Medicare

(Yes, I know that electric trains generally only have a powered third rail. I'm just extending the metaphor.)

One of the most tired phrases in politics is "Social Security is the third rail of American politics."  The problem is that it's true - Bush figured that out by squandering all of his political capital trying to reform it back in 2005.  It turns out that old people vote and they can be easily scared when the spectre of taking away their government checks is brought up.

We face a similar problem with health care.  It's obvious that the system doesn't work, and not just for people with pre-existing conditions and those who lose coverage.  It costs too much and isn't portable.  The lack of a true national market and the employer coverage model is a failure.  Too many people lack coverage and those people stick hospitals with huge bills for admissions that could have been solved with a visit to the family doctor, if they had one.

That being said, there are a lot of solutions better than Obamacare.  We've heard them before on this site and others and they aren't the point of this post.  The problem is that if Obamacare is defeated, no politician in their right minds will touch the healthcare issue with a 10-foot pole.  In persuing the worthy goal of defeating one specific bill, the issue has been demagogued to the point of insanity with threats of "death panels" (Sen. Isakson (R-GA), who put the provision nominally at issue, thinks this is nuts), "keep government away from my Medicare (note: WTF?) and all sorts of hyperbole about the continued "existence of the republic."

And don't think for a minute that every accusation about killing grannies and such lobbed against government can't be lobbed at private insurers.

So instead of a debate on what to do, we have people holding up pictures of Obama with a Hitler mustache shouting down elected officials before they can answer questions.  We have liberals convinced that people who oppose Obamacare are foam-at-the-mouth dittoheads and birthers organized by lobbyists.  And they're partially correct - many (not all) town hall shouters have spouted a lot of nonsense and many are making this personally about the president and anger at losing the last election.  It's embarrasing to people who have real issues with Obamacare who want to and make something work instead of yelling until they're red in the face.

The window for reasonable debate has closed by conservatives who want to make this Obama's Waterloo and liberals who are circling the wagons against a perceived onslaught of crazies.  The next reform proposal from either side will fall into the same pattern.  Eventually, everybody with power to do anything will throw their hands up.

Now healthcare is a "third rail," just like Social Security.  There are other, smaller, third rails to contend with.  Our primary system is rigged to prevent any serious talk about ethanol.  Serious agriculture subsidies reform is stymied because the committees that make ag policy are filled with congressmen from districts that feed off the USDA teat.  We can't have a serious discussion about Israel for long without someone getting called an anti-semite or a zionist likudnik stooge.

The problem?  You can't cut the size of government with all of these third rails in the way.  Everything has to be on the table.

Healthcare isn't just a sixth of the U.S. economy, it's a very big chunk of government spending.  The problem with the deficit hawkery I've heard recently is that it's small bore.  Spending freezes avoid the difficult choices about what exactly we want to cut.  Pork appropriations, non-military foreign aid and arts funding seem like ripe targets for popular cuts, but they make up a vanishingly small part of the budget and won't change the overall fiscal picture.  Survey after survey shows that people think government is too big, but they don't want to cut funding for Medicare, Medicaid, Social Security education, defense or anything specific beyond the amorphous "waste."  The only real solution is to slow and reverse the growth of healthcare costs while still providing the care people demand, and we are in the process of blowing it for the next several decades by turning a deadly serious issue over to the loudest, angriest, least reasonable wing of the movement, destroying any hope of comprimise a la Wyden-Bennett.

In the zeal to stop a bad new policy, we have guaranteed decades of the bad old policy.  Good job guys.

If you can make it through the puerile and prurient ravings of David Shuster, sitting in for the normally oh-so-(mentally)-balanced Keith Olbermann, you find this nugget at 5:50 into the 8-minute-long stream of sexual jokes:

Lawrence O'Donnell, "[Medicare and Social Security] are well-working Socialist programs within the American government.  There's absolutely no other description of them."

Nice to hear a liberal admit this instead of trying to pretend these programs are anything but government taking from some to give to others.

Paul Krugman makes an argument that we're going to see again and again in the health care debate...

The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it.

I know that’s not what everyone says; some pundits claim that the United States has a uniquely individualistic culture, and that Americans won’t accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have a program — you may have heard of it — called Medicare. It’s a program that collects money from every worker’s paycheck and uses it to pay the medical bills of everyone 65 and older. And it’s immensely popular.

I suspect this argument isn't entirely wrong.  OECD countries who have universal health care generally do like their health care systems.  And since we're dealing with taking away some of the visible, tangible costs from consumers and replacing them with less visible secondary costs or moving them into the unseen future, it's not at all implausible that the public would like it.

After all, we are not choosing between government-managed health care and free market health care, but between government-managed health care and...a different form of government-managed health care.  The Right would  love to defend free markets in health care for various good philosophical and economics reasons.  Instead, we end up defending the status quo, which has rather less to recommend it.  That's not a good place for us.

However, there are three problems with what Krugman claims about Medicare being "immensely popular"...

1. The recipients of Medicare get it, basically, for free.  Since they're not paying for it at the point of purchase, it's not surprising that they think it's quite a nice thing.
2. Indeed, a lot of the real costs of Medicare lie in the future.  And they are enormous.   The costs are being hidden for now, while voters mostly approve of the more tangible benefits.   Should voters ever have a chance to make a real cost/benefit trade-off, we'll see just how much they actually value it.  
3. But, you might argue, polls show that 76% of Americans approve of Medicare.  And so they do.  But look what else those polls show about public approval of Medicare...

Rating the Performance of Nine Government Services

Q: "How would you rate each of the following government programs and services?"

October 2005 results

Base: All Adults

73% of adults rate the performance of Medicare negatively.  That's a remarkable number.

Of course, Paul Krugman and the Left have a remedy for that.   It involves astronomical increases in your taxes.  In 2005, Paul Krugman said the US "should be getting 28% of GDP [gross domestic product] in revenue. We are only collecting 17%."

That's around a 50% increase in taxes.  How will the public like that part of the equation? 

[Promoted - Conn Carroll shows just how wasteful and perverse goverment health care spending is; the eventual fiscal crisis from this will dwarf anything we've seen before - Jon Henke]

The exploding costs of Medicare are already killing the future of this country. If current trends continue, Social Security and Medicare spending will jump from 7.5% of GDP today to 13% by 2030. The Democrats solution to this problem: Medicare for all. The left actually believes they can control sky rocketing medical costs through government control of the health care industry. They are truly blinded by their love for big government.

Just look at the battle on Capitol Hill this week over Medicare. In 2003, conservatives passed a law requiring HHS to use completive bidding when purchasing medical equipment instead of using the price controlled fee schedule they do now. Under the current system, in some parts of the country taxpayers are paying $1,825 for a hospital bed anyone else can buy online for $754. If HHS went to competitive bidding they could save $1 billion a year annually.

So who could be against such a common sense move? Democrats. Sen. Max Baucus (D-MT) introduced a bill that would delay the implementation of competitive bidding for another 18 months. The reason? He doesn't want to hurt the businesses that currently make profits by overcharging US taxpayers.

And that is why government will never be able to reduce health care costs. Politicians are incapable of turning off the federal spending spigot when their constituents could be harmed. The better solution for controlling health care costs is a conservative pro-market  approach like consumer-driven health care.