Monday, June 29, 2009

Debunking Arguments Against the Necessity and Efficacy of the Government Health Plan

Before we get to the actual substantive arguments, I'd like to call attention to an often-used tactic, in this case by the shameless Diane Feinstein, who opined today that criticism from the left on healthcare "doesn't move me one whit" and who also has taken campaign contributions from the healthcare industry (though in fairness not nearly as much as some of her democratic colleagues in Congress. Feinstein said on CNN, “I don’t know that [Obama] has the votes right now. I think there’s a lot of concern in the Democratic caucus.” And that controlling costs of the new system is a “difficult subject.”

The idea is to convince us that the ship has already sailed, that though a a majority of Americans support the option of a public plan (and an even larger majority of her democratic constituents), the effort has already failed. You see this tactic used all the time. In the primaries, the Clintons tried to convince people that Obama would never win enough white male votes to get elected, so Hillary was the only option. Yes, we know you want Obama, but he's already lost. No use pining for what you can't have... So, here's Feinstein trying to portray the situation as something that's already failed because then there's nothing she could or should do about it. Ordinarily I'd do my job, but the task before me is impossible, or in any case, highly improbable, so you see, there's no point in getting upset about it. Of course, the left (and not merely the left), are upset about it. So Feinstein has a choice - either acknowledge the clearly-expressed will of her constituents, or like Ayatollah Khameni, declare the protesters insignificant. One wonders how disconnected a public servant is from her central mission when the public will is something to be dismissed.

But I digress - as the point of this post was to debunk bad arguments against the public health option. So above - we can't have a government option because it's too hard to pass is false. That's a determination to be made after the fact, not as an excuse for inaction beforehand. Everyone has challenges at work. This is your job, Senator Feinstein. Shut up and do it. Or as a friend of mine likes to say: "I don't want to hear about the pain - just show me the baby."

Second, the argument that the government can't run anything as competently as private for-profit industry. This is also patently false. Medicare's administrative costs amount to three percent of its budget - private insurance's more than 27 percent. Moreover, private insurers need to make a profit, the government just needs to break even. Our system of for profit insurance has resulted in the 37th best care in the world at the highest cost. Almost every country ahead of us, including the very top ones on the list, have some form of socialized care that costs less than ours and has far better outcomes.

Third, if we socialize healthcare, we'll become socialist. False. Our police and fire departments are socialized; so is our criminal justice system and our water supply. That doesn't mean you can't hire a security guard or buy bottled water. It does mean that many of our essential services are run by the government. Health care is an essential service.

Fourth, the free market is more efficient at setting prices for care than the government. This is false for two reasons (1) because one who needs an essential medical treatment isn't in a good position to bargain for a good price; and (2) because in many cases one lacks the expertise to determine whether a particular medical procedure is necessary. If the buyer has no choice but to buy no matter the cost, the market cannot possibly be efficient. And if the buyer lacks a proper basis to make an informed purchase, he's put in the position of trusting the seller to decide whether and how much he should buy. How anyone could possibly think such a system would be anything but disastrous to the American consumer is mind boggling. Health care is not like the latest electronic device where you are perfectly free to buy it or not buy it based on your financial situation and your personal priorities. You can also pretty easily grasp the pros and cons of owning that device on your own. In cases like that, the free market works perfectly well. Not so with healthcare.

Fifth, if the government's running health care, it'll put private health insurers out business. Might be true, might be false. Who cares? If it puts them out of business, then it proves the point that the government plan was a better deal. If it doesn't put them out of business, then it's false. Either way, it's not a serious objection. In fact, it's actually the point of the public plan - either to demonstrate the raw deal we're getting or to force the private insurers to come up with a fair one.

Sixth, turning insurance over to government and cutting costs will stifle innovation, e.g,, life-saving medical devices and drugs. Maybe, maybe not. Some of the biggest "innovations," e.g,, cholesterol lowering drugs, make a ton of money for the pharmaceutical companies, but do not significantly reduce the risk of heart disease. When profit is the chief motive for medical researchers, then they will do what most reliably yields a profit. Marketing drugs as life saving based on what they can do (lower cholesterol) is easier than to make drugs that actually save lives. Real innovation in any field is difficult. You can't just throw a billion dollars at Jerry Bruckheimer and expect him to make art with it. What you usually get is product, commerce. Something that can be marketed and sold. While it's not impossible for creative breakthroughs to happen while chasing the money (Fyodor Dostoevsky wrote many of his novels to pay off his gambling debts), it's the exception rather than the rule, and it's unclear that researchers motivated by smaller profits and something as pathetic as the good of mankind would fare worse.

Seventh, we can't afford it. This is the stupidest argument of all. First off, the current for profit system is what no one can seem to afford, least of all the federal government for which it's the biggest long-term liability. Second, if people don't get care, and remain sick, they'll continue to fill emergency rooms, costing more money than if they received timely treatment. Third, chronically sick people are unproductive in the workforce and drain otherwise productive family members who need to speed time caring for them. The cost in GDP of having substandard care for a substantial number of American workers must also be taken into account.

Never mind that treating the sick - rather than squeezing every last penny out of them and their families - is also the right thing to do.


Leo Wong said...

Got here from a tweet: InsurgentDesire Some good debunking of anti-healthcare reform arguments. Most important: *the debate is not over, decision not finished*

Thanks for the blog.

Phoebe said...

The current system is not affordable. And I do believe Obama's reform will pass. I think it's a done deal.

Having said that, I have thought of an alternative that would be fair and would absolutely force change - because Obama's reform is not harsh enough. It doesn't kill the behind-the-scenes deals between the insurance companies, pharma and doctors. This alternative is to require payment up front from everyone. No insurance, no billing and no credit. What, you say? Pay before you get the "goods"? Why not. You will never get your money back for inappropriate, harmful or ineffective care currently. Instead of letting some people go without necessary care to the death, as we do now, we can just let the ones who cannot pay die. What's good about this is that those who are afraid of being taxed, and god forbid, paying for someone else's care, are going to oppose this new system even more. You see, they believe THEY will never need care, or that their insurance will cover it. If they actually had to pay for care, they would put an end to this system in a hurry. The real truth is that they do not want to pay for their own care. Threaten them with that possibility, and watch prices go down to where most everyone actually could pay for their own medical care. There should be no medical insurance companies, and no need for them.

With this system, we would know the cost before accepting the treatment, and that would put an end to the BS games going on now. People might actually learn and choose for themselves what is "medically necessary", as the legitimate insurance companies from the distant past used to do.

Let the market decide!

Chris Liss said...

Thanks for the feedback - and I agree that perhaps the most sinister ploy, happily abetted by the media at every turn - is that reform is doomed to fail or has already failed. If it didn't get done by August recess, then it failed. Why? Because if they can convince us of that, then they no longer bear responsibility for making the effort. As for the alternative plan, I don't think costs would come down to where people could pay for it. The relatively healthy could, but the unhealthy could not. Heart surgery is never going to be cheap, even without the middleman. Also, the free market doesn't work with healthcare because the sick are in no position to bargain for a good price - and that's even assuming they knew enough about medicine to make an informed decision which they don't.