Can Conservatives Stop Socialized Medicine?
The SCHIP Debate Will Be a Test
By Bluey Posted in Congress — Comments (57) / Email this page » / Leave a comment »
Topping the Democrats' to-do list when they return to Washington is the reauthorization of the State Children's Health Insurance Program (SCHIP). The House and Senate passed two different versions of the bill before August recess and now must reconcile them before sending it to President Bush's desk for a veto.
Although the Senate bill passed with a veto-proof majority, Democrats won't be able to push their new bill through the House as easily. Just five Republicans defected from party leadership, giving Bush the backup he needs to veto this massive expansion of government-provided health care. My Heritage Foundation colleague Ernest Istook, the former Oklahoma congressman, explains in this video why SCHIP is no longer about helping only low-income children, but rather a path liberals want to use to bring socialized medicine to America.
The question is whether conservatives can do any thing to stop SCHIP's expansion? With the program expiring on Sept. 30, Democrats are under the gun to get something done. That means they might just be in the mood to compromise.
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Conservatives have spent the past couple weeks gearing up for the SCHIP fight, calling it a new-look HillaryCare. They have plenty of information to show the dangerous fiscal consequences of heading down this path, such as the reliance on tobacco taxes to pay for SCHIP's expansion. The House bill raises taxes by 45 cents and the Senate bill increases them by 61 cents. Those tax hikes would be disastrous for state finances. What's worse is that millions of Americans would have to start smoking just to pay for this new entitlement.
Just as troublesome is the move by liberals to strip out language in the bill to eliminate the so-called Medicare trigger. That language was part of the controversial Medicare prescription drug bill that narrowly passed in 2003. Fiscal conservatives insisted the language be included in that bill to force the president and Congress to address Medicare's unfunded obligation. However, in a move that would allow Congress to ignore the $32 trillion unfunded obligation of Medicare, liberals inserted a provision in the SCHIP bill to eliminate the trigger. The non-partisan Concord Coalition called the move a mistake.
Given Medicare's growing burden on our economy, it's no coincidence that the trigger was "sprung" in April when the Medicare trustees issued their annual report. But will Congress do anything about it? Under the current law, they cannot simply turn a blind eye toward Medicare's rapidly increasing costs. But if liberals get their way with the SCHIP bill, it would allow them to do just that.
What's worse is that while Congress removes the trigger -- the only entitlement spending warning in law -- liberals are trying to create one more entitlement by modifying the nature of SCHIP (particularly in the House version of the bill). This debate clearly illustrates the left's mentality toward health care and federal spending. It also pinpoints exactly where liberals are trying to take America.
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Can Conservatives Stop Socialized Medicine? 57 Comments (0 topical, 57 editorial, 0 hidden) Post a comment »
We have the best medical system in the world. We need to start saying this.
The horror stories of Britain and Canada need to be repeated and repeated and repeated.
The truth is that its impossible for everyone to have health care. But we need to make it possible that more and more people get the opportunity to purchase it. Socialized medicine is just one more example of giving people an excuse not to better themselves.
Like all disagreements between liberals and conservatives, it comes down to whether you pull someone up, or you pull others down. To give "universal" healthcare, the excellent care many people have will be lost, and the government will decide your health future, and who and what will and who will not be covered, treated, etc. Its a scary thought.
Its not a bad thing for a poor person to be hungry for food or health care. Nothing motivates a person more. Most of us on here, when times have been tough, have been motivated to do more, to do better. Its human nature. Of course, its just this human nature that liberals deny.
The key to stopping this is to get the word out, to get the facts out, and not to compromise in the name of "the new tone".
Just since you asked.
Oh, and here's an interesting piece on that particular subject as well.
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Diplomacy is the art of saying 'Nice doggie' until you can find a rock.
It cannot and will not be stopped. Employers are banking on the government bailing them out of providing employee health insurance. Politicians do not have the will to fight something that the nanny state citizenry is begging for. They don't want to be perceived as the Ebenezer Scrooges who would put sick little children out on the street. They are more worried about keeping their butts in DC than doing what is best for the long-term welfare of the USA.
Nope. It's inevitable, even if the GOP wins. The Republicans don't have the guts to prevent it and the Dems just can't wait to implement it.
...when they see me they'll say, "There goes Loren Wallace,
the greatest thing to ever climb into a race car."
Rudy's plan can be implemented - and employers would support it because it shifts the responsibility to individuals, but it gives them tax incentives to do - making it affordable. There's too much doom and gloom over this issue. If it was "inevitable" than it would have happened in 1993 when you had a Democrat congress and White House who were pushing hard for it. It failed.
Worst case scenario would be a two-tiered system in which there is a government system that poor people would use, and a private system in which anyone with money would use. There's no way the U.S. would turn to a system like Canada that outright BANS private insurance. Insurance companies and doctors simply wouldn't stand for it - and it's probably unconsitutional to boot.
“.....women and minorities hardest hit”
The two-tiered system is to some extent what France already has. According to co-workers living in France the top 30+ percent purchase supplemental health insurance. The handle routine care through the state system and use the supplemental for more complicated care.
I believe a significant problem with health care in this county is the insurers. Their administrative costs are rediculous. Iv'e read 20-30 cents on every dollar spent, and given their salaries and lobbying expenditures, I don't find that hard to believe.
I agree we will never move to a Canadian system. I think we should look to Germany.
The GOP has largely already conceeded this fight - we're merely haggling over the price and rate of government take-over.
Within 2-generations, private medical insurance will be a fading memory. And it will be wonderful - until you get sick, that is.
Otherwise, what "bs" said.
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Diplomacy is the art of saying 'Nice doggie' until you can find a rock.
Oh yeah, lots of us have not planned well for the future. We may have fat 401k's but who wants to shell out 1000/month for health insurance in your 50s?
And with universal, you can quit your job and go write that novel or start up that business or just watch the grass grow.
Yeah it sounds good. Sounds better every year. Pass the SCHIPs please...
or thereabouts, no matter what. The only question is whether you - or your retirement plan - pay it in private insurance or in taxes. Now whether or not my Boomer cohort can grasp that essential fact is another question. Experience tells me that the generation that largely refused to grow up will still believe in a health insurance tooth fairy.
My health insurance is a part of my retirement benefit and the plan is reasonably well funded. However, I have no doubt that the State of Alaska - and most other retirement plans - will act quickly to make any government provided plan the primary plan for retirement beneficiaries and then just sit on the earnings from a plan funded to include the health insurance.
In Vino Veritas
Newt as usual hit the nail on the head when he came out from under his rock to talk about Green Conservatism awhile back. We have to start owning this or we'll only get left behind and have little say in the final legislated products.
Like it or not, this issue, like the environment, has arrived. We do ourselves no favors by stonewalling, blaming consumers, and giving the Dems extra ammunition (Republicans don't care about poor children ! ). It's low hanging fruit for them. If universal health is going to come, we had better start pushing some genuine market-based ideas on how to do it. Better business models for the insurance industry would be a start.
When the Dems say health insurance is a 'protected' industry, they're only half right, but worse is that they undercut conservative arguments against single-payer systems. We need to come up with real reforms to make the industry leaner, meaner, and more responsive to consumers, because right now they have incentive to inflate admin. costs and minimize coverage and delivery of services.
We need to jump past defending the status quo and move on to how the market can be used to incentivize preventive care and lower administrative overhead while giving consumers more pricing information and choices. If we don't, the Dems will be able to point to a lack of ideas (yes, Rudy's is a start, but it ignores some of the bigger problems) and claim we don't care about po' folks again, and they'll sell another monstrous government bureaucracy to the American public. The reality is that wailing about 'socialized medicine' isn't going to cut it this time, because the scales have tipped on this one.
Be nice or i'll slap you cross-eyed!
- Granny
....just not taxpayer funded single-payer garbage. Contrary to popular belief, or how the leftists would have you believe, there IS a way to achieve universal coverage with private insurance and free market principals.
Again, I'm not a Rudy supported necessarily, but he has far and away the best health care proposal out there.
“.....women and minorities hardest hit”
will always find a way to ensure quality health care for themselves. Health care will be rationed (there will always be more demand than the supply can provide) either by long queues or by cost. In a capitalist system we favor cost as the method of rationing. The universal health care approach favored by M Moore seems to be to give a medical license to anyone who wants to be a doctor, but professionals will find a way to distinguish themselves even if this happens. (Board certified for example). Even today the wealthy in Canada and GB pay to find doctors in other countries when they are in need of critical care and want to improve their chances.
I believe universal health care will end up being a two tiered system in the US if it is passed. This is how I read the approach of California. But I will also stand by my belief that granting entitlements to the low income class should come with reasonable taxes added to their burden, so they see that there is no free lunch.
As soon as you involve the government, all plan management decisions become political rather than economic and plan administrators lose their ability to engage in meaningful cost containment measures. Whatever some loud group wants covered will be covered, cost be damned.
In the '90s we moved strongly to engage in cost containment with our State provided plans for employees. Everything we did that pushed some interest group or specialty provider away from the teat got lots of quality time with legislators about how we were being "unfair" to this, that, or the other health care scammer. We won some, but we lost some.
Glasses were obscenely expensive in Alaska because of a small and monopolistic provider group that made its living off Medicare, Medicaid, and Indian Health where it could lobby for its interests. When we moved to a PPO for State employees, I got one of the better butt chewings of my life from the committee chairman - who just happened to have my budget in his committee - for what I was doing to his "friends" the optometrists and opticians. Ultimately, we were forced to re-institute coverage for non-PPO service, but we did manage to keep the plan biased towards it.
Mind you, we could get union support for a lot of the cost containment strategies and use that support to thwart the providers. The unions weren't being good guys; it was just in their interest to have money to go on paychecks rather than go invisibly to HI. For a plan for the general population, you'd have no such counterweight and it would be a free-for-all.
In Vino Veritas
Why are we so entrenched against providers making money but unsheathing our swords every time insurance profits are threatened? Insurers don't provide the health care. Why do we continue to defend a business model that works overtime to ramp up their costs and keep actual services out of reach? Why not a system that rewards doctors and hospitals for giving quality care and preventive care, something that gets people out of emergency rooms for everyday stuff and into a doctor's office? This would by definition drive service costs down and allow insurers to actually market different coverages within more reasonable price ranges, whereas now they are just trying to hold the line on everything. Their idea of cost containment is simply finding ways not to pay out. Why aren't they being pushed to shop for lower drug prices, or rewarding more preventive care? So much of our health care costs are already administrative; which is why calling out any Dem plan as government bloat can be thwarted by pointing the finger at insurers.
Again, if we have better ideas, then we need to do a better job of marketing them, or we risk getting slapped with the mean ol' white men label. The political climate this cycle is not ripe for telling folks to simply fend for themselves; we have to be pushing better ideas and making them sound more appealing.
Be nice or i'll slap you cross-eyed!
- Granny
what plan administrators tell them, and pay them, to pay. Most of the horror stories about refusals to pay come from people who didn't know what they'd bought in a private plan or were pushing the coverage. You might have to argue with them, but if it is in the paid for coverage, they'll pay.
The kind of cost containment I'm talking about is, as you suggest, disincentives to emergency room use, disincentives to "brand name" drugs - I'd love to ban direct to consumer drug advertising; everytime a new one comes out, everybody has to have it whether they need it or not and doctors will sign a leaf that blows in thru the window if you have health insurance. One of our biggest cost centers was psychiatric/psycological services to minor dependents. We had a group of providers who basically were advertising along the lines of "if you teenager is giving you grief or not making As" send him to us for six weeks. Some healthy co-pays and deductibles on that one put a few of those outfits out of business. We also put heavy qualifiers and deductibles on stomach stitching. We had people actually going on diets to gain weight so they could meet the morbidly obese criteria for the surgery.
It is a constant battle; the insurer tries not to pay more than it has to, the plan recipients want something for nothing and don't want to do anything on their own, the providers are always looking for some way to get their hooves in the trough. My fundamental point is that running a plan through government makes all the decisions political rather than economic. If enough single mommies want to run to the ER rather than taking time off for a Dr. appointment when their baby has the sniffles, you'll be letting them if it is solely a government decision.
In Vino Veritas
And you're right for the most part - we see this stuff everywhere. it's perfectly valid criticism of the industry. But why do we have a problem with providers getting their 'hooves in the trough' as you say? Are we against providers profiting from their services anymore than we're against insurers making bank? It seems like we paint ourselves into a corner on this. As far as elections and policy go, we aren't going to make the sale by calling out the consumers and the doctors, regardless of their responsibility for the crisis. We still have the fundamental problem of the insurers (administration) being the profit center while providers are almost entirely a cost center, while premiums and copays continue to skyrocket and businesses continue to hemorrhage money and cut plans.
It's getting to the point where corporate folks are starting to line up behind some single-payer proposals and it even looks like they are going to start backing candidates who tow that line. That's bad news for us, and imo, bad news for the taxpayers. One personnel guy I had drinks with recently told me that they're starting to gravitate that way because they don't see the GOP putting forward anything competitive (they're not buying Rudy's, yet). They're getting their lunch eaten every year by the carriers, and government relief (that they have a hand in, mind you) is better than no relief at all at this point. I hate to be doom and gloom, but we've got to bring something workable to market and soon, and pitch it right, or we'll get relegated to zoo animals sure as the day is long.
Be nice or i'll slap you cross-eyed!
- Granny
is that a lot of them are scammers, pure and simple. There's this huge pot of poorly regulated gold, and they want some. Medical doctors may have all that helping/saving people ethos, but medical services providers, for which most doctors work, have only one ethos: making money. Don't get me wrong, I don't think that is a bad thing, I just know that as one formerly involved in plan administration, I considered them to be my adversary, and on some days, my enemy.
As to the rest; you're right: the employers would love to shuck the HI costs and they'll line up behind whomever promises to do it. Likewise, if they get a Democrat, a lot of the legacy industries are going bankrupt and shucking their retirement liabilities. Hold on to your wallet!
In Vino Veritas
You're sort of the wrong person to ask, huh? ;)
I recognize the problem you talk about re: political vs. economic decisions on coverage. It's not a trade most sensible conservatives want to make.
But we're back to the sale: most working folks will take the gov't because at least with them, they feel they have some kind of recourse - their vote. With the 'big, bad insurance companies', they feel powerless: dropped coverage, customer service problems - a prevailing feeling that the carriers are out to screw them. That's the public perception right now, and companies are starting to feel screwed as well, ergo they're piling on.
Don't get me wrong - they're gonna go with moderate Dems wherever possible, or at least guys that are willing to play ball with their other concerns, but if they're to the point where they feel the health care status quo is untenable (even in the short term), then Houston we have a problem. Here in Texas, things are not trending our way at the moment, and it's coming from all sides. We need a counterpunch because the other side is making a lot of hay on issues like this, and we're still playing hide-the-ball. If the Lege gets flipped on us this cycle, people will go into bunker mode, and an avalanche could come in '10. That's why it's crucial for us to get to work on real alternatives now, because we may not have the opening to do it later. We should be leading the way down here, but a lot of the troops have gotten soft and lazy.
Be nice or i'll slap you cross-eyed!
- Granny
Alaska and TX would be the last places to fall for socialized medicine. (Where are we CA guys going to run to?)
"Why not a system that rewards doctors and hospitals for giving quality care and preventive care, something that gets people out of emergency rooms for everyday stuff and into a doctor's office?"
Socialized medicine will not move in this direction, the only way a system can be designed to reward sectors is to incentivize them. Of course this is the key message of many HMOs who fight tooth and nail to force the consumer into a box but by and large reward the docs who keep costs down. Unfortunately, sometimes a case can be made for seriously treating the patient and not driving everyone crazy fighting to get the right referrals.
I admit that the current system is ripe for improvement, but we risk stripping quality from the mission statement when we go to a single payer system and I agree that if the government gets involved then the costs will go up while the quality will go down. This seems like enough reason to fight any single collectivist proposal. I am also optimistic enought to believe that the US will not readily give up its current multiplan system because enough voters of every stripe realize that when you need care, you want some say in who provides the care. (even at the risk of buying some pretty pricy healthcare insurance).
Finally one last comment, this issue has to be treated like the camel's head in the tent that it is. (I know we gave in on helmets and seat belts which was the foot in the door.) But if ever there was an invitation to rampent socialism this is it. If a system like mandatory single payer HC is approved, how can one hope to stop the attempts to tax obesity, fast food, driving SUVs, firearms, smoking, and drinking (opps sorry about those last three, they are already regulated, but you can see where this is going).
The last thing I want is socialized medicine. I want to see preventive care incentivized and quality care rewarded, and carriers manage their risk better and be able to market an actual product to consumers (who, you'll remember, are never 'wrong') but no way is the old HMO model gonna sell again. Maybe under a different name with some tweaks, but the HMO brand is tainted, like S&Ls-in-the-1980s kind of tainted.
My point is that we won't keep a lot of working class and rural Pub voters in our tent by simply calling any Dem proposal socialist. We've been running this by voters a lot of late and it's just not playing like it used to. Why? Because it's old, and times have changed. My group has been doing some target polling, and you'd be surprised how many GOP and swing voters ask us "what's your plan? My company is trying to drop our health plan and shove me into an HSA, and I don't get paid enough money to do that." Add that to the school vouchers issue - which cost us a few seats in the Lege in '06 - rural seats, mind you - and a growing angst about the war, and our electoral margins are getting slimmer by the day.
It's not just statistical noise. Our opposition has gotten smarter and younger. They've started to drain the swamp and recruit better candidates and make better pitches, and we've got a lot of incumbents still sitting on their hands who aren't paying attention. Some of us are trying to change that, but it's been dicey. We need to at least be stirring the pot with new ideas.
Be nice or i'll slap you cross-eyed!
- Granny
Texas has been and will again be my winter home. Right now I am in CA helping our son rehabilitate from a major trauma accident that has left him with an amputation, partial paralysis in two limbs, and major damage to his urethra. The care he has been receiving has been with a regular POS, an HMO, and now a PPO. Guess which system receives a failing grade?
Many Californians are happy with Kaiser, an HMO that does all you say about preventative medicine and is lower in cost than just about anything -- but we are very glad to be with a PPO given the care our son still needs. The governator is trying to sell a plan to insure more of the uninsured poor but using the present insurance companies as a stepping off point. It (Arnold's plan) would be acceptable to me but only because other plans are alos availble options.
I too agree that some changes are inevitable given the shortcomings of the current system, but I expect the medical establishment to support a mixed system over a single payer because the best of the medical community expected to be well rewarded for the effort they put into the profession. I can't fault them for this.
...like getting rid of insurance mandates. Like chiropractic. They are tanned, rested and organized! And they will have a cow if you take the out of the coverage.
SCHIP is being financed by the Socialist's salami slice nationalized medical care, by reducing payment so medical professionals by a 42% reduction in payments.
So all those hard working nurses and nurse's aide will get pay cuts f 42%.
I propose an amendment. expand the surcharge to compensation for lawyers, too. Fr lawyers working in the medical Field or suing for medical malpractice, impose an additional special 42% surtax to go "fer the l'il chilren". So the attorneys will also be taxed with a 42% surtax. Instead of extorting 33 cents out of every dollar awarded to poor victims, the lawyers would get 58% of the 33%, or 19.1%.
The rest, 42%, goes to help finance SCHIPP.
Let's look at a real world example. Why presidential candidate and ambulance chaser, Mr. Edwards fortune would decline from $70 million to only ONLY $40.6 million, if this had been in effect.
Meanwhile the nurse's aid making $8.00 per hour, would have her pay cut to $4.64 cents an hour. That equates to the extravagent sum of $9,466. per year. Yes, the Jackass lawyers are really looking out for the little guy !!
meanwhile, How could Mr. Edwards possibly feed his family? How could he afford to send them to Andover, Exeter, Harvard and Yale. Where would he find the money to buy them a McDonald's Happy meal?
How could he ever get by on a measly $40 mill?
Between Medicare, Medicaid, and VA we already have socialized medicine. And it isn't going anywhere.
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Underlying most arguments against the free market is a lack of belief in freedom itself. - Milton Friedman
I wouldn't say we lost, becuase over the scope of history, no battle is ever won or lost for all time.
But we started losing thanks to Medicare and Medicaid, and sadly it's those subsidies that are causing the price problem that's encouraging MORE socialization of medicine.
I wouldn't put VA in the same category, though, just as an aside.
I wouldn't put VA in the same category, though, just as an aside.
If you are looking for the most Soviet-style health care operation in the US, it would have to be the VA. It is really the most objectionable part of our socialized system based on how it is run. It also happens to be the part that serves the fewest people, so it doesn't get as much attention as the behemoths that are Medicare and Medicaid.
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Underlying most arguments against the free market is a lack of belief in freedom itself. - Milton Friedman
VA may be mismanaged, I don't know. VA may be unionized and atrophied, like a lot of government. But I categorize it differently because it was created with a different purpose.
It's there becuase fighting a war can cause physical ailments for the rest of your life, and many of us believe we owe it to veterans to help them through those problems.
It's far from the progressive impulse behind Medicare and Medicaid.
Providing health care (and other benefits) for soldiers is a great thing that we need to do. The VA just happens to provide those in the most idiotic way imaginable. Medicare looks pretty good by comparison.
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Underlying most arguments against the free market is a lack of belief in freedom itself. - Milton Friedman
Think about what's happened to the power of the state in Estonia over the last 20 years. A lot can happen in a relatively short time.
Pessimism has no place in our movement. Let's put up a fight, but let's not grouse and grumble, buying into the lefty utopian views and their alleged historical inevitability.
History is not a one way arrow.
In a conservative's utopia, maybe. But plenty of folks like myself have been polling this and other issues extensively in target districts and I can guarantee you it's about to become a real problem for all of us...along with the war, school vouchers, and a few other issues. This is a critical juncture for the conservative nation, and frankly I'll be damned if I'm going to simply tilt at windmills while we watch everything we worked for over the last 12 years go down the toilet just because some of us are afraid to get creative and build a better mousetrap. Voters aren't going to leave us in power if we're not offering them anything - and no, I don't mean handouts. I mean ideas for better governance. The old saw at amusement parks is that you need a new rollercoaster every five years, and we're past due for one.
Be nice or i'll slap you cross-eyed!
- Granny
I'm telling us, the activists, to buck up and not start talking about inevitable failure until we make it one by talking down our drive to fight.
What does that have to do with selling anything to the nation?
nor is there 'surrender' in coming up with OUR OWN IDEAS for universal or at least expanded health care coverage. It's called being responsive and smart and taking ownership of the issue. It'd be 'surrender' to simply pout and fight a tidal wave while putting no viable alternatives to said socialism on the table.
Be nice or i'll slap you cross-eyed!
- Granny
You want us to do the Democrat-lite™ thing, and preempt the Democratic-Socialist coalition with our own brand of state-centralized medical apparatus.
Hmmm... no sir, I don't like it. (50 points for the first with the reference)
But your response is sadly indicative of what I hear from some of our elected reps. You're missing the point.
Be nice or i'll slap you cross-eyed!
- Granny
We lost one lege district out west last cycle, that went 2-1 for Bush in '04 The Republican took money from Leininger, who was a big help 8 years ago when we were flipping Dem seats left and right, and got raked over the coals for it. We also lost 5 other seats, nearly all of which made vouchers an issue and leveraged it to their advantage. Vouchers polled badly in the sticks and the suburbs as well. Right now it looks like for every minority/urban vote we pick up on this issue, we lose two in rural districts. It's become a net loser for us, at least down here.
Be nice or i'll slap you cross-eyed!
- Granny
...a long habit of not thinking a thing wrong, gives it a superficial appearance of being right...
---Thomas Paine---
can be found at the Texas Secretary of State's website: http://elections.sos.state.tx.us/elchist.exe
As for vouchers, exit polling confirmed our worries about it, and our own subsequent work has borne it out again. It'd be unprofessional of me to post data that has been paid for by clients, but suffice it to say that Dems have managed to scare rural and suburban voters (where there are admittedly fewer private schools) with the pitch that vouchers = gutting public school funding. It's nonsense, of course, particularly in light of what was actually proposed in 2005, but that measure failed in a GOP-dominated lege despite Craddick's heavy-handed advocacy, and now the issue is being harped on even though no one that I know of plans to bring it up again next session - and Craddick is likely toast whether we hold the House or not (another albatross for another thread).
We ceded control of the issue, though, largely because we didn't market it very well and didn't see the hijack coming, and didn't take the opposition to it seriously - a pointed lesson as to why we need to do a better job of making the sale on our policy goals even when we're the party in power.
Be nice or i'll slap you cross-eyed!
- Granny
Achance illustrated the point perfectly when he recounted his story of people actually gaining weight in order to meet the criterion of "morbidly obese" so that they could get their stomachs stapled. When it comes to health care, people will act in an economically rational manner, just as they do for every other aspect of their lives. Look at the RAND Corporation study of several years back which demonstrated that families with "free" health care will consume more of it than families that don't, with no measurable difference in health between the two groups. I think the job of the conservative should be to make sure each individual has the economic information necessary to make rational health care decisions. That means don't hide the costs of everything and don't try to insure every little bit of health care provision, which exascerbates the cost-hiding. (I have always wondered why health insurance paid for routine doctor visits - my car insurance doesn't pay for routine oil changes!) Perhaps the government should require clinics and hospitals to post a schedule of charges and fees. Under no circumstances, though, will individuals make rational economic decisions if the government or an insurance company pays for all the costs. There is simply no incentive to do so. We can point to Medicare to illustrate THAT point when it comes to government as single-payer, but we should also make the case when it comes to insurance companies as the payer as well. As conservatives IMO that should be our tactical advantage for how we want to change the status quo. Don't give more power to either government or insurance companies; instead decentralize the economic power to individuals and families. We should really push the concept of Health Savings Accounts and how those empower individuals to manage their health care as they see fit. In fact, why not transform the whole EITC idea into an HSA for working poor people?
Just a few thoughts.
We need to develop it further. And be able to pitch it so that voters will buy it. Somehow the calculus has to wind up with:
-cheaper (long run?) for most Americans
-more choices for consumers/open markets for services
If we can put it across as positives this way, we can probably sell it over more government control. I just don't think clinging to the status quo like we were able to in '93 is going to work this time.
Be nice or i'll slap you cross-eyed!
- Granny
French spend more taxes because of their system but it's all made up in reduced premiums and out-of-pocket medical costs.
First off, welcome to RedState. Here's a hint for you, seeing as you've been here less than 90-minutes to this point - there's nothing wrong with being a cheerleader for your POV, but a little more in the way of sourcing other than "Sez Me!" goes a good long way. Just saying.
Here's a couple of points - the French are a tort-averse culture (believe it or not) when it comes to medical expenses. Care to guess how much malpractice insurance and general defensive medicine are driving up our healthcare costs in the US? Muzzle the trial lawyers and this cost largely goes away.
Second, they do not spend the way Americans do on, to put it bluntly, the last days of a person's life. No one spends like we do to extend the life of terminal patients by matters of weeks (if not days - there are links aplenty). Factor that into the costs as well for an apples-to-apples comparison.
Mind you, I actually think the French system has a great deal to recommend it. But to toss it out there as the end-all-be-all is going to be a reeeeeeeeeeeeally tough sell. Good luck with that.
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Diplomacy is the art of saying 'Nice doggie' until you can find a rock.
Poulation of US? France spends half as much? Let me do the math here....carry the two...square root of Pi...uhhh, doesn't look good for your argument!
I bet Uganda spends even less on medicine. Wanna use those figures instead?
Of course, seeing as I'm the only one who's linked an article with that sort of figure, I'm loathe to put more words into our newbie's mouth.
Cheers -
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Diplomacy is the art of saying 'Nice doggie' until you can find a rock.
As of 2003.
Source: Organisation for Economic Co-operation and Development
I'm all for arguments on socialized medicine but I just hate that particular argument. Ask people in other countries about waits and you will rarely hear about individuals dying on a waiting list. Of course there are stories that come out, just like there are stories about our system not treating people based on not having insurance. Truth is that some people do wait, and the wait is based on the severity of the situation. If you hurt your shoulder you will probably wait while guys with heart conditions have surgery first.
But the wait is only for those strictly using the government health plan. Almost all those countries have supplemental health insurance offered that can get you treated faster. I lived in Canada for a few years, and when I tore my ACL, I was able to have surgery 4 days later.
And I'm not supporting socialized medicine, I'm just saying that there aren't thousands of people dying outside the hospital doors in Canada because they have no room. Make the arguments about the overall cost to taxpayers (taxes in Canada are insane), the fact it hurts the advancement of medicine (Doctors must be encouraged to get better), or the sheer bureaucracy and corruption that putting the government in charge of this would cause. But people dying on waiting lists is rare, as rare as those who die in this country because they have no insurance.
but country to country comparisons in dollars spent are essentially meaningless inasmuch as they don't factor in the different economic systems. Add 20+ percent to most of them just to account for the US tax system. I don't think anyone could do a straight across comparison to our defensive medicine and malpractice costs. And then there is the matter of end-of-life care, something done much differently in most other countries. Even in private plans, end-of-life is often the most expensive single component and in Medicare/Medicaid, it almost definitionally is the major component.
In Vino Veritas
You left out the really cheap places... like Pakistan or Somalia. The lower per capita spending on health care, the better, right?
You also might want to factor in the tab we are forced to pick up on drugs for those industrialized nations on your graph that have price controls.
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Underlying most arguments against the free market is a lack of belief in freedom itself. - Milton Friedman
By spending more per, are we getting more life expectancy for it, and how much are we spending annually for each year of life expectency.
Here's a fairly simplistic normalization, take the life expectency, and divide it cost per year on health care, and we should get a rough approximation for how much we are spending in health care, for each year of life.
(A better normalization would work from as estimate of life expectency with no health care -- maybe 35 rather than the 0 assumed here, and we aren't covering diet differences, and look at the distributions of income vs. life expectency in each country -- but this is a back of the envelope calculation for a random post, not a significant research paper, so we'll make the assumption that the distribution of income and life expectency in first world counties is roughly the same)
Using 2000 figures from here, we can get the life expectency:
http://geography.about.com/library/weekly/aa042000b.htm
And from the life expectency, we can calculate how much each country spends per capita per year, for each year of life expectency.
US: 77.1 years, 74 dollars/year^2
UK: 77.7 years, 29 dollars/year^2
Switzerland: 79.6 years, 48 dollars/year^2
Norway: 78.7 years, 48 dollars/year^2
Netherlands: 78.3 years, 37 dollars/year^2
Luxembourg: 77.1 years, 60 dollars/year^2
Japan: 80.7 years, 27 dollars/year^2
Canada: 79.4 years, 37 dollars/year^2
Not bothering to do the math for the rest, but it's pretty clear that we are paying more in absolute dollars for each year of life expectency than a bunch of first world nations starting with the letters J-Z (plus Canada, since we always compare to Canada).
It should still be normalized against personal income. Sadly, personal income data is a bit hard to come by, so per capita GDP is used as an approximation.
2004 stats can be found with the IMF, or from this handy wikipedia article with a much shorter URL:
http://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28PPP%29_per_capi...
US: 43444, (5711/43444)/77.1= 0.17% Per-Capita GDP /year^2
UK: 35051, (2317/35051)/77.7= 0.08% Per-Capita GDP /year^2
Lux: 80471, (4611/80471)/77.1= 0.07% Per-Capita GDP /year^2
Canada: 35494, (2998/35494)/79.4= 0.11% Per-Capita GDP /year^2
I leave the rest of the math as an excercise to the reader.
Now, even this normalization has problems -- by using the life expectency, rather than expected increase in life expectency, we are skewing all our numbers a bit lower (they won't change order for that, though, most of the final numbers should be roughly doubled), and we are ignoring issues of diet and excercise.
But, it seems pretty clear that either:
1. We are spending a greater percentage of per-capita income for less results.
2. Americans have so many health disadvantages (obesity, etc), that to get to the same life expectency as elsewhere we must spend a greater percentage of per-capita income than other first world countries.
3. Some combination of 1 and 2.
From here it might be fun to begin normalizing for Body Mass Index, because Americans really are fat compared to a lot of the world. That might be the difference right there.
We had a post a while back on this site that discussed how different countries compile infant mortality rates (these effect life expectancy). Anyway the poster reported that many countries list the death of a baby born prematurely as a still birth, while the US counts all infant deaths in its infant mortality rate. The end result is that life expectancy in the US is deflated and life expectancy in Europe is inflated.
P.S. Problems such as the above abound in international comparisons.
...a long habit of not thinking a thing wrong, gives it a superficial appearance of being right...
---Thomas Paine---
It's up to the grassroots to make themselves heard just like we did on the immigration bill. Now, it's highly unlikely that there will be that kind of outrage this time, but at least we don't have the president supporting the SCHIP expansion. He has promised a veto, and I'm assuming (hoping) that most of the offensive language will be stripped out - it seems like there is a decent amount of opposition...Mitch McConnell and John Boehner had some stong words about it. Combine that with opposition from the president, and I don't think the Dems will get this thing through in its current form. There's an outside chance they could get an override of a veto in the Senate, but there's no way they can achieve that in the House.
I hope Tom Cole is already producing attack ads on this thing for red-state Dems who vote for it.
“.....women and minorities hardest hit”