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Thursday, June 25, 2009

Nail On Health Care Head

I didn't watch the ABC-White House health care special last night because the set up was one-sided. From an ABC report of the program, however, it appears that all did not go as planned for the White House, as two physicians in the audience challenged Obama on the implications of government-run health care, which always involves rationing.

The plans being discussed in Congress, surely with input from the White House, involve severe rationing of health care services so as to cut costs sufficiently to cover everyone. As in Britain and Canada, the proposals envision an unaccountable health board which would make cost-benefit decisions as to which treatments were permitted nationwide, without regard to any particular patient.

The physicians in the audience last night, at least according to the ABC report, asked Obama if he would be willing to limit his family's treatment to whatever such health board determined was cost effective treatment. Needless to say, Obama would not so commit:

Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick, they will be able to afford the best care available, even if it's not provided by

Devinsky asked the president pointedly if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get.

The president refused to make such a pledge, though he allowed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care.
And therein lies the paradox and fundamental fraud of the Democratic health care proposals. The wealthy, including the President and Congress, always will be able to get whatever care they want, by paying out of their own pocket or purchasing extra private coverage at substantial cost. (Although the government's decisions on procedures and medications may result in such benefits being available to no one, since it would not be cost effective for a company to develop a surgical procedure if the public plan bans the use of such procedure.)

The public, by contrast, will be stuck with what the government decides. Unless the health care plans outlaw such extraordinary private coverage, so that everyone is on a level playing field.

The public plans and government control of health care will result in a greater disparity between rich and poor (with the middle and upper-middle classes being shifted into the "poor" category), unless the government uses its police powers to ban the wealthy from purchasing additional health care benefits.

Greater disparity or a health care police state. At least one person at the ABC-White House television special hit the nail on the health care head.

UPDATE: Yes, this should be Obama’s Michael Dukakis moment if we had an honest mainstream media, but we don't so it won't.

Related Posts:
Deception and Tyranny Key To Health Care Reform
Getting Punked On Health Care Reform

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  1. And good for Dr. Orrin Devinsky! I didn't watch the program either, and have been really surprised that there hasn't been much, or anything, said on the new this morning. I wonder what the numbers were?

    The government is trying to get into every aspect of our lives, and we don't want it.

  2. A couple of things:

    In the UK at least the 'unaccountable health board', NICE, doesn't ban procedures that don't exist, so it would be a particularly prescient company that could decide not to develop such a procedure.

    I'd object strongly to any system that prevented supplementary care outside the government system (and so far as I can tell, current Democratic plans have no such provision, but who knows). So what you seem to be saying is that people who can afford more will be able to get more/better care. How is that different to the current situation?

  3. And that seems to dovetail nicely into the tax thing. Its real easy to support higher taxes if you know you won't have to pay it in any case.

    What will happen to health care under his plan is exactly what happened to education. the vast majority of americans accept public education because 1) they are paying for it anyway, and 2) its "free." (yes that is paradoxical, but its utterly true.) thus the great majority of us go to terrible schools that are increasingly not getting the job done in an even minimal way. meanwhile the rich get to go to private schools that actually, you know, teach people. Oh and if your children are facing discrimination at the hands of the school, in most cases the answer is tough. And of course we know that some poorer people get help to go to private schools, especially if they are religious (especially catholic). I am not sure the same spirit will transfer over to health care although there is some evidence it might.

    Now if we wanted to look at a model where the government has intruded successfully into the market, we might look instead at the university system. I would say our state universities are by and large quality institutions. And why? because they charge tuition and depend on those revenues to remain open.

    So make it free and it will suck. charge a premium and maybe it has a chance.

  4. So because the wealthy will be able to purchase better health insurance than the government provides to the poor, the government shouldn't provide anything to the poor at all. What an unbelievably stupid argument. Seriously, try to make even a little bit of sense.

    You are inadvertently arguing in favor of a Canadian-style system in which everybody is forced onto a single-payer system. There are strong egalitarian arguments in favor of such a system. But I don't think you support those arguments. So you're left saying that we have to have a massive difference between the quality of care available between social classes, because an effort to moderate that difference would be unequal.

  5. Ah, the best compliment a commenter can receive: you refuse to publish my comment, even though it was unquestionably civil and on point. It is a tacit admission that you have no response to my argument. You can keep your blog clear of posts that demonstrate your illogical and poorly thought out arguments, but we both know the truth that this post made no sense whatsoever.

    Really, it's a shocking statement: we can't provide any health care benefits to the poor, because that would increase inequality. Orwell would be impressed.

  6. Satya -- No reason to be paranoid. This is a moderated blog, and when you post a comment you are given a prompt indicating that there may be a delay in the time the post appears on the website. And that is why your original comment did not appear immediately, I couldn't check pending comments for about 90 minutes. If you notice on other posts, I allow critical comments. The slight delay in your comment appearing is a sign of nothing.

    As to your substantive point, health care benefits already are provided to the poor through Medicaid. It is the expansion of a mandatory system, which will push out private insurers and run the deficits through the roof, which are the problem.

    And I think you missed the point on the equality argument. I am pointing out the inevitable consequences of what Obama is proposing, which are contrary to his stated goals.

  7. So what I'm still not understanding is how the 46 million Americans who are currently uninsured are going to be worse off by free participation in a public plan than they currently are. For example, I'm currently receiving, for free, a public plan run by the State of Massachusetts, which provides a solid package of benefits in return for nothing. That is, to put it mildly, way better than Medicaid. Yes, there are people in Massachusetts who can afford better plans - but I'm not one of them. So how am I worse off again?

    Rationing in health care is inevitable. The questions that drive the health care debate are (1) should the rationing be done by the government, who at least should have the interests of the individual at heart, or by corporations who exist only to provide a profit to their shareholders?; (2) should people who cannot afford private health care be able to access quality health insurance? Pretending to be on the side of the poor by opposing their access to decent health insurance is, well, transparently illogical.

  8. So you want everyone else to pay for your health benefits? And if everyone is on the receiving end of free benefits, who will pay? Massachusetts is sinking under the cost of its health care programs, and so is the federal government under existing Medicaid and Medicare.

    And if you trust the government to make these decisions, good for you, but I don't. If a private insurer makes an incorrect decision, I can switch or sue. If some government board makes the decision that no one can receive a certain procedure, then there is nothing you can do.

    And that 46 million number is fluff, as it includes multi-millions who could afford insurance but choose not to purchase it, and also multi-millions more who qualify for existing programs but don't enroll.

  9. Fine, if your argument is that other people shouldn't have to pay for the health care benefits of poor people (I'm more in transition than poor, but that's an aside) then make that argument. But don't then turn around and pretend to be on the side of poor people! You aren't. You believe poor people should be left to fend completely on their own for their health care needs.

    And under Obama's plan, if you are on a public plan and you don't like the benefits offered, you can switch to a private insurer. In other words, you'd be in the exact same situation you are in now - except you'd have a minimum level of health care provided for you.

  10. Needless to say, Obama would not so commit:

    Which from a political standpoint, is utterly incomprehensible.

    It's not like any other promise he's made hasn't had an expiration date, what's one more?

    46 million Americans
    Cite where you got that, please. Back to it's source.

    If you do that, you'll find that it's a made up number. A guess at best. But apparently it includes college students (who are on their parent's insurance, but they list them separately to jack up the numbers), about 10-15 million illegal immigrants, and a number of people who have chosen to forego insurance. (The Frosts, for an example.)

    There are maybe 5 million truly "uninsured" in the country.

    But even, even if you're right on the 46 million - that's under 12% of the total population. It makes very little sense to completely reorganize the system when it's got - even according to inflated numbers, ~90% coverage.

    (It's not letting me log in with the OpenID..)

  11. I think the issue is whether people should be forced or free to help others. Liberals believe that charity only works when it's coerced. Conservatives believe that charity works best when it's voluntary. That's why liberals believe that conservatives hate poor people; we're pro-choice. (Which is also why conservatives think liberals hate babies, but that's another topic.)

  12. "(1) should the rationing be done by the government, who at least should have the interests of the individual at heart"

    This is the fundamental worldview disconnect between Satya and conservatives.

    I do not believe that the government has the interests of the individual at heart. The government has the interests of those in charge of the government at heart. The government is largely incapable of seeing anyone as an individual, up until the individual sets its interests against that of the government, by doing things like violating the law.

    In particular, a progressive government that sees people not as individuals but as the labels they carry, is incapable of seeing people as individuals for purposes of healthcare, or any other reason. At least as a policyholder from "corporations who exist only to provide a profit to their shareholders", you represent a revenue stream that the companies are largely loath to lose. They have no business other than collecting premiums, paying claims and negotiating for as much of the former and as little of the latter as possible. You would think these parasitical corporations would balk at the most expensive of treatment, namely cancer treatment, but that is one area at which the profit-driven US healthcare system excels. Paradoxical, no?

    I forsee some version of ObamaCare with a public option passing, as much as I wish it wouldn't. And since the people who will use the public option will insist on equivalence to private coverage, for the first few years the coverage will be very good, with few restrictions. "See!" the proponents will cry, "You were silly to be concerned." A few years down the road, when the cost estimates are wildly exceeded, benefits will be ratcheted down, though taxation will not. Meanwhile, the other insurance plans who are unable to print money like the public option can, who have to do silly things like maintain reserves, will lose many clients to the public plan simply because the public plan will almost assuredly be cheaper than a private plan of equivalent benefit.

    The net result will be the majority of patients treated under the public plan, with increasing costs despite suboptimal treatment options (a demographic certainty, if a version of Medicare becomes the "public plan"), while a minority of people willing to pay over and above the taxation that is required to support the public option (both for them, and for others) will get better care. Regardless, the government will have essentially taken control of another 14% or so of all economic activity in the country, and whether the plans fail or succeed, the taxes will remain.

    The simple truth is that we cannot afford a public system that provides care to everyone at a level of service we are accustomed to receiving under private plans. I know this because virtually every other nation that has tried to do so has not, Massachusetts cannot for long, and even Hawaii's limited plan for children folded in short order. This is not invention of a system, it's adoption of systems that have already been tried and found wanting elsewhere.