Friday, December 28, 2007

I am not health care reform: which can also be said of single-payer!

Read it here before the single-payer lobby gets back to it: "I am Not Health Care Reform" by the ubiquitous Drs. David Himmelstein and Steffie Woolhandlers, whose advocacy research underlies almost all of the nationwide push for single-payer health care.

They start by critiquing a Richard Nixon plan that never passed: "He wanted to combine a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income."

They next tar all the current Democratic presidential hopefuls (except that pillar of rationality Dennis Kucinch) for attempting to put into place Nixon's plan and that of other states: "Their plans resemble measures that were passed and then failed in several states over the past two decades."

There follow a list of states (Massachusetts, Oregon, Tennessee, Vermont, and Washington) that have instituted plans "similar" to Nixon's, only to see the number of uninsured individuals actually continue to rise. This leads them to their standard conclusion that:

The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

With the exception of Dennis Kucinich, the Democratic presidential hopefuls sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage.

Now before you get the urge to run out and sign up your DE legislator to support SB 177 for single-payer health care reform, let's unpack this a bit:

Woolhandler and Himmelstein use "negative" statistics, focusing only on the number of uninsured; they don't tell you (nor do they want to tell you) how many people actually received new coverage under all those state plans. Nor do they give you any comparatives for how fast the uninsured population grew in other states without such programs.

It is also a clever (and not uncommon) tactic to ascribe all of the increasing cost of health care to private insurance companies, who must also be to blame for the fact that fuel costs three times what it did ten years ago or that the greater number of high-tech options for treatment now available cost a lot of money.

The last deft touch is the comparison to Canada, where the single-payer system "debate should be over."

Yeah, Canada has been so effective in driving out private insurance that 65% of all Canadians still find it necessary to purchase some form of secondary private health insurance.

Health insurance is a tough question, and it is made tougher by the issues that most single-payer advocates don't want to touch, for example:

How many people who have coverage now will actually stand to lose some benefits?

How will waiting times and de facto rationing of services affect your health care?

How do you tout Medicare as a wonderful, cost-contained program when it has repeatedly broken through the ceiling of every budget projection ever made for it, and now seeks to contain its own costs by (among other neat, humanitarian ideas) refusing lung transplants to senior citizens?

What are the true cost projections for a single-payer plan (not the breezy, "we'll save $350 billion" crap) and how on a national scale do you intend to fund it?

This is a policy debate, not a slam dunk.


Alan Coffey said...

When a good is priced to $0.00, where do we end up on the demand curve? No, it is not free, but it will appear to be so to the low income user. I would like to know how they plan to pay for the upsurge in quantity demanded when the price falls to $0.00.

Steve Newton said...

If you--you damned hard-hearted right libertarian (thought I'd save Dana the trouble there)--actually insist on asking that question then it's obvious you have no social conscience.

Nothing--including the failure of 25,000 Delawareans to sign up for existing medical benefits to which they are legally entitled--is accountable behavior for the "progressives" amongst us.

Which is NOT to say that there isn't a health care access problem. It's just that the single-payer advocates appear constitutionally unable to see that anything less than immediate utopia would result from implementing their plans. (Which at least some of them want to pay for by gutting our national defense to the point where we could either have reserve components or a truncated active military, not both).

Ah, damn, I raised that socially unprogressive and politically incorrect question of how much this is all going to cost, didn't I? bad bad boy

Alan Coffey said...

I got tired of being called names by some on the blogosphere, so I now pretty much don't comment on the socialist element.

And we all know how to lower health insurance costs RIGHT NOW;

Fewer mandates.

Equalized tax treatement for private vs employer provided insurance.

Price transparency from providers.

Allow purchase of insurance regulated by other states (market concentration).

That would be a good start. Then, if society thinks it is necessary, we could subsidize the purchase of health insurance by poor individuals and families.

The government does not run grocery stores, they provide food stamps. Why should they control our healthcare providers?