[ExI] Health system, again
thespike at satx.rr.com
Fri Apr 4 15:35:32 UTC 2008
At 08:07 PM 4/1/2008 -0500, Max More wrote:
>Are you sure that a
>true free market in medical care wouldn't be a major improvement.
>Answer me with a "yes, of course, you market-lovin' bozo", and it
>might spur me to finally put together a piece (for my brand spanking
>new blog) on what steps toward such a system might be.
I'm in general agreement with this piece today in the NYT by Paul Krugman:
Elizabeth Edwards has cancer. John McCain has had
cancer in the past. Last weekend, Mrs. Edwards
bluntly pointed out that neither of them would be
able to get insurance under Mr. McCains health care plan.
Its about time someone said that and, more
generally, made the case that Mr. McCains
approach to health care is based on voodoo
economics not the supply-side voodoo that
claims that cutting taxes increases revenues
(though Mr. McCain says that, too), but the
equally foolish claim, refuted by all available
evidence, that the magic of the marketplace can
produce cheap health care for everyone.
As Mrs. Edwards pointed out, the McCain health
plan would do nothing to prevent insurance
companies from denying coverage to those, like
her and Mr. McCain, who have pre-existing medical conditions.
The McCain campaigns response was condescending
and dismissive a statement that Mrs. Edwards
doesnt understand the comprehensive nature of
the senators approach, which would harness the
power of competition to produce greater coverage
for Americans, reducing costs so that even
people with pre-existing conditions could afford care.
This is nonsense on multiple levels.
For one thing, even if you buy the premise that
competition would reduce health care costs, the
idea that it could cut costs enough to make
insurance affordable for Americans with a history
of cancer or other major diseases is sheer fantasy.
Beyond that, theres no reason to believe in
these alleged cost reductions. Insurance
companies do try to hold down medical losses
the industrys term for what happens when an
insurer actually ends up having to honor its
promises by paying a clients medical bills. But
they dont do this by promoting cost-effective medical care.
Instead, they hold down costs by only covering
healthy people, screening out those who need
coverage the most which was exactly the point
Mrs. Edwards was making. They also deny as many
claims as possible, forcing doctors and hospitals
to spend large sums fighting to get paid.
And the international evidence on health care
costs is overwhelming: the United States has the
most privatized system, with the most market
competition and it also has by far the highest
health care costs in the world.
Yet the McCain health plan actually a set of
bullet points on the campaigns Web site is
entirely based on blind faith that competition
among private insurers will solve all problems.
Id like to single out one of these bullet points
in particular the first substantive proposal
Mr. McCain offers (the preceding entries are
nothing but feel-good boilerplate).
As Ive mentioned in past columns, the Veterans
Health Administration is one of the few clear
American success stories in the struggle to
contain health care costs. Since it was reformed
during the Clinton years, the V.A. has used the
fact that its an integrated system a system
that takes long-term responsibility for its
clients health to deliver an impressive
combination of high-quality care and low costs.
It has also taken the lead in the use of
information technology, which has both saved money and reduced medical errors.
Sure enough, Mr. McCain wants to privatize and,
in effect, dismantle the V.A. Naturally, this
destructive agenda comes wrapped in the flag:
Americas veterans have fought for our freedom,
says the McCain Web site. We should give them
freedom to choose to carry their V.A. dollars to
a provider that gives them the timely care at
high quality and in the best location.
Thats a recipe for having healthy veterans drop
out of the system, undermining its integrated
nature and draining away resources.
Mr. McCain, then, is offering a completely
wrongheaded approach to health care. But the way
the campaign for the Democratic nomination has
unfolded raises questions about how effective his
eventual opponent will be in making that point.
Indeed, while Mrs. Edwards focused her criticism
on Mr. McCain, she also made it clear that she
prefers Hillary Clintons approach Sen.
Clintons plan is a great plan to Barack
Obamas. The Clinton plan closely resembles the
plan for universal coverage that John Edwards
laid out more than a year ago. By contrast, Mr.
Obama offers a watered-down plan that falls short
of universality, and it would have higher costs per person covered.
Worse yet, Mr. Obama attacked his Democratic
rivals health plans using conservative talking
points about choice and the evil of having the
government tell you what to do. Thats going to
make it hard if he is the nominee to refute
Mr. McCain when he makes similar arguments on
behalf of such things as privatizing veterans care.
Still, health care ought to be a major issue in
this campaign. I wonder if well have time to
discuss it after we deal with more important
subjects, like bowling and basketball.
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