HEALTH CARE: WHAT DO WE WANT AND CAN CONGRESS DELIVER IT?
Bill Dunkelberg is currently a professor of economics at Temple University where he served as dean of the School of Business from 1987-95. Prior appointments were at Purdue, Stanford and the University of Michigan. He has served as the Chief Economist for the National Federation of Independent Business for 35 years, is the Chairman of Liberty Bell Bank (NJ) and Economic Strategist for Boenning & Scattergood (1914, Philadelphia).
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The debate over health care “reform” has been confusing indeed and its meaning seems to have eluded even those who are attempting to write the legislation that is supposed to “reform” the system. For some, this is about efficiency, delivering the same or more health care at a lower cost. For others, it is about “redistribution”, giving access to the “poor”, funded by taxpayers. And some are concerned about “fairness”, desiring all people to have access to health care, regardless of their health (and have this access funded regardless of the cost, thus protecting families from dreaded medical bills that result in financial ruin). Most recently, the debate has focused on “insurance”, guaranteeing insurance to everyone regardless of cost, rather than on “efficiency”, reducing the cost of delivering the current level of care. Failing to distinguish clearly among these objectives is responsible for much of the turmoil surrounding the issue.
The goal of adding “47 million” alleged uninsured to the health care market while lowering costs appears logically impossible to achieve (without reducing the level of medical care received by currently insured individuals). Resources are limited and it takes a decade to increase the supply of doctors. On the day of Census measurement, there may have been 47 million who told the Census they were uninsured. But far fewer are uninsured for long periods of time (they get jobs). Roughly 10 million of these people are non-citizens, and taxpayers should be able to decide how much if any care they wish to provide to this group. Another 9 million are covered by Medicaid, but haven’t signed up because they haven’t accessed the medical care system (or may not view this as insurance). When they do, they are covered. Similarly, about 4 million “uninsured” children are covered under SCHIPS, but have not been enrolled. About 10 million are from families making enough money to buy health care (income exceeding 300% of poverty line) but choose not to, some paying for care out of pocket, others, many young, preferring to spend the money on a better car and take their chances, knowing that if they have an accident, the hospital will take care of them. Using “47 million” is misleading and not helpful for identifying the nature of the issues and what might be done. Indeed, many critics of reform point out that everyone gets health care today since none are turned away. This is inefficient, but suggests that we aren’t going to add “47 million” new people to the system, creating doctor shortages, because they are already in the system and their care is paid for by explicit and implicit subsidies (hospital room charges cover bad debts for example).
Most industrialized countries set a health care budget and manage (ration) delivery to meet the budget. In the U.S., we don’t know how much we spend until we add it up at the end of the year. One observer noted that the goal of managed systems is to “save money” while the U.S. goal is to “save lives”. There is an important kernel of truth in that statement. All health care is paid for by consumers, directly, or through private insurance, or through taxes (to pay for Medicare, Medicaid and SCHIPS for example). In that sense, the government’s concern about its budget is misplaced, it is just one conduit we use to pay for the medical care we want. Characterizing the large share of our GDP paid for health care as a “crisis” is not appropriate if one believes that the task of markets is to deliver what consumers want. It is appropriate to worry about inefficiencies (including price distortions like a “free” doctor visit or excessive law suits) that cause us to misuse or overuse our valuable medical resources. But as the baby boomers age, they will spend more on health care and it is inappropriate (if you believe in consumer sovereignty and markets) to attempt to reduce the care retirees take.
Routine health care has become cheaper over time (removing an appendix etc.) as technology and scale have reduced costs and hospital stays. New “stuff” is very expensive and requires wider use (learning curve experience) to reduce costs (an argument against restricting its use artificially). New “stuff” is always more expensive. Denying access to it will reduce “spending” (and lower the quality of health care provided), but will stifle innovation and development. We dance around “end of life” care issues because it has a very dark side and also violates private property rights. If individuals wish to use private funds (rather than taxpayer money), poorer elderly consumers are denied the same end-of-life care. Reducing these expenditures is most difficult but would be easier if health care services were priced closer to market cost and not “free” (subsidized), so individuals, and not the government could manage these decisions. “Nothing but the best for Grandma”, as long as someone else is paying the bill.
Many of our health care issues have been created by government meddling with markets, including the vastly different requirements for health care policies across states that result from mandating coverage of unusual items (social workers, hair pieces, marital counseling, reconstructive surgery, acupuncture, eye glasses, hip replacements etc.). And, the tax deductibility of health insurance for employers has produced a system that provides little or no choice to workers (one must take the plan selected by an employer) and no portability (the executive order establishing tax deductibility was put in place to offset the distortions created by another regulation, wage controls!). Just the term “insurance” confuses the issue. President Clinton talked about the fear of financial ruin, something that could be managed with catastrophic health care cost insurance, not very expensive. But for most, “insurance” means “pre-paid medical care”, “first dollar coverage”. Visits to the doctor might require only a $10 co-pay for example, far below the cost of the visit (and processing the claim is also expensive) and that encourages misuse. Car insurance doesn’t pay for maintenance (oil change). If it did, the cost would be hugely higher and very inefficient and “free oil changes” would clearly result in more of them (but perhaps be “preventive care”?).
Some argue that our businesses are at a competitive disadvantage due to rising health care costs. This argument is somewhat “soft”, and assumes that there is no economic limit on pay, which includes cash wages, employment taxes, 401k contributions, and health care benefits. No private sector company can survive paying workers more than the value they add to the organization (only state-owned enterprises can do this). More for benefits means less cash pay. At least to date, firms are not mandated to provide health insurance or any other benefit. It may be difficult to continue to provide the same policy as health care costs rise, but this is a matter of negotiation between the firm and the employee. If the tax deductibility of health care benefits were eliminated, many, perhaps most, employers would simply give the money they spent directly to the worker who could then seek the kind of coverage they wanted from tens of thousands of insurance agencies where they get auto, home and life insurance. Employees today have little or no choice, the employer chooses their insurance program for them and deducts the cost from their total pay.
Overall, we can make our health care system more efficient, meaning we can pay less for the care we currently receive and more accurately price the services to let consumers, and not a government panel, manage use. Forcing people to buy coverage is of somewhat questionable legality and tough when legally they must be cared for when care is needed. Perhaps the uninsured can be added to Medicaid where most of them probably already are if they just sign up. Vouchers and subsidies for lower (but not “poor”) income consumers can provide access, without scrapping the whole system.
But there are many conflicting objectives competing in the “reform” debate:
Health care is a “right”, so everyone must have it, regardless of ability to
pay for it and this obliges taxpayers to provide the needed care for all.
Consumers must not live in fear of a catastrophic medical event that would
result in financial ruin, so catastrophic coverage is needed.
No one should be excluded, regardless of medical condition and
insurance must be “portable” – in simple terms, owned by the consumer
and not by a company. While working, the worker is paying for his/her
medical care so they should continue to do so after departing an
employer.
The system is plagued with inefficiencies and price distortions produced
by government intervention over the decades and our legal system.
Eliminating these intrusions will permit consumers to shop for insurance
coverage and costs would be reduced substantially while maintaining
incentives to innovate and develop new drugs and technologies.
The Federal budget is being consumed by Medicaid, Medicare,
Prescription Drugs etc. and Congress wishes to shift the cost of this to the
private sector so it doesn’t blow up the national budget.
One thing for sure, if health care is “free”, we will never have enough to satisfy demand and the costs will be huge. If health care services are properly priced, we will buy less and choose the services we want. The poor will get less than the rich, as is true for everything else in society (democratic or totalitarian). Most important now is to clearly define what we are trying to accomplish with “reform”: lowering costs for what we do consume by raising efficiency, or giving insurance to everyone (define “everyone”), or reducing the government budgetary costs for what we do consume so deficits aren’t so large. Consumers are entitled to whatever healthcare they want, if it is appropriately priced. Consumers will pay for whatever health care we consume, directly out of our pockets, or though the sharing of pre-tax benefits with our employer who buys insurance for us or on April 15 though taxes to support public programs. Trying to “fix” all of this in one bill by August (or course we missed that deadline) is likely to lead to many mistakes and since the health care bills don’t take effect until 2013 (conveniently after the next presidential election), what’s the hurry? Let’s keep learning and debating and perhaps deal with one issue or problem at a time. Congress is notoriously bad at correcting mistakes, we should try to avoid them.
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September 28th, 2009 at 4:46 pm
The problem has been misunderstood. One look at the anger of the “Reagan Democrats” in the town halls will help you to understand what this furore is really about.
The issue is that many middle class white people think that “government option” means “sitting next to other races in the waiting room” when what they want is “private health care” which means “whites only” in the town’s nicest suburban hospital and everyone else goes to Mercy downtown. Very similar things go on at the local level in terms of education.
I’m surprised media commentators haven’t picked this up. This is about race and that’s why Obama has been a lightning rod in the debate. He needs to back off and have Sebelius carry the ball for a while.
September 28th, 2009 at 7:54 pm
Really? Really?! You think this is about race? Please… There are more people wierded out by sitting next old people that smell old and sick in a general practice office than would be freaked out sitting next to Julio Gonzalez and Luthor Jackson. It is not about that at all. The reality is we all have to sit together anyhow…because there aren’t enough general and family practice offices to meet the primary care needs anyhow. Or they take Tues and Thursday afternoons off, and you end up at the Med-Check or hospital anyhow! We are all in this big pile of doo–regardless of class, race, age. It is crap.
The PROBLEM is that people in their right mind have NO FAITH that the government that buys $800 hammers (remember those?) and can’t effectively address the financial sector’s problems and can’t work together nicely, but instead act like immature children…these people are going to FIX THE PROBLEM?? I don’t think so, and neither do at least half of the U.S. population. It isn’t a Democrat or Republican thing. It’s a “these guys are so screwed up with what’s on their plate now they can’t handle something as important as healthcare” thing. It is so beyond Red or Blue or Black or White, or North and South, or East Coast and West Coast…
The reality is things can be fixed without drastic moves. The bad part is that the things needing fixed take years to fix, like shortages of doctors in certain fields. This requires scholarships, and tax incentives to encourage med students into fields that we need. Interestingly, the reason medicine is practiced almost like a Jiffy Lube oil change is because Medicare and Medicaid pay sooooo little that the patient and the relationship have no value, only the number of patients seen! Thanks Uncle Sam!
Other things that should be remedied require unpopular, but more savory answers than the government getting into healthcare… Health Insurance companies should not be public, they should be mutuals. They should serve their policy holders and no one else. A motive for excess profit is removed from the table. Any excess savings are ultimately shared among the mutual holders. It is structurally inane to allow health insurance companies to be publicly traded with a profit motive. Why? Because when driven for profits, they are motivated not to act in the policy holders best interest and it is easier to raise rates than to actually improve efficiencies. So they raise rates, they deny claims, they drag payments. I would guess 80-90% of the things insurers do to all (patients, doctors, and hospitals) is either to meet an earnings estimate, make a ratio look good for an analyst, or to make $ on the float for a few more days…
Removing the profit motive is ultimately the reason WHY the government wants to come in and “force” prices down. The reality is it will create an even more unequal system that will allow profit oriented health insurance to drop and ignore whole geographic and demographic areas of our country. I don’t think anyone wants that to happen. Ask a Floridian how he likes the state run home insurance that doesn’t even have enough $$ to cover all the policy holders if a hurricane blasts through (thank God this is a good year!) All the private insurers pulled out and Floridians are stuck with a sucky, no good home policy. Look for more of that to happen with healthcare if the government gets in the business more than it is already.
I’d say they’ve done enough damage with Medicare and Medicaid. They’ve made most specialists into mechanics that make their living on how many patients they get in front of, rather than focusing on the quality.
I must get off my stump now… But quit making this political, racial, or any other bias.
It is about COMPETENCE
September 28th, 2009 at 8:14 pm
Let me count the straw-men he set up to knock down! Wow, there are a lot! But my favorite quote has to be, “car insurance doesn’t pay for maintenance (oil change). If it did, the cost would be hugely higher and very inefficient and “free oil changes” would clearly result in more of them (but perhaps be “preventive care”?).” We’ll ignore the glaring fact that a lot of new car warranties do cover oil changes, yet car prices haven’t exploded as a result of giving them away. And we’ll ignore the fact that preventative care could be limited to an appropriate number of times/year, as current insurance does (for some reason in his world government insurance would look nothing like private insurance). I know that I love nothing more than sitting at the oil change place for an hour or two. Or maybe even get to hassle with having someone else pick me up and drop me off! Oooh, and I really wish my insurance would pay for me to go to the doctor as much as I want. I’d go at least once a week. It’s so much fun! The only thing that prevents me from going is that pesky $10 co-pay. I simply can’t afford that as a single man on my middle class income, so I settle for once a year or less. I mean, look at those Canadians, their GDP is what, half of ours because they all spend their lives in doctor’s waiting rooms.
The best part is that this comes to this conclusion after he whittles down the true number of uninsured by a huge factor. He shows that some 1/3 of the uninsured are actually insured by medicaid or SCHIP (State Children’s Health Insurance Program not SCHIPS as he calls it – does this guy even know what he’s talking about?) and entitled to free care and aren’t utilizing it. So first he shows that even if it’s free, a 1/3 of the “uninsured” people don’t utilize the coverage they have, the goes on to conclude that if it’s free, the other 2/3 will over-utilize it to the point of overburdening the existing system. Talk about twisted logic.
So to answer his heartfelt concern over why we have to do all these things at the same time… maybe because they’re all related? If you do it half-assed you’ll get half-assed results. Of course, that’s what he’s really wants. He only wants us to do a little bit. Meanwhile the situation will continue to get worse. Then he can point at that little bit that was done and blame it for the situation getting worse. Like his other straw-men, he and his ilk can point to it and say, “See, look, we need to privatize more, not less.” And that will guarantee that we don’t actually get this thing done and end up with, god forbid, some type of socialized healthcare like every other first world nation (who have obviously suffered severely as a result, as evidenced by the US economy zooming ahead since they implemented such programs – oh wait, that hasn’t happened either). Sorry, I’m not fooled by the smoke and mirrors. There are plenty of rational arguments for socialized health care. There are also plenty of rational ones against it. Mr. Dunkelburg makes none of them in exchange for cheap-shots and knocking down straw-men.
September 28th, 2009 at 8:33 pm
I posted something earlier–hopefully BR ok’s it or edits it for public consumption.
I do have some additional comments though. Keep in mind, the uninsured are a cost on the system that we all pay for now by way of higher premiums, so we are not talking about “adding” people into the system. They are already there. Docs and hospitals refer to these people as “no pays”. Thankfully, due to the hippocratic oath, a doctor can not generally ignore these people once they present themselves. What, you actually think that gsw (gun shot wound) is going to whip out a hmo or ppo card? Ha! Or that non-licensed driver who caused the wreck and suffered multiple fractures and internal bleeding? He had no license–he’s going to have a high deduct plan? right. But they are treated. And your premiums pay for it, thank you. And your premiums pay for every infant with an ear ache that goes to the most expensive medical facility (the ER) because the primary care system is broken.
Look, there are sooooo many things we can do without radically involving a huge government plan. There are nudges they could result in great improvements. So, so much that could be. So little spine.
September 28th, 2009 at 9:04 pm
JasRas,
re: $800 Hammers, see http://clusty.com/search?input-form=clusty-simple&v%3Asources=webplus&query=Proxmire%27s+Golden+Fleece+awards
September 28th, 2009 at 10:01 pm
We will get whatever Mr Obama, the Congress, the AMA, the pharmaceutical industry and the insurance companies says we will get.
How far do you really think all of our bitching and moaning really goes? They will pretend to listen to save face; but, all of the important decisions are made later in conference/committee when no one except the money players are in attendance. …..And then (when no one else is looking), it will be decided what you get or don’t get.
For the most part, we aren’t really a part of the process. We just pay for whatever the above parties agree upon. Once they get your vote, they are basically done with you for at least (2) years.
September 28th, 2009 at 10:06 pm
I have managed employee benefits for 30+ years and have worked aggressively to constrain the growth of healthcare costs. Before getting Government involved any more than it is, why can’t we just look at the current system and fix what is wrong. Then, if the politicians want to move to a new GOVERNMENT model, so be it. What is wrong?? Believe it or not, much of what the author suggests is correct. here’s a list I came up with:
1. • For the past 30 years, the patient has become farther isolated from healthcare decisions and costs that directly affect him or her. “The insurance company pays!!”
2. • The entire prescription drug system is a mess. Prescription drug industry advertising is a major problem! How much is spent on advertising that could reduce drug costs.
3. • When health insurance programs first started, they simply covered catastrophic expenses. The basic idea was that the individual could pay for the regular day-to-day medical expenses but should be protected from unplanned catastrophic expenses. Health insurance has evolved, particularly in the public sector, to nothing more than an income transfer program.
4. • States have mandated coverage for many specific procedures or illnesses with no consideration of cost.
5. If you want a peek at the future, look at Medicare. It has a large and increasing deficit. No one is attempting to control costs. Further, the bureaucracy of the system is staggering. The procedural part of the system is actually designed to make you fail. The complexities of choice are incredible.
6. • The cost of Medical Malpractice iInsurance is extremely high and increases at a rate faster than the CPI. When various countries’ medical systems are held up as models, it is important to look at their medical tort systems.
7. One subject that is never mentioned in the mainstream media is plan design. Choosing an appropriate mix of coverages, limits, co-pays and deductibles can have a significant impact on costs. Take a look at public sector plans.
A quick solution or “reform” – Health Savings Accounts in combination with High Deductible insurance plans are a big first step. By their design, they provide incentives to learn how much services cost and actually consider alternatives. They also significantly reduce claims processing costs. The reduction in paperwork would be dramatic. For Medicare recipients, Medicare Savings Accounts would achieve the same results.
Without “flaming” anyone, I wonder how many of the people responding here and elsewhere actually understand the specifics of the current healthcare system.
September 28th, 2009 at 10:18 pm
Disappointed to see this drivel on The Big Picture.
Two points:
Lack of health insurance kills at least 22k Americans every year, as cause of death.
http://www.alternet.org/blogs/peek/81895
Lack of health insurance contributes to the death of many more, over 100k per year.
http://content.healthaffairs.org/cgi/content/abstract/27/1/58
Some economic elites feel this is only a concern for “the poor” and therefore it is unpopular to fix the problem. But those of us who don’t live in a bubble know we are one layoff away from lack of health
insurance. This IS a problem of the middle class.
The conservatives who are bleating about the cost of this overwhelmingly supported the Bush tax cuts, which cost us more than this reform is expected to.
I personally feel that those who don’t care about the Americans who die from lack of insurance have blood on their hands. I know several who died, and another whose health was horribly damaged.
If this is the best American capitalism can do, it is an evil system. I am certainly sick of it, and sick of its apologists.
September 28th, 2009 at 11:30 pm
reply to nkbay99 post:
1. • For the past 30 years, the patient has become farther isolated from healthcare decisions and costs that directly affect him or her. “The insurance company pays!!”
This is a lovely cliche’. How is the patient isolated from healthcare decisions? Only when the insurer says no to a procedure. Granted most people have to rely on their doctor to suggest the ‘proper’ procedure. Would you choose the cheaper ‘breaksalot’ procedure for your knee replacment or would you prefer the pricier ‘gibraltar’ procedure.
2. • The entire prescription drug system is a mess. Prescription drug industry advertising is a major problem! How much is spent on advertising that could reduce drug costs.
How does cutting advertising reduce the price of a drug? This simply changes the profit picture of the drug co. A doctor has to write a prescription before any costs are incurred by the system.
3. • When health insurance programs first started, they simply covered catastrophic expenses. The basic idea was that the individual could pay for the regular day-to-day medical expenses but should be protected from unplanned catastrophic expenses. Health insurance has evolved, particularly in the public sector, to nothing more than an income transfer program.
Define catastrophic please. Perhaps a $5000 set of petscans for a flight attendant make 20k or so. In Japan an MRI test costs approximately $100. Here it is over 1k. I agree it’s an income transfer, from employees to insurance companies. That is why they want the status quo.
4. • States have mandated coverage for many specific procedures or illnesses with no consideration of cost.
My state has mandates for alcoholism, newborns, colorectal cancer screening, breast cancer screening and similar, not too “out there”, though newborns can cost a good deal.
5. If you want a peek at the future, look at Medicare. It has a large and increasing deficit. No one is attempting to control costs. Further, the bureaucracy of the system is staggering. The procedural part of the system is actually designed to make you fail. The complexities of choice are incredible.
How about that Medicare prescription drug bill. Let’s not forget the coming boomer fest.
6. • The cost of Medical Malpractice iInsurance is extremely high and increases at a rate faster than the CPI. When various countries’ medical systems are held up as models, it is important to look at their medical tort systems.
This is a good one. You are correct, malpractice rates increase, true even in Texas, where they already have tort reform. Prehaps we can start to look at actual malpractice, given that only approximately 1 in 100 actually harmed by a doctor ever get any money.
7. One subject that is never mentioned in the mainstream media is plan design. Choosing an appropriate mix of coverages, limits, co-pays and deductibles can have a significant impact on costs. Take a look at public sector plans.
Agree completely here. Plan to have certain illnesses while you have the proper coverage. We can call it the healthcare lottery, lotteries are really in now.
Please do ignore every other developed country and their healthcare system except regarding torts.
“Without “flaming” anyone, I wonder how many of the people responding here and elsewhere actually understand the specifics of the current healthcare system.”
Yeah, I wonder that too.
September 28th, 2009 at 11:42 pm
There is no doubt that lack of health insurance for a chronic or terminal illness is a death sentence. There is no doubt this is an important issue that needs attention now. However, what I call into question is the current approach. I question the efforts of both parties to throw around loaded and emotionally charged statements, twist statistics, and generally grandstand. Frankly, I would expect more than rehashed drivel that we’ve been hearing for twenty plus years.
There are things that can be done to change healthcare without turning it into a government run operation. I am for oversite and nudges by the government, but isn’t that what government is? The ref?
How about pricing healthcare by using the whole population of the U.S as the group instead of just the company that is providing it. An example: I worked for a company where the average age of the employees was 57 and the healthcare was priced as such. I was in my 3o’s, yet my premium was higher b/c my co-workers were older and male. Oh, and I work in a different state than the headquarters. The headquarters is in a state where healthcare is much more expensive and since the bulk of our company employees worked there, I paid more b/c of that too. Older, male, more expensive state… Now should that have any relevance to the health insurer? No. They offer coverage in many states, many ages, and both genders. In fact, in all likelihood, a cross sampling of their whole base of clients would probably be representative of the nation… Yet for our company they could charge much more because of our grouping of age, gender and location. The notion of insurance is to create large pools so as to spread the risk over many. Most will need very little care and thus be inexpensive to cover, while a relatively small sample will have deadly, chronic, expensive medical issues and benefit from the group. Tada!! Insurance. Now, if you interject a profit motive into this model, I would want my pool of insureds to be healthier than the general population. I rake in much higher profits that way. Now if I really want to be profitable in a gross way, I make sure my sample sizes are smaller so I can justify higher premiums to cover the higher risk insureds…. anyhow. You see, the government could force the insurers to use much larger sample sizes, then the premiums would go down.
It’s not unlike PnC…home insurance rates went up all over the nation after Katrina, not because South Dakota could get hit by a hurricane, but because they spread that risk over every policy. A home in Dayton, OH could pay home insurance for 3o years without incidence, and that helps offset a home in Nola or the Panhandle…. But that is not how they do health insurance…
Now have you ever seen the insured rate for a visit versus the non-insured rate? My experience is the insured rate is usually higher because they are subsidizing the non-insured and the non-pay. If everyone had insurance, that would all even out. It can get done with government involvement, but they need to do it differently than they are now. What they are contemplating now is adding just a new layer of disaster to the onion we can America.
September 28th, 2009 at 11:42 pm
“Look, there are sooooo many things we can do without radically involving a huge government plan. ”
If that were true, then the hyper-efficient private sector would have done it by now. But the fact is that these insurers are basically lying and stealing from their customers, many times because of their near monopolistic control over the system.
Even if the public plan turns out to be a disaster, it will be a marked improvement over what we have right now. Has anyone who is against the public plan even bothered to offer a defense of the current insurance system? They cannot because it is largely indefensible. What exactly are we trying to salvage here?
September 29th, 2009 at 12:12 am
@soulmatico9- which economic class did you take? The hyper-efficient private sector has maximized profits b/c that is what they are motivated to do. They are motivated to do this because most are publicly traded companies with mandates for growth. There are other structures that would align the motives of the insurance companies with the insured. Publicly trade for profit and Private for profit are not in the insureds’ interest. Mutual companies certainly can be and should be.
You must be a neo-classic to believe that a completely unfettered highly efficient private sector will come up with the best solutions… unfettered capitalism destroys itself….hint, look at the financial system… It’s like leaving a house with a stocked bar and a bitchin’ stereo and a Porsche in the garage in the hands of a teenage boy—it’s a really bad idea…but a good movie.
What has made America great is the hybrid of capitalism with a little of all the other “-isms”. When the government acts as a caring parent that guides and provides rules of the road–that’s when America hums. When the government acts like that inattentive parent that lets the child stay up all hours and watch whatever–that’s when we get disasters like the housing bubble,…(oh, read Barry’s book…)
I you read the comments prior to yours, you will see not one defending the current system as is. Can you defend Medicare and Medicaid and justify why they are run and administered so well that I should trust the government to take on more? Really?!
I’ve posted too many times tonite, but this is the bottom line:
Guys in D.C. make laws.
In theory that means they can do whatever they want, if it passes.
Do you REALLY think the current option they are proposing is the best game they’ve got?
Or are they tiptoeing around special interest groups?
What I propose might not make the special interest groups (corporations) happy, but it is a hell of a lot better than the government taking over another project they can’t handle.
Pass laws that make the corporations (insurers, pharmas, medical devices, doctors, hospitals) do things differently.
Enforce these laws.
Observe.
Make changes if necessary.
Look, they can do ANYTHING—if there is any doubt, look at all the stuff that has happened in the last eighteen months. If you had brought any of that up in a business class at any university three years ago, you would have been laughed out of the room. They can do ANYTHING. So let’s open our eyes, think outside the box, color outside the lines, and think about this like we are capable of doing. That’s all I am saying.
If you really think the best solution they can come up with is the current one floating around D.C., you need practice imagining things.
September 29th, 2009 at 2:21 am
The health care insurance industry is only profitable with economies of scale. I think that’s why we tend to have regional monopolies. Getting real competition may require AT&T style breakup and regulation.
Regarding the lack of doctors: doctors do too much in this country. We could and should give more autonomy to nurses and technicians. Also, tort reform may reduce doctor attrition.
September 29th, 2009 at 7:01 am
[...] HEALTH CARE: WHAT DO WE WANT AND CAN CONGRESS DELIVER IT? This is the most level-headed piece I’ve read on health care reform. Bill Dunkelberg explains that the goals are not at all clear. Without clear goals, we surely can’t get a “solution”. [...]
September 29th, 2009 at 11:39 am
nkbay99, i applaud your well presented commentary.. thank you for the insights as well as your practical suggestions.
September 29th, 2009 at 7:34 pm
By now, we should realize that what Congress and the President say they want to do is impossible:
1. Large committees have great difficulty accomplishing anything. Congress is composed of two very large committees, plus a third 1-person committee.
2. Committees in which each member has a vested interest in a competing issue — in this case being re-elected- also have great difficulty accomplishing anything. Imagine a jury in which three people are relatives of the accused and three people are sworn enemies.
3. As a further complication, each member of the committee owes allegiance to an outside group — a political party — that itself has issues.
4. There are a huge number of problems to solve:
a. Providing sufficient money for health care to people who can’t afford it, but want it.
b. Providing sufficient money for heath care to people who can’t afford it, but don’t want what is offered.
c. Providing sufficient money to compensate doctors, nurses, hospitals, pharmaceutical companies, equipment research and development.
d. Navigating through the byzantine tax sytem.
e. Satisfying special interests like abortion, long-term care, elderly
And on and on and on. You get the idea. The difficulty is demonstrated in this blog where everyone seems to have a different belief, and everyone seems to think the other guy’s belief is stupid.
So knowing a good big plan is impossible, perhaps we should consider a series of small plans. Perhaps Congress should pick one problem, any problem, and try to agree on a solution. Then go on to the next problem.
Yes, I know. Solutions often are related. But since we absolutely, positively will not come up with a good big plan, perhaps trying to solve individual problems might work. Can we cut that 5lb steak into bite-size pieces?
Thoughts?
Rodger Malcolm Mitchell
http://rodgermmitchell.wordpress.com