Right or Privilege?
New York magazine’s Jonathan Chait on conservative opposition to health-care reform:
Opponents of the law have endlessly invoked “socialism.” Nothing in the Affordable Care Act or any part of President Obama’s challenges the basic dynamics of market capitalism. All sides accept that some of us should continue to enjoy vastly greater comforts and pleasures than others. If you don’t work as hard as Mitt Romney has, or were born less smart, or to worse parents, or enjoyed worse schools, or invested your skills in an industry that collapsed, or suffered any other misfortune, then you will be punished for this. Your television may be low-definition, or you might not be able to heat or cool your home as comfortably as you would like; you may clothe your children in discarded garments from the Salvation Army.
This is not in dispute. What is being disputed is whether the punishments to the losers in the market system should include, in addition to these other things, a denial of access to non-emergency medical treatment. The Republican position is that it should. They may not want a woman to have to suffer an untreated broken ankle for lack of affordable treatment. Likewise, I don’t want people to be denied nice televisions or other luxuries. I just don’t think high-definition television or nice clothing are goods that society owes to one and all. That is how Republicans think about health care.
Read the whole thing here.
Since when is a broken ankle an example of “non-emergency medical treatment”?
but not deprivation of basic medical care
I think there is a legitimate debate to be had over basic medical care. Contraception, sterilization and abortifacients can hardly be called ‘basic’, nor can removing spending caps. Unfortunately, the world we inhabit does not allow the unlimited provision of any good, even medical care.
A broken ankle is non-emegency because, if you go to the ER, it will be temporarily casted and you will be sent home to see your physician at a regularly scheduled appointment.
If you don’t have insurance, then duct tape and newspaper make a fine splint and the outcome is usually just fine 80% of the time. The ER picks up the cost of the hospital visit.
Stuart,
A broken ankle may not be an example of “non-emergency medical treatment,” but, if you read the rest of Chait’s post, you will see that it is an example of the medical conditions millions of uninsured Americans don’t get treated.
Bruce,
No one is talking about the unlimited provision of medical care. The question is whether the inevitable limits should be determined by relative need or by personal wealth.
Joe,
What can I say? If only there were more doctors like you, how much cheaper health care would be.
This Thursday will historic and notable. What will Anthony Kennedy do. A previous article in the New Yorker claimed that SCOTUS will not alter the law drastically. http://nymag.com/daily/intel/2012/06/how-badly-will-scotus-screw-up-obamacare.html Some Catholics are looking at contraception as being focal in this decision. But really it is almost beside the point. Politics being what it is my view is that the Republicans oppose this law since they did not propose. They lost out on the New Deal and now on health care. What can they boast of? Taxing the rich less. This group on the Supreme court are really intriguing. The activists Catholics will reveal more of themselves. Who do they represent? Fortnight for Freedom, btw, has been a massive failure. All of this makes great drama. Hopefully needy people will not be deprived in the politics of it all.
A true irony here is that the mandate, the part of the bill most often criticized, the part debated extensively by the Court for public consumption, was originally a Republican proposal hatched by conservative minds at the Heritage Foundation, backed by Newt Gingrich and later put into effect on the state level by none other than Mitt Romney. All through the 2008 campaign, Obama said he was against the idea, only to change his mind and try incorporating it into health reform in the foolish hope of winning support from the Naysayers From Hell. Instead, they’ve relished hoisting him on their old petard. I get the sense he expects more of the same on Thursday. The only question is will that be It? Or will they strike down everything, including the ban on those pre-existing conditon clauses everybody claims to hate? Some say the Affordable Care Act can’t function without the mandate, and that striking it down effectively kills the bill. But why? Obama himself made a pretty good case for health reform sans mandate back when. Being forced by Republicans into doing it his way could turn out to be the secret to success.
Bill Mazzella:
I have strong feelings against the hype and money spent on this Fortnight for Freedom and have given no support to it, especially when I learned that each diocese has increased its subsidy to the USCCB by 3% to support the Ad Hoc Committee for Religious Liberty. But what makes you think that has been a massive failure?
“A true irony here is that the mandate, the part of the bill most often criticized, the part debated extensively by the Court for public consumption, was originally a Republican proposal..”
I trust nobody thinks I was referring to the HHS mandate. There are mandates, and then there are mandates.;-)
How does one judge the success or failure of something like the Fortnight for (of, for?) Freedom? If there’s some way to register a vote, symbolic or otherwise, I’d love to know about it.
Helen,
Fortnight for Freedom is a failure in the same way World Youth Day has been. It is relatively easy with so many parishes to get a lot of people to go to these rallies which for the most part is organized by clicques within parishes with some agreeable people mixed in. On the grassroots level I have seen no enthusiasm for Fortnight for Freedom as I have not seen for WYD. They are like political rallies without the numbers.
Shouldn’t Chait wait for the actual decision before he serves the sour grapes? I saw a little sidebar story in the Cleveland Plain Dealer over the weekend in which the newspaper surveyed 21 constitutional law professors, and 19 of the 21 think the Affordable Care Act passes constitutional muster. It seems well within the realm of possibility that the law will be left standing, either in its entirety or with most of its important provisions left intact.
Chait asserts that Republicans – apparently, all of ‘em – believe that health care is not a human right … but brings forth not a single scintilla of evidence to support that accusation.
The possibility that Republicans do think that health care is a right, but that the Affordable Care Act is the wrong way to deliver it, seems to not have occurred to him.
“The possibility that Republicans do think that health care is a right, but that the Affordable Care Act is the wrong way to deliver it, seems to not have occurred to him.”
Fair enough. So what is the alternative they have put forward?
“Fair enough. So what is the alternative they have put forward?”
Here’s a good starting place: http://www.forbes.com/sites/aroy/2012/06/20/mitt-romney-outlines-his-plan-to-replace-obamacare/
Here’s another: http://www.forbes.com/sites/aroy/2012/04/30/how-george-w-bush-would-have-replaced-obamacare/
And here are a couple of bipartisan options depending on how the Court rules: http://www.forbes.com/sites/aroy/2012/05/19/what-should-congress-do-after-the-supreme-court-decision-on-obamacare/
The notion suggested by Chait that if the mandate is struck down, his parade of horribles will follow is a hollow one. Don’t ask Chief Justice Roberts, ask liberals like Howard Dean and Michael Waldman who have adamantly opposed the mandate from the start.
(As regular readers know, the fact that employers can purchase health insurance for their workers tax-free, whereas individuals can’t, is the original sin of the U.S. health-care system.)
This quote is from http://www.forbes.com/sites/aroy/2012/04/30/how-george-w-bush-would-have-replaced-obamacare/
As someone in the business of health insurance, I have to ask why a tax break will solve the problem of the uninsured for anybody? Businesses get a tax break now and this does nothing to solve their real problem of rising prices. Many millions of people buy individual insurance without a tax break. I guess I am not seeing how a deduction on the first $7,500 or $15,000 of a person’s income will free up the $7,500 to $15,000 they need to buy an insurance plan. When we speak of a deduction, aren’t we only talking about the tax liability of the deduction? It’s not like people are going to get a $7,500 to $15,000 tax refund with which they can buy insurance. Yes, the same people are proposing a credit for people who can’t pay taxes at all and get the benefit of the deduction. But I don’t see the credit as coming close to being able to pay for insurance in the current market.
In your first citation, Romney claims that he wants to solve the problem of “pre-existing conditions” by allowing anyone who has ever had insurance to have insurance again even if they have pre-existing conditions. While this begs the question of what happens to those who have pre-existing conditions and have NEVER been able to get insurance because of it, it also begs the question of how this is different from a mandate that requires insurance companies to cover anyone. The article itself says that the latter is a recipe for disaster, since it provides an incentive for people to simply wait until they need insurance in order to buy it. But what does the Romney plan do that is different? Unless he is secretly proposing a mandate too?
I think there should definitely be a tax deduction for self-purchased insurance, and there should also be a full deduction for child care costs. But it’s certainly not the solution. Daycare in NYC runs about $15000 a year and up (unlicensed is cheaper). Crappy self-purchased family insurance can be around $18,000 plus a year. Even with tax deductions, these expenses are still very unaffordable for working people.
“As someone in the business of health insurance, I have to ask why a tax break will solve the problem of the uninsured for anybody? Businesses get a tax break now and this does nothing to solve their real problem of rising prices. Many millions of people buy individual insurance without a tax break.”
Maybe this will help: http://economix.blogs.nytimes.com/2009/05/22/is-employer-based-health-insurance-worth-saving/
A helpful list of the major problems: opaqueness, temporariness, and, as she points out, discourages certain coverages.
The notion that the current employer deduction for health insurance is irrelevant to the question of cost and coverage is a surprising one, given the bi-partisan consensus (as evidenced in the post) that it is a problem (not the ONLY problem, but a major problem).
Per Bill: “Fortnight for Freedom is a failure in the same way World Youth Day has been. …”
Oh my; this shows the level of your disconnect. The 15 million or so young folks who have gathered over the years at WYD celebrations since the days of JP2 would beg to differ:
1985 300,000 in Rome
1987 1 million in Buenos Aires
1989 400,000 in Santiago de Compostela
1991 1.6 million in Częstochowa (Poland)
1993 500,000 in Denver
1995 5 million in Manila
1997 1.2 million in Paris
2000 2 million in Rome
2002 800.000 in Toronto
2005 1.2 million in Cologne
2008 500,000 in Sydney
2011 1.5 to 2 million in Madrid
And WYD in Rio (2013) will likely draw a large crowd as well.
I’m well aware of the history of health insurance in the United States. I know that employee sponsored healthcare is a problem (from the point of view of business, who would like to get out of the business). But changing the current business deduction to a universal personal deduction does not 1) address the problem of the uninsured (for I have not seen a good case made that the problem of the uninsured in the US is that they don’t have a tax deduction) and 2) it creates a new problem with more costs passed on to the worker in cases where they do have insurance. Business wants to get out of the insurance business because they are hit with costs each year that rise faster than inflation. Their desire to get out is to reduce these costs. Getting out does not reduce costs as such; it would only allow them to pass these cost increases to the consumer. I have seen the argument that if consumers had “control” over their insurance (a right wing meme for consumers bearing all the costs) then costs would go down. I am not seeing this; I don’t see a mechanism for this.
So the Republican plan seems to me to be a zero sum plan to benefit business at the expense of the consumer.
Jeff,
Statistical Catholic you are. The kids were on a fun trip often paid by others.
I doubt that there is data about the effects on the youth or their local churches from these trips, but anecdotally, some accounts I’ve read had some posive effect — albeit more often on the already devout, however. I don’t know how to evaluate these longitudinally or what that says about anything, but I think the “Fortnight” is a far different catregory oin any case.
In our diocese, judging from the public press, it has been more of a rallying point for those of us who oppose the rhetric and often the substance of the “fortnight” (see Richard Rohr’s blog for succinct statement) but so much related to the authority the bishops are attempting to exercise from issues with LCWR to the sex-scandals to the conscience issues reawakened themselves. I don’t know if it’s going to be a ‘success” for the hierarchy, but it’s stirred up folks. And now waiting for SCOTUS on healthcare….
Jeff, thanks for those Avik Roy links – very interesting stuff.
Suppose that the Court decision leaves the ACA in tatters, or even strikes it down entirely. And suppose we end up with this configuration after the November election:
* President Romney
* Republicans in control of the House, perhaps with a slightly smaller majority than they have now
* Republicans or Democrats with a narrow majority in the Senate
(I don’t think it’s probable – nor extraordinarily improbable – that Romney will win. This is just a hypothetical).
Istm that with this configuration, Republican-sponsored legislation to enact major reforms to ACA, or to replace ACA in its entirety, could receive serious consideration. My question is: would Democrats in the House and Senate collaborate with Republicans to solve the problem of 43 million uninsured, with the knowledge that Republicans would take political credit for it?
“The kids were on a fun trip often paid by others.”
Bill, puritanical Catholic you are.
But this is not a thread about World Youth Day or the Fortnight for Freedom. Back to the topic at hand: health care — is it a right or a privilege?
Jim,
That’s an interesting question, but I see no reason to think the Republicans would do anything to take care of those 43 million uninsured if they were again in control of the House, the Senate, and the White House. You’ll notice they’ve stopped talking about “repeal and replace”; they are now promising only to repeal. They’ve had many chances in the last twenty years to pass their own health-care reform, and they never have. They had an alternative plan when they opposed the Clintons’ proposal, but once they succeeded in killing that proposal, they quickly forgot all about their alternative plan: it was never meant to be anything more than a foil. Likewise, they now protect themselves from the charge that they don’t care about the uninsured by pointing out that conservative proposals for health-care reform really do exist. But there are two things to notice about these proposals. The first is that many of them wouldn’t do much — or anything — to address the problem of those 43 million uninsured Americans, and the ones that would are not obviously more “conservative” than the Affordable Care Act, whose basic mechanism was the brainchild of a conservative think tank. The individual mandate was a conservative idea that enjoyed broad support among Republicans until Obama got behind it. After that, it became a piece of unconstitutional socialism. Call it the triumph of partisanship over ideology. (You can read the whole sorry story here.) The second point is that none of the (currently) conservative proposals has widespread support among Republican lawmakers. It’s important for Republicans to be able to say, “Our policy experts have ideas, too,” — and just as important for them to be able to distance themselves quickly from those ideas when, they’re rejected by the Republican base, which does not regard health care as a right.
When opponents use the epithet “socialism” they mean it in the same way that Social Security and Medicare are “socialistic.” They realize that there is no political support to end either program, so they want to nip universal care in the bud, as they know they won’t be able to once it is instituted.
I think the idea may be that the “right” is contained in the market and that untrammeled (by regulation or taxation) access to the market is the primary right here. Within the market, people have preferences rather than privileges. Some people may have more money than others, but everyone has an equal opportunity to produce wealth, so everyone has an equal opportunity to get health care; provided the market is working.
For those who are uninsured, some are uninsured because they don’t want insurance; some because they are too lazy to create wealth, and a few because the market (which is heavily regulated) coupled with the current taxation system prevents them (unaturally) from having access. Or, the same (external) distortions (via regulations) are keeping entrepreneurs from approaching those consumers.
I think the idea that changing the tax system will help this assumes the following:
1. Employer funded insurance acts as a drag on wealth creation in the private sector. If this burden were removed from business, they could create more wealth/jobs for everyone.
2. Employees, being the passive recipients of health insurance benfits from their employers (for the most part) do not have an incentive to find the best insurance package tailored to themselves personally and THIS is in part what is causing costs to go up.
The bottom line asssumption is that the freer the market, the more wealth is created and the more wealth that is created the more money/jobs there are for people to have benefits. This is why all roads lead to the private sector.
If the individual mandate goes , I see followup stories in every metro area .e.g. When the un-insured healthy 25 year old crashes his motorcycle and incurs 500 thousand to a million in tax payer health costs it will be just like the Citizens United unintended consequences decision. One would think that conservatives would be for the mandate!
Get ready for new category = Welfare Princes.
Per Bill “…The kids were on a fun trip often paid by others.”
Careful Bill, talk like that might cost you your Democrat street cred! How dare you siggest people pay for things themselves.
:-)
Ooh – this is getting good. Of course “kids” go on trips paid for by others, that is one reason why at that age, they are still called “kids”. The WTD trips for these kids are usually by their families and the kids (if they have jobs), their parish, youth group project funds, or a combination thereof.
WYD trips I mean -
Here’s another ‘basic medical need’
Obese adults should get counseling, federal task force says
Under the healthcare law, insurance companies would be required to cover the panel’s recommended weight-loss treatments.
The question is whether the inevitable limits should be determined by relative need or by personal wealth.
Matthew,
So if I have the money to purchase medical care but it not provided under the government insurance plan, you are going to prohibit me from purchasing it? Thats the only way to implement your idea.
And removing caps on medical insurance payments is definitely a big step toward unlimited medical care. If there is no limit on the payment, what is the limit??
If the obesity is pathological, why shouldn’t it be treated? And if it is treated, why shouldn’t it be covered?
No, Bruce, that is not the only way to implement my idea. Nor is it even the way it is usually implemented.
Once we ensure that everyone has an adequate level of care, there is no reason the rich can’t pay out of pocket for treatment not provided under a government-sponsored system. Do you really imagine that rich people in the United Kingdom or France or Canada are unable to pay for medical services their governments don’t cover?
Again, the people who should be determining what gets covered and what doesn’t are people whose main priority is public health, not private profit. The proper criterion for the just distribution of basic health-care resources is purely medical; a patient’s wealth or poverty should have nothing to do with it.
Obese adults will get the help they need – if the Obama economy keeps floundering like this, soon people will not have the money to gas the car or buy enough groceries. Pushing a wheelbarrow to the market piled with enough money to buy some bread, they will then exercise more and eat less – problem solved; everyone slim and trim!
;-)
“1. Employer funded insurance acts as a drag on wealth creation in the private sector. If this burden were removed from business, they could create more wealth/jobs for everyone.
2. Employees, being the passive recipients of health insurance benfits from their employers (for the most part) do not have an incentive to find the best insurance package tailored to themselves personally and THIS is in part what is causing costs to go up.
The bottom line asssumption is that the freer the market, the more wealth is created and the more wealth that is created the more money/jobs there are for people to have benefits. This is why all roads lead to the private sector.”
The arguments in the links I’ve provided don’t say one word about “wealth creation.” Rather, they explore the notion that businesses who receive a deduction for buying costly health policies for their employees are advantaged vis-a-vis many families (and individuals) who purchase their own plans after-tax. The idea behind levelling the tax system is to benefit those families, and reduce costs by increasing transparency in the market.
You obviously disagree with the impact this reform will have. But you make a serious mistake in attempting to dismiss the idea by setting up strawman arguments that you then knockdown. It also bears noting that the ACA has an element of this in it as well by capping the deduction for employers who purchase so-called “cadillac” plans. The proposal isn’t meant to be a cure all, but one element that has bi-partisan support.
Health care is a right and the US is worse than too many countries. when it comes to social justice. And High definition tv’s can be bought for $100.00…
Tell me why vocations have not materialized from WTD. It was pure propaganda. So they were colossal failures. Not puritanical Mathhew. I don’t appreciate spin over substance.
One of the arguments you linked to very clearly wants business to be out of the business of providing insurance. It is a fact, accepted by all sides I think, that the current health care system in the United States is a drag on the economy in general and business in particular. One might ask why one would want business out of the health insurance industry. It is so they don’t have that cost. What would business not having that cost mean? It would mean more productive business, which in turn would mean more wealth production. It’s not a hard argument to follow and it is not an off the wall argument relative to the whole thrust of Republican economic thought, which is to support business for reasons of general wealth (and job) creation. If you think that I am putting up a straw man, it’s because it is an intrinsicly weak argument although it is consistent and coherant.
You say that businesses that have tax breaks are advantaged vis-a-vis the consumers that don’t? This would only make sense if businesses were somehow competing with these consumers. And is that what you are saying? Because if you aren’t, what is this supposed “advantage”?
Matthew -
1. “That’s an interesting question, but I see no reason to think the Republicans would do anything to take care of those 43 million uninsured if they were again in control of the House, the Senate, and the White House. You’ll notice they’ve stopped talking about “repeal and replace”; they are now promising only to repeal.”
- Apparently you didn’t read or listen to Mitt Romney’s recent speech in Louisiana where he spoke about repealing and “replacing” explicitly. You could also take a gander at one of the links I posted.
2. “They’ve had many chances in the last twenty years to pass their own health-care reform, and they never have. They had an alternative plan when they opposed the Clintons’ proposal, but once they succeeded in killing that proposal, they quickly forgot all about their alternative plan: it was never meant to be anything more than a foil. Likewise, they now protect themselves from the charge that they don’t care about the uninsured by pointing out that conservative proposals for health-care reform really do exist.”
- Again, the link above notes the Bush introduced a reform plan towards the end of his second term after the Democrats took control of Congress.
- I’ll just note the co-sponsors of that “foil”: John Chafeeand, Bob Dole, Chuck Grassley, Orrin Hatch, Richard Lugar, Alan Simpson, and Arlen Specter. Rabid right-wingers!
3. “The individual mandate was a conservative idea that enjoyed broad support among Republicans until Obama got behind it. After that, it became a piece of unconstitutional socialism.”
- There was nothing like “broad” support among conservatives for the mandate. From the beginning, people like Joe Scarborough dismissed the mandate as unconstitutional. But you are partially correct: liberals have been the more vocal critics of the mandate because many have seen it as a boon to the insurance business. You can read more about that here: http://www.forbes.com/sites/aroy/2012/04/02/once-upon-a-time-liberals-hated-the-individual-mandate/
4. “The second point is that none of the (currently) conservative proposals has widespread support among Republican lawmakers. It’s important for Republicans to be able to say, “Our policy experts have ideas, too,” — and just as important for them to be able to distance themselves quickly from those ideas when, they’re rejected by the Republican base, which does not regard health care as a right.”
Apparently you missed the recent New York Times article detailing the split among Democrats over the ACA. Or Barney Frank’s recent comment that passing the ACA was a huge mistake. These disputes are primarily over whether the President went to far in trying to get conservative Democrats to support the plan. So the idea that this great Democratic party is unanimous in the right for all to have health insurance doesn’t seem to pan out.
“It is a fact, accepted by all sides I think, that the current health care system in the United States is a drag on the economy in general and business in particular.”
Of course no one is disputing that. What you’re arguing, however, is that ONLY reason conservatives support amending the tax provision is to unleash business. And that is not accurate at all. Rather, Roy’s (among others) argument is that the current tax deduction contributes to the high costs and distorts the market. In other words, the tax reform is targeted at improving one particular market: insurance. By the way, note that one of the critics I linked to above actually supports extending Medicare and MEdicaid as a way of insuring more rather than an individual mandate. So the idea isn’t exactly the bastion of greedy right-wingers.
By the way, you assert that “everyone” wants business out of insurance. That isn’t borne out by polling at all. And the polling also suggests that while businesses may be frustrated by the current system, they fear the regulatory uncertainty with the ACA MORE.
When I said “everyone” want business out of the business, I was speaking about everyone in business.
Roy’s tax argument (it distorts the market) seems incoherant to me other than as an argument that taxation distorts the market since each tax dollar spent is one that the private sector is not spending.
“When I said “everyone” want business out of the business, I was speaking about everyone in business.”
The businesses I’m familiar with are more worried about the (regulatory) costs of ACA. Take a look again at Uwe Reinhardt’s comments – the problem with the ACA from her perspective is that it strengthens and reinforces the current system in an effort to graft greater coverage onto a distorted system.
“Roy’s tax argument (it distorts the market) seems incoherant to me other than as an argument that taxation distorts the market since each tax dollar spent is one that the private sector is not spending.”
Then why did the President include a similar feature in the ACA? Unless buying overly-expensive health insurance plans which is rewarded under the current tax structure has no impact.
By the way, the President has made the same “general” argument you refer to above about the benefits to business for the reforms in the ACA despite being, as you say “an intrinsicly weak argument although it is consistent and coherant”.
“Apparently you didn’t read or listen to Mitt Romney’s recent speech in Louisiana where he spoke about repealing and ‘replacing’ explicitly.”
Point well taken, Jeff. I was thinking of the Republicans on Capitol Hill. Anyway, the proof is in the replacement. If you think Romney has a plan that will take care of the 43 million uninsured Americans, please tell us exactly how you think it will work — and please make sure you refer only to what Romney has publicly endorsed, not to some obscure policy paper gathering dust at Cato or AEI.
“Apparently you missed the recent New York Times article detailing the split among Democrats over the ACA. Or Barney Frank’s recent comment that passing the ACA was a huge mistake. These disputes are primarily over whether the President went to far in trying to get conservative Democrats to support the plan. So the idea that this great Democratic party is unanimous in the right for all to have health insurance doesn’t seem to pan out.”
To claim that Republicans do not think of health care as a right is not to imply that every Democrat does. Most Democrats do, a few don’t; hence the controversy you cite, which does not tell against Chait’s argument, or mine. Because the Republican Party was united in its opposition to the ACA, Obama needed every Democratic vote he could get, and this required painful, perhaps regrettable compromises. The Democratic Party is now much less ideologically uniform than the Republican Party. You don’t need me to tell you that, and you don’t need to keep reminding me that there are Democrats who disagree with the positions I support. Surely it cannot still be a mystery to you why, given my positions, I would regard the Democrats as generally better than the Republicans on this and most other issues.
The rational libertarian/Republican argument that I find the most logical, in theory at least, is that the only way to bring down cost of medical care is to re-establish a medical care marketplace where consumers actually bear the cost of the services they receive (at least proportionally). The theory is that health insurance, Medicare and Medicaid are actually the culprits since they insulate consumers from the actual cost of the services they receive. In a free marketplace, individuals would help keep costs down by refusing unnecessary tests and procedures, which they now receive at low- or no cost. In the current system, Doctors are actually motivated to call up unnecessary procedures to protect themselves against malpractice claims in the current system.
So, all the motivations are wrong, and the consumer does not have a stake in keeping costs down. Lots of unnecessary tests and procedures, lots of equipment costs for medical gear that needs to be amortized by using it and charging for it, lots of hidden expenses.
The problem with fixing this, of course, is that it is the vast majority of the working class who will have to bear the burden of reduced and/or more personally expensive health care.
“The problem with fixing this, of course, is that it is the vast majority of the working class who will have to bear the burden of reduced and/or more personally expensive health care.”
Healthcare is a right of the rich. It is a privilige for all others, granted at the whim and will of Their Betters.
Get used to it.
“The Democratic Party is now much less ideologically uniform than the Republican Party. ”
Matthew, I don’t want to cause a major digression in your topic, but … I’m not sure I agree with this. In my view, the GOP was a lot more united and disciplined 20 years ago than it is now. This seems to me especially true on the values-laden social issues like gay marriage and contraception that we’ve tended to kick around here.
@Jim: Yes. One solution would be to allow health insurance ONLY for the rich. Everyone else should be true ‘fee for service.’ That would drive costs down while not infringing on the wealthy, who, after all, have earned their privileges.
(Sorry, the above was response to Jim McCrea)
“The problem with fixing this, of course, is that it is the vast majority of the working class who will have to bear the burden of reduced and/or more personally expensive health care.”
The Republican response would be to point to some of the policies proposed by conservatives, such as market-based competition, health savings accounts and tax credits, that would ameliorate the expense and, hopefully, reduce the current trends in health care costs.
But beyond that – the cynical part of me would note that what you’ve predicted is inevitable. What we are seeing now in Illinois is that, when the debt reaches a high enough level, cutting back on promised benefits (in the case of Illinois, that would be retirement benefits for public-sector employees) becomes reality. In other words, the working class is paying for more of its benefits than was promised. And benefits get cut for the poor, as Illinois is now doing by reducing Medicaid payouts by billions of dollars.
“That’s an interesting question, but I see no reason to think the Republicans would do anything to take care of those 43 million uninsured if they were again in control of the House, the Senate, and the White House.”
My own intuition is that the landscape has changed among the electorate. In part, that is because the public has become used to the notion that the ACA will be with us, and politically it’s much harder to take away an existing benefit than it is to block the creation of one that doesn’t exist yet. (Hence recourse to the courts to wield the bloody ax.) The other feature, I believe, is that things are different now in 2012 than they were in 2009 when the country was aflame with the health care debate. I don’t think many people believed three years ago that unemployment would be as high three years later as has turned out to be the case; and because of the weak jobs market, many more voters, or members of their families, have now personally experienced gaps in their families’ lives in which they’ve had to work without health care insurance coverage.
What does Fetal Personhood have to do with passing a Flood Insurance bill in the Senate? If this question seems ridiculous on its face here, well, I only put it up to show how low the GOP will stoop when it comes to grandstanding or kibbutzing on any issue so its pols can demonstrate their genuine prolife chops regarding abortion.
And they wonder why they can’t get anything done; why nobody in DC takes them seriously and after all the millions showered on the prolife movement by millions of hearbroken prolife activists, et. during the past 40 years … we have nothing to show for it all. Catholics need not fear of government “persecution” more than they need to be wary of some political “friends” in high places who demonstrate time after time their lack of political IQ and what that’s done to give their opponents more encouragement to pull whatever they desire on the biggest bunch of losing crusader naifs since the Children’s Crusade.
In the meantime, while Catholic bishops and their mislead lay flock seem so furiously whipped up into thinking the Obama Administration’s got the lions all riled up and waiting for dinner in stadia across the land . . . you never hear the bosses in the UCCB say a peep about all the taxpayers’ money they’re institutions are still taking from Uncle Sam.
“Hypocrisy about persecutions directed against Catholics by Washington, no way!”
“Bishops and Catholic college presidents, your federal research grants and federal student loan program money for this year ….”
Ah, but will the Inspector Bishop Reynaults be just as upset with the “help” we get from such prolife grandstanders like Sen. Paul whose antics just help the other side beat the living daylights out of our side for the umpteenth time since January 1973?
“I was thinking of the Republicans on Capitol Hill.”
As a Republican more interested in those dusty policy papers, I freely admit to a lot of frustration with the fact that most elected Republicans seem to be ignorant of the fact that they exist. Nonetheless, Ryan’s budget contains Medicare reforms built/premised on his work with Alice Rivlin, Robert Bennett introduced a health reform bill with Ron Wyden in the last session, and Tom Coburn and Richard Burr introduced a bill primarily aimed at FDA reform which has some cost-savings impacts for Medicare and Medicaid (and the bill gained the tentative support of some Democrats). As for Romney, again, his vagueness is maddening to me, but knowing some of those who support him and their proposals, I can see glimmers. (By the way, I find Romney’s frustrating vagueness no less frustrating that the vagueness of the President with respect to healthcare during the debate, and no less frustrating that his current vagueness with respect to his plans for deficit reform).
A Republican plan wouldn’t address all 43 million uninsured at once. Of course, under EMTALA they would receive health CARE even if they didn’t have health insurance. Nonetheless, even under ACA (as Ezra Klein points out in a blog post today), the enforcement mechanism in the ACA is so relatively weak that the likely outcome is that many will find it cheaper to forego the mandate, and not purchase insurance until they have to, so its not as if the mandate solves all the problems at once either.
Look out, JIm P. If you keep looking at the facts of how the poor folks have to live, you might end up like my dear old Republican friend — he’s turned into a raving liberal. Be careful.
Ann, I’ve been duly warned :-). It’s much easier to just live in a cocoon and read opinion pieces that echo one’s comfortable preconceptions. It’s this darned Christianity that complicates things.
Setting up a basic, minimal national health care plan is not as comlicated as you folks are making it out to be.
1-Put basic healthcare in the purview of the federal government
2-Limit the scope of the plan; understand thta the government cannot do everything for you
3-Slap a tax on everyones income to cover the cost
4-Allow individual or groups to supplement the national plan as they please and as they can afford
5-Move on with our lives
Again, the people who should be determining what gets covered and what doesn’t are people whose main priority is public health, not private profit.
Matthew,
You keep wishing away the limits. First, there is the cost of actually providing the service ie do we have the resources to pay for all this ‘public’ health care. And second, is the price sufficiently high to attract all the necessary resources to the industry. Right now, it seems that there is no consensus on one and complaints that even with our current inadequate coverage, the price of the second is too high.
Bruce -
You ask a crucial question that our country has been avoiding ever since Sarah Palin invented the concept of “death committees”, or whatever it was she called them.
The question is: can the U. S. fund the finest sort of American medicine practice for everyone always? I fear the answer is going to be No. When I say “the finest” I mean the sort of care that now only the very rich or the extremely well-insured can now afford. (The extremely well-insured are middle-class people like me who have both Medicare — which already spends a small fortune per year for some of us) and those who are fortunate enough to be able to afford supplemental insurance which covers most but not all of what Medicare does not cover. (No, Medicare plus supplement does not cover everything, but the remainder is manageable.)
It is often said that other countries, e.g., Cuba, provide universal health care and do it more cheaply than the U. S. does and for only *partial health care”. The problem is just what does “universal” care mean there: what do their “basic” services provide? Would we be satisfied with that? I’m quite sure the those who now get the best American medicine would NOT be satisfied.
I’m not thinking of end-of-life costs only. Yes, those can wipe away a life-time of middle-class savings. I’m thinking of the sorts of medical practices that stave off the effects of old age. For instance, in recent years I’ve had physical therapy for several periods of time just to help me stay on my feet (shingles and a mugging had affected me badly, though I wasn’t exactly “sick” — just weak). Would all weak old folks who have had a stroke, for instance, continue with therapy for as long as it can do them even a bit of good? That might last for years — for most of the rest of their lives, even as they (we) inevitably grow weaker and weaker.
And, of course, there are often those end of life treatments. Can we afford them universally? If not — and here’s the biggest question — what principles of triage would have to be employed? Very ugly thought, that. But it’s coming. For you as well as me. And we need to think about it now before the boomers are all old.
Bruce,
I guess I’m not as impressed with your question as Ann is. Yes, of course there are limits — always were, always will be — but no health-care economist believes the United States isn’t rich enough to provide everyone with decent health care. Countries less rich than ours manage to do it, and those countries end up spending less of their GDP on health care while getting better overall results. The burden is on people like you to say exactly why what works in nearly every other developed country wouldn’t work here if we ever able to get it up and running. Of course, there are many powerful people whose interests are served by our not getting it up and running. Private insurance companies, pharmaceutical companies, and many doctors have a lot to lose; they make less money in countries with better health-care systems. The inefficiency of our system is part of their profit margin.
Ken’s comment raises an interesting question, one spurred on by a blog post by Ezra Klein a couple days ago (http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/25/lets-say-the-affordable-care-act-is-overturned-what-happens-next/) in which he suggests a fairly straight-forward, relatively easy way that Democrats could accomplish what they want with health care coverage – namely extending medicare and medicaid coverage, which Ezra suggests can be done through a wholly constitutional means in Congress.
The question is: why wouldn’t liberals cheer the demise of (at least) the individual mandate, in not the entire ACA, and welcome the opportunity first to campaign, and then to govern, on the premise of directly expanding medicare and medicaid coverage (which are hugely popular programs – even among conservatives) and stop fighting over what all sides agree is a flawed bill?
Leave aside the constitutional issues of the mandate and whether the bill “bends the cost curve” (most experts, CBO included, have said it won’t). From the standpoint of political economy, dumping the ACA for a cleaner, more straightforward plan would seem more attractive if I were a liberal. If you believe that health care is a human right that can only be delivered best by direct government action at the federal level, i.e. a single payer system, then it seems to me you would be free to frame this choice in an election, and push it through Congress if you win a majority. To be sure, certain elements of the ACA are popular – and the President has shifted his policy from defending the whole of the bill, to its more popular individual, piece-meal reforms, but overall the bill remains deeply unpopular with Americans by wide margins(primarily because most Americans are satisfied with their current health coverage and fear the displacement of that system). So if the ACA goes down in whole or part, why wouldn’t liberals cheer, and say, “now let’s do what we really want” and avoid the costly compromises with Big Insurance and Big Pharma?
“The question is: why wouldn’t liberals cheer the demise of (at least) the individual mandate, in not the entire ACA, and welcome the opportunity first to campaign, and then to govern, on the premise of directly expanding medicare and medicaid coverage (which are hugely popular programs – even among conservatives) and stop fighting over what all sides agree is a flawed bill?”
A cynical answer, provided by Jay Cost, is: because that arrangement wouldn’t allow Democrats to dole out plums to their pet constituencies.
” … the mandate itself is the method by which the Democrats have delivered literally billions of dollars worth of patronage to the key interests groups that lined up with them during the health care debate. The party sought to apply new layers of regulations upon doctors, nurses, hospitals, retirement care facilities, etc., and they rightfully feared a rebuke from these key “stakeholders,” as the Obama White House called them. What better way to buy their silence than to require 30 million Americans become their customers, whether they want to or not! All it took was a flip-flop on the part of the president – who conveniently disavowed his campaign opposition to a mandate – and suddenly all those opponents turned in to lusty supporters, eager to get their hands on all that new revenue.
“But what about the “public option”? The inclusion of a public option would have mitigated the perniciousness of the mandate – for then, at least, the government would not be requiring individuals to contract with private, for-profit entities as a condition of their citizenship. Liberal Democrats, naturally, blamed Republican perfidy for the death of the public option – but it never stood a real chance, anyway. The White House hinted early in the health care process that there were many ways to get to universal coverage, and never once suggested that the exclusion of a public option would be a deal-breaker. And that was because none of those stakeholders whom the mandate bought off wanted to compete with the government! And what would be the point of buying them off with a mandate while including a public option? So, in reality, the “will they or won’t they” drama over the public option in the fall of 2009 was mere kabuki theater: the insurers, the drug makers, the doctors, hospitals, nurses, and so on would go ballistic. It was never going to make the final cut.”
http://www.weeklystandard.com/blogs/mandate-represents-what-s-wrong-democrats_647884.html