Saturday, March 06, 2010

Politics: Health Care "Reform" - Its about the power not the health care

Mark Steyn nails it.

Excerpts:

I’ve been saying in this space for two years that the governmentalization of health care is the fastest way to a permanent left-of-center political culture. It redefines the relationship between the citizen and the state in fundamental ways that make limited government all but impossible. In most of the rest of the Western world, there are still nominally “conservative” parties, and they even win elections occasionally, but not to any great effect (let’s not forget that Jacques Chirac was, in French terms, a “conservative”). The result is a kind of two-party one-party state: Right-of-center parties will once in a while be in office, but never in power, merely presiding over vast left-wing bureaucracies that cruise on regardless.
.....
Once the state swells to a certain size, the people available to fill the ever expanding number of government jobs will be statists — sometimes hard-core Marxist statists, sometimes social-engineering multiculti statists, sometimes fluffily “compassionate” statists, but always statists. The short history of the post-war welfare state is that you don’t need a president-for-life if you’ve got a bureaucracy-for-life ...
.....
Obamacare represents the government annexation of “one-sixth of the U.S. economy” — i.e., the equivalent of the entire British or French economy, or the entire Indian economy twice over. Nobody has ever attempted this level of centralized planning for an advanced society of 300 million people. Even the control-freaks of the European Union have never tried to impose a unitary “comprehensive” health-care system from Galway to Greece. The Soviet Union did, of course, and we know how that worked out.
.....
Yes. Because government health care is not about health care, it’s about government. Once you look at it that way, what the Dems are doing makes perfect sense. For them.

I guess it takes a Canadian to understand US politics?

10 comments:

Anonymous said...

I guess this author nails it in the sense that you conservatives are never really serious about solving the health care problem in this country but instead are more focused on winning the power game.

What is the fear of the government regulating, and I have to emphasize this is not a takeover, of 1/6 of the economy when it has already been taken over by a few insurance companies? Remember, the government is accountable to the people and not the big insurance.

Anonymous said...

I guess this author nails it in the sense that you conservatives are never really serious about solving the health care problem in this country but instead are more focused on winning the power game.

What is the fear of the government regulating, and I have to emphasize this is not a takeover, of 1/6 of the economy when it has already been taken over by a few insurance companies? Remember, the government is accountable to the people and not the big insurance.

Rene said...

Sorry there has been some problem with comments moderation. It looked like anonymous' comments had disappeared so I re-posted it and now there are two version of it!

Rene said...

If agreement is not possible, then let there be at least clarity on the differences.

Who wants more power?

The Democratic leadership and the White House that wants to bring more regulatory control over 1/6 of the economy to Washington DC or those who stand with the American people who don't support such an action?

Who wants more power?

Those who want the government taking over health care by regulations or those who want a multitude of insurance companies to compete and innovate thus leaving more choice to the people?

I don't follow the health insurance business but there are more than just a few insurance companies.

Off the top of my head: Healthnet, Blue Cross, Kaiser, Cigna, Aetna, Humana, Wellpoint, PacificCare ... and many more ...

Who wants more power?

The Democratic leadership and the White House that wants to pass this bill with 51 votes in the Senate and 218 in the House because they believe they know better than the American public or those who think more modest proposals that would garner wider support in Congress and the public?

An example of such that I heard, since one big concern is helping provide coverage and services for lower income folks is to increase funding for Community Health Clinics?

How many pages of legislation would it take to increase funding and build more of these?

Probably not ~ 2000 pages!

Anonymous said...

I think you should read this interview of Wendell Potter, a health insurance industry insider:

http://www.pbs.org/moyers/journal/07312009/transcript4.html

A quote from it:

"It was absolutely stunning. It was like being hit by lightning. It was almost-- what country am I in? I just it just didn't seem to be a possibility that I was in the United States. It was like a lightning bolt had hit me. "

You said:

"Off the top of my head: Healthnet, Blue Cross, Kaiser, Cigna, Aetna, Humana, Wellpoint, PacificCare ... and many more ..."

Unfortunately, a few of these companies dominates the market in most of the states. Wellpoint is part of Blue Cross.

http://www.gao.gov/new.items/d02536r.pdf
http://www.americanprogress.org/issues/2009/06/pdf/health_competitiveness.pdf

If you believe lower income people should go to a separate and probably lower quality medical system then may be community clinic is the solution. My question is whether these clinics provide access to hospital as well?

Rene said...

Thanks for the informative links.

Hey, maybe if the people in DC talked about the issues we are here, something might get done that the average person can support?

The reality is that equality of health care access is ideal but not practical, i.e. wealthier person can buy more care and coverage. I accept that as the unfairness of life and it isn't the government's role to take away their money and options if they want to spend it that way.

And the reality is that we need to retain profit motive to drive innovation in medicines, procedures and devices. These things just don't magically appear.

As for community clinics, if they can help, I'm all for it!

Can a reform package include some taxes to help fund that?

As for competitiveness in the states, it is indeed remarkable how in some states there are more options than in others!

I live in California and it looks like this state has the least domination by the 2 largest carriers and indeed, I'm getting my coverage from somebody other than those two.

I don't know what the "magic number" is but I'd agree that there is a line where something is too big.

I think most people would agree that a company with 83% is too much as in Alabama and 95% for two companies as in Alaska is too much even owing to some economies of scale for this industry.

So what kind of regulations might foster more competition?

Perhaps allowing sale across state lines?

Perhaps, a cap (gasp to libertarians!) to the market share of the top companies in a state?

If, in a more modest reform proposal, market share was capped at X%, would there be an X that > 60% of Democrats and Republicans could agree upon?

Would legislation addressing the two issues above take up 2000 pages?

Rene said...

An attempt to find some common ground ...

http://a4theroad.blogspot.com/2010/03/politics-modest-proposal-for-health.html

Anonymous said...

You said:

"Hey, maybe if the people in DC talked about the issues we are here, something might get done that the average person can support?"

That is the crux of problem in Congress now.

(I have include references to the summary of Obama's proposal in my responses below. You can download the summary from: http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf)

You said:

"...it isn't the government's role to take away their money and options if they want to spend it that way."

The current proposal does not take anything away from people who can afford insurance now. They will probably use the same insurer that they have been using. The difference is where they will shop for it; at an insurance exchange where any insurance company can have a shot at getting their business, sort of like a stock market exchange (pg 1 second bullet from the top).

You said:

"...need to retain profit motive to drive innovation in medicines, procedures and devices..."

The profit will still be there for the medical providers. They still get paid from the insurance. It is the profit margin of the insurance companies that will be potentially affected. However, the decrease in margin may be more than offset by the increased number of premium paying insurers.

"Community clinic/health center "

Increased funding to community health center is part of the proposal (pg 3, third paragraph)

"Can a reform package include some taxes to help fund that?"

The proposal does include taxes to fund it (pg 7 - 9). One that caught my eyes is the Medicare tax (FICA). Under current tax law, this tax is not levied on income that is not earned in the form of salary (interest, dividend, royalty etc)! Wealthy should pay FICA too!

"Perhaps allowing sale across state lines?"

See insurance exchange above.

Rene said...

Its been good to kick ideas back and forth. I'm sure there are aspects of the ObamaCare that I'd agree with.

But my position remains that I believe a smaller focused package makes more sense than trying to draw an inside straight with a big plan.

I believe it is fairer to pay for it by a broad based tax rather than a hodgepodge of taxes on narrow groups: medical device makers, tanning bed owners, cadillac plan buyers, the wealthy, etc.

Since I don't make a living studying the intricacies of health policy, I have to plead ignorance on much of the details but I do find it interesting and challenging to understand the issues.

While web surfing, I came across these two items:

Discussion of impact of state level regulations:
http://www.heritage.org/research/healthcare/cda05-07.cfm

Discussion of how a state level health insurance exchanges might look like:
http://www.heritage.org/Research/HealthCare/wm1515.cfm

I do wonder what kind of regulations are in effect in the states where one or two companies dominate the insurance market? Has it actually proved detrimental to their customers? Which states do better and which do worse in terms of helping the uninsured get some level of access and coverage?

One wonders if in states with highly dispersed populations or low population, insurance companies decide not to enter those states to do business figuring it isn't profitable to compete against a company that is entrenched? In which case, is a limited monopoly is tolerable?

Because there is such regional and state variation, I'm automatically hesitant to trust a Federal level solution from the top down.

Nonetheless, HEI does sound like an interesting concept but how will it be administered? Will it be a light hand fostering competition or a heavy hand with strict rate controls, profit caps, benefit mandates, etc. Certainly, the Democratic rhetoric and track record suggests it will be heavy handed.

Perhaps a good way forward is to allow states who want to try it, to do so and see what happens.

So we do have agreement on some items and differences in others.

Feel free to have the last word ... 8-)

Anonymous said...

To me, the health care reform debate boils down to this: Do we, as a nation, believe in taking care of our own sick people? If we do, we should figure out a way to do it right.

I hope we all believe in taking care of our own people but sometimes I am not sure about it with some of our congressmen and people who are obstructing the process.

The details of how to do it can and should be vigorously debated but the discussion should be pragmatic and not dogmatic. The implementation should also be practical.

Bearing all that in mind. These are my responses:

I know you have an inclination towards a state implementation of any reform. The practical question I have is how do you get the states to undertake this effort? The Federal government can certainly not mandate what law the state legislatures make. Even if some of the states undertake the effort voluntarily but others do not, some of the 45 million uninsured will still be uncovered. More than likely the states with more uninsured will avoid the issue than to confront it.

Then there is the disadvantage of the smaller economy of scale for a state vs a Federal implementation. Also, states with larger population will have more people sharing the risk and thus lower premiums than smaller states. This will further polarized access to health care in different parts of the country.

I am always to open to new ideas but a state level reform is a non-starter just based on these superficial observations.

"Discussion of impact of state level regulations:
http://www.heritage.org/research/healthcare/cda05-07.cfm"

Any regulation to the benefit of the patients, e.g. patients with pre-existing conditions not denied insurance, no recission, etc, will always reduce the profit to the insurance companies and cause them to raise premium. I think the study was stating the obvious. The key question is whether regulation is necessary? If you do not believe in taking care of the sick then regulation is not needed. This, of course, makes the whole health care reform debate meaningless.

"Discussion of how a state level health insurance exchanges might look like:
http://www.heritage.org/Research/HealthCare/wm1515.cfm"

Not having a regulatory component in HIE, as the Heritage study suggested, is again not a good idea. Without it, insurance companies will cherry-pick who they cover and we will still end up with people with pre-existing conditions and the likes not covered. Also, my previous question still applies as to how to get states to start a program on their own.

"So we do have agreement on some items and differences in others."

As long as we all focus on the goal (taking care of the sick), there is no disagreement that cannot be bridged. The reason why the debate is so polarized is people forgot what this is all about and is distracted by unrelated issues (dogmas like big vs small govt, socialism vs capitalism, etc).