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2012 Feb 9 |
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http://www.theatlanticright.com/2009/08/10/legitimate-concerns-about-health-care-reform/
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Posted by Arvak   |   10 comments

image.pngWriting at The Moderate Voice, Jazz Shaw disproves the dominant meme that all health care reform skeptics are just hardline ideologues and ignorant flacks paid by the insurance industry. The points that Shaw outlines are perpetually ignored by reform advocates:

Any time top-down price control is attempted by governments the result is uniformly bad. Generally it’s used to try to keep prices down, but on rare, odd occasions it’s been used to artificially inflate prices, such as in Italy during the early 1900’s. It didn’t work well there either.

Forcing prices down below market rates results in lower availability of resources as per basic laws of supply and demand. You can’t make the manufacturer of five million dollar M.R.I machines start selling them for fifty thousand dollars. (Well, you can, but they won’t stay in business for more than five minutes.) The same applies to insurance companies providing the commodity of health care coverage. If you make them “compete” with a government plan which doesn’t have to obey the same market rules as everyone else, and attempt to dictate who they will cover, what services they will provide and what they can charge, you drive them out of business and your “choices” go away.

The difficulty in getting reform advocates to move beyond simple name-calling to actually engage these kinds of intelligent criticisms is extreme. Indeed, it is likely that the whole point of the recent spate of attention from left-wing blogs to “birthers” and the endless exaggeration of the antics of protesters at the “town hall” meetings is specifically to avoid serious critics by denying their very existence.

But all the smears in the world don’t make legitimate concerns about health care reform go away. If the proposals now in Congress are enacted, the forces driving providers out of business by clumsily coercive cost-cutting and the budgetary forces driving down equipment underinvestment could severely undercut availability regardless of how much energy liberals invest in calling conservatives names. And as Canadians have long ago learned, access to a waiting list is a very different thing from access to health care.

If liberals really care about the poor, the unemployed and really anything more than just chalking up a “W” in an ideological war against conservatives, they would open up the health care bills for real, detailed debate about how best to mitigate the problems. There are provisions that could be added — multi-year budgeting, flexible and region-sensitive reimbursement schemes, incentives to employers to maintain private insurance instead of overusing the “public option” — that could redress or at least mitigate the kinds of concerns that Shaw highlights. But these kinds of discussions can’t really happen as long as demonization remains the primary tactic of the pro-reform political fight.

The time has come to see if the “hope and change” promise of a post-partisan era of pragmatism was real or just window dressing. And the President can’t prove it himself, the judgment will be determined by the behavior of his supporters. And so far, things look pretty grim.

  1. Posted by c3
    | Quote | Trackback | Link #100192 ›
    c3 I work for an insurance company (yes, I am EVIL.) What is striking is the continued use of a term or two attached to a fixed belief that if insurance companies didn't exist health care would be so much cheaper and everyone would have it. Believe me the employers who "hire" the health insurance companies are very much pushing prices lower. Even Medicare turned to private health insurance companies some time ago to see if they could impact the serious health care inflation rate. England has a governmentally run system and yet their medical inflation rate is higher than ours. By the logic of commentors on TMV that shouldn't happen. And if it were all about profit then Kaiser would have conquered the medical world some time ago (thought granted they've done pretty well.) finally, our best model of a US Governmentally run program is medicare. It will be "bankrupt" in less than 10 years. Physician participation is dropping. (that says nothing of state by state physician participation in Medicaid, which may be more what the public option will look like.) Will we be giving folks at ticket to the ball, but none in site.
  2. Michael Merritt "which may be more what the public option will look like" And yet physician participation in the Medicaid program in my state is abysmally low. It seem like the rate is maybe 1 or 2 doctors per specialty or general practitioner per town. To get a dentist while on it, I had to go a town over. I was able to get a GP in town only because my mother and father had been with him for years.
  3. Posted by Tully
    | Quote | Trackback | Link #100199 ›
    Tully Physician participation in MCD is down to around 60% or less nationwide. For MCR it's around 75-80%, and dropping. MCR is spending more than it takes in now -- the balance is drawdowns from the "trust fund." Of course, those dollars have to come from new borrowing or revenue, since the "trust fund" consists of government's IOU's to itself.
  4. Posted by Brad Templeman
    | Quote | Trackback | Link #100209 ›
    Brad Templeman The only think you ever hear from liberals is that Medicare is popular and supposedly has low administrative costs. Yes, but what about the $89 trillion in unfunded liabilities? Doesn't that show that there is at least a political problem in that way it has been handled over the years? No, it's going to save money, just take their word for it.
  5. Posted by RAGGEDSTEP
    | Quote | Trackback | Link #100221 ›
    RAGGEDSTEP c3, Is is not the case that if you have two patients recieving identical procedures with one on Medicare and one with a private insurer, the hospital will actually collect more from the the private insurer than from Medicare? Would you say,then, private insurance has an important role in subsidizing government healthcare?
  6. Posted by Tully
    | Quote | Trackback | Link #100236 ›
    Tully RAGGEDSTEP, that is in general exactly the case, though it may not apply to each and every private insuror -- it depends on what contracts they hold with what providers. In fact, if MCR and MCD paid the same as private insurance overall, private insurance would cost about 15% less. That's the additional amount that private insurance pays to providers (and charges to policyholders) to subsidize MCD/MCR through cost-shifting. Also, the claim that MCR has lower administrative costs ignores some very real admin costs that private insurors pay and MCR does not. Fraud prevention, for example, is a very legitimate and substantial overhead/admin cost that counts in private insuror overhead but does not show up at all in MCR/MCD overhead/admin. This is because MCR/MCD fraud prevention costs are outsourced to other units of government (law enforcement) and fraudulent claims paid are not counted towards MCR/MCD overhead/admin. It's estimated that 10% of overall health care system expenditures go to fraud and fraud prevention (NOT counting law enforcement expenditures) either in moneys lost to fraud or moneys spent to prevent fraud. It has been estimated that 15% or more of MCR/MCD payments are fraudulent. The fraud level on private insurance is enormously lower, and even after adding fraud prevention costs back in, it's still far lower than MCR/MCD's double-digit losses. Right there is a hidden overhead "administrative" cost that damn near equalizies the difference between private and MCR/MCD overhead/admin costs.
  7. Posted by c3
    | Quote | Trackback | Link #100237 ›
    c3
    RAGGEDSTEP : c3, Is is not the case that if you have two patients recieving identical procedures with one on Medicare and one with a private insurer, the hospital will actually collect more from the the private insurer than from Medicare? Would you say,then, private insurance has an important role in subsidizing government healthcare?
    Medicare generally pay less than most private health plans. In fact, during negotiations between health plans and hospitals what "percent of Medicare" is a common reference point for rate negotiation (i.e. 110% of Medicare.) Subidization suggests Medicare reimbursement doesn't not cover the costs of the hospital care and that private insurance reimbursement is more than cost. That gets into hospital finance and I would suggest that it is unclear as to whether medicare across all hospitals pays less than costs of care. I don't believe so. on the other hand, neither Medicare nor private healthcare want to be the payor for the "shifted cost". Both are trying to "drive out cost". Medicare's primary means of doing that is via rate reductions. Private insurance has done rate reduction, utilization review ("no I won't pay that extra day in the hospital") and "re-engineering the system" (i.e. gatekeeper; didn't play out to well) I have great empathy for Medicare. For many years it saw a point of "insolvency". That approach was accelerated with the Medicare drug benefit. Their means to manage cost are limited and they are heavily influenced by politics. In all the heat of the debate I haven't heard one Republican congressman suggest we should eliminate the Medicare drug benefit. And yet it exemplifies the core problem with healthcare reform. We already spend "too much" on healthcare so why is more money needed? And if you spend more money and create a new program/benefit/entitlement you will not be able to take it back. For that was good about the medicare drug benefit, we couldn't and can't afford it.
  8. Posted by Doomed
    | Quote | Trackback | Link #100240 ›
    Doomed Having read about 2/3'rds of the bill right now I have a couple observations. First 97 pages deal with how the government is going to set panels to determine everything. How much. who, what, when, where, why and because and who gets penalized for not having health care. It will now be a crime to not have health care and you will be subjected to fines and punitive actions. It also lays out how the president gets to set up commissions to oversee the health care fiasco that is fixing to be unleashed on America. About 3/4 of the way thru the bill the government gives themselves the rights to COME INTO YOUR HOME and counsel you on having children, raising children and how to be a parent. And if thats not enough....They then lay out in black and white what criteria they will use in coaching Americans on how to raise their children. Nanny state? Its moving beyond that. Way beyond.
  9. Posted by Doomed
    | Quote | Trackback | Link #100241 ›
    Doomed Additionally moneys are being made available for Universities that have an arbitrary set of criteria in place that are at the sole discrection of the US Government in the form of aid and grant money. This money will be given to those Universities that show a willingness to essentially educate minorities into the health care field with the Government setting arbitrary evaluations of this fact. No hard and fast guidelines just simply an arbitrary yes youve done enough or no sorry you need to do more..... How much more? Well we will let you know when we are satisfied.
  10. Posted by Tully
    | Quote | Trackback | Link #100248 ›
    Tully First 97 pages deal with how the government is going to set panels to determine everything. How much. who, what, when, where, why and because and who gets penalized for not having health care. But they won't be rationing by fiat. I know that's true because Obama told me so. :-)
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