Brian PCF's Blog

Cato’s "Anti-Universal Coverage Club"

So I just joined the above “club” and had some interesting give and take with some friends of mine. First here’s the clubs manifesto:

The following principles explain the club’s opposition to “universal coverage”:
Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.

“Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.

In a free society, people should have the right to refuse health insurance.
If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

And here’s a response from my friend Tim:

Here’s what I have to say regarding this “manifesto” that you’ve pledged your allegiance with. Quoting from the website… The following principles explain the club’s opposition to “universal coverage”:

Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.

> I couldn’t agree more.

2. “Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.

>Why are these the only options? There have been plenty of proposals over the last 30 years that would give people the choice to opt out of any plan as well as giving people the chance to pay slightly more out of pocket for the right to choose whatever level of care they want. The important point is that your providing a service to the people of America that can’t otherwise afford it. This is exactly what good government should be all about. We need to set a baseline of care in this country so that we know people are guaranteed access to health care. Right now there are thousands (maybe millions) of people that are effectively unable to get care because they can’t show an insurance card to the receptionist at the hospital.

3. In a free society, people should have the right to refuse health insurance.

> First of all, see my previous statements. Second of all, who says? Where in the Declaration of Independence does it say that? Or is it in the constitution? Is that an inalienable right? The government is here to provide services to the community that wouldn’t otherwise be provided for. You can’t “opt out” of income tax or sales tax either. Sometimes you have to pay for things that are worth while. I know the current administration doesn’t agree with that, but it’s the truth. If we want better health care, there’s a cost. And we’re already spending the money, it’s just being mishandled by the insurance companies who need to turn a profit.

4. If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

>Now you’re sounding like the critics of the public school system. We see how well the voucher system has worked for education. Again, we’re talking about establishing a baseline of care for the country, not subsidies. Health is not a commodity. A govt run health care system would effectively make all hospitals and clinics “public” and “uncompensated”. Take the profit out of it.

My other friend Dan’s response to the manifesto:

Most of what I was quoting on WED came from below . . .

http://www.nybooks.com/articles/18802

I completely admit that one article is in no way exhaustive research, and it is possible that we’re all wrong about universal healthcare (as Brian will no doubt smartly site what he sent out about the low fat diets . . . which is fascinating by the way) – but I think to some degree, you can look at what we’re doing now, and comfortably say “this isn’t working.” And because of that, I’m willing to try something else.

I like what Tim is saying above.

I haven’t seen studies of how Vouchers have affected the public school system, but I would be curious. Frankly, I would like one of the candidates, who all say they’re serious about education, to stand up and say that we need year around schools (with short breaks throughout the year). This is the most common sense thing ever – what %age of knowledge is lost each year as they sit home watching reruns in the summer?

Here’s my reply to Tim:

Tim, to reply to your points:

Within your Section 2:

a. “There have been plenty of proposals over the last 30 years that would give people the choice to opt out of any plan as well as giving people the chance to pay slightly more out of pocket for the right to choose whatever level of care they want. “

Do I have the option to opt out of paying for Medicare/Medicaid right now, though this only serves a minority of the population? Why would you feel that I would have the option of not paying for other peoples’ healthcare if even more people are covered by a government system?

b. “The important point is that your providing a service to the people of America that can’t otherwise afford it. This is exactly what good government should be all about.”

I will assume you meant a “necessary service.” But won’t you admit that by providing any service “for free” the government eliminates all competition from that service sector, whether that be roads, schools, healthcare, etc. By eliminating competition don’t we limit an individuals right to choose and eliminate the motivation for innovation?

c. “We need to set a baseline of care in this country so that we know people are guaranteed access to health care.”

Isn’t that exactly what Medicare and Medicaid were supposed to do? Set a baseline of care for the poor and the elderly? Why does this now need to be expanded to cover everyone? Won’t this just mean that those who are healthy and have money must subsidize those that don’t make the same quality health and financial decisions? Isn’t private insurance designed so that those that make good health (medical) and financial (auto, home, life), are rewarded for those good decisions through low premiums but are still protected from unexpected outcomes and situations? Further, by allowing the individual to choose don’t we have freedom, competition, and personal responsibility for decisions? Instead with Medicare/Medicaid you are charged a flat percentage of your income.

Within your Section 3:

a. “Where in the Declaration of Independence does it say [In a free society, people should have the right to refuse health insurance]? Or is it in the constitution? Is that an inalienable right? The government is here to provide services to the community that wouldn’t otherwise be provided for.”

He doesn’t say in the Declaration of Independence or the Constitution, he says in a free society. A free society, whether it be a philosopher or any basic logical conclusion, is one where I have the freedom to do whatever I choose so long as I in no way limit your same absolute freedom.

However, if we wish to frame the debate within the Declaration of Independence and the Constitution, you argue they don’t say that we have a right to refuse health insurance. That partially depends on your idea of “Life, Liberty, and the Pursuit of Happiness.” However, please show me in Article I.7-9 where the Congress or States have a right to force someone to have health insurance. You can’t, it’s not in there. Can you make the argument that the Founders had that in mind when they wrote it? Please show supporting data. b. “Sometimes you have to pay for things that are worth while. I know the current administration doesn’t agree with that, but it’s the truth. If we want better health care, there’s a cost. And we’re already spending the money, it’s just being mishandled by the insurance companies who need to turn a profit.”

The current administration doesn’t support that? Medicaid spending increased 23% from 2005 to 2007, all of which were through acts sponsored and pushed through by Bush. Moreover, if you look at this Kaiser Family Foundation report, you’ll see that Medicare spending has been highest under Nixon, Reagan, and Bush.

Mishandled by the insurance companies? So not in anyway mishandled by Medicaid/Medicare. Please google “waste in medicare”. Here’s a NYT article from 1997 detailing waste, fraud, and abuse in Medicaid/Medicare. One interesting article from the Washington Post in 2005 relays the story of Palm Beach Gardens Hospital. Read this and ask yourself if any consumer would continue to go back to a place like this if they had choice or if there were competition in the marketplace. If you went to a restaurant and saw something comparable to “Trash cans and soiled linens were stored in hallways. IV pumps were spattered with dried blood. One patient’s wife said she saw a medical assistant tear surgical tape with his teeth” would you ever go to that restaurant again?

You wouldn’t, but Medicare still paid this place more and more with these conditions. Medicare is now over 40 years old. The government and the citizens have had years to tinker with the system and figure out what works, instead “…most high-spending states rank near the bottom in quality of care, Medicare data show. Louisiana ranked 50th in quality yet first in Medicare spending in 2001, the most recent year available. New Hampshire was first in quality but 47th in spending.” So it seems that we can spend all we want in this government run system that has existed for 40 years, and it won’t make any difference.

But you argue that either this is the Bush Administration’s fault or insurance companies? See the bottom of that Post article, “Only the most cynical among you will not be surprised,” he told lawmakers, “when I tell you that the greatest current threat to this congressionally mandated demonstration is Congress itself.”

Your section 4.

a. “Now you’re sounding like the critics of the public school system. We see how well the voucher system has worked for education.”

We have? Teacher’s Unions haven’t tried to stop this program wherever it is proposed? Moreover, perhaps the numbers reported are wrong, maybe there aren’t 15% increases in Washington DC Charter School enrollment between 2005-2007. But this is a logically flawed argument since the charter school system is either funded by local government or by the federal government and relies on more than just “school choice” for funding. A government entity is still responsible for measuring performance, and hence distributing funds. So it is not a free marketplace at all.

b. “A govt run health care system would effectively make all hospitals and clinics “public” and “uncompensated”. Take the profit out of it.”

I feel I’ve demonstrated above that insurance companies, HMOs, hospitals, and doctors are working for profit in the government system as it currently stands, which causes widespread fraud, abuse, waste, and most importantly unsatisfactory care. If we stick with that as a given in this problem set, then by your argument we would have to completely eliminate any motivation for profit from anyone that is providing any healthcare related service. So how do you propose that we pay doctors, nurses, hospital managers, pharmaceutical companies, medical technology companies, medical supply companies, secretaries, IT professionals, security staff, maintenance personnel, research and development divisions, and the janitor? That would be left to the government correct? What would prevent the same result as what happened in the Palm Gardens Hospital? What’s the solution and how would it yield different results?

More to follow once I read the NYT article Dan posted.

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January 18, 2008 - Posted by | Uncategorized

1 Comment »

  1. Two additional links I need to work on later are

    The High Price of Too-Low Administrative Costs
    http://www.cato-at-liberty.org/2007/12/03/the-high-price-of-too-low-administrative-costs/
    Michael Cannon
    Cato Institute

    Comparing Public and Private Health Insurance: Would A Single-Payer System Save Enough to Cover the Uninsured?
    http://www.manhattan-institute.org/html/mpr_05.htm
    Benjamin Zycher
    Senior Fellow, Manhattan Institute for Policy Research

    And further items from Cato

    http://www.cato-at-liberty.org/?s=medicare+waste

    Comment by exqweezme | January 18, 2008


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