Healthy Skepticism on Health Care 3

Lots of liberal pundits are urging the President to seize the opportunity to reform the American health care system. What, exactly, is he doing? It looks to me like a full court press. But increasingly the Administration spokesmen are saying things like: "this process is in its early stages", or "this thing will take time." Let me translate: it ain't going well.

One problem is that almost all Americans (75-80%) like the heath care we are getting. We like our doctors, and we get to see them pretty quick, and we get treated promptly. We understand that, in the abstract, the system is inefficient and too expensive, and we think it's a good idea if that were fixed. But we want that to be done without the bill going way up or our current arrangements to be modified in ways not to our liking.

Barack Obama has been promising us, since he began running for the Oval Office, that the satisfied 75% of us would get to keep our current health care arrangements. From Jake Trapper, at ABCNews.com:

No matter how we reform health care, we will keep this promise to the American people," President Obama told the American Medical Association on June 15. "If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what."

That sounds like a pretty firm promise. But all those periods turn out to be periodic.

ABC News asked how the president could make such a guarantee if the public run plan were cheaper, thus possibly enticing employers to enroll employees in that plan.

"When I say if you have your plan and you like it,…or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform," the President said.

Well, that is helpful! So: "you'll be able to keep your health care plan, period," means "you won't get to keep it, but someone besides the government will take it away." That's promise keeping Obama style.

Here's the problem: the President wants a "public option" to be part of any reform. That means that the government will offer health care plans as an alternative to any currently available plans. The public plans will be heavily subsidized, and employers will jump at the chance to dump their healthcare expenses on the government. Since most Americans get their heath care from their employers, that means we don't get to keep our doctors or health care plans, as the President promised. Meanwhile the Government will get a virtual monopoly on health insurance, at a very large public cost (if the Congressional Budget Office is to be trusted).

Of course, that is what the President is counting on. He wants what a lot of Congressional Democrats have long wanted: single payer, government run health care. Socialized medicine, to use the traditional terms. He just figures he has to con us into buying it.

Maybe the President can pull this off. I'm doubtful. The Democratic majorities in both Houses of Congress have to wonder what will happen when tens of millions of Americans get cute little letters from their employers informing them that their health care plans are being discontinued. No bother: you'll get a cheaper plan from Uncle Obama. They also have to wonder what will happen when the tens of trillions of debt that our President is sign off on comes due for the American economy. I wouldn't bet on courage.

Comments

[Dawn]

The President pointed out that your employer can change your health care provider tomorrow even if NO health care reform takes place at all. It's already happened more than once at my workplace that available plans have changed from year to year. It's also already happened that my doctor became weary of the struggles involved in being a primary care physician under the profit-driven system and left to become a specialist. The President is talking about reform where 1) those who want a public option, LIKE ME and over 80% of Americans, can get our choice too. 2) those who want to stay with profit-driven plans, like you, can do so. 3) your plan will be SAFER because companies won't be allowed to dump you just because you get sick, or deny health care you need after years of having pocketed your premiums. This is health care reform that we NEED!

[A.I.]

Great point Dawn. The anti-reformists are quick to fear monger every possible downside of a public option while ignoring the fact those same problems exist in the current system. So far as I know, that poll they continually cite about 75-80% of Americans being happy with their current plan didn't ask if they were at all certain their employer would continue to offer the same plan forever. Nor did it ask if people thought they could afford the $1,000/mo or so it would cost to maintain a decent family plan under COBRA if they lost their job or if they even thought they could get insurance if the job loss was due to chronic illness.

We call what we have now insurance, but really it isn't. It's more like casino gambling. We pay in more than we use in services (win) so the "insurance" company (house) can pay overhead and make a profit. If we get really sick and the malady is covered, we may get back more than we paid in (we win while the house looses). But like any well run casino, the insurance company always tries to win in the long run meaning if you get sick too often, your rates will go up--often dramatically. If the insurance company is still loosing, the company will drop your coverage (no longer let you play). And with your claims (win) history, it's likely every other insurer (casino) will do the same.

This is a big part of the health care system anti-reformers call the envy of the world. In fact, much of the rest the world thinks we're crazy. Perhaps we would all be better served if those supporting a private-insurer-only system joined Gamblers Anonymous while the rest of us try to devise a system that actually guarantees health care to those who've paid for it.

[daniellezito]

If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California

[Kate S.]

Holy mongo-sized comment, Batman!

[Erik]

Mr. Mayer,

Thanks for the very useful link. I'm going to post it on my facebook page.

Erik

[KB]

Mr. Wagner: I deleted your comment because I thought it a bit large for the purpose. Disease near nuclear power plants is an issue for another time. Perhaps you could post a link here to the whole thing.

Dawn: if the President knows that you can't be sure to keep your doctor, even under the present system, then perhaps he shouldn't have said: "you will be able to keep your doctor, period" under his plan. Saying something like that might give someone the idea that they will get to keep their doctor.

You seem to be in favor of a system where the public option is one choice among many. I don't think that's necessarily a bad idea, I just don't think that is what the President is really after.

A.I.: Thank you for explaining what the 80% of Americans are deluded about. I have a more favorable view of most of my fellow countrymen. They know what they like and they want to keep it. If the President can show how they can do that, while fixing all the problems, then hooray.

I do not share you distaste for profit making enterprises. Private insurance companies indeed want to make a profit. What do they do with it? They invest it in the productive economy. Government government only moves money around, from those that can pay to those that vote (like the elderly). Since I am moving in the latter direction, again hooray.

Neither do I share your distaste for gambling. Insurance is always gambling. It's hedging your bet. Covering those who cannot pay in is not insurance, but charity. I am not opposed to that, but it might be good to sort these things out.

Eric: I went to Mr. Mayer's site and found a lot of bold assertions without any hint of where the information came from. I have post some information of my own on the next post.

[A.I.]

KB, I am not saying the 80% are deluded, I'm saying the poll cited is misleading. Yes people like their current plan, but many are concerned about its sustainability relative to losing their job, getting "too" sick, etc. They realize the precarious nature of their coverage and would like a guarantee.

I have nothing against profits if they a generated by an industry that provides a useful product or service. That does not describe the insurance industry as currently exists. Yes, it provides some coverage. But, it also polices your access to the underlying service: health care. It's ironic that some hospitals, for example, are non-profit while the insurance companies they bill are for profit. So while the folks that actually care for patients struggle to limit costs by forgoing profit, a layer of bureaucrats between them and patients marks up their services to make a profit and seeks to limit access to those services to enhance profits. I appreciate irony as humor as much as anyone, but that isn't funny.

[KB]

A.I.: we seem to agree on what most Americans want. They want the level of care and choices they currently enjoy. Maybe they also want a guarantee that it won't be taken away from them. Such a guarantee is, as I think we all agree, not in the power of the President to provide. So perhaps he shouldn't have promised it. To be sure, his plan will include no such guarantee. The current system may indeed be on track to change, but that won't make anyone feel better about a policy that intentionally does away with what people want. That is an obstacle to the President's preferred reform, which was my point.

As for private vs. public institutions and insurance: it seems to me silly to say that the health insurance industry provides no service. The question is whether the service is good enough, and whether a better system might be devised.

You do seem to think that public institutions are somehow morally superior to private, for-profit ones, and I think that is simply false. Any public health care administration is going to be beholden to a wide range of interested parties: medical professional organizations, unions, trial lawyers, public interest lobbies, and angry coalitions of parents who are sure their children's autism was caused by vaccinations. Each of these groups, and countless others I have not the time to list, will vociferously pursue the interests of its members. Each will be sure that their own interest is the same as justice and the common good.

Thanks for your frequent comments. I appreciate all my participants, but you, Miranda, and Erik deserve special mention.