Am I the only one whose cynicism about politicians and the American public has been exhausted by the extent of the popular delusions and knowing falsehoods which are emerging during the whole “healthcare debate”? It is interesting to listen to liberal and conservative health policy specialists who aren’t too focused on partisan politics talk candidly about our healthcare system; they may disagree as to the solution, but they generally agree that our employer-based system burdened by state level regulations is totally sub-optimal. To be less prim it kind of sucks ass. In contrast, the politicians want to “reform” the system while keeping its rotten heart intact because the public is totally loss-averse.
– Yes, Obama does want to socialize risk.
– Yes, it will cost more.
– No, we do not have a free market in health care. Medicine is socialized between the ages of 0 and 18, and 65+, and for many of the poor. Private insurance is heavily regulated. Do you know that many states force insurance to cover infertility treatment? That means that stupid poor people who breed early are subsidizing the life choices of intelligent richer people who keep putting off having children for the sake of advancing their career or furthering their education. But that’s what the stupid voters demand through their representatives.
– A genuine libertarian or conservative healthcare solution would terrify the American public as much as the Left-liberal vision does. That’s why the Republicans aren’t offering much of an alternative.
– Yes, rationing will occur, and does occur, whether by government or insurance companies. Scarcity is a fact of economic life. But in politics everything is possible and resources are infinite. Every man a king!
– Most medical consumers are stupid, and the intelligent ones don’t make choices which are sensitive to cost because of the nature of insurance.
– Doctors make a lot of money because licensing limits the labor supply and they can bid up their services. Yes, nurses can do most of what a family doctor does. No, doctors are not geniuses, I helped some current practicing M.D.’s with their chemistry and calculus homework back in the day, and let me tell you that there is one emergency room physician who had a notorious tendency to “space out” randomly who I wouldn’t want to be treated by in a pinch (though she was a very nice person). I recently went in to get some medicine for my bronchitis and I told my M.D. exactly what to prescribe and she diligently complied after a minimal check-over of my health status. $150 that insurance pays up just for signing the prescription!
– Many diseases are genetic. But many are due to lifestyle. Fatty and sugary food taste very good. Soft drinks are irresistible. I think so personally, but generally avoid them because of concerns about my health. I forgo pleasure now because of the risk of disease later. Other people do not forgo pleasure, or can not. These tendencies are likely partly hardwired, but if half the population has them by definition they’re not preexisting conditions, so these people get insured too. Steak and soda tastes so damn good!
– Lifestyle changes are not impossible. Seventh Day Adventists add ~half a decade to their life expectancy through healthy living. Ah, but are they having fun?
– Americans demand more and more services and refuse to stop complaining about the increased premiums which those services entail. A large number of patients at my doctor’s office refuse to be seen by the nurse practitioner for basic appointments because they want “the best” care. The reality is that in most of these cases you’re getting very little extra medicine (if any) for multiples more of price. Americans demand more government services and lower taxes, so this sort of behavior is not surprising.
At some point we’re going to come to the end of the line with all this nonsense. We’re a mammoth nation of ~300 million people, can we truly coordinate our disparate values and abilities to realize what we wish to be? Conservatives wonder as to the scalability of the European Union, with the all the kludginess entailed by its common monetary policy. But the late great financial panic makes me wonder if these United States is of appropriate scale either. Ah, but that’s an unpatriotic thought.
Note: And don’t get me started on the student loan racket and higher education inflation.
Fatty and sugary food taste very good. Soft drinks are irresistible. I think so personally, but generally avoid them because of concerns about my health.
You mean you’re not on the high-fat/high-meat diet like agnostic?
jeffries, let’s just say *i love almonds*. though i do generally think at this point that sugar and refined carb consumption are more of a public health threat than fat because consciousness is pretty high on that issue. remember heart disease mortality rates are declining, but type ii diabetes induced morbidity is sky-rocketing.
A genuine libertarian or conservative healthcare solution would terrify the American public as much as the Left-liberal vision does. That’s why the Republicans aren’t offering much of an alternative.
Alternative hypothesis: most Republicans have no interest in a “genuine libertarian or conservative healthcare solution.”
I think I agree with everything else you wrote.
Beautiful. Absolutely beautiful. Exactly the sort of thing that needs to be said in this ongoing debate over health care “reform.”
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As someone who teaches biochemistry to first year medical students, and who interacts with clinical faculty on a regular basis, I can wholeheartedly attest to the fact that doctors are not geniuses. The model of incorporating more of a sliding scale in training/licensing requirements for routine procedures is on target, in my opinion.
Yes, it will cost more.
More than what? Countries that socialize risk already have cheaper health care than the US system.
That’s not to say that it’s *impossible* to make our system worse, but we do seem to have the least efficient system currently in existence. It seems strange to baldly assert that a particular change will make it *even less* efficient without any supporting evidence.
Chris,
How are you making that judgment?
The US leads the world in actual outcomes.
I agree with the gist of your post.
It is annoying that both sides are “stuck on stupid” with regards to health care reform. The current employer-provided system is expensive, reduces competitiveness of US industry and is hardly something that Republicans should want to preserve.
Sarah Palin’s “death panel” concerns are valid – but only if government is the only provider. It is odd that Republicans are now allied with senior citizens to make sure that Medicare continues to be funded without restraint. Am I the only one that finds this a bit disingenuous?
The Democrats seem to be stuck pushing the same old, monolithic, mid-twentieth century solutions. Why didn’t Obama, of the famously subtle and judicious temperament, not benchmark some other health care systems first (eg. Switzerland, Singapore) instead of letting Pelosi and Co. slap this current monstrosity together in such a hurry? Instead, like the stimulus and the budget, he just tries to ram it through as fast as he can.
Well said.
A genuine libertarian or conservative healthcare solution would terrify the American public as much as the Left-liberal vision does. That’s why the Republicans aren’t offering much of an alternative.
There lies the problem. Ron Paul was the only congressman who voted against a bill that prohibits insurance companies from genetic discrimination. Most people just don’t want a free market in health care. On the other hand, most people get that government doesn’t do things efficiently, and they want their own doctors, so they are against Obamacare, too. Most people who have seriously thought about health care either want socialism or libertarianism, but neither side can win a majority of the public, so we are stuck with our expensive hybrid system.
I can’t resist steak and cake. I might cost the health care system a bit more, but I’ll collect less social security.
Some may be interested in my bipartisan approach to health care. It pretty much bypasses employer-supplied health care. It can be found at:
http://www.plan.bipartisanhealthplan.com
It has some features in common with the Wyden-Bennett bill but is more radical, involving government supplemented Health Funding Accounts and private guaranteed-renewable health policies from birth to death. These replace all other government health plans, including Medicare, Medicaid and SCHIP.
The approach, by design, solves the inherent contradictions between pre-existing conditions, guaranteed issue, community rating, and market competition which have been on view in town hall meetings this August and which have frustrated politicians and citizens of both parties.
It also has elements in common with David Goldhill’s recent article in the Atlantic “How American Health Care Killed my Father”.
http://www.theatlantic.com/doc/200909/health-care
Goldhill and I have in common the facts that we are not health care professionals and were brought to the field by the real-life experiences of relatives.
@Michael in PA Cite, please? I don’t doubt that the upper-middle & higher class Americans get great care, but what’s the median or average overall? And Americans of a higher class also tend to do more preventative care in general. How do they compare to their British or Swedish counterparts?
More than what? Countries that socialize risk already have cheaper health care than the US system.
americans want “gold-plated” services. they want all the tests, all the procedures, etc. whether we are more or less efficient per unit of service offered it not even relevant to my point. my point is that americans want such an enormous quantity of service combined with quality of service that it will cost more. chalk this to some extent to our culture, but i think it is partly driven by “third-party payment” psychology as well.
I am probably not like most Americans in that I’d like to receive less “healthcare”. What I mean by that is that I’d rather not be forced to go to my PCP twice a year to get new prescriptions for medicines I’ve been on forever that are still working.
Nor do I want calls reminding me that it’s time for this or that “preventive test”. I’m not a likely candidate for breast cancer and I see no reason for yearly mammograms simply because of my age.
I’d like to be able to call my PCP (who is a physician’s assistant) and make arrangements over the phone for the one test I do think I need yearly and I’d like to be referred to a neurologist for this condition, yet I’m stuck with reading a radiologists report along with my PCP.
Part of the inefficiency of our system is built-in and I don’t see any proposals actually addressing that. Inefficiency isn’t exactly the same as waste and fraud.
What I oppose is change for the sake of change and merely reshuffling the pockets that are filled.
People should think through the economics. A healthy diet & lifestyle does not reduce health costs much, if at all. You simply delay your treatment to an older age. In addition by living longer you healthy types are wrecking the pension system.
Maybe that’s why Obama smokes. If he can start a trend back to cigarettes he will save the USA TRILLIONS!
Those things you wrote are all true. It’s in a terrible state, and I don’t think it’ll be getting better any time soon.
Well said. I think both sides in this debate look horrible.
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