Tuesday, October 2, 2007

Healthcare: two columns, and I'm not grumpy about either

Here's a column I would be tearing apart if it was really possible for me to do so. Harrop is, from my experience, one of the better left-wing columnists and this is a perfect example of why. If you dislike Bush, you enjoy the way she tears apart the uncontestable contradiction in Bush's stance on healthcare today compared to in his first term. If you're on the right, you're given a reminder of the size and scope of the drug program Bush pushed. If you're a moderate who is somewhat inclined to take the Democrat's side on the issue, Bush looks heartless and unreasonable. When I talk about the way people should write, ie. to convince people that their point of view is correct, this is what I'm talking about.

Another column from a similar point of view is slightly more problematic. It's not Campos-esque or anything, but I feel the need to address some of the content which reflects some of the flaws in the debate. These flaws extend to both sides of the debate.

The larger point is that private markets in health care are not necessarily better than the government-run variety.

Given the shocking waste in U.S. health care, it's embarrassing that Bush still fails to see this. The United States spends nearly twice as much per person on health care as "socialized" Sweden or France, yet Americans' life expectancy is shorter. The profligate spending comes because doctors and patients make indulgent medical decisions while sticking third-party insurers with the cost.

...

Where unfettered private initiative produces evidently bad outcomes, most people prefer an alternative.


I'm going to ignore lines like "the free market has no solution for the uninsured", which would pretty much require an entire litany of right-wing talking points to properly refute. I'm not interested in doing much of that.

Behind the above sentences is an assumption: US healthcare today is the result of 'free market' policies. On the left and the right this assumption is used as a comparison to 'universal'-style healthcare in other countries. If they have a government/public system, we must therefore have a private one. Right-wingers say "socialism will lead to more costs!" and left-wingers say "then how come the US pays twice as much?"

The problem with the assumption is that it fails to recall the origin of today's US healthcare system. In olden times before most people reading this were born, there was a system of "wage and price controls", meaning there were regulations on how much you could pay for something and how much you could pay someone. It didn't cover absolutely everything but it was endemic enough to cause businesses to find a major loophole: benefits. The recent GM/UAW deal centered around benefits doled out half a century ago, benefits that only existed because of governmental regulation. Businesses couldn't compete with each other or entice employees with cold hard cash, so they did it with items like medical care.

Healthcare thus took on the primary characteristics of socialized medicine: the person receiving care was not directly responsible for the cost of medical care. If a person received medical insurance from his or her employer in one country, and a person received comparable insurance from the government in another, what would the difference be in how the insured consume medical care? I can't think of any significance there. The crux of the libertarian/conservative opposition to universal healthcare is that it takes away personal responsibility, but said responsibility has largely been removed anyway, even in cases where people have to buy their own insurance.

The health insurance industry in the US is far removed from other types of insurance, which center around major events. Mallaby references the need of some type of insurance in his column:

But a large share of health spending comes when people face emergencies: when they are sick, scared and about as far from feeling "empowered" as they possibly could be. Moreover, emergencies involve huge hospital bills that consumers are not going to pay out of pocket, even in the Bush team's shiniest scenario. Catastrophes will always have to be covered by insurers, so consumers' incentive to control this important component of health-care costs will always be imperfect.


Granted, but try finding a health insurance policy that's emergencies-only. Today's policies were spawned by businesses wanting something employees would be interested in, and that meant more than just getting a hospital stay covered if you break a leg. It meant things like minor doctor visits, the relative nickel-and-dime stuff that represents the majority of incidents if not spending. Insurers soon entangled themselves in all aspects of medical care, and their internal bureaucracies have hassled doctors and patients alike, creating incalculable amounts of paperwork and anxiety. It would be like homeowners' insurance getting involved when you call a plumber to fix a clogged sink. The insurance company represents a third party who leeches off the first two *and* costs them time with paperwork.

This mindset became the norm, and eventually state governments made the situation permanent by mandating what things *must* be covered by any health insurance sold within their borders. Insurers thus craft policies for every state, and few states have so little regulation that it could reasonably called "unfettered private initiative". The end result is the hassle, inefficiency and lack-of-personal-responsibility associated with 'big government', without the socially harmonizing benefit of universiality.

That's not to say I favor socialized medicine. Rather, I'm annoyed that so many people fail to see the roots of the current US healthcare system and the ways in which it's nothing like 'free market'. Those on the left should be skeptical that replacing one bureaucracy with another will have a significant positive effect; those on the right should realize that just because something is technically private-sector doesn't mean it should be defended from criticism. It's possible to be libertarian AND a critic of the healthcare system; as I've demonstrated it's actually quite easy. Sadly partisanship leads many on the right to oppose universal coverage proposals with no substantive counter-proposal, which leads the public to think that the right is satisfied with the problematic status quo.

For all the reasons I outlined, the right should be just as upset as the left. Because it isn't, the debate is being won handily by the left. The poor quality of debate on this issue is bad for everyone, and sadly I don't see that changing any time soon.

1 comment:

Unknown said...

Good points, but you left one out: licensing of doctors. This has allowed the AMA to cartelize the medical industry. This can't happen on a free market. It can happen in our non-free market.

Another point is the requirement that one go to a doctor to get a prescription, even if one knows exactly what he needs. The doctor is not providing treatment ... he is providing permission. And you pay him for it. Thousands of people doing that for chronic medication every month will create enough demand for doctor minutes that the price of those doctor minutes will rise ... but yet, the doctor is providing the public with no service.