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Wednesday, October 29, 2008
Peter Pitts :: Townhall.com Columnist
Closing the Idealism Gap on Healthcare Reform
by Peter Pitts
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Will the Dems' health care Christmas Present to America be an improvement or detriment to our health care system?


A new survey from the Center for Medicine in the Public Interest shows that there is an “idealism gap” among young voters when it comes to their support for government-managed health care. While a strong majority -- 83 percent of those polled -- believes that America’s healthcare system is in need of reform, just 49 percent support paying for a new government-run health care program through taxes.

These results weren't surprising. With tens of millions of Americans uninsured and costs through the roof, change is obviously -- and urgently -- needed. But voters are rightly skeptical of paying for a massive overhaul of our system.

Already, the U.S. government pays for around half of all healthcare expenditures. In Great Britain, where health care is socialized, 95 percent of all healthcare costs are paid for by the taxpayer.

The problem with government-run health care isn't just its price tag. Canada and other countries with “universal” care have seen increased government intervention in which types of treatments patients are allowed to access are based on cost rather than effectiveness.

For patients like Linda O’Boyle of the United Kingdom, such policies can be deadly. She was diagnosed with cancer and told that medication not covered by the National Health System would increase her chances of survival. So she used her savings to pay for the medications. Upon discovering this, the NHS stopped allowing her to have chemotherapy because government laws ban patients from combining public and private care. She died in March.

Patients in the U.K. and Canada also have longer wait times to see specialists than do insured patients in the United States. Twenty one percent of Canadian hospital administrators said it would take over three weeks to do a biopsy for possible breast cancer on a 50-year-old woman. In the United States, fewer than one percent of hospital administrators said it would take that long.

With horror stories like this, it isn't surprising that 62 percent of the young U.S. voters polled said they would not support healthcare reforms that could increase wait times, availability of medicine, or increase government involvement in decisions affecting patients.

Luckily, a few commonsense reforms would enormously expand access to affordable care within our existing system.

Right now, about five million uninsured Americans are eligible for employer-provided coverage -- but haven't taken advantage of the plans. To start addressing the accessibility problem, employers could begin enrolling their employees by default, with an opt-out option instead of an opt-in option. This would prevent new employees from going months without being enrolled. And it would cut down on confusing paperwork.

Lawmakers should also work to ensure that the 12 million Americans without health insurance who are eligible for Medicare or the State Children’s Health Insurance Program sign up for those programs.

Lawmakers also could expand access to private health insurance coverage by providing tax credits for part-time and low-wage workers to buy their insurance from private companies directly. In this system, health insurance would be portable, so there would be no disruption of service when a person changes jobs. Nearly 27 million of the 45 million uninsured U.S. residents worked at least part-time in 2007.

Expensive government-run health programs that provide shoddy service should not rob young voters of the hope that health care should be available to all Americans. We can start closing that idealism gap now by reforming public health programs and increasing direct access to private insurance.

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About The Author
Peter Pitts is co-founder and President of Center for Medicine in the Public Interest.
 
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Not conservative positions, not at all
Mr. Pitts mentions a few marginal reforms, but these owe far too much to liberal health policy to be genuinely conservative. A real conservative should know that the individuals should be responsible for the full cost of all health care services. No Medicare, no SCHIPS, none of that tax credit business, none of that socialist stuff.

As for those young people who don't want long lines, etc., someone needs to tell them that health care is already rationed; an employer's health plan doesn't cover every conceivable health problem. Therefore, the private sector rations health care as much as government could possibly do. Ever heard of utilization review? Look it up, folks.

The true conservative take on health care is that it is what economists call a market good; its availability and quality should be a function of the consumer's ability to pay, just like houses, cars, and most other things in life. Conservatives need to just say this traight out and stop trying to sound liberal.

So, come on, conservatives, get with the free market approach to health care. If you can't pay for it, you don't deserve it. Isn't that the American way you guys are defending all the time?

Gestell: Good diagnosis, but your remedy
...would presumably be to replace our current quasi-control-freak system with a federally-mandated completely control-freak system.

It is not conservatives, but the left that believes in the myth that the autonomous, self-centered individual must either wrest what he needs from a cruel world by the power of his wallet, or else receive it gratefully from beneficient politicians. Therefore, we do not believe in a "free market approach to health care". Neither markets, nor bureaucracies are capable of caring - about health or anything else. People are required for caring. Families, churches, neighborhoods, small towns, charities, etc; these are the true vital organs of a society. That is where health care belongs. It is not a utility that can be passively provided to the public, like say, a sewer system.

We believe that the free market is the best way for society to perform economic allocation. Political piracy (aka "socialism") results in the loot -er, I mean, allocation - going to the pirates -er, I mean - politcians.

So, I have 3 objections to "universal health care": it won't be universal, it won't be healthy, & it won't be caring. Other than that...

Regards,

Social engineering through the tax code
I agree with Pitts (and McCain) that those who cannot get insurance through their employers should not be put at a disadvantage (through the tax code) to those who can. In other words, either everyone should get tax credits for health insurance or no one should.

To fix that injustice, I agree with the idea of giving credits to everyone (for now) because the alternative, if we're going to level the playing field, is to give a massive tax hike to those who get insurance through their employers. Ultimately, I would prefer a consumption tax that does not allow any coercive credits or deductions (except a rebate for taxes paid on poverty-level spending, in order to prevent a massive hike on the poor).

Corrections
"With tens of millions of Americans uninsured and costs through the roof, change is obviously -- and urgently -- needed."

Most of those uninsureds are young, single adults who either have decided not to buy insurance because they're young and single or do not get it from their employers. That's was my situation when I worked for five years to save money for college. Now, post-college, I have health insurance through my employer and I still have not used it much. But the leftists like to portray most poor and/or uninsured people as perpetually stagnant in that position. The truth is that most uninsured Americans are only in that position temporarily, and often by choice. So why is Pitts repeating the canard by implication?


"Already, the U.S. government pays for around half of all healthcare expenditures."

The gov't doesn't pay for anything. Taxpayers do. Pitts seems to get that, judging by his next sentence, but he needs to be clearer.

Purely cosmetic? More coercion?
"To start addressing the accessibility problem, employers could begin enrolling their employees by default, with an opt-out option instead of an opt-in option. This would prevent new employees from going months without being enrolled."

Is the goal here just to improve the statistics so we can report having fewer uninsureds? Pitts seems to assume that those who do not opt in fail to do so out of ignorance. First, I'd like to see some statistics on that. Second, is Pitts aware that many employers have waiting periods (usually a few months) before new employees may participate in the health plan?

Is Pitts proposing to trick people into being covered "by default" when they otherwise would have chosen not to purchase health insurance? Sounds like more gov't regulations for the sole purpose of coercing people into doing what bureaucrats arrogantly think is in their best interest. In other words, more nanny state.

A bipartisan plan
McCain could throw a bone to Obama when he becomes President (I am the eternal optimist) and give him an opportunity to finally reach across the aisle and do something worthy in a bipartisan way on health care. It's time to put the brakes on the runaway, socialist train and pull the Illuminati powers down from on high. We need a workable plan.

It's a mess.
The proposition that health care should be based on one's ability to pay is indeed the pure conservative - or I should say - free market approach. But that only guarantees that some people will not be able to pay the current costs - and therefore, they will not have healthcare.

And this number will grow, because the underlying issue of health care in the US is that it's costs are increasing faster than peoples income, so that we are paying almost 2X as much as those citizens in Britain, for example, are paying. In fact, on a per capita basis, our government is covering 1/2 the people for almost the same cost that Britain pays to cover 100% of its people.

It's fine to drive a Mercedez if you can afford it, but if not, you need to have a Ford alternative, and we don't.

To say that we need to over-haul our system - is an understatement. Unlimited litigation, malpractice and hospital and clinic insurance costs that are simply exorbitant, excessive hospital and doctor administration costs due to 1000's of competing plans, excessive medical school costs, excessive payments to doctors, are all a part of this mess.

If we had set out to create the worst of all systems - I doubt that we could have done a better job.

Response to Redlac
"Worst of all systems" you say? I would encourage you to go to an Indian reservation and see what the government has created there. Many VA hospitals are unfortunately sub standard also.

We are on the brink of creating a Freddie Mac / Fannie Mae styled health care system. The Federal Government under any administration has a long and proven track record of failure.

Having been involved in health care related software and consulting for the last 20 years I am not just making a knee-jerk reaction to your uninformed comment.

I have a now 30 year old daughter who at the age of two had a childhood related malignant brain tumor. I did some study on it back then and this is literally the only country in the world where she could have survived. That includes Canada and the UK. I often think of the many parents in other countries standing in the doorway of an empty bedroom at night as they weep for a life that once held such promise. Thank God I live in the USA!

We have problems in health care and there is no question about that. But to throw yourself at the mercy of politicians is sheer folly.

If you think national health care is so great then I advise you to move to Cuba. You won't be missed here.

HEALTHCARE REFORM?
I had a conversation with a Candanian Doctor a few years ago and she said the exact same thing that is mentioned in this article. Her words, "The Candanian Medical System is a Mess, the Americans have a better system". A British friend recently told me that the Healthcare system in England is almost broke. Why do you think so many foreign students come to the United States to train in the medical fields? Because we have the most advanced medical knowledge in the world. This would change under socialized medicine, we will lose many fine doctors and medical professionals who will not want to work under a socialized health system.
Also, bear in mind that Obama's healthcare plans would also include illegal immigrants. Our tax dollars already provide medical benefits to illegal immigrants, how much more can we afford in the future?

Dave
Your tangent is not mine. I did not say we should have government health care. However, I did say that we have the worst of all systems in regard to cost. And like you, I can give you horror stories - but the reverse, as to our medical system. Like it or not, it doesn't matter if your daughter could survive - if we can't pay for it. This is what Americans are increasingly facing. We cannot spend 17% for health care, as we are now doing, while others spend 9% to 10%. When I point out the issues, they are very real. Litigation, excessive administration, excessive medical school and doctors costs. Those are real.

This debate rages because of these facts.

And the bottom line is that if you and everyone else don't get off your high horses and deal with it - you will get government health care in a single payer system. That, my friend, is where we're headed. We already have the government paying for 50%. As costs rise, the pressure increases to have it pay for more, as it becomes increasingly unaffordable for ever incresing numbers of people. This has been the trend for 40 years. We started with Medicare, added Medicaid, added the Drug Entitlement Act, and are now moving to add even more. And none of this charts the evolution of the expansion of State and County health care.

So what's your problem? Do you want government in all of it? Or do you want to solve the problem by going to the root of the problem. Which is cost?

I'm certainly not going to pay 17% for American Medical care when I can get equivalent care elsewhere for 9%. That's silly. And our system is downright foolish.

Reba
Quoting Doctors from other countries ignores the fact of their own self interest. 11 of the top 15 paid positions in the US are occupied by doctors. The highest brackets make more than CEO's. Of course they like a system like ours. Wouldn't you? Granted, if you pay twice as much, some of that will reflect in more research and development. But don't ever forget that the principal reason doctors in other countries like the US, is that the US pays doctors entirely differently than we pay attorneys, engineers, CEO's, and virtually everyone else. Now tell me - why would we do that?

REDIAC & DOCTOR'S INCOME
Tell me Rediac, do you know any doctor in the United States who received $90 Million Dollars bonus, plus salary in 6 years, as Fred Raines did at Freddie Mae? If you do, give me his name.

Don't just read, think about this

I’m not saying that Government paid (by taxpayers of course) Health Care is the way to go, but if you are going that way, give this some thought. Don’t just read it, think about it.

The way to reduce Health Care costs is simple. Just eliminate all insurance companies, their buildings, computers, and employees, and get rid of all Government paper-pushers in the health care system.

Give every qualified doctor, hospital, and pharmacy a special computer program, and a blank checkbook so they can write a check each evening for all the services they provided that day.

Of course costs and expenses are different for different locations, that must be considered.

Make it a Capital Crime to mess with the computer program, and for any lawyer who even talks to a patient, and carry out that punishment within 30 days.

If the doctor makes a mistake, so what, you are most likely there because you made a mistake. If the doctor commits a crime, that’s the problem for the government to punish, not a lawyer who promises a check for the patient.

Just hire a bunch of auditors to check and made sure they aren’t stealing any more than is being stolen today. And on and on.

And I bet the cost would be cut in half.

You will not deal with a DMV or Post Office type health care office, you will deal only with your doctor. He gets paid for what he does, the auditors watch to see he is doing it right. computer systems, carefully controlled, will check to make sure you aren’t going to several doctors, and that doctors are being honest.

If you consider the billions a year that are being stolen each year now, plus the cost of the insurance industry, there must be a lowering cost.

I did not present the final answer, I presented the opening comment.

Try to think of what I really said, not what you thought I said.

And I appreciate your comment.


Earth calling Town Hall
A big problem with THers is that they rely on the anecdotal information presented in pidly columns like this while the rest of America is watching documentaries like Sicko and the 60 Minutes story on RAM (linked below).

http://www.cbsnews.com/stories/2008/02/28/60minutes/main388 9496.shtml?source=search_story

And then you're shocked that so many people think so differently than you do. Pull your heads out of the sand and then you might be able to understand.

I talked to a lady this week from Edmonton who has a daughter that's a nurse. She raved about their system. She couldn't understand why a modern society would choose to have the system we have. (She was also appalled at the homelessness here.)

If the health care systems in these other countries are so bad, why don't they vote to go private? Conservative leaders like Thatcher, Merkel, and Sarkozy have never even suggested getting rid of their government-run systems.

Gestell Lestat The best way
that govt can reduce the cost of every phase of healthcare is to remove all taxes from it by repealing all the hundreds of taxes and replacing them with a single, fair, efficient tax levied on living persons.

Getting the Breck Girl and other GREEDY trial lawyers out of the healthcare system will also help a lot.

Remember this too: Hawaii shut down its free healthcare plan after SEVEN MONTHS because so many people dropped their employer-provided insurance to get the free care.

Reba
I'm quoting department of Commerce stats. The purpose, by the way, is not to invalidate you, nor make doctors solely to blame. You, like many, don't know why we pay so much more for health care - do you. I also suspect that you have no meaningful way of comparing different health care models and their costs - to ours.

Presumably, you'd like a non partisan evaluation of that as well. It is, after all, the heart of the problem.

The problem is a system. If we can't look rationally as a nation at every contributing factor, then we'll simply end up with a single payer government system - because we cannot pay 17% of every dollar for health care. Nor, can we permit that 17% to continue to rise as it did the last six years, which was 78%.

Don't you get it? It's not the 17% today alone, it's the 20% tomorrow. And, if these costs continue to rise ast their current rate, the 25% further downstream. I'm simply trying to get people to stop fighting - and first go back to basics.

I will promise you this. If we don't deal with cost - you will end up with a government system because the costs of health care are outstripping the ability of the middle class to pay for it.

reply to Jeffrey
From a free market standpoint, "heatlh care" refers to the mix of goods and services produced by health care providers and purchased for consumption by people formerly called "patients" but now called, in health care economics, "health care consumers." In a free market, those who can purchase good health care will be free to do so; those who cannot will not receive health care. I just wish free market conservatives would admit this directly instead of going off as you did on some ramble about how families and churches and all of that are going to take care of people who can't afford health care. Of course that sort of thing happens, but there is no way such a process will provide health care to every poor person in the country.

Conservatives, Republicans, ...
disgruntled Democrats, Hillary supporters, and anyone else who believes an Obama presidency would be disastrous...

VOTE!!!

Obama hasn't won this election. It hasn't even occurred yet. Don't let the propaganda depress our voice. Do not sit at home on election day. It may be the most important vote you ever cast. Don't let them tell you there's no chance. Don't let them get the better of you. If you do nothing else in support of John McCain this election cycle, go vote on November 4th. Do not hand this thing over willingly. Put up some fight, at least.

"disastrous"
What is this "would be" disastrous? Read the business section lately, Ben? That IS disaster. How about 4,200+ dead service people from an invasion based on a lie? 'Can't get much more disastrous than that. If Obama tried as hard as he could, he could not possibly make the US more "disastrous" than the guy you voted for twice.

Gestell - A few more points on free market health care:

1. Conservatives seem to forget that we had a perfect opportunity to take advantage of free market forces with the 2003 Medicare Drug Act. Of course, the Republicans passed on that in favor of maximizing profits for the pharmaceutical companies by prohibitting Medicare from negotiating prices.

2. In order for any free market system to work, there has to be an information feedback system. Consumers need to know when a company is performing poorly. Michael Moore has filled that need better than anyone in the US. Of course, he hasn't received too much love from the "free marketers". The obvious conclusion is that the real intent is to maximize profits (and dividends) rather than provide health care to all. Ol' Mike's conclusion was that we should scrap the profit-driven health care system entirely for government-run system. In the free marketplace of ideas, it appears Moore's view is prevailing.

Everybody has access
Nobody is denied access to healthcare. In my city, and most, there is a public run hospital. People go there who don't have insurance or can't afford it otherwise. Many years ago, I had to take advantage of this for back surgery. It took me 5 months just to get an appointment and another 6 to have surgery. I waited as much as 9 hours after my appointment and the avg. was 4 hours wait. The care was satisfactory, but the one thing I noticed is the lack of "empathy" for people. People are treated more like cattle, because there is NO incentive for them to do otherwise. They are providing a free service and get paid the same no matter what.

It's not that people lack access, they want to be able to go anytime they please and not have to worry about it any bills. A govt. run system would not improve healthcare, it would do the opposite. If the govt. is going to do anything it should provide funds, but stay out of the business of running or managing healthcare.

People seem to resent money being made in healthcare. Why? Why should people make money selling us food? We have to have food. Or fuel? We have to have fuel. Somehow people feel that healthcare should be this great big-hearted benevolent organization.

Businesses need profits just as much as individuals. After you pay for all your living expenses, the rest is profit. Maybe you should just give that to the govt.

They couldn't even run a whore house selling booze and make money. The Mustang Ranch was taken over by the govt. for back taxes. They failed at the business and had to sell it.

Gestell: re: post #17
It seems that your concept of "society" is frightfully narrow. There is more to society than just isolated individuals & vast, impersonal authority. Families routinely take complete care of a class of people who can pay for nothing on their own. Those people are called "children". We took care of my mother-in-law when she came down with Alzheimer's; my wife's sister has taken in her aunt who can't live on her own anymore. There are millions more such. Talking about them is not "rambling off" of the subject; it's the heart of the subject.

Let's try to get at this a different way. I submit that a fundamental rule of human societies is that power must be balanced its consequences. When it's not, dysfunction results. Authority w/o consequences is tyranny; consequences w/o authority is slavery. If it's bad enough, the society dies. The problem with our health system is that the power is with employers, insurance co's & the gov't, while the consequences are borne by individuals.

It isn't going to work well until the power to make a healthcare decision rests with the ones who have to deal with the consequences -- individuals & families. If that means that a large number of people are going to have to depend on each other, well, that's why we call it "society" not "individualty". Folks depending on each other is vastly preferable to the alternative, which is people depending on the gov't. There is precious little historical evidence that depending on the goodness of gov't produces good outcomes. Believe in freedom. It works.

Regards,

Health Insurance
There is a group of people who are at risk in the health insurance lottery. These are individuals who are age 50-64. If you are self-employed or lose your job, you may be unable to get remotely affordable insurance, if at all. Apparently 50 is the magic number when the pricing starts to get really ugly. Many people are and will be losing their jobs in this nasty economy. COBRA is awfully expensive for someone with a dramatically reduced or suddenly non-existent income.

I don't have the answers, but there is much wrong with the system we have now and it has been well-known for many years. Any of us who don't have government jobs are particularly vulnerable.

Astroturf
Peter Pitts, an old high school classmate of mine, has long been a lobbyist for Big Pharma -- the large drug companies which are scared to death that the government might possibly exert some bargaining muscle with regard to drug costs. Several years ago, he spearheaded a campaign against parallel importation of pharmaceuticals -- a free market answer to the problem of high drug prices. Now, he is paid well by the same drug companies to oppose anything else that might make drugs more affordable, including "single payer" national health insurance or even a "public" health insurance option. Best to read anything he says with this in mind.
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