By now we are all aware that should liberal health care reform pass through Congress we will face government-sanctioned euthanasia of the sick, elderly and mentally incompetent; we will sit in lines longer than the opening night of the third Lord of the Rings film just to see our primary care physician, who will then turn out to be a disgruntled DMV worker with a stethoscope replete with Gestapo uniform; and when we do receive “care” it will be so subpar as to be in fact harmful – far more harmful, in fact, than no care at all.  Obama will quite probably set up a “death panel” to determine which citizens are worthy and which have outlasted their usefulness.  This panel will quite possibly include the judges of popular left-wing television show American Idol.  (They’d call the panel a “Life Panel” though, wouldn’t they?)

And yet…

Reading over Philip Giraldi’s piece at the American Conservative on our no good, very bad health care system, I’m reminded of just how prohibitive health care costs really are for most Americans.  There are a number of reasons for this, of course, but at least part of the reason is the fact that benefits are tied so closely to employers and outside of that partnership you really do find yourself with few options – especially if you’re older, sicker, or poor. [Read more →]

Philip Giraldi: [Read more →]

It’s taken me awhile to get to this – mostly because I’ve been (unusually) busy with real life – but I wanted to offer a few  thoughts on Mark’s post on Wyden-Bennett, and particularly his broader issue with liberals and Democrats assuming the worst of conservatives and Republicans.  Here’s Mark in his own words, if you didn’t read the post:

I’m usually one of the more cynical people when it comes to politicians, but in this case the evidence that Republicans would turn against Wyden-Bennett if it came to a vote is pretty weak.  It appears to me that liberals who assume that Republican support for Wyden-Bennett would disappear were it actually pushed are committing the cardinal sin of underestimating their opponents, attributing the worst possible motives to all of those opponents despite clear evidence to the contrary and without any supporting evidence.

I don’t think liberals are underestimating their opponents as much as they are drawing lessons from the past few years of conservative governance.  On issue after issue, conservatives (or, to be more accurate, Republicans) have regularly argued and negotiated in bad faith.  Take the stimulus, for instance.  The Obama administration’s first move in pushing for a stimulus package was to argue from the center.  Tax cuts made up a significant chunk of the stimulus package, and the administration was more than willing to cut money from various provisions, even those – like direct aid to states – which were the most useful.  In return, the administration got a nearly party-line vote against the stimulus, and the charge that Democrats were taking us on the road to fiscal irresponsibility.  Indeed, Republicans have been haranguing the administration about the deficit from the beginning, seemingly oblivious to the fact that it is, in significant part, a legacy of George W. Bush’s presidency.

Looking at the current “debate” over health care, it is abundantly clear that Republicans aren’t actually interested in constructive criticism.  As Andrew Sullivan has recently (and repeatedly) noted, far from attempting a vast overhaul of the health care sector, Democrats are proposing a series of modest reforms aimed at expanding coverage to low-income Americans and reforming the insurance industry.  And as Matt Yglesias has pointed out, there is plenty of room in those proposals for conservatives to make substantive input.  But that’s not at all what we’re seeing.  Honest efforts to reduce costs or raise revenues are met with screeching and accusations of socialism, and innocuous provisions in the bill become fodder for incredibly outlandish claims (the Democrats what to kill your grandparents!).  Republican leaders are actively spreading lies and misinformation, and encouraging their supporters to respond to Democratic outreach with quasi-violent confrontations.

For all of the Republican support that Wyden-Bennett has received, pace Mark, I don’t think the Republican response would be any different if that bill were up for serious consideration.  And I don’t necessarily blame Republicans for taking this approach; politically, it’s in their best interest.  Even a successful bipartisan bill will solidify Democrat gains for at least the next two or three election cycles, and Republicans know that their path back to relevancy is much easier if they can sink a Democratic health care bill.  It’s almost unreasonable to expect them to do anything else.  That said, Mark’s right, it is unfair of liberals to assume bad faith of Republicans.  But in an argument, you have to earn the assumption of good faith, and Republicans clearly haven’t.

TWO UPDATES, SEE BELOW:

A common refrain I keep hearing for why Wyden-Bennett would have no chance of succeeding if it ever came to a vote is that even though it has bi-partisan co-sponsorship, the Republicans co-sponsoring it are merely using their co-sponsorship as political cover since they know it has no chance of actually passing.  Were Wyden-Bennett to actually come to a vote, they argue, not only would no more Republicans vote for it than have already signed on as co-sponsors, but most of the Republican co-sponsors would actively drop off.  As such, goes the refrain, advocacy of Wyden-Bennett is the surest way to guarantee that there will be no health care reform at all. 

I have two problems with this line of thinking, which largely seems to stem from this Ezra Klein post.  When I first read that post awhile back, I thought it made sense, although I thought Klein was ignoring that any remaining Republican support whatsoever would significantly undercut the power of the Blue Dogs to water down Wyden-Bennett in the way they have watered-down HR 3200. 

My first problem with this line of argumentation is its implicit assumption that HR3200, in whatever form it finally passes, would at least be an improvement over the status quo from the point of view of anyone who actually cares about health care reform.  However, as I’ve pointed out before, there are plenty of reasons to believe that it would not be enough of an improvement over the status quo (and would in fact double-down on the single worst element of our health care system) to justify the huge expenses associated with it, particularly at a time when our national debt is already disturbingly high and accelerating by the minute. 

My second problem is that this line of argumentation goes beyond mere cynicism (which I fully support) to the point of automatically assuming the worst of one’s political enemies regardless of whether there is evidence for that assumption.  [Read more →]

What do we mean when we talk about the “rising costs of health care” in America?  It’s a very ambiguous term with a lot of different possible meanings.  We could mean the cost of health care per capita, or as a percentage of GDP.  In 2007, total health care spending was $2.4 trillion dollars.  Per capita, health care costs were an average of $7900.  This number is rising, and total spending is supposed to reach over $4 trillion by 2017, an estimated 20% of GDP.  Premiums on employer-based coverage rose 5% in 2008.

In 2007, here’s how medical spending broke down:

Then again, when we talk about costs of health care, we might also be talking about government expenditures.  This is another set of costs altogether, and according to the CBO: [Read more →]

“We have not been committed to a deadline. We’re committed to getting a job done[.]” ~ Sen Chuck Grassley on health care reform. [Read more →]

The Wyden-Bennett “Healthy Americans Act” really is the most sensible health-care reform bill out there right now.  I don’t think health care reform is a hill worth dying on for conservatives (there are other, better hills to die on), but it is worth the effort to find a plan that will actually work, that is fiscally sound, and that still covers most, if not all, Americans.  The “Healthy Americans Act” does all these things, and it’s worth setting aside ideology to achieve meaningful reform.

Yesterday, in the Washington Post, the Senators pushed their plan once again.  It’s worth noting that right now the Wyden-Bennett proposal has more bipartisan support than H.R. 3200, the bill being pushed by many Democrats, including the bought-and-paid-for chairman of the Senate Finance Committee, Max Baucus.  Not only that,  Wyden-Bennett also does a better job, and is far more fiscally sound a proposal than H.R. 3200. [Read more →]

“By treating any and all social safety nets as irreversible steps on the Road to Serfdom, we allow liberals and progressives to shape those policies in ways that are inefficient, ineffective, and overbroad – even though Adam Smith, Hayek himself, and Friedman each advocated for a form of social safety net, demonstrating that social safety nets can be consistent with libertarianism.” ~ Mark Thompson

“I actually think a certain fusion of the best of 20th Century classical/market liberalism and welfare liberalism is the best political philosophy.  I also think it may be possible to persuade many other people of this, and that they will find it attractive.”  ~ Will Wilkinson

In many discussions I have with liberals there is this common refrain – if there are safety nets, then it isn’t libertarianism. Or it isn’t conservatism – or whatever.  The perception of libertarian economic thought (or modern conservative or classical liberal economics in general) is that it is simply against any implementation of the welfare state.  I know for a long time I was very critical of libertarian economic ideas because I felt that they were:

• A) too impractical or too difficult to implement in our particular system of governance (required purity, etc.) or
• B) did not pay enough heed to the importance of safety nets, or
• C) that they ignored moral and ethical implications leveled by anti-consumerist, protectionists, and others skeptical of free trade and capitalism.

I have been largely disabused of these notions through various debates here at the League, though I still think that the political process we face makes limiting government very difficult and that too much cultural emphasis on profits, consumption, and so forth is socially detrimental.  There is still a need to apply cultural pressure to help Americans see themselves as citizens and neighbors (and fathers and friends, etc.) rather than as merely “consumers.”

I think government can work, but it is naturally inclined to not work very well, and seems to stop functioning by degrees the fewer its limitations and the greater its scope.  This is why, in theory at least, a local government completely corrupt with unlimited power within its small sphere is far worse than a big federal government well-restricted by a savvy constitution and responsible lawmakers.  “Big” and “small” are irrelevant terms compared to “limited” and “unlimited.”  Then again, this is also why local governments are generally more adept at running such things as schools and libraries. [Read more →]

Arnold Kling has them.

[N/B: See below for a significant update/clarification]

One of the criticisms levied at the alternative health care proposals discussed by E.D. and I over the last few weeks has been that these proposals, which rely heavily on vouchers and/or subsidies, are irrelevant to the debate that is actually taking place.  Yet this is not really true – in fact, as it turns out, these proposals are quite similar to Senator Wyden (D-OR)’s bipartisan proposal, which has 14 co-sponsors in the Senate.  A good summary of this proposal is here (Wyden’s proposal appears to rely on tax credits, as commenter Willybobo has advocated, rather than vouchers, but the premise is the same).  A better discussion that places Wyden’s proposal and the more-dominant “public option” proposal in context is here.

Yet this proposal, despite bi-partisan support, has exactly zero chance of going forward.  It has, so far as I can tell, been largely ignored by grassroots advocates of health care reform, who have largely jumped on the “public option” bandwagon, however flawed that legislation will be if it is to become law. 

What is so particularly strange about this is that the legislation that is most likely to actually pass will ensure that our health care system places even more emphasis on employer-based health care coverage – even though the employer-based nature of our system is the single biggest cause of that system’s problems. 

For all the comparisons between European and American health care, the employer-based nature of the American system is the one element that both sides of the higher echelons of this debate seem to ignore consistently.  Yet it is the one element that actually distinguishes the American system from just about any system in the world – and not in a good way. 

As Wyden points out in the Slate article above, the employer-based system traps people in jobs that they would otherwise leave, which reduces labor flexibility even as the capacity for employer mobility increases at breakneck speed.  Beyond that, as I’ve tried to point out on numerous occasions and as our friend Kip recently pointed out, the employer-based system ensures that the consumer and the customer are two very different entities with two very different sets of interests.  Meanwhile, the leading proposal adds ever-more complications to the already too-confusing tax code to raise money to pay for the additional expenditures – and, importantly, these complications are not just as a result of the surtax on the wealthy.

[Read more →]

[updated below]

Peter Suderman, from his new perch at Reason Magazine, dissects the looming breakdown of the public option in Obama’s push for health care reform.  At the crux of the issue lies the cost, which the CBO estimates at $1.6 trillion dollars over the next 10 years.  This is a hefty pricetag.  I’ve been following all of this and reading a good deal on the subject of regulatory capture and public choice theory, and suffice to say, I’ve had some pretty eye-opening discussions especially with brother Mark on all of this, so I’d just like to revisit health care in light of what looks to be a reform bill that – when it’s done – will probably bring the worst of all worlds together into one epic reform failure.

Mark pointed out something to me that I think is too often left out of the health care debate, which is essentially that there is a pretty striking difference between subsidizing the supply side (i.e. insurance providers) vs. the demand side (consumers of health care insurance) in that the former is more likely to become a subsidy of fewer providers, whereas the latter at least theoretically would be better for competition and leave the door open to many different providers.  Thus a health insurance voucher program would at least theoretically be less likely to unduly benefit a handful of insurance companies over the rest.

This makes sense to me, though I still worry that voucher programs would meet up with a few problems – namely pre-existing condition limits, but also the fact that we already have such an entrenched system that it seems unlikely that many new health insurance providers would be able to emerge.  The system has been anti-competitive for so long, I’m not sure how we can turn it back to a more decentralized, competitive environment.

But I wonder if we should break this out a little more.  So here’s some ideas: [Read more →]

I think the one thing that free-market health care advocates have yet to illustrate is, as Freddie mentions in the comments to his latest post, how a free-market solution will provide affordable coverage to all Americans.  And not just affordable coverage, but coverage that is both affordable and actually covers everyone adequately.  I can easily imagine a free market wherein the only affordable insurance for the poor and the sick and the elderly is also terribly inadequate.  Insurance is tricky business, and unlike your car, repairs on the human body can be extremely expensive.  Poor insurance coverage that seems affordable on a monthly-payment basis, may suddenly turn out to be woefully inadequate when it comes to the nitty gritty, the fine print.  Typically an affordable health care plan will include very high deductibles and very limited coverage.  And this is because the concept of insurance and the concept of prevention, while both referencing health, are talking about two very different things.

Health insurance, in its most basic form, really means a protection against catastrophe.  I’m using catastrophe lightly here – this could mean a broken leg or the onset of a disease, etc.  In other words, catastrophe describes the bill a lot more accurately than it describes the problem itself, though both may indeed be catastrophic.  It probably would not be terribly difficult for the free market to provide catastrophic insurance coverage at reasonable prices to all Americans, especially with some sort of means-tested government assistance in the mix, and a mandate.

This is crucial.  Without a mandate the entire system is thrown off balance.  This may seem authoritarian, but really it’s more akin to the car insurance mandate we already have in place.  Car insurance mandates are used to protect the “other driver” who may not be at fault, but who is still on the hook if they get hit by an uninsured driver.  Think of a hospital or a doctor or a local government or whoever has to pick up the tab on the uninsured as the “other driver” when it comes to health insurance.  That is why a mandate is necessary in a free market system.  More on this…. [Read more →]