Let's assess our understanding of the current debate, then I'll recommend an MPR piece featuring a leading expert.
If you look at the history of healthcare reform in this country then the current debate can be put into context. Background reading: http://content.healthaffairs.org/cgi/content/full/24/6/1679). We've been at this for quite a while and never have we come close to a socialized or universal healthcare. We've been left with a series of compromises instead (Medicare, Medicaid, etc.). It actually seems more complicated than I thought when listening to Ted Marmor this morning. I may have to read his book. For now, let's ask what we think we know and what actions we might like to be taken and then what we think Congress/President are doing and how close that is to the reality we'd like to see.
MPR: http://minnesota.publicradio.org/display/web/2009/08/25/midmorning2/
Subscribe to:
Post Comments (Atom)
Posts
Which book? I just looked him up on Barnes & Noble's web site, and he's got at least 10 books (just the first page) on health care that he's written over the last 25 years, including one due out in October.
ReplyDeleteThis is a topic I intend to read a lot on soon, as I don't really know anything about it. The Undercover Economist (very good book so far-book review will be coming by this weekend, most likely) has a chapter on health care, but I just started that chapter.
From what I've understood of the criticisms (leaving aside the 'death panels'), the opponents either claim that it is socialism or a step toward socialism, that they don't want to pay for other people's health care, that government is never efficient at running things, and maybe a few other complaints. These completely disregard the aspects of our country that at least have tendencies of socialism (transportation networks, police, fire fighters, schools, etc). Also, from what I've read, the reform bill only requires people to have insurance, not to have the federal plan, whereas it seems like opponents argue that they don't want to be on a federal plan. Perhaps they're afraid that one day the private insurers will be gone, and the federal plan will be required.
So what are the proponents of Obama's health care reform supporting? They've been less vocal, so it's harder to pin down. Is it mainly that people in poverty need to also be covered? Is it that the plan could drive down costs for everybody by competing with the insurance companies (which almost implies collusion with insurance companies)? Making it illegal to block coverage based on pre-existing conditions (I'd say increasingly important with genetic testing)? Are these accurate, and/or are there other aspects to support?
A couple points mentioned in the Undercover Economist that I have noticed so far and bear mentioning include the typical coverage of young adults who are less likely to need coverage and/or have a steady job with insurance, and therefore often don't have coverage. In turn, those that have coverage are more likely to need it, so premiums go up. Would required coverage help with this problem?
A question I have based on The Undercover Economist stems from the fact that he mentions in one point that waiting times in some countries with universal coverage (Canada being his example) are long for some procedures. In another point, he mentions that spending on health care in the US is significantly higher in comparison to GDP (like 33% higher than the second highest spender), while life expectancies are comparable. My question from these facts though is that what if the countries with universal coverage are avoiding more deaths at a young age, but the elderly are dying a little earlier due to delays or other problems with the system? Just a thought-it will require looking at more statistics to figure that out. But if that were the case, what reason would people currently with insurance have to support reform?
One other potential aspect to consider is the effect of insurance being tied to jobs on GDP in general. Harford hints at this, noting that people often stay at jobs longer until they find another so they aren't without medical coverage. How often might this lead to people who are mailing it in performance wise (or job-searching while at their current job), and decreasing productivity? It's probably not a huge factor, but probably worth considering. Though I'd guess fantasy football and March Madness are probably bigger causes of lost productivity.
In the past 20 years the federal budget has grown an average of 5.1% each year. I could not find yearly data for all healthcare cost but I did find data for Medicare and expenditures increased an average of 8.2% each year over the same 20 years. Only one president of the past five has had even a single year when federal expenditures were lower than federal revenue (Clinton ’98, ’99, ’00). The over simplistic way to understand this is that Reagan and Bush 41 cut taxes but not the budget and Bush 43 cut taxes and put two wars on the books, while keeping them off the budget. Now, what does all this have to do with healthcare? We can’t afford it.
ReplyDeletehttp://en.wikipedia.org/wiki/File:GAO_Slide.png
President Obama keeps saying two-thirds of reform will be picked up by taxing the top 5% money earners. The other third will be made through the cost savings of reform and preventative care. Sorry, but that will not happen. The reason other countries have lower healthcare costs is they don’t eat as much crap and they exercise more (more dependent on public transit or walking). Obama is really copying what Bush 43 did. Keeping taxes low, but his 2 “wars” off the budget are the stimulus and healthcare reform.
I consider Healthcare to be just as much a social issue as an economic issue for our government, as fewer things facilitate and perpetuate a class-system more than accessibility (or lack thereof) to healthcare. Until a majority of Americans except it as a social issue we won’t have the best option which is probably single-payer. Increase taxes on every individual to pay for it. Just like education, police, firefighters, waste management, etc.
http://www.amazon.com/Fallacies-Foolishness-Medical-Management-Policy/dp/9812566783
ReplyDeleteI will read this book and review it.
Judging by that slide, the bigger problem is interest. I'm assuming that's interest on the national debt, correct? The curious part to me is that Medicare spending is anticipated to grow much more than Medicaid, even through 2080. I can see it spiking now with the baby boomers retiring, but would it necessarily continue to grow over the next 70 years in comparison with Medicaid?
ReplyDeleteI think to compare Obama's efforts with Bush's wars is a little faulty. The total cost of the stimulus package compared to the war may be in the same range, but as I quoted in one of my book reviews:
"The standard response to a recession is to cut interest rates. . . Japan was slow to cut interest rates after the bubble burst, but it eventually cut them all the way to zero, and it still wasn't enough. Now what?
The classic answer, the one that has been associated with the name of John Maynard Keynes, is that if the private sector won't spend enough to maintain full employment, the public sector must take up the slack. Let the government borrow money and use the funds to finance public investment projects-if possible to good purpose, but that is a secondary consideration-and thereby provide jobs, which will generate still more jobs, and so on. The Great Depression in the United States was brought to an end by a massive deficit-financed public works program, known as World War II." (The Return of Depression Economics by Paul Krugman)
Spending on public works projects (i.e. rebuilding failing infrastructure such as the 35W bridge) at least is a recommended response to the current crisis & has benefits in the future for the American system. Does the Iraq war have any benefits for America (other than we're now safe from al Qaeda, or not)? And as you said, health care is also a social issue in addition to an economic one.
That also makes me curious what the economic response is to wars in general. If wars spur on the economy in times of slumps, should they also not further spur it in times of growth? In that case, wouldn't governments always be at war for financial gain? Eventually the people won't buy into the wars, so that is a pitfall to continuous war, but I need to look into this.
Getting back to health care, (this may be a foolish question), but if health insurance companies turn a profit, wouldn't the government insurance option also be able to at least break even? It doesn't need to make money, but couldn't it get by without being subsidized?
I think we need to focus on this topic for a while longer. I think sometimes with the blog other topics come up that may seem interesting, and the older discussions get left behind. This one's too important for us to become more informed on.
Briefly, on wars: read 1984 and you will see when Oceania is not at war with Eurasia they are at war with Eastasia, and vice versa. It is always good for the government to be at war.
ReplyDeleteHealthcare: my argument was not intended to side-step the issue or diminish its importance. Nor was it intended to generate a discussion on the recession.. The democrats plan is flawed, and because the GOP only offers scare tactics and not real ideas, I take their place as the fiscal conservative (for argument's sake). Here are my points hopefully made more clear:
1) Right now the government plans to pay for reform with more government spending (an estimated 900 billion over 10 years). My argument is they cannot afford this long term (20, 30, 40 years from now) because as I previously stated Americans are not going to magically become healthier because of reform. So the government option would probably end up going bankrupt like social security and possibly Medicare.
2) To me healthcare is a social issue and everyone should have it like education, police protection, etc. Now, let’s say we increase taxes on everyone to pay for a single-payer system. 900 billion over 10 years in 90 B/year. There were 139.3 million tax returns filled in 2007. If you only taxed the individuals filing tax returns that would be $647.50 a year ($53/month). That is pretty cheap healthcare for a whole year (The student health benefit plan at the UofMN is $1100/year). Obviously, you could do a scaled payment system similar to the income tax in general.
3) Like you stated in your response, insurance companies make a profit. The government could make a profit on a single-payer system as well. Or they could scale up/down the taxes each year depending on previous year costs. What is the best argument against single-payer besides it being socialist/Marxist/communist?
I didn't think your comments on here were meant to curb the discussion (one of the pitfalls of typing things is definitely misinterpretation). It was more that I didn't want to get distracted by the binaral rivalry or any other new posts.
ReplyDelete1-As with everything else, health needs to be properly incentivized. I think insurance companies already offer discounts or will pay for gym memberships for people that actually use them. Not everybody sees the long term effects of health in their immediate decisions, but they will see the immediate benefits of cash in their hand. If something along these lines is not included in the eventual government insurance option, it should be. And I'm sure there are plenty of other ways to encourage healthy lifestyles.
2-I need to think about this one a little more before I respond. I'll try to get to it tonight.
3-Besides strictly calling it socialism, I think the other arguments are either directly or indirectly based on that premise (like I mentioned, government's not efficient, people want their health "just between them and their doctor" despite the fact that the insurance company already has a say, etc).
1) I agree incentives would be great. If you had a single-payer plan the government could offer deductibles for (e.g., gym memberships, not smoking, healthy BMI).
ReplyDelete2) Please check this, my math may be off. But I think we should consider the cost of a single-payer system.
3) I don’t see how a single-payer system puts the government between the individual and his/her doctor. The government is just providing the money right? Besides, there are already CEOs between many individuals and their doctors.
3-I think the argument is that the government option is just a stepping point to the government overtaking the private insurance companies. At that point, with a monopoly, the government could dictate things more. I'm not saying it's a logical argument, but I believe that's the case being made.
ReplyDelete1) It is a social issue but suppose everyone was doing everything he/she needed to do and was living longer because of it. They'd still die and most of any person's medical costs are in the last few years. This cultural/social issue as far as I can tell has never been addressed and would have to be (except in that book The Giver by Lowry). "Death panels" have to be discussed actually.
ReplyDelete2) The cost of health insurance is more like $2500/yr through the University (I think it's $1,100/semester).
3) If your position is that healthcare is broken (you'd actually have popular support here I believe), then the next logical step is to look at the insurance companies. Those whose position is that government option healthcare represents an interference to the current market-based system (I think this is their position but can't be sure) may not acknowledge that the current system is broken.
1-If we suppose that everyone lives healthier and longer lives, then their medical expenses should at worst stay the same on an annual basis, or if they are healthier, they should decline. Given longer, healthier lives, would not revenues then increase, and expenses decrease, making it easier to cover the medical expenses the last few years?
ReplyDeleteWhat about "death panels" would need to be discussed?
2-I've paid $3469 (well, $200 from me, the rest from Michigan, but I'm assuming with a public plan I could opt out and just get that money directly) so far this year in health insurance. At that rate, I'll put in over $5000 for the year ($420/mo). This makes $53 in comparison seem rather low, and that some calculation must be off. What does the $900 billion cover, exactly?
3-Assuming health care is broken and has spiraling costs, would you not first look at health care (who establish the costs) rather than insurance companies (who pay the costs)?
Can people really argue that a government option interferes with market selection any more than insurance companies? The insurance company I got through the University of Michigan isn't accepted at the University of Michigan. My first few weeks I worked at the UM hospital, and I literally couldn't be seen right across the hall. I don't think this was in the selection pamphlet I got, otherwise I wouldn't have taken it. In this case, I'm not sure who would be to blame. Is it UM for not accepting the insurance, or does the insurance not cover things at UM? I'm not sure how that works.
1) “death panels” as in “end of life counseling”?
ReplyDelete2) Yeah, this calculation is off. 900 billion is the estimated cost of reforming healthcare. Canada’s single-payer cost ~10.6% GDP. The U.S. already pays 15.2% GDP according to Health Systems Resources (WHO report 2008). So, the reform costs should be toward reforming what we have into single-payer system (appears we could afford it)
The UofMN’s new graduate health plan says incase of an emergency I need to drive to the St. Paul's hospital and can’t go to Fairview or Riverside. (Similar to Steve’s circumstance)
Brent touches on a good point. We need to ask whether it is ethical to have private health insurance companies. I can’t blame a private company for not accepting people with pre-existing conditions or dropping people when they cost too much or trying to make a bigger profit each year. That is what a private business by definition does. The question is, is it ethical for us to have private health insurance companies. Imagine the anger if education was all privatized and all the rich kids had Ph.D. teachers and the best schools and the poor kids had crap…oh wait…but seriously it would be at least 10 times worse if education were given over to the private sector. Kids would be kicked out of school for bad grades in elementary and I’m sure they would not accept mentally challenged. That is why we have a government run educational system.
A new way to prey on fear:
ReplyDeletehttp://www.startribune.com/lifestyle/health/55766797.html?elr=KArksLckD8EQDUoaEyqyP4O:DW3ckUiD3aPc:_Yyc:aUUI