Republican Health Care Reform

When public behavior and pronouncements are obviously inflammatory and antithetical to civil discourse, does it not behoove the mature and decent leaders (of both parties) to speak out and condemn such demagoguery as John McCain did in his reaction to Joe Wilson's vile display?

I have little use for phony decorum, and if what Wilson had said was true, his outburst would have been entirely appropriate. It wasn't true, though. Health care reform does not cover illegal immigrants, and that--and not the alleged violation of decorum--is why Wilson should be horse-whipped. That's the same reason the loons you mention deserve the same fate. It isn't that they make asses of themselves; it's that they're serial liars, and the truth isn't in them.

You may think of GOPers as asshats; frankly, they aren't the ones with "bottom" in their name, now are they?

They most certainly are.

My name is Richard Bottoms. So what? I first heard this line of humor in junior high school about forty years ago. Time for some  new material.

Yuk it up laughing boy, we'll see what's what in 2010.

Is expense the overriding concern here? Why? I guess it only seems expensive if the current system is working well for you. But, we don't treat National Defense in this manner. We spend ourselves silly creating redundancies and going the extra mile to insure that we are as safe as we can be miitarily. I'd propose that safeguarding our health as a Nation is every bit as important, and that expense is secondary to me.

Our defense appropriations are riddled with waste and fraud too, and I think we should all be concerned about reforming defense spending.  On top of that, there is a point at which defense spending becomes inefficient -- we pay for a military in the hopes that it will lower the net coercion against us, or to put it simply, because we believe that the cure is better than the disease.

One of the reasons defense spending is so byzantine and wasteful is that there aren't the same opportunities for market forces.  While you can have bidding and outsourcing/contracting to a certain extent, you don't have individual "consumers" of defense deciding how much defense they'd like to buy, and how much risk they're willing to take on.  It's all done by central planning, the ultimate single-payer system, and if the Right didn't think it was one of very few legitimate government functions, they would be locked in battle against it. 

In the matter of health care, I believe that expense is important, though of course we also have to keep outcomes in mind.  I believe that Obama's proposed reforms will both increase cost and reduce health outcomes compared to the status quo, even though they're intended to help some people with very poor outcomes.

In terms of safeguarding the whole nation's health, I'm open to proposals for real public health issues like public sanitation and handling epidemics/pandemics.  I don't think that requires broad government-provided healthcare for all maladies.

I actually believe that we can provide health care more efficiently and less expensively through reforms than through our current system. Are you aware that our government spends more money, per-capita, on healthcare for Americans than Canada spends, per-capita, on health care for Canadians, and yet we don't have Universal coverage? What is your source that it will cost more?

As far as I am aware, all of the proposed bills would increase healthcare spending by somewhere in the neighborhood of $1T to $1.3T, and they're hoping to bring it down to $900B.  And considering how much more Medicare cost than it was originally estimated to cost, I'd expect the final figures for ObamaCare to be much, much higher.  While there may be reforms that could lower the amount we spend overall, they aren't the reforms on the table.  We aren't choosing between the Canadian system and the status quo.

On the employer-provided model:

I agree with you that this is a terrible delivery system for Health Care, and I would prefer that we moved away from that model. I don't believe that Obama's plan further entrenches us in that model as much as it maintains the status-quo on that model with a slight movement (the Public Option) toward another model. I've never understood why Business wants to be involved in the health care system. I don't get why they don't lobby this one away, and I've always understood that the Right likes this system.

The Right has pushed for more individual health insurance for a while now -- HSAs, vouchers, more out-of-pocket expenditures for routine care, and equalizing the tax treatment of individual- and employer-provided insurance.

Obama's ideas, if I understand them correctly, are fairly hostile to individual competitive insurance.  Just for starters, it expands tax credits to small employers to cover their employees (thereby crowding out individual policies and shrinking the market), forces large employers to cover a certain percentage of their employees or be fined (even if those employees prefer individual coverage), and caps out-of-pocket expenses, making it impossible for people like me to have a catastrophic coverage plan.  It preserves and universalizes far-reaching mandates and caps charges on routine procedures, thereby raising the cost of insurance for people who want more limited coverage.

On consumer-oriented care through markets:

I don't believe that Healthcare makes a good commodity for the open markets. But, for example, Canada maintains a free market for medical providers. Canadians get to choose their docs, just like we do. The only difference is that those docs get to bill a single provider.

Well, medical services aren't a commodity, but there's no reason we shouldn't be able to purchase them in an open market with different models of coverage.

Canada does not maintain a free market for medical providers; a free market is one in which coercion and fraud are minimized, but in Canada there are a raft of regulations that prevent the consumer from seeking out whatever kind of care they desire, and prevent firms from offering care as they see fit.  If a third party is forcing the consumer and producer into a particular kind of relationship, then it's not a free market.

 I don't believe that the Insurance industry adds any value to the Health Care market place; rather, I think they provide less. Very few of us ever really shop for insurance in a meaningful way; we take what our employer offers, or we take what we can get, and we stay put as long as we can with that. And, we really have very little way to distinguish meaningfully between insurance options; if we choose a plan with less coverage, we don't know for certain that we won't need that coverage, and in the end, the gamble makes our system less efficient and more expensive. How do you think shopping for insurance improves our health care?

We don't shop for health insurance because competition has been severely constrained by regulation.  A somewhat less regulated insurance market, car insurance, does have a variety of providers running commercials all the time and trying to compete with each other on price -- because they still have a little bit of elbow room to do so.

Most of us take what our employer offers because our employer gets a bigger tax break than we can get for individual or family insurance.  That right there is a big reason the individual insurance market is relatively small, and why our insurance isn't portable, which requires schemes like COBRA and Obama's proposed "Exchange".  Going through our employers is another way that we the consumers are insulated from the healthcare decision-making process, which results in higher, un-transparent prices, incomprehensible billing, and less personalized, consumer-oriented care.

If we had individual health insurance combined with health-status insurance, we could have portable, reliable, customized coverage that we wouldn't lose when we lose our jobs, move, get divorced or suddenly get a condition that's expensive to cover.  There would be no reason for insurance companies to drop customers, and there'd be no reason for costly bureaucratic "solutions" like COBRA or an Exchange to get us through the hard times.  But currently, regulations make that system impossible.

On protecting bureaucrats:

I just simply disagree that anything in Obama's plan will make for less accessible bureaucrats. First, Obama's plan keeps private insurance in place. But, what rationale would you use to suggest that an Insurance company is more responsive than a government agency? I've never had any interaction in any meaningful way with my insurance companies. However, I do get to vote and campaign for changes in my government on a frequent basis. Insurance companies are motivated by profit to deny coverage in a way that I believe would be different with government agencies. I don't accept the knee-jerk explanation that all government is bad by definition.

Not all government is bad by definition, but there's no way you're holding bureaucrats "accountable" in any government program.  Those programs don't go away; they stay around and usually get bigger budget authority over time.  Our representatives can't hire and fire them.  Occasionally they make an example of someone who manages to make the news, but there's nothing like the responsiveness of a profit-and-loss system you get in a truly free market, where businesses can fail or succeed, firms have to make decisions in real time and the customers (and other firms) are providing constant feedback.

Medical insurance companies and other firms that are protected from competition and which are insulated from their customers because they deal with third parties (your employer) become less responsive to customers.  If they had to compete in a free market and dealt with consumers directly, it stands to reason that they would have to become more responsive to you.

Obama's plan severely constricts what little private insurance is left and by their own admission is likely to crowd millions of people out of the private market.  The law doesn't state that you'll lose your current insurance, but in effect many people will lose it.

On the reality of conservative and libertarian ideals of health care reform:

Can you point to the success of these ideas in other countries? What's your model? Single payer has proven to be relatively successful in many countries, despite the unfounded and irrational criticisms it receives here.

Unfortunately, no developed country has tried a free market model for its entire medical sector in the last 70 years; everyone regulates, and subsidizes, and controls.  Already over 45% of health care spending in the US is done by the government.

• I can point to successes in the places where the current model isn't dominant, like Lasik eye surgeries, where prices drop and quality rises.
• I can point to veterinary services as evidence of responsive service and low cost, though there are certainly important differences between veterinary and human medicine.
• I can argue that the US is the last wealthy country in which price discovery for various medical goods and services is still possible, which helps the public medical systems in other countries to set their own prices.  And I can argue that if the US no longer plays that role, we could see very serious problems setting prices correctly, leading to huge misallocations of resources.
• I can point to the successes of relatively free markets in other goods and services, and contrast them with the failures of relatively controlled markets, and point out that healthcare is one of the most regulated, litigated and subsidized industries in the country.
• I can point to other goods and services where the government has severely restricted competition, resulting in higher prices, poorer service and less innovation. 

 Wow.  This comment was wayyyy too long.  Many times the length of the OP.