Friday, October 30, 2009

United We Stand

A friend gave me a copy of his union's newsletter. The big article supported health care reform. At first I thought this union has good care, why would they want to jeopardize it? Then I remembered they're in bed with Obama so of course they support it.

The piece replied to six "myths" about reform, responding with "facts." Let me quickly go over them. (Clarification note: the myths are in quotes--the union thinks they're all incorrect, of course. The comments following are mine, responding not to the myths, but the union's arguments against them.)

1. "Reform doesn't affect people who already have health insurance."

This isn't usually a big point--in fact, usually this "myth" is sold as a good thing. But I guess since everyone reading the newsletter has insurance, the union feared complacency and wanted to make it clear that reform will help even them.

I should note that one of their counter-arguments is the cost of Medicare and Medicaid are bankrupting us, and a public option will provide competition to help keeps costs down. So a huge government program is unaffordable, and the only solution is more government. (It is true that a government takeover of health care could potentially keep costs down, but only by lowering the quality of care.)

2. "A public plan option will force all Americans into a government-run program."

Just because the strongest voices in favor of reform want this to happen doesn't guarantee it will. But it's no good to keep saying people will get to keep their insurance if they like it when, after the government gets more involved, there'll be forces beyond their control deciding who gets what.

3. "Reforming health care will cut Medicare benefits for seniors."

I think we know that somewhere along the line, someone's gotta lose something. The most obvious target is seniors since they consume so much health care and have so much money. But I suppose if they lobby enough they might be the ones who are protected.

4. "Co-ops are an adequate substitute for a national public insurance plan."

The argument against this is co-ops simply wouldn't be big enough to have effective bargaining power against the health insurance industry. So we see, at the very least, the union foresees a massive government program, no matter what the demand. And if no one wants the government program? I guess that's not allowed to happen.

Anyway, why are co-ops too small to fight? If they're any good, they'll get more and more people. That's how competition works. Unless we're talking about a union-supported massive government spending program, where the idea is to knock out the insurance industry.

5. "America's deficit will increase by $1 trillion due to healthcare reform and force many familes to go broke."

Here's the union's argument: "President Obama has said he will not sign a bill that would add to the national debt or deficit." So there you have it--in addition to his other abilities, he's clairvoyant. Bills of this sort always cost more than advertised, but President Obama knows exactly how much the final tab will be.

The union goes on: "[President Obama] has proposed that two-thirds of the cost of reform be paid by reducing waste, fraud and abuse in exisiting programs and ending overpayments to insurance companies." This is great--we can save hundreds of billions just by making Medicare more efficient. And apparently the government's been overpaying insurance companies for a long time--quite a scandal. I guess, like Dorothy, politicians have always had the power to run government health programs better, but Obama is the first one to click his heels. Let's make a deal. If he can cut half a trillion from Medicare over the next five years, we'll let him pass any law he likes.

By the way, the other third of that trillion will be paid for by cutting deduction from couples earning over $250,000. (This means, of course, they'll do the same to single people making $125,000+. ) These allegedly rich people have become the Democrats' favorite punching bag, but they're already paying everyone's taxes. There's only so much more you can get out of them, and when you do, you remove it from the economy elsewhere, where it does stuff like create jobs and keep businesses afloat.

6. "Congress is moving too quickly."

The union says the time for healthcare reform is now. Perhaps. But if this is a crisis, it's a long-running crisis. Since passing reform is likely irrevocable (as its advocates know), shouldn't we take our time? And since all the different plans under discussion don't have the benefits kick in until 2013 or later, they apparently don't believe there's a rush, either.

11 Comments:

Blogger QueensGuy said...

It is true that a government takeover of health care could potentially keep costs down, but only by lowering the quality of care.

I disagree. Almost all health economics experts agree that providing strong incentives to encourage preventive care and better routine care of chronic illnesses could potentially go a long way toward keeping costs down without lowering the quality of care. Whether a government-run system would accomplish that is, of course, a separate question.

7:41 AM, October 30, 2009  
Blogger LAGuy said...

People have been talking about improving preventive care for longer than they've talked about health care reform. There's no reason to think it will ever work in any significant way, and even if it did, it would just kick the can down the road a bit.

8:07 AM, October 30, 2009  
Anonymous Denver Guy said...

The thing that keeps people from getting preventive care is not the cost - it is the inertia of the healthy. The vast majority of Americans have health insurance, and do not stay away from the doctors because of a $30 co-pay. They stay away because 1) people don't like/fear doctor visits, 2) don't want to waste time, and 3) don't have a relationship with a doctor they trust.

I don't see how health care reform can address any of these issues. Look, the easiest preventive care measure is quitting smoking. Yet the gov't can hardly budge smoking rates, and only does so at all by massive tax penalties and making smoking illegal almost everwhere. So unless health Care Reform provides jail time for people who refuse to go to see their doctor, I don't see a rise in preventive health care.

8:28 AM, October 30, 2009  
Anonymous Anonymous said...

I don't know if health care reform is a good idea or not but I do take issue with the argument that preventative care cannot be improved with different coverages. A few years ago I switched from my HMO to my wife's Blue cross plan (she's a teacher so I guess its considered good) I routinely went for periodic checkups under my HMO (mainly because the doc said so (Lipitor,blood pressure.... etc.) but the plan also encouraged and paid for them). When I switched and then stupidly didn't check the fine print, the periodic visit cost $500 with tests. Sorry for the dull medical story but thats one small example but its clear I will do something preventative thats free- I won't do something preventative that costs $500.

I have no idea whether the public option/required care pays for periodic checkups but offer it only as a single example where the type of coverage can have fairly significant impact on preventative care.

10:05 AM, October 30, 2009  
Blogger LAGuy said...

It's easy to come up with personal examples. But this is the kind of thing that supporters think is easy when it's very very hard, and unlikely to work. There have been plenty of efforts for decades to get people in better shape, and they don't seem to be working. The only response is "but this time it'll work." Yeah, we've heard that before.

Furthermore, as noted above, the idea this will save us money is questionable. People will still get sick, maybe just later.

10:13 AM, October 30, 2009  
Anonymous Anonymous said...

Getting people in shape is exactly one part of preventative medicine and focusing on that is a disingenuous attempt to skew the argument off in to discussion of sidetopics (although I work for an employer who provides various health coverage to various employee groups and the ones with health club discounts attached have lower rates of illness). These are all nudges What are experiences of the nation but the sum total of several personal ones. It seems basic economics that paying for annual checkups versus not paying for them will increase the number of annual checkups which will improve preventative care. Not really that hard to see.

1:07 PM, October 30, 2009  
Blogger LAGuy said...

"Getting people in shape is exactly one part of preventative medicine and focusing on that is a disingenuous attempt to skew the argument off in to discussion of sidetopics"

I'm not trying to skew the argument. I'm talking about absolutely every type of preventive care that can be done and can be imagined.

There is simply no good reason to believe that preventive medicine will make any large scale difference in cost (and probably not that much difference in health, for that matter). It's been tried, and tried in many ways, and made, at best, a small difference. Furthermore, the biggest large scale improvements have already been tried--right now we're talking about marginal differences at best. But that doesn't stop people who believe if we just use more government to try something that's already been tried, this time it's finally going to work.

Short of a miraculous new discovery (more likely to come about if we keep the free market alive in health care), the idea that we will be able to seriously cut costs without cutting quality is a fantasy. I'm not buying, and I hope the public isn't either. There may be arguments for government health care, but this isn't one.

1:25 PM, October 30, 2009  
Anonymous Denver Guy said...

And I'm not even questioning whether preventive health care (annual check ups, mamograms, prostate exams, etc.) wouldn't help make people healthier. let's assume it would - you would think that alone would be enough incentive to get people in to see doctors on a regular basis. But it isn't. How many multi-millionaires have died of Prostate cancer, a preventable death if caught early. Frank Zappa is the first that comes to my mind. He certainly could afford to see the doctor.

People don't like going to doctors. I don't think most people would have their eye's examined if it wasn't a requirement to get a driver's license.

1:47 PM, October 30, 2009  
Anonymous Anonymous said...

People don't like to see doctors, that's true. The way to make them go is to make it "free". That is, the government pays for it through taxes. From that point on, any time someone's sick they'll go to the doctor. There'll be more doctor visits. So many that the costs would actually go up, and the government would either put limits on what you can get or at least create far longer waiting periods, thus limiting quality.

2:17 PM, October 30, 2009  
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