Health care reform: getting the good stuff without paying for it
President Obama gave a press conference recently at the G-8 summit. In response to a question about health care reform, he said:
…whatever bill is produced has to be paid for, and that creates some difficulties because people would like to get the good stuff without paying for it.
It occurred to me when I heard those words that this is what a government option for universal coverage is about: having the poor get “the good stuff” without paying for it themselves. And yes, someone will have to pay for it, but it will be other people. Any system of universal health care that includes the poor will quite naturally have this aspect; there’s no way around it.
Even now, even without universal coverage, we have a de facto (albeit reduced) version of the same thing, with the rest of us footing the bill by way of increased hospital charges to cover the free care given the indigent using the emergency rooms there. I am not for abolishing a decent level of care for the poor, and I am willing to pay to do so, but the question is what’s the proper level and how best to finance it. But let’s acknowledge what’s happening.
It seems that it’s Obama himself who is pretending that his proposals aren’t a version of “getting the good stuff without paying for it.” But we’ve become used to that sort of obfuscation—and even duplicity—from him.
In many cases the poor get equal or better care than the paying clients. There was a recent Yale study that showed that children on Medicaid were rapidly steered to Children’s hospitals and elaborate care.
I can vouch for this. My daughter had a congenital heart defect corrected at a year old (17 years ago) and I spent a few days sitting with her in the hospital. Children clearly on Medicaid were there and getting the same high level care. What they did not get was parental care. I did not see any parents or relatives of several of the children and my wife and I tried to play with them as much as we could.
I’ve said it before and I’ll say it again – there is not enough resources out there for everyone to get health care at it’s top form – period. Anything that assumes it is so is doomed to failure.
We can ration it by your ability to pay, we can ration it by your perceived worth to society, we can ration based on how likely you are to live, or we can do truly unfair things like ration based on political support (and with govt run health care I will bet any amount of money that this will have some effect). Of course there is also the option of “go broke and bring everything down to nothing” which seems to be the way we are going.
Personally ration based on ability to pay with a *reasonable* minimum payed for by higher costs seems the best way to me. Not that our system is currently that either – too much of the idea of we can get all the good stuff for free in there.
Whether he knows it or not, Obama’s meaning is slightly different. It’s not that the poor don’t want to pay – he takes that as a given. He means the rich here. The rich want to live in this nice place called America, but don’t want to pay what he’s charging. In the back of a progressive’s mind there is always the sense that we are a rich country, that this wealth belongs to “the country,” that Wise People can decide what is done with this wealth, and that those who resist are the ones who are trying to get something for nothing. Liberals do not merely believe that it would be a good idea if we let them make decisions, they believe they are entitled to, on the basis of their professed concern for all the people, unlike selfish conservatives who are only out for themselves.
When one states it this baldly, they deny that they believe any such thing. But get a few drinks in ’em and you will uncover this vast sense of entitlement, perceived by them as generosity and nobility.
I actually had a supposed intellectual former co-worker who said he admired the Cuban Health Care system! Of course, this guy was a card carrying member of the ACLU. He also felt the Supreme Court put there finger up in the air and when 50% of the population felt a certain way they voted for it. While it appears some members of the court may sorta do that with “emerging international opinion”- he seemed to be ok with the courts making decisions based on 50% opinion- not whether such a thing was Constitutional. He also seemed perfectly at ease with the idea of World Government.
How is it possible otherwise intelligent people can get so off?
How is it possible otherwise intelligent people can get so off?
If you’re use to being the smartest person in the room, then you’re use to knowing what’s best for folks.
If you know what’s best for folks, then of COURSE what you want is right.
It’s for their own good, after all.
How is it possible otherwise intelligent people can get so off?
Much of it, I think, is growing up with and taking for granted the fairness and prosperity of America, then assuming the whole world is more or less the same, if perhaps a bit behind us (though we are too polite to point that out).
I expect things to change for these Americans when they get mugged by a reality they cannot ignore, when their lives are directly affected. It’s going to take a real bloody nose for many Americans before they start questioning the assumptions of the liberal, transnational narrative.
Even then it will be dangerous because there is the chance they will decide the solution is to head farther to the the left, towards greater government control.
How is it possible otherwise intelligent people can get so off?
Because intelligence, being fairly common, is so readily mistaken for wisdom, a rare commodity indeed.
This is such an important topic and no future healthcare program will be without limits and massive problems.
In case you’re not aware of it TennCare in my home state of Tennessee is a great example of the trials and tribulations of programs such as Obama wants to enact.
A link to it is here: http://en.wikipedia.org/wiki/TennCare
But bottom line: it almost brought the whole of the state government’s annual budget down as people moved into Tennessee from everywhere to take advantage of this rich assortment of “free” benefits.
In the end—it will never be over— Gov. Phil Bredesen, a fiscal conservative Dem, has had to make some very tough decisions toning the program down, while the state has been sued by predatory lawyers every step of the way. All this has threatened schools, education, prisons, parks, highways, and everything in between. This state case needs to be studied by all honest people who struggle with universal care.
In the end, I’m with you Neo. I never mind paying more at the hospital—though I now negotiate all my bills and get a great rate and have very low insurance rates with a high deductible—in order to help others who don’t have insurance. Still, when the government starts mandating too much, it leave me cold.
Sadly there’s no free lunch here and the people who take the best care of themselve through diet and exercise and healthy lifestyles will be required to pay for those who want a high level of care while continuing to smoke and eat bon-bons.
But at some point a line will always have to be drawn and re-drawn. And if it’s a lesser line that’s when lawyers like John Edwards come rushing in to file massive class-action lawsuits. That only adds to the cost.
If nothing else we need to limit liability for these predatory suits. That alone would keep some costs down.
“I am not for abolishing a decent level of care for the poor, and I am willing to pay to do so…”
Yeah, but it would be nice if they asked how I felt about it now and then. Oh, that and maybe a little gratitude instead of the vilification.
If we want quality care for the poor, we should buy it directly and provide the services (as Bush did with community health centers). Having us push towards a single payer system, where eventually every person would have to be covered, is just another example of getting the entire country hooked on a state program narcotic; in the same way we are stuck with the current employer-provided insurance system due to government intervention (but at least we/employers still have choices), we would be stuck with the single payer for generations to come and at the mercy of bureaucratic decision makers.
Also, speaking of getting the good stuff without payign for it- much of the rest of the world benefits from our system. Just as europe did not have to pay for their own defense during the cold war, they did not have to pay for innovation in health systems- they could, as megan mcardle has put it recently, “cherry pick” the best from our system while incorporating it into a national health care system. Those free rider days will be over.
We hear a constant litany of complaints that “emergency room” care is very expensive and a major cost burden is treating indigents is these facilities. How about this? The admitting staff refers non-emergency cases to a nearby general practitioner under contract?
Same old Jedi mind trick bs. Didn’t he open his salvo for this in a speech where he said something about ‘we are out of money’ and morphed that into a pitch for this expensive program?
There are three things that would impact healthcare costs without much tinkering with the system.
1. Tort reform. Put limits on pain and suffering rewards. Bush tried this, but was rebuffed by the Dems and the trial lawyers. Such reform woulld lower malpractice insurance rates.
2. There are not enough Drs. and nurses to handle all the present demand for medical care. The government could incentivize students to train as doctors and nurses through scholarships, grants, and tax incentives. When you have a larger supply of trained professionals competition increases and prices do not rise as quickly.
3. Reverse the ruling that allowed drug companies to advertise their drugs. They are spending huge sums advertising erectile dysfunction drugs, anti-cholestoral drugs, sleep aid drugs, and similar high cost drugs. Is there anyone who has read a news magazine or watched TV who doesn’t know about these drugs? Why do they keep pushing them like no one had heard of them? Could they not charge less if they didn’t advertise? Also, why do drug prices keep going up. I take generic blood pressure drug that’s been off patent for a long time. But every so often the price goes up. Why?
Obama and company have not identified where they would bring costs under control. They are just saying, “Pass this legislation and prices will somehow be brought under control.” Fortunately, many people don’t believe them.
Those who cannot afford health insurance or pay for health care themselves are part of the problem because they can always get care at an emergency room. It is, however, very expensive care. Encouraging store front clinics such as Walmart is setting up in some of their stores, could be a place where low cost and charity care could be dispensed that would take a load off the emergency rooms. Medicaid is basically medical welfare for low income people. These clinics could be for Medicaid recipients as well. That might help cut costs at the margins and make care more convenient to access.
It’s a knotty problem and there are no clear cut answers.
Jim G. Says:
“3. Reverse the ruling that allowed drug companies to advertise their drugs.”
They must think they get more than they spend.
Roy Lofquist Says:
“The admitting staff refers non-emergency cases to a nearby general practitioner under contract?”
If the government does take over heath care, when the dust settles and the history of what happened gets sorted out, I think a lot of it will have to do with the industry not being creative and fixing these kinds of problems. I mean your right, ERs are full because the same people use them over and over for primary care. Then there is the stupid insurance system we have (not that private insurance is bad, just how it is ordered now)… et cetera…
How about giving ERs the right to reject folks who aren’t actual emergencies?
I know even in the small town my aunt was a receptionist for, they had folks coming in with *slivers*, or other “wounds” cured with a band-aid and tweezers.