A liberal co-worker and I have had a back and forth via email
over health care. Here's some if it.
Me:
I was very bothered the other night in the debate to hear Obama,
the champion of “change” try to scare voters by saying that McCain
wants to do away with the tax break that employers get for
providing health care. IF ONE IS EVEN A PASSING STUDENT OF OUR
CURRENT SYSTEM, ONE MUST ACKNOWLEDGE THAT THE CURRENT METHOD OF
EMPLOYER-FUNDING IS THE REASON WE ARE IN THE MESS WE’RE IN. I write
that in all caps, because, if you don’t agree with that, there is
no point in reading further.
I have to start with first principles. These are mine, not
someone else's, though I am sure others believe them as well. They
are not the only first principles I could list, but they are the
most apt to this problem:
- I believe that a free and open marketplace provides the best
odds for distribution of resources in a market/economy.
- I believe that individuals, given enough information, will make
decisions that are in their best personal interest (this would
include health care decisions, as well as financial decisions,
among others).
I will stipulate these facts vis a vis the health care situation
in the United States, and agree that addressing these issues would
go a long way towards solving the problems many people see in the
health care industry:
- Health care costs are rising out of control, outpacing
increases in wages, and even the inflation rate, and that this is a
decades-long trend that any solution must reverse.
- There are far too many people (who are not in transitory
situations), who are without health insurance, and this number must
be reduced, to zero as a goal.
- A pure free market insurance solution will seek to apply higher
costs to the sick.
Looking at the range of solutions, they are bracketed by a
purely consumer based solution, where we all pay what the services
actually cost, out of our pocket, and a completely government-run
entitlement system, where we pay nothing at the time of service,
but the system is funded by the government (through our tax
dollars, deficit-spending, whatever schemes the government needs to
devise to pay the providers). The answer lies somewhere in between
these two extremes.
For me, in evaluating the health care position of a candidate, I
care whether the plan adheres to first principles, as well as how
well it will address the realities stated above.
Neither John McCain, nor I, are advocating turning each
individual loose to handle health care costs on their own,
negotiating with doctors separately. Obviously, insurance companies
bring the power of a collective to bear, and use that power to
influence the prices they pay to doctors, hospitals, drug
companies, etc. I don't think anybody with a serious proposal is
suggesting anything other than using the insurance model for health
care. I advocate having a system that encourages a national market
for health insurance among many insurers, while at the other
extreme are those who advocate a single insurer, the US
Government.
My core disagreement with Obama's plan, is that the ultimate
result is government will put itself in competition with private
insurers, and due to its size, continuing demands from
constituents, and Congress's insatiable appetite to buy votes, we
will find ourselves with a single payer system. I realize
"government run healthcare" is an invective to some, but, recall, I
started this thread after Obama said that John McCain wanted to
raise his taxes via the elimination of the employer health care tax
credit, a statement that is arguably untrue.
Where the government is making decisions for us, we lose
freedom. Since this is ultimately about freedom, the question
voters should be asking themselves is, "Who do I trust to make
decisions about my health care? Government bureaucrats, or myself?"
You might say, how is that different from today, with the role of
government bureaucrat played by a private insurance company?
The difference is, in the government case, you have no
alternatives to choose from and decisions will be made by a
government who is prepared to enforce its decisions at the point of
a gun. In a thriving, free-market system, the disgruntled consumer
would switch to another insurer. In a government-run system, are
you going to throw the bums out? That doesn’t seem to have worked
with most of the crises of our time.
I responded to his specific comments:
[Him] I think we can agree that the current system for health
insurance and health care is broken. The discussion is how best to
address it. Also note that I'm not convinced the Obama plan is the
best plan.
[Jay] The current system of employer-funded health care is,
indeed, if not broken, seriously flawed, and has been since its
inception. Growing out of the Blue Cross days of the 20’s and 30’s,
it was developed and expanded during WW2, in an environment of wage
controls; offering health insurance as a way for employers to
attract employees and retain them was later encouraged by the
government through tax policy. Thus, we have our problem today. It
was interesting to hear Obama praise this system in debate 2, and
attempt to scare people that McCain wants to change this system.
Some change there.
[Him]The first thing to point out is that "government run health
care" is often thrown about like an invective.
[Jay] If everyone agreed the government ran things great, we
wouldn't see it as an invective? I point it out and will
continuously point it out, because I believe this is absolutely NOT
the path I, nor the majority of Americans want to follow. As much
as we know what caused this current mess, we do not want to replace
it with what will ultimately be another, equally bad for the
consumer, and really, really, really bad for the taxpayer, mess –
which is what a single-payer, government-administered, system will
be.
[Him]Since McCain has benefited from government run health care
for just about all his life, it must not be all bad.
[Jay] Whoa! Do you think McCain went into the military and then
public service because of the quality of the health care? I can
tell you, having experienced the military health system firsthand,
that most assuredly is not why he did it (maybe it had more to do
with two generations of sailors before him?). Maybe he did go into
politics for the health care. Having lived in DC, and been part of
the DoD complex, I know what the Federal Employees Health Benefit
Program (FEHBP) is, and, actually, as a model for the solution, it
may be close to what we actually want. The interesting thing about
that, is during the Hillary-Care fiasco, at one point the
Republicans were proposing (I think it was Phil Gramm, that
wascally McCain advisor) that we extend the FEHBP to all Americans,
under the guise that if it were good enough for Congress, it ought
to be good enough for the rest of America. Of course, that is
ancient history, and we still would have had to figure out the
funding issues.
[Him]Furthermore, many other countries have found ways to
improve the health care of their citizens through some sort of
government intervention.
[Jay] And many have ended up with rationing (ending up with long
waits for services) and price controls, and a two tiered system
that sees the wealthiest either going off-shore, or paying doctors
(in some cases illegally) under the table. I'm curious to hear the
good examples.
[Him]So we need to stop using that phrase like some kind of
scare tactic.
[Jay] I am resisting the temptation to launch into a tirade that
“government-run health care” has now entered the lexicon as
verboten. How about not scaring them about McCain’s plan?
[Him]One problem with free-market health insurance is you lose
the bulk buying benefits of a group policy like you get with an
employer (be it private or the government).
[Jay] I think you are confused by what I (and others) mean. No
serious person is suggesting we do away with private insurance.
We’re suggesting that the United States government not become the
primary insurer of most Americans (it already is for seniors,
military retirees, and the poor).
As Barney Frank might say, this is a shibboleth. You seem to
assume we're all going to negotiate directly with our doctors.
There are obviously still going to be insurers. They'll be private
insurers, not the single payer that many government-sponsored
(how's that sound) proponents favor. One of the changes McCain
wants to make is to allow consumers to be able to cross state lines
and buy health insurance. This would allow us all to seek the
insurer who's plan most closely matches our needs and pocketbook,
without being tied to some of the cost-creating legislation that
some states like to add. Just as states like SD and DE make it
easier for credit card companies to operate in their states, other
states would become clearinghouses for health insurers. Ultimately,
you’d see rationalization in these plans as consumers settle on the
minimums acceptable to them. This would go a ways towards
introducing free-market forces into a system largely devoid of
them.
[Him]My recent MRI would have cost me $1200 out of pocket, but
my health insurance company had negotiated a rate of only $630. The
same is true for a private (or COBRA) insurance plan, it would cost
me thousands of dollars more than the one with AT&T.
[Jay] The point is that bulk creates negotiating ability. Sure,
I agree, but, without competition, don't we just create the New
AT&T, only this time run by bureaucrats. I think we can all
agree the consumer is much better off after telcom deregulation.
Much the same would be true if we allowed the free market a greater
hand in health care.
[Him]I personally hate the effects of the whole "Consumer Driven
Health Care" movement. What it does is cause you to sometimes avoid
a procedure or medical action if the cost is too high. And I'm not
talking about elective surgery. Awareness is good. Choosing to
avoid medical care because of cost is not.
[Jay] Perhaps the devil is in the details here. And, you need to
recall that CDHP’s are a relatively new invention, and still
limited by regulation. Democrats in Congress have successfully
fought to place limits on what qualifies as CDHP’s and when you can
use an HSA. Conservatives have long proposed that those very large
deductibles and out-of-pocket expenses that it takes to today
qualify as a CDHP/HSA be reduced, making them more attractive to
consumers. This is another free-market reform we could achieve
today. Regardless of WHO has thwarted this (Democrats),
Conservatives and Libertarians want to see these plans made more
available and more attractive, by decreasing those deductibles and
out-of-pocket maximums, and increasing the amount of money people
can put into HSA’s.
Part of the reason I don't use the AT&T HSA plan is really
the reason you cite here. The out-of-pocket expenses are too high
for me, joining it with two kids and a wife. If I was 23, it would
be a no brainer though. However, because HSA's are limited in
number, they are also limited in what kinds of plans qualify for
them. A more friendly Congress to consumer choice could help
alleviate the problem you mention, by lowering the amounts on the
plan to qualify for HSA, and increasing the amount of money you can
put into an HSA. These are reforms and things conservatives have
pushed for. However, in that these plans force the consumer to
think twice about going to the DR for the sniffles, going to the
emergency room for a little cut, or deferring care for items they
shouldn't be wasting expensive doctor’s or ER time on, I think
that's a good thing. I know when we were growing up, we didn't go
to the Dr. for everything. People are conditioned to do that now,
because the cost is shielded from them.
Do you have firsthand knowledge of someone who has avoided a
medical care because of their participation in a CDHP? Or, is this
theory?
[Him]No I do not agree with you that competition is the key to
solving this problem.
[Jay] I know. I believe in the free market, and you may not. The
fact that a purely free market would surely charge the sick more
for insurance is a problem that we have to come to grips with when
applying purely free market solutions to health care. That is the
largest problem to purely free market solutions and is why this is
such a difficult problem. But, I think we can design a system that
maintains as many free market principles as possible and address
the cost issue for higher-risk people, the portability problem, and
the coverage problem. I’m not arguing as a Libertarian, who might
just say – “let them eat cake.”
[Him]Here's a nice (and fair) analysis of their two
proposals:
[Jay] I looked at the site. It seems a reasonable analysis of
the plans as they stand today. I like the voting, obviously this
site is hit by those on the left much more than those on the right.
Even on the funding issue, where there is NOTHING good said about
the Obama plan, the "voters" still give it an overall passing
grade. Either the site is hit by partisans, or, people are willing
to pay ANYTHING for what Obama is offering. At any rate, the
analysis doesn't go far enough to suggest the ultimate result of
Obama-care, which will be a government run single payer system.
[Him]Universal coverage is critical to any plan I would support,
but I am concerned about what the Obama plan would cost.
[Jay] It would cost a lot. It would eclipse Medicare and
Medicaid immediately and would rival social security. Plus, it
would ultimately put the government in charge. You may trust your
government to do the right thing, I don't. I see Obama's plan as a
step towards socialism. The United States is not England, Canada,
France, or Cuba. I will reject arguments that we should be more
like them. We are the greatest country on earth precisely because
we are not like them.
[Him]I would like to see the best of both plans, and other
ideas, combined - but the likelihood of the country coming together
is pretty slim.
[Jay] It won’t happen as long as Obama continues to scare people
by telling them lies about McCain’s plan, as he dis in the debate
and does on his stump speeches (I watched one yesterday, it was
maddening listening to the misrepresentations).
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