The last argument against universal coverage is that it is socialist, and therefore bad.
Whenever critics start throwing labels around, its obvious their position is not based on facts, data, and logic. And/or they are just lazy, as not much is simpler than saying “that’s bad because it is socialist/fascist/communist/libertarian”.
(have you noticed that as we get to the bottom of the list the I-Hate-Universal-Coverage crowd’s arguments get thin to the point of invisibility?)
The socialism-is-bad argument has been reprised on this blog by ‘Brent’ – (btw ‘Brent’ is a pseudonym for an executive in a managed care firm). Here’s a quote from one of his comments: “socialism has failed in every country in which it has been installed”
Here’s another. “All countries in which socialism has become the form of government have declined. Healthcare is no different from housing, food or entertainment: it is a personal choice and a personal cost.”
According to this logic, health care systems in all other Western countries and pretty much every other developed nation are ‘socialist’. If the definition of ‘success’ is lower costs and better outcomes for the entire population, the stats certainly indicate that the ‘socialist’ model works better than our’s.
I’ll hit the highlights here, but those interested in a detailed and thoughtful discussion of the US v. Socialist models should read Jonathan Cohn’s piece.
I’m not sure how health care is a “personal choice and a personal cost”. My father did not ‘choose’ to contract cancer, I did not ‘choose’ to get cataracts at an early age, a business associate did not ‘choose’ to be maimed in a car accident. Yes, some health conditions are directly linked to personal choice, but many appear to have no such link.
From a ‘cost’ perspective, unhealthy people ‘cost’ a society in diminished productivity and a lower standard of living. If workers can’t make enough widgets, the company doesn’t make enough profit. If a highly intelligent individual can’t work because of an untreated chronic condition, society loses. Does that ‘cost’ the person? Sure, but it also ‘costs’ society.
The gold standard in measurement of health care outcomes is “Disability Adjusted Life Expectancy” (the number of healthy years that can be expected on average in a population). And here the US ranks 24th. However, we spend 140% above the median industrialized country.
That’s a pretty poor return on investment, one any business person would be fired for ‘achieving’. Yet proponents of the US health care system argue that because these other systems are ‘socialist’, they are bad.
Perhaps they are blinded by ideology, and therefore aren’t able to see facts.
Joe, I would like to say that I have enjoyed and learned from the discussion you have generated on this topic over the last several weeks. It has also taught me however that this is not a topic that someone is swayed on, or comes to terms with based on facts or logic…It is an emotional issue. Much like stem cell research, unless you are personally affected by a situation where Universal Coverage may have changed an outcome for a loved one, or family friend, no logic, statistics or empirical data will ever affect a change in someone’s stance, as long as there are political labels and viewpoint attached to the debate. Although I am guilty of throwing several political salvos myself, I do not believe we will ever be able to really address these issues until UC is made into a center point of the fabric of the social conscious in this country, much as Social Security (I do not know anyone who does not believe we as a society have a obligation to financially protect the elderly). Although we may differ on how to fund SS, no one rejects the need for it. Until UC has been brought to that point within our society we will never get a political mandate to really fix this healthcare crisis.
A few thoughts on this.
First, my own preference for achieving universal coverage for the under 65 population is a voucher system funded primarily by a payroll tax split 80-20 between employer and employee. It would cover the cost of a basic package to be defined by policymakers and there would be a strong role for private insurers. This is in contrast to a Medicare for All system where government is the only buyer, devises a one size fits all benefits package, and dictates reimbursement rates. Under this approach, private insurers would be limited to selling Medi-Gap policies.
The key problem with the Medicare for All approach is that I just don’t trust the government to control costs or devise a system that results in efficient resource allocation and incorporates innovation. I note, for example, that it took 41 years after Medicare was enacted in 1965 before Congress finally passed a prescription drug benefit. Drugs were not an important issue in 1965, but became much more important later. Budget constraints are often dealt with by squeezing provider payments which, in some cases, don’t cover their costs. Moreover, as a customer, if I’m not satisfied with the insurance plan, I don’t have anyplace else to go. With vouchers and a variety of private insurers competing for my business, I do. Even if administrative costs are somewhat higher, it’s a better approach, in my opinion.
Regarding the quality metrics and satisfaction levels among different healthcare systems, I think it is important to determine to what extent the people who are most satisfied have the least interaction with the system because they are generally healthy. I think a better measure of satisfaction (and outcomes) is how well the system deals with those who are the sickest – especially those who suffer from heart disease, cancer or stroke – our three biggest killers. While lifestyle choices like diet, exercise, smoking, etc. have a strong bearing on the incidence of these diseases, how the healthcare system deals with them once they occur, including long term survival rates, is more instructive, in my view. In addition, there may well be considerable differences in peoples’ expectations as to what constitutes satisfaction with the system.
On infant mortality, setting aside the issue of the definition of a live birth which varies among countries, the variation in the U.S. from state to state has more to do with the degree of poverty than with the percentage of the population that has insurance or whether or not women have access to prenatal care.
Finally, on disability adjusted life span, it would be useful to factor out deaths from murder and car accidents which probably cut more lives short in the U.S. (relative to the population) than elsewhere. I understand, for example, that the U.S. murder rate is eight times higher than in France which doesn’t have anything to do with the quality of the healthcare system.
“I’m not sure how health care is a ‘personal choice and a personal cost’.”
Healthcare is a personal choice because you know and I know that the majority of healthcare dollars are not spent on glaucoma, cancer, or car accidents. The majority of dollars spent are on chronic “lifestyle” conditions such as heartburn, brought on by poor diet and stress, chronic depression, brought on by one’s own poor life choices, and high cholesterol, brought on by poor diet. For my entire book of business, these three drug classes make up nearly 40% of pharmacy spend. And this isn’t only for my book of business. If you check Medco and Express-Scripts’s annual reports you will see that the rest of the country follows the same trend.
“we spend 140% above the median industrialized country. . . That’s a pretty poor return on investment”
You are neglecting one very, very important fact. Pharmaceuticals sold in other countries under socialized medicine systems are priced at or near margin. These other countries are not helping fund the R&D which goes into developing those drugs. The socialist countries think they are getting the best of both worlds, new therapies without any cost increase over the old therapies. And the worst part is that the lawmakers know exactly what they are doing. They are intentionally shifting the burden to other industrialized countries for “the greater good”. That’s bullshit. The lawmakers are gaining power and furthering their political careers by fooling the public. They think that the programs will remain solvent until they retire and, if they don’t, they will just blame the opposing political party.
Anyway, the point is that the socialist countries are not contributing their share towards modern medical developments, but they are reaping the benefits of those developments. That’s why the US spends 140% above the median.
Managed Care Matters, a rebuttal
Joe:
I wanted to take time and go through the whole list of ten items and detail a single response. It undoubtedly will not change your mind but it is a good exercise for me to flesh out my responses and thoughts..
Part 1. We can’t afford it.
Your right, we can afford universal healthcare.
Also:
We can afford the best possible National Defense.
We can afford the absolute best National Infrastructure (roads, bridges, dams etc.)
We can afford to protect the environment against any and all depravations no matter how trivial.
We can afford a free college education for every American and illegal alien in the country.
We can afford the best libraries, hospitals, waterworks, electrical utilities and other public services and utilities for everyone regardless of need.
We can afford to provide a generous income to all Americans and illegal aliens regardless of their ability or productivity.
We can afford a generous food allowance for everyone regardless of his or her need; no one should want for food.
We can afford to provide a generous retirement for all working Americans and working illegal aliens and even those who don’t work. No one should face their golden years worrying about money even if they don’t save.
We can provide everyone with a great place to live and a vacation house as well. Everybody should have both.
Whoops, we can’t do all of that. We ran out of taxpayers and money somewhere along the line. We will have to prioritize how we spend taxes and how much we take from our citizens. The supply of both is not unlimited. I guess you mean in your opinion it is of such a high priority that everything else is of less importance. If so then we probably can afford it. But if you think we are really already paying for unlimited healthcare for everyone in this country I think your wrong by a factor of probably three and maybe more.
Part 2. People don’t have insurance because they choose not to buy it.
You say it is not a matter of choice it is “Not a matter of Choice, but affordability.”
Your right. Whoops, see Part one.
If health care insurance cost nothing everyone could afford it.
.
Your 2% is those who say they don’t need health insurance. The percentage that says I don’t want to pay the price even though I could is a lot higher. Remember they really can afford it see Part one. If they choose to. The number who really can’t afford health insurance is small if they are willing to sacrifice everything else for the health insurance premium. They prioritize and make the choice. A nice car, a nice apartment, a vacation, nice clothes, retirement savings, investments, whatever, before health care premiums. Of course they make the matter worse for those that make the choice to buy health care insurance, but it is a free country.
Part Three. UC won’t solve the health care crisis.
I taught business to high schools for four years, part time, first period, as a volunteer while still running my business. We had a democratic candidate for congressional office come in one day and part of his platform was universal care. We proposed that all the cost of care and premiums redistributed equally would take care of all the medical costs in this country and everyone would have full care.
After he left the kids made fun of his position. They could not figure out if he was stupid or just naïve. They had learned that human needs are limited and wants are unlimited. If we could use medical care whenever we wanted for any purpose that the cost of medical care in this country would multiply. A single payer government run system with unlimited coverage and costs would run amok. This was high school kids.
Part Four: UC will give the government too much power. Part Five: Is a devastating blow to Personal Liberty
The government will at some point in time start rationing the health care dollars. Whether it is for procedures the government thinks is unnecessary, or experimental, or unwise or just too expensive. I really don’t want the government saying to me you can’t try a new procedure for your prostate cancer. The tried and true method is to surgically remove it and probably become impotent. I prefer a choice thank you. The scenario you lay out will force the government to stifle research and experimentation in the name of cost savings. Do you really want the government rationing the health care for you and yours?
Will UC be an affront to personal liberty? Of course it will. Every government regulation is. We allow some to enforce the social contract. When some go to far, such as prohibition, even though well intended we reverse them. If the government ever controls health care (more than they do now) do you think it will be able to be reversed or will we start going else where for treatment (those of us who can afford it?) like much of the world currently comes here. Though India and Singapore are catching up thanks to our training their doctors.
Part 6. A mandate is not necessary, as the free market will solve the problem.
65% percent of French citizens express satisfaction with their health care system. As opposed to what? We see both systems here in this country. You are comparing a fully regulated system with no choices to a system here with multiple ways of getting or not getting coverage and some (though not complete) public understanding of what the cost is; i.e. the individual health care insurance policy. Choices themselves will make for dissatisfaction. Any sociologist will tell you that the more choices there are the more problems will be perceived. If there were only one style of shoe to buy no body would object because there would be no point in doing so. Check your studies on the dynamics of choice, it will disarm your conclusions here.
Part 7. If you give people more coverage they will use it.
I will just disagree with you here. Unlimited access will lead to a substantial increase in usage. I need to get my love handles trimmed. I would like a hair transplant. Lasik surgery please. I don’t need it but how about viagra for the old farts. My wife doesn’t really need a powered wheel chair but why not. (If she really needed one I would by it, but if its free, why not). I want the best drug not just a cheaper version that’s maybe just as effective, I want the best. I need three pair of glasses not just the one I carry. I have a bifocal, I need a single vision for sports, a short range for the computer, a dark pair for outside, a special frame for racquetball, a special set for my skin diving mask and a specialized pair for when I am piloting my airplane (rent not own). My optometrist agrees, he just won’t lower the price where I feel the need to pay for them all. Free, I will take two of each, thank you.
Part 8. It will drive up costs, which will lead to rationing.
See part seven and part one.
Part 9. Why not M programs for all
UC will be Medicare in the end. It is the only way possible to compel everyone and to include everyone. UC is of course the antithesis of Insurance, which is a sharing of risk and acceptance of the cost of the group risk. UC says we will pay for what everybody wants or needs as long as we say they can have it.
You yourself decry Medicare as the “worst option”
Part 10: It is socialist and that is bad.
The problem with a socialistic system is not that it is socialism, but that it removes the individual from the decision making process and substitutes the group. In this country the individual is preeminent. That preeminence has made this country into the superpower in wealth and might that it is. It is why people from all over the world strive to get in and stay in. Personal freedom to succeed or fail by ones own decisions and striving is embedded in what has made this country great.
If continuing to trumpet the philosophy of our founders that has led this country to become the “Shining City on the Hill”, is “blinded by ideology”? I will choose to be blinded
Joseph, this has been a good exercise for me. I think I will form it into a speech for my toastmasters group. It has forced me to think about your arguments and probably unfairly stereotype you and your philosophy. We will probably never meet but I want to thank you for making me think.
I don’t have the answer for the problems of health care in this country. There are a lot of things that could be done to help. The government (which controls all medical schools) could allow a lot more doctors to be graduated or immigrate, which would drive down costs and increase availability. The government which has the patent on patents and allowing monopolistic pricing could force drug companies to spread their R&D cost around the world by refusing to allow drugs to be sold to in foreign countries for less than they are sold here. There are others things that would help and I think that those kind of incremental changes will in the long run be a lot easier to implement and produce results than attempting to force UC down the throats of the unwilling. We will see in Massachusetts and California if it can be done and if it will work. I think success is highly unlikely.
Regards,
Charles J. Read