McCain's Health Care Plan: Why It's Another Dumb Idea
John McCain has just issued a new health-care bulletin about his health-care plan. In response to criticisms from the likes of Elizabeth Edwards, who notes his plan wouldn’t cover people with pre-existing conditions like her and, indeed, like McCain himself, McCain has amended his plan: States would create “high-risk” pools for people with risky pre-existing conditions.
Wha? Lots of states already have high-risk pools. Thirty states require insurance companies operating there to cover people with pre-existing conditions. Problem is, the premiums they charge for such policies are often twice as high as those for people without pre-existing conditions, and the co-payments and deductibles they charge such people are beyond belief. In other words, the insurance companies technically obey they law. They do offer health insurance to high-risk people. But it's so expensive almost no high-risk person can afford it.
McCain says his plan would get around this problem by subsidizing the states, which in turn would subsidize insurance companies that offer such “high-risk” plans. But McCain doesn’t specify how much the subsidy would be worth, or how it would work.
This is becoming something of a pattern with McEconomics. McCain issues a policy, such as his tax cuts for everyone under the sun including corporations, followed by a vague “don’t’ worry about the price tag.” But as old-time conservatives used to be fond of pointing out, there’s no free lunch. The net price tag on McCain’s election-year promises already dwarf everything HRC and Obama have proposed. His “high-risk” pool idea is in the same broad “don’t worry about it” category. Which means we should worry.
McCain's health care plan won't work even for average people without pre-existing conditions. He wants to end the tax break for employees who get health insurance from their employers (I’ve gone on record in support of de-coupling health insurance from employment), but would offer only $5,000 per family in tax credits to pay for what they’ve lost or never had. Absurd. The average cost of employer-funded health care in the U.S. last year was over $12,000 per family.
Watch your wallets.
Wha? Lots of states already have high-risk pools. Thirty states require insurance companies operating there to cover people with pre-existing conditions. Problem is, the premiums they charge for such policies are often twice as high as those for people without pre-existing conditions, and the co-payments and deductibles they charge such people are beyond belief. In other words, the insurance companies technically obey they law. They do offer health insurance to high-risk people. But it's so expensive almost no high-risk person can afford it.
McCain says his plan would get around this problem by subsidizing the states, which in turn would subsidize insurance companies that offer such “high-risk” plans. But McCain doesn’t specify how much the subsidy would be worth, or how it would work.
This is becoming something of a pattern with McEconomics. McCain issues a policy, such as his tax cuts for everyone under the sun including corporations, followed by a vague “don’t’ worry about the price tag.” But as old-time conservatives used to be fond of pointing out, there’s no free lunch. The net price tag on McCain’s election-year promises already dwarf everything HRC and Obama have proposed. His “high-risk” pool idea is in the same broad “don’t worry about it” category. Which means we should worry.
McCain's health care plan won't work even for average people without pre-existing conditions. He wants to end the tax break for employees who get health insurance from their employers (I’ve gone on record in support of de-coupling health insurance from employment), but would offer only $5,000 per family in tax credits to pay for what they’ve lost or never had. Absurd. The average cost of employer-funded health care in the U.S. last year was over $12,000 per family.
Watch your wallets.
posted by Robert Reich | 2:26 PM
57 Comments:
With all due respect, why should he offer anything that borders on rationale and common sense? How many of us have turned off our TVs when idiotic speeches were given by high ranking officials? Or when idiotic questions are asked in debates? Or when "scientific" analyses are given about the possible character flaws that emerge out of having attended a pastor's sermons? Or when hate-spreading political commentators who have their own TV talk shows rant with that "I know everything" smug look?
Never. Not once. We listen. As if what they are saying is worth listening to and not worth discarding.
Will all due respect sir, we deserve what we get. The fault does not lie in the stars.
Dr. Reich,
You mentioned that "the average cost for employer funded health care last year was $12,000 for a family." (I assume this is an average family of 3).
For comparison, in Holland my wife and I have a private health care plan with a $750 deductible that costs us $3,000 a year(Euros 2,000 adjusted for Dollar). Adding two children would increase this to about $5,000 a year (Euros 3,350).
This is abo 58% less than the cost of the company health care plan you mention.
It's still a mystery to be solved as to why medical costs in the U.S. are so much higher than in most advanced industrial countries like Holland or Germany, for example. One study reports that Americans pay roughly $6000 per capita or twice what Europeans pay, and that the costs are increasing at three times the rate of inflation in the U.S. So, something is very wrong. For example, a hip replacement will cost (all-inclusive) $34,000 to $48,000 in the States compared to $11,000 to $20,000 in Germany.
Another example: a doctor in our family recently temporarily treated a visiting family friend for a very serious kidney stone attack, knowing that he shouldn't do too much because the costs in Canada for the patient's complete treatment would be less than half that in Florida.
When one doctor was asked to explain why he charged an insurer the extremely high sum of $32,000 just for his surgical services for a hip operation, he replied:
"We don't have any idea of what we are supposed to be billing because we don't know what the different insurers are going to pay, which is kind of a funny way to do business." The doctor said that when he submits a bill to an insurer, he doesn't specify an actual amount. He puts in a code for the procedure he's done, and the insurance company pays what it calls its reasonable customary rate. Some insurance firms pay a lot, and others, like Medicare, pay less, with the higher payers subsidizing the lower ones. In the end, the result is higher costs than just about anywhere else outside the U.S.
I tell this story to illustrate just how out-of-touch McCain and our entire Government is about the ludicrously costly health care system in America. It's a complicated and inconsistent system of billing and payments that defies understanding. On the positive side, I read some three months ago, that some U.S. agency has picked the Swiss and Dutch health care systems out of a number of systems as the best to be examined carefully to see if something can be learned from how these two counties run their health care systems. That's hopeful development.
I have seen data showing that Canada's health care system administration cost is
$.14 of each dollar of total system cost compared to $.18 for our Medicare system.
So there are substantial potential cost savings in our system in a few key directions -- some say in the order of magnitude of $50-75 billion a year. But major changes must occur. Obama's good judgment in seeing the nonsense of the gas tax holiday is also evident in his approach to the issue of health care in general. For he has consistently said heavy focus must be on ways to reduce health care premium costs to more competitive levels closer to those in Europe.
In any case, Dr. Reich is right on target ... McCain's health care ideas for those with known preconditions are going to result in even higher costs for anyone buying into what he's proposing. This and the gas tax holiday are all the same "bandaid & no-real-cure" answer to serious social-economic problems.
I can't help but wonder if McCain cuts & pastes his ideas wholesale from 'industry experts'.
Frank Thomas thanks for the interesting commentary.
I would love to hear more on why employment and health care should be separated.
I get it in a general manner- a health insurance worker explained to me that the employers write up the plans coverage and then submit it to the insurer who gives them a price. So when we hear about these denials of coverage for medical procedures its actually the employers who wrote it into the plan, presumably to reduce costs. However its not something I've heard any of the candidates talk about, nor have I ever seen delineated the advantages of separating the two (employers & health care)
Dr Reich,
I'm sure you realize that the purpose of insurance is to spread out the risk of unforeseen problems. Existing health problems are known, rather than unforeseen. Saying that health insurance companies should offer cheap insurance to those with pre-existing conditions is like saying a car insurance company should offer cheap retroactive insurance to a person who has already been in an accident. It makes no economic sense. What you desire are subsidies for those who have unusually poor health. Tell it like it is.
Dan
Then, according to this logic, health insurance is a privilege and and not a human right. In all industrialized countries, they treat it as a right and thus they have adopted universal health care. I was listening to an interview with the German minister of health. He said that under their policy even new immigrants are fully covered. The reporter asked him how they can afford it. His answer was astonishing:
"The Germans are way too proud of their country to see it without universal health care. They consider it unpatriotic to leave any resident without insurance."
It is only in the US that I have come across that menatlity that has turned this issue into a privilege.
Finally, it struck nme as refreshing to hear that there are some people out there who think that ensuring universal health care is a sign of patriotism. Now go tell them that there are ladies on TV asking a presidential candidate why he does not wear the flag lapel pin and is he a true patriot when he does not, and they will laugh. Or cry.
Athena,
My main point was just that Prof. Reich (like his allies) is deceptively characterizing a call for more entitlements as a call to correct an insurance market failure.
Regarding your broader point, deeming health care (rather than the right to health care) to be a universal human right is problematic because it creates an implied obligation for someone to pay for that health care. Traditional American rights, such as the right to freedom of speech, create no such obligation. So I don't think it's fair to define health care as a universal human right without explicitly defining the particular persons obliged to pay for it. Who is obliged to pay for the health care in the world's poor countries? Why does the German obligation to pay for such a universal right stop at its borders?
I must admit that I feel no shame or lack of patriotism for asserting the American ideal of self-reliance, particularly when health care safety nets are already in place for most people truly in need. The US has not turned health care into a privilege-- it has always been so, since the time of cave men. Europe is the one that has invented the novel concept of a universal right.
You have reached my quotes collection twice now with your comments.
I appreciate your keen grasp of the comic (obscene?) state of our news media.
It's also nice that you have mentioned the often forgotten notion that is completely lost on some of us. There exists a fundamental difference between those who scamper anxiously to catch a sound byte of Bill O'Reilly's talking points and those of us who embrace the progressive social Zeitgeist; health coverage is a natural human right that should be denied to nobody.
No partisan spin can change that.
My sister's health insurance has just denied coverage for her MS medication. She is now having problems with her optical nerve and cannot see or go to work anymore. She will end up in the hospital with a much more higher bill because the insurance refuses to pay for her medicine. She was very capable of working, but now she can't. She is 40 years old. What a great country we live in. I'm ashamed.
Saying that health insurance companies should offer cheap insurance to those with pre-existing conditions is like saying a car insurance company should offer cheap retroactive insurance to a person who has already been in an accident. It makes no economic sense.
Exactly, which is why we need to get rid of the profit motive completely and transition to a Universal Health Care plan. Thank you for making such a great argument for Universal Health Care. Get rid of the profit motive and we can make sure everyone has decent access to health care.
The fundamental issue is the fact that we need insurance to see a physician to start with. The use of insurance always leads to the issues that we now see, run away pricing.
We build these ponzi schemes then ask the government to take over the ponzi scheme once prices driven by greed get out of control. It is madness.
At this point people are driven to insurance to be able to afford a normal doctors visit. That is not how insurance is supposed to work. Insurance should only be used for extreme and catastrophic cost associated with health care.
With that said, the best way to fix the health care process is to create a government non-prophet health care system for all Americans. The system would serve all non-catastrophic health, basically everything that does not required extended hospital stays.
The next step is to allow for social security rebates to low income individuals for the express purpose of getting health insurance.
The issues associated with cost will only go down when politicians finally get the guts to stand up to the real issue associated with costs, the AMA.
I live in a small city, and for the most part, all the wealth I see being accumulated are by doctors. The AMA allows the restriction of the number of doctors thus limiting competition. It is worse than a union it is a monopoly.
Health care will continue to be expensive until we start being outraged by doctors building million dollar mansions and taking kickbacks from big pharmaceutical companies. It seems that every Doctor feels that they should make the money that a CEO of a fortune 500 company.
Nationalizing the health insurance ponzi scheme without changes to the underlying issue of doctor greed will only cause higher debt for the country and not give us a better health care system.
The reason for the Hippocratic Oath is to prevent a physician from using his power over life and death for immoral purposes. I say that most doctors in the U.S. are breaking this oath and are driven by greed.
The only people I hate more that politicians are doctors, needless to say.
Addendum: Any quacks out there that feel that they are only being repaid for the years of schooling that they endured, I say "Bull$%#%". I know many teachers with PHD's that do not make $3 million dollars a years. You are rats that prey on people when they are most vulnerable and you should be ashamed.
I caught you on Kudlow earlier...
Almost EVERY TIME I see you debate someone on that show, your opponents never respond to any of the factual references that you offer. Rather, they appeal to vague ideological positions that are often, from a practical standpoint, useless to the topic being discussed.
I'm a big fan of philosophy, thus I have no problem with academic discussions on right-wing economics (or economic ideology). But I can't for the life of me figure out why, on television, these right-wingers often act like they have no opposition to democracy. Their fundamental claims are in many cases the EXACTLY ANTITHETICAL to democratic practices. I'm not claiming here that they're wrong. But I think its somewhat disingenuous for them to NEVER acknowledge this. Perhaps its because viewers may be very uneasy towards opinions that go against democratic interest.
aly k
The concept that a universal health system is a right and not a privilege derives from many sources:
The UN Declaration of human rights in article 25 states : “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
The International Covenant on Economic, Social and Cultural Rights recognizes “The right of everyone to the enjoyment of the highest available standard of physical and mental health. [to be implemented by] the creation of conditions which would assure to all, medical service and medical attention in the event of sickness.”
Also the World Health Organization
Furthermore the Physicians for a national health Program
And many other sources as well...
The problem in the US is not the very poor who are indeed insured. It is memebrs of the middle classes who can not afford to insure their families. In my plan for example, to have the rest of my family insured I have to pay close to 800 a month. I could be paying less if I chose to have 80% of my expenses covered.
In many European countries, the universal health care implies the existence of public hospitals. The private and the public ones compete. Everyone who works has to pay contributions to the public insurance coverage that covers the whole family. Due to the inefficiency of the system and at times long waiting lists, many people purchase private insurance as well. However the cost is much lower since they have such a fierce competition from the state.
It may not be complete, but at least McCain will give us something. A tax credit of $5000 is better than the present nothing. Its a start.
The big problem is that my insurance premiums went up about 14% this year, 20% last year, and 17% the previous 3 years. What's up with the rate of increase?
If the gov can't afford to subsidize premiums for high risk people, how can the middle class possibly afford to subsidize them via higher premiums? The problem is out of control costs in the US. Simply mandating that middle class people, or their employers, subsidize something that is affordable solves nothing.
The problem in this country is not limited to insurance. If it costs an average of 10k per family in medical costs, the insurance will be 12k (administration adds a bit). There is no way around these numbers.
Perfect competition brings down cost, and increases quality. Give us a true free market, or give us a reasonably efficient gov run VA type health care system. The current de jure monopoly system is affordable only to the very rich.
The poor get free care, the rich can afford it, and the middle class is up the creek. The middle class can't afford it, and the gov can't afford to subsidize them. The middle class needs an affordable system, not another mandate that it can't afford.
Athena,
You do realize that by saying healthcare is a right you have effectively stated that you have a right to the labors and property of others?
If so, you really need to reconsider your definition of rights.
Anonymous 8.19
As I have stated it is not my definition, it is the definition of world organizations far more worthy than myself. Furthermore all industrialized countries except for the US have treated health care as a right. So I don't feel that alone.
To protect certain inalienable human rights, naturally we take away money from some common pool to which most of us contribute. To follow your argument, yes, I expect you in your time of true need to infringe on parts of the products of my labor. I could not call myself a civilized person if I did not.
Athena Smith,
Europeans, in general, see health care as a universal right and don't get caught up in all our ideological euphemisms of "right versus privilege." Our too often ´Shoot yourself in the foot ideological correctness´ does not enter thinking here when it comes to basic general welfare values. But Europeans apply this concept of shared human values and dignity towards many other societal priorities as well, such as a fair working wage, education, and far less dispersion in salary structures.
Your last remarks about the differences in the two health systems was quite off the mark, at least as they apply to Holland and a few other European countries.
Let me try to explain. In the Dutch system, everyone is entitled to the same BASIC quality of services from any hospital. ALL hospitals are public. You are free to choose your health insurer but the government controls what the hospitals can charge for the whole matrix of hospital treatment procedures and services, including doctor rates for operations. So this keeps the insurers reasonably honest and sensible. Their client premiums thus don´t have great variation or volatility and are relatively much lower compared to the U.S. This is why Holland can make health care obligatory.
Furtermore, to add other complications to your thoughts, the Dutch Government gives a monthly refund of the BASIS monthly premium rates of one´s private insurer (which, as I said above are not very different among the private insurers) based on income levels. Those falling below a certain reasonable living income receive a monthly Government deposit to their bank accounts up to one-third or more of the standard insurer´s monthly premiums for the BASIS health care package.
All this results in very low average costs compared to America. Of course, there are upgrades or special health Packages that cost more. Drug stores are also Government controlled in what they can charge for many essential drug products. It´s a very intelligent system and not based on market greed factors.
If you look at Canada´s program carefully, you will see some of these same balanced, equitable values in their system... also resultiing in sharply lower costs for EVERYONE. vs, the U.S. ...and Canada is a population of only about 28 million vs. 300 million in the States.
I´ve been saying this for years. We Americans can land a rocket on Mars within meters of planned landing target, but we´re definitely third-class when it come to managing social problems.
Therefore, I was for the first time in 30 years uplifted when I read not long ago that a U.S. agency is looking carefully into the Dutch and Swiss health care systems to learn, hopefully, how Holland combines public and private factors in a very human, pragmatic, and fair way to their health care system. It´s affordable to all and people are generally very content with it.
I enjoyed your humorously critical opening post which reflects frustrations I´ve felt for so many years about our cultural dialogue in America.
Frank Thomas, The Netherlands
Athena Smith,
I forgot to health care system. Everyone receives a Refund from the Insurerup to $375 if one doesn't have any claims on the system above his or her deductable.
This is a subtle stimulus to the cost conscious Dutch not to overuse the system for trivial health complaints.
Also, the Dutch health authorites are very active fostering and promoting preventive health care by control of weight, healthy foods, exercise, and avoidance of too much stress.
Athena Smith;
Correction: First sentence should read:
I forgot to mention another small but important factor about the Dutch health care system.
Frank
I suppose the Dutch system works like the Belgian then. I lived in Brussels for a few years, I had my second child there, and the system was very similar to what you decsribe. But what I was referring to in my previous post was actually the systems applied in the UK, Finland and Greece (which wrongfully I placed under the general umbrella of "European"). These countries and others I presume, allow private hospitals to operate and you may buy private insurance in case you are not happy with their NHS.
Dear Athena,
How coincidental! Our second daughter, Carmen, was born in Brussels.
Besides the joy of watching her birth with one doctor and one nurse, we made a Profit because Ford paid the whole bill
and the Belgian Government did
also!
frank thomas:
You fail to connect the dots. There is a reason that our economic growth exceeds that of most European countries.
You are treading on the sacred cow of unbridled capitalism. We have been taught, ad nauseum, that the marketplace knows best what correct prices should be.
Let me give you a couple of personal examples:
In 1995, after being unemployed for a year, my COBRA was running out and I sought pricing for converting to a private policy. I had had a heart attack in 1982 and though I had no further problems I was taking heart medication and visiting my cardiologist three times a year. My wife had been undergoing numerous tests for memory problems with, at that time no diagnosis, but the nature of the tests did not portend good news to a fiscally responsible insurance company.
I was paying $3,600/year on COBRA. I received the conversion quote from the insurance company and all they wanted was $4,000....per quarter to cover just the two of us.
It was determined that I had an aortic aneuryism in 2004. I underwent surgery at a cost of $76,000. My insurance company paid $38,000 for the surgery. Had I been uninsured I would have been billed, and expected to pay, the full $76,000.
All may be fair in love and war but capitalism is a different story.
Aware of your admiration for Obama, illogical as it may be, and though his health plan might be easier to pass, it is not as good as Hillary's, due primarily to no mandates, and it is far from, as is Hillary's, single payer universal health coverage, which is the best solution. Hybrid systems are almost always the worst options.
BTW: Would agree the gas tax holiday is stupid whether by McCain or Hillary. Pandering is part of the game I often mention though.
Dr. Reich:
Please tread softly on Senator McCain's economic follies. If we just let him keep proposing and we keep adding to our ammunition, November should be little more than a Turkey shoot.
I am a little surprised since Carly Fiorina is a very bright lady and I would assume she is behind much of his economic euphoria. Apparently economic theory is not one of her strong points; to say nothing of the real world.
The man who paid $38,000 for something a cash customer would have been charged $76,000 for shows that we do not have a competitive free market. If we did, no one could get away with charging twice as much as a service costs to provide. A competitor would charge the $38,000 to cash customers, and drive everyone else out of business. Competition would likely drive costs far lower than that by forcing adoption of an efficient business model.
Its time to stop pretending we have a free market. Either give us a competitive free market, or national health care already. Enough with Americans paying twice as much as other nations.
If we just let him keep proposing and we keep adding to our ammunition, November should be little more than a Turkey shoot.
You fail to give enough credit to the Republican noise machine. Shame on you.
Art, as far as Clinton's health care plan goes I don't know if it would be definitively single-payer either. Here's how they describe the roles:
Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.
Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.
Whereas I would describe single-payer healthcare as a system in which the government negotiates and insures a pool that includes the entire population, thereby dramatically reducing the insurance risk. Not necessarily requiring an insurance company.
I believe Kucinich was the only candidate who proposed a true single-payer system.
If I've misunderstood single-payer health care or missed an important point which makes Hillary's plan essentially a single-payer system please forgive and inform.
On a different note, not only is it looking like recession the expansion wasn't great either.
http://www.epi.org/content.cfm/bp214
dan:
Curious as to how self-reliant you are. If you own your own business, plausible, but we cannot all own our own businesses. If you are employed then your self-reliance is dependent on the good graces of your employer or hopefully other employers who would employ you should you lose your job.
Most pre-existing health problems do not start out at birth. If you are insured and you have a health event and then through no fault of your own you end up unemployed, after COBRA, if you can afford that, then you no longer have coverage unless you seek a private policy. That is where the inequity creeps in.
The founding of our nation was predicated on equality. Equality of rights and of opportunity. If the free market, which is often far from free, prices the disadvantaged out of the market then they are not free to exercise their privilege (opportunity). Thus we segue, not only away from equality of opportunity but we trangress back to a survival of the fittest, where only the healthy are allowed continued existence.
We could take an approach, out of fairness and equality of capping allowed prices for health insurance. I'm sure this would have you screaming at eagles for "price controls" are anathema to capitalism and self- determination the latter inuring to self-reliance.
We could, in an effort to avoid much of the problem, require genetic testing at birth or before and those exhibiting a high likelihood to serious illnesses could be euthanized.
Those, with no insurance, setting foot outside their homes or maybe even out of bed, could be required to send an email acknowledging that they are personally accepting the risk of an accident and should serious misfortune fall upon them they give the state the right to decide their fate. This would be far preferable to a permanently disabled person draining all those tax dollars from the coffers.
We could set up food inspectors who would audit the eating habits of folks and those who have poor dietary habits could either be rehabilitated or Dr. Kerkorian could be called in.
We could establish monitors who review those living in extremely hazardous environments, inner cities, near industrial plants, in the area of polluted streams and rivers, and they could be advised to move or again call in Dr. Kerkorian.
Now for those poor unfortunates, whose genetic tests were fine and they eat a fairly good diet and they live in an environmentally safe area, should they be faced with a serious costly health problem, we merely tell them that sh-t happens and call in Dr. Kerkorian. These would be the kind of folks who wouldn't have purchased health insurance for they did all the right things and they were in great health just yesterday.
Now all this will cost money. Dr. Kerkorian would expect a stipend, as well as expense reimbursement, and all those health inspectors would need to be paid. Rehabilitation is not cheap. Valuable land would be scoffed up to provide more burial room, unless, of course, we just wanted to cremate these unfortunates and they could disappear as if they never were here.
Now there could be some solutions here that veer away from the American way but dammit, people should be self-reliant, they should be responsible, not only for known knowns, but even those unknown knowns that they should have known were unknown as opposed to those that were known but it was unknown that they were known.
The coup de grace? Tax cuts from all the government savings.
Or, we could take a basically American approach and recognize that none of us know what health problems lie behind the squeaking door and suggest a program where we all chip in and pay a little rather than leaving the unfortunate to pay a lot; novel I know.
Trust me you don't know what health scenario awaits you down line nor your wife nor your kids. The current system is fine if you have insurance and nothing catastrophic befalls you or your family. The vagaries of life are many and the monetary impact of our current system affects us all, insured or not. Even though it flies in the face of our true national religion, capitalism, it might be a slight diversion would be a good thing. Certainly it can't be construed as anti-American.
ty_010:
No I agree Hillary's plan is not single payer either. I believe you are right in that Kucinich was the only one with a truly single payer plan.
Most experts, Dr. Reich included, don't believe a single payer plan can pass muster in the Congress or perhaps with the American people at this point. So in the spirit of good, ole American compromise we will offer up a hybrid, be it Hill's, Obama's or McCain's and more than likely we will end up with bigger headaches a few years from now.
Great discussion everyone!
@Professor Reich - As Dan notes, insurance is designed to cover the unforeseen. Those which already-known conditions shouldn't have their care covered by insurance. Those who can afford it should (and would be willing to) cover their own expenses. Those who cannot should be covered by society, with gradations for those in between. Copayments enlist the patient in controlling costs, which is right up there with universality as an issue.
"The net price tag on McCain’s election-year promises already dwarf everything HRC and Obama have proposed."
The numbers I've seen don't reflect this. Who's doing your counting?
McCain's health care plan decouples health care from employment, which means that your health care doesn't change when you change employers - a very good thing. Since employers are rational, they would be happy to get out of the health care business (see GM) and would likely encourage (with cash) employees to go that way. That's where the additional money comes from for those who have insurance now. The $5,000 is a big help to those who buy their own insurance today.
@Frank - Holland and the rest of the world are freeriding on the US in that everyone else pays far lower prices for things like pharmaceuticals and medical devices. The higher prices we pay here provide the profits that pay for the research that makes it all possible. That's not the only reason for the difference (e.g., compare Europeans' far healthier lifestyle choices) but it's a big factor.
@Dan - totally agree on your clear and reasonable distinction between rights and privileges. Rights can only be taken away.
@Puppyjive - McCain agrees that our system needs bigtime fixes and is proposing changes that move the ball way down the field.
@Bruce - "Get rid of the profit motive and we can make sure everyone has decent access to health care." The profit motive is what drives progress. That's why the US has more innovation in health care than the rest of the world combined.
@Anon anon - "I live in a small city, and for the most part, all the wealth I see being accumulated are by doctors. The AMA allows the restriction of the number of doctors thus limiting competition." I agree that if we had a lot more doctors (increase the supply) the price of a doctor visit would go down. Curse you AMA.
@Athena - If we treat the UN Declaration of Human Rights as a list of all the stuff we should get for free, the world would be a very different place. The world tried "to each according to his needs" last century but only North Korea and Cuba are still on that page.
Art Layman,
Very sorry to hear about your past and recent medical problems.
You would have been fully covered for one-half the cost in Holland and stressful complications, I can assure you.
I don't want to bore you at length about Obama vs. Hillary's health care plans. He's shown for me superior judgment on many things and a special, unpretentious integrity in how he has energized so many to get involved in our country's problems. He hasn't done this by rhetorical skills only.
He'll never leave those poor 10-15%of uninsured naked without a health care coverage provision. This is simply Not in his character. But he'll be focused and cost effective manner in this and other matters. His health plan will ultimately be universal. His bail out approach to home mortgage victims of sub-prime lending further confirms my confidence in his natural leadership skills in such complex mattters -- as it is for Dr. Reich, many other economists as well the superdelegates who seem to be migrating to his candidacy lately.
I've been in business for myself all my life. I know the value of capitalism, but living in Europe one learns another balance about market and government forces. For a lot of reasons, America can't and shouldn't copy Europe's model(and vice versa), but we can learn and take from the best of each other.
Because, believe me, Europeans and particularly the Dutch observe the best of America and adopt/adapt selectively certain of our strengths to their systems without compromising their unique balance of social-economic-cultural values. Americans are just very weak in doing this because we think we know everything. We're obsessed with "isms" and ideological purity when simple common sense and recognizing our mistakes is needed. And we almost do know everything in certain areas but not in how to manage effectively social programs affecting Everyone ...and not in understanding that Government is there to guide a fair playing field, an up-to-date social welfare and infrastructure system, and an equitable access to all the benefits of the market place. Unbridled capitalism would drive these mauch smaller nationalistic countries into the ground for host of logical reasons time limits my going into.
You'd undoubtedly be moved by these differences, as most Americans are who have lived abroad anywhere for a few years years and have learned the language. I'm not trying to say one societal paradigm is better than the other, but merely one can learn a lot from other cultures when one dispenses with one's own Utopian self-assuredness (speaking for myself, of course)
Cultural interchange in some depth has made me more realistic about my own preconceived perceptions and thus less vulnerable to one of the messages in Kristof's recent writing you brought so kindly to my attention, namely, that many of us are biased by the drive "to hear what we want to hear, or to recognize only what we have been brought up to recognize."
Somehow I think you are very aware of all this, but you seem to fight it as the unmoveable contrarian for some reason... perhaps just for the sake of argument or a perceived realistic cynicism.
Whatever it is, I enjoy our give and takes ... in certain, selective ways as a European would say.
Frank Thomas
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Athena Smith said...
"To protect certain inalienable human rights, naturally we take away money from some common pool to which most of us contribute. To follow your argument, yes, I expect you in your time of true need to infringe on parts of the products of my labor".
Well-said. Likewise, Kant and Hobbes provide good logical arguments for the existence of a health care "right".
btw: Capitalism stifles genuine medical research rather than promotes its development; look no further than our extreme emphasis upon treatment rather than cure. Treating people is far more profitable than curing them. Medical research should be done by those who will benefit from cures rather than by those who profit from treatment.
The philosophy of insurance, is socialist to the core.
It requires that all pay and share the risk. Some get too much benefit and some get too little. That's all part of the socialistic contract.
If you're going to make an argument that the right to health services is invalid because it's a socialistic ideal, then you should be against the socialist ideal of insurance altogether.
It is hypocritical to argue that the socialistic ideal of insurance, applied in a capitalistic system, should not have socialistic components.
Private and Public Insurance is applied Socialism.
If you don't like socialism, drop all of you insurance policies.
Don't be a hypocrite, pay as you go.
Art A Layman,
My wife suffered Heart Failure a few years back. They gave her 90% odds that she'd die.
She lived and is doing well.
The bill for her one week stay was over $50,000.
Because we were uninsured, the price was lowered to just over $20,000.
My regular doctor has two price structures. The insurance covered pricing, and the half off, uninsured pricing.
I try not to be a cynic but the idea that an insurance company is going to to give me a deal with sick people insurance is mind boggling. A company places all their policies that they feel are bleeding you dry into a single pool then decide if your going to give them affordable insurance. Sure!
weaseldog:
That is good news but it is by far the exception rather than the rule. Doctors are much more inclined to practice fairness than are hospitals, clinics, etc. The doctor/patient relationship is far more personal in nature.
Granted in most cases of this sort, hospitals are forced to settle for less but only after imposing great stress and sometimes legal expenses on the patients.
As someone here posted, the answer is one price for medical procedures whether being paid by the individual or an insurance company. The two-tiered pricing model evolved from insurance companies knocking down a reasonable price forcing a higher price for un or lesser insured folks to hopefully make enough money to keep an institution running.
weaseldog:
Sorry!
Was absolutely great news that your wife is well and got through it.
The polls are silly. They show McCain and the Democrats in close races. Mark my word. The more the shit hits the fan, the more populism will run rampant. McCain has made so many statements that the economy is okay, has sided with special interests, dumped his wife for a rich woman, and thinks healthcare is okie dokie.
He'll be bulldozed come election time.
I think that the media is just setting up the perception McSame has wide support.
With electronic black box voting, they can give him the election by a close margin and the public will be none the wiser.
Larry
By oversimplifying, you don't convince anyone. The world did not try "to each according to his needs." Some countries did. Many failed. The Scandinavian stayed the course until recently when their system started being abused greatly and thus they have been moving away.
As for the UN declaration of human rights, let's look at article 3. It states:
"Everyone has the right to life, liberty and security of person."
I do not take it to mean a free ride in all aspects of life.
If you are interested in reading the whole declaration, you may find it here
I think everyone who's this interested in health care reform should watch the fascinating Frontline documentary Sick Around the World which aired a few weeks ago. You can watch it online on the Frontline PBS site linked above.
It explores how 5 other rich, industrialized nations run their universal health care systems, range from socialistic to more market approaches, and do it for less than half of what we spend on our system. And they get better health results. Fascinating.
Dr. Reich,
My apologies for putting this post on your Health Care blog article, although it has some remote connections. Just have to get it off my chest. For readers not interested ... simply skip this post by all means.
In your blog article of April 11th,
"The Fed and Democracy," I outlined a Three Part analysis of our economic dilemmas: (or maybe better called "mess")
PART I .......Credit Crisis: Responsibility (for)
PART II ......Deficits
PART III......Transition to a Stable Economy
As you know, I divide our Government Budgets and Performance Evaluations in Three Cost Centers:
A).....National Budget
B).....Medicare Trust Fund
C).....Soc. Security Trust Fund
Budgets B and C each have their own Tax Revenues and Outlays, and therefore Government data publications should allow average citizen to see overall results of these Trust Funds separately.
I. INTRODUCTION
Parts I and II were posted April
11th. This Part III post (which is extensive, so I warn readers) focuses on WHERE do WE go from here and HOW? As Joe Doe citizen, I will try to give an integrated OVERVIEW of a Tax/Spend framework strategy (and choices) for giving a "new lift" to our economic situation -- without accelerating current annual $400-$600 Billion Deficits irresponsibly. An underlying goal in my summation
is that we strive for national budget Surpluses of 3-4% of GNP in next 4-6 years reinforced by balanced policies offering more structural stability in our economy.
I don't pretend any monopoly on originality or technical answers to our complex problems. This is the rightful purview of our best brains from many fields and alliances. I'm simply sharing my layman's search for a creative, integrative, non-contradictory PACKAGING of some key policy options and programs on HOW to minimize our tendency to have recurring large-scale financial crisises. I hope comments come across in Plain English and add constructively to a serious national debate concerning the huge social-economic challenges confronting current and future generations of Americans.
II. REALLOCATION OF RESOURCES
As noted in my April 11th posts, taxpayer funds need to be redirected INWARD to the decaying social and educational fabric of our society. As David Brooks not so long back wisely said in his arguing for a "Human Capital Revolution" to capture a national spirit of reform: "Among the lower and middle class there is a poisoning spiraling of economic stress and cultural decay."
But, to take up this challenge and change course, "Where are investments most needed; what are the costs, sources of funds, priorities? For we can't do everything.
So first I list Investment Needs and Financing Sources. A final followup Part III will explore Selecting/Packaging/Prioritizing them in a balanced framework to best stimulate near and long-term economic growth and correct some imbalances in our social-economic model going into the 21st century.
A. .....ADDED INVESTMENT NEEDS
1. Pre-college educational programs and facility improvements;
Worker retraining, skills upgrading (including Veterans) to offset deepening educational gap and resultant economic stress of lower-middle class Americans
2. Infrastructure renewal including roads, bridges, mass transit, waste disposal, etc.
3. Extension of Health care to over 44 million uninsured Americans and making it more affordable to ALL Americans
4. Incentives to stimulate alternate fuels, more efficient vehicles as part of goal to sharply reduce dependence on imported liquid fossil fuels
5. Individual and company tax cuts structured not to be so more costly (as historically) than inflated expectations of tax revenue windfalls... so as to minimize annual deficits and contribute more effectively to stable GNP growth
6. Near term support such as bolstering Unemployment Compensation, Food Stamps
7. Increased Military spending for Veterans' medical treatments, replacement of equipment stocks, expansion (??) of force levels
8. Making Soc. Security 2030financially sound (e.g., stop using it to finance our Deficits) and secure for all who have and are paying into it
B. .....SOURCES OF FUNDS
1. Reduction of spending in Iraq (and eventually Afghansitan) and negotiated settlement of refund of major portion of U.S. funded infrastructure costs and costs for smaller security forces expected to remain there for some time
2. Gradual reduction over next 3-4years of all Military spending to 3.5% of GNP vs. current totally unaffordable levels of 5-6% of GNP (caused mainly by added costs of engaging in two wars, i.e., Iraq and Afghanistan)
3. End Bush tax cuts going mostly to top 10% income earners and estimated to increase Deficits another $2.2 Trillion over 10 years or at least +$200 Billion a year
4. Reduce so-called "Pork Barrel"
spending ($20-25 Billion annually) that is truly frivolous State spending and/or contributes nothing essential to social-infrastructure improvements
5. Tax increases, decreases, tax incentives:(these must be computer model tested for ideal results)
....(a) set higher marginal tax on top income earners earning more than, say, $400,000 annnually
....(b) increase earned income tax credit (Dr. Reich) and phase it out at higher wage level
....(c) eliminate or retain alternative minimum tax
....(d) increase capital gains tax
....(e) increase taxes appreciably on health destructive products products like Tobacco which also help reduce future health care costs
....(f) double Federal gasoline tax to $.39 cents/gallon and offer a tax credit of up to $3,500 for purchase of most efficient cars and hybrid cars to 0% for cars in low efficiency categories and/or for non-hybrid alternate fuel cars
....(g) eliminate tax loopholes, special tax concessions given to oil companies; offer tax incentive for level of investments in alternate clean fuels reducing dependence on foreign imports of liquid fossil fuels
....(h) "windfall profit" taxes on oil companies -- pros and cons
....(i) eliminate income tax (not Medicare/Soc. Security withholdings) entirely on those with an independently certified adjusted gross income below $20,000a year
6. NEW FUNDING IDEA
In WWII, our society came together with Uncle Sam's Bonds to help finance the wars in Europe and Asia. The response from all Americans was magnificent .... a proud, altruistic, united people for a critical moment in time.
Idea? Let's do it again for a different purpose but one equally critical! This time we might call the Bonds, " The Invest in America Trust Fund." Main purpose? To upgrade our Human Capital assets.
Use of funds would be limited to costs for upgrading nationwide pre-college educational system, offering retraining and education of displaced workers (victims of downsizing, outsourcing, plant closings, redundancies from mergers & acquisitions, etc.) and special-skill training for Veterans.
This WWII "bottoms-up" financing source might conceptually work as follows: in the Fall the Federal Government would organize a large issue of U.S. 20-year guaranteed bonds in $500 and $1000 denominations yielding a tax-free fixed 5% interest paid quarterly and a fixed tax-free repurchase price of $900 at the end of year
20.
Individuals and corporations could buy the bonds. In return, they would be given an immediate tax deduction (with limits) equal to 50% of total face value of bonds purchased. So an individual in the 25% tax brackett purchasing one $500 bond would receive a tax reduction of $62.50 (12.5% of bond investment). A corporation in the 35% tax brackett purchasing one-thousand $500 bonds ($500,000) would receive a tax reduction of
$87,500 (17.5%).
All proceeds would go into The Invest in America Trust Fund. Funds received from individual purchases would be distributed back to each State based on an equitable weighted index that considers, for example for each State:
(a) average income per capita
(b) average GNP per capita
(c) bonds purchased per 1000 of population
Funds received from corporations
(institutions, investment and pension funds, etc.) would be redistributed to each State based on (a) average GNP per capita.
This is to avoid disproportionate funds going to States where a large number of corporations are located. The aim would be to equalize opportunities to achieve more uniform educational/training improvements across ALL States.
Semi-annual certified reports of expenditures and projects would be provided by each State for its own Oversight approvals as well as for Oversight control of Federal Government. Simple to measure, appropriate criteria would be established to measure performance results of The Invest in America Trust Fund.
BENEFITS:
-- Substantial grass roots monies are raised critically needed for our educational/training fabric from broad spectrum of American society... funds that would otherwise have to raised by selling Treasury bonds to China or Europe. It's Americans united for a noble cause in everyone's interests
-- Interest payments go to Americans (rather than to the Chinese) for investing in our own country through a safe investment vehicle
-- Investment offers a tax-free annual return of 5% over lifetime of bonds plus tax-free recovery of initial investment assuming a 3% annual inflation rate
-- Deciding how to use funds is of course the responsibility of each State to ensure 'hands-on' local attention to educational/training problems based on some goal guidelines
-- Financing idea has a neutral Deficit effect vs. borrowing from foreign countries; annual returns going to Americans will stimulate consumption; funding this way obviously reduces dependence on foreign financing, particularly from China; there may also be positive confidence effect for the Dollar.
-- Idea is to unite support for our Common Interests as our nation enters the 21st century with some powerful competition on the horizon (China and India)... where nothing is more important than our Human Capital assets for retaining our world leading position in all levels and facets of the Knowledge world. We are enjoining and empowering a broad cross-section of our citizens to be up-to-date quality educated and trained for current and evolving sectors of the job markets.
-- In short, I'm sure others could greatly refine, expand on, and make more attractive this idea, assuming it has the merit I see in it.
Part III will be continued and completed soon as time permits. It will address:
III. Pros and cons of Investment priorities and Funding possibilities (listed above); the estimated Investment outlays and offseting Funding Sources
IV. Right mix of Investments and Funding possibilities while also keeping Deficits under control
V. Getting a better balance between Consumption and Investment in driving our economy
VI. Medicare improvement possibilities
VII. Making Soc. Security sound and secure
Frank Thomas, The Netherlands
@Athena - What quality about something makes it an inalienable right? And does that list change over time? Based on what? (I don't propose answers because I fear it would just upset you.)
"The world did not try "to each according to his needs." Some countries did. Many failed. The Scandinavian stayed the course until recently when their system started being abused greatly and thus they have been moving away."
Exactly. It worked sort of, for a little while, in a few very unusual places (Scandinavia is small, non-diverse, and has contributed little to advances in care.)
"Everyone has the right to life, liberty and security of person."
The above matches my idea of rights - things that you have when you are born, and that can only be taken away from you. Things that have to be taken away from someone else in order for me to have them violate their rights and my dignity. That cannot be justified by calling it a right. I am willing to go along with it when it seems to be the lesser evil, but that's it.
@notsofast - "Capitalism stifles genuine medical research rather than promotes its development"
I agree that we need to make markets in cures that are more attractive than today's treatment-focused approach. But what other system has shown that it produces more cures (or improved treatments) than the capitalist one? Neither the communist nor socialist models worked. Europe's model is less effective than ours by leagues and ours could be vastly improved (in the sense of more people living longer and better) by making it more market-focused.
@Weaseldog - "If you're going to make an argument that the right to health services is invalid because it's a socialistic ideal"
That's not the argument. Further, insurance long predates socialism and flourishes in the least socialistic environments we know of, such as Hong Kong.
"My regular doctor has two price structures. The insurance covered pricing, and the half off, uninsured pricing."
If we had universal insurance, there would only be one price structure. Any guess which of the two it would be? Not how I'd go about controlling costs, personally.
All the best to your better half.
@James - "5 other rich, industrialized nations run their universal health care systems, range from socialistic to more market approaches, and do it for less than half of what we spend on our system. And they get better health results. Fascinating."
I haven't seen the piece, although Frontline is typically dedicated to the proposition that America sucks in every way. Did they cover the ways in which the population and their lifestyles present dramatically different problems from ours? Did they describe where health care innovations come from (non-anecdotally, because innovation is not dead there, except in comparison with the US.)
Larry said…..
“Neither the communist nor socialist models worked“.
Well for the sake of argument let’s assume Soviet Stalinism was actually communist or socialist. We do know that the Soviets were every bit our equal and better in a number of pure science fields. Examples would include mathematics, chemistry, and physics. We also know that suppression of ideas in the fields of biology and genetics greatly diminished practical research in these particular fields.(authoritarian stalinism)
They produced a technological might rivaled only by the U.S. by being preoccupied with theoretical science. This dominated their entire science and research effort for several decades due to existential fears of being wiped out by the U.S. We don’t know what would have happened if they had used their scientific talent in pursuit of medical knowledge to cure disease. We might assume that they would have had far more contributions to medical research than what the record indicates, although advances they made in theoretical science surely helped others around the globe in practical medicine.
So we can simply say they never really tried to advance medical knowledge in any serious manner.
Extraordinary scientific achievement is a legacy of the old Soviet Union. By inference, I fail to see how free market capitalism is needed to produce excellent science and valuable contributions to knowledge. Trying to distill human motivation down to a profit motive is nonsensical.
Does Boris have a take on this?
here's Obama wooing confederate voters down in north carolina:
bi
ha
@NotsoFast - "We do know that the Soviets were every bit our equal and better in a number of pure science fields."
Seriously? The Soviets excelled in chess and math and beat us to orbit, but that's about as far as I'll go. They failed at literally everything else from nuclear power (Chernobyl) to food production.
"existential fears"
We had the same fears. We also developed most of the technology (which they then stole) involved. And yet, we not only stayed well ahead of them in weapons of war, but passed them in technical areas such as electronics, software, and every bio area except possibly bioweapons.
"theoretical science"
Medicine requires theoretical science, at which we led the world during the period. It also requires massively complicated empirical science at which we ...
"So we can simply say they never really tried to advance medical knowledge in any serious manner."
That's for sure. Their lifespan today is not much greater than that of Cambodia.
"I fail to see how free market capitalism is needed to produce excellent science and valuable contributions to knowledge. Trying to distill human motivation down to a profit motive is nonsensical."
It's not about motivation. Soviet doctors and researchers certainly wanted to help their patients. But their society wasn't organized in a way that allowed or rewarded them for doing so. As with democracy, capitalism is a terrible system - it's just better than any other we've come up with. Free competition and the promise of riches with straightforward access to capital accelerate change like nothing else we've encountered.
I just don't understand why anybody can believe the government can fix the health care system.
The only reason why we are having this discussion is because companies are tired of having to provide coverage to employees.
The best solution to the problem of health care is to:
1. get rid of the AMA.
2. Restructure of trade policy to promote job growth in the U.S.
3. Fix the illegal immigration problem.
4. Stronger Labor organization laws
Quality completive companies that have to compete for employees will provide health care in order to keep their workers.
The problem all stems back to Reagonomics. Trickle down my leg economics.
I am not going to argue what works somewhere else, because the U.S. government is unique in its ability to not fix a single issue it has on its plate.
So all you neo-socialist who think anybody but big business wins by government health care are drinking Kool-aid.
Address the real issues instead of trying to redesign the world into a Utopian dream. The problem is cost, the government has proven that it will fail to control costs.
The problem is lack of job growth.
Trusting the Government to do anything but screw you over some more is stupidity.
Dr. Reich,
I'm back off my macro-micron economics perch, and on to your Health Care blog article.
In my description of the Dutch system -- based on one price for medical procedures and essential drugs set by the appropriate government agencies and paid by the insurance companies)-- I forgot another important element is the "Gatekeeper" doctor.
This condition requires that patients must first be checked by their General Practitioner before they go to higher cost specialists. If there is still a difference of opinion after doing this (and maybe after also getting a second opinion), the client-patient has the flexibility to go direct to a specialist for a small added premium payment. I'm not sure how this works in the States.
Some other European countries make the Gatekeeper idea optional but offer premium discounts if you go to the Gatekeeper first or charge you a premium "co-op payment" if you go around the General Practitioner (like Holland).
Whatever the policy, this
is a another important underestimated practice in keeping down overall societal health care costs in continental Europe. It avoids excessive overuse of expensive specialist time not in reality warranted for the many health complaints easily solvable by the lower cost local doctor.
Holland's health care system is among the least costly in Europe at 9% of GDP. This compares to almost 12% of GDP in Switzerland (where Gatekeeper condition is optional)and 11% of GDP in Germany (where no Gatekeeper is required but a premium must be paid for this privelege)
Continental Europe has a history of innovations and R%D investments in medicines by their drug companies that match the U.S. anyday. The difference is the suppliers of pharmaceuticals here, as well as the procedures and operations of doctors, are far more sharply price controlled by government agencies in each country ... employing slightly different control techniques in managing their universal systems but having the same overall results, namely much lower family health care costs than in the U.S.
I read some three months ago, that some U.S. agency has picked the Swiss and Dutch health care systems out of a number of systems as the best to be examined carefully to see if something can be learned from how these two counties run their health care systems.
.................
Dinu
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frank thomas:
BTW, thanks for your concerns for my health. I'm fine and merely go about daily activitities never knowing whether each day might be my last. Little different than all the rest of you. Wife's a different story but for another time.
Actually we, in the US, have cycled through your "gatekeeper" process. We had for a number of years HMOs which required a Primary Care Physician, our term for "gatekeeper", who was at the center of all medical activity. These HMO policies were devised to keep costs down but they failed miserably.
We have since moved to many variations of a similar approach. Not sure of all the variations but my most recent experience was with a PPO (Preferred Provider Organization) where you have a network of general practioners and specialists and hospitals. You are free to go to any doctor, specialist or otherwise, without referrals, but if you go outside the network of approved providers you pay all of the expense; the insurance company pays nothing.
This works fine most of the time. Biggest problem is when your GP is not in the network or when a highly vaunted specialist, who you would prefer to see, is not in the network or when the hospital that is most convenient to you and your family is not on the list.
Other little blips can pop up in semi-emergencies. When my GP, actually a cardiologist, discovered my aneurysm he was quite concerned and arranged for me to meet with a vascular surgeon at the hospital seemingly for immediate surgery. After two CAT scans the urgency subsided and we set up an office visit. Once away from the aura of the fierce urgency of now, I remembered to check and make sure the surgeon was in my network. Alas, he wasn't. He did route me to a vascular surgeon who was but only after I paid him $500 out of my own pocket.
I have long argued that rather than reject universal health care out of hand, using all the emotional labels, our best and brightest should review in detail the various plans in place around the world and then craft a program that fits our needs. In true American spirit I have argued that we could create a program that would be better than all of them, insuring everyone and at much lower overall cost than the current system is providing.
The problem lies, once again, in movement conservative's ideology that suggests that government can never be the solution. That all the government can do is make things worse and much more inefficient. Should conservatives even consider universal heath care that is not driven by the free market they are abandoning their basic premise. Should a program be passed into law and prove to be an improvement, conservatives will see this as a Pandora's Box the opening of which will seriously begin to destroy their operating philosophy. Without this philosophy and the successful selling of it, their whole rationale for governing goes down the drain.
The mechanics of a universal health care solution are not the real issue. Options abound for various machinations that could work well. The issue is getting over the, now ingrained, idea that the government will only take your tax dollars and waste them. Or, even worse they will take your dollars and spend them for somebody else. In the US, community is defined as a collection of me's.
Our problems are not that we don't have bright people that know how to fix our problems; our problems are that we have had essentially a stalemate government for the past 13 years and meaningful, problem solving legislation can't get past it. Conservatives have amassed enough of a plurality, at times, to get some of their programs done but most of those programs have been detrimental to our progress.
I always find it fascinating that after having conservative presidents for 19 of the last 27 years and conservative control of the Congress for much of that period they always have to harken back to Reagan to find an icon. In all that time they have not produced any leaders that can stand alone to further their cause.
Larry said…..
“As with democracy, capitalism is a terrible system - it's just better than any other we've come up with“.
Not exactly a ringing endorsement considering the others we’ve actually experienced in practice are generally feudalism and slavery. But this illustrates how capitalism disguises its exploitation and is perpetuated. Socialism is dismissed using a flawed analysis of the repressive Soviet model. Theories are pulled out of thin air to mask similarities with serfdom and slavery. Ruling classes were just “providing for” and “helping” their serfs and slaves and not exploiting them. Similarly, economists develop fancy theories denying the existence of a process that produces a surplus and subsequent capitalist confiscation. Instead, everyone contributes and is fairly rewarded. Capital doesn’t emanate from exploitation but rather the admirable traits of the capitalist. And those who can’t accumulate capital, have no one to blame but themselves and are destined to a life of wage-slavery.
Those concerned with social justice, improved living conditions for those most in need and earth-friendly policies, won’t settle for such an inferior system.
“Free competition and the promise of riches with straightforward access to capital accelerate change like nothing else we've encountered“.
This is just more sophisticated capitalist propaganda. I do agree with the “free” part. Change results from the advancement of pure science. More often than not, these advancements rely on significant cooperation and not competition among colleagues. Very few scientists are motivated by “the promise of riches”. In fact, as far as I can tell very few people are as well. The capitalist may be motivated by the promise of riches but this is usually something independent of the creative process itself. The profit motive creates the exploitive dynamic for all but a few. Capitalism isn’t necessary or even necessarily a desirable precursor for the betterment of humanity.
The final word is yours if you so choose.