[ExI] Health system, again

[Damien Broderick]

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. McCain’s health care plan.

It’s about time someone said that and, more 
generally, made the case that Mr. McCain’s 
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 campaign’s response was condescending 
and dismissive ­ a statement that Mrs. Edwards 
doesn’t understand the comprehensive nature of 
the senator’s 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, there’s no reason to believe in 
these alleged cost reductions. Insurance 
companies do try to hold down “medical losses” ­ 
the industry’s term for what happens when an 
insurer actually ends up having to honor its 
promises by paying a client’s medical bills. But 
they don’t 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 campaign’s Web site ­ is 
entirely based on blind faith that competition 
among private insurers will solve all problems.

I’d 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 I’ve 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 it’s 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: 
“America’s 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.”

That’s 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 Clinton’s approach ­ “Sen. 
Clinton’s plan is a great plan” ­ to Barack 
Obama’s. 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. That’s 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 we’ll have time to 
discuss it after we deal with more important 
subjects, like bowling and basketball.