Posts tagged with: healthcare

Our latest health care video short is up: “Why Consumer-Driven Healthcare Beats Socialized Healthcare.” And John Hinderaker of Powerline has an incisive analysis of the president’s speech last night to a joint session of Congress. The passage that stood out to me was this one about competition:

This seems to me to be the most critical moment in Obama’s speech:

My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down.

In fact, Obama and Congressional Democrats have zero interest in increasing choice and competition. If they did, there is an easy solution. There are over 1,000 health insurance companies in the United States; why do you think it is that in Alabama, one company has 90 percent of the business? It is because there are major legal obstacles to insurance companies operating across state lines. State legislatures, and lots of the companies, like it this way. Competition is hard. But if Obama really wanted to expand “choice and competition” in health care, all he would have to do is go along with the Republican proposal to allow health insurance companies to sell on a national basis. Like, say, computer companies, beer companies, automobile companies, law firms, and pretty much everyone else.

The video and transcript of President Obama’s speech is available here. And more Acton analysis of healthcare policy is available here.

[UPDATE BELOW] I discussed the creepy side of President Obama’s “science czar” here. But there are more creepy things in the cabinet. The Wall Street Journal reports that the president’s health policy adviser, Dr. Ezekiel Emanuel, wants to implement an Orwellian-sounding “complete lives system,” which “produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

The WSJ piece continues:

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care.

Now a freer healthcare market could take care of rationing much more simply, while providing increased incentives for healthcare providers to provide better value to choosey consumers. The problem is, a freer healthcare market wouldn’t route power through Washington.

And yes, it is more about power than about wanting to spread scarce healthcare services around more equally. Otherwise, the government would pursue something like healthcare tax credits for lower and middle income Americans. And they would pursue meaningful tort reform to curtail wasteful defensive medicine and the regressive transfer of wealth from consumers (who pay higher medical costs) to wealthy trial lawyers.

And no, I’m not proposing that these power-hungry politicians are monsters. Most are probably sincerely convinced that their increased power will help them pursue the greater good down the road. It’s just that others have been down this road before, and it isn’t pretty.

UPDATE: Longtime medical ethicist Wesley J. Smith has a nuanced look at Dr. Emanuel here. The post concludes:

[H]e explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece [in the Hastings Center Report]:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.

ABC is refusing to air a national ad by The League of American Voters, featuring a neurosurgeon asking the question, “How can Obama’s plan cover over 50 million new patients without any new doctors?”

ABC justified the decision by pointing to a long-standing policy against running partisan commercials. Dick Morris, a onetime advisor to former President Bill Clinton and chief strategist for the League of American Voters, called the ABC decision “the ultimate act of chutzpah.” As he explains:

“ABC is the network that turned itself over completely to Obama for a daylong propaganda fest about health care reform,” he said. “For them to be pious and say they will not accept advertising on health care shuts their viewers out from any possible understanding of both sides of this issue.”

Fox News reports that NBC may also choose not to run the ad.

I suggest we respond to this abuse of the public airwaves by creating a little homegrown balance. Forward the commercial to friends and family, and while you’re at it, steer them to Acton’s health care page, which includes this piece on “The Problem with Socialized Government Healthcare.”

This week Radio Free Acton continues its discussion on healthcare reform. Dr. Donald P. Condit and Dr. Kevin Schmiesing are back, along with host Marc VanderMaas, to talk about alternatives to the current health care proposal and ideas for reforming the system in ways that will both increase the availability of care for all who need it and make economic sense.

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The argument from federalism: One of the great benefits of federalism is that the states can act as the laboratories of democracy. If a new public policy is tried in the states and works (as happened with welfare reform in Michigan and Wisconsin), then a similar program has a good chance of succeeding at the national level. The welfare reform went national and proved to be one of the most successful public policy initiatives of the last half century. On the other hand, major governmental healthcare initiatives have been tried in Tennessee and Massachusetts. Neither of those have panned out. That should be a cautionary sign to avoid rushing ahead to just get a bill done!

The argument from misery: I cannot think of any encounter with my government that I willingly seek out. I hate going to the DMV. I hate going to the post office. I hate getting my car inspected. I hate getting a passport renewed. All of these things eat up productive time in my day and are filled with useless, inefficient waiting. This basic situation also applies to people who rely on the government for their healthcare. When my wife did indigent care in Houston, her clients did not pay for her services. They paid with their time. LOTS OF WAITING. I don’t need more waiting in my life. And because government employees are typically unionized, I don’t need to be at the mercy of a bunch of unionized employees any more than I already am.

The argument from incentivization: If the government provides the care too cheaply, then there will be a glut of clients who overwhelm the system and create the nightmare of waiting as the price to pay. If the government offers the care too expensively, people will opt out which is exactly what they wanted to avoid. If the government tries to control utilization by deciding what services you can and can’t have, then you are up against a far worse foe than the worst HMO you ever faced. And the government will go where the insurance companies fear to tread. They will decide who should live or die.

The argument from missing the verdammten point: It is exceedingly clear that a huge reason for the skyrocketing costs of medicine is the problem of predatory litigation driven by lawyers looking for 30-40% of a bloody fortune from an industry thought to be able to afford it. Between the cost of malpractice insurance, the payouts, and the defensive medicine that must be practiced to ward off lawsuits, it is easy to see why healthcare is outrageously expensive. Yet, the president very clearly said he would not seek to deal with that problem in the legislation. WHAT? WHY? Because the trial lawyers are very good political donors? Not a compelling reason for the formation of a particular public policy.

The argument from economic theory: Look at two sectors of the healthcare market that are typically paid out of pocket without the influence of insurance providers or the government. I am thinking of plastic surgery and lasik procedures for improving eyesight. Both of those services are becoming less expensive in real dollars rather than skyrocketing out of control. This happens to be the portion of the healthcare industry where actual market conditions apply. Customers pay for and receive value at a price that is becoming more reasonable all the time.

[update below] British physician Theodore Dalrymple weighs in on government healthcare and “the right to health care” in a new Wall Street Journal piece. A few choice passages:

Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?”

When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population. This is not to say that in every last case the treatment is bad: A pauper may be well or badly treated, according to the inclination, temperament and abilities of those providing the treatment. But a pauper must accept what he is given.

After 60 years of universal health care, free at the point of usage and funded by taxation, inequalities between the richest and poorest sections of the population have not been reduced. But Britain does have the dirtiest, most broken-down hospitals in Europe.

[update] Also, later today we’ll be posting the first part of a conversation our multimedia manager, Marc Vander Maas, had with Kevin Schmiesing and physician Donald Condit on healthcare reform. Schmiesing is an Acton research fellow and has posted regularly on health care topics here on the PowerBlog. Condit is the author of Acton’s new monograph, A Prescription for Health Care Reform.