather more resembles the market for cable television, where Comcast rips me off every month and offers mediocre quality and my alternative is Dish Network ripping me off up front and offering inconsistent quality. I just want to be able to see the doctor when I have a problem without wargaming the billing scenario every time.
June 15th, 2009 at 8:24 pm
@ 14:
Thanks, I just remembered the election night estimates. Now I’m much more confident in the analytical abilities of my fellow Americans.
June 15th, 2009 at 8:30 pm
Which is why it’s nearly impossible to get medical treatment in my hometown of 40,000 people, mostly poor people, retirees, and military… those three full-service hospitals can just barely keep their doors open. That’s also why Florida and the Southwest are desperate for physicians, I suppose, and the few they do have are living on the edge of financial ruin. Damn government-funded healthcare, making care virtually unobtainable for entire geographic areas!
June 15th, 2009 at 8:32 pm
So, Nathan, which advanced democratic countries do you think the US would beat on efficiency grounds? (Never mind that the existence of the five in the study thoroughly undermines McCain’s ridiculous statement).
June 15th, 2009 at 8:42 pm
@17:
Just informing the public.
June 15th, 2009 at 8:44 pm
I bet that forms filled and processed in American healthcare system are more numerous that for the rest of the planet combined.
The US healthcare system keeps the clipboard industry afloat. Not the doctors’ clipboards, but the ones handed out at every front desk.
With governments setting what insurance plans must provide, we have effectively regulated cheap plans out of the market.
Uh huh. Tell us, Nathan, what the market could provide for a premium of, say, $100/month if it wasn’t for EVIL GUBMINT, and what would be trimmed from its coverage. Shill away.
June 15th, 2009 at 8:44 pm
Obama may soon have to ditch the whole bipartisan thing and start calling this as it is – the GOP has no intention of honest debate, of honestly presenting facts, of honorably negotiating disagreements, and their sole purpose seems just to be in power, where they have no clue what the hell they’re doing and just enable the world to go to hell in a hand basket.
We have massive issues and challenges, who seriously wants the Republican Party to attempt to solve them? They can’t even speak honestly about them, in some cases not even being able to accept them. I’d call them out harshly and publicly, and basically tell the people the truth about those who are lying to them.
June 15th, 2009 at 8:47 pm
Do you people really think the costs associated with American health care are a market phenomena?
It’s true. Our healthcare system is not really a free market system but do you really think it would be better if it was? And if it was better, how much better? If we implemented a free market system and it was 10% better (without getting into how we would define “better”), that would be a big improvement and it would prove that a free market system is better than the current one which has a fair amount of government intervention but it would still not be nearly as good as the “socialist” healthcare systems that other countries have implemented.
June 15th, 2009 at 9:17 pm
Markets work in this fashion – the more wealth you have, the more you can get out of the market.
In many ways, and for particular market products, we don’t want to interfere with that, it is what it is, imposing equality from above would be harmful and counterproductive, so the rich can buy more stuff, while those who are poor can by much less, and many categories of products are wholly unavailable to them.
Health care is not something any respectable person should argue a poor person should go without, just as we would say about law enforcement. If you’re rich, you can hire more security, buy homes in more secure environments, but you are not entitled to greater protection from the police, and the poor certainly shouldn’t be entitled only to law enforcement they can afford.
Similarly, with health care, you ought to be able to upgrade your service in health care markets, relatively unimpeded, by making choices how to spend your wealth, but a core, essential level of health care ought and should be guaranteed to all, just as protection of the person by law enforcement (or the provision of legal counsel in criminal court), and the argument can also be made that you shouldn’t have to pay for it (especially emergency care), though arguments can also be made for a means-based, sliding scale of cost that more resembles the current system.
With how inefficient and expensive our current system is, moving in this direction is likely to greatly improve the health care situation in this country, both for more healthy people and more efficient, less costly care, which of course synergizes in the sense that healthier people require less health care and so on, though you have the counter-balance that healthier people will live longer too, raising costs over time, so there’s really no easy solution, for any of the countries in the world or any of the current health care approaches (as since the success of a health care system would lead to more healthy, older people requiring more health care as they age, in a world where can’t just continue to allow massive population growth to support aging society).
June 15th, 2009 at 9:47 pm
It’s apparent you know nothing about what happens to the number of doctors in countries with universal health care.
http://www.thelocal.se/19630/20090524/
Keep on thinking that everyone in the world is out to get you and “rape” the masses of all their non existent money. Never mind that you only get treated by someone under your own free will.
You don’t seem to understand. Comparing the inefficient 50% government based system of the US to government dominated health care in countries that regularly allow people to die and pay doctors pennies on the dollar is recipe for disaster. Why are you so quick to point out the fallacy of looking at efficiency in other market structures, and then embrace it like your first born in pushing for more government destruction? The hypocrisy is so apparent it has to be eating you from the inside.
June 15th, 2009 at 9:55 pm
Better tomorrow? Most likely not. In 10 years, a generation? Absolutely. 5% better compounded over 10 years is a hell of a an improvement over socialized systems.
I still don’t understand why the left continues to think people like Mises, Hayek, Friedman, Rothbard were just puppets of the rich. They were paupers. They spent their lives as poor professors and intellectuals. The rich LOVE government programs they can design with a few pennies to their local congressman. Eliminating any competition that provides a cheaper service and convincing the public the “threat” of monopoly is so great we must have a governemtn provided system is the goal of the insanely wealthy.
June 15th, 2009 at 9:55 pm
You’re avoiding my point re: Medicare– American doctors would presumably avoid markets (aside from a few short stints in underserved areas to help w/loans, no one tells them where to live & work) where they can’t make a decent living, and there doesn’t seem to be any shortage of physicians in heavily Medicare-funded areas. That appears to be the situation in America, not in other countries, which certainly makes me wonder if maybe they’re just stupid by moving to areas where they’re guaranteed to be mere government wage slaves instead of free-market titans.
June 15th, 2009 at 10:11 pm
Nathan is ignoring the fact that every objective study (meaning not including people just cherry-picking anecdotes) has shown that the U.S. health care system gets no better outcomes, and may well get slightly worse outcomes, than its far less expensive peers.
That said, it is absolutely true we don’t have a pure market system. Indeed, a pure market system would involve lots of poor people (including children and the elderly) literally dying in the streets, and we long ago decided as a society that we were no longer going to allow that result.
The obvious conclusion, given the well-demonstrated poor efficiency of our hybrid system, is that this is one of those situations where half measures are a terrible idea: once you abandon the idea of a pure market system, you really need to go all the way to a full single payer system for basic health care, or otherwise you can’t really control costs. But of course people like Nathan are indeed either pseudoreligious zealots, or partisan hacks not wanting to give the Democrats a victory. And in that sense, people like Nathan have to be simply outvoted, because they have made themselves immune to reason.
June 15th, 2009 at 11:43 pm
Obama may soon have to ditch the whole bipartisan thing and start calling this as it is
I certainly hope he doesn’t. The more reasonable he is in his outreach, the more the Pugs look like gibbering idiots. Just look at McCain, or “Nathan” here — if Obama took a hard line, it would be correspondingly harder to see them for what they are, a pair of poo-flinging monkeys.
June 16th, 2009 at 12:15 am
in countries that regularly allow people to die and pay doctors pennies on the dollar
Which ones are those, then? And no, your three rotating anecdotes really won’t suffice. While you’re at it, tell us all what $250/month in premiums will get a family in your imaginary unregulated market.
A couple of basic premises: 1) the cost of medical treatment for serious illness or injury is not priced for retail purchase; 2) no-one plans to be diagnosed with cancer or has a rainy-day fund for that heart attack or stroke. Work from those.
June 16th, 2009 at 2:18 am
Who knows. This is akin to asking how the markets would provide provide apples. Who will tell the farmer how much fertilizer to use, and how many acres to plant? Surely the markets can’t handle such complicated and intricate operations? What about computers? Thousands of part manufacturers must add value to basic silicon and plastic at hundreds of steps. Surely only the government has the expertise to do such things! Yet it happens, every day. And when people of no expertise or ability from within the government attempt the same we see wasted money and improperly allocated resources.
June 16th, 2009 at 2:20 am
I suppose the 40,000 that die every year on government made roads are the economically efficient amount?
June 16th, 2009 at 2:36 am
I feel a wistful ambivalence that Obama is my President.
Part of me wishes a lesser man were at the helm. When the ship goes down I could laugh maniacally at the absurdity of it all and care not a wit that the tragedy, our collective sinking, was deserved.
I watched the Obama speech today, the one to the AMA. He went in to the lion’s den, again, for us, for his people, and slapped the lion the around. It was a pointed FUCK YOU to an intransigent organization that has screwed the American people for so long I was forced to tally time in terms of decades -decades long before I was even born.
The speech ended shortly after Obama chided the doctors that they too should remember that they are, in fact, Americans. And low and behold whose face should immediately fill my TV screen? Joe Lieberman. LIEBERMAN!
From steel balls oratory to rat talk in a digital instant -the rat expertly chopping oratory to bits, in seconds, with practiced and nonchalant sound bites.
Rats abandon the ship first, don’t they? That will be the most painful part, watching the rats abandoning the ship while a courageous and thoughtful President mans the tiller.
June 16th, 2009 at 4:47 am
What about computers? Thousands of part manufacturers must add value to basic silicon and plastic at hundreds of steps. Surely only the government has the expertise to do such things! Yet it happens, every day. And when people of no expertise or ability from within the government attempt the same we see wasted money and improperly allocated resources.
Actually, the world’s first electronic computer was built entirely by a government institution.
June 16th, 2009 at 6:24 am
In terms of relative efficiency, you could compare traditional Medicare to the private Medicare Advantage programs that compete with it. The latter require substantial subsidies to do so.
June 16th, 2009 at 6:34 am
Whatever Obama’s faults, I’ll remember this and be glad he won.
June 16th, 2009 at 6:40 am
Re: Damn government-funded healthcare, making care virtually unobtainable for entire geographic areas!
I lived in Florida for five years (until last year). I assure you I had no trouble obtaining healthcare. I had one doctor who took no insurance except Medicare (and cash payments of course). His rates were rather low, 60$ for an office visit and because his paperwork requirements were minimal he had only one full time employee, not a small army of people in his offices. ( OK probably he also had a cleaning service and an accountant I never met too). And rather than rushing from patient to patient trying to cram as many into his day as he could the way today’s HMO-indentured doctors do, he had the time to get know people who came to him.
You don’t know what you are talking about.
June 16th, 2009 at 7:43 am
I suppose the 40,000 that die every year on government made roads are the economically efficient amount?
I honestly have no idea what point Nathan is trying to make here. It fails even as pure anti-government rhetoric, since obviously most of those people are killing themselves or each other in privately-made and privately-operated vehicles. Indeed, if a lot more people were travelling in mass transit (buses and trains and such), the fatality rate per passenger mile would go down substantially, but something tells me Nathan would not support public investments to that end either.
Anyway, getting back to the actual issue, the profit-maximizing strategy for the health insurance industry would naturally involve excluding many millions of people, namely those who could not afford to pay the premiums the health insurance industry would need to generate a likelihood of a profit minus their expected claims. That category would include many poor and middle-class people with pre-existing health conditions, an increasing percentage of people as they got older, children in poor families, and so on.
And without health insurance, many of those people would end up needing health care they couldn’t afford out of pocket. And then many of those people (again, including lots of children and the elderly) would die for lack of health care, assuming health care providers were also profit maximizing.
Again, all this would be a necessary outcome of health insurance and health care being provided on a profit-maximizing basis. Nor should we be surprised at that result: whatever its other merits, a profit-maximizing scheme for providing a good or service almost never results in every person being able to afford as much of that good or service as they might want (or in this case, as they might need).
Now Nathan may well harden his heart and welcome the prospect of all these poor children, poor elderly people, poor and middle-class people with pre-existing health conditions, and so on dying for lack of health care, in the name of keeping the government smaller (or the Democrats from having a victory). But even Nathan should be able to recognize that too many of his fellow citizens simply will not tolerate that outcome, regardless of what Nathan would want.
Or not–maybe Nathan will continue to offer up irrelevant points about highways, thereby removing himself from the adult conversation our society is having about health care. That’s his choice, and I for one doubt that conversation will be worse for his absence from it.
June 16th, 2009 at 8:06 am
Hi Max424,
Let’s not make the President out to be more then he is.
Any serious attempt to systematically control health care costs must involve malpractice reform. (Just as any reasonable comparison between costs, and efficacy, of health care in America vs other countries must take into account the differing regimes to handle malpractice.)
But there are “lion’s dens” the President is unwilling to enter, and “lions” that slap him around.
Hi Ajay,
The University of Pennsylvania is not a government institution.
June 16th, 2009 at 8:36 am
Let’s not make the President out to be more then he is. Any serious attempt to systematically control health care costs must involve malpractice reform. . . . But there are “lion’s dens” the President is unwilling to enter, and “lions” that slap him around.
Well, malpractice reform turns out to be one of the “lion’s dens” Obama is willing to enter, since that is an issue he specifically addressed in his speech to the AMA:
AMA Speech
And here is a NYT article on the subject:
Obama Open to Reining in Medical Suits
Obama is apparently thinking of things like a robust system for alternative dispute resolution (which he has proposed before), and liability protections derived from the evidence-based treatment guidelines Obama also supports generating.
June 16th, 2009 at 8:56 am
Hi DTM,
The sense from the coverage of the AMA speech is that there is no serious expectation that the President is going to do anything substantive in the near term to reign in malpractice costs.
Most likely, malpractice reform will wait until we have a single payer system and the malpractice costs are being borne more directly by the government.
I think, tho, if you want to be fair about it, the argument that “our current health care system costs more and is less effective then alternatives therefore we need a single payer system” is undermined by the reality that our current system could be made much more cost-, and health-, effective without a single payer system, with sensible reforms including malpractice.
June 16th, 2009 at 9:36 am
Why is we rank 37th out of a total of 40 industrialized country`s in health care overall? overhead, it has to pay these exorbitant salary`s for the CEO`s,red tape that includes tons of paper work,not a single standard set of rules industry wide and we have over 13000 health insurance company`s that run amok.Why and how does our V.A. for our military which is socialized meaning the Gov`t run agency owns the hospitals and owns the equipment and pays the salary`s and is in good shape to take care of our military heroes and why and how does Medicare which is for our elderly run at 2 to 3 percent overhead,can anyone tell me why they are so bad for the rest of this country that other country`s model their programs based on the V.A. and Medicare?$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$.
June 16th, 2009 at 10:12 am
JonF@37: I was being sarcastic. The fact that so many physicians do choose to practice (or are hired by existing practices) in areas with a high proportion of retirees, and that they also seem to do very well for themselves, makes the incessant whining about pathetic Medicare reimbursement seem… implausible.
June 16th, 2009 at 10:14 am
The sense from the coverage of the AMA speech is that there is no serious expectation that the President is going to do anything substantive in the near term to reign in malpractice costs.
Your link doesn’t support your claim: rather, it simply discusses Obama being booed by some people at the AMA speech when he said he wouldn’t support legislative caps on damages awards, and why it would be politically inexpedient for Obama to support such caps even if he did believe in them. But unless you are claiming that is the only form substantive malpractice reform could take, then there are still plenty of other measures that Obama could (and in fact does) support.
I think, tho, if you want to be fair about it, the argument that “our current health care system costs more and is less effective then alternatives therefore we need a single payer system” is undermined by the reality that our current system could be made much more cost-, and health-, effective without a single payer system, with sensible reforms including malpractice.
The problem with this theory is that it is completely unproven in the real world. We know that single payer systems are much more efficient than the U.S. status quo, because there are real world examples of such systems. In contrast, the idea that the U.S. status quo could merely be tweaked and set on a more efficient path has been tried before, and it has never yet worked. And every year we keep futzing around trying things that don’t end up working, we waste more money. So I think we are long past the point when we should have given up tweaking, and instead gone with reforms we have good reason to believe can work.
June 16th, 2009 at 10:25 am
Throwing malpractice victims out of court isn’t a genuine reform – it doesn’t reduce the cost of malpractice. From a systemic perspective, both the lawsuit and the attempt to eliminate it (along with all the legal stalling maneuvers that really drive up the cost) are mere cost-shifting – the only way to *truly* reduce the cost of malpractice is to reduce the *rate* of malpractice, i.e., improve medical practice.
Also, most of the damages in many malpractice cases are the further medical treatment needed to repair the damage from the malpractice; anything that controls medical costs would thus control this element of damages too. Malpractice that leads to temporary or permanent disabilities or death would still have lost wage costs, though – to say nothing of pain and suffering if a plaintiff actually manages to recover some. But again, those costs exist whether anyone sues for them or not – they measure the damage *actually caused by the malpractice*. Some people who argue for “tort reform” don’t seem to understand what a tort *is* or how the amounts of damages are determined (the rest are just lying, I guess).
P.S. @38: don’t forget how much higher that death toll would be if Big Government didn’t arrogantly ram seatbelts down everyone’s throats, first forcing manufacturers to install them, and then even more intrusively forcing drivers and passengers to wear them. How dare government save people’s lives like that!
June 16th, 2009 at 10:38 am
Better tomorrow? Most likely not. In 10 years, a generation? Absolutely.
Assume for a moment that I am not on “the left” and that I do not disagree with that statement. Okay?
Your belief that it would be absolutely better in ten years is based entirely on faith. You do understand that, don’t you?
June 16th, 2009 at 11:08 am
Hi crease,
I think that CEO salary as a percentage of total health care costs is near negligible.
In as much as medicine is constantly evolving it probably does not make systematic sense to have a single set of rules industry wide.
Finally, in any event, its not like private insurers have a real freedom in making decisions given how tightly they are bound by state regulators and concern of lawsuit.
June 16th, 2009 at 11:45 am
And never would have been thought or conceived by a private individual? Another classic fallacy of the statist. Just because the government pumped billions of dollars into machines to better kill people in war (many first computers calculated trajectories of shells) you think the personal computer would never have existed? Never mind the idea for a calculating machine has been around for several hundred years.
Why is America so rich? What is the cause of our wealth? Could having some of the lowest taxes and freest trade policies on earth for much of our history have anything to do with it? Why are prices in free markets so much lower than governments? Why does government health care regularly kill those it serves?
Killing themselves? Interesting you are far more willing to force health care onto people who kill themselves through diet, lack of exercise, and lifetimes of smoking. Private highways kill people at roughly half the rate of government roads. If roads were privately owned and 40,000 died every year there would outrage. We would have hearings in the Congress to get to the root of the problem. But because the government has screwed it up, we assume it can’t be done any better.
How do those with multiple DUI’s get insurance? There is a price and a level of coverage that anyone can afford. Will a 90 year old life time smoker be able to get a comprehensive plan for 5 bucks? Probably not. If there isn’t someone providing that price or level of coverage, you are free to create your own company to do so.
June 16th, 2009 at 12:18 pm
Matthew, You’re exactly right. Here’s what’s wrong with McCain-ite thinking: 1. If I could do “it”, you should also be able to do it, regardless of the help I had. 2. Yes, I used Government Healthcare, or my Daddy’s money, or Affirmative Action, or Welfare or whatever…but if YOU do it, you’re weak and dependent on “the evil government.” 3. “Government is useless.” Lord knows, since Reagan, they do EVERYTHING possible to make it useless. I say, MOVE THOSE repugnicans out of the way, do what we know needs to be done to save our country–healthcare, education, loans, etc., instead of trying to “compromise” by placating their hatred by watering down what we need done!
June 16th, 2009 at 1:11 pm
Killing themselves? Interesting you are far more willing to force health care onto people who kill themselves through diet, lack of exercise, and lifetimes of smoking.
You are really descending into incoherence. We haven’t been talking about “forcing” health care on anyone. At most, we are talking about mandatory contributions to health insurance, and in fact that is an answer to the moral hazard problem created by implicitly guaranteeing the availability of expensive emergency care to everyone without first requiring them to contribute to health insurance, at least to the extent they have some means to contribute.
Private highways kill people at roughly half the rate of government roads.
I have no idea where you are pulling this statistic from, but I will guess it doesn’t involve controlling for all of the relevant factors.
If roads were privately owned and 40,000 died every year there would outrage. We would have hearings in the Congress to get to the root of the problem. But because the government has screwed it up, we assume it can’t be done any better.
Look, if you want to push for reform of our transportation system to make it more safe, be my guest. Like I said above, the obvious place to start would be moving more people to inherently safer modes of transportation.
How do those with multiple DUI’s get insurance? There is a price and a level of coverage that anyone can afford.
What exactly is your obsession with irrelevant analogies to cars? And I might note some people can’t drive precisely because, among other things, they can’t afford the minimal amount of required insurance in their jurisdiction.
Anyway, you are theoretically correct that everyone could afford some level of coverage, but in practice, the de minimus coverage many people could afford may not cover the non-premium costs of providing it to them. And even if you somehow removed this practical problem, the level of coverage many poor people could afford would be less than what would be necessary to keep many poor people, including many children and elderly, from dying for lack of health care. So we are right back to the same problem.
If there isn’t someone providing that price or level of coverage, you are free to create your own company to do so.
Again, if that company has to make a profit to survive, it won’t be able to provide the level of coverage our society de facto demands.
Look, I apparently know the libertarian shtick better than you, so I will speed this along. What I am describing–our society’s insistence on providing at least some health care to poor people, including many children and elderly–could be called a form of charity. And if you are a hard core libertarian, you will argue that no one should be forced to be charitable to other people. But that is a principle a large majority of your fellow citizens don’t accept, so they are going to keep outvoting you on this sort of thing.
Now feel free to sulk about it, but those are the facts.
June 16th, 2009 at 1:13 pm
Hi DTM,
I would think that any alternative reform would be as politically inexpedient — for the same reasons — as caps. The President did not say “This is how I am going to address your concern”, rather he said, in effect, “I recognize your legitimate concern, I think we need to explore a range of ideas in the future, but, for the moment, I have nothing concrete for you.”
As far as incremental reform vs overhaul. I do agree that any reform has to be serious. It does not not seem to me that there has ever been any serious, holistic, effort at incremental reform. I also do not think it is difficult to answer the question “it works elsewhere, why not here?” Specifically: our demographics and politics are very different from other nations.
Hi Chris,
I agree that the goal should be to reduce malpractice rates. I do not believe the current system best furthers that goal. I believe the goal would be better served by having medical experts pass the judgment as to whether something is malpractice or not and by having clear and consistent standards and outcomes. From what DTM posted, this view seems in line with the President’s thinking.
June 16th, 2009 at 1:40 pm
I would think that any alternative reform would be as politically inexpedient — for the same reasons — as caps.
I don’t see why you are assuming that is the case. Caps don’t attract broad support because there is no real reason to believe they are to the benefit of anyone but people on the liability side. However, the alternatives people like Obama are floating are based on addressing the interests of patients as well as providers, and hence are more attractive to a wider group of people (maybe not the plaintiff’s bar, but they are also outnumbered by themselves).
The President did not say “This is how I am going to address your concern”, rather he said, in effect, “I recognize your legitimate concern, I think we need to explore a range of ideas in the future, but, for the moment, I have nothing concrete for you.”
He wasn’t specific in the AMA speech, but read the NYT article I linked above (”Obama Open to Reining in Medical Suits”).
It does not not seem to me that there has ever been any serious, holistic, effort at incremental reform.
Go back and look at what people were saying at some of the relevant times (say, the discussions surrounding HMOs starting back in the 1970s). They always promised this time would be different, meaning that they were really serious this time about controlling costs. It is only with the benefit of hindsight that we learned better.
I also do not think it is difficult to answer the question “it works elsewhere, why not here?” Specifically: our demographics and politics are very different from other nations.
This is too vague to credit. The fact is that our health problems are not so different from our peers, and the ways in which they control costs are relatively straightforward. Meanwhile, we have adopted both limited forms of single payer (e.g. Medicare) and even socialized medicine (e.g. the VA).
So to the extent “politics” is a barrier, it is right at this very point, with people rationalizing our failure to adopt a proven approach in the past and opposing efforts to do so now. But if we ever got over this initial resistance, there is no reason to assume we would have any more trouble adapting to an alternative system than our peers.
June 16th, 2009 at 2:45 pm
Hi DTM,
The analysis posted indicated that the political hurdle was not so much broad opinion as much as strong opposition from key Obama supporters. The substance of the NYT article is, I think, the same as his AMA speech. This is something he is willing to talk about, something he probably wants to do eventually, just unlikely right now.
My concern of politics is not simply of the political will to try something, but the manner in which our government makes choices. Our politics seems, in general, to closely mirror Britain’s, (even if there are formal differences) and so I suspect that something similar to the British Healthcare Service represents the most realistic expectation for us.
June 16th, 2009 at 3:04 pm
DTM. Your post are basically impossible to read wall of text. There is a quote function that works extremely well.
I would expect this from someone whose only life goal seems to be justifying expansion of government programs.
As someone who apparently knows the Social Democratic party line better than you, I have a question. How can you claim charity and decency when millions of immigrants are barred from entry to this country? Wouldn’t that be the most charitable thing possible? Letting just a few in to make bare bones wages would drastically improve the welfare of millions of people…
But this is a problem from those living in a Social Democratic utopia. Eventually welfare can no longer pay. And the government must tax the upper middle class, then the lower middle class, and eventually confiscate the large majority of all wages to provide “the most basic levels of care.”
I guess charity only extends to those who have votes? My guess is your intentions are not nearly as charitable as you claim.
June 16th, 2009 at 4:28 pm
How much of these efficiencies depend upon the government controlling costs by limiting services and/or payment to providers? If Doctors in these other countries make on average say $75k and doctors on average in the US make $175k, how can we come close to these efficiencies unless providers (hospitals and doctors) reduce their fees?
June 16th, 2009 at 5:12 pm
Your post are basically impossible to read wall of text. There is a quote function that works extremely well.
I prefer italics for quoting other posters here, and I put text from elsewhere into block quotes.
I would expect this from someone whose only life goal seems to be justifying expansion of government programs.
Nah, there are plenty of government programs I would be happy to eliminate or cut. But I also think that when we have government programs, we should do them in a smart way. Right now, our approach to health care is dumb and unnecessarily costly, and we need to change that.
How can you claim charity and decency when millions of immigrants are barred from entry to this country?
Have you ever come up with a red herring or a straw man, and decided not to use it?
I made no claim that in all ways possible, the American people are maximally charitable and decent. In fact, I would agree that in many ways, the American people are relatively uncharitable when it comes to foreigners–that includes immigration policy, trade policy, direct foreign aid, starting wars, and so on.
But the American people are charitable enough that they don’t want to see millions of young children and old people dying in their own streets for lack of health care. Which if you think about it, is actually kinda a low bar when it comes to charity.
June 16th, 2009 at 6:11 pm
[...] problem is the senator is badly mistaken. According to Ali Frick of ThinkProgress, via Matt Yglesias, the United State’s ‘free market’ approach is really, really bad: Compared with [...]
June 16th, 2009 at 6:34 pm
Millions of people? Dying in the streets? Typical liberal made up bull shit. Thousands of people needlessly die in socialized countries, and in most cases a government policy decides when.
June 16th, 2009 at 8:58 pm
Millions of people? Dying in the streets? Typical liberal made up bull shit.
Nope, that is simply a fact: there is just no way to make a profit on insuring many millions of people for even basic care these days, and without basic care injuries, disease, and so on would wipe out millions (the disease factor would, of course, be self-reinforcing). I’m sorry you can’t grasp this, but that is why people treat you as irrelevant to the adult conversation on these subjects: you are denying the sky is blue.
June 16th, 2009 at 9:07 pm
So you argument essentially boils down to this:
I don’t give two shits if you call me on making stuff up, I’m and “adult” and I can wave my hand and magically things are true.
Yea, real mature.
June 18th, 2009 at 12:36 am
Nathan, somehow I thought that that was your argument (#60), not someone else’s.
You seem to be adept at fabricating “facts” out of the thin air. Do you really believe that doctors in Canada, NZ, the UK, France, Germany, Denmark, Sweden, Finland, Norway, the Netherlands, and so on are barely scraping by? Do you really believe that single payer countries have people dying from lack of treatment the way that people in the US are? Do you really believe that caring about what happens to your fellow citizens is just an excuse for wanting expanded government programs? Have you forgotten why “governments were instituted among men?”